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Home My WebLink About02 February JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 21,2002 Board Members: Dan Titterness, Member - County Commissioner District # 1 Glen Huntingford, Member - County Commissioner District #2 Richard U/ 0/1, Member - County Commissioner District #3 Ger!ffr1!Y Masâ, Vice Chairman - Port Townsend City Counâl ]ill Buhler, Member - Hospital Commissioner District #2 Sheila U/esterman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (County) Staff Members: Jean Baldwin, Nursing Services Director LArry FC!)', Environmental Health Director Thomas Locke, MD, Health Officer Chairman Westerman called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exception of Commissioner Huntingford. APPROVAL OF AGENDA Vice Chairman Masci moved to approve the Agenda. Commissioner W ojt seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Buhler moved to approve the minutes of January 17, 2002. Member Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Charles Chase asked for an update regarding health issues on property located on the Egg and I Road, which he brought to the Board's attention at the January meeting. (See later in minutes: Chronology ofGaikowski Complaint) OLD BUSINESS Letters to Board of County Commissioners and Port Townsend City Council Re: Gambline Tax Receipts and Public Health Fundine: Chairman Westerman asked if there were any comments on the draft letter to the County Commissioners concerning the proposed gambling tax receipts and public health funding? HEALTH BOARD MINUTES - February 21,2002 Page: 2 Commissioner Titterness referred to the language in RCW 9.46.113, "...shall use the revenue trom such tax primarily for the purpose of enforcement of the provisions ofthis chapter by the county, city or town law enforcement agency." This language appears to be inconsistent with the Board's original request. Dr. Tom Locke and County Administrator Charles Saddler explained that the courts have used a broad interpretation of this language and ruled that general support of law enforcement has a chilling effect on illegal gambling, thus meeting the requirements of the statute. Because the tax has to be used for law enforcement rather than public health, the letter asks to use these funds to offset other general fund dollars for public health. Member Buhler pointed out that the last paragraph stating "maintain support for Jefferson County Public Health systems during this period of crisis" does not sound like a request for ongoing support. Dr. Locke explained that Public Health sees this as a symptom of a larger problem. If a dedicated source of funding were found to replace lost municipal and county dollars and stabilize the public heálth system, it is likely that the governing bodies might choose to reallocate this funding. The Board suggested revising the letter to say, "during this period of uncertain public health funding" rather than "during this period of crisis." Vice Chairman Masci expressed fear that these funds could easily become diverted to another use over time. He suggested a memorandum of understanding be approved between the City and County clarifying that the gambling tax would be used for law enforcement so that other funding can go towards public health. County Administrator Saddler suggested the Board might want to relay this fear to both governing bodies, asking that this intent be specified in an interlocal agreement with the level of funding calculated on a formula basis. Chairman Westerman agreed with the concern that funds could easily be reallocated over time and recommended staff consider alternatives to ensure that the funds are specifically used for public health. Commissioner Wojt moved that staff send the letter as amended. Vice Chairman Masci seconded the motion, which carried by a unanimous vote. Chronolo2:Y of Gaikowski Complaint: At the January 17, 2002 Health Board Meeting, Charles Chase asked that something be done regrading the condition of his neighbors property on Egg & I Road in Chimacum. Chairman Westerman acknowledged that the Board received a timeline of activities on this matter and noted an incorrect date. She expressed concern about the time that elapsed between the first site visit and first notice. She asked for Board comments about the timeline. Member Buhler asked whether there is documentation of further site visits? HEALTH BOARD MINUTES - February 21,2002 Page: 3 Larry Fay assumed staffhas never been on the property. Because there was no response to the notice of violation sent last September nor was the situation corrected, he believes staff would recommend this as an opportunity to test the new civil infraction procedure from the On-site Sewage Code. County Administrator Saddler said he believes this matter might develop into a criminal infraction. Larry Fay said it would initially be a civil infraction to be ruled on by a judge, however if there is a lack of compliance, the party may be held in contempt of court. Vice Chairman Masci said ifthe goal is to remove the health danger from one piece of property, fines may not solve the problem. He is curious about the possibility of cleaning up the property and billing the owner. It was suggested that staff investigate how Clallam County is handling such matters. There was discussion of the County's enforcement authority. Dr. Locke indicated the Board of Health has legislative authority to pass ordinances and resolutions for the abatement of nuisances. Larry Fay said the law offers a broad definition of a nuisance but nothing specifying how to abate one. In response to questions about the effectiveness of ticketing to solve the problem, he used as an example how Animal Services issues tickets - if a fine is paid but the problem is not remedied, another ticket is written. Vice Chainnan Masci asked if there is support for drafting an enforcement ordinance for the Board of Health? Member Buhler asked ifthe Board is required to prove that the nuisance is a health hazard? Dr. Locke said he believes it has to be health-related. In other words, a nuisance detrimental to public health. There was Board support for a suggestion by Dr. Locke that staff first research what other Boards of Health and Counties have done. Chairman Westennan was supportive of the Board of Health, rather than the County Commissioners, pursuing a fast track enforcement solution. Expressing interest in citizen complaints being addressed promptly, she requested stipulating a response timeline in the policy. Larry Fay responded that while there may be a need for a mechanism, he would discourage a specific timeline. Each situation is different and a clear violation might not be able to be determined in 60 days. Commissioner W ojt suggested writing the code so that indigence cannot be used as a defense. County Administrator Saddler said the availability of a grant program could be part of the County's record, which would be in the documentation submitted to the Court. Larry Fay explained the County would soon finalize its standardized complaint response procedure, establishing tracking, investigation, and enforcement measures as well as providing staffwith investigator certification training. HEALTH BOARD MINUTES - February 21,2002 Page: 4 NEW BUSINESS Fee Committee Report re: Proposed Fee Increase: Chairman Westerman reviewed her experiences as Chair of the Ad Hoc Fee Advisory Board under direction of the County Commissioners. After considering their underlying charge that the fees should cover 100% of the delivery cost and 75% of the administrative cost, some members forcefully disagreed with this approach. In later meetings, a number of issues arose that seriously damaged the process. Several members had been led by a Commissioner to believe that they did not have to honor the process as outlined. Some members proposed staff not be allowed to participate. Members also violated the ground rule that they would not review each fee individually by, at one point, taking control of the meeting to do just that. Chairman Westerman went on to report that even with two additional meetings, there was not enough time allotted to complete the task. It would also have been helpful had the meetings been recorded. She does not feel good about many of the specific recommendations produced by the committee because they were made outside of the underlying direction. Some members did not support the group process or the ultimate recommendations. A member agreed to circulate a draft report for Committee input before delivering a final version to the County Commissioners. Chairman Westerman believes the County Commissioners were brave to try to address the situation and hope they have the courage to move forward. David Sullivan commented that the experience was worthwhile. He and others learned a lot about the fee structure. Some members felt if the County could cut costs, maybe fees would not need to be raised. Others were concerned about affordable housing and the lack of control over rising costs in general. Still others were concerned about employment. There was no agreement on where to cut the budget. While members were aware of possible competition for funding, they did not want to raise the cost of a building permit plan review or fill the empty planner position. The group had difficulty understanding the connection between paying fees and maintaining the expected level of service. Each person wanted an opportunity to express their individual view and submit their own report, so it will be hard to produce a report summarizing the different opinions. Chairman Westerman said members wanted vote tallies on each of the recommendations because there were many close votes. It is her understanding that the Board of Health can set Environmental Health fees. For the purpose of discussion, Vice Chairman Masci moved to submit to the County Commissioners a recommendation that the Board of Health review and set the Environmental Health fees. Commissioner Wojt seconded the motion. Staff noted that there are roughly 75 individual fees covering solid waste, onsite sewage and food. The same rationale could be presented to the Board of Health that was presented to the Fee Committee, which is that the County Commissioners would like the fees imposed by the Building and Community Development Department and the Health Department to pay for the delivery of the service and 75% ofthe administrative costs. Commissioners and Mr. Saddler commented that because loss in revenue are already being felt, it may be most efficient this year to run the fees through the County Commissioners rather than the Board of Health. It was noted that the report by the Fee Advisory Committee is nearly 30 days overdue, but there was Commissioner interest in postponing a decision until after examining that report. HEALTH BOARD MINUTES - February 21,2002 Page: 5 Vice Chairman Masci amended his motion to reflect that this review would take place beginning next year. Commissioner Wojt seconded the motion as amended. There was further discussion about the charge of the Fee Committee, which was to confirm that staff correctly interpreted the task given to them by the County Commissioners, making fees cover the cost of the services provided. It was recognized that the process was not as successful as it could have been because members ofthe Fee Committee either did not agree with the philosophy or were unhappy with the specific results. County Administrator Saddler pointed out that there will likely be a major mid-year revision ofthe Health Department budget. The County may even need to revisit fees this year. The motion carried by a unanimous vote. Public Health Fundin~ Crisis: Dr. Locke said that the press packet from the February Conference in Olympia contained many warnings from the Association of Local Public Health Officials and Health Officers, often referring to public health in the state with this particular backfill funding as "the bottom of a house of cards." It appears inevitable that the State legislature will fail to supply the needed money, leaving the public at risk in certain areas of the State, especially regarding the communicable disease programs. Dr. Locke talked about the severe budget loss in some Counties. New revenue forecasts reflect a shortfall in the current biennium of up to $1.5 billion, which pales in comparison to what is expected in the next biennium. Jean Baldwin reported that some legislators mistakenly believe that federal anti-terrorism funding will replace the $26 million in lost MVET funds. Although there may be some funding for staff exercises and training, because the federal bio-terrorism funds are categorical, it is unlikely any ofthe bio-terrorism money will show up in the budget. Community Health Partnerships and Re2ional Public Health Service Coordination: Jean Baldwin reviewed that at the last meeting, the Board was interested in having further discussions on fiscal matters. There was also a desire not to have policy driven explicitly by the budget. With the potential for laying off staff and closing programs, the Board also suggested investigating regional partnerships. Staff met with Bremerton / Kitsap Health District and Clallam County and agreed to work on: 1) budget shortfalls and maintaining a minimum amount of safety in public health for the communities; 2) efficiency studies for clinical services; 3) regional bio-terrorism response; 4) training for hospitals and medical staff by Drs. Locke and Lindquist; 5) program evaluations, billing, tracking and infrastructure; 6) reviewing new or current programs before negotiating with State Departments of Health, Ecology, and Social and Health Services; 7) developing ten shared indicators to track long-range community health; 8) fee structures; and 9) exploring a three-county arrangement to share resources on drug labs and drinking water issues. Commissioner W ojt asked ifthe State legislature has been told that counties need a free hand to utilize funds to provide minimum staff? Staff responded that the only non-categorical money counties are receiving are the funds that are going away. The rest is categorical federal pass-through funding. Jean Baldwin reported having a series of meetings with the hospital about the impacts ofthe Department's closure of programs and cutback of services. They also discussed areas offuturé collaboration. The hospital expressed interest in certain findings from the Data Steering Committee and HEALTH BOARD MINUTES - February 21,2002 Page: 6 the prenatal risk survey. She commented that it is staggering to think that if local public Health, Departments do not provide services, the State Department of Health, by statute, would be responsible for providing them. She just received notice that about $60,000 in cuts, that were not expected until later, are comIng now. County Administrator Saddler noted that the hits to operational capabilities will be more significant than the reports have indicated - a 30-35% reduction. With the local Board of Health and Health Department having liability, at what point will we say we can not do it and ask the State to take it over? Jean Baldwin, as incoming chair for WSALPHO, said they will define public health core issues that must be funded. While they could close family planning, maternal child health, foot care, and other unmandated programs, they will have to close out basic programs and hold the state accountable. Some counties have said they will only do TB prevention. Dr. Locke reviewed RCW 70.05.060 - Powers and Duties of Local Board of Health which he believes is an important reference. Staff agreed to continue to provide budget updates. The Department may be in a budget shortfall by June and a long-range planning session may be needed. Community Delinquency Prevention Grant: Jean Baldwin distributed a draft letter of support rrom the Board for a juvenile justice grant which will enable the continuation of the OLDS/Best Beginning Project. Commissioner Wojt moved that the Board approve the letter of support. Vice Chairman Masci seconded the motion, which carried by a unanimous vote. Bioterrorism Preparedness Tabletop Exercise Follow-up Report: Dr. Locke noted that the agenda packet included a copy ofthe January training exercise. The exercise was a good opportunity to appraise how the Department worked in action, the biggest benefit being that it allowed other agencies to see how dependant they would be on the local Health Department in a biologic emergency. At the end of the exercise, they identified areas to work on: surge capacity, clear agency roles, and more collaboration between the Health Department and the Hospital. It also underscored the importance of quick communication to the media. A summary of the discussions and recommendations will be mailed to the group. Once a local plan is complete, regional response planning will begin, which is where federal funding is targeted. Several officials are frightened that it is not a matter of if, but when an biologic emergency will occur. Based on this exercise, he believes there is a lot oftalent with which to conrront an emergency. Customer Survey: Larry Fay suggested this item be tabled until the next meeting. A telephone survey instrument is being designed to regularly evaluate the on-site sewage program. The Board was asked to submit questions it might want to ask Environmental Health clients. AGENDA CALENDAR/ADJOURN HEALTH BOARD MINUTES - February 21,2002 Page: 7 Budget Shortfall Impacts and Update from Dr. Chris Hale on BRFSS. The meeting adjourned at 4:35 p.m. The next meeting will be held on Thursday, March 21,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. pFFERSON COUNTY BOARD OF HEALTH JW~Wh~rl~ Sheila Westerman, Chairman 2~~ asci, Vice Chairman (Excused) Richard W ojt, Member /~~¿V, Roberta Frissell, Member (Excused) Glen Huntingford, Member ~ Dan Titterness, Member Erin Lundgren BOCC Office PO Box 1220 Port Townsend W A 98368 Jefferson County Board of Healt7Ri g t; ít! I ~f - u F£B , 1 5 ZOO" II.: ,.... (, fi ',," ti' ¡') 00.4 tI. 'f). . u\ ..Yu"¡'" ,'" !1 . (., ,.. IV , d " -it (>0"11 V'Jú f¡i n, '." IfrM! .., 1 , I",SSIONERS Agenda & Minutes February 21, 2002 JEFFERSON COUNTY BOARD OF HEALTH Thursday, February 21, 2002 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda III. Approval of Minutes of Meetings of January 17, 2002 IV. Public Comments V. Old Business and Informational Items 1. Letter to Board of County Commissioners and Port Townsend City Council re: Gambling Tax Receipts and Public Health Funding 2. Chronology of Gaikowski Complaint VI. New Business 1. Report of Fee Committee Larry/Sheila 2. Public Health Funding Crisis Tom 3. Community Health Partnerships and Regional Public Health Service Coordination Jean 4. Bioterrorism Preparedness Tabletop Exercise-- Follow-up Report Tom 5. Environmental Health Customer Survey Larry VII. Agenda Planning 1. March Meeting - Chris Hale BRFSS Presentation VIII. Next Meeting: March 21, 2002: 2:30 PM - 4:30 PM JEFFERSON COUNTY BOARD OF HEALTH -c- MINUTES O~~f \ Thursday, January 17, 2002 DRAFT Board Members.' Dan Titterness, Member - County Commissioner Dirtrict # 1 Glen Huntingford, Member - County CommÙsioner DÙtrict #2 Richard U7 o/t. Member - County Commissioner District #3 Geoffrry Masct: Vice Chairman - Port Town.rend City Council ]ill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (Coun!YJ StaffMembm.· Jean Baldwin, Nursing Services Director Larry Fqy, Environmental Health Director Thomas Locke, MD.. Health Officer 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 Tittemess 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 Historv of Public Health Funding: 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 Washin!!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 by Washin2ton Counties 42% Local Govemment/MVET 9% MedicaidlFederal 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./Fund Balance/Other 7% Fees 7% Licenses/Permit Funds Received by Jefferson County 44% Local GovernmentlMVET Local Sources 1 % Medicaid Title XIXlOther Fed. Fee for Service 2% Federal 6% State, Other StatelFederal 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 Countv 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 cåunty 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 tþe 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 Wojt 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%. Therewas 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. Mter 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 healthcare 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. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chairman Jill Buhler, Member Geoffrey Masci, Vice-Chairman Richard Wojt, Mem1;Jer (Excused) Glen Huntingford, Member Roberta Frissell, Member Dan Tittemess, Member Board of Health Old Business Agenda Item V., 1 Letter to Board of Countx Commissioners and Port Townsend Council February 21,2002 DRAFT Jefferson County Board of County Commissioners Courthouse - P.O. Box 1220 Port Townsend, W A 98368 Port Townsend City Council Port Townsend, W A 98368 Re: Dedicated Public Health Funding Sources Dear Commissioners/ Council Members: As the duly constituted Board of Health for Jefferson County, we are writing to express our growing concern over the unstable funding of essential public health services and to recommend a specific, short-term action to address this issue. Provision of essential public health services is a fundamental duty of all governments from the municipal to federal level. Prior to 1996, this obligation was met by a combination of city, county, state, and federal funding sources. In 1996, the Washington State Legislature transferred_ the municipal obligation for public health to a statewide pool funded by the Motor Vehicle Exise Tax. In 2000, following passage ofInitiative 695, the State Legislature repealed this tax, eliminating a important source of public health funding. Beginning with the 2001-2003 State Biennial budget, the legislature restored 90% of this funding as "1-695 Backfill". At the urging of Governor Locke, the legislature is now considering eliminating this funding beginning in 2003. Public health funding is heavily tied to federal and state categorical funding programs. Only about 23% of the average local health budget is available to meet essential public health needs like communicable disease control, bioterrorist response preparation, and community health surveillance activities. Loss of state "backfill" funding, will eliminate almost half of these local resources, crippling the ability of our health department to respond to urgent local public health needs. "Belt tightening" will not solve this crisis. Core public health programs must be eliminated to close a budget gap ofthis magnitude. The Legislature's repeal of appropriated funds for local public health is occurring in the context of Washington State's worst recession in 20 years. Existing local revenue sources are unable to fill the gap created by the state's unilateral decision to cut local public health funding. A long-term solution to this impending crisis will require Legislative action and a probable vote of Washington's citizens. Until that occurs, local governments must be innovative in their search for potential revenue sources. One such area of unused taxing authority is contained in RCW 9.46.110, allowing taxes on various gambling activities, including punch boards and pull tabs. Such a tax would need to be enacted by both the county and the city of Port Townsend to cover the entire county. Revenue rrom such a tax must be dedicated to law enforcement activities. We are proposing that this tax be enacted and general fund "saving" for law and justice activities be dedicated to local public health funding to replace lost MVET funds. The Jefferson County Board of Health is responsible for carrying out the duties outlined in RCW 70.05.060. We understand that the good health and long life that most Jefferson County residents enjoy is possible only because ofthe foundation oflocal public health services that has existed since the 19th century. This foundation is now in jeopardy. We respectfully ask for your support in utilizing your taxing authority on gambling activities to maintain support for Jefferson County's public health system during this period of cnSlS. Sincerely, Sheila Westerman Chairman, Jefferson County Board of Health Geofrrey Masci Vice Chairman, Jefferson County Board of Health ... .....0.......... "-'....... RCW 9.46.110 Taxation of gambling activities -- Limitations -- Restrictions on punch boards and pu~l-tabs -- Lien. (1) The legislative authority of any county, city-county, city, or town, by local law and ordinance, and in accordance with the provisions of this chapter and rules adopted under this chapter, may provide for the taxing of any gamb~ing activity authorized by this chapter within its jurisdiction, the tax receipts to go to the county, city-county, city, or town so taxing the activity. Any such tax imposed by a county alone shall not apply to any gambling activity within a city or town located in the county but the tax rate established by a county, if any, shall constitute the tax rate throughout the unincorporated areas of such county. (2) The operation of punch boards and pull-tabs are subject to the following conditions: (a) Chances may only be sold to adults; (b) The price of a single chance may not exceed one dollar; (c) No punch board or pull-tab license may award as a prize upon a winning number or symbol being drawn the opportunity of taking a chance upon any other punch board or pull-tab; (d) All prizes available to be won must be described on an information flare. All merchandise prizes must be on display within the immediate area of the premises in which any such punch board or pull-tab is located. Upon a winning number or symbol being drawn, a merchandise prize must be immediately removed from the display and awarded to the winner. All references to cash or merchandise prizes, with a value over twenty dollars, must be removed immediately from the information flare when won, or such omission shall be deemed a fraud for the purposes of this chapter; and (e) When any person wins money or merchandise from any punch board or pull-tab over an amount determined by the commission, every licensee shall keep a public record of the award for at least ninety days containing such information as the commission shall deem necessary. (~) (a) Taxation of bingo and raffles shall never be in an amount greater than five percent of the gross receipts from a bingo game or raffle less the amount awarded as cash or merchandise prizes. (b) Taxation of amusement games shall only be in an amount sufficient to pay the actual costs of enforcement of the provisions of this chapter by the county, city or town law enforcement agency and in no event shall such taxation exceed two percent of the gross receipts from the amusement game less the amount awarded as prizes. http://search...NiewHtml.asp? Action=Html&Item=29&X= 1231134047 &p= 1 &X= 123113414 12/31/01 Page 2 of 2 (c) No tax shall be imposed under the authority of this chapter on bingo or amusement games when such activities or any combination thereof are conducted by any bona fide charitable or nonprofit organization as defined in this chapter, which organization has no paid operating or management personnel and has gross receipts from bingo or amusement garnes, or a combination thereof, not exceeding five thousand dollars per year, less the amount awarded as cash or merchandise prizes. (d) No tax shall be imposed on the first ten thousand dollars of gross receipts less the amount awarded as cash or merchandise prizes from raffles conducted by any bona fide charitable or nonprofit organization as defined in this chapter. (e) Taxation of punch boards and pull-tabs for bona fide charitable or nonprofit organizations is based on gross receipts from the operation of the games less the amount awarded as cash or merchandise prizes, and shall not exceed a rate of ten percent. At the option of the county, city-county, city, or town, the taxation of punch boards and pull-tabs for commercial stimulant operators may be based on gross receipts from the operation of the garnes, and may not exceed a rate of five percent, or may be based on gross receipts from the operation of the games less the amount awarded as cash or merchandise prizes, and may not exceed a rate of ten percent. (f) Taxation of social card games may not exceed twenty percent of the gross revenue from such games. (4) Taxes imposed under this chapter become a lien upon personal and real property used in the gambling activity in the same manner as provided for under RCW 84.60.010. The lien shall attach on the date the tax becomes due and shall relate back and have priority against real and personal property to the same extent as ad valorem taxes. [1999 c 221 § 1; 1997 c 394 § 4; 1994 c 301 § 2; 1991 c 161 § 1; 1987 c 4 § 39. Prior: 1985 c 468 § 2; 1985 c 172 § 1; 1981 c 139 § 8; 1977 ex.s. c 198 § 1; 1974 ex.s. c 155 § 8; 1974 ex.s. c 135 § 8; 1973 1st ex.s. c 218 § 11.J NO'l'ES: Effective date -- 1999 c 221: "This act takes effect January 1, 2000." [1999 c 221 § 2.] Severability 1981 c 139: See note following RCW 9.46.070. Severability 1974 ex.s. c 155: See note following RCW 9.46.010. http://search...NiewHtml.asp? Action=Html&Item=29&X= 1231134047 &p=l &X= 123113414 12/31/01 "... Page 1 of 1 RCW 9.46.113 Taxation of gambling activities -- Disbursement. Any county, city or town which collects a tax on gambling activities authorized pursuant to RCW 9.46.110 shall use the revenue from such tax primarily for the purpose of enforcement of the provisions of this chapter by the county, city or town law enforcement agency. [1975 1st ex.s. c 166 § 11.] NOTES: Severability -- 1975 1st ex.s. c 166: See note following RCW 9.46.090. file:////LEGINFOB-2/RCW$/RCW 9 TITLE/RCW 9.46 CHAP.../RCW 9.46 .113.ht 12/31/01 Board of Health Old Business Agenda Item # V., 2 Chronology of Gaikowski Complaint February 21, 2002 Date: February 14, 2002 To: Jefferson County Board of Health From: Larry Fay, Environmental Health Director Re: Follow up to the January Board of Health Meeting - Charles Chase Attached is a chronology of activities related to the concern expressed by Mr. Chase regarding possible health violations on his neighbor's property. At this time, we have not been able to actually gain access to the property to verify the complaints. From the road, travel trailers have been observed and we have presumed a - violation exists. To date the property owner has not picked up the mailed notices. If the most recent notice is not picked up, arrangements will be made to post the notice in cooperation with the sheriffs office. 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 TIMELINE OF ACTIVITY FOR GAIKOWSKI COMPLAINT-EGG AND I RD- 2-13-02 Prior to 9-26-00 calls were made regarding this site and site visits were made but only one travel trailer was on the site and no signs of occupancy. 9-26-00 Action request received from Permit Center. Cc to this office for action on occupancy without septic system portion of complaint. Site visit completed - several travel trailers now onsite, no one present at time of visit but does appear that site may be occupied, will make another visit. No trespassing signs and security signs on site. Further site visits made and saw smoke coming from chimney and more sign of activity and cars 9-17-2001- Notice of violation sent certified requiring owner to contact designer and apply for permit or vacate site. Cc notice to Building Official. Notice was picked up. Did not receive any response to the letter. 10-10-2001- site visit made - nothing removed from site, no one on site at time of visit but the site does appear to be occupied. 19-26-2001- 2nd Notice of violation sent certified. Stated that case may be referred to Pros. Attorney if not informed of status on site. Cc notice to Building Official. Notice not picked up. 11-19-2001- Received another complaint on the site regarding many issues including suspicion of drug production and sales on site along with abandoned cars and the lack of septic system. 1-24-2002- Complaint referred by DOE to this office. Caller reported that a pipe had been attached to a trailer and occupants of the site were draining their gray water directly to the ditch that is upgradient from the callers well. 1-25-2002 - another site visit was made and photos taken. There is a black plastic pipe going into the roadside ditch but no sign of suds or algae indicating wastewater. A trench has been dug from a travel trailer out to the road and there was a piece of white 1" -1 ~" pvc pipe in it. It appears to be possibly for phone or power. Out of state RV pulled up on lot as I was leaving. I reported to Sheriffs office my observations based on concerns of adjacent property owners that an RV has been on site and they are concerned about drug activity when it is there. 1-29-2002- 3rd notice of violation sent and cc to Pros. Attorney with cc to Building Official. Have not received notice back as of2-13-02. No response from property owner. Have had several phone conversations with concerned citizens over this site during the entire time period. Board of Health New Business Agenda Item # VI., 2 Public Health Funding Crisis February 21, 2002 Washington State Association of Local Public Health Officials AN AFFILIATE OF WASHINGTON STATE ASSOCIATION OF COUNTIES FOR IMMEDIATE RELEASE January 30, 2002 CONTACTS: Rick Mockler 425.238.4610 nnockler@shd.snohomish.wa.gov M. Ward Hinds 425.356.8907 whinds@shd.snohomish.wa.gov Vicki Kirkpatrick 360.753.1886 vkirkpatrick@wacounties.org Local public health in critical condition Health officers testify Feb. 8; poor funding & political games risk lives OLYMPIA-The leaders of Washington state's 34 local health jurisdictions will go on the record Feb. 8, warning the House Health Care Committee that budget cuts to public health could cost lives. The health officers hope to preserve all current funding in the state budget that is designated for local public health. "Insufficient public health funding carries a human price tag- irresponsible decisions now will cost lives later," said Pat Libbey, President of the National Association of City and County Health Officials. "If we learn anyone lessonÆrom the nation's recent tragedies, it must be that our public health Infrastructure is decayed and has to be rebuilt in order to protect the nation. This could be our only chance to change that," he said. Libbey, who also serves as Health Director for Thurston County, is among the speakers slated to testify the afternoon of Feb. 8. "In my home state of Washington, where not one anthrax spore was found in 2001, our public health capacity was stretched to its limits trying to respond to 'credible threat' samples," said Libbey. "Imagine the panic if we had found the real thing." In addition to the national perspective, the House Committee will get the statewide picture from State Board of Health member, Tom Locke, MD, MPH, Health Officer for Clallam and Jefferson counties. "Washington state's local public health agencies are chronically underfunded, understaffed and .unrecognized for the enonnotis responsibility of protecting the public's health," Dr. Locke said. "Every year new threats to public health emerge -international epidemics, antibiotic-resistant infections, and now bioterrorist attacks- and every year our capacity to respond falls farther behind. The health security of Washington's citizens is at stake," he continued. "Cutting funds for essential local public health protection cripples an already weakened system and is a dangerous move in the wrong direction." In recent years funding streams for public health have dried up. Originally cities and counties funded local health, but the state legislature changed that in 1996 by redirecting a percentage of the motor vehicle excise tax (MVET) to public health. Four years later the legislature eliminated the MVET and committed to "backfill" the lost public health dollars. The 2002 proposed budget reneges the promised ...MORE... 206 TENTH AVENUE SE, OLYMPIA, WA 98501 TELEPHONE: (360) 753-1886 (360) 753-2842 PUBLIC HEALTH OFFICERS, Page 2 January 30, 2002 backfill and fails to provide new funding to meet resource needs for disease surveillance. Snohomish County's health officer and chair of the Washington State Association of Local Public Health Officials, M. Ward Hinds, MD, MPH, will address the House Committee on the need for disease surveillance at the local level. "We 'locals' carry the burden for detecting disease outbreaks," said Dr. Hinds. "We need to watch for the earliest sign of something going wrong and be able to mobilize. If we lose our current state funding during this legislative session, our surveillance systems will be greatly weakened and the limited surge capacity we now have at the local level will be lost," he said. "We have many professionals who know what we need to do to prepare, but we simply do not have the resources to do it at the needed level," Dr. Hinds said. "For example, if a significant outbreak of smallpox were to occur in Everett, we quickly would be overwhelmed- the 600,000 lives in my county and three million lives along the 1-5 corridor would be in jeopardy." The Washington State Association of Local Public Health Officials is a non-profit organization that brings together the leadership of local health departments. The Association creates a constructive and collegial environment needed to advance the broad interests of public health. The Mission of public health is to improve health status through the promotion of health and the prevention of and the protection from injury and disease. To support this mission, the purpose ofWSALPHO is to encourage improvement in the quality, capacity and leadership of health departments/districts in order to provide a more effective, efficient and consistent public health infrastructure throughout Washington state. For more information about WSALPHO, contact Vicki Kirkpatrick, 360.753.1886. ###END### NOTE: Media Q&A opportunity with Health Officers, Feb. 8,11:30 am-12:15 pm, Ramada Inn Governor House, 621 S. Capitol Way, Olympia W A. Health Officers' testimony before House Health Committee scheduled to begin at 1 :30 p.m., John L. O'Brien Bldg, Hearing Room C. Washington State Association of Local Public Health Officials AN AFFILIATE OF WASHINGTON STATE ASSOCIATION OF COUNTIES WSALPHO health officials testifying before the Washington State Legislature House Health Care Committee, February 8, 2002: M. Ward Hinds, MD, MPH, Health Officer - Snohomish Health District whinds@shd.snohomish.wa.~ov 425.339.5210; 425.356.8907 pager Ward Hinds, MD, MPH, has led Snohomish Health District since 1986, serving a county of 606,000 people north of Seattle. A graduate of Vanderbilt University Medical School and the University of Washington School of Public Health and Community Medicine, he is board-certified in Public Health. He served in the U.S. Anny as a Prevention Medicine Officer during the Vietnam Conflict. Dr. Hinds has worked at the Washington State Division of Health, the Cancer Center of Hawaii, and the Kentucky State Health Department, where he was the state epidemiologist. He currently chairs the Washington State Association of Local Public Health Officials, and is a past member and chair of the Washington State Board of Health. Dr. Hinds is a Clinical Professor in the University of Washington School of Public Health and Community Medicine. Patrick M. Libbey, Health Director - Thurston County libbeyp@co.thurston.wa.u 360.786.5581, ext. 7204 Pat Libbey directs the Thurston County Public Health and Social Services Department, serving a suburban and rural population of 210,000 near the state's capital. He is president of the National Association of County and City Health Officials and past president of the Washington State Association of Local Public Health Officials. In recent years he also has served as president, Washington State Association of County Human Services; chair, NACCHO County Forum; member, Washington State Core Government Public Health Functions Task Force; member, Public Health Improvement Plan Steering Committee; and chair, Performance Measures Technical Advisory Committee. In 1993 Mr. . Libbey received the Award for Excellence in Environmental Health from the National Association of County Health Officials. Thomas Locke, MD, MPH, Health Officer - Clallam and Jefferson counties tlocke@co.clallam.wa.us 360.417.2437 Tom Locke, MD, MPH, lives on the Olympic Peninsula where he works as the Health Officer for C1allam and Jefferson counties and serves as the Medical Director of the Port Gamble S'Klallam Tribal health program. He is a graduate of the University of Kansas School of Medicine and the University of Washington's Preventive Medicine residency. He is board-certified in General Preventive Medicine and Public Health. Dr. Locke is a member of the Washington State Board of Health and Washington State Medical Association's Inter-Specialty Council, representing local public health officials. He is a past president of the C1allam County Medical Society and 20-year member of the Olympic Medical Center's mediCal staff in Port Angeles. 206 TENTH AVENUE SE, OLYMPIA, WA 98501 TELEPHONE.: (360) 753-1886 (360) 753-2842 Washington State Legislature House Health Care Committee February 8, 2002 Testimony ofM. Ward Hinds, MD, MPH Health Officer, Snohomish Health District Madame Chair and members of the Committee, as the chair of the Washington State Association of Local Public Health Officials, I can assure you that local public health officers and directors know that we are very underprepared to deal with large communicable disease outbreaks or bioterrorism in our State. And, it is important to note that any such event will happen locally first. We must be better prepared locally if we are to be able to detect such events as quickly as possible and respond in a higWy effective way. Our current disease surveillance systems are adequate for monitoring of many diseases, but they often cannot quickly spot many small outbreaks of disease that now occur naturally. It is commonly several days after illnesses begin to occur before we identify an outbreak. We need to enhance these systems - we need to make them more active and less passive - to make them more sensitive and more responsive to unusual disease occurrences. Loss of 1-695 backfill funding would instead drastically weaken these systems. Our surge capacity is not substantial at this time. We have a very limited number of nurses and environmental health staff that we can shift from their regular responsibilities to respond to an unusual event of any size. This became very clear last October and November as we struggled to deal with the thousands of phone calls and visits from the worried public during the anthrax exposure events. And that was without a single case of anthrax in our state. Loss of 1-695 backfill funding, as proposed by Governor Locke, would markedly reduce the number of public health staff at the local level and cripple our surge capacity. This State would become very vulnerable to any large outbreak of disease, whether from a bioterrorism event, a meningitis outbreak or an event such as the E. coli outbreak of 1993. Local public health's ability to respond would be weakened to a dangerous level if we lose this funding. We live in a time of emerging new infectious disease threats, such as West Nile Virus, antibiotic-resistant tuberculosis and Ebola Virus. We face the new threat of old diseases such as smallpox, plague and anthrax spread by bioterrorists. The world has become very small and diseases from another continent are now only hours away by jet plane. There is new federal funding for bioterrorism preparedness apparently on the way. However the total amount coming to Washington State is less than the amount of 1-695 backfill funding that Governor Locke proposes cutting. Only a part of the new federal funds will come to local public health. Even with the new bioterrorism funding, public health will fall further behind in preparedness if 1-695 backfill for local public health is rut. "- This is a time to strengthen our local public health system, not to weaken it as would ~appen with the Governor's budget. Lives will be endangered if our public health system IS weakened. We hope you will agree and will preserve 1695 backfill for local public health. Testimony before the House Health Care Committee Thomas Locke, MD, MPH Health Officer, Clallam and Jefferson Counties Member, Washington State Board of Health In October of 200 1, in the midst of growing national alarm over the threat posed by bioterrorism, the Washington State Board of Health examined the level of preparedness ofthe state's public health system to respond to a biological emergency. The Board heard testimony fÌ'om local, state, and national public health experts and reviewed extensive national research on the subject. On November 14, 2001, the Board published its findings and recommendations. The verdid - Washington's public health system is underjunded, understaffed, and underprepared to deal with the extraordinary threat posed by a bioterrorist attack. In the best of economic times, adequate preparation for a public health threat of this magnitude would be a monumental challenge. Instead, Washington State finds itself in the midst of a recession and a major budget crisis. Legislators are being forced to make painful choices between competing priorities. A major share of local public health funding, in the form of "backfill" MVET appropriations, is on the chopping block. Bioterrorism experts are in agreement that a strong local public health surveillance and response capability is the only effective defense against a biological attack. Ifthe biological agent is communicable (like smallpox, plague, or Ebola) and primary containment fails, the resulting epidemic will go national or international in a matter of days. This is the brutal reality of bioterrorism defense - your first chance may be your only chance. Washington State has a bare bones local public health workforce that has weathered over two decades of relentless cuts in public health funding. This workforce is maintained by an unstable collection of categorical programs, user fees, grants, and contracts. Loss ofMVET backfill funding will cause this house of cards to collapse in many parts of the state. In terms ofbioterrorism defense capability, Washington will move from being seriously underprepared to dangerously vulnerable. The threat ofbioterrorism is very real. The amount of time we have to-prepare is uncertain. An attack anyWhere in the country will have major repercussions on Washington, as was well demonstrated with the East Coast's anthrax exposures. An attack on our state will have consequences unimaginable to most of its citizens. They will, however, know whom to hold responsible if we fail to adequately prepare for ~ch an attack. The health officers of this state recognize the severity ofthe current budget crisis. But we must issue an urgent warning: Local public health is our frontline defense against biological disasters, including bioterrorism. Loss of core local health funding will result in large gaps in this frontline defense. The public health consequences could be nothing short of catastrophic. Washington State Association of Local Public Health Officials AN AFFILIATE OF WASHINGTON STATE ASSOCIATION OF COUNTIES The Honorable Members of the Washington State Legislature The Washington State Association of Local Public Health Officials' Local Public Health Preparedness Memorandum February 7, 2002 To: From: Subject: The undersigned local public health officials agree that local public health agencies in Washington State are suffering from chronic underfunding. Loss of 1-695 backfill funding will make this problem much worse. We are experiencing increasing difficulties. especially in smaller jurisdictions. in carrying out our communicable disease prevention and control responsibilities. We are underprepared to respond to a significant bioterrorism event. Our disease surveillance systems arc not adequate to quickly identify outbreaks of illness that might signify a bioterrorism event or other public health emergency. Our capacity is very limited for shifting staff resources to respond to a significant bioterrorism event or a communicable disease outbreak. Loss of the critical 1-695 Backfill funding will further weaken a system that is essential for prötection of public health at the local level. Now is the time to strengthen the local public health system. not to weaken it. Local public health needs a stable funding source for our basic communicable disease control responsibilities. Name Ill-¡ 'î f1,~ h D f; hI- fL'l \ IJ~~ ~ µ<?ft- ~ áJu.oJ l£PJu,µ In}? t11 PH '\ ;', I' I r -t- vv,J,J~ )'>',I('µ- ):~:'LI'~~;JZ~J ~ù ÅM~' Il· '\1~, l. .~J , l.~\) \ kAt> H I C~\IJ t~l tllO 206 TENTH AVENUE SE. OLYMPIA. WA 98501 Local Health DepartmentlDistrict K,ff,t'<. <; C. "7 //",,¡;/( 1~""t...4 ~I~ ~RÙ-S~ rPfALl.);..... ~ - .µ '^ \~ CJt.(.'ú,/) Joud~~t Hljj~"ð~ f-((:'J~ lJ~{~\ C.owl~-t'l: c.ouV\~ t-\~ ~ti... ~~?T .~\ ~~""'^ <S;UL" "t.-: {to \jJA\...\..i~~",^ e..()\Ã.~~ ~$ ~ ~ ~ \-\'^-VV'\Øo."" <;v t..... ~~\ ~ N ð( fh tç.i rT {' i (Bo. h1 I \eo. t ~~ lìd ",7t- C1~-rlU ~«~'-:...... f-'t.J "~ a\J.1J,¡ '\ I 1 \ TELEPHONE: (360) 753-1886 (360) 753-2842 ~/;.-..,~ f1~MfH-.5~ ~~f)~ ;&it#l ì. ~ /YW:J /»ðrW ~ ~. ¥tè #e~ J¡~?J ~Yr/- 7kr.s-~ ~ ~~¿~ ~ð, mfff Ç5~.A-.'/F...JJ~ I-k({~ '>YI.. t7J 111 ~ H- LJ f< ({ Co U It. ( ~ I-f.~ r+Lr Au.- ~ ( h Ù W\{Pt\c.~ (ooµ\1 K~ + \{~ ~\~ ~ ~ W ~~ ......-Ð 'M~""" ~",..,-~ ~ ~\,\.... D""" ~~__ #~(M$,~Prt c.l"'tLlool\- c.c,",~~H"'tc1,,-"':)..S:~.tp, ~_ ~~~ ~H ;:r-Q.{µ~o..,:)L-le~(t~{.~....:s~u:c.e..5 ~(). J?~. .~) #1fll ~,/¡) tvA-. .f.ka!~.1 JJI.5f¡r,C! t- . S,£t . ~ ~.tf( "'r· 0 I '/ () - \. I k",{ H.. i-0M'M- .;,C'~ ~~- ~ . v\A rH- ~,-J~'\r'" C ð ""^ I '. . ~ '0 - ~ .~ ~~ r¿ Jt~LÃ~ /)(=,= '. ð7?'..Pf.~ , . ?\. lf~~~J-// . i-v-rl-/~ é:j þ ¡¿f!;f::: (~"t¡ Jt...-t/L -L-Þr" .-h~...;¡-- I~\\o----~\ G;,,J ~v\,,>< c.b~ ",,' ¿U.f.M_.L. ? -:: I " ~ I-k..J. II . 1 ., ~ ð ¡l/oYtA;~~t 11"'1 Cv.-,r¡(y nd, /J~ V/5//:(ì . ~, .. 7' ~/.,-, ~ k"/;"., ~ J/,cL7),.-I-ncr- -Pl1It¡~LJY) c\ ~ ¡¡'L<f'5 k-I CowY'1¡ p",b} Ie- fk<l-/¡j¡ Public Health Dollar$ in Critical Condition $ Historically Counties & cities Legislature directs cities & counties to fund local public health 1996 Counties & * Legislature e1iminates cities' mandate to fund loc8I public health MVET Legislature redirects MVET to fund public health 2000 ~T Legislature eliminates MVET Backf"Ill Legislature commits to backfill of lost MVET dollars 2001 Bioterrorism hits the nation, puts new demands on public health; resources overwhelmed by emergent needs 2002 B~Ill Governor's proposed budget eliminates backfill for basic public health; no money to prepare Cuts to public health funding put the public at risk: inadequate disease . surveillance, insufficient response capacity, no resources for timely disease investigation. We appreciate your ongoing support of local public health! Washington State Association of Local Public Health Officials AN AFFILIATE OF WASHINGTON STATE ASSOCIATION OF COUNTIES FEDERALBIOTERRORISM FUNDING WON'T REPLACE 695 BACKFILL FOR PUBLIC HEALTH Federal Bioterrorism Funding · $2.5 million goes to hospitals, not public health. · Bioterrorism funds are very categorical, not flexible - with specific outcome requirements. · Much of the $17.9 million for public health will be used for improving state-level capacity, such as the state lab. · The guidelines calls for regional plans, not funding for every county and district. Every local health jurisdiction will not receive federal bioterrorism funding. · Federal funds intended to achieve a higher level of preparedness. Backfill funding for Public Health · $24.5 million loss annually to Local Health Jurisdictions · Represents 30% - 50% of the unrestricted funding in local health jurisdictions. · Much of the backfill supports communicable disease control - the foundation of public health protection. · This funding used to come from cities - the Legislature changed that funding stream to MVET. Reality · Loss of backfill funding ensures our public health system will be less prepared despite new federal funding. · Counties will not be able to provide additional funding for public health. · Taking away the backfill funding will severely damage the foundation of local public health. Building a new floor, such as we must do for bioterrorism preparedness, cannot be done without a strong foundation. 206 TENTH AVENUE SE, OLYMPIA, WA 98501 TELEPHONE: (360) 753-1886 (360) 753-2842 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 of the 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.] Board of Health New Business Agenda Item # VI., 3 Community Health PartnershieÆ And Regional Public Health Service Coordination February 21, 2002 615 SHERIDAN · PORT TOWNSEND, WA 98368 · FAX 360-385-9401 February 13, 2002 Scott Lindquist, MD Bremerton Kitsap Management Team 109 Austin Drive Bremerton, Washington 98312 Dear Dr. Lindquist and Bremerton / Kitsap Health Management Team: Thank you for coming to Jefferson County to discuss possible regional Public Health services last week. It is rerreshing in these horrendous fiscal times to talk about providing Public Health with strength and vision that each of our departments can share. We look forward to further talks. In summary our initial focus will be: · Strengthening our Bioterrorism Regional Response through doing regional medical staff, hospital training and active surveillance. · Viewing our current inrrastructures and systems such as program evaluation, billing, tracking as we all try to improve Public Health standards. · New partnerships are necessary for Public Health survival in the state of Washington. Partnership will be strength-based on adequate local fiscal support and trained staff. · New and current programs can be reviewed regionally before contracts are negotiated with DOH, DSHS, etc. We look forward to meeting with you and Clallam County Health and Human Services next week for an in depth review of regional services. With kind regards, Jean Baldwin Community Health Director Larry Fay Environmental Health Director 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 New Business Agenda Item # VI., 4 Bioterrorism Preparedness Tabletop Exercise - Follow-up Report February 21, 2002 Hands-On Training for Public Health Emergencies ® Washington State Department of Health Northwest Center for Public Health PI'lIc:tlce Purpose of Exercise · Understand policies needed for a large scale Communicable Disease (CD) outbreak or bloterrorlsm (BT) event · Promote interagency collaboration regarding emergency prèparedness Instructions to Remember · Respond as a group to information as it emerges · Maintain your community role · Focus on policy issues over specific procedures . Use any materials you have available J-\IIðcn. V Introduction: This learning activity is an opportunity to gain skills in how to prepare for an emerging disease outbreak or bioterrorism event through the recognition of related policy needs & Issues. You will learn about preparing for such an emergency and about the related information/communication needs. Purpose of Exercise · Recognize the roles of various public officials in a large CD outbreak or BT event · Identify gaps In local preparedness & coordination · Identify related training/learning needs Instructions to Remember · Meeting notes will be kept by a note-taker · Individual notes should be kept on the lower half of the pages provided · Do not look ahead in the exercise · This activity will be followed by a debriefing 1 Storyboard 1--the Setting Cedar County · 150,000 residents · 1 major city of 40,000 · Site of upcoming trade conference · 2 hospitals · 1 public water supply · Local health department of 70 staff Storyboard 1--the Setting Pine County · 15,000 residents · Many Pine County residents work in Cedar County · On the Cedar County water supply · Local health department of 14 staff Day l--Friday · Increase In persons presenting with the following symptoms: · Severe diarrhea · Vomiting · Fever . · Abdominal pain · Chills · Bloody stools · Headache · Nausea Storyboard 1--the Setting Dogwood County · Just north of Cedar County .35,000 residents · Water recreation and resort area · Multiple small water systems · Local health department of 25 staff Day l--Friday Gastrointestinal illness strikes: . Presenting via nurse hotlines, private providers, & ER's on ''lli"fridav,,:¡:>.t~·L_¥,"_«'''J¡___'!!J__=__,'. ,tt*~_\"\...~~~,¡,~mw,(,,,~m':i#.~~~!ft\i**z.Qf@ , . Presenting patients tend to be middle-aged adults, with about 10% > than agl~ 65 . 30 people seen in hospital ER's by late Friday Day l--Friday . Stool samples taken on 6 of cases .3 people hospitalized for dehydration or other gastrointestinal complications 2 Day 2--Saturday AM · Patients still being seen in the ER's and urgent care centers · At 10 AM the number of patients exhibiting symptoms is up to 45 · Decision made to notify the health department · Concerns regarding the capacity of the clinics to handle number of patients needing treatment Day 2--Saturday PM The Cedar Co. Health Department begins V~"""W1!íi",=~"",;, .'" \j:;II.~n",nt..a<;>.",...~. -. .~x:.":<::,t·_ ';-' -!.if";.<, _ ,^,,_ ___~.<tW~~"'Y.('[~,~~. ' - -.,. - _..w*__- .. Day 2--Saturday PM Hospital personnel have confirmed to the news media that a large number of people are being seen with some type of "intestinallllness,1I but they refer media calls to the health department. Day 2--Saturday Noon · The known patient count is up to 60 · Local health officer decides to convene a meeting around next steps · Local pharmacist calls the hospital, asking what is happening, since her store is almost out of anti-diarrheal medicine due to heavy demand Day 2--Saturday PM . Dogwood and Pine County providers report many patients complaining of severe gastrointestinal (GI) problems ..~~~~~~~~~~~~~~ · 16 stool specimens have been taken · 6 people have now been hospitalized Day 2--Saturday PM · 5:00 PMna tour group operator reports to the health department that 35 out of 50 group members have become ill with severe diarrhea, vomiting, and nausea · None have sought medical attention 3 Day 2--Saturday PM · All tour group members ate at local restaurants in the area during the past week · These tourists are non-English speaking visitors from Southeast Asia Storyboard 2 Investigation Results The restaurants & grocery stores: . National chains to upscale dining and shopping eiP(f).'tll'S~\\ÑftffJ¡biJsm1êsš*fm~!&,&·-mi government officials . Some are popular with tourists Day 3--Sunday AM · Health department personnel continue interviewing cases · Lab results on patients will be available Monday (Day 4) · Many ill patients have not eaten at a restaurant in the past week Storyboard 2 Investigation Results Food service establishments are indicated: . Many restaurants are being identified but no one restaurant is standing out (12 in Cedar County, 1 in Dogwood County) . Some cases have not eaten in restaurants in the week prior to their illness Storyboard 2 Investigation Results The restaurants & grocery stores: .3 restaurants with food handling violations histories /îIV~f1!êšml!f~a"'~š~Mi&êff1ftfcrfèJð~'!J.I!'¡¡i¥ (Mexican, Asian) Day 3--Sunday AM Interviews find commonly named food items consumed include: .Fresh salsa . Pesto . Pizza .Asian soups .Gourmet salads 4 Day 3--Sunday AM · Emergency rooms and clinics are becoming overwhelmed · Medical care facilities are short staffed because of personnel ill with "gastrointestinal upset" · Medical staff are concerned about potential spread of the illness within the hospital and urgent care clinics Day 3--Sunday PM Early results of diagnostic tests indicate that Shigella sonne; is the 4f~~W~'~--- Day 3--Sunday PM . Message also threatens to continue contamination unless the upcoming economic trade conference is canceled . The Mayor shares the message with the County Commissioners, Heath Department Director & Chief of Police Day 3--Sunday PM · Patient count is up to 250 after a news report on the disease outbreak · Report states that the source is not yet determined, but food is suspected--particularly fresh herbs · Most cases are middle-aged adults (Age range of cases is 5 to 82 years) Day 3--Sunday PM · Extremist group sends message to mayor of large city in Cedar County J!jrM~~.'liãte~éI~~~.."íìF% "contaminating the food supply - with a bacterial agent" Day 3--Sunday PM Someone from the extremist group calls the local newspaper and says she represents a group who wishes to take credit for "making people sick with food contaminated with botulism." 5 Day 3--Sunday PM The Health Officer declares a Public Health Emergency. Day 4--Monday AM . Reported patient count is over 400 . 80% of cases are from Cedar · Remainder of cases come from Pine and Dogwood counties Day 4--Monday AM · State University microbiology laboratory (located in Maple Co.) reports to Campus police that several vials of Shigella sonnei are missing · Vials were last seen 7 days ago · A few vials from the original batch are still available Day 4--Monday AM Health Department phone lines are jammed with concerned callers. Day 4--Monday AM · 30 cases are restaurant workers · Affected cases range from age 4 to n... · 30 cases are hospitalized--S are in serious condition Day 4--Monday AM . Campus security contacts Maple County Sheriff . Maple Co. Sheriff contacts local health department (Maple County Health) 6 Storyboard 3 The Terrorist Action -A terrorist group stole bacterial vials from the State University in Maple County -An infectious broth was produced with the stolen vials of Shigella sonnei Day 4--Monday PM Business at area food establishments has decreased ,~'H~~ìtilGa4il~_ Day 4--Monday PM Cedar County Health Department is re-interviewing cases and working closely with restaurants to identify common ingredients. Indications are cilantro and basil as the most likely contaminated products. Storyboard 3 The Terrorist Action -Broth was sprayed onto produce at a food distribution warehouse in Cedar County over a 2 day period -Contaminated produce was used in restaurants & bought directly In grocery stores Day 4--Monday PM News media from other states are calling various county ~_~ti'e~l~wøa~m information. - Day 4--Monday PM An elderly woman (86 years old) dies from complications resulting from Shigellosis. Her family threatens a lawsuit against the "responsible agency." 7 Day 14, Friday-- Recovery period · Nothing more is heard from extremists · No other new cases attributed to the identified food source in the past 7 days · Secondary cases continue to occur including 3 daycare outbreaks Discussion . Strategies to prevent/control outbreaks or bioterrorism threats"i.NÇL ~'~'ld~·¡;1~.O ta~s, ., ..,.-...·.,~:_;"-.'M(.';"''*'·J:w'.:\;':>. ,.:' ,,' - "... " ' _ ,," ____,,~~ ø~",'~~~~"".%:«:,i(~.,";.if'_"¡¡ - ..'. " _. ~. -. . -,<;<. ",Jf&mWri¥~,'0r)w} "'c:;to"r~a'ss e e pu IC' . Interactions between affected agencies For More Information . Julie Wicklund, Bioterrorlsm Surveillance Coordinator - Washington State Department of Health (206) 361-2881; iulie.wicklund(å)doh.wa.aov . Greg Smith, WEDSS Development ' Director - Washington State Department of Health (206) 361-2924; area.smlth(å)doh.wa.aov Day 14, Friday-- Recovery period · People still call about food safety and are concerned by cases continuing to occur · The trade conference is scheduled to be held 1 week from today Discussion · Evaluation of incident response system for management of a CD or BT event jt,;mrtag~!l!:º~matto'W~W'ii~*~*,_'Ui_ _ · Strengths & challenges of response · Gaps in policy or training · Gaps in communication planning · Gaps in information management systems 8 Board of Health Media Report February 21, 2002 Jefferson Coun Health and Human Services JANUARY ~ FEBRUARY 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 programs for the public: 1. "Food worker classes change in February", P.T. LEADER, January 16,2002 2. "Jefferson: Old, damaged child car seats cashed in", Peninsula Daily News, January 22. 2002. 3. "Local Governments brace for knockout budget punches", Peninsula Daily News, January 20, 2002 4. "Jefferson appeals well-monitoring ruling", Peninsula Daily News, January 23,2002 5. "County budgets for capital facilities", P.T. LEADER, January 23, 2002 6. "Trimmed county budget means service cuts", P.T. LEADER, January 30,2002 7. "Seawater intrusion input sought by county", P.T. LEADER, January 30, 2002 8. "County faces water well action plan", Peninsula Daily News, February 5, 2002 9. "Seawater intrusion issue seeps from island to county", P.T. LEADER, February 6, 2002 10. "Budget shortfall may harm state bio-terrorism defense", Peninsula Daily News, February 11,2002 11. "County 'exempts' terrorism emergency management plans", P.T. LEADER, February 13, 2002 I -:Pr Lt: AD E r¿ l-tfo-Õ2-- 2- Jefferson: Old, damaged child car seats cashed in The AM is offering a $5 reward to those who turn in old, used and damaged chil- dren's car seats and booster seats. Seats can be dropped off at the'Jefferson County Sheriffs Office, 81 Elkins Road, Port Hadlock, or at the Washington State Patrol office, 62 Old Olympic Highway, Port Angeles, A seat is considered no longer safe if it has already protected a child in a car crash, if it is more than six years old, if it is miss- ing parts and pieces that cannot be repla,ced by the manufacturer, or ifit is listed on'the recall/defect list. The reward program continues through Jan, 31. f>D J /- 7,-2 -{)L . ' PENINSULA DAlLY NEWS , I, J-O-l>d-, Local governmentš' braceforknockout:\ b.·udget:,p'J;1ç;hes,:· BY PAUL QUEARY THE AssocIATED PREss OLYMPIA - With six deputies to help him patröl 800 square miles, Garfield County Sheriff Larry Bowles says he already runs a lean operation. Dispatchers double as matrons in the rural county's six-person jail, find sometimes at night theré's nobody patrolling the county's lonely roads, just a deputy on call. But soon his skinny operation could become a skeleton, victim of a pro- posal to eliminate mìllions in state aid for local govern- ments. "It could be really devas- tating to us, and it could be devastating to the people of our county," Bowles said. Before Initiative 695 passed in 1999, some of the motor vehicle excise tax it abolished was kicked back to local governments - especially those with tax bases too small to support themselves. Although 1-695 was tossed outby'the courts, lawmakers bowed to the voters~ will and repealed the hated car-tab tax. But with the economy booring and state coffers fat, the Legislature didn't leave local governments to suffer the full conse- quences. Instead, they approved a new subsidy known as "695 backfill," restoring some of the loss. In Garfield County, that money makes up about 4() percent of the total budget, Now fast-forward to today. The state budget is in the tank along with the broader economy. GDv. Gary Locke and the budget-writ- ers in the Legislature are looking for ways to erase more than $1 billion in red ink. And the $84.6 million in backfill money for fiscal 2003 is gone in Locke's pro- posed budget. "The 695 funding was intended to help local gov- ernments adjust to a major tax revenue change,"Sfµd. Ed. :eenhale'l:ìspo~éSJ:a411 for Loclte's Of'ficeofMJ.m.- ageIIlept and B\iQgét.."1t's . tough on these localgovérn~ ments, but it's not some- thing that was ever intended as Ii permanent. We're dealing with 13.$1.25 billion budget problem. Something had to~." ., Senate Ways án.d Méåhs Chairwoman Lisa Brown doesn't hold out much hope for its restora.tion as law- makers alter Locke's pro- posal. . "We can't share revenue if we don't have it,"sa.id Brown, D-Spokane, who hopes to preserve some money for the smallest gov- ernments. "That's just the way it is." No room to adJust Many of the smallest local governments don't have room to' adjust. But counties may have an eVen tougher tÜ).1ecöP7 ing with decreaæd$tá~ support,said Bill VÓgIi.ir, executive director of the Washington State Associa- tion of Counties. Counties lost 47 percent of their státe support wl1E(n lawmakers repealedthe~- tab tax. Now they stand tø lose the rest. "The combined cost to the counties is nearly $50 rillion ayear, in thet"}"? areasthatVf~" .."......~ by státeJawt¡o . 'Çlø+' public safétyllfldpUbli¢ health for the citizens," . Vogler said. Counties were already hurting from the same economy-related dip in tax revenues tha,t's causìrÌgthe state's problems. And th~ . expect to lose án. additional $20 million in potential rev- enue to the property tax limit imposed when voters approved Initiative 7471a.st year, Vogler said.' . . 'OJ) e 1- - ::s I.. 'OJ) e I- I.. o ...., I- e o E I - - Q) ~ () - co Q) Q. Q. co C o tJ)oo '- ~oo Q) ~~ t:: ~~ Q)H ..., ~ Æ ~£~ ~lJ:g£~ca.g~~~$ '"' >. 0 I-< ...., Õ o.;:j 0 ~ 'S ~ (1 æ 1:r S' 'õ 1¡¡ ~ Þ Q) 0"...., ~ 0" Q) ~ ¡:: ::s... Q) ..c: ¡::..c: 1¡¡ þ'" (1 ~ ...., o 0 ...., I-< ::s ...., ...., ... "C ;> t) t) t) . ¡:: Q) Q) 0 I-< (1 I-< ¡:: Q) .¡:: . I-< Q) "C ¡g:.=l..c: "C 0 0 ~] o·~ "C ...., gj .s -:5 §.~.~ ~ 15 ~ b.O"'" ~ 1:: ~ gj] (1 i3,.i::b.O ¡:: ¡::ª~Q) I-< ~ gp ~ .¡:: ãP: ~oo 0 ~'!> 00 "C Q) fa 8 1¡¡ .¡:: Q) ...., ::s;.¡;¡] ~ ~ 2 ~ ¡::"§ QS ~ 1¡¡ ¡;~ ~ f.S ¡{j ]!ê.s ê'1¡¡~"õ ~;>,-:5 Þ 15 ~ 1:: È ~ .(1.~ -:5 ~.S Q) 1:: ~ .¡:: >. 15 ;;; 8 b.O b.O §.. 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"':! 0 ~ (1..9 00"0 irtJ..c:.... b.O"'" fi5 O..c: Q)'8 ¡:: ;.... rtJ ......!j ¡:: ;>, ::s Z > ¡;;¡ Q) ¿;! ...., ... ... ...., rI,) ~ ~~ S I:: .Qp @ 1i3 E:;:: ~s.~~¡;J § ffi]~i3~ ~ .Q 1¡¡ .E.s 8'E ~ ¡:: § § @ o¡::> >. Q)¡::8uo.¡:: E-< ::s 0 C/~ "C ¡:: ~ ro Q) gj .... OQ)¡::(1 gQ.)::E1-< I-<rI,) ~ u 'B:3 ~ 1¡¡.¡$: ..c: .s § ~oo ~ o ¡:: ~ 0:1...., If: t' "C ..... .Q ~ " 0.... '"3 ~¡:: Q) ~ I-< rtJ ¡:: ....... ~ Q) b.O Q.) ...> "':! Q) 0 0:1'0 ::s I-< ~§~[:¡~ :5ð~~8.-ê i J rJ Ç) \ ~ rl I - ----:2 If .ç- County budgets for capital facilities By Shelly Testerman Leader Staff Writer Jefferson County government's $38.2 million 2002 budget, adopted last Dec. 27, aims to move key capital projects forward. The single biggest item in the county's $2.1 million capital facilities budget is $1.5 mil- lion for relocation and expansion of the· Jefferson County Sheriff's Office adminis- tration, E-911 dispatch and the emergency operations center. According to Sheriff Pete Piccini, the space currently occupied by the sheriff's administration will likely be used by dis- patch, which is now housed within the jail. Dispatch's vacated space can then be filled by emergency operations, and the sheriff's administration, including Piccini's office, will be.moved.to.a new building. Othèr m!ljo~projects at th.e sheriff'sjcor- t.; rections facilµ,y in Port Hadlock iriclude $25;OOOfor replacement of 10 toilets in the county jail, $35,500 for padding the jail's panic cell, and $36,000 for expanding evi- dence storage. Plans for a $13 million law and justice center housing courts, prosecutors and clerks have been placed on hold, with no money budgeted in 2002 for further design or con- struction. "This project is of the scale that can only be funded through a voter-approved levy," County Administrator Charles Saddler wrote in a Nov. 21 budget memo. Improvements to the coùrthouse facility total $178,000, with $143,000 for seismic retrofitting and $14,000 for resuIfacing the parking areas. No money was specifically eannarked for clocktower renovations, but Saddler said if a $2.5 million state grant is awarded; the county will have to come up with a $1 million match that has not been budgeted. The county is currently negotiating for the purchase of the facilities it has leased for the last decade at Castle Hill, adjacent to the Port Townsend Guality Foods Center. According to Deputy County Administrator Gary Rowe, the county's monthly payments will not change substantially with the purchase, but annual payments of $180,000 will be going tow¡¡rd eventual ownership, not rent. h ~~.~j2, $265,000 is budgeted for remodeling the fa- cilities, which currently house the depart- ments of Community Development and Health and Human Services. One county department will be relocat- ing due to budget constraints. District Court's adult proþation department - currently co- housed with Superior's Court's corrections department in Port Hadlock - will be mov- ing to the county courthouse Î.i1 March. The dep~ent will save a total of $53,000 in 2002 by eliminating rent payments and one unfilled administrative position. Rowe has recommended relocating the department to the new sheriff's administrative facility, but until it is' constructed, housing probation staff in the space currently occupied by the assessor's mapping department. Next week: Changes in county services due to 2002 budget cuts. 1?\': LEADeR. .1- ~3 -ó 2- '" < rJj ..- = ~ ~ ~ .- è ~ r;'j, r;'j, ª ~ e ..- ~ ~ -c = ~ ~ = = o ~ -c ~ e e .,.. ~ N o o N Ò to'! .. ::¡ c: ~ .. 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Õ ~ 0 0 (I:) C"'I >oM 'E ~~~~~~er/J~~~o8§~·~~!~~:oo~U"""OUVJO~OO _U'~OI1)~""O""'~O_ -' -01.l-t- o-ð~'õ §~o..2.c"'O£u o td Q.. > ~ ~ 0 _ c::: U ::;:. 0.5 ~ bl) 0 .... bIJ r:= co"=' 0 0 - ""'" ~ 0 ';;:j U 0 0 0 ~ 'S .¡:: -g ¡:¡ 0 en c:: 0 0 '0.... § '0 0 E ÇI. bO c:: 0 t¡ bO ..: 0 0 ÇI. e ~~:l,~O'=~~a~~-5~ß eß!8~~ª~BBð ~~; 7 Seawater intrusion input sought by county By Barney Burke Leader Staff Writer The Jefferson County Board of Commissioners has scheduled a hearing for 2 p.m. Monday, Feb. 4, to solicit input on options for complying with a state deci- sion regarding seawater intrusion and the county's Unified Devel- opment Code (UDC). Jan. 10, the Western Wash- ington Growth Management Hearings Board upheld an ap- peal from the Olympic Envi- ronmental Council and the Shine Community Action Council. The county had ar- gued that it had no authority to regulate wells, but the hearings board disagreed. Now, the county has 180 days to either appeal the decision or comply, and David Christiansen, the county's manager of natural resources, says three options for complying with the order have been developed. Christiansen said one option is to comply using the staff and resources already available to deal with the issue. A second option ,,:,ould be to either cut an- other county program to free up resources or develop a new rev- enue such as a water"manage- ment district. The county could also look beyond the issue of wells and include the taking of surface water; that would involve significantly more time and money, he said. Meanwhile, Chief Civil Deputy Prosecuting Attorney David Alvarez has filed a motion for reconsideration of the order. Alvarez said he filed the motion on his own initiative and had not been directed to do so by the Board of Commissioners. Alvarez said that while the county would like the decision overturned, he didn't see that as a likely outcome of the motion. Rather, he explained, the county feels that the decision raises questions that need to be an- swered before amending the UDC to comply with the deci- sion. If the county decides to appeal the decision, it would have to file a separate motion in Superior Court. Alvarez's motion for recon- sideration says that the growth board's decision contains items that are either "misinterpreta- tions" of the law or "cleriçal mis- takes." Only the Department of Ecology (DOE), not the county, has the authority to regulate the consumption of well water, his motion states. Among other things, the mo- tion asks whether the decision means that Jefferson County has jurisdiction beyond its bound- aries if an aquifer exterids to those locations. The motion also questions whether the coimty can limit the number of wells allowed when state law requires that building permit applicants must. have a source of po~ble water. Outside of the èity's service area, water is usually supplied by wells, ill- cluding individual wells, wells serving several properties in a de- velopment, and larger well sys- tems operated by Public Utility - District No.1. Christiansen stressed tþat the primary goal. of the motion to reconsider is to seek Clarification. "We do intend to comply" with the order, Christiansen said. C()lette Ko~telec, tbe engineer who represented the appellants, could not be reached for com- ment Monday. Last week, she said she was preparmg a response to the county's motion to recon- sider. 7?r LeA:D6~ 1- 30- 02. ,,-. ~ o ..µ ~ .~ ~ Q) ~ .. In - - ~ ~ $5 1:: jJ .~ c8 '+-<.o.g -~ S:5 "g _~.Q) ~ jJ ~~ ::bÔ ~r~L 0~Q)~ ~ Q)~ 0 00 ~~~O s:: ~~ 'bO$58"1j ~~~p.. t)~:~bO 005'+-<~ $5o:g81d s:: Id $ § ~ p.. § ~ ::;j .... ~ Q) 0 0 ta Q) 0 ~ :8;g ~" ' 8 ~:..,.:S ~ ~ td ª :5 . OJ $5 .fr ~ 8e td ..c= 8 ¡g Þ Q) ,': ~ ".":J:5 ~ '+-< s:: ~ bO Id g;¡ ftOJ Id..c:: ".":J ... ....~. 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S ~,.J:J..c:] t) .Q.5 ~.~ 'õ 50 Ito+> "C+>"1jQ)I-<<JJI-< -+>1-< Q)_.... 1-0 Q) ~~..c: Q) cO en_ Q) ÞO':) ~ §~;:s 0 alE-< §'<s::{J ~ ~1Ø ~ S ~.~ ö ~ ~:3 ~ ª ~ ~ ~ Q I \n \ ç-'b ----:2 ¡::3 -e-- c¡ Seawater intrusion issue seeps from island to county By Philip L. Watness Leader Staff Writer Jefferson County could spend as much as $300,000 per year to comply with a state board's rul- ing to monitor seawater intrusion in private wells. That's a rough estimate pre- sented Monday to the county commissioners by county water resources specialist David Christensen in what some resi- dents have called a "draconian" response to the recent ruling of the Western Washington Growth T-r: Lf""AD ef2. d..- 6 '-0 2- Management Hearings Board, Christensen offered three op- tions to comply with the board's January order that Jefferson County establish a monitoring program to ensure that ground- water near shorelines isn'l con- taminated by saltwater. The first option - and least costly - places the burden on the property owner to prove that his well isn't susceptible to seawa- ter intrusion or will not affect adjacent wells. The Jefferson County Public Utility District would monitor wells within Critical Seawater Intrusion Ar- eas, defined as wells reaching below sea level within one-quar- ter mile of shorelines. "No development would be aI- lowëd .Ù¡¡µ mcreased seawat~ in-. _ truslon' or had the' potentiål to' cause increased seawater intrusion use to Jefferson County. The for adjacent wells;' Christensen county would impose mandatory wrote in lús briefing paper. water conservation measures in The second option would re- Critical Seawater Intrusion Zones. quire property owners to install Christensen estimated that flow meters on wells located in ar- Option 2 would cost the county eas highly vulnerable to seawater $ J 00.000 per year in staffing ane! intrusion - Critical Seawater In- monitoring costs. trusion Zones - defined as those In the third. most costly op- areas with high chloride readings tion. Jefferson County would within one-quarter mile of shore- manage water resources with a lines. and to provide annual re- protection strategy concerning ports regarding water quality and seawater intrusion as well as other potential impacts on water quality. Option 3 would essen- tially mean that the county would take over the responsibility for water use and rights from Wash- ington state agencies such as Department of Health and De- partment of Ecology. The county would regulate and monitor all water utilization - both withdrawals and uses. This could mean establishing minimum lot sizes based on the rate an aquifer would be recharged. Restrictions on water use could be imposed in any area where water use could impact water quality, including seawater intrusion. in-stream flows. fish habitat and surface water quality. The county commissioners discussed Christensen's three options Monday but didn't settle on a preference. They did hear from half a dozen residents, sev- eral of whom encouraged them to use volunteers in addressing the stale board's order. Rita Kepner of Marrowstone Island said she favored none of the three options. The options "will result in angering fearful people who op- pose regulation;' Kepner said. ¡'These options will also anger groundwater activists q,nd the growth management board - because they are likely to fi ·l" al. Rita Kepner resident Marrowstone Island , .. .~ ~ "And, given the political climate in Jefferson County, these op- tions will also anger groundwa- ter activists and the growth management board - because they are likely to faiL" Kepner encouraged the com- missioners to first admit that the county has a problem with groundwater quality; educate themselves. staff and residents concerning the complexity of the issues; then utilize volunteers to screen wells bUI turn to profes- sionals in hot spots indicated by lúgh levels of chloride in wells. Colette Kostelec of Port Townsend represented the suc- cessful effort of the Olympic Environmental Council and Slúne Community Action Com- o nùtte~ to convince the state hear- ings board that the còunty had failed to provide adequate safe- guards for drinking water. She said the three options represented a good-faith effort to comply with the board's order, but she hadn't had time to review them in detail, having received- Christensen's briefing paper at Monday's workshop. "The burden is on the county to comply with the hearings board. and we'lI certainly look over the options." Kostelec said. "We'll argue thai they're in com- pliance or not [before the board]. We'd liI.œ to be optimistic that compliance can be aclúeved and we can move forward." Christensen and county long- range planner Josh Peters will meet this afternoon in Olympia with representatives of the state departments of Health and Ecol- ogy to discuss the ramifications of the hearings board order. "We need to clarify conflicting statements of who has the legal authority over water rights," Christensen said. The hearings board decision "is causing a lot of discussion. We hope to get agree- ment from Health and Ecology where the lines of authority are." County Commissioner Rich- ard Wojt offered a fourth option: a mediated discussion among the litigants, other affected residents and the county. Kostelec said that could have been achieved before the Olym- pic Environmental Council and Shine Community Action Com- mittee went to the hearings board. but the county decided against further negotiations when she proposed having a mediator at the table. 10 Budget shortfall may harm state bio-terrorism defense He~l~h officials say there's no n10nèy to deal with threats THE AssoCIATED PRESS OLYMPIA - Public-heaJth officiaJs say Washington state's budget shortfaJl could threaten its first line of defense against a bioterrorism attack or outbreak of disease. Directors from across the state told lawmakers last week that cuts in Gov. Gary Locke's proposed budget would leave them unable to effectively pro- tect against threats ranging from anthrax to undercooked meat. "Cutting these funds will place our cities at greater risk from an infectious disease out- break," Snohomish Health Dis- trict Director Ward Hinds told the House HeaJth Care Com- mittee on Friday. "Now is the time to strengthen our public heaJth system, not weaken it." Hinds, who heads the state Association of Local Public HeaJth Officials, said lives will be endangered if the state does- n't help out. "We are currently underpre- pared to deaJ with any sizable disease outbreak in our state, whether it be from natural causes or bio-terrorism," Hinds said. "This became very clear last October and November as we struggled to try to deal with . concerns about contami- nated letters and powders. And that was without a single case of anthrax in our state." The proposed $25 million cut would force 10caJ depart- ments to reduce staff and ser- vices, King County Health Director Alonzo Plough said, resulting in fewer available vac- cines - and fewer nurses to administer them. In January, President Bush pledged more than $1 billion to defend the nation against bio- logical attack. Washington's share of those funds is about $20 million, and some will go to toc~ì b"eaith districts and hospic tals. But it won't replace aJI they stand to lose. Patrick Libbey, president of the National Association Df County and City HeaJth Offi- ciaJs, said he expects the state to lose as much as haJf its dis- ease-response capability because of the cuts. Funding for public-health departments came from the state's motor vehicle excise tax until the Legislature repeaJed the levy in 1999, prodded by the passage of Initiative 695. For the past two years, the state has helped cover the loss, but funding was eliminated this year. "We had to make some very difficult decisions this year to fill the $1.2 billion budget gap," rr>j)rJ J--fl-ð À Locke spokesman Pearse Edwards said.. "The 695 b&ckfill money was temporary' and never intended as a long-term solution." " "I think the committee is well awa,re of the problem," Committee Chairwoman Eileen Cody, D-Seattle, told the health officiaJs. "But as you know, we also are well aware of the budget, and so we hope that we can reach some amicable solution." She said if the Legislature could not find adequate funding for public heaJth, then lawmak- ers could at least provide coun- ties with authority to raise the funds themselves. A bill to do that has found little support outside King County, said House Appropria- tions Committee Chairwoman Helen Sommers, D-Seattle. '^,' '¡' . "'. I{ County 'exempts' terrorism emergency management plans By Patrick J. Sullivan Leader Staff Writer Jefferson County government has already announced its inten- tion to invoke a Public Disclo- sure Act exemption on a "terrorist response" plan not yet written. The county has an emergency management plan that attempts to coordinate response to a vari- ety of incidents - from floods to. earthquakes, fires to hazardous waste spills. New to tlùs plan is a proposed "annex" of how the county would coordinate a "ter- rorism response," said County Administrator Charles Saddler. The terrorist attacks of last Sept. 11 have changed many things, Saddler noted, including how Jefferson County gears itself to face such emergency issues. The proposed terrorism response annex would include how to handle threats of suspicious pow- der uncovered in the mail. Four such incidents - all non-threat- ening - happened locally last year. ''The rest of the [county emer- gency response] plan is public," he said. "TIùs is an annex to the plan, and in regard to terrorism response, it will be kept private." The U.S. Postal Service is not hiding the precautions being taken inside post offices to screen mail for possible contaminants, nor how a public building - es- pecially one containing other public offices - would be evacu- ated. However, the actual inves- tigation of the source of any such mail is kept private by postal inspectors. Some of the county's pro- posed "terrorism" categories would be "policies, weapons of mass destruction, directions and control, sequencing, initial re- sponse, reporting, roles and route responsibïtities,agenciesrespon· sible, and federal agencies." All are intended to specifically apply to acts of terrorism, not '¡ ~~/3~O:J- "This is for criminal actions, not natural disasters and not accidents :' Charles Saddler administrator Jefferson County general accidents or emergency incidents, Saddler noted. For example, Saddler indi- cated that the annex includes re- sponse to biological threats, which would not be open for public review. But if a biological 'threat came as a hazardous waste accident - such as a semi-trailer of ammonia overturned on a lo- cal highway - that is already cov- ered under a different emergency response chapter that remains public infonnation. "TIùs is for criminal actions, not natural disasters and not ac- cidents," Saddler said. Public disclosure Last year, the state Legislature crafted new rules regarding ter- rorism, including an exemption to the state public records law that keeps "terrorism response;' plans out of the public's hands. The Revised Code of Wash- ington42.17.31O (1) (22) allows a public records exemption for: "Those portions of records con- taining specific and unique vul- nerability assessments or specific and unique response plans, either of which is intended to prevent or mitigate criminal terrorist acts as dermed in RCW 70.74.285, the public disclosure of which would have a substantial likeli- hood of threatening public safety." The county document is still in !iraft form and therefore is exempt from disclosure as a pub- lic record. Once the document is complete, Saddler said it will be reviewed to determine which portions will be open as public record and which are exempt. He anticipates something being ready before month's end. . "TIùs is new to us, too, but we are trying to do the best we can based on our understanding of the plan," Saddler said. "This type of document, if it became public knowledge, to most people it wouldn't mean any- tlùng, but to those who want to use it for illegal or terrorist pur- poses, it might give them certain infonnation that would allow them to take advantage of weak- nesses." Saddler would not say if the county has already implemented any terrorism response plans. School plans Public school districts have their own contingency plans for evacuation drills, some more de- tailed than others. The county's intention, Saddler said, would be to not make public any specific school evacuation plan dèaling specifically with a terrorist re- sponse. Port Townsend School Dis- trict Superintendent Carol Andreasen, who works with the Port Townsend Police Depart- ment and not the county, said the district's school evacuation plans are and will be public. "Our evacuation plans are public," Andreasen said. "The school board reviews the plans at a public meeting and we practice them openly." Specific plans that the police or sheriff have in response to a bomb threat or other terrorist act may be kept private, but Andreasen said she would al- ways want parents to know how the public school district is car- ing for their children. 1\vo years ago the Chimacum School District finished its "Our evacuation plans are public. The school board reviews the plans at a public meeting and we practice them openly:' Carol Andreasen Port Townsend School District Superintendent public plan on disaster or crisis response, reported Chimacum School District Superintendent Dr. Mary Lynne Derrington. A summary was sent to parents, and teachers received full details. The plan includes response to meet the situation, such as bomb threat, earthquake or fire. "In some situations, you would keep the kids inside and protected, and in other cases, get them outside and as far from the building as possible," Derrington said. The infonnation not publicly circulated is exactly where off- campus students might be taken during an emergency. In such a case, a person posted at the school gate would infonn incom- ing parents where to retrieve their children. As to what records the county might decide to keep private in regard to "terrorism" response, Derrington said that's different from a school plan. "Our relationship with the county in disaster crisis plan- ning has been outstanding," Derrington said. "I have confi- dence in them." (Leader reporter Shelly Testerman contributed to this story.) Provider Newsletter Jefferson County Health & Human Services 615 Sheridan Street, Port Townsend, Washington 98368 Phone: 360-385-9400 Fax: 360-385-9401 Money, Money, Money... We all thought we were going into Health Care professions to increase healthy outcomes for individuals and communities. We thought we were going to make a difference in the lives of individuals. Increasingly, all of us in Health Care are spending more and more time watching the bottom line and the accelerating changes of community needs. Unfortunately, recent changes in the Health Department will have an impact on some of your practices. The repeated passage of initiatives has taken a large toll from the Health Department, as a publicly funded government agency. Yes, we are still here and yes, we will continue to strive for improvement in our proficiency of communicable disease and communicable disease reporting. Some of the changes will include bioterrorism training with the hospital and the Emergency Management Teams will continue throughout this yèar. With the University of Washington School of Nursing we will continue Mental Health Screening, the Dr. David Olds Home Visits, and Childcare Center Assessment that identifies children with mental health issues. The Jefferson County Commissioners' budget for 2002 could no longer support some of our services due to a declining county revenues. The changes you will see will include: February 2002 Inside this issue: Data Steering 2 Committee Jefferson County 2 works on Bioterrorism Preparedness Behavioral Risk 3 Factor Survey System Hear and Say 3 Reading Method Pregnancy Risk 4 Assessmeñt · We will no longer be doing community flu clinics in the fall. We currently see approximately 1,400 people and have a large web of volunteers. Some people will be choose to go to Costco, QFC, pharmacies, Safeway, others will appear at your practices, requesting this important vaccine. · We will be decreasing our walk-in Immunization Clinic to two days a week - Tuesday and Thursday afternoons That will only allow us to do PPD TB testing on Tuesday. TB testing is required for people going into drug and alcohol treatment, childcare workers, and others. We have also finished our TB protocols, and are willing to share those with any of you who are interested · We will no longer be providing HIV counseling and testing in the jail. · Family Planning Clinic has continued to grow and expand in client demand. ]CHHS will continue to have Family Planning Clinic in Quilcene one day a week and four days a week in Port Townsend. Monday will no longer be open for Port Townsend Family Planning clinic services Port Hadlock Clinic has closed. Emergency Contraception will be available five days a week during business hours. Hopefully you and local pharmacies also can provide Emergency Contraception. · ]CHHS will no longer be able to see walk-ins complaining of communicable diseases. Continued on Page 3 Page 2 ~ t f ; , I I I í I - Data Steering Committee Behavioral Risk Factor Survey System (BRFSS), Prenatal Risk Assess- ment (PRAMS), arrest records and ER data from Jefferson General and Harrison Hospital. In General Jefferson County is a healthy county with few individual health outcomes that are problems. Preliminary health outcomes that appear to cross all age spectrums include: mental health issues, substance abuse and family violence. Jefferson County also is home to a significant proportion of 65+ residents. Many of these issues that have multiple spectrum impact will become more clear as we fmal- lze our work with BRFSS, census and PRAMS. Please contact Jean Bald- win at 385-9408 if you are interested in more information and if you would like to be more activelY involved, or watch www.co/~fferson.wa.us Jefferson County Works on Bioterrorism Preparedness The purpose of the Data Steering Committee is to identify health outcomes and problems. Committee membership includes . representation from city and county government, citizens, Olympic Community Action Program, and ]GH, WSU and courts. Under the guidance of Dr. Chris Hale, the committee is looking at county and regional data, vital statistics, Census, On January 30th a Bioterrorism Preparedness Tabletop Exercise, sponsored and facilitated by the Washington State Department of Health, was held at Jefferson General Hospital. The exercise was well attended by staff from many agencies including: ]GH, ] CHHS, EMS, City and County Law Enforcement, County Emergency Operations Center, Fire Districts, Red Cross, OlyCAP, P.T. School District, Port Town- send Paper, Navy Fire District. The goal of the exercise was to help participants to identify the communication, resources, data, coordination, and organizational elements associated with a biological emergency response. Identifying gaps in local preparedness, allows community responders to better coordinate services and determine additional training needs. The participants are now being asked to help prioritize the preparedness gaps that were identified and discuss possible solutions. Next steps will include medical and EMS training. Behavioral Risk Factor Survey System The BRFSS was concluded in December 2001. 600 Jefferson County adults voluntarily responded to all or part of the following modules: health status, health care coverage, health care access, blood pres- sure, diabetes, tobacco use, alcohol use, firearms and safety, demographics, impairments, cancer screening, domestic violence/sexual assault history, environmental health concerns-air and water quality. The BRFSS analysis will be available in March 2002. Dr. Chris Hale, epidemiologist and demographer, will be working with our staff to interpret the results. The information will first be shared with the Data Steering Committee. For more information, or to be included in the mailings, please contact Jean Baldwin at 385-9408. Page 3 Hear & Say Reading Method University of Washington researcher, Dr. Colleen Huebner, with the support of the Jefferson County Health & Human Services, is bringing a reading program to all parents of two-year-olds in Jefferson County.· Parents who learn the Hear and Say Reading Method can expect enhanced language acquisition for their child, and children who participate in this reading program typically start school ready to learn to read. Dr. Huebner brings the program to all eligible county participants without cost. Her research projects will attempt to determine the best way to deliver the program to parents. Three different parent cohorts receive one of three methods for teaching Hear and Say reading: Through small group instruction, Through a videotape and phone support, or Through videotape alone The study will measure which methods were most effective in delivering the parent-child reading instruction and enhancing children's expressive language development. All families will receive a video and Children's Book. The literature shows this is an exciting way to impact school success. Classes are at Jefferson County Library, PT Library, Child Care Centers. For additional iriformation on the project, or to participate, contact the project at 360-3794471. Money, Money, Money Continued from Page 1 This includes spider bites, rashes, wounds, scabies and head lice. J CHHS will be an infonnational source for things such as head lice and scabies, and maintain handouts for home treatment. We will also continue to work with school volunteers at the begin- ning of every school year and screen all classrooms. The success of doing all the head lice checks for buildings has decreased intensity of outbreaks and the problem of school closures. . We are also decreasing the number of women we see for Breast and Cervical Cancer screen- mg. JCHHS has seen 58 women a year. The payments have increased in this program and so has the ability to do referrals and obtain payment for positive cancer fmdings. Ellen Phillips, a private provider in Port Hadlock, is seeing BCHP. Marilee Mount is a provider. If others are interested in this federal program, please contact Julia Danskin at 385-9420. Women between 40-60 are not appropriate in Family Planning Clinic because often times they have other primary care needs. Other decreases in services that you may notice will be a significant drop in our caseload of families involved with Child Protective Services. We currently serve families with problems which have become issues of abuse and neglect. Maternity Support and Home visiting is in its third year of the Dr. David Olds study with the University of Washington and the University of Colorado. We will continue to serve 40 clients a month and we , anticipate having the same outcomes as Dr. Olds over the last 20 years. (Call for research articles if interested). ~ P:e::e~~c~u:s~r~:~s:e~ent ~:,~::~::rne effern of rob,ceo ::ge 4 i anecdotes reveal rich and complex histories of alcohol; benefits of folic acid; and risks of HN domestic violence, substance abuse and families The Jefferson County Pregnancy Assessment will living in poverty. Research tells us that without be modeled after the Centers for Disease Control intervention, these problems follow families, PRAMS (prenatal Risk Assessment Monitoring impacting community, school, and law and justice Survey). JCHHS is fortunate to have a partnership systems. with the Washington State Department of Health Jefferson County Health & Human Services is PRAMS Unit. undertaking a Pregnancy Risk Assessment Thirty-two states partner with the CDC to conduct Initiative. The purpose of this initiative is to PRAMS. Since 1987, PRAMS data has been utilized to survey all Jefferson County mothers who give identify pregnancy risk and community outcomes. . birth in 2002. Topical areas covered in this President Clinton utilized PRAMS to identify the need assessment will include: for longer postpartum hospitalization. PRAMS data · Attitudes and feelings about the most recent has also been used to identify problems with substance pregnancy abuse and health care access. · Content and source of prenatal care The Data Steering Committee recommended that . Maternal alcohol and tobacco consumption ]CHHS explore use of a PRAMS-like survey. As a . Physical abuse before and during pregnancy result of the recommendation, ]CHHS has obtained . P 1 d b"di permission from the CDC and Washington State regnancy-re ate mor 1 ty . I £ h I h Department of Health to conduct a PRAMS-like · n ant ea t care . ... h will all 2()02 b· h h . lllitlatlve t at survey ltt mot ers ln · Maternal living conditions ff, ail d . c . will b , ]e erson County. Det e lnlOrmatlOn e · Mother s knowledge of pregnancy-related health available in the near future. Jefferson County Health & Human Services 615 Sheridan Street Port Townsend, Washington 98368 Depression Screening The incidence of major depression in pregnancy and in the fIrst year after birth is 10-20%. Factors such as inadequate support, previous depression, low income, and unresolved loss/trauma increase the risk of a major depressive episode. Women often do not look or act depressed, as they may feel ashamed or afraid to admit to how badly they are feeling. Research has shown that the baby's behavior and development are affected when women experienc- ing major depression are not treated. We use the Center for Epidemiol- ogical Studies Depression (CES-D) screening tool to screen all pregnant and postpartum women who are part of our Maternity Support Services and Maternity Case Management. The CES-D's accuracy in recognizing major depression in the general adult population is well supported by research. This tool has been simple to use and score. Our clients have responded well to being educated and screened for depression. If a woman screens positive we talk about self-care, discuss medication as a possible option, refer her to her primary provider, and also to Jefferson Mental Health. We offer to send a copy of the completed CES-D to her provider but some women do not want us to do this. If a woman appears in acute crisis or is suicidal we use Jefferson Mental Health's crisis line and the emergency room if needed to access immediate care. Some women are ready to treat their depression but even the women who are not ready benefIt from the education. The women who qualify for Maternity Case Management will be followed until their baby is 1 year old. As trust builds within this longer relationship the woman might feel more able to accept her depression and seek treatment. 11ùs also allows us to be alert for later onset post-partum depression. Some women are more receptive to medication and/or coun- seling after a repeat screen. This tool can be given to the woman in the waiting room and reviewed with the clinician during the visit. Items 4, 8, 12, and 16 are scored in reverse. A total score of 16 indicates the probability of major depression. Item 11 needs to be clarifIed with pregnant and mothering women. If a woman's sleep is restless because of her baby or pregnancy discomforts it is not scored positive. An excellent resource for women who like to read is the book "\Vomen's Moods" by Deborah Sichel, MD.. and Jeanne Watson Driscoll, MS.. R.N. This book is very readable and explains the complex interplay between genetic influences, life events, honnones, brain chemistry, and women's moods. It explores the options of counseling, self-care, and medication. It is available locally. For any further questions please call Quen Zorrah 385-9424 or Carol Hardy 385-9419. CES - D Center for Epidemiologic Studies Depression Instructions for Questions: Below is a list of the ways you might have felt or behaved. Please tell me how often you have felt this way during the past week: rarely or none of the time (less than one day); some or a little of the time (1 - 2 days); occasionally or a moderate amount of time (3 - 4 days); most or all of the time (5 - 7 days). During the Past Week: 1. I was bothered by things that don't bother me. 0 1 2 3 2. I did not feel like eating; my appetite was poor. 0 1 2 3 3. I felt that I could not shake off the blues, even with help 0 1 2 3 from my family and friends. 4. I felt that I was just as good as other people. 0 1 2 3 5. I had trouble keeping my mind on what I was doing. 0 1 2 3 6. I felt depressed. 0 1 2 3 7. I felt that everything I did was an effort. 0 1 2 3 8. I felt hopeful about the future. 0 1 2 3 9. I thought my life had been a failure. 0 1 2 3 10. I felt fearful. 0 1 2 3 11. My sleep was restless. 0 1 2 3 12. I was happy. 0 1 2 3 13. I talked less than usual. 0 1 3 14. I felt lonely. 0 1 2 3 15. People were unfriendly. 0 1 2 3 16. I enjoyed life. 0 1 2 3 17. I had crying spells. 0 1 2 3 18. I felt sad. 0 1 2 3 19. I felt that people dislike me. 0 1 2 3 20. I could not get "gorng". 0 1 2 3 ,. ...,M " '-, -~ ~:, :' ~: »" ~ ~ ~ = 00 ~ u -< ~ Jefferson County Assessment Highlights Fact Sheet February, 2002 Birth/Maternal Child Health Indicators · Births to Unmarried Mothers, 2000 · Medicaid paid delivery, 2000 · Medicaid paid delivery, 1999 · AFDC/TANF Participants, 2000 · Low Birthweight rate (1996-2000) · Non-Smoking Mothers, 2000 · First Trimester Prenatal care, 2000 · First Trimester Prenatal care, 1998 Comments: · In 2000, births to unmarried mothers accounted for 42% (87) of all births · In 2000,62.3% (127) of all Jefferson County births were funded through Medicaid. This is a 7.8% (12) increase from the 1999 total of 54.5% · Jefferson County Medicaid paid deliveries has been greater than 45% during all years 1992-2000 · Jefferson County participation in AFDC/TANF programs has continued to drop from the 1992 14.2% (33) to the 2000 total of 1.4% (3) · Mothers who smoked during pregnancy gave birth to low birthweight babies at a rate greater than twice that of non-smoking mothers; 8.6% and 3.6% respectively for 1996-2000 · In 2000, 73.2% (153) of mothers reported not smoking during pregnancy · In 2000,77.3% (160) of mothers reported beginning prenatal care in the first trimester; in 1998, 87.1 % (171) of mothers reported beginning prenatal care in the first trimester Jefferson 42% 62.3% 54.5% 1.4% 5.1% 73.2% 77.3% 87.1% WA State 28% 33.5% 32.5% 3.2% 5.8% 86.5% 82.6% 83.0% Hospital of Delivery Indicators 2000-211 Total Births/127 Medicaid Paid deliveries · Jefferson General Hospital, 2000 · Home/Midwife-attended births, 2000 · Harrison Memorial Hospital, 2000 · Olympic Memorial Hospital, 2000 · King County Hospitals, 2000 1999-220 Total Births/115 Medicaid Paid deliveries · Jefferson General Hospital, 1999 · Home/Midwife-attended births, 1999 · Harrison Memorial Hospital, 1999 · Olympic Memorial Hospital, 1999 · King County Hospitals, 1999 Comments · In 1999 and 2000, Jefferson General Hospital delivered over half of the births born to resident mothers; greater than 50% of these births were paid for through Medicaid. · Home/Midwife-attended deliveries increased significantly from 1999 to 2000. % all births 63.6% 11.8% 7.6% 6.6% 5.7% % Medicaid 62.2% 12.6% 7.9% 4.7% 6.3% 66% 5.5% 12.3% 4.5% 6.8% 72.2% 4.3% 12.2% 3.5% 4.3% Socio-Economic Indicators · Estimated Median Household Income, 2001 · Estimated Median Household Income, 2000 · Estimated Median Household Income, 1999 · Median House Sales Prices, 2001 (third quarter/not year-end) · Median House Sales Prices, 2000 · Housing Affordability, 2001 (third quarter/not year-end) · Housing Affordability, 2000 · First-time Home-buyer Affordability index, 2001 Comments: Jefferson $38,826 $34,662 $33,446 $174,400 $174,700 90.8 78.1 53.6 W A State $50,182 $50,152 $48,289 $183,200 $176,900 123.2 108.4 74.7 · $38,826 was the 2001 (third quarter/not year-end) Jefferson County median household income compared to $50,182 in Washington State · Jefferson County households earned an estimated 23% less than Washington State households, but housing costs were roughly the same. $174,400 was the median house sale price in Jefferson County at the end of September 2001, nearly equal to the Washington State average $183,200 · Housing Affordability indices point to economic disparities often encountered by first time home buyers, most often young families, who are unable to afford to purchase homes in the county. Population Indicators Jefferson WA State · Growth Rate, 1999-2001 1.7% 2.5% · Population Age 65+ 2001 20.9% 11.2% · Population Age 85+ 2001 2.2% 1.5% · Median Age, 2001 47.3 35.6 · Median Age, 2000 47.1 35.4 Comments: · The county's growth rate seems to have slowed and is now below that of the state · Jefferson County population age 65+ is nearly twice that of t,he state · Jefferson County population age 85+ is one and one-half times that of the state JEFFERSON COUNTY BOARD OF HEALTH Glen Huntingford, Jefferson County Commissioner Dan Titterness, Jefferson County Commissioner Richard Wojt, Jefferson County Commissioner Jill Buhler, Jefferson General Hospital Commissioner Roberta Frissell, Citizen at Large Geoffrey Masci, City Council Member Sheila Westerman, Chair, Jefferson County Board of Health February 21,2002 -, Jefferson County Board of County COITllTIissioners Jefferson County Courthouse P.O. Box 1220 Port Townsend, Washington 98368 FEB 2 5 200.2 RE: Dedicated Public Health Funding Sources Dear Commissioners: As the duly constituted Board of Health for Jefferson County, we are writing to express our growing concern over the unstable funding of essential public health services and to recommend a specific, short-term action to address this issue. Provision of essential public health services is a fundamental duty of all governments from the municipal to federal level. Prior to 1996, this obligation was met by a combination of city, county, state, and federal funding sources. In 1996, the Washington State Legislature transferred the municipal obligation for public health to a statewide pool funded by the Motor Vehic1e Excise Tax. In 2000, following passage of Initiative 695, the State Legislature repealed this tax, eliminating an important source of public health funding. Beginning with the 2001 - 2003 State Biennial budget, the legislature restored 90% of this funding as "1-695 Backfill". At the urging of Governor Locke, the legislature is now considering eliminating this funding beginning in 2003. Public health funding is heavily tied to federal and state categorical funding programs. Only about 23% of the average local health budget is available to meet essential public health needs like the communicable disease control, bioterrorist response preparation, and community health surveillance activities. Loss of state "backfill" funding, will eliminate almost half of these local resources, crippling the ability of our health departments to respond to urgent local public health needs. "Belt tightening" will not solve this crisis. Core public health programs must be eliminated to close a budget gap of this magnitude. The Legislature's repeal of appropriated funds for local public health is occurring in the context of Washington State's worst recession in 20 years. Existing local revenue sources are unable to fill the gap created by the state's unilateral decision to cut local public health funding. A long- term solution to this impending crisis will require Legislative action and a probable vote of Washington's citizens. Until that occurs, local governments must be innovative in their search for potential revenue sources. One such area of unused taxing authority is contained in RCW 9.46.110, allowing taxes on various gambling activities, including punch boards and pull-tabs. Such a tax would need to be enacted by both the county and the city of Port Townsend to cover the entire county. Revenue from such a tax must be dedicated to law enforcement activities. We are proposing that this tax be enacted and general fund "saving" for law and justice activities be dedicated to local public health funding to replace lost MVET funds. The Jefferson County Board of Health is responsible for carrying out the duties outlined in RCW 70.05.060. We understand that the good health and long life that most Jefferson County residents enjoy is possible only because of the foundation of local public health services that has existed since the 19th century. This foundation is now in jeopardy. We respectfully ask for your support in utilizing your taxing authority on gambling activities to maintain support for Jefferson County's public health system during this period of uncertain public health funding. Sincerely, s~~ ~()~-\tVw-o.--- Sheila Westerman Chairman, Jefferson County Board of Health ffrey Masci Vice Chairman, Jefferson County Board of Health ~~n&~~ -. The Courthouse Journal February 15, 2002 Issue No.6 Supreme Court Upholds Local Transit Authority to Assess Car Licensing Fees On Thursday, February 14,2002, the state's transit providers received a valentine from the Washington Supreme Court. The Court said that Initiative 695 and the Legislature's subseqUent repeal of the Motor Vehicle Excise Tax did not undo the authority of transit districts to levy a special excise tax of up to .725 percent of a car's value under RCW 35.58.273 and the duty of the Department of Licensing (DOL) to collect it once it is levied. Writing for the majority, Justice Susan Owens said the "spare legislative history of SB 6865 (Chapter I, Laws of 2(00) does not reveal intent to repeal RCW 35.58.273.» The Court added that the adnûnistrative inconvenience to the OOL of collecting the tax does not amount to legal inconsistency between RCW 35.58.273 and SB 6865. The Court acknowledged "awkwardness created by our decision" but proposed that "it is the legislature's job- not ours - to stem the tide of potential absurd results that might result:from impartially applying the plain meanîng of statutory language." It added that "no inconsistency results from a municipality's decision to lay a tax upon itself over and above state taxes imposed by the legislature.» It is unclear at this point whether the Legislature will attempt to repeal the transit authority's taxing authority, which could be about $200 million annually statewide. Awful Reality Begins to Sink In This was the week when legislators learned that their awful situation was about to get worse. Early reviews of the revenue and caseload forecasts became the major topic of conversation. For the first time the "T' word was seriously discussed as a solution for the state's problems. Legislators cannot :find the additional savings they need without cutting basic huroan services or education. This is a bitter pill for members who have spent years cutting spending in other areas to improve education and maintain core human services. At the same time, legislators are becoming more concerned about the county financial crisis. House leadership has kept a bill alive through the various deadlines to provide local option taxes for counties. Counties face several challenges in realizing the benefit of this support. Cities continue to oppose countywide tax options for counties. Some counties do not have enough of an economic base to effectively use any of the options under consideration. Other counties will have trouble passing any tax increase at the ballot box. A last group of counties has tax rates that are too high to increase those rates. This week also saw the first of what will probably be a series of decisions to convert local health districts or joint county-city departments to county departments. Many counties are telling WSAC that they will not be able to replace the lost state assistance. In addition, other revenue losses will force them to make further cuts in their support for local public health. Legislators have been told by their staff that the new federal anti-terrorism funding will replace these lost funds. The latest news on these federal funds shows this will not be the case. Of the $20 million the state will receive, a significant atnount is dedicated to increasing state lab capacity. Another portion needs to be spent to provide state emergency capacity and to prepare hospitals to respond to bio-terror. That leaves little for local plblic health, which will lose $24.5 million on an annual basis. For the first time in recent memory, state and local officials are looking at the statutes governing the failure of local public health systems. Those statutes call for the state's health department to provide services and to bill the county for those services. Washington Counties' Scholarships Available! County elected officials and employees who have students in their families take note! The Washington Counties' Scholarship Fund is offering five $1500 awards to children of county employees who will be enrolled full-time during the 2002/2003 school year in a baccalaureate program. associate degree program or vocationalltecbnical certification program. Applications must be postmatked no later than April 8, 2002. Complete information, applications and flyers are attached to this newsletter and are also available on the web at www.wacounties.org/waco. Call WSAC or WACO if you have any questions. Please post the flyer and copy the 1 ne ~eame lJIDes: ~altomus OC uplIllon: nuaget cms unaemnne UlULenunsIll ueleuses rage 1 U1 .) A S'i!'rvÏ<:e of The Seattle TÎ;l"nes Company ~ ~ NW ;¡~~_~~4~'i'1~t i~.;~;~-,.:,;': EDITORiALS & OPINION H Home :: t.ontaf :: Searct times.com HOME Site index « Editorials 8. opinion Wednesday, Februaty 13. 2002 - 12:00 a.m. Pacific GUBst cù!unmis.t ,~ -'.- ~. ,- ._- .~ Budget cuts undermine bioterrorism defenses By Alonzo Plough Special to The TImes After the October anthrax attack in the Northeastern United States, and the hundreds of hoaxes in the Northwest, support for public health was visible daily, and even frantic. Diseases used as weapons of terror generated nationwide fear and the belated awareness that an often-ignored and marginally funded public-health system was, in fact, the front line defense against biotelTOrism. f;:.m.ª-H.J;h.l~.ª[ttç.t~ fDJ!tJJ:Ü!>...ª-rJ;¡ç].<;! '<;¡ª.ªDiJ1.}·(J~º_.ªrçh¡Y'<;! Public Health~Seattle & King County, your local health department, went on heightened alert, stretching our core infectious disease-çontrol and surveillance capacity to the breaking point to resppnd to this new threat. We also responded to multiple daily media requests for over two months- newspaper, radio and TV coverage - all asking the same question: Do we have sufficient public-health capacity to handle the need? What is the margin of safety public health can provide? Prominent articles in the Washington Post, Newsweek and even the Wall Street Journal pointed out the imperative to strengthen public health at local and national levels. During this same period, in Olympia, proposals before the Legislature would eliminate $24.5 million annually in core funding for local public health. Today, it is essential we continue to have the critical public and media attention and outcry. The threats of bioterrorism loom just. as large, and the more usual public health threats of E. coli infection and pandemic influenza continue. The same vulnerabilities in our basic public-health system are present. How is it that this assault against the very guts of local public-health capacity goes unmentioned in the critical issues facing the Legislature this session? If nearly one-third of the core funding for this county's fire or police capacity were eliminated, I would imagine there would be an outcry. In fact, this is the impact of the proposed cuts on our local health core capacity, and there is hardly a whisper about it. Local public-health funding in Washington state has been a political bouncing ball. Before 1995, state law required the cities in a county to contribute funding for the public-health-protection services they used. This $10 million paid for basic services such as public-health nursing, immunization and http://seattletimes.nwsource.comlhtmlleditorialsopinion/134403 809 _ alonzoop 13 2/19/02 1 ne ~eattle 1 unes: hOltonalS «- uptnlon: l:Suaget cuts unaermme Olmerronsm uerenses rage ,¿ 01 .) infectious disease control. King County and Seattle governments contñbuted a roughly equal amount to the core local funding for basic public health. After 1995, the city responsibility was shifted to the state in the form of the Motor Vehicle Excise Tax (MVEl). After Initiative 695, the cities' portion, minus a 10-percent cut, was shifted to the state general fund as part of the "backfill" to restore basic services devastated by this initiative. Now, under the proposals before the Legislature, the total amount of core local funding from the state is to be eliminated in 2003. This is just the opposite of a pathway to stabilize public health and strengthen our ability to respond to the new challenges. It weakens ollr already strained ability to provide a margin of safety vocally demanded by the public only months ago. The situation is further exacerbated by new funding from the federal government for public health to combat bioterrorism. Washington state will receive a one-time allocation of $20 million to build core capacity at the local level, adding the extensive new activities required for readiness to respond to an intentional smallpox exposure or other biological threat where local public health is the lead first responder. This new funding is intended to create new capacity, such as hospital surveillance, training of first responders and training of physicians to recognize early the symptoms of the most likely biological threats. However, the federal government assumed that existing resources would provide a base, not be eliminated. Think about having a fragile one-story house and getting money to add a second floor. At the same time someone else removes your foundation. Obviously, the structure will crumble, as will public health's ability to rise to the challenge of these difficult times. If core local public-health funding is not restored, we will not be able to provide a new margin of safety against biological terrorism while continuing our protection against other public-health threats. Those of us on the front lines never thought that the new awareness of the critical role of public health forged in the tragedy of Sept. 11 would fade so rapidly in Olympia. Dr. Alonzo Plough is director and health officer for Public Health-Seattle & King County. (>'!;J'(·~g~~i 20C:2 1he Sc,;;Üt;ç1 ;'TiC~ C;),;1;J;:;¡P:{ M.9!:~~!i.$-ªdª~~_IJ!;-ªp-¡nig!t.b~ll!L~ ~_e_ªttlej;lme~~çøn'LIlº1J'Ie I,Q;;ªIJ1gWê I $pqrn? I ßJJê!nªêê~Jgçhnº¡ggy I f;c!y'çª-tlg!1 I IJ1'''-ª¡:¡ttgªt¡ºn~âQ\tçLªL¡~rQjªg;ê NªlìQnl?<wQrid I f>grêc:!f)<!ltg¡:t)n9IQ9'l1 Q!:Üt\,\ªrigê I ¡;Qìtº{íª!;;;~QPínìºn I Ç()Iµ!I1nì!;þ;; I Art~~ªntgrª¡l}mªJ}t Nºd:t!'II!,ª~\:Wfª I th;ªJtl1~!>_<:.iªnçª I TIªY:ª~ I Nºd:hwggW~~ªf!º I p'_ªçifjçJ':!Qft.n'll!ª~tÆª9ª?i!]§ ~"" '''''''~ "'~",""~ ....""..~_ ,_ _, ".' _"..~~w.">,_"".··,, '_'.'·"~"'''','·'''';.'~W''',·«,,·w,< "m",,,,,,..,,_...,,,;,_,_,,...,,.,,,,~".~·_,",,.,,~_œ,,_,,,,;,....'V·~"'~"·""'····"@'_'·=""·""_'~'_"·".~""',,>'~"'~,_~."u__,·,,~,_~·~·,····,,~ http://seattletimes.nwsource.com/htmlleditorialsopinion/134403809_alonzoopI3 2/19/02 t\ ~nJÐ~ ~ ~--~ JEFFERSON COUNTY BOARD OF HEALTH Glen Huntingford, Jefferson County Commissioner Dan Titterness, Jefferson County Commissioner Richard Wojt, Jefferson County Commissioner Jill Buhler, Jefferson General Hospital Commissioner Roberta Frissell, Citizen at Large Geoffrey Masci, City Council Member Sheila Westerman, Chair, Jefferson County Board of Health February 13, 2002 OJJDP Title V Community Delinquency Prevention Grant Program Office of Juvenile Justice Department of Social and Health Services P.O. Box 45203 Olympia, Washington 98504-5203 To Whom It May Concern: The Jefferson County Board of Health is supportive of the Jefferson County Health and Human Services application to the Community Delinquency Prevention Grant Program to request support for the Nurse Family Partnership, an intensive Public Health Nurse home visiting program. We currently have two Public Health Nurses providing this service in the county, and funding for a third RN would enable us to offer the program to all eligible first time mothers. Nurse Family Partnership is a Best Practice violence and substance abuse prevention program that we fully endorse. The program has demonstrated remarkable results, including: reduction in intellectual impairments for young children, fewer subsequent births for the mother, reduced arrests and criminal convictions for the mother, as well as benefits for the child that last at least through adolescence. Children whose mothers received Nurse Family Partnership, delinquency and substance abuse is lowered significantly and continues to stay low even 15 years later. In a rural county with sparse resources, early intervention is cost effective. Not providing these services has a huge impact on stressed schools, the juvenile justice system, the health department, mental health systems, CPS. We strongly encourage you to help us bring Nurse Family Partnership to all eligible mothers in our county. Thank you for your consideration of the Jefferson County Health and Human Services application in this matter. Sincerely, Sheila Westerman Board of Health Chair