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Home My WebLink About01 January JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 17, 2002 Board Members: Dan Titterness, Member - County Commissioner District # 1 Glen Huntingford, Member - County CommÍJJÍoner DÙtrid #2 Richard U/qjt, Member - County Commissioner District #3 Ger!ffr1!Y Masâ, Vice Chairman - Port Townsend City Counâl Jill Buhler. Member - Hospital Commissioner District #2 Sheila W?esterman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (County) S taffMembers: Jean Baldwin, Nursing Services Director LAr'Q1 PC!)', Environmental Health Diredor Thomas Locke, MD, Health qfficer Chairman Buhler called the meeting to order at 2:32 p.m. All Board and Staff members were present, with the exception of Commissioner Huntingford. PUBLIC COMMENT Charles Chase, a 17-year resident of Jefferson County, expressed concern about health issues in his neighborhood on Egg and I Road in Chimacum. He described a neighboring one-acre parcel, which now has about five travel trailers and a mobile home, no septic or water, an incorrect fire sign and is known for drug activity. He has received no response to his calls to the Sheriff and the Health Department. He and his neighbor are concerned about health and safety issues associated with the syringes and beer cans that he has found in his own driveway. They are also concerned about the safety of their shared well. He wants to know how compliance will be addressed? Dr. Tom Locke explained that the Board has the authority to address illegal dumping of sewage and potential impacts on the drinking water. Larry Fay said he is aware of the long-term issues of this case, which Linda Atkins has been pursuing. He was unaware of the status of the violations, but agreed to investigate and report back to both the Board and Mr. Chase. He added that the situation Mr. Chase describes is common in the County - trailers, accumulation of trash, no water, no sewer. Although some issues can be dealt with through sewage permitting, that does not address the underlying problem. Unless the County begins to deal with this type of housing situation directly, it will continue to be a problem. Jean Baldwin said this issue occurs in the Data Steering Committee's discussions of affordable housing. We are different from surrounding counties in that it is easier to "squat" here. Vice Chairman Westerman noted that the lack of an enforcement officer makes the problem difficult to track. She asked Staff to provide the Board with a status report in the future. HEALTH BOARD MINUTES - January 17, 2002 Page: 2 APPROVAL OF AGENDA Member Masci moved to approve the Agenda, with the addition of New Business Item 5. EnviroStars, as proposed by Larry Fay. Member Westerman seconded the motion, which carried by a unanimous vote. ELECTION OF BOARD OF HEALTH CHAIR/VICE-CHAIR FOR 2002 Out-going Chairman Buhler thanked the Board for the opportunity to serve over the last year. She called for nominations for the position of Chair. Member Frissell nominated Sheila Westerman. There being no further nominations, Chairman Buhler then called for nominations for the position of Vice-Chairman. Commissioner Titterness nominated Geoff Masci. There being no further nominations, Commissioner Wojt moved to elect Sheila Westerman as Chairman and Geoff Masci as Vice-Chairman. Member Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Vice-Chairman Masci moved to approve the minutes of December 20, 2001. Commissioner Wojt seconded the motion, which carried by a unanimous vote. OLD BUSINESS Jean Baldwin circulated two articles: 1) West Nile Virus from the Washington State Department of Health and 2) news release on Streptococcus Infection in British Columbia. Letter of Commendation: Chairman Westerman suggested a minor change to the Board's letter commending Linda Atkins and Dave Christensen for getting an article published. Instead of your high professional standards far exceeded our expectations, she recommended your success at obtaining this grant confirmed our expectations. Larry Fay noted that while he expected that we would get the grant, the work done to win it was far superior to other health departments in the state. Chairman Westerman moved to approve the letter as revised. Member Frissell seconded the motion, which carried by a unanimous vote. NEW BUSINESS PUBLIC HEALTH FUNDING - STATE AND LOCAL POLICY ISSUES A Brief History of Public Health Fundinu:: Dr. Locke said he believes it is important, when trying to address today's problems, to consider the context of public health funding. He noted that the sizeable HEALTH BOARD MINUTES - January 17,2002 Page: 3 public health infrastructure of 100 years ago gradually declined as the medical sector began to benefit from the technologies emerging to control epidemics. Around 1977, the dedicated millage, which counties had been collecting for public health funding, no longer had to go to public health. The priorities of the era and an economic recession brought on a decade of incremental dismantling at a rate of 3-5% per year. In 1988, a national report entitled The Future of Public Health detailed the severity of the problem and triggered the creation of the State Department of Health. The public health community was empowered to come up with a public health improvement plan, which they did in 1993. In 1995, the legislature stepped up to provide the down payment which pays for the County Health Officer. Dr. Locke said that in 1996, the State, in an effort to prevent City-County battles over public health funding, transferred MVET funding to Counties and relieved the Cities of any obligation to pay for public health funding. The MVET funds then disappeared and the legislature replaced 90% with backfill funding. Now the governor is proposing to stop that funding. When testifying recently on bio-terrorism funding, Dr. Locke said a representative remarked that we have not used that backfill money very well to prepare for bio-terrorism. Dr. Locke reminded him that this funding was in the base funding allocation (municipal contribution) that persisted over the better part of the last century and did not exactly represent new dollars to deal with the new threat. Public Health Funding in Washinu:ton State (Where It Comes From And Where It Goes): Referring to the pie charts in the Analysis and Recommendations for Financing Public Health in Washington State, Jean Baldwin noted where local departments across the State get their money versus where Jefferson County gets its money: Funds Received bv Washin2ton Counties 42% Local Govemment/MVET 9% MedicaidIFederal Fee for Services 8% Federal from Other Sources 7% State from Other Sources 2% Local Capacity Fund 9% Federal Pass Through Money From DOH 7% State Department of Health 2% Misc.IFund Balance/Other 7% Fees 7% Licenses/Permit Funds Received by .J efferson County 44% Local Govemment/MVET Local Sources 1 % Medicaid Title XIX/Other Fed. Fee for Service 2% Federal 6% State, Other StateIFederal 2% Local Capacity Fund (Health Officer Funding) 10% Federal Pass Through Money from DOH 4% State Department Of Health 2% Misc./Fund Balance/Other 29% Fees 0% Licenses/Permit She noted that fees cover 29% of Jefferson County's public health expenses, reflecting our aggressive billing of insurance companies and Medicaid. She explained that for every $5 of funding, $1 comes from Jefferson County General Fund and $4 dollars comes from somewhere else (client fees, insurance, Medicaid, federal or state grants). The funding structure is delicate and each program is comprised differently. Adjusting staff schedules to make FTE cuts is extremely complex and difficult to explain to the public. She reported that the Finance Committee began working on allocations and funding distribution formulas as part of the Public Health Improvement Plan. In the second year, they realized they were dealing with a legislative issue. A central issue the committee looked at was determining what parts of HEALTH BOARD MINUTES - January 17,2002 Page: 4 public health should be paid for by what parts of the population. Because charging a fee jeopardizes the community's health by creating a barrier, local health jurisdictions should have a policy regarding fee waivers. The Department needs to come to some agreement on these kinds of issues. In light of the changing fiscal picture, we need to make sure policy is not driven exclusively by the budget. The Board will need to reach agreement on whether it is a greater good issue, an individual issue, or for the protection of all. The second piece to look at is unfunded needs and whether these are needs of the community or discretionary services. Jefferson County Budu:et Directives: County Administrator Charles Saddler pointed out that the differences in distribution between the State and Jefferson County are due in large part to demographics and how they are reported. Loss of funding that might be critical to some jurisdictions is catastrophic to counties like ours. We are expecting a $200,000-$250,000 loss from the legislature in State and Federal pass-through funds in July 2002, which will result in the loss of five employees. He said the Department needs guidance on these priorities. The County Commissioners has also instructed all departments to determine how to get revenues in line with expenditures. We now know the County is likely to lose an additional 5%: $300,000 in MVET and backfill funds, $100,000 in Juvenile Detention Services, and $200,000 in Health, totaling a loss of about $600,000 from a current expense budget of $12 Million. To address the shortfall, a series of subcommittees, working through a budget and management team, will concentrate on: (1) developing a financial business plan for the organization, (2) reviewing different programs - identifying what is mandatory or discretionary (i.e., not required by statute or contractual requirement), and (3) determining level of service. He asked the Board of Health to work collectively with Staff to identify level of service issues by July 1, 2002. Jean Baldwin said a second budget would begin to be developed in April and the timing of its completion will depend on how the Board wants to do the prioritization. She noted that the Board set priorities as a part of the County Strategic Plan and chose to use the State Department of Health's standards. She asked whether these standards should be revisited in order to address the level of service within them. Chairman Westerman commented that because you cannot provide everything, you have to make decisions about who you are going to serve and what you will provide. In some cases, it would be worse to cut back the level of service than to stop programs altogether. She suggested a workshop to prioritize programs, noting that there was some discussion of this at the access summit. Member Buhler also spoke in favor of holding a workshop and collaborating with other organizations such as the hospital. Jean Baldwin added the need to collaborate with other departments, too. Charles Saddler then introduced a proposal for the Board's consideration. For background, he reminded that in 1977 a state statute established a dedicated millage and identified the level of funding to be provided by municipalities within the county for public health purposes. Last year, the City agreed to fund basic public health services and health and human service activities as part of the analysis of the Behavioral Risk Factor Surveillance System (BRFSS). At that time, the City made it clear that it would not be able to provide a continuing level of service to the County. He asked the Board to recommend to the County Commissioners and City Council that they investigate imposing a tax on profits of gaming, HEALTH BOARD MINUTES - January 17,2002 Page: 5 dedicating a sum equivalent to this revenue to public health in Jefferson County. The Washington State Gaming Commission would collect and remit this "sin tax" in Jefferson County and the City of Port Townsend. He has been told that this would be a stable financial resource for the department - generating $66,000 a year in Jefferson County alone - and would make up for the loss of MVET money. While we will probably lose far more than the tax could generate, if we do not have the types of cuts expected, these funds could appreciably reduce current public health expenses. Chairman Westerman asked about the potential losses in state or federal funding if we reduced the current expense contribution? Mr. Saddler said it depends, but wherever the County mandates cuts within the Department it would be done so as to not affect other funding. He noted that the County Commissioners reviewed a list of mandated versus discretionary programs and the percentage of County current expenses contributed. Few expenses went into contract services they have with the Washington State Department of Social and Health Services and other state and federal agencies and more went into the mandatory core public health programs. He noted that when assuming responsibility for contract administration with state agencies, the County charges 12-17% to keep administrative costs as low as possible. If the County loses the grants, it will have repercussions on administrative overhead. He asked whether the Board was supportive of the County continuing to gather information in pursuit of a tax on so-called "pull tabs?" Chairman Westerman expressed concern over not having the "bigger picture." She would not want to gain $66,000 at the risk of losing other state or federal funds. Mr. Saddler explained that the $66,000 would go into the General Fund and then the County would allocate an equal amount. Chairman Westerman moved that the Board express to the City and the County Commissioners its recommendation to investigate a gaming tax for the purpose of augmenting the Health Department's budget. Vice-Chairman Masci seconded the motion. During discussion, Member Frissell said with Law and Justice and Transit each getting some of the sales tax, $66,000 sounds paltry. Mr. Saddler explained that its value is an ongoing stream of funds that would not require administration. He said it is a lawful capacity to levy a tax that is not being utilized. Chairman Westerman mentioned she likes the fact that this is a stable funding source replacing the one being lost. The motion carried by a unanimous vote. Commissioner W ojt moved that the Board write a letter to the County Commissioners and City Council suggesting that they further investigate the gaming tax. The letter would be signed by the Chairman and Vice-Chairman. Vice-Chairman Masci seconded the motion, which carried by a unanimous vote. Jefferson County Fee Study Group: Larry Fay explained that Environmental Health has been almost entirely funded by a mixture of fees and the General Fund. As part of this year's budget strategy, the County is working under a policy statement that people who benefit from the services being provided should be paying for the cost of delivering those services. Accordingly, Department managers developed a fee schedule to cover 100% of direct costs of delivering the program and 75% of the associated administrative costs. During the December 24, 2001 County Commissioners budget meeting an ad hoc Fee Advisory Board was formed to review the proposed fee schedule, of which he is a member and Sheila Westerman is chair. The committee's charge, at least with regard to Building and Community HEALTH BOARD MINUTES - January 17,2002 Page: 6 Development, Environmental Health and Animal Services, is to recover 75% of the administrative costs plus the direct costs of programs out of fees. Chairman Westerman talked about the group's process. In light of the large amount of information being reviewed, they engaged in a discussion with staff from Community Development and Environmental Health about whether the approach taken to satisfy the policy was sensible, rational and comprehensible. She believes it has been a worthwhile process, with thoughtful questions and good discussion. In her opinion, the County is far behind in charging adequate fees and has been subsidizing programs through the General Fund for a long time. It will be a difficult transition for the County because of the public's skepticism about the use of funds in County government. Larry Fay said the policy statement means that for Environmental Health the amount to be recovered in fees is $84,000. Even with fee increases, the County in many cases would still be in the lower half in the state, with the exception of the food program which would be in the upper one third. It was noted that the new fees would still put the County lower than the City by about 20%. There was a perception that because permits were down, the County needed to increase fees to keep people employed. However, the purpose of the increase is that we are shifting $84,000 of Environmental Health costs from current expense to fees. They based their fees on an assumption of a stable permitting activity. Member Frissell said the public does not fully understand what it is getting for its taxes and recommended finding a way to educate the public about how funds are used. Mr. Saddler said public education and outreach will be a component of working on the financiallbusiness management plan. Jefferson Access Project - Next Steps: Kris Locke announced that the hospital received a $15,000 grant from the Washington Health Foundation to continue its work to refine and develop three work products: Jefferson Passport Project, Civic Engagement in Health Project, and Jefferson Access Project. After distributing additional information on the products, Ms. Locke reviewed the next steps which include designating an "access point person," preparing a comprehensive grant proposal, having a joint meeting with the Board and the Hospital Commissioners to propose a plan for moving forward, utilizing the expertise of the Work Group to help refine ideas, and planning a Spring Summit to inform the community of the Project's activities. Ms. Locke then described alternatives other communities are considering, some of which are variations of the same projects. Referring to the Jefferson Passport Project, she talked about the resources that such a project would require. She believes there are many entities that would be interested in this project and there may be funding and support through the Insurance Commissioner or Governor's office to do more research. She described the Civic Engagement in Health Project as an opportunity for the Board of Health to engage the community in a dialogue about health care issues, including costs, and to elicit from the community its healthcare priorities. She recommended the Board consider taking on the Civic Engagement Project as a good step in thinking about the public health issue and what might be attempted in this community. She noted that a group called Human Links has put together a training program on how to engage people in a discussion of these issues. She believes the Passport Project would fit with the hospital and that an access coordinator could help bring the projects together and HEALTH BOARD MINUTES - January 17,2002 Page: 7 coordinate the work. There was some Board support for working on the Civic Engagement Project for the purposes of educating people and helping the County Commissioners prioritize how we will spend our dollars. Referring to the high cost of health insurance plans, Vice-Chairman Masci spoke of the mis-perception that small business owners and their employees can afford coverage. Even the insurance provided by major employers such as the County is perceived as being affordable. When Commissioner Titterness and other Board members expressed interest in what would happen if everyone stopped carrying health insurance, Dr. Locke said that discussion is a focus of the Civic Engagement project. There is a need for public discussion of alternative ways that money could be distributed. Jean Baldwin asked what the difference was between this proposal and the previously discussed healthcare authority? She questioned whether healthcare access is the problem or is it the funding for the care that the hospital is providing? Kris Locke said that fewer and fewer small employers can keep up with the increasing cost of healthcare. One of the reasons it costs so much is that there are so many mandated benefits. Kris Locke added how you support them is also critical in terms of what services residents should have and who pays for it. How they pay is a different question. She said it is not just health services, but public health as well. One of the things that the Access to Critical Health Services points out is that they are both important. The Board responded affirmatively to continuing its commitment to access and to scheduling a joint meeting with the hospital. Dr. Locke said Staff will follow up with the Board about scheduling a two- hour joint Board meeting sometime during the middle two weeks of March. Congressional Bio-terrorism Funding Update: Dr. Locke said the bill would provide $16 million in Washington State for public health preparedness. Eligibility for and apportionment of these funds have not yet been determined. He said there has been a growing consensus that an effective bio-terrorism response has to occur at the local level. Jean Baldwin announced that the Bio-terrorism Tabletop Exercise is scheduled for Wednesday, January 30, 2002 from Noon-4:30 p.m. The Board is invited to attend this exercise with the Hospital, EMS, and the community system, though their presence is not required. EnviroStars: Larry Fay distributed a memorandum explaining the EnviroStars Program, a hazardous waste and pollution assistance and incentive program. Circle and Square Auto in Port Hadlock has applied to be the first to receive an award. Because this is a Health Department function, he asked if the Chairman and/or Vice-Chairman would attend the presentation of the award. HEALTH BOARD MINUTES - January 17,2002 Page: 8 AGENDA CALENDAR/ ADJOURN Update of 2002 Strategic Plan with Budget Shortfall Impacts and Report on Access Project. 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) The meeting adjourned at 4:32 p.m. The next meeting will be held on Thursday, February 21, 2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. L;~~Cill~C:::::- Sheila Westerman, Chairman (Excused) Glen Huntingford, [)~ Dan Titterness, Member fi:~/~ ,j~{ Roberta Frissell, Member JEFFERSON COUNTY BOARD OF HEALTH Thursday, January 17,2002 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Election of Board of Health ChairNice-Chair for 2002 III. Approval of Minutes of Meetings of December 20, 2001 IV. Public Comments V. Old Business and Informational Items 1. Letter of Commendation, Environmental Health Staff 2. Document Signatures VI. New Business 1. Public Health Funding - State and Local Policy Issues · A Brief History of Public Health Funding Tom (10 min) · Public Health Funding in W A State Jean (15 min) · Jefferson County Budget Directives Charles (10 min) · Jefferson County Fee Study Group Sheila/Larry (15 min) · State FY 2002 (7/02-6/03) Budget Cut Impacts 2. Jefferson Access Project - Next Steps Kris Locke (30 min) 3. Congressional Bioterrorism Funding Update Tom (5 min) 4. Bioterrorism Preparedness Tabletop Exercise January 30, 2002 Tom (5 min) VII. Agenda Planning VIII. Next Meeting: February 20, 2002 + Joint Board Meeting (?) JEFFERSON COÙNTY BOARD OF HEALTH f1 MINUTES DR A DR~ Thursday, December 20, 2001 '1FT Board lvlemberj: Dan Titternm, ¡"1ember - COHn!>, CommirjÙmer Dirtriet #1 Gkn HunJingjÕrd, Member - C()un!y CommiSJ'ioner DÙlrict #2 Richard W~jt, Member - Counf} CommÙJ"ioner District #3 Geoffrry AIasLi, AIm/ber - p()rI Tmvn.rend Ci!Y C()lmLiI ]ill BHbJer, Chairman - Hospital CommÙjioner Dirtrir:t #2 Shdia Wet/erman, Vke Chairman - CitiZe1t a/ LArge (ei!)!) Roberta Frimll - Citizen at L:zrge (CounfY) S/afflvIembm: Jean Baldwin, Nur.ring Services Direct()r L:zrry Fqy. Environmental Hea/tf.¡ Dirct'tor Thoma! Locke, MD, Health Officer Vice Chairman Westerman called the meeting to order at 2:40 p.m. All Board and Staff members were present with the exception of Chairman Buhler and Commissioner Huntingford. Member Masci moved to approve the agenda. Commissioner Wojt seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Masci moved to approve the minutes of October 17, 2001 with one correction, noted by Dr. Tom Locke on Page 3, paragraph 4 under Bioterrorism Preparedness: In the last sentence, the words "There is no way to" should be replaced with "We can. " The date of the minutes should also be corrected from October 17 to October 18, 2001 Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT New resident, Fernando Caneo said he is happy to be here, but has no other comment. David Sullivan said he is concerned about how the 0% increase in the County budget will affect healthcare and is curious how the Board will respond to the changes. OLD BUSINESS Comparing Sewage Svstems Article: Larry Fay complimented Linda Atkins, David Christensen and Staff for putting together this project, funded by a grant from the State Department of Health to reduce nitrogen, which resulted in getting the article published. Member Masci moved to direct Staff to write a letter of commendation to both Linda Atkins and Dave Christensen on behalf of the Board for getting the article published. Commissioner W ojt seconded the motion, which carried by a unanimous vote. HEALTH BOARD MINUTES - December 20, 2001 Page: 2 Local Board of Health W orkshoD ReDort: Member Frissell discussed the highlights of the workshop she attended in October. ./ Keynote speaker Tom Milne, Executive Director of the National Association of County and City Health Officials [NACCHO] reported the Centers for Disease Control (CD C) is creating a new resource center to aid environmental health, looking at bio-terrorism, infectious diseases and smoking. Mr. Milne characterized public health preparedness and awareness in Washington State as far better than in other States. Nationally, there has been a significant switch in outlook and approach to public health issues as a result of the events of September 11,2001, moving public health to the forefront for the first time and creating an opportunity to build public health infrastructure. Mr. Milne's handouts were given to Jean Baldwin. ./ Washington State Secretary of Health Mary Selecky's presentation, coming in the midst of the anthrax scare, made the point that law enforcement must determine whether something is a credible threat. ./ Scott Lindquist, Kitsap County Health Officer stressed the importance of communication among Health Departments, emergency management personnel as well as the need for ongoing training for emergency room staff to recognize these diseases. In considering whether county-wide forums could be held to provide information to the media, he said his Department used a full- page ad in the newspaper to educate the public and also prepared a video for in-house training. He recommended that 9-1-1 operators be given a list of questions to aid screening of credible threats, and suggested Health Departments learn new terminology in order to better communicate with police (e.g., credible threat = probable cause). ./ Methamphetamine labs were discussed at the workshop and Member Frissel1 was struck by the range of services needed when meth labs are destroyed. For example, contamination is limited to the Jab area only but there is economic impact on other renters and landlords when their properties are used for labs. While the meth-making technique has changed (chemicals no 10nger need permeate and ruin a structure for further habitation), there is still the potential for explosion, fire as well as great health risks and serious issues related to child abuse and neglect. Member Frissell strongly believes that mental health services for individuals are essential to changing behavior. One suggestion was that local Boards of Health address coordination between agencies by becoming a convener and determining what is happening in this County so we can reach these kids before they make decisions about substance abuse. Describing the workshop as time very well spent, Member Frissell recommended as many Board members as possible try to attend in the future. Vice Chairman Westerman asked whether other Boards have expanded to include citizen participation? Member Frissel1 said that while a few have, she believes our Board's constitution is unique in that regard. Dr. Locke said to his knowledge only Kittitas County has taken a similar step, but added that he believes there is strong support in Clallam where the Board is examining the issue. Member Frissell said she has communicated that having non-commissioner members can help de-politicize some of the issues. HEALTH BOARD MINUTES - December 20, 2001 Page: 3 Hearine Examiner Decision re: Port Ludlow Sewers: Larry Fay said this item is mo~t1y ~or information and relates to the Board's discussion a few months ago about sewer extensIons III Port Ludlow and consideration as to whether the current on-site sewage regulation and policy work are for, against or neutral in promoting sewer extensions. He said this case is a little different in that ORM (Olympic Resources Management, now Ludlow Development) has applied to the County for a short plat of the property and proposed developing this property with septic systems. While there was no argument from Environmental Health that lots and the soil requirements are suitable for a septic systems, the ordinance gives prefercnce to sewers when they are available. In this case, the question is not one of availability but cost. The Hearing Examiner's recommendation to the Community Development Department, on approval of the plat, was to require that they extend sewers to the lots they are creating. The Hearing Examiner was clear that they were cOrrect in making sewer extension a requirement of the plat. As of the final date of the appeal period, Ludlow Development had not asked for a review of this issue. Mr. Fay believes this decision will set the stage for what local development can expect in the future. In response to a question about the attitude of the people attending the hearing, Mr. Fay said it was the first one at which there was a showing of public support. NEW BUSINESS Bio-terrorism Preparedness Undate: Jean Baldwin reported that the Department is on the waiting list for a table-top exercise. Having completed several Emergency Management Plan exercises with JPREP, the sheriff, and law enforcement, they have come up with some resolutions about how to respond to anthrax. Locally there were five suspicious packages or letters that went to the State lab to be investigated, a number considered high for a small county. And although they all tested negative, the two and a half months of handling this matter cost the County $4,500. She said this expense raises the question, what would happen if the County was to increase its surveillance and awareness, and continue to meet twice a month with the hospital? She noted that Jefferson County Safety Officer Mark Bowes did several training sessions about how to handle the mail and the Nurse Communicable Disease Coordinator also attended to provide information on the diseases and risks. With this being the first opportunity to put the plan into action, it revealed some difficulty with interpretation. Dr. Locke said the local concern has been on suspicious mail and the anthrax threat, which in the scheme of bio-terrorist incidents is probably the easiest to manage because it is treatable and is relatively straightforward to diagnose, and there is no person-to-person transmission. Given this, however, there remains an incredible expense to respond to the events. Much of what was thought to be known about anthrax - that it required large doses to contract and that cross contamination through mail was a virtual impossibility - has been proven wrong. He believes the lesson we have learned from anthrax, in terms of bio-terrorism, is that weaponized infections are enormously more dangerous than the naturally occurring forms of the infections. He believes this has put pressure to find out about small pox and plague and other biological weapons. It has also applied pressure to improve coordination among response agencies for an all-hazards approach and made this a front-burner issue in terms of working with the hospital on infectious disease threats more generally. In addition to bio-terrorism, there are also concerns about HEALTH BOARD MINUTES - December 20, 2001 Page: 4 antibiotic resistant infections and new emerging diseases. He noted we would almost certainly have occasion to use any system we develop for the naturally occurring infections. Dr. Locke reviewed the many things occurring at the state level since the Board of Health last met. The SBOH held a hearing in October and information from this session was incorporated in a report adopted in mid-November, the executive summary of which was included in the Board's agenda packet. He called to the Board's attention the report's recommendations because he believes the whole point of a preparedness assessment is to ask the question "Are you ready to deal with this problem?" If the answer is no, then "What is it that we need to do and what are the priority tasks to be accomplished?" The SBOH's answer was No - there is not adequate protection. Referring to the State Board of Health Resolution No. 01-001, Vice Chairman Westerman, said the measure seems to support funding levels that provide for adequate state and public health. She asked what is to be done with the resolution? Dr. Locke said he would prefer to answer the question by reviewing some of the recommendations listed on page 6 of the Final Report titled "Response Capacity During a Health Emergency" because they are more specific. Number 2 asked the Governor and State agencies to advocate for the federal funding, which has now been decided. Number 3 refers to what the State will do with federal funding - expanding response capacity not using it to offset cuts in State contributions to existing programs. Number 4 also addresses the budget issue in that the capacity for bio-terrorism or biological emergency response at a local level essentially involves mobilizing people to do the kinds of intensive surveillance, investigation, vaccine and medicine distribution, and quarantine activities that really only public health can accomplish. It comes down to how many appropriately trained staff we have. He noted the ways Washington public health departments have maintained themselves by cobbling together different kinds of programs and contracts from different state and federal agencies. This pays for the public health nurses and the epidemiologic capabilities and the environmental health specialists, items very much threateped in the state budget. The most noticeable element to begin with is the misnamed "1-695 backfill." This funding gap was created when the legislature repealed the motor vehicle excise tax and displaced a source of money that used to come primarily from cities, but that had been a stable part of public health since the 1970s. Without this, we are at pre-1970s funding levels and are probably worse off now than ever. Rather than continuing that funding through the biennium, the Governor's budget proposes to stop it all together six months short of the end of the biennium. Number 5 deals with the issue of flexible versus categorical funding. Much of the funding received from state and federal agencies has a lot of strings attached to it. Since this makes mobilizing that capacity for communicable disease efforts much harder, we need flexibility. HEALTH BOARD MINUTES - December 20, 2001 Page: 5 Recommendation 6 focuses on the Medicare system. Medicare has lost its excess capacity and virtually all hospitals are "lean and mean" in staffing and bed support. At any given time there is only an excess of 40-50 intensive care beds in the entire Seattle area system - so there is little, if any, surge capacity. Even a small release of Botulinum toxin would require at least 10,000 respirators and a huge intensive care capacity to keep people alive until the effects of the toxin wore off. While we would not propose to have 10,000 ICU beds, currently the ICU surge capacity is zero. This would also be a real problem in the event of an influenza pandemic. Item 7 deals with a need to identify and set priorities. Item 8 is mostly a federal issue but one we are becoming more and more aware of, related not just to bio-terrorism but all communicable diseases. The vaccine production system is breaking down and we arc seeing the effects in public health. Vaccine production is not attractive to the pharmaceutical companies in an environment where the worldwide market for vaccines is about $3 billion and the market for Viagra is $5 billion. The final recommendation, Number 9, asks if the Board is looking at its own statutory authority, but it very much overlaps with the statutory authority of local Boards of Health. We have seen that our current system for notifiable conditions is really not adequate to deal with the urgency of reporting bio-terrorism outbreaks. Dr. Locke said these are the priorities that emerged after a fairly detailed review by the State Board of Health. He urged the Board to review the whole report, stressing that there are certain issues that can only be dealt with on the community level. When asked what an individual can do to protect him or herself (against anthrax, smallpox or botulinum) he tens people the only way to be safe and secure is to have a functional public health system at the community level. Member Frissell asked what steps can be taken to give the public the kind of information they would need? Dr. Locke said although he could not attend, he heard the Clallam hospital's bio-terrorism forum was well received. Efforts have been geared toward the medical staff and continuing education presentations. Jean Baldwin talked about the significant amount of work that needs to be done with the hospital in dealing with infectious disease, quarantine, moving vaccine, and all the players involved. Another step being taken locally is a Memorandum of Agreement (MOAs) between Jefferson, Kitsap and Clallam Counties. Dr. Locke provided a draft resolution, which is an opportunity for the Board of Health to formally support any or all of the recommendations. Member Masci moved to adopt the resolution dated December 20,2001. Commissioner Wojt seconded the motion. During discussion of the motion, Dr. Locke clarified that resolutions will be grouped and forwarded to the Governor, the legislature, and the State Board of Health. The motion carried by a unanimous vote. HEALTH BOARD MINUTES - December 20,2001 Page: 6 Vice Chairman Westerman said becausc of the challenges in the County budget and inadequate resources to support current levels of service, she asked whether this Board, as a local action, would like to discuss making specific recommendations for the County to come up with additional funding for the Health Department? Commissioner Tittemess asked how to address the funding issues given that the issues are bigger than just the Board of Health? Vice Chairman Westerman would like to see the Board of Health come out publicly in support of trying to find a stable funding mechanism for the Health Department. She believes part of the reason the Board was expanded was to support that process. While there is huge pressure not to raise taxes, she feels the Board of Health should do more than to pass general resolutions which sound good, but do not really produce the needed results. Commissioner Tittemess said he believes the general attitude is that there can be support if you identify a specific goal for which you can generate public. support, but you have to have the authority to target that goal. He pointed out that the Board of Health doesn't have that authority" Dr. Locke said he believes it is already a priority on a state and local level to find a stable, dedicated source of public health funding. The proposed solution is connected to a public utilities tax. If people want public health security, this would be the way to vote it in. Commissioner Wojt commented that he believes the other aspect to which Member Westerman was referring was that people have to realize that you don't gear up after the disease threat. It is our responsibility to educate people on what they are getting for their dollar and that the cycle of funding does not necessarily correspond to the cycle of disease. Member Masci responded that when the legislators appeared at a law and justice council meeting, they were proposing a utility tax for law and justice issues. He noted even within the County there are competing interests for the elusive utility tax and its assignment for specific needs. 2002 Data Steerinl: Committee Fact Sheet: Member FrisselJ and Member Masci recognized Kellie Regan and Dr. Chris Hale's efforts in compiling the information. Member Masci then reviewed data which was broken into three areas: Birth/Material Child Health Indicators, Socio-Economic Indicators, and Population Indicators. Member Masci noted that our rapid growth in the 65+ and 85+ age ranges is atypical in Washington, and identifies us as a special needs population. He also noted a big spike in the over 45-55 range. He believes we are fortunate to have all of this va1uable data, noting that more wi11 be available in about three months. Jean Baldwin said Kellie Regan and Dr. Chris Hale are also developing an environmental health satisfaction survey which is expected to be available in January and that will quantify many of the Environmental Health measurements. Larry Fay said the goal of the survey is to better gauge what is and is not working. HEALTH BOARD MINUTES - December 20, 2001 Page: 7 Update of 2002 Strates!Ïc Plan with Bud2et Shortfall Impacts: Due to insufficient time remaining, the Board agreed to spend a significant portion of the next meeting on this topic. Commissioner Tittemess said it appears, based on revenue projections, that the County will have to severely cut expenses or find additional revenues. Letter to the Editor: Vice Chairman Westerman requested the Board's permission to identify herself as a Board of Health member in writing a letter to the editor regarding her support of an affordable housing project. She believes the Board of Health should discuss whether they can come up with guidelines or a policy about whether members can speak out on behalf of an issue. Given the data the Board is receiving and the tremendous pressure that elected officials come under, she feels that there will be an increasing desire to speak out on some of these issues and that public officials need support. While the Board expressed no concern about an individual member making statements on their own behalf, there were severa! comments and concerns about referring to the Board of Health. One suggestion was that a member could state "this is not necessarily a position of the Board," however it was thought that even this use of the Board's name implies advocacy and might lead people to think that there is a Board position favoring one project or another. Member Frissell said the organizations in which she has been involved ask that members not use their name unless they are referring to stated and agreed-upon policies. HEALTH BOARD MINUTES - December 20, 2001 Page: 8 AGENDA CALENDAR / ADJOURN Update of 2002 Strategic Plan with Budget Shortfall Impacts and Report on Access Project. 2002 AGENDA ITEMS ./ CONTINUED STABLE FUNDING TO REPlACE MVET ./ ACCESS HEALTH CARE ,/ PROGRAM MEASURES (Genetic Research and Public Health Implications) ,/ METHAMPHETAMINE SUMMIT ,/ PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT ./ TOBACCO PREVENTION AND COALITION ./ FLUORIDE ,/ TRANSIT AND PUBLIC HOUSING ,/ BIOTERRORISM READINESS & PLAN ,/ AGING POPULATION ,/ WATER ,/ MATERNAL CHILD PREVENTION GOALS (0-3) Meeting adjourned at 4:25 p.m. The next meeting will be held on Thursday, January 17, 2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH (Excused) Jil1 Buhler, Chairman Geoffrey Masci, Member Sheila Westerman, Vice-Chairman Richard Wojt, Member (Excused) Glen Huntingford, Member Roberta Frissell, Member Dan Titterness, Member /' Board of Health New Business Agenda Item # VI., 1 I Public Health Fundin9-: State and Local Policy Issues January 17, 2002 RCW 70.05.060 Powers and duties of local board of health. Each local board of health shall have supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction and shall: (1) Enforce through the local health officer or the administrative officer appointed under RCW 70.05.040, if any, the public health statutes of the state and rules promulgated by the state board of health and the secretary of health; (2) Supervise the maintenance of all health and sanitary measures for the protection ofthe public health within its jurisdiction; (3) Enact such local rules and regulations as are necessary in order to preserve, promote and improve the public health and provide for the enforcement thereof; (4) Provide for the control and prevention of any dangerous, contagious or infectious disease within the jurisdiction of the local health department; (5) Provide for the prevention, control and abatement of nuisances detrimental to the public health; (6) Make such reports to the state board of health through the local health officer or the administrative officer as the state board of health may require; and (7) Establish fee schedules for issuing or renewing licenses or permits or for such other services as are authorized by the law and the rules of the state board of health: PROVIDED, That such fees for services shall not exceed the actual cost of providing any such services. [1991 c 3 § 308; 1984 c 25 § 6; 1979 c 141 § 79; 1967 ex.s. c 51 § 10.] RCW 70.05.120 Violations -- Remedies -- Penalties. Any local health officer or administrative officer appointed under RCW 70.05.040, if any, who shall refuse or neglect to obey or enforce the provisions of chapters 70.05, 70.24, and 70.46 RCW or the rules, regulations or orders of the state board of health or who shall refuse or neglect to make prompt and accurate reports to the state board of health, may be removed as local health officer or administrative officer by the state board of health and shall not again be reappointed except with the consent of the state board of health. Any person may complain to the state board of health concerning the failure of the local health officer or administrative officer to carry out the laws or the rules and regulations concerning public health, and the state board of health shall, if a preliminary investigation so warrants, call a hearing to determine whether the local health officer or administrative officer is guilty of the alleged acts. Such hearings shall be held pursuant to the provisions of chapter 34.05 RCW, and the rules and regulations of the state board of health adopted thereunder. Any member of a local board of health who shall violate any ofthe provisions of chapters 70.05, 70.24, and 70.46 RCW or refuse or neglect to obey or enforce any ofthe rules, regulations or orders of the state board of health made for the prevention, suppression or control of any dangerous contagious or infectious disease or for the protection ofthe health of the people of this state, shall be guilty of a misdemeanor, and upon conviction shall be fined not less than ten dollars nor more than two hundred dollars. Any physician who shall refuse or neglect to report to the proper health officer or administrative officer within twelve hours after first attending any case of contagious or infectious disease or any diseases required by the state board of health to be reported or any case suspicious of being one of such diseases, shall be guilty of a misdemeanor, and upon conviction shall be fined not less than ten dollars nor more than two hundred dollars for each case that is not reported. Any person violating any of the provisions of chapters 70.05, 70.24, and 70.46 RCW or violating or refusing or neglecting to obey any of the rules, regulations or orders made for the prevention, suppression and control of dangerous contagious and infectious diseases by the local board of health or local health officer or administrative officer or state board of health, or who shall leave any isolation hospital or quarantined house or place without the consent ofthe proper health officer or who evades or breaks quarantine or conceals a case of contagious or infectious disease or assists in evading or breaking any quarantine or concealing any case of contagious or infectious disease, shall be guilty of a misdemeanor, and upon conviction thereof shall be subj ect to a fine of not less than twenty-five dollars nor more than one hundred dollars or to imprisonment in the county jail not to exceed ninety days or to both fine and imprisonment. [1999 c 391 § 6; 1993 c 492 § 241; 1984 c 25 § 8; 1967 ex.s. c 51 § 17.] Agenda Fee Review Advisory Board to the Jefferson County Board of County Commissioners 1. Call to Order by the Chair ( Shiela Westerman, Vice Chair, Board of Health) 2. Committee's Charge ftom the Commission Commission policy is that development fees cover the cost of the program or service and 75% of the division/department administrative cost. Review the recommended fee schedules in view of the division/department's cost estimate for the program or service. Benchmark our cost/fees to other jurisdictions. Recommend appropriate fees for the services if different from those recommended by staff. The Committee has the expressed authority to question staff as to how fees were determined, request relevant supportive data, make recommendations regarding staff procedures that might produce efficiencies or cost savings and report on any additional information they gather. A final report from the Committee is due to the Board of County Commissioners no later than January 24, 2002. 3. Introduction 1. Committee 2. Staff 4. Staff Reports 1. Legislative Background 2. Administrative Directive 3. Departmental Response 1. Environmental Health's Approach to Fees (With handouts) 2. Community Development's Approach to Fees (With handouts) 4. Summary 5. Questions about staff presentations , J I , ( \ , - (þ Ô'.!) ....., . c/' r ý\..- U >--rrA-f 1 vp -e )0 pc.,. ,;0, , '7 Next Meeting (suggest Tuesday January 8, 2002 at 7 p.m.~ 5. ~ ð tr--' ~ J -'1 "'"ft?,) -Çlq ~ ~() ~ 'Vt(~ i C> ~ ~ ~~} '1d iv.~.;f. 6. Announcements -- Date: January 7, 2002 To: Fee Committee /) ~ Larry Fay ~ 0 Fee Adjustment Rational From: Re: Under the administrator's directive to cover 75% of divisional administrative costs, Environmental Health must collect an additional $84,000 in fees. Since there are a number of reasons, as discussed last week, for not including solid waste programs in this analysis, all the additional fees must come from the four remaining programs. A greater percentage fee increase has been proposed in the food program for two main reasons. These are: · Pennit costs can be passed on to the consumers who benefit from the program · Part ofthe fee is picked up by non-residents who may visit local establishments. The distribution offee increases as proposed covers the $84,000 revenue increase needed. An alternative approach would distribute the $84,000 revenue proportionally among the four programs based on the current revenue projections. The result would be larger increases in septic pennits and smaller increases in food permits. COMMUNITY HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 .. ....... .....to tOtO tOo> 0> OJ g¡ UI C):::o OJ CD _'0 (') 0 c: ..., méD ..... a. CDO" =:;'< ..., "U o c: 30" off ï1I ~CD "U~ 0..... 'O:J" C:ï1 mS ::::!:DJ o :::I :::1(') oS OJ co ¡¡jC) OJ 0 :::I 3 0.3 -o~ c: CD Q:CD c)" I CD OJ ~ ï1 So OJ :::I (') So co C) o 3 ~ ..... CD CD o OJ ¡¡j .. ~ (f) (f) -:ac... :::I C) C) 0 (f) OJ ï ..., CD IG) :J" :::I ^ -8ãr UI 0 ![ OJ :J" Ã CD m OJ ..., OJ :E So ..., OJ :E éi 0 c... 0..., :::I 0",< m 3 co c: ëiï co UI UI ;::;: 0 ;::;: OJ CD 0 a. Q UI N 3 3 ëiï :::I 0.:::1 ::T - < _ CD ......., ..... "C ~. ~ N 01 N 0> Z 01 W 0 W Z W C :::!'! 0> N 0 01 0 C) .so 0 () 0 0"0.... CD =0> CD o ~.... -0 :J ~ CD 01 -~ "C .... N N ..... ..... ..... N í\3..... W ..... CD c: CD -- 0> 0> W 01 0 01 ~ ~ 0> W 0 :J" 0 C" - 0 0 0 01 0 0 .so W 0 0 -:::I c: _OUl .... ~-e CD 0 .... 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CJl -. oc5 Please publish 1 time: December 12, 2001 Bill: Jefferson County Commissioners Office PO Box 1220 1820 Jefferson Street Port Townsend, W A 98368 rRECEIVED [DEC 1 3 2001 äerSOlll CÐI.:! .' f ~~¡r~ NOTICE OF PUBLIC HEARING NOTICE IS HEREBY GIVEN that a public hearing is scheduled by the Jefferson County Board of Commissioner to take comments on a proposed Ordinance amending the fees for the Environmental Health Division and Animal Services Division of the Health & Human Services Department and the Building Division of the Department of Community Development. The hearing is scheduled for December 24, 2001 at 10:05 a.m. in the County Commissioners Chambers, Lower Level, Jefferson County Courthouse, 1820 Jefferson Street, Port Townsend, WA 98368. JEFFERSON COUNTY BOARD OF COMMISSIONERS Page 1 ~ , In the matter pfan Qrdinance Amending Spe'cific Fee Schedules Contained in Ordinances 12-1209-96, 11-1115-99, and 10-1108-99 for the Health & Human Services, Environmental Health Department, Animal Services, and the Department Community Development ", STATE of WASHINGTON COUNTY of JEFFERSON } } } } } } } } ORDINANCE NO. SECTION 1 - PURPOSE AND SCOPE: The purpose of this ordinance is to amend or repeal and replace fee schedules for the following Jefferson County Departments and/or Divisions of Department: Health & Human Services - Environmental Health Division; - Animal Services Department of Community Development (formerly Permit Center) ., - Building Division SECTION 2 - FEE SCHEDULES: The following fee schedules are to be amended as follows. Only new and changed items are listed. Fees that remained the same are not listed - previous ordinance for these fees. HEALTH & HUMAN SERVICES DEPARTMENT- ENVIRONMENTAL HEALTH DIVISION ON-SITE SEWAGE FEE 2001 Proposed Additional Fee and/or 2002 Fee Other Information SEWAGE DISPOSAL PERMITS New Conventional 250.00 340.00 Valid for 3 years New Alternative 300.00 410.00 Valid for 3 years New Septic tank and/or pump chamber 110.00 150.00 Issued in conjunction with an existing sewage disposal system or . community system New Community or >1000 G.P.D. (Base fee) 250.00 340.00 Plus $57 per connection - Valid for 3 years New Commercial> 1000 G.P.D. Conventional 300.00 410.00 Valid for 3 years Page 2 PROGRAM/SERVICE re: Fees for Various County Services I FEE 2001 I I i Proposed i 2002 Fee Additional Fee and/or Other Information Ordinance No. Alternative 325.00 440.00 Valid for 3 years I Repair/upgrade 55.00 80.00 Applies to existing installed sewage disposal system Expansion 200.00 270.00 Redesign 55.00 80.00 Applies to pending or active but not installed. Reinspection 70.00 100.00 Renewal 60.00 90.00 EV ALUA TION OF EXISTING SYSTEM Filing Fee 20.00 To record EES done by --"'!. "._- -2rivate inspector Septic System only 100.00 ~ 175.00 ) Septic System plus water sample 125.00 208.00 Retest/Re-inspection 50.00 70.00 OTHER WaiverNariance Application 85.00 120.00 WaiverNariance Hearing 200.00 Technical Assistance - Minimum 50.00 58.00 Technical Assistance - Per Hour 50.00 58.00 Wet Season Evaluation 200.00 270.00 LICENSES Installer, Pumper, Operator (maintenance person) 200.00 270.00 Retest 80.00 110.00 Renewal 140.00 190.00 Renewal after January 31 200.00 270.00 ON SITE SEWAGE On Site SPAAD 200.00 Page 3 Ordinance No. re: Fees for Various County Services PROGRAM/SERVICE FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information Septic Permit with SPAAD (Conventional) 150.00 Septic Permit with SPAAD (Alternative) 225.00 FOOD SERVICE ESTABLISHMENT FEES (Annual Permit) Immediate Consumption Limited 70.00 110.00 Non-Complex 90.00 140.00 Complex 0-50 seats 160.00 250.00 51-100 seats 190.00 300.00 101-150 seats 215.00 340.00 Alcohol served in multiple areas 70.00 110.00 - Not for immediate Consumption Limited 70.00 110.00 Non-Complex 90.00 140.00 Complex 215.00 340.00 Annual Permit Issued After September 1 50% of fee same Late Fees 50% of fee same Additional Temporary Permit -'"-"'-" Non-Complex 55.00 ( sQòò) Limited 30.00 50.00 Other Food Fees Plan Review Minimum 50.00 58.00 Per Hour 50.00 58.00 Page 4 Ordinance No. re: Fees for Various County Services ! FEE 2001 Proposed 2002 F ec Additional Fee and/or Other Intormation : PROGRAM/SERVICE Reinspection First inspection 40.00 70.00 Second inspection 75.00 120.00 Administrative Hearing 110.00 170.00 Food Handler Card 8.00 8.00 Reissue Unexpired Food Handler Card 2.00 2.00 Manager's Course 110.00 170.00 SOLID WASTE I Landfills requiring environmental monitoring 400.00 410.00 Inert Landfills 250.00 260.00 Bio-solid Utilization 350.00 360.00 Other Solid Waste Facility Permits 250.00 260.00 Drop Boxes 110.00 120.00 New Facility Application 320.00 330.00 Plan Review 50.00 58.00 Per Hour WATER Drinking Water (notice of intent) 80.00 120.00 Notification of Availability 30.00 50.00 Well Site Inspection 160.00 240.00 Water Sample Bottles Cost Plus $2 Cost Plus $3.00 LIVING ENVIRONMENTS Pools 160.00 220.00 Spa 160.00 220.00 Pool/spa combined 220.00 300.00 Page 5 Ordinance No. re: Fees for Various County Services , PROGRAM/SERVICE i ! FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information i I 200.00 300.00 Plus $15.00 Per Lot I 58.00 Per Hour i i Subdivision Review Base Fee I Plan Review I ANIMAL SERVICES Only new and changed items are listed. Fees that remained the same are not listed - see previous ordinance for these fees. I FEE 2001 Proposed Additional Fee and/or 2002 Fee Other Information DELETE Senior Discount on License Fees 50% ------------ DELETE Replacement of Lost Tag 2.00 4.00 IMPOUND Surrender Fee (to owner) 20.00 REDEMPTION - Fertile Dogs and Cats ~ First Offense 30.00 45.00 Fee may be refunded if dog or cat is spayed or neutered. Second Offense 32.00 48.00 Education required Third Offense 45.00 67.00 Plus spay/neuter fee REDEMPTION - Sterile Dogs and Cats First Offense 16.00 24.00 May be refunded Second Offense 32.00 48.00 Education Required Third Offense 45.00 67.00 Board for Dogs and Cats 8.00 16.00 After first 24 hours - per each subsequent 24 hour period. LIVESTOCK Impound Fee 21.00 42.00 After first 24 hours - per each subsequent 24 hour period. Board 8.00 20.00 After first 24 hours. Page 6 Ordinance No. re: Fees for Various County Services ¡ PROGRAM/SERVICE FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information ¡ Transportation 21.00 I 42.00 The greater of $42.00 or I I I ! actual cost. I EUTHANASIA AND CREMATION SERVICES Euthanasia 21.00 32.00 Cremation Services PRIVATE: o pounds t01 0 pounds 20.00 30.00 Over 10 pounds to 40 pounds 40.00 60.00 Over 40 pounds to 75 pounds 60.00 90.00 Over 75 pounds to 110 pounds 60.00 110.00 Over 11 0 pounds 110.00 130.00 COMMUNAL: o pounds t01 0 pounds 10.00 15.00 Over 10 pounds to 40 pounds 15.00 25.00 Over 40 pounds to 75 pounds 20.00 30.00 Over 75 pounds to 110 pounds 25.00 40.00 Over 11 0 pounds 30.00 45.00 Remote Pick up by Animal Services Employee 10.00 20.00 KENNELS AND DANGEROUS DOGS Kennel License Fee 31.00 75.00 Commercial -- If paid after February 28 add $10.00 Dangerous Dog Registration Fee 181.00 250.00 ADOPTION FEE Dogs 55.00 60.00 ~udes ~ Spay or , . ion. and Veterinary Exam. Page 7 Ordinance No. PROGRAM/SERVICE re: Fees for Various County Services ¡ FEE 2001 ! Proposed 2002 Fee Additional Fee and/or Other Information Cats 55.00 I 60.00 DEPARTMENT OF COMMUNITY DEVELOPMENT (formerly Permit Center) BUILDING DIVISION, DEVELOPMENT REVIEW AND LONG RANGE PLANNING a) Applies to new construction only, otherwise, number 6 applies. b) The fee is determined by a schedule established in the Uniform Building Code, and is based on the value of the structure. c) The fee that is charted by the Auditor's Office for filing. d) Applies to commercial, industrial, multi-family construction and is calculated as a percentage of the base fee. e) The fee is based on Building Valuation Data established by ICBO, Buidling Standards, modified for Western U.S. Washington State. BUILDING, MANUFACTURED HOME, AND FEE 2001 Proposed Additional Fee and/or OTHER PERMIT APPLICATIONS 2002 Fee Other Information 1) Main Floor b b Base Fee 30% 65% Plan Check Fee a, e a,e Valuation 2) Additional Floors, Finished Basement b b Base Fee 30% 65% Plan Check Fee a,e a,e Valuation 3) Unfinished basement b b Base Fee 30% 65% Plan Check Fee a,e a,e Valuation 4) Carports, Garages, Pole Buildings, b b Base Fee Decks 30% 65% Plan Check Fee $10.00 per square a,e Valuation foot Page 8 Ordinance No. I PROGRAM/SERVICE re: Fees for Various County Services I FEE 2001 ! Proposed 2002 F e< Additional Fee and/or Other Information 5) Modular Home foundations and b b I Base Fee foundations for relocated structure 30% 65% Plan Check Fee $26.00/sq.foot $26.00/sq. Valuation foot 6) COMMERCIAL structures, construction Cost or Fair Market Cost or Fair or improvement Value Market Value UBC Fee UBC Fee 65% 65% Plan Check Fee 7) Manufactured Homes (one or two 141 .00 151.00 sections) 8) Additional manufactured home sections 29.00 31.00 9) Wood stoves, inserts, propane tanks and 48.00 47.00 pellet stoves (in existing structures) 10) Inspection; reinspection 48.00 47.00 11) Change of Use or Occupancy 120.00 129.00 - 12) Title Notice Removal c c 13) Renewal 56.00 94.00 14) DELETE Variance 159.00 DELETE 14) Fire Marshall Services 47.00 per hour 15) Notification of Water Availability 32.00 In addition to Health Department Fee for same thing. RIGHT OF WAY, UTILITY & ADDRESS APPLICATIONS 16) Road Approach 39.00 141 .00 Type I Permit 17) Application for 911 Number/Address 29.00 141 .00 18) Application for 911 Replacement 5.00 5.00 Number 19) Road Approach & Address 51.00 141 .00 Combined Page 9 Ordinance No. re: Fees for Various County Services PROGRAM/SERVICE FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information 20) Utility Installation of General Permit I 39.00 1 41 .00 LAND USE APPROVAL APPLICATIONS (Unified Development Code) 21) Pre-application Conference 80.00 188.00 Not applied to permit I 22) Appeals of Type II and Type III Base 400.00 470.00 Decisions, Code Interpretations, State Pub. Hear Notice 113.00 121 .00 Environmental Policy Act Notice Boards 15.00 8.00 Determinations, and Notice and Order 1 21 .00 Notice of Application (Abatement) 23) Revisions to Land Use Applications 111 .00 94.00 Base Requiring a Second Public Hearing 121.00 Public Hearing Notice Notice 24) Site Visit (first site visit is included in 39.00 per hour 94.00 application base fee) 25) Code Interpretation Base 120.00 282.00 Notice of Application 111 .00 26) Notice Board 15.00 for two 8.00 Each 27) Hourly Rate 39.00 47.00 TYPE I PERMITS 30) Allowed "Yes" Use Consistency 39.00 Base 47.00 1 hour charge 47.00 minimum. Per Hour prorated for additional time. 31) Stormwater Management Permit 188.00 Stand Alone Only 32) Boundary Line Adjustment 169.00 188.00 33) Minor Plan Modification (Preliminary Base 169.00 188.00 approval only) App. Not. 111 .00 Hearing Not. 113.00 Page 10 Ordinance No. re: Fees for Various County Services i FEE 2001 Proposed I 2002 Fee I Additional Fee and/or Other Information ¡ PROGRAM/SERVICE ¡ 134) Site Plan Approval Advance : 39.00/hour I I 188.00 Determination (SPAAD) 35) Shoreline Master Program Base 167.00 282.00 Exemption App. Notice 111.00 36) Shoreline Master Program Permit Notice 113.00 94.00 Revision 37) Last Will & Testamentary Division 169.00 282.00 38) Home Business 113.00 Base 47.00 1 hour charge 47.00 minimum. Per Hour prorated for additional time. 39) Temporary Use 56.00 Base 47.00 1 hour charge 47.00 minimum. Per Hour prorated for additional time. 40) Sign Permit 29.00 Base 47.00 1 hour charge 47.00 minimum. Per Hour prorated for additional time. 41) Minor PRRD (Planned Rural Residential 39.00/hour Base 47.00 1 hour charge Development) Amendments 47.00 minimum. Per Hour prorated for additional time. 42) Additional fee for State 225.00 423.00 Base Environmental Policy Act (SEPA) Minimum 121.00 Notice of Review (including SEPA base fee, Pend Not. 56.00 8.00 Application Notice of Application, and Notice Board) Notice 113.00 Notice Board TYPE II PERMITS (Require Notice of Application and Notice Board 43) Discretionary "0" or Unnamed Use 120.00 1 88.00 Base Classification 111 .00 121.00 Notice of 15.00 8.00 Application Notice Board Page 11 Ordinance No. PROGRAM/SERVICE re: Fees for Various County Services i FEE 2001 i ! Proposed 2002 Fee Additional Fee and/or Other Information r I 1,269.00 I Base 144) Short Plat (including Planned Rural 563.00 Residential Development Application Plus $21 per lot 111 .00 121 .00 Notice of Application 15.00 8.00 Notice Board . 45) Conditional (Administrative) "C(a)" 281.00 470.00 Base Use 111.00 121 .00 Notice of Application 15.00 8.00 Notice Board 46) Conditional (Discretionary) "C(d)" 281.00 470.00 Base Use 111 .00 121.00 Notice of Application 15.00 8.00 Notice Board 47) Cottage Industry 281.00 470.00 Base 111 .00 121.00 Notice of Application 15.00 8.00 Notice Board 48) Wireless Telecommunication 228.00 470.00 Base 111 .00 121 .00 Notice of Appli_cation 15.00 8.00 Notice Board 49) Temporary Use 56.00 Hourly Review Fee 111 .00 1 21 .00 Notice of Application 15.00 8.00 Notice Board 50) Variance, Minor 169.00 470.00 Base 111 .00 121.00 Notice of Application 113.00 -------- Hearing Notice 15.00 8.00 Notice Board 51) Shoreline Substantial Development 281.00 705.00 Base (Primary Use) 111 .00 121.00 Notice of App. 113.00 -------- Hearing Notice 15.00 8.00 Notice Board 52) Forest Practices Act/Release of Six 169.00 282.00 Base Year Moratorium 111.00 121 .00 Notice of App. 15.00 ------- Notice Board Page 12 Ordinance No. ! PROGRAM/SERVICE I i re: Fees for Various County Services FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information 153) Conversion Option Harvest Plans 169.00 282.00 Base 111.00 121 .00 Notice of App. 15.00 8.00 Notice Board 54) Binding Site Plans (including 3,995.00 Base Planned Rural Residential Development 121 .00 Notice of App. application) 8.00 Notice Board 55) Additional fee for State Minimum 225.00 423.00 Environmental Policy Act (SEPA) Pend. Not. 56.00 Review Notice 113.00 Notice Boards 15.00 TYPE III PERMITS (Require Notice of Application, Public Hearing Notice and Notice Board) 56) Conditional "C" Use 281 ;00 1 ,034.00 Base 111 .00 121 .00 Notice of App. 113.00 121.00 Public Hearing Not 8.00 8.00 Notice Boards 57) Wireless Communication 228.00 1,034.00 Base 111 .00 121.00 Notice of App. 113.00 121 .00 Public Hearing Not 15.00 8.00 Notice Boards 58) Long Plat, Preliminary (including 563.00 Planned Rural Residential Development Plus $21 per lot 3,995.00 Base application.) 111 .00 121.00 Notice of App. 113.00 121.00 Pub. Hrg. Notice 15.00 8.00 Notice Board 59) Variance, Major 169.00 940.00 Base 111.00 121.00 Notice of App. 113.00 121 .00 Pub.Hrg. Notice 15.00 8.00 Notice Board Page 13 Ordinance No. re: Fees for Various County Services PROGRAM/SERVICE FEE 2001 Proposed 2002 Fee Additional Fee and/or Other Information I I 940.00 ! Base I 60) Reasonable Economic Use Variance 169.00 111.00 121.00 I Notice of App. 113.00 121.00 Public Hrg. Not. 15.00 8.00 . Notice Board 61) Shoreline Substantial Development 338.00 1,128.00 Base (Secondary Use) 111 .00 121.00 I Notice of App. 11 3.00 121.00 Pub. Hrg. Notice 8.00 8.00 I Notice Board 62) Shoreline Conditional Use 394.00 1,128.00 ! Base 111 .00 121.00 Notice of App. 113.00 121.00 Pub.Hrg. Notice 15.00 8.00 Notice Board 63) Shoreline Variance 169.00 940.00 Base 111 .00 121.00 Notice of App. 113.00 121.00 Pub.Hrg. Notice 15.00 8.00 Notice Board 64) Additional Fee for State Minimum 225.00 423.00 Environmental Policy Act (SEPA) Pend Not. 56.00 Review Notice 113.00 Notice Boards 15.00 TYPE IV PERMITS 65) Short Plat, Long Plat, Binding Site 141 .00 Plans; Final (including Planned Rural Residential Development application) TYPE V PERMITS 66) Special Use (Essential Public 281.00 1,034.00 Base Facilities) 111 .00 121.00 Notice of App. 113.00 121 .00 Pub. Hrg. Notice 15.00 8.00 Notice Boards 67) Jefferson County Comprehensive No Fee Plan/UDC Amendment Suggested) Page 14 Ordinance No. re: Fees for Various County Services ¡ PROGRAM/SERVICE FEE 200] Proposed 2002 Fee Additional Fee and/or Other Infonnation ! 68) J.C. Comprehensive Plan/UDC 250.00 2,250.00 I Amendment (Site Specific) includes SEPA 69) J.C. Shoreline Master Program 2,250.00 CURRENT USE TAX ASSESSMENT APPLICATION 70) Open Space/Open Space & Open 281.00 1,034.00 Base Space Timber Applications 111 .00 121.00 Notice of App. 11 3.00 121.00 Pub. Hrg. Notice 15.00 8.00 Notice Board 71) Open Space Agriculture Applications 11 3.00 121.00 Base 111 .00 121.00 Notice of App. 113.00 121.00 Pub. Hrg. Notice 15.00 8.00 Notice Board 72) Application to Transfer Forest Land 111 .00 121.00 Base (RCW 84.33) to Timber Land (RCW 113.00 121.00 Pub. Hrg. Notice 84.34) 15.00 8.00 Notice Board 73) Copy or Duplicating Fee 11" x 17" Page $.30 Color or Oversized Documents At cost Cassette Tapes 5.00 Land Use Maps $1 0.00 Publications At Cost SECTION 7 - REPEALER This Ordinance repeals and replaces the Permit Center-Building Division Section of Ordinance No. 12-1209-96 and the Permit Center-Building Division Section of Ordinance No.13-1213-99 and Ordinance NO.1 0-11 08-99. It also repeals the Environmental Health Division Fees of the Health & Page 15 Ordinance No. re: Fees for Various County Services ! FEE 2001 i Proposed 2002 F ef Additional Fee and/or Other Information ¡ PROGRAM/SERVICE I Human Services Department Section of Ordinance No. 11-1115-99 SECTION 8 . SEVERABILITY If any section, subsection, or sentence, clause, phrase, or figure of this Ordinance or its application to any person or circumstance is held invalid, the remainder of the ordinance or the application to other persons or circumstances shall not be affected. SECTION 9· EFFECTIVE DATE This Ordinance shall become effective January 1 2002. APPROVED AND ADOPTED this day of ,2001. JEFFERSON COUNTY BOARD OF COMMISSIONERS SEAL: Glen Huntingford, Chairman ATTEST: Dan Titterness, Member Lorna Delaney, CMC Clerk of the Board Richard Wojt, Member Page 16 ;. ...~"'-. f/ .. '" . . ~ '. " .' '- - , .F "C ',- ,,' ;' '. "1",,,- " - -, ,".'.. -' Executive Summary . This report lays a foundation for improving the financing of the public health system in Washington State. The principles and recommendations contained in this report were developed by a state-local Public Health Financing Committee which worked to understand funding for public health; to inform the Department of Healtn's 2001 Public Health Improvement Plan (PHIP); and to identify the policy questions and implications of current and future funding methodologies. Problem Definition Three broad system financing problems exist. Rrst is a lack of underlying principles or philosophy for this highly interdependent system. The lack of a systematic approach has led to revenue insufficiency across the system, wide variations in the level of public health investment, and great variation in the level of service and size of health jurisdictions. Disagreements exist about the benefits and costs of regional approaches, accompanied by strong concerns about potential loss of local control and attention to local priorities. The second system shortcoming is the mechanism for allocating funds in the system. Categorical funding - "strings" on expenditures by state and federal agencies - constrains responsiveness to commuDity priorities and the cost-effective use of funds. local Health Jurisdictions (LHJs) lack trust in funding distribution formulas because they are complex, not updated regularly, and the role of the State in the public health system is unclear. The third system problem is poor linkage between system funding and standards and outComes. LHJs and the State are working together toward public health performance standards, but lack a defined set of core or basic services that should be available statewide. Thus, there is no way currently to demonstrate the return on public investment in the public health system, and financial data systems do not support good decision making or understanding of the financing system. Approach. After defining these problems, the Public Health Rnancing Committee used several resources to inform its work, including a recommendation framework to parse policy questions into four manageable issue areas: underlying philosophy, revenues, expenditures, and outcomes/standards. Other resources included revenue and expenditure data and a 1997 survey of funding formulas; prior years' PHIP principles and recommendations; the input of WSALPHO members; and a look into learnings from other states dealing with public health financing issues. Using this broad information, the Committee laid out the following system principles and recommendations to guide the financing of public health in Washington. Financing System Principles and Recommendations Education and Communicating System Needs. Education about the essential role· of public health is needed at all levels of federal, state~ and local government and with the public. To implement this principle, the Committee recommends designing specific financing strategies that mesh with the work of the Standards Committee; estimating state and local costs to meet the performance standards; Public Health Financing Committee Report - December 2000 Page i identifying a core set of public health services that must be provided and the cost to provide them; and developing a communications plan to explain the principles to system partners, why public health is important, and how it should be funded. Shared State and local Responsibilities. Public health funding is a shared responsibility of federal, state and local government. . Res1onsibiJities for funding shares among state and local partners need to be defined to implement this principle, using Standards Committee outcomes, core services definitions and funding flexibility principles (see below) as a foundation. How regional and statewide financing arrangements may change also needs clarification. State Role and Responsibility in Public Health. The role of the State is to develop and administer the public health system and the state and federal revenues that support it This includes: ~ ~nsuring a core set of defined public health services are provided across the State, and interceding where they are not available. ~ Developing policies and regulation~ ensuring regulatory compliance, providing technical assistance and some regional services. ~ Evaluating and measuring system performance; and ~ Acting in a coordinating role among other system partners, including community provider~ local health jurisdictions and the state and federal government. The Committee recommended defining a basic set of public health services that must be available in all communities; and determining the process of intervention and funding implications if the State and LHJs do not meet the public health standards. Finally,-the Committee will work to ensure the separate, strategic planning efforts of lHJ's and DOH work in concert, to develop joint system goals. local Role and Responsibility in Public Health. The role of local health jurisdictions is to provide and/or assure provision of core public health services in their community as well as community-specific services. This includes: ~ Locally determining strategies to meet public health performance standards. ~ Working with partners to identify community health need~ community capacity, and strategies to promote and protect community health. ~ Providing the most cost-effective/lowest-cost services. ~ Developing local policies and regulations. This means that a definition of "most cost-effective" needs to be developed, and the cost of service and service delivery options should be explored further. Flexible Funding. Federal, state and local funds can be used most effectively when restrictions are fe~ while still maintaining accountability for public health outcomes. The Committee's recommended strategies to de-categorize funding include: )- LHJs examine local budgets to maximize resources and the State examines its· allocations and use of its funds. )- Identify least flexible sources and issue areas. ~ Identify categorical sources that can be blended or distributed differently. ~ Develop a timeline to address categorical funding issues with state or federal agencies. Public Health Financing Committee Report - December 2000 Page ii Who Pays for Public Health? A 1996 principle states that "the degrëe of benefit to the individual and the community, as well as whether the activity is conducive to fee collection, are two of the factors...in determining the financing of a public health activity..." The Committee supports this principle and recommends an update and review of the 1996 Fee Toolbox, and technical assistance at the state level to help lHJs maximize revenue capacity. Funding for Core SelVices. Sufficient, stable sources of funding should be directed to core services .and to meet minimum performance standards. In addition, funding should be directed to local community priorities and needs. To support this principle, the Committee must define sufficient funding - including costs for system partners to meet the standards; the capacity of state and local governments to raise funds (assessing existing and potential revenue sources). Then identify which tax base funds/should support which services (as noted in the who pays section). Equitable Allocations. State and federal sources should be allocated based on regularly updated, well-defined/documented/communicated, measurable characteristics. To further study and clarify this principle, the Committee suggests that specific grants be prioritized and analyzed that have oldest formulas and are least flexible. Then model differently weighted allocations and test additional factors to distribute funds (may include local Willingness and ability to pay, local population characteristics, service delivery cost factors, nature and extent of community health risk, and allocation of a "base" amount to alllHJs). Finally, develop weights for these factors based on system priorities. Financial Incentives for Cost-Effectiveness. Financial incentives should exist to encourage partnerships that result in less costly and most cost-effective public health services. The Committee recommends that these incentives should be developed and included in revised funding formulas (see recommendations for equitable allocations). Need for Standards. Accountability tools such as system standards, performance measurement, and consistent reporting are essential to improving the public health system and demonstrating the need for funding. The Committee supports the development of a performance-based contracting system to implement this principle. link Standards to Funding. Public funding should be linked to the provision of a core set of public health services and meeting the performance standards. To improve these links, the Committee recommends revising BARS coding to align with performance standards and core services to support management-level decisionmaking. Also, funding structures and algorithms should be made more explicit (as noted in the equitable allocations section). The specific activities to link standards and funding need to be defined, and policies and protocols for evaluating performance, confirming provision of services, assuring contract compliance, and reporting activities and outcomes should be developed. . Public Health Financing Committee Report - December 2000 Page iii ~ext Steps This report sets the 2001 workplan for the Public Health Rnancing Committee. All recommendations need further development and study, and are linked to the actions of the PHIP Standards Committee and future Communications Plan. Recommençed actions include: . ~ Develop a list of public health services that should be available in every community. ~ Identify the financial incentives to support adequate state and local investment in public health; and make the Committee's vision of public health system financing a reality. ~ Carry out analyses of funding flexibility and allocations needed to support the principles. ~ Support the performance standards process through further evaluation of ways to link funding flows to the standards. 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Board of Health New Business Agenda Item # VI., 2 Jefferson Access Project - Next Ste~ January 17, 2002 Next Steps Jefferson Access Project Draft by Kris Locke December 15,2001 The Jefferson Health Access Summit produced a variety of ideas for ways to improve access to health care in East Jefferson County. Since then, the economy has taken a serious downturn. The 2002 state legislative session will be dealing with an estimated $1.2 billion deficit. Most state agencies have been directed by the governor to propose budgets with 15% reductions. This translates into severe cuts to the Medicaid and otner state health programs. These cuts, coupled with Medicare reductions and increasing costs for health insurance, will result in worsening local access problems and more financial instability for health care providers. A new Washington Health Foundation mini-grant has been received by Jefferson General Hospital to continue access work in Jefferson County. The goals of this grant are to: · Identify next steps for the project - short and long term · Clarify the roles of each board as well as joint areas of focus relative to access projects · Prepare a concept paper for staffing the Jefferson Access project · Prepare a comprehensive grant proposal to fund activities over a 1-2 year period · Convene a gathering to inform the community of activities. Next Steps Product. I think there are three separate but related work activities: 1. A project exploring alternative insurance arrangements using high deductible plan coupled with a community basic health component. (Jefferson Passport Project) 2. A project to discuss and seek consensus on what constitutes critical or essential health services. (Civic Engagement in Health Project) 3. Establishment of a community based-access project coordination function. (Jefferson Access Project) Process. The decision-making process to affirm or modify these ideas and then implement them needs to be planned and agreed to. I'd like to propose the following: · Draft a more detailed paper describing next steps. · Meet separately with Commissioners and Board of Health to propose plan and potential organizational roles. · Modify products or process based on discussions with boards. · Bring proposal to Joint Boards and discuss roles of each organization. · Initiate work (detail depending on discussion). This is the phase where I think we could use the expertise of the Work Group to refine ideas and give reality check on practicality and acceptability. · Plan Spring Summit. Board of Health New Business Agenda Item # VI., 3 Congressional Bioterrorism FundingJlpdate January 17, 2002 INAC1- II ASSOCIATION OF COUNTY & CITY HEALIH OFFICIALS NEWS FROM WASHINGTON A NACCHO MEMBERSHIP MONTHLY Supplement January 2002 Even as Congress abandoned efforts to pass highly visible and partisan economic stimulus legislation before the end of2001, it acted the week before Christmas to pass generous funding bills for the Department of Health and Human Services and for homeland security and bioterrorism preparedness. Federal funding for public health is now on a steep upward trajectory. On Dec. 20, the last day of the session, the Senate also passed a bill establishing new mechanisms for funding bioterrorism preparedness. The House had passed its version earlier in the month, but time ran out before the bills could be reconciled. Congress Funds Public Health Preparedness at New High Level On Dec. 20, Congress appropriated $865 million in supplemental spending to upgrade state and local public health capacities. These funds are in addition to the regular FY2002 appropriations for the Department of Health and Human Services (DHHS). The supplemental spending is part of the $40 billion that Congress voted to spend on disaster recovery and counterterrorism shortly after September 11. The total to be spent on public health and bioterrorism activities is $2.5 billion, of which $865 million is eannarked for state and local capacity. The conference report (the final statement of House and Senate conferees who reconciled the House and Senate versions of the bill) specifies how these funds are to be used: 'The conferees believe that a portion of this funding ($865 million) should be available immediately to meet the needs of state and local health departments as a result of the September 11,2001 attacks and other subsequent events related to terrorism. The conferees also believe that a portion of this funding should be granted under the authority of the Public Health Threats and Emergencies Act, which calls for assessments of public health needs, provides grants to State and local public health agencies to address core public health capacity needs, and provides assistance to State and local health agencies to enable them to respond effectively to bioterrorist attacks. " The next step is for the Department of Health and Human Services to detennine more precisely how to administer these funds and apportion them between bioterrorism preparedness activities and core public health capacity-building (among which there are many overlaps). NACCHO leaders have met with CDC and DHHS officials and have been assured that Secretary Thompson intends to get the money get out quickly and assure that local public health infrastructure benefits directly. NACCHO's pre-September 11 objectives for public health capacity funding were $40 million for the Health Alert Network program (for which support will be included in the $865 million supplemental funding) and $100 million for implementation of the Public Health Threats and Emergencies Act in FY2002. Clearly these objectives are been greatly exceeded as fears and threats ofbioterrorism have brought public attention to the years of insufficient support for the governmental public health system. cnc, HRSA Programs Receive Increases for FY2002 Congress also completed its routine annual appropriations work, passing the FY2002 funding bill for the Department of Health and Human Services two and one-half months after the fiscal year began. The final result was worth waiting for. CDC received an overall increase of 11 percent to achieve a total of $4.3 billion. The total increase for the Health Resources and Services Administration was 10 percent, for total agency funding of $6.1 billion. The National Institutes of Health received the largest percentage increase, 15 percent, and its budget now totals $23.38 billion. The single greatest percentage increase at CDC was for public health improvement (34%), a line item that, at $149 million, also is the smallest at that agency. It includes prevention research, some activities in information technology, and new funding of $17 million to initiate an environmental health tracking network and capacity development in environmental health at state and local health departments. Congress continued CDC's bioterrorism funding at $189 million, including $34 million for the Health Alert Network (HAN). This compares to $32 million for HAN and a similar amount for other bioterrorism activities last year. These are the numbers that Congress did not increase in the regular FY2002 appropriations bill because of its intent to fund public health and bioterrorism preparedness through the special supplemental funding discussed above. The FY2002 funds are modest by comparison, but they will be available in addition to the $865 million supplemental appropriation. Other programs at CDC receiving increases include immunization (14 percent), environmental health (12 percent) and infectious disease control, HIV/AIDS, STDs and tuberculosis, all increased by nine percent. The preventive health and health services block grant to states received level funding. Programs at HRSA receiving increases include community health centers (up 15 percent to $1.34 billion), the National Health Service Corps (19 percent) and Healthy Start (10 percent). Ryan White AIDS programs were increased by six percent, while the maternal and child health block grant was held to a three percent increase. The Community Access Program, which the Administration had proposed to abolish, was decreased from $125 million to $105 million. House and Senate Pass Differing New Bioterrorism Measures Congress also addressed bioterrorism by acting on new authorizing legislation, although work was not completed by the Dec. 20 adjournment. News reports about Congressional action can be misleading because they often fail to distinguish between legislation which authorizes federal spending and sets the terms and condition for that spending, and appropriations, which is legislation that actually provides money. Senators Ted Kennedy (D-MA) and Bill Frist (R- TN), whose pioneering work led to passage of last year's Public Health Threats and Emergencies Act (aka "Frist-Kennedy"), also led the way this year in devising more approaches to bioterrorism preparedness. They introduced "The Bioterrorism Preparedness Act of200l" on Nov. 15. These are both authorizing bills that do not actually provide funds. The proposed new Bioterrorism Preparedness Act would leave intact the program established by last year's Frist-Kennedy bill for assessing and building core public health capacities and would add to it a block grant program for bioterrorism preparedness. States would receive grant funds, apportioned among states on a population basis, and would be required to use the funds to produce and implement a bioterrorism preparedness plan. This bill passed the Senate unanimously on the last day of the Congressional session. The House of Representatives also passed its own, different version ofbioterrorism legislation the previous week. The House bill, by contrast, does not establish a new funding mechanism for public health preparedness, relying instead on the existing authority of Frist-Kennedy. Passage of new legislation was not necessary to provide new funding for bioterrorism preparedness, because it is the appropriators who actually propose funding levels and who may impose terms and conditions of their own. This year, the failure of new authorizing legislation for bioterrorism programs did not hinder Congress from appropriating the ample new funds described above and prescribing in broad terms how they should be spent. NACCHO's position has been that the Public Health Threats and Emergencies Act provides ample authority and an effective scheme for improving state and local public health capacities and public health preparedness, and that no new authorizing legislation is needed. This year, the House of Representatives agreed. It is likely that the House and Senate will reach a compromise between their two bioterrorism bills and pass a new one next year, which may then playa role in the complex "dance oflegislation" that will precede FY2003 appropriations. CHECK OUR SPECIAL WEB PAGE FOR LATEST NEWS, INFORMATION AND ACTION ALERTS "NACCHO Responds to Bioterrorism" available at www.naccho.org This month, please write to your Members of Congress to say "thank you" for their support of the new funding for public health preparedness and to ask that it continue. See the Legislative Action Center on our Web site for quick and easy ways to convey this important message. For more information, contact Donna Brown, Government Affairs Counsel, by phone at (202) 783-5550 or bye-mail at dbrown@naccho.org. INAccml_'o~ ASSOCIATION OF COUNTY & CITY II ""'TH OFHC'"" Board of Health New Business Agenda Item VI., 4 Bioterrorism Preparedness Tabletop Exercise January 17, 2002 615 SHERIDAN . PORT TOWNSEND, WA 98368 . FAX 360-385-9401 January 8, 2002 Dear, You are invited to attend a Jefferson County Bioterrorism Preparedness Tabletop Exercise sponsored and facilitated by the Washington State Department of Health, coordinated by Jefferson County Health and Human Services and Jefferson General Hospital. The other counties around the state that have participated in this exercise have been giving it very good reviews. January 30, 2002, 12:30 - 4:30 PM, Jefferson General Hospital auditorium Please RSVP to Colleen at 385-9413 This Tabletop Learning Activity is designed as an opportunity for public health personnel and other members of the local health system to prepare for and respond to a large-scale communicable disease or bioterrorism event. Participants address a hypothetical incident in the form of an infectious disease outbreak to acquire this learning. The exercise enables participants to identify the communication, resources, data, coordination, and organizational elements associated with an emergency response. The exercise is aimed at identifying the policy and procedural questions that need to be considered in responding to a Bioterrorism event. Exercise Objectives: · Understand measures that can be performed at the local level to prepare for a large-scale communicable disease or bioterrorism incident · Promote interagency collaboration/coordination regarding emergency preparation and responsiveness · Recognize the roles of a variety of public officials and agencies in a large-scale communicable disease or bioterrorism incident · Recognize need for intense teamwork and communication to prepare for a large scale communicable disease or bioterrorism incident · Identify gaps in local preparedness and begin coordination discussions · Identify additional related training/learning needs (an "assessment tool") To ensure that there is a broad range of participants in this exercise, emergency and health related personnel from the following areas are being invited. Public Health EMS Coordinator Hospital EOC Coordinator Fire Department Officials Mental Health Law enforcement Officials School District Officials We look forward to seeing you. If you have questions please contact Lisa McKenzie at 385-9422 or Julia Danskin at 385-9420. Sincerely, Tom Locke, MD, MPH Health Officer COMMUNITY HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 Board of Health Media Report January 17, 2002 Jefferson County Health and Human Services DECEMBER 2001~ JANUARY 2002 NEWS ARTICLES These issues and more are brought to you every month as a collection of news stories regarding Jefferson County Health and Human Services and its program for the public: 1. "County fees increase Dec. 24", P.T. LEADER, December 12,2001 2. "Bioterror attack could strain state", Peninsula Daily News, December 16,2001 3. "Meth lab uncovered by deputies", Peninsula Daily News, December 18, 2001 4. "Poverty rates vary: Jefferson in decline, Clallam numbers rise", Peninsula Daily News, December 20,2001 5. "County budget plan increases health fees", P.T. LEADER, December 24,2001 6. "Jefferson taps fund reserves", Peninsula Daily News, December 28,2001 7. "County fee increases frozen", P.T. LEADER, December 31,2001 8. "County balances budget by cutting staff', P.T. LEADER, December 31, 2001 9. "Taxing districts not levying $1.1 million for 2002", P.T. LEADER, December 31, 2001 10. "Propane tanks dislodge: Duckabush homes evacuated as river overflows its banks", Peninsula Daily News, January 9, 2002 11. "County health clinic in Hadlock closes", P.T. LEADER, January 9, 2002 County fees . mcrease Dec. 24 Fee increases are a key component to balancing the Jefferson County budget for 2002. Fees charged for services offered by the county's envi- ronmental health department and building and permit cen- ter are due to increase in 2002, some dramatically. As County Administrator Charles Saddler explained, "We are trying to change the focus of our pro- grams associated with devel- opment to be fee-driven" rather than funded through property taxes. "It's a majðr change in policy," he said. These fees, for services such as septic permits and building permits. were last re- vised in 1999. Saddler said the proposed changes bring the county into the "middle of the pack" for other counties that charge the same fees. Before, Jefferson County had been at the lower e~ of the cost spec- trum. Both the environmental health division and the depart- ment of community develop- ment are being challenged to fund 75 percent of their ad- ministrative costs from fees rather than the general fund. Fees charged by the county's animal services pro- gram are also slated to in- crease, and the 50 percent senior citizen discount on Ii" cense fees is proposed to be rescinded. A public hearing to take comment on the amended fee schedule,is ,set. for I 0;05 a.m.' Monday"Dec. 24 in, the com-, missioners' chambers at the Jefferson County Courthouse. The lengthy legal notice be- ginning on page C8 of this is- sue lists all the proposed fee changes by category. After taking action on the -fee schedule Dec. 24, the com- missioners are expected to adopt the 2002 budget, which calls for general fund expen- ditures of $12.3 million. I ,p T L f"A-b6-r¿ !:l-{d-..-Ò I ì \ 1 Bioterror attack could strain state THE AssocIATED PRESS OLYMPIA - Washington hospitals and laboratories would have trouble handling the strain if the state were to come under a sustained bioter- rorism attack, a Health Department official has told a legislative committee. . The attacks would have to be of a wider scale than the recent anthrax threat on the East Coast, Assistant Health Secretary Jac Davies said. But if such an attack were to occur, whether from anthrax or some other chemi- cal or biological threat, Davies said hospitals would have diffi- culty keeping up with the 1 DJ 1:2--1 b ~o { patient load, and laboratories in the state might not have the resources to perform proper testing. 80 envelopes tested Since anthrax was first dis- covered in mail on the East Coast, the state Department of Health has tested nearly 80 suspicious envelopes and pack- ages, turning up no actual threats so far. "We've handled the work- load," Davies said at a hearing of the House State Govern- ment Committee earlier this month. "But if we had a real event - that would expose some real needs." Even as Washington and the West Coast have so far avoided the problems on the other side of the countFY, Davies said, the heavy news coverage has stirred up con- cerns here, already placing a burden on the state Health Department even in the absence of actual attacks. "We often don't have enough people to answer our phones," Davies said. \"There are a lot of public concerns out there." , Health Department needs Davies outlined these needs that the Health Department is requesting to improve bioter- rorism detection and response: . Training for health offi- cials and providers in recog- nizing and responding to potential bioterrorism d.isease agents. . Implementation of a sys- tem of rapid electronic report- ing and communications that would allow the Health Department to quickly coordi- nate its response with public health and law enforcement officials statewide. . Development of a system that would seek out patterns of symptoms and diagnosed diseases. . Expansion of the emer- gency capacity capabilities of local and state health agen- cies, labs and-hospitals. 3 Lab: Two arrests Meth lab uncovered by deputies CONTINUED FROM Al District Court Judge Mark Ruth ordered the husband held on a cash bail while he allowed a bond or cash for the wife during their initial appearance Monday. Sheriffs deputies discov- ered nearly one ounce of what appeared to be meth, along with chemicals used to manu- facture the illegal drug, during their investigation of a domes- tic violence complaint, a report said. Chief Criminal Deputy Bob Anderson said Deputy Brian Post respond,ed to a complaint Saturday. afternoon by Phillip Maki Sr. that Rosanne Maki had threatened him with a handgun. Maki Jr. claimed that his wife had pointed a gun-shaped cigarette lighter at her father- in-law, according to an inci- dent report. But when he went to get the lighter against Post's instructions, Post fol- ... lowed him into the house at 37 Sea Rome Road. Surveillance cameras The deputy said he noticed surveillance cameras aimed at the driveway. Maki Jr. allegedly thrust his hands quickly into his pocket, alarm- ing Post, who grabbed him and searched him. That search discovered a residue-stained cocaine or methamphetamine pipe. Maki Jr. led Post into another room where the deputy found addi- tional pipes for smoking pow- BY PHILIP L. WATNESS PENINSULA DAILY NEWS PORT TOWNSEND - A domestic violence complaint led to the discovery of a methamphetamine lab on the Coyle Peninsula, Jefferson County sheriff's deputies reported Monday. Iz:vestigators said Phillip Maki Jr., 40, and his wife ~o~anne, 39, were being held In h?u of ~IO,OOO bail for pos- seSSlOn wIth intent to distrib- ute the potent drug. TuRN TO LAB/A2 ~D J ,;}.. -I f-D t der or marijuana. Post and Sgt. Rick Smith then'secured a search warrant from Ruth, leading to the dis- covery of several propane tanks apparently filled with anhydrous ammonia and other ingredients used in making methamphetamine. The Washington State Patrol's Statewide Incident Response Team was at the house Monday, removing the toxic chemicals while Detec- tive Dave Miller continued the Sheriffs. Office's investiga- tion. "We think there's more methamphetamine out there somewhere," Anderson said. "It looked to be a significant lab, especially because of. the amount of precursor chemi- cals. "We won't knów until later just how big this operation was." Anderson said the lab was inactive at the time of the arrest Saturday. " THURSDAY, DECEMBER 20, 2001 AS Poverty rates vary Jefferson in decline, Clallam numbers rise PENINSULA DAlLY NEWS AND THE AssOCIATED PRESS New Census 2000 figures show that the poverty rate has increased in Clallam County, and decreased in Jefferson County, since 1989. The figures show 7,832 res- idents live in poverty in Clal- lam County. That's 6 percent more than in 1989., A family of four is said to be living in poverty by Census standards if its annual income is $17,650 or less. Clallam County is one of 10 counties in Washington state where poverty rates have remained flat or continued to climb during the last decade. The other nine are Thurston, Klickitat, Cowlitz, Kitsap, Island, Adams, Garfield, Ferry and Lincoln. In neighboring Jefferson County, poverty is on the decline. Census figures show 3,071 residents - 9 percent fewer than in 1989 - are living in poverty in Jefferson County. Statewide poverty Statewide, poverty rates fell by 10 percent during the 1990s, according to the Census figures, which were released Wednesday. Douglas, Kittitas and Yakima counties saw the At a glance . THE AssOCIATED PRESS Poverty rates declined in most Washington counties from 1989 to 1998, accord- . ing to Census estimates. County name, followed by number of people living in poverty, followed by per- cent change in poverty rate from 1989 to 1998: AdarT\SCounty: 2,464,3% Asotin County: 3,202', -14% Bènton County: 13,547, -6% ÇhelanCounty: ß,3a?, -13% Clall¡sm County: 7,832, 6% Clsl'kCounty: 29,703, -8% COlumbia County: 546, -11% Cowjitz County: 11 ,755, 1 % Qou9!as County: 3,421, -35% ... Ferry.County: 1,385, 9% Franklin County: 8,145,-18% Garfield County: 245, 7% Grant County: 1O,ß10,~9% Grays. Harbor County: 10,819, - 1% Island Coun'ly: 5,510, 1% . . Jefferson County: 3,071, -9"/Ó King County: 126,999, -5% Kitsap County: 20,322, 1% Kittitas County: 3,998, ·24% Klickitat County: 2,934, 0% Lewis County: 9,658. -9% Lincoln County: 1,216,18% Mason County: 5,810, ·8% Okanogan County: 7,543, -12% Pacific County: 3,227, ·1% Pend Oreille County: 2,111, -12% Pierce County: 69,007, -13% San Juan County: 1,018, -6% Skagit County: 11,065, ·13% Skamania County: 968, ·17% Snohomish County: 39,479, -10% Spokane County: 49,591, ·11% Stevens County: 6,133, -11% Thurston County: 18,005, 0% Wahkiakum County: 400, -14% Walla Walla County: 6,829, -17% Washington: 569.83), -10% Whatcom County: 17,460, -13% Whitman County: 4.749, -13% Yakima County: 39,617, -23% Source: U.S. Census Buråau C lallam County is one of 10 counties in Washington state where poverty rates have remained flat or continued to climb during the last decade. biggest declines. But statewide poverty fig- ures could be changing - since January, 38,000 jobs have been lost. Most counties made strides in reducing poverty rates dur· ing good economic times. The Associated Press looked at poverty rates from 1989 to 1998, the most recent figures available. In 1998 there were 569,830 people living in poverty in Washington state, 10 percent of the population. Child poverty rates fell 18 percent from 1989 to 1998 in Washington. Child poverty decreased in all but four counties: Lincoln, Island, King and Whitman. Statewide in 1998, there were 206,558 children living in poverty, 14 percent of the pop- ulation under 18. The federal poverty level in . 1998 was $16,450 for a family· of four. Now it's $17,650. A 2 · Monday, December 24, 2001 s- County budget plan increases health fees No one at the Jefferson County Courthouse was thrilled about the idea of conducting important government business on Christmas Eve, but the pace of the county's drawn-out bud- get process left the elected offi- cials with no choice. So on Monday morning, Dec. 24, the Board of County Commissioners meets in its regular chambers at 10:05 a.m. to hold a public hearing on in- creasing certain fees for county services. The board is scheduled to discuss the 2002 budget - which is predicated upon those fee revenues - at 10:45 a.m. Both the fee increases and the budget could be adopted before noon, which is when the court- house is scheduled to close for the Christmas holidays. The fees charged by the en- vironmental health division of Health and Human Services, the Department of Communi ty De- velopment, and Animal Ser- vices are proposed to increase by as much as 50 percent in an effort to wean these departments from relying'on general fund revenues. The public hearing will give county residents an opportunity to voice their opin- ions on this policy change. The $38 million proposed county budget, of which $12 million is housed in the general fund, was balanced in part by program and staffing.cuts and reductions in Health and Hwnan Services. Programs for maternal child health, family planning and. inoculations are on the chopping block. If decisions about adoption of either the fees or the budget can- not be reached Monday, the top- ics could be held over until the next Monday - New Year's Eve. ... .. ~.- 4' ;. .~. { ~ ~. .' . '.,1,: December 28-29, 2001 Jefferson taps fund reserves By PHILIP L. WATNESS PENINSULA DAILY NEWS PORT TOWN- SEND - The Jeffer- son County Sheriffs Office will have one less patrol deputy next year following the approval Thurs- day of the Jefferson County budget. Jefferson County commissioners carved away here and there to make up for an estimated $300,000 deficit in the $38 million fiscal 2002 budget. They decided to draw $171,870 from the fund balance - a county reserve fund - to make up most of the deficit. But they also cut the patroJ posi. tion as well as several other county jobs to make up for expected revenue shortfalls. The Juvenile Services and HeaJth and Human Services departments each lost one position - in addition to a two-person cutback previously included in the budget. j;'~J"ö~¡~~!1;)';" . Juvenile serVlces expects hard budget hits/AS Workloads affected Sheriff Pete Piccini and Juvenile Services Director Barb Johnson each said the cuts will have an effect on their departments' workloads, but not enough to cause concern. "I fully expected that to happen," Piccini said. "We worked hard to try to keep that person, but I feel good we lost one instead of two. "The biggest impact it will have is we won't be able to man a south county annex as we wanted to do." Johnson said the support staff position she lost hadn't been filled since September, so it was a palat- able cut. TURN TO BUDGET/A2 . - '- -..-- -".. -- .. . 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"0 B u ó ;jOS::~ OS::s::C(.O '-' "0 Q);> <.,::; (1._ (1 $ ~I...c<l) Eo)è~15 êê.....s <lJS::o...c .- ¡:; ~ .:-: C·- en ~ a S Q) ~ 0 s::.:; ;>:2 ~ 8:: ~ .~ a ~ È g "'.......- ...c o <lJs::..... s.....,~OJrJJ III "O-5a Sc C - Q) ....... 'õ .9:!.- rJJ "C :9.5 @ r.2 8 0. ~ S æ ~ U rn E g-o:: 2 <.:. U Q)Q)o..CfJ <lJQ)<lJ :J "Ö~o"" .OQ)"o...c o bD- C "0...., ti.. ....,. - s::Q)Q) (1 0 "0 c: >...... Ii'; E OJ "'0 I-. ..., ...., () :J Q)~Qt .~<lJ1S"o§~ 1II...cQ) ",bDç:"'OEl-oo<lJ Q) E-< I-. >. c..:: .......·û (l) '" E t; Q) U.~(l)Q) QJ 0 c: IJ.. .5 C:"O.D "'0 E co "'._ ~ nI - County fee increases frozen Fee review advisory board appointed, meets Jan. 3 from $1.722 to $2,299. This IS an increase of one-half of I percent in the 10lal cost of the home. Gene Seton complained. "The development industry is the only thing raising taxes in this county," so why would you eliminate public tax subsidies for it? Commissioner Huntingford 'said he.disagreed with the policy supported by Tinemess and Wojt. which is to have fees cover the entire cost of the service. "If we charge for fees and collect taxes. what am I gelling for my taxes?" Huntingford asked. He later told the Leader. ''1'11 support a fee increase, but not that much." Some speakers expressed concern that higher fees will re- sult in lower compliance with the county's regulations. "It's just going to force more people not to get permits," said Bill Marlow. "And you'll defeat the very pur- pose you're trying to accom· plish," added Pat Rodgers. In the end, the board voted 2- I to delay adoption of the fee schedule. with Wojt opposed. If the county eventua-lly adopts fees similar to those in the original proposal. as Tinemess p~icU¡ il;wilLlefferson Coun!)' will move from "the bonom of the middle of the pack" to the top of the middle in relation to what similar jurisdictions charge for similar fees. "For the most part I believe that the comminee will generally concur that staff has done a good job." said Tinemess. He added, "If they come to the same con- clusion we did, which I think for· the most part they will, we can move forward with most of this fee schedule as drafted." By Shelly Testerman Leader Staff Writer Perhaps Chris King of Chimacum put it best when he complained to the county com- missioners that increased county fees could negatively affect his quality of life as a resident and business owner in Jefferson County: "Every time you upsize, we downsize:' he said. "That's not my picture of government. and I hope it's not yours." Mark Grant of Middlepoint likened the "J Ith hour" fee in- creases to the commissioners' rush to adopt the Unified Devel- opment Code at the end of 2000. "Don't ram an ill-advised fee in- crease on Christmas Eve," added Allen Frank, an outgoing Port Townsend city councilor. It was stiff resistance from at- tendees such as these at a public heanng the morning of Dec. 24 Ihat prompted the Jefferson County commissioners to delay ¡he adoption of fee increases that were expected to generate $240,000 in revenue in 2002. The resultant hole in the county budget has been filled by cuning unfilled staff posi- I ions (see related story. this page) and spending ex.cess cash. from reserves. And in an unprecedented move, an ad hoc committee has been appointed to review the pro- posed fee increases. The nine- member committee is first scheduled to meetJ an. 3, is slated to make a recommendation to the commissioners by the end of the month, and then is expected to disband. The elected officials are expected to adopt some fonn of fee increases within a 3D-day window dating from Dec. 27. New committee Fees for services provided by the county departments of Com- munity Development. Environ- mental Health. and Animal Services - such as building per- mits, onsite septic inspections and dog licenses - were proposed 10 increase to the point where each fee covered J 00 percent of the costs of providing the service and 75 percent of the adminis- trative costs associated with the service. In the past, fees have covered aboUI 50 percent of the service costs and none of the associated administrative costs. The heads of these departments were di- rected by the board to suggest appropriate fee increases. The comminee appointed to review the proposed fee sched- ule is bound 10 honor this new county policy of the proponent paying the full costs of devel- opment and environmental re- view. The commiuee's task is not to question the underlying philosophy behind these fees, but to study the methodology that county staff used to recom- mend the higher fees and to report on the impact these i~- creased fees may have on the users. The following committee members were appointed by the board last Thursday, foregoing advertisement of the volunteer positions. Each commissioner appointed three people from his own district. with Dan Tinemess (District I) appointing Ann Avary, Aldryth O'Hara and Sheila Westerman. Glen Huntingford (District 2) named Phil Flynn, Mark Grant and Judi Morris. The District 3 represen- tatives appointed by Richard Wojt are ~ill Leaviu, Susan Miller and David Sullivan. The committee includes the director of the Economic Devel- opment Council of Jefferson County. a certified--'þublic ac- countant. it genera1.contr.actor, an. excavating contractor. a nurse- and the elected county treasurer. Christmas Eve complaints About IS people attended the Dec. 24 hearing, as did IS staff. Eighteen written comments from the public were received as well, many chastising the commission- ers for scheduling a public hear- ing on Christmas Eve. The commissionets didn't receive much specific feedback on the proposed fee increases. 1~-3/-()1 "The development industry is the only thing raising taxes in this county;': so why would you eliminate public tax subsidies for it? Gene Seton developer Spoken comments ranged from suggestions to balance the bud- get by paying'county employ- ees minimum wage, to "destroying" ~.e Port Townsend city charter so that one of the two governments serving the county's small population could be eliminated. to levying a "$5 access fee" for the privilege of voting in an election. One anendu opined that. the., cOllnty's "budget woes" would·- be solved ifWaI·Mart and Costeo were "allowed" to open stores in the county. ("For the record," Comrnis.siQßer Tinerness assured the speaker. "We're wQrking very hard to make that possible.") To put the proposed in- creases in perspective. County Administrator Charles Saddler said the development fees paid to the county by the builder of a $100,000 single-family home would increase by one-third. .., Q:¡ " .. ., ....J ~ rfJ. 0Jj .s ~ ü ~ .,.D ~ 0) ~ ] rJj (j) ü ª 'cd .,.D Ò § o U C ::J o U c ~ i ~ -g ., ~ ~ t:: o 0. o o '" M Q:¡ .0 E '" v '" o ~ :51 ~ i' '00"01:' 0."0·-..<:::......6 6 :¡¡ ..c:: ¡:: ¡;¡ ~ vó u ª,'~ ~'':;::<;;: "0 ... ::I ¡:¡. <'I ::I .5..c:: '" "0 ¡:::> . OJ) o 4-<"0'" :g::l;>"O~. ..0 C "0. -...... e Vol ::: .. .. 0 v.t... - 0 0 \0 C'1 0·.... 0 . . "0 .~ 0 o '':;: ~ ~ <'I. C'1.';:I e·';:: ~ 53 ~.';:: "0 Õ ~ -S g. 0 00 00 æ '':;: ~ » '" ..c:: 0 '" OJ) 0 ..<:::"Oo¡:¡.r--<'IC..<::: C "0 "0_ :<;;"'..c::K~M::Ia~~¡::~~]~~ ~0-~~""'~J::¡8 0 '" i3 '" -S C C M :: ~ IE'S 0 » ~..c:: .'" 0 È i3 --: ~ ~ ~ ~ ~ 0 ~ 9 :-'oc: -S .2.0 ~ g¡ ~~r--::IE"OoIl)S~~_o"'~..c:: Q ::s N u 0 ß > .-' V)::J::J (I') ~ _ ~ . 0.. . II) "0 -;:;¡ ~ II) C';:: .... ~ . 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U-:Ucc<:;1~ 1I)0ê.:::~n¡]§i70~~ ~ u ~ ....; c5 Õ ~ 0 -5 ~'v ~ § Q 0 1k C ;> .- !ä 0 ë ¡j I v.: C'-""0 0"'0 Q) V'JO"" .¡: ::;¡ § ::;¡ I '" ~ ~ I ::::;¡ ..t:: c .t:) ~..c It) > ..c '- iU VUr--:N ~ v: tJ~ 5 ~3: >. ~ c N 8 5 t .5 x "= 0 ~ ~ 3§~N~gE~~~6'~ .:: ~ ~ .š "§ .~ ~ ~ ~ « 0--5 J¿ ..ês gË 8. 8. 8 ~s ? local taxes not being levied 2002 2002 2002 Maximum Amount Amount Levied Per Amount of Savings To Taxing District Which Could Be Levied Budgets/Resolutions Taxpayers (Banked CapacIty) County General Levy $5,313,650 $4,815,050 $498,600 County Roads $2,952,150 $2,725,150 $227,000 Conservation Futures $158,150 $153,000 $5,150 County (sub)Total $8,423,950 $7,693,200 $730,750 Port of Port Townsend $649,000 $635,150 $13,850 Public Utility District $434,500 $380,6.50 , ~,850 .. City of Port Townsend $1 ,546,075 . $1,366,975 $179,100 JCRLD (Library District) $926,250 $806,250 $120,000 Grand Total $11,979,775 $10,882,225 $1,097,550 Source: Jefferson County assessOr Taxing districts not levying $1.1 million for 2002 When all the taxiIig districts in Jefferson County had submit- ted their 2002 property tax levy amounts, county Assessor Jack Westerman III did some simple math. He discovered that the various elected officials had left untouched more than one million dollars which they could have levied on their taxpayers: $1,097,581, to be exact. . "That's not $1.097,581 in value,') Westerman emphasized. "It's $1,097,581 in taxes. That's a substantial amount in a county our size." The $1.1 million figure rep- resents the "banked capacity" of Jefferson County, the City of Port Townsend, the Port of Port Townsend, Public Utility District No.1, and the Jefferson County Rural Library District. "That's like a prè-Pebruary Christmas " present. Jack Westerman III Jefferson County assessor That represents a $110 "sav- ings" for each of the estimated 10,000 property owners in the county. "That's like sort of a pre-Feb- ruary Christmas present," said Westerman, noting that tax state- ments go out Feb. 14. In his position as county as- sessor, Westerman has gathered that Tim Eyman's statewide ini- tiatives are the main reason local taxing districts have limited their tax levy amounts. "Even though up until now they [the initiatives] have all . been unconstitutional, as elected· officials they feel there's a mes- , sage that the people are giving 'them: 'We'd really like you to control property taxes,'" Westerman related. Now Initiative 747, which passed convincingly statewide and in Jefferson County, has so- lidified that stand. It limits tax- . ing districts to 1 percent annual increases or the rate of inflation, . whichever is less, without hav- . ing to seek voter approval. 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'~:'.~ ;'", "t~ ¡~"l··\·. t hfOl '; it,~ .. . '.1 . '~ :r~~' . . .~, . . r' . ':,. ;" t,,)~ \ ..; )tp {It! 1 \ ". . .1'.. . / \ ~y-+. "*f (~\"LV \( i, :'. / 'I.~'_'_',~q\ ',. ;., ,- t.· ",;}..; '.. ~., (. ,.' - "I!. I¡o .\. ; ~,H .... " '~""" ~,~, """"'j ,.}..¡.,' . . !¡' ': t,' .;;.'.:( '~.f . )p' 'à 'Yo. 1\"7'~ '~ J Î ". ' .., ,: , /t: ~ ¡ , .~. \. ',I" I, " :"! ~~.:~;: ,;; . .:t~ ' /-1..... ~:) i. ¡ ',~" Pili ' .., ~:~;;;~ :\~~:;:,; ;~; , / ..:- \\~ï!'f~. . S:1.. '.\,.' \, l'1'? :~,''\ ,,.,:\..... '.. j , ¡i E '. z i~ i ! J ~ . - """. i I. ;.,;..... .-~ ~~I -.-. ..-....-. -.....,. ::..~ January 9, 2002 Propane tanks dislodge Duckabush homes evacuated as river overflows its banks BY STUART ELLIO'lT PENIN81JLA DAILY NEWS The cumulative effect of warm rain IUJ melted snow led 'to evacuationa and road cl, eurea in south Jeffenon County on Tueaday. Homea were evacuated after the Duckabw River near Brinnon overflowed, popping ope large propane tanks. US. Highway 101 near Lilliwaup re~ain! cloeed for a second day following s slide c Monday. . Transportation officials are now saymg tl highway could be closed for up to a week. The problems were partly the result of se· eraI days of warm weather and ~ abundan, of rain, which caused snow and Ice to mel~ : the mountains and send water down trib, tariea. South of Brinnon, a haIf-dozen homea ne. the Duckabush River were evacuated Tuesdl morning after the - river overflowed ar knocked loose five propane tanks. TuRN TO FLooD!} If) " County health clinic in Hadlock closes Due to Jefferson County budget reductions, Jefferson County Health and Human Ser- vices is cutting back some ser- vices, effective January 2002. Flu clinics in local commu- nities will be eliminated, the Port Hadlock Family Planning Clinic is closing, and Family Planning hours in Port Townsend will be reduced. Im- munization hours in Port Townsend will be Tuesday and Thursday afternoons only, and WIC will be offered one less day a week. Family Planning Services will continue to be offered at 'If L£A1)6K 1-'1-02- Jefferson County Health and Human Services (JCHHS) in Port Townsend, next to QFC. The Family Planning clinic in Quilcene will continue every Wednesday, 12:30-4:30 p.m. on Roger Street, next to the South County Clinic. Emer- gency contraception is available at both the Port Townsend and Quilcene clinics. You may also call the Port Townsend Clinic at 385-9400 or 1-800-831-2678 Monday-Friday, 9 a.m.~4:30 p.m., to obtain emergency con- traception information. JCHHS and the Washington State Department of Social and Health Services thank indi- viduals and organizations that have supported the Port Hadlock clinic for the last five years. It also thanks the Leader for the donated clinic space in Kivley Center; the Oak Bay Clinic' for loaning equipment; the physicians of Olympic Pri- mary Care, who shared their office space at Kivley Center when JCHHS first had a satel- lite office; the Tri-Area Cham- ber of Commerce, which graciously shared its space; and the Tri-Area residonts who em- braced this clinic and made it their own. H Q. ...., (~ 0 v.:.+ . Next Steps Jefferson Access Project December 15, 2001 The Jefferson Health Access Summit produced a variety of ideas for ways to improve access to health care in East Jefferson County. Since then, the economy has taken a serious downturn. The 2002 state legislative session will be dealing with an estimated $1.2 billion deficit. Most state agencies have been directed by the governor to propose budgets with 15% reductions. This translates into severe cuts to the Medicaid and other state health programs. These cuts, coupled with Medicare reductions and increasing costs for health insurance, will result in worsening local access problems and more financial instability for health care providers. A new Washington Health Foundation mini-grant has been received by Jefferson General Hospital to continue access work in Jefferson County. The goals of this grant are to: . Identify next steps for the project - short and long term · Clarify the roles of each board as well as joint areas of focus relative to access projects · Prepare a concept paper for staffing the Jefferson Access project · Prepare a comprehensive grant proposal to fund activities over a 1-2 year period · Convene a gathering to inform the community of activities. Next Steps Product. I think there are three separate but related work activities: 1. A project exploring alternative insurance arrangements using high deductible plan coupled with a community basic health component. (Jefferson Passport Project) 2. A project to discuss and seek consensus on what constitutes critical or essential health services. (Civic Engagement in Health Project) 3. Establishment of a community based-access project coordination function. (Jefferson Access Project) Process. The decision-making process to affirm or modify these ideas and then implement them needs to be planned and agreed to. I'd like to propose the following: · Draft a more detailed paper describing next steps. · Meet separately with Commissioners and Board of Health to propose plan and potential organizational roles. · Modify products or process based on discussions with boards. · Bring proposal to Joint Boards and discuss roles of each organization. · Initiate work (detail depending on discussion). This is the phase where I think we could use the expertise of the Work Group to refine ideas and give reality check on practicality and acceptability. · Plan Spring Summit. Jefferson Passport Project and Civic Engagement in Health Project Goal: To design and implement an alternative mechanism to provide affordable health coverage for small employers and individual residents in East Jefferson County. There are a number of "new" approaches to explore this type of coverage but most will only work with a favorable risk group (younger, healthier people). These approaches involve using a stop loss or catastrophic plans and structuring the cost of services below the stop loss threshold in a variety of ways. The Jefferson Passport Project would likely also employ a cç¡tastrophic plan but would focus on using a community-based/community owned local health system to provide "basic services" and structure financing in a way that will support maximum access and stability. The Jefferson Passport Project might begin with a limited set of services (i.e. those provided directly by the hospital or health department) but could expand over time. This project will require resources to 1) research what type of coverage people want and how much they will pay 2) determine a financial structure that will be sustainable 3) figure out the relationship with catastrophic coverage 4) research and negotiate legal or regulatory obstacles 5) determine basic policies or structure that will fairly facilitate access but provide adequate incentives to prevent unintended financial problems for the local health system and residents. A variety of entities would be very interested in helping with this type of project (Governor's Office, Office of the Insurance Commissioner, Business). Key to this concept is engaging the community in a dialogue about what are the basic priorities for health care (Civic Engagement in Health Project). Because most people think of health coverage as benefits based insurance and most with employer sponsored insurance don't understand the costs (and how they are escalating), there needs to be a community campaign to educate people and engage them in a dialogue about what is most important (assuming we can't afford everything for everyone). Several projects are underway including the Washington Health Foundation support for a Human Links project and Washington State Board of Health "Access to Critical Health Services". In fact the conference theme for the 2001 Washington Health Legislative Conference was "Civic Engagement". Finally, there needs to be a community "access point person" someone to coordinate and document this work, look for additional opportunities, provide two- way communication (both to Jefferson partners and others interested state-wide), and just be accountable for keeping the ball rolling. ~ I ~sr 00: \:; v )- /~ rj+~ ¡~-J '::t -r ~ ~i0 m£f De...h ~ tQ &. v-<:i,'·K CO v-e' ~ b~ ) cC{-hch.-of>~ìL P{ct V\ e ?:tJ~óoo cf2.¡¡>d.~c+? ..- ~ (" aJeS~hlc.. pre. ~ r::tzy 5 c VV'O.. '-1 VtGt vo-( Co (.2^ y 'S (o1k v co:::rJ. "S he¡ ~ DV ~4-) ----·-·-1-------------- - .... -Ij~ o t.s <-f: )--8 Y ~ e ~ !J' ý)' r_ ~ ' '"d ~it1"1~1~ ~ I) ~ \I ~cp '"'~ ~ -t ~ V\ S ~ 1f ~/~_ ~~ 77 :iJS' ()(:)O J 7-;> JPc1 w..-h 'd--e -. ~".~.._--_.. ,,--j<2~-k v5~ PetS5 Pov-I- pC\.. Lf S UI~ '- \1 '- ( I:Y'CL"S cC-. s..cVÙlLe....-S tZ.ù~~[C1.þ'-< è'Y\. 2:. Jc..-+-H v6~ ) I WV\.""(cM- $-C v¡)',ú5 ~éO(.l-('vøl u~v ea...d-..- block ~ . ~ -\-0 VhCL V ~\'"Zé -+'u vJ: ~ ( M.eð-'(cCA ~J. I f3 f-f .eV\vûl\~- PVOJ~(:i j I ~ -tc> s-Jvú ck Lé: Y'¿lCv--h'01-'S AJp 'S' % \ 01 óc- L s ~. PD ('(2 (\..f:! I :52ù ~ -I- Cl [ I 6:) wk:: s )t a. y,J) () q.Á :/" j Ïk~Tih News Release For Immediate Release: January 17, 2002 Contacts: Jack Lilja, Local Health Support Donn Moyer, Communications Office (02-09) 360-236-3366 360-236-4076 West Nile virus surveillance fmds mosquito species not previously identified in western United States OLYMPIA - A West Nile virus (WNV) surveillance project in Washington has identified a mosquito species in King County previously not found in the western United States. The newly discovered Asian mosquito is known as Ochlerotatus japonicus japonicus. In the U.S., it has not previously been found west of the Mississippi River. This species is difficult to control because it deposits eggs in small containers such as tires, discarded bottles and cans, and other areas where water may collect. It is a daytime biter rather than a morning or evening biter and therefore harder to avoid. The Department ofHea1th recently completed its first full year ofWNV surveillance activiti~ under a grant from the federal Centers for Disease Control and Prevention. WNV, which is carried by mosquitoes and can cause encephalitis in humans and horses, has been spreading westward since it first appeared in New York in 1999. In 2001,47 human cases ofWNV encephalitis occurred in eight eastern states resulting in four deaths. The virus has been detected as far west as Iowa and some experts believe it could be seen in western states in a year or two. The surveillance project aims to identifY mosquito species in the state that can transmit the virus, monitor for the virus in dead birds, and investigate possible cases in horses and humans. "A good statewide surveillance system for West Ntle virus is essential to effective prevention and control," according to State Health Officer, Dr. Maxine Hayes. "Washington residents play an important role by eliminating mosquito habitat on property and taking steps to avoid bites." Twelve Washington counties participated in the surveillance project. The report is available on the Internet at http://www.doh.wa,gov/Publicat/2002 news/WestNileVirusSurv.pdf -More- West Nile virus surveillance January 17, 2002 Page 2 Mosquitoes breed in almost any body of water. Small containers such as tires or cans are favorite breeding sites as well as lakes and marshes. There are several things residents can do to help reduce mosquito-breeding sites: · Properly disposing of tin cans and other water-holding containers · Removing discarded tires ITom your property · Keeping rain gutters clean and operable · Turning over plastic wading pools, wheelbarrows, etc. · Changing water in birdbaths weekly · Eliminating any stagnant water on your property It is also important to protect yourself ITom mosquito bites by having properly screened doors and windows, staying indoors when mosquitoes are active, wearing protective clothing such as long- sleeved shirts, and using mosquito repellents when you are in active mosquito areas. In 2002, the agency will focus in part on determining the geographic distribution of this new _ mosquito species in Washington. The surveillance program also detected other potential mosquito carriers ofWNV in eight counties, and carriers of west em equine encephalitis (WEE) and St. Louis encephalitis (SLE) in nine of 12 participating counties. WEE and SLE have occurred previously in Washington in horses and humans and the mosquitoes that carry them are thought to be widespread throughout the state. The collection and analysis of dead birds that are susceptible to WNV have also begun. Birds become infected with the virus when bitten by mosquitoes. Crows, jays, ravens, and magpies are particularly good species for use in detecting the presence ofWNV in a community. No birds have tested positive for WNV in Washington. This effort, being coordinated through local health departments, will be expanded substantially in 2002. Editor's note: For specific information about West Nile virus survei1Jance findings in King County, please contact James Apa, Public Health - Seattle and King County, 206-205-5442. ### ~ f'.hb.\)J-S ~ C([ BC Centre for Disease Control NEWS RELEASE Invasive Group A Streptococcus Infection in British Columbia VANCOUVER - January 15,2001 The purpose of this report is to summarize information on the occurrence of invasive group A streptococcal disease in British Columbia for 2001 and 2002, to-date. The implications of apparent increases in the rate of disease are discussed. Descriptive Epidemiology Summary for 2001 and 2002 (to 14 January 2002) · Ninety-seven laboratory-confirmed cases of invasive group A streptococcal (iGAS) infection were reported in British Columbia during 2001. · This is an 82% increase above the historic average number of reported cases reported since 1998 (the first complete year of routine provincial surveillance of iGAS) and represents a crude incidence rate of 2.5 per 100,000 population per year. · Almost two thirds of iGAS cases (62 of 96 with age reported) in 2001 occurred in adults 20 to 64 years of age. However, the highest rates of iGAS were reported in seniors 65 years and older (3.5 per 100,000), and preschool children 0-4 years of age (2.8 per 100,000). · Four further cases of iGAS have been reported in 2002 up to 14 January 2002, and with enhanced surveillance, public health may be notified of previously unreported cases. · Eighty-one per cent of reported cases for 2001 were from 7 of the 15 health service delivery areas across the province: Vancouver (21 cases); South Fraser and Capital (16 cases each); Simon Fraser (14 cases); Thompson (l cases); and Northern Interior (6 cases). · A significant change in geographic distribution of reported cases of iGAS in 2001 compared with the previous 3 years, was the relative decrease in proportion of total cases reported from South Fraser, falling from a historic 32%, to 16%. The highest regional crude incidence rates during 2001 occurred in: Capital and Thompson (each 5.1 per 100,000); Northern Interior (4.5 per 100,000); South Fraser Valley (2.9 per 100,000); Vancouver (2.8 per 100,000) and Simon Fraser (2.7 per 100,000) · Eight deaths associated with iGAS infection were reported in 2001, resulting in a case fatality rate of 8.2%. Seven of 8 deaths involved males, with an range of 31 to 90 years of age (mean 57 years old). Three of the deaths were associated with necrotizing fasciitis (NF, or flesh-eating disease), 2 with pneumonia, 2 with septicemia and one other. · The case fatality rate for necrotizing fasciitis (NF) in 2001 was actually lower than in some previous years in BC: 30% in 1998; 15% in 1999; and, 22% in 2000. · Twenty-one cases ofNF were reported in 2001, comprising 22% of all iGAS cases. The proportion of all iGAS represented by NF in 2001 was the same as the historic average proportion since 1998. A research and tasching centre affiliatad with UBC 655 West 12111 Avenue Vancouver, British Columbia Canada V5Z 4R4 Page 1 of 3 Tel 604 660.2040 Fax 604 660-6066 www.beede.org CI( · BC Centre for Disease Control The crude incidence rate for NF in 2001 was 5.4 per million, which is 86% above the average rate of 2.9 per million over the previous 3 years. Since 1998, a trend of increasing incidence rate of reported NF has been observed in BC, rising from a baseline rate of 1.0 per million in 1998. Three deaths associated with NF in 2001 correspond to a case fatality rate for NF of 14%. · The overall increase in provincial incidence of NF is largely attributed to a substantial increase in cases of iGAS from Vancouver Island., particularly during late 2001. From September 2001 to 14 January 2002, there have been 20 cases of iGAS reported from Vancouver Island, reflecting a notable temporal clustering of cases from this area. From November to present, cases of iGAS reported from Vancouver Island have comprised over half of all cases province-wide during this period. Eight of 21 (38%) of cases of NF in BC during 2001 were reported from Vancouver Island between September to December 2001, representing a rate of NF from Vancouver Island of 11.3 per million over this time, almost 3 times higher than the crude incidence rate for the rest of the province in 2001 (3.9 per million). · · · Serotype M1 was the most common serotype of group A streptococcus associated with iGAS in BC during 2001. Where serotype data are available, the M1 serotype was identified in 37% (18 of 49) of iGAS cases and 42% (5 of 12) of NF cases. This is consistent with other jurisdictions where increased incidence of iGAS is reported. Notably, several other serotypes are observed to be in simultaneous circulation. What Explains the Increase in Cases on Vancouver Island · While greater diligence in reporting cases may contribute, the most likely explanation is that there is widespread circulation of group A streptococci in the population at this time. · Group A streptococci are passed from person to person through close contact and respiratory secretions. This bacteria colonizes the throat, nose or skin of most people at one time or another. Over time, increases and decreases in the rate of colonization will occur naturally. Family physicians on Vancouver Island have been commenting on a recent increase in minor group A streptococcal infections (e.g. strep throat), which likely indicates increased circulation of this organism. This also increases the likelihood that a few people may get more severe, invasive group A streptococcal infections. General Information About Prevention and Control of iGAS Infection Group A streptococcus (GAS) is often found in the nose and throats of healthy people. It is normally passed from person to person through close personal contact with an infected person, such as through kissing, sharing forks or spoons or cigarettes. Therefore, reducing exposure to other people's saliva may reduce your risk of GAS infection. Those at highest risk are: · persons living in the same household; · people who share the same sleeping arrangements; or · people who have direct contact with the mouth or nose secretions of the case. Certain health conditions and behaviours also carry a higher risk of getting the disease. Illicit injection drug use is the most important risk factor. Other risk factors include skin wounds (burn, trauma, surgery), immunosuppression due to disease (e.g. HIV / AIDS), other chronic disease (e.g. Page 2 of 3 A reseatCh and laaching centre affiliated with use 655 West 12th Avenue Vancouver, British Columbia Canada V5Z 4R4 Tel 604 660.2040 Fax 604 660-6066 www.beede.org C([ BC Centre for Disease Control chronic heart, lung or liver disease, alcoholism), chicken pox, and recent close contact with a person who had iGAS. Vaccines are under development that may someday protect people against iGAS infections. At present however, no such vaccine is available. At present, public health contacts close contacts of all cases ofNF and other severe forms of iGAS and recommends antibiotics (for example, persons living in the same household). Since this severe form of streptococcal infection can progress rapidly, the best approach is to seek medical attention soon. Important clues of a more severe streptococcal infection for which a physician should be seen immediately, are: . a skin infection which seems excessively painful, is accompanied by a fever or where the redness appears to be persistently spreading. It also makes good sense to always take good care of minor cuts, to reduce the chance of infection getting into the tissues under the skin. Antibiotics are an important part of the treatment for these infections. However, antibiotics on their own are not usually enough for severe group A strep infections. This is because necrotizing fascütis cuts off the blood supply to body tissue, and the antibiotics must be carried by blood to the infected site in order to work. Surgery, combined with antibiotics is the usual treatment. However, researchers are investigating other methods that can be used to supplement antibiotics and surgery. If you have questions, please contact your local public health office. Additional general information about iGAS and necrotizing fascütis is also available at: h tt:p: II www.healthservices.gov.bc.ca/hlthfile Ihfùe60.html. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcalg.htm http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcalt.htm http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcala.htm BCCDC contact number for further information is 604-660-6061. Contact persons: Dr Dave Patrick or Dr Mark Bigham Page 3 of3 A research and teaching centre affiliated with uae 655 West 12th Avenue Vancouver, British Columbia Canada V5Z 4R4 Tel 604 660.2040 Fax 604 660-6066 www.bccdc.org Lv)aaM "(""" 0 0 N ... 0 ~v )aaM m ... Q) 6£ )aaM tn ctS Q) L£ )aaM tn .- C 9£ )aaM - ctS ££ )aaM (.) (.) "C 0 ~ £ )aaM C (.) +-' ~ 0 (1) ..... 6l )aaM U) .!!l. 0- C ~ 0 fit ..... a )aaM 'to- "C en 0 c « 9l )aaM ~ ~ (1) C 0- s: ëõ ::s £l )aaM 0 :!: L. . 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