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Home My WebLink About2015- March • Jefferson County Public Health Agenda Minutes 1 r9e4gr. mo" Public Healt • March 19, 2015 JEFFERSON COUNTY BOARD OF HEALTH • March 19, 2015 Jefferson County Public Health 615 Sheridan Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of February 19, 2015 III. Old Business and Informational Items 1. 2015 National Public Health Week: "Healthiest Nation 2030: Let's make America the healthiest nation in one generation" 2. Food Sanitation and Safety Prevents Food and Waterborne Infections 3. Health and Wellness EXPO 2015 4. New York Times—Visiting Nurses, Helping Mothers on the Margins IV. New Business • 1. 2015 Jefferson County Public Health Heroes Awards 2. Public Hearing: Jefferson County Environmental Health Fee Revisions 3. 2014 Environmental Health and Water Quality Performance Measures 4. Measles Outbreak Update 5. School Entry Vaccination Levels—Jefferson County 6. Vaccine Hesitancy—State and National Efforts to Increase Community Immunization Levels V. Activity Update VI. Public Comments VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: April 15, 2015 2:30—4:30 Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 98368 • f • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 19, 2015 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, County Commissioner,District#2 Jean Baldwin,Public Health Services Dir Kathleen Kler, County Commissioner,District#3 Julia Danskin,Public Health Manager Kris Nelson,Port Townsend City Council Jared Keefer,Env.Health Services Dir Sheila Westerman, Chair, Citizen at large Veronica Shaw,Public Health Deputy Dir Jill Buhler,Hospital Commissioner,District#2 Chair Westerman called the February 19, 2015 meeting of the Jefferson County Board of Health to order at 2:30 p.m. A quorum was present. Members Present: David Sullivan, Jill Buhler, Sheila Westerman, Kathleen Kler Staff Present: Tom Locke, Veronica Shaw, Jared Keefer, Julia Danskin Members Excused: Kris Nelson • APPROVAL OF AGENDA Agenda was approved as written. Chair Westerman moved to approve the agenda; the motion was seconded by Member Kler. The motion passed unanimously. APPROVAL OF MINUTES Chair Westerman called for approval of the minutes of the 1/15/2015 meeting of the Board of Health. Member Buhler moved to approve the minutes as presented; the motion was seconded by Member Kler.No further discussion. The motion passed unanimously. PUBLIC COMMENT There was no public comment. • • OLD BUSINESS AND INFORMATIONAL ITEMS 1. Jefferson County Recycling Update Jared Keefer, JCPH Environmental Health Director, gave a follow-up report describing the ways in which JCPH is getting the news to the public regarding expansion in the recyclable items accepted in the county. 2. Marijuana Then and Now Julia Danskin, Community Health Manager, JCPH, shared with the Board an upcoming event to be held at the Chimicum High School Library on Monday, March 9th from 6-8 PM. This is a public awareness event given by Scott McCarty, Prevention System Project Manager with Washington State Department of Social and Health Services, Division of Behavioral Health and Recovery. The event is a Chimicum Coalition event sponsored by OESD 114, 4-H,the Chimacum High School, JCPH, and the WA Department of Social and Health Services and has been advertised via the Coalition newsletter. All school districts in the county are invited to attend. JCPH will further advertise the event via its website 3. E-cigarettes Follow Up Ms. Danskin reported to the Board in a follow-up to a discussion held at the January 15, 2015 BOH meeting. There is current legislation at the state level concerning the growing numbers of youth involved in using tobacco products via new delivery systems. Legislation is focused on age limits, restriction areas, and school district bans on aerosolizing delivery devices. Ms. Danskin directed the Board to Governor Jay Inslee's press release concerning legislation that will serve to "curb the increase in use." 4. Public Records Request Tracking and Expense Update Veronica Shaw, Deputy Director, JCPH, reported on the increasing number of public records requests that Jefferson County Public Health responds to and the growing cost of doing so. Member Kler voiced concern over cost and potential harassment requests. Member Sullivan reiterated the intent of the law is to be helpful to the public, and Chair Westerman reminded the group of the need for government transparency. Member Kler informed the group of an effort by the Washington Associations of Counties to tabulate individual county costs for the purpose of demonstrating to the public the local cost of the disclosure law. Mr. Keefer explained a database designed to house all septic records online to ease public access. Ms. Shaw mentioned an 0 & M fund managed by the Auditor's office that could potentially pay for an employee who could scan all Environmental records into the database. 5. Board of Health Member Resignation—Election of Vice-Chair Chair Westerman reported on a meeting at which she accepted the unexpected resignation of Board member and newly elected Vice-Chair Sally Aerts. This resignation requires the Board advertise for a new member. Additionally, the resignation requires the Board to hold a new election to replace Aerts. Member Buhler motioned to elect Member Kler to • the post of Vice-Chair. Members discussed the position's duties and time commitment. . Member Buhler motioned to elect Member Kler to the post of Vice-Chair. Member Sullivan seconded Buhler's nomination. There was no further discussion. The motion carried. 6. Board of Health Correspondence Two letters were received by JCPH. One complimented Mina Kwansa, Food Safety Inspector, on her thorough and ethical inspection practices. The other letter was an award from "Hope Senders" congratulating JCPH on its success in keeping food safe and as a result keeping "the community safe and healthy." NEW BUSINESS 1. Jefferson County Environmental Health Fee Revisions—Recommended Call for Public Hearing March 19,2015 Mr. Keefer reported and explained to the Board fee revisions to the Environmental Fees, pointing particularly to the Sewage Disposal Permits, Evaluation of Existing Systems/Monitoring Inspections, and Waiver Variance applications. Mr. Keefer explained at length various models used to determine new fees, both reductions and increases. Member Sullivan motioned to hold a public hearing at the March 19, 2015 Jefferson S County Board of Health meeting. Member Buhler seconded the motion. There was no further discussion. The motion carried. 2. Proposed Shellfish Rule Changes for Vibriosis Prevention Michael Dawson, Environmental Health Specialist, JCPH, introduced Laura Johnson, WA Department of Health, who gave a presentation on a new Shellfish Rule that is focused on prevention rather than reaction to reported shellfish related illnesses. If the Rule is adopted at the state level, DOH and the Department of Fish and Wildlife will hold training meetings to update and train local health jurisdictions on new preventions measures and practices. 3. Measles Outbreak Prevention—National, State, and Regional Dr. Tom Locke, JCPH Public Health Officer, updated the Board regarding measles cases in Clallam County and the measures taken to quarantine those potentially exposed. Dr. Locke further explained measles outbreak control protocols, the ongoing presence of measles as an international infection acquired by unvaccinated travelers, the specific strain found in Clallam County, and the strong link between vaccination exemptions and the current outbreak. Ms. Danskin reported to the Board regarding vaccine supplies held by JCPH and the difference between Child and Adult vaccines. 4. Influenza Update—Seasonal and Avian Dr. Locke reported to the Board that the influenza season is nearly at its end. This year's S predominate flu strain, H3N2, was challenging in that it was strongly associated with increased rates of hospitalization and death. Because of emergence of a new strain of • H3N2 after this season's vaccines had begun production, available vaccine was only partially protective. The usual 50-60%influenza vaccine efficacy was reduced to 23%. Regarding Avian Flu, Dr. Locke explained that the greatest problem associated with Avian Flu is the potential of infection at massive poultry operations. Where infection is found all birds must be slaughtered. Among backyard flocks, infection results in all birds having to be killed as well. Control and cleanup is costly. Avian flu generally does not cause human disease. There is, however, the remote possibility that a human (or other animals like swine)will become infected with both human influenza and avian influenza,producing a new virus that has the potential to be a global pandemic strain. 5. Public Health Heroes Chair Westerman reported on the meeting held to determine this year's focus for the Public Health Heroes Award. After reviewing past award recipients and current national trends, it was decided to focus on honoring those who actively engage in supporting children and in so doing support a national movement to achieve Healthiest Nation 2030. It was decided that the BOH would honor Jumping Mouse Children's Center and Nurse Family Partnership for their efforts to promote family and childhood health. Chair Westerman motioned to honor Jumping Mouse Children's Center and Nurse • Family Partnership at the March 19th 2015 Jefferson County Board of Health meeting. Member Kier seconded. There was no further discussion. The motion carried. ACTIVITY UPDATE There was a review of Board Action Items, 2014 The 2015 meeting schedule was reviewed. Discussion to cancel the November BOH meeting was tabled until the March 19, 2015 meeting. It was decided the BOH packet would no longer contain a Media Packet; rather, the packet will contain a face sheet containing headlines, dates, and source. JCPH will retain its notebook containing one copy of each article for convenience. Otherwise, Board members may read listed articles online at their leisure. PUBLIC COMMENT There was no public comment. AGENDA PLANNING CALENDAR There was no further planning. 1111 NEXT SCHEDULED MEETING t • The next Board of Health meeting will be held on Thursday, March 19, 2015 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA ADJOURNMENT Chair Westerman adjourned the February 19, 2015 Jefferson County Board of Health meeting at 4:23 PM JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson, Member Jill Buhler, Member David Sullivan, Member Sheila Westerman, Chair SKris Nelson, Member Kathleen Kler, Member EXCUSED Respectfully Submitted: Denise Banker • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 19, 2015 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, County Commissioner,District#2 Jean Baldwin, Public Health Services Dir Kathleen Kler, County Commissioner,District#3 Julia Danskin, Public Health Manager Kris Nelson,Port Townsend City Council Jared Keefer,Env. Health Services Dir Sheila Westerman, Chair, Citizen at large Veronica Shaw,Public Health Deputy Dir Jill Buhler,Hospital Commissioner,District#2 Chair Westerman called the February 19, 2015 meeting of the Jefferson County Board of Health to order at 2:30 p.m. A quorum was present. Members Present: David Sullivan, Jill Buhler, Sheila Westerman, Kathleen Kler Staff Present: Tom Locke, Veronica Shaw, Jared Keefer, Julia Danskin Members Excused: Kris Nelson • APPROVAL OF AGENDA Agenda was approved as written. Chair Westerman moved to approve the agenda; the motion was seconded by Member Kler. The motion passed unanimously. APPROVAL OF MINUTES Chair Westerman called for approval of the minutes of the 1/15/2015 meeting of the Board of Health. Member Buhler moved to approve the minutes as presented; the motion was seconded by Member Kler. No further discussion. The motion passed unanimously. PUBLIC COMMENT There was no public comment. • • OLD BUSINESS AND INFORMATIONAL ITEMS 1. Jefferson County Recycling Update Jared Keefer, JCPH Environmental Health Director, gave a follow-up report describing the ways in which JCPH is getting the news to the public regarding expansion in the recyclable items accepted in the county. 2. Marijuana Then and Now Julia Danskin, Community Health Manager, JCPH, shared with the Board an upcoming event to be held at the Chimicum High School Library on Monday, March 9th from 6-8 PM. This is a public awareness event given by Scott McCarty, Prevention System Project Manager with Washington State Department of Social and Health Services, Division of Behavioral Health and Recovery. The event is a Chimicum Coalition event sponsored by OESD 114, 4-H, the Chimacum High School, JCPH, and the WA Department of Social and Health Services and has been advertised via the Coalition newsletter. All school districts in the county are invited to attend. JCPH will further advertise the event via its website 3. E-cigarettes Follow Up Ms. Danskin reported to the Board in a follow-up to a discussion held at the January 15, 2015 BOH meeting. There is current legislation at the state level concerning the growing numbers of youth involved in using tobacco products via new delivery systems. Legislation is focused on age limits, restriction areas, and school district bans on • aerosolizing delivery devices. Ms. Danskin directed the Board to Governor Jay Inslee's press release concerning legislation that will serve to "curb the increase in use." 4. Public Records Request Tracking and Expense Update Veronica Shaw, Deputy Director, JCPH, reported on the increasing number of public records requests that Jefferson County Public Health responds to and the growing cost of doing so. Member Kler voiced concern over cost and potential harassment requests. Member Sullivan reiterated the intent of the law is to be helpful to the public, and Chair Westerman reminded the group of the need for government transparency. Member Kler informed the group of an effort by the Washington Associations of Counties to tabulate individual county costs for the purpose of demonstrating to the public the local cost of the disclosure law. Mr. Keefer explained a database designed to house all septic records online to ease public access. Ms. Shaw mentioned an 0 & M fund managed by the Auditor's office that could potentially pay for an employee who could scan all Environmental records into the database. 5. Board of Health Member Resignation—Election of Vice-Chair Chair Westerman reported on a meeting at which she accepted the unexpected resignation of Board member and newly elected Vice-Chair Sally Aerts. This resignation requires the Board advertise for a new member. Additionally, the resignation requires the Board to hold a new election to replace Aerts. Member Buhler motioned to elect Member Kler to the post of Vice-Chair. Members discussed the position's duties and time commitment. • • Member Buhler motioned to elect Member Kler to the post of Vice-Chair. Member Sullivan seconded Buhler's nomination. There was no further discussion. The motion carried. 6. Board of Health Correspondence Two letters were received by JCPH. One complimented Mina Kwansa, Food Safety Inspector, on her thorough and ethical inspection practices. The other letter was an award from "Hope Senders" congratulating JCPH on its success in keeping food safe and as a result keeping "the community safe and healthy." NEW BUSINESS 1. Jefferson County Environmental Health Fee Revisions—Recommended Call for Public Hearing March 19, 2015 Mr. Keefer reported and explained to the Board fee revisions to the Environmental Fees, pointing particularly to the Sewage Disposal Permits, Evaluation of Existing Systems/Monitoring Inspections, and Waiver Variance applications. Mr. Keefer explained at length various models used to determine new fees, both reductions and increases. Member Sullivan motioned to hold a public hearing at the March 19, 2015 Jefferson County Board of Health meeting. Member Buhler seconded the motion. There was • no further discussion. The motion carried. 2. Proposed Shellfish Rule Changes for Vibriosis Prevention Michael Dawson, Environmental Health Specialist, JCPH, introduced Laura Johnson, WA Department of Health, who gave a presentation on a new Shellfish Rule that is focused on prevention rather than reaction to reported shellfish related illnesses. If the Rule is adopted at the state level, DOH and the Department of Fish and Wildlife will hold training meetings to update and train local health jurisdictions on new preventions measures and practices. 3. Measles Outbreak Prevention—National, State, and Regional Dr. Tom Locke, JCPH Public Health Officer, updated the Board regarding measles cases in Clallam County and the measures taken to quarantine those potentially exposed. Dr. Locke further explained measles outbreak control protocols, the ongoing presence of measles as an international infection acquired by unvaccinated travelers, the specific strain found in Clallam County, and the strong link between vaccination exemptions and the current outbreak. Ms. Danskin reported to the Board regarding vaccine supplies held by JCPH and the difference between Child and Adult vaccines. 4. Influenza Update—Seasonal and Avian Dr. Locke reported to the Board that the influenza season is nearly at its end. This year's predominate flu strain, H3N2, was challenging in that it was strongly associated with • increased rates of hospitalization and death. Because of emergence of a new strain of • H3N2 after this season's vaccines had begun production, available vaccine was only partially protective. The usual 50-60% influenza vaccine efficacy was reduced to 23%. Regarding Avian Flu, Dr. Locke explained that the greatest problem associated with Avian Flu is the potential of infection at massive poultry operations. Where infection is found all birds must be slaughtered. Among backyard flocks, infection results in all birds having to be killed as well. Control and cleanup is costly. Avian flu generally does not cause human disease. There is, however, the remote possibility that a human (or other animals like swine) will become infected with both human influenza and avian influenza,producing a new virus that has the potential to be a global pandemic strain. 5. Public Health Heroes Chair Westerman reported on the meeting held to determine this year's focus for the Public Health Heroes Award. After reviewing past award recipients and current national trends, it was decided to focus on honoring those who actively engage in supporting children and in so doing support a national movement to achieve Healthiest Nation 2030. It was decided that the BOH would honor Jumping Mouse Children's Center and Nurse Family Partnership for their efforts to promote family and childhood health. Chair Westerman motioned to honor Jumping Mouse Children's Center and Nurse Family Partnership at the March 19th 2015 Jefferson County Board of Health • meeting. Member Kler seconded. There was no further discussion. The motion carried. ACTIVITY UPDATE There was a review of Board Action Items, 2014 The 2015 meeting schedule was reviewed. Discussion to cancel the November BOH meeting was tabled until the March 19, 2015 meeting. It was decided the BOH packet would no longer contain a Media Packet; rather, the packet will contain a face sheet containing headlines, dates, and source. JCPH will retain its notebook containing one copy of each article for convenience. Otherwise, Board members may read listed articles online at their leisure. PUBLIC COMMENT There was no public comment. AGENDA PLANNING CALENDAR There was no further planning. • NEXT SCHEDULED MEETING • The next Board of Health meeting will be held on Thursday, March 19, 2015 from 2:30—4:30 p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA ADJOURNMENT Chair Westerman adjourned the February 19, 2015 Jefferson County Board of Health meeting at 4:23 PM JEFFERSON COUNTY BOARD OF HEALTH Phil Johns', Member ill Buhler, Member ".i)14t11 air clef Davi Sullivan, Mem®er Sheila Westerman, Chair Kris Nelson, Member Kathleen Kler, Member EXCUSED Respectfully Submitted: Denise Banker • Board of Health III Old Business Item 1 2015, National Public Health Week: 1 ehs°`t Public Healt "Healthiest Nation 2030: Let's make America the Healthiest Nation in one Generation" . March 19, 2015 4110 ii , 1 \ I \s, , ,, , \ ,., 2 , ,, , ‘ \ s Let's make A ierica the healthiest nation in one generation. E t :3k : 8 6 d ::..:"..':''. ,A'",,.,,..,.,.,C':.i.::2',!;,:''.,',-?i:..,''it.i,,.-'',:''':'.''-!'e'it,,i-1.,-"'t-47. 1 $° Esq ' G %d & _ 4l1; t' , s '.2:-::.:,....)...,..'''.7. ,.. Pitf"''.4'.' ',..':.... ' '''''--"" ' ..,‘ .. . :„:1, . 41.',1.'.:Zi. '').111NtoggitiCi. -,:ii:', ,..* Right now,the U.S.spends more on health care than IP other cot tparallo countries.What do we have to National Public Health Week show for that spending Numerous studies show that April 6-12,2015 we live shorter lives and struggle with more health issues such as obesity,infarct irtortality,diabetes, heart disease and more.And this is true for •. National Americans of all ages and socio-economic groups. Weeks Ileal#h Week..�...,.ri„ • I"Iris is the defining challenge of our generation-that «. ,. o .,,. we,the public health community,are uniquely www.nphw.org positioned to overcome. Health Week 2015,the public health cornniunity That's why,during National Public is rallying around a goal of making the U.S.the I fealthiest Nation in One Generation—by 2030. In the 20 years we've been celebrating Natioiial Public I.lealth Week we have seen the tremendous success we can achieve working together across all fields of public health.Moving forward,wt:need tor collaborate with alt even broader.range of partners to address all of the issues that have at profound ef..fect oil our health. Let's build a groundswell of support for the prevention and public health programs we know improve the health of our coram unities. JOin us for National Public Health Week0 :15 and becreating the Healthiest . • • $,,, vripriatimootooliteatacilmvaiimowiwimgamemaiftkotaganottiv u ed in Na ,i:::''''''''""'''fli,..„,,,,,,::4 i'. '''''' ''', '' ' k �a� ' Sign our pledge to help create the healthiest nation at www.aphaorg12030 � , :;Attend and promote APHA events , Astoiti''.':` Host your own event r Become an NPI-IW partner by signing up at www.nphw.org and linking to the site .. . •Visit www.nphw.org to download materials and.find out more about this year's daily themes and activities teXARLigtiiralkisitatitKitakVimaiimaiiikaPottiormizoht,„.„„_ Af-yito. *II *.ctqtlgtmigigpwkw,*gopgowtst.tkgiefoArvigtioGwl j i Viz. S•14‘xft4,,144:hi.;fk4WXOVNMWASANiNdsnff§tigMRV:MTRWtjtag,e,*VgknV4;t15AVAS*.tp;:,:,,,,„t wa rte.. ": " 015 is �,'s lothAnniversary for 3 . organizin 'onal Pu • =Health Week! .',,,':,!;!,:r.„:1,,,,,,;,,,,,,:,:',,,i t to mi s year's events. � � you won' � we„,,,,wso„,,,,,,Atv,„,„,,,,„,„,,,„.„,,,„,,,„,„,A0,,tmett,,,,,,,6,„„....44,41tiati4,„0404404,0,440w4;,!„-4, 042#4 American Public Health Association pionities s •the health of all people and all communities.We'N: are the only organization that influences federal policy,has "' a 140-plus year perspective and brings together members s from all fields of public health.Learn more at www.apha.org. Ai Aigit:,111 p'lkj*,..Wip:100,41k,AP � . �atassoanTtora • Visiting Nurses, Helping Mothers on the Margins - N Y l imes.com Page 1 ot 4 MI SECOND • Ijie erk attaw http://nyti.ms/1CRJp72 HEALTH Visiting Nurses, Helping Mothers on the Margins By SABRINA TAVERNISE MARCH 8,2015 MEMPHIS — When it came time to have the baby, Shirita Corley was alone. Her mother was at the casino, her sister was not answering her cellphone, her boyfriend had disappeared months earlier, and her father she had not seen in years. So she got in her green Chevy TrailBlazer and drove herself to the hospital. "I feel so down," she texted from her hospital bed. "I'm sick of these deadbeats. I'm sick of having to be so strong." The message went not to a friend or family member, but to a nurse, Beth Pletz. Ms. Pletz has counseled Ms. Corley at her home through the Nurse-Family Partnership, which helps poor, first-time mothers learn to be parents. Such home visiting programs, paid for through the Affordable Care Act, are at the heart of a sweeping federal effort aimed at one of the nation's most entrenched social problems: the persistently high rates of infant mortality. The programs have spread to some 80o cities and towns in recent years, and are testing whether successful small- scale efforts to improve children's health by educating mothers can work on a broad national canvas. Home visiting is an attempt to counter the damaging effects of poverty by changing habits and behaviors that have developed over generations. It gained popularity in the United States in the late 1800s when health workers like Dr. S. Josephine Baker and Lillian Wald helped poor mothers and their babies on the teeming, impoverished Lower East Side of Manhattan. At its best, the program gives poor women the confidence to take charge of their lives, a tall order that Ms. Pletz says can be achieved only if the visits are sustained. In her program, operated here by Le Bonheur Children's Hospital, the visits continue for two years. It is Ms. Pletz's knack for listening and talking to women — about misbehaving • men, broken cars, unreliable families — that forms the bones of her bond with them. http://www.nytimes.com/2015/03/09/health/program-that-helps-new-mothers-learn-to-be-parents-... 3/11/2015 Visiting Nurses, HelpingMothers on the Margins -NYTimes.com Page 2 of4 She zips around Memphis in her aging Toyota S.U.V. with a stethoscope dangling from the rearview mirror. Her cracked iPhone perpetually pings with texts from her • 25 clients. Most of them are young, black, poor and single. Few had fathers in their lives as children, and their children are often repeating the same broken pattern. "I was lost, going from house to house," recalled Onie Hayslett, 22, who was homeless and pregnant when she first met Ms. Pletz two years ago. Her only shoes were slippers. "She brought me food. That's not her job description, but she did it anyway. She really cares about what's going on. I don't have many people in my life like that." Infant mortality rates in the United States are about the same as those in Europe in the first month of life, a recent study found, but then become higher in the months after babies come home from the hospital— a period when abuse and neglect can set in. (The study adjusted for premature births, which are also higher in the United States partly because of poverty. They were kept out of the study, researchers said, because the policies to reduce them are different.) In Memphis,where close to half of children live in poverty, according to census data, the infant mortality rate has long been among the country's highest. Sleep deaths — in which babies suffocate because of too much soft bedding or because an adult rolls over onto them — accounted for a fifth of infant deaths in the state, according to a 2013 analysis of death certificates by the Tennessee Department of Health. When Ms. Pletz recently visited Darrisha Onry, 21, she saw Ms. Onry's week-old child, Cedveon, lying beside her on a dark blue couch. The room was warm, small and crowded with a large living room set, a glass table, porcelain statues of dogs and an oversize cage holding two tiny, napping puppies. "Where is he sleeping?" Ms. Pletz asked. Cedveon started to cry, and Ms. Onry walked out of the room to make his bottle. "The safest place for him is alone by himself on his back in his crib," Ms. Pletz said, scooping up Cedveon, who had launched into a full-throated squall. A little later, Ms. Pletz said, "You know never to shake the baby, right?" Ms. Onry nodded. Ms. Pletz continued: "Nerves get shot and sometimes people lose their cool. If that happens,just put him on his back on a bed and close the door, and take a little rest away from him." S http://www.nytimes.com/2015/03/09/health/program-that-helps-new-mothers-learn-to-be-parents-... 3/1 1/2015 '• Visiting Nurses, Helping Mothers on the Margins -NYTimes.com Page 3 of 4 The program is unusual because it is based on a series of clinical trials much like those used to test drugs. In the 1970s, a child development expert, Dr. David Olds, • began sending nurses into the homes of poor mothers in Elmira, N.Y., and later into Memphis and Denver. The nurses taught mothers not to fall asleep on the couch with their infants, not to give them Coca-Cola, to pick them up when they cried and to praise them when they behaved. The outcomes were compared with those from a similar group of women who did not get the help. The results were startling. Death rates in the visited families dropped not just for children, but for mothers, too, when compared with families who did not get the services. Child abuse and neglect declined by half. Mothers stayed in the work force longer, and their use of welfare, food stamps and Medicaid declined. Children of the most vulnerable mothers had higher grade-point averages and were less likely to be arrested than their counterparts. The program caught the attention of President Obama, who cited it in his first presidential campaign. His administration funded the program on a national scale in 2010. So far, the home visits have reached more than 115,000 mothers and children. States apply for grants and are required to collect data on how the families fare on • measures of health, education and economic self-sufficiency. Early results are expected this year. "The big question is, can the principle of evidence be implemented in a large federal program?" said Jon Baron, president of the Coalition for Evidence-Based Policy, a nonprofit group in Washington whose aim is to increase government effectiveness in areas including education, poverty reduction and crime prevention. "And if so, will it actually improve health?" Experts say federal standards are too loose and have allowed some groups with weak home visiting programs to participate, even if they show effects on only trivial outcomes that have no practical importance for a child's life. Congress should fix the problem, Mr. Baron said, warning that the program in its current state is "a leaky bucket." "If left unchanged, essentially anyone will figure out how to qualify,"he said. Its future is not assured. Funding for the home visiting initiative runs out as early as September for some states, and if Congress does not reauthorize it this month, programs may stop enrolling families and the $500 million the Obama • http://www.nytimes.com/20 1 5/03/09/health/program-that-helps-new-mothers-leam-to-be-parents-... 3/11/2015 Visiting Nurses, Helping Mothers on the Margins -NYTimes.com rage4 01 1114 administration has requested for 2016 will not be granted. Last week, its supporters urged Congress to extend it. • In Tennessee, where home visiting programs have bipartisan support, infant mortality is down by 14 percent since 2010, and sleep deaths dipped by 10 percent from 2012 to 2013. State officials credit a multitude of policies, including the home visits. Ms. Pletz worries that she has helped only a handful of her clients truly improve their lives. But Ms. Corley, 28, the mother who drove herself to the hospital, said Ms. Pletz, who has been visiting her for two years, had made a difference. She "has been my counselor, my girlfriend, my nurse," Ms. Corley said. Ms. Pletz helped her cope with the disappearances of her children's fathers, taught her to recognize whooping cough and pushed her to set career goals, she said. "She knows more about me than my own family does," Ms. Corley said. "I feel like I've grown more wise. I feel stronger for sure." The morning after Ms. Corley gave birth, Ms. Pletz brought her breakfast: eggs, flapjacks and bacon. The new baby, Daniel,lay in a clear plastic crib next to Ms. Corley's hospital bed, and the two women talked over his head like old friends. "Can I pick him up?" Ms. Pletz asked. • Ms. Corley replied: "I think he's waiting on it." Correction:March 11, 2015 An article on Monday about a federal effort aimed at improving children's health by educating mothers misidentified the profession of S.Josephine Baker, whose work around the turn of the loth century with poor mothers and children in the immigrant communities of New York City inspired later programs. She was a medical doctor, not a nurse. A version of this article appears in print on March 9, 2015, on page Al of the New York edition with the headline: Visiting Nurses, Helping Moms on the Margins. © 2015 The New York Times Company 411 http://www.nytimes.com/20 1 5/03/0 9/health/pro gram-that-helps-new-mothers-leam-to-be-Parents-... 3/1 1/2015 Board of Health II • IV New Business Item 1 2015, Jefferson County Public Health Heroes Award Affason. Public Ne-at March 19, 2015 4/-N. 615 Sheridan Street 1' ®� Port Townsend, WA 98368 4` www.JeffersonCountyPublicHealth.org • Public He Pal March 19, 2015 Jefferson County Board of Health Honors 2015 Public Health Heroes: Jumping Mouse Children's Center and Jefferson County Nurse-Family Partnership The 2015 National Public Health Week theme is"Healthiest Nation 2030, Let's make America the healthiest nation in one generation."Based on this theme,as well as the 2015 Jefferson County Community Assessment Priority(Access to Mental Health and Substance Abuse Care),the Board of Health has selected Jumping Mouse Children's Center(JMCC) and Jefferson County Nurse-Family Partnership (NFP) as recipients of the 2015 Public Health Hero Awards.JMCC and NFP received this award for fulfilling the challenge of providing critical services to our youngest community members. Early intervention with infants and children provides the foundation for long-term healthy behavior. Preventing Adverse Childhood Experiences(ACEs) reduces the risk of adult mental health issues and substance abuse. Additionally, preventing ACEs reduces the risk of developing chronic diseases.These • issues are some of the highest public health priorities of the current year.The work that JMCC and NFP do around these issues is one of the many reasons they are recognized as 2015 Public Health Heroes. About Jumping Mouse and Nurse-Family Partnership Jumping Mouse Children's Center transforms children's lives by providing expressive mental health therapy for as long as necessary.JMCC nurtures each child's healthy development and supportive relationships at home and in the community. Nurse-Family Partnership helps transform the lives of vulnerable first-time moms and their babies. Through ongoing home visits from registered nurses, low-income,first-time moms receive the care and support they need to have a healthy pregnancy, provide responsible and competent care for their children, and become more economically self-sufficient. National Public Health Week is April 6—12, 2015. More information, as well as a helpful Healthiest Nation 2030 Partner Toolkit can be found at http://www.nphw.org/tools-and-tips/toolkit. • Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487 Board of Health IV New Business Item 2 Public Hearing: Jefferson County JJeison Public Healt Environmental Health Fee Revision • March 19, 2015 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2015 Additional Fees and Other Information GENERAL Health Officer Administrative Hearing 314.00 Administrative Hearing Appeal 314.00 Technical Assistance/Plan Review-Minimum 86.00 Technical Assistance/Plan Review-Per Hour 86.00 Filing Fee 54.00 Recording Fee 65.00 Plus the Auditors Office recording fees Notice to Title Rescission 525.00 ONSITE SEWAGE DISPOSAL Sewage Disposal Permits New Conventional 569.00 Valid for 3 years New Alternative 829.00 Valid for 3 years New septic tank and/or pump chamber only Issued in conjunction with an existing sewage disposal 340.00 system or community system New Community or Commercial Conventional 719.00 Base Fee-Valid for 3 years Alternative 919.00 Base Fee-Valid for 3 years Each Connection 90.00 Add to base permit fee Development and Review Financial Assurance and System 86.00 Per Hour Operation Agreements Septic Permit with Approved SPAAD(conventional) 307.00 Septic Permit with Approved SPAAD(alternative) 569.00 Applies to existing installed sewage disposal system;the Technical Assistance/Plan Review hourly rate will be Repair 50%of fee charged for repairs where the applicants require additional assistance odification or Reserve Area Designation 258.00 Expansion 538.00 Redesign 172.00 Applies to pending or active but not installed Reinspection 215.00 Evaluation of Existing System/Monitoring Inspection Septic system only 334.00 Septic system plus water sample 377.00 Retest/Reinspection 172.00 On Site Sewage-Building and Planning OnSite-Site Plan Advanced Approval Determination(SPAAD) 397.00 Subdivision Review Base Fee 516.00 Boundary line adjustment or Lot Certification review fee 202.00 Planned rural residential development review fee 202.00 For Subdivision Review, Bounrdy Line Adjustment and Per lot fee 90.00 Planned Rural Residential Development Review fees Pre application meeting fee 202.00 Density exemption review fee 129.00 Field Work for Density Exemption Review 86.00 Per Hour Building application review: Residential-Individual OSS 129.00 Review after Building Permit issued, is same fee Commercial-Individual OSS 258.00 Review after Building Permit issued, is same fee Community OSS 258.00 Review after Building Permit issued, is same fee Revised Site Plan Review 65.00 Review of resubmission before Building Permit is issued Other Waiver/Variance Application 237.00 SaiverNariance Hearing 387.00 et season evaluation 538.00 General environmental health review fee 86.00 Per Hour Licenses Installer, Pumper. Operator(maintenance person) 538.00 Retest 215.00 Homeowner Authorization 10.00 • Annual Certificate Renewal 299 00 Delinquent Renewal after January 31 538.00 FOOD SERVICE ESTABLISHMENT FEES PERMIT FEES(Annual Permit) Restaurants/Take-Out(Based on menu complexity&seating-menu changes may change category) 0-25 seats(Limited Menu) 191.00 No cooling or reheating 0-25 seats(Complex Menu) 339.00 Cooling and reheating allowed 26-50 seats 340.00 51-100 seats 407.00 101-150 seats 462.00 With Lounge, add 149.00 Separate lounge area Bakery Business 149.00 B& B 191.00 Caterer w/commissary or catering-only kitchen 339.00 w/restaurant, additional fee for catering 191.00 Concession/Commercial Kitchen/Church 149.00 Espresso Stand 149.00 Grocery 1-3 checkouts 191.00 May serve pre-packaged baked goods >3 checkouts 462.00 Meat/Fish Market 339.00 Mobile Unit Limited Menu 191.00 No cooling or reheating Complex Menu 339.00 Cooling &reheating allowed School Cafeteria Central Kitchen 339.00 . Warming Kitchen 191.00 Tavern w/food (see Restaurants) Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee Temporary Permits Single Event Initial Application (First Event) 107.00 Not to exceed 21 days at your location Additional Event(Same Menu Only) 61.00 Not to exceed 21 days at your location Organized Recurring Event(e.g. Farmers Market) Limited Menu 107.00 Not to exceed 3 days a week at a single location Complex Menu 142.00 Not to exceed 3 days a week at a single location Late Fee for Temporary Permits +50%of fee Additional(Paid when application is submitted less than 7 days prior to the event) Other Food Fees Permit Exemption 41.00 Waiver/Variance 86.00 Per Hour Reopening Fee 86.00 Per Hour Manager's Course 231.00 Plan Review Pre-opening inspection 86.00 Per Hour Minimum 86.00 Per Hour 86.00 Reinspection First Inspection 95.00 Each inspection after first 163.00 Food Handler Card Reissue Unexpired Food Handler Card 10.00 • SOLID WASTE Annual Permit Fees Landfills requiring environmental monitoring 557.00 Biosolid/Composting Facilities 489.00 Inert Waste Landfills 353.00 Solid Waste Facilities 353.00 Otherrop Boxes 163.00 Miscellaneous Fees New Facility Application 448.00 Exempt Facility Inspection 353.00 Facility Reinspection 50%of fee Plan, Document and Waiver/Variance Review 345.00 +$86.00/hour for>4 hours WATER Inspection of well construction,decommission& Application Fee 163.00 reconstruction Determination of Adequate Water Supply base fee 129.00 Tech Assist and Document Review, billed at the hourly rate Well Inspection&Water Sample for Loan 137.00 Well Site Inspection-Proposed public water supply 326.00 LIVING ENVIRONMENTS Water Recreation Facilities Operation Permit Single Swim Pool(in operation for<6 months of the year) 296.00 Single Swim Pool(in operation for 6 months of the year) 299.00 Single Spa Pool(in operation for<6 months of the year) 259.00 Single Spa Pool(in operation for>months of the year) 299.00 Single Wading Pool(in operation for<6 months of the year) 214.00 Single Wading Pool(in operation for>_6 months of the year) 377.00 Spray Pool or Pools(in operation for<6 months of the year) 107.00 Spray Pool or Pools(in operation for>_6 months of the year) 162.00 Each Additional Swim, Spa, or Wading Pool(in operation for<6 months of the year) 64.00 Each Additional Swim,Spa, or Wading Pool(in operation for>6 onths of the year) 85.00 m einspection 86.00 Per Hour plus associated lab costs an Review 86.00 Per Hour indoor Air(Tobacco) Compliance Enforcement 86.00 Per Hour Reinspection 80.00 Rebuttal Application 160.00 Note: 2013 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW). The CPIW is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistics for the United States Department of Labor. The annual fee adjustment shall be calculated as follows: each fee in effect immediately prior to the Adjustment Date will be increased by the percentage increase in the CPIW as reported for the month of September preceding the Adjustment Date. Increases wit be rounded to the nearest dollar. A fee shall not be reduced by reason of such calculation. However,fee increases in accordance with this calculation shall not exceed 5 percent per year. • Board of Health IV New Business Item 3 2014, Environmental Health and Water Quality Performance Measures • A Mason Public Health March 19, 2015 • b o `D pa til7 pa 7 c v, cn . oCo a (,)• o 4 . : . oa CD 0 (IQ 02 8 5D • 0-, • c° D= • O 5 = w ° „• B s 0 N5 .-4, v, CD ( V, . en 0 �+ 0 r-y ••e • 0 ..d 'Lf O' A 'C3 O '•Cs o f3 p O. 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R 2 o / CD 5 E . 02 / E - Q com .. 2 d « \ w co k ƒ o / ƒ x. r+ dCT /-s/ U/ -' CO .. / r 2 w C W SU 07 c / J k fa- • U /r+ e CD � CD / « \ w / % 0 Board of Health • IV New Business Item 6 Vaccine Hesitancy — State and National Efforts • Allason Public Health To Increase Community Immunization Levels March 19, 2015 Bills Banning Most Vaccine Exemptions Fail in Northwest Page 1 of 2 Cbc NEWS • Bills Banning Most Vaccine Exemptions Fail in Northwest Oregon and Washington lawmakers drop divisive measures eliminating most vaccine exemptions By SHEILA V The Associated Press SALEM, Ore. Legislative efforts to increase pressure on parents to get their kids vaccinated failed in Oregon and Washington state Wednesday amid stiff opposition as a handful of other statehouses consider similar bills prompted by a measles outbreak at Disneyland. Oregon's measure, which had the support of Democratic Gov. Kate Brown, would have made the state the third in the country allowing exemptions from immunizations only for medical reasons, and no • longer for religious, philosophical or personal reasons. Mississippi and West Virginia are the only other states that have comparable laws in place. In Washington state, a similar effort to remove personal or philosophical opposition to vaccines as an authorized exemption from childhood school immunizations died in the state House after failing to come up for a vote before a key deadline.Religious and medical exemptions would have remained under that bill. Washington state Rep. June Robinson, who had sponsored the bill, said she didn't have the votes she needed. The Democrat from Everett said the pushback from parents and others opposed to the change had an effect on some lawmakers. "There was a very loud outcry, much of which was filled with false information," she said. The Oregon bill's sponsor, Democratic Sen. Elizabeth Steiner Hayward, of Portland, said opposition largely revolved around who was right or wrong about the benefits of vaccines and she has decided not to pursue the legislation. "She strongly believes that making personal choices such as whether or not to vaccinate children are largely a matter of privacy, but ??? as with all matters of personal choice ???we have to be certain that our choices don't impinge on our neighbors' health and well-being," said Paige Spence, Steiner Hayward's chief of staff. • Several other states have been considering similar bills eliminating personal and philosophical exemptions to vaccinations as dozens of people across the country fell ill from a measles outbreak that http://abcnews.go.com/Health/print?id=29564095 3/12/2015 t • • Bills Banning Most Vaccine Exemptions Fail in Northwest Page 2 of 2 started at Disneyland in December. According to the Centers for Disease Control and Prevention, 142 people from seven states, including one from Oregon and two from Washington, were linked to the outbreak. In February, three California lawmakers introduced legislation that would require parents to vaccinate their children before they enter school unless they can't for medical reasons. That bill has yet to come up before a committee, though Democratic Gov. Jerry Brown has suggested he'll support it. In Vermont, which is in the top three states for people taking an exemption, a group of lawmakers announced plans last month to introduce legislation eliminating the philosophical exemptions for parents who don't want their kids immunized, though a similar effort failed three years ago. In Maine, two bills, one removing philosophical exemptions and one that aims to make it harder for parents to get that exemption, are awaiting a public hearing. Last year, Oregon passed a law requiring parents with kindergartners to consult with a health professional or watch a one-hour educational video before shots are waived. Steiner Hayward, who also sponsored that bill, said she'd heard parents were only going through the motions of watching the video when they attended consultations, which is why she sought to strengthen the state's immunizations requirements. This year's measure drew heated testimony from parents who argued it took away their medical freedom and right to informed consent. The bill was pulled before it got a committee vote, though it did get a public hearing. Dozens of parents who showed up at a hearing in Washington also said the measure would take away their rights to make decisions for their children. 41) "The fundamental issue was that of informed consent. We're supportive of safe and effective vaccinations. We're not anti-vaccine. We're pro-informed-consent," said Vern Saboe, a chiropractor from Albany who testified against the Oregon bill. La Corte reported from Olympia, Washington. Associated Press writers Alanna Durkin in Augusta, Maine, and Fenit Nirappil in Sacramento, California, contributed to this report. Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Copyright©2015 ABC News Internet Ventures 111 http://abcnews.go.com/Health/print?id=29564095 3/12/2015 What doctors should tell parents who are afraid of vaccines - The Washington Post Page 1 of 6 CMI .Itington post • PostEverything What doctors should tell parents who are afraid of vaccines When it comes to parents decic ing whether to vaccinate heir chilcren, focus on the direct benefits of immunization for the kic . 1 By Kristin S. Hendrix March 9 410 A, Kristin S. Hendrix is an assistant professor of pediatrics at Indiana University School of Medicine. r.> In recent years, the U.S. has witnessed multiple outbreaks of vaccine-preventable illnesses, including pertussis (whooping cough) and measles. In the same time frame, vaccine refusal rates have gone up, and an increasing number of parents are requesting modified vaccine schedules that differ from the one recommended. by the American Academy of Pediatrics. The majority of parents do have their children vaccinated on schedule. It's a small number of parents who refuse all vaccinations for their children. A slightly larger minority want their children to receive some but not all vaccines or want a different vaccination schedule. S http://www.washingtonpost.com/posteverything/wp/2015/03/09/what-doctors-should-tell-p... 3/12/201 5 What doctors should tell parents who are afraid of vaccines - The Washington Post Page 2 of 6 Why do these groups disregard AAP recommendations about vaccination? A 2011 study suggests it has a lot to do with fear of vaccines' negative side effects. Some parents worry about the "chemical composition" of vaccines or multiple vaccines being given at once. Some don't believe vaccines are effective. Others feel the illnesses some vaccines protect against, like influenza or varicella (chickenpox), aren't that serious. Importantly, though not the focus of this article, the AAP Committee on Bioethics notes that some parents might refuse vaccines due to cost issues or barriers to accessing appropriate health services. Although research overwhelmingly supports the safety and effectiveness of vaccines and indicates that the risk of negative side effects from childhood vaccines is extremely small, many parents still have concerns about vaccine safety. Parents today have access to incredible amounts of information via the Internet, which has been shown to significantly affect parents' vaccine attitudes. Within this wealth of information about immunization, it can be challenging for parents to separate what's reliable from what's not. And, we tend to seek out, pay more attention to, and recall information that we suspect might be true. This is called biased assimila tion. So a parent who believes vaccines are dangerous might preferentially register information supporting that view. The continuum of vaccine attitudes Vaccine attitudes fall on a continuum. At one end, there are parents who are completely in favor of vaccines, and at the other end are parents who oppose vaccines. In between there is a broad and complex spectrum of parents who are vaccine-hesitant or vaccine-uncertain. The common thread among all parents — http://www.washingtonpost.com/posteverything/wp/2015/03/09/what-doctors-should-tell-p... 3/1 2/20 1 5 ,What doctors should tell parents who are afraid of vaccines - The Washington Post Page 3 of 6 no matter their vaccination choices — is that they're trying to do what they feel is best for their children. With parents who fall towards the vaccine-opposing end of the spectrum, health- care providers can experience difficulty when trying to change attitudes about vaccines. These parents may have strong feelings and be very confident in what they believe to be true about vaccines. But parents somewhere in the middle of the spectrum, who are hesitant or uncertain about vaccines, are oftentimes less set in their beliefs about vaccination. That's why some researchers stress the importance of proactive intervention efforts aimed at the very broad group of vaccine-hesitant parents. Parents on this part of the continuum are typically receptive to information about vaccination from trusted health-care providers. Thus, the way nurses and physicians communicate with these parents about vaccination is very important. 11 • How should health-care providers talk about vaccines? There is a wealth of research examining communication about vaccines, and researchers are still identifying what methods tend to work well. Communication about vaccination occurs in a variety of ways, from one-on-one conversations with doctors and nurses to large-scale outreach from health departments, such as billboards and radio ads. What can make the provider-parent discussion about childhood vaccination a complex one is that parents' decisions and attitudes vary, depending, for example, on the type of vaccine. And, in many cases when parents have negative attitudes about vaccines, they're often based on erroneous information or hearing emotional narrative accounts about adverse reactions from a vaccine. It can also http://www.washingtonpo st.com/posteverything/wp/20 1 5/03/09/what-doctors-should-tell-p... 3/12/20 1 5 1 I What doctors should tell parents who are afraid of vaccines - The Washington Post Page 4 of 6 be very challenging for health-care providers to correct people's misperceptions about risks. There are a few strategies that health-care providers can use when talking about immunization with vaccine-hesitant parents. In clinical settings, although potentially time-consuming in already-short appointments, it's important to address parents' specific concerns. Clinicians should discuss vaccines from multiple perspectives, like the benefits of vaccination (preventing illness for oneself and others), as well as the risks of not vaccinating (being susceptible to illness). Research suggests that tailoring the discussion to parents' concerns can positively affect the provider-parent relationship and foster trust. Since health-care providers can help build public trust in vaccines, communicating accurate information about risks should be part of the conversation. Here, it might be tempting to avoid discussion about the risk of any negative side effects of vaccination, even though the risk is very low. But risk communication is vital. The AAP suggests tailoring the conversation to the parents, understanding and responding to their specific concerns. Physicians should talk to parents about managing common side effects and what to do if a more serious reaction occurs. For some parents, quantifying the risks of vaccinating versus not vaccinating could be helpful. Providing written materials to explain risk is another strategy. It is important to note, however, that more research is needed. Several researchers urge caution about some vaccine communication strategies for fear they may "backfire" and decrease parents' intentions to vaccinate their children. What about discussing herd immunity? http://www.washingtonpost.com/posteverything/wp/2015/03/09/what-doctors-should-tell-p... 3/12/201 5 ,What doctors should tell parents who are afraid of vaccines - The Washington Post Page 5 of 6 A 2013 study on what influences adults to the get the flu shot suggests people may • be more likely to get vaccinated if their peers do it. Among adults, evidence also suggests awareness of herd immunity — or when a critical threshold of individuals is vaccinated so as to make it harder for an illness to spread — can have a positive effect on one's intention to be vaccinated. Though adults are most concerned about their personal risk of getting sick, they can also be sensitive to the societal benefits of vaccination. However, when it comes to parents deciding whether to vaccinate their children, it may be more important to focus on the direct benefits of immunization for the child. Though mentioning societal benefits of vaccination will likely not hurt. To presume or not presume? In order to increase vaccine uptake among parents for their children, some researchers recommend a "presumptive" approach, which assumes parents are going to vaccinate their children. This is compared to a "participatory" approach in which the health-care provider asks parents about their preferences on vaccination. These investigators question the appropriateness of shared decision making in the context of vaccine decisions. Advertisement However, other researchers advocate for a "guiding" approach. Here the focus is on addressing vaccine-hesitant parents' concerns and helping them to understand vaccines' importance and necessity. It differs from a "directive" approach wherein the provider essentially instructs parents to vaccinate. More research is needed to determine which interventions and ways of • communicating information about vaccination are most effective at reducing http://www.washingtonpost.com/posteverything/wp/2015/03/09/what-doctors-should-tell-p... 3/12/201 5 ,What doctors should tell parents who are afraid of vaccines - The Washington Post Page 6 of 6 parents' vaccine hesitancy and refusal. What is clear from existing research is that • respectful, tailored communications and recommendations to immunize coming directly from the health-care provider are associated with increased vaccination uptake. This article was originally published on The Conversation. Read the original article. • • http://www.washingtonpost.com/posteverything/wp/2015/03/09/what-doctors-should-tell-p... 3/12/2015 C • s PEDIATRIC „,„,,rfictAL,sjouRNAI THE,,Amoocisis A� Responding to Parental Refusals of Immunization of Children Douglas S. Diekema Pediatrics 2005;115;1428 DOI: 10.1542/peds.2005-0316 The online version of this article, along with updated information and services, is located on the World Wide Web at: • http://pediatrics.aappublications.org/content/115/5/1428.full.html PEDIATRICS is the official journal of the American Academy of Pediatrics.A monthly publication, it has been published continuously since 1948.PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,Illinois,60007. Copyright©2005 by the American Academy of Pediatrics. All rights reserved.Print ISSN: 0031-4005. Online ISSN: 1098-4275. 9\ C. American Academy of Pediatrics = • DEDICATED TO THE HEALTH OF ALL CHILDREN' „nn,ti";„ Downloaded from pediatrics.aappublications.org by guest on March 12,2015 AMERICAN ACADEMY OF PEDIATRICS CLINICAL REPORT . Guidance for the Clinician in Rendering Pediatric Care Douglas S. Diekema, MD, MPH; and the Committee on Bioethics Responding to Parental Refusals of Immunization of Children ABSTRACT. The American Academy of Pediatrics zation-administration practices, 7 of 10 pediatricians strongly endorses universal immunization.However,for reported that they had had a parent refuse an immu- childhood immunization programs to be successful,par- nization on behalf of a child in the 12 months pre- ents must comply with immunization recommendations. ceding the survey.5 Measles-mumps-rubella vaccine The problem of parental refusal of immunization for was refused most frequently, followed b varicella children is an important one for pediatricians. The goal Y of this report is to assist pediatricians in understanding vaccine,pneumococcal conjugate vaccine,hepatitis B the reasons parents may have for refusing to immunize vaccine,and diphtheria and tetanus toxoids and per their children, review the limited circumstances under tussis vaccines. Four percent of pediatricians had which parental refusals should be referred to child pro- refused permission for an immunization for their tective services agencies or public health authorities,and own children younger than 11 years. When faced provide practical guidance to assist the pediatrician faced with parents who refuse immunization, almost all with a parent who is reluctant to allow immunization of pediatricians reported that they attempt to educate his or her child. Pediatrics 2005;115:1428-1431; immuni- parents regarding the importance of immunization zation,parental refusals, medical neglect,vaccine refusal. and document the refusal in the patient's medical record. A small number of pediatricians reported ABBREVIATION. AAP,American Academy of Pediatrics. that they always (4.8%) or sometimes (18.1%) tell parents that they will no longer serve as the child's OVERVIEW OF THE PROBLEM physician if, after educational efforts, the parents he marefuse pemn • tudeimof infectiousunization agents ofchildren has been hgainstaileda asmuonelti- confine Thue AAPto strongly enrmissiondorses for universalanimiumization.5muniza- of the most important health interventions of tion. However, for universal childhood immuniza- the 20th century.1-3 Immunizations have eliminated tion programs to be successful,parents must comply smallpox infection worldwide, driven polio from with immunization recommendations. The problem North America, and made formerly common infec- of parental refusal of immunization for children is an tions like diphtheria, tetanus, measles, and invasive important one for pediatricians. Parents may have Haemophilus influenzae infections rare occurrences.By many reasons for refusing immunization. Some par- one account, pediatric immunizations are responsi- ents may object to immunization on religious or phil- ble for preventing 3 million deaths in children each osophical grounds, some may object to what seems year worldwide.3 Despite this success, some parents to be a painful assault on their child,and others may continue to refuse immunizations for their children. believe that the benefits of immunization do not The number of pertussis cases has increased steadily justify the risks to their child. Many commonly held in the United States over the past 20 years, and Web beliefs about the risks of immunization are not sup- sites critical of immunization are prominent on the ported by available data, and they frequently origi- Internet, a source that many parents rely on for nate from the unsupported claims of organizations health information.4 It is ironic that the remarkable that are critical of immunization. These antivaccine success of vaccine programs has resulted in a situa- information sources not only propagate unproven tion in which most parents have no memory of the claims regarding vaccines but also may undermine devastating effects of illnesses such as poliomyelitis, the physician-family relationship by challenging the measles, and other vaccine-preventable diseases, parents' trust of the medical profession. making it more difficult for them to appreciate the What should the pediatrician do when faced with benefits of immunization. a parent who refuses to consent to immunizations for According to a periodic survey of fellows of the a child? The goal of this clinical report is to provide American Academy of Pediatrics (AAP) on immuni- guidance to the pediatrician faced with this difficult situation. The physician faced with a parent who refuses to immunize a child faces 3 important and The guidance in this report does not indicate an exclusive course of treat- distinct issues that will be addressed in this report. ment or serve as a standard of medical care.Variations,taking into account First,are there situations in which parents who with- 0 individual circumstances,may be appropriate. doi:10.1542/peds.2005-0316 hold immunizations from their children risk harm PEDIATRICS(ISSN 0031 4005).Copyright©2005 by the American Acad- ing them sufficiently that their decision constitutes emy of Pediatrics. actionable medical neglect and should be reported to 1428 PEDIATRICS Vol,115 No. May 2005 . ownloa ad ro pe Iatncs.aappublications.org by guest on March 12,2015 state child protective services agencies? Second, are which the decision of a parent places a child at there situations in which a parental decision to with- substantial risk of serious harm may the health care hold immunization from a child puts other individ- professional be obligated to involve state agencies in uals at risk of harm sufficient to justify public health seeking to provide the necessary immunization over • intervention? Finally, how should the pediatrician the parents'objections.For example,for the situation respond to a parent who refuses immunizations for in which a child has sustained a deep and contami- his or her child? nated puncture wound,it might be justifiable to chal- lenge the decision of a child's parents to refuse treat- PARENTAL REFUSALS AND THE BEST INTERESTS ment with tetanus vaccine. In these situations, the OF CHILDREN health care professional would involve the appropri- Health care professionals and parents are bound ate state child protective services agency because of by the duty to seek medical benefit for and minimize the concern about medical neglect.It would be up to harm to children in their care. When faced with the the state agency to decide whether immunization decision to immunize a child,the welfare of the child would be required.Although this role of the state has should be the primary focus. However, parents and been recognized as constitutionally valid in the physicians may not always agree on what constitutes United States, courts have closely examined such the best interest of an individual child. In those sit- actions, showing reluctance to require medical treat- uations, physicians may need to tolerate decisions ment over the objection of parents "except where they disagree with if those decisions are not likely to immediate action is necessary or where the potential be harmful to the child.6 Although decision-making for harm is rather serious."13 involving the health care of children should be shared between physicians and parents, parental COMMUNITY INTERESTS AND PUBLIC HEALTH permission must be sought before children receive The benefits provided by most vaccines extend medical interventions, including immunizations.' beyond benefit to the individual who is immunized. Parents are free to make choices regarding medical There is also a significant public health benefit. Par- care unless those choices place their child at substan- ents who choose not to immunize their own children tial risk of serious harm. increase the potential for harm to other persons in 4 Whether parents place their children at substantial important ways.14 First, should an unimmunized risk of serious harm by refusing immunization will child contract disease, that child poses a potential depend on several factors, including the probability threat to other unimmunized children. Second,even of contracting the disease if unimmunized and the in a fully immunized population,a small percentage morbidity and mortality associated with infection. of immunized individuals will either remain or be- The results of such an analysis will also vary depend- come susceptible to disease. These individuals have • ing on the prevalence of disease in the community in done everything they can to protect themselves which the child resides or the areas in which the through immunization, yet they remain at risk. child is likely to travel.The balance between the risks Third, some children cannot be immunized because and benefits to a given individual favors immuniza- of underlying medical conditions. These individuals tion most strongly when rates of immunization in the derive important benefit from herd immunity and community are low and disease prevalence is high. may be harmed by contracting disease from those In most cases, however, as immunization rates in- who remain unimmunized. Finally, immunized in- crease and disease prevalence decreases,the balance dividuals are harmed by the cost of medical care for may tip the other way.8'9 Although the benefits of a those who choose not to immunize their children and measles-vaccine program, for example, clearly out- whose children then contract vaccine-preventable weigh the risks at a population level,10 an unimmu- disease. nized child living in a well-immunized community A parent's refusal to immunize his or her child derives significant indirect protection from herd im- also raises an important question of justice that has munity." Even in a community with high immuni- been described as the problem of "free riders."14-16 zation rates, the risk assumed by an unimmunized Parents who refuse immunization on behalf of their child is likely to be greater than the risks associated children are, in a sense, free riders who take advan- with immunization. However, the risk remains low, tage of the benefit created by the participation and and in most cases the parent who refuses immuni- assumption of immunization risk or burden by oth- zations on behalf of his or her child living in a ers while refusing to participate in the program well-immunized community does not place the child themselves. The decision to refuse to immunize a at substantial risk of serious harm. child is made less risky because others have created The role of the physician in these situations is to an environment in which herd immunity will likely provide parents with the risk and benefit informa- keep the unimmunized child safe. These individuals tion necessary to make an informed decision and to place family interest ahead of civic responsibility. attempt to correct any misinformation or mispercep- Although such parents do reject what many would tions that may exist. For example, in a national sur- consider to be a moral duty, coercive measures to vey of parents,25%believed falsely that their child's require immunization of a child over parental objec- immune system could become weakened as a result tions are justified only in cases in which others are • of too many immunizations.12 Exploring and ad- placed at substantial risk of serious harm by the dressing parental concerns may be an effective strat- parental decision. egy with reluctant parents. Only in rare cases in Compulsory immunization laws in the United American A2c my of Pediatrics 1429 Downloaded from pediatncs.aappublications.org by guest on March12, 0 States have been upheld repeatedly as a reasonable for a list of Internet resources related to immuniza- exercise of the state's police power in the absence of tion). an epidemic or even a single case.17-18 They also have Many parents have concerns related to 1 or 2 spe- been found to be constitutional even for cases in cific vaccines. A useful strategy in working with • which the laws conflict with the religious beliefs of families who refuse immunization is to discuss each individuals.19 vaccine separately.The benefits and risks of vaccines When others are placed at substantial risk of seri- differ, and a parent who is reluctant to accept the ous harm,the range of choices of the individual may administration of 1 vaccine may be willing to allow be restricted. With regard to immunization, the key others. question becomes whether the harms associated with Parents also may have concerns about administer- unimmunized individuals are great enough to make ing multiple vaccines to a child in a single visit. In restrictions permissible.In times of epidemic disease, some cases, taking steps to reduce the pain of injec- when an effective vaccine can end the epidemic and tion, such as those suggested in the Red Book,26 may protect those individuals who have not yet con- be sufficient. In other cases, a parent may be willing tracted the disease, the answer clearly is yes. to permit a schedule of immunization that does not In a highly immunized population in which dis- require multiple injections at a single visit. ease prevalence is low, the risk of disease from the Physicians should also explore the possibility that small number of children who remain unimmunized cost is a reason for refusing immunization. For a does not usually pose a significant-enough health parent whose child does not have adequate preven- risk to others to justify state action.20 Diseases with tive care insurance coverage,even the administrative very high morbidity and mortality (such as small- costs and copayments associated with immunization pox), however, might create a situation in which can pose substantial barriers. In such cases, the phy- even a single case of infection would justify manda- sician should work with the family to help them tory immunization of the population. For most rou- obtain appropriate immunizations for the child. tine vaccines, less forcible alternatives can be used For all cases in which parents refuse vaccine ad- justifiably to encourage parents to immunize chil- ministration,pediatricians should take advantage of dren because of the public health benefit. In the case their ongoing relationship with the family and revisit of vaccines routinely recommended for children,the the immunization discussion on each subsequent AAP supports the use of appropriate public health visit. As respect, communication, and information measures, education, and incentives for immuniza- build over time in a professional relationship, par- tion.7 Because unimmunized children do pose a risk ents may be willing to reconsider previous vaccine to other children who lack immunity to vaccine- refusals. • preventable infections,the AAP also supports immu- Continued refusal after adequate discussion should nization requirements for school entry. be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic).Only then should state agencies RESPONDING TO PARENTS WHO REFUSE be involved to override parental discretion on the basis IMMUNIZATION FOR THEIR CHILDREN of medical neglect.Physician concerns about liability What is the pediatrician to do when faced with a should be addressed by good documentation of the parent who refuses immunization for his or her discussion of the benefits of immunization and the child? First and most important, the pediatrician risks associated with remaining unimmunized. Phy- should listen carefully and respectfully to the par- sicians also may wish to consider having the parents ent's concerns, recognizing that some parents may sign a refusal waiver (a sample refusal-to-immunize not use the same decision criteria as the physician waiver can be found at www.cispimmunize.org/ and may weigh evidence very differently than the pro/pdf/RefusaltoVaccinate_2pageform.pdf). In gen- physician does.21 Vaccines are very safe,but they are eral,pediatricians should avoid discharging patients not risk free;nor are they 100%effective.22 This poses from their practices solely because a parent refuses a dilemma for many parents and should not be min- to immunize his or her child. However, when a imized. The pediatrician should share honestly what substantial level of distrust develops, significant dif- is and is not known about the risks and benefits of ferences in the philosophy of care emerge, or poor the vaccine in question, attempt to understand the quality of communication persists, the pediatrician parent's concerns about immunization, and attempt may encourage the family to find another physician to correct any misperceptions and misinforma- or practice. Although pediatricians have the option tion.23_25 Pediatricians should also assist parents in of terminating the physician-patient relationship, understanding that the risks of any vaccine should they cannot do so without giving sufficient advance not be considered in isolation but in comparison to notice to the patient or custodial parent or legal the risks of remaining unimmunized. For example, guardian to permit another health care professional although the risk of encephalopathy related to the to be secured.27 Such decisions should be unusual measles vaccine is 1 in 1 million, the risk of enceph- and generally made only after attempts have been alopathy from measles illness is 1000 times greater.22 made to work with the family. Families with doubts Parents can also be referred to one of several repu- about immunization should still have access to good • table and data-based Web sites for additional infor- medical care,and maintaining the relationship in the mation on specific immunizations and the diseases face of disagreement conveys respect and at the same they prevent (see pages 52 and 53 of the Red Book25 time allows the child access to medical care. Further- 1430 RESPONDING TO PARENTAL REFUSALS OF IMMUNIZATION OF CHILDREN Downloaded trom pediatn cs.aappub ications.org by guest on March 12,2015 more, a continuing relationship allows additional 11, Fox JP,Elveback L,Scott W,Gatewood L,Ackerman E.Herd immunity: basic concept and relevance to public health immunization practices. opportunity to discuss the issue of immunization Am j Epidemiol. 1971;94:179-189 Over time. 12. Gellin BG,Maibach EW,Marcuse EK.Do parents understand immuni- zations?A national telephone survey.Pediatrics.2000;106:1097-1102 • COMMITTEE ON BIOETHICS,2003-2004 13. Wing KR.The Law and the Public's Health.3rd ed.Ann Arbor,MI:Health Jeffrey R. Botkin,MD,MPH,Chairperson Administration Press;1990 Douglas S. Diekema,MD,MPH 14. Veatch RM.The ethics of promoting herd immunity.Fam Community G. Kevin Donovan, MD,MLA Health.1987;10:44-53 Mary E. Fallat,MD 15. Menzel PT. The pros and cons of immunisation—paper four: non- Eric D. Kodish, MD compliance:fair or free-riding.Health Care Anal.1995;3:113-115 16. Ball LK,Evans G,Bostrom A.Risky business:challenges in vaccine risk Steven R. Leuthner,MD, MA Marcia Levetown, MD communication.Pediatrics.1.998;101:453-458 17. McMenamin JP,Tiller WB.Children as patients.In:American College of Legal Medicine. Legal Medicine:Legal Dynamics of Medical Encounters. LIAISONS 2nd ed.St Louis,MO:Mosby Year Book;1991:282-317 Christine E. Harrison,MD 18. Dover TE.An evaluation of immunization regulations in light of reli- Canadian Paediatric Society gious objections and the developing right of privacy.Univ Dayton Law Marcia Levetown,MD Rev.1979;4:401-424 American Board of Pediatrics 19. Jacobson v Massachusetts,197 US 11(1905) 20. Ross LF, Aspinwall TJ. Religious exemptions to the immunization Arlene Morales,MD statutes: balancing public health and religious freedom. J Law Med American College of Obstetricians and Ethics.1997;25:202-209,83 Gynecologists 21. Meszaros JR,Asch DA,Baron J,Hershey JC,Kunreuther H,Schwartz- Buzaglo J. Cognitive processes and the decisions of some parents to STAFF forego pertussis vaccination for their children.J Clin Epidemiol.1996;49: Alison Baker,MS 697-703 22. Maldonado YA. Current controversies in vaccination: vaccine safety. JAMA.2002;288:3155-3158 REFERENCES 23. Wilson CB,Marcuse EK.Vaccine safety—vaccine benefits:science and 1. Centers for Disease Control and Prevention.Impact of vaccines univer- the public's perception.Nat Rev Immunol.2001;1:160-165 sally recommended for children—United States,1990-1998. MMWR 24. Pattison S. Ethical debate: vaccination against mumps, measles, and Morb Mortal Wkly Rep.1999;48:243-248 rubella:is there a case for deepening the debate?Dealing with uncer- 2. Centers for Disease Control and Prevention. Ten great public health tainty.BMJ.2001;323:840 achievements—United States, 1990-1999. MMWR Morb Mortal Wkly 25. American Academy of Pediatrics. Parental misconceptions about im- Rep. 1999;48:241-243 munization.In:Pickering LK,ed.Red Book:2003 Report of the Committee 3. Bonanni P.Demographic impact of vaccination:a review.Vaccine.1999; on Infectious Diseases.26th ed.Elk Grove Village,IL:American Academy 17(suppl 3):S120-5125 of Pediatrics;2003:50-53 4. Davies P,Chapman S,Leask J.Antivaccination activists on the World 26. American Academy of Pediatrics.Managing injection pain.In:Picker- Wide Web.Arch Dis Child.2002;87:22-25 ing LK,ed.Red Book:2003 Report of the Committee on Infectious Diseases. • 5. American Academy of Pediatrics,Division of Health Policy Research. 26th ed.Elk Grove Village,IL:American Academy of Pediatrics;2003: Periodic Survey of Fellows No.48:Immunization Administration Practices. 20-21 27. American Medical Association,Council on Ethical and Judicial Affairs. Elk Grove Village,IL:American Academy of Pediatrics;2001 6. Buchanan AE, Brock DW. Deciding for Others: The Ethics of Surrogate Termination of the physician-patient relationship. In: Code of Medical Ethics:Current Opinions.2002-2003 ed.Chicago,IL:American Medical Decision Making.New York,NY:Cambridge University Press;1990 7. American Academy of Pediatrics, Committee on Bioethics. Informed Association;2002:110 consent,parental permission,and assent in pediatric practice.Pediatrics. 1995;95:314-317 8. Pertussis vaccine.Br Med J(Clin Res Ed). 1981;282:1563-1564 9. Vaccination against whooping cough.Lancet.1981;1(8230):1138-1139 All clinical reports from the American Academy of Pediatrics 10. Ilinman AR,Koplan JP.Pertussis and pertussis vaccine.Reanalysis of automatically expire 5 years after publication unless benefits,risks,and costs.JAMA.1984;251:3109-3113 reaffirmed, revised,or retired at or before that time. • American anAg�a my of Pediatrics 1431 from pediatrics.aappublications.orgby guest nMarhl2,21 S Responding to Parental Refusals of Immunization of Children Douglas S. Diekema Pediatrics 2005;115;1428 DOI. 10 1542/peds 2005-0316 Updated Information& including high resolution figures,can be found at: Services http://pediatrics.aappublications.org/content/115/5/1428.full.h tml References This article cites 16 articles,5 of which can be accessed free at: http://pediatrics.aappublications.org/content/115/5/1428.full.h tml#ref-list-I. Citations This article has been cited by 32 HighWire-hosted articles: http://pediatrics.aappublications.org/content/115/5/1428.full.h tml#related-urls Subspecialty Collections This article,along with others on similar topics,appears in the following collection(s): Committee on Bioethics http://pediatrics.aappublications.org/egi/collection/committee on bioethics Permissions& Licensing Information about reproducing this article in parts(figures, tables)or in its entirety can be found online at: htttp://pediatrics.aappubli cations.org/site/misc/Pennissions.xht • Reprints Information about ordering reprints can be found online: http://pediatrics.aappublications.org/site/misc/reprints.xhtml PEDIATRICS is the official journal of the American Academy of Pediatrics.A monthly publication,it has been published continuously since 1948.PEDIATRICS is owned,published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard,Elk Grove Village,Illinois,60007. Copyright©2005 by the American Academy of Pediatrics.All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. \5,.1•, American Academy of Pediatrics y • a1, DEDICATED TO THE HEALTH OF ALL CHILDREN' "Foi\1‘‘`„ Downloaded from pediatrics.aappublications.org by guest on March 12,2015 Media Review I e. lc eAson Public Healt% • Jefferson County Public Health February/March 2015 NEWS ARTICLES 1. "Second case of measles in Port Angeles confirmed in 5-year-old girl," Peninsula Daily News, February 13th, 2015. 2. "More measles cases feared on North Olympic Peninsula after unvaccinated girl exposes school, clinic," Peninsula Daily News, February 15th, 2015. 3. "Disneyland's worries over measles outbreak revealed in emails to California health officials," Peninsula Daily News, February 16th, 2015. 4. "Brinnon dried out and back to normal following second flood in as many months," Peninsula Daily News, February 17th, 2015. 5. "Olympic Medical Center raises tent to isolate measles exams from hospital building; four on Peninsula being tested for disease," Peninsula Daily News, February 17th, 2015. 6. "Measles warning issued to Jefferson County schools," Port Townsend Leader, February 18th, 2015 7. "Health inspections: Food safety a priority," Port Townsend Leader, February 18th, 2015. 8. "Young girl's measles infection started with visit to Port Angeles clinic, state spokesman says," Peninsula Daily News, February 19th, 2015. 9. "East Jefferson County schools to exclude unvaccinated children for 21 days if a measles case merges," Peninsula Daily News, February 19th, 2015. • 10. "A third case of measles in Port Angeles confirmed by tests," Peninsula Daily News, February 20th, 2015. 11. "No measles cases in Jefferson County after two tests come back negative," Peninsula Daily News, February 20th, 2015. 12. "Girl's exposure to measles took place at different clinic than originally reported," Peninsula Daily News, February 20th, 2015. 13. "Flu past its peak but still active, health officials say," Peninsula Daily News, February 20th, 2015. 14. "Fourth case of measles confirmed in Port Angeles; `potential for wider exposure,' public health officer says," Peninsula Daily News, February 23rd, 2015 15. "No measles in Jefferson County, but Port Townsend hospital alert just in case," Peninsula Daily News, February 23rd, 2015. 16. "Vaccinations against measles at a clinic near you this week in Jefferson, Clallam counties," Peninsula Daily News, February 23rd, 2015. 17. "No new cases of measles confirmed on Peninsula; as many as 20 in quarantine," Peninsula Daily News, February 24th, 2015. 18. "ACLU sends letter to Jefferson Healthcare claiming hospital is going against state law on abortion services," Peninsula Daily News, February 25th, 2015. 19. "Clallam expands free measles vaccine clinics to Forks starting Thursday," Peninsula Daily News, February 25th, 2015. 20. "BOCC says roll marijuana into existing ag rules," Port Townsend Leader, February 25th, 2015. 21. Salmon grow on trees," Port Townsend Leader, February 25th, 2015. 22. "No new cases of measles on Peninsula," Peninsula Daily News, February 26th, 2015. • 23. "Abortion referral a practicality, not policy, Jefferson Healthcare says following ACLU letter on pregnancy termination services," Peninsula Daily News, March 1St, 2015. 24. "HEALTH CARE — Free clinics in Port Angeles, Sequim, Port Townsend help local residents with care and advice," Peninsula Daily News, March 1st, 2015. 25. "MEASLES - How does your local school rank? A new look as state lists percentage of school measles exemptions," Peninsula Daily News, March 1st, 2015. 26. "MEASLES — Peninsula health officials emphasize importance of vaccination against measles; new dates, times for no-cost shots," Peninsula Daily News, March 1St, 2015. 27. "Washington flu season — most deadly in years — is slowing, but is not over," Peninsula Daily News, March 2nd, 2015. 28. "Marijuana and the teenage brain," Port Townsend Leader, March 4th, 2015. 29. "Jefferson Healthcare commissioners urged to offer abortion services following ACLU letter," Peninsula Daily News, March 6th, 2015. 30. "Child has fever, itch — but it's from the vaccine, not the measles," Peninsula Daily News, March 10th, 2015. • • ' 4 Second case of measles in Port Angeles confirmed in 5-year-old girl By LEAH LEACH, Peninsula Daily News, February 13th, 2015 • . ,,,,, ,, , ,o.to ,,,, , „ ‘ . ,,,k ....,,,,Ii. ,';',1:. t� ytla it. 8......1:7A . , kl: .. y :;:,‘4,,,,,,, , At'tt 4 T, ,, Day four rash (CDC) U.S.Centers for Disease Control and Prevention Young boy with measles. PORT ANGELES —A second case of measles has been confirmed in Port Angeles. Tests showed Thursday that a 5-year-old girl evaluated at Peninsula Children's Clinic on Wednesday has measles, said Dr. Tom Locke, public health officer for Clallam and Jefferson counties. 11,The child, who was not identified, is at her home and has been kept from others outside her family since Wednesday evening, he said. The case is the second confirmed on the North Olympic Peninsula. There was no information released on how she may have been exposed to measles. Anyone who was in the waiting room at the clinic at 902 Caroline St. on Wednesday was exposed, Locke said. Those people will be contacted, he said, adding that he did not know Thursday what time the child was examined. The child was seen on the first day of developing a rash and would have been contagious beginning Saturday. She will remain contagious until Monday, but since she is isolated from others, the period of risk was Saturday through Wednesday, Locke said. Asked about whether the young girl was in school or pre-school, Locke said: "There was no school exposure” during the period before she was diagnosed with measles. (SEE RELATED STORY: "Measles perilous yet preventable: Here are answers to your questions"— http://www.peninsuladaiiynews.cam/article/20150209/NEWS/302099977) •Public health officials will check to see where the child had been. If she was in publiclaces, an advisory Y will be issued, Locke said. f "If you are immune, you have no problem whatsoever," he said, adding that most people are immune to *measles. Those who are not sure about their immunity or who have questions should call their health care provider, he said. If they lack a provider, they can call Clallam County Health and Human Services at 360-417-2274. Locke asked that anybody who has a fever and a rash be evaluated but should not go to doctor's offices without calling ahead first so they can be isolated from other patients. Even after exposure, vaccination with the measles, mumps and rubella (MMR) vaccine can help those who are susceptible to the disease, but the vaccination must be within 72 hours of exposure, Locke said. Hospitalized man recovers Meanwhile, a 52-year-old Clallam County man hospitalized with measles has fully recovered. The man, who was hospitalized with measles at Olympic Medical Center in Port Angeles on Feb. 1, was discharged Thursday, Locke said. The man, who was not identified, has returned to his Port Angeles home after spending several days in the intensive care unit. He was considered to have been infectious for four days prior to the rash appearing and for four days •after it appeared, Locke said. A list of public places where he went was released last weekend. The man had other medical conditions that were exacerbated by the measles, Locke said. "A prolonged hospitalization is unusual for measles," he said. Another person was tested in Jefferson County. That turned out not to be measles, Locke said. How infected? State health officials said earlier the Clallam County man was the fourth Washington state person confirmed with measles this year. Officials said they had not determined where he got the disease. More than 70 people in California — including six Disneyland employees — and about two dozen others in six states, Mexico and Canada have been sickened in a recent measles outbreak. Measles is airborne and considered highly contagious. Once regarded as a childhood illness, measles can be a serious threat to infants, pregnant women, recipients of organ or bone marrow transplants and people who take immunosuppressant drugs. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leah.leach@peninsuladaiiynews.com. .Last modified: February 12. 2015 11:48PM r More measles cases feared on North Olympic Peninsula after unvaccinated girl exposes school, clinic eBy James Casey and Leah Leach, Peninsula Daily News, February 15th, 2015 Characteristics of measles The virus is A rash. spread by 4lastiegfive breathing in virus. to six days, Containing droplets . appears about or by touching gyp.., the face and contaminated `` head,spreading surfaces. v to through the .e' torso to the hands and test. The virus grows in ceps 5 The virus can be it the back of the Y'. transmitted Irpm throat and lungs. : four days prior to and Symptoms appear four days after the after 10 to 12 appearance of the days. rash.. 3 infected person has a lever fasting i two to tour days, followed by a cough,runny nose and red, watery eyes. Copyright©2015,New York Times News Service FREE IMMUNIZATION CLINICS for measles, mumps and rubella will be offered at special clinics Tuesday,Thursday and Friday at Clallam County Health and Human Services, 113 E. Third St., Suite 1-A, Port Angeles. Each clinic will run from 8:30 a.m. to 4 p.m. Those who should receive the MMR vaccinations include: • ■ Unimmunized children,who will need two doses of the vaccine about a month apart. • Adults born after 1957,who need one dose. Adults born before 1957 are presumed to be immune. People who want vaccinations for themselves or their children should make appointments by calling 360-417-2274. Walk-ins will be seen but may have longer wait times. Health authorities caution people who think they or their children may have measles to call ahead to their health care providers and not to visit a doctor's office, clinic or emergency room unannounced. People who might have measles will be isolated and examined before they are treated and sent home or hospitalized. The precaution is designed to prevent the spread of disease to people in waiting rooms. Peninsula Daily News PORT ANGELES —The North Olympic Peninsula's public health officer said more cases of measles are possible after a second case was diagnosed in Port Angeles last week. "Every time you get a secondary case like this, it raises the possibility that other people have been exposed," said Dr. Tom Locke, public health officer for Clallam and Jefferson counties. "You never know until it happens," he added. "It's possible but unknowable." .A 5-year-old girl who attended kindergarten at Olympic Christian School at 43 O'Brien Road in Port Angeles was diagnosed with measles after being examined Wednesday at Peninsula Children's Clinic, also in Port Angeles. Hers was the second case diagnosed in the county this month. •She had not been vaccinated and had been in contact with a 52-year-old man hospitalized on Super Bowl Sunday with measles who has since recovered. Those who could have been exposed to measles from the girl include those at the children's clinic at 902 Caroline St. on Wednesday or on Feb. 6 at the school. Olympic Christian School students who can't prove immunity to measles are under quarantine until Feb. 27 — 21 days after their date of possible exposure Feb. 6. Students at the private school must provide proof of measles immunity if they are to re-enter school Tuesday (Monday is the Presidents Day holiday). Unimmunized students must stay at home, avoid public places and have no contact with people who are not immune to measles until the last Friday in February. If more cases surface, health authorities would expect to see them the middle of this week or late in the week, Locke said. "Given how contagious measles is and how we have a relatively high number of people who are susceptible in the population —those two things mixed together say there is a definite possibility," he said. The two cases of measles are the only ones confirmed in Clallam or Jefferson counties as of Saturday. •The girl, who is considered to have been contagious from Feb. 6 through Saturday, was quarantined away from the public at her home Wednesday night, Locke said. Most people develop measles within 10 days of exposure, Locke said, but the incubation period can be as long as three weeks. So the final day for cases of measles from the man —who visited several places in Clallam and Kings county during his contagious period —would be Feb. 22 and the last day for those from the girl would be March 4. New cases — a third wave, as Locke put it —would extend the period. "Every time we get a new one, the date extends," Clallam County Health and Human Services Director Iva Burks said Friday. Only those who are not immune and who were exposed could get the disease. Measles can linger in the air for two hours or so. An estimated 90 percent of people who aren't immune to measles will catch the disease if they're exposed. Health authorities plan to list sometime this week the places and times other people may have been in contact with the girl, who was quarantined Wednesday evening in her Port Angeles home. "This was a child, and at least she wasn't going all over the place," Burks said Friday. &Locke initially had said the 5-year-old had not been at the school while she was contagious but that he revised his estimate to include one day of exposure. "I made the call," Locke said Friday afternoon. "Now, we are proceeding as if a school exposure had occurred." Clallam County Health and Human Services employees and the staff of the private school worked Friday to determine which children and their families could be at risk of measles. All those who were in the clinic waiting room Wednesday have been contacted, Locke said, and anyone who was a candidate for vaccination was vaccinated or otherwise treated, Locke said. Babies too young to be vaccinated and older unvaccinated children were given emergency inoculations of gamma globulin, a temporary form of immunity, late Thursday after the case was confirmed. At least four people received this treatment, Locke said. The measles vaccine is not effective outside a 72-hour window post-exposure, he said. Locke said he could not reveal the time and place the man and the girl came into contact or the man's place of employment. He said that the man and girl were not members of the same family. Tracing the man's movements led health authorities to 96 people with whom he had come in contact — including a toll-taker on the Tacoma Narrows Bridge, Burks said. Meanwhile, the source of Clallam County's measles cases remains a mystery. "The true index [first] case is where the 52-year-old man got it from," Burks said. "'The genotype of the virus that infected both the man and the girl Locke said the genotype is of"a new strain that hasn't been detected in the state before" but that is common in Asia and the Philippines. It is not the same as those of viruses that have turned up in Grays Harbor County and Vancouver, B.C. or as that of the so-called Disneyland outbreak that emerged in late December. Measles vaccine is effective against all strains, he added. Measles once was a common childhood disease that largely disappeared thanks to required immunization of schoolchildren. However, Washington is one of 20 states that allow parents to exempt their children from vaccinations for personal, medical or religious reasons. Nearly 20 percent of Clallam County kindergartners and more than 52 percent of such students in Jefferson County lacked complete immunity, according to statistics compiled by Clallam County Health and Human Services for the 2011-12 school year. In Clallam County, about 7.2 percent of all school children were exempt from vaccinations in the 2013- 2014 school year, according to state figures. That means that their parents submitted signed forms citing medical, religious or personal reasons for not immunizing their kids. .Jefferson County has a 12.8 exemption rate. At Olympic Christian during the 2011-12 school year, 18.4 percent of students, or 19 total pupils out of 82, were exempt, all for parents' personal reasons. Gary Rude, principal administrator at Olympic Christian, said those levels remain about equal in the Alk Gary school year. He said the school was closed Friday but probably would reopen after the Presidents Day holiday, although he would need to talk with the board of directors first. As for the school's teachers, "my sense of that is they've all had their shots," Rude said. That means they not only will not get measles, they cannot carry the virus, according to Locke. "There is no carrier state with measles," he said. "If you're immunized, you have nothing to worry about. If you're not immunized, you should reconsider that decision." The child's illness is the fifth measles case in Washington state this year. Nationally, at least 125 cases in 17 states and Washington, D.C., have been reported. "With a second case of measles in the community and the possibility of more in the near future, all Clallam County residents should assess whether they are immune to measles," Burks and Locke said in a news release. "If they are in need of vaccination, they should make plans to receive it at their earliest opportunity." •For details about measles, vaccinations, symptoms, morbidity and other information, visit http://tinyurl.com/PDN-CDCmeasles. Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcaseypeninsuladailynews.com. Managing Editor/News Leah Leach can be reached at 360-417-3531 or at leak.leach@peninsuladailynews.com. Last modified:February 14. 2015 11:16PM • irk Disneyland's worries over measles outbreak revealed in emails to California health officials •By AMY TAXIN and ALICIA CHANG, The Associated Press, Peninsula Daily News, February 16th, 2015 The genotype of the measles virus that infected both the 52-year-old man and the 5-year-old girl in Port Angeles is of"a new strain that hasn't been detected in the state before"but it is common in Asia and the Philippines, according to Dr. Tom Locke, public health officer for Clallam and Jefferson counties. He said itis not the same as those of viruses that have turned up in Grays Harbor County and Vancouver, B.C. or in the Disneyland outbreak. Measles vaccine is effective against all strains, according to Locke. ANAHEIM, Calif. —As the measles outbreak spread last month, Disneyland executives sent a series of emails to California health officials asking them to emphasize that the theme park was not responsible for the illnesses and was safe to visit, documents obtained by The Associated Press show. There is no evidence Disneyland — or health officials, who incorporated at least some of the theme park's suggestions —tried to downplay the seriousness of the outbreak or mislead the public. Nor is it unusual for companies to try to get public officials' ear during a crisis. But the email exchange pulls back the curtain on what can be a delicate process. And it shows Disneyland's concern about the disease's potential harm to "The Happiest Place on Earth" even as the theme park worked with health authorities to alert the public to the danger. As the infections multiplied, Disneyland forwarded suggestions to the California Department of Public Health and tried to insert language into an update from the Orange County Health Care Agency, according to correspondence spanning the first two weeks of the outbreak. The emails were obtained through a public records request. In one exchange, a Disneyland official wanted the state to make it clear the park was not responsible for the outbreak. In another, Disneyland wanted the state to clarify that it was safe for vaccinated people to visit the theme park. In that instance, the state updated its website to address Disneyland's concern. More than 70 people in California — including six Disneyland employees — and about two dozen others in six states, Mexico and Canada have been sickened in the outbreak. While measles was declared eliminated from the U.S. in 2000, the illness has reappeared in recent years, brought in from overseas and transmitted to Americans who didn't get vaccinated. On Thursday, Disneyland spokeswoman Lisa Haines said the resort was in constant contact with health authorities during the outbreak "in order to ensure that factual and accurate information flowed both ways to avoid confusion and properly inform the public." First word of the outbreak came Jan. 7 when California authorities confirmed a cluster of infections in people who visited Disney's California theme parks days before Christmas. Disneyland's medical team worked with health investigators to identify people who had close contact with infected workers, and it offered employees vaccinations and blood tests to see if they were immune. The next week, Disneyland Resort's vice president of communications emailed state health agency spokesman Ron Owens, laying out her desire to advise the public that measles is highly contagious and can only be prevented through vaccination. "Basically, our goal is to ensure people know that the exposure period at the Disneyland Resort is now over, that this has nothing to do with Disneyland and this could happen anywhere," Cathi Killian wrote. •She added: "Can you please let us know if you are able to help us on this front?" The state health department's website included similar language. State health spokeswoman Anita Gore told the AP in an email: "When clarification is needed, we make adjustments where necessary." Killian also sent wording suggestions to the health department in Orange County, where Disneyland is situated, for a news release. In that instance, Dr. Matthew Zahn, the county's medical director for epidemiology, said he had no problem with the proposed wording but saw no need to include it, the records show. Deanne Thompson, a spokeswoman for the county health department, told the AP that Disneyland made "no attempt to control or pressure" the department to incorporate any suggestions. In one of the email exchanges, Disneyland's chief medical officer, Dr. Pamela Hymel, forwarded to California's top epidemiologist, Dr. Gil Chavez, a statement from Disneyland's public relations arm with "some points," including: "It is absolutely safe to visit these places, including the Disneyland Resort, if you are vaccinated." Chavez replied that Disneyland's statement was "100 percent consistent"with what he said publicly a day earlier, when he announced that it was fine to visit Disneyland with the proper vaccinations but that those who haven't gotten their shots should stay away. Chavez went ahead and had a version of Disneyland's statement posted on the state health department's website. .Crisis communications experts said that it is not uncommon for companies to make suggestions during a disease outbreak and that their view can be helpful as long as they don't try to distort the message. "At the end of the day, you are trying to balance potentially competing interests, but you are also trying to give people the best advice possible," said Glen Nowak, a former spokesman for the Centers for Disease Control and Prevention who now heads the Center for Health and Risk Communication at the University of Georgia. Last modified: February 15. 2015 12:33PM • Brinnon dried out and back to normal following second flood in as many months By Charlie Bermant, Peninsula Daily News, February 17th, 2015 • i "4, Charlie Bermant/Peninsula Daily News Brinnon resident Bob Shadbolt compares the water level from this month's flooding to previous high levels in December and in 2007. BRINNON —A flood that made national news earlier this month has left few signs in this small south county community. "Things are pretty much back to normal," Curtis Lightner, a lieutenant with the Brinnon Fire Department, said last week. "Some of streets may need to be shored up, but things are back where they should be." Bob Hamlin, director of the Jefferson County Department of Emergency Management, called the Duckabush River floods this month "a pretty minor event," especially in comparison to the floods of that river and the Dosewallips River in the Brinnon area in early December. "The floodwaters came up fast, left a lot of gravel and blew a few fences around," Hamlin said. •"A few people were inconvenienced, and there was some damage to cars, but no one was out of their homes for very long." The Duckabush River, fueled by at least 7 inches of rain in a 24-hour period in the Olympic Mountains, spilled over its banks in the areas of Kelly, Shorewood and Duckabush roads Feb. 6, flooding the same area that had been hard-hit by high water in December. Brinnon firefighters, aided by swift water rescue teams from Clallam County and state Fish and Wildlife, helped those who wanted to leave their threatened homes. Swift water teams rescued three people from a pickup truck that was swept away by the river near a mudslide on Duckabush Road. No one was hurt and those who evacuated returned to their homes within hours, according to authorities. Hamlin doesn't want to downplay the danger but said there was a some media overreaction. After the water came up overnight, a Seattle news agency helicopter broadcast flood pictures and tweeted that several homes were severely damaged by mudslides. This turned out to be incorrect, he said. "This was over the top, and we started getting calls from media all over the country," he said. 111"A lot of our energy was devoted to the media rather than the issue at hand, which was handled pretty well." It was the second major flooding of the Duckabush River this season, after a heavy rainstorm pounded the area in December. •"It came up a lot faster this time, but it wasn't as deep," said Bob Shadbolt, who lives on Kelly Road between the Duckabush River and Pierce Creek. "One of my neighbors had to replace a carpet after the last flood, which he didn't have to do again because the water didn't come up as high," he said. Shadbolt measured the water level on a shed door across from his property and judged that it was about a foot lower than the high levels he recorded in a 2007 flood and this December. Lightner said the fire department canvassed all the homes in the flood plain and only one household, a family of five, requested assistance in evacuation. Alyssa Brown, 16, was part of the family whose parents and younger siblings were rescued. She said the water level reached almost to the top step leading into the house, although the water did not enter the house as it did in December. "I wasn't really scared because this isn't the first time it happened," she said. "But I did wish that the rain would stop." According to Karen Sickel, who lives on an area of Duckabush Road that was not flooded, Jefferson County crews responded quickly when she reported a hazard. "I was worried about one section of the road where someone could have easily driven off of the edge if they came in at night and hydroplaned. •"I called the county and they came right out and put up warning flashers," she said. Sickel said she was pleased that newly elected County Commissioner Kathleen Kler visited the site "because it has never happened that a commissioner has shown that level of interest." Public Works Director Monte Reinders said his department's costs were not substantial and only consisted of some overtime hours. County Administrator Philip Morley said last week that he had not yet received a damage estimate from either the county Department of Emergency Management or Public Works Department, but he did not think the cost would be large enough to qualify for emergency assistance. Hamlin said that additional costs for emergency response were minimal and were mostly handled as part of regular shift work, but the cumulative effect of all the recent storms puts the county in a serious situation. "This whole series of storms beginning in December could cost the county a total of$1 million and we don't know where that will come from," he said. Another situation where the Hoh River is encroaching on Oil City Road will probably qualify for$150,000 in assistance, he said. Several television camera crews covered the flood, with the story leading the NBC Nightly News on Feb. 7. A photo by Peninsula Daily News photographer Keith Thorpe was included in that broadcast. • Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 ocbermant( peninsuladailynews.corn s Olympic Medical Center raises tent to isolate measles exams from hospital building; four on Peninsula being tested for disease ii)By Arwyn Rice, Peninsula Daily News, February 171h, 2015. '' 1_ ,,,,,,„. .... ,„, , , ' ":tr I 7* 4 f at ',f i� ,,r ,°.:;',4 ; .. s , A =.en. s ,..7._./2„.....1„ 1,,,,,,,wid,,,,,..Iti,,,,o, , y.�n t. 117,--,1„ ,,n, '',441,,soqi-74,f IS x rad �'x: This medical tent with heaters, chairs and a table was set up Monday in a parking lot of Olympic Medical Center in Port Angeles for evaluation of possible measles cases. —Photo by Arwyn Rice/Peninsula Daily News Shot clinic today • Free immunization clinics for measles, mumps and rubella will be offered at special clinics from 8:30 a.m. to 4 p.m. today, Thursday and Friday at Clallam County Health and Human Services, 113 E. Third St., Suite 1-A, Port Angeles. Those who should receive the MMR vaccinations include: • Unimmunized children,who will need two doses of the vaccine about a month apart. • Adults born after 1957, who need one dose Adults born before 1957 are presumed to be immune. People who want vaccinations for themselves or their children should make appointments by calling 360-417-2274. Walk-ins will be seen but may have longer wait times. PORT ANGELES —A tent has been set up at Olympic Medical Center to screen potential new measles cases, and four individuals are being tested for the virus —three in Clallam County and one in Jefferson County, according to public health officials. The tent at the hospital is a new measure to prevent the spread of measles to hospital patients, visitors and staff in the event someone with the virus came to the hospital, said Dr. Tom Locke, public health officer for Clallam and Jefferson counties. A sign posted at the hospital's main entrance Monday directed anyone with measles symptoms to go to the emergency room's west entrance and phone 360-417-7381 or, lacking a cell phone, wave at the door for a medical attendant's assistance. liThe yellow medical tent with chairs, heaters and a stainless steel medical table was set up in the parking lot outside of the west entrance. Olympic Medical Center administrators were not available for comment Monday due to the Presidents' .Day holiday. The tent is an emergency structure already owned by the hospital and can be used as a location where anyone with measles can be evaluated without exposing additional people to the virus, Locke said. Health authorities caution people who think they or their children may have measles to call ahead to their health care providers and not to visit a doctor's office, clinic or emergency room unannounced. People who might have measles will be isolated and examined before they are treated and sent home or hospitalized. The precaution is designed to prevent the spread of disease to people in waiting rooms. Officials at Forks Community Hospital and Jefferson Healthcare in Port Townsend were also unavailable Monday to comment on whether similar plans exist at those hospitals. The four people now being tested are not thought likely to have the disease, and they have not had known contact with either of the two individuals in Clallam County who have confirmed diagnoses, Locke said. "We are treating all rash illnesses as a measles potential," he said and noted that there are several viruses that produce rashes. Locke said test results for the four, whose cities of residence were not available Monday, were expected •to be available late this afternoon. As of Sunday, two people in Clallam County had been confirmed as having the measles virus. No cases have been confirmed in Jefferson County. The first case was a 52-year-old man who was hospitalized Feb. 1 and has since recovered. It was not known how he contracted the virus, which was identified as a strain common to Asia and the Philippines and not the same as the current outbreak associated with Disneyland, which has been linked to 125 cases in 17 states. A 5-year-old girl who attended kindergarten at Olympic Christian School at 43 O'Brien Road in Port Angeles was diagnosed with measles after being examined at Peninsula Children's Clinic last Wednesday. She is currently quarantined at her Port Angeles home. The girl was known to have had contact with the 52-year-old man, but the nature of the contact has not been released. Those who may have been exposed via the girl include patients at the children's clinic at 902 Caroline St. last Wednesday or at the school Feb. 6. Olympic Christian School students who can't prove immunity to measles are under quarantine at home until Feb. 27 — 21 days after their possible exposure. 110If more cases surface, health authorities would expect to see them bythe middle of the week, Locke said. week or late this • Most people develop measles within 10 days of exposure, but the incubation period can be as long as .three weeks, he said. The final day officials expect they may see cases of measles contracted from the man —who visited Clallam and Kings county locations while contagious —would be Feb. 22, and the last day for those who might have contracted it from the girl would be March 4. For more information on measles, visit http://tinyurl.com/PDN-CDCmeasles. Reporter Arwyn Rice can be reached at 360-452-2345, ext. 5070, or at arice@peninsuladailynews.com Managing Editor/News Leah Leach and reporter James Casey contributed to this report. Last modified:February 16. 2015 6:12PM • • kr Measles warning issued to Jefferson County schools Port Townsend Leader staff I Posted: Wednesday, February 18, 2015 Syringe in medical gloves hand, injection. Free measles vaccine offered at Jefferson Healthcare this week and hours have been extended to help parents get their children immunized. Jefferson County Public Health is advising Jefferson County schools that in the event of a confirmed case of measles linked to a school, all unvaccinated children in the school will be excluded for 21 days. In a Feb. 11 memo sent to Jefferson County schools, which included a request that school staffs share the information with students and families, the health department explained that the incubation period for measles ranges from seven to 21 days from exposure to the onset of the disease, which is why children who have not been immunized would be excluded from school for 21 days. The health department noted that Jefferson Healthcare is providing MMR (measles, mumps, rubella) shots for those who currently do not have a primary care provider. In addition, hours have been extended for MMR immunization appointments through Friday, Feb. 20. For an appointment, call 379-8031. Clinic hours this week are 8 a.m.-5 p.m., Wednesday, Feb. 18 and Friday, Feb. 20; and 8 a.m.-6 p.m., Thursday, Feb. 19. OUTBREAK Between Jan. 1 and Feb. 6, 2015, the memo notes, 121 people from 17 states and Washington, D.C., have reported measles, a disease that health officials thought had been eradicated in the U.S. in 2000. Although Jefferson County currently does not have any reported cases of measles, neighboring Clallam County has had two reports, including a 5-year-old girl who attends Olympic Christian School. The girl was quarantined after being diagnosed with measles on Friday, Feb. 13. A 52-year-old Clallam County man who was diagnosed earlier has recovered. The two cases in Clallam County were the first confirmed cases since 1990. The U.S. has had a record number of cases in 2014, with 644 cases from 27 states, according to the •memo to schools. The most recent multi-state outbreak is linked to exposures at Disneyland, although another wave of cases is currently being identified. Measles outbreaks typically occur when unimmunized international travelers become infected abroad and return to the U.S. during their contagious period, officials said. Measles is transmitted from person to person through large respiratory droplets, but can also spread by an airborne route, according to the Centers for Disease Control and Prevention. Dr. Tom Locke, health officer for both Jefferson and Clallam counties, said last week that the goal of the health department is to prevent outbreaks, and the primary way to do that is to immunize children. In an interview on Thursday, Feb. 12, before the second Clallam measles case was confirmed, Locke said that getting more parents in Jefferson County to immunize their children is one of the health department's four top priorities identified for the county in 2015. "It's in response to the fact that Jefferson County has one of the highest exemption rates in the state," Locke said. Locke noted that in public health, a single case is considered an outbreak. •Statistics from the state Department of Health indicate that in the 2013-2014 school year, the latest for which data is available, an estimated 14.4 percent of all students in schools in Jefferson County opted out of some immunizations for medical, personal or religious reasons. Of those, 10.7 percent specifically opted out of the MMR vaccine. Health inspections: Food safety a priority 410By Patrick J. Sullivan of the Port Townsend Leader I February 18, 2015 0L, ft Y llY' cr uY:V Food Inspection: Mina Kwansa Jefferson County health inspector Mina Kwansa checks food temperatures in the kitchen of The Cup in Port Townsend on Tuesday morning, Feb. 17. Photo by Nicholas Johnson Having a "reality TV" chef call the kitchen at a Port Hadlock restaurant "disgusting," multiple times, caught the attention of staff at Jefferson County Public Health (JCPH). The county employees are tasked with monitoring food safety at any business or entity that serves food, from restaurants to school lunchrooms to the county jail. •Each food service establishment is routinely inspected twice a year; low-risk establishments are routinely inspected once a year if there is a good performance history. Inspections assess points in red (high risk) and blue (low risk) criteria based on the chance for food-borne illness. Something like dirty floors, walls and ceilings would amount to a "blue" two-point penalty, while lack of employee hand washing stations, for example, is a "red" violation worth 25 points, noted Jared Keefer, director of the county's Environmental Health and Water Quality operations. Any inspection that hits 35 "red" points means that the establishment fails the inspection and draws an automatic re-inspection. HEALTH FACTS When it comes to the recent attention on Zoogs Caveman Cookin in Port Hadlock, subject of the Food Network's "Restaurant Impossible" program that aired Feb. 4, here are two health department facts: • There have been no customer complaints about food-related sickness at Zoogs, according to JCPH records. The JCPH responds to every public complaint regarding something like food poisoning, which generally occurs within 24 to 72 hours of a person •dining. "Studies show that one is much more likely to get a food-borne illnesses from a private *residence than out of a restaurant," Keefer noted. • The only restaurant subject to emergency closure in 2014 on a health violation was Zoogs — but it was not for anything people may have seen on the Reality TV show. A complaint was made to JCPH last July that Zoogs was operating without hot water, and that prompted an inspection July 29 where that proved to be true. The lack of hot water for sanitary facilities and hand washing is an automatic closure, Keefer said. The broken water heater was replaced and the restaurant was reopened July 30. Overall, about 10 different food service businesses scored poor enough in 2014 to merit a prompt re-inspection to ensure corrective action was taken, said Mina Kwansa, the JCPH environmental health specialist who conducts inspections. Zoogs was one of those businesses. "People take pride in their food. It reflects on them and you have a responsibility to your customers," Kwansa said. The top four basic rules of food handling, things that score "red" points, deal with this sequence of events: Cook, chill, separate and wash hands, Keefer noted. .Establishments are closed immediately for these imminent health hazards: lack of water, lack of hot water, sewage backup and lack of electrical power. Other problems revealed on inspection must be fixed immediately, and some must be done within 30 days. INSPECTION PROCESS JCPH typically inspects food service operations twice a year, unannounced. Plus, inspections (and follow-ups) may be made based on complaints or poor performance. If a restaurant must be inspected more than twice a year, the establishment must pay a re- inspection fee. "Management of a restaurant is day to day and we're there once every five or six months," Porto said. Routine inspections take up to two hours, and are a "snapshot" in time, Keefer noted. "Red" items must be fixed while the inspector is on site, or the restaurant can be closed. Another factor with inspections is a menu's complexity. A cook-and-serve place has less steps than a place that cooks, holds food cold, and then reheats and serves. A restaurant does need JCPH permission to change the menu when it involves going from low-risk, pre-packaged meals to cooking hamburgers, for example. A restaurant that adds more seating, for example, also needs pre-approval, which is tied to food storage or sewage capacity. INSPECTING ZOOGS Public records obtained by the Leader indicate Zoogs was visited five times in 2014. A routine inspection on April 16, 2014 resulted in 14 points, with the "red" for no consumer advisory posted on the lunch menu regarding the health danger when eating raw or uncooked foods. There were "blue" hits for single-use and single-service articles not property stored (must be displayed handle-out), nonfood contact surfaces not maintained and clean, and toilet facilities not property constructed, supplied or cleaned. The inspector's notes include, "shelves, floor at cook's line needs to be thoroughly cleaned," and "cutting board must be cleaned immediately, [when] used to cut BBQ ribs or at least must be moved to dirty dishes area." Based on a complaint, an inspection was made May 28. The complaint about seeing mouse droppings was proven unfounded; the items seen were flower seeds. An inspection was made July 29 regarding lack of hot water (see above) with a score of 35; a follow-up on July 30, with the water heater replaced, registered no violations. •A routine inspection was made Nov. 5 [the Food Network chef was on-site Nov. 16-18], and 5 points were assessed with "red" violations for three food worker cards not being current (a common item for many, many restaurants), new food workers not trained. "Blue" points were for wiping cloths not properly used or stored, 5 points (sanitizing solution is best prepared fresh every two to three hours) and food contact surfaces not maintained, cleaned or sanitized, also 5 points. The inspector's hand-written notes indicate the door to the kitchen's ice machine was broken; it had been broken about two weeks, Kwansa was told. "Equipment must be in good repair at all times. Proprietor plans to replace the ice machine or the door within a week. Black plastic bag used to cover opening of ice machine until door is replaced," she wrote in the inspection. During the "Restaurant Impossible" episode, there were two electric fans in the kitchen, both of which appeared to be dirty; one was blowing near the ice machine, which still had a broken door. "Those fans were not there when I inspected," Kwansa said. "If [a fan would have been near the ice machine] I would ask them to clean or remove it." • The inspection also noted the "good cold holding and hot holding temperatures" of meat and other food items, an improvement over a 2013 inspection. For example, Kwansa • said that fresh, hot food needs to be placed in a metal hotel pan inside the cooler, •uncovered, so it cools properly and once it reaches the proper cold temperature, then it can be covered for cold storage. KITCHEN RANGE HOODS In terms of the greasy range hood highlighted on the TV show, the JCPH inspector does not remove filters to investigate up the hood for the grease trap. Kitchen range hoods must be maintained at least every six months, according to state fire codes. Range hoods are to be inspected by the fire department and sewage traps are to be inspected by the public health's sanitary sewer staff. In November, an inspection sticker indicated the range hood had been maintained about four months prior. "What we saw [on TV] tells a different story," Kwansa said of the range hood. Holly Pritchett, manager at Zoogs, told the Leader that she believes the business hired to clean the range hoods did not do an adequate job. "The expectation by fire marshals is that grease accumulation does not occur," Keefer noted. That said, a restaurant like Zoogs does have a greasy menu, so it is natural that grease ',buildup occurs, and more frequent cleaning would be needed. "It's up to the establishment owner and management to pay attention," said Susan Porto, JCPH environmental health specialist, inspector Kwansa's supervisor. East Jefferson Fire Rescue's goal is to conduct restaurant "life safety" inspections annually, said Brian Tracer, assistant chief. A business is responsible for providing their own kitchen range hood cleaners. Chief Tracer's predecessor, assistant Chief Bob Low, and Frank Benskin of the county's Department of Community Development, inspected the premises in 2013 during the time when the restaurant was changing hands, according to Bill Beezley, EJFR public information officer. "At the time, several issues were identified and corrective action was recommended." Tracer and DCD staff (a show producer had previously contacted the county and confirmed that a building permit was not necessary) conducted a walk-through during filming of "Restaurant Impossible" to verify that the filming process and overall conditions were appropriate. "At the time, they saw that the prior corrective issues hadn't been *addressed, so they discussed them again," Beezley told the Leader. During a re-inspection on July 9, 2013, records show that Zoogs was dinged 28 points Ai for "red" violations of food worker cards not current, raw meats not below or away from 11,ready to eat food, improper cold holding temperatures (over 45 degrees), and a "blue" violation for improper thawing methods used. WHAT'S ON TV In terms of the kitchen shown on "Restaurant Impossible," that coupled with the inspection reports do indicate an ongoing issue with cleanliness, Porto noted. Contributing factors would include an old building with older equipment. "Some of the things that were observed on the show do not necessarily contribute toward food-borne illness," Porto said. For example, the food debris, and what appeared to be an old menu, inside the lower portion of a metal cabinet that was not used for any restaurant purpose, would not amount to a food safety penalty because that area — as the restaurant staff noted on the TV program — is not used for food storage or food handling. However, the expectation is that an establishment would clean this sort of debris at the end of each day or during a slow time of day. COMPLAINTS The food safety scores of any place that sells food products are available to the public at the JCPH website. Anyone seeking more details, such as the inspector's notes, simply needs to file a public records request and that detail would be provided, Keefer said. "We encourage the public to see for themselves," Keefer noted. Jefferson County Public Health welcomes complaints, which are confidential but not anonymous. A name and contact information is required for staff follow-up. Complaints may be made in person to the offices at 615 Sheridan St. in Castle Hill Center in Port Townsend, via email to mkwansa@cojefferson.wa.us or by phone 385-9444. The JCPH staff encourages restaurant customers to let them know if they believe something needs to be inspected. • r Young girl's measles infection started with visit to Port Angeles clinic, state spokesman says 0 By James Casey, Peninsula Daily News, February 19th, 2015 7 '# # i ik. .. ... , ,,,„,,, . 1 „ ,------„,,, , ,_ ,., , i 7, ' ' kr, p'y '¢ Keith Thorpe/Peninsula Daily News Olympic Medical Center lab assistant Deana Heimbigner looks over an isolation tent near the hospital's emergency room in Port Angeles on Wednesday. The tent would be used to temporarily quarantine incoming patients with measles and prevent the disease from entering the hospital. PORT ANGELES —A 5-year-old Olympic Christian School student who has been quarantined with measles caught the virus at Peninsula Children's Clinic, 902 S. Caroline St., according to a state Department of Health spokesman. The girl is one of two people who have been confirmed to have measles in Clallam County. None have been confirmed in Jefferson County. However, four people —three in Clallam County and one in Jefferson County— have been tested for the measles virus. Public health officals awaited test results Wednesday afternoon. The girl had not gone to the clinic feeling ill but had visited with other family members, said Paul Throne, spokesman with the Department of Health. She was diagnosed Feb. 11. She had left the clinic an hour after a 52-year-old Port Angeles man, who later was diagnosed with measles, had left it, the spokesman said. The man was the first case confirmed in Clallam County. He was diagnosed Feb. 1. The measles virus can hang in the air or on environmental surfaces for two hours or more. The girl had not been vaccinated. Dr. Tom Locke, Clallam County deputy public health officer and public health officer for Jefferson County, has said that all who were in the clinic waiting room the day the girl was there were contacted and vaccinated or treated if they were not immune to measles. Twelve students at the private Olympic Christian School, 43 O'Brien Road, Port Angeles, were thought to have been vulnerable to measles from exposure to the girl at the school Feb. 6, Clallam County health officials said. •Those who were thought to have no immunity were quarantined. Some of the students were found to have had one measles, mumps, rubella (MMR) vaccination and, after receiving a second shot, were readmitted to the school. Students without immunity must remain home until Feb. 27, the end of the period during which they could be contagious. If they have not had measles by then, they can seek immunization. IIIAnyone who was inside the school on Feb. 6 may have been exposed. An estimated 90 percent of such people are at risk of measles. Dr. Jeannette Stehr-Green, interim health officer for Clallam County, said that none of the four suspected measles cases, for which officials are awaiting test results, were "classic cases" of measles. "When you have the possibility of measles, you have all sorts of rashes coming out of the woods and people going to see their healthcare providers," she said. It takes 24 to 36 hours for the tests to be completed at the state Department of Health in Shoreline, which received the blood samples Tuesday. Meanwhile, Clallam County HHS will hold a no-cost clinic for measles, mumps, rubella (MMR) vaccine today at its public health clinic, 111 E. Third St., Port Angeles. Together with office fees and injection fees, the vaccinations usually cost $112, according to Christina Hurst, public health program director. "We're hoping to get to those people who don't have a healthcare provider in the community," said Iva Burks, Clallam County HHS director. Plenty of MMR vaccine is available. •"We have hundreds of doses and are ready to take on the masses," Stehr-Green said. Four more clinics are scheduled for next week. They are from 8:30 a.m. to 4 p.m. Monday, 8:30 a.m. to noon Tuesday, 8:30 a.m. to 4 p.m. Thursday and 8:30 a.m. to 5 p.m. Friday. Stehr-Green advised people to call for an appointment at 360-417-2274, although walk-ins are available. They should not visit the clinic if they suspect they have measles but call their healthcare provider for a screening. Clinics are set in Port Townsend at the Jefferson Healthcare Primary Care Clinic, 915 Sheridan St., from 8 a.m. to 6 p.m. Thursday and from 8 a.m. to 5 p.m. Friday. Vaccination appointments are required and are available by calling 360-379-8031. There is no charge for a vaccine, but an administration fee will be billed to the patient's insurance. Olympic Medical Center has erected a tent to conduct measles exams in isolation. At Forks Community Hospital, those with symptoms of measles—fever and rash — are asked to either call ahead to alert hospital staff that they are coming, or remain in their car and call 360-374-6271. Information about the procedure at Jefferson Healthcare was not available by 5:30 p.m. Wednesday, but public health officials have said that all those who suspect they have measles should call ahead to care providers to avoid exposing others. Clallam County has received help from an intern from the Centers for Disease Control and Prevention and two nurse-epidemiologists from the state Department of Health laboratory in Shoreline, Burks said. Burks praised officials at Olympic Christian School in Port Angeles, attended by a 5-year-old girl who was diagnosed with measles, for their help in tracking students, parents and teachers with whom the girl •had contact. She also said the U.S. Coast Guard deserved "a big gold star" for vaccinating all its personnel Clallam County HHS hopes to build a measles page on the county website, according to Stehr-Green, that will include latest information on new measles cases, if any. To check progress on the page, visit www.clallam.net/hhs/PublicHealth/. Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey aApeninsuladailynews.com. S East Jefferson County schools to exclude unvaccinated children for 21 days if a measles case emerges fibBy Charlie Bermant, Peninsula Daily News, February 19th, 2015 PORT TOWNSEND — School districts in East Jefferson County are poised for a possible measles outbreak, warning parents that if any student in a school is diagnosed with measles, then all those who are not vaccinated against the disease will be required to stay home for three weeks. No cases of measles have been confirmed in Jefferson County, although authorities are awaiting the results of one test. Results also are awaited of tests given to three residents of Clallam County, which has had two confirmed cases of measles. The Jefferson County Department of Health prepared a letter this week for distribution to parents, informing them that if a case of measles is linked to a school, all unvaccinated children in that school will be excluded for 21 days — the longest possible incubation period for the highly contagious virus. The letter, dated Feb. 11, informs parents that vaccinations are available from 8 a.m. to 6 p.m. Thursday and from 8 a.m. to 5 p.m. Friday at the Jefferson Healthcare Primary Care Clinic, 915 Sheridan St. Vaccination appointments are required and are available by calling 360-379-8031. There is no charge for a vaccine, but an administration fee will be billed to the patient's insurance, the letter states. Ask Schools track children as to whether they are fully vaccinated, unvaccinated or exempt from certain up procedures. County schools are distributing the letters differently, with some sending them out to all students and others targeting those who would be affected by an outbreak. Chimacum High School Principal Whitney Meissner said the school sent out about 40 letters to high school students and has called on all staff members to supply proof of vaccinations or get a booster shot. "I'm not worried about this," Meissner said. "We need to follow the guidelines from our public health department, which might not always be convenient but will help us to reduce the risk of exposure or a broader epidemic." The Chimacum School system has three other schools — a primary, grade school and middle school — all distributing the letters to all the parents in the district. The Port Townsend School District's three schools each took a different tack. At Grant Street Elementary, the letters were sent to about 20 students who were out of compliance, according to Principal Mary Sepler. Blue Heron Middle School sent the letters home with all the students in a way that protected the student's privacy, according to Principal Diane Lashinsky. "If we had mailed the letters to parents, we would have done this differently," she said. "Since we sent the letters home, we didn't single out those who were unvaccinated because it would be 11. • letting everyone know about a personal situation." Port Townsend High School posted the letter in the school and on its website but did not actively distribute it, according to school secretary Jan Boutilier. Quilcene Schools did not receive the letter until Wednesday and will distribute it to those who are out of compliance today, according to district secretary Carrie Thompson. Thompson said about 4 percent of students in the elementary school and 5 percent of high school students are out of compliance, while the middle school has a 100 percent vaccination rate. In Brinnon, only one student was notified, according to administrative assistant Donna Prater. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermantApeninsuladailynews.com. Last modified: February 18. 2015 6:47PM • • w, A third case of measles in Port Angeles confirmed by tests By James Casey, Peninsula Daily News, February 20th, 2015 FORT ANGELES —A third case of measles has been confirmed on the North Olympic Peninsula. All three cases are in Port Angeles. The patient, a 43-year-old Port Angeles man, has been quarantined since Feb. 5 — including the period in which he was infectious — because he was a personal acquaintance of a 52-year-old man who was the first in Clallam County to be confirmed to have measles. The latter man, also of Port Angeles, was diagnosed with measles Feb. 1 and was hospitalized at Olympic Medical Center. He has since recovered. Clallam County Health and Human Services said Thursday the 43-year-old man's diagnosis was confirmed by test results late Wednesday. Meanwhile, a 5-year-old girl who is a student at Olympic Christian School in Port Angeles remains quarantined with measles. No cases have been confirmed in Jefferson County. Paul Throne, manager for health promotion and communication in the Office of Immunization of the state Department of Health, said Thursday she was exposed to the 52-year-old man at the Lower Elwha Health Clinic, 243511 W. U.S. Highway 101, Port Angeles. e had been there an hour before while he was contagious. The measles virus is airborne and can stay in room for up to two hours after an infected person has left. The girl's diagnosis led Clallam County health authorities to order the quarantine of non-immunized students at Olympic Christian School, 43 O'Brien Road, Port Angeles, until Feb. 27. An unknown number of other people may have measles in Clallam County, state and county health officials said Thursday. The number is uncertain because private health care providers as well as public health authorities can submit blood tests to the state Department of Health laboratories in the Seattle suburb of Shoreline. Public health authorities learn of such cases only if measles is confirmed. That the 43-year-old man did not spread measles was attributed to his adherence to quarantine, his daily reports to public health nurses and his cooperation, said Dr. Jeanette Stehr-Green, Clallam County health officer. Personnel at the tribal clinic had no immediate comment Thursday about the case or what precautions they might take to combat the spread of measles. Immunized people can neither contract measles nor spread it to others. Children require two vaccinations about a month apart to get full immunity. •ults born after 1956 usually require one vaccination. Adults born before 1957 generally are thought to be immune. People with measles can spread the disease to others from four days before the infected people develop the ailment's telltale rash. They remain contagious for four days after the rash appears. lallam County Health and Human Services' Public Health Section will continue with no-cost clinics from MIPS:30 a.m. to 4 p.m. today at 111 Third St., Port Angeles. Additional no-cost clinics are scheduled for 8:30 a.m. to 4 p.m. Monday, 8:30 a.m. to noon Tuesday, 8:30 a.m. to 4 p.m. Thursday and 8:30 a.m. to 4 p.m. Friday, Feb. 27. People can call 360-417-2274 to make appointments. Walk-ins will be served but may face a wait. Including administrative and injection fees, the shots normally cost $112. Health and Human Services officials are evaluating when and where to have clinics outside of the Port Angeles area, said Iva Burks, director of the department. All parents are encouraged to check the vaccination status of children, she said. Meanwhile, OMC's "most famous tent in the nation" has seen at least four suspected measles patients since it was erected Feb. 11, the hospital's top doctor said Wednesday. It was not known if any of the cases have been confirmed. More people probably will visit the yellow shelter outside OMC's waiting room, Dr. Scott Kennedy told hospital commissioners. "It seems most likely we will see more cases before this is over," he said of the measles outbreak that aecame public when a Port Angeles-area man was diagnosed with the disease at OMC on Super Bowl unday. Regarding the temporary enclosure, "this is probably the most famous tent in the nation right now," Kennedy said, explaining that its function wasn't to delay care but to keep possibly unprotected people safe from the measles virus. "The tent is not to prevent patients who need to come in," Kennedy said. "It's a triage tent. We have signage that says, 'Measles alert." People who suspect they have measles should not enter OMC's emergency room or any other health care facility where they could infect other people. Instead, they should call ahead to their health care providers for advice on where and how to receive a measles examination. A blood test can confirm immunity. In Jefferson County, residents can call the Jefferson Healthcare Primary Care Clinic, 360-379-8031, which has extended its hours to provide immunizations to unvaccinated children. Forks Community Hospital has posted signs asking patients who have symptoms or known exposure to measles to stay outside and call for medical assistance at 360-374-6271. Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey(a7peninsuladailynews.com. ot modified:February 19.2015 7:14PM No measles cases in Jefferson County after two tests come back negative By Charlie Bermant , Peninsula Daily News, February 20th, 2015 MORT TOWNSEND—Tests of two Jefferson County people with suspected measles came back negative, said a MIllounty public health official Thursday. "This data has been confirmed, so there are no reportable cases of measles in Jefferson County right now," Lisa McKenzie, county communicative disease specialist, said Thursday. McKenzie said the county public health clinic at 615 Sheridan St. in Port Townsend—which operates from 1 p.m. to 4 p.m. Tuesdays and Thursdays—has seen an increase in people who are unvaccinated or not fully vaccinated against measles and requesting immunization in the past few weeks. She had no figures on the increase. The clinic can provide vaccinations on a walk-in basis. Jefferson Healthcare hospital also is administering vaccinations at its walk-in clinic at 934 Sheridan St., according to Kate Burke, the hospital's marketing director. The hospital clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations aren't available for walk-ins. People must schedule them by calling 360-379-8031. On Thursday, Burke said the clinic's hours would be expanded to accommodate vaccination requests. I "We are encouraging parents to vaccinate any unvaccinated children," she said. A letter was distributed to parents in the four East Jefferson County school districts last week informing them of the clinic's policy of offering vaccinations—which are provided for a small administrative charge—to all unvaccinated �tudents. a case of measles is confirmed at any school, all unvaccinated students will be kept out of school for 21 days, according to both McKenzie and Jefferson Healthcare Chief Medical Officer Joe Mattern. Those who believe they may be infected should not visit a clinic without calling ahead, In a presentation to the hospital board Wednesday, Mattern said potentially infected patients should call ahead to their provider, who will then make arrangements for access that will avoid exposure to others. Mattern said that once a confirmed measles patient visits a clinic, the facility must be closed off for two hours after departure. While most of the vaccination discussion centers around children, there is a concern among adults, and the hospital clinic will be stocking increased numbers of adult vaccine, Mattern said. While proof of vaccine isn't always available for adults, Mattern said it can be assumed that anyone born before 1957 will have been safely vaccinated due to the contagion mentality surrounding measles at that time. "We are not recommending that people get vaccinated who were born before 1957 unless they are in a high-risk situation, like attending the same Super Bowl party with someone who turned out to be infected," he said. Those who believe they may be infected or exposed can contact the clinic even if they do not have a primary care provider, Mattern said. III, Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or at cbermant@peninsuladailynews.corn. ast modified: February 19. 2015 7:07PM Girl's exposure to measles took place at different clinic than originally reported By James Casey, Peninsula Daily News. February 20th, 2015 LYMPIA—A state Health Department spokesman said Thursday the Lower Elwha Health Clinic was where a 5- ear-old girl contracted the case of measles that resulted in quarantining some students at Olympic Christian School. He identified the clinic after learning that the Peninsula Daily News had erroneously reported that the girl was exposed at Peninsula Children's Clinic, 902 E. Caroline St., Port Angeles. Paul Throne, manager for health promotion and communication in the Office of Immunization, said it was incorrect that the girl had been exposed there. Dr. Madeline Harrington of Peninsula Children's Clinic said the PDN article was "completely not true. It was another clinic." Throne said the clinic where the child was exposed was the Lower Elwha Health Clinic, 243511 W. U.S. Highway 101, Port Angeles. He said the child "shared air" there with a 52-year-old Port Angeles man diagnosed Feb. 1 with measles. The measles virus can linger in the air up to two hours after someone with the disease has coughed or sneezed. Iva Burks, health and human services director of Clallam County, confirmed Thursday that the child was exposed at the Lower Elwha Health Clinic. On Wednesday, Throne had told the PDN that the 5-year-old "was going along with a family to the waiting room at the clinic"where the man had visited about an hour earlier. He did not name the clinic. st week, Clallam County health authorities said the girl had visited Peninsula Children's Clinic while she was ontagious. The people in the waiting room when she was there were contacted and, if they were not immune, were vaccinated or otherwise treated, according to Dr. Tom Locke, Clallam County deputy public health officer and public health officer for Jefferson County. The girl was a kindergarten student at Olympic Christian School, 43 O'Brien Road, Port Angeles. Public health officials said she could have been contagious Feb. 6 and exposed other students to the disease. The girl has been quarantined, and her schoolmates who have not been vaccinated have been told to remain at home until Feb. 27. Dr. Joel Yelland, director of the Lower Elwha Tribal Health Clinic, was unavailable for comment Thursday. However, Darcey Hodges, the tribe's emergency management coordinator, offered to respond to written questions from the PDN about the measles contact. By late afternoon, the newspaper had not received answers to its questions that included what other people might have been in the waiting room with the 52-year-old man, if the clinic diagnosed more measles cases, if it had set up triage procedures to keep possible cases from contact with other patients and if it would offer special measles vaccination clinics. Ileporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey(cr7peninsuladailynews.corn. ast modified: February 19. 2015 7:02PM Flu past its peak but still active, health officials say By Rob 011ikainen, Peninsula Daily News, February 20th 2015 .PORT ANGELES —The worst of the flu season is over, but health officials say influenza remains widespread across the state. "We're probably over the peak of it at this point, and it's dropping, but we'll continue to see influenza activity well into March," Dr. Tom Locke, Clallam County deputy public health officer and public health officer for Jefferson County, told the Clallam County Board of Health on Tuesday. Clallam County has seen five influenza-related deaths since the flu season began late last year. All of those were elderly patients who had other medical conditions that contributed to their deaths, Locke said. Jefferson County has had one flu-associated death as of Wednesday, Health Supervisor Julia Danskin said. "This is why we are so serious about seasonal influenza," Locke said. "It can be a killer, especially in the very old and the very young." 101 deaths in state State Department of Health officials said there have been 101 laboratory-confirmed flu deaths this season, including one child. Statewide figures lag about two weeks behind local reports. Most of the reported flu deaths in the state have occurred in people with pre-existing health conditions, officials said. State history There were 79 flu deaths in all of last year's flu season. There were 54 influenza deaths in 2012-13 and 18 in 2011-12. "This year, the predominant circulating strain of influenza has been the so-called H3N2 strain, which tends to cause more severe illness," Locke said. This year's flu vaccine was only about 25 percent effective against H3N2. Health officials say hand hygiene and staying home from work or school when you're sick are effective ways to combat the flu. "We're still seeing fairly widespread influenza activity in the state," Locke said. "Hospitalizations have certainly been up. "We've had a significant fatality rate in Clallam County." Reporter Rob 011ikainen can be reached at 360-452-2345, ext. 5072, or at rollikainen eninsul CSA adatlynews.com. Last modified: February 19.2015 5:42PM Fourth case of measles confirmed in Port Angeles; 'potential for wider exposure,' public health officer says By Rob 011ikainen, Peninsula Daily News, February 22nd, 2015 ORT ANGELES —A fourth case of measles has been confirmed in Clallam a am County— and the teenage boy is a sibling of the second case that was discovered earlier this month, health officials said. The 14-year-old was identified as having measles late Thursday and has been quarantined during his infectious period to avoid contact with the public, health authorities said Friday. He is the brother of a 5-year-old girl who was diagnosed with measles Feb. 11. A person with measles is contagious from about four days before the onset of a rash to four days after the rash appears, interim Clallam County Health and Human Services officials said. Dr. Jeanette Stehr-Green, Clallam County public health officer, said the boy developed a rash Thursday. His period of infection is believed to be from Feb. 15 to Monday, she said. "It is reassuring that our processes are working and that the fourth case has been in quarantine and not exposed to susceptible people," Stehr-Green said in a Friday interview. All four measles cases in Clallam County have affected Port Angeles residents. No cases have been confirmed in Jefferson County. "I think there is potential for wider exposure," Stehr-Green said. ere might be other exposures that we don't know about," she added. "I think people need to be aware of the risk. I think people need to get vaccinated." An unknown number of tests for measles from Clallam and Jefferson counties are being undertaken at a state lab. The number of samples is unknown to public health officials because private providers can submit their own samples. Clallam County's public health department sent "a few" samples to the state Department of Health laboratories in the Seattle suburb of Shoreline on Friday, Stehr-Green said. She suspected that more would be sent to the lab over the weekend. "With each of those cases, I have to say the measles picture wasn't classic," Stehr-Green said. "The collection of symptoms isn't a great picture for measles." A 52-year-old man was diagnosed with the highly contagious viral disease Feb. 1. He was hospitalized at Olympic Medical Center (OMC) in Port Angeles and has since recovered. The sister of the teen boy, a girl who attends kindergarten at Olympic Christian School at 43 O'Brien Road in Angeles, caught measles after she was in the Lower Elwha Health Clinic about an hour after the 52-year- man on Jan. 29, state and county health officials said. Measles is an airborne virus and can remain in an area up to two hours after an infected person has left. "Our clinic has notified all that were present that there was a possibility of exposure," Lower Elwha Klallam tribal Chairwoman Frances Charles said Friday. Se definitely went right into action and have taken the appropriate measures to make sure that everyone was ified. Nothing has transpired since then." Since the exposure at the clinic at 243511 W. U.S. Highway 101 in Port Angeles, the tribe has informed its members about the outbreak and placed signs around its facilities, Charles said. A staging area has been set up outside the tribal clinic to handle potential measles cases through an agreement with OMC. Suspected measles cases go to OMC rather than inside the clinic, Charles said. At OMC at 939 Caroline St. in Port Angeles, a yellow tent has been erected for examining suspected measles cases. "It's been very challenging, but all steps have been taken," Charles said. At Olympic Christian School, students who were not vaccinated prior to being exposed to the girl Feb. 6 are being kept away until Feb. 27 out of an abundance of caution. "Everyone who was excluded remains excluded," Stehr-Green said. The third measles patient, a 43-year-old man, was confirmed to have measles by test results Wednesday. He was an acquaintance of the 52-year-old man who was the first case in Clallam County. "It was not a health clinic exposure," Stehr-Green said. Ikat [43-year-old] individual also has been in full quarantine." Public health officials have investigated possible measles exposures, followed up with individuals and stand ready to respond to more cases. Immunized people can neither catch measles nor spread it to others. Adults born after 1957 generally require one vaccination. Adults born before 1957 are thought to be immune. Children require two vaccinations about a month apart for full immunity. All parents are encouraged to check the vaccination status of their kids. Measles is associated with a high fever, cough, runny nose and red, watery eyes leading to a measles rash three to five days after symptoms begin, according to the federal Centers for Disease Control and Prevention. The person who transmitted the virus to the 52-year-old male remains a mystery to public health officials. The last measles outbreak occurred in Clallam County in 1990, Health and Human Services Director Iva Burks has said. For details about measles, vaccinations, symptoms, morbidity and other information, visit http://tinyurl.com/PDN-CDCmeasles. Reporter Rob 011ikainen can be reached at 360-452-2345, ext. 5072, or at rollikainenApeninsuladailynews.com 4 No measles in Jefferson County, but Port Townsend hospital alert just in case By Charlie Bermant, Peninsula Daily News, February 23b, 2015 41111111101W t* \ s• • : Jefferson Healthcare infection preventionist Laura Flowers said the hospital is prepared for any measles cases in Jefferson County. although no cases have occurred so far. —Photo by Charlie Bermant/Peninsula Daily News PORT TOWNSEND — If any cases of measles occur in East Jefferson County, Jefferson Healthcare hospital officials may erect a quarantine tent like the one at Olympic Medical Center in Port Angeles. No cases of measles had been confirmed in Jefferson County as of Saturday. Four cases have been *confirmed in Clallam County. All are from Port Angeles. Three Jefferson County residents presenting with rashes were tested for the measles virus, but none had the highly contagious disease, said Laura Flowers, the hospital's infection preventionist. She said at least one of the people tested was a child. If a case is discovered, the hospital's treatment protocol will intensify, perhaps leading to the opening of a quarantine tent like the yellow shelter OMC erected Feb. 11 to screen possible measles cases. "We are most concerned about people who have symptoms turning up unannounced," Flowers said. "It's very important that they call ahead so we can bring them into another entrance and isolate them from other patients or people in the waiting room." A person suspected to have measles is given a three-stage test consisting of a nasal swab, a urine sample and a blood test. The blood test is the least conclusive for measles infection, Flowers said. "We can tell from the nasal and urine tests whether someone has the disease. The blood test tells us if they have immunity," she said. The hospital sends tests to the University of Washington's Shoreline lab. This is a state requirement to allow accurate tracking of the disease, Flowers said. "We want to make sure that whenever someone shows up for testing that we have a consistent response," she said. *Flowers said initial measles symptoms are subtle and resemble other ailments. At first, the disease appears to be a cold. The person has a runny nose, watery eyes and a fever. After four days, a rash appears. A rash isn't a conclusive sign of measles, Flowers said. Only a test can accurately document it. Patients are contagious from the time of their exposure until four days after a rash appears, for a total of about nine days, according to Lisa McKenzie, Jefferson County's infectious disease specialist. McKenzie said there is no mechanism to enforce quarantine in the county. Those who believe they have measles or who have been tested are advised to stay home and minimize their contact with others even if test results have not arrived. On Feb. 11, the Jefferson County Public Health Department prepared a letter for all parents of school- age children in the county. The letter said if an outbreak of measles occurs in a school, unvaccinated children will be kept out of classes for 21 days after the last possible day of exposure. Those who have had the disease are immune for life, McKenzie said. *Anyone born prior to 1957 has an assumed immunity, she said. A person who is unsure about his or her vaccination history can get an additional vaccination. The measles, mumps, rubella (MMR) vaccine is administered to children in two doses. Adults born after 1957 may need one dose. Flowers said adults who are unsure if they are immune can be tested for immunity, but those tests are expensive and not always covered by insurance. She recommended simply getting vaccinated. Flowers said she is aware of some controversy surrounding vaccinations but that from her standpoint as a health official, there is no reason children should not be vaccinated. "I feel that the process we have is safe and effective," she said. "Getting vaccinated is the responsible thing to do. It benefits yourself and your family." The Centers for Disease Control and Prevention in Atlanta says on its website at www.cdc.gov that a study published in the March 29, 2013, edition of Journal of Pediatrics found no link between vaccines and autism. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(c7i.peninsuladailynews.corn. ast modified: February 22. 2015 8:01 PM Vaccinations against measles at a clinic near you this week in Jefferson, Clallam counties Peninsula Daily News,February 23d,2015 CI.Ilia in f;trttnty Itrvlth anti Human Services Will Dr IR:cla',nIinit NO !'(M47' immiunization (linies for MMH %'arrint lflauanxin w.Mlnt*i1 s.11tb44111l a l 'lnrunr..23,24115 16 304{11111 to l DOpns ii l rbrnnrt 2 1.24115 11:,ttlnm to noon � li'brntar.26.21115 8.30n,n to 141111pna r` li'lrrnnr, 27.2015 1b304tin to 1:f11pt11 t'.11 Ins no aµpai.cainrns 31144 1€7427 I g w flank-in•wltt In.woo ban w<;..ham.,a Inwpe,'onie time, ' Sun trot,t 4arrtmmt'ma: :_ .1 nimmuucrr llrildrra .tnittO lionober I*3;Rood 404.0 Ni*twin, X. -4duli,Ion,&bore MG;oar moused immaar:raat ,In and seed n rarwiNai3na I:IziIItiin Comm, Health and Human Semis^rai 11 I li:3ril Street Sails I Port i mels.:.1%'.1 98:1102 :1613 111•2271 :360-152-1-192 fax VACCINATION AGAINST MEASLES are available at clinics on the North Olympic Peninsula. ilkefferson County Public Health Clinic at 615 Sheridan St. —which operates from 1 p.m. to 4 p.m. Tuesdays and Thursdays—offers the measles, mumps and rubella (MMR) vaccine on a walk-in basis. Jefferson Healthcare hospital also is administering vaccinations at its walk-in clinic at 934 Sheridan St., according to Kate Burke, the hospital's marketing director. The hospital clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations aren't available for walk-ins. People must schedule them by calling 360-379-8031. The vaccine is free at both clinics. But the hospital clinic charges an administrative fee billable to insurance. Clallam County Clallam County Health and Human Services' Public Health Section will continue with no-cost immunization clinics from 8:30 a.m. to 4 p.m. Monday at 111 Third St., Suite 1A, Port Angeles. Additional no-cost clinics are scheduled for 8:30 a.m. to noon Tuesday, 8:30 a.m. to 4 p.m. Thursday and 8:30 a.m. to 4 p.m. Friday. People can call 360-417-2274 to make appointments. Walk-ins will be served but may face a wait. Including administrative and injection fees, the shots normally cost$112. Health and Human Services officials are evaluating when and where to have clinics outside of the Port Angeles area, said Iva Burks, director of the department. Allarents are encouraged to check the vaccination status of children, she said. Last modified:February 22.2015 8:04PM No new cases of measles confirmed on Peninsula; as many as 20 in quarantine By Arwyn Rice, Peninsula Daily News, February 24th, 2015 Public health officials in Clallam County are awaiting test results to see if they have caught a measles outbreak early enough to stop it at four people. As of Monday, there had been no new cases of measles confirmed, but as many as 20 people are in quarantine, said Iva Burks, Clallam County Health and Human Services director. All those in quarantine had been in direct contact with the four confirmed measles cases, all of whom live in Port Angeles, Burks said. "We are waiting to see. We are not in the clear just yet," Burks said. None of the four people who have been diagnosed with measles in Clallam County this month had been vaccinated prior to catching the illness, Burks said. They include the first known patient, a 52-year-old man who was diagnosed on Feb 1 and who has since recovered; a 5-year-old girl attending Olympic Christian School, who was diagnosed on Feb. 11 after she was exposed to the first case; a 43-year-old man diagnosed on Feb. 18, who was a friend of the 52-year- old man; and a 14-year-old boy —the brother of the 5-year-old girl —who was diagnosed Thursday. Burks said the teenager is a homeschool student. Several unvaccinated students from Olympic Christian School, 43 O'Brien Road in Port Angeles, and people who had known contact with the four patients are among those quarantined. .Both the 43-year-old man and the 14-year-old boy were in quarantine at the time they become contagious and are not thought to have exposed the public. The two children had not been vaccinated, and the two adults had no memory or records of having received vaccinations, Burks said. The adults were given tests for measles antibodies which indicated that they had never been vaccinated, she said. It was not known how the initial patient was infected with measles. "We'd love to solve that mystery," Burks said. Fully immunized people typically can neither catch measles nor spread it to others. Adults born after 1957 generally require one vaccination. Adults born before 1957 are thought to be immune. Children require two vaccinations about a month apart for full immunity. All parents are encouraged to check the vaccination status of their children. Clallam County Health and Human Services' Public Health Section will continue with no-cost immunization clinics from 8:30 a.m. to noon today, and 8:30 a.m. to 4 p.m. Thursday and Friday at 111 •Third St., Suite 1A, Port Angeles. As many as 40 to 60 people per day have received vaccinations or boosters at the clinic, Burks said. "We would like to see more," she said. 1111 Call 360-417-2274 to make an appointment. Walk-ins will be served but may face a wait. Burks said West End clinics are planned, but no details are yet available. Measles is associated with a high fever, cough, runny nose and red, watery eyes leading to a measles rash three to five days after symptoms begin, according to the federal Centers for Disease Control and Prevention. For details about measles, vaccinations, symptoms, morbidity and other information, visit http://tinyurl.com/PDN-CDCmeasles. Reporter Arwyn Rice can be reached at 360-452-2345, ext. 5070, or at ariceRpeninsuladailynews.com. Last modified: February 23. 2015 6:42PM • • T • ACLU sends letter to Jefferson Healthcare claiming hospital is going against state law on abortion services By Charlie Bermant, Peninsula Daily News, February 25th, 2015 PORT TOWNSEND —The American Civil Liberties Union has accused Jefferson Healthcare of being in noncompliance with state law in its provision of abortion services. The ACLU Seattle office said in the letter sent to the hospital Thursday that it believes that a public hospital that provides maternity care but not abortion services violates state law. Jefferson Healthcare, which is in Port Townsend, says on its website on its "management policies" page that it refers women seeking abortion. "Referral and informational services are provided to offer women and family choices regarding voluntary termination of pregnancy," the website says. The letter from Leah Rutman, ACLU's policy counsel, asks that the hospital change its policies and practices "to fulfill its obligations under the Reproductive Privacy Act." The ACLU's Seattle office sent letters of concern also to Whidbey General Hospital in Coupeville and Mason General Hospital in Shelton at the same time that it filed a lawsuit alleging noncompliance against Skagit Valley Hospital on Thursday. "We sent the letter due to our concern about the hospital's policy that suggests that it isn't providing a full range of reproductive services," Rutman said. • "If a public hospital provides a wide range of maternity services, which Jefferson Healthcare does, it needs to provide a full range of termination services," she said. In the letter, the ACLU cites an August 2013 state attorney general opinion. The opinion says that state law requires a public hospital that provides maternity care service or information also must provide "substantially equivalent benefits, services or information" regarding contraception and abortion. "We express no opinion on exactly how hospital districts may comply with this requirement," the attorney general's opinion says. Rutman said the ACLU is conducting an investigation of Jefferson Healthcare practices and did not rule out filing a lawsuit if the investigation results warranted. She added that the ACLU is investigating every hospital in the state concerning this issue. If a hospital did not receive a letter, it does not indicate the ACLU believes the hospital is in compliance with law, Rutman said. No pregnancy termination services are available now in Jefferson County, according to Julia Danskin, a nurse with the Jefferson County Department of Public Health. • Those in need of abortions are referred to hospitals in Port Angeles, Bremerton or Seattle, Danskin said. s d • The letter, which was sent to the hospital board as well as to CEO Mike Glenn, was a surprise, said Jill Buhler, board chairwoman. "I was flummoxed when I heard about this," she said. "We've always been committed to providing a full range of services including women's health. "We are now taking a deeper look at this." In an email to the Peninsula Daily News, Glenn said the letter raises some interesting legal and capacity-of-care questions for which the hospital intended to provide a thoughtful response. "I will say that meeting community need in all service lines, including reproductive care, is very important to the board of commissioners, administration and all providers associated with Jefferson Healthcare," Glenn said. In the ACLU's lawsuit against Skagit Valley Hospital, it says that patients have been routinely referred to Planned Parenthood or other private clinics when they seek abortions, rather than given such services on-site. The dispute boils down to whether such off-site referrals are substantially equivalent to the maternity care the hospital offers. Skagit Valley Hospital performed 1,200 deliveries in 2012 — nearly three-quarters of all births in • Skagit County — but never performs abortions by medication and rarely performs surgical abortions, the ACLU said. At a news conference Thursday, the ACLU called the referrals an unacceptable barrier to abortion rights. In a phone call with Associated Press reporters, two hospital district executives — Dr. Connie Davis, its chief medical officer, and Balisa Koetje, its chairwoman — said Skagit Regional Health follows the law. The ACLU is bringing the case on behalf of Kevan Coffey, a 29-year-old Mount Vernon nurse practitioner who worked at Skagit Valley Hospital for two years until last June. "It was just accepted that we didn't really have those services available," she said. She said it's also a personal issue: She takes medication that can cause severe birth defects, and she would need an abortion if she were to become pregnant. The Associated Press material was used in this report. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or at • charlie.bermant@peninsuladailynews.com. Last modified: February 24. 2015 7:32PM °4 a Clallam expands free measles vaccine clinics to Forks starting Thursday Peninsula Daily News, February 25th, 2015 S FORKS — Clallam County public officials have expanded opportunities for residents to be vaccinated. No-cost vaccines for measles, mumps and rubella will be offered in Forks this week. The MMR vaccine will be offered in Room 102 at Forks Elementary School, 301 S. Elderberry Ave., on Thursday and at the Bogachiel Clinic, 590 Bogachiel Way, on Friday. Clinic hours at both locations will be from 1 p.m. to 4 p.m. Four cases of measles have been confirmed in Clallam County this month, the latest last Thursday. "No additional cases have been reported since last week," Jeanette Stehr-Green, interim public health officer for Clallam County, said Tuesday. No cases have been confirmed in Jefferson County, said Lisa McKenzie, communicable disease program manager with the county public health department. Neither county has any tests at the state lab now, said McKenzie and Iva Burks, Clallam County Health and Human Services director. Two cases of measles have been confirmed in Grays Harbor County. Both pre-dated the Clallam County outbreak, Burks said. eResidents quarantined As many as 20 Clallam County people are in quarantine because they were exposed without being immunized or not fully immunized, Burks said. "If they don't break out [in a rash], they will be out of quarantine," she said. None have been tested, either because they refused to have the test done or because their immune status is uncertain, she said, adding that the blood test will be positive for measles if the person has ever had the disease or been vaccinated. PA, PT clinics Immunization clinics continue in Port Angeles and Port Townsend. In Port Angeles, the clinics are from 8:30 a.m. to 4 p.m. Thursday and Friday at 111 Third St., Suite 1-A. Call 360-417-2274 to make an appointment. Walk-ins will be served but could face a wait. In Port Townsend, clinics are at the Jefferson County Public Health Clinic at 615 Sheridan St. and at the Jefferson Healthcare hospital's walk-in clinic at 934 Sheridan St. The county clinic offers the MMR vaccine on a walk-in basis from 1 p.m. to 4 p.m. Tuesdays and Thursdays. Jefferson Healthcare's clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations must be scheduled by calling 360-379-8031. The vaccine is free at both clinics. The hospital clinic charges an administrative fee billable to insurance. !No vaccination None of the four diagnosed with measles in Clallam County this month had been vaccinated prior to exposure, Burks said. The first case was a 52-year-old man who was hospitalized at Olympic Medical Center after he was diagnosed Feb. 1. He has since recovered. The second confirmed case was a 5-year-old girl attending Olympic Christian School who was diagnosed Feb. 11. She had been exposed to the 52-year-old man, public health authorities said. The third case was a 43-year-old man diagnosed Feb. 18. He had been a friend of the 52-year-old man. The fourth case was a 14-year-old boy diagnosed Thursday. He is the brother of the 5-year-old girl who caught measles. He is home-schooled. The two most recent cases were quarantined before they became infectious, so there was no public exposure to them, Burks said. But there were public exposures from the first two cases. Among those quarantined are several unvaccinated students at Olympic Christian School, 43 O'Brien Road in Port Angeles, and others who had had known contact with people with measles. •It's unclear who exposed the county's first case. "With Clallam County as a gateway to cross-border travel, there's continued potential" for exposure, Burks said. "Vaccination is the best protection." Highly contagious Measles is an airborne virus. Those susceptible to it can get it just by walking into a room where an infected person has been in the prior two hours. Children should be vaccinated with two doses of the MMR vaccine, with the first dose between 12 and 15 months and the second at 4 to 6 years old. Adults born after 1957 usually require one vaccination. Adults born before 1957 generally are thought to be immune. For more information, see http://tinyurl.com/PDN-CDCmeasles. Last modified: February 24. 2015 6:58PM BOCC says roll into existinga rules Y marijuana g 4•By Nicholas Johnson of the Port Townsend Leader I Posted: February 25, 2015 3:00 am Ilin_. X y �w m ^a David Sullivan Board of County Commissioners chair David Sullivan is slated to advise the Jefferson County Planning Commission on March 4 that the BOCC believes marijuana businesses to be governed by the same county rules as any other agricultural activity or cottage industry, save for a few minor adjustments. File photo by Nicholas Johnson *Marijuana businesses ought to be governed by the same county rules as any other agricultural activity or cottage industry, save for a few minor adjustments. That's what Board of County Commissioners chair David Sullivan plans to tell the county's planning commission Wednesday evening, March 4 on behalf of the board. "Our code really does address virtually every issue except where we've found that little loophole or that little place where we need to make a change for everybody," Sullivan said Feb. 25 moments before he and his fellow commissioners unanimously agreed to direct Department of Community Development (DCD) staff and the planning commission to consider how existing land-use rules can effectively address the county's planning concerns. "The general focus of all these things is producing and processing of agricultural products — marijuana being a subset of that," County Administrator Philip Morley said during Monday's meeting, referring to work he, Sullivan, DCD Director Carl Smith and planner Colleen Zmolek did Friday afternoon, Feb. 20 to develop a code framework applying to all agriculture, including marijuana. Most planning commission members agreed Feb. 4 that while marijuana is agriculture, it's not equal to traditional agriculture such as corn or kale and should be regulated distinctly. •A four-member subcommittee of that nine-member advisory body suggested Feb. 4 focusing land-use rules on impacts from traffic, light and noise, as well as those to property values. PRODUCING "'On residential land of 5 acres or more, DCD staff suggests growers be allowed permanent or temporary buildings up to 5,000 square feet. For such lots larger than 1 acre, growers would be allowed such structures up to 1 ,000 square feet. "If it's smaller than 1 acre, it's not going to have a permanent or temporary growing structure," Zmolek said. Buildings up to 10,000 square feet would be allowed on residential land of at least 10 acres and zoned at RR 1 :10 or RR 1 :20. "This is new because for most agricultural structures, there's no size limit other than the impervious surface limit," said Morley, adding that no size limits would apply to such structures on forest, agriculture or light industrial lands. Permanent growing structures, unlike temporary structures such as greenhouses, would not be allowed in commercial areas, would require a building permit and at least a 5-foot setback from the property line. The state Liquor Control Board (LCB) requires video surveillance of an unobstructed 20- foot distance beyond a fenced perimeter, which amounts to an at least 20-foot setback from the property line. The LCB requires an 8-foot sight-obscuring fence for outdoor grows and temporary structures. The county would require a building permit to erect a fence taller than 7 feet. •'For somebody who wants to build a temporary structure for growing tomatoes, unless they put up a greater than 7-foot fence, we would not be reviewing it," Zmolek said. County Environmental Health officials would review permanent structures hooked up to water or septic systems, while hours of operation and number of employees would not be regulated. The state Department of Ecology would review outdoor grows and temporary structures for water use, while a septic review would depend on whether the land is served by a septic system. "In some cases we would be routing it to environmental health, but not in all cases," Zmolek said. "If there's no septic on the property, there's no reason to route it to them." PROCESSING Processors setting up outside agricultural and light industrial areas would need a cottage industry permit, which limits hours of operation and number of employees. It also limits parcel size to at least 1 acre and requires sight-obstructing landscaping around the business' perimeter. For combined producing and processing businesses, DCD staff proposed allowing a total 5,000 square feet of building area. Outdoor grows would not be limited in size. "If they are also processing, they can't do as big an indoor grow as if they are just *growing," said Morley. "That's the kind of thing I would look to the planning commission to examine real carefully," Sullivan said, acknowledging greater combined square-footage might be .allowable on larger parcels with greater setbacks. "If we do consider a larger combined operation, we may want to look at other mitigating measures against potential impacts," Morley added. Environmental Health officials would review processing structures hooked up to water or septic systems. The state Department of Ecology would also review commercial agricultural water usage. "Agriculture is wide open, basically, according to our standards," said commissioner Phil Johnson. "But processing of cheeses, jams and jellies is not wide open. I've got to say, at first glance, I think this looks pretty good." BACKGROUND On Feb. 9, the commissioners extended for another four months a less-restrictive version of a moratorium of marijuana business first established in August 2014. It now ends June 11 . Smith said Monday he might call for a special meeting of the planning commission for March 18, "just to keep the ball rolling." Like the original, the new moratorium limits marijuana growing and processing businesses to forest, agricultural and industrial areas. Now, outdoor growing is allowed ion all residential lots and indoor growing is allowed on all such lots greater than 5 acres. Processing is allowed on residential lots of at least 1 acre with a cottage industry permit. The original moratorium held up some 19 businesses — whether planning to grow, process or both. Four of those are located on rural commercial land. The remaining 15 are on rural residential land, eight of which had plans to set up on more than 5 acres, meaning they are now free to move forward. • • Salmon grow on trees Plant- --Than turne 10, teen involvement sets record Port Townsend Leader, Februar 25 2015 et 4'4...ani K ;. e 4,4 Photos by Charles Fspey Salmon grow on trees At the 10th annual Plant-A-Than,175 volunteers from five schools planted 3,000 trees to Improve salmon and wildlife habitat at the Tarboo Wildlife Preserve.Participating students were from the Port Townsend School District's OCEAN program,Port Townsend High School's Students for Sustalnabillty club,Chlmacum High School PI Program,Swan School and Jefferson Community School. The Northwest Watershed Institute Plant-A-Thon celebrated its 10th anniversary with another large-scale planting event at the institute's Tarboo Wildlife Preserve. On Feb. 14, 175 youth and adult volunteer tree planters (45 were teenagers) helped to restore salmon and wildlife habitat, as well as mitigate climate impacts, by planting 3,000 native trees. With the sound of a traditional drumbeat, Port Gamble S'Klallam tribal spiritual leader Gene Jones and his wife, Suquamish leader Marilyn Jones, gathered attendees together in a circle on the Tarboo Wildlife Preserve east of Quilcene. Jones, a founding board member of Northwest Watershed Institute (NWI), welcomed participants with stories and a song. "It's really exciting to see such a fine group of people out here today - the big ones and the little ones, especially the little ones," Jones said. "It's important that we take care of our environment, and tree planting is part of helping to keep our waterways here clean and clear." Jones sang a traditional Suquamish prayer song by intertribal Chief Dan George to a spellbound crowd. With that, the group of children, teens and parents, dressed in colorful rain gear and mud boots, picked up shovels and broke into groups to learn the new techniques to be used to plant illnative trees near Tarboo Creek. Since 2005, hundreds of students, parents, teachers and friends from seven local schools have participated. Collectively, they have planted more than 33,000 trees along Tarboo Creek while earning more than $125,000 for school programming, said Jude Rubin, NWI director of stewardship. This year, participating school groups include Port Townsend School District's OCEAN program, Port Townsend High School's Students for Sustainability, Chimacum High School's Pi Program, and Swan School and Jefferson Community School in Port Townsend. STREAMSIDE FORESTS The plant-a-thon is an education and outreach effort coordinated by NWI as part of the Tarboo Watershed Program, a long-term effort involving 40 organizational partners to protect and restore salmon and wildlife habitat from headwaters to bay in the Tarboo-Dabob watershed. Since 2004, more than 2,000 acres have been preserved, and more than 600 acres have been re-meandered, replanted and restored. This year's plant-a-thon returned to the Tarboo Wildlife Preserve, a 490-acre wildlife refuge managed by NWI. This was the second time that volunteers have tackled a challenging section of Tarboo Creek and nearby wetlands that is dominated by invasive nonnative reed canary grass, with the purpose of reviving native shrubs and trees. Streamside trees provide shade, stream structure for shaping salmon spawning and rearing areas, and is the vegetative base of the food chain that supports young coho salmon during their first year of living in the stream before migrating to sea. Innovative planting methods used successfully last year were expanded, Rubin noted. The methods include live-staking willows through cardboard to shade out the invasive reed canary grass. Rubin said another technique being used is based on the natural example of conifers growing on nurse logs in wetland forests. Volunteers planted spruce and cedar in hollow log rounds and constructed planter boxes to establish trees above the wet soils. Although these special methods are both labor-and materials-intensive, she said that they had excellent survival rates. Standard methods of planting bare root seedlings and potted plants were also used, Rubin said. SPONSORSHIP Funding for the plant-a-thon varies from year to year. The costs of trees, field supplies and staffing were funded by Jefferson County Public Health's Water Quality Division, with funding from the Hood Canal Clean Streams grant from the Washington State Department of Ecology. • (See all the sponsors on a "Thank you" advertisement on this page.) Many businesses contributed field supplies, and other businesses donated lunch to the participants. Port Townsend Students for Sustainability funded a bus to the event with proceeds they had earned from previous fundraisers. Transportation enabled 45 high school students - a record number- to participate, Rubin noted. Students have raised about $15,000 this year by selling "tree cards" with the artistic image "Infinite Moment(um)" by Jesse Joshua Watson, which depicts a child holding up a tree seedling within a swirl of salmon at all life stages. SALMON GROW ON TREES Last November, before selling tree cards or planting any trees, students in participating schools studied "How salmon grow on trees, and trees grow on salmon," gaining the big picture of the interdependence of salmon and temperate rainforests. They needed this information in order to talk with friends and family about the project, and to understand their role in restoring Tarboo Creek. On the morning of the plant-a-thon, a trained team of 20 high school students and 10 adult mentors taught groups of volunteers to identify native trees and shrubs, use several different tree-planting methods and follow safety protocols before heading to their planting areas. iGrace Webb, an 11-year-old student at Swan School who began planting "in preschool," checked up on her past plantings to find that most had survived, but a few of the older trees by the creek had been flooded out. "That's OK,"Webb said. "It is still good, because salmon need wood in the stream to improve their habitat." Daniel Molotsky, lead teacher for Port Townsend School District's OCEAN program, seemed to summarize the feelings of many participants when he said, "Plant-a-thon is a really powerful experience. Being out there, working together with so many people who care what happens to the natural world ... it gives me real hope for the earth." Those interested in supporting the 2016 NWI Plant-A-Thon may contact Jude Rubin at 385- 5358 or j.rc e@rttaterhed,c . • No new cases of measles on Peninsula Peninsula Daily News, February 26th, 2015 .There are no new confirmed measles cases on the North Olympic Peninsula and no tests pending at state laboratories, Clallam and Jefferson County public health officials said Wednesday. Vaccinations are being encouraged for children and eligible adults after four Port Angeles residents were stricken with the highly contagious viral disease earlier this month. All four cases are out of quarantine, said Dr. Jeanette Stehr-Green, Clallam County interim public health officer. Others have been in quarantine without tests being done, health officials have said. No-cost vaccines for measles, mumps and rubella are being expanded to the West End beginning today. Clallam County Public Health will offer a no-cost immunization clinic from 1 p.m. to 4 p.m. today at Forks Elementary School, Room 102, 301 S. Elderberry Ave. Another clinic will be held from 1 p.m. to 4 p.m. Friday at the Bogachiel Clinic, 590 Bogachiel Way, Forks. In addition, the Clallam County Public Health Clinic in Port Angeles will offer no-cost vaccination clinics from 8:30 a.m. to 4 p.m. today and Friday at 111 Third St., Suite 1-A. Call 360-417-2274 to make an appointment. Walk-ins will be served but could face a wait. In Port Townsend, vaccination clinics are offered at the Jefferson County Public Health Clinic at 615 Sheridan St. and at the Jefferson Healthcare primary care clinic at 934 Sheridan St. The county health clinic offers the MMR vaccine on a walk-in basis from 1 p.m. to 4 p.m. Tuesdays and Thursdays. Jefferson Healthcare's clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations must be scheduled by calling 360-379-8031. Although the vaccine is free to children, both the hospital and Jefferson County Public Health Clinic charge an administrative fee billable to insurance. "We've had no cases, and no tests are pending at this time," said Lisa McKenzie, communicable disease program manager Jefferson County Public Health. Health officials are working with schools to encourage vaccinations, Stehr-Green said. Those who were in contact with the four measles cases in Clallam County are being monitored but have shown no signs of having measles. "It has been a really busy couple of days," Stehr-Green said. Airborne measles is so contagious, it can remain in the air two hours after an infected person leaves. Children should be vaccinated with two doses of the MMR vaccine, with the first dose between 12 and 15 months and the second at 4 to 6 years old, officials said. Adults born after 1957 usually require one vaccination. Adults born before 1957 generally are thought to be immune. For more information, see http://tinyurl.com/PDN-CDCmeasles. Last modified: February 25. 2015 5:37PM w Abortion referral a practicality, not policy, Jefferson Healthcare says following ACLU letter on pregnancy termination services �By Charlie Bermant, Peninsula Daily News, March 1st, 2015 1.1 .t, Jefferson Healthcare Chief Medical Officer Dr.Joseph Mattern PORT TOWNSEND —Jefferson Healthcare's practice of referring women elsewhere for abortion services adequately serves those seeking such services, said the hospital's chief medical officer. "There is nothing in our bylaws, there is no directive, for us to not provide termination services," Dr. Joseph Mattern, the hospital's chief medical officer, said last week. The hospital does not perform abortions on-site because of practicality, not policy, according to staff members. "The reason we don't is decided through medical staff and the willingness or interest on the part of that staff to provide that service and organizational support," Mattern said. "If we are going to do it, we want to do it well." OThe Seattle office of the American Civil Liberties Union has said it believes a public hospital that provides maternity care but not abortion services is in violation of state law. The ACLU accused the East Jefferson County hospital of being out of compliance with state law in its provision of abortion services in a Feb. 18 letter addressed to the hospital board and CEO Mike Glenn. "If a public hospital provides a wide range of maternity services, which Jefferson Healthcare does, it needs to provide a full range of termination services," said Leah Rutman, ACLU's policy counsel, who wrote the letter. The letter asks that the hospital change its policies and practices "to fulfill its obligations under the Reproductive Privacy Act." Glenn is preparing an answer to the letter, Jefferson Healthcare Marketing Director Kate Burke said last week, adding that it would be several days before it is ready. No abortions are performed in East Jefferson County, according to the county public health department. Patients who desire or require abortions are referred to clinics in Port Angeles, Bremerton or Seattle, according to Julia Danskin, a nurse with the Jefferson County Department of Public Health. Referrals are made at the doctor's discretion. These clinics are "well-oiled machines," according to Dr. Molly Parker, a family practitioner on Jefferson frealthcare's staff. "Patients at these clinics get a supportive response, consulting about other options, the procedure and recovery," Parker said. "It's done with good support." OC such as Planned Parenthood also have specific equipment for the procedure, she said. An average of 57 abortions are requested annually in Jefferson County. "We don't offer termination services because we feel that other agencies perform them well and offer the best option for patients," Mattern said. "We provide services based on volume and staffing at what makes sense." Olympic Medical Center in Port Angeles operates in a similar fashion, according to Executive Assistant Gay Lynn (seri. She said OMC does not perform terminations in the hospital and that referrals are up to the physician's discretion. The Port Angeles branch of Planned Parenthood receives referrals for abortion, according to spokeswoman Katie Rogers. She said it does not track the origin of those referrals. Officials at Forks Community Hospital did not respond to a request for comment Friday. Jefferson Healthcare, OMC and Forks Community are the only ones on the North Olympic Peninsula. Neither OMC nor the Forks hospital received letters from the ACLU like that sent to Jefferson Healthcare. In addition to the Jefferson County hospital, the ACLU also sent letters of concern to Whidbey General Hospital in Coupeville and Mason General Hospital in Shelton. At the same time, it filed a lawsuit against Skagit Valley Hospital alleging noncompliance with state law because it routinely refers patients to Planned Parenthood or other private clinics, rather than providing abortions on-site. The ACLU is disputing the idea that referring patients off-site for abortions is substantially equivalent to the maternity care the hospital offers. In the letter to Jefferson Healthcare, the ACLU cites an August 2013 state attorney general opinion. The opinion says state law requires a public hospital that provides maternity care service or information to also provide "substantially equivalent benefits, services or information" regarding contraception and abortion. "We express no opinion on exactly how hospital districts may comply with this requirement," the attorney general's opinion says. Rutman said last week that the ACLU had not had any contact with Jefferson Healthcare since the letter was sent and that her agency is conducting an investigation of local procedures. She said the ACLU is investigating every hospital in the state concerning this issue. tf a hospital did not receive a letter, it does not indicate the ACLU believes the hospital is in compliance vith the law, she added. Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cberrnant(a�peninsuladailynews.com. a. HEALTH CARE—Free clinics in Port Angeles, Sequim, Port Townsend help local residents with care and advice jaw By Diane Urbani de la Paz, Peninsula Daily News, March 1st,2015 figkiw,w. nT Y 711:7‘.0. e s Diane Urbani de la Paz/Peninsula Daily News Rose Gibbs is clinic director of the Dungeness Valley Health &Wellness Clinic while Dr. Kip Tulin is the volunteer medical director. HOW TO CONTACT FREE LOCAL CLINICS HERE IS INFORMATION about how to contact free clinics for medical services: • Volunteers in Medicine of the Olympics, aka VIMO, 819 E. Georgiana St. in Port Angeles, is open Mondays through Fridays for medical and counseling appointments, diabetes education, a hypertension clinic and a breast and cervical health program. Information is available at 360-457-4431,www.VlMOclinic.org and on VIMO's Facebook page. For appointments and information at VIMO's Dental Clinic, phone Susan Gile at 360-460-3007. ■ Dungeness Valley Health&Wellness Clinic is at the back of the Sequim Medical Plaza at 777 N. Fifth Ave. Urgent care clinics open at 4:45 p.m. Mondays and Thursdays. A chronic health care clinic is also available. For information, phone 360-582-0218 and visit www.SequimFreeClinic.org. ■ JC MASH,aka the Jefferson County Medical Advocacy Service Headquarters, at 1136 Water St., Suite 109, offers a free medical and informational clinic from 7 p.m.to 8:30 p.m. Tuesday. For information, see www.JCMash.com, and to reach the answering service, phone 360-385-4268. In addition, a youth mental health clinic is open from 4 p.m.to 7 p.m. Thursdays,with information at 360-379-2630. While measles and flu make the headlines, a small army of doctors and nurses contends with another public health ailment. Its symptoms: high insurance deductibles and premiums; copays that add up; doctors who don't take Medicaid. Alk malady is lack of access to basic health care. One solution lies in a kind of parallel medical sector: the free clinics on the North Olympic Peninsula, three of which belong to the Washington Health Access Alliance, the state organization of free and charitable clinics. .4. On any given week at the Dungeness Valley Health &Wellness Clinic in Sequim, at JC MASH —Jefferson County Medical Advocacy Service Headquarters— in Port Townsend and at VIMO, or Volunteers in Medicine of the *Olympics in Port Angeles, scores of patients receive care and advice. In these offices, there are paid staff, but many more unpaid providers who share the belief that health care is a right, not a consumer product. Sequim clinic Take Dr. Kip Tulin, one of 11 volunteer physicians and nurse practitioners at the Sequim clinic. He's retired from a long career at Kaiser Permanente in Bakersfield, Calif., and is now the clinic's volunteer medical director. Tulin and his team see eight to 10 people come in on any given Monday or Thursday evening, when walk-in urgent care clinics are held. The doors open at 4:45 p.m. Mondays and Thursdays. If the waiting room becomes too jammed for the one provider working that night, clinic director Rose Gibbs has five more signed up to be on call. "And they will come in," she said. "That's tremendous." Beyond urgent care, nurse practitioner Larry Germain runs the Tuesday and Thursday afternoon Chronic Healthcare Clinic for people coping with diabetes, high blood pressure, high cholesterol and respiratory illness. Patients see the same provider each time they come, which can make a huge difference in their health, Tulin said. Even with the Affordable Care Act making health insurance available to people who couldn't get it before, many still cannotfoot the premium and copay bills, Gibbs said, adding that still others don't want to get onto the state or *federal "grid" at all. Sequim's clinic has a paid executive director and clinic director, a prescription assistance program and a wellness education program, all outlined on its elaborate website—and all the outgrowth of founder Mary Griffith's clinic- feasibility research, begun 15 years ago this month. Port Townsend clinic JC MASH, by contrast, is a smaller, computer-free operation, now two decades old. Dr. James K. Rotchford, the founding physician, sees people who are homeless, struggling with drug addiction or mental illness, or all three. A handful of patients come to his walk-in clinic each Tuesday night, but rather than primary care, JC MASH's providers offer people moral support and guidance to local resources. VIMO As for VIMO, it's an appointment-only health center, recently moved to a larger building at 819 Georgiana St., down the street from its former location. There, Executive Director Gary Smith and his team of volunteers and paid staff hope to see more patients than ever—which is saying something, since Smith reports VIMO's 2014 patient count at 1,479. Like its Sequim and Port Townsend counterparts, VIMO seeks to be a haven for those whose only other care would come after a long wait in the hospital emergency room. •VIMO will be among the participants at this Friday's Project Homeless Connect. The free event for people struggling with homelessness will run from 9 a.m. to 3 p.m. at the Vern Burton Community Center, 308 W. Fourth St. • There, VIMO will offer flu shots as well as vaccinations for measles, diphtheria, tetanus, and pertussis. Affordable Care Act sign-up also will be available. •"We'll be offering a regular medical clinic," said VIMO development coordinator Zoe Apisdorf, adding that clinic manager Mary Hogan, nurse practitioner John Melcher and registered nurse Mary Sherwood will be working. Dental care Both the Sequim free clinic and VIMO see many people suffering from dental ills: abscesses, infections—and no insurance. The clinics can provide these patients with vouchers enabling them to see a dentist, get antibiotics or both. Yearly, VIMO sees some 500 people suffering from dental pain, Smith said. Staffer Susan Gile, known at VIMO as the Tooth Fairy, runs the dental health programs for children and adults. VIMO hopes to add a dedicated dental clinic at its new location, Smith said, while Gile seeks to connect with more dentists who will accept Medicaid. Dental help is something Mauria Lombardo, the clinic's sole paid staffer, is working on, too. "One of my current tasks is to see which dentists might be willing to do low-or no-cost service once a month," she said. Volunteers, donations All three clinics survive on a mix of volunteer hours, donations from local people, grants and support from community agencies. *United Good Neighbors, local churches and individuals keep JC MASH afloat, while fundraisers, private donors and Olympic Medical Center support VIMO. At Sequim's free clinic, donations can appear in a variety of ways. "At Christmastime, someone left two $100 bills in an envelope with a note that said 'Thank you," said Pam Leonard-Ray, executive director of the Dungeness Valley Health &Wellness Clinic. Even the most impoverished manage to give something, Gibbs added. "I've had patients come back in a couple of months later," she said, with contributions of$2 to $300. "When you work because you have a passion to take care of people, the work is less hard," Sequim's Tulin added. Like him, Gibbs is a veteran of large hospitals and has found that running this clinic is what her profession is all about. "I came from the bureaucracy and the politics," she said. Devoting time to people, not insurance billing, "is why I went into nursing." Features Editor Diane Urbani de la Paz can be reached at 360-452-2345, ext. 5062, or at diane.urbani(a�peninsuladailynews.com. Last modified: February 28.2015 11:22PM MEASLES—How does your local school rank?A new look as state lists percentage of school measles exemptions ilk By James Casey, Peninsula Daily News, March 1st, 2015 PORT ANGELES — Eighty-nine percent of students in Port Angeles schools have complete immunity to measles, whooping cough and other communicable diseases, according to the state Department of Health. That drops to 56 percent in Port Townsend School District, the department's figures compiled for June 2014 say. Furthermore, school districts' figures don't"add u "when you subtract students who have been exempted 9 pp from vaccinations from each district's total students to get the number of students who have complete immunity. For instance, Port Angeles listed 3,594 total students, of whom 3,211 had complete immunizations, a difference of 383. But the district lists only 249 students as having exemptions, which seems to leave 134 students incompletely immunized or unreported. Port Townsend's numbers are even further out of whack: Of 1,253 students, 701 were exempt for 2014, but only 196 claimed personal, medical or religious exemptions, an apparent anomaly of 505 students. No enforcement State Department of Health officials blame the discrepancy on a law that, although it requires schools to report immunizations and exemptions, has no enforcement provision. ak The "missing" number may reflect students listed as "conditional"—working toward complete immunization and students who are "what we call out of compliance," said Paul Throne of the Department of Health. These are students who furnished their schools with neither certificates of immunization nor proper claims of exemption, said Throne, manager for health promotion and communication in the office of immunization. Although measles outbreaks in Port Angeles and elsewhere have attracted lots of attention, only seven cases had been confirmed in the state as of Friday. That compares with 32 students statewide in 2014, Throne said, although the "measles season" usually runs from March through July. Seventh in state A Whatcom County man was the seventh person in the state to get the measles this year, Health Department spokesman Donn Moyer said. The man was exposed while visiting a contagious relative in California. Six other people in the state have contracted measles this year: four people in Clallam County and two in Grays Harbor County. The Centers for Disease Control and Prevention reported that more than 150 people across the United States have gotten measles this year. Amk The measles outbreaks have had a positive side, Throne said, in that they have produced "a groundswell of support for making it more limited how many kinds of exemptions parents can have." Parents in Washington and 47 other states can claim medical or religious reasons not to have their children vaccinated. But Washington also is one of 20 states that allows a vague "personal" exemption that by far is the most popular among parents seeking to avoid their children's getting shots. 1111A bill co-sponsored by 24th District state Rep. Steve Tharinger would eliminate the "personal" or "philosophical" exemption. It has made its way from the Legislature's state Health Care Committee and to the House Rules Committee as of Friday, Tharinger said. Measles is not the only ailment that once was common among schoolchildren but thought to be almost extinct in recent years thanks to widespread required immunizations. Other immunizations Students also can be immunized against diphtheria, pertussis (whooping cough), mumps, rubella (German measles), tetanus (lockjaw), varicella (chickenpox), hepatitis B and polio. While exemption rates vary from district to district, they are highest for the MMR vaccine, which protects against measles, mumps and rubella; for hepatitis B; and for polio. School districts Here are breakdowns of North Olympic Peninsula school districts with their total enrollments, numbers of completely immunized students and exemptions. For details, including percentages of exemptions by type, visit http://tinyurl.com/PDN-www-doh- immunizations. .■ Brinnon: 35 students, 22 completely immunized, three exempt. • Cape Flattery: 117 students, 101 completely immunized, eight exempt. • Chimacum: 1,168 students, 845 completely immunized, 177 exempt. • Crescent: 223 students, 177 completely immunized, 26 exempt. • Lake Quinault: 163 students, 147 completely immunized, four exempt. • Port Angeles: 3,594 students, 3,211 completely immunized, 249 exempt. ■ Port Townsend: 1,253 students, 701 completely immunized, 196 exempt. • Queets-Clearwater: 22 students, 14 completely immunized, zero exempt. • Quilcene: 205 students, 199 completely immunized, six exempt. • Quillayute Valley: 1,171 students, 943 completely immunized, 19 exempt. • Sequim: 2,865 students, 2,380 completely immunized, 270 exempt. • Tahola: 183 students, 176 completely immunized, one exempt. •Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey�a peninsuladailynews.com Last modified: February 28.2015 11:18PM MEASLES— Peninsula health officials emphasize importance of vaccination against measles; new dates, times for no-cost shots Ai By Peninsula Daily News staff, March 1st, 2015 Vaccination against measles remains important even though February's outbreak on the North Olympic Peninsula doesn't appear to have extended into March. No new cases have been reported on the Peninsula since four people were diagnosed with measles in February. They started with a 52-year-old Port Angeles man who was hospitalized with measles Feb. 1 at Olympic Medical Center. That man apparently infected the second case, a 5-year-old girl who was exposed when she was in a room within two hours of him. A 43-year-old friend of the man's came down with the disease, and the 5-year-old's brother, who is 14, also was diagnosed. Both the 43-year-old and the teen were in quarantine during the time they were infectious and so did not expose others, health officials said. Danger until April 6 The danger of infection from this "chain" of cases will remain until April 6, said Iva Burks, Clallam County Health and Human Services director. It's also possible that infection could come from other sources. A usual "measles season" typically runs into summer, according to the federal Centers for Disease Control and •Prevention. "We're not in the clear yet," Burks said. Clinics available In Port Angeles, no-cost measles vaccinations will be offered from 11 a.m. to 7 p.m. Thursday at the Health and Human Services public health clinic, 111 E. Third St. "We're concerned about people who cannot get off work to get a shot," Burks said of the clinic's extended hours. Vaccine also will be supplied to Volunteers in Medicine of the Olympics personnel, who will immunize people at Project Homeless Connect on Saturday at the Vern Burton Community Center, 308 E. Fourth St. Another immunization clinic is planned from 9 a.m. to noon in the Pirate Union Building at Peninsula College, 1502 E. Lauridsen Blvd. The no-cost vaccinations waive the price of the vaccine, the fee for giving the shots and the administration charge. Combined, they make a $110 immunization available for free. In Port Townsend, clinics are at the Jefferson County Public Health Clinic at 615 Sheridan St. and Jefferson Healthcare hospital's walk-in clinic at 934 Sheridan St. The county clinic operates from 1 p.m. to 4 p.m. Tuesdays and Thursdays and offers the MMR vaccine on a walk-in basis. Jefferson Healthcare's clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations aren't available *for walk-ins. People must schedule them by calling 360-379-8031. The vaccine is free at both clinics. The hospital clinic charges an administrative fee billable to insurance. Last modified: February 28.2015 11:1 ppp.p..------- Washington flu season—most deadly in years—is slowing down, but is not over By Donna Gordon Blankinship, The Associated Press, Peninsula Daily News, March 2nd, 2015 4t. AA as Paul Swenson,director of the Seattle-King County Department of Public Health's laboratory,prepares to use a fluorescence microscope to view a slide of cells that have been exposed to the flu virus.—The Associated Press SEATTLE —The deadliest flu season in Washington state in at least five years is winding down, but it's not yet over. State health officials said state labs have confirmed at least 120 flu deaths since the season started in September, but only a fraction of those who die from the flu are tested for the virus. "We know the total is much higher than that," said Donn Moyer, spokesman for the Washington Department of Health. Flu death numbers are underreported because influenza may not be listed as a cause of death, testing may not have been performed and some test results may not have been reported to public health officials. •Clallam County had seen five influenza-related deaths as of late last month, which was the most recent statistic available Sunday. All of those were elderly patients who had other medical conditions that contributed to their deaths. Jefferson County had one flu-associated death. Last year's full season left 79 people dead statewide, according to lab reports. Confirmed deaths from the previous three seasons totaled 54, 18 and 36. The state did not track flu deaths in the same way before 2010, but 60 would be a more typical number of confirmed flu deaths in Washington, Moyer said. The flu was at its highest level in late January-early February in Washington state. It peaked nationally on New Year's Day. The state does not track how many people get the flu, because it is so common. Moyer said it's not clear whether more people died because this was an especially widespread flu season or because the strain was especially virulent. "Flu season appears to have peaked, though there's still considerable flu out there," Moyer said. ,There are still people hospitalized with the flu in Washington state and more deaths are likely, he added. Students at Washington State University kicked off the flu season with a rush of diagnosed cases in late September, but flu cases since the new year have been lower than expected on campus, according to Dr. Dennis Garcia, medical director at the WSU Health and Wellness Services. Garcia credited an increase in student vaccinations — 300 more than usual —for cutting the season •short. Officials with the Centers for Disease Control and Prevention predicted this would be a tough flu season and they were correct, in part because the flu vaccine wasn't working very well against the strain that made the most people sick this season. Overall the flu vaccine was only 23 percent effective this year, according to the CDC. Flu vaccines are 50 to 60 percent effective in their most useful seasons. The most common strain this year was a mutation of the H3N2 strain. Seasons when H3N2 viruses are most common tend to be the most severe, with higher numbers of hospitalizations and deaths, according to Michelle Harper, health educator with the Washington Department of Health. Most of the deaths in Washington and across the nation have been in older people with underlying health problems, but one previously healthy child has died in Washington this flu season, as well as two healthy people in the 30-to-40-year range. At least 26 flu deaths have been reported in King County. But the county likely saw closer to 200 flu deaths, including unreported cases, estimated Dr. Jeff Duchin, interim health officer for Public Health-Seattle & King County. eDuchin called it a moderately severe season, but added that it's the most deadly in the past five years, with more outbreaks than usual in long-term care facilities. "Influenza is still out there, but we're clearly past the peak," Duchin said. Duchin, who was at the CDC in Atlanta this past week, said next year's vaccine will likely be more effective since it will include the mutated strain that was not well covered this year and strains of the vaccine usually hang around for a few years. However, he said, "There is a bit of unpredictability in the influenza business." Last modified: March 01. 2015 7:32PM • Marijuana and the teenage brain Port Townsend Leader, March 4, 2015 The public is invited to attend "Marijuana: Then and Now," a presentation that considers the neurological impact of marijuana on the developing teenage brain; 6-8 p.m., Monday, March 9 in the Chimacum High School library. The talk covers the difference between marijuana today and in the past, and describes the process and impact of new delivery systems such as vaping and edibles, according to a press release from Jefferson County Public Health. Speaker Scott McCarty, Ph.D., discusses recent changes in law and policies, and explains the health implications of marijuana for youth. McCarty works with the Washington State Department of Social and Health Services, division of behavioral health and recovery. He is the division lead on the subject of marijuana and the implementation of 1-502. "[McCarty] has the great ability to intertwine scientific facts with real world • application in a lighthearted and engaging style," said Julia Danskin, a supervisor at Jefferson County Public Health. The event is arranged by the Chimacum Prevention Coalition. For further information, visit tinyurl.com/leakc45 and tinyurl.com/puy4kv7. f 1111. Jefferson Healthcare commissioners urged to offer abortion services following ACLU letter By Charlie Bermant, Peninsula Daily News, March 6th, 2015 • r g t Charlie Bermant/Peninsula Daily News Christel Hildebrandt, left,and Megan Hudson appeared at the Jefferson Healthcare Board of Commissioners meeting Wednesday to request the hospital provide abortion services. PORT TOWNSEND — Jefferson Healthcare hospital commissioners were told at a meeting this week that the hospital should provide abortion services. "If you can have your tubes tied here at the hospital, you should also have access to other reproductive health care," Christel Hildebrandt of Port Townsend said at a hospital board meeting Wednesday. The Seattle office of the American Civil Liberties Union accused the East Jefferson County hospital of being out of compliance with state law in its provision of abortion services in a Feb. 18 letter addressed to the hospital board and CEO Mike Glenn. The letter asks that the hospital change its policies and practices "to fulfill its obligations under the Reproductive Privacy Act." Hildebrandt was one of three people, accompanied by two others who remained silent, who spoke up to convince the hospital to offer or facilitate abortions. "There is no policy that precludes abortion services being provided," Glenn said in response. "I'm told that from time to time, the staff has reviewed the issue and have chosen to only provide the care that we can offer in an efficient, compassionate, best-practices manner," he added. Since receiving the ACLU letter, Glenn has been developing a written response, "which could be ready in a few days," according to Kate Burke, the hospital's marketing director. The ACLU also sent letters of concern to Whidbey General Hospital in Coupeville and Mason General Hospital in Shelton. At the same time, it filed a lawsuit against Skagit Valley Hospital alleging noncompliance with state law because it routinely refers patients to Planned Parenthood or other private clinics, rather than providing abortions on-site. Leah Rutman, ACLU's policy counsel, who wrote the letter, said the ACLU is examining the policies of all public hospitals in the state. goNeither Olympic Medical Center nor Forks Community Hospital —the other two hospitals on the North Olympic Peninsula — received letters from the ACLU like that sent to Jefferson Healthcare. In the letter to Jefferson Healthcare, the ACLU cites an August 2013 state attorney general opinion. The opinion says state law requires a public hospital that provides maternity care service or information to also provide "substantially equivalent benefits, services or information" regarding contraception and abortion. "We express no opinion on exactly how hospital districts may comply with this requirement," the attorney general's opinion says. The ACLU is disputing the idea that referring patients off-site for abortions is substantially equivalent to the maternity care the hospital offers. Jefferson Healthcare officials have stated that the low number of annual abortions— 55 in 2013 — makes it difficult for abortion providers to establish a presence in the county in an efficient, cost-effective way. According to the state Department of Health's statistics for 2013, Jefferson County has the second highest per capita rate of abortions in the state, reporting 15.5 out of 1,000 women in childbearing age between 14 and 44 opting for the procedure. The highest rate was Pierce County, with 16.8 per 1,000, or 2,794 abortions. Clallam County, with an 11.8-per-1,000 rate and 121 abortions, came in 11th. In Jefferson County, abortion referrals —which are up to the individual medical provider— are made for clinics in Port Angeles, Bremerton and Seattle, according to Julia Danskin, a nurse with the Jefferson County Department of Public Health. Ali Dr. Joseph Mattern, Jefferson Healthcare chief medical officer, has said this referral process best serves Vir the patients who need the service. During the public comment period, Debbie Jahnke said the process discriminates against low-income women. "When you require people to leave town multiple times for a medical abortion or a surgical abortion, you are limiting their access," she said. "Poor women are the least able to do this, so it's a matter of equal treatment, and I think you need to reconsider this." Those who asked for abortion services at the hospital plan to conduct a strategy meeting to discuss their next steps next week. The meeting will be at 5:30 p.m. Thursday at Manresa Castle, 651 Cleveland St., Port Townsend. Hildebrandt said the strategy meeting is for people to discuss how best to address access to reproductive health care services with the hospital commissioners. The public is invited, and hospital commissioners are welcome to attend, she said. The meeting will work toward presenting a unified voice at the next commissioners meeting at 3:30 p.m. March 25 in the hospital auditorium, 834 Sheridan St., she said. • Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant(cr7peninsuladailynews.com. Last modified: March 05.2015 7:50PM • Child has fever, itch— but it's from the vaccine, not the measles By Leah Leach, Peninsula Daily News, March 10th2015 • PORT ANGELES —A Clallam County preschooler with a rash suffered an adverse reaction to the measles vaccine but did not have the disease, public health authorities said Monday. The case was a possible fifth case of measles on the North Olympic Peninsula. Samples sent to the state laboratory last week from Jefferson County also tested negative for measles, said Lisa McKenzie, communicable disease program coordinator for the county public health department, on Monday. No cases have been confirmed in Jefferson County. No measles cases have been confirmed on the North Olympic Peninsula since the last week of February, when the fourth case was diagnosed. The child who suffered a reaction to the vaccine itched and had a fever for two to three days, but had not caught measles. That meant the preschooler was not contagious, according to Dr. Jeanette Stehr-Green, Clallam County public health officer. The child also was not liable to the complications that measles, rarely, can cause, she said. The Clallam County Department of Health and Human Services received test results Monday from the Centers for Disease Control and Prevention in Atlanta, Ga., that showed that the child's rash was a *reaction to receiving the measles vaccine. About one in 20 — 5 percent — of those who are vaccinated with the measles, mumps and rubella (MMR) vaccine develop a skin rash and fever, public health officials said. The county public health department has given 458 vaccinations against the disease since early February through Monday, Stehr-Green said. "In addition, many local providers have vaccinated a number of children," she said. Having one averse reaction out of that number is not surprising, but "because of the recent cases of measles in our community, we had to treat this rash as if it were a case," until a test proved otherwise, said Iva Burks, director of the public health department. "The possibility of a mild reaction should not discourage people from getting vaccinated," Stehr-Green said. "The benefits of vaccination for both the individual and the community substantially outweigh the occasional reaction to the vaccine," she added. Measles usually means that the sufferer stays home, very ill, for at least a week and then recovers and is therafter immune to the disease. But in rare cases, measles can cause complications. 5One in 20 with measles develop pneumonia, and one in 1,000 get encephalitis, a swelling of the brain. Of the latter, one to three people die, Stehr-Green said. Health officials remain on alert for more cases. The two most recent cases of measles in the county were identified before they were contagious and stayed home to reduce the chance of exposure of unvaccinated persons. III However, "we're being cautious and so we're on alert for additional cases," Stehr-Green said. If no more cases are confirmed, "we'll be in the clear on April 6th," she added. Measles is highly contagious and spread through the air. It can be caught just by walking into a room where someone with the disease has been in the last couple of hours. Seven cases have been confirmed in Washington state. Two were in Grays Harbor County and one in Whatcom County. The CDC says that from Jan. 1 to last Friday, 173 people from 17 states and the District of Columbia were reported to have measles. No-cost vaccinations clinics for both children and adults are avialable in Clallam County. They are offered for children only in Jefferson County. An immunization clinic is set from 9 a.m. to noon today in Room J-47 at Peninsula College, 1502 E. Lauridsen Blvd., Port Angeles. Another clinic is set from 1 p.m. to 7 p.m. Thursday at Health and Human Services' Public Health Section, 111 E. Third St., Port Angeles. Call 360-417-2274 for an appointment. Walk-ins will be seen but could face a waiting time. In Port Townsend, clinics are at the Jefferson County Public Health Clinic at 615 Sheridan St. and Jefferson Healthcare hospital's primary care clinic at 915 Sheridan St. The county clinic operates from 1 p.m. to 4 p.m. Tuesdays and Thursdays and offers the MMR vaccine on a walk-in basis. Jefferson Healthcare's clinic is open from 8 a.m. to 5 p.m. Mondays through Fridays. Vaccinations aren't available for walk-ins. People must schedule them by calling 360-379-8031. The vaccine is free to children, but both the public health and hospital clinic charge an administrative fee billable to insurance. The fee is on a sliding scale. Vaccine for children is purchased by the state while the county buys vaccine for adults in Jefferson County. Vaccine for adults is billed to insurance. For more Clallam County information, see http://tinyurl com/PDN-measlesalerts. For more in Jefferson County, see www.jeffersoncountypublichealth.orq. Last modified: March 09. 2015 7:17PM • • More discussion is (The Leader asked Jefferson County health officer Dr. Tom needed on vaccines Locke to respond: "Ms. Huenke is entitled to her I am aware that our health de own opinion but not her own set partment does not conduct test- of facts. I have reviewed the'One ing. Neither does the FDA. Dr. More Girl' website and it fails to Tom Locke's statement that "the provide evidence for the claims it FDA evaluates and licenses vac- asserts. It is perilous for a scien- proving safety and efficacy as it is cines after extensive testing" is tist to debate a pseudoscientist -- for:proving injury,vaccines might very misleading. well o away. one sticks to the facts, the other Watch this video interview In 1986, Ronald Reagan believes that passionately held with HPV expert Dr.Diane Harp signed the National Injury Coin- er, beliefs have equivalent validity wherein she reiterates what pensation Program, which took to fact. Ultimately, it is up to Dr.Locke insists she"disavowed": each individual to decide where the drug manufacturers and phy- onemoregirlmovie.com. to get credible evidence about The "tin foil hat" pejorative sicians off the hook for vaccine in- vaccine safety and effectiveness. is reserved for those who legiti_ jury. Taxpayers were put on that But be forewarned, the microbes hook in theirplace. Where is the mately question the safety of vac- that cause communicable dis- cines. Yeo le who wonder if the incentive for manufacturers to p y eases don't really care what you ensure safety and efficacy? do more harm than good are justbelieve. They are engaged in an as concerned about children's Merck is in the news once ancient evolutionary battle — if health as those who have faith in again. cued by their own virolo- they find a susceptible host,they vaccines. Ridicule is a poor sub- gists for falsifying data on the will exploit their advantage and stitute for constructive dialogue MMR vaccine (Truth-Out.org, cause infection.Most victims will and rigorous examination. 212). Research the history of survive, but some will not. Vac- Vioxx and the criminal charges cines allow us to dramatically Merck pled guilty to.Tell me.why change these odds, offering both we should trust them. Monetary 411111 settlements typically include gag community protec- tion.personal lPseanan d sc ocomm based beliefs orders that prohibit victims from offer no such protection.") discussing the lawsuit. Search "FDA whistleblower Graham" and "CDC whistleblow- er Thompson." Read the stories, pay attention to the threats and intimidation I)r. Graham en- dured. Examine how the news sources you trust (e.g, the [New York Times, Wall Street Jour- nal]) covered those events. Be curious, think critically, do your own research. F'ollow the money. ANNETTE HUENKE Port Townsend • • • / �QGr Septic system classes offered in March • Port Townsend Leader, Wednesday, March 11, 2015 Taking care of your septic system not only saves money, but is also an integral part of protecting public health and water resources. Jefferson County Public Health offers free classes to homeowners that cover septic system operation, maintenance and inspection. Homeowners who want to make their own monitoring inspections need to complete two training courses: Septics 101 and 201 . Septics 101 covers the basics of septic system operation and maintenance. Topics covered include operation, maintenance, landscaping, garbage disposal and the impact of a working or failing system has on drinking, ground and surface water. Septics 201 covers step-by-step inspection of the septic system and reporting the results. Both courses are offered back-to-back on the following dates and times. Thursday, March 26, 5-9 p.m., Tri-Area Community Center, 10 W. Valley Road, Chimacum •Friday, March 27, 9 a.m.-1 p.m., Tri-Area Community Center, Chimacum Tuesday, April 7, 9 a.m.-1 p.m., Quilcene Community Center, 294952 Hwy. 101 , Quilcene. Registration is required, and space is limited. Contact 385-9407 to sign up. (See a class advertisement on page B 10 of this Leader issue.) After completing the classes, homeowners may be able to complete required septic system monitoring inspections at a more reasonable cost. All training courses for the program are offered free of charge to attendees. Many resources about caring for a septic system are available for homeowners at jeffersoncountypublichealth.orq. Reproductive services policy spurs public meeting March 12 in PT • By Patrick J. Sullivan of the Port Townsend Leader, Wednesday, March 11, 2015 A strategy meeting to discuss Jefferson Healthcare and the public hospital district's stance on reproductive services has been set for 5:30 p.m. Thursday, March 12 at Manresa Castle, across Eighth Street from the hospital campus. The March 12 gathering is open to the public. Childcare will be provided at the venue, according to Christel Hildebrandt of Port Townsend, event organizer. Hildebrandt said she hopes medical professionals, community activists and any groups or individuals "who are concerned with equal access to healthcare and women's reproductive rights will attend."A representative of the American Civil Liberties Union (ACLU) may also attend. Jefferson County had the second-highest abortion rate of any county in the state per 1,000 women in 2013 — but the 55 women who had abortions that year did not go to Jefferson Healthcare. The public hospital system here does not offer abortions, and that's an issue for the ACLU. Jefferson Healthcare officials are in the process of responding to an ACLU letter dated Feb. 18 that challenges the local public health care system's failure to offer abortions. In that letter, ACLU policy council official Leah Rutman asks Jefferson Healthcare to "change its policies and practices to fulfill its obligations" with the 1991 Reproductive Privacy Act (RPA). An ACLU representative said that if a hospital district provides maternity care benefits, services or information, it must also provide abortion services. •Jefferson Healthcare officials say they do not have a policy against abortion services; they provide referrals regarding voluntary termination of pregnancy. Hildebrandt said the March 12 meeting will be used to discuss the ACLU letter and lawsuit pending in Skagit County, the state attorney general's clarification on state law and current Jefferson Healthcare policy. "We will draft a statement to the Jefferson Healthcare Board of Commissioners requesting full and equitable women's healthcare services on site," Hildebrandt said. "We will also choose a spokesperson to deliver the statement to the board for its March 25 meeting. We will discuss additional strategies for persuading Jefferson Healthcare to begin providing elective termination services." The Jefferson Healthcare commissioners conducted an executive session at the board's March 4 meeting to discuss the issues raised by ACLU. The executive session discussion did not result in any board action. (Leader Staff Writer Allison Arthur contributed to this story.) • 1 Policy of exclusion is not 'No Policy' regarding reproductive services • by Debbie Jahnke By the age of 45, 3 in 10 American women will have had an abortion (Guttmacher Institute, link below). Think of all the women you know and ponder which 30% are included. It must be among the least- acknowledged common medical procedures. A majority of women seeking abortions, 61%, already have at least one child, and 34% have at least two children. Religious affiliation of women in the study is reported as 37% Protestant and 29% Catholic. Our Jefferson Healthcare CEO states that our publicly funded hospital has no policy against abortion. But having 'no policy'is merely semantic. If we routinely send women out of county when they seek a legal procedure, we have established a de facto policy not to provide that procedure. That is not 'no policy', that is a policy of exclusion, whether inadvertent or by design. The hospital's 'Women's Health Services'page (link below) on their website declares, "We provide female medicine for patients from adolescence through menopause and beyond."It lists specialized services... "which include contraceptive care" ... "and minor surgical services offered by our OB/GYN physician include tubal sterilization and hysterscopic D & C for intrauterine fibroid and polyp removal". When I was a young person, 'D & C'was often a euphemism for what a woman had done when it was illegal to have an abortion but she was able to find a doctor who would treat certain 'female problems'. The Washington State Attorney General's 2013-3 opinion (link below) states that if a public facility provides, directly or by contract, maternity care benefits, services or information, it shall also provide substantially equivalent benefits, services or information to permit voluntary pregnancy termination. That leads to another question about the list of 'Women's Health Services'. Our publicly funded hospital Mir provides 'referrals for specialized services'but the only other 'continuation of care'facility listed is the Swedish health care system 'for those women needing specific expertise'. But Swedish, now run by Providence and affiliated with the Catholic Church, does not do abortions. There is no mention in this 'Women's Health Services'webpage of where a woman is referred to for a medical or surgical abortion, or even for 'morning after'emergency contraception. Our public hospital is now affiliated with Swedish and therefore affiliated with Providence. Is that relationship responsible for this 'no-policy'policy of exclusion? In the hospital's 2011 newsletter, it declared: 'Partnering, Not Purchasing: Rest assured that Jefferson Healthcare will remain an independent, locally owned and controlled hospital- the affiliation with Swedish is not a "buyout."'(link below). Using National Survey of Family Growth Data from the Centers for Disease Control, the authors of a February 2015 Brookings Institute study found that rates of sexual activity were equivalent across income groups. They calculated that women living at or below the federal poverty level ($11,200 per year) and not actively trying to conceive are twice as likely not to use contraception as their wealthier counterparts (those at four times or more above the poverty level, over $44,700 per year). Poor women not trying to conceive are also three times more likely to get pregnant than their higher income counterparts (9% compared to 3%), and ultimately 5 times more likely to give birth. In addition, abortion rates among the poor are lower, with 32% in the highest income bracket having an abortion compared to 9% of low-income terminations. (Brookings Economic Study Press Release, February 2015, link below). Contraception is not perfect. It is also expensive, especially when you live near the poverty line. Abortion is also expensive. And those women least likely to have immediate access to the financial resources necessary are those who end up more often carrying to term. The median time reported by Finer et al. in 2006 (link below) for a woman to suspect pregnancy was 33 days from last period. Median time from that suspicion until a medical or surgical abortion added another two weeks, often because of time needed to e 'make arrangements', including to come up with funds. Then add on the time needed to arrange at least two rounds of transportation to a clinic an hour or more away by car and likely inaccessible by public transit. It is a race against the biology of gestation to get an early abortion. • First trimester abortions have clear public support in our state. The longer a resolution is delayed, the more problematic it becomes. Abortion is a difficult choice at any time. But it is not one that should be influenced or restricted by financial status (Brookings Economic Study Press Release, February 2015). To minimize income biases, all legally required women's health care services should be explicitly provided locally. Let's stop dancing around the truth. a few links: Guttmacher Institute: httpi!www.quttmacher.orq/sections/abortion.php Jefferson Healthcare Women's Health Services: http.//wwwjeffersonhealthcare org/health services/womens health services.aspx Attorney General's Opinion 2013 no. 3: http://www.atq_wa.gov/ago-opinions/whether-public-hospital,, district-violates-rcw-902-if-it-contracts-.rovider-health-care Jefferson Healthcare Fall 2011 newsletter: http:/iwww jeffersonhealthcare.orq/sitesiwww/Uploads/Jefferson%20Heaithcare/Overviewlfa112011.pdf Brookings Institute: http://www.brookings.edu/research/papers/2015/02/26-class-gaps-in-unintended- childbearing-reeves Finer et al: http://www.guttmacher.orq/dubs/2006/10/17/Contraception74-4-334 Finer.pdf ACLU Washington: https://aciu-wa.orgibloq/reproductivefreedom-fundamental-right-choose-or-refuse- abortion This content was contributed by a user of the site. 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