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2015- August
!Olson Public Hea It • File Copy Board of Health Meeting August 20, 2015 Jefferson County Public Health Agenda Minutes 6ft; Public Health August 20, 2015 JEFFERSON COUNTY BOARD OF HEALTH August 20, 2015 • Jefferson County Public Health 615 Sheridan St. Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of July 15, 2015 Board of Health Meeting III. Public Comment IV. Old Business and Informational Items 1. Port Townsend Paper Corporation Settlement Agreement 2. Youth Mental Health Training 3. New Naloxone Law Takes Effect 4. West Nile Virus Death Reported in Benton County V. New Business 1. Olympic Accountable Community of Health Briefing—Peter Browning 2. Solid Waste Enforcement Planning 3. Food Safety Program Analysis 4. Community Health Improvement Plan- Activity Update 5. Community Health Director Interview Process VI. Activity Update VII. Public Comment VIII. Agenda Planning Calendar IX. Next Scheduled Meeting: September 17, 2015 2:30—4:30 PM Jefferson County Public Health 615 Sheridan St. Port Townsend, WA IP • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, July 16, 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 Michael Dawson,Water Quality Dir John Austin,Citizen at large Vice-Chair Kler called the July 16, 2015 meeting of the Jefferson County Board of Health to order at 2:35 p.m. A quorum was present. Members Present: David Sullivan, Kathleen Kler, Phil Johnson, Kris Nelson, Jill Buhler, John Austin Members Excused: Sheila Westerman • Staff Present: Tom Locke, Jean Baldwin, Jared Keefer, Julia Danskin, Michael Dawson APPROVAL OF AGENDA Vice-Chair Kler added item 5, Agency Drought Informational Meeting to Old Business items. Vice-Chair Kler asked for approval of the July 16, 2015 Agenda. Member Nelson moved to approve the agenda; the motion was seconded by Member Buhler. No further discussion. The motion passed unanimously. APPROVAL OF MINUTES Vice-Chair Kler mentioned an awkward construction in the fourth line of item 3,New Business and asked for clarification. Jean Baldwin, Director, suggested taking out the word "and." Vice-Chair Kler called for approval of the minutes of the May 21, 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 No public comment. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Measles Death in Clallam County. Dr. Tom Locke, Health Officer, JCPH, discussed the risk of measles transmission among the growing number of people on immunosuppressant drugs and why this reality makes it all the more important that measles vaccination rates improve. Dr. Locke asserted his support for strict school entry immunization requirements such as those recently adopted in California that allow only medical exemptions from vaccination. He emphasized the efficacy of vaccines combined with the very low-risk of potential side effects, and reminded the Board the study that associated measles vaccine with autism had been thoroughly debunked. Jean Baldwin, Director, JCPH, pointed out that an important result of the tragic measles death in neighboring Clallam County is that vaccination is no longer a"me and my kid" issue; the death in Clallam county has made vaccine exemption a community health issue, which changes the dialogue. 2. California Adopts Strict Vaccination Laws Removing Religious, Personal Exemptions. • The Board continued its discussion of the increasing potential for outbreaks of diseases that have been eradicated by readily available, safe vaccines. They pointed out the problem of misinformation perpetuated by the vocal, famous elite. Dr. Locke said one of the four priority areas in the Community Health Improvement Plan is to form a task force to address the declining vaccination rates in Jefferson County. 3. WIC Newsletter: SmileMobile Returns to Jefferson County. Julia Danskin, Public Health Manager, JCPH, reported upcoming events and activities sponsored and promoted by WIC efforts in Jefferson County. The SmileMobile, a mobile dental clinic, will be serving the dental needs of community members at the Chimacum Tri-Area Community Center. Continuing WIC efforts include additional dollars afforded the Farmers Market checks program, with matches available to increase purchasing power; to celebrate World Breastfeeding Week, a WIC sponsored picnic; and an exercise and nutrition class focused on empowering women. Ms. Danskin emphasized the importance of visibility: WIC activities and community health awareness programs change prevailing attitudes and promote healthy lifestyles. 4. Boards Official Business: John Austin appointed to Jefferson County Board of Health for term ending May 31,2018. The Board welcomed Mr. Austin, Jefferson County Citizen at large, to his new term as board member and thanked him for his continued support and guidance. • • 5. Agency Drought Meeting. Dr. Locke reported on an agency-wide meeting he, Jared Keefer, EH Director, JCPH, and Susan Porto, Environmental Health Specialist, JCPH, attended earlier this month. Among those present were representatives from the Department of Health, Department of Ecology, Department of Commerce, Port Townsend Paper Corporation(PTPC), and City of Port Townsend. The group discussed concerns surrounding the area's drought status: river water flows are at September levels and snowpack predictions point to a continuation of drought conditions well into 2016. Dr. Locke reported on the City's 5- stage plan to mitigate issues related to the needs of various stakeholders, and told the Board that the PTPC also has a contingency plan. Mr. Keefer reported on the amount of water PTPC is already saving by making the decision to rent cooling towers rather than using water. The public health role in this situation is to inform the public of boil water alerts should pumping of surface water in drought stricken supply lakes—Lords Lake and City Lake—cause turbidity, which would in turn cause the failure of purification system techniques. Ms. Kler mentioned the ongoing drought forecast. Jill Buhler, Hospital Commissioner, mentioned her concern regarding area agriculture. Mr. Keefer explained the status of shallow wells, and the increased questions he's fielded in regards to drilling deeper wells. Ms. Kler explained how community members, particularly in Quilcene, whose wells have stopped producing, get free water at community parks. The county pays for this water supply. • NEW BUSINESS 1. Adoption of Civil Infraction Ordinance. Mr. Keefer reviewed the situation wherein the Infraction ordinance was inadvertently repealed when prior action had been taken concerning revisions to the Solid Waste Code. Based on County Attorney David Alvarez's newly drafted ordinance, which was presented to the Board at the June 18th meeting, Vice-Chair Kler opened the public hearing. No one was present to offer testimony. The public hearing was then closed. Member Sullivan moved that Adoption of the Jefferson County Board of Health Ordinance, 06-0716-15, Authorizing Environmental Health Civil Enforcement; Member Nelson seconded. No further discussion ensued. The motion passed unanimously. 2. Proposed Food Safety Program Fee Revisions, Part 1. Mr. Keefer opened a discussion of Jefferson County Food Establishment Fees, and presented the Board with the first part of a revision plan that is based on a robust dataset collected and compiled by Jefferson County Health food inspector, Mina Kwansa, over the past four years. Numbers extrapolated from the data point to the need for several fee revisions including the potential for a one-time New Establishment Fee, which differs from a re-opening permit fee, being added in addition to the general, yearly permit fee. Vice-Chair Kler voiced her concern that if permit fees were based on distance from JCPH, it would penalize establishments located farther rather than nearer to the JCPH • physical premises. Mr. Keefer responded that the travel costs component of permit fees • are based on an aggregated number—individual restaurants are all charged the same fee for the same type of license regardless of the distance inspectors must travel. Member Nelson mentioned, as a restaurant owner, the problem of loopholes exploited by some restaurateurs. This is an ongoing discussion the Board will continue at its future meetings. 3. Solid Waste Code Enforcement re. local impacts of State Budget Cuts. Mr. Keefer explained that the Solid Waste Budget appropriation was cut by 62%. In real numbers this means Jefferson County Environmental Health Solid Waste Program will function with approximately $62 thousand dollars split evenly over two years. The expected appropriation was approximately $160 thousand split evenly over two years. The result is JCPH will be working to fund programs related to Solid Waste education and enforcement with $31 thousand dollars rather than $80 thousand dollars for each of the next two years. Mr. Keefer presented a new policy statement, he wishes the Board to consider, that sets priorities for code enforcement programs. Ms. Baldwin warned of the importance of remaining active with several high profile solid waste cases in the county, and further warned that the ground we've gained may be lost. In regards to fielding complaints, Member Austin mentioned addressing issues by telling a complainant thank you for contacting us and that we will look into the issue, rather than burdening a complainant with too much information and/or frustrating caller by simply referring to him/her to the Sheriffs Office or ORCCA, depending on the nature of the complaint. 4. Kitsap, Jefferson, Clallam Behavioral Health Organization Update. • Ms. Baldwin, Vice-Chair Kler, and Ms. Buhler attended, along with Catharine Robinson, Vice-Chair, JC Substance Abuse Advisory Board, a workshop to discuss how the group would come together in light of the Peninsula Regional Support Network's efforts to become a Behavioral Health Organization prior to its becoming part of the Accountable Community of Care, in 2020. The group's main concerns are how create a governance structure and administrative capacity; how to develop a governing body and structure for funding; and how to refine communication that promotes transparency and regional awareness. Vice-Chair Kler emphasized the need to remain viable as a major contributor to mental health services and chemical dependency recovery services while grappling with this complex challenge involving fiscal oversite management and allocation, as well as a nuanced understanding an ever-evolving business model. The disparate community of stakeholders are under the ongoing pressure to make services fair and accessible to everyone. At the workshop, members monitored their tempers as difficult questions and demands for clarification were brought to the table. The group made some headway on preliminary decisions, one of which was to call themselves the Salish Behavioral Health Organization. Jefferson County representatives, Kler, Baldwin, Buhler, and Robinson will keep the Board updated on developments vis-a-vis this important organization's development. 5. Chimacum Prevention Coalition Strategic Plan Update Ms. Danskin presented the update for Kelly Matlock, JC Community Health Educator, who wrote the strategic plan, which may be viewed at the Jefferson County Public Health • Web site. Danskin highlighted Chimacum Prevention Coalition achievements and reported to the Board the continued improvements the Coalition has brought to the • community. With continued support from the Division of Behavioral Health and Recovery, the Coalition will broaden its reach and is currently participating in Youth Mental Health First Aid training hosted by the YMCA. The importance of Coalition activities was affirmed by the new Chimacum School District superintendent Rick Thompson, who attended its meeting in June. 6. Public Health Policy Issues and Consumer Use of Fireworks. Dr. Locke addressed the Board at the request of one of its members and provided an article from the American Public Health Association to aid in broadening awareness of hazards associated with fireworks. Consumer fireworks cause avoidable injuries to community members and the environment. There is a ban in the City of Port Townsend, but, Vice-Chair Kler noted the difficulty in effecting a county-wide ban, noting timeframes governing how banning ordinances must be implemented. It was also noted that the County has no jurisdiction regarding Tribal land. Mr. Keefer offered a Yakima policy related to policing land borders in an effort to keep fireworks limited to areas where they are not banned. The difficulty of implementing state-wide bans also surfaced. ACTIVITY UPDATE Ms. Buhler reported Jefferson Healthcare voted unanimously to adopt recommendations to form a Reproductive Task Force. • Ms. Baldwin reported JCPH opened a newosition for a CommunityHealth Director and will P open the School Nurse position; there will be a Pertussis update at the August BOH meeting; Peter Browning, Browning Solutions, project manager structuring the next stage in the development of the Accountable Community of Health, will attend the August meeting. Mr. Keefer informed the Board that he will provide an update to the Port Townsend Paper Corporation's permit application. Vice-Chair Kler shared the Public Health threat created by poachers selling and consuming poached shellfish. Member Phil Johnson shared Ecology plans to study the effects of Fish Net Pen bans, which will save the Washington State Association of Counties (WSAC) from having to ask that a study be performed. PUBLIC COMMENT There was no public comment. • NEXT SCHEDULED MEETING The next Board of Health meeting will be held on Thursday, August 20, 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 July 16,2015 Jefferson County Board of Health meeting at 4:08 p.m. JEFFERSON COUNTY BOARD OF HEALTH Phil Johnson, Member Buhl i er EXCUSED David , . r ivan, e ber Sheila Westerman, Chair ,C y Kris Nelson, Member Kathleen Kler, Vice-Chair VV1 Respectfully Submitted: Denise Banker • Board of Health • IV Old Business Item 1 PTPC Settlement Agreement 11 iTffelm Public Health August 20, 2015 41 Board of Health IV Old Business Item 2 Youth Mental Health Training • 6:effelson Public Health August 20, 2015 The Chimacum Prevention Coalition Presents: 410 YOUTH MENTAL HEALTH FIRST AID COMMUNITY TRAINING covered Topics r p eed Youth Mental Health First Aid is designed to teach parents, include caregivers, teachers, and other adults who regularly interact with depression, young people how to help an adolescent (age 12-18) who is experiencing a mental health and/or addiction challenge or is in crisis. disorders in which This free, 8-hour workshop introduces common mental health psychosis may challenges for youth, reviews typical adolescent development, and Occur, teaches a 5-step action plan for how to help young people in both crisis and non-crisis situations. Registration is required and space is limited. and eating FACILITATORS disorders. • Stephanie McDonald, OESD 114 lPathwa s to Success M. Linton Petersen, LMHC, DMHP of West End Outreach DATE/TIME/LOCATION August 24, 2015 / 8:30 a.m. - 4:30 p.m. (Working-Lunch) Jefferson County Public Health / Pacific Room - SPACE IS LIMITED - 615 Sheridan St., Port Townsend, WA 98368 TO REGISTER, CONTACT: Kelly Matlock Workshop and lunch provided by the sponsors below: 360-379-4476 ,� ,�� kmatlock@ • `: �, ! `: oma,,. 400. co.jefferson.wa.us fp._.__ WPublic Heatlt � :ftARE Board of Health Iv Old Business Item 3 New Naloxone Law Takes Effect -\1\ • O� nn��fferson Public Healt August 20, 2015 S New naloxone law in ettect'TODAY Page 1 of 2 Subscribe Share " Past Issues Trans . View this email in your browser Center for Opioid Overdose Opioid Safety Update Education Pretending overdose deaths � July 2015 in Center for Opioid Safety Education 4-4',..„%_ i New naloxone law intoeffect goes s - 7' TODAY! I _ � July 24, 2015 • HB1671 is now active law in WA State.This law seeks to scale-up access to naloxone by making naloxone distribution to laypersons more efficient. The law specifically permits naloxone to be: • prescribed directly to an "entity" such as a police department, homeless shelter or social service agency. • distributed by non-medical providers (e.g., health educator, counselor, syringe exchange volunteer) under a prescriber's standing order. For more details on the new law and what it might mean for your organization or overdose prevention program, read our naloxone update on stopoverdose.orq. New naloxone "Persons who use 4. CDC.) , guidance from - � drugs perform 83% WASPC mninivR of reported reversals." The WA Association of Sheriffs& Police Chiefs recently released guidance Highlights from the latest for law enforcement on the CDC report on overdose new naloxone law. Includes prevention programs recommendations and providing naloxone to tools to equip officers with • laypersons. naloxone. http://us 10.campaign-archive l.com/?u=3979296480e 16c5415af373d6&id=86e6b46e24&e... 8/14/2015 Board of Health IV Old Business Item 4 West Nile Virus Death Reported in Benton County 46effeirson Public Health August 20, 2015 • r Washington State Department of * Health ews a ease For immediate release: August 13, 2015 (15-153) Contacts: Sharon Moysiuk, Communications Office 360-236-4074 Kelly Stowe, Communications Office 360-236-4022 West Nile virus death reported in man from Benton County First death in Washington in 2015; high number of detections in mosquitoes and horses OLYMPIA—The first person to die from West Nile virus in Washington this year was reported in a Benton County man who was in his 80s. He was hospitalized before his death and was likely exposed to the virus near his home. The Centers for Disease Control and Prevention (CDC) are currently conducting tests to confirm the infection. Ten other people have been diagnosed with West Nile virus infection this year and one blood donor with no symptoms tested positive for the infection; the cases were exposed in Adams • County(1), Benton County(8), Franklin County(1), and one multi-county exposure. Year after year, south-central Washington has been a"hot spot" for the virus with the most in- state human and animal cases exposed in this area. So far this year, a higher than average number of animal cases and infected mosquitoes have been identified in this region. Six horses have been confirmed as positive for West Nile virus in Adams, Benton, Franklin, and Yakima counties. Ninety-eight mosquito samples have tested positive in Benton, Franklin, Grant, Walla Walla, and Yakima counties. While most testing of mosquitoes for the virus happens in the south-central part of the state,the species that transmit the virus are found throughout the state. Regardless of where you live or travel, you should take precautions to avoid mosquito bites. A few simple precautions can help reduce your chances of being bitten by a mosquito: • Stay indoors around dawn and dusk when mosquitoes are most active, if possible. • Use a mosquito repellent when spending time outdoors. • Wear long sleeves and long pants outside when mosquitoes are most active. • —More— � Board of Health • V New Business Item 1 Olympic Accountable Community of Health Briefing 4111 ffffej`sm Public Hag Peter Browning • August 20, 2015 Board of Health V New Business Item 2 Solid Waste Enforcement Planning • .6-\':effeAson Public Health August 20, 2015 Board of Health • V New Business . Item 3 Food Safety Program Analysis ,61:effgo4 Public Health • August 20, 2015 2015 Food Safety Activity and Fee Review • Introduction During the last board meeting we discussed the review design and aggregate data points. • 22 food permit types exist • Low risk (or Limited) establishments are inspected at least once per year • High risk (or Complex) establishments are inspected at least twice per year • Inspection activity on 305 establishments were analyzed • 2697 work activities were tracked for time (1671 Inspections,Travel for 1026 Inspections) • 30 new food establishments permits tracked from beginning to end Mean time spent per inspection Approx.35 minutes (expenditure in today's dollars of$50.17) Range of Minutes spent per inspection 15—110(min -$21.50; max-$157.67) Mean time spent per inspection type Pre-Opening (47 minutes;$67.37) Routine (34 minutes;$48.73) Reinspections (32 minutes;$45.87) Mean time spent traveling per inspection Approx. 17 minutes (expenditure in today's dollars of$24.73) • Range of Minutes spent per permit 5—420 min (min-$7.17; max-$602.00) Mean time spent for new establishments Approx. 243 minutes($348.30) Range of minutes spent for new establishments 215—290 min (min-$308.17; max-$415.67) *Expenditures are estimated at the current hourly rate-$86.00 Today's Takeaways Today we will review inspection detail by establishment type, uncompensated activity detail for new establishments & new owners of establishments as well as examine proportional time spent by program staff. Annual Inspection cost by food establishment category School Warming Kitchen $218.07 Small Limited Restaurant $97.52 X-tra Large Restaurant $206.18 Meat&Fish Market $96.75 Complex Mobile Unit $193.50 Bed&Breakfast $87.95 Medium Restaurant $187.93 Concession $87.59 Caterer from Commissary $180.60 Small Grocery $83.91 Large Restaurant $168.75 Caterer from Restaurant $80.88 Small Complex Restaurant $157.67 Espresso Stand $80.43 School Central Kitchen $151.52 Commercial Kitchen $66.89 • Limited Mobile Unit $114.67 Bakery $66.29 Large Grocery $112.88 Church $60.92 Tavern $52.32 *Expenditures are estimated at the current hourly rate-$86.00 2015 Food Safety Activity and Fee Review 0 Activity Detail for New Establishments Pre Application Review Review Payment Phone Face to Travel Post Mail permit intake application Corrected Face Mtg. Time Inspection /Deliver App • On average this entire process is taking 2.28 hours($196.08) per establishment • Administrative processing (Intake—Payment) accounts for approx. 30%of the time • New establishments averaged 2.87 hours ($246.97) per establishment • New owners averaged 1.86 hours ($159.91) per establishment Proportion of Food Program Time Spent on Annual 111 Facilities 0" rNew Businesses / 12% Travel Time 6% 4 Annual Inspections 19% Inspection Time 13% Administrative& Enforcement 34% 4110 • Board of Health V New Business Item 4 Community Health Improvement Plan — Activity Update • Dea !awn �, Public Health August 20, 2015 Board of Health • V New Business Item 5 Community Health Director Interview Process Public Health • August 20, 2015 0 ,,,,,inb,,,.- :7-y .. ,,..x.,,;.;.',1.-**4-4, . - - #i - l A 'IT!I __ny lik i 1. . 111.111,1 ' 1 1 II ' I � S s n At t fie , , ha. . . 1,\ To protect.the health of all Jefferson County residents by promoting safe, . healthy communities and environments. JCPH is seeking a progressive and innovative leader to serve as its next Community Health Director 4( N-ff ce &son Public Healt II615 Sheridan Street I Port Townsend,WA 98368 Phone:360-385-9400 I fax:360-385-9401 info@jeffersoncountypublichealth.org Jefferson County Public Health l Community Health Director 1 • �x w pIP :i. OHM VinikiMONNotiOnatfterargo JEFFERSON COUNTY Located in the North Olympic Peninsula on the Northwest tip of the continental US,Jefferson County stretches 2,100 square miles from the Pacific Ocean to Puget Sound.The Olympic Mountain range goes through the center of the county,with national and state parks scattered throughout the land. Port Townsend is the center of this vibrant rural community with an active arts and tourism scene, maritime recreation,and diverse economy.A full time population of 410 30,000 citizens call Jefferson County home. COUNTY GOVERNMENT Jefferson County is governed by a Board of three County Commissioners, representing different geographic areas. There are several separately elected officials as well as six County departments with Directors appointed by the County Administrator. BOARD OF HEALTH The Jefferson County Board of Health is composed of the three County Commissioners,a representative of the City of Port Townsend,a Jefferson Healthcare hospital commissioner,and two citizens.The Jefferson County Board of Health governs JCPH (the Local Health Jurisdiction), sets Public Health priorities,and works with the department to provide services and build catalyst partnerships for a community plan. THE DEPARTMENT Jefferson County Public Health is a productive department within the government of Jefferson County.With a dynamic management team and supportive staff,JCPH comprises ason 41, Community Health, Environmental Health,Water Quality, and some human services, including Developmental Disability support.Services are provided throughout Jefferson Public HgPCITII County.The Department also manages contracts for local vendors. Jefferson County Public Health I Community Health Director 2 4*AiN',Ct.4., lf "iips, 0 ,--x,4i, 'kr' ' ' -,...,. -, Ale .n r: ¢y 1 ' - ' g f a s.. ... COMMUNITY HEALTH DIVISION Current services include epidemiology, community assessment,communicable and chronic disease Prevention,family support services including Women Infants and Children (WIC), home visits, Nurse Family Partnership(NFP),and supportfor children with special health care needs. Additional local services include family planning, immunizations, • international travelers'clinics,school nursing,and school based primary clinics. All Community Health services are provided throughout the county by JCPH or in partnerships with Jefferson Healthcare,school districts,or other vendors. Many programs administered by the Community Health Director are a range of federal,state,and local programs.The Community Health operating budget is$1.9 million. COMMUNITY HEALTH DIRECTOR The Community Health Director is a new position in the JCPH management team and will work within the structure of JCPH under the Jefferson County Board of Health and JCPH Director.The JCPH Community Health staff of 21 professionals includes a Health Officer,Advanced Nurse practitioners, Public Health nurses,and clinic support staff. Public health community work is population-focused and requires unique knowledge, competencies, and skills. Salary:This is a Grade 20 Exempt Position, starting at$65,885 to$69,900 annually, DOEQ Hours:40 hours/week(100% FTE), may include evening or weekend hours Status: Exempt,full-time,with benefits Closing Date:August 14, 2015 • 4. 69eifvrson Public Healt w. Jefferson County Public Health I Community Health Director 3 e .. e a a� i 40 Y f4• f. Ilia ,,,,-/, - , bt. .-4, ; , ., -= ...* 741' ' Z .'t''^';“.' .,fr *0. 4.f i•y " CANDIDATE PROFILE JCPH is looking for a motivated individual with a strong background in public health,skilled at working in teams and building partnerships with the goal of developing and managing innovative,evidence-based,and culturally appropriate public health services within communities.The ideal candidate will: • Work toward primary prevention, illness prevention,and health promotion • Design, deliver,and evaluate services to diverse communities using knowledge from nursing, public health,and health policy 411 • Provide orientation,staff development, consultation,and leadership • Evaluate assets and needs of communities, proposing solutions in partnership or leadership using proven best practices and epidemiology • Deliver community focused solutions that have influence on the health and illness of individuals,families, and local communities. As a key leader,the Community Health Director is responsible for the administering, planning,organizing, directing, and evaluating the Community Health programs,services, and policies of JCPH. He or she is accessible and approachable,and moves easily and comfortably among a variety of constituencies such as staff, a Health Officer, Board members,the County administrator, and the Public Health Director.This person works to develop and manage community health programs and procedures to accomplish local,state, and federal public health goals and policies. JEFFERSON COUNTY PUBLIC HEALTH 2015 Director,JCPH Health Officer Jean Baldwin 4 Dr Thomas Locke c"ertni.e.iir Hi,wit Decca-v A.i-r --r, iiiik ir:eif f.,i-1—.mant 11 Yfr.Uth i, ,),torr the car, t;,••uit+ct d7are-,, vc.nrr.,c.a Shx.. jtre4 Keefer Mv _,, zm; "S3'S" �r '*iiwi..7' "a" e a M :, ti • Jefferson County Public Health I Community Health Director 4 QUALIFICATIONS Knowledge and advanced understanding of the principles and practices of Nursing and Public Health Policy of all department activities. Knowledge of laws, management,and administrative practices. Knowledge of health care system, public health system, Behavioral Health service systems locally and in WA State,and principles and practices associated with public health, healthcare providers, and human services. illKnowledge of principles and practices in the medical fields of family planning,vaccine preventable disease,and communicable disease, including medical treatments and pharmacology. REQUIREMENTS Master's degree in Nursing, Health Administration, Public Health, or related field;or combination of related undergraduate education and experience to equate to a master's level degree; Three years progressively responsible and relevant public health program management supervisory experience required, or equivalent combination of education and experience. TO BE CONSIDERED Jefferson County Public Health is a progressive equal opportunity employer and all qualified candidates are encouraged to apply as soon as possible.To be considered, please go to www.co.jefferson.wa.us and download the Jefferson County Employment Application and full County Job Description. Include a resume and cover letter expressing your passion for public health and fit for the role. Letters may be addressed to Jean Baldwin. Mail completed application, resume, and cover letter to Jefferson County Board of County Commissioners, PO Box 1220, Port Townsend,WA 98368. ' eV r dl n Public Hedt Media Review • fr \-\*ogeffelson Public Health • • 1 . Jefferson County Public Health July/August 2015 NEWS ARTICLES 1. "Mystery Bay, Kilisut Harbor closed due to marine biotoxins," Port Townsend Leader, July 9th, 2015. 2. "Enough: It's time to stop measles and misinformation," The Seattle Times, July 11th 2015. 3. "Mystery Bay, Kilisut Harbor now off-limits to shellfish harvesting," Peninsula Daily News, July 12th, 2015. 4. "Shellfish harvest closed around Port Townsend due to biotoxins," Port Townsend Leader, July 15th, 2015. 5. "Jefferson Healthcare developing plans for abortion services," Peninsula Daily News, July 17th, 2015. 6. "Recreational shellfish closures announced in two new Jefferson County locations as restrictions are lifted at another site," Peninsula Daily News, July 17th, 2015. 7. "North Olympic Peninsula recreational pot stores pass compliance checks on rule against sales to minors," Peninsula Daily News, July 19th, 2015. 8. "Woman recognized as advocate for women's rights by Jefferson Board of Health," Peninsula Daily News, July 21st, 2015. 9. "Merryman honored by JCPH," Port Townsend Leader, July 22nd, 2015. • 10. "SmileMobile stops in Chimacum July 27-31," Port Townsend Leader, July 22nd, 2015. 11. "Pregnancy services to include abortion option," Port Townsend Leader, July 22nd, 2015. 12. "Whooping cough outbreak travels west from Jefferson to Sequim," Peninsula Daily News, July 23rd, 2015. 13. "Plan B ruling," Peninsula Daily News, July 24th, 2015. 14. "Peninsula's first naloxone program tied to needle exchange starts today in Clallam County," Peninsula Daily News, July 24th, 2015. 15. "Celebrate World Breastfeeding Week at Aug. 5 picnic," Port Townsend Leader, July 29th, 2015. 16. "Gibbs Lake closed due to toxin; Lake Leland still open as summer swimming hole," Port Townsend Leader, August 6th, 2015. 17. "Gibbs Lake south of Port Townsend closed because of toxin," Peninsula Daily News, August 6th, 2015. 18. "Sports physicals offered at School Based Health Center," Port Townsend Leader, August 12th, 2015. • • Mystery Bay, Kilisut Harbor closed due to marine biotoxins Port Townsend Leader,Thursday, July 9, 2015 2:03 pm Shellfish samples from Mystery Bay have been found to contain elevated levels of marine biotoxins that cause Paralytic Shellfish Poisoning (PSP). As a result, the Washington State Department of Health (DOH) has closed Mystery Bay and Kilisut Harbor for recreational shellfish harvest. The closed area includes all of Kilisut Harbor up to the southern edge of Fort Flagler State Park. Mystery Bay was previously under a seasonal closure. A danger sign has been posted at Mystery Bay, warning people not to consume shellfish from this area. Shellfish harvested commercially are tested for toxins 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. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crabmeat is not known to contain the biotoxin but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (also known as the "butter"). • Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing, and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 911. In most cases the algae that contains the toxins cannot be seen, and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH Shellfish Safety Map at doh.wa.gov/ShellfishSafety.htm or call the DOH Biotoxin Hotline at 1-800-562- 5632 before harvesting shellfish anywhere in Washington State. Recreational harvesters should also check Fish and Wildlife regulations and seasons at wdfw.wa.gov/fishing/shellfish or call the Shellfish Rule Change Hotline 1-866-880-5431. • and misinformation Enough•• It's time to stop measles By Jeffrey Duchin, Paul Pottinger • Edgar Marcuse Special to The Seattle TiMeS05 pm Originally published Jul} 11, 2015 at 4 tizens from measles and protect ci ton state needs to do more to p vaccinations, write three medical Washing by other diseases that can be prevented experts. Inness woman with an underlying state health officials reported that an adult Clallam County is and LAST week, died due to complications of a measles infecion.profoundly is tragic a dnd system ears, is that weakened her immune immunization rates now, lest we return to an era where death, the first from measles in the United States in Y preventable call to improve should serve as a wake-up measles deaths are no longer rare. in 1963, there were approximately ahalf-million cases and had h consequences: measles-associated45 deaths each year in the United States. Many complications seriouss and uen had An Before measles immunization was available ed death. And 48,000 averagee of150, term neurological respiratoryecomplons and of 150,0oc people with measles ik of long leve ne encephalitis, associated with a hospitalized every year. art thanks to people with measlesv were and measles was arrived and high levels of children were asinterrupted in large Once the measles vaccine ongoing transmission of meas school immunization mandates, on9 g The United States experienced a record declared eliminated from the United States in 200Qks are surging. states. This is the nutmb r of measles years, measles casesg and during 2014, with 23 outbreaks and 668 cases in 27 number of cases greatest number since 2000. If this trend continues, additional severe infections and deaths should be transmission in multiple countries, expected. uncontrolled measles encs is ongoing, o the The main reason for the , theand Africa. This results in frequenintroductionswu immunization rates. including in s by infectedn, Asia, the Pers, followed by spread of measles in communities United States by travelers, the air from an rates. spread readily throughs before someone Ines diseases known. It can e ability to take step Measles is one of the most contagious ears, limiting person before the characteristic rasht {happened in the recent fatal case, where an innocent • infected precisely can spread the disease. This is bystander acquired the infection in a health-care facility from another patient who wasn't recognized to have measles. • Once introduced into areas where unimmunized people are clustered, measles can gain a foothold, increasing the risk for transmission to vulnerable groups, such as the increasing number of people who cannot be vaccinated because of underlying medical conditions, those with weakened immune systems, infants too young to be vaccinated, and the few who are properly vaccinated but do not develop protection. In all recent U.S. outbreaks, the majority of cases have been in unvaccinated individuals, and most of these intentionally so. The measles vaccine is highly effective and has a long track record of safety. Recent concerns regarding a link to autism have been conclusively debunked. To be most effective in preventing outbreaks, child vaccination rates in the mid-to high 90 percent range are needed. Alarmingly, in 2014-15, 66 Washington state school districts reported that 20 percent or more kindergartners were unvaccinated for measles. And more than three-quarters of people who chose to have their child exempted from required vaccinations do so for nonmedical reasons — personal or religious beliefs. Washington, we can do better. To prevent the spread of measles, to both protect our children and to protect vulnerable people who cannot be vaccinated, we must do better. First, we should accept exemptions to school immunization requirements for measles vaccination only for valid medical reasons. Second, we should empower schools to accurately document and report child- vaccination coverage — including posting immunization rates online— and to facilitate administration of needed vaccines to students, such as through school-based health centers. Third, we each need to step up and be sure all of us—children and adults— are up-to-date on our vaccinations. That means at least one dose of measles-containing vaccine for adults, and two doses for international travelers and health- • care workers. This preventable measles death should compel us all to take full advantage of available and safe vaccines to safeguard our community from outbreaks and protect everyone —those who are vaccinated as well as the most vulnerable among us for whom vaccination is not possible —from a serious and potentially fatal disease. Dr. Jeffrey Duchin is health officer for Public Health - Seattle & King County and a professor in the University of Washington's division of infectious diseases. Dr. Paul Pottinger is a specialist in infectious diseases at UW and president of the Infectious Diseases Society of Washington. Dr. Edgar Marcuse is a pediatrician and UW emeritus professor. • Mystery Bay, Kilisut Harbor now off-limits to shellfish harvesting Peninsula Daily News, July 12, 2015 • PORT TOWNSEND — Mystery Bay and Kilisut Harbor have been closed to recreational shellfish harvesting because of elevated levels of marine toxins that cause the potentially lethal paralytic shellfish poisoning. The closed area includes all of Kilisut Harbor up to the southern edge of Fort Flagler State Park. It is for all species of shellfish. The state Department of Health found the elevated levels in samples of shellfish from Mystery Bay, Jefferson County Environmental Health said in a news release issued Friday. Mystery Bay was previously under a seasonal closure. A danger sign has been posted at Mystery Bay warning people not to consume shellfish from the area. Shellfish harvested commercially are tested for toxins prior to distribution and should be safe to eat. Elsewhere in Jefferson County, Hood Canal beaches from the Hood Canal Bridge south to Brown Point are closed to recreational harvest of all types of shellfish, as are those on Discovery Bay and Port Ludlow, including Mats Mats Bay. In Clallam County, beaches on the Strait of Juan de Fuca east to the Jefferson County line are closed to recreational harvest of all species of shellfish, as are Sequim and Discovery bays. Ocean beaches in both counties are closed for the season. • The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crabmeat is not known to contain the biotoxin, but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (also known as the "butter"). Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of paralytic shellfish poisoning (PSP) can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions, call 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 shellfish safety map at www.doh.wa.gov/ShellfishSafety.htm or call the biotoxin hotline at 800-562-5632 before harvesting • shellfish anywhere in the state. Recreational harvesters should also check Fish and Wildlife regulations and seasons at www.wdfw.wa.gov/fishing/shellfish or call the hotline at 866-880-5431. Shellfish harvest closed around Port Townsend due to biotoxins 111 Posted: Port Townsend Leader, Wednesday, July 15, 2015 4:17 pm Shellfish samples from Fort Flagler State Park and Mystery Bay have been found to contain elevated levels of marine biotoxins that cause Paralytic Shellfish Poisoning (PSP). As a result, on July 15 the Washington State Department of Health closed Admiralty Inlet and Port Townsend Bay to recreational shellfish harvest. The closed area includes Admiralty Inlet from North Beach south to Kinney Point, including Port Townsend Bay. Danger signs are being posted at commonly used public access points, warning people not to consume shellfish from this area. The closure pertains to clams, oysters, mussels, scallops and other species of molluscan shellfish. This closure does not apply to shrimp. Crab meat is not known to contain the biotoxin, but the guts (also known as the "butter") can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts. MARROWSTONE ISLAND Mystery Bay and Kilisut Harbor continue to be closed for recreational shellfish harvest due to high levels of PSP. The closed area includes all of Kilisut Harbor and Fort Flagler State Park. HOOD CANAL Marine biotoxins south of the Hood Canal Bridge have declined and the closure earlier in the season has now been lifted. The reopened area is on the Jefferson County shore from the Hood Canal Bridge to • Brown's Point on the Toandos Peninsula. There is still a vibrio warning and all shellfish harvested from the Hood Canal area should be cooked prior to consumption. BE CAREFUL 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 present first as tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions, call 911. In most cases, the algae that contains the toxins cannot be seen and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH shellfish safety map at doh.wa.gov/ShellfishSafety.htm or call the DOH Biotoxin Hotline at 800-562-5632 before harvesting shellfish anywhere in Washington state. Recreational harvesters should also check Fish and Wildlife regulations and seasons at wdfw.wa.gov/fishing/shell-fish or call the Shellfish Rule Change Hotline, 866-880-5431. (This news story appeared July 15 on ptleader.com.) • Jefferson Healthcare developing plans for abortion services By Charlie Bermant, Peninsula Daily News, July 17th,2015 • PORT TOWNSEND —A new reproductive health policy is now in place at Jefferson Healthcare that will lead to the Port Townsend hospital offering a full range of women's health services, including abortion. "I think that the hospital has been very responsive and responsible," said Christel Hildebrandt, a citizen member of the task force that created recommendations for the new service. "The board recognized that the hospital is publicly owned, and the majority of the members of the public that I talked to said they wanted a full suite of women's healthcare services." On Wednesday, the hospital board unanimously approved adopting the recommendations of a task force that was formed in response to the American Civil Liberty Union's assertion that the East Jefferson County hospital was out of compliance with state law in its provision of abortion services. The Seattle office of the ACLU informed the hospital of its stand in a Feb. 18 letter addressed to the hospital board and its CEO, Mike Glenn. The hospital's quick response and resolution could set an example for other hospitals, according to Jennifer Shaw, the ACLU's deputy director in its Seattle office. "We were pleased how responsive they were in creating the task force and approving its recommendations," Shaw said. "It could serve as a model for other rural hospitals, in their staying connected to the needs of the community." • The ACLU will watch how the new plans are implemented, Shaw said. "They still need to hire the staff and get the services in place." The ACLU also sent letters of concern to Whidbey General Hospital in Coupeville and Mason General Hospital in Shelton at the same time that it filed a lawsuit alleging noncompliance against Skagit Valley Hospital on Thursday. The other hospitals have not made appreciable progress on the matter, Shaw said, and she hopes Jefferson Healthcare will share information with administrators from those organizations, The report was first presented to the board on June 17 but no action was taken at that time. On Wednesday, Glenn presented the goals, which are to develop a "one stop" resource for pregnancy counseling, options and referrals, develop an office based surgical miscarriage management program, develop a medical abortion program and, when all these are in place, develop a surgical abortion program. The 11-member task force had seven hospital staff members, two public health representatives and two citizen representatives. The next step will be for the hospital to form a committee charged with developing an implementation plan for the recommendations which will begin meeting in the fall, according to hospital spokesperson • Kate Burke. There is no timetable for the service offerings since the new committee is charged with developing the logistics, Burke said, but the expectation is that everything will be in place in 2016. . This process will be monitored both by the ACLU and the community, representatives say. Hildebrandt said the task force has plans to meet again in about four months. • A meeting is scheduled for next week of the ad-hoc group that initially lobbied the hospital board to take action. "We need to see how this gets implemented," Hildebrandt said. "We'll be checking back." Jefferson County Editor Charlie Bermant can be reached at 360-385-2335 or cbermant@peninsuladailynews.com. Last modified:July 16.2015 10:14PM 1111 411 Recreational shellfish closures announced in two new Jefferson County locations as restrictions are lifted at another site Peninsula Daily News, July 17th, 2015 PORT TOWNSEND — Recreational shellfish harvest closures have been expanded to two new locations on the North Olympic Peninsula, while the state Department of Health has re-opened another. Shellfish samples from Fort Flagler and Mystery Bay have been found to contain elevated levels of marine biotoxins that cause potentially deadly paralytic shellfish poisoning. The Department of Health has closed Admiralty Inlet and Port Townsend Bay for recreational shellfish harvest, it announced Thursday. Admiralty Inlet is closed from North Beach south to Kinney Point, including Port Townsend Bay. Commercially harvested shellfish are tested for toxins prior to distribution and should be safe to eat. South of the Hood Canal Bridge, marine biotoxins have declined and an earlier closure has been lifted. • The reopened area is on the Jefferson County shore from the Hood Canal Bridge to Brown's Point on the Toandos Peninsula. Mystery Bay and Kilisut Harbor remain closed for recreational shellfish harvest due to high levels of the biotoxin. The closed area includes all of Kilisut Harbor and Fort Flagler State Park. The Hood Canal area south of the Jefferson County line remains closed. A vibrio contamination warning remains in place in the Jefferson County Hood Canal area. All shellfish harvested from the Hood Canal area should be cooked prior to consumption. Elsewhere in Jefferson County, closures include Discovery Bay, the area around Port Ludlow, including Mats Mats Bay. In Clallam County, beaches on the Strait of Juan de Fuca from Pillar Point east to the Jefferson County line are closed to recreational harvest of all species of shellfish, as are Sequim and Discovery bays. Ocean beaches in both counties are closed for the season. Danger signs are posted or will be posted at commonly used public access points where beaches are • closed to harvesting. The new closure is for harvest of clams, oysters, mussels, scallops and other species of molluscan shellfish. r Crabmeat is not known to contain the biotoxin but the guts can contain unsafe levels. Clean crab thoroughly and discard the guts (also known as the "butter"). • Marine biotoxins are not destroyed by cooking or freezing. Symptoms of paralytic shellfish poisoning (PSP) can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and potentially death. Recreational shellfish harvesters should check the shellfish safety map at www.doh.wa.gov/ShellfishSafetv.htm or call the biotoxin hotline at 800-562-5632 before harvesting shellfish anywhere in the state. Recreational harvesters should also check Fish and Wildlife regulations and seasons at www.wdfw.wa.gov/fishing/shellfish or call the hotline at 866-880-5431. Last modified:July 16.2015 9:55PM • • North Olympic Peninsula recreational pot stores pass compliance checks on rule against sales to minors Peninsula Daily News, July 19, 2015 OLYMPIA— North Olympic Peninsula marijuana retail stores passed the first round of checks on compliance with laws directing no sales be made to those under 21. Mister Buds, Hidden Bush and Sparket in Port Angeles, Sea Change Cannabis in Discovery Bay and Herbal Access Retail in Port Hadlock passed the compliance checks conducted at 157 stores from mid- May until the end of June, the Washington State Liquor Control Board reported Friday. Eighteen stores in the state sold to minors—one twice for a total of 19 violations—the liquor control board said. Three stores were in Everett, with one selling to an underage investigative aide on two occasions. Three were in Tacoma. One each were in Shoreline, Blaine, Lake Stevens, Arlington, Spokane, Eastsound, Rochester, Olympia, Shelton, Okanogan, Kenmore and Seattle. The co-owner of the Blaine store said that a math error caused the violation there, according to The Bellingham Herald. Jacob Lamont, Evergreen Cannabis co-owner and manager, said the customer's identification showed a birth date only a couple months shy of 21. The employee "did her own math, and that was the problem," he said. 110 The checks represent an 88 percent no-sales-to-minors compliance rate, the state said. "Our goal is 100 percent compliance," said Jane Rushford, chairwoman of the liquor control board. "While perfect compliance is always a challenging goal, it is clearly in everyone's interest that our licensees be vigilant about preventing underage sales," Rushford said. The 18 businesses will be cited for selling marijuana to minors, with cases referred to the respective prosecuting attorney's office for potential criminal prosecution. Businesses cited for sale to a minor face a 10-day suspension or $2,500 fine. A second violation within three years requires a 30-day suspension with no monetary option. Businesses who receive three public safety violations within three years face license cancellation. The compliance checks were the first of retail marijuana stores since they opened following 2012 voter approval of Initiative 502 which legalized recreational marijuana for adults. Investigative aides between 18 and 20 years old assist officers with compliance checks. For more information, see "press releases" at WWW.liCI.VVa.CPDV/. Last modified:July 18.2015 7 23PM • Woman recognized as advocate for women's rights by Jefferson Board of Health Peninsula Daily News,July 21, 2015 L.0.4.,— ,. ,„,, .., -.,‘„, .. :, . ' e ,,,,, ),„. aka i �� �e*,:•:: ::,..4., `� �'��Ib teci Ruth Merryman,center,was recently honored with a certificate of appreciation at the Jefferson CountyBoard of Health meeting June 18.From left are Julia Danskin,Wendy White,Merryman,Sheila Westerman and Jean Baldwin. PORT TOWNSEND—Ruth Merryman was honored with a certificate of appreciation at a recent Jefferson County Board of Health meeting. Board Chairwoman Sheila Westerman commended Merryman for her"hard work and dedication as an advocate for women's rights, particularly in the areas of reproductive health and economic advancement." Merryman served as the co-chairwoman of the Women Who Care Giving Circle, which was instrumental in funding Jefferson County Public Health's Family Support Programs Assessment and the first Adverse Childhood • Events measurements in Jefferson County. "Ruth is an important community advocate who encouraged the county to provide family planning services in the mid- '90s,"said Jean Baldwin, director of Jefferson County Public Health. "She is a role model who inspires and energizes women and girls. Her service to the community has removed barriers and provided opportunities for many in Jefferson County and beyond." In addition to her work with public health, Merryman also founded Working Image, a clothing bank that provides business attire for low-income women in the community, and served as a mentor to Habitat for Humanity homeowners. Merryman honored by JCPH Port Townsend Leader,Wednesday, July 22 2015 1 10 am ter' e ' req ae m a Ruth Merryman was presented with a certification of appreciation by Jefferson County Public Health. Pictured(from left)are Julia Danskin,Wendy White,Ruth Merryman,board of health chair Sheila Westerman and JCPH Director Jean Baldwin. Ruth Merryman was honored with a certificate of appreciation at the June 18 Jefferson County 111 Board of Health meeting. Board chair Sheila Westerman commended Merryman for her"hard work and dedication as an advocate for women's rights, particularly in the areas of reproductive health and economic advancement," according to a press release from Jefferson County Public Health (JCPH). Merryman served as the cochair of the Women Who Care Giving Circle, which was instrumental in funding JCPH's Family Support Programs Assessment and the first Adverse Childhood Events measurements in Jefferson County. "Ruth is an important community advocate who encouraged the county to provide family planning services in the mid'90s," said JCPH Director Jean Baldwin in a press release. "She is a role model who inspires and energizes women and girls. Her service to the community has removed barriers and provided opportunities for many in Jefferson County and beyond." In addition to her work with public health, Merryman also founded Working Image, a clothing bank that provides business attire for low-income women in the community, and served as a mentor to Habitat for Humanity homeowners. • SmileMobile stops in Chimacum July 27-31 Port Townsend Leader, Wednesday, July 22, 2015 3:00 am The SmileMobile, a full-service mobile dental office providing accessibility to affordable exams, cleanings and other dental services, sets up in Chimacum next week Offering service to kids, teens and pregnant women, SmileMobile accepts Apple Health as full payment, and bases fees on a sliding scale for those without insurance. The SmileMobile helps meet one of the identified Jefferson County health priorities: Increase access to needed preventive care, with special focus on dental, according to a press release from Jefferson County Public Health. To schedule an appointment the week of Monday-Friday, call 888-286-9105. pP July 27-31, The SmileMobile is made possible by the Washington Dental Service Foundation, which partners with Seattle Children's Hospital and Jefferson County Public Health to bring free and low-cost dental services to local children, teens and pregnant women. For more information, contact Jefferson County Public Health at 385-9400. • • Pregnancy services to include abortion option By Allison Arthur, Port Townsend Leader I Posted: July 22, 2015 3:30 am The American Civil Liberties Union of Washington was looking to Jefferson Healthcare to serve as a model for how small rural hospital districts could take on the controversial issue of abortion. On July 15, five months after the ACLU told Jefferson Healthcare it felt it was violating state law by not providing abortion services, hospital district commissioners voted unanimously to approve a recommendation by a reproductive task force to start offering such services. Jefferson Healthcare, headquartered in Port Townsend, became one of the first rural hospitals in the state to take on the issue. "The process of including the community voice, we thought, was a good way to look over a whole range of issues," said Jennifer Shaw, deputy director of the ACLU's Seattle office, when asked for a reaction to the decision after the July 15 board meeting. "We were hoping by having a rural hospital district like Jefferson, which is smallish, take on this and be proactive, that other hospitals will follow a similar path." She acknowledged that the ACLU did prod Jefferson Healthcare. Although Shaw said the ACLU is pleased with the board's actions, she said the ACLU will continue to watch over how the hospital district actually implements the task force's four-prong recommendation that leads to elective medical and surgical abortion services. PUBLIC COMMENT • Only one of the five who spoke at the board's July 15 meeting, Deacon Carl Swanson of St. Mary Star of the Sea Catholic Church in Port Townsend, asked to delay action. Swanson beseeched the board to reach out to the community more and consider not doing what he called a "culture shift of life saving" to that of life taking. He noted that his father had been on the hospital board in the past. Four other members of the public, Julie McCormick, Debbie Jahnke, Sally Robbins and Tom Thiersch, all praised hospital officials for moving forward to provide better pregnancy-option services. There is no set timeline for the abortion services to be offered, and when they are, CEO Mike Glenn said they are expected to be provided in a clinic setting, not in a hospital, to keep the costs down. More that one provider is expected to be able to perform the elective surgery. Three services first need to be developed: • A standing one-stop pregnancy resource program that offers pregnancy options, counseling and referrals. • An office-based surgical miscarriage management program that augments the current medication- and hospital-based program. • An office-based medical abortion program. When all three of those programs are on line and when "qualified, trained and interested providers are in place," the district will then develop a surgical abortion program. • After the five people spoke, the board spent little time in discussion. Commissioner Matt Ready complimented Glenn and staff for taking the time to listen to the community, create a task force • and evaluate their suggestions. Commissioner Marie Dressler also complimented administrators. Glenn said the first three recommendations are expected to be completed by the end of this year or no later than the first quarter of next year, with in-clinic abortion services to follow in a clinic setting. THE PROCESS A letter from the ACLU in February 2015 together with a public outpouring of support for better access to care for women were the catalysts for the task force., The ACLU put Jefferson Healthcare and two other public hospitals in Washington on notice that the ACLU believes public health care providers are violating state law by not providing abortion services and what it calls a full range of reproductive services. Glenn said July 15 that hospital officials don't believe they were violating the law by not providing the service, but after public input, they decided to review what services were offered and appoint a task force to examine the issue. Members of the task force were primarily associated with the health care system and Jefferson County Public Health Department. Two of the 10 members of that task force were community members: Amanda Funaro and Christel Hildebrandt. Earlier, both had also complimented the district on the process of evaluating options. Others on the task force were Drs. Molly Parker, Rachel Bickling, and Joe Mattern; nurses • Jackie Levin, Amber Hudson and Lisa Holt; Jean Baldwin, director of Jefferson County Public Health Department; public health nurse Susan O'Brien; and community representative Bertha Cooper was asked to facilitate the meeting. The task force met six times in private and came up with a list of recommendations contained in a 10-page report that was released in June. On July 15, Glenn condensed that report into four recommendations for board approval. Although the hospital currently does not offer abortion services, it did so in the past, for years. A doctor who had been performing the procedures between 1978 and 1995 became tired of doing so and his staff also did not want to do them, so that service was discontinued about 20 years ago. Since that time, between 50 and 55 women from Jefferson County leave the county for such services each year. They typically go to Kitsap County or Seattle for those services. So far, Jefferson Healthcare is the only public hospital that has responded to the ACLU's letter. The other hospitals receiving letters were Whidbey General Hospital and Mason General Hospital. • r Whooping cough outbreak travels west from Jefferson to Sequim By Arwyn Rice, Peninsula Daily News, July 23, 2015 • SEQUIM —A whooping cough outbreak that has infected people in Jefferson County has reached Clallam County, with five confirmed cases in Sequim. Dr. Jeanette Stehr-Green, Clallam County interim health officer, announced the news to the county Board of Health on Tuesday. Neighboring Jefferson County, which has had an ongoing outbreak since March, has had 27 confirmed cases of whooping cough, also known as pertussis. Whooping cough is a serious respiratory infection caused by the pertussis bacteria, which begins with cold-like symptoms and develops into violent coughing that can cause pneumonia, seizures and brain damage, and can be fatal for infants younger than 1 year. Diagnoses have been confirmed this summer in five people, all from one family in two households in Sequim, Stehr-Green said. The illness first appeared in a 55-year-old Sequim resident June 1, followed by members of the same household, who became sick later that month, she said. The other members of the household were a 39-year-old adult who began showing symptoms June 18, a 12-year-old who became sick June 28 and a 10-year-old whose symptoms began June 29. • Stehr-Green said they remained at home self-quarantined and did not immediately seek medical attention. The four younger members of the family went to a Kitsap County clinic this week, where they were diagnosed and the infections were reported to the Clallam County Health Department, Stehr-Green said. A 62-year-old woman, grandmother of the children, began having symptoms July 9 and saw a Clallam County doctor, who diagnosed her with whooping cough, Stehr-Green said. She said the two children were not vaccinated by parental choice and the two adults in the household did not know their vaccination history. The 64-year-old grandmother did not know she should be vaccinated, Stehr-Green said. Time from exposure to onset of infection can be from five to 21 days, and debilitating symptoms can last more than three months. One of the primary symptoms of pertussis is extreme coughing, leading to nausea or"turning blue" from oxygen depravation. "It's also known as 'the hundred days' cough,- she said. • Lisa McKenzie, communicable disease nurse for Jefferson County Public Health, said the disease can be treated with antibiotics in early stages for those who know they have been exposed. Early treatment can reduce or eliminate the long, lingering cough, McKenzie said. There have been 37 total cases in Jefferson County since March, according to laboratory testing, but early treatment stopped the cough in 11 people before their illness reached the Centers for Disease Control and Prevention requirement of two weeks of coughing to be classified as a confirmed case, she • said. McKenzie said the rate of new infections has slowed since school was let out for summer. Only one new case was reported this month, she said. The CDC recommends diphtheria and tetanus DTaP (diphtheria, tetanus and pertussis) vaccinations at age 2 months, 4 months, 6 months and 18 months, and a booster between the ages of 4 and 6 years old. Stehr-Green said pregnant women also should be vaccinated because the illness can last three months or more, and a pregnant mother may give her child pertussis immediately after childbirth. Adult members of a family who will be exposed to an infant should also be vaccinated, and older children should get a booster, she said. The vaccine is most effective in the first year after vaccination; after a year, its effectiveness drops to about 50 percent, Stehr-Green said. After five years, the pertussis vaccine continues to reduce the severity of a pertussis infection but is not as effective at preventing infection, she said. • Stehr-Green said boosters are recommended after five years to renew immunity. The state outbreak has reached 897 cases in Washington state, compared with194 cases during the same time period in 2014. Statewide, the outbreak is most common among teens ages 14-18, 323 teens representing 36 percent of the confirmed cases, followed by 101 early adolescents age 10-13, with 20.2 percent, and 132 children age 5 to 9, representing 14.7 percent of those who have become ill. A total of 55 babies 1 year or younger have been infected, representing 6.1 percent, and 11 were hospitalized, according to the health report. Reporter Arwyn Rice can be reached at 360-452-2345, ext. 5070,or at aricefteninsuladailynews.com. • • Plan B ruling SEATTLE—A federal appeals court panel says Washington state can force pharmacies to dispense Plan B or other emergency contraceptives. The unanimous decision Thursday by the three- judge panel of the 9th U.S. Circuit Court of Appeals • overturned a 2012. ruling by U.S.District Court Judge Ronald B.Leighton, who had found that the state's rules violated the • religious freedom of phar- macy owners. It was the second time the appeals court reversed Leighton in the case. Washington adopted . rules in 2007 following reports that some women had been denied access to Plan B,which has a high dose of medicine found in birth-control pills and is . effective if a woman takes it within a few days of • unprotected sex. Some consider the medi- cine tantamount to abor- tion. The Associated Press • /),/ 11111 7 /v//J- t Peninsula's first naloxone program tied to needle exchange starts today in Clallam County By Diane Urbani de la Paz, Peninsula Daily News, July 24,2015 II ,„„, w, w woc 0i44.s3 o' norx„ __ „,NO.3389”'! NALOXONE ,.... HYDROCHLORME 2M9 c.,...._ ' lSy414"p Eqitta SkStpy� The Associated Press PORT ANGELES — Beginning today, the scores of people who use Clallam County's public health syringe exchange service— half of them self-reported heroin users—will have access to a potentially life-saving antidote. It's the first such program on the North Olympic Peninsula. Clallam Health and Human Services has received a donation of naloxone (pronounced nuh-LOX-own), a drug that halts the effects of heroin overdose, public health program manager Christina Hurst said Thursday. Kaleo, a pharmaceutical company based in Richmond, Va., made the grant for 100 doses of naloxone— • $40,000 worth of medication — in prefilled, single-use auto-injectors. Like Jefferson County Public Health, Clallam officials had planned to purchase the antidote later this year. And the Kaleo grant is just a start, Hurst added. Jefferson County Public Health Director Jean Baldwin, meantime, has said her department hopes to have the drug by this fall. In Port Angeles, "this is huge for us," said Hurst, who added that Clallam's health department has worked on a naloxone initiative for two years. Yet 100 doses won't match the need, she said. In 2014, the Clallam County syringe exchange service logged 865 client contacts. That many people brought used needles and syringes in to the weekly exchange in order to get sterile ones for later use. "Every year," Hurst said, "we slightly increase." Of the people who visit the syringe exchange, 50 percent report injecting heroin, while 50 percent report using methamphetamine. Mixing the two for a "speedball," Hurst added, is not uncommon. Death from prescription opioid and heroin overdose has become a top concern in Clallam's communities, • said Dr. Jeanette Stehr-Green, the county's interim health officer. The state's 2013 overdose death rate was 14.8 per 100,000 people, she noted. Clallam's death rate was nearly twice that: 29.0. Port Angeles police officers and Jefferson County emergency medical technicians already carry naloxone. Hurst said the police have used it to save four lives since March. • A private individual with a doctor's prescription for the drug also can obtain it at a pharmacy, she added, noting that in May, Gov. Jay Inslee signed HB 1671, authorizing distribution of medicine such as naloxone to people at risk of a drug overdose. The naloxone auto-injector, called Evzio, is simple to use but expensive, said Hurst. Clallam Health and Human Services already has begun researching how it will purchase the next supply. But naloxone only buys the patient some time; he or she must find medical care to recover from the overdose. Hurst and her colleagues, of course, hope to connect with drug users before they face a life-and-death situation. The naloxone kits could help. When a user comes to the syringe exchange and is offered the antidote, he or she will be asked to sign a contract and have a conversation. "It gives us an ability to spend time," said Hurst, "to build a relationship" and talk about what is happening in the client's life, what may be standing in the way of finding treatment. More information about Clallam's syringe exchange and naloxone program is available, Hurst noted, by phoning 360-417-2274. • Features Editor Diane Urbani de la Paz can be reached at 360-452-2345, ext. 5062, or at diane.urbani@peninsuladailynews.com. • • Celebrate World Breastfeeding Week at Aug. 5 picnic Port Townsend Leader: Wednesday, July 29, 2015 3:00 am In honor of the annual World Breastfeeding Week, Jefferson County Public Health (JCPH) is sponsoring a breastfeeding picnic at 11 a.m. on Wednesday, Aug. 5 at Chetzemoka Park in Port Townsend. Current and former breastfeeding moms, along with their children, families and friends, are invited to bring a lunch and celebrate and support those who breastfeed. This year's theme is "Breastfeeding and Work: Let's Make It Work." Making accommodations for breastfeeding mothers is not only good for mothers and children, but also is good for business, said JCPH event organizers. Reports from the Office on Women's Health, a division of the U.S. Department of Health and Human Services, show that breastfeeding- friendly businesses have lower employee absenteeism rates, lower turnover rates, and higher employee productivity and loyalty, according to a press release from JCPH. Jefferson Healthcare medical providers and JCPH's Women, Infants and Children (WIC) program provide education and support to help ensure that woman successfully meet their breastfeeding goals. WIC breastfeeding support includes: Breastfeeding Tea support group, held each • Wednesday, 11 a.m.-12:30 p.m. at Jefferson County Public Health; and the WIC breast-pump loan program. Breast pumps are available for breastfeeding WIC moms working or going to school part- time. WIC recognizes the importance of breastfeeding and its impact on health and the reduction of long-term illnesses such as diabetes, asthma and obesity. For more information about WIC or to sign up for services, call 385-9432 or visit ieffersoncountypublichealth.orq. Jefferson County businesses interested in learning how to become breastfeeding friendly may call JCPH at 385-9432. More information about World Breastfeeding Week can be found at worldbreastfeedingweek.orq. • i Gibbs Lake closed due to toxin; Lake Leland still open as 0 summer swimming hole By Port Townsend Leader Staff I Posted: Thursday, August 6, 2015 9:29 am x aT' y, q H ti `x ars 7 f, 4 1 k k q r @ Wj;,, ..- ,C Gibbs Lake Gibbs Lake is closed as of Aug.6,2015 due to a high level of toxins, as reported by Jefferson County Public Health Leader file photo by Patrick J.Sullivan Gibbs Lake is closed due to high levels of the toxin microcystin that were detected in a water sample taken from the lake Monday, Aug. 3. Lab results show that the toxin level is 14 micrograms per liter, • which is above the Washington State recreational criteria of 6 microgram per liter. Microcystin is produced by bluegreen algae, also known as cyanobacteria, and can result in illness in people and animals. As a result, Jefferson County Parks and Recreation has closed the lake for recreation including fishing, boating, and swimming. Visitors are also urged to keep pets out of the water. Jefferson County Public Health (JCPH) has posted "Danger, Lake Closed" signs at lake access points. The rest of Gibbs Lake County Park remains open for hiking, biking, and horseback riding. JCPH has monitored local lakes for bluegreen algae seasonally since 2007. Monthly monitoring of Anderson, Gibbs, and Leland lakes began in April of this year. No algae bloom was observed at Gibbs Lake earlier this summer. Anderson Lake closed in May due to high levels of anatoxin-a, another algae toxin. Lake Leland has a light algae bloom, but toxin levels have remained low. The lakeside county park is open for swimming and water activities. People are advised avoid areas of scum, do not drink lake water, keep pets and livestock away, clean fish well and discard guts. Lake conditions can change rapidly and lake status can change between samples. JCPH urges recreationists to avoid contact with heavy blooms or scums. If you observe a bloom in a Jefferson County lake, please report it by calling 360-385-9444. To check the status of Jefferson County Lakes and learn more about toxic cyanobacteria monitoring, consult the JCPH website at leffersoncountvpublichealth.orq/index.php?lake-water-quality or call 360- • 385-9444. For fishing seasons and regulations see the Washington Department of Fish and Wildlife website wdfw.wa.gov/fishino. Gibbs Lake south of Port Townsend closed because of toxin Peninsula Daily News,August 6th, 2015 • PORT TOWNSEND —Gibbs Lake south of Port Townsend has been closed for recreation including fishing, boating, and swimming because of high levels of the toxin microcystin. Microcystin, which is produced by blue-green algae, can cause skin irritation, nausea and muscle weakness if touched and liver damage if swallowed over a long period of time. Lab tests from a sample taken Monday show that the microcystin level is 14 micrograms per liter, which is above the state recreational criteria of 6 microgram per liter. Jefferson County Parks and Recreation closed the lake for all recreation and urged visitors to Gibbs Lake County Park —which remains open for hiking, biking and horseback riding —to keep pets out of the water, Michael Dawson, lead environmental health specialist for the Jefferson County Water Quality Program, said Thursday. The county department has posted danger signs at lake access points. Jefferson County Public Health has monitored local lakes for blue-green algae toxins seasonally since 2007. Monthly monitoring of Anderson, Gibbs, and Leland lakes began in April this year. No algae bloom was observed at Gibbs Lake earlier this summer, Dawson said. • State rangers closed Anderson Lake in May because of high levels of anatoxin-a, a potentially lethal nerve toxin, which also is produced by blue-green algae. The state park around the lake remains open. Lake Leland has a light algae bloom, but toxin levels have remained low. A caution sign is up. Blue-green algae, which occurs naturally, can begin at times to produce toxins in a process researchers still don't understand. Toxins can be present only after an initial bloom, Dawson has said, but a bloom can die off and, although the lake looks clear, it could be poisoned. For more information about Jefferson County lakes, visit httP://tinyurl.com/ieffersonlakequality. Those who see a bloom on a lake are urged to report it to 360-385-9444. County health officials urge lake visitors to avoid contact with algae blooms. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258. For fishing seasons and regulations see the state Department of Fish and Wildlife website www.wdfw.wa.gov/fishing. • Last modified:August 06.2015 10:48AM Sports physicals offered at School Based Health Center Port Townsend Leader, Wednesday, August 12, 2015 3:00 am The School Based Health Center offers sports physicals at Chimacum and Port Townsend high schools, helping Jefferson County student-athletes prepare for the upcoming school year. The center, a partnership between Jefferson County Public Health, Jefferson Healthcare and the local school districts, provides health care services to meet the needs of adolescents. Appointments are available from 9 a.m. to 3 p.m. on Aug. 18, 21 and 26 at Chimacum High School, and Aug. 18, 21 and 25 at Port Townsend High School. To set up an appointment, contact the School Based Health Centers at 360-385-9400. The center can bill students' insurance, offer a sliding scale, or perform a physical for $45. A sports physical, along with other school district paperwork, is required before a • student-athlete may participate in sports programs. High school football programs are allowed to begin practice Wednesday, Aug. 19. All other fall sports may begin Monday, Aug. 24. • StopOverdose.org -Naloxone Law in Washington: 2015 Update Page 1 of 1 • StopOverdose.org Opioid overdoses can be prevented and reversed! Home/Opioid OD Education Naloxone Law in Washington Where to Get Naloxone / FAQ Washington State's new"Naloxone Law"HB1671 goes into effect on July 24, 2015.This law expands access to naloxone by supporting more efficient Sources for Help distribution options. Law Enforcement What's in this new law? The law specifically allows naloxone to be: Evaluation of WA Law prescribed directly to an"entity"such as a police department,homeless shelter or social service agency.This will allow an organization to have naloxone kits on site without a Pharmacy/Prescribers prescriber writing a prescription for individual staff persons. distributed by non-medical providers(e.g.,health educator,counselor,syringe Other Drugs and Overdose exchange volunteer)under a prescriber's standing order.Therefore,the prescriber(or pharmacist with a collaborative practice agreement to dispense naloxone)will not need to meet with each person to whom naloxone is distributed. Resources This law gives an official legal"green light"for any organization to have News naloxone on site for its staff to administer directly in case of an overdose.This also allows staff to distribute naloxone to clients who are at risk of having or Center for Opioid Safety witnessing an overdose via one of the mechanisms above. Education {COBE} HB1671 in detail (.pdf) What does this mean for my organization? • You may want to explore these new options for getting or distributing naloxone with a medical provider affiliated with your organization or with your county health officer. Which method you choose to pursue (prescribing to an entity or standing order) may depend on the needs of your organization. How does a standing order for naloxone work? A standing order for naloxone delegates authority from a prescriber(often a local health officer)to other people, such as non-medical staff or volunteers,to distribute naloxone according to a specific protocol without a physician's exam. But this is the first time standing orders have been explicitly mentioned in state law. Below is an example of the current standing order protocol currently used in Clark County to distribute naloxone: Clark County Standing Order(.pdf) If you need ideas or assistance on how to implement a naloxone program at your organization,the Center for Opioid Safety Education (LOSE)is available to help answer your questions.You can reach us at: infopistopoverdose.orq. We will post new information about the naloxone law is it becomes available along with tools and best practice models. This information made available by the UW Alcohol&Drug Abuse Instititute http://stopoverdose.org/naloxonelaw.htm Contact us II Updated 7/2015 I I Privacy•Terms http://stopoverdose.org/naloxonelaw.htm 7/24/2015 WASHINGTON ASSOCIATION OF SHERIFFS & POLICE CHIEFS • 3060 Willamette Drive NE Lacey,WA 98516—Phone:(360)486-2380—Fax (360)486-2381—Website:www.waspc.org Serving the Law Enforcement Community and the Citizens of Washin•ton F8� MEMORANDUM 4 TO: WASPC Members FROM: James McMahan, Policy Director DATE: Tuesday, June 02, 2015 RE: Opioid Overdose Antagonist(Naloxone) The information contained i<n,thiscommunication is intended to serve as an educational =' resource to law enforcement administrators. It is-not t tended,nor should it be,used as,'t= legal or medical ad vice; There has been recent interest and discussion by law enforcement executives, the U.S. Department of Justice, and the Washington State Legislature regarding the availability and use of medication to reverse the effects of an opioid overdose (Naloxone). Recent actions by the State Legislature and interpretations by state healthcare regulators have enabled easier access to • Naloxone by law enforcement agencies and other first responders. The purpose of this communication is to provide Sheriffs and Police Chiefs with information about Naloxone and how to equip officers with Naloxone, should you determine it to be appropriate for your agency. Executive Summary: Effective July 24, 2015, licensed physicians can prescribe and dispense, ~ Naloxone to law enforcement agencies. Law enforcement agencies and law enforcement officers acting in good faith and with reasonable care are immune from criminal and civil liability for -_ possessing, storing,distributing,or administering an opioid overdose antagonist. WASPC recommends that agencies interested in equipping officers with Naloxone contact their county- medical program director to obtain supplies of Naloxone. About Naloxone Naloxone is a Schedule II legend drug under Washington law. Naloxone is commercially available under the brand name "Narcan" and "Evzio." Naloxone is in a class of medications designed and used to prevent and/or counteract an opioid overdose—known as opioid antagonists. 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. President President Elect Vice President Past President Treasurer CASEY SALISBURY KEN HOHENBERG BRIAN BURNETT ERIC OLSEN KEN THOMAS .Sherif/'-Mason County Chief--Kennewick Sheriff-Chelan County Chief--Kirkland Chief-Kent 111 Executive Board DUSTY PIERPOINT BONNIE BOWERS STEVE STRACHAN MARK NELSON JOHN TURNER Chief-Lacey Chief-Anacnrles Chief-Bremerton Sheriff-Cowlitz County Sheriff-Walla Walla County VACANT MARK COUEY JOHN BATISTE FRANK MONTOYA,JR. MITCH BARKER Sheriff Director-01C Chief-WA Slate Patrol SAC-FBI,Seattle Executive Director Special Investigations Unit 4. • Naloxone is said to be remarkably effective in reversing the effects of an opioid overdose. Naloxone is also said to be a 'no harm' drug—meaning that it causes no harm if administered to a person who is not suffering from an opioid overdose. Accessing Naloxone While current law provides immunity to those who would administer, dispense,prescribe, purchase, acquire, possess, or use Naloxone (RC W 69.50.315), its protections only applied to individual persons, and was not applicable to an entity(such as a law enforcement agency). Physicians were still required to have a doctor/patient relationship with a person to prescribe a legend drug. Therefore, there were no appropriate means by which a physician could prescribe any legend drug to an agency, because a physician cannot establish a doctor/patient relationship with an entity. In the Fall of 2014, WASPC began working with the Washington State Department of Health (DOH)to obtain policy interpretations from various DOH boards governing medical practitioners to establish clear authority for a physician to prescribe and a pharmacist to dispense opioid antagonists to law enforcement agencies. WASPC has obtained such interpretations from the Washington State Medical Quality Assurance Commission, and the Washington State Board of Osteopathic Medicine and Surgery. Each of those interpretations are provided below under "Additional Resources. " • In January, 2015, State Representative Brady Walkinshaw invited WASPC to partner on legislation (HB 1671)to amend the law to establish clear authority and protections for the prescription, dispensing, and administration of opioid antagonists. HB 1671 The 2015 Washington Legislature enacted HB 1671, which, among other things, provides clear authority, and protection, for physicians to prescribe opiod antagonists to any person at risk of experiencing an opioid overdose and to a first responder, family member, or other person or entity in a position to assist a person at risk of experiencing an opioid-related overdose. The legislation also provides clear authority for a pharmacist to dispense an opioid overdose antagonist pursuant to a prescription authorized in the bill. Finally, the legislation provides criminal and civil immunity to any person (including law enforcement agencies and law enforcement officers)who possesses, stores, distributes, or administers an opioid overdose medication in good faith and with reasonable care. HB 1671 becomes effective on July 24, 2015. Other Considerations Cost While WASPC believes that there is now clear authority and protections for a law enforcement agency to acquire Naloxone and authorize its officers to administer Naloxone,this medicine is not free. Narcan, the commercial brand of Naloxone available in a nasal spray, is said to cost approximately$42 per dose. Agencies • Page 2 of 3 • considering equipping its officers with Naloxone should consider the resources available to purchase Naloxone. Shelf Life Naloxone is said to have an 18-24 month shelf life. Agencies considering equipping its officers with Naloxone should consider a schedule to replace and replenish Naloxone that is not administered prior to its expiration date. Training Proper administration of Naloxone requires proper training. Agencies considering equipping its officers with Naloxone should establish clear and sufficient training requirements using qualified trainers. Additional Resources • Law Enforcement Naloxone Toolkit—U.S. Department of Justice, Bureau of Justice Assistance • www.stopoverdose.org- University of Washington, Alcohol and Drug Abuse Institute • First Responders and Naloxone - Washington State Medical Quality Assurance Commission • Possession and Administration of Naloxone - Washington State Medical Quality Assurance Commission • Use of Naloxone by Law Enforcement Officers - Washington State Board of Osteopathic 411111 Medicine and Surgery • Page 3 of 3 a Top 3 Highlights From the New CDC Report on Naloxone Programs I Tessie Castillo Page 1 of 2 iQ epp Android app More Loa in ': create Account • .luly zq,2m5 / /JiIII v iii /'/ //!i,r/ //, `Ut ilttRIi 0 r l' ��rII i/j _ .„07,441,111fg'25,111,‘,.,:::,41,113:17:111111,11111rari,„„„,„. ,•„,„‘S„,..,-;„•'„:„.,;.„,;,,,:„,„!,„„41,1111m.iiirTriliovpiftstimitlit 7„,,,,komityrissomeno ossomoung li Y� � t „ l "st� gCdr GETTICKETS PIS d / H4T Qm ' ^ �soowisaimosa =-a r y� I " { }d %,>�..,. � nviACJ e ltio ,'s ..-a, ax :S.l..,u t t e g , o tii:,,,;:4411111-111111111:111111.11111:11114111.MithiliNNERTAKIIIIInginglitgaagolorpo,--7-:"."--. ..,.1.:1::: „ ... 1 410 ....„,..„,„„,. ......„.„.....,.„,„,,„... L - y ^s / This week the CDC released its long-awaited report on overdose prevention programs providing naloxone to laypersons.The detailed report, which surveyed 136 naloxone distribution programs nationwide,confirms some of what overdose prevention advocates already knew,but also holds a few surprises.Here are the top three highlights: 1.In the past four years alone,the number of organizations that distribute naloxone has more than doubled-From 1996 to 2010,the date of the first naloxone distribution survey,48 organizations had trained approximately 53,00o laypeople to reverse a drug overdose using naloxone,resulting in over 10,000 reversals.But in 2014,when the most recent survey took place,136 organizations were providing naloxone to over 150,000 laypeople,resulting in over 26,000 reported reversals.In just four years the number of organizations providing naloxone increased by 183%,the number of laypeople trained on how to use naloxone and provided a kit went up by 187%and the number of reported reversals increased by 160%. "We've seen a massive scale up in the last couple years,"says Eliza Wheeler,an author on the report."The last survey we did[in 2010] showed naloxone was mostly distributed through syringe exchange programs and community based organizations,but this time around we heard back from Veterans Administration programs,substance use programs,and even pharmacies." • http://www.huffingtonpost.com/tessie-castillo/top-3-highlights-from-the b_7638796.html 7/24/2015 Top 3 Highlights From the New CDC Report on Naloxone Programs I Tessie Castillo Page 2 of 2 • 0 S, a.,, u t Yom' x 5' MA rtS .12 as. V,2 2>5 :55 2051,10t >05> 1111 5>50 2>0t Sit} .512 t411> 2>>4' Yx# 2.The overwhelming majority of successful overdose reversals were carried out by people who actively use drugs and their loved ones-Until this report there were no official numbers on which naloxone recipients were most effective at reversing a drug overdose.Now we have data to confirm what most naloxone distribution programs already knew.82.8%of the reported reversals were done by people who use drugs and 9.6%by family and friends of a user.Service providers came in at a distant 0.2%. "In order for naloxone to be most effective,we need to get it into the hands of people who are most likely to be on the scene of an overdose," says Dr.Stephen Jones,also a researcher and author of the report."An opioid overdose is a life-threatening medical emergency.If laypeople have naloxone,they can start the process of reviving the person before paramedics or law enforcement come through the door." ism IE ' 3 7.4 ,,, I� ,� x fit. s "a v x° • 1111 sa•€ >" a ,n, 02,11 3. Most naloxone overdose reversals involved heroin- Heroin was involved in 81.6% of reported reversals,while prescription opioids were involved in 14.1%.Overall,heroin accounts for 19%of drug overdose deaths,while prescription opioids account for 37%.This demonstrates that overdose prevention programs are most successful at reaching heroin users,but indicates potential gaps in out-reach to people who overdose on prescription medications,who make up the majority of those who die from opiate drug overdose. "We need newer and better methods to get naloxone into the hands of people who use prescription opioids,"says Dr.Jones. "The data is really encouraging,"says Wheeler."But it also indicates that there are huge gaps around the country,states where there are few or no distribution programs.We also heard back from many existing programs that they struggle with funding and recent price increases for naloxone.I think the take-away here is that these programs are saving many lives but are often under-resourced and that needs to change." MORE:Naloxone Narcan Overdose Drugs Overdose Prevention Harm Reduction Opioids Opiates Prescriptions Conversations 0 Comments Sort by Top Add a comment.. i Facet ook Conmrenls Plug rr Hufington Post Search • Advertise I Lp9 In I Make HuffPost Your Home Pape I RSS I Careers I FAQ User Agreement I Privacy I Comment Policy I About Us I About Our Ads I Contact Us Copyright 02015 TheHuffingtonPost.com,Inc. 1 The Huffington Post"is a registered trademark of TheHuffngtonPost.com,Inc.All rights reserved. Part of AOL Lifestyle http://www.huffingtonpost.com/tessie-castillo/top-3-highlights-from-the_b_763 8796.html 7/24/2015 c r U U J U U U U U U J U U U CJ U U U U U U U U U U U 'U U U U U U U U U U U U U U U J J J J J J J J J J U ❑ U U U U U J J J UNIVERSITY of WASHINGTON ADA! AC3rug Abuse'`©"°i INF ( BRIEF Institute Medication Assisted Treatment for Opioid Use Disorders: Overview of the Evidence June 17, 2015 Medication assisted treatment (MAT) can be a life-saving and cost-saving intervention for those with opioid use disorder. While there are three FDA approved medications for treating opioid use disorder, the evidence base for these medications varies. Clinical effectiveness -- how these medications work in the real world -- is the relevant standard for selecting appropriate medications. Opioid addiction treatment medications work in quite different ways and may be more or less effective for particular types of patients and in particular social and geographic contexts. The evidence is incomplete in terms of which medications work best for In the midst of an epidemic of opioid overdose which patients in which settings and contexts. In the midst and opioid use disorder,all evidence-based of an epidemic of opioid overdose and opioid use disorder, all • medications should be accessible to patients, evidence-based medications should be accessible to patients and considered by their healthcare providers. and considered by their healthcare providers. The research literature generally shows that methadone and buprenorphine have a strong evidence base supporting their clinical effectiveness. Extended-release naltrexone (Vivitrol) does not have such an evidence base supporting its use (studies are ongoing); however, there may be some patient populations for whom it is a good fit. Because of particular concerns about overdose risk when patients are going on or off Vivitrol, it is recommended that Vivitrol should not be offered as the only option. The literature is also clear that there is a range of patterns of use of MAT over time, and that short term detox using these medications leads to relapse and increased overdose risk. It is not clear for whom long term medication is needed and for whom medication can be stopped. Patients' functioning should inform the nature and duration of treatment, not a pre-determined schedule. The fact that opioid use disorder is a chronic, relapsing condition is consistent with the fact that for many patients, long term MAT will be appropriate and effective. Under DSM-5 diagnostic criteria for opioid use disorder, tolerance to and withdrawal from opioids are not considered for people who are taking opioids solely under appropriate medical Patients'functioning should inform the nature supervision for substance use disorder, i.e. a person and duration of treatment,not apre-determined receiving MAT as directed is no longer diagnosed in active schedule. "addiction." I 1 11 Ira J iJ ;J U J J J J J U J J 'J J U U U U U U U U U U U J J U U U U U ❑ U U J U U U U J J J J J J J J J U J J J J J J J J J J • PEER-REVIEWED RESEARCH STUDIES The Evidence Doesn't Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine Health Affairs 2011; 30(8): 1425-1433. Mortality and cost savings associated with buprenorphine and methadone in Massachusetts' Medicaid program compared to non-medication treatment and continued drug use. Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug &Alcohol Dependence 2015 May 1;150:112-9. Describes varying patterns of buprenorphine use over a 42 month period. SYSTEMATIC REVIEWS OF CLINICAL EVIDENCE Methadone maintenance therapy versus no opioid replacement therapy. Cochrane Reviews 2009, Issue 3. Art. No.: CD002209. Maintenance treatments for opiate-dependent adolescents. Cochrane Reviews 2014, Issue 6. Art. No.: CD007210. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Reviews 2014, Issue 2. Art. No.: CD002207. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Conner HS. Harvard Review of Psychiatry 2015;23(2):63-75. Review for clinicians on medication assisted treatment options. FACT SHEETS & POLICY REVIEWS Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders. SAMHSA 2014, SMA14-4854. Medicaid coverage of medication-assisted treatment for opioid and alcohol de- pendence; treatment effectiveness and cost effectiveness as well as examples of innovative state im- plementation approaches; cost offset/savings are reviewed for methadone and buprenorphine. Management of Patients with Opioid Dependence: A Review of Clinical, Delivery System, and Policy Options. Final report, New England Comparative Effectiveness Public Advisory Council, July 2014. Detailed review by a policy group for New England Health Plans compares methadone, buprenorphine, and naltrexone on mortality, retention, and costs. Medication-Assisted Treatment for Opioid Addiction, Office of National Drug Control Policy Healthcare Brief, Sept. 2012, 3 p. Overview of methadone, buprenorphine and Vivitrol including table summariz- ing pharmacology, clinical settings, and uses and relevant regulations regarding prescribing and dispensing. Consensus Statement on the Use of Medications in Treatment of Substance Use Disorders. National Association of State Alcohol and Drug Abuse Directors (NASADAD). Overview of the role of medica- tions to support recovery from alcohol and opioid addiction. Thank you to Dr. Alex Walley and the other clinical and research experts who provided feedback for this brief. iCitation: Medication Assisted Treatment for Opioid Use Disorders: Overview of the Evidence. Caleb Banta-Green. Alcohol & Drug Abuse Institute, Univ. of Washington, June 2015. http://adai.uw.edu/pubs/infobriefs/MAT.pdf 2 �_ Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 1 of 3 ABOUT US NEWS CONTACT Q • Naloxone for Community Opioid Overdose Reversal Like 41 Tweet 20 Share Pt i i 1(A TION i) i E: Monday,June 22,2015 110 1 � 7 Introduction Research and Evidence Policy Implications Drug overdose is the leading cause of injury-related death in the United States, killing more people every year than car crashes. Opioids— both prescription painkillers and heroin —are responsible for most of these deaths. The death rate from prescription opioid-caused overdose nearly quadrupled from 1999 to 2013, while deaths from heroin overdose rose 270 percent between 2010 and 2013. Together, heroin and prescription pain medications take the lives of almost 25,000 Americans per year— nearly 70 people per day. They also cause hundreds of thousands of non-fatal overdoses and an incalculable amount of emotional suffering and preventable health care expenses. Nearly all opioid overdose deaths are preventable by the timely administration of the medication naloxone. This medicine, which requires a prescription, is not a controlled substance and rapidly reverses opioid overdose in most cases. While naloxone has been used in hospitals and ambulances for decades, the rising tide of overdose deaths has resulted in calls to make it more available to laypeople and first responders. Since 2010, states have moved rapidly to change law, regulation, and policy to increase access to this lifesaving medication. These legal changes http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal Public Health Law Research Page 2 of 3 include immunity protections for medical professionals who prescribe and dispense the • medication and people who administer it, as well as individuals who call 911 to report an overdose. Many laws also permit the medication to be dispensed to any person who is either at risk of overdose or may be in a position to assist in an overdose, even if they have not been examined by the prescriber. Initial evaluations suggest that increased naloxone access can reduce fatal overdose as well as health care expenditures from emergency visits and hospitalizations while likely reducing the emotional trauma caused by losing a friend or loved one to overdose. About the Author Corey Davis, JD, MSPH, EMT-B, Deputy Director— Southeastern Region,Network for Public Health Law About the Reviewers • Phillip Coffin, MD, MIA, San Francisco Department of Public Health. Traci C. Green, PhD, MSc, Boston University/Boston Medical Center Injury Prevention Center and the Department of Emergency Medicine, Warren Alpert Medical School at Brown University T. Stephen Jones, MD, MPH, Centers for Disease Control and Prevention(Ret.) Additional Resources • Click here (/sites/default/files/uploaded images/PHLRKnowledgeAsset Naloxone FINALbrief 22June1.5.pdf) to download a printable Policy Brief. • A printable version of the full Knowledge Asset is also available here (/sites/default/riles/uploaded irnages/PHL,RKnowledgeAsset Naloxone FINAL 22June15.pdf). • Visit the LawAtlas dataset (http://lawatlas.org/query?dataset=laws-regulating-adrni_nistration-of= naloxone#.U3YljijzDEU) on naloxone for overdose prevention to explore the interactive map. in http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 3 of 3 SIGN UP FOR OUR NEWSLETTER GO • Topics Evidence & Experts Resources for Researchers & Grantees About Us News Contact • • http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 ` Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 1 of 3 ABOUT US NEWS CONTACT • Naloxone for Community Opioid Overdose Reversal Uke [41 E Tweet 20 Share Pt HiAC:1T1a\DA IT: Monday, June 22,2015 • Introduction Research and Evidence Policy Implications Opioid overdose is a serious and growing public health problem. Naloxone has been used for decades to reverse opioid overdose. It is a prescription medication, but is not a controlled substance and has no abuse potential. There is a growing interest in training and equipping more people to administer naloxone to reverse opioid overdose. Laypeople are willing to and capable of recognizing opioid overdose and administering naloxone. Medicalanystates riskshave associatedmodified with naloxoneandregulation administration are low, particularly comparedaloxonebylaypeopto inaction. Laws can act as a barrier to increased naloxone access. Mlaw to increase access to nle • and non-medical first responders such as police and firefighters. Increased access to naloxone does not appear to increase drug use or risky behavior. http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 i Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 2 of 3 Naloxone access programs may reduce overdose-related morbidity and mortality. Naloxone access programs may reduce health care costs. References About the Author Corey Davis,JD, MSPH, EMT-B, Deputy Director— Southeastern Region,Network for Public Health Law About the Reviewers Phillip Coffin, MD, MIA, San Francisco Department of Public Health. Traci C. Green, PhD, MSc, Boston University/Boston Medical Center Injury Prevention Center and the Department of Emergency Medicine, Warren Alpert Medical School at Brown University T. Stephen Jones, MD, MPH, Centers for Disease Control and Prevention (Ret.) Additional Resources • Click here (/sites/default/f les/uploaded images/PI IL RKnowledgeAsset Naloxone FINALbrief 22June15.pdf) to download a printable Policy Brief • A printable version of the full Knowledge Asset is also available here (/sites/default/files/uploaded images/PMML RKnowledgeAsset Naloxone FINAL 22June15.pdf). • Visit the LawAtlas dataset(http://lawatlas.org/query?dataset=laws-regulating-administration-of- naloxone#.U3YljijzDEU) on naloxone for overdose prevention to explore the interactive map. LI SIGN UP FOR OUR NEWSLETTER GO • Topics http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 3 of 3 Evidence & Experts • Resources for Researchers &Grantees About Us News Contact • • http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal Public Health Law Research Page 1 of 4 ABOUT US NEWS CONTACT Q • Naloxone for Community Opioid Overdose Reversal Like ,1 41, Tweet 20 Share Pt 131 It 11 ION 1)VI E Monday,June 22,2015 Introduction Research and Evidence Policy Implications Opioid overdose is a medical emergency. Naloxone has been used for decades to reverse it and restore normal respiration. Over the past 15-20 years, community groups and, later, governmental organizations have worked to increase community access to the medication so that naloxone is available when and where it is needed to reverse potentially fatal opioid overdoses. Increased naloxone access is supported by a large number and variety of organizations, including the World Health Organization, the American Medical Association, the American Public Health Association, and the National Association of Boards of Pharmacy. It is a key component of the federal government's response to the overdose epidemic, and is supported by agencies including the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of National Drug Control Policy. It is undisputed that, if administered in time, naloxone reverses opioid overdose in the vast majority of cases. A variety of data suggest that individuals who are trained in opioid overdose • identification and response, including naloxone administration, are willing to and capable of administering naloxone in an emergency. Medical risks regarding naloxone administration are http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 2 of 4 low, and in most if not all cases are much lower than failing to administer the medication in the event of opioid overdose. The sooner naloxone is administered and respiratory depression is reversed, the better outcomes are likely to be. It therefore makes sense to increase access to the medication, and to fund robust evaluations to ensure that increased access has the intended effect, that any negative consequences are addressed, and that best practices are identified and publicized. Unfortunately, naloxone is often not available when and where it is needed. There are a number of actions government at all levels can take to address this problem. At the federal level, agencies including SAMHSA and CDC should fund both naloxone access and training programs and systematic evaluations. The Centers for Medicare and Medicaid Services should ensure that the medication is covered by both Medicare and Medicaid, without prior authorization or other barriers. Because one of the greatest barriers to broader access is the fact that naloxone is a prescription medication, both FDA and Congress should strongly consider taking action to make it available over-the-counter or otherwise modify the prescription requirement. At the state level, states can and should pass laws and modify regulations to ensure that naloxone is available to all who may need it. This may include making it available through community-based organizatoins and at pharmacies without a patient-specific prescription, • ensuring that people at high risk of overdose such as those receiving high-dose opioid painkillers or leaving correctional institutions or drug treatment facilities are provided naloxone at no or minimal cost, and providing education to clinicians to raise awareness of the importance of prescribing and dispensing naloxone to individuals at risk of overdose. They should also pass and publicize comprehensive overdose Good Samaritan laws so that people who witness overdoses are not punished for calling for help. Localities should also consider whether equipping firefighters and law enforcement officers in their jurisdictions with the medication might meaningfully decrease time to naloxone administration, possibly improving outcomes. Naloxone alone will not stop the overdose epidemic. However, existing evidence supports rapid scale-up of programs to increase access to the medication, of which legal and policy changes are a key component. About the Author http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 3 of 4 Corey Davis,JD, MSPH, EMT-B, Deputy Director—Southeastern Region,Network for Public Health • Law About the Reviewers Philip Coffin, MD, MIA, San Francisco Department of Public Health. Traci C. Green, PhD, MSc, Boston University/Boston Medical Center Injury Prevention Center and the Department of Emergency Medicine, Warren Alpert Medical School at Brown University T. Stephen Jones,MD, MPH, Centers for Disease Control and Prevention(Ret.) Additional Resources • Click here (/sites/default/files/uploaded_images/PHL.:RKnowledgeAsset Naloxone FINALbrief 22June15.pdf) to download a printable Policy Brief. • A printable version of the full Knowledge Asset is also available here (/sites/default/files/uploaded images/PHL,RKnowledgeAsset Naloxone FINAL 22June15.pdf). • Visit the LawAtlas dataset(http://lawatlas.org/query?dataset=laws-regalating-admin..istration-of= • naloxone#.U3YljijDEU) on naloxone for overdose prevention to explore the interactive map. 1I vi3 SIGN UP FOR OUR NEWSLETTER GO Topics Evidence & Experts Resources for Researchers & Grantees About Us News Contact • http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015 Naloxone for Community Opioid Overdose Reversal I Public Health Law Research Page 4 of 4 I IP http://phlr.org/product/naloxone-community-opioid-overdose-reversal 7/24/2015