Loading...
HomeMy WebLinkAbout2015- June • 89£86 `puasumoi pod is uuplaagS S 19 u;InaH o![gnd Xiunoj uosJadda f aid 0£:17—0£-Z SIN '91 1cInf : uiiaayAt palnpagos ixaN XI :aupualu0 21.1iuueld upuo0V IIIA sivatuwoJ o!Ignd •IIA aiupoll iCi!n!iod 'IA pauog Lios!npd asngy aouu;sgns and uo!iuotlddd •L aiupdn uoISsas anlielst5a' •9 ivauquatJ°sopaan0 uloaaH E su auoxoluN of ssaood uo aiupdn •S apo0 ivatuaoaodug Itnc0 gi[uaH ollgnd kiuno0 uosaadda f'Up uo!idopuag :uotssnosiu'iollod •i aisuM P!10S puu `saoinaaS giluaH IuoluT0 paiaaauJ `giivaH pI!ti0 luuaaiu'J :saansuoJAJ aouutuaodaad tiOZ •£ aiupdn aad giluaH Iuivatuuoalnug—2u!auaH o!Ignd Z II/ uutuktialAt ging—uo!iu!oaaddddo aiuogliaa0 •I ssau!sng '' 1 •A /13IV(A03-S2iaw)snalnuuoao0 auzoapuits Xaoivaldsox isug aIPp!IAI •j7 aa5uuuJAJ 41unO aaiuJ paiuloddy uosmuQ laego J •£ uiuQ ivaljJ 5u!uuuid/ cured 1CiunoD uosaaddaf uo iaodaj gi[uaHJO •idOQ •Z aiupdn slssniaad aims uoi,3u!gsEM •I small Iuuoliutuaodul puu ssaulsng PIO 'AI ivaunuo0 ollgnd •if[ S i OZ 'TZ/cuyAI do u!iaayAt gi[uaH do pauog do sainum do lunoaddd •II upuaddo lunoaddd I Laid 0£:f—0£:Z VM 'puasunto,L pod unglat.IS ST9 u;InaH ailand Liuno3 uosaajpar Mt`81 aunf dO 1111V011 AINI1O3 MOS2Ia Wr • JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, May 21, 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,Health Officer David Sullivan,County Commissioner,District#2 Jean Baldwin,Public Health Dir Kathleen Kler,Vice-Chair County Commissioner,District#3 Julia Danskin,Public Health Manager Kris Nelson,Port Townsend City Council Jared Keefer,Env.Health Dir Sheila Westerman,Chair,Citizen at large Veronica Shaw,Public Health Deputy Dir Jill Buhler,Hospital Commissioner,District#2 Vice-Chair Kler called the May 21, 2015 meeting of the Jefferson County Board of Health to order at 2:33 p.m. A quorum was present. Members Present: David Sullivan, Kathleen Kler, Phil Johnson, Kris Nelson Members Excused: Sheila Westerman, Jill Buhler, Staff Present: Torn Locke, Jean Baldwin, Jared Keefer, Julia Danskin, Philip Morley • APPROVAL OF AGENDA Vice-Chair Kler asked that item 4 move to item 1 in New Business. Vice-Chair Kler asked for approval of the May 21, 2015 Agenda. Member Nelson moved to approve the agenda; the motion was seconded by Member Sullivan. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Vice-Chair Kler called for approval of the minutes of the March 19, 2015 meeting of the Board of Health. Member Nelson moved to approve the minutes as presented; the motion was seconded by Member Sullivan. No further discussion. The motion passed unanimously. PUBLIC COMMENT Peter Lawrenson requested an update on the paper mill taking financial responsibility for the landfill. Jared Keefer, Environmental Health Director, JCPH, informed Mr. Lawrenson that the closure cost estimates and financial assurance agreements are nearing completion. Once they come to an agreement,they send the documents to the Department of Ecology for final review. • Mr. Keefer said that this process is still ongoing but proceeding appropriately, and that the change in ownership has not affected this issue—the mill is fully responsible for all closure costs under its current permit. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Public Health Outstanding Food Safety Awards Mr. Keefer announced the recipients of the 2014 Public Health Outstanding Food Safety Awards and presented certificates to those in attendance. The 2014 winners are: Belmont Catering, Blue Heron Middle School, Brinnon School District, Cedarbrook School, Chimacum Primary School, Chimacum Elementary School, Chimacum Middle School, Chimacum High School, Ferino's Pizzeria, Food Co-op Grocery, Inn at Port Ludlow Catering, Jefferson County Horse Project 4H, Jefferson County Jail,Jefferson Mental Health, Lanza's, Lively Olive Tasting Bar, Port Townsend Senior Nutrition, Port Townsend High School Cafeteria, QFC#106 Deli - Port Townsend, Queets Clearwater Elementary School, Quilcene School Cafeteria, and Timberhouse Restaurare 2. Update on PSP Closures, Sewage Spills, Beach Closures, and Lake Algae Levels Dr. Tom Locke, Health Officer, JCPH, reviewed the recent press releases issued by JCPH • Environmental Health that identify shellfish/beach closures and sewage spills within Jefferson County. Dr. Locke spoke about the increase of these incidents, both man-made and naturally occurring. The Board discussed at length issues with toxins in the water, and Dr. Locke reviewed the risks involved to the public. Dr. Locke informed the Board that the results from sampling that took place after the Port Ludlow Bay sewage spill are pending. He assured the Board that when the results do arrive, they will give JCPH valuable information to guide the duration of future closures, should they be necessary. Vice-Chair Kler informed the Board that she attended a presentation hosted by JCPH and given by Clara Hard of the Washington State Department of Health. Information from that presentation is on the JCPH website. NEW BUSINESS 1. 2014 Community Health Performance Measures: Prevention Julia Danskin, Public Health Manager, JCPH, presented the 2014 Population and Prevention Program Performance Measures to the Board. Additionally, Ms. Danskin provided the Board with a Community Health Department budget, broken out by category, as well as a Local Public Health System Annual Report to the Legislature by the Washington State Association of Public Health Officials. Items in the budget and performance measures Ms. Danskin highlighted include: The Population and Prevention section of the budget includes healthy community dollars. JCPH pays the County for rent • and I.T. services, but this money is included in the overall budget and skews the numbers. Jefferson County • Public Health Agenda Minutes t, Olson Public Health June 18, 2015 Family Planning and WIC programs get state and federal dollars and JCPH provides this • service in-house. JCPH is in negotiations for the school nursing program. Marijuana funding might have too many contingencies so they are not counting on this as a revenue source in the near future. Karen Obermeyer, Health Educator, JCPH, is looking at the City and County Comprehensive plan to make sure health is represented (walkable communities, bike routes, healthy nutrition, etc.). Ms. Danskin will present Targeted Clinical Health Services to the Board at the upcoming meeting in June. 2. 2014 Communicable Disease Performance Measures and 2015 Updates for Gonorrhea and Pertussis Cases Lisa McKenzie, Public Health Nurse, JCPH,presented the 2014 Performance Measures for the Communicable Disease (CD) Program to the Board. Additionally, Ms. McKenzie provided the Board with an update on the 2015 Gonorrhea and Pertussis numbers for Jefferson County. Items Ms. McKenzie highlighted include: 180 CD reports confirmed (which accounts for a Gonorrhea outbreak in the last half of 2013, and an increase in Chlamydia and Chronic Hepatitis C. Outreach and testing for Gonorrhea have increased); an increase in Provider Alerts in 2014 (23 total), which increased due to Ebola planning, screening, and infection control. Ms. McKenzie informed the Board that completeness of the full immunization series for children seeing Jefferson County providers continues to increase each year and is equal to the state number (56%total, 61% for DTaP, Hep-B, HIB, MMR and Polio). JCPH Family Planning and STD clinics follow the CDC • screening recommendations for women who are at a high-risk for Chlamydia and screening volumes increased from 60.4% in 2013 to 63.4% in 2014, and are above the national and state screening numbers. HIV Screening numbers are also up from previous years because free testing is more accessible and testing is now universal and not risk- based. Ms. McKenzie provided the Board with a recent press release issued by JCPH that details a Pertussis (Whooping Cough) outbreak in Jefferson County. She informed the Board that the most current numbers for Pertussis are 19 confirmed cases, and 6 suspect. 3. 2014 Syringe Exchange Annual Report and CDC Health Advisory Re: Syringe Exchange Program Ms. McKenzie presented the Jefferson County Syringe Exchange Program (SEP) 2014 Annual Report to the Board. Ms. McKenzie explained that Syringe Exchange Utilization in Jefferson County has increased substantially (185 clinic visits and 24,596 syringes exchanged in 2013, 350 clinic visits and 42,809 visits in 2014), and explained part of this increase is that JCPH has an increase in males aged 30+, females, and new clients who were once secondary exchange users and are now secondary exchange providers. Ms. Danskin explained to the Board that funding no longer comes from the state and pointed out in the Community Health Department budget and that$3,000 is used for supplies and that all visits are absorbed by CD staffing. The Board was provided with a CDC handout as an informational item. It shows that cities that institute a SEP early on in outbreak places have lower HIV numbers. • • 4. Application for Substance Abuse Advisory Board Ms. Danskin provided the Board with an application from Adam Marquis, Jefferson Mental Health Executive Director, to become a member of the Substance Abuse Advisory Board (SAAB). Ms. Danskin noted that she, Catherine Robinson, and Vice- Chair Kier expressed support and recommended Mr. Marquis be approved to join the SAAB. Member Sullivan motioned to approve Mr. Marquis to the Substance Abuse Advisory Board. Member Johnson seconded the motion. No further discussion. The motion passed unanimously. 5. Jefferson County Environmental Health Fee Revisions—Recommended Call for Public Hearing June 18, 2015 Mr. Keefer provided the Board with an updated Environmental Health Fee Schedule. He explained these changes in fees are to make adjustments for the hourly rate. Member Nelson motioned to hold a public hearing at the June 18, 2015 Jefferson County Board of Health meeting. Member Johnson seconded the motion. No further discussion. The motion passed unanimously. 6. Articles of Note The Board was provided the following articles: "Executive Constantine proposes strategy • to put every child in King County on path toward lifelong success," "GROW Healthy Kids & Communities, Blue Heron Middle School Bike Shelter," and"Bike to School Day, May 6, 2015." ACTIVITY UPDATE Mr. Keefer provided the Board with an update on the Drinking Water Program. He completed a data analysis that showed 37% of the monetary loss that program experiences is due to Building Permit reviews, and that the update to the Fee Schedule will help recoup that money. Additionally, 32% of the loss is unrecovered costs due to fielding questions from the public. He is looking into ways to proactively get information to the public. Mr. Keefer said that, after looking at the time and money involved in doing sanitary surveys for DOH, it doesn't make sense to stop doing them as those costs are covered, as are the costs involved in decommissioning wells, and issuing well drilling permits. Mr. Keefer will review the Solid Waste Performance Measures at the next Board meeting. PUBLIC COMMENT There was no public comment. • S AGENDA PLANNING CALENDAR Jean Baldwin, Director, JCPH, updated the Board on the progress of the Accountable Community of Health(ACH), which has been recognized by the Healthcare Authority. The three-county ACH has now hired a staff person, Peter Browning. Dr. Locke and Ms. Baldwin met with Mike Glenn, CEO of Jefferson Healthcare, and Eric Lewis, CEO of Olympic Medical Center, to discuss next steps in Washington State's health care system integration and reform efforts. Among the issues discussed were concerns that Medicaid and Medicare are the main sources of revenue for rural hospitals and these programs have been targeted for major"savings" by the State. Jefferson Healthcare will meet with Peter Browning soon. A next step identified for Jefferson County is to meet with medical providers and other stakeholders to draw them into the regional reform process. Ms. Baldwin explained to the Board that those who manage billing for services will experience the change first, so they need to be consulted. Ms. Baldwin informed the Board that the four groups from the Community Health Improvement Team will start meeting, and Board members can expect to be contacted to take leadership roles. NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, June 18, 2015 from 2:30—4:30 • p.m. at Jefferson County Public Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Vice-Chair Kler adjourned the May 21, 2015 Jefferson County Board of Health meeting at 4:04 p.m. JEFF ":41.ON G ,NTY BOARD OF HEALTH 07,/ zi) ,t/Q.. Phil o . p, ember Ji 1 Buhler, Member David ullivan, i em`- Sheila Westerman, Chair \A/1 , . ka,to.evv.Icei Kris Nelson,Member Kathleen Kler, Membe Respectfully Submitted: • Natalie Crump Board of Health • IV Old Business Item 1 Washington State Pertussis Update • Public HealtA June 18, 2015 Washington State Family PlanningØiITth e Client Data Sheet 2014 DOH 930-136,March 2015 Office of Healthy Communities (360)236-3693 Imo,: Illey Points.... The Department of Health's Family Planning Program provides access to contraceptive services, 1 An estimated 429,910 women in supplies,and information to all who want and need them.Priority is given to persons from low- Washington are in need of publicly funded, income families.In 2014,the program distributed family planning funds to 16 agencies*supporting contraceptive services and supplies.' 55 family planning centers throughout Washington. • In 2014,the program served 79,958 family *t 5 agencies received state and federal(Title X)funds;1 agency received state funds only. planning clients,nearly 19%of the state's women in need.The vast majority(87%)of clients obtained care in the county where Family Planning Centers and Clients Served,201: they live. Population groups with the greatest need \. Pend Oreille for publicly supported family planning �25<a°+► Okanogan 61 Skagit '21 Ferry St services include women under age 20, evens 2;6°5 66 453 women with low income,and women of laa•d • color? i�zsa U 0 374 • snono,nin - r 9955 • In 2014,80%of clients had an income at '"iette* °1M " 931NrtsaP 9;194" DougOas or below 138%of poverty,50%used �' ,..11 311 S'° L0'*I Medicaid coverage;32%were persons of Udn it, • 19:515 +� aa 795 color Or Cyo ` ,, N,eita• B45` P,et,t 1106 Ydnitmsm ,. Access to affordable,effective e�2liFF Adam „41a contraceptive methods is critical to preventing unintended pregnancies 2An • • Fronkiln 6. Gdoeld estimated 288 unintended pregnancies arePeale • Z°,9 6 prevented per 1,000 users of publicly f wr19k■a1 Coluni6 a 36 Attestfunded contraceptive services? Number of Clients byit •• VOW.Wal a- 290 1,000' County of Residence s9am•m• „ • In 2014,the program's contraceptive ss. 6.254 1°' tu1e9w9 services prevented nearly 19,400 255-491 • • •o+ unintended pregnancies. This translates to INN 93a-2.637 -2,636-14,516 9,700 fewer births from unintended • rimy mamma c90I4irs Out of State Clients Served=1.527 pregnancies,6,600 fewer abortions and 3,100 fewer miscarriages. Long-acting reversible contraceptives Age Females Males Total Ethnicity&Race (LARC)-intrauterine devices and : hormonal implants-are among the most 17 and 7,877 245 8,122 effective methods for preventing under 11% 5% 10% Non-Hispanic(NH) unintended pregnancy.2 American Indian/Alaska Native,NH 1,136 2% 18-19 8,829 338 9,167 ( ) • In 2014,90%of female clients used some 12% 7% 110/0 method of birth control,including 15%who Asian,NH 3,419(5%) used LARC. 20 24 22,761 1,427 24,188 Black/African American,NH 3,542(5%) Publicly funded contraceptive services 30% 30% 30% and supplies yield a net savings of$5.68 16,108 1,133 17,241 Multiple race,NH 1,743(3%) for every$1 invested.4 25.29 21% 23% 22% • Instate fiscal year 2014, Washington's Native Hawaiian/Pacific Islander,NH 704(1%) Medicaid program paid for 41,456 births at 30-34 9,626 709 10,335 s 13% 15% 13% White,NH 46,849 68 0 an average cost of$9,253. An estimated ( ) 50%of these births are unintended at 35 and 9,919 986 10,902 Hispanic,of any race 11,495(17%) conception. The annual cost for publicly older 13% 20% 14% funded contraceptive care in Washington i about$335 per person.3 Total 75,120 4,838 79,958 Unknown race and ethnicity 11,070(14%) 100% 100% 100% Public investment in family planning *Percentage based on total clients with known race/ethnicity programs also helps avoid cervical 'All percentages may not add to 100 due to rounding. cancer,HIV&other sexually transmitted References: infections,infertility,and preterm and low 1. Frost JJ,Zolna MR,Frohwirth L.Contraceptive Need and Services,2012 Update.New York,NY:Guttmacher Institute;2014. Il h weight births.When these broader 2. Washington State Department of Health.Unintended Pregnancy.Health of Washington State.Olympia,WA:Washington State Department of Health;2013. nefits are included,the return on 3. Frost JJ et al.Contraceptive Needs and Services,2010:Methodological Appendix,New York,NY:Guttmacher Institute;2013. investment increases to$7.09 for every 4. Frost JJ,Sonfield A,Zolna MR&Finer LB.Return on Investment:A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded public dollar spent' Family Planning Program.Milbank Quarterly,92:696-749;2014. 5. Washington Health Cam Authority.State of Washington pregnancy related expenditures fiscal years 1988-2014;2015. http://www.doh.wa.gov/You andYou rFam ilv/Fam it yPlan ni nq/C IientDataSheets Primary Source of Payment Family Planning Client Data Sheet, 2014 Source No. % Percent of Clients by Federal Poverty Level(FPL)* Charge 8,556 11% •g.<100%FPL) Percent Title XIX 32 887 41% 0 10 20 30 40 50 60 70 (Medicaid) FPL group Take Charge 6,945 g% 100%and below 66 (Medicaid) Private Insurance 19,725 25% 101%-138% 16 Other(including full 11,845 15% &partial self pay) Total 79,958 100% 139%-250% 12 Note:Primary source of payment is the expected source of payment at time of visit and may not above 250% represent the source that eventually paid for the visit. 11 1 Clients Receiving Selected Services Physical Examinations *Excludes 5,589(7%)clients for whom FPL status could not be determined. No. % In 2014,the federal poverty level(FPL 100%)was$11,670 annual income for a single person household. Initial and annual* 30,466 41% Breast* 13,268 18% Percent of Female Contraceptive Users by Method* Pap test* 11,402 15% 0 20 Percent 40 Method Category 60 Genitalia** 1,274 26% Combined hormonal methods(pill,patch, ring) 52. I Contraceptive Services Hormone injection* 7,700 10% 411R3-Month hormone injection C insert(IUD, IUS&hormonal implant)' 5,307 7% Long-acting reversible contraceptives(IUD, IUS,hormonal implant) Emergency contraception* 18,967 25% Barrier(sponge,condom,diaphragm) Contraceptive 54,340 68% counseling* Other specified methods(female sterilization, Pregnancy Services spermicide used alone,FAM,abstinence, male vasectomy) Pregnancy test* 38,742 52% *Includes 75,120 female contraceptive users.Excludes the 7,741 females(10%)who did not use a Preconception contraceptive method due to pregnancy or other reason. counseling* 4,358 6% Pregnancy ° Use of Long Acting Reversible Contraceptives(LARC) counseling* 3,711 5� Among Female Method Users,by Age and Year, STD/HIV Services Title X Family Planning Centers* Percent who 20 Chlamydia test*** 44,904 56% use LARC Chlamydia test- 25,673 65% 15 females ages 15-24* _ , Gonorrhea test*** 44,600 56% 10 ''f Age Groups STD treatment*** 2,614 3% —10-24 5 HIV test*** 6,900 9% 25-34 di/HIV 63,879 80% 0 35+ nseling*** 2007 2008 2009 2011 2012 2013 2014 includes female clients only *Excludes client data from non-Title X sites due to limited years of available data. **includes male clients only 1 *"includes female and male clients Page 2 of 2 —� For people with disabilities,this document is available on request in other formats. Healthy Cas To submit a request,please call 1-800-525-0127(TDD/TTY call 711). ,,,., Wei Wtoii(glts Shoe aVtittit ealth Weeklypertussis update for Washington State P 9 2015 year to date (YTD) confirmed and probable cases reported through 6/6/2015 (week 22) This update summarizes reports of pertussis in persons with 2015 onsets received by local health jurisdictions (LHJs) during weeks 1-22 made visible to Washington State Department of Health (DOH) - Communicable Disease Epidemiology, and containing sufficient information for a DOH case classification to have been assigned. • There have been a total of 707 cases reported statewide through week 22, compared to 132 reported cases in 2014 during the same time period. Dates for the 2014/2015 comparison were based on LHJ notification date. Number of Pertussis Cases Reported in Washington State by Notification Week, 2014 vs.2015 80 75 _i Additional cases may have occurred,especially in the 70 most recent 3 weeks,that to 65 are not yet visible to DOH. ° 60 a o` 55 d 50 45 ce• 40 _ v 35 30 0• 25 d 20 15 • z 10 7 41 s - .9 7, l31s. Tj )y2, a0)2sc2jgip 4, 41,1 .,/ P, >r‘iSs jtib , sti Notification week Year IN 2015 0 2014 Health WA State Pertussis Cases Reported by Month and Year with Projected Baseline and Epidemic Thresholds,2005-2014 and 2015(through May) 950 900 3 850 a son 0 750 a 700 `0 650 m 600 E 550 e 500 8 450 w 400 m 350 300 -; O 250 2Do Baseline* Epidemic threshold E 150 = 100 .M ? 0,p ONS O 7n''WW1g T,S'ta'!:,1Q to;g 7sS7�. LHJ Notification Year and Month Health •Monthly data values From the epidemic period were not used to,project the baseline and epidemic threshold Page 1 of 3 • Eleven counties have reported no pertussis activity so far in 2015. IP • Among the twenty-eight counties with pertussis activity, the number of pertussis cases reported in a given county this year ranges from 1 to 183, and the year to date rate of disease in a given county ranges from 1.3 to 75.1 per 100,000 persons (see Table 1). o The median and mean county rates in counties reporting pertussis activity are 7.8 and 14.6 per S 100,000 persons year to date, respectively. • The overall incidence year to date is 10.5 pertussis cases per 100,000 Washington residents with a rate in infants under one year of age of 42.9 per 100,000 (see Table 2). Thirty-eight infants under one year of age were reported as having whooping cough and eight of them were hospitalized. Of these hospitalized infants, six (75%)were three months of age or younger. Table 1. WA State pertussis cases by county, Table 2. WA State pertussis cases by age group, 2015 YTD 2015 YTD 2010 OFM Number Rate per Age 2010 OFM Number Rate per %cases County Population of 100,000 Group Population of 100,000 by age cases persons (years) Cases persons group Asotin 21,700 1 4.6 <1 88,544 38 42.9 5.4 Clark 435,600 183 42.0 1-4 355,275 53 14.9 7.5 Columbia 4,150 1 24.1 5-9 432,656 94 21.7 13.3 Cowlitz 100,000 8 8.0 10-13 346,396 145 41.9 20.5 Douglas 38,500 1 2.6 14-18 454,703 272 59.8 38.5 Franklin 75,500 1 1.3 19-24 577,706 8 1.4 1.1 Grant 87,700 11 12.5 25-44 1,830,703 38 2.1 5.4 Grays Harbor 71,600 3 4.2 45-64 1,823,910 43 2.4 6.1 Island 81,100 9 11.1 65+ 823,357 16 1.9 2.3 Jefferson 29,300 22 75.1 All ages 6,733,250 707 10.5 King 1,933,400 88 4.6 Kitsap 248,300 94 37.9 • Kittitas 40,500 1 2.5 Lewis 75,600 12 15.9 Mason 57,100 2 3.5 Pacific 22,100 8 36.2 WA State Pertussis Rates by Age Group Pend Oreille 13,100 1 7.6 2005-2014 Pierce 814,600 75 9.2 450 Skagit 119,300 2 1.7 400 Skamania 10,900 1 9.2 8 350 Snohomish 711,100 95 13.4 8 300 ^ Spokane 470,300 11 2.3 = 250Stevens 44,300 1 2.3 V 200 Thurston 252,400 18 7.1 g 150 \ } Walla Walla 59,600 32 53.7 ;, Whatcom 195,500 16 8.2 100 -�---,: Whitman 43,600 2 4.6 50 Yakima 239,100 8 3.4 _ z Note. Counties with no reported cases classified as confirmed or 2005 2006 zoo7 zoos zoos 2010 2011 2012 2013 2014 probable,2015 YTD:Adams, Benton,Chelan,Clallam,Ferry, Onset Year Garfield,Klickitat,Lincoln,Okanogan,San Juan,and Wahkiakum. Age group(yrs) <7 _ 1b ---7-10 e 11-14 - 15-18 - 19. iI Healfh • Page 2 of 3 glir Recent Pertussis Incidence by County (March 2015—May 2015 Notifications) • ,<-77: \ I #' t l 1 I c kPr t lit ,.,..,.,Iiiiivilj,_,,_r_jr.,___ ilLs-C---.3 Incidence per 100,000 population I 10.0 1 i 0.1-9.9 ®10.0-19.9 num > =20.0 41111 •If you have a disability and need this document in a different format,please call 1-800-525-0127(TDD/TTY 1-800-833-6388). Page 3 of 3 DOH 348-254 June 2015 0 Board of Health IV Old Business Item 2 Dept. of Health Report: 0 4z- -- A 09effeAson Public He-alt Jefferson County Family Planning Client Data June 18, 2015 Jefferson County Public Health Wshottita Sher :mitta‘ Client Data Sheet-2014 4 Health DOH 930-136,March 2015 Office of Healthy Communities (360)236-3693 ;= Key Points.... .. , Jefferson County Public Health(JCPH)is one of 16 agencies contracted by the Washington wi State Department of Health in 2014 to distribute state and federal(Title X)family planning 1; An estimated 429,910 women in funds.*In 2014,JCPH's contract with the Department of Health supported family planning Washington are in need of publicly funded centers in Jefferson County. contraceptive services and supplies.1 "• In 2014,JCPH served 917 family planning *15 agencies received state and federal(Title X)funds;1 agency received state funds only. i clients;97%of clients obtained care in their I home county. Population groups with greatest need forIIII!1I.P County Where Family Planning publicly supported family planning Services Were Provided services include women under age 20, T.Client's County of Residence women with low income,and women of Jefferson color.' Jefferson 893 04 • In 2014,85%of JCPH's clients had an (97%) income at or below 138%of poverty;75% Clallam 13 p percent used Medicaid coverage;and 5% (1%) i were persons of color. King 6 r i Access to affordable,effective (1°6°) F1 contraceptive methods is critical to Other preventing unintended pregnancies.' An (2%) 0 "' estimated 288 unintended pregnancies are Total l P 9 917 t,, prevented per 1,000 users of publicly (100%) funded contraceptive services.' 114%. .. . , w, ;rte-,', • prevented nearly 220 uninteIn 201 ,JCPH's t nded rvices `Age Females Males Total Ethnicity Race ' pregnancies. This translates to about 110 `I fewer births from unintended pregnancies, 17 and 243 9 252 70 fewer abortions and 40 fewer under (29%) (10%) (27%) Non-Hispanic(NH) miscarriages. 18-19 99 5 104 American Indian/Alaska Native,NH 5(1%)* Long-acting reversible contraceptives (12%) (5%) (11%) (LARC)—intrauterine devices and hormonal implants—are among the most 20-24 163 21 184 Asian,NH 0(0%)* effective methods for preventing (20%) (23%) (20%) unintended pregnancy.' 107 15 122 Black/African American,NH 2(0%)* In 2013,92%of JCPH's female clients used 25-29 (13%) (16%) (13%) some method of birth control,including 18% 88 19 107 Multiple race,NH 10(1%)* who used LARC. 30-34 (11%) (20%) (12°k) Publicly funded family planning services Native Hawaiian/Pacific Islander,NH 14(2%)* yield a net saving of$5.68 for every$1 34&Older 124 24 148 invested.° (15%) (26%) (16%) White,NH 867(95%)* In state fiscal year 2014, Washington's Total 824 93 917 Medicaid program paid for 41,456 births at (100%) (100%) (100%) Hispanic,of any race 16(2%)" an average cost of$9,253.5 An estimated *All percentages may not add to 100 due to rounding. 50 percent of these births were unintended at conception.2 The average annual cost for Unknown race and ethnicity 3(0%) publicly funded contraceptive care in Washington is$335 per person.3 *Percentage based on total clients with known race/ethnicity. Public investment in family planning References: programs also helps avoid cervical 1. Frost JJ,Zolna MR,Frohwirth L.Contraceptive Need and Services,2010:National and State Report.New York,NY:Guttmacher Institute;2013. cancer,HIV&other sexually transmitted 2. Washington 2013 State Department of Health.Unintended Pregnancy.Health of Washington State.Olympia,WA:Washington State Department of infections,infertility,and preterm and low 3. Frost JJ et al.Contraceptive Needs and Services,2010:Methodological Appendix.New York,NY:Guttmacher Institute;2013. birth weight births.When these broader 4. Frost JJ,Sonfield A,Zolna MR&Finer LB.Retum on Investment:A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded r. ' benefits are included,the return on Family Planning Program.Milbank Quarterly,92:696-749;2014. 4 ( . 5. Washington Health Care Authority.State of Washington pregnancy related expenditures fiscal years 1988-2014;2015. investment increases to$7.09 for every public dollar spent.° 1 http://www.d oh.wa.q ov/Yo u a ndYou rFam ily/Fam i ly Pl an n i n o/C l ient DataSh eets Jefferson County Public Health Primary Source NPayment Sourceo % Client Data Sheet-2014 No Charge 5 1% {e.g.<100%FPL) )11 Percent of Clients by Federal Poverty Level(FPL) Title XIX 509 56% Percentage (Medicaid) Take ChargeFPL o 10 20 30 40 50 60 70 80 {Medicaid) 170 19°/° group roU Private Insurance 180 20% 100%and below Other(including full 53 6% &partial self pay) 101%-138% _ Total 917 100% Note:Primary source of payment is the expected 139%-250% source of payment at time of visit and may not - represent the source that eventually paid for the visitII 250% Clients Receiving Selected Services - Physical Examinations *In 2014,the federal poverty level(FPL 100%)was$11,670 annual income for a single person household. No. % Initial and annual* 119 14% Breast* 134 16% Female Contraceptive Users by Method* * ° Percentage Pap test 119 14% 0 20 40 60 Method Genitalia** 39 42% Combined hormonal(pill,patch or ring) Contraceptive Services • Hormone injection* 179 22% 3-Month hormonal injection LARC insert(IUD, - • 1US&hormonal 73 9% Long-acting reversible contraceptive(IUD,IUS or . - implant)* hormonal implant) :. Emergency contraception* 383 46% Barrier(sponge,condom or diaphragm) Contraceptive abstinence,Other(female sterilization,spermicide used alone, R 843 92% FAM,abstimale vasectomy,or other non i counseling* specified) y I Pregnancy Services *Includes 761 females identified as contraceptive users.Excludes the 63 females(8%)who did not use a contraceptive Pregnancy test* 254 31% method due to pregnancy or other reason Preconception counseling* Use of LARC Among Female Contraceptive Users by Age and Year, 80 10% 2012,2013,and 2014 Pregnancy counseling* 38 5% Year STD/HIV Services Chlamydia test*** Age 2012 2013 2014 580 63% 10-24 80 90 76 Chlamydia test— (15%) (16%) (16%) females ages 15.24* 320 63% Gonorrhea test*** 576 63% 25-34 55 53 45 STD treatment** (29%) (26%) (27%) 58 6% HIV test*** 108 12% 35 and older 17 28 19 STD/HIV (10%) (16%} (17%) counseling*** 836 91% • * includes female clients only All ages 152 171 140 ** includes male clients only (17%) (18%) (18%) *** includes female and male clients --.-- Healthy Communities Page 2 of 2 For people with disabilities,this document is available on request in other formats. —-- washeotczn To submit a request,please call 1-800-525-0127(TDD/TTY call 711) 9*gnynmmnnw Board of Health • IV Old Business Item 3 Michael Dawson • Mason Public Health Appointed Water Quality Manager June 18, 2015 /17\47—N-if615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org Public Heat • April 23, 2015 Mr. Michael Dawson 615 Sheridan Port Townsend, WA 98368 Dear Michael: Subject to approval by the Board of County Commissioners, I am pleased to offer you the position of Water Quality Manager with Jefferson County Public Health,effective May 1,2015.This position is an Exempt MGR18,Step 1,with a starting wage of$4,751.35 per month. All new employees are subject to a six month probationary period during which time they will receive two performance evaluations. In addition,while vacation hours will be accrued during this probationary period, those hours will not be accessible until the end of the six months. Michael, I am delighted to have you join the management team and look forward to your future • contributions to our department and Jefferson County. Sincerely, Jean Baldwin Jefferson County Public Health Director Cc: Philip Morley Jefferson County Board of Health • Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487 • Board of Health IV Old Business Item 4 Middle East Respiratory Syndrome • I 4 ogjason Public Health Coronavrius (MFRS-CoV) Alert June 18, 2015 • Key Messages for Health Care Providers Regarding the Washington Slate Dem bunt of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) iI-Iecilth Since April 2012, MERS-CoV has caused severe respiratory illnesses. As of June 2015, 1179 laboratory-confirmed cases including at least 442 deaths had been reported to the World Health Organization (WHO). All cases have occurred in or been linked to the Middle East, including the current cluster of illness in the Republic of Korea. In the US, there have been only 2 imported cases, both diagnosed in May 2014. The virus can spread from person to person and has caused outbreaks in healthcare settings.Approximately 30%of cases have been fatal, and 20% of cases have occurred in healthcare workers. Evaluating and Reporting Suspected MERS Cases Consider MERS in persons with fever and acute respiratory illness who have recent travel in the Arabian Peninsula or the Republic of Korea, or have had contact with an ill traveler from these areas. MERS-CoV is reportable as a "Rare Disease of Public Health Significance." Providers and facilities should immediately report to their local health department any person suspected of having MERS-CoV for timely infection control precautions, testing and case investigation. When evaluating patients with an infectious presentation suggestive of MERS, • • use appropriate infection control • obtain a travel history with dates of travel • ask about exposures in healthcare facilities • record date of symptom onset • obtain appropriate specimen types for testing • notify local health department,or, if unavailable, state public health (206-418-5595 or 877-539-4344) Patients in the U.S. Who Should Be Evaluated for MERS-CoV Infection Healthcare professionals should evaluate patients in the U.S. for MERS-CoV infection if they meet the following criteria, defined as a Patient Under Investigation (PUI): A. Fever AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND EITHER: o A history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset, or close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula, OR o A history of being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset, OR o A member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology in which Washington State Department of Health DOH 420-108 Updated 06/10/2015 g p P MERS-CoV is being evaluated, in consultation with state and local health • departments in the US. B. Fever AND symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND o A history of being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country in or near the Arabian Peninsula in which recent healthcare-associated cases of MERS have been identified. C. Fever OR symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and o Close contact with a confirmed MERS case while the case was ill. Symptoms and Severity of MERS-CoV • The symptoms of MERS include fever, cough, shortness of breath, chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose. Illness ranges from mild to severe, and may cause respiratory or kidney failure. • People with pre-existing medical conditions (also called comorbidities), may be more likely to become infected with MERS, or have a severe case. • Approximately a 30%of confirmed cases have died. Infection Control in Healthcare Settings Centers for Disease Control and Prevention (CDC) recommendations are available at: http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html. • • Immediately implement standard, contact, and airborne precautions for MERS-CoV persons under investigation (PUI). Use gloves, gowns, eye protection and an N95 or higher respirator for all patient care activities. • Care for PUI in an Airborne Infection Isolation Room (AIIR). If this is not available, transfer the patient as soon as possible to a facility with an AIIR. Pending transfer, place a facemask on the patient and house in a single-patient room with the door closed.The patient should not be placed in any room where room exhaust is recirculated without high-efficiency particulate air (HEPA) filtration. • HCP should perform hand hygiene frequently, including before and after all patient contact,contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. MERS-CoV may be in respiratory secretions,stool,and urine. Antiviral Medication and Vaccination for MERS-CoV • There are no known treatments for illness caused by MERS-CoV. Medical care is supportive and intended to help relieve symptoms. • There is currently no vaccine available or under development against MERS-CoV. • Washington State Department of Health DOH 420-108 Updated 06/10/2015 •- Diagnostic Testing at Washington State Public Health Laboratories (PHL) • Washington State Public Health Laboratories (PHL) can test respiratory and serum specimens for MERS-COV using a CDC-developed PCR assay. CDC can perform serum antibody testing. • All testing must be discussed with and approved by local health before submission. http://www.doh.wa.gov/AboutUs/PublicHealthsystem/LocalHealthlurisdictions.aspx • Use appropriate infection control precautions when collecting respiratory tract,serum and stool specimens. Collect and submit specimens from two or more sites, such as respiratory and serum. Lower respiratory samples may include bronchoalveolar lavage, tracheal aspirate, pleural fluid, and sputum; upper respiratory samples include nasopharyngeal and oropharyngeal swabs and nasal aspirate. CDE provides testing information http://www.doh.wa.gov/Portals/1/Documents/5100/420-109-MERS-CoV- PHL-Testing.pdf. CDC guidelines for testing for MERS are at: http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html • PHL require all clinical specimens have two patient identifiers, a name and a second identifier (e.g., date of birth) on both the specimen label and a completed PHL Virology Submission form available at: http://www.doh.wa.gov/Portals/1/Documents/5230/302- 017-SerVirHlV.pdf. Specimens will be rejected for testing if not properly identified. Also include specimen source and collection date. • An investigation guideline and a case investigation form are also available: http://www.doh.wa.gov/ForPublicHealthandHealthcare Providers/NotifiableConditions/ MERSCoV.aspx Washington State Department of Health DOH 420-108 Updated 06/10/2015 Board of Health 0V New Business Item 1 Certificate of Appreciation • A Ne&on Public Healt Ruth Merryman June 18, 2015 ? ' <:) ;..' Cill) 1 CID .: /- t ''•V''''-r- .( Ra P J(L If .O °Cr.? r UOlt..? -,-,\., P- , P ci) § 0 a., P _ v ) m• n, „di, z r_i_ s,, z 2., ,..- 9,_, re4- . , , . --,s-,, '- ' p9 % 'S.,' a r tri) \ ° )silJCx'tC7o 'd tJ. :( ._ J n) r.s.', rb PI P E. 1., C 0. . ,,,,, , , „.. R., w „ „, ,.., „, „.,, (-1) Z 0 a 0 .).0 , (s_..-,. , , cil • C..) ,-, ' 0 i . 1it,f, O OzA) z J1H O f)-. a � 45 CD m ( ,'''''''.2--;f: .'-'\:-' ?--nr1) 2 10 r.i.. )17/ cn ed (1) 1 - \ '--- ,,-- :--1 0 -5.'• )--... c.) 7 rzo, clik) •_ .,,,...„... .. k ,/.., , )-d - N rb c.o.) o n -6--i - -,. - }ti \ n ° Q O II • 1 ' . L q z n 0 01-k • /--)-- ) , 4. .,,, ,._. _, c.„ ,,. . , , . , _ -,) . Pt- ,.-... ` O \ .k._ . l '„, • .7) . 1' T. 77,._. )., ..-. --- ''. - ''\ ---.,:t_ - ---(i_------_,I, '..‘..;:, -7,,,.... .-:, c. r . . .:. .: ..:. .„- ..) J r ,,,. .______. ...., - ,1 (i_�= , - ,� ;,:=1;.: � � ,....„.. ......--1,.. . _, :,\,-7.- .____..f �` • Board of Health V New Business Item 2 Public Hearing 09efferson Public Healt Environmental Health Fee Update June 18, 2015 STATE OF WASHINGTON JEFFERSON COUNTY BOARD OF HEALTH • AN ORDINANCE TO AMEND Ordinance No. FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH Section 1 —Purpose Section 2—Effective Date Section 3—Fees Section 4—Severability Section 5 —Prior fee schedule repealed WHEREAS, the purpose of this Ordinance is to amend the fee schedule for Jefferson County Public Health, Environmental Health Division WHEREAS, this Ordinance promotes the health,safety and welfare of the citizens of Jefferson County, and WHEREAS, this Ordinance is proposed and may be enacted pursuant to the general police power granted to Jefferson County and its Board of Health by the State Constitution, SW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section 1 —Purpose That the Fee Schedule for Jefferson County Public Health be amended to reflect adjustments to services affected by the hourly rate adjustment, Ordinance 03-0319-15. Section 2—Effective Date That this Ordinance (and its Attachment) shall be effective as of July 1, 2015. Section 3—Fees That the schedule for Jefferson County Public Health, Division of Environmental Health, adjustments to the Environmental Health Fee Schedule, Environmental Health hereby set by the Jefferson County Board of Health as listed on the attached fee schedule of the proposed Ordinance; That any text listed, specifically text within the columns entitled "Administrative Hearing fees, Technical Assistance/Plan Review fees, Temporary Permit fees, Annual Permit fees, Miscellaneous fees, Water, Living Environments, and Indoor Air fees," is deemed regulatory rather than advisory and as such has the full force and effect of local law. Section 4—Severability Adetermination that anytext, fee, or fees adopted as part of this Ordinance is unlawful or illegalal shall not cause any other text, fee, or fees adopted as part of this Ordinance unaffected by that determination to be repealed, •sed, or reduced. Section 5—Prior Fee Schedules Repealed Any prior fee schedule previously adopted by this Board that contains or reflects fee amounts that are less than . those adopted herein is hereby repealed and replaced by this Ordinance. AN ORDINANCE AMENDING 2015 FEE SCHEDULE FOR JEFFERSON COUNTY PUBLIC HEALTH,ENVIRONMENTAL HEALTH DIVISION ADOPTED day of 2015. JEFFERSON COUNTY BOARD OF HEALTH David Sullivan, Member Sheila Westerman, Chair • Kathleen Kler, Vice-chair Kris Nelson, Member Phil Johnson, Member Jill Buhler, Member JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION(Proposed Fees) ENVIRONMENTAL HEALTH J 2015 J Additional Fees and Other Information GENERAL Realm Officer Administrative Heating 333.00 - Administrative Hearing Appeal 333 00 Technical Assistance/Plan Review-Minimum 86.00 Technical Assistance/Plan Review-Per Hour 86.00 • Filing Fee 65.00 Recording Fee 65.00 Plus the Auditors Office recording fee Notice to Isle Rescission 5255".00 ONiSITE 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 34090 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 tee Development and Review Financial Assurance and-System Operation Agreements 86.00 Per Hour Septic Permit with SPAAD(conventional) 307.00 Septic Permit with SPAAD(alternative) 569.00 Applies to existing Installed sewage disposal system;the Repair 50%of fee Technical Assistance/Plan Review hourly rate will be charged for repairs where the applicants require additional assistance Modification or Resaive Area Designation 258.00 Expansion 538.00 Redesign 172.00 A.ples to pending or active but not Installed Reinspection 216.00 Evaluation of Existing SystenmMoniforing Inspection Septic system only 33400 Septic system plus water sample 377.00 Retest/Reinspection 172,00 On Site Sewage•Building and Planning OnSile-Site Plan Advanced Approval Determination(SPAAD) 397.00 Subdivision Review Base Fee 516.00 Boundary foe adjustment or Lot Certification base review lee 202.00 Planned rural residential development review fee 202.00 Per lot fee 90,00 For Subdivision Review.Boundaray Line Adjustment and Planned Rural Residential Development Review fees Pre application meeting fee 202.00 Density exemption review lee 129.00 Field Work for Density Exemption Review 86.00 Per Hour Building Application Review. Residential-Individual OSS 129.00 Review alter Building Permit issued.Is same fee Commonest-Individual 055 258.00 Review after Building Permit Issues 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 11, Otter WaiverNadance Application 237.00 WalvsrNarience Hearing 387.00 Wet season evaluation 538.00 General environmental health review fee 86.00 Per Hour Licenses Instatar,Pumper,Operator(maintenance person) 536.00 Retest 216.00 Homeowner Authorization 10.00 Annual Certificate Renewal 299.00 Delinquent Renewal after January 31 538.00 FOOD SERVICE ESYASUSHMENT FEES POMMIES RestaurantsfTeke•Ouf(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 482.00 With Lounge,ado 149.00 Separate lounge area Bakery Business 149,00 B&B 191.00 Caterer w/commissary or catering-only kitchen 339,00 vii restaurant.additional fee for catering 191.00 Concession/Commercial Kachen/Church 149.00 Espresso Stand 149.00 Grocery 1-3 checkouts 191.00 May serve prepackaged baked goods >33 checkouts 462.00 Meat/Fish Markel 339.00 Motile UNI Limited Menu 101.00 No costing or reheating Complex Menu 339.00 Cooling&reheating afbwed School Cafeteria Central Kitner 339.00 Warming Kitchen 191.00 Tavern w/food(see Restaurants) Annual Permit Issued after September 1 50%diem 150%of Aeneas Permit Fee Temporary Permits Single Event INbal 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 129.00 Not to exceed 3 days a week ate single location • Complex Menu 172,00 Not to exceed 3 days a week at a single location Late Fee for Temporary Permits +50%of feeAdditional(Paid when application Is submitted less than 7 drys poor to the event) Other Food Fees Permit Exemption 41.00 WaiverNariance 8690 Per Hour Reopening Fee 86.00 Per Hour Managers Course 231.00 Plan Review 1 of 2 ENVIRONMENTAL HEALTH 2015 Additional Fees and Other Information Pre-opening Inspection 86.00 Per Hour Mlrssruln 86.00 Per Hour 86.00 Per Hour Relnapectlon First tnspecaon 95.00 Each inspection altertirtit 18300 - - Food Handler Card Reissue Unexpired Food Handler Card J 10.00 Annual nal Permit Fees Landfills requiring environmental monitoring 888 00 • BlosokMComposting Faclldres 602.00 Inert Waste Landfills 430.00_ Other Solid Waste Facilities 43000 Drop Boxes 705,00 Miscellaneous Fees New Facility Application 566.00 Exempt Facility Inspection 430.00 Facility ReinspectIon 50%of fee Plan,Document and WaiverNarlance Review 345.00 .586.OURtour far w 4 hours WATER: ' Application Fee 208 fX1 Inspection of well construction.decommission& reconstruction Determination of Adequate Water Supply base fee 129,00 Tech te Assist and Document Review is billed at the hourly Well Inspection&Water Sample for Loan _ 172.00 Well Site Inspection-Proposed public water supply 400 00� l tVINPr IENVIRQNMENTIS Water Recreation Fealties Operation Permit Single Swim Pool(In operation for<6 months of the year) 296.00 Single Swim Pod(In operation for t 6 months of the year) 977 00 Single Spa Pool(in operation for<8 months of the year) 259.00 Single Spa Pool(in operation for 5 6 months of the year) 37700 Single Wading Pool(in operation for<6 months of the year) 214,00 Single Wading Pool(In operation for 5 months of the year) 377.00 Spray Pool or Poole(In operation for c 6 months of the yea! 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 64,00 months of the year) Each Additional Swim,Spa,or Wading Pool(In operation for 6 86.00 months of the year) Reinspection 86,00 Per Hour plus associated lab coats Plan Review f 86,00 Per Hour indoor Alr(TObartael,. .. _... Comphance Enffrcemenl 56 00 Per Hour Reinspection 00.00 Rebuttal Application 172.00 Nolo 2014 ports have boon adpluf d P.Cohortco 122.1200-58.Sedan 4-Annual Fee Mdnung Piaee amount loos estabished wither ordinance ahal be defeated armuaey an the area budNroes day al January(Adiuelud Cate 1 by the amount of the Imams In the Corium.Price Index ICPIW I The CPIW Is the Consumer Price Index-US City Average for All Linen Wage Eamore and Clamor Wakes,pubhaved by the Baru or Labor SlellelSe fate United Steles Department of Labor The.noel fee admstmenl shell bo calculated as follows:each fee In affect Immedldely pilar to the Adjustment Dale will be Ineres.d by the percentage Increase In the CPIW as reported for the month of September preceding the AdJuetment Data Mamas will be rounded to the nearest doll. Afros shall not be reduced by reason of such celouteean tidN'eVer,fee Increases In accordenoe with this calculation shall not enured 5 percent per year • 2of2 Board of Health 0V New Business Item 3 2014, Performance Measures: Maternal Child Health; Targeted Clinical Health Services; Solid Waste 0 1 4/ 4 deffezon Public Health June 18, 2015 Jefferson County Public Health 2015 Community Health budget HTH 120 Nursing Admin 219,614 11% Population and Prevention HAD 210 Drug and Alcohol preveniton 39,927 2% HAD 215 Drug and Alcohol preveniton 53,058 3% HAD 212 Healthy Communities-community Transformation 26,000 1% additions to HTH 445 Tobacco prevention 5,000 0% 2015 budget* HTH 290 School Health 71,669 4% HTH 125 Health Care Access - 0% 195,654 10% Targeted Clinical Health Services HTH 260 Family Planning state and fees 312,959 16% HTH 262 SBC Family Planning 73,500 4% HTH 270 Family Planning Federal 27,603 1% HTH 291 Foot Care 48,277 3% HTH 292 SBC Primay Care 63,621 3% HTH 430 Breast and Cervical Health Program 1,638 0% 527,598 27% Family Support Services HTH 220 Maternity Support Services 73,420 4% HTH 222 Child protective services 37,848 2% HTH 225 NFP other 176,471 9% HTH 228 Nurse Family Partnership 118,278 6% HTH 250 Children with Special Health Care Needs 20,456 1% HTH 252 MCHBG Con Con -ACES work 18,864 1% HTH 280 WIC 124,937 6% HTH 281 WIC Breatfeeding 4,830 0% 575,104 30% Communicable Disease Prevention HTH 320 Immunization children 95,236 5% HTH 321 Adult Immunizations-Travelers 98,372 5% HTH 322 Immunization Con Con 8,582 0% HTH 325 Immunization Public Health 30,649 2% HTH 330 Sexually Transmitted Disease 17,765 1% HTH 340 TB 9,637 0% HTH 352 Syringe Exchange program 3,360 0% HTH 390 Communicable Disease 82,471 4% HTH 395 Communicable Disease PH 29,422 2% HTH 880 PH Emergency Preparedness 34,653 2% HTH 888 Emergency response- Ebola - 0% 410,147 21% Total Community Health Budget 2015 1,928,117 100% * with additions listed above • April 16, 2015 AD P XI . < «i < ... c � `� N CCD (IQ IC t" 0 •• CD CD 4/ 0. — O "P �_' • 0 a. m'. Cp c CD0 ` obciCs 0 a o C1 CD .•' til .. Cr z C o ..i • 5•'71 t CD • •0 Q' o < 0 CD 'CD CD aq n � 1• 0 CCD CD Q N .-I 5�. Q' (7 (D UQ N 0 0' 9 A• go n o ,-, o. c<o H. o C. o. ', o o4. ri WUU ° t C17FIL TJ �' 'Ts FA) CD .O•. A) O' 0- '' CD Q.. to V) n Cr .-y�G CD <• < "' `" '* cr Q•• goo a co a o o cro C (IQ ''G CD r) Cla til tz Co c'Da N CD 0 CD" li -s �•, °-n Uma 0, p 'Z', .'L" O C UY• vO t- 0- W ' ( ° lY r b -• < n �� 0 — Er, ^ O � -N . LJ 0 C, = 5 CD CL CL F. ls � A, a o .tiw '1'i5 no y0 FS y y-, o o b CD w CD - }, O (D CD r"`G C p o ' Cl) vocs) o N O fa.O W A) O _� CD V) O �Sj (D n < OG N UQ CD a a N c e:::, w b to 0 o o (D to o rn o Ci L.,..) N co < n J to N - - = ' . co CD vw, NO_ C W — N A) N fD A O < 4 a. C, ° W (D N 5 `" UrQ O N _ W ti•� . oz 0 0 0 ON O C) R C� 0 n Co 0 0 ep aQ ,d w °' 0. 0 a • O N A Wt.il LaAD C N •A w e4M C' O v? ... ,. k 2:1 O n r p 0, •' 7 -. O r3 0 11. e, 0 '1' 11 o o `D 5' •; =t' a.U0 cD 0 CA a o m 0 CD 5 0-'0 0. y c• - 0 _ 0 0 CD O OQ = 0 p ncDC • wa w o CD co o aQro o o CD 0 C `< C�Lv, C • v, aa '+ �0 0 `� < CD .-t < O' C 44. nVQ o 5. w 5' tv p • C' ; '» a, w 0 2 �' c, C `< CD c0) 10 0 tii 0 CD• `< "D ••-• a. CLCD - m ~o CD y C. o Q ✓ °CD (.0• A. o ci, o °as c w x� c `n w 0 o ' y �Q C 49 0 c A) 0 CCE) CD 0 CD `° " ..,`G o c •.. C)• .r p, .-9 `< d w^• w.0o` S < yC° '' ° ? C CD o ', -h O ril pqo o 0 rc *TI > � ^o 0ci AOnc,' Ue, v tCrlp • A coy P. O A pv vQ d 0 P O `O 0 O 0 CD CD cn n O P" P 0 N , A) ° °nom. DCII < F C, o CC,, m o N O z 5- ., '� CD 0 d *. "'', 0 ryp M A CD ,� R. H O "CY O H r' 0, (D N O ^nt v' CD 'C7 a' ¢' Oq Z `C A) 0, CD CD • O J� CD CD t].: CSqD CD N OC 'rii C .,.-. Z 5' r+ '-ri O v, C ...t u, CD v, CD CD O rr '* to to n C "3 x <D V) 0 to C� to '- < A, 0 �, to I ., , O p M W "t, ,-S• CII N A7 an o✓ C >?'L. N 0 `<' a. .� `< O 0 CD 0 CD 0 .-r• y C'� -. � o _. z = � o � ''ti � CD n o k A En C y 0 0 = b � � E''' Ft ° O o' 0cf CL � C � a o ° < cd1 p y w �' S 5 o b z °' ° w C ?'_ 0 `-D o 'er cia nao Yr" w 5 a COLD " .- ▪ 'pa � n. CD 0 o C A, ° rn P-7 AD `< n _ x P. C ° C, v, n CD C', p, ¢. :3' v, , n CCD O� o K, v) O CD C 1 Cr73 'l "' 0OQ CDD .• 7". 0 „CD 0 G - �'-•• -t-t N v, W (D ¢' 0 0 "C"" 0 CCD CD C7 0 0 CD O. 0 C rn 10 a' X 0 .Cr rn ' C7 0 G .� me -`Y '0-r 0'• (IQ re-'. y C CD v, M Ap .-' GL (D Cr ''Y "t 0 *0 CL cD d Cr w 0 t Ak) + a C d CD CD 0 W ?. O o '1a7 0 0r �� PV Z a c�'o C C cCD vA' �G C�� 9 ,r3 �j so C O A7 p� tai, G (D4:1) 'Lf �' '-', Mt N •-r W v, CO ¢ 00 0 0 C CD CD P. C. Ai rn 0 " c o o. N OZ 0 v 0 x tii O A7 'T1 'Cf '-r B.UQ n C C C rn• CD5. C' p .-dr G C R' m x) • riy C. . CD 0• -e w v, p CD ^G Ot o C O x' 0-4`� C• Ao I'D C C0 „C,t • < 07 O .�'... - O 0 CD (� "�7 P • V) 0) 5 c, o•�`,, " 0 "v B .- 000 o co Z Ut oo 0 oN Cil ? d o0 o c° o a ° 0 C. E o •,..:,,,,&, N AD O `0 ~a << (9 cr DE- o • a. O-',� 0) w n c,' w — O ri7 P' o �. 0) C„tD o..C$ a o o CD = o �. Y �, n 4 d o rn A, n pa C-) • O K n. • co CDCs `< - u, N 00 `-.- O� up C,,. Cl) 0 0 0 0. CD 0 7 vo 4 > O 0 - 0 r� til •..' C 9 fl-t. ,.; fCD b O o 0 d CD ". O 5• th 00 00 CD N C17 U? O. O N C N N CD A7 C '".j 0 CD c V U • Vi • CS' 0 0 0 n C. CSD t3 N C 0 e c NC N O 0 CD C.' O O 0 G 'CS (�- a a C 0 rr C C 0 C 0 A, UQ N p N A) 0 0• 0 d W ▪ '*, d fl Ai .4 0 0 00 • C ,-3 5CL N A� . -, v,, •T C 00 o-. C) CD `< M o' O - W GO n o O d ''r Z 0 (D CD �'' o o N C '0' Q.. p CD p 0 p �, CD K, 0 A) n AD W Cr 5 O 01 '10 0 ci, C7 a ca. cn C C < <• A• CCD codb p b C• 0 5CD ' t0. AD E'* ..t C 0 CD CD " A) T3 0-r 0 uC, ' '"'''O '° < -, a �' C. w a 0 0 o o' w g rn m 0 C 0 0) ¢, O .C-. C rn C3, oo N CD o `< o a `� < o CD o 0 o C A c . CCD t. 0• h N 0 CD 0 0)•• N 6, N .°�� O o aQ w _ cr o Cl) ° O CD cc) C d VD C 0 dVI 00 • CD ,' CD w c" NJ 0Ca a o V) .1,`p o. `y° o (PPo 0 t'' `4,.., (/)1:f0 A) � cD � ,t a co a C7 5' W A) .-r p �. 0 v, () N ,cpt cr p .t N N pj a, 0 'TJ O R. � � p c A, t , " � � o � 4 . o a CD S' a A oro ° `-° •0 5' '" CD w '" t/a CD C o `� U, N c0D 5' n r° w45 w �. gow ow " 0- �: • 0 m w () ' '" o C CD o• C , w 0 5' c a .-. C" CD C' �. =. o - 7J 0 w �•CD w 0 - o t•J r °o w' w --,coara 0 a s``� o K, 0el p 0 r11 Q- --.1 cr A Ua 0 0-4 C-' C" <cD o. O w AD CD o 0 a 55' N .0 4 O CD 1" 5 w y " n ., O u°a C z C Ua n cD A ° CL o g AD `3 co 'oP ; btD0 � � 50v, oma ,, y �C w o � 4 0 0- 0 CD5' � c m Zc 77' 0 0 o vo o a w �* cc " 'ti7 �; 5' o 0 w r (-) CD 0. vt w - N �'`-' tTi> Cd o' °' v, 0 '` o � Y v oS• 5 a � a- (j o '"' " N DD ?; 0 CD Q, 5 ' c 5 < 0 '< �, 0 a h � a W N \ CCD iD �. w .-1 0 c�D � ` �°' t' or a � CD ay � � w °, w � � CD . n h �' co o N pj < cD 'I r=, t'l C� Q. S m 5• -' a a N co0tco D w a. Di m Z 0' o y H A) A)-1 aYw < p � 5 0 S x ~ti o MI (1 4 m5 0 o CD �CD � 5+ F, o trr1xl C P a, ,- 0 `3~ () N C/J Z 0 Cra (i-a 0 0 o O" 0 " ° M n a M >a y pAO ,•N • � ) asZ -. � .1 n CD CD a 0 0 W m N A� C�s'J c0D 0 cu co a o 0 ora b " c '11 CD CD 1,4 CD " -- ti ... ''ti Al A) cD0 ' Cl. o CD C 5 x A CD • o '85 -7a' S q as a o 0 a a. N b7 Cd w CD a `� 0 '° <. on Q: CD a c0D o (7, c<D o Via �;' ? n0- --+)~0 c w• o' "" PP. cuCD ' O N• 0, •'�+ () O. • '� N . "° A� lD Ln 5 'Lf O) .ta x .1, 05 < CDk..,,, 0 ,: 040a •-• orzma' cnCr'CS Lel CD 0 � AD CL 10 x 0 CD p 1°a T C � � ': ca Awa ° 5• o in p N q g 4,- it 4 y y 0 r+ • Yvw N r on 0 o ` cu 170 Z O ". O w N 0 w 0 • lo?2• N O' O UQ O ^, .-l-, �O in p r.N O '.•' OCD • �o -, O 3 17 < mpz ' 0 •.. . � Coo OO.ty 17. 0 yOp�, Op0 O `O ^ -t . co g (.711 t '-' CCD '<CD A ii OC Cho 0 0 ': `� sv -C a. 0S < .cc a O co w C3' W 0 ny � 4, cw - cnC/J () -j m C7Cn - `, o- O Cfg p O X nnp O0OG•. CD NO5 0 , W ur O E, W 0' N c, , O-. O < co CIO o n Cil O O 0 = r — a ,-, .-t coO °17nm 000r,, v, a E' w«, voCD o <_CD P " sv _ " a o o 11) O N 6' a ?: o Cr v N a. 4 7:1o ? C ' a'1:$ x Da co •• 0- x o N' v' CI. o ,-n v, O CA r. Co uZ O U� i 6. ',cm a Co b yv Z v, co o Cr o 05 A) 0 ' v) ,-i 50-• o a 0 AD 5• ai-i o z x z y n z 5' Y n CD ° 0 (to � � 'Ci �O' O 0 Oa O 0 5 CD MUQ( O -sO 7 AS' ?. — ,rt, 0 0 •--•--1, -h i ,-+, < XJ n rI isf 0". r' n 0. .... ..c: rz ,.ii xj a < „ A. w Y b b ¢ ao „ •a rn Ua o — CD E7' Er O A.' v, 0 n 0 <. N' CD o' O 0-• •H ..t ¢ - 0 n3 a a --• , 0 a 0 ` co o CII p. Lit Nil '5• C) v, 0 o o w Ca" 0 °0 a 0 0 0 1-3 O : p_ x4 . N N - ? ON N �. A C ° o a H p, --.1 — J O '--� co O� < - b a w Q 4J o Q\ O A l ` f> N � Li, v, 0 pzJn N '-.. •— A N N 0 oo N wco : ; : u N O 4., O 00 N N A Ln NO J Oo N A O O J •w O N . W E, CD N Wr rAr N O O o =O0O O O O O0 eD A N )--h O. E. • 0 0 • — .p t,)GC tJ A n C J 0 0\ --- 0 G Au C r* c WN tl. a • ¢ n NO O Nx Cp- n - 'pij ' O C ,--1 0 '- O CD CD CS n (Dy p. O �C UQ — p 0 o n p) 0 O UQ < P) (cl., CD ¢D o F B <. and (i �' a ow n p• a n A) o v- p .-•'• P) x r•r CD ' O v) .+• COD () (D 0 CD CD .`S R' fr. rte. �: (D N O .O .�' ¢' N v) O cm CpO 7 r+ CD n pr CCfl .t C CD p. p. CD h S C- 0" O . G n CrJ 0 • O0 � ( 5 comcn 0 r,p w _ " p• ..•• 0 CN cn r .11 CD . En E4 P f• ¢; I. f 4 -t P- 'zi c3' P CO N O 0 • (:::, v, n d >v „Do 0 •s O C� (� 0 ciQ ss C� I 0 En 0 • o `b 5, n UOQ `Z7 0 c- 0-• K P CD xi 0• "C4 r+2 ""= x p m v) 4(4 Q. b o �' cD .-• O' P p n >v UQOn ' n " xP ' � � OP • o 0 0o o ! CDmO t C " ?n. n C0 0 _ . d o e, o o on o t 0 .� 0 Q- z ;3 v) .-. CD 0 0 n •� 'i Cr ca, cn CD n 1 A) v) :s 0 O C3' 0 to 0 0 0 '�� T,CD CD < ,- n 00 D 0 ¢, cn .0 , cn n• 0 0 C'" •C x . 'rS O CD v) 0 •-+ CD 0 b caD d O `0 r+ 0 > P i cn 0 n • O 0 0 0 (14 j c's C) O 0 '- CD vVI im', UQ to • rnn. 2 G� "= 0 0 0 O n v) 0 • "'l ri n >v 0 FO+, b vv)• W C�1 r , ,- cn d -3 C/] 0 En 0 00 UQ 0 I 4 r-r 'O 'L3 0CSD p .0S O� C O ¢, n 0 CD CD 0 0 r `d CCD 0 0 0 0 0 C) p O CD t'll 7� 0 0 • 5 . Y )7 o cm,O0 0 0 UQ `' Ori N 0 `O cl.. 0 0 CD `< 5' - CSD CA .> F,_,.) im.0-h .0 . )n P f0. C) 6-• C .0h CCD 0-) e' 0 0 CD UfQ Cni7 „ O `C 4fig p) 0 cn til P `C 0 O ci) CD P- • 0 0 V) n ril CCD C C• R "` uPQ CCD 0 0) 0 ;U 2 5, a0) 0 Q- U' 0 0 n CDCP4 A >v vi rn b N O 0 U > P 0 CD ' o N' a, U) v) P CD 0 , t N CD 0 SL. C) n PI 0 (14 CD a. ..; W p �n 00 r* n .� v) n x 0 g 0 O Pi 2 UOQ Q- Or OUQ O %.0 P Iv t P O r--j r, 0 V, 0 H n O .Ti VD '.�• H 4 l • c ' c < o P e 0 o 0 y N CD CD m o -o p- o CD .0 w a ( 0 �1• 0. ,,.., rte+ G 0- ! G - CD PJ • la, 0 CD P Dr CD o CD• O. 0 Co — m m Q 7 7 CD n O d 7 V1 rN+ (7 >Z < 7J �7 m r*ro ft) V) CD P Cr ,Oi, �. O. 0 ,, CD r r+ fD fD a1 c� 0 r. (0 7" ` 0 CD —— CD O pCD Uo a) cr, • n CO p F'D' o CD Cr. (D o 3• 00 7 - C °M 3 •Oa 0 v, 0 6 r* o_ 3 O o O (No CD CD c0D _• 0 w0 O •'< v j -f?) n fD 7 0 _ v N n Q 0 v C fD CD P7 n rte+ �..* N CA Z d C < 0 0 o (D -0 Q �cA "! c Cr rA 0 o r* • rt CD C = Q -Z rD 0 VI D O P CD W CD n CD O ' cn c. 0.. '0 F N 0 --I, 0 s` cn FSI O O. W • 0D �CCD� CD 0 r". (1 0 N -s O (D 7 l ) W 0 `G '"'� r' R. 7 n CD (D 1-71 Q o Ts �. 0 o 0 , -0 �.. C cn o CAP C" o o E • P ns 'C 0 3 o d = CD o 0 o rY a) 7 -0 r+' oo r-1• o0 .< "` r1. -, M O o- co -, 0 L.' w u, O� v, DOO °' W N 0 r* o aQ 3 p ot FO, CD R. Dil `< 1n o- O_ 3 7 O M� = C C Qn N 0 r' v Q rt rll CD 7 M C ►r• n v' 7- C Co- N /" �D �n�I co-' w w C (D C 7 O 1 ' O 0 v, O < O .7 Q vC, r+ 7 p.'. P < �' 0 v Q �D = m 1, fD fD 0- O.. CD cD o _• 7 0 cu n N < M-h C u, Co , n. 1? v R' O CIQ Al O N Ir CD 7 v InN O Q n *It S; O v (o = N n n zr, o *0 ,; Q CD CD • t') r CAO\ 0) 01 O v _ w \ N 0- N PI cn co cn C vi N 7 O O A O o O co C O� N c o o = W n Co ,-f b :=1:.,_ S aJ Nn — 07 O 0 o r.« A C9 0. • d N `0 'a N n 01 O O O O O O CD ■+ o c 0 y A -s. k 0. " v ) CD • O A)EL A) 0 0 0 = 5• CD - OD cn . co CCD o`N A, A' to w E N A' A x Ua' ?'r• ,..-<- W o v 0 CD w r) cD > w .(71! o b cu a N v v, �, t cr rr w ?j • 4 o a o GC? _ CCD '�. C a- En .`i0 vi 'O V] tri A> W ("D 0 0 () ni v) N b v) Aa7 C� cD o O a- c 0 CD c x o Cc a,4. wo < o o a o 0 a- c CD x a y ?w o `< o N va qo c � w '' .o • •? 0 CD ¢ 0 cr F0„ 0 0 0 CD remit O O t CA 0- CD 0 co • o a C .0 0L c ~.y am. f0i •-t.. o A) '100 0 0 CD cn E. 0 V./ a u -t'CS „ m __ toCD CD 0- O W 0 cn CI: CD cD o-< CD = N 0 as o D a. " CD C: o It o 4t ;t ;t ^a 7O CO C7 () (-) C7 4toan CD CD 0 CD CD 0 0 0 O (-M 0 .o-n ' ,- �•, CA cD v' _� � As' '� 0, Fj CL O • IsJ O a T1 w y 'CD ` ` C/� A' .-, C OQ r. _ "t ,r+„ 0 �_ .a-- CSD N CA .-r 0 PA�• ,.O A") «.t C a -� ti O V, C) 'O V 1 *rip-, 0• C CD 0 CD O CD "•t «o. Cr.) 0 H n -0T CD k, et, CD '.Y P O n a' 0. Cop < < ,CD Hl cp En < 5 v, C v, O 1� n"5 i - I_ �t 1r C•) .1, CD No v; \' N 4i o ~k CD _ _ '8 0 J O w O O\ - O w w N CM O \' 0 0 _ 0 _ �, J O N w w O VIO O (=-,::, w w 0 0 0 rD C' C Cr • --1 S CD Q > v > < 71 * r - v.) N rD y V7 3 rD C N 0 a Q CD o rt S • n N N O p _ n rD N s °� Q Q. rr, = (D a' 3 3 rD OQ C rD p c N - N Q �O ? (D S v co O rD N rD -1 C fD * ao Q C -,, Vt ( c 3 -0 , c > • 0 (D CD 0 v v, 0- S C O 0 r-r' v, rD S v) = a) -z Q ,rt nrti o� a r, r+ (D D) h °- < S c we m tv °' p �, °' O rD v, .-« Z H H O• o .•P r+ c c 3 a- 3 Q ,••r ,, S —rD _ -, o I c v �,' rD rD a) rD Cr -a v, r7' Q 2 O r+ N 0 �, A S Q - r+ 00 S N Q; Q H = 0 W �' < n NO \ 0 3 v, O '_.t (D CD co v, a) 3 a) - �o rt vi n CD n C VI - n 0 v 2 O -, S N O ra -v -. o •< — a) Q Q N N CD C D — !? — W _ to C 00 N ut "0 S r-r S O 0 0 3 S r+ O � L+ • Q 3' v n s - °, 0_ p• o rD < c CD ao o v v, < °: O cn rD 3 v CO' N 0 * .S' rD ,-+ S C C V, 3 �, - .I oet r+ S n Q o -I, �, N 77 v, !v CD ,n-r Q N N •< -n O -, r+ v, G1 (D -.% I--1 O mrD3 CD v ' Qc d R rD _ r- • S r+ S N • 0 3. S 5 a 5 (. rD O Z n rD N v l 1 rD O OU N Q C r_-r -(h 73 X. a) N 0o O 3 3 p ti 3 (7 n O 0 p rD S r r Q v, s v , M��y1 ,-1- 3 � 3 O -0 < ,N--r• -0 < CD O S 0- -' v' ,--r CD CDD n W N c c o rD r) -. (D a) -o CD -, r+ 0 Q CD O 0 v, p v, n C v nj O < < + n 4, s p 0 _• -0 0 ..< CC 7'. rD '0 -3 3' v, Q — 0- CD S _ CM — 3 ao v" a) a) o o rD a)-11 3 c -Cr 'D S Q' v, . r r _s rD d — MTi co n -0 (D OU = S tnrt cn T. ar < 0. CM r+ N p. O /�V FrI cn <. 0 CD v, 7 v C rD (D O (") -, O = Mil S 0 rD K Q CTQ v C v '-+ N Q < - 1 W C Ut 7 7 r=i (7 r•+ Q o -s N O •G O 1 v, .-s- ` v, v S 3 O . -, CD D S 0• O 0 — 0 m n • • rD -I r r rD °; ov -' = r..r rD r�D -10 D 0� v v v rD v oo• CL, VI N n C Q 3 Cr 0 0 v Q o c rD o a C. v rt O a) C Q S rD N Di C ntil c n = Q r+ c op N * _,- 3 v) v, 4 CD C rD �' a) S Cl) S (D N C f7 rD r+ y r+ 0 Ir [7 r-r 0 (D O n 7, r+ rD .- - 0 v v 7c < 0 < 0 D n .--r O t^ p co 0 N (7," v N Q G C v �• ^ ^' o 0 w °0 Q rD OS < * 3 a N 3 'Nr CI1 • 3 v, o rD + CO v ao ^ ` 1 ` CD 0_ a,— p .< =O c O -I, pq rt TQ O _O -1.) a) rD -1, v 94 CA C 0 v rD X a) 7 . . 7 rD -s 0' r1. O (D -0. N -S. 0 -. S 1S rD O 4/1 N -4 CD rD * vt CD v fD Q ,-+ v, C 3 rD v, '-` CA Ln r0+ �' Q � 0 0 P) a) - (D X -1 -• 0- 5- O v' Q N �y �' rD '0•r Q N C C 3 to (D v, ,v'+ v, O Cl- rD N O cn + Ti v + v Q to a) ai d 3 rr ,-+ S 0 V, N r+. _ S r1 (D CD 0 F-, X -1, (D a) a) Ul '0 -, a) O (D 7 ,.+ CD Cr 0 N . a) CD v, rD r', ,.,f 0 rD •v, CD rD r7 v 0 (D (D. -0 X c v• r+ v v h . O C O 0 -a 3 O v`'i < S < Cr 0 S C = 0) C ,,+ C 0 CD C v C `C p �c- 0 - O my' W p a) CDD f=r ! ,0+ D.) a) 0 0 �* p (SD n 0- • rQD c„, O O C Q rD Cl)CO 7 0- 0 Q N O j 0 , -1-. r+ II C _ p o a) Incn 0 D 4 N f+' 0 rD 0 rD 0 -^ a, 0 ro Di 0 C CIO < n n v, v c rD rD F, fD rD I-� N • v' n - .-r ,. 3 ; '` Q Cr 3 C co = - VI A -5 A Q CD 0 0 = rD < a• ° v n 0 0 rD 5' 0 r, 0 n N (D CSD -< r+, 0 ' C rt. v ° fl- `—' -h D v v, 0 -• v, -%0 n _ cD o• s v C -< n rD °-5 0 m a C Cr) v rn - O 0 rD n CO r+• n _ Q 0 OOu OW 5• 5• n s OD n OD Q O n B O o n c C. < c Q v CD n CD v 0- c p v v p rr Ill OO ro o v,' n p rD Q rD x 0• n 0 Cu n' 0 fl, a, fl n o c n o v X , o -` v, -s rD a c O o v, v0 rD �' -� n v v, 0 0_ Q c v ° v v m n Q O c v rp °- a _ ..< rD - r* O v, r+ r+ v C 0 'a -s r* O O n r'+ 04 - o n ro ' . n O v' n -0 0- c ro °� 3 0 (D 0 0 a w v a N v' or) p. O w 0 v 0• ' v m Q -< rD. O � 3 o v CD v 0 ° °' rD 0- o cn m ° -4, v CCD 0 Et' rD �, - n m v, a CI o 0 , O n 0 3 0 ] r = fD CD a na.)- ,--.- ,-a• � �+ vs 5- O r r O °� vv. vO ~h o v CID 0 r+ O m 0 r- u ..< -� rt, a CD O .-+ r+ O CD O •n, ° C <. 0 0- T. rD "O CD ° 4 o v v n rD O' c i"'i < v 0 v, -0 v 0_ a' v, rD r+ 0 n cm S oO �, s _• v v v, v G c; rD 0 0 � �. Q --1 O (D f�D C O (D O ;D C'7 rt I� �, o n v ° rD 0 0 m c v 0 O '< rD may, (D p O -n (D O C' 0 C. r+ "o rn• rD l 1 o m °C n— m Q * °- 0 •� Q v p CM fD 7 W "00 N r+rD v, H -0 rD T v --n C OOU OU - 1 CM 0 NO v, rD 0 �-r cn N lD r+ N+ rD C cu w, Cr OO r+ "a CD O r+ C D .0- N ,-+ rD -< C to O v ro -. o n Q 0 5' Q <' Cu n rD C Q 0 v kyl N m < rcr 0- `DD fl,0'1 n 0rD CDD 0 0 0 v C 0 v, r*• ro v 0_ o Q3 co 0 m).• v C -0 Cr rD aO o o , NJ v d b 0 • "a O- ..< = CDD rCL 0'� Cu v r+ Q s E• v p Q r-r �+ = fl v .--F p rD 7 N 0- Oc rD '� CDD N d4 --I-I a, CSD W S a) �, VI 0- r°°D o rD h o v n < 0- c cu n v v 0 °' < fCS n ovO o fD 0 0 v' CD v ° '' v r_° '-• v o 0 A9 0 n oo p • v, -< C) v 0 0 °- 0 o• 0O Q = n ° n v -< v, N v O rr Q rD rD 0'a Di 0 O 1 CD 0 0 , n _0• 0 0 r* N n + •f r r' a, lD CD (D 'o r O0 0.• ` (T) -4, O O (<D T� n0 N �< p fD �, -n !D N emt- n a, v, rD V1 ,x v N ,-r- _. 0 0 co 0 <' ° rD �' v 0 b carp r 0OD co p h �. p Q CD Cfl -4; n . rt rte+ 7 C O0 Ln n to O- D- rD -C3 (D - rD c N v H n v, p on c o a, -s o ® ,..h O n r+, N N �' c ° ? — S c v n r0 4. ) 3 O n' Q O p o v 6' e.4" Cu X -,0Di C et CS C 01.1 O r-' 13 O Q O C "'s N Q C Oo N -0 o v 0- 0 rn Q o v1 C 0. s * v ° v N Mari : In-, rD O r2 C = 0� N N -I O 7 p n F.) 0 v r* n 0 Q m Q CD 7c o -0 cm• m rt 0 * n `" Q- o pq 0 N 74 cn N rD S ••< o N 0- 0 -. D! O C ,--1- ° 0 ri- DJ O rte-' CD Q CU_ v N 00 n H Q 0 F, c rD ° O_ 9) 3 v, n Ocl IIn vD v v i Q p 4 c -, 0 v "0 ro D rD 0_ 3 rc., rD w OO i'l a. m v, ro c r* N -� CD n .P Cu fD rD o -< °° rro„ CO 3 vi rD _n rD O n -. c-D n 4, rD cu CM vv, Cu n+ -s rt O -z v N rD co a0, n 0 o a, 0 rD � CM C D -t O 7 (!, -n rD ''* ut rD .rte+ o �• 3 o C -• v O_ _ v, CD N C -s 'N•' Z rn N lD rD �, Q rn fD n Di C Di rD rt. a, — c rD Q 0 O C �' O n G v 0 -z C 0- 0 rD -hvs vs 7 C VI N < co r-4- m ° D 0 p CDn < r+. Hm QQ 0 rD < OOC DJ n -I C Q rD n -DoLA v' 0- 0- SW ° 0 CD CD )<r rD Cu o •a) N vnn i --n (D CD 0 n D --I m v s v, d a, v -I N ' H cn n • n z (-Ds '° ssv, o 0 CD ao O ,=r ° rD 0 -a rD v, n� N r+ '0 CU a O r+ r�r C n v 'r n (D . VI o --,, 3 (CD N 'n rD ` (CD 00 = O• a y O m_ n 77 v (D � � � n • vh Q. v �, `.- m =, 3' v o m � (rD r« ,rt z o C m ° O 13 0 0 0 3• 3• N al ° v CD 0 DJ Nv : CD cu N o (D a 3 r<-r' O -• r h Q (D (D < v v 3 (D 0'0 t•DQC (• 4 r•r Q O H rf C -U rD _,, O < Q N n Q CD S •* O_ CD pq. fD Uii < -T (D O_ N of -h 0 3 n 0 r_* v 3 ami s (D Q v C v rD v n - o _ : . V, r+ F) a, Q- rD r+ 0 m " m n cC �' �' Q- a v v rD rr =6'4. O c 74 _, a, F.Do +• 0-0 ^l CD a '^ rD °� - (D 3 O O n (D O - O -, c 2 v 0- rD -D N O -=• _ rt o 3 ao n n m Cu ° CD 3 f-r N Q rD n_ O __=. '< ..+ `< C V, C N N 0 fD Q N Cr *�h rD (12 rD v, (D Q 0U r-r N .< O 00 v, n 3 v rD CD m 5- - C n O O rD ,-r (D n �p -7 Q .1 o v Q. • 3 rD (D. 5 -0 ° 7 -, O .7 v = .n C r"I CA ao Q (+ — C' Q rt 3 O v ro v m 0 °* '� v O N = = C a� _ _- 7' v0i' 0 a" a- < O: , n 7 cn H Q r*, Q - (D CD v, n5. C ` CD v �y O- v (D fD 3 v 0tl N v (p 0U 3• ,< a- v rt, Q - r=t -s• N' ? . • 2) K 0p 0) S 0 CD ' Gl ° 0 fl- a°o C n Q v Q N 3 d = 0 n `� v C Co In p o C o 0 0 r� N 1 r� 3 2 ° v n -0 U) t;,' v as 0 co (D F�+� o "0 v - � v o w- ° � o � r+0) U h N `-+. = (D °l. CO rD �• �' -CJ N N N 0 • a, v n m S n, (D .< rD n �y I.0 "". n v rD °- 0 3 * n o N CD r' 0 C ° s ''Y. 7 rt fD v 0 C f.y '� - D CD < Q N fD V ` •< O `� et eu, o nv no Q Cl) °z n n AD s O 0 v 3 - WC ,-r 00 O rt Co -• rD 5 rD H ro C •• < �•• ° O° R> CD ° v o + v 0 * O +Cr 7 O� v © �"h O N rD fD 3 fD N '� (D (D v CDQ -+, <� Cu n * "D (D , rD rD r0+ `< n ra, "I 2 ,cn* 7 0 -0 r-r Q- - <• xm < 3 O fl _ Q (D D m m •• •nano Q 3 °_ s 3 b AD GU r+. n0 ; b. CD O n — p 10 0 n O" O -I V1 in' O O X O Q O f�D .--" f-D < O (D 1,..) a O r+ 00 (D N n !D _ CDD ,=•+ fD dOq r0-' es-r CD O �• N O G W (DD • O N � fZ O O n + v (D a rt n -, oa -,-,- c A 0) N 3 C fl, n fp' L-A. C Q, fl, rrt (D 3 v fD Q = •• rte'+ =• a) CDD CO r+ 7 (D 'fin v' O_ 3 v in r0-r i^ r+ O D N D Q C �' `rt• (n (D"1 FD- 5. o in• CD _, O o = `-' 3 N' = it) fp w to ° c O m n O ° — , CD C rD fp 3 n O N C C" a' ((D CJA -• ,..f Nin (p CD O O.. (D N -i, C cu 0 0 3 n o D.) LI' n r+ Q-• CD c 0 co C CL . sz r+ rD o5. -• O D, _ s3 (D = co N (D v r* (D N rD (D v, n _• 3 CD O N Di CD v CD CO Q N 0� 3 Q_ n N O -co v, O fl, O to p O r+ x r+ n O r*• O O to Q n. O_ Q In O O -, n + Q O O CD (D O O N a Co n, (D O (D N cnCimi (D O SeD N O v v �, N r-r, CD �^ v N O rrt (D v -, 3 r•r 0_ cn (D -O O (D Q v N O" n inC = O O fD rn-r r+ fl, O X 'Ln •U[1 (D < N O v F < el J vCA •It 3 o no n. 3 fl, s op CD as cl_CDD -< w c (D — 0- _ n 3 N -a o (� rt (o r '! r* O rt °- ' r. -p — (D H 7,.. . (D O cy v1 Q o • 3 H (D o o m- 3' m c co -o rD CO v 3. 3 °' O vo CD c lD s fD lD O O• '�. CD Q Q N O p, O MSI :� O -z r+ C n 'O (o fl, vs f, 3 O D 3 O v v 0- vs l 1 -• 'O rv'y. O O n (D •O (D O rt al < `n (D n r -< rD o_ CCi, * O ,+ o 7 -• n O Q co DD, Q_ a, 73 O cc/) p r'+. Q fz O CDD CD fD tz Q — O (�D O' `^ FSI -�r-tN O n a m rD CL C o v v, O 'n f D o m Z C n O ° Q pV• Q fl, V, NVO Ln z 0- 3°' QlD 0- CS- �. O r=r O CL D' v, " O fl, CD ' OUo r+ r+ V, v O Cor+ O n NO ~+ � n n o S N CD XCA CDcu Cnj - (D n (D - 3 v O O D, — v -i, VI n -+ C h PC i CD n Q s� a0o n a 0A n s v o — c o C- �• '^ r+ a M o ,•+ r+ 'n -5. (D C ao et m r+. °�. vs r+ NCD W �, o _ wo cn • rD v Cu v v co `� c o i CD m s (D o r+' ao 3 Q 3 n r 3• n o Q r+ C (D fD (D CD (� 2',24. Q7 ,n-r. v,' �, c �, 30 Q °'. O O v O rDs (moo N 3 -v C!U N ri C v (D Ovl � ('D 0- CO ,�+ r Uq Cu ,-+ - -O O O� p -� (D CA a' r"'r VI o fD co fD fl, N '� O 'Ci, Di al fD _ n CD Di O, O r+ v, C (D -O CD 3 3 -• (D. �T. p '� h co CD �_ (° fl, N 0,00 (D 3 v o n Ort r., o ►-�] Q v n+ (D 3 v r aD C D m (D a, 3 3 c Din, Q n, N n v �, O_ O D) (D a, 'n' = n Q ;4. Q. N CD O O fl, a, O CD Q -+ v x n Q 'n O cn n (D n O O C r+ -z r-r p) (D 7- v o 0 ,� O- 0- -a Q CD (D O D v, CD 3 N O n O ; O (D O (D O (D -r, ` ,-+• N = CD o_ O CD n Dr, (D n O �-r O = v O v `S cit -l• -n lD Di CD . < Di CD O CD O O c !. d cro N < n O O V' O `, V, 0. °—' N 3 -O -• v 3 -. CD 0CA r, CS 0 CU O- Di O Q C/cl N, (�D O n N r-r O n CD n Cl) O n V) O 'n �• O DJ N W fD r 0 _ • CD O p O S v 3 O w { ' a, O fl + Da (D CD 3 N < N 3 v UO — -, V, D (D Q ny -< flJ v CD v, cD Di Cr CD • O n 'moi, CO 'rD N* N O r0't es- 3 co (D 3 co O (OD O -6 o CD ra S+, rte-,• • Q (D O O r+' 0 O r•r N a- (D C O 0- * n '� (D r (D 0 tS -�+, cr 0 r+ -z v V1 r* (D IN._ CD v D -S CD D (o 5 CD C2 O (D V, "a O n O ,N+ tNi, h, N+, � �-r v S ,-+ Q v O "O tn' •O r-+ 0 O N v CD fll O• O (D jr 0- O O Co 3 C VO, n O �+ n O v (D n . 'moi, O ' -"' rt < (D Q- 6 C -z O 3 • !D a_ (D S fD UQ h (D VIIMIIIIIIIIIIIIIIIII 7 4t IF LA IF H < o H It 4F It 4F H H Cr Q o cr o P o 0 0 -, o 0 0 0 0 0 0 0 o 0 0 t� ,.. 0 -"n •-h �-n p' p, 0 r-1, ._r, •-•, ^n = w w a ,,- -, a � P . E a . . 0 0 p' 0 0 0 0 E g x O :-n a :-n as as ao <G -, n 0 -, LA 0 0 a CD 0 c( "' -t 0 �. '"1 '� 9 y a m a o `-t 0 0 w a 0 u =.-o -0 y tt' R a _9 a- 0 0 c vo r• a 0 0 0 0 a 5 5 d o 0 0 �--� cu - ,, W O 5' Gy --,-t N N o• O n Z �(o CD a. O. 0 0 0 o 0 < <- o. 0 4 0. 0 o (>' a (a 0- 0- tn 0 Z CSD Co v, VD y CD T. '(---Al 0 atiD --• 3 < C ►! 0 co CAO .: n �, no 0 (a 0- . x ' Coate y o t 0 d t b o t-.) VA N — V •J p p u N O O .C N00 cn o 00 4 C = .-.-J -' N ® i CD 0 A o0 0 o w A o o y �= ttwoc N �O Oo O N a Vi N Vi J J O . . 0 chi, 0 R� CD co N c„,,,, O O N _ 0. , a© tmllaPZ tn N N C CD - Lh J NJ p a1 N N Vi vi .O OW., Or ^_ I�1 N N 49 W N 00 N NJ O N N -� O J CO CD W V] b b O<N _ O N c"'',,,,.`0. N a1 — J J c�..:0 lla N. O .P Oo N N O a> a1 O O O cn ,..• H+ et N' N 0 0 -P co 0 O coo 0oO — -- a1 a\ N O C4 It Irk at 4ct rnIt It It lt *t *t It 4t 4t It % H 3 It It It CP o It o �' o 0 0 0 0 0 0 0 0 o 0"- 0 0 0 0 0 - ,� oD po NwN. o n y fN D 0o r-,* Fa. > ra. .4 ''' a < CD ,U....' C,c' ,--, et •-t O 0 viwS n a0� ,- CD ` O CD CD n 0 cr z -- .- N (Qo r..1 O � 'O �..i -t N a0o fsdw , < CD v ' " Cd V co 0 o O En cu < CO .� v ,.t CD O y 0 CD£ , fD V x �• 5 (/� f<D O. cD O N `Ci Ai. O. O n N O-cv �. .-1' x p '-* O g w < 0. ri7 "i O to O O 0 0 `. . o EA n '.r7 a 5, a. O w W 0 CD ¢' O A `C'S 0 w w C cD 0 Cr p O N y to �s w p O O 0 G rr7 5 D' q CD C) a• w R. P 5 p' 0 ¢ co o 2 v° N. .. tN = m- O '.3 > O •'d o N "'t vci v' N O `� b W to rD h �. '+ AAD �• 0 CD n to N ...i O W N ri, w0 Y czt �as y o EA N �-t- w 0 Q. N w Q+ ems•' ❑ ° 0g 0 5 0. to �_ gD, CD CD•a CD 0, to 0 n' '0 0 T� 0"1% O'� w O. N O 0 V t M"h �'cD' CD 0 CD O' e' CCD Le) t4• O t.) .`3 w R. CA .. ►! o c D 0 0 n CD r ri) o 9, co M"* O O C O 0o CD S CD Aa&DD lNh Q ? � � c Z � o _ o � � s; p o -. rte.. 6N n z CD ;y Imo' 7 N CD CD 0 16lII^^YYY�� 1+/ o 0 0 o 1-4 n o , o c, N w .. a = co a' O Vr A O W "'s p e-I- "S p T� I O ?a �< UIQ �• I Cr CD O 0 CD ^co N p c9 H oo — c, N �, � � !� n Cr) Cr ~ N N R : CO C !v is _ C. a(le CD w CDn ON _ p CD wO C N . , - x w O O • O _ Q ' . CD = OcA N o N _iiJ oo O r — '.� A a, O W M 0 N N v N N p N �1 N N p, 0 m. O w0 NO v, — w cn t w O u, ,c,(--, N ip N O 0, = to lh O 0 �, O O 6 c o Q• O.., y t DA v, U.O og J w . w A = CO, oAo N J a1 O N N W w w 0 0 0 up o n P O -4,A L. n C • E (• 3 D n D O N O C n cp r-r 7 D Fa O_ '�' S — fl d co (CD n lD n CD N c O Oh OW Q. O ,--r -O 'a in u, a CD N O_ O N O Cl co �. e—f• '� N -, CL 1--� '�u Z � 3 �• ��O ra cu Di `' '` E s C CD CU co n W MSI O 1 N CU }V N O r O G (D S✓'fit ti ✓ ✓ �.. 6 y? ¢' T nil v. 00 z'✓ ✓�- ✓✓ ✓ - t✓✓ F c:3 ✓x�'�# g✓ r" J.—. 0CD CDCD0 OLD I^ v pia - -r f ✓r "%,✓ ✓`� �. ,�� �� Q� Cu "C3 us ✓/ 5 , ro Do cr, 0.) �.✓ �.,51 'dJ O_ CD co O Q ❑1us V1 7 n Q Q O Do rD D �. O r'1 O cu UC1 7 ro .-r f"' Q .r.1 2' (D e. O V� 0 C 0 CD r(7 (D N 7 CD C raii7 co O_ O" C 7 (D N cn rD N (D r O • t i N mo s oO � < r0oDD oan -n Po o G) ov - m r*. O''n n < D m Q 0 _. v c—' o c, m <. i �, o- �: 0- D)Fc; CI- CD NJ 7 O 7 rr+ nl rD t,:,' O C N O =! O v v N a N 97 rD N ni < G) DQ fD 'D p O O ,-r Q W 0, G7 n O x. v 5' Q.. N N N fD v i D rr. N N cr an m — cD O [l 0 0 /Z m c7 to D° �' n (l S < n ' v 0 N fD OCD CD °+in 3. rt m 0- cD CD 0 r0 0 cO 3 3 a-h Co �' O = -0 -v c m mmm < < CDm z Z C Z Z Z Z CDcD ,--i- (' CD O o n n n O O OOOO o n o vn K rT CM C v y o ►b v< < < < < < < < v) (;.1„) rD C< < < < z OOOOcD m BOroO vvivvn v, n3 * NOO 0 V, i, VI p 0 N t:; =, r-r O F! :f. N a Z z z < < < < Z f<D N l<D f<D CD 0 N N r<D '� O O O vOi cOi+ rD tOi, 0 ,n 0 0 0 to cn vi VI � �e.� -O �+ -s. y, C CD o s = co VZ p ►-h zzz zzzz z zzzz rD (D CD "o • o cCDD Di 0 0 0 0 0 0 0 0 0 0 0 0 n _� tll N X AD 0Ln cr,0 O 0_ vet n 0 C ® ft>y/ < < < < < < < < < < < < rD 0. a !D lD CD CD CD N N v, ,n fD rD CD CD ,n ,n 0, lD (D N to vi N V1 in /D .-t .-i `< 21: 0 cr C : 0. 0 10 Z Z Z zzzzZZZZ (<D <-< -< -< �' -0-, OcA O O O O O O O to O O O O in ,n ,n in CD 0- : < F-+ F-. NJ W W W U.) W A A A A U"i U, Cr") Ci N 0 Board of Health • V New Business Item 4 Policy Discussion: Readoption of a Jefferson County Public Health Civil Enforcement Code 4, gelleitson Public Healt June 18, 2015 Chapter 8.01 ENVIRONMENTAL HEALTH CIVIL ENFORCEMENT Page 1 of 1 Chapter 8.01 • ENVIRONMENTAL HEALTH CIVIL ENFORCEMENT (Repealed by Ord. 9-05) The Jefferson County Code is current through Ordinance 2-15, passed February 9, 2015. Disclaimer:The Clerk of the Board's Office has the official version of the Jefferson County Code. Users should contact the Clerk of the Board's Office for ordinances passed subsequent to the ordinance cited above. V S S http://www.codepublishing.corn/WA/JeffersonCounty/html/JeffersonCounty08/JeffersonC... 6/11/2015 rrI ` CC-• �D t r TCt' r i i/23JC`� S JEFFERSON COUNTY BOARD OF HEALTH ORDINANCE NUMBER 09-1020-05 (Repeals and Replaces Ordinances#09-0715-04 and#08-0919-02) SOLID WASTE REGULATIONS i October 20, 2005 S t STATE OF WASHINGTON • Jefferson County Board of Health An Ordinance } Authorizing Environmental } ORDINANCE NO. Health Civil Enforcement } WHEREAS, the Jefferson County Board of Health wishes to establish civil penalties for violations of public health laws, regulations and/or ordinances adopted by the Washington State Legislature, Washington State Board of Health, Washington Department of Health or the Jefferson County Board of Health; and, WHEREAS, all conditions which are determined by the Health Officer to be in violation of any public health law, regulation and/or ordinance shall be subject to the provisions of this ordinance because they are detrimental to the public's health, safety and welfare; WHEREAS, all violations of public health laws, regulations and/or ordinances are detrimental to the public health, safety and welfare and are hereby declared to be public nuisances pursuant to Ch. 7.48 RCW; WHEREAS, a civil infraction process, established pursuant to Ch. 7.80 RCW, can protect the public from the harmful effects of violations, will aid in enforcement, and will help reimburse the County for expenses of enforcement; WHEREAS, enactment of this Ordinance promotes the health, welfare and safety of the citizens of Jefferson County; and WHEREAS, the Jefferson County Board of Health enact this Ordinance pursuant to the authority granted them by various state statutes, including, but not limited to, those codified at Ch. 7.48 RCW, Ch. 7.80 RCW and Ch. 70.95 RCW. WHEREAS, the Board of Health chooses to revive this Ordinance, which was originally adopted as Board of Health Ordinance #08-0919-02, an Ordinance which was mistakenly repealed in its entirety by Board of Health Ordinance#09-1020-05. NOW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section I. Purpose: It is the express purpose of this ordinance to provide for and promote the health of the general public and not to create or otherwise establish or designate a particular class or group of people who will or should be especially protected by the terms of this ordinance. It is the specific purpose of this ordinance to place the obligation of complying with its requirements upon persons, businesses or companies required to meet provisions of the health regulations. Enactment of this Ordinance and its terms and provisions does not impose any duty • upon the Jefferson County Health and Human Services Department or any of its officers or employees unless a duty is imposed on such officers or employees by the express terms of this Ordinance. Implementation or enforcement of this ordinance by County officers or employees • shall be discretionary and not mandatory. Section II. Authority This ordinance is promulgated under the police power granted to the Jefferson County Board of Health, including, but not limited to, authority granted to them by Ch. 7.48 RCW, Ch. 7.80 RCW and Ch. 70.05 RCW to protect the public health, safety, and welfare of the people in Jefferson County, including those County residents residing within the City of Port Townsend. Section III. Applicability Provisions of this ordinance apply to violations of the following statutes, regulations and/or ordinances as they now exist or as they may hereafter be amended: Chapter 70-90 RCW Water Recreation Facilities Chapter 70-95 RCW Solid Waste Management Chapter 246-203 WAC General Sanitation Chapter 246-215 WAC Food Service Chapter 246-260 WAC Water Recreation Facilities Chapter 246-261 WAC Recreational Water Contact Facilities Chapter 246-272 WAC Onsite sewage systems Chapter 246-290 WAC Public Water Supplies Chapter 266-291 WAC Group B Public Water Systems Chapter 173-304 WAC Minimum Functional Standards for Solid Waste • Chapter 173-308 WAC Biosolids Management Chapter 8.05 JCC Food Service Sanitation Chapter 8.10 JCC Solid Waste Chapter 8.15 JCC Onsite Sewage Section IV. Conflict In case of a conflict between this Chapter and the Chapters of the County Code relating to Food Service Sanitation, Solid Waste and/or Onsite Sewage, as currently enacted or as may in the future be amended or recodified, the text of those three Chapters shall control except that the Local Health Officer shall have discretion to interpret and implement any County Code sections enforced by Public Health(or its successor agency or division)which are at variance with one another in a manner that best protects and furthers public health. Section V. Designation of Civil Infractions Any violation of the laws,regulations and ordinances specified above in section III (including any future amendments to those statutes, regulations and ordinances) shall constitute a civil infraction. Each (twenty-four) 24-hour period when a violation is found to exist shall constitute a separate and distinct violation. The owner or Lessor of any real property shall be and is jointly and severally liable with any • tenant, occupier or user of real property for any violation alleged against that property or alleged to have occurred on the owner's property. The legality or illegality of the use or occupancy of the land by a person or entity shall not be a defense available to the owner of said property if it is alleged a violation of this Ordinance occurred on that property. A first violation shall be a Class 3 civil infraction as established in Chapter 7.80 RCW. A second violation shall be a class 2 civil infraction as established in Chapter 7.80 RCW. A third violation shall be a class 1 civil infraction as established in Chapter 7.80 RCW. Section VI. Processing and Adjudicating Civil Infractions: Such violations shall be adjudicated and any related fines determined in accordance with the procedures established in Chapter 7.80 RCW, the Jefferson County District Court rules for Infractions and the Washington State Rules for Courts of Limited Jurisdiction, which shall have precedence over the terms and obligations of this Ordinance if this Ordinance conflicts with state statutes or court rules. Upon a determination that the County has met its burden of proof regarding any contested violation alleged against a person or entity pursuant to this Ordinance, the County may seek to obtain attorney's fees against the violating party or entity pursuant to RCW 7.80.140. Utilization of the procedures and penalties laid out in this Ordinance and the underlying state statutes shall not prohibit this County from utilizing any other lawful means or seeking any other lawful remedies against the person or entity that has allegedly violated the terms of this Ordinance. Nothing in this Ordinance shall prevent the Judge hearing these civil infraction matters from reducing or mitigating the monetary fines that would otherwise be imposed. Section VII. Enforcement Officers The Board of Health, or its designated Health Officer, may authorize one or more persons to serve as an "enforcement officer," duly authorized to enforce this Ordinance. Section VIII. Severability Should any section, paragraph, phrase, sentence or clause of this ordinance be declared invalid or unconstitutional for any reason, the remainder of this ordinance shall not be affected. Section IX. Effective Date The effective date of this ordinance shall be the date of its adoption. Signature Page: • AN ORDINANCE AUTHORIZING ENVIRONMENTAL HEALTH CIVIL ENFORCEMENT, JEFFERSON COUNTY PUBLIC HEALTH APPROVED AND ADOPTED this day of , 20_ Sheila Westerman, Chair Kathleen Kler, Vice-chair David Sullivan, Member Phil Johnson, Member Kris Nelson, Member Jill Buhler, Member • • Board of Health V New Business Item 5 Update on Access to Naloxone as a Heroin Overdose Treatment ID A delleAson Public Health June 18, 2015 • HOUSE BILL REPORT ESHB 1671 As Passed Legislature Title: An act relating to increasing access to opioid antagonists to prevent opioid-related overdose deaths. Brief Description: Concerning access to opioid overdose medications. Sponsors: House Committee on Health Care &Wellness (originally sponsored by Representatives Walkinshaw, Griffey, Cody, Smith, Peterson, Magendanz, Riccelli, Stanford, Appleton, Robinson, Tharinger and Jinkins). Brief History: Committee Activity: Health Care & Wellness: 2/10/15, 2/13/15 [DPS]. Floor Activity: Passed House: 3/2/15, 96-1. Senate Amended. Passed Senate: 4/8/15, 47-0. Senate Amended. • Passed Senate: 4/21/15, 48-0. House Concurred. Passed House: 4/23/15, 97-1. Passed Legislature. Brief Summary of Engrossed Substitute Bill • Authorizes prescribing, dispensing, distributing, and delivering opioid overdose medications to a person at risk of experiencing a drug overdose, as well as to a first responder, family member, or other person in a position to assist a person at risk. • Requires a pharmacist dispensing an opioid overdose medication to provide instructions on the proper response to an overdose. • Permits any person or entity to possess, store, deliver, distribute, and administer opioid overdose medications with a practitioner's prescription or order. This analysis was prepared by non-partisan legislative stafffor the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it • constitute a statement of legislative intent. House Bill Report - 1 - ESHB 1671 HOUSE COMMITTEE ON HEALTH CARE & WELLNESS Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. • Signed by 15 members: Representatives Cody, Chair; Riccelli,Vice Chair; Schmick, Ranking Minority Member; Harris,Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Jinkins, Johnson, Moeller, Robinson, Rodne, Short,Tharinger and Van De Wege. Staff: Alexa Silver(786-7190). Background: Naloxone is a legend drug that is used to prevent opioid-related overdoses. Opioids, such as heroin, morphine, and oxycodone, act on opioid receptors in the brain and nervous system, causing depression of the central nervous system and respiratory system. Naloxone blocks these opioid receptors and reverses the effects of the opioid. Naloxone may be injected in muscle or intravenously or sprayed into the nose. It is unlawful to possess, deliver, or dispense a legend drug except pursuant to a prescription issued by a health care professional with prescriptive authority who is licensed in Washington. A person acting in good faith, however, may receive a naloxone prescription, possess naloxone, or administer naloxone to a person suffering from an apparent opiate- related overdose. It is not unprofessional conduct under the Uniform Disciplinary Act for a practitioner or a person to administer, dispense, prescribe, purchase, acquire, possess, or use naloxone if the conduct results from a good faith effort to assist either: (1) a person experiencing, or likely to experience, an opiate-related overdose; or(2) a family member, • friend, or other person in a position to assist a person experiencing, or likely to experience, an opiate-related overdose. Summary of Engrossed Substitute Bill: A health care practitioner who is authorized to prescribe legend drugs may prescribe, dispense, distribute, and deliver an opioid overdose medication: (1) directly to a person at risk of experiencing an opioid-related overdose; or(2) by collaborative drug therapy agreement, standing order, or protocol to a first responder, family member, or other person in a position to assist a person at risk of experiencing an opioid-related overdose. At the time of prescribing, dispensing, distributing, or delivering the opioid overdose medication, the practitioner must inform the recipient that as soon as possible after administration, the person at risk of experiencing an overdose should be transported to a hospital or a first responder should be summoned. A prescription or protocol order issued under these circumstances is issued for a legitimate medical purpose in the usual course of professional practice. Any person or entity may lawfully possess, store, deliver, distribute, or administer an opioid overdose medication pursuant to a practitioner's prescription or order. A pharmacist may dispense an opioid overdose medication pursuant to such a prescription and may administer an opioid overdose medication to a person at risk of experiencing an overdose. At the time of dispensing the medication, the pharmacist must provide written instructions on the proper response to an opioid-related overdose, including instructions for S House Bill Report -2- ESHB 1671 r seeking immediate medical attention. The instructions to seek immediate medical attention • must be conspicuously displayed. The following individuals are not subject to civil or criminal liability or disciplinary action under the Uniform Disciplinary Act(UDA) for their authorized actions related to opioid overdose medication or the outcomes of their authorized actions if they act in good faith and with reasonable care: practitioners who prescribe, dispense, distribute, or deliver an opioid overdose medication; pharmacists who dispense an opioid overdose medication; and persons who possess, store, distribute, or administer an opioid overdose medication. The provision in the UDA related to naloxone is repealed. "Opioid overdose medication" means any drug used to reverse an opioid overdose that binds to opioid receptors and blocks or inhibits the effects of opioids acting on those receptors, excluding intentional administration via the intravenous route. "Opioid-related overdose" means a condition, including extreme physical illness, decreased level of consciousness, respiratory depression, coma, or death, that results from consuming or using an opioid or another substance with which an opioid was combined, or that a lay person would reasonably believe to be an opioid-related overdose requiring medical assistance. "First responder" is defined to mean a career or volunteer firefighter, law enforcement officer, paramedic, first responder, or emergency medical technician, as well as any entity that employs or supervises such an individual. "Standing order" and "protocol" mean written or electronically recorded instructions prepared by a prescriber for distribution and administration of a drug by designated and trained staff or volunteers of an organization or • entity, as well as other actions and interventions to be used upon the occurrence of defined clinical events to improve patients'timely access to treatment. Appropriation: None. Fiscal Note: Not requested. Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed. Staff Summary of Public Testimony: (In support)This bill came from a constituent who lost his sister in a heroin overdose. There has been an extraordinary increase in opioid overdoses over the last 10 years. In 2012 there were over 600 overdose deaths from heroin and prescription medications. Overdoses are spread evenly across the state, with the highest rates in southwest Washington, Skagit County, Whatcom County, and the Nooksack Valley. Opiate use in Snohomish County has been declared an epidemic. Naloxone or Narcan is a very effective drug that reverses the effects of an overdose, and expanding access to it will save lives. The bill allows for third-party providers to have Narcan in stock. Because it is administered through a shot or nasal spray, non-medical professionals can easily administer it. The bill includes language that it cannot be . administered intravenously by someone who does not have a medical background. The delay House Bill Report -3 - ESHB 1671 between a first responder's arrival and the arrival of a paramedic can be significant. By increasing access for first responders, a person may begin normal breathing five to ten110 minutes earlier. There is significant interest in stocking naloxone in police cars. Existing law allows law enforcement to have and use naloxone, but the problem is getting it. A summit is being held with law enforcement officers and health care providers to talk about this issue. There are currently three programs in King County that use this drug; one program provides it to people who attend needle exchanges, one program is a jail health-services pilot project that trains people on the use of the drug, and one program supports expanded access for paramedics and emergency medical technicians. A health impact review of this bill found evidence that it has the potential to increase the number of opioid antagonist rescue kits distributed and administered, decrease complications and deaths, and decrease disparities. (Opposed)None. Persons Testifying: Representative Walkinshaw, prime sponsor; Jeff Duchin, Seattle and King County Public Health; Sierra Rotakhina, Washington State Board of Health; and James McMahan, Washington Association of Sheriffs and Police Chiefs. Persons Signed In To Testify But Not Testifying: None. • 11110 House Bill Report -4- ESHB 1671 eninsula Daily News Page 1 of 2 This is a printer friendly version of an article from www.peninsuladailynews.com 0 To rint this article open the file menu and choose Print. __ Article published Apr 26, 2015 Heroin overdose averted by Port Angeles police By Rob 011ikainen Peninsula Daily News PORT ANGELES —A potentially deadly heroin overdose was reversed Friday thanks to an antidote deployed by Port Angeles police. Cpl. Josh Powless and Officer Sean Ryan were dispatched to a report of an accidental overdose on the 200 block of East Vashon Avenue at 2:27 p.m., Deputy Police Chief Brian Smith said. When they arrived 21/2 minutes later, police discovered a 29-year-old man who was not breathing and did not have a pulse. As they began CPR, Powless administered a 0.4-milligram dose of naloxone, which temporarily blocks the effects of heroin or other opiate drug and helps a person who is having an overdose breathe. Powless injected a second dose into the man's muscle tissue. The man regained a pulse and began shallow breathing, Smith said. Cillaiire department paramedics and emergency medical technicians, who arrived minutes after police, ugig advanced life support measures and administered more doses of naloxone, Smith said. "Within 15 minutes of the initial call, the patient was conscious, talking and able to stand up," Smith said. Based on the man's quick recovery after the administration of naloxone, personnel on scene determined that the opiate overdose was reversed by the antidote, Smith said. The Port Angeles Police Department recently secured 64 naloxone auto injectors through a grant from Kaleo, a Richmond, Va.-based pharmaceutical company. Officer Sky Sexton applied for the grant and helped train other officers to use the auto injectors in March. Part of the reason police wanted the antidote is because they often arrive to medical calls before emergency medical technicians. On Friday, the first-line fire ambulance and engine were assigned to other calls when the overdose was reported. "In a case like this, a minute can be a lot," Smith said in a telephone interview. The man who had the overdose was taken to Olympic Medical Center for evaluation. O•rs believe he had injected heroin intravenously. tp://peninsuladailynews.com/apps/pbcs.d11/article?AID=/20150426/news/304269971/heroin-overdose-ay... 4/27/2015 eninsula Daily News Page 2 of~2 The incident was the first time Port Angeles police have used naloxone to reverse an overdose. "We were excited that we were able to do that," Smith said. • The department is the only law enforcement agency on the North Olympic Peninsula that carries the drug. Public health officials have said more law enforcement agencies should have access to naloxone. Reporter Rob 011ikainen can be reached at 360-452-2345, ext. 5072, or at rollikainen@peninsuladailynews.com. All materials Copyright © 2015 Black Press Ltd./Sound Publishing Inc. • • :p://peninsuladailynews.com/apps/pbcs.dll/article?AID=/2015 0426/news/3 04269971/heroin-overdose-ay... 4/27/2015 Clallam, Jefferson counties target heroin overdoses by planning to offer kits with antidote By James Casey, Peninsula Daily News, May 26, 2015 4 � V .€rase ient. A typical naloxone injection kit. North Olympic Peninsula counties are expected to start offering naloxone injection kits to heroin addicts and their families this year through syringe exchange programs. The life-saving strategy could start as early as this summer in Clallam County, and Jefferson County could have a similar program in place by fall. Naloxone, an antidote to opiate drugs, already is carried by Port Angeles police officers and Jefferson County emergency medical technicians. t can counteract an overdose quickly and sufficiently for a drug abuser to receive necessary medical atment. The Clallam County Board of Health at its April monthly meeting had delayed distributing naloxone while it made sure county employees could be shielded from liability for dispensing the antidote. However, Gov. Jay Inslee signed House Bill 1671 on May 8 to grant "Good Samaritan" protection starting July 24 to people who administer the drug in good faith. The Board of Health voted unanimously last Tuesday to approve distributing naloxone through its Syringe Services Program in which drug abusers exchange dirty needles for sterile ones. Jefferson County is examining its policy options and costs, said Jean Baldwin, county public health director. "We're exploring with our Board of Health how much does it cost, how much should we assume as the Board of Health, and should we pursue outside funding," Baldwin told the Peninsula Daily News. "We have to set the policy piece — and Clallam is ahead of us there— but we should have this by fall." An average 600 people died of unintentional heroin overdoses in Washington in the years 2009-2011, according to the University of Washington. 410piates are drugs naturally derived from opium or synthetically produced to have the same narcotic, painkilling effects. In Clallam County, according to figures for 2011-2013 from the university, fatal opiate overdoses totaled about 15 per 100,000 people, or around 11 to 16 deaths per year. In Jefferson County, the rate was about 11 per 100,000 people, or roughly three deaths per year. "This is a crisis of our time," said Clallam County health board member Bryon Monohon, who is also mayor of Forks, at last Tuesday's meeting. People who receive the kits that include two doses of naloxone — also known by its trade name, Narcan —will be trained in how to inject them and be told to follow through by immediately calling for medical aid to an overdosed drug user, said Iva Burks, Clallam County Health and Human Services director. A heroin or other opiate overdose depresses a person's central nervous system and stops his or her breathing. Naloxone binds to those nerve receptors, rapidly— and often unpleasantly— reversing the overdose for 20 to 90 minutes, according to Dr. Jeanne Stehr-Green, interim Clallam County health officer. According to the Narcan label on the U.S. Food and Drug Administration website, reversal of opiate effects in those physically dependent on them can cause withdrawal symptoms including body aches, fever, sweating, nausea, vomiting and increased blood pressure. It has no adverse effect on people who do not need it, Stehr-Green said, has no potential for addiction and shows little evidence of enabling heroin use. Clallam County ranked third among the state's 39 counties in per capita deaths and hospitalizations from opiate overdoses, she said, adding that offering naloxone through the Syringe Services Program would reach the target segment of the population. The program —offered from 2:30 p.m. to 4 p.m. Tuesdays at the public health clinic, 111 E. Third St., Port Angeles— already reduces the spread through shared needles of hepatitis and other contagious diseases, she said. It exchanged 274,000 needles last year. Health and Human Services also may make voluntary drug abuse counseling available on exchange days, Burks said. Jefferson County deaths and hospitalizations ranked 17th in the state. It exchanged almost 43,000 syringes in 2014 through its service from 1:30 p.m. to 2:30 p.m. Mondays and Wednesdays at the public health clinic, 615 Sheridan St., Port Townsend. The radical and rapid rise in heroin use is attributed to health care providers' prescribing far fewer prescription opiate painkillers like oxycodone, Vicodin or Percoset during the past three years than they once did, Stehr-Green said. "A lot of [addicts] will say, 'I started out on pills. Then the doctor wouldn't prescribe them anymore, and someone told me heroin cost half the price that pills do,- Clallam County Health and Human Services Department nurse David Doran told health board members last Tuesday. • Clallam County will buy the kits consisting of two syringes prefilled with naloxone for $35 per kit from the King County Public Health Pharmacy, which offers the lowest price for them, Stehr-Green said. If given only to known opiate abusers, the program will cost about $4,000 a year, said Burks, from funds already budgeted for the department or taken from its contingency fund. 11 distributed to people at risk of addiction and to their friends and family members, it would cost about 13,000 annually, Burks said. Some Clallam County addicts have been obtaining naloxone doses in King County, which has distributed them since March 2014, Doran said. At least seven more Washington counties also do so. In the past month, Stehr-Green told members of the board of health, Port Angeles police officers had saved the lives of at least three overdosed opiate abusers with naloxone. Administering the drug to an overdosed person actually might help stem an addict's habit, Doran said. "If you saved another person's life, it could be a huge turnaround," he said. "It could change a person's life." Besides, an untreated overdose leaves no room for recovery, Doran said. "You can't clean up a dead drug user." Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey(c7peninsuladailynews.com. • • Board of Health V New Business Item 6 Legislative Session Update (Mason Public Healt • June 18, 2015 Board of Health V New Business Item 7 Application for Substance Abuse Advisory Board A( vont` Public Healt June 18, 2015 DAVID J. STANKO JEFFERSON COUNTY SHERIFF JEFFERSON 79 Elkins Road • Port Hadlock, Washington 98339 • (360) 385-3831 oouN- June 10, 2015 Julia Danskin Jefferson County Public Health 615 Sheridan Port Townsend, WA 98368 Dear Ms. Danskin, I would like to be considered for a position on our SAAB board. I believe the success of any program is in partnerships and collaborations between community stakeholders. I also believe it is important to have a law enforcement perspective while considering the challenges and solutions for substance abuse situations within Jefferson County. 1111 Thank you for our consideration. f J Dave Stank\\b David Stanko Sheriff Jefferson County Sheriff's Office 79 Elkins Rd. Port Hadlock,WA. 98339 360 344 9752 • / r � J Media Review , ogeffehson Public Health Jefferson County Public Health May/June 2015 NEWS ARTICLES 1. "Sewage discharged May 13 into Port Ludlow Bay; water off-limits until May 20." Port Townsend Leader, May 14th, 2015. 2. "Biotoxins close Ludlow, Mats Mats bays to recreational harvest of shellfish," Port Townsend Leader, May 20th, 2015. 3. "Shellfish harvesting closed to Port Ludlow, Mats Mats Bay beaches," Peninsula Daily News, May 21st, 2015. 4. "Clallam, Jefferson counties target heroin overdoses by planning to offer kits with antidote," Peninsula Daily News, May 26th, 2015. 5. "Free youth mental health clinic moves under OIyCAP umbrella," Port Townsend Leader, May 27, 2015. 6. "Women's Health and Birth Control," Port Townsend Leader, May 27th, 2015. 7. "2014 food handling awards present by Jefferson board," Peninsula Daily News, May 31St, 2015. 8. "Whooping cough breaks out in Jefferson County," Port Townsend Leader, June 3rd 2015. 9. "Food safety awards recognize consistency," Port Townsend Leader, June 3rd, 2015. 10. "Discovery Bay beaches in Jefferson closed to shellfish harvest due to biotoxins; • Dabob Bay reopens, but with vibrio warning in place," Peninsula Daily News, June 9th 2015. 11. "Jefferson recreational marijuana moratorium lifted; regulations now in place for pot entrepreneurs," Peninsula Daily News, June 10th, 2015 12. "BOCC adopts marijuana land-use rules," Port Townsend Leader, June 10th, 2015. 13. "Second annual Hempapalooza to celebrate cannabis culture June 19-22 in Brinnon," Peninsula Daily News, June 10th, 2015. • • Sewage discharged May 13 into Port Ludlow Bay; water off-limits until May 20 Posted: Port Townsend Leader, Thursday, May 14, 2015 12:29 pm An estimated 72,000 gallons of inadequately treated effluent were discharged into Port Ludlow Bay on May 13. Olympic Water and Sewer, Inc., officials reported an accidental release of sewage at the Port Ludlow Wastewater Treatment Plant on Wednesday, May 13, due to a mechanical failure. Repairs were made and the problem corrected Wednesday afternoon, according to a press release May 14 from Jefferson County Public Health. Jefferson County Public Health has issued a "No Contact" Health Advisory for Port Ludlow Bay and posted warning signs in effect until Wednesday, May 20. The public is advised to avoid any contact with the water in Port Ludlow Bay, including swimming, kayaking, fishing, and harvesting of shellfish and seaweed. The harvesting of shellfish is always closed in Port Ludlow due to the proximity of the sewage treatment plant outfall and marina. IIFor more information on this advisory, contact Jefferson County Public Health's Water Quality Program at 360-385-9444 or visit our webpage at www.jeffersoncountypublichealth.org. Beach goers can view current beach advisories at the BEACH program website: https://fortress.wa.gov/ecy/coastalatlas/Tools/BeachClosure.aspx. Recreational shellfish harvesters can get current information about closures anywhere in Washington State at the DOH website at http://www.doh.wa.gov/shellfishsafety or by calling the DOH Biotoxin Hotline at 1-800-562-5632. Shellfish harvesters should also consult Washington Fish and Wildlife rules, regulations, and seasons at wdfw.wa.gov. • Biotoxins close Ludlow, Mats Mats bays to recreational harvest of shellfish Port Townsend Leader, May 20, 2015 10:49 am Washington State Department of Health has closed Port Ludlow and Mats Mats bays to the recreational harvest of shellfish after Paralytic Shellfish Poisoning (PSP)-causing marine biotoxins were detected at elevated levels in shellfish samples collected May 19. The closure zone extends east around Tala Point but does not include the Tala Shore beach. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat. Danger signs are being posted at high-use beaches, warning people not to consume shellfish from this area, including clams, oysters, mussels, scallops, and other species of molluscan shellfish. This closure does not apply to shrimp, and while crabmeat is not known to contain the biotoxin, the guts (also known as the "butter") can contain unsafe • levels. Crab meat should be cleaned thoroughly, and the guts discarded. Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty with breathing, and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions, call 911 . In most cases, the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. • NEWS BRIEFS: Shellfish harvesting closed to Port Ludlow, Mats Mats Bay • beaches Peninsula Daily News, May 21, 2015 PORT TOWNSEND — Port Ludlow and Mats Mats Bay beaches have been closed to recreational harvesting of all species of shellfish because of high levels of potentially deadly biotoxins. Marine biotoxins that cause paralytic shellfish poisoning (PSP) were found at elevated levels in shellfish samples collected Tuesday, so the state Department of Health closed the beaches to harvesting, said Michael Dawson of the Jefferson County Water Quality Program. The closure zone extends east around Tala Point but does not include the Tala Shore beach. Previously announced closures to all species in Jefferson County — stretching from Dabob Bay, including Quilcene Bay, to the Mason County line — remain in effect because of PSP levels. Also in Jefferson, Kilisut Harbor, including Mystery Bay, and Port Ludlow, including Mats Mats Bay, remain closed to butter and varnish clam harvesting. In Clallam County, all beaches on the Strait of Juan de Fuca are open to shellfish harvesting of all species, with the exception of Discovery Bay and Sequim Bay, which are closed to the harvest of butter clams and varnish clams. All Pacific coast beaches are closed for the season. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat. For more information, see www.doh.wa.gov or phone 800-562-5632. • Clallam, Jefferson counties target heroin overdoses by planning to offer kits with antidote .By James Casey, Peninsula Daily News, May 26, 2015 wm 401411, A typical naloxone injection kit. North Olympic Peninsula counties are expected to start offering naloxone injection kits to heroin addicts and their families this year through syringe exchange programs. The life-saving strategy could start as early as this summer in Clallam County, and Jefferson County could have a similar program in place by fall. Naloxone, an antidote to opiate drugs, already is carried by Port Angeles police officers and Jefferson County emergency medical technicians. Aihlt can counteract an overdose quickly and sufficiently for a drug abuser to receive necessary medical treatment. The Clallam County Board of Health at its April monthly meeting had delayed distributing naloxone while it made sure county employees could be shielded from liability for dispensing the antidote. However, Gov. Jay Inslee signed House Bill 1671 on May 8 to grant "Good Samaritan" protection starting July 24 to people who administer the drug in good faith. The Board of Health voted unanimously last Tuesday to approve distributing naloxone through its Syringe Services Program in which drug abusers exchange dirty needles for sterile ones. Jefferson County is examining its policy options and costs, said Jean Baldwin, county public health director. "We're exploring with our Board of Health how much does it cost, how much should we assume as the Board of Health, and should we pursue outside funding," Baldwin told the Peninsula Daily News. "We have to set the policy piece — and Clallam is ahead of us there — but we should have this by fall." An average 600 people died of unintentional heroin overdoses in Washington in the years 2009-2011, according to the University of Washington. Opiates are drugs naturally derived from opium or synthetically produced to have the same narcotic, painkilling effects. In Clallam County, according to figures for 2011-2013 from the university, fatal opiate overdoses totaled about 15 per 100,000 people, or around 11 to 16 deaths per year. Sin Jefferson County, the rate was about 11 per 100,000 people, or roughly three deaths per year. "This is a crisis of our time," said Clallam County health board member Bryon Monohon, who is also mayor of Forks, at last Tuesday's meeting. People who receive the kits that include two doses of naloxone — also known by its trade name, Narcan —will be trained in how to inject them and be told to follow through by immediately calling for medical aid to an overdosed drug user, said Iva Burks, Clallam County Health and Human Services director. A heroin or other opiate overdose depresses a person's central nervous system and stops his or her breathing. Naloxone binds to those nerve receptors, rapidly— and often unpleasantly — reversing the overdose for 20 to 90 minutes, according to Dr. Jeanne Stehr-Green, interim Clallam County health officer. According to the Narcan label o n the U.S. Food and DrugAdministration s ration website, reversal of opiate effects in those physically dependent on them can cause withdrawal symptoms including body aches, fever, sweating, nausea, vomiting and increased blood pressure. It has no adverse effect on people who do not need it, Stehr-Green said, has no potential for addiction and shows little evidence of enabling heroin use. "Clallam County ranked third among the state's 39 counties in per capita deaths and hospitalizations from opiate overdoses, she said, adding that offering naloxone through the Syringe Services Program would reach the target segment of the population. The program — offered from 2:30 p.m. to 4 p.m. Tuesdays at the public health clinic, 111 E. Third St., Port Angeles —already reduces the spread through shared needles of hepatitis and other contagious diseases, she said. It exchanged 274,000 needles last year. Health and Human Services also may make voluntary drug abuse counseling available on exchange days, Burks said. Jefferson County deaths and hospitalizations ranked 17th in the state. It exchanged almost 43,000 syringes in 2014 through its service from 1:30 p.m. to 2:30 p.m. Mondays and Wednesdays at the public health clinic, 615 Sheridan St., Port Townsend. The radical and rapid rise in heroin use is attributed to health care providers' prescribing far fewer prescription opiate painkillers like oxycodone, Vicodin or Percoset during the past three years than they once did, Stehr-Green said. "A lot of[addicts] will say, 'I started out on pills. Then the doctor wouldn't prescribe them anymore, and someone told me heroin cost half the price that pills do,- Clallam County Health and Human Services Department nurse David Doran told health board members last Tuesday. 410 Clallam County will buy the kits consisting of two syringes prefilled with naloxone for $35 per kit from the King County Public Health Pharmacy, which offers the lowest price for them, Stehr-Green said. If given only to known opiate abusers, the program will cost about $4,000 a year, said Burks, from funds already budgeted for the department or taken from its contingency fund. If distributed to people at risk of addiction and to their friends and family members, it would cost about $13,000 annually, Burks said. Some Clallam County addicts have been obtaining naloxone doses in King County, which has distributed them since March 2014, Doran said. At least seven more Washington counties also do so. In the past month, Stehr-Green told members of the board of health, Port Angeles police officers had saved the lives of at least three overdosed opiate abusers with naloxone. Administering the drug to an overdosed person actually might help stem an addict's habit, Doran said. "If you saved another person's life, it could be a huge turnaround," he said. "It could change a person's life." Besides, an untreated overdose leaves no room for recovery, Doran said. "You can't clean up a dead drug user." Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey@peninsuladailynews.com. • s Free youth mental health clinic moves under OIyCAP umbrella Port Townsend Leader: May 27, 2015 12:05 am A free youth mental health clinic that had operated under the nonprofit JC MASH for two years is moving under umbrella of Olympic Community Action Programs (OIyCAP) and will be heading to Port Hadlock. The goal is to make the clinic accessible to more youth throughout Jefferson County. The program moves on Thursday, May 28 to Kivley Center, 131 Oak Bay Road, below an existing medical clinic, said founder and clinic manager Karen Ciccarone. The clinic is to be open from 4 to 6:30 p.m. on Thursdays, as it had been when it was based in Port Townsend. "This gives us more room and more capability. If I need to have two therapists come in at 4 p.m., they can both come in. So I see it as a real benefit," Ciccarone said. "And with the clinic as part of the OIyCAP system, it will be easier for the youth to transition to any additional services that they require," she said. The clinic provided 102 service hours last year to youth at risk, a number Ciccarone said was high for such a small program, which operates on a budget of$12,000- $14,000 a year. Funds for the program come from United Good Neighbors, the Port Townsend Rotary Club and private donations, all of which will follow the program to OIyCAP. A grant from the Jefferson County Community Foundation helped start the program. Ciccarone says OIyCAP offers a number of services many of the youth she sees need, from personal hygiene products to clothes to help in finding housing, all of which OIyCAP can offer. "Some don't have a home or can't buy clothes. When you are upset, the last thing you want to do is start over with new paperwork," she said of believing the connection with OIyCAP will benefit the people she serves. Allicarone noted that the location is more centrally located in Jefferson County to provide access to youth in imacum, Irondale, Port Hadlock and Quilcene. Three out of four clients currently live in those areas; only one is in Port Townsend, she said. Getting to the first clinic will require a $1 bus ticket. But after that, Ciccarone said, she has free bus passes to hand out for those who need them to get home or return to the clinic the following week. "As the RN clinic manager, I can advocate for these clients directly and call OIyCAP for appropriate services that are needed for their situation," Ciccarone said. Ciccarone's husband, Rich, is on OIyCAP's board of directors. STARTED TWO YEARS AGO The program was started two years ago in Port Townsend with a goal of serving people 13 to 25 years old. "No insurance, no money, no worries" was the mantra when the program opened in August 2013. Since then, she said, the program has grown over those two years. Ciccarone said the new space in Port Hadlock is larger, with two therapy rooms, which will allow the program to increase capacity as needed. Patricia Grant, a licensed mental health counselor, and Carroll Hernandez, a clinical psychologist, staff the clinic along with Ciccarone, a registered nurse, who does nursing intakes. For help For more information on the free youth mental health clinic, call Karen Ciccarone at 973-670-0551. For dates on the program look for OIyCAP Youth Counseling Clinic on Facebook. • Come talk to us about Women's Health and Birth Control i`A„} m k c J S 4 �f 4 i',d c� t r '. , If w A 7i '4, �.Y t ' '^"ewe.eas. }�ft:',- to 4^ 9 tr v f S f s4 S5 "'"'f ``Wonderful staff!!Everyone was vee y friendly, informative and willing to help. My best clinic experience ever!" Short wait times for appointments f • We bill insurance, Apple Health, or sliding scale Q%l y 4 Our services cornpliment your primary care / `' z'...-...\ �.. $P Appointments 'ite.1 yz 360-385-9400 Public Health • • • I2'Togea. �/ • 2014 food handling awards present by Jefferson board Peninsula Daily News, May 31st, 2015 PORT TOWNSEND —The 2014 Outstanding Achievement Awards were presented at a recent Jefferson County Board of Health meeting to recognize 22 restaurants, full-service food establishments and their proprietors who demonstrated the highest standards for safe food handling over the past year. Jefferson County Public Health and the Board of Health recognized 22 restaurants and proprietors for their dedication in 2014 to preventing illness and encourages the entire food industry to strive for the same honor. Criteria for the award were developed by the county's Food Safety Roundtable and food safety staff. These are based on food safety inspections conducted in the areas of personal hygiene, food temperature safety and prevention of contamination. All food workers must hold a current Washington state food worker card. 2014 Outstanding Achievement Award winners are Belmont Catering, Blue Heron Middle School, Brinnon School District, Cedarbrook School, Chimacum Primary School, Chimacum Elementary School, Chimacum Middle School, Chimacum High School and Ferino's Pizzeria. • Also, Food Co-op Grocery, Inn at Port Ludlow Catering, Jefferson CountyProject Horse 4-H, Jefferson County Jail, Jefferson Mental Health, Lanza's, Lively Olive Tasting Bar, Port Townsend Senior Nutrition, Port Townsend High School cafeteria, QFC No, 106 Deli-Port Townsend, Queets-Clearwater Elementary School, Quilcene School cafeteria and Timberhouse Restaurant. • Whooping cough breaks out in Jefferson County Port Townsend Leader, June 3, 2015 Jefferson and Kitsap counties are experiencing an increase in pertussis (whooping cough) cases. To date, 17 cases have been diagnosed in Jefferson County, including high school, middle school and elementary school students, according to Jefferson County Public Health officials. In 2012, Washington had an epidemic with nearly 5,000 cases; three years later, pertussis is on the rise again statewide. So far this year, there have been 319 reported cases of pertussis compared to 49 during the same period last year. Pertussis is a highly contagious bacterial infection that causes coughing with little or no fever, health officials say. It is spread when infected people cough near others. Severe illness is more common in young children who have not been immunized. Older children or adults with pertussis often have milder symptoms, but can still be contagious to others. Young infants are at highest risk for severe complications and death; pregnant women, the • elderly and individuals who have weakened immune systems are also at higher risk. Public health control efforts involving pertussis focus on protecting infants and pregnant women from exposure to active cases. Vaccination and early detection of cases are the best ways to prevent life-threatening illness in infants. Vaccines are available in a pediatric form (DTaP) and one used for adolescents and adults (Tdap). Children should have a series of five DTaP vaccines beginning as early as six weeks after birth. Adolescents and adults should have at least one Tdap. Among adults, the highest-priority groups for vaccination are pregnant women (who should be vaccinated with every pregnancy), caretakers of infants, and health care workers who provide care to infants and pregnant women. The county health department offers a walk-in immunization clinic for both children and adults on Tuesdays and Thursdays, 1-4 p.m. For more information, go to the JCPH website, jeffersoncountypublichealth.orq. Immunizations are also available at local pharmacies; contacts each for details. Pertussis should be suspected in infants with worsening cough illness, in older children and adults who have cough over seven-days duration who have severe fits of coughing followed by vomiting and/or the "whooping" sound that gives pertussis its common name. Cough illness of • any duration without alternate explanation occurring in pregnant women or those who have contact with pregnant women or infants should be investigated for pertussis. Finally, pertussis should be suspected in anyone with a cough lasting longer than two weeks. Pertussis is treated with antibiotics. Children with pertussis are excluded from daycare and schools until they have taken antibiotics for five days, or 21 days have passed since the start of their coughing. Adults with pertussis should avoid contact with infants and pregnant women until noncontagious. The best ways to prevent pertussis are to follow vaccination recommendations and practice good respiratory hygiene (frequent hand washing, covering coughs, and staying home when sick). For more pertussis information, go to doh.wa.qov/YouandYourFamily/I IlnessandDisease/WhoopingCough. • f , Food safety awards recognize consistency Port Townsend Leader, June 3, 2015 • - 111100 41 S' M its 3 l'il 1 1, • z 14,.)• M . 'fi(J , 4 III F -°° :,,,,i-F-n � , Food establishments in Jefferson County are awarded for maintaining excellent standards.Among those award winners are(from left)Glenda Meek,4-H Horse Project; Robert Gray,Port Townsend Senior Nutrition; Liz Mays,Jefferson Mental Health(JMH);Jefferson County Environmental Health's Jared Keefer;Alice Yantz,JMH; Nate Maxwell,JMH;and Adam Marquis,JMH. The 2014 Outstanding Achievement Awards were presented at the May 21, 2015 Jefferson County Board of Health meeting to recognize 22 restaurants, full-service food establishments and their proprietors who demonstrated the highest standards for safe food handling during the past year. The restaurants and proprietors listed below worked in 2014 to maintain excellent food safety standards; most are full-service establishments that work with complex menus, so they have additional food safety •challenges. Jefferson County Public Health (JCPH) and the Board of Health recognized them for their dedication to preventing illness and encourages the entire food industry to strive for the same honor. Criteria for the award were developed by the JCPH food safety round-table and Jefferson County food safety staff. These are based upon food safety inspections conducted in the areas of personal hygiene, food temperature safety and prevention of contamination. All food workers must hold a current Washington state food worker card. The 2014 Outstanding Achievement Award Winners are: Belmont Catering, Blue Heron Middle School, Brinnon School District, Cedar-brook School, Chimacum Primary School, Chimacum Elementary School, Chimacum Middle School, Chimacum High School, Ferino's Pizzeria, Port Townsend Food Co-op grocery, Inn at Port Ludlow Catering, Jefferson County Horse Project 4-H, Jefferson County Jail, Jefferson Mental Health, Lanza's Ristorante, Lively Olive Tasting Bar, Port Townsend Senior Nutrition, Port Townsend High School cafeteria, Port Townsend QFC No. 106 deli, Queets Clearwater Elementary School, Quilcene School Cafeteria, Timber-house Restaurant. View JCPH's website for favorite restaurants and scores at •jeffersoncountypublichealth.org/foodsafety/index.php. C. ' t Discovery Bay beaches in Jefferson closed to shellfish harvest due to biotoxins; Dabob Bay reopens, but with vibrio warning in place •Peninsula Daily News,June 91h,2015 M „.,,,,-:,7 mss.exp r . '';',4,,,tiPiltS.ft ' w a National Oceanic and Atmospheric Administration Olympia oysters DISCOVERY BAY — Discovery Bay area beaches have been closed to recreational shellfish harvesting due elevated levels of marine biotoxins that cause paralytic shellfish poisoning. Recent shellfish samples from the area showed an increase in biotoxins, prompting the state Department of Health closure, according to a Jefferson County Water Quality Program news release Monday. Shellfish harvested commercially are tested for toxins prior to distribution and should be safe to eat. Another closure ends Meanwhile, marine biotoxins in Dabob Bay have declined and the closure there from earlier in the season has been lifted. However, there is still a vibrio bacteria warning in place, and all shellfish harvested from the Dabob Bay area should be cooked prior to consumption. In Clallam County, all beaches on the Strait of Juan de Fuca remain open to shellfish harvesting of all species, with the exception of Sequim Bay, which is closed to the harvest of butter clams and varnish clams. All Pacific coast beaches are closed for the season. Elsewhere in Jefferson Previously announced closures to all species in Jefferson County — including Quilcene Bay and the area south of Dabob Bay to the Mason County line — remain in effect because of biotoxin levels. Port Ludlow and Mats Mats Bay beaches remain closed to all species. This closure zone extends east around Tala Point but does not include the Tala Shore beach. Also in Jefferson, Kilisut Harbor, including Mystery Bay, remain closed to butter and varnish clam harvesting. Danger signs are being posted at high-use beaches in closed areas, warning people not to consume shellfish from these areas. 41)The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crab meat is not known to contain biotoxins, but the guts can contain unsafe levels. Crabs should be cleaned thoroughly and the guts, or"butter," discarded. Marine biotoxins are not destroyed by cooking or freezing. Signs of poisoning Symptoms of paralytic shellfish poisoning can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions phone 9-1-1. In most cases, the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. •Recreational shellfish harvesters should check the Department of Health shellfish safety map at doh.wa.gov/ShellfishSafety.htm or phone the Department of Health Biotoxin Hotline at 1-800-562-5632 before harvesting. Recreational harvesters should also check Fish and Wildlife regulations and seasons at wdfw.wa.gov/fishing/shellfish or phone the Shellfish Rule Change Hotline 1-866-880-5431. • Jefferson recreational marijuana moratorium lifted; regulations now in place for pot entrepreneurs .By Chris McDaniel , Peninsula Daily News, June 10th, 2015 eks Ohl f iON' V on .11 Jefferson County commissioners debate a recreational marijuana ordinance Monday. From left are Kathleen Kler,Phil Johnson and David Sullivan.Sullivan voted against the ordinance.—Photo by Chris McDaniel/Peninsula Daily News PORT TOWNSEND —Jefferson County's moratorium on recreational marijuana businesses has been lifted, with a new set of rules officially in place for pot entrepreneurs. "'During their regular meeting Monday, the three Jefferson County commissioners voted 2-to-1, Commissioner David Sullivan dissenting, to enact an ordinance outlining the regulations recreational marijuana business owners must adhere to, breaking down allowable locales by type and location. For instance, such businesses will be prohibited at all golf facilities and outdoor gun ranges, while they are allowable in most bed-and-breakfast locations. The most tolerant regulation areas for marijuana businesses are in designated rural village areas, which are Brinnon and Quilcene. The new rules include a list of specific "performance standards," such as landscaping, setbacks and security. The ordinance was crafted by the Department of Community Development. The ordinance took effect immediately upon passage and repeals a moratorium on marijuana growing operations that had been in place for 10 months and was set to expire Thursday. The commissioners could have extended the moratorium to allow further study of the issue or simply allowed it to lapse. Instead, Commissioners Phil Johnson and Kathleen Kler voted in favor of the new rules. •Sullivan opposed them, as he has during past meetings. "There are reasons to be concerned about marijuana, but I don't think this [ordinance] addresses them," Sullivan said before the vote, noting he believed that adopting the ordinance would be more harmful than *extending the moratorium. "As I look at this, I am disappointed that we haven't taken an approach that would deal with the impacts of sales in general, separate from the issue of marijuana, because I think that really clouds it." After the approval of statewide Initiative 502 legalizing recreational marijuana in 2012, Jefferson County originally dealt with cannabis like any other agricultural product. But public controversy led to the institution of a six-month moratorium Aug. 11. When that moratorium was set to expire, the DCD requested a four-month extension because it had not developed a policy. "And now we are feeling pressure because 10 months hasn't been enough to really deal with it," Sullivan said. "I find myself looking at a different type of moratorium, perhaps on just marijuana businesses, but having it narrow down to limiting those that have a larger-size building that are not set back far enough and whatever other conditions you think we might need to add." "That is what we had attempted to do" with the ordinance, Kler responded. "The problem is that this is predictive. We don't know all of the impacts, and that is a lot foggier. ."How we can be fair and balanced for the pioneers, the people that are out there taking the most risks?" During the meeting, Sullivan proposed an amendment to the moratorium that would have allowed smaller-scale operations to proceed while the moratorium remained in effect for businesses larger than 10,890 square feet. "In doing this code, there is an unfairness to it, and that bothers me," Sullivan said. "I find myself [with] sympathy for wanting size restrictions [and] some setback restrictions, and wishing we would deal with those impacts rather than dealing with this as a marijuana issue. In fact, I would be willing to consider extending the moratorium or changing the moratorium and dealing with the impacts." That option was rejected by Johnson and Kler because any substantial changes to the rules would require a public hearing and delay action. Sequim-Dungeness Valley Editor Chris McDaniel can be reached at 360-681-2390, ext. 5052, or cmcdanielpeninsuladailynews.com. • BOCC adopts marijuana land-use rules •By Nicholas Johnson, Port Townsend Leader I Posted: June 10, 2015 " Marijuana God Bud 2014 The flower of a marijuana strain known as God Bud a week before harvest. Not only do strains have their own names, each may have genetic qualities intended to target specific medicinal purposes or, in non- medicinal cases, reach for greater highs. Photo by Alana Linderoth Jefferson County's commissioners have adopted land-use rules for marijuana businesses, in spite of board chair David Sullivan's ongoing effort to refocus the debate toward issues of scale and intensity. "'In a 2-1 vote with Sullivan dissenting, the boards?dopted June 8 rules unanimously recommended by the county's planning commission and simultaneouy called an end to the county's moratorium on marijuana businesses in certain areas. The adopted rules establish a distinct set of performance standards for marijuana businesses, rather than folding such businesses into existing agricultural code, as Sullivan has advocated since January. "In focusing on marijuana, we're saying you can't have as big an impact as other people do," Sullivan said. "I regret that we haven't spent this time as wisely as we could have over the last 10 months." Sullivan on June 8 proposed modifying and extending the existing, four-month moratorium, which was set to end June 11. "I am offering this compromise because I see it as less unfair than what's been proposed," Sullivan said of his proposal, which would have carried forward key scale and intensity limits for marijuana businesses on residential and forest lands from the now-adopted rules. "If people are set back far enough and have screening and are at a small enough scale, they're not going to have those kinds of impacts. And yet, the concerns people have about marijuana are not so much land-use concerns; they are social concerns that are not going t.o be addressed in this code. This isn't going to solve some of the real community concerns about marijuana. It's not going to decrease youth use of marijuana, for example." Commissioner Kathleen Kler couldn't be convinced. "We have experience in agriculture, even when it's pig farms," she said. "Even though it shouldn't be about marijuana, it's the big elephant in the room. It is about marijuana and we don't know yet what's •ahead and whether the fears are founded or not. That has certainly colored how we've made our decisions." Commissioner Phil Johnson said his prerogative was to move on. "I think we move forward with what we have and immediately start refining some of it," said Johnson, though staff acknowledged that process could take several years. "I'd like to revisit some of it right away, like the requirement for an engineered fence." APPROVED RULES The approved rules allow growing on industrial and agricultural lands, while such activity on forest and residential lands is subject to county review and conditions, such as limits on building sizes and requirements for setbacks. Growing is not allowed on commercial and public lands, among others. Processing of marijuana is allowed outright on industrial lands, while such activity on agricultural, forest and residential lands is subject to conditions. Such activity on forest and residential land also requires a cottage-industry permit. Processing is not allowed on commercial or public lands, among others. The rules also address retail marijuana businesses, allowing those on industrial and commercial lands, except in areas zoned convenience crossroads, which are intended for stores offering daily necessities to the local and traveling public. Regarding growing on residential lands, outdoor growing of any scale is allowed while limiting the size of temporary and permanent growing structures to five percent of a parcel's total square footage, meaning the larger an applicant's land area, the bigger their production facility can be. With a cottage-industry permit, processing facilities would be allowed 5,000 square feet, independent of limits on growing structures. BACKGROUND It's been 10 months since Jefferson County planners received an application for a particularly large Ai•marijuana business on residential land that spurred the first of two moratoria. That application called for 40,000 square-feet of structures, three greenhouses, 30 parking spaces and a septic system capable of serving 57 people, leading the commissioners to invoke Aug. 11, 2014 a six- month moratorium on such businesses. When that expired in February 2015, commissioners adopted a less restrictive, four-month version, allowing many previously held-up businesses to move forward. • > _ Second annual Hempapalooza to celebrate cannabis culture June 19-22 in Brinnon By Charlie Bermant, Peninsula Daily News, June 10th, 2015 .4 .=: " ,. s 4 .. „,,,, „,.... .s...„ ' ." , '''0! d'n '.. .t, „,,,,,e, .. , x , ,. ... ,‘, ,_ "1 „,,,,,,o,,„k,,,„ . .. t ivi,-- ; :, , v George Sickle and Diane Grau at last year's Hempapalooza. BRINNON —A weekend festival celebrating marijuana will allow people to explore the new worlds Ids created after Washington voters approved the legalization of the drug recreationally in 2012, an organizer says. "Cannabis has been around for years, but now it's gone mainstream," said Nicole Black, who is sponsoring the second annual Hempapalooza on June 19-22, an expanded event from last year's. "We want people to come here, have a good time and smoke some weed with their friends but also want to keep it responsible and educational." Tickets are available now. They are $25 per day or $60 for the weekend "camping adventure," in which attendees can carve out their own campsite on the 50-acre parcel located at 1014 Duckabush Road, which is owned by Black's parents. Black will discuss the upcoming festival at tonight's meeting of the Brinnon Parks and Recreation District. She will conduct a question-and-answer session at the meeting that will begin at 6:30 p.m. at the Brinnon Community Center, 306144 U.S. Highway 101. She hopes to coordinate with businesses and sign up volunteers. Black, who has operated a medical marijuana store in Brinnon for two years, said she hopes the festival will celebrate the "cannabis culture" that is gaining traction as the use of the drug is demystified due to its legalization. This year's event has grown considerably from last year, when it was a marijuana "farmers market" that was held in the backyard of Black's store at 91 Corey St. This year, Black has prepared space and sanitation for up to 5,000 attendees, along with a full slate of enjoyment, entertainment and education. Attendees can explore forest trails, discover a mountainside plateau and enjoy the sights and sounds of Olympic National Forest, Black said. Several local musicians are slated to perform along with top names such as Grammy-winning trumpet player Julius Melendez and guitarist Randy Hansen, who pays tribute to Jimi Hendrix. •A new movie, "Star Leaf and Midnight Delight," will have its Washington premiere. The business angle, according to Black, is what sets the event apart. A it Attendees will have the opportunity to audition for the Marijuana Show, a Web-based series that connects people with ideas about cannabis business opportunities with investors. 11, Black said the event's purpose goes beyond getting high: She would like to stimulate interest in hemp- based industries. Hemp, a non-psychoactive strain of the marijuana plant family, can be used as a raw material but is forbidden by drug laws. "I want to get people more information about hemp," Black said. "I can't understand why it isn't grown to make paper products so we don't have to cut down so many trees." Black said hemp can be used to make food, fuel, clothing, medicine, livestock feed, building material and paper, and has the ability to create economically and environmentally sustainable alternatives to logging. Black said she is looking for local food vendors to set up booths at the festival as well as cannabis-based businesses, adding that she will supply them space without charging vendor fees. Tickets are available at www.eventbrite.com by searching for"Hempapalooza." For more information, call 360-301-0844. i 41-Nff 615 Sheridan Street Af AmonPortTownsend, WA 98368 www.JeffersonCountyPublicHealth.org 4111 Public Healt July 2, 2015 Claus Janssen, MD 1010 Sheridan Street, Suite 101 Port Townsend, WA 98368 Dear Dr:4arrs5 'n: Thank you very much for your application for appointment to the Jefferson County Board of Health and taking time out of your busy schedule to interview for the position of June 18, 2015. Commissioner Sullivan and I very much enjoyed the opportunity to meet with you and were very impressed with your knowledge of public health issues and your commitment to community service. After careful consideration,the County Commissioner have decided to appoint an alternate candidate to the vacant Board of Health position. I very much appreciate your interest in community health and the critical role you play in assuring access to high quality primary care in Jefferson County. There will be many opportunities to get involved in the • community health partnerships that are dealing with local priority health issues and Washington State's ambitious effort to regionalize and reform the health care system. Currently the priority areas for the local coalitions are: 1)Access to mental health and substance abuse care, 2) Healthy eating, active living, and chronic disease prevention, 3)Access to Medical and Dental Care,4) Increasing Immunization Coverage. Please let me know if you are interested in participating in any of these. Again,thank you for your application and your commitment to community health improvement. Sincerely, Thomas Locke, MD, MPH Jefferson County Health Officer 10 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