HomeMy WebLinkAbout07 July
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, July 18, 2002
Board Members.'
Dan Titterness, Member - County Commissioner District #1
Glen Huntingford, Member - County CommiJ'Jioner DÙtrid #2
Richard U7qjt, Alember - County CommÙsioner District #3
Geofftry Masâ, Viæ Chairman - Port Town.rend City Counàl
]ill Buhler, Member - Hospital Commissioner District #2
Sheila Westerman, Chairman - Citizen at LArge (City)
Roberta Frissell, Member - Citizen at LArge (County)
Staff Members:
Jean Baldwin, Nursing Services Director
LAr'Q1 FC!)', Environmental Health Dim-tor
Thomas Locke, MD, Healtb qfficer
Chairman Westerman called the meeting to order at 2:35 p.m. All Board and Staff members were
present, with the exception of Member Masci. Commissioner Huntingford joined the meeting at 2:45
p.m.
APPROVAL OF AGENDA
Commissioner Titterness moved to approve the Agenda as presented. Commissioner Wojt seconded the
motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Dr. Tom Locke asked that a correction be made to minutes of Thursday, June 13, 2002 . On page 6
under State Board of Health - Arsenic a sentence reads, "This is expected to affect nearly 13 million
people, largely in Group B water systems." It should instead be "Group A." Member Frissell moved to
approve the minutes of Thursday, June 13,2002 as amended. Commissioner Titterness seconded the
motion, which carried by a unanimous vote.
PUBLIC COMMENT - None
OLD BUSINESS AND INFORMATIONAL ITEMS
Civil Penalties Ordinance: Larry Fay reviewed the draft ordinance and Complaint Response Policy,
which he prepared after receiving direction from the Board at its last meeting. He requested the Board
provide input so that Staff could begin advertising a notice of legal adoption in August. Excluded from
the ordinance is procedural information (which is defined in other parts of the referenced RCW), court
rules regarding the filing of a ticket, etc. He proposed that the Complaint Response Policy -- originally
HEALTH BOARD MINUTES - July 18, 2002
Page: 2
intended to be a County standard operating procedure for dealing with complaints, investigation and
compliance -- be used as a companion document.
Member Buhler inquired about Page 2 of the ordinance, Section IV Designation of Civil Infractions
which reads "each 24-hour period when a violation is found to exist shall constitute a separate and
distinct violation." She asked if this would necessitate separate tickets, resulting in "first offense, second
offense, etc." for each 24 hour violation? Mr. Fay explained that he interprets this to mean that Staff
could write a ticket with a time frame. In practice, jurisdictions have not used the ordinance this way but
have instead cited a specific violation on the day they were there. The overall intent is to get the case and
person in front of a judge. If convicted, depending on whether it is the first, second and third offense it
would be classified as a Class 3, Class 2, or Class 1 civil infraction.
Member Buhler then asked to receive a better understanding of the statement on page 16 of the policy,
under Violation Compliance Deadline which states "In most cases, the deadline recommended for the
correction of any violation is seven to thirty (7-30) days following receipt of the written notice." Mr. Fay
explained that this refers to the notice of violation. The suggested procedure is investigation followed by
notice of violation and corrective action. If the problem is remedied, then there is no ticket.
To avoid confusion in the two areas mentioned by Member Buhler, Chairman Westerman recommended
defining "violation" and "offense" after the first instance of these terms or having a separate definition
section, to which Mr. Fay suggested might be added in a new Section III.
Referring to Section VI, Enforcement Officers, Commissioner Titterness said he spoke with the Sheriff
and more than one candidate for Sheriff about why the Sheriff's Department would not be the most
appropriate enforcement agency. He also spoke with Deputy Prosecutor Alvarez about whether or not
the Sheriff's Department could act as enforcement officers, but his response was that right now that is
not the way it is done.
Larry Fay explained a situation where a ticket was written by one of the Deputy Sheriffs regarding a
food violation in 1996-97. Sheriff personnel may know ticket writing but they are not trained in public
health. Similar issues exist in Animal Control; while a City Police Officer or Deputy Sheriff could each
write the same ticket, they generally rely on the Animal Control enforcement officer. In recent
discussions, Deputy Tracer expressed interest in joining in some of the investigation and enforcement of
solid waste nuisance property violations. In talking with Pete Piccini about expanding the Animal
Control enforcement officer's commission to give them the authority to write tickets under Public
Health, Piccini was reluctant due to the enforcement officer being a Health Department employee and a
clerk versus a teamster member.
Dr. Tom Locke reported that under state law all police and law enforcement officers shall enforce any
lawful order by a Board of Health, Health Officer, or State Board of Health. Related to issues of bio-
terrorism, police organizations were unaware of this requirement to enforce a quarantine or an isolation
order. It is equivalent to all of the other laws they enforce and is their legal obligation.
Commissioner Titterness said he is reluctant to start appointing enforcement officers other than those
under the jurisdiction of the Sheriff. He is looking for a way to cooperate with the Sheriff's Department
HEALTH BOARD MINUTES - July 18, 2002
Page: 3
to have them assist with enforcing this ordinance and proposed that the Board involve a member of the
Sheriff's Department in this discussion.
Larry Fay agreed and said their input would be more appropriate in discussing the standard operating
procedure. The Board could proceed with the ordinance and have a separate discussion about
enforcement and whether there is a mechanism for involving officers if a situation gets to the ticket-
writing stage. Staff could also follow up with Deputy Tracer.
Chairman Westerman suggested that because this is a Board of Health issue, any initiation of
communications with the Sheriff come from the Board of Health and Dr. Locke as the Health Officer,
not from the County Commissioners.
Responding to Commissioner Huntingford's concern about how the Sheriff's activities in this area
would be funded, Dr. Locke explained that while the use of police powers have come up in the context
of bio-terrorism (such as in a disease outbreak) it also applies to other significant issues of public health.
He thinks law enforcement will become more comfortable with this role as the bio-terrorism training
continue.
In response to a question by Member Frissell about how many tickets Staff would anticipate writing
over the course of a year, Mr. Fay said he would expect one or two dozen in a variety of areas. But after
a couple of years, they would hope that number to decrease as people realize it is far easier to respond to
the notice of violation.
Chairman Westerman then asked about the statement in the ordinance under "Purpose" on page 1, which
says "No provision of or term used in this ordinance is intended to impose any duty upon the Jefferson
County Health and Human Services Department nor any of its officers or employees for whom the
implementation or enforcement of this ordinance shall be discretionary and not mandatory." Larry Fay
explained that if Staff decided against writing a ticket, it would not be accountable or legally liable to
another citizen for a failure to do so. This language came directly out of other county ordinances.
Dr. Locke said he believes Staff should investigate revising that sentence to clarify "discretionary and
not mandatory."
There was further discussion about who to involve in the policy discussion. There was support for
inviting representation from both the Police and Sheriff's Departments.
Commissioner Huntingford spoke of the need to involve the Sheriff's Department before having a
hearing to adopt the ordinance. He believes they should have opportunity to see what they are being
asked to enforce.
Chairman Westerman responded by referring to page 3 of the ordinance which states that the Board of
Health, or its designated Health Officer, may authorize one or more person to serve as an "enforcement
officer," duly authorized to enforce this Ordinance. The ordinance establishes civil penalties for
violations of public health and the policies and procedures would outline the method of enforcing the
ordinance, but does not obligate the Sheriff. The Sheriff and Police Departments could be involved in
HEALTH BOARD MINUTES - July 18, 2002
Page: 4
the discussion and adoption of the ordinance or subsequently, during a discussion of the policy and
procedures.
Larry Fay noted there is an opportunity to do investigator training and certification through either the
Washington Department of Licensing or with the Council on Licensor and Enforcement. If the Board
finds that the Sheriff or Police do not want to get involved, then training and certification might be
appropriate. He then reviewed areas to which Staff will give further consideration: (1) changing title
"civil enforcement" to "civil penalties", (2) clarifying (per Deputy Prosecutor Alvarez) Section 1 --
Purpose "discretionary and not mandatory," and (3) include definition of "offense" and "violation."
Commissioner W ojt moved to direct Staff to proceed with scheduling a Public Hearing on the
Environmental Health Civil Enforcement ordinance, including possible modifications as
discussed. Member Frissell seconded the motion, which then carried with one no vote by
Commissioner Huntingford.
Complaint Investiu:ation Enforcement Manual: Chairman Westerman suggested that in future
discussions of these procedures, the Board discuss how to proceed with the involvement of both the
Sheriff and Police Departments.
Larry Fay said that if in discussions these departments indicate a willingness to become involved in
enforcing this ordinance, the policy would likely be completely redrafted. The procedures outlined were
prepared with the assumption that the Department would be handling the actions.
Commissioner Titterness proposed that the Health Board Chair and Health Officer send a letter with
information about the legislation as well as a request to participate in a discussion about how we might
work together on ordinance enforcement. There was no objection from the Board to proceeding in this
manner. Larry Fay noted at least one officer in the Sheriff's Department expressed interest.
NEW BUSINESS
2002 Washinu:ton State Health Report: Dr. Locke explained that this report is a product of the State
Board of Health under a 12 year old legislative mandate to establish priorities for State agencies
budgeting for health issues. Although to date, this report has been more of a wish list than a strategic
planning document. This new report was developed with the Governor's subcabinet on health. The
report focuses on issues that this Board has dealt with in the past. He reviewed the Strategic Health
priorities as listed:
Maintain and improve access to critical health services
Improve patient safety and increase value in government-purchased health services
Bolster the health system's capacity to respond to public health emergencies
Reduce disproportionate disease burdens among racial and ethnic minority populations
Encourage responsible behavior to reduce tobacco use, improve nutrition, and increase physical
activity.
HEALTH BOARD MINUTES - July 18,2002
Page: 5
He stressed his commitment to reminding individuals in the executive agencies that they agreed to these
priorities and asking where they are reflected in their budgets?
Commissioner Titterness commented that he was impressed that 13.2% of the gross national product is
spent on healthcare, noting that 13.2% of Jefferson County's budget goes towards personal health
insurance for its employees. With the money the County and other government agencies are paying for
health insurance he wonders if we could help the entire County?
Chairman Westerman noted this was the main topic at the day-long health summit. Despite all the
representation in attendance there and the desire to improve the situation, she is uncertain how to move
forward on this issue but feels that if it were easy to do, it would already have been done.
Jean Baldwin said a major issue discussed with the hospital today, is the need to get their cost
reimbursement through Medicaid and Medicare, which would be at a much higher rate. Health
professionals will have political discussions with legislators on the issue of reimbursement rates, but she
stressed that as elected officials, the Commissioners' voices have more importance at the State and
Federal level.
Chairman Westerman spoke of the need to address the inequality of reimbursement rates between
Washington and Florida.
Commissioner Huntingford expressed some concern about the misperceptions, spread by the article in
The Leader, regarding the hospital going bankrupt. He also questioned the benefit of some of the options
(such as the HIPPA program) that the State or Federal government keep sending to hospitals. The cost to
implement it would seem to far outweigh the benefit.
Member Buhler explained that help is needed on the federal level with regulatory reform. For every hour
of patient time in the emergency room there is one hour of paper work. The disparity between Medicare
payments arose when Medicare asked for efficiencies.
Member Frissell commented that some legislators erroneously assume that it costs less to treat patients
in a rural counties than in urban areas. Medical reimbursement rates are lower in rural counties than in
urban counties. State and Federal legislators appear to be hearing of these problems for the first time.
Member Buhler said that with the break down of the healthcare system, the hospital will be able to
continue only because of the Critical Access Hospital designation. She noted that the critical access
designation currently comes with a 15-bed limit, but another bill in Congress would increase that to 50
beds and provide not only cost-based reimbursement but cost-based enhanced reimbursement, which
would provide even more funding for capital expenditures for technology and equipment. She noted the
cost of malpractice insurance has doubled and there is no support for tort reform in the State.
Chairman Westerman was most impressed that this report narrowed the list to five priorities, which
appear to be the priorities that would have the most impact for the least investment.
HEALTH BOARD MINUTES - July 18,2002
Page: 6
Jefferson County Tobacco Prevention and Control Report: Kellie Regan reported that tobacco use
was one of the last Behavioral Risk Factor Surveillance System (BRFSS) modules to be analyzed.
Referring to the report included in the packet, she reviewed the following Jefferson County data:
· Fifty-five percent reported having smoked at least 100 cigarettes in their lifetime compared to
51 % of the State. (Fig. 1)
· Sixteen percent of the adults are current smokers, compared to 21 % of the State. (Fig. 2)
· Thirty-nine percent consider themselves former smokers (not smoked for 30 days or longer).
· Jefferson County is not statistically different by gender. (Fig. 3)
· Current smokers by age showed 28% of 18-34 year olds, 19% of 35-64 year olds, and 5% of 65+,
compared to the Washington State numbers of 24%,22% and 10% respectively. (Fig. 4)
· Twenty-eight percent of those with a high school education or less are current smokers, 15%
with some post secondary education, and 8% of those with four or more years of college,
compared to the State's 30%, 21 % and 11 % respectively. (Fig. 5)
· In zip code 98368, 11 % are current smokers while the rate in other County zip codes is 21 %. She
noted that Washington State's health goals are to reach 12%. Dr. Chris Hale commented that as
you reach the lower percentages, intervention costs go up. (Fig 6)
In rating their own overall health status, nonsmokers report being in better general health status
than current smokers -- 86% compared to 78%. (Fig. 7)
Thirty-four percent of those who reported heavy drinking in the past 30 days are also current
smokers. (Fig. 8)
Jefferson County is significantly better than the State in those trying to quit smoking -- 76%
compared to 49%. (Fig. 9)
The percentage of 18-34 year olds trying to quit (28%) was significantly lower (worse) than the
State's 55%. However, 72% of those 35 and older tried to quit, compared to 42% of the State.
(Fig. 10)
Fifty-nine percent with a high school education or less quit for one day or longer, as compared
with 42% of Washington State. Of those with any college, 41 % tried to quit compared to 50% of
Washington State. (Fig. 11)
Of those living in zip code 98368, 24% said they tried to quit during the past 12 months, as
compared to 76% in the other County zip codes combined. (Fig. 12)
Ms. Regan mentioned that the statewide media campaign launched 18 months ago, involved bus
billboards and television commercials. She has asked herself whether the media spots could be having an
effect on the younger audience to whom it is targeted? Noting that BRFSS only surveys those 18 years
of age and older, she is uncertain whether the Healthy Youth survey planned for this fall will include a
question about those who have tried to quit. She then reviewed data about smoking in the home.
Seventy-nine percent in the county said smoking is not allowed in the home, as compared to 8%
who said it is permitted ih some places and 13% who said there were no rules. She was surprised
that there were this many people across all age groups who said it is not allowed. (Fig. 13)
Respondents with more education are significantly more likely to prohibit smoking in the home -
- 71 % with high school or less, 79% with post secondary, and 85% with 4+ years of college.
(Fig. 14)
HEALTH BOARD MINUTES - July 18, 2002
Page: 7
Among current smokers only 43% do not allow smoking in the home as compared to 86% of the
nonsmokers (Fig. 15). It appears information about second-hand smoke is affecting smoking in
the home. Rules about smoking in vehicles are not known.
Eighty-one percent of respondents who report excellent/very good/good health are significantly
more likely to prohibit smoking in the home. (Fig. 16)
Current smoking among adult respondents with children under 18 years old is significantly
higher (worse) than households without children (13%). (Fig. 17)
Households with children under 18 years old are significantly more likely to prohibit smoking in
the home (87%) as compared to households with no children (76%). (Fig. 18)
Ms. Regan then reviewed the data on the age of first use and age of regular use:
· The median age for reported first use was 13.5 years among 18-34 year olds, as compared to 16.7
for 35-64 year olds.
· Among the 18-35 year olds, the median age of reported regular use was 18 years, as compared to
20.3 years among those 35-64.
· Among those with a high school education or less, the median age of reported first use was 14.7
years as compared to 17.9 years among those with some post secondary education, and 16.4
years among those with 4+ years of college.
Overall, Jefferson County's smoking rates are good, comparable to Washington State. People are
motivated to quit and have clear messages about smoking in the home. The BRFSS analysis was
completed after she submitted the annual tobacco prevention control Statement of Work. The BRFSS
data has given her a clearer path to her target audience, which are the 18-34-year-olds. She speculated
that even though there is a higher prevalence of smoking outside of 98368, they most likely work in the
City of Port Townsend. One of the best practices known is periodic healthcare provider intervention;
however, because 18-34 year olds are the most healthy, they are not as likely to get this intervention.
Alternative ways to reach them are through intervention at the family planning clinics and through
employer outreach.
In response to concerns expressed by Chairman Westerman about employers getting involved in
discouraging employees from smoking, Ms. Regan said the desire is for employers to have resources
available, such as the Quit Line. It is known that smokers lose more work days, so there are economic
costs involved.
Commissioner Wojt said he would be interested in the results of how many have adopted a lifestyle that
avoids smoke, first-hand or second-hand.
Commissioner Huntingford mentioned that Kellie Regan provided him with a County brochure of
smoke-free restaurants. What caught his attention was the statement that said if you find any of these
restaurants that are not smoke free, contact Kellie and she will follow up. Ms. Regan confirmed that she
follows up with a letter. Responding to his question about how this enforcement is funded, she added
that funding for these activities come from tobacco settlement dollars.
HEALTH BOARD MINUTES - July 18, 2002
Page: 8
Commissioner Huntingford expressed interest in getting the same data about illicit drug use. Recent
figures show increasing numbers of drug use and he is concerned about our ability to solve the drug
problems unless there is a way to quantify usage. Jean Baldwin responded that asking those sorts of
questions is illegal -- there are issues of privacy and confidentiality. Staff has done other extrapolations
on drug use and age profiling based on the number of people in treatment and those who go to
assessments. They also look at medical referrals and ER data. The same 18-34 age group is the concern.
The Substance Abuse Board, who reports to the County Commissioners, has requested another work
project from Chris Hale and Kellie Regan to look at substance abuse issues. She agreed to get the Board
more information about these issues. Segments of the BRFSS data was presented at the Meth Summit,
the Domestic Violence Meeting, and the Law and Justice Meeting.
Kellie Regan mentioned that the school survey analysis showed that Jefferson County is higher than the
State in the particular areas of marijuana use and early use of marijuana. Dr. Locke noted that marijuana
is five times as dangerous as tobacco.
Kellie Regan said part of the required activities for the tobacco work plan for this year is to convene a
group of stakeholders to advise community planned development and implementation. Rather than
create another board, she asked whether the Board of Health has interest in being this stakeholder board?
The purpose is to receive periodic updates. Although it was recognized that the Substance Abuse Board
also addresses addictive substances, there was no objection to the reports coming to the Board of Health.
The Health of Jefferson County and Port Townsend - Julv 8. 2002 Report to Port Townsend City
Council: Jean Baldwin reported that she and Dr. Hale conducted a workshop with the City Council.
Following a motion to provide more financial support, Michelle Sandoval, Kees Kolff and Geoff Masci
agreed to meet with Jean Baldwin to discuss the City's responsibility for health care, to look at the
BRFSS data, to prioritize their funding of programs, and to move toward some action on the
prioritization of community issues and community programs. Particular indicators of interest are teen
pregnancy rate, suicide rate, housing affordability, and living wages. The City is interested in continuing
on the Data Steering project. Member Frissell also agreed to help with community indicators.
Jefferson Critical Access Designation: Member Buhler reported that in 2001, the hospital lost $1.3
million from operations. Also during this time, Medicare and Medicaid paid about $1.6 million less than
what it cost to provide those services. Had they paid what it cost, the hospital would have had a profit of
about $300K. The hospital district finished the year with $4.7 million in operating reserves, which
indicates they are not close to bankruptcy, despite what was reported in The Leader. She noted there was
a good article in The Peninsula Daily News today. For next year, the hospital is considering the critical
access hospital designation, which is cost-based reimbursement. They do not have to cut services and it
does not limit them from implementing new programs and services. At worst, it may mean that once a
month they may have to turn someone away from the hospital, but it would not be emergency care.
To a question by Chairman Westerman about how the costs are determined and whether an upper level is
set, Dr. Locke said the hospital submits a cost report and they allow a certain cost that falls within their
expected parameters and in many instances they place a cap.
HEALTH BOARD MINUTES - July 18, 2002
Page: 9
AGENDA CALENDAR I ADJOURN
The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, August 15, 2002 at 2:30
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
~~W1hV~
Sheila Westerman, Chairman
Dan Titterness, Member
JEFFERSON COUNTY BOARD OF HEALTH
Thursday, July 18, 2002
2:30 - 4:30 PM
Main Conference Room
Jefferson Health and Human Services
AGENDA
I. Approval of Agenda
II. Approval of Minutes of Meetings of June 13, 2002
III. Public Comments
IV. Old Business and Informational Items
1. Civil Penalties Ordinance - First Draft
2. Complaint Investigation Enforcement Manual
V. New Business
1. 2002 Washington State Health Report
2. Jefferson County Tobacco Prevention and Control
Report
3. The Health of Jefferson County and Port Townsend-
July 8, 2002 Report to the Port Townsend City Council
4. Jefferson Access Project/Joint Board Project Update
VI. Agenda Planning
VII. Next Meeting:
August 15, 2002, 2:30-4:30 PM
Main Conference Room, JHHS
Larry
Larry
Tom
Kellie
Jean
Tom
Jean
JEFFERSON COUNTY BOARD OF HEALTH
DRAFT MINUTES DR
Thursday, June 13, 2002 '4¡:r
Board Members.'
Dan Titterne!!, Member - Count)' CommÙsioner DÙtrict #1
Clen Huntingford, Member - CountY CommiJ'jioner District #2
Richard W'o/t, Member - County Commissioner District #3
GeoJlrry Masci, Vice Chairman - Port Townsend City Counâl
Jill Buhler, Member - Hospital Commissioner District #2
S heiia Westerman, Chairman - Citizen at Ll17;ge (City)
Roberta Frimll, Member - Citizen at Lorge (COU11!y)
Stoff Members:
Jean BaldwÍ11, NHr.ring Services Director
La'?)' Fc:;', Environmental Hcaltb Director
Thomas Locke, MD, Health O.fJicer
Vice Chairman Masci called the meeting to order at 2:00 p.m. All Board and Staff members were
present, with the exception of Chairman Westerman.
APPROVAL OF AGENDA
Member Frissell moved to approve the Agenda. Commissioner Wojt seconded the motion, which carried
by a unanimous vote.
APPROVAL OF MINUTES
Commissioner Wojt moved to approve the minutes of Thursday, May 16, 2002. Member Buhler
seconded the motion, which carried by a unanimous vote.
PUBLIC COMMENT· None
OLD BUSINESS AND INFORMATIONAL ITEMS
Abatement of Public Health Nuisances - Policy Options: Referring to his memorandum to the Board
regarding abatement issues and authorities, David Alvarez summarized two available tools: Civil
Infraction and Abatement. Civil infraction is similar to writing a speeding ticket. Recipients go to
District Court and pay a fine. The disadvantage or deficiency is that if the individual is unable or
disinclined to pay, the problem (cars, garbage, or septic system) may go unabated. It does not work on
individuals who refuse to comply and may not be a way to proceed with someone who defies the system.
Abatement leads to Superior Court where the case gets lined up behind expedited cases. An abatement
case requires both proof of the nuisance and pre-trial discovery, which is a multi-layered and extremely
HEALTH BOARD MINUTES - June 13,2002
Page: :2
cumbersome process. Given that a letter from the Prosecuting Attorney works to abate the nuisance 60-
80% of the time, at issue is whether we should devote judicial and prosecutor resources to pursuing the
few cases. He noted that Pierce, Kitsap and Grays Harbor Counties have been successful in their active
pursuit of violators. If the County successfully presented a case and the judge ordered the abatement, the
County could clean up the property but be unable to recover their costs, which would come from the
general fund.
To Commissioner Titterness' comment that recovery could be guaranteed by a lien, David Alvarez noted
that the property involved might be worth less than the lien. A lien involves getting a warrant for a
specific dollar amount and recording that with the State. He added that while the tools exist to pursue
cases, deciding to use them is a policy/resource issue. Some people respond to a civil infraction, which
he would recommend as the first level of action.
Commissioner Titterness wondered whether adopting a policy of abatement and publicizing this fact
might result in the Health Board having to actually prosecute only one in ten cases?
Referring to Page 8, Paragraph 4 of David Alvarez' memorandum, Member Buhler asked if this means
that the County could be sued for creating a nuisance? Mr. Alvarez said that while Counties have a great
deal of protection, they could potentially be liable.
Vice Chairman Masci asked about the possibility of empowering someone within the Department of
Health, such as Larry Fay and Linda Atkins, to act as Enforcement Officers. Mr. Alvarez said the
Department could then use Chapter 7.48 and the Notice of Civil Infraction (NOCI).
Member Buhler moved to appoint Larry Fay and Linda Atkins as Notice of Civil Infraction
Enforcement Officers with Jefferson County Environmental Health. Member Frissell seconded
the motion.
To a question from Commissioner Titterness about the resources needed to pursue infractions, Larry Fay
explained that significant staff resources would be used in initial preparation and in court time.
However, once a regular system of processing is established, it should take less time. It is his opinion
that while some violators will pay their ticket, most will not. Those who at first contest the infraction
usually respond much better when in front of a judge.
Mr. Alvarez said that an attorney could walk the NOCI Enforcement Officers through the process of
presenting the case. The Enforcement Officer would testify to what was seen and the case could be
decided on those grounds. If staff is comfortable presenting cases this way, the process could be
streamlined.
Commissioner Titterness clarified that this would not require adding a staff person, but would be a
readjustment of resources.
Vice Chairman Masci commented that this approach has been the intent over the last three years, but we
have not had the "hammer" which this would finally provide.
HEALTH BOARD MINUTES - June 13, 2002
Page: 3
Noting that today's action would have no effect until the codes are changed, Commissioner Wojt asked
about getting these conditions codified so that they can be enforced.
Larry Fay agreed that more work is needed on a procedures ordinance similar to those in Kitsap and
Pacific counties, which says, "violations of health codes... is, among other things, a civil infraction." All
of our codes would be combined into one compliance code so that infractions for any violations - solid
waste, on-site sewage, drinking water, etc. - could be addressed. The Board of County Commissioners
could then adopt a parallel ordinance to create a standardized procedure for civil infraction for building
and zoning violations. The first step is the normal notice of violation, followed by work toward
resolving the problem, then issuance of a civil infraction and then abatement. Ideally, there would be a
need for a compliance officer who knows the system and could "birddog" all the cases. Initially,
however, we could move along effectively by creating those authorities, providing training, and getting
some consistency about how we approach these problems interdepartmentally.
Motion carried by a unanimous vote.
Commissioner W ojt moved to direct staff to prepare the necessary process and framework for the
designated Notice of Civil Infraction (NOCI) Enforcement Officer. Commissioner Titterness
seconded the motion, which carried by a unanimous vote.
The Board thanked Mr. Alvarez for his memorandum, after which Mr. Alvarez then left the meeting.
Larry Fay then referred to the solid waste report of violations over the last year, which was included in
the agenda packet. There has been a resolution to most of the situations.
DOH Policy 96-02 Consideration - Reauired Connection: Larry Fay noted based on discussions at
the last meeting, he made modifications to Policy 96-02 to require connections to public water when
there is a compelling public health concern. However, due to some of the recent work on the seawater
intrusion policy regarding requiring such connections and alternative water systems, he believes it would
make more sense to create a unified Board of Health water code addressing public health issues. While
the Board could choose to move forward with the policy as amended, he would like to pursue the
development of a water code linking the Department's requirements regarding water development and
water improvement to the outcome of the Critical Areas Ordinance.
Member Frissell noted that a compelling public health interest would include saltwater intrusion.
. .
Commissioner Huntingford questioned whether the Board's approval of the modifications makes any
difference since these requirements already exist as part of the Coordinated Water System Plan? When
requiring proof of potable water, the first thing the Building Department does is look for a water service
area. The individual is required to hook up to this service unless the purveyor states in writing that they
do not have the capacity, in which case the property owner can drill an exempt well.
Mr. Fay agreed that this does happen as part of a Health Department Well Construction Utility Service
Review, but modifications to the policy actually reduce the connection requirement. Currently the policy
HEALTH BOARD MINUTES - June 13,2002
Page: 4
states that if public water is available, you are required to connect, whereas the modified policy requires
connection only when there is a compelling public health reason. When he was drafting this policy he
was primarily addressing densities that cannot be supported by septic and wells. Now, in light of
seawater intrusion issues, he suggests that if the Board wanted to approve these modifications that it
might consider an addition to Page 2 of Policy 96-02. Under the first paragraph where it says, "and there
is a compelling public health interest" it could add "or other County Code requirement."
Commissioner Huntingford said it would seem that any potential health concerns about seawater
intrusion are already addressed by the words "compelling public health interest...." Larry Fay said this
might be where you run into problems. The thresholds that are in the critical areas ordinance are lower
than those in the drinking water standards for potability. This is why he is a little leery of beginning to
view seawater intrusion as a public health problem.
Dr. Locke said the policy is supposed to be an interpretation of such existing statutory authority. When
we address a case through policy as opposed to a code or ordinance, we are out on a limb and stretching
authority. This policy has created a monopoly for water purveyors who can set up a water operation and
declare a large rural area to be within this service area, yet someone on a 10-acre parcel included in that
area can be forbidden from drilling a well even though there is no prohibitive health issue. He believes
the existing language limits the Board in the area of public health.
Commissioner Huntingford moved to approve the proposed modifications to Policy 96-02 as
presented in the agenda packet. Commissioner Titterness seconded the motion. During discussion
of the motion, there were questions about how this language would address areas with higher densities?
Larry Fay explained that Policy 96-02 references Policy 97-02 and the On-Site Sewage Code, which lists
the minimum land area requirements and alternatives. The motion carried by a unanimous vote.
Jefferson County Board of Commissioners - Resolution #31-02: Commissioner Wojt referred to the
Resolution and the attached matrix, which reflects Departmental cuts. It was noted that although the cuts
will also impact the Health Department, because the cuts are treated as an Operational Transfer, they are
not noticeable as a department cut. Larry Fay noted the newspaper article referencing cuts to the
Department of Community Development and Law and Justice did not mention the $147K cut in the
Department of Health budget, which he reminded is in addition to the $90K cut earlier in the year, which
also impacted the 2002 budget.
Member Frissell reminded that many Health Department programs are preventative. If the programs are
not supported now, it will cost another agency a lot more later. Commissioner Titterness noted that the
Olds Project, which is a preventive program, has been recently funded through a grant and will serve 100
or so families, as opposed to current 50-60.
NEW BUSINESS
Vaccine Shortau:e: Dr. Locke reported that the State Department of Health issued an emergency rule
yesterday dealing with school entry requirements. To address the shortage, the State Department of
HEALTH BOARD MINUTES - June 13, 2002
Page: 5
Health felt it had no choice but to create an expansion of an existing category titled Conditional Entry,
meaning that entry is conditional upon the completion of the required vaccine series at appropriate
intervals. This will now allow kids who cannot get vaccinated because of shortages to be admitted rather
than to force families into exemption.
In response to a question by Member Buhler about there being only one supplier, Dr. Locke explained
that principal among several factors, is low profitability. The other factors are that the regulations are
tighter for vaccines and that there are natural delays in creating vaccines.
To the question whether we should be gearing up for a potential outbreak, Dr. Locke said that while the
risk varies among vaccines, the only concern in the DtaP is the whopping cough component. Tetanus is
not transmittable person-to-person and the last case of Diphtheria was in 1985. On the other hand, there
were Pertussis outbreaks even when there were adequate vaccine supplies. Staff will be in a heightened
surveillance mode for Pertussis in schools, for which there are antibiotics. However, since the vaccine is
the only tool against the viral infections like Measles the shortage is much more serious. Because the
vaccine wears off when you reach adolescence there is concern about adults reinfecting kids, especially
thoseunimmunized. Currently, all kids are vaccinated for their primary series for DtaP, which provides
immunity for 95-97%. The 4th and 5th doses, to be deferred, are booster doses. While most children will
remain immune through their initial school years based upon their primary series, the immunity of 10-
15% of these will wane if they have not had a booster. He noted that we are at an all-time high in
vaccine levels in the County and at an all-time low of vaccine preventable diseases. So we are not seeing
any increase of outbreaks during the shortage, but we are coasting on benefit of a vaccinated population.
Vice Chairman Masci asked if there is a plan to address the fact that many kids are vulnerable because
their parents lack knowledge. Dr. Locke noted that three years ago, Jefferson County peaked at an 8.9%
exemption rate for vaccinations, as compared to the State average of 3%. It now appears that after an
aggressive effort, this exemption rate may have dropped to 5%.
Member Frissell suggested Dr. Locke consider publishing his article about the importance of
vaccinations in The Leader again.
Commissioner Wojt asked about the State's plans for identifying a protocol for notification in the event
of an outbreak. Dr. Locke said a single case of measles constitutes an outbreak. In any such disease
where there is a person-to-person risk, all non-immunized kids can be pulled from school.
Dr. Locke mentioned that Health Officers from throughout the State wrote to the congressional
delegation in order to bring the vaccine issue to the federal level. He asked the Board of its interest in
taking similar action to express concern about the shortage and provided a draft letter for review.
Commissioner W ojt moved that Staff send the draft letter as presented to both Representatives
and Senators. Member Buhler seconded the motion. Member Masci proposed a friendly
amendment to the motion to include that the entire Washington State Delegation receive a copy of
the letter. The motion as amended carried by a unanimous vote.
HEALTH BOARD MINUTES - June 13. 2002
Page: 6
Member Frissel1 asked if Dr. Locke knew the compliance rate among home schooled kids and whether
there is a requirement that when home school kids come into the school environment they have to be
vaccinated. Dr. Locke said he does not believe the mandatory requirement applies to those home
schooled, especially if schooling is within the family unit, although it would apply to commercial
preschools. Vice Chairman Masci said he thought they did have to comply when they come into school
service. Dr. Locke said he is meeting with the State Board of Education next week and they will try to
identify issues on which there is not good coordination. He said schools are often confused about their
role regarding enforcement.
State Board of Health - Arsenic: Dr. Locke announced that federal standards for arsenic have now
been raised, which is thought to be one of the most costly rules ever adopted by the EP A. The
permissible level of arsenic in public water system will be lowered from 50 ppb to 10 ppb. This rule was
passed after a comprehensive review by the Bush Administration found the health risks first detected
during the Clinton Administration to be even greater than feared. This is expected to affect nearly 13
million people, largely in Group B water systems.
Larry Fay explained that the drinking water program in Washington State is broken into two groups:
Group A water systems, comprised of 15 or more service connections to be regulated by the Federal
Government, and Group B, which is a state program. The state policy question is whether to follow the
federal lead and impose the 10 ppb standard on the Group B systems as well. He went on to say that
there are about six systems in Jefferson County that would exceed the 10 ppb standard.
Dr. Locke then explained that large systems could extract arsenic from the water at a very cost effective
87 cents per person per year. A small system, however would face very high incremental costs; the
minimum treatment capacity is about $3K, so it would not be cost effective for 2-4 connection well. The
risks from arsenic are primarily cancer. Of the 13 million people exposed to arsenic at levels of between
10 and 50 ppb, the excess mortality is about 50 cases a year. Other linked conditions include accelerated
rates of heart, neurological and gastrointestinal disease. Slow, chronic exposures damage tissue and
accelerate various degenerative disease processes.
There was additional discussion about whether the County should consider requiring people to test for
arsenic as a condition of a building permit, knowing that at least some of the public water supply wells
are currently exceeding this standard. Larry Fay noted that the metals test costs about $250.
Commissioner Huntingford expressed concern that as more people find they cannot afford to comply
with the increased testing, they will decide to not obtain a building permit. Mr. Fay said that Staff does
not go out and confirm that it is being treated, but has the property owner sign a restrictive covenant,
stating that they tested the well at a specific concentration and that to make it potable they should be
treating it for arsenic. The desire is for people to make informed decisions about their personal lives.
Community Assessment Activitv Update: Jean Baldwin announced that she and Dr. Chris Hale would
present the BRFSS, vital statistics and census information at a City Council workshop on July 8th at 6:30
p.m. at City Council Chambers. Other invitees to the three-hour workshop include schools, hospitals, the
EDC and the Board of Health. Still being discussed by the Data Steering Committee is how to break the
HEALTH BOARD MINUTES - June 13, 2002
Page: Î
data into manageable modules for taking action and what type of framework will work best for looking
at performance indicators.
Jean Baldwin announced that the Health Department received an $80K prevention grant from the
Governor's Commission on Juvenile Justice, the first non-juvenile justice group to do so.
AGENDA CALENDAR / ADJOURN
The meeting adjourned at 3:30 p.m. The next meeting will be held on Thursday, July 18,2002 at 2:30
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
(Excused)
Sheila Westerman, Chairman
Jill Buhler, Member
Geoffrey Masci, Vice-Chairman
Richard Wojt, Member
Glen Huntingford, Member
Roberta Frissell, Member
Dan Tittemess, Member
Memorandum
To: Jefferson County Board of Health
From: Larry Fay --fJ ~
Date: July 10, 2002 f- \
Re: Draft Civil Penalties Ordinance and Complaint Response Policy
Attached for your review are the above referenced documents. These have been prepared
at the direction of the BOH in the June Board meeting.
The draft civil penalties ordinance was developed using the Bremerton Kitsap Health
District, Pacific County and Klickitat County civil penalties ordinances as models. It has
been reviewed and edited by David Alvarez, Deputy Prosecutor. The Board is being
asked to review and comment. If acceptable, we can initiate appropriate legal advertising
and schedule for hearing in August.
The second document, "Complaint Response and Investigation Procedures", was
originally prepared at the request of Charles Saddler as a rramework for a standardized
county enforcement methodology. To date no action has been taken at a county level.
However, it would be a relatively straightforward matter to edit the procedure so that it is
specific to Health and Human Services and adopt it as a standard operating policy at the
same time that the Board moves forward with the civil penalties ordinance (inf it chooses
to do so).
Staff recommends moving forward with both documents and having the board schedule a
public hearing at our next regular meeting, August 15th.
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
,
~.f
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JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE
ENVIRONMENTAL HEALTH CIVIL ENFORCEMENT
WHEREAS, the Jefferson County Board of Health wishes to establish civil penalties for
violations of public health laws, regulations and/or ordinances adopted by the
Washington State Legislature, Washington State Board of Health, Washington
Department of Health or the Jefferson County Board of Health;
WHEREAS, all conditions which are determined by the Health Officer to be in violation
of any public health law, regulation and/or ordinance shall be subject to the provisions of
this ordinance because they are detrimental to the public's health, safety and welfare;
WHEREAS, all violations of public health laws, regulations and/or ordinances are
detrimental to the public health, safety and welfare and are hereby declared to be public
nuisances pursuant to Ch. 7.48 RCW;
WHEREAS, a civil infraction process, established pursuant to Ch, 7.80 RCW, can
protect the public from the harmful effects of violations, will aid in enforcement, and will
help reimburse the County for expenses of enforcement;
WHEREAS, enactment ofthis Ordinance promotes the health, welfare and safety of the
citizens of Jefferson County; and
WHEREAS, the Jefferson County Board of Health enact this Ordinance pursuant to the
authority granted them by various state statutes, including, but not limited to, those
codified at Ch. 7.48 RCW, Ch, 7.80 RCW and Ch, 70.95 RCW.
NOW, THEREFORE, be it ORDAINED by the Jefferson County Board of Health as
follows:
Section I Purpose:
It is the express purpose ofthis ordinance to provide for and promote the health ofthe
general public and not to create or otherwise establish or designate a particular class or
group of people who will or should be especially protected by the terms of this ordinance.
It is the specific purpose ofthis ordinance to place the obligation of complying with its
requirements upon persons, businesses or companies required to meet provisions of the
health regulations. No provision of or term used in this ordinance is intended to impose
any duty upon the Jefferson County Health and Human Services Department nor any of
its officers or employees for whom the implementation or enforcement of this ordinance
shall be discretionary and not mandatory.
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Section II Anthority :ø p> };::)
This ordinance is promulgated under the police power granted to the Jefferson County ,
Board of Health, including, but not limited to, authority granted to them by Ch, 7.48
RCW, Ch, 7.80 RCW and Ch, 70.05 RCW to protect the public health, safety, and
welfare of the people in Jefferson County, including those County residents residing
within the City of Port Townsend.
Section III Applicability
Provisions ofthis ordinance apply to violations ofthe following statutes, regulations
and/or ordinances as they now exist or as they may hereafter be amended:
Chapter 70-90 RCW
Chapter 70-95 RCW
Chapter 246-203 WAC
Chapter 246-215 WAC
Chapter 246-260 WAC
Chapter 246-261 WAC
Chapter 246-272 WAC
Chapter 246-290 WAC
Chapter 266-291 WAC
Chapter 173-304 WAC
Chapter 173-308 WAC
Chapter 8.05 JCC
Chapter 8.10 JCC
Ordinance # 08-0921-00
Water Recreation Facilities
Solid Waste Management
General Sanitation
Food Service
Water Recreation Facilities
Recreational Water Contact Facilities
Onsite sewage systems
Public Water Supplies
Group B Public Water Systems
Minimum Functional Standards for Solid Waste
Biosolids Management
Food Service Sanitation
Solid Waste
Onsite Sewage
Section IV. Desh:~nation of Civil Infractions
Any violation of the laws, regulations and ordinances specified above in section III
(including any future amendments to those statutes, regulations and ordinances) shall
constitute a civil infÌaction.
Each (twenty-four) 24-hour period when a violation is found to exist shall constitute a
separate and distinct violation.
The owner or Lessor of any real property shall be and is jointly and severally liable with
any tenant, occupier or user of real property for any violation alleged against that
property or alleged to have occurred on the owner's property. The legality or illegality
of the use or occupancy of the land by a person or entity shall not be a defense available
to the owner of said property if it is alleged a violation of this Ordinance occurred on that
property .
A first offense shall be a Class 3 civil infÌaction as established in Chapter 7.80 RCW.
A second offense shall be a class 2 civil infraction as established in Chapter 7.80 RCW.
A third offense shall be a class 1 civil infÌaction as established in Chapter 7.80 RCW.
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Enforcement Ordinance 2nd draft 070502.doc
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Section V. Processin~ and Adjudicatin~ Civil Infractions:
Such infractions shall be adjudicated and any related fines determined in accordance with
the procedures established in Chapter 7.80 RCW, the Jefferson County District Court
rules for Infractions and the Washington State Rules for Courts of Limited Jurisdiction.
Upon a determination that the County has met its burden of proof regarding any
infraction alleged against a person or entity pursuant to this Ordinance or upon the
decision of the alleged violator to not contest the infraction, the County may seek to
obtain attorney's fees against the violating party or entity pursuant to RCW 7.80.140.
Utilization of the procedures and penalties laid out in this Ordinance and the underlying
state statutes shall not prohibit this County from utilizing any other lawful means or
seeking any other lawful remedies against the person or entity that has allegedly violated
the terms of this Ordinance.
Nothing in this Ordinance shall prevent the Judge hearing these civil infraction matters
from reducing or mitigating the monetary fines that would otherwise be imposed.
Section VI Enforcement Officers
The Board of Health, or its designated Health Officer, may authorize one or more persons
to serve as an "enforcement officer," duly authorized to enforce this Ordinance.
Section VII. Severability
Should any section, paragraph, phrase, sentence or clause of this ordinance be declared
invalid or unconstitutional for any reason, the remainder of this ordinance shall not be
affected.
Section VIII. Effective Date
The effective date ofthis ordinance shall be
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Jefferson County
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Manual
Draft 6/2002
I. Introduction
This document seeks to provide general guidelines for use by all Jefferson County
Departments dealing with responses to citizens' complaints, and basic enforcement
procedures for civil infraction ticketing. Certain Departments may have specific compliance
codes to follow. This document does not override or replace those codes.
Jefferson County must occasionally seek damages from an individual or other entity, if a
clear and present violation of applicable codes exists. Jefferson County wishes to seek all
possible recourse BEFORE issuing a ticket for a civil infraction. Jefferson County commits to
the following guidelines when approaching a potential violation:
· The County will always strive to respect the rights of private property owners when
conducting an investigation.
· The County will keep a database of "No Trespassing" notices, for ease of contacting
individuals who may wish to conduct the interview at a neutral site.
· The County will review each case before beginning a full-scale field investigation. Its
field inspectors will, to the greatest degree possible, use the telephone and mail in lieu of
site visits
Jefferson County is committed to a friendly and helpful approach using good common
sense reasoning.
This document details the procedures to be followed when responding to ,çornplaintsand
enforcing provisions of Jefferson County Regulations as these regulatiQns apply to aU
persons.
ßP' IMPORTANT: Before conducting any enforcement, it is very important that
inspectors understand the contents of all sections of this document to determine
which enforcement approach is applicable. Any questions about these procedures
should be directed to the appropriate program supervisor or manager.
II. Standard Complaint Enforcement Procedures
A. COMPLAINT RECEIPT
Most suspected violations are reported to the Departments via telephone calls and
letters. The inspector or person receiving the complaint Shb~d determine if it falls
under the Department's jurisdiction. If not, the caller should be fòrwarded to the
appropriate Department or agency. If the complaint is within the Deparhnent's
jurisdiction, the complaint must be recorded onto a sequentially numbered Jefferson
County Complaint Form. A sample complaint form is located in Appendix A. Be
advised that emergency complaints require special consideration and handling.
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Record the following information on the standard complaint form as completely and
accurately as possible as described below:
· Record the date and time the complaint is received
· Check the box indicating the complaint type. Complaint type determination is
explained in more detail further on in this document
· Record the name, address, zip code, and phone number of the complainant
W' IMPORTANT: Jefferson County does not investigate anonymous complaints. The
name of the complainant person must be revealed to the County employee,
although the complainant's name can remain confidential, i.e., known only to
County employees.
If the complainant indicates that they wish to remain confidential, and/ or indicates that
disclosure of their name may endanger their life, physical safety, or property, check the
IIYFSII box following the question liDO YOU WANT TO REMAIN CONFIDENTIAL?II on the
complaint form.
Mter staff have received a complaint and completed the complaint form, the completed form
must be forwarded to the staff member responsible for logging complaints into the complaint
database and assigning complaints to the appropriate inspector.
· If known, record the name, address, zip code, and phone number of the alleged
violator.
· If known, check the appropriate box to indicate if the alleged violator is the owner of
the property.
· Write a description and record the address of the alleged violation.
W' IMPORTANT: Public requests for copies of complaint files must be forwarded to a
supervisor or program manager.
Consider every request for a copy of a complaint file, whether the request is oral or in
writing, to be a request for public records pursuant to the state law known as the Public
Disclosure Act, codified at RCW 42.17.250.
A.1 Law firm or ACLU requests handling:
Any request for a complaint file, which comes from a law firm or the ACLU, shall be
immediately referred to the Risk Manager or the Civil Deputy Prosecuting Attorney.
A.2 Request for Public Records:
When complying with a request for public records the County employee should
redact on a copy (cross out with magic marker) the name of any complaining person
who asked that his or her name remain confidential.
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w:r IMPORTANT: County employees are strongly encouraged to contact the Civil Deputy
Prosecuting Attorney if they have any questions or concerns about what is the proper
response to a citizen's request for public records or public documents because failure to
comply with the Public Disclosure Act can have negative financial and public relations
consequences for the County.
B. COMPLAINT TYPE DETERMINATION
The Department's supervisor or designated program lead will first review all complaints to
determine whether the complaint is an emergency or non-emergency. If the complaint is
determined to be an emergency, the supervisor will handle it. If the complaint is determined
by the supervisor or program lead to be a non-emergency, it will be assigned to the
appropriate staff member for follow-up.
1. Emergency complaints
Emergency complaints include any report of an incident where significant
environmental damage, severe injury or death has occurred or is imminent is the
situation is not corrected immediately.
Staff members receiving complaints of an emergency nature must:
a.) Log the complainant's name and phone number, complaint description, and
directions to the incident,
b.) Immediately forward this information to 9-1-1, and
c.) Immediately forward all documented information to the program
supervisor or manager.
2. Other complaints
Program staff can directly respond only to reported or suspected violations within the
program area and within its Department's jurisdiction. Certain complaints will need
to be referred to other agencies or County Departments with primary responsibility
for that type of complaint. Appendix "B" includes complaint referral and contact
information for related federal, state and local agencies.
JY IMPORTANT: To help protect the safety of staff in other agencies or programs, be sure
you advise them of any known or potentially hazardous situation regarding the
complaint.
If the complaint involves a situation handled by another jurisdiction,
· The complainant should be told to whom we are forwarding the complaint, and be
given a contact person and telephone number.
· Record information given to complainant from first bullet on the complaint form.
· Staff must advise the contact at the other jurisdiction of any known or potentially
hazardous situation regarding the complaint.
· The complaint should then be logged-off the complaint database as "forwarded".
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3. Complaint coordination
Many complaints received by Jefferson County will involve multiple issues and
require coordination with another agency. Inspectors should use their judgment in
determining if it is necessary to contact another agency or Department in advance of
conducting a site inspection. Conducting joint site inspections can be a useful tool to
help facilitate interagency or interdepartmental coordination. If a joint inspection will
be conducted, it is recommended that a pre-inspection meeting be held so that all
inspectors can agree on what will be covered during the site visit. A list of other
contacts is listed in Appendix B.
"no" go there.)
For instance, If "yes", go here, if
D. INSPECTION PREPARATION
Pre-inspection preparation is an important part of the complaint response process. The
amount of preparation will vary significantly by the type and alleged severity of the
complaint. Pre-inspection preparation includes:
. Completion of required training.
· Possession of knowledge of applicable ordinances, policies and procedures,
· Confirmation and collection of additional complaint information, and
· Gathering necessary supplies, equipment, and protective clothing.
1. Training
In addition to general training and orientation of new staff, training specific to complaint
response and investigation techniques is a requirement for all staff having responsibility
for compliance. Training such as the NCIT offered by the "Council on Licensure,
Enforcement and Regulation" or equivalent is desirable.
The EP A Basic Inspector Training Course is recommended, and may be REQUIRED, for
inspectors. Other field staff training will be periodically provided. Although it is
management's responsibility to provide required staff training, staff is encouraged to
recommend any other training opportunities or needs that would improve the function of
the program or further improve field safety.
2. Applicable Policies and Procedures
In addition to this procedure outline, field staff conducting complaint inspections must be
familiar with the appropriate Jefferson County Ordinances, Departmental Policies, and all
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other adopted County policies and procedures. See the program supervisor or manager
about questions on any of these policies or procedures.
3. Complaint Information
Mter receiving a new complaint, the inspector (if he/ she did not receive the complaint)
should call the complainant to verify the nature and location of the problem and other
information not normally collected at the time the complaint was filed. This procedure is
recommended as a guideline and may not be necessary in all cases. Make sure that you
can answer" yes" to all of the questions listed below before performing an on-site
inspection:
· Do you clearly understand the complainant's concern?
· Is the nature of the complaint within the Department's regulatory jurisdiction? If
there is overlapping jurisdiction, a joint inspection with another agency or
Department may be appropriate.
· Has the complainant been asked to offer any and all additional information that
was not initially recorded on the complaint, such as:
i. Date/ time the problem occurred or was first noticed
11. License plate numbers, knowledge of previous problems/violations,
and/ or
111. The alleged violator's name, address, telephone number, and place of
work, etc.
· Have you checked the complaint database to see if previous violations for this
person (or property) have been logged?
· If applicable, have you or your Department conducted a more detailed review of
historic cases if previous violations are identified?
I:Y IMPORTANT: It is critical to record all information pertinent to the complaint on
the complaint form, including information collected while preparing for the site visit.
Feel free to use additional pages if needed.
4. Supplies and Equipment:
The supplies and equipment listed below are required (or optional, as indicated) for all
enforcement fieldwork. All required and most optional items are provided to staff at the
Department's expense. Optional items not provided by the Department mayor may not
be approved for purchase. Pre-approval on any business expense not listed is required.
Check with the program supervisory or manager for clarification of reimbursement and
purchasing procedures.
a. Required supplies and equipment
· Jefferson County picture ID (worn in plain sight)
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· Jefferson County business cards
· Appropriate educational materials
· Completed complaint forms for the day's inspections
· Field notebook and/ or laptop computer
· Pepper spray and holder (carried at all times in the field when conducting
enforcement)
· Noise making device, such as a whistle or a canned air horn
· Camera and extra film or a digital camera
· Cellular telephone and emergency contact telephone numbers
· Appropriate personal protective equipment (PPE) for the employee.
Depending upon the type of complaint, hard hats and heavy duty gloves may
be appropriate
· Evidence collection supplies
· Sharps container
· Violation notices as appropriate
· Order to Correct Violation Compliance Agreements
b. Optional supplies and equipment
· Dog biscuits
· Other supplies specific to the Division and/ or type of complaint
4. Field Clothing and Personal Protective Equipment:
Appropriate attire for conducting field activities is required. In some cases, basic personal
protective equipment is necessary. In general, dress appropriately for the type of weather
you may be facing when you go out in the field. Boots or other hard-soled shoes are required
at all time (steel toe recommended). Gloves are required for any circumstances where the
inspector will touch the materials, such as when collecting evidence. If you have a question
about appropriate clothing or PPE, talk with a program supervisor or manager.
W' IMPORTANT: Jefferson County picture ID must be worn AT ALL TIMES when
employee is in the field. The ID should be visible to the citizenry or shown to them if
such a request is made.
E. SITE INSPECTION
The purpose of the site inspection is to document facts related to the complaint. This
includes, but may not be limited to:
· Field notes
· Witnesses and/ or alleged violators interviews
· Photo documentation, and
· Collecting physical evidence
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This infonnation is used to build a case and determine if a violation has been committed.
Unless otherwise approved by a program supervisor or manager, all inspections must occur
during the investigating Department's normal business hours, or a time mutually agreed
upon with the Department and the appropriate property owner or property custodian.
r;r IMPORTANT: Jefferson County staff, as a matter of courtesy, should always attempt to
contact the property owner or custodian by phone before conducting a site visit, unless the
violation is a clear and compelling risk to public health and/or safety
a. Site Entry and searches
While conducting inspections or surveys, Department inspectors must often enter private
property. Because the state and federal constitutions prohibit unreasonable searches,
inspectors must decide whether to enter a particular property to conduct an inspection.
As explained in this section, each situation is different. There are no blanket rules
regarding allowable searches. In all cases, an inspection can occur only after obtaining
consent from a responsible party (owner or tenant), or by making observations from a
location where the inspector may legally be without consent or from a place he/ she has
consent to be, or with a search warrant. To assist you in determining whether you may
enter a property, discussed below are some basic constitutional doctrines:
Please review RCW 10.79.040 regarding the rights of a private property owner. Note
well that unlawful entry onto private property without a search warrant amounts to a
gross misdemeanor according to RCW 10.79.045.
Reasonable Expectation of Privacy: There are two components to a reasonable
expectation of privacy. The first is a subjective component: Does the person have a
subjective expectation of privacy in a particular object or location? The second is an
objective component: is this expectation one that society recognizes as reasonable?
Generally, a person has a reasonable expectation of privacy in his/her home, in the area
immediately adjacent to the home, and in areas where he/ she has taken steps to exclude
the public and shield the area from the public's view.
r;rImportant: PRIOR NOTICE GIVEN
From time to time, there will be individuals who notify the county by written or oral
means that county personnel are not allowed on their property without prior written or
documented permission. When an inspector learns that such notice has been provided
to the County, the inspector will not enter upon that owner's property unless the
inspector has received permission from the owner or the owner's authorized
representative (e.g.: Legal counsel) or has obtained a valid search warrant. This
restriction to access supercedes the normal principles as discussed under curtilage.
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Residence: A person always has a reasonable expectation of privacy in his/her home.
You may NOT enter a person's home or outbuilding, except with the resident's consent or
with a valid search warrant issued by a court of competent jurisdiction.
Curtilage: Curtilage is the land immediately surrounding and associated with the home,
i.e., that area associated with the intimate activity of a home and the privacies of life.
Curtilage receives the highest level of protection under both the federal and state
constitutions. You may not enter the curtilage without a resident's consent, except as
explained below. To help determine if an area is within the curtilage, answer these
questions:
Q. How close is the area you want to inspect to the house?
A. The closer the area you want to inspect is to the house, the more likely it will be
considered within the curtilage.
Q. Is there a fence or other enclosure that surrounds the house and the area you
want to inspect?
A. A fence that surrounds the house suggests the limits of the curtilage. Accordingly,
where a house is situated on a standard lot and the lot is fenced, that is the limit of
the curtilage. On a larger piece of property there may be a fence around the
perimeter of the property, and an inner fence enclosing the house. In that case, the
interior fence would indicate the limits of the curtilage. A clearing or maintained
area has the same effect. Thus, on a larger piece of property that is forested, the
cleared area surrounding the house would indicate the limits of the curtilage.
Q. What is the area you want to inspect used for?
A. The concept of the curtilage is to protect those activities normally associated with
the home and the privacies of life. Thus, if an area near the house is used for family
or personal activities (e.g., play area, patio, garage), then it is probably within the
curtilage. However, if the area is used for activities not associated with home life,
especially illegal activities, then it probably will not be considered within the
curtilage. You may use evidence you obseroe from the road or a neighbor's
property. .. if you have permission to be there... or information a neighbor gives
you, to determine if an area is being used for an activity associated with the home or
some other activity.
Q. Has the resident taken any steps to protect the area you want to inspect
from observations of passersby?
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A. If a fence--especially a sight-obstructing fence--or hedge shields the view of the
house from the street and neighboring properties, then the area within the fence or
hedge will probably be considered within the curtilage.
Q. Can an inspector ever enter the curtilage?
A. Yes. You may enter the curtilage to contact the resident. In doing so, however, you
may use only a recognizable access route, such as a driveway, walkway, or path.
Approach the house as any reasonably respectful citizen would. Normally, you
should not enter a side or back yard. You may, however, call out or try to get
someone IS attention if you see or hear something that leads you to believe the
resident is in a side or back yard.
Other factors to consider when conducting an inspection of private property:
No Trespassing Signs: A "No Trespassing" sign or "No Solicitors" sign does not prohibit you
from approaching a residence using a recognized access route for the purpose of contacting
the resident. A recognized access route would generally be the same route a UPS truck
driver would walk in order to deliver a package. BUT this sign clearly and strongly indicates
a notice of expectation of privacy. Consider adjusting your approach appropriately. You
may want to try and contact the party by phone first, and set up an appointment.
Open Fields: Areas that are outside the curtilage are considered "open fields" and do not
always receive the same high level of constitutional protection that the curtilage does. In an
urban area, you will likely not find any open fields. . In outlying areas, however, you are
likely to encounter them. An open field doesn't need to be either "open" or a "field". It could
be a thickly wooded area or a beach. Generally, an open field is any unoccupied or
undeveloped area outside the curtilage.
In many instances, you will be able to enter open fields without the permission of the owner.
However, you need to consider whether the owner has manifested an "expectation of
privacy" in the area you want to enter. Some manifestations of an "expectation of privacy"
are:
1. A long driveway
2. "No Trespassing" or "No Solicitors" signs
3. Fences, especially sight-obstructing fences, or maintained hedges
4. A locked gate, or
5. The area cannot be seen from a road or neighboring property.
Each situation is different, so it is not possible to provide a blanket rule for entering open
fields.
Open View: If you are in a place you may legally be, such as a
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· Roadway
· Public property
· A neighboring property that you have permission to be on, or
· You are approaching the residence via a recognized access route, and then you can
base an enforcement action on anything you can see from that vantage point.
· Accordingly, if a person allows you in his/her backyard, and you can see a clear
violation, you can write a notice and order to correct the violation or a notice of civil
infraction, based on what you can see from the neighbor's property. As long as you
remain on the property you have permission to be on you can take photographs of the
alleged violation.
· Do not go to extraordinary measures, such as using ladders and/ or binoculars to
document an alleged violation. Although these actions are legal, they clearly are in
conflict with the individual's "reasonable expectation of privacy.
Plain View: The plain view doctrine applies when you have entered a property with the
resident's consent. The plain view doctrine allows you to use anything that you see
inadvertently as you walk through the area. The object must be in plain view; you may not
move anything. For example, you may not remove a garbage container lid to look inside.
Plain view works the same way when the resident has given you permission to look around.
If you want to see inside or under something, ask the resident's permission.
Implied Consent: An inspector obtains valid consent to inspect when he or she asks the
resident for permission to conduct an inspection and receives an affirmative VERBAL
response. An inspector need not inform a person of his/her right to refuse an inspection but,
if the person asks whether he/ she may refuse, the inspector must tell the person that yes,
he/she may refuse.
Statements such as "I'm going to look around" or "I have to inspect the property" MUST be
avoided. A person who submits to an inspection after such a statement has not given his/
her consent to the inspection and a court could suppress anything that is found during the
inspection, and may subject the Department and/ or the employee to civil liability. Always
phrase as a question, e.g. "May I have your permission to look around?"
JT IMPORTANT: In situations where the field worker is uneasy or unclear about how to
proceed, it may be best to consult with a supervisor and/or seek legal guidance from the
Prosecuting Attorney's office before entering.
F. Conducting the Inspection
Conduct the inspection within the bounds of your job. You are conducting the inspection to
determine the "who, why what, where, when, and how" as they relate to the complaint.
When doing the inspection keep in mind what evidence, facts or items you might someday
need to assert and prove in court in order to obtain a judgment on a civil infraction. What
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information would you need to collect in order to prove in court that the owner has failed to
do what the Ordinance obligates him/her to do? What evidence would you need in order to
prove in court that the owner has done what the Ordinance prohibits? Avoid discussing
violations or making any enforcement promises until after investigation and evidence
collection as been completed and you have thoroughly formed your enforcement approach.
While you are conducting the inspection, take thorough notes in a field notebook. Do NOT
use the complaint form for field notes except for the simplest complaints. In most cases,
the complaint form is your formal statement related to the case. You should thoughtfully
prepare it when you have returned to the office and had a chance to review your notes and
other evidence. More complex cases may require preparation of a more formal inspection
report.
Photos are useful tools the inspector can use to document suspected violations. If you take
photos, record information about each photo in your field notebook. At a minimum, this
information should include:
1. Subject of the photo (what are you trying to show?) It is useful to
include an everyday object, for scale. Be sure and note the
placement of such an object.
2. Where you were standing when you took the photo
3. The direction in which the photo was taken
4. Mter the photos have been developed, you should complete a "photo
log" (Appendix "e"), and
5. Attach the photos to the log.
Witness and suspect interviews are very important investigation tools. Conduct interview in
a non-emotional, objective, and non-accusatory manner. Be certain to record the:
a.) Name
b.) Address and
c.) Telephone number of all people you interview in case you
need to follow-up and get more information later. This
information is also necessary to validate the information
collected in the interview.
W" IMPORTANT: Always request to see photo ID of witnesses and suspects. H they
refuse, provide a detailed written description of the people involved.
Occasionally, inspectors will encounter a case that is fairly "straight forward II and be able to
formulate an enforcement approach before the inspection is completed. In these cases, it may
be possible to complete a written compliance agreement before leaving the site. Verbal
orders to correct a violation may be used in conjunction with a written order, but should not
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be used alone. If a verbal order is issued, refrain from doing so until after the inspection is
completed. Premature discussion of any violation may cause the inspection to be cut short
before you've had the chance to collect all available evidence. Take clear notes of any verbal
order, agreement, or promise made while at the site.
A business card and/ or "door hanger" should be left if no contact is made during a
residential or business inspection and violations are found. The door hanger lists the general
violation noted, and requests that the occupant contact the inspector. A sample copy of the
door hanger is included in Appendix IIDII.
W" IMPORTANT: H the violator threatens an inspector during an inspection, either directly
or indirectly, the inspector shall immediately leave the site. The inspector shall:
1. Immediately report the incident to his/her supervisor
ii. Fill out an incident report
Hi. Determine whether a warrant is appropriate before returning
to the site.
IV. If the inspector DOES return to the site, do so only with law
enforcement backup. Backup shall be provided by the
appropriate jurisdictional law enforcement agency.
Threatening a public servant is a class B felony in the State of
Washington under RCW 9A.76.180
G. General Field Employee Safety
This section briefly discusses employee safety while in the field. Because a field site visit
cannot be a controlled situation, the responsibility for personal safety rests with the
employee who is conducting the visit. These are merely guidelines; the most critical of
which is to USE YOUR GUT FEELINGS. Some suggestions to increase safety include the
following:
1. Plan ahead: If the referral you've taken is in a location
unfamiliar to you, try to find another worker who may be
more familiar with the area to brief you to any known risks
or hazards
2. Pre-site contact: As a matter of courtesy and to respect the
individual's right to an expectation of privacy, it is
Jefferson County's policy to contact the potential violator
ahead of time by phone or letter. This is also helpful in
ensuring that the employee will not take anyone by
surprise.
3. Stay in contact with the office while in the field: Leave an
itinerary at the office. Keep your address file updated.
Call in to the office at scheduled times. If working in pairs,
stay together.
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4. Carry nothing unnecessary: Lock or conceal your purse in
the trunk of the car before leaving the office. Take only the
items necessary to do your job. Select forms~ brochures~
etc. that you will need each day and arrange them in a
briefcase or other carrying device.
5. Noise making device: Carry a noise-making device...a
whistle or canned air horn.
6. Extra keys: Carry two sets of car keys. One set to use and
one set to have in reserve and concealed in your notebook
or bag.
7. Think about where you park: It's always better to park on
the street than in a driveway. That way, there is no danger
of being blocked in when you want to leave. This also
ensures that the employee is not parked on private
property .
8. Approaching the dwelling: Pause at the door before
knocking and listen. If you hear loud quarreling, sounds
of fighting, or some other disturbance, leave immediately.
9. Potential Meth lab danger: Be careful when walking in
yards with discarded glassware and containers. If these
are Meth lab residues, any contact with the contents can
contaminate you. Typical containers found at a Meth lab
look like common household glassware. The "sludge"
residue of the cooking process closely resembles used
crank case oil. Do not touch anything or lift any container
lids.
H. POST-INSPECTION DOCUMENTATION
1. Research
Always record all information obtained in the Complaint Database after your
inspection before the end of the workday~ IF FEASIBLE. Often the inspector will
need to do some research to locate the violator, property owner~ or gather other
necessary information. There are a variety of resources available to help gain this
information including County Assessor's (taxpayer) records.
2. Inspection report
The inspection report is probably the most important piece of evidence in a complaint
investigation. Mter the inspection is complete, you should:
a. Review your notes from the field and other sources and,
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b. Prepare an inspection report. The report should be limited
to the facts you collected about the case and your
observations during the site inspection. It should be
professionally written, thorough, and objective. DO NOT
INCLUDE OPINIONS IN AN INSPECTION REPORT!
Include only facts and observations. In most cases, the
inspection report should not initially be written on the
back of the complaint form. The complaint form, along
with the inspection report, should be completed after the
investigation. In more complex cases, a more formally
prepared inspection report may be warranted. The
program supervisor or manager can assist you with
determining which report format is appropriate.
c. The inspection report should include each and every piece
of information, evidence, observation or item that you
might someday take to court in order to prove that the
violator did in fact violate a state law, regulation or local
Ordinance. For this reason always err on the side of being
overly inclusive and detailed rather than being brief or
omitting items.
d. The report should, in most routine cases, be filed by the
end of the workday during which the site visit occurred.
I. ENFORCEMENT OPTIONS:
The general approach to compliance is as follows unless there are different procedures
specifically addressed in the applicable ordinance.
1. Warning letter: A warning letter is appropriate in some situations. Examples of these
situations are:
a. No clear evidence of a violation,
b. The violation warrants education rather than enforcement;
or,
c. The offense is the first for the violator and does not
constitute a public threat.
A sample-warning letter is contained in Appendix "E".
2. Compliance agreement (Violator present and/ or tenant agreement; violator is a non-
mail receiver)
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As stated previously, sometimes you will be able to form an enforcement approach
while conducting an inspection. In this case if the violator is present during the
inspection, the inspector can fill out a Compliance Agreement at the end of the
inspection. The Compliance Agreement fulfills all the requirements of a Notice and
Order to Correct Violation (NOCV). Mter the inspector completes the form, the violator
signs the bottom of the agreement and receives the bottom copy. An example
Compliance Agreement is provided in Appendix "F". If a rental property is involved,
as explained below, the renter and the property owner must jointly receive a separate
written NOCV prior to the issuance of a civil infraction notice. Therefore, when a
Compliance Agreement is used with a tenant, a copy must be mailed to the owner of the
property. Compliance Agreements can also be useful if there is some indication that the
violator does not (or may not) receive mail.
w-IMPORTANT: Process servers may be used in cases where it is doubtful the
violator receives or is picking up the mail, or at other times, as deemed appropriate
by the supervisor.
3. Notice and Order to Correct Violation (NOCV)
If the violator is not present, or cannot immediately be identified, the inspector should
issue a written Notice and Order to Correct Violation (NOCV). The content of the
written notice must conform to the requirements of the regulations. An example NOCV
letter is provided in Appendix "G." Letters that include non-standard language must
be supervisor approved prior to being sent.
The NOCV must be served on the person to whom it is directed by mailing a copy of
the order via certified and regular mail to such person at hisfher last known address,
or via a process server. The process server may attach the NOCV to the door of the
residence.
· Mter receipt of the NOCV, the person receiving the notice may request an
extension of the compliance date. The inspector must require this request to be
in writing, either by letter or electronic mail (email).
· Upon receiving the return certified mail receipt, attach it to the file copy of the
NOCV. If there is reason to believe that the certified mail copy will not be
delivered or accepted, then a Declaration of Mailing should be completed for
the copy sent by regular mail. A copy of the Declaration of Mailing is
contained in Appendix "H".
· A process server may be used to deliver the notice.
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Violation Compliance Deadline:
In most cases, the deadline recommended for the correction of any violation is seven to
thirty (7-30) days following receipt of the written notice. Compliance deadlines should
generally not exceed more than thirty days. Deadlines can be shortened or extended
depending on the severity of the violation, or as otherwise determined by the inspector using
best professional judgment.
As a courtesy when appropriate, if the violation occurs within the City limits or on an Indian
reservation, the inspector should send a copy of the Compliance Agreement of NOCV letter
to the appropriate staff within that jurisdiction. See Appendix "B" for a list of contacts.
Rental Property Violations:
For rental premises' violations, the inspector must write the NOCV to the renter and the
property owner. Each party's name should be included in the address block of the NOCV,
and each party should be sent a copy. If the violation continues past the compliance
deadline, each party will be written, separately, a civil infraction notice as explained below.
Past Deadline Violation Status:
After the deadline specified in the written notice has been reached, the status of the violation
must be determined. This can be accomplished either through:
· A phone call to the complainant, with an appropriate follow-up site visit.
· If site inspection is conducted, document the inspection just as thoroughly as the
initial inspection.
· If a violation still exists at follow-up, other enforcement options as described in this
section may be appropriate. Under normal circumstances, failure to comply with a
NOCV is followed by a Notice of Civil Infraction (NOCI).
Violation Corrected process:
If the violation has been corrected, this must be:
· Noted on the complaint form (with the date of the inspection and the inspector's
name),
· The complaint is then abated, logged-off the database, and filed.
Violation partially corrected:
If the violation is partially corrected, the inspector should use professional judgment to
continue enforcement activities. This may include:
i. Issuing a ticket or
ii. Agreeing to a revised compliance date with the violator, if
authorized.
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There are exceptions to the use of the NOCV. The NOCV is not required in cases of illegal
dumping and in other instances. In these cases, a ticket can be written without a proceeding
NOCV.
4. Letter from the Prosecuting Attorney's Office:
The Civil Deputy Prosecuting Attorney may, upon written request, and if his or her
schedule and workload permits, write a letter to the person or entity that is allegedly
in violation which will outline the consequences of not coming into compliance. The
Civil Deputy Prosecuting Attorney will only write this letter based upon receipt from
the County Department of a written file describing with specificity the:
1) property and persons involved,
2) alleged violation and
3) steps previously undertaken by the County Department.
A. Precondition:
The County Department must have written at least one letter or memo to the party
that is allegedly in violation of a state law, state regulation or County Ordinance and
shall send a copy of its letter to the Civil Deputy Prosecuting Attorney as a
precondition to the Civil Deputy Prosecuting Attorney writing such a letter.
This letter from the Civil Deputy Prosecuting Attorney can be sent only before a Notice to
Correct Violation has been issued.
5. Notice of Civil Infraction (Ticket)
Notices of Civil Infraction procedures are also known as "ticket writing" procedures.
Example of a completed ticket is provided in Appendix IfL" In most cases, tickets are issued
following failure to comply with the NOCV. However, a NOCV is NOT required prior to
issuing a ticket. A ticket can be issued to a defendant during the initial site inspection or any
other time the inspector has reasonable cause to believe that the person has violated the
regulations.
Before writing a ticket, the inspector should conclude for himself or herself that he or she has
a reasonable level of confidence that he or she could provide to a Judge information,
observations, evidence and items which would lead that Judge to convict the alleged
violator. A reasonable level of confidence is not the same as "complete confidence", in the
legal sense.
Each time an inspector writes a ticket he or she should do so with the expectation that it will
end up in court. It may not lead to a court case, but preparation is the key to succeeding in
court.
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~ IMPORTANT: A notice of civil infraction can only be written in cases where the
inspector has made a direct observation of the infraction being cited.
Prior to writing the ticket, if within the City or another jurisdiction, the inspector must
contact the appropriate code enforcement officer where the infraction is occurring to ensure
that duplicate tickets for the same infraction are not being written.
The inspector must write only one infraction on the ticket even though several infractions
may exist. The inspector should generally choose the infraction that is easiest to prove but
must also consider which infraction or violation is most harmful to the public welfare and
safety regardless of how difficult it might be to prove in a court of law that such a violation
occurred. In other words, the inspector should not be hesitant to write an infraction that is
both serious and yet also hard to prove because public policy supports the idea that the
County should have a "zero tolerance' attitude about the most severe and egregious
violations. Public Good does come from attempting but failing to convict the most severe
violators. If this approach is followed, the inspector may choose to inform the judge in court
that several other offenses were committed but not cited.
For infractions on properties with more than one property owner, the inspector should write
separate tickets, one for each of the property owners. District Court should be notified of this
fact when the ticket is forwarded to the court. The judge is the final arbiter of who
committed the infraction. It is up to the defendant to decide how to respond to the ticket. If
both property owners contest the infraction, a motion (through the Prosecuting Attorney)
can be made to consolidate the cases and ask the court to hear both at the same time. Each
defendant has the right to counter the motion and ask that his/her individual case be heard
on its own. If this occurs, it is up to the judge to decide how to hear the cases.
When tickets are written for premises infractions caused by renters on rental properties, the
renter and property owner shall each receive, separately, a civil infraction notice. The
procedures are the same here as they are for multiple property owners.
If the owner of a property is a corporation, the ticket should be written to the corporation
itself and the ticket served on the president or the registered agent of the corporation. This
information can be found be contacting the Washington State Secretary of State's office.
The following details must be completed on all tickets
· Check the following boxes on the top portion of the ticket: "INFRACTION", "NON-
TRAFFIC", and COUNTY OF JEFFERSON COUNTY
DEPARTMENT.
· In the spaces provided, complete as much information about the defendant as
possible:
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1. The defendant's name and address are required, at a minimum
2. If the defendant is present while you are writing the ticket, request to see his/her
driver's license or state identification card. Confirm that the information is current
and copy this information to the ticket.
3. The residential phone number is needed to notify the defendant of a change in the
court date or time.
· Indicate the infraction date in the space provided below the personal information.
The time of all infractions should be noted in military time (1-24 hours).
· On the next line, indicate the location of the infraction. This could be an address or tax
accounts number. When written in this space, the term "situs" indicates that the
infraction occurred at the defendant's address as listed on the top of the ticket.
· Do NOT complete any of the information in the large white box (motor vehicle
section) in the center of the ticket.
· In the next section, describe the specific section(s) of the regulations violated and
provide a brief narrative describing the infraction.
· Indicate the potential penalty amount in the "PENALTY/BAIL" box. The penalty for
one infraction will be identified in the authorizing ordinance.
ør IMPORTANT: When subsequent tickets for the same infraction are necessary, they
should not be written until after a judgment has been reached on the first ticket. H a
violation remains after a judgment has been reach on a second ticket, consult with a
program manager or supervisor.
· Indicate the date the infraction was observed in the "DATE NOTICE ISSUEDII box.
The ticket should be written as soon as possible after the infraction has been observed
(and/ or as necessary after an infraction has not been corrected as required).
· Sign your name in the IIOFFICER" box and put your employee number in the
"NUMBER" box. Print your name in the box below the "OFFICER" box.
· On the next line, indicate the date the ticket is written, and write IIJefferson County II
after the word "PLACEII.
· If the defendant is present when the ticket is written, show him/her the ticket and
explain what the ticket is being issued for and then do the following:
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1. Have the defendant sign in the "DEFENDANT'S SIGNATURE" box (failure to
sign a ticket is a misdemeanor).
2. Advise the defendant that by signing the ticket, he/ she is not admitting guilt,
only promising to respond to the court within 15 days.
3. After he/ she has signed, detach the green copy and give it to the defendant.
4. The response instructions are explained on the back of the defendant's (green)
copy.
5. Review verbally each of these options with the defendant.
6. If the defendant refuses to sign, or is not present when the ticket is written,
write the word "INVESTIGATION" in the signature box.
· Do not complete the "ABSTRACT OF JUDGMENT" section of the ticket.
· Provide a narrative of case events on the reverse side of the yellow copy, and then
sign it on the bottom. This narrative is the only testimony the court will see
from the inspector if he/ she is not present for a hearing. Therefore, a general
guideline for completing this section is to be thorough enough to describe and
prove your case in the event you are absent from court. Include a description
of all infractions in your narrative, even though you may have written the ticket
for only one or two. When completed, the copy of the ticket with the narrative
will be forwarded to the court, so the inspector should make a photocopy of the
narrative for his/her records. If the ticket is completed at the site, the narrative
may be completed after returning to the office.
. A pre-printed label with the Jefferson County District Court address must be affixed
to the bottom of the green copy of the ticket. The inspector should affix these
labels to all the tickets in a ticket book as soon as it is received.
. The defendant should be told that the inspector could dismiss the ticket if the
infraction is corrected prior to the court date (when one has been requested).
To dismiss a case:
1. Complete and sign a "Motion, Certification, and Order to
Dismiss" form
2. Forward the "Dismissal Order" to the Prosecuting Attorney's
office, Civil Division, to be signed.
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3. The inspector or Deputy Prosecuting Attorney must then forward
the signed Dismissal Order to the court for the judge to sign.
4. A copy of the Dismissal Order must also be sent to the defendant
after all appropriate signatures are obtained. An example
Dismissal Order is provided in Appendix "I."
rYIMPORTANT: This process must be started a minimum of one week before a
hearing date and the inspector may also verbally request dismissal during a hearing.
It:7 IMPORTANT: The inspector should dismiss any ticket pending against a first time
violator if the violator complies with the Department's NOCV prior to the court date.
rYIMPORTANT: The inspector must never give legal advice to the defendant or
attempt to predict what the District Court judge will do when the case goes to court.
Copies of the completed ticket must be routed as follows:
· Green Copy: Defendant (if present)
· White and Yellow Copies: (Green also, if defendant not present) District Court
· Gold Copy: Inspector
. Blue Copy: Supervisor
The court's copies must be filed in District Court within 48 hours of writing the ticket,
excluding Saturdays, Sundays, and holidays. The inspector should attach a business card
and note the court's copies requesting notification of the court date and location (if one is
scheduled). Court copies can be delivered through interoffice mail to District Court. Mailed
copies should be sent to Jefferson County District Court.
When a ticket is issued, the defendant has 15 days to respond to the court. Instructions for
this response are on the back of the defendant's (green) copy. Possible responses include:
· Request for a hearing (contested or mitigated), or
· Payment of the monetary penalty.
1. The court will notify the inspector of the court date and type of hearing if the
defendant requests one.
2. The inspector, or a qualified substitute, must represent the Department at all
hearings on their tickets.
3. If the defendant fails to respond within 15 days, the court enters a default
judgment against the person named on the ticket and the full fine amount is
levied.
Additional questions about filling out the ticket should be directed to an experienced staff
member or the program supervisor or manager.
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5. Other Enforcement Options
Some cases may require other enforcement options in addition to those previously
mentioned. Certain Departments have the ability to issue abatement orders, stop-work
orders, and/ or to request the Prosecutor's Office to pursue a court order or civil lawsuit for
abatement. Each of these options is used only in the most extreme cases. If you believe a
case warrants one of these approaches, see the program supervisor or manager for assistance.
J. COURT
1. Preparation
The inspector writing the ticket (or a qualified substitute) must represent the Department
in court. The inspector should dress in a professional manner at all court appearances.
The inspector may request to have a substitute appear in his/her place only if the
substitute has personal knowledge of the case to the extent that the substitute has made a
documented site visit.
The inspector must always be extremely well prepared when going to District Court.
The inspector bears the complete burden of proving through the evidence that he or she
presents that the violator's actions (or failure to act) rise to the level of a violation of a
state law, state regulation or local Ordinance. This is called the "burden of proof" and
cannot be shifted to anyone else. The inspector must be objective, honest, and credible
when testifying or answering questions in court. The inspector should never attempt to
answer any question in court if he/ she doesn't know the answer. In these situations, the
inspector should simply state that he/ she does not know the answer.
The County's Deputy Prosecuting Attorney assigned to the Department may be notified
of upcoming court appearances by Jefferson County employees. The Prosecuting
Attorney will not be present in court during the hearing.
W" IMPORT ANT: Any requests by Department staff for legal opinions or other
services from the Jefferson County Prosecuting Attorney's Office should be made in
writing through the Department Director.
A subpoena should be issued to any witness who needs to be present in court to support the
Department's case.
. A subpoena should be issued whether or not the witness is appearing voluntarily.
A subpoena form is included in Appendix "1".
. Before completing the form, contact the Deputy Prosecuting Attorney assigned to
the Department and brief him/her on the case and the reason why the subpoena is
needed.
22
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With the approval of the Prosecuting Attorney, in issuing a subpoena the inspector would:
. Complete the subpoena form and return it to them for processing.
· Contact the witness and notify them that a subpoena is being issued to them and
that it is not a reflection of their willingness to appear.
The site of the violation should be revisited just prior to the date and time of the hearing.
r;rIMPORTANT: Previous to this step, follow "Entering Private Property" procedures
before continuing. Dated photographs or Polaroids should be taken to document the status
of the violation. These photographs need to be developed quickly so they can be presented
in court. Dated digital images are admissible in court.
All available evidence must be taken into court by the inspector. This includes, but is not
limited to:
· Jefferson County Assessor's records providing a legal description of the property and
the name(s) of the property owner(s),
· An Assessor's map showing the exact location of the violation (the violation should be
marked on the map),
· A copy of all complaints, correspondence, inspection reports, and signed certified
letter receipts (green slips), and
· A copy of any applicable regulations.
2. Hearing
· Testimony: When your case is called, stand up in front of the clerk's desk and when
prompted,
1. Give the court a summary of the case.
2. This is your opportunity to present all the evidence, facts, items, observations etc
that you possess in order to prove to the Judge that the actions (or the failure to
act) of the alleged violator constitute a violation of a state law, state regulation or a
local Ordinance. Be both concise and complete in your presentation to the Judge.
3. Pass any pictures of the violation to the judge (via the clerk) to review while you
are giving your testimony.
· Give a full history of the complaint including how many
complaints were received.
· The date(s) the complaint(s) were filed.
· When inspections were performed, and what was observed.
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5/16/02
· Describe the enforcement measures taken by the Department
including how these measures were successful or unsuccessful in
gaining compliance.
· Include any agreements (verbal or otherwise) between the
Department and the defendant and how these agreements were
successful or unsuccessful.
. Always address the judge as "Your Honor".
4. If the judge requests the identity of the complainant, the inspector should:
· Explain that all of the evidence collected in the case was done so by the
inspector and that the complainant's name does not affect the status of the
violation.
· If the complainant requested that their name be held confidential, the inspector
should explain this request to the judge. The inspector should advise the judge
that the Department asks complainants if they would like to remain
confidential to encourage the reporting of problems in Jefferson County.
. If the judge still request the name of the complainant, the inspector should
make a motion to view the complaint "in camera" (privately with the judge).
· If the judge cannot agree to view it privately, the complainant's name should be
provided.
JërIMPORTANT: An inspector may make a penalty recommendation to the court,
however, do not do so until after the judge has issued a "committed" judgment. Penalty
recommendations are discussed in more detail in the following paragraph.
5. Judgment:
Should the judge find that a violation was "committed" and he/ she offers the defendant time
to correct the violation, the inspector should always request the judge to set a second hearing
to determine compliance. The inspector should appear on that date, prepared to show that
the violation either has or has not been corrected.
If the violation has NOT been corrected at the time of the compliance hearing, the inspector
should be prepared to recommend a penalty to the court. This could include all or part of the
original penalty or community service.
4. Court follow-up
If a violation is not corrected when the court has finished hearing a case, the inspector can
issue an additional civil infraction notice.
. No more than two tickets should be written for the same violation
. If a violation remains after a judgment has been issued on a second ticket, consult with
a program supervisor or manager on how to proceed with the case.
24
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The final outcome of all the tickets written must be documented for program planning and
reporting purposes. The following information must be documented on the bottom of the
blue file copy of each ticket:
1. Did the infraction go to court or was it dismissed before going to court?
2. Was the infraction undeliverable?
3. Did the defendant pay the penalty in lieu of a hearing?
Record this information only after the case is completely played out in court. If the judge
continues the hearing, wait until the judge makes a final determination before recording the
results.
If a hearing is held on a ticket, you will receive a written copy of the judgment including the
amount of the penalty. A copy of the judgment should be attached to the complaint and the
blue copy of the ticket.
~IMPORTANT: If a property is inside the City limits of Port Townsend and remains in
violation following the application of all legal remedies, the inspector must forward all
complaint information to the City. The City should be notified that a violation exists on
the property. A recommendation should also be made that the property be handled
according to City procedures. In these cases, complaint information should be forwarded
to the City Building Official.
25
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26
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Washington s.t
~
Governor's'u
,~:;'f
G¡\RY LOCKE
Governor
S1A.1E Of WA.SHING10N
OffICE Or THE GOVERNOR
P.O.'" 40002 . Olymp'" W"h",I"" 98504-0002 · (360) 753.6780 · www.,,,,m",.w,.,"
May 6, 2002
Washington State Board of Health and
the Governor's subcabinet on Health
P.O. Box 47990
Olympia, W A 98504-7990
It was a pleasure to meet with representatives of the State Board of Health ""d Governor's
subcabinet 00 Health last week. I >Un returUing herewith, with my approval, ¡he 2002
Washington State Health Report.
Ladies and Gentlemen:
RCW 43.20.s0(I)(b) provides that ¡he State Board of Hca!¡h shall prcparc a report in
j""uary of evcry even.n"",bered year ',hat outlines ¡he heal¡h priorities of the ensuing
biered""''" It forther stipula"'s that I must approve, modify, or disapprove ,he report.
This report clearly artiCUla"'s the key challenges ""d opportunities facing state health care
agencies ""d SUggests f,ye stratcgic directions for state health policY:
. maintain and improve accesS to critical health services;
. improve patient safety ""d increase value in gove_eat-purchased health services;
. ¡,ols",r the health sys",m' s capacity to respond to public health emergencies:
. reduce disproportio- disease burdens amoug racial ""d ethnic ndno,¡ty
populations; and
. encoumge responsible behavior to reduce tobacco use, improve nutrition, ""d
increase physical activities.
I appreciate your collaborative efforts on this doc"",ent. It win be a useful tool for my
office ""d agency directors as we prepare budgets ""d re~uest legislation for the 2003-05
biennium.
~
o
«~',.
STATE OF WASHINGTON
WASHINGTON STATE BOARD OF HEALTH
1102 Sf Quince Street · PO Box 47990
Olympia, Washington 98504-7990
February 15,2002
The Honorable Gary Locke
Governor of Washington
Legislative Building
Olympia, WA 98504
Dear Governor Locke:
We are pleased to forward to you the proposed 2002 Washington State Health Report for your consideration and
possible approval.
Since 1990, the Washington State Board of Health has been responsible for producing a biennial State Health Report
"that outlines the health priorities ofthe ensuing biennium." RCW 43.20.50(1 )(b) stipulates that the report be produced in
January of even numbered years and that it serve as an aid to you in beginning the budget process. It further stipulates
that you must approve, modify, or disapprove the report. If approved, the report is to be used by state agency administra-
tors as a guide for preparing agency budgets and executive request legislation-in this case, for the 2003-2005 biennium.
This is the sixth State Health Report and the first that is a collaboration between the Board and representatives of the
Governor's Subcabinet on Health. It draws on a wide variety of research and policy development efforts to suggest five
strategic directions for state health policy:
.. Maintain and improve access to critical health services
.. Improve patient safety and increase value in government-purchased health services
.. Bolster the health system's capacity to respond to public health emergencies
* Reduce disproportionate disease burdens among racial and ethnic minority populations
.. Encourage responsible behavior to reduce tobacco use, improve nutrition, and increase physical activity
These strategic directions are just that-they are not intended to be all-encompassing or restrictive. The report contains a
summary of why each strategic direction is included, a "for instance" that describes one example of an initiative deserving
further consideration, and a list of possible actions that illustrate the scope of the strategic direction. It does not attempt
to enumerate action strategies for the 2003-05 biennium. The Board and Subcabinet representatives concur that decisions
about specific health programs should be made by agency heads coordinating their efforts through the Subcabinet. It is
our belief that a brief, strategically focused report will ultimately prove most useful.
The Board and Subcabinet recognize the significant challenges facing public health, health care, and the delivery of
government services. It is our hope that identifying a specific, limited set of strategic directions can inform agency actions
and help the state make Washington a safer and healthier place for all residents.
~~~
Linda Lake, Chair
Washington State Board of Health
Introduction
The Washington State Board of Health is responsible for producing a State Health Report "that outlines the
health priorities of the ensuing biennium." RCW 43.20.50(l)(b) stipulates that the report be produced in
January of even numbered years and serve as an aid to the governor and agency directors during the budget
process. The 2002 report is a collaboration between the Board and representatives of the Governor's Subcabi-
net on Health. See the Background section, page 14, for a description of the process that led to this report.
The Role of State Government
State government's health responsibilities grow from our State Constitution's commitment to provide for the
public health and welfare and care for our most vulnerable populations (Article XIII, Section I), and to
regulate medicine and pharmacy (Article XX, Section 2). The Legislature has interpreted these duties to
entail:
2
Maintaining and Improving Public Health
.. Keeping records of births and deaths and monitoring patterns of illness
and disease
.. Acting swiftly and effectively to control the spread of communicable
diseases
.. Reducing preventable diseases and injuries
.. Protecting the safety of our food, water, and air
.. Safeguarding the health of vulnerable populations by assuring that
residents have access to health services critical to their ability to lead
healthy, independent, and productive lives
.. Preventing injury and disability within the workforce in the state
Purchasing Health Services
.. Purchasing health services for the poor, dependent children, the
disabled, the elderly, injured workers, prisoners and public employees
.. Ensuring that these public investments return the greatest possible value
for our state's taxpayers by working constantly to contain the costs and
improve the quality of these health services
Regulating Health Facilities, Health Providers,
and the Health Insurance Industry
.. Ensuring that health care professionals and health facilities meet
minimum safety standards and encouraging them to strive for the highest
level of quality
.. Ensuring that health insurers remain solvent to meet their commitments
to their policy holders and that the private insurance market operates
fairly and equitably for our state's health insurance consumers
2002 Washington State Health Report
Strategic Policy Directions for 2003-05
State government must periodically re-examine these duties and strategically focus resources to improve the
health of citizens, to respond to new health threats, to take advantage of new health discoveries, and to live
within the ever-changing financial and social realities of our state and nation.
Our strategic health policy directions for 2003-2005 are:
* Maintain and improve access to critical health services
* Improve patient safety and increase value in
government-purchased health services
* Bolster the health system's capacity to respond to
public health emergencies
* Reduce disproportionate disease burdens among racial
and ethnic minority populations
* Encourage responsible behavior to reduce tobacco use,
improve nutrition, and increase physical activity
3
2002 Washington State Health Report
Maintain and improve access
to critical health services
Summary
Access to quality, affordable health care is a major
indicator of health-both nationally and in Washing-
ton State.
Multiple studies, reports, and articles show that the
state and national health care systems are in need of
change. Access to care and quality of care need to be
protected and improved. The Institute of Medicine
report Crossing the Quality Chasm, A New Health
System for the 21st Century states that as medical
science and technology have advanced, the health
care delivery system has lost ground in its efforts to
provide consistent, quality care to all Americans.
Factors that limit access to care include: lack of
insurance, lack of a regular place of care (a "medical
home"), and a variety of financial, structural, and
personal barriers. Health care costs are rising dra-
matically, the number of providers appears to be
shrinking, and many people are finding health
insurance increasingly difficult to obtain or afford.
These factors suggest that access to care is likely to
be a growing problem in Washington State.
4
One area of concern is residents without health
insurance. According to preliminary data from the
Washington State Planning Grant on Access to
Health Insurance, 8.3 percent of the state population
lacks health insurance. The state's three-year average
rate for 1998-2000 was lower than the national three-
year average. There are several subpopulations,
however, for which the uninsured rate is 19 percent
or higher: 19- to 24-year-olds, members of house-
holds making less than $35,000 per year, Hispanics,
and American Indians/Alaska Natives.
The number of uninsured in Washington State has
declined because of expansion of government
programs and businesses competing for employees in
a tight labor market. This decline is not likely to
continue in the short term. The state is looking to
offset a revenue shortfall on the order of $1.25 billion
by reducing spending and the labor market is no
longer as competitive as it was, given the nationwide
recession and rising unemployment rates.
Uninsured adults are 30 percent less likely to have
had a checkup in the last year and 40 percent more
likely to have skipped a recommended treatment or
test than insured adults, according to the Kaiser
Commission on Medicaid and the Uninsured. They
are more likely to forgo preventive care, require
hospitalization for avoidable conditions, die during
hospitalization, and be diagnosed with cancer during
late stages of the disease.
Access difficulties are not limited to the uninsured-
or even the growing number of under insured. Re-
search by the Southwest Washington Health District,
for example, found that residents with insurance were
having difficulties obtaining timely care even with
insurance, due primarily to provider shortages. Who
Will Care for You?, a recent Washington State
Hospital Association report, identified many shortage
areas and noted, "During the past year, 55 percent of
hospitals in Washington state went on 'divert status'
due to a shortage of nursing staff." Shortages are
particularly acute in rural areas, in communities of
color, for key professions (pharmacists, nurses, etc.),
and for providers willing to accept patients on
Medicare and Medicaid.
A 1997 statewide public opinion survey by the State
Board of Health asked respondents to name the most
important health area on which government should
work. The greatest number, 22 percent, said access to
health care. When asked about the seriousness of
various health issues, the greatest number, 79 per-
cent, said state government should give access to
health care a high or very high priority.
During its 200 1 research, the Board found extensive
support in the literature for making access a top
priority. Additionally, key informants interviewed as
part of this research frequently mentioned access as
one of the biggest issues facing the state.
2002 Washington State Health Report
A 'For Instance'
Enhanced Delivery of Minimal
Clinical Preventive Services
According to the Washington State Health Agency
Medical Directors (AMD) and the Board's own
research, there is broad agreement on the clinical
preventive services that should be offered to children
and adults.
Several state health care programs rely on the United
States Preventive Services Task Force Guide to
Clinical Preventive Services; the Department of
Social and Health Services Medical Assistance
Administration uses the federally mandated Early
Periodic Screening, Diagnosis, and Treatment
(EPSDT) standard for children; and the Board has
developed a list of recommended "Children's Clini-
cal Preventive Services." These evidence-based
standards are largely consistent.
There is less agreement as to whether these services
should be delivered uniformly or selectively based on
a provider's clinical judgment. Notwithstanding this
disagreement, there are concerns that current practice
does not pay adequate attention to the delivery of
clinical preventive services. Therefore, the AMD
recommends that state agencies explore the effective-
ness of mechanisms for measuring and monitoring
the appropriate delivery of preventive services.
Specifically, AMD recommends reviewing the
effectiveness of all preventive measures, comparing
existing state requirements against the experiences of
other states, defining a minimum set of clinical
preventive services, requiring minimal clinical
services in contract language, and evaluating the
effects of contract provisions on utilization and
outcomes.
This work would begin with children's services
during the remainder of the 2001-03 biennium and
could be extended to adult services in 2003-05.
Other Possible Actions
.. State Planning Grant: The state intends to seek
an extension to a $1.3 million, one-year federal
planning grant to profile the state's medically unin-
sured and identify ways to address gaps in access to
health insurance and care. The emphasis for 2003-05
might include implementing top interventions
identified by later phases of the project.
.. Targeted Reimbursements: Provide targeted
fee increases for specific providers whose services
are in scarcest supply (e.g., primary care physicians,
child psychologists) to improve access for Medical
Assistance clients.
.. Public Health Improvement Partnership
(PHIP): Continue efforts to implement PHIP stan-
dards by encouraging local health jurisdictions and
the Department of Health to measure access to
critical health services and mobilize community
efforts to close identified gaps.
.. Clinical Services for Children: Explore school-
entry requirements and other avenues for ensuring
children have access to well-child checkups and
associated preventive care.
5
.. Restructure Public Benefits Plans: Explore
ways to use the evidence-based "Menu of Critical
Health Services" developed by the Board as a
starting point for restructuring benefits in the Basic
Health Plan, Public Employee Benefits Board plans,
and Medical Assistance Administration programs,
using any savings to expand eligibility.
2002 Washington State Health Report
Improve patient safety and increase value
in government-purchased health services
Summary
Americans spent 13.2 percent of the gross national
product on health care in 2000, according to the
Centers for Medicare and Medicaid Services. Health
care, not housing, is now the biggest purchase most of
us will make in our lifetime. Compared to other
industrialized nations, however, we are losing ground
when it comes to infant mortality and life expectancy.
It is not always best to buy the cheapest product. We
commonly consider quality when purchasing a car,
yet rarely factor quality into medical purchasing. The
Institution of Medicine Report To Err Is Human:
Building a Safer Health System found that medical
mistakes cause between 44,000 and 98,000 deaths
each year-more than HIV/AIDS, breast cancer, or
vehicle accidents. It estimated the annual costs of
these preventable errors at $17 and $27 billion. A
follow-up report, Crossing the Quality Chasm: A
New Health System for the 21st Century, called for an
overhaul of health care to increase quality and safety.
6
Government is the primary funder of health care in
the United States, according to data from the Em-
ployee Benefit Research Institute and other sources.
A major share of government health expenditures
comes from state funds and federal funds adminis-
tered by states. It is not surprising, therefore, that
health care is considered the most critical cost driver
for state government.
As a major purchaser of health care services, Wash-
ington State is committed to obtaining value-and
defines value as quality divided by price. Cost-
containment is only one piece of the health care
purchasing puzzle. The state recognizes that it can
improve value by improving efficiency in contracting
and purchasing and by improving patient safety and
overall quality of care.
In 1999, the 50 states spent $238.5 billion on personal
health care, which represented 27.1 percent of state
spending. Of that, 73 percent was spent for Medicaid,
7.9 percent for employee health benefits, 6.3 percent
for community-based services, 5.5 percent for public
health, 3.1 percent for state-run health care facilities,
and the rest for a mix of health care for students in
higher education, incarcerated populations, children
enrolled in the State Children's Health Insurance
Program (SCRIP), and other participants in state-
sponsored efforts to improve access to insurance and
care (e.g., Washington State's Basic Health Plan).
Medicaid, the Basic Health Plan, and other state
programs insure more than 15 percent of Washington
residents. The Public Employee Benefits Board
covers approximately 300,000 state employees,
retirees, and their dependents-or roughly 5 percent
of the population. The Medical Assistance Adminis-
tration covers more than 850,000 people in the state.
According to the 2001 Pulse Indicators being
prepared by the University of Washington Health
Policy Analysis Program, 43 percent of the state's
2001-03 budget will go to health expenditures (this
includes federal funds appropriated by the state for
programs such as Medicaid).
Health care costs have been growing at a rate that far
outstrips inflation. National estimates of increases
vary, but a survey of employers released in December
2001 by the William M. Mercer consulting firm
found the cost of covering each employee rose 11.2
percent in 200 I, and is expected to increase another
12.7 percent in 2002. In 2000, the Washington State
Health Care Authority (HCA) experienced increases
of 8.8 to 16.4 percent for the Basic Health Plan and
for state employee health coverage, according to
HCA's 1999 Annual Report. Spending per Medicaid
enrollee is currently believed to be growing by more
than 10 percent a year, according to the Kaiser
Commission on Medicaid and the Uninsured. Factors
contributing to escalating health care costs include:
prescription drug costs, increased utilization, in-
creased consumer demand, medical advances that
provide treatments for a growing number of condi-
tions, and wage pressures in the health care industry.
2002 Washington State Health Report
A 'For Instance'
Consolidated Purchasing and
Management of Pharmacy Benefits
Escalating expenditures for pharmaceuticals-
attributable to increased utilization, newer, more
expensive products, and price increases-is a major
driver of state health care costs.
A 2001-03 biennial budget proviso calls on the
Department of Social and Health Services (DSHS) to
implement cost containment and utilization strategies
that would reduce general fund costs by 3 percent
below projected levels. As part of the effort to meet
this mandate, DSHS will implement the Therapeutic
Consultation Service in January 2002. The program
seeks to ensure the appropriate, cost-effective use of
prescription drugs by Medicaid clients. Clinical
pharmacists will review selected clients' drug pro-
files and consult with their providers to promote the
most effective drug therapies.
Similarly, the Governor's proposed 2002 supplemen-
tal budget suggests the Washington State Health Care
Authority (HCA) be authorized to put in place fair
and equitable strategies to reduce prescription drug
expenditures by 15 percent.
The Prescription Drug Project, an interagency work
group, has recommended a comprehensive program
that includes a statewide Pharmacy and Therapeutics
Committee, a statewide Preferred Drug List, and
consolidated pharmacy management and information
services. When implemented, the program will
ensure patients have access to rational, clinically
appropriate, safe, and cost-effective therapy while
supporting an affordable and sustainable drug benefit
program.
These and other efforts to control expenditures
related to increasing costs and utilization of prescrip-
tion drugs are likely to continue through the 2003-05
biennium.
Other Possible Actions
.. Medicaid Reform: DSHS has applied for a
waiver that would allow it to sustain subsidies for
low-income health care by covering parents of
children enrolled in Basic Health and SCHIP and by
adopting premiums, copayments, and new benefits
packages. Implementation will extend into 2003-05.
.. Value-Based Purchasing: HCA has begun
evaluating health plan using scores and metrics that
include access, quality, and affordability. These allow
HCA to understand how the plans perform in cus-
tomer service, basic prevention activities, and
administrative processes. The information is used in
contracting and is available for all covered members.
.. Demand Improvement: Improve quality by
encouraging consumer choices that improve out-
comes, reduce costs, or both-often by addressing
the overuse, misuse, or underuse of procedures or
drugs. The AMD has recommended pilots, such as
addressing excessive or ineffective use of antibiotics.
.. Disease State Management: Coordinate efforts
to provide systematic, cost-effective care to people
with complex and sometimes progressive disorders,
particularly chronic conditions (e.g., diabetes).
7
.. Administrative Simplification: Contain costs,
reduce provider burdens, improve service, and
comply with the Health Insurance Portability and
Accountability Act by establishing standards for
administrative practices. One example would be
single-source credentialing of practitioners.
.. Patient Safety: Try to reduce adverse events
and medication errors by identifying specific, critical
patient-centered outcomes that can be measured to
track quality of care and better inform consumers.
.. Technology Assessment: Develop a more
systematic or centralized system for making
evidenced-based decisions about when to employ
new medical technologies.
2002 Washington State Health Report
Bolster the health system's capacity
to respond to public health emergencies
Summary
When introducing the Frist-Kennedy Public Health
Threats and Emergency Act of 2000, Senator Edward
Kennedy called new and re-emerging diseases, anti-
biotic-resistant microbes, and bioterrorism the "Three
Horsemen of the Modem Apocalypse." He added:
"Today we face a world where deadly
contagious diseases that erupt in one part
of the world can be transported across the
globe with the speed of a jet aircraft. The
recent outbreak of West Nile Fever in the
New York area is an ominous warning of
future dangers. Diseases such as cholera,
typhoid and pneumonia that we have
fought for generations still claim millions
of lives across the world and will pose
increasing danger to this country in years
to come. New plagues, like Ebola virus,
Lassa Fever and others now unknown to
science may one day invade our shores."
8
Whether the disaster is a naturally occurring disease
outbreak, a mass trauma event along the lines of the
September 11 tragedy, a natural disaster, or the use
of weapons of mass destruction by terrorists or
conventional militaries, the first response to a health
emergency will come from the local and state level.
Many experts and organizations have called for a
more "robust" public health system in response to
possible bioterrorism threats. They note that public
health programs and activities needed to respond to a
bioterrorism attack-disease surveillance, laboratory
testing, risk communication, vaccine distribution,
public education, environmental monitoring, and
more-are the very programs public health uses
quietly every day to create a safer and healthier nation.
Last year, the Centers for Disease Control and
Prevention (CDC) asked itself, in response to a
congressional inquiry, "is public health's
infrastructure up to the task, prepared for the global
health threats of the 21 st century?" It concluded,
"Unfortunately, the answer is no." A host of studies,
expert pronouncements, assessments, field exercises,
and real-world events support the CDC's conclusion.
Washington State is regarded among public health
professionals as having a high-performing network
of state, academic, and local public health agencies.
When it comes to preparing for bioterrorism and
other major disease outbreaks, it is ahead of most
other states. The response of the Department of
Health, the Governor's Office, the Emergency
Management Division, and other state entities in the
wake of September 11 was exemplary. The state,
however, is part of the national infrastructure and
shares both its strengths and its weaknesses.
In 2000, the Department of Health, as part of a joint
Department of Justice and CDC nationwide effort,
conducted a Public Health Emergency Preparedness
Assessment. It asked the 39 counties to answer a
series of questions based on the Draft Public Health
Emergency Standards. "In general," the Department
concluded, "Washington's local public health
systems are not adequately prepared for a major
biological emergency."
Concerns are not limited to public health; they also
extend to the health care delivery system. A U.S.
Health and Human Services survey of emergency
departments at all hospitals in Washington, Oregon,
Idaho, and Alaska attempted to assess whether
hospitals are prepared to respond to chemical or
biological attacks. The researchers concluded that
emergency departments are generally not prepared to
respond to a biological or chemical weapons attack.
One area of concern in Washington State is the surge
capacity of the health care system. In recent years,
cost and profitability concerns have squeezed excess
capacity out of the system-but during times of
health emergencies, excess capacity can become
surge capacity that is necessary to mount an adequate
response to a major disease outbreak or mass
casualty event.
2002 Washington State Health Report
A 'For Instance'
Adequate State, Federal Funding for
a Robust Public Health System
In November 2001, the Board adopted Response
Capacity During a Health Emergency--A Review of
Selected Issues. The report made nine recommenda-
tions most of which concerned the need to increase
,
the capacity of the public health system by promoting
adequate government funding.
Since the potential threats from bioterrorism, new
and re-emerging diseases, and antibiotic-resistant
microbes are unlikely to diminish significantly in the
short-term, consideration of these recommendations
is likely to be critical during the preparation of the
2003-05 biennial budget.
Other Possible Actions
.. Education and Training: Expand and improve
training for medical personnel in how to identify and
report symptoms of biological weapons exposure,
and for public health professionals to rapidly evalu-
ate and respond to potential disease outbreaks.
Strategies could include funding continuing medical
education; working with education institutions to ex-
pand offerings; collaborating with professional asso-
ciations to disseminate courses; distributing trainings
over the state network; and mandating training.
'* Syndromic Surveillance: Explore implementa-
tion of systems to detect and rapidly investigate
illness clusters and critical clinical syndromes such
as respiratory problems and diarrhea. Study existing
syndromic surveillance systems; evaluate their
effectiveness and use; and develop pilot systems in
target population centers around the state.
'* Regional Pharmaceutical Stockpile: As an
individual state or as part of a regional compact,
establish a backup to the federal pharmaceutical
stockpile in easily accessed locations near transpor-
tation hubs. Analyze pharmaceutical supplies and
distribution mechanisms in the Northwest; identify
pharmaceuticals most appropriate for a regional 9
stockpile; and determine the best mechanism for
implementing and maintaining a stockpile.
'* Reporting and Communication Systems:
Enhance and expand existing electronic reporting
and communication systems to include all local and
state agencies with a role in emergency response, all
hospitals, and key health care providers.
'* Surge Capacity: Improve capacity at local
health agencies, DOH, laboratories, and health care
facilities to respond to mass casualty events by
assessing current capacity; estimating resources
needed in each community; developing community
or regional strategies; and deploying resources to
provide surge capacity as identified in community or
regional plans.
2002 Washington State Health Report
Reduce disproportionate disease burdens
among racial and ethnic minority populations
Summary
Healthy People 2010, the federal strategic health
plan, identifies only two major goals for improving
the nation's health in the next decade-and one is to
reduce health disparities (the other is to increase
quality and years of healthy life). Health disparities
is a term that describes a disproportionate burden of
disease, disability, and death among a particular
population or group.
Racial and ethnic minorities make up roughly one-
fifth (18 percent) of Washington State's population.
Yet their disease burden is significantly higher. In
Washington State, according to the Board's 2001
Final Report on Health Disparities:
.. The infant mortality rate for American
Indians and African Americans is more than
double the rate for Caucasians.
.. African Americans are more than three
times as likely as Caucasians to die from
HIV/AIDS, while Hispanics are more than
1.5 times more likely to die from the virus.
10
.. The rate of tuberculosis for Asians is
more than 15 times greater than it is for
Caucasians.
.. African Americans are more than three
times as likely to die from diabetes as
Caucasians; the death rate for American
Indians/Alaska Natives is 2.5 times higher
and for Hispanics it is 1.5 times higher.
Disparities affecting racial and ethnic minorities can
be observed for 18 of 24 disease conditions in the
1996 Department of Health report Health of Wash-
ington State. Epidemiological data for those 24
conditions show that African Americans have a
disproportionate disease burden for 18 conditions'
,
American Indians for 16 conditions; Hispanics for 11
conditions; and AsianlPacific Islanders for three
conditions.
Many complex factors interact to produce health
disparities. Risk factors believed to contribute
include poverty, behavior and lifestyle, nutrition,
environment, access to health care services, genetic
predisposition, education, and employment. Re-
search by Public Health-Seattle & King County
found that for people of color, racism or the percep-
tion of racism in health care settings is also a barrier.
Research shows a diverse health care workforce can
improve the health status of racial and ethnic minori-
ties. During the 1999-2001 biennium, the Board
showed that people of color are underrepresented in
our state's health care workforce and underserved by
its health care system. Its final report identified
multiple opportunities to build a more diverse health
care system, including recruitment and retention
programs that serve students of color (and help
alleviate critical workforce shortages).
The key informants interviewed by State Board of
Health staff and the people who responded to the on-
line survey overwhelmingly supported the Board's
past work on health disparities and said some form of
health disparities work should continue. When asked
to rate items on the Board's list of possible priority
projects, continuing to work on health disparities
scored highest across all groups.
Suggested foci for future work included: continue
efforts to increase workforce diversity; examine
racism in health care settings; research affordability
of care, provider access, and insurance availability
for the poor and for communities of color; develop
effective interventions for specific disease conditions
within affected communities.
The federal government has emphasized the latter
approach. Healthy People 2010 objectives call for
achieving parity in cancer screening and manage-
ment, cardiovascular disease, diabetes, HIV / AIDS,
immunizations, and infant mortality across racial,
ethnic, gender, and socioeconomic groups.
2002 Washington State Health Report
A 'For Instance'
Increased Diversity Within
the Health Care Workforce
The State Board of Heath 2001 Final Report on
Health Disparities describes the growing body of
research that shows that a diverse health care
workforce can improve the health status of racial and
ethnic minorities. It also documents the degree to
which people of color are underrepresented in the
health care workforce.
Increased recruitment of people of color into health
professions will also help address shortages in many
health professions. Who Will Care for You?, a Wash-
ington State Hospital Association and the Association
of Washington Public Health Districts report, shows
that shortages threaten quality of care for everyone,
and cites lack of diversity as a contributing factor.
The Board report makes six recommendations, many
of which will require continued work during 2003-
05. They are:
1. Enumerate the composition of the health
care workforce
2. Establish guidelines for health career
development programs
3. Facilitate training and credentialing of
people with prior health care experience,
including foreign-trained and mid-career
professionals
4. Create a Graduate Medical Education
incentive pool
5. Develop a health care workforce diversity
report card
6. Coordinate health care workforce diversity
efforts through a public/private panel
Other Possible Actions
· Indian Health Initiatives: Recognize and
support leadership in Indian health and health policy
and develop opportunities to work collaboratively
with American Indian leaders, communities, and
organizations.
· Cultural Competency: Work with provider
groups, health care facilities, health professional
schools, and health care and public health organiza-
tions to ensure the health care workforce has the
skills needed to work with diverse populations.
· Academic Enrichment/Career Development:
Aggressively pursue additional federal grants and
private funding for programs that prepare students of
color for future academic success and encourage
them to pursue health careers.
· Childhood Obesity: Childhood overweight and
obesity is particularly endemic to Hispanic and
African American populations, affecting 22 percent
of all children in both groups, compared to a still
problematic 12 percent of white children. Intitiatives
concerning diet and activity (see next page) should
address obesity in culturally appropriate ways.
11
· Diabetes Collaborative: Continue work of
public/private cooperative focusing on implementing
quality improvement of clinical management of
diabetes. Diabetes is the seventh leading cause of
death and is much more common in African Ameri-
cans and Hispanic Americans. American Indians,
Alaska Natives, and African Americans have higher
rates of diabetes-related complications such as
kidney disease and amputations.
· Provider Incentives: Create incentives, such as
scholarships and loan foregiveness, for nurses and
other providers who agree to practice in areas where
the proportion of minority health care workers is
lower than the minority population (similar to
existing programs for providers in underserved rural
communities).
2002 Washington State Health Report
Encourage responsible behavior to reduce tobacco
use, improve nutrition, and increase physical activity
Summary
About 50 percent of our health is determined by our
behaviors. The behaviors most damaging to our
health are tobacco consumption and the interrelated
behaviors of insufficient physical activity, poor diet,
and inadequate nutrition.
A study of "Actual Causes of Death in the United
States" in 1990, published in the Nov. 10, 1993
Journal of the American Medical Association, found
that tobacco accounted for 400,000 out of roughly 2
billion deaths that year. Diet and activity patterns
accounted for another 300,000. Combined, they
explained about a quarter of all deaths. No other
cause accounted for more than 5 percent.
Healthy People 2010, the federal government's
strategic plan for health improvement, lists "physical
activity" and "overweight and obesity" as its top two
health indicators, followed by "tobacco use."
12
When asked to rate the seriousness of various health
issues in the Board's 1997 public opinion survey,
respondents listed, in order, "misuse of alcohol and
other drugs," "lack of exercise and poor eating
habits," and "tobacco use and secondhand smoke"
(tied with "sexually transmitted diseases").
Tobacco use received a few mentions in the Board's
key informant interviews and the on-line survey
responses, largely because respondents considered
tobacco cessation to be a Department of Health
effort. Obesity, however, was one of the items
mentioned most often. Local community health
assessments have also identified tobacco use and
obesity as important issues.
Tobacco Use
In 1997,36 percent of all adolescents and 24 percent
of all adults in the United States were smokers.
Deaths from tobacco use cost the nation an estimated
$50 billion per year. The 2000 Behavioral Risk
Factor Surveillance System (BRFSS), which reports
statewide prevalence of risk factors, reports that
more than 22 percent of Washington's total
population currently smokes and that between 1999
and 2000 the smoking rate increased. The
Department of Health's Washington State Vital
Statistics report states that half of all pregnant
women smoke during pregnancy. In King County,
tobacco use has increased, especially for people
younger than 18.
Diet and Physical Activity
The media have given significant coverage in the last
few months to the rise in obesity and, as a result, the
increasing incidence of diabetes. They have also
covered in some depth the controversy around the
sale of candy and soft drinks in school cafeterias.
Most health trends, nationally and in Washington,
are moving in the fight direction. One of the few
exceptions is obesity. Americans are getting fatter.
According to the most recent National Health and
Nutrition Examination Survey, the number of
overweight children and adolescents has nearly
doubled in 20 years. Health leaders such as Dr.
Jeffrey Koplan, director of the Centers for Disease
Control and Prevention, and Surgeon General David
Satcher have called obesity an national epidemic.
Conditions related to obesity and overweight add
$117 billion annually to the nation's health care bill.
According to the 2000 BRFSS, 73 percent of the
total Washington population does not engage in
"regular or sustained" physical activity during one
month. More than 83 percent does not engage in
"regular or vigorous" physical activity during one
month. About 55 percent of the total state population
is overweight or obese.
On average, higher body weight is associated with
higher death rates. Diabetes, which is linked to
obesity, has consistently been the sixth or seventh
leading cause of death in this state during the 1990s.
During that time, the percentage of all deaths
resulting from it has risen slowly.
2002 Washington State Health Report
A 'For Instance': Diet and Activity
Development of Effective
Health and Fitness Assessments
On December 13,2001, Surgeon General David
Satcher suggested that the number of premature
deaths caused by weight-related illnesses may soon
surpass the number caused by smoking. Dr. Satcher
suggested steps to address the problem, many of
which concerned diet and exercise in schools.
Washington State has included an Essential Aca-
demic Learning Requirement for Health and Fitness
as part of the Washington Assessment of Student
Learning (WASL). All Washington schools are
currently required to teach Health and Fitness. Health
and Fitness assessments are being developed for the
classroom that would measure whether a student has
the skills necessary to maintain an active and healthy
life. Health and Fitness assessments will be available
for voluntary use during the 2005-06 school year.
They will become mandatory during the 2008-09
school year.
Other possible schools-related initiatives would be to
provide more healthy food choices for students and
to explore options for restricting student access to
vending machines serving calorie-dense snacks and
soft drinks.
A 'For Instance': Tobacco
Successful Implementation of
Tobacco Prevention and Control
Eighteen months ago, Washington launched its first
comprehensive program to prevent youth from
becoming addicted to tobacco, and to help adults
quit smoking. A variety of initiatives have begun:
*" A statewide media campaign that
focuses public attention on the dangers of
tobacco use-90 percent of youth polled had
recently seen an anti-tobacco ad on television
*" A telephone tobacco Quit Line that has
provided free counseling and assistance to
more than 13,000 tobacco users
*" Local, tribal and school anti-tobacco
programs
*" OutrageAvenue, a Web site that engages
youth in the fight against tobacco use (visit
www.OutrageAvenue.com). which had more
than 237,000 hits in the first nine months.
*" Reduced sales of tobacco to underage
buyers through a contract with the Liquor
Control Board.
13
For 2003-05, continue the use of money from the
tobacco settlement funds for tobacco prevention and
control programs designed to prevent children from
getting addicted to tobacco and helping users quit.
New elements might include: establish a youth quit
line and a quit line Web site; train Maternity Support
Services staff to counsel clients about quitting
tobacco and reducing secondhand smoke in homes;
continue the media campaign with advertising
created specifically for Washington; and evaluate the
program's media campaign, cessation program, and
school and community-based programs.
2002 Washington State Health Report
Background
The Washington State Constitution promised the
people that their state government would provide for
public health and welfare. It established the Washing-
ton State Board of Health to help lead this effort.
Since 1989, one responsibility of the Board has been
to produce the State Health Report. RCW
43.20.50(l)(b) stipulates that the report be produced
in January of even numbered years and that it serve
as an aid to the Governor at the beginning of the
budget process by suggesting health priorities for the
ensuing biennium. RCW 43.20.50(1)(b) further
stipulates that the Governor must approve, modify, or
disapprove the report. If approved, the report is to be
used by state agency administrators as a guide for
preparing agency budgets and executive request
legislation-in this case, for the 2003-2005 bien-
mum.
This is the sixth report prepared by the Board, and it
differs from prior iterations in several respects. Those
differences concern both the process and the final
product.
14
Statute defines the minimum process required. The
Board is required to hold public forums every five
years and to consider public input gathered at those
forums in the preparation of the report. The Board is
also required to consider the best data available from
the Department of Health and the Department is
required to submit a list of high-priority study issues.
Finally, the Board must ask for the assistance of local
health jurisdictions and consider input from the
directors of state health care agencies.
In preparation for this report and to help it establish
its own priority projects for 2001-03, the Board held
a series of public forums in 2000 and Board staff
conducted extensive research in the spring of 200 1.
The research phase had two major components-a
literature review, which included an examination of
the best available data from the Department of
Health, and key informant interviews. Finally, the
Department provided a memo dated July 5, 2001 that
described high-priority study issues.
For the literature component of the Board's research,
Board staff reviewed more than 40 print and elec-
tronic documents, including federal and state govern-
ment reports, articles from scientific and medical
journals, policy analyses published by foundations
and other nonprofit organizations, public opinion
surveys, and local health assessments. Staff members
prepared a document called the "survey of surveys"
that summarized the findings. The Board asked the
University of Washington's Northwest Center for
Public Health Practice (NWCPHP) to review the
document, and the reviewers found it to be very
complete.
For the qualitative survey portion of the research,
Board staff assembled a list of key informants with
expertise in health policy formation and implementa-
tion from around the state. The list included two
groups whose input is required by statute-officers
from local health jurisdictions and the heads of state
health care agencies. They also included legislators,
legislative staff, congressional staff, agency directors,
gubernatorial policy staff, directors of minority
affairs commissions, deans at public health and
medical professional schools, policy directors of
professional and industry associations, and directors
of health advocacy organizations.
The Board contracted with the NWCPHP to inter-
view the state's key medical and public health
faculty, many of whom were already on the key
informant list. Board staff members then divided the
list of the remaining key informants and conducted
interviews with all informants who were available to
participate. Combined, NWCPHP and Board staff
interviewed 52 key informants. Additionally the
Board posted on its Web site a survey instrument
based on the script used for the key informant
interviews. Twenty-three people completed and
submitted the survey.
Both the survey and the interview script focused on
the Board's priorities, but they also provided oppor-
tunities for the respondents to speak to what they
thought were the health priorities facing the state.
2002 Washington State Health Report
The findings from the key informant interviews, the
Web-based questionnaire, and the survey of surveys
have been incorporated into a July 2001 staff report,
Research on Board of Health Priorities. The full
report is available from the Board's office or on its
Web site, www.doh.wa.gov/sboh/.
Revamping and expanding the research that
undergirds the report is the first of two significant
process changes between this report and the last. The
other change acknowledges the important role of the
newly created Governor's Subcabinet on Health.
Established in January 2001 by Executive Order 01-
02, the Subcabinet is charged with developing and
coordinating state health care policy and purchasing
strategies, providing a forum for the exchange of
information between agencies, and coordinating
efforts to provide appropriate, available, cost-
effective, quality health care and public health
services to the citizens of the state.
The Board feels there are clear synergies and areas of
complementary responsibilities between the Board
and the Subcabinet. Many members of the Subcabi-
net are the very agency heads with whom the Board
is required to consult, and to be effective, the health
priorities put forth in this report should align with the
goals and intent of the Subcabinet.
To promote consistency and avoid duplication of
effort, the Board worked closely with representatives
of the Subcabinet in the development of this report.
Board staff members drafted this report in close
consultation with both the full Board and a working
group that comprised the executive director of the
Board, the chair of the Subcabinet and administrator
ofthe Health Care Authority (RCA), the health
policy adviser from the Governor's Office of Execu-
tive Policy, and senior policy analysts from the Board
and HCA.
Board staff members have also consulted with key
members of the Subcabinet and relied heavily on the
priority-setting work of the Washington State Health
Agency Medical Directors group (AMD), which
supports the Subcabinet's work. AMD enhances
collaboration across agencies and seeks to "identify
and assess new opportunities for state agencies to
increase quality, and to promote cost effectiveness,
access, and affordability in the state's medical care
financing and delivery system." It proposed a priori-
tized list of interagency projects to the Subcabinet.
In addition to changes in the process leading up to
this report, there have been significant changes in the
final product-the content of the report itself. Past
reports have been lengthy (80-120 pages) and have
included, in addition to a fairly broad list of health
priorities, extensive research findings, lists of priority
study projects, examples of recent successes, and
comprehensive listings of action strategies for nine
health-related agencies.
This year, the Board and Subcabinet representatives
have agreed to feature a limited number of strategic
policy directions. This approach is consistent with
RCW 43.20.050(1)(b) since it provides agency heads
with an outline of state health priorities. The strategic
directions proposed in this report are not all-inclu-
sive, nor are they meant to be prescriptive. State
agencies provide numerous health-related services
that are not covered by these strategic directions, but
are important and appropriate. Rather, these strategic
directions suggest areas of emphasis-areas where
state efforts to create new activities or preserve
existing activities are most likely to be effective.
15
Furthermore, this report does not attempt to identify
recommended action strategies for the 2003-05
biennium. The statute does not call for that level of
detail and Board and Subcabinet representatives
concur that decisions about specific programs should
be made by agency heads coordinating their efforts
through the Subcabinet.
F or each strategic direction, this report contains a
summary of why it is included, a "for instance" that
describes one example of an initiative deserving
further consideration, and a list of possible actions
that illustrate the scope of the strategic direction.
2002 Washington State Health Report
About the Washington State Board of Health
The State Board of Health serves the citizens of Washington by working to understand and prevent disease
across the entire population. Established in 1889 by the State Constitution, the Board provides leadership by
suggesting public health policies and actions, by regulating certain activities, and by providing a public
forum. The governor appoints ten members who fill three-year terms.
Board Members
Consumers
Linda Lake, M.B.A., Chair, has 25 years of
experience in the field of health and social services.
She has directed several community health and social
service organizations, including the Pike Market
Medical Clinic.
Joe Finkbonner, R.Ph., M.B.A., is director of the
EpiCenter at the Northwest Portland Area Indian
Health Board and has served as chair of the
American Indian Health Commission.
Elected County Officials
The Honorable Neva J. Corkrum, Vice Chair, is a
Franklin County commissioner and member of the
Benton-Franklin Health District Board of Health.
16
Elected City Officials
The Honorable Margaret Pageler, J.D., is a
member of the Seattle City Council and serves on the
Board of Public Health in Seattle and King County.
Department of Health
Mary Selecky is secretary of the Washington
Department of Health and former administrator of
Northeast Tri-County Health District.
Health and Sanitation
Charles R. Chu, D.P.M., a practicing podiatrist, is
president of the Washington State Podiatry
Independent Physician Association.
Ed Gray, M.D., is health officer for the Northeast
Tri-County Health District and chair of the Basic
Health Plan Advisory Committee.
Carl S. Osaki, R.S., M.S.P.H., former director of
environmental health for Public Health-Seattle &
King County, is on the faculty at the University of
Washington.
Vickie Ybarra, R.N., M.P.H., is director of planning
and development for the Yakima Valley Farm
Workers Clinic. Much of her work is dedicated to
supporting children and families.
Local Health Officers
Thomas H. Locke, M.D., M.P.H., is health officer
for Clallam and Jefferson counties and medical
director of the Port Gamble S , Klallam tribal health
program.
Board Staff
Don Sloma, M.P.H., Executive Director
Craig McLaughlin, M.J., Senior Health Policy
Manager
Doreen Garcia, M.P.P., Senior Health Policy
Advisor
Marianne Seifert, M.A., Health Policy Advisor
Desiree Day Robinson, Executive Assistant to the
Board
Jennifer Dodd, Assistant to the Board
2002 Washington State Health Report
The Washington State Board of Health and Ida Zodrow, chair of the
Governor's Subcabinet on Health, submitted this document to Governor
Gary Locke, who approved it on May 6, 2002.
For additional copies or more information, contact the Board staff or
visit the Board's Web site:
1102 SE Quince Street
PO Box 47990
Olympia, WA 98504-7990
Telephone: 360 236-4100
Fax: 360 236-4088
E-mail: wsboh@doh.wa.gov
Web: www.doh.wa.govjsbohj
For people with disabilities, this document is available in other
formats on request.
Jefferson County 2001 BRFSS
Tobacco Analysis
DRAFT July 10, 2002
Tobacco
Jefferson County 2001 BRFSS
Tobacco use is the leading single cause of preventable death in our society - one
in five of all deaths can be attributed to tobacco use. More than 20% of
Washington adults continue to use tobacco despite increasing knowledge about
its harm. Adult tobacco use in Jefferson County is generally lower (better) than
the state.
· Regular tobacco use is defined as having smoked at least 100 cigarettes (5 packs)
in a person's lifetime, according to the COC definition. Fifty-five percent of Jefferson
County respondents report having smoked at least 100 cigarettes in their lifetime;
this rate is significantly higher (worse) than the 51 % of state respondents (Figure 1).
· Current smokers, by COC standards, are people who smoked on some or every day
during the last 30. Sixteen percent of Jefferson County adults are current smokers;
this rate is significantly lower (better) than the state rate, 21 % (Figure 2).
· Of the current adult smokers, 15% are males; this rate is significantly lower (better)
than the state, 22% (Figure 3). There were no significant differences between male
and female county residents or between county and state rates for females.
· Twenty-eight percent of residents age 18-34 are current smokers; this rate is
significantly higher (worse) than the state rate, 24% (Figure 4). Within the county,
the current smoking rate among 18-34 year olds is significantly higher (worse) than
residents age 35-64 and 65+ (19% and 5% respectively).
· Significantly more residents who are current smokers (28%) have a high school
education or less as compared to 15% with some post-secondary and 8% with four
or more years of college (Figure 5). Rates among current smokers with some post-
secondary education (15%) are significantly better than the state, 21 %.
· Among households within ZIP code 98368, the current smoking rate is 11 % and is
significantly lower (better) than the 21 % among households in all other ZIP codes
(Figure 6).
· Among current smokers, 22% report fair/poor general health status; this rate is
significantly higher (worse) than the 14% of all respondents who report fair/poor
general health status (Figure 7). The label on this figure is crossing the column.
· Among the 16% of adults who currently smoke, 34% reported heaving drinking (5+
drinks at one setting) within the previous 30 days (Figure 8). The presence of
smoking is associated with heavy drinking.
1 of 1
Within reported age of first use and age of regular use, there are significant
differences among residents
· Among the 18-34 year olds, the median age of reported first use was 13.5 years as
compared to 16.7 years for 35-64 year olds; this difference is significant.
· Among the 18-35 year olds, the median age of reported regular use was 18 years as
compared to 20.3 years for 35-64 year olds; this difference is significant.
· Among those with high school education or less, the median age of reported first use
was 14.7 years as compared to 17.9 years among those with some post-secondary
education and 16.4 years among those with 4+ years of college; these differences
are significant.
· Among those with high school education or less, the median age of reported regular
use was 18.8 years as compared to 21.3 years for those with some post-secondary
education; this difference is significant.
· Among household with children less than 18 years old, the median age of reported
regular use was 17.9 years as compared to 21.7 years among households with no
children less than 18 years old.
Jefferson County residents are motivated to quit.
· Seventy-six percent of everyday smokers tried to quit smoking for one or more days
during the past 12 months; this quit rate is significantly higher (better) than the state
rate, 49% (Figure 9).
· Twenty-eight percent of everyday smokers age 18-34 tried to quit; this is significantly
lower (worse) than the state rate, 55% (Figure 10). However, 72% of currently
smoking residents age 35 and older tried to quit; this rate is significantly higher
(better) than the state, 42%.
· Fifty-nine percent of everyday smokers with high school or less education quit for
one or more days; this rate is significantly higher (better) than the state rate of 42%
(Figure 11). However, only 41 % of currently smoking county respondents with any
college tried to quit; this rate is significantly lower (worse) than the state rate of 50%.
· Seventy-six percent of everyday smokers in households with other than ZI P code
98368 tried to quit; this rate is significantly higher (better) than the 24% of everyday
smokers who tried to quit in ZIP code 98368 (Figure 12).
. The median age of those who quit smoking ten years ago or longer is 62.1 years as
compared to 47.2 years for those who quit smoking within the past ten years.
Jefferson County households generally have clear rules about smoking in the
home.
· Seventy-nine percent of all respondents reported that they do not allow smoking
inside their homes (Figure 13).
· However, 17% of respondents age 65+ reported no rules about smoking inside the
home, compared to 10% of the 18-34 and 12% of the 35-64 age groups; the
difference between younger ages (both groups) and those 65+ is significant. (Figure
13).
· Respondents with some post-secondary or four or more years of college are
significantly more likely to prohibit smoking inside their home (79% and 86%
respectively), while only 71 % of respondents with high school or less education
reported that they prohibit smoking inside the home (Figure 14).
· Forty-three percent of currently smoking adults prohibit smoking inside their home;
this is significantly lower (worse) than the 86% on non-smoking adults who prohibit
smoking inside their home (Figure 15).
· Eighty-four percent of the respondents who reported that their general health status
was excellent/very good/good also reported that they prohibit smoking in the home;
this rate is significantly higher (better) than the 33% of respondents who reported
fair/poor health status and who either allowed smoking in some places / at some
times or had no rules about smoking inside their home (Figure 16).
Children's Exposure to Adult Risk Factors for Poor Health
· Sixteen percent of all adults reported currently smoking cigarettes, but 24% of adults
whose households include children younger than 18 smoked (Figure 17).
· Although 24% of households with children younger than 18 include currently
smoking adults, 87% of these households prohibit smoking inside the home (Figure
18).
DRAFT
7/11/02
Figure 1. (Q1Ox1) Have you smoked at least 100 cigarettes in your entire life?
Jefferson County 2001 and Washington State 2000 BRFSS
Jefferson County*
Smoked at least 100 cigarettes in lifetime 55%
Washington State
51%
Figure 1. Have you smoked at least 100 cigarettes
in your entire life?
Jefferson County 2001 and
Washington State 2000 BFRSS
100%
Source: Jefferson County Department of Health & Human Services BRFSS, 2001;
State - CDC BRFSS website
90%
. Jefferson County*
DWashington State
80%
70%
60%
55%
0%
51%
50%
40%
30%
20%
10%
Smoked at least 100 cigarettes in lifetime
'County is significantly higher (worse) than the state
DRAFT
Figure 2. (1Ox1 X 1Ox2) Currently smoking among those who ever smoked
Jefferson County 2001 and Washington State 2000 BRFSS
Current Smoker
Former Smoker (not currently smoking)
Never Smoked
Jefferson County*
16%
39%
45%
Washington State
21%
Figure 2. Current Smoker, Jefferson County
2001 and Washington State 2000 BRFSS
Source: Jefferson County Department of Health & Human Services BRFSS, 2001;
State - CDC BRFSS website
100%
. Jefferson County*
o Washington State
90%
80%
70%
60%
50%
45%
40%
39%
21%
30%
20%
10%
0%
Current Smoker
Former Smoker (not
currently smoking)
Never Smoked
'County is significantly lower (better) than Kitsap County and the state
7/11/02
DRAFT
Figure 3. (Q1Ox2) Do you smoke everyday, some days, or not at all, by gender.
Jefferson County 2001 and Washington State 2000 BRFSS
All
Jefferson County
16%
Current Smoker
Washington State
21%
Male*
Female
15%
17%
22%
20%
Figure 3. Current smoker, by gender.
Jefferson County 2001
and Washington State 2000 BRFSS.
Source: Jefferson County Dep<rtment of Health & Human Services 2001;
State - CDC BRFSS website
. Jefferson County
o Washington State
100%
90%
80~.
70%
60~.
50%
40%
30~.
21%
20~.
10~.
0%
All
22%
20%
Male*
Female
'County male respondents are significantly lower (better) the state, p<.01.
7/11/02
DRAFT
Figure 4. (Q10x2) Do you smoke everyday, some days, or not at all, by age.
Jefferson County 2001 and Washington State 2000 BRFSS
....current smoker
All
Jefferson County**
16%
Washington State*
21%
18-34 year olds
35-64 year olds
65+ year olds
28%
19%
5%
24%
22%
10%
Figure 4. Current smoker, by age.
Jefferson County 2001 and
Washington 2000 BRFSS.
100%
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS;
State - CDC BRFSS website
90%
. Jefferson County**
o Washington State*
80%
70%
60%
50%
40%
20%
30%
10%
0%
All
18-34 year
olds
35-64 year 65+ year olds
olds
"The rate among county 18-34 year olds is significantly higher (worse) than the state rate.
""Rates among county residents age 18-34 year is significanlty higher (worse) than in other age groups.
7/11/02
DRAFT
Figure 5. (Q10x2) Do you smoke everyday, some days, or not at all, by education.
Jefferson County 2001 BRFSS and Washington State 2000 BRFSS
..current smoker
All
Jefferson County
16%
High school or less**
Some post-secondary*
4+ years of college
28%
15%
8%
Washington State
21%
30%
21%
11%
Figure 5. Current smoker, by education. Jefferson
County 2001
and Washington 2000 BRFSS
100%
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS;
State - CDC BRFSS website
90%
80%
70%
60%
. Jefferson County
OWashington State
50%
40%
30%
21%
20%
10%
0%
All
High school or
less**
21%
11%
Some post-
secondary*
4+ years of
college
*County rates are significantly lower (better) than state rates among respondents with some post secondary education.
**County rates among respondents with some post secondary and 4+ years of college are signifcantly lower (better) than
7/11/02
Figure 6. (Q10x2) Do you smoke everyday, some days, or not at all, by ZIP Code.
Jefferson County 2001 BRFSS
Jefferson County
Current Smoker 16%
ZIP Code 98368
11%
All other ZIP Codes
21%
Figure 6. Current smoker, by ZIP Code.
Jefferson County BRFSS, 2001
Source: Jefferson County Department of Health & Human Services, 2001 BRFSS
100%
90%
. Jefferson County ø ZIP Code 98368 m All other ZIP Codes
80%
70%
60%
50%
40%
30%
21%
20%
0%
10%
Current Smoker
'The smoking rate in ZIP Code 98368 is significantly lower (better) than All Other ZIP Codes, p<.05
7/11/02
DRAFT
Figure 7. Current smoker, by general health status
Jefferson County 2001 (n=595.
All
Current Smoker
Non-Smoker
.. ..general health status
ExcellenWery Good/Good* Fair/Poor*
79% 21%
78%
86%
22%
14%
,-
I
I
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
o%L
L_. ~
7/11/02
Figure 7. Current smokers, by general health status.
Jefferson County 2001 BRFSS
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
[ III Current Smoker
86%
o Non-Smoker
78 %
~
22%
14%
.- ,
ExcellenWery Good/Good*
Fair/Poor*
.__._--------_._----_._------_._-,--~_._-
-..... ---~--._'-'_._.._--,----,._--_.__._._-
Figure 8. Heavy drinking (5+/time) among current smokers. (n=400)
Jefferson County BRFSS, 2001.
All
Heavy Drinker (5+/time)
Heavy Drinking No Heavy Drinking
17% 83%
Current Smoker*
Non-Smoker
34%
15%
66%
85%
Figure 8. Heavy drinking (5+/time) among current
smokers, Jefferson County BRFSS, 2001
100%
Source: Jefferson County DepéV"tment of Health & Human Services BRFSS, 2001
80%
I It! Heavy Drinking o No Heavy Drinking I
85%
83%
66%
34 %
17 %
15 %
- ,
,
90%
70%
60%
50%
40%
30%
20%
10%
0%
All
Current Smoker*
Non-Smoker
·Current smoking among respondents who report heavy drinking within the past 30 days is significantly higher (worse)
than respondents who report no heavy drinking within the past 30 days; p<.001
7/11/02
DRAFT
Figure 9. (Q10x3) During the past 12 months, have you quit smoking for 1 day or longer
(people who smoke everyday)? Jefferson County 2001 and Washington State 2000 BRFSS.
(Jefferson County n=74)
Jefferson County
Tried to quit smoking for 1 or more days 76%
Washington State
49%
Figure 9. Tried to quit smoking during the past 12
months, Jefferson County 2001 and
Washington State 2000 BRFSS.
Source: Jefferson County Department of Health & Human Services BRFSS, 2001;
State - CDC BRFSS website
I · Jefferson County
o Washington State
100%
90%
80% 76%
70%
60%
50% 49%
40%
30%
20%
10%
0%
Tried to quit smoking for 1 or more days
County is significantly higher (better) than the state
7/11/02
DRAFT
Figure 10. (Q1Ox3) During the past 12 months have you quit smoking for 1 day or longer, by age.
Jefferson County 2001 and Washington State 2000 BRFSS. (Jefferson County n=74)
18-34 years old*
35 years and older**
Quit for 1 day or longer
Jefferson County Washington State
28% 55%
72% 42%
Figure 10. Tried to quit smoking during the past
12 months, by age, Jefferson County 2001 and
Washington State 2000 BRFSS.
Source: Jefferson County Department of Health & Human Services BRFSS, 2001;
State - CDC BRFSS website
. Jefferson County
o Washington State
100%
90%
80%
72%
70%
60% 55%
50%
40%
30% 28%
20%
10%
0%
42%
18·34 years old* 35 years and older**
'Rates for county respondents age 18-34 are significantly lower (worse) the state.
"Rates for county respondents age 35 and older are significantly higher (better) the state.
7/11/02
DRAFT
Figure 11. (Q1Ox3) During the past 12 months have you quit smoking for 1 day or longer, by education
Jefferson County 2001 and Washington State 2000 BRFSS. (Jefferson County n=74)
High school or less**
Any college*
Jefferson County
59%
41%
Quit for 1 day or longer
Washington State
42%
50%
Figure 11. Tried to quit smoking during the past
12 months, Jefferson County 2001
and Washington State 2000 BRFSS.
Source: Jefferson County Department of Health & Human Services BRFSS, 2001;
State - CDC BRFSS website
. Jefferson County
o Washington State
100%
90%
80%
70%
59%
60%
50%
42%
40%
30%
20%
10%
0%
50%
High school or less-
Any college*
'Rates for county respondents with any college are significantly lower (worse) the state.
"Rates for county respondents with high school education or less significantly higher (better) the state.
7/11/02
DRAFT
Figure 12. (Q1Ox3) During the past 12 months have you quit smoking for 1 day or longer,
by ZIP Code. Jefferson County 2001. (Jefferson County n=74)
Jefferson County
76%
Quit for 1 day or longer
ZIP Code 98368 All Other ZIP Codes
24% 76%
Figure 12. Tried to quit smoking during the past
12 months, by ZIP Code,
Jefferson County 2001.
Source: Jefferson County Department of Health & Human Services BRFSS, 2001
. Jefferson County ø ZIP Code 98368 m All Other ZIP Codes
100%
90%
80'Y. 76%
70%
60'Y.
50'Y.
4O'Y.
30'Y.
20%
10%
O'Y.
76%
Quit for 1 day or longer
'Rates for county respondents with any college are significantly lower (worse) the state.
HRates for county respondents with high school education or less significantly higher (better) the state.
7/11/02
DRAFT
Figure 13. (24x6) Which statement describes the rules about smoking inside your home, by age
Jefferson County 2001 BRFSS. (n=599)
All respondents
Rules about Smoking in the home
Not allowed Some places / some times
79% 8%
No rules
13%
18-34 years old
35-64 years old
65+ years old*
76%
79%
79%
14%
9%
4%
10%
12%
17%
Figure 13. Smoking rules inside your home, by
age, Jefferson County 2001 BRFSS
(all respondents).
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
100%
90%
79%
80%
70%
60%
50%
o Not allowed ~ Some places I some times ~ No rules
79%
79%
76%
40%
30%
20%
10%
0%
All
respondents
18-34 years old 35-64 years old 65+ years old*
I
I
L ~_~~_____.
--~-"-~--~_._-,..,-_.._.^.,.,.~ -,
-____-.-J
7/11/02
DRAFT
Figure 14. (24x6) Which statement describes the rules about smoking inside your home, by education
Jefferson County 2001 BRFSS. (n=600)
All respondents
Rules about smoking in the home
Not allowed Some places / some times No rules
79% 8% 13%
High School or less
Some Post-secondary*
4+ years of college*
71%
79%
86%
12%
10%
4%
17%
11%
10%
Figure 14. Smoking rules inside your home, by
education, Jefferson County 2001 BRFSS,
(all respondents, n=600)
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
100% o Not allowed ~ Some places I some times ~ No rules
90% 86%
79% 79%
80%
71%
70%
60%
50%
40%
30%
20%
10%
10%
0%
All respondents High School or Some Post- 4+ years of
less secondary* college*
'Respondents with some post-secondary or 4+ years of college are significantlly more likely to prohibit smoking in the
.'. ---_.__._~._~----
---_._---_.._.._._---------,-_._.__.,._-~.__._~--~--
7/11/02
DRAFT
Figure 15. (24x6) Which statement describes the rules about smoking inside your home.
Jefferson County 2001 BRFSS. (n=599)
All respondents
Rules about Smoking in the home
Not allowed Some places / some times / no rules
79% 21%
Current Smoker
Never smoked/former smoker
43%
86%
57%
14%
Figure 15. Smoking rules inside your home,
by current smoker, (n=599).
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
100%
l DAlI respondents iii Current Smoker 13 Never smoked/former smoker
90%
86%
- - --
80%
79%
- - --
-----
- - --
-----
- - --
-----
- - --
-----
- - --
-----
70%
- - --
-----
- - --
-----
- - --
-----
- - --
-----
60%
- - --
57%
-----
- - --
-----
- - --
-----
- - --
-----
50%
- - --
-----
- - --
43%
-----
- - --
-----
- - --
-----
40%
- - --
-----
- - --
-----
- - --
-----
- - --
30%
fo----------
fo-:-:-:-:-:
- - --
-----
- - --
21%
-----
- - --
20%
fo-:-:-:-:-:
- - --
14%
-----
- - --
-----
10%
- - --
-----
-----
- - --
- - --
-----
-----
- - --
- - --
-----
- - --
-----
- - --
- - - -
- - --
- - --
- --
-----
0%
-----
- - --
Not allowed
Some places I some times I no rules
·Current smokers are significantly less likely to prohibit smoking in the home; p<.001
L_
'~"---_.._'~--'-"-"-"---
7/11/02
DRAFT
Figure 16. (24x6) Which statement describes the rules about smoking inside your home,
by health status. Jefferson County 2001 BRFSS (n=598)
...general health status
All respondents
Rules about Smoking in the home
Not allowed Some places / some times No rules
80% 9% 11%
ExcellenWery Good/Good*
Fair/Poor
81%
67%
6%
19%
13%
14%
Figure 16. Smoking rules inside your home,
by general health status.
Jefferson County 2001 BRFSS, (n=598).
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
100% ¡
90%
80% I 80%
70%
60%
50%
40%
30%
20%
10%
0%
o Not allowed
~ Some places I some times
~ No rules
81%
67%
13%
I
Ii: All respondents ExcellenWery FairlPoor I
Good/Good*
I '
I *R~~ndents_wt¡~~epo~ excellenUvery good/good health are Si~nifiCantly more likely to prohibit s:oking in the_~me; ___J
7/11/02
DRAFT
Figure 17. (Q13x6 & Q21x3) Current smokers and the presence of children < 18 in the household.
Jefferson County 2001 BRFSS
Current smokers
All households
16%
Children < 18*
24%
No children < 18
13%
Figure 17. Current smokers, and the presence of
children < 18 in the current household,
Jefferson County 2001 BRFSS.
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
100%
90%
80%
70% .AII households 0 Children < 18* [J No children < 18
60%
50%
40%
30%
24%
0%
13%
20%
10%
Current smokers
·Current smoking among adult respondents in households with children less than 18 years old is significantly higher (worse)
than households without children less than 18 years old; p<O.01
-----..--
-----
7/11/02
DRAFT
Figure 18. (24x6) Which statement describes the rules about smoking inside your home,
by the presence of children < 18 in the household. Jefferson County 2001 BRFSS, (n=602)
I
I 'Households with children less than 18 years old are significantly more likely to prohibit smoking in the home; p<.01.
1_____ __
All households
Children <18*
No children <18
100%
90%
80% 79%
70%
60%
50%
40%
30%
200/.
10%
0%
7/11/02
Rules about Smoking in the home
Not allowed Some places / some times No rules
79% 8% 13%
87%
76%
7%
9%
6%
15%
Figure 18. Smoking rules inside the home, and the
presence of children < 18 in the current household,
Jefferson County 2001 BRFSS.
Source: Jefferson County - Department of Health & Human Services, 2001 BRFSS
o Not allowed ~ Some places I some times ~ No rules
87%
76%
13%
15%
All households
Children <18*
No children <18
---'_.'-'_."---~---'-
-~--~--~-~--------
Jefferson County
Tobacco Prevention & Control Program
Supplemental Materials
· Smokefree Guide
· Drinking, Dining, & Desserting Establishment Letter - June, 2002
· Retailer Letter - June, 2002
· BRFSS Fact Sheet (included in Retailer and Establishment packets)
· Tobacco Use and Exposure Chapter from The Health of Washington State,
Washington State Department of Health -July, 2002
~
~~~
Dear East Jefferson County Drinking, Dining, & Desserting Establishments,
Congratulations!!! Your establishment has been included in the Smokefree Drinking, Dining, & Desserting
in East Jefferson County 2002 update. Welcome to the newly smokefree Harbormaster Restaurant and
Lounge and Flagship Grill and Spirits (formerly The Old Alcohol Plant). Your decision to provide
smokefree environments increases public health and safety.
Sixty-four percent of Washington State respondents think that breathing secondhand smoke is YmY
harmful.1 Eighty-three percent of Washington State respondents think that all children should be
protected from secondhand smoke.1 Seventy-nine percent of Jefferson County residents report that
smoking is not allowed inside their homes.2
Secondhand smoke (SHS) is a Group A carcinogen (the deadliest of all), known to cause cancer in
humans, and is linked to lung cancer and heart disease in nonsmokers. SHS also causes serious
respiratory problems in kids, increases the risk for Sudden Infant Death Syndrome (SIDS) and middle ear
infections in children. SHS toxins cannot be removed by ventilation systems.
Although your establishment provides a smokefree interior, there are other things you can do to promote
a smokefree environment. Perhaps your customers complain about walking through a smoke cloud to
enter your establishment. You can discourage smoking near the entrances by:
· posting reminders that request that as a courtesy to customers, people not smoke within 50 feet
of an entrance
. removing ashtrays
· reminding employees of the dangers of SHS and customer concerns
You can also provide incentives to staff who may be motivated to quit tobacco. Incentives can be as
simple as a healthy supply of chewing gum, hard candy, toothpicks, straws or bottles of bubbles, even
notes of encouragement. You can post the Washington State Tobacco Quitline phone number in
employee break rooms or include Quitline inserts in paychecks. Most smokers want to quit and it takes an
average of ~ attempts for a tobacco user to quit and stay quit.
Please take a few moments to review the enclosed materials. These are available at no cost through the
Jefferson County Tobacco Prevention and Control program. If you want additional materials, please
contact me at 360-385-9446 or kragan@co.jefferson.wa.us.
On behalf of the citizens and visitors of Jefferson County, your efforts to reduce SHS exposure are greatly
appreciated.
s~
Kellie Ragan, MA
Jefferson County Tobacco Prevention and Control Program
, 2001 Washington State Department of Health, Tobacco Prevention & Control Program Adult Telephone Survey, Olympia, WA Fall 2000
, Jefferson County 2001 Behavioral Risk Factor Survellience Survey, Jefferson County Health & Human Services
COMMUNI1Y
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
June 2002
Dear East Jefferson County Tobacco Retailers,
Congratulations!!( n a recent series of tobacco compliance checks conducted by the Jefferson County
Tobacco Prevention & Control Program, 23 out of 25 retailers we checked were in compliance with
Tobacco Youth Access Laws. In other words, most clerks refused to sell tobacco products to minors who
tried to buy tobacco. This recent round of compliance checks continues our high overall compliance rate.
We know that minors can access tobacco products through many methods-including friends and
parents. However, tobacco retailers can face fines and possible license revocation for multiple tobacco
youth access violations.
As you may know, smoking is one of the leading causes of preventable death in the United States today
and many current smokers began smoking as teenagers. Current youth access laws are making it
tougher for youth to access tobacco products. Efforts are also at work in our schools and communities to
provide education about marketing techniques of tobacco industry, immediate and long-term health
consequences of tobacco use, and cessation classes and support.
You can provide incentives to staff who may be trying to quit tobacco. Incentives can be as simple as a
healthy supply of chewing gum, hard candy, toothpicks, straws or bottles of bubbles, even notes of
encouragement. You can post the Washington State Tobacco Quitline phone number in employee break
rooms or include Quitline inserts in paychecks. Most smokers want to quit and it takes an average of
~ attempts for a tobacco user to quit and stay quit.
Perhaps your customers complain about walking through a smoke cloud to enter your establishment. You
can discourage smoking near the entrances by:
· posting reminders that request that as a courtesy to customers, people not smoke within 50 feet
of an entrance
· removing ashtrays
· reminding employees of the dangers of secondhand smoke and customer concerns
Please take a few moments to review the enclosed materials. These are available at no cost through the
Jefferson County Tobacco Prevention and Control program. If you want additional materials, please
contact me at 360-385-9446 or kragan@co.jefferson.wa.us. "'
Thank you for your efforts to reduce youth access to tobacco products.
s~
Kellie Ragan, M.A.
Jefferson County Tobacco Prevention and Control Program
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
TOBACCO FINDINGS FROM THE 2001 JEFFERSON COUNTY
BEHAVIORAL RISK FACTOR SURVELLIENCE SURVEY*
Adult tobacco use in Jefferson County is
generally lower (better) than the state.
Sixteen percent of Jefferson County adults are
current smokers**; this rate is better than the state
rate of 21 % (Figure 1).
Twenty-eight percent of county respondents age
18-34 are current smokers (nearly 3 in 10); this
rate is worse than the state rate of 24% (Figure 1).
Currently smoking county rates among 18-34 year
olds is worse than people age 35-64 and 65+ (19%
and 5% respectively).
100%
Figure 2. Quit for 1 day or longer in past 12
months, by age
I_Jefferson County DWashington State I
80%
76%
72%
60%
40%
20%
0%
All
18-34 years old' 35 years and
older"
100%
Figure 1. Current Smokers, by age
. Jefferson County**
DWashington State*
80%
60%
40%
28%24%
20%
0%
All
18-34 year 35-64 year 65+ year
aids aids aids
Current smokers in Jefferson County are motivated
to quit.
Seventy-six percent of currently smoking county adults
tried to quit smoking for one or more days during the
past 12 months; this quit rate better than the state rate
of 49% (Figure 2).
Twenty-eight percent of currently smoking county adults
age 18-34 tried to quit; this rate is worse than the state
rate of 55% among 18-34 year olds (Figure 2).
However, 72% of county adults age 35 and older tried
to quit and is better than the state rate of 42%.
Jefferson County households generally have clear
rules about smoking in the home.
Seventy-nine percent of all respondents report that
they do not allow smoking inside their homes (Figure
3).
87% of the households with children younger than 18
prohibit smoking inside the home, even though 24% of
those households include currently smoking adults
(Figure 3).
Figure 3. Rules about Smoking in the home
o Not allowed _ Some places I some times EI No rules
100%
80%
60%
40%
20%
0%
87%
79%
76%
9% 15%
8% 13% 7% 6%
All households Household with
children <18*
Households
without
children <18
*The Behavioral Risk Factor Surveillance System (BRFSS) consist of modules or small groups of questions developed by the US Center
for Disease Control and Prevention (COG) beginning about 1985. These questions all have validity and reliability sufficient to meet the
standard of scientific acceptability. The focus of modules was originally on health care access and chronic disease risk factors, but in
more recent years it has been expanded to include modules on firearms, family violence, and environmental health.
The Jefferson County BRFSS questionnaire was administered to a random sample of 603 county residents between April 1 and
December 31, 2001. Although the sample size might seem small, in fact it gives a statistically accurate portrait of the county's adult
population and allows us to calculate rates that are valid within a range of ± 4%. The method used is the same used by political parties
and other large organizations that routinely do public polling.
"Current smokers, by CDC standards, are people who smoke on some days or everyday.
Tobacco Use
and Exposure
Summary
Tobacco use is the leading single cause of
preventable death in our society - one in five
of all deaths can be attributed to tobacco use.1
More than 20% of Washington adults
continue to use tobacco despite increasing
knowledge about its harm. The Washington
State Department of Health has launched a
comprehensive Tobacco Prevention and
Control Program to prevent tobacco use
initiation, increase quitting, and reduce
exposure to secondhand smoke. This program
includes interventions that have proven
successful in other states, such as a paid
media campaign and telephone quit line.
Time Trends
Data from the Behavioral Risk Factor Surveillance
System (BRFSS) indicates that the use of cigarettes
among Washington adults remained essentially
constant from the late 1980s to 2000. In 2000, 20.7%
(j; 1.3%) of Washington adults reported current
Adults Reporting
Current Cigarette Smoking
WA State BRFSS
30 ,
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------~--,_._-~._.._~-_.~...__.
The Health of Washington State
Washington State Department of Health
Definition: Tobacco use and exposure includes the intake of
tobacco smoke from cigarettes, cigars, and pipes, either by the
individual smoking or via exposure to environmental tobacco
smoke, and the oral absorption of nicotine and related toxins
through smokeless tobacco (snuff, dip, chew). An adult who has
smoked at least 100 cigarettes in his or her lifetime and currently
smokes every day or some days is defined as a current smoker. A
current youth smoker is an adolescent who has tried cigarettes
and has smoked on at least one of the past 30 days.
smoking. National trends are similar, and 23.2% of US
adults reported current smoking in 2000.
Data from the Pregnancy Risk Assessment Monitoring
System (PRAMS) indicates that smoking during the third
trimester of pregnancy has remained essentially constant
from 1996 to 1999. In 1999, 11.7% (± 2.5%) of
Washington resident mothers reported smoking during the
third trimester of pregnancy.
The Washington State Survey of Adolescent Health
Behaviors (WSSAHB) indicates that, among youth,
cigarette smoking within the past 30 days increased
during the early 1990s, and has remained constant since
then. In 2000, 19.8% (± 1.4%) of 10th graders and 27.6%
(± 2.0%) of 12th graders reported current use of
. 2
cIgarettes.
Year 2000 and 2010 Goals
Healthy People 2000 and 2010 Goals. Washington did
not meet the Healthy People 2000 goal of reducing the
prevalence of adult smoking to 15%. Birth certificate data
from 1998 - 2000 combined (see technical note) indicated
that almost 14% of women smoked during pregnancy and
so Washington did not meet the goal of reducing smoking
among pregnant women to 10%. Washington data are not
available to measure the Healthy People 2000 goals for
youth.
The national Healthy People 2010 goals for tobacco use
include reducing current smoking among adults to an age-
adjusted prevalence of 12% or less. Washington's age-
adjusted prevalence of smoking in 2000 was about 20%.
Additional Healthy People 2010 goals include increasing
smoking cessation among pregnant women to 30%, and
reducing current smoking among high school youth
(grades 9 - 12) to less than 16%. In 1999, approximately
28% (± 2%) of high school youth in Washington reported
smoking. 3
Washington State Goals. State goals include reducing the
proportion of adult current smokers by 3% per year
through 2010 (so that the 2010 BRFSS finds a prevalence
Tobacco Use and Exposure
updated: 07/0212002
of 16.5% or less); reducing the proportion of mothers
who smoke during pregnancy by 4% per year through
2010 (so that the 2010 PRAMS fmds a prevalence of
8.0% or less); and reducing the proportions of youth
in 10th and 12th grade who are current smokers by 2%
per year through 2010 (so that a school-based survey
in 2010 finds prevalences of 16.2% and 22.6% or
less, respectively). These goals are more conservative
than the Healthy People 2010 goals and are based on
the observed success of tobacco control programs in
other states.
Geoaraphic Variation
County data on current smoking reported in the
BRFSS and WSSAHB are not generally available
because of the small number of respondents fÌom
many counties. Similarly, PRAMS cannot be used to
measure county variation in smoking during
pregnancy. However, smoking during pregnancy
reported on the birth certificate, represented below,
varied among counties fTom 5% to nearly 30%. (See
teclmical note.)
SELF REPORTED SMOKING DURING PREGNANCY
WA Birth Certificates 1998·2000
Percent
Ii 2..56 to 10.17
10.41 to 13.73
15.45 to 18.62
18.74 to 27.47
State Rate: 13.73
Proóuoed by DIRM GIS
Urban and Rural
Washington BRFSS data for 1998 - 2000 combined
did not show differences in current smoking among
residents of urban, suburban, large town, and small
town/isolated rural areas. Washington PRAMS and
WSSAHB data are not available to describe urban
and rural variations in tobacco use. However, birth
certificate data (see technical note) fÌom 1998 - 2000
combined indicated that among women giving birth
at age 25 years and older, more women living in
Tobacco Use and Exposure
updated: 07/0212002
small town and isolated rural areas reported smoking
during pregnancy than women in other areas. For women
under age 25, slightly fewer living in large towns report
smoking during pregnancy than did women in other areas.
Smoking During Pregnancy
Urban and Rural
WA State Birth Certificates, 1998-2000
Urban
Suburban
2).9
Large Town
Small
Town/Rural
o
10 20
Percent
11II Women 25+ years
o Women <25 years
30
Age and Gender
Based on the Fall 2000 WSSAHB4 and combined BRFSS
data fÌom 1998 - 2000, the prevalence of current smoking
increased fÌom 6th through 12th grades, and then generally
decreased with age after age 24. The prevalence of current
smoking among 8th, 10th, and 12th grade girls was
significantly higher than among boys.
Current Cigarette Smoking
Age and Gender
WA State BRFSS 1998-2000, WSSAHB 2000
65+ 15.3 I
Bl
45-64
35-44
25-34
18-24
12th grade
10th grade
8th grade
6th grade
0
24.9
I
25.6
24.6
27
217
29.3
29.6
17.5
218
26.1
29.3
Il3
14.5
10 20 30
Percent
[~~emale III M~leJ
40
2
The Health of Washington State
Washington State Department of Health
Combined PRAMS data trom 1997 - 1999 indicated
that prevalence of smoking during the third trimester
of pregnancy was highest among young mothers.
Among mothers younger than 20, 19.2% (± 4.7%)
had smoked during pregnancy, and among mothers
age 20- 24,18.8% (± 3.3%) had smoked during
pregnancy. In contrast, only about half as many
mothers in older age groups had smoked during
pregnancy.
Race and Ethnicitv
BRFSS data indicated that Native Americans have
the highest prevalence of cigarette smoking, followed
by blacks, whites, and Asian/Pacific Islanders. The
prevalence of smoking among Hispanics was not
significantly different trom non-Hispanics.
Am Indian/
Alaska Native
AsianPacfic
Islander
Current Cigarette Smoking
Race and Ethnicity
WA BRFSS 1998-2000
I
34.1
White
z.
'õ
l:
-"
W
Black
Z3.4
..
o
..
a:
------
Hispanic
Non-Hispanic
o
10
20 30
Percent
40
50
The comparatively low prevalence of current
smoking among Asian/Pacific Islanders can be
deceptive. There are significant cultural differences
around tobacco among subpopulations within this
group, and there are significant gender differences in
tobacco use within these connnunities as well. The
low overall group prevalence probably masks high
use rates among males within specific subgroups.
One study conducted in King County found that the
prevalence of smoking among Korean and
Vietnamese men was about 30%, while smoking
among women in these same populations was about
4%.5
PRAMS data trom 1997 - 1999 indicated that the
prevalence of smoking during pregnancy was highest
among Native Americans (24.9% ± 2.7%), followed
by whites (14.3% ± 2.0%) and blacks (12.4% ±
2.2%), and lowest among AsianlPacific Islanders
(6.7% ± 1.6%) and Hispanics (3.4% ± 1.2%).
The Health of Washington State
Washington State Department of Health
WSSAHB data indicated that the prevalence of youth
smoking for all grades was highest among Native
American youth, followed by blacks, Hispanics, and
whites, and was lowest among Asian/Pacific Islanders.
For example, among 10th graders the smoking prevalence
was 40.5% (± 1.0%) for Native American youth, 22.8%
(± .8%) for blacks, 20.9% (± 1.0%) for Hispanics, 19.2%
(± .8%) for whites, and 14.8% (± .7%) among
Asian/Pacific Islander youth.
Income and Education
Increasing levels of education and annual household
income are associated with decreases in prevalence of
current cigarette smoking.
PRAMS data trom 1997 - 1999 indicated that the
prevalence of smoking among Medicaid recipients (low-
income mothers) was 20.7% (± 2.7%), nearly three times
greater than among non-Medicaid mothers.
Washington data to describe the socioeconomic status of
youth who smoke are not currently available.
Current Cigarette Smoking
Income and Education
WA State BRFSS 1998·2000
<tiS Graduate
c:
.2
..
o
"
"U
UJ
<$25,CXDýear
$25- 9J,CXDýear
..
E
o
o
.£
$9J,(((}tijear
33.2
HS G rad.G ED
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o
10
20
30 40 50
Percent
Other Measures of Burden
Smokeless Tobacco
In the 2000 BRFSS, 3.1% (± 0.7%) of Washington adults
reported using smokeless tobacco in the past month.
Among adult men, the prevalence of smokeless tobacco
use was 6.3% (± 1.5%), while among women the
prevalence of smokeless tobacco use was less than 0.1 %.
Among 12th grade boys the rate was 16.3% (± .2%). For
1998 - 2000, use of smokeless tobacco was lowest among
those living in urban core areas (1.9% ± .5%), increased
among residents of suburban and large town areas (2.5%
± 1.5%, and 4.1 %, ± 2.1 %, respectively), and was highest
3
Tobacco Use and Exposure
updated: 07/0212002
among residents of small town and isolated rural
areas (6.1% ± 2.9%).
Cigars
In the 2000 BRFSS, 4.2% (± 0.6%) of Washington
adults reported smoking cigars in the past month. For
1998 - 2000 combined, cigar smoking was highest
among those living in urban areas (4.6%, ± 0.8%) and
decreased to 1. 7% (± 1.4%) in the small town and
isolated rural areas.
Health Effects
Cigarette smoking causes heart disease, several kinds
of cancer (lung, larynx, esophagus, pharynx, mouth,
and bladder), and chromc lung disease. Smoking also
contributes to cancers of the pancreas, kidney, and
cervix. As a direct result of tobacco use, more than
430,000 people die annually in the US and more than
8,300 die in Washington.6 Other tobacco products,
such as smokeless tobacco, cigars, pipe tobacco, and
novel tobacco products, such as clove cigarettes
(kreteks) and bidis, also pose serious health risks and
are not safe alternatives to cigarettes.
Smoking during pregnancy is associated with
spontaneous abortions, premature births, low
birthweight, and sudden infant death syndrome.? The
1998 - 2000 birth certificate data indicated that about
11,000 infants are born in Washington each year to
mothers who report smoking during pregnancy.
Immediate health consequences for youth who use
tobacco include impaired lung growth and function,
increased respiratory illnesses, and poorer overall
health. Early initiation of smoking has also been
associated with increased risk of subsequent drug use
and might be a marker for underlying mental health
problems, such as depression. 8
Nationally, exposure to environmental tobacco
smoke (ETS) contributes to the deaths of an
estimated 3,000 nonsmokers from lung cancer each
year. ETS makes thousands more ill and contributes
to their deaths from other conditions. Nationally, ETS
causes up to 300,000 children to suffer from lower
respiratory tract infections each year. 9
Barriers and Motivation
In the 1998 - 2000 combined BRFSS, about half of
current smokers reported making a serious attempt to
quit during the past year, and nearly 80% of all
current smokers indicated that they wanted to quit
smoking. Pregnant women can be especially
. d . 10
motIvate to qUIt.
Tobacco Use and Exposure
updated: 07/0212002
Youth are put at increased risk for imtiation of tobacco
use by complex social, environmental, and personal
factors. Social and environmental factors include
availability of tobacco products, tobacco industry
promotion practices, the price of tobacco products,
perceptions that tobacco use is normal, peers' and
siblings' use and approval, and lack of parental
involvement. Personal risk factors include low self-image
and low self-esteem, the belief that tobacco use provides
some benefit, and a lack of skills to refuse offers of
tobacco.8
High Risk Groups
Lower income and education levels are important risk
factors for tobacco use. In addition, Native Americans and
some groups within the Asian community are at increased
risk of tobacco use. Youth are a high-risk group for future
tobacco use. Among adults who currently smoke in
Washington, the average age of smoking initiation was
about 15, and approx~tely three-fourths began smoking
while younger than 18.
Compounding these risk factors are the promotional
efforts of the tobacco industry. National marketing
expenditures by the tobacco industry increased 22.3% to
$8.24 billion from 1998 to 1999.12
Intervention Strate~ies
In 1999, Washington received the first ofa series of
payments from the national Master Settlement
Agreement. This settlement between the tobacco industry
and a group of state Attorneys General, led by
Washington Attorney General Christine Gregoire, is
expected to generate $4.5 billion in payments to
Washington over 25 years. With this funding, DOH
launched a statewide comprehensive tobacco prevention
and control8rogram in 2000, based on best practices from
other states and with the advice of a statewide tobacco
council. A recent review of evaluated interventions for
tobacco prevention and control supports the program's
design. The review found that mass media campaigns and
telephone cessation support systems, in particular, are
highly effective interventions.14
Cessation Programs. A multi component telephone
counseling service has been shown to be effective in
helping adult tobacco users to quit. Health care provider
training to promote effective clients interventions and
establish provider reminder systems are also effective
population-based strategies to reduce smoking.14
Public Education & Awareness. Media campaigns
targeted toward high-risk youth have been shown to
reduce smoking initiation among youth. Successful
4
The Health of Washington State
Washington State Department of Health
campaigns contain carefully developed themes that
resonate with the target audience. Mass media
strategies that market telephone quit lines to adults
and targeted education and awareness campaigns
using print and other media are also effective in
d· b 14
re ucmg to acco use.
Community-Based Programs. The Centers for
Disease Control and Prevention (CDe) recommends
community-based programs as an important element
of comprehensive state tobacco prevention and
control programs.13 Implementing smoking bans and
restrictions and working with health care providers to
give smokers strong messages to quit and referral to
other services (such as a quit line) are two
community-based interventions that have been
successful in reducing tobacco use.14
School-Based Programs. A recently released long-
term study of a curriculum-based tobacco prevention
program found that education alone is unlikely to
reduce tobacco use among youth.15 Rather,
comprehensive school-based tobacco prevention
programs that include curriculum, policy, staff
training, linkage with communities, intervention
services for youth, and parent involvement have been
successful in reducing rates of smoking among
16
youth.
See related chapters on Indoor Air
Quality, Coronary Heart Disease and
Luna Cancer.
Data Sources (For additional detail, see Appendix BJ
Behavioral Risk Factor Surveillance System, 1987 - 2000.
Washinqton State Birth Certificate Data, 1980-2000 CD-
ROM issued November 2001.
The Preqnancy Risk Assessment Monitorinq System
(PRAMS), 1998 - 2000.
Washington State Survey of Adolescent Health Behaviors,
2000. Analysis completed by Assessment and Evaluation
Unit ofTobacco Prevention & Control Program, DOH.
For More Information
Washinqton State Department of Health. Tobacco
Prevention and Control Proqram, (360) 236-3665
Centers for Disease Control and Prevention, Office on
Smoking and Health
The Guide to Community Preventive Services: a
comprehensive review of published community-based
interventions to reduce tobacco use
Centers for Disease Control and Prevention, State
Tobacco Activities TrackinQ and Evaluation System
The Health of Washington State
Washington State Department of Health
Technical Notes
Smoking During Pregnancy. Currently, delivering mothers in
Washington are asked whether they smoked during their
pregnancy (not during a specific time, such as third trimester),
and responses are included on the birth certificate. A mother is
classified as a smoker if she reports that she has smoked at
some time during the pregnancy. Research has indicated
significant under-reporting of this measure (up to 30%);
however, if under-reporting is constant, differences in smoking
rates are valid.
Endnotes
1 McGinnis JM, Foege WHo 1993. Actual Causes of Death in the United
States. JAMA. 270:2207-12.
2 OSPI 2001. Washington State Survey of Adolescent Health Behaviors
2000: Analytic Report. Office of the Superintendent of Public
Instruction, Safe and Drug-Free Schools Program. Olympia, WA.
3 Bensley L, VanEenwyk J, Schader J, Tollefesen P. (2000).
Washington State Youth Risk Behavior Survey: 1999. Olympia,
Washington: Washington State Department of Health and Office of the
Superintendent of Public Instruction.
4 Adult prevalence was measured using BRFSS, and youth prevalence
measured using WSSAHB.
5 Smyser M, Krieger J, Solet D. 1998. The King County Ethnicity and
Health Survey. Public Health - Seattle and King County. Seattle, WA.
6 DOH 2000. Tobacco and Health in Washington State: County Profiles
of Tobacco Use. Washington State Department of Health, Office of
Community Wellness & Prevention. Olympia, WA. DOH Pub. 345-150
7 DiFranza JR, Lew RA. 1995. Effect of maternal cigarette smoking on
pregnancy complications and sudden infant death syndrome. Journal of
Family Practice. 40(4):385-394.
8 US DHHS 1994. Preventing Tobacco Use Among Young People: A
Report of the Surgeon General. Atlanta, GA. US Department of Health
and Human Services, Public Health Service, Centers for Disease
Control and Prevention.
9 NC11999. Health Effects of Exposure to Environmental Tobacco
Smoke: The Report of the Califomia Environmental Protection Agency.
Smoking and Tobacco Control Monograph no. 10. Bethesda, MD. US
Department of Health and Human Services, National Institutes of
Health. NIH Pub. No.99-4645.
10 US DHHS 2001. Women and Smoking: A report of the Surgeon
General. Atlanta, GA. US Department of Health and Human Services,
Public Health Service, Centers for Disease Control and Prevention.
11 DOH Tobacco Program 'Adult Telephone Survey' 2000-01.
12 FTC 1999. Cigarette Report for 1999. Washington, D.C. US Federal
Trade Commission.
13 US DHHS 1999. Best Practices for Comprehensive Tobacco Control
Programs. Atlanta, GA. US Department of Health and Human Services,
Public Health Service, Centers for Disease Control and Prevention.
14 Hopkins DP, Fielding JE. 2001. The Guide to Community Preventive
Services: Tobacco Use Prevention and Control. Am J Prey Mec!.
20(2s).
15 Peterson AV, Kealey KA, Mann SL, Marek PM, Saran son IG 2000.
Hutchinson Smoking Prevention Project: Long-Term Randomized Trial
5
Tobacco Use and Exposure
updated: 0710212002
in School-Based Tobacco Use Prevention - Results on Smoking.
J Nail Cancer Inst 92:1979-91.
16 MMWR 2001. 'Effectiveness of School-based Programs as a
Component of a Statewide Tobacco Control Initiative - Oregon,
1999-2000' August 10, 2001. 50(31 );663-6.
Tobacco Use and Exposure
updated: 07/0212002
6
The Health of Washington State
Washington State Department of Health
Summary: After presentation
to Port Townsend City Council,
on July 8, 2002
Establish COIDlllunity Visions
· Prioritize Issues (problems and assets)...
ie: Education, Fitness, Disparity
· Who are Partners...
ie: City, County, Hospital, EDC, Citizens, Schools
· Policy Implications and Vision
Funding decisions
Benchmarking
Accountability
Actions: Set Goals
· Data Steering Committee
· Community Input & Work
Focus Groups
Substance Abuse
Seniors
Families with young children
Health care access
· Policy Makers
Jefferson County Health and Human Services
JUNE ~ JULY 2002
NEWS ARTICLES
1. "An Open Letter to the Board of County Commissioners for Jefferson County", P.T.
LEADER, June 5, 2002.
2. "County cutting budget", P.T. LEADER, June 5, 2002
3. "State receives rest of bioterror grant", Peninsula Daily News, June 7, 2002
4. "County backs plan to fight salt water in wells", Peninsula Daily News, June 11, 2002
5. "Jefferson health, law officials to discuss public-nuisance controls", Peninsula Daily
News, June 13,2002
6. "County rolls back 2002 budget", P.T. LEADER, June 12,2002
7. "County plans crackdown on dumping", Peninsula Daily News, June 14-15,2002
8. "Some vaccinations excused", Peninsula Daily News, June 14, 2002
9. "County's new garbage ordinance finally has 'teeth"', P.T. LEADER, June 19,2002
10. "County health budget cut", P.T. LEADER, June 19,2002
11. "Health forum offers Clallam snapshot", Peninsula Daily News, June 25, 2002
12. "Dozens of smoke-free establishments listed in report" and "Most Stores don't sell
smokes to kids", P.T. LEADER, July3, 2002
13. "County faces widening revenue gap", Peninsula Daily News, July 1 0, 2002
14. "County changes budget style", P.T. LEADER, July 10,2002
15. "Have, have-not gap widening in PT, county", P.T. LEADER, July 10,2002
I
An Open Letter to the
Board of County
Commissioners for
Jefferson County
Commissioners:
As you consider reductions in the County
budget for the second half of2002 and 2003,
we urge you to:
· Clearly communicate with the public
about which services you intend to reduce
or eliminate, and how the community will
be affected.
· Commit to holding future public
hearings at times when most working
members of the community can attend,
including County employees.
· Work with the unions that represent
County employees to preserve services to
the community.
From Jefferson County Employees
Represented by United Food and
Commercial Workers Local 1001
"0 ~S' -0 '2-
7>. T. LeA [J FfL.
-I'
~
County
cutt~g
budget
Jefferson County's budget roll-
back will be $30,000 shy of the
. $900,000 target the county com7
missioners aimed at, but that's
close enough, particularly because
about $300,000 of thè cuts were
meant tö restore reserve funds
dipped into late last year to bal-
ance the current budget.
- The county plans to, pare the
$12 million general fund budget
as a result of à weakening
economy ¡µ1d~e absence of state
funding due tb cutbacks by the
Legislatuie earlier 'this ,year. ,
The c~minissióners are also
likely to deèide to spend as much
as $50,000 for a capital facilities .
study of the Tri-Area. ' ,
The coriunissioners conducted
a' budget workshop ànd public
hearing May 29 on the proposed
budget cutS. Some final details of
the amended 2002 budget had ye~
to be worked out, but cutbacks
amounted to a total of about
$870,000. The commissìoners ex~
pect to have the finalnumbei's
Monday, June 10, 'and could ap¡
prove the amended budget at that
time. '
"
'f·T. LGAD:GR-'
I£; ~5~- O::L-
3
State receives rest of bioterror grant
U.S. to release remaining $16.5 millión
after reviewing attack preparedness plan
The money is part of $1.1
billion in federal bioterrorism
preparedness grants to states
and U.S. territories. Besides
helping states prepare for
potential attacks involving
infectious diseases, the grants
will improve the ability of hos-
pitals to deal with large num-
bers of casualties from such
attacks, as well as improving
THE AsSOCIATED PRESS
WASHINGTON - Wash-
ington state has turned in a
solid bioterrorism response
plan and will receive the
remaining $16.5 million of its
$20.6 million allocation to pre-
pare for a potential attack,
Health and Human Services
Secretary Tommy Thompson
said Thursday.
./-
fY1) J
fo~1-{J?-
disease surveillance and
reporting.
Part of national grant
The grants were authorized
under a $2.9 billion nation-
'wide bioterrorism plan signed
into law by President Bush in
January.
States were asked to submil
plans for using the grant
money by Jan. :J l. and all were
given 20 percent of tlwir allot-
ted funding at I.hat tiIllL'.
Washington was one of 24
states whose plans were fully
approved, so it will get the
remainder of its allotment,
Thompson said Thursday.
Washington gets a total of
more than $18.1 million for
general bioterrorism funding
from t he federal Centers for
Disease Control and Preven-
tion in ALlanta.' In addition,
the st.atL' gets more than :J;2.fj;¡
million for regional ho,.;pitnl
plans to respond to a biotel'-
rorisrn attack.
en
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Port T ojVnsend & Jeff~rson County Leader
County rölls back 2002 budget
By PhÚip l. Watness
Leader Staff Writer
Jefferson County's budget
rollback will be $30,000 shy of
the $900,000 target the county
commissioners aimed at, but
that's close enough, particu-
larly because about $300,000
of the cutbacks were meant to
restore reserve funds dipped
into late last year to balance the
current budget.
On Monday, the county pared
the $12 million general fimd bud-
get as a result of a weakening
economy and the absence of state
funding due to cutbacks by the
Legislature earlier this year.
The commissioners also ap-
proved spending as much as
$50,000 for a capital- facilities
study. . of the Tri-Area
(Chimacum, Irondale, Hadlock)
in the amended budget. The study
must be done before they can
establish an Urban Growth Area
in Ironqale aDd Port Hadlock.
The commissioners settled on
$826,844 in cuts following a
public hearing and workshop on
the amended budget held May
29.
In early May, the commis-
sioners decided to not fill open
positions and to layoff two
people - a courthouse security
guard and a deputy prosecuting
attorney. Prosecuting Attorney
Juelie Dalzell proposed other
cutbacks, however, averting the
latter layoff, while Sheriff Pete
Piccini said he plans to hire the
security guard to temporarily fill
a position available due to the
retirement of one of his staff
members.
Employees in the offices of
Auditor Donna Eldridge, Asses-
sor Jack Westerman III and Trea-
surer Judi Morris won't have to
give up pay because the elected
officials volunteered to take 4
percent pay cutS instead.
County Administrator David
Goldsmith said Monday he met
with representatives of the Teám-
sters union and the United Food
and Commercial Workers union
June 5 to discuss impacts on their
members.
"Because management and
elected officials took more than
the 4 percent in cuts through vol-
untary salary cuts and through
eliminating a couple of positions
and clerk hires, that meant less
than a dozen workers will expe-
rience a loss of hours," Gold-
smith said.
The Department of Commu-
nity Development and the
sheriff's office gave up the most
ìn dollar amounts, $69,596 and
$63,071 respectively, closèly fol-
lowed by Superior Court
($57,754) and Juvenile SeIVices
($52,660).
The cuts establish a new base
budget for next year as the com-
missioners turritheir attention to
eliminating programs that aren't
mandated by state law, such as
the Parks and Recreation' Divi-
sion of PublicWorks,theAni.mal
SeIVices_ Department - and other
programs. The commissioners
have: expressed ·an i~terest in
making substantial, sustainable
cuts to match the revenue stream
with the expense stream, particu-
larly regarding personnel costs,
which have traditionally in-
creased at a faster rate ilian in-
creased revenues.
The commissioners have
also discussed whether to raise
property taxes by reaching
back in time to tecapture prop-
erty tax increases they had pre-
viously voted against
imposing: They have said they
would support placing a mea-
sure on the ballot which would
ask voters whether they ap-
proved using the "banked ca-
pacity" property taxes for
specific purposes, such as
fimdÍng re.Creation programs.
- -
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'June 14·15, 2002
7
County, plans
crackdown'
on dumping
Illegal septic
systems also
criminal targets'
./
By STUART ELLIO'IT
PENINSULA DAILY NEW~
The Jefferson County Board of
Health is developing an ordinance
that would crack down on properties
that ·illegally stockpile garbage or
have ongoing septic violations.
A so-called "nuisance abatement"
measure under consideration would
introduce property owners to fines
and appearances before a judge if
junked properties aren't cleaned up.
The ordinance, being drafted by
the Department of Environmental
Health, would targét offenders who
repeatedly collect mounds of
garbage on their property or dispose
"-
./-
of human waste improperly, among
other issues.
Currently, the county only mails
out notices to alleged offenders.
Some don't pay heed.
"It was triggered by the board's
concerns about long-term prob-
lems," said Larry Fay, Jefferson
County environmental health direc-
tor.
"Basically, this will get people in
front of a judge.
"It shows them we're willing to go
the whole nine yards."
Fines of up to $250
The ordinance could mean fines
of up to $250. In some instances, the
county would get .permission to
cléan up sites from a judge and send
the bill to the owner, Fay said.
The ordinance, discussed at a
Board of Health meeting Thursday
could be in place by the fall. '
TURN TO DUMPING/A2
Dumping: Violation types
their property.
Others dump illegally on
property on which they tres-
pass, Fay ,said. Former Pope
Resources land is a popular
choice.
Jefferson County Chief
Civil Deputy Prosecuting
Attorney David Alvarez, who
sends letters threatening
criminal prosecution to
chronic offenders, said some
"have a 'come and get me' atti-
tude" which he attributes in
part to "libertarian political
beliefs or hermit-like atti-
Some violatj¡ms occur when tudes."
RVs are set up permanently on "They are the pard-core
a property ora shack is built offenders that we could be
without a septic system in more proactive about,"
place. Alvarez wrote in a memo.
That can result in substan- Fay said offenders would be
dard outhouses or people subject to a series of tickets at
dumping raw sewage on their first. Cases would progress
property, Fay said. from Jefferson County District
Garbage violations typically Court to Superior Court if res-
involve those who don't have olution isn't achieved.
garbage collection service and '.' The cO';lnty is also looking
allow their refuse to pile up on at regulatIOns that would tar-
CONTINUED FROM A1
During the past year, there
were approximately 80 com-
plaints to the Environmental
Health Department regarding
jùnk and garbage.
The majority of those
about 65 - were dealt with,
but around 15 illegal garbage
sites remain.
Fay said they include sites
in both the rural and urban
areas of the county.
Violation scenarios
get junk yards, improper set·
backs and illegal structures.
Those rules would enforced
by Jefferson County planners,
but Alvarez saìd that county'"
staffers "have expressed their
reluctance to add enforcement
duties to their already long list
of duties."
Hiring an enforcement offi·
cer is another idea.
But its likely the coun1Y
doesn't have $50,000 to spare
with the current budget situa-
tion, Alvarez said.
Fay said that several other
counties in Washington have
recently moved forward with
nuisance abatement regula-
tions, including Kitsap, Pierce
and Klickitat counties.
He saï'd the Jefferson ordi·
nance would resemble the Kit-
sap ordinance.
Fay said his staff has been
working on a nuisance abate-
ment plan since March.
!èiiu5'etl
Medicine shortage means dela~
doesn't affect 'primary' shots
BY STUART ELLIOTI'
PENINSULA DAlLY NEWS
A continuing nationwide
vaccine shortage means chil-
dren entering schools in Jef-
ferson and Clallam counties
are temporarily excused
from getting certain immu-
nizations, the state Board of
Health decided.
Dwindling supplies of
vaccine for DtaP - diphthe-
ria, tetanus and pertussis
(whooping cough) - booster
shots mean students will be
able to enroll under "condi-
tional status" without those
shots this fall.
After the shortage
When the shortage is
over, children on conditional
status wiU have 60 days to
bring their immunizations
up to dElte, said Dr. Tom
Locke, h~.alth officer orClal-
lam and Jefferson counties.
Locke, who discussed the
vaccine shortage at a Jeffer-
son County Board of Health
meeting Thursday, said the
shortage won't pose a seri-
ous health concern in local
schools,
"Parents should not be
concerned about sending
kids to school," he said.
"The increased risk of see-
ing a whooping cough out-
break is very small."
Tetanus can't be trans-
mìtted person-to-perspnLn&
classroom setting, Lock~,
said. Diphtheria waslast
seen in 1985.
The shortage only applies
to the fourth and fifth.. '. .... ....
booster shots som!:! stùdentsJ. .
receive prior to entering
school.,
It doesn'tapplytot4~.'
first· three "primary"sijqp
of the vaccine. .... .' .... .
Not receiving the fqurth
and fifthbòost,ershots I.TItl1;
mean the vaçcine is les~ .
effective in lQ l?~rcent t,0W,
perceIlt of thbsèwhocalt~.~~~;Y
havet,he firstt,hFee s~ots.; ." .,.
Locke estimated that 85
percent of chì1drenirì CJåbY
lam and Jefferson h&ve:
received fOllfof rþ~ir'.))tal=!
shotsinth~q}~t seyefa1
years of.l!fe, well, b¡:¡fore¡
starting school. ". '.
"Weqo have agp?q.l~0~1
. ofFmelyoyaccintlt,iqll!>; ",þ~::¡
said. . .
Overall, students must
receiveyacdl'lati()ns fOr
hepatitis B'polidand
influenza B bacteria that
can lead to meningitis,
measles, mumps and
rubella.
Improvements cited
Locke said there had been
major improvements in ,
recent years in the percent-
age of kids entering school
"Parents should 'not be
concerTled about sending.
kids to school. The: .
. increased risk of seeing a ,
whooping cough oútbreak
is very small. ) .
, DR. T()M LOCKE
c. .. c' he~Jthòfficer,
. ClaUàm and Jefferson counties
EX~,~ptlons aI!Ç>V'~ c.:
Parent$ 'can exempt their
childreq from. Val) '. ions
, forieU'giðus;méç!,i
philoßophical reM . :~,
B\.it Locke . ,ep;j',.':Yas '.'
";'~$Q:c?ncerri:~, "".,' PWz~Ílt~ ;"
.··.slgmng the exemptlçmto' . '. "
.: "rush their kids into., '
. :.school. " . "" .....
, ·'!We wanted'tom4kesure.
parents making informed
decision," he said. . .'
Partially as a result of a
public outreach campaign,
that number had dropped to
5 percent of all children who
were not immunized this
'past September.
Things are heading in the
. other directiçm in Glallam
County, however.
g;
FRIDAY, JUNE 14, 2002 Ail
The number of children
. wl1ohE!ven't been fully VE!C-
,cinâted has increas.ed over
.' thêpast several years, Locke
, said.
"It's almost a whple dif·
ferE1tltstory/' Locke said.
.' Statistics for Clallam
County weren'timmediately
. av¡¡"jlable Thursday.
Record-high nationally
:)qyerall, natiomvide vacci-
1).ationlevels ~reat a record
hig-pt
"This protection allows
us to delay some vaccina-
tións," Locke said, "but we
can only coast on past suc-
, ¢Ë§$¥~S91ol)-gi".>.. '.'
Ci, t;oç.k,rsa}dtheshortt;lg~Qf
'vaccines h.a'speen aj)roblem
that has beellþµildingJor '
the last ryÝPYelfrs, but"only
recentlycaÌneon the
na t.io;l}~lrE!darscreen.!'
Mä~Þ~rtly a resµltpf a
d~çt~~,sein the number of
U.$~:mà,Pufacturers of.yacc<:
ciné~·..>·..·b!'Jcause t4e,vaccine.'
pusil)-eês is'nptprofittWle--
and becàuse of recen,t· qual~
ity a~suranc~prP9lems,,;/; .'
.'i; ~()~~e:to¡d;¡;h~;$~qttl(!;
''J)mesthilt thei:!hortage'wM
'~a national disgrace" and
said the federal government
should have a stockpile of
vaccines in reserve for when
the market fails.
Locke said a French man-
ufacturer was currently
'stockpiling large portions of
the vaccine and that short-
ages could be Qver by the
end of the year.
A 14 · Wednesday, June 19, 2002
County's new
garbage ordinance
finally has 'teeth'
By Janet Huck
Leader Staff Writer
,,-
Sometimes, neighbors finally
get fed up and file a complaint with
the county about black bags of
household garbage strewn over a
yard, stashed in an old car or fill-
ing an abandoned trailer. When ap-
proached by a staff member of the
Jefferson County Envirorunental
Health Department, many such
property owners clean up the
garbage and overflowing septic
systems.
But a few "hard core" offend-
ers have thumbed their noses at
COlmty Mes. '
'These remaining offenders
typically have a 'come and get me'
attitude based in part on libertmian
political beliefs or hennit-like atti-
tudeSl-and ignore the letters [we
send]," said David Alvarez,
Jefferson County's chief civil
deputy prosecuting attomey. 'They
are hard-core offenders that we
could be more proactive about"
The Jefferson County Board of
Health decided to crack down.
Board comÌnissioners asked Envi-
rorunental Health officials and
Alvarez to fónnulate a "nuisance
abatement" ordinance that would
authorize tickets, fines and even an
appearance before a judge if gar-
bage-strewn home sites aren't
cleaned up in a reasonable amount
of time. The new civil service or-
dinance, now being drafted by En-
vironmental Health, could be in ,
effect this fall but first must be au-
thorized by the county commis-
sioners.
''We needed something to make
our authority stick," said Larry Fay,
Environmental Health director. "It
would only have teeth if we are pre-
pared to go all nine yards."
"We could never
get any of the.
cases in front of
a judge before.,
This new
ordinance is an
expedient way to
get them in
" " "
court.
Larry Fay
director
Environmental Health
Jefferson County
Alvarez recommended the fol-
lowing outline for the ordinance:
If an enforcement officer finds "just
cause" and the property owner
doesn't respond to letters and vis-
its, the officer can, under the ordi-
nance, write a citation that is filed
in Jefferson District Court within
48 hours. If the person contests the
order, the defendant may hire a law-
yet and request a bench trial in
which the judge has the sole power
to make decisions. If the judge de-
tennines that an infraction did oc-
cur, he can levy fines ranging from
$25 to $500 per infraction, accord-
ing to the Alvarez memo.
In the past, Environmental
Health could only order cleanups
but not enforce them. A compli-
ance/abatement program for solid
waste was created last February in
the envirorunental department that
uses a series of carrot-and-stick let-
ters and visits.
In the last five months, Molly
Pearson, environmental educator
I
and technician, documented 84
cases that had been reported, Usu-
ally by neighbors who can remain
. confidential. Of those 84 cases, 56
. cases were abated and closed
through a series of letters and vise
its. Several property owners signed
up for future garbage service. Nine
illegal dumping complaints were
investigated and abated. Four were
commuruty-sponsored cleanups
such as the Dabob Bay cleanup.
However, 15 violation investiga-
tions are still ongoing.
'There are a few tough nuts,"
said Pearson.
Some people consider Linda
Sexton a tough nut. Ever since the
mid-1970s, there have been com-
plaints against the Chimacum resi-
dent who collects garage sale
leftovers, spring-cleaning clisc:ards
and jettisoned building supplies.
Even though Sexton said, in a 1998
interview, that she was a Onistian
who believed hard times proph-
esied in the Bible will come - and
her collected goods would eventu-
ally be needed as people struggle
to sUIVive - the county has ordered
her at least twice to clean up her
"excessive" collection. In 1977 and
1997; the health dëpartment also
ruled she was operating a solid
waste facility and ordered her to
apply for a pennit She appealed
the 1997 ruling, but her appeal was
derued. A stalemate ensued.
When asked if the new ordi-
nance would handle the
department's enforcement prob-
lems with Sexton, Fay said, "I'll
let that slide."
However, Alvarez thought the
hard-core offenders could be
handled with the new ordinance
that sends recalcitrants to District
Court.
"We could never get any of the
cases in front of a judge before,"
said Fay. "TIlls new ordinance is
an expedient way to get them in
court."
/D
,r-
County health
budget cut
Editor, Leader.'
I read with Ï11terest the story in the
June 12 Leaáer conceJ;11ing,the budget
cuts that Jeffersõn Ç,ounty departments
are facing. However, I was dismayed to.
see no reference to the significant reduc-
tion in cOunty expenditure in Health and
Human Services.
Health and Human Services. has a
$3.7 million dollar operating budget, of
which about $750,~ comes ffomtbe
county general fund. With the action that
the Board of County Commissioners
took on June· 10, th,e county contribu-
tion was reduced by nearly $150,000,
or about 20 percent. This reduction will
have an impact on services available
from the Health Department, including
the elimination of flu vaccination clin-
ics and reduction in clinic sites in Fam- ,
ily Planning.
I know, tliat the county is straggling
with~¡m.àjôtfi.$ëá1é1iåuengès righf riow.
These cötrtments'åì'è' ribt lrÙèntlë¿rto
miniliùze. the sacrifices that other depart-
tnents are being forced to live with. As
a member of the Board of Health, I am
simply' concerned that anyone reading
the article may not be aware that the
, Health Department budget has beencut.
as well.
ROBERTA FRISSELL
Port Townsend
rpr: lE7A-DE=~
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Budget: General fund in decline?
CONTINUED FROM Al
Several measures used to fix
an $800,000 shortfall in the
$12.1 million budget for 2002
will be kept in place, officials
said. And about a dozen
unfilled positions will remain
vacant.
Belt-tightening measures -
everything from cutting office
supplies to out-of-state travel
- will be also be enacted,
Rowe said. But 4 percent cuts
" previously directed in
employee salaries and hours
will be restored. .
A decline in projected rev-
enue growth for 2003 is one of
the key reasons for the reduced
budget.
General fund revenue
growth, comprising largely
property and sales taxes, has
gone up apprmdmately 4.9 per-
cent annually for the last five
years, Rowe said. But it's only
expected to increase a· net of
2.4 percent annually for the
next five years, Rowe said.
"The downturn in the state
and laca] economy has had a
significant effect on retail sales
tax revenue and timber har-
"est taxes." nowe said.
~)
Interest on county invest-
ments has also dropped dra-
maticaJly, with projected rev-
enue from investments in 2002
expected to be 25 percent
lower than last year.
Fees offset revenue losses
The losses have somewhat
been offset by fees collected by
the county, which have gone up
19 percent in the last year,
Rowe said.
The Department. af Com-
munity Development colleds
about 90 percent of license and
permit ff'PS gflt.hf'rf'rJ hy the
county.
The county reserve fund is
also strong, he said.
At $2..'5 million, ifF ahout
dödble the 10 percent reserve
goal previously set by eommis-
sioners.
The economic situation may
also be improving, Howe said.
Earlier this year, commis-
sioners trimmed the current
fiscal budget to $11.3 million
to match revenw'.
But Rowe f'airJ it looks like
revenue could climb to $J 1.6
million by the end of' the year.
I nerenses cou Id he d1il~ to
excise tax on timber sales,
which may be experiencing a
turnaround, and increased fed-
eral payment in lieu of taxes,
called PILT money, for lands
owned by the federal goven-i-
ment in Jefferson CountJt .
COl,1nty administrators also
said in April that they expected
about $11.1 million in revenue
in 2003 - $1 million short of a
$12.1 million projected budget
at the time.
But expected revenue has
since been revised to about
$11.5 million for 2003.
Budget goals approved
In. tHe budget goals docu-
ment approved Monday, com-
missioners said growth in gen-
era] fund property taxes will
not exceed 1 percent next year
- the 1 percent cap is required
under Initiative 747.
And "banked capacity"
taxes wiJI be used only for one-
time expenses that are for a
speci/ic duration.
A one-tenth of 1 percent
increase in sales tax, which
wou Id generate about
$220,000 to cover the cost of
juvenile detention, will be on
the ballot for November, com-
missioners said.
In a break with how bud-
gets were prepared in the past,
county departments are being
asked to adapt their financial
plans to existing resources.
Commissioners settled on a
model Monday for how to dis-
tribute general fund money to
several different "functional"
areas.
Approximately 41 percent
of the budget will cover law
and justice expenditures,
which include the courts,
police and prosecuting attor-
ney's office.
Approximately 19 percent
,will cover general government,
including the assessor's, audi-
tor's, county administrator,
commissioners' and trea-
surer's offices as well as other
departments.
Close to 12 percent goes to
public services, which include
departments such as parks and
recreation and community
development.
Other categories include
non-departmental expendi-
tures, 15 percent, and operat-
ing transfers. 13 percent.
I: ~
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A 8 . Wednesday, July 10, 2002
/
"Cõunty chaD.g¢Sj~1Jdg~t~~t~Jé
R~ye l ueforeca~~&Ot~ri¥~',9)eR9rttn~Dt:~R§Qdj n9 ,
8y Philip L. Watness ' forecast. Any programs or serf. i ....bµdget ça:Jl" Món~ày in which ,;. nicreåtion,:and community de- .
Leader Staff Writer . vices that aren't covered by šò::J 'departments were officially in" velopment ~ 10.69 percent.: , ,
called "..shared·; r~sources"., forme~ of thè (imeline'for pr'o-' .:;. Non~deþartmentàl overhead '.
Jefferson CountY departments' (propertyllijdsales: taxes) V¡'ill, vi ding prelimina'ry budgets ".:...14.75 percent. .... ¡ .' , . ,
will shift the way they dev~lop' havetobecoveredbyothei:f¡.u¡ds "<f\µg:.1.2)and}inal'b~<!g;t 'j ,·'.'Operating transfers'to the'
their annual budgetS following a - either fees, ~es.or grants. - h,eårings (Oc t." 7 -11)'.; The 'health qepartIl1entànd public .
direcûve issued'Monday þy the The ~ounty .~q!l1l11i~~i9.nt;rs:,; ti~eli~eitself.h~s been mov~d :, works -.13:34 percent: ,', ".
county 'commissioners; The. also unanimously.; adoþ~ed"': forward from' previous years; ~ ,': "We're saying to departrnents', "
change is based on an eXP,ected goals and objectives ,fqr the with the goal of approving the I' 'We only have so much rèsources ;
2003 general fund budget of ~003 budget as. a formal'reso- budget Dec. 16. '.' . ~ I, '; to go arourid,'so build your bud-
$11.43 million. " . ,lution. One signifi~~nt ,~bjec-. , ',.', ,. " :: gets based bn that,not on what
No longer will departments" 'tive calls for the co.unty,to ,: Buôget breakdown; , · you've histori~ally spent,'" Rowe
; '~~art, the,budge,ting proces~:bYf e$tablish separat~, (unciin,g :fo\., , The còunty commissioners .. saíd: ''The flip side is if the state
t looking at, thepreviòus year's 'Ani mal, Services, ,Parks and,: settled ,on usingth~ currerit'dis- ,', gives them more O1òney, they can '
)njclget, Instead, the county com- ,Recrea~ion,Çqn:1I1;lUnity D,eYe17, ,tribuûon ,of shared resources for budget for that." ¡
¡;i1išsioners will let them· know opment and:Coop~rafiŸt~ ~x-, 2003.. Deputy CoùntyAdffiinis- 'j ": Departments can secure
what percentage (.>f tax rev.enue tension r~tþer ;t~an :co~~in.ue· trat()r G¡µ-y Row~ provided the ; grants, impose fines or raise
'they can expect to receive, and using general fund r~Yenue. , . commissionerS a breakdown of ' money through fees to cover ad.
the departm~nts will have to,base AudiW DOnnaEldridge !s~ .budget., allocations directed to ,ditional expenses beyònd those
their budgets on that revel1,ue" sued th~}t~tu,~orpyrequir,ed, ; fivefunclional are~s",T,heir. ¡ c.o:r~red,by tax revenues. For in-
, , , ' j, 'f, . sha}'es c.>f.the general í\1nd tax pie' \' stànce, the law and justice area
are:. ,~: ',',;. i,s expected to spend $5.4million
. ' Lay.'andjusûce, compnšing 'in'2oo3, butóIilY $3.54 million
superior and district courts, ju- ,wil(come from: tax ~eYenues.
" venile and famµy court servi~es. 'Thatme~s' the crirrÜnal justice
: ,sheriff's office arid,prosecuting sy~terj¡ mus(find $1.8 million
. attorney - 41.84 pe~cent.' " from other sources, including
. General goverI}ffient, com- coî'I!;t, fines' and, state or' federal
prising the departments ofaudi-' grants:', '
tor, assessor,treåsùrér, cOllnty;" ':"Wäè eni:;u~aging collabo-
comnÚssioners' anó c9u,iliy:,ad- "raûon in' this maImer; much like
miIÙstrator -19,37 percent.' "we've åJieady seen in the law and
. Public services,inclúding'.justice area," Rowe said.
planning comnùssioIÌ, parks and' ". ,.. .:, "
, ,:', '.' "L~ss¡'eýènue expect~d
. ' .Ro~e said his budget forecast
;'in~i~aies: ie!fèrson County will
, have less re,venue in 2003 than
"it 'expected,ln2002.alIhough
revenue ,from several sources
¡;)¥ill be greater next year, specifi-
"cally federal, money provided
:couniiesbased on the anlOunt of
acreage owned by the U.S. gOY-
',enµnent (p~u'ks: forests and wil-
>4erness areas) under a program
,called Payment In Lieu ofTaxes.
Salès taX receipts are expected
:to be'$120,OOO lower than they
were this year, however. Timber
harvest taxes were also 58 per-
,cent below projected revenues of
'$213;160 in2002; though they're
,'expected to rebound next year..
'The countyþas' also seen its re-
turn qn InyeSIments plumn1et
since 2001, 'dropping from oyer
, .$6~0.0Q0: iIi 'eárly200Q'1o' a pro-
"Jeëtèä'~456,OOOthis yêar:""" ..
, CQuniy 'department heads
willhave a 4 percent salary de-
crease restored for 2003, Rowe
said. Elected oftìcials and de-
partment duectors agreed to ¡he
4 percent salary rollback durin<>
, the second half of this vear ¡i;
~rder to help bring Ihe ~urrenI'
budget into balance. ,
]--/ð-Ó:L-
./-
Haver'liå¥e~UQt:gap },
wideniQg !1},I!,T1 ,EßHP!~~';¡j
By Philip L Watness ' , , said the survey results c~ be "
Leader Staff Writer ,Il,C, hildr.:en,u, ''rider,' used to prioriti~eprevention ef:
forts,,:particularly among young
Young families in' Jefferson '¿]S" 'a,',ré1i1~,C,)l:mOre children living at or below the
County have it bad. That com- national poveny level.:: '
mon knowledge has been con- :', likely to be living . "We have a lot~ofthings slip-
firmed by' ån intensive' survey, ,';,' : ,z'n , a' ,h,o'"U",' 's,'e', " h' 'o',ld' ',' "ping away quickly," she said; ''It's
conducted for the Jefferson very, very inexpensive to intervene,
County Health Department, by {vit"hwHa," t S, 'at a yowig' ag'e, buti,t's veiy;very
epidemiologist Chris Hale:: expensiv,e by the ~ the kid is in '
, Hale presented a synopsis of 'e'" c_,ò,n~,.ider,ed an the juvenile justice' systel1}>:'
the Behavioral Risk Factor Sur- ': Councilor (Jeoff Masci~ said
vejllance System (BRFSS) study ,,'\ ';~aþ: jis k~ :ádul t, ' he hoped the Çity' CO,uncil would,
Monday to the Port Townsend','"Th'dt'Sihe~rèvêrSé!' CthOenScioduenrtybUhdegajetthingdempartm0neYenft~sr ..'
City Council. The council con- '
tributed $.50,000 to the two-yeaf :o.f W, hat Y"o, U,',d, l,l,',ke early prevention programs; par-
, study, cóndùcted by Hale and As- 'J, ticularly because federal and
sociates Inc., Hale's consulting tose~ in' a more state goverruT1ents are providing
1irm. less money for those programs.'
The study also ìi1dicats:,s that perfect world:' ''The city may need to step up,
, elderly residents..while thèyacefar . and fund those programs," Masci
bet~toff both physically and fi~ Chris Hale' said.' "If we're going to affect
nanciallythan young families, ' epiden;¡lologist future generations in a positive
face sigiUficanthea1th care issues, manner, we have to fund pro-
particularly as the federal govern- grams for the long term."
ment considers rolling back cov- housing prices ~titsÌrip the state- ' Mayor Kees Kolff, Councilor
, , erage ¡¡nder the Medicaid and wide average while the median Michelle Sandoval ami Masci will '
M~care' jJrograms, she said.' ' household income con,tinues to lag meet as an ad hoc committee to
¡ , The news for children is per- behind the state averagè:Tliat's review the data irigreater detail
! ,haps the most dire element of the even mcire telling cif the plight ôf and discuss strategies the city CaIJ .
survey results, Tobacco smoking 'young folks in light of Ù!e fact'that, implement to counter some of the
.. and heavy alcoHolic consump- the statewide average is skl:wered, more' negative realities.
, tion are more common in house- by the huge þQpuJations in King.
' holds which include children PierCe a!Jd Snohomish èounties. ' Resident focus 'groups,'
younger than 18 than in hou,se- Tlie,~tudyfouÌ\c! thatthe$ame' The count¥ healtJ! departmeni
holds without children. 'statistics apply wheth':r living in' also plans to put together focus
Another disturbing revelation 'rurãl Jefferson County or Port groups in which residents,health-
is that a higher percentage of Townsend. Usi¡¡g !,he 98368 zip care providers, school representa-
households with children under code to cull statistics for the City, tives and poJicy·makers'will
18 than those without children Hale showed that city residents discuss portions of the findings
had adults in the home who siÜd 'and: coUnty inhabitants' are 'not with an eye to prioritizing needs
they had experie,nced physical or significantly different in educa-; and establUihing responses,
sexual abuse as children. I.\on, aIcohol cOlJ.Sumption or ex-, ' : "'We now,have a baseline, and .
"Children under 18 are much ercise patterns," we need to prioritiie our goals
more likely to, be living in a house- , ,The county as a whole looks and'decide what's acceptable,":,
hold with what's considered an rem,arkably healthy; ,\vith life ex- , Baldwin said. "Some bf the di~
'at-risk' adult," Hale saìd. ''That's, pedancy reaching levels only' reètions Men't for ¡>blicy-makers,
'the reverse of what ,you'd like to seen in European countries, Hale such as deterrnini¡¡g'the accept-'
see in a more perfect world.": siúd. Residents also look more, able level of senior suicide, tee~ '
Younger adults are incrells- continental in their alcohol con- pregnancy and alcohol use." "
ingly unable to afford to buy sumption patterns, with frequent:' Thos~ are societal issues';;
homes as the county's median but moderate alcohol Use. Baldwin said, tha.t are best ad- :
The latter, concerns Hale, dressed through commuriiry en~ '
however, who wondered whether' gageme,nt. ¡.. '
children are getting,the,meSsage', "'The issue of less Medicare;' ,
tha.t .-alcohQ\ ~eì isi ¡in accepted ~ ' and 'Mçdjcaid reift1þ'~~n}$¡¡¡3~ _
'beh'lv,Î,QtprJ,hal ;ycQl\QLis,appÚh for i~,s~~,nce, can' best ,be- ad~;
priate in llÌoderation.," ::' ' dres,sedtliroughr~sidents!con<
' , ' ' tacting their congresÚonal
Older population,;' delegation, HaJe said; " ~.
Hale warned of "a demo- / ''They'need to tèll theirrepre:
graphic timebomþ" due to the ex- sentatives and senators : that
plosion of elderly residents' changes to'Medicare Will hit
moving into Jelferson County.' home here," Hale sajd,
particularly those 85 years old or, Bàldwin said the health de'
more. partmentwill incorporate addi: '
"In only three counties ,_' tional data collected in October
'Jefferson, Clallam and San Juan during a countywide survey of
- do you see the in:¡njgra¡jon of grade and high school student.Ì
,much older age groups," she said, regardïng.their use of alcohol,
''The most rapidly growing por- tobacco and drugs. The "healthý ,:
tion is the'people 85 years old youth" survey will provide a,
and older, and that has very im- more complete picture than the
portant implications for your BRFFS, Hale said.
public health services," "We know about adult health
.' Jefferson C;ounty Community risks. out we don '[ have the kids'
Health Director Jean Baldwin risk behavior," she said, '
!'
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1--10 --0 2-
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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
June 21, 2002
Dear Congressman Dicks:
This country is rapidly developing a crisis situation regarding childhood vaccines. Over the past two
years, shortages have developed for vaccines that protect children against measles, mumps, rubella,
diphtheria, tetanus, whooping cough, chickenpox and pneumococcal disease. The health of our
children is being placed at risk by deferral of recommended doses of essential vaccines. The progress
that was made over the past decade in improving childhood immunization rates is being eroded.
Vaccination has been repeatedly shown to be among the most effective and cost-effective disease
prevention tools that we have in medicine and public health. We strongly believe that you must make
it one of your highest priorities to ensure a reliable supply of vaccines to protect our children ftom
diseases that continue to cause millions of deaths elsewhere in the world and could do so again in our
country as well.
Behind this impending crisis are economic forces and a ftagile vaccine manufacturing system that is
increasingly concentrated in a small number of private companies. Since 1967, the number of
companies in the U.S. producing vaccines has fallen ITom 26 to only 12. Moreover, several essential
childhood vaccines are produced by a single manufacturer in the U.S. Because of the current
shortages and deferrals, immunization schedules are being disrupted and many children will never be
fully immunized. We are aware of the Congressional GAO study of the impact of these shortages,
which will highlight the nationwide threat to our children. This is a situation that must be addressed
and we believe solutions can come only ftom the national level.
As members of the Jefferson County Board of Health, we urge you to take leadership measures quickly
to address this developing crisis through whatever means are necessary. The health ofthe children of
our nation depends on your action.
Sincerely,
Sheí{a Westerman
Sheila Westerman
Chair, Jefferson County Board of Health