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Home My WebLink About08 August JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, August 15, 2002 Board Members: Dan Titterness, Member - Counry Commissioner District #1 Glen Huntingford, Member - County Commiuioner DÙtrid #2 Richard U7qjt, Member - ComIty Commissioner District #3 Gec1frey Masci, Vice Chairman - Pori Townsend City Council ]ill Buhler, Member - Hospital Commissioner District #2 Sheila U7esterman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (County) Staff Members.' .Jean Baldwin, Nursing Services Director LArry Fcry, Environmental Health Dimtor Thomas Locke, MD, Health qfliær Due to the lack of a quorum, the items scheduled for discussion were postponed to the next meeting on Thursday, September 19, 2002. Discussion was held by the members present (Dan Titterness, Geoff Masci, Jill Buhler, Sheila Westerman, Roberta Frissell). See attached notes. August 15, 2002 Discussion Notes Page: 2 Charles Chase asked for an update on his two~month old complaint about the nuisance property on Egg and I Road. He is concerned about traffic, pollution and well safety because of his neighbor's lack of compliance with on-site sewage requirements and building permitting. He said his frustration with Staff's lack of response might move him to "go public" and to complain to the State and Federal government. As a tax~ paying citizen who has waited two years for resolution to this public health concern, he feels he has no other recourse. Sheila Westerman recognized Mr. Chase's concerns and explained that the Board has been discussing creating a civil penalties ordinance, which would enable Staff to bring violators before a judge. Larry Fay provided Mr. Chase with a copy of the draft ordinance. He apologized for Staff's lack of response and acknowledged that the problem at the site in question persists despite the issuance of two notices of infraction. The first fine has now gone to collection and the second notice for the same violations has been issued. He said that while the civil penalties are limited, they do lay the groundwork for abatement. The new ordinance would allow for as many as three progressive infractions before any abatement. Jill Buhler expressed interest in Staff's process for following up with the complainant. Mr. Fay explained that individuals are given the option of being advised of any actions. Mr. Chase further commented that he, as a taxpaying citizen, is the one being penalized rather than his neighbor (who is also not paying property taxes). He has spoken to the Sheriff and anyone else he can to get some resolution, but has received none to date. Sheila Westerman again recognized Mr. Chase's frustration. She explained there has been action on this matter in the form of infractions. If there is no response to the third infraction, the Board will determine whether to proceed with abatement. She asked Staff to notify Mr. Chase of all actions taken in this matter and invited Mr. Chase to contact her directly if this is not done. Mr. Fay clarified that while Environmental Health is dealing with one or two possible violations (on-site sewage and solid waste), there are a number of planning use and building code violations on those properties that may be out of its control. Everett Koder, of 50 Mustang Lane, said he had asked for a response regarding a complaint that he filed 2-3 weeks ago about his neighbors. He and others also had a special meeting with Larry Fay about this solid waste nuisance property. He detailed some of the many serious issues involving this family, which he has also reported to Child Protective Services and Animal Services. Mr. Koder said his Club is supportive of the Civil Penalties Ordinance. Mr. Fay said there has been some response from this family, whkh is contacted almost yearly for various issues. Sheila Westerman expressed sympathy for Mr. Koder's situation and thanked him for supporting the passing of this ordinance. Civil Penalties Ordinance: Sheila Westerman recognized that changes requested at the last meeting have been made but acknowledged that without a quorum the Board would not be able to adopt this ordinance. Referring to paragraph three of the cover memo, which talks about the term "offense" being changed to "violation" for consistency, Commissioner Titterness pointed to inconsistent uses of "violation" and "infraction" in Section 5. It was noted that since consistency of terms had been discussed by the Board at the last meeting this would not be a substantive amendment for which there would need to be another notice August 15, 2002 Discussion Notes Page; 3 of hearing. Dr. Tom Locke pointed out that with this ordinance the Board is declaring violations of the public health codes to be civil infractions, so the reference to infraction in paragraph 4 should remain. Discussion of proposed changes to Section 5 as follows: · Paragraph 1 - "infractions" would be changed to "violations" and "shall be paramount to" would be changed to "shall have precedence over." · Paragraph 2 - "any contested infraction" would be changed to "any contested violation" Roberta Frissell said she is happy to finally see this ordinancc being finalized. Several Board members expressed their frustration about having to wait to approve this ordinance and it was suggested that a special meeting be called. After an unsuccessful attempt to reach Commissioner Huntingford by phone for his approval, the item was tabled. Mr. Fay noted that this ordinance becomes effective upon the date of adoption. Jefferson County Seawater Intrusion Policy: Natural Resource Manager David Christensen reported that the seawater intrusion provisions in the Critical Areas Ordinance were adopted by the BOCC several weeks ago and will become effective September 21. In areas where seawater intrusion has been shown to be likely, the Seawater Intrusion Ordinance would educate residents about the seawater intrusion issue, water conservation practices, and options for developing their property. This ordinance was based on what other counties are doing as well as input from the citizen-based Seawater Intrusion Task Force. A well with chloride levels over 100 mg./L creates an "at-risk zone" in a 1,000 ft. radius of that well. He noted that "at risk" relates to water quality degradation, but is below any kind of threshold for health risk. People in that zone who want to get building permits would have to monitor their water quality or sign up for a County-approved monitoring program. With annual monitoring they would have to install a flow meter and report water use results to the County. Chloride levels of 200 mg/L or more, though still below the health risk and the threshold of taste, is a definite sign of "high risk" for seawater intrusion. He referred to a map of those wells that have been tested for chloride since 1996 (when data began being collected). In high-risk areas, measures that would need to be taken in order to utilize the groundwater are: a) approval from Ecology to build the well, b) signing onto a water monitoring program, and c) mandatory water conservation. If they already had a well, then a hydrogeologic assessment would be required to demonstrate that use of the well would not further degrade groundwater. While these are the main designations under the program, additional education and outreach will occur through WSU Cooperative Extension. He noted there are inland areas with high chlorides, such as on Center Valley Road, but they are due to connate seawater that was trapped during the glacial period. Use of a well under these conditions would not degrade the groundwater. Mr. Christensen added that as part of policy implications, the Task Force felt property owners should be given alternatives to drilling new wells, so they pushed the idea of alternative water supplies. However, the group was unanimous that from an environmental and public health standpoint, the best alternative is to promote public water from safe, unaffected sources. Therefore, in all of the seawater protection zones, connection would be required where public water is available. August 15,2002 Discussion Notes Page: 4 Larry Fay noted that the ordinance states that those who are in a high risk seawater intrusion zone can develop alternative water supplies if public water is not available and Ecology has not granted a waiver to build a well. Alternatives identified in the ordinance are rainwater catchments, hauled water, and desalination systems. However, because none are established in the ordinance, it may fall to the Board of Health to establish minimum system standards. In doing so, the Board would have to weigh the public health risks of a rainwater catchment system versus drinking salty water. His concern, as expressed in his memo, is whether or not to list as an alternative a system with a potentially higher public health risk. Commissioner Titterness recognized the concerns, but said rainwater catchment systems are at work throughout the world. Geoff Masci asked to understand the rationale behind establishing an expensive rainwater catchment system when you could install a less expensive reverse osmosis system between your well water and your faucet. Dave Christensen explained that continuing to use the well would not protect the groundwater resource and the aquifer would still be impacted. Using the Growth Management Act's resource protection law, the County argued unsuccessfull y before the Hearings Board for the various saltwater treatment options which would present a much lower health risk. Geoff Masci said it does not appear that the Hearings Board ruling used the best available science. He is uncertain how the Board would make an implementable policy and respond to questions from citizens. Sheila Westerman asked Staff to research standards for alternative water systems. Mr. Fay responded that Island County's standards for rainwater catchment systems were modeled after Jefferson County's. Although he will revisit these standards for a qualitative discussion, he questioned whether the Board's desire would be to promote rainwater catchment technology. Sheila Westerman then asked if the County has had specific problems with the few operating alternative water systems? Mr. Fay said he has no knowledge of whether or not there has been a problem. However, the Board may want to consider prioritizing alternative systems - e.g., it may be safer to establish standards for hauled water rather than trusting what comes off the roof. Sheila Westerman asked what would occur if a citizen were to come in today for direction about a well that is unusable? Noting that this ordinance will not be in effect until September 30, Mr. Fay said that the only time the County gets involved with an individual water supply is when someone is applying for a building permit. Someone wanting a rainwater catchment system would receive a list of things to consider, but would otherwise be essentially told they do not need a permit unless they are using that water supply as the basis for getting a building permit. The only law under which the County regulates individual water supplies is RCW19-23~97, which says the County and City or any building official has the authority and responsibility to determine that the person has an adequate supply of potable water for the intended use of that building. Sheila Westerman then asked what would happen if a citizen wanted to build a house? Mr. Fay responded that if a citizen wants to put in a rainwater catchment system rather than a well, the County would say they do not have that option unless it can be demonstrated that the probability of getting potable water from a well is zero. If it can, the burden is on the applicant to design the catchment system. The County's August 15, 2002 Discussion Notes Page: 5 policy is based on performance standards and is not prescriptive. If the citizen goes to an engineer, they will design a system that addresses certain criteria. At that point, the County would record a restrictive covenant with the property title that says that the basis for the building was the rainwater catchment system and attach a copy of the design plans. Jill Buhler said the critical link is in the testing of the water, no matter what the source. With the establishment of a monitoring program for wells in seawater intrusion areas, could the County establish a monitoring program for alternative systems? Mr. Fay saw the question as What would the County do with consistently bad water quality from an alternative system? Currently, we do not know how welI they work, how they are maintained and what standards would need to be considered and developed. To the Board's further interest in why standards could not be developed, Mr. Fay explained that the County lies in an 18-inch rainfall area. A 2,000 square foot house would produce, at most, 30 gallons a day. Issues of water quality aside, this amount assumes highly efficient capture and storage. An adequate supply of potable water is fundamental to public health. Sheila Westerman suggested that the amount considered "adequate" might not be the amount needed, but may be the amount used because it is what is available. She would be happy to research alternative system standards, but is not comfortable rejecting them out of hand. Mr. Fay restated that his memo suggested that the Board begin a review of baseline minimum standards for alternatives systems. The Board will want to evaluate whether it wants to move people from one type of water to another with larger risk. Jill Buhler drew attention to a statement in the agenda packet document of Frequently Asked Questions on seawater intrusion. The last two sentences at the bottom of Page 1 state "Areas without public water supplies can always utilize Alternative Water Supplies which are ALLOWED under the new regulations. Therefore, you have several options to develop your property." Mr. Fay said that under the adopted planning ordinance, it is up to the Board of Health to establish standards for those systems. He suggested that when the Board compares those systems, it should do so against the problem we are fixing. He wonders if the Board should clarify this by saying that even though an alternative is allowed, the Board of Health would not recommend one because it lacks a set comprehensive of standards that would make it safe. Geoff Masci suggested Staff rank the alternative systems in order of preference. Sheila Westerman called attention to page 2, paragraph 4 of the Frequently Asked Questions document, which states "If you are not building a new home, then the new regulations DO NOT APPLY TO YOU. There are no regulations that are triggered at the time a landowner applies for an onsite sewage disposal permit." She felt the paragraph seems disingenuous and asked why anyone would apply for an onsite sewage disposal permit if they did not intend to, at some point, build a house? Mr. Fay explained that this statement was borne out of the BOCC's desire to not have regulations triggered with the septic permit application. Although it was Staff's recommendation to not issue a septic permit without considering other potential development needs on the lot, the BOCC advised the inclusion of a disclaimer with the septic permit which clarifies that this development might preclude any further development. August 15,2002 Discussion Notes Page: 6 Everett Koder noted that their development in Quilcene started as a camp area and still has many lots with septic tanks on them, which are only used once or twice a year by RVs. Dave Christensen said one positive impact of this ordinance is that public water may be coming to Marrowstone Island. Residents there appear to be interested in addressing the water problem with the PUD. 2001 Jefferson County Sexually Transmitted Disease: Jean Baldwin said the purpose of this report is to provide the Board with a program update. In September, Staff will evaluate the Department using the New Public Health Standards, criteria which she reminded the Board it chose as goals during the County's Strategic planning process. One of the Public Health Standards calls for an annual report on communicable disease activity. Staff is now beginning to ensure the protocols are written and that there is follow through on these projects. The Board wi1llikely receive Staff program updates of the 65 reportable diseases bundled into two or three categories. Dr. Tom Locke noted that Communicable Disease and Immunization Coordinator Lisa McKenzie compiled these statistics. The report reflects activity in the major STDs: Gonorrhea, Herpes, and Chlamydia, which is the most widely seen sexually transmitted disease. Other STDs such as HIV, Hepatitis Band possibly C, which are considered blood pathogens, will be covered in future reports. STDs are very much age-linked - with 25% of those aged 18-24 having experienced an STD. The rates of STDs in the United States are an order of magnitude higher than those of Western and Northern Europe, despite equal or nearly equal rates of sexual activity. Many of these are entirely curable infections and could have been eradicated but for our inability to address them as a public policy issue and take measures to lower the rates with intensive screening in high-risk populations and the use of barrier methods of contraception. Uncured cases have resulted in very significant problems in San Francisco and Seattle; high-risk behavior turned into higher rates of STDs. Jean Baldwin mentioned that the testing is often missed in a private practice. She noted that it is unusual for the Health Department to diagnose nearly equal the cases as private practice, but people often do not get care and it spreads without diagnosis. Roberta Frissell asked what happened between 1998-99 during which the rates almost doubled? Dr. Locke said it could be that the rate of infection increased, but it is more likely due to improved screening. He noted that rates for Jefferson County's 15-19 year olds are. below those of the state, whereas females 20~ 24 are above the state rate. The data does not tell how many cases were assymptomatic (picked up through screening) and how many represented more advanced disease. He added that the Department's screening program is exemplary, with the all of its clients being assessed. How close to this goal others are coming is uncertain but preventing transmission is the key to public health. We could substantially reduce the transmission if we were better at the contact tracing and treatment processes. Jean Baldwin noted that CDC just changed the recommendations for the follow-up treatment of Chlamydia. The publications highlighting the changes that came in last month have been sent to practitioners. One recommendation is for a retest for re-exposure after a positive Chlamydia test. In research done in Seattle and other sites they found the client is likely to be positive again. August 15, 2002 Discussion Notes Page: 7 Jill Buhler asked why testing for STDs is not done as part of a yearly physical? Jean Baldwin responded that there are screening criteria. Dr. Locke suggested that private practitioners should take a sexual history as part of a routine or preventive exam, but it is often not done because the subject is taboo. Roberta Frissell asked about the status of outreach and education. Sheila Westerman explained the good job Hillary Metzger with the Health Department is doing in the schools. Jean Baldwin noted that Metzger's program is paid for by the school district. Jefferson County Family Planning Program: Jean Baldwin reported that the Board received informational reports "Adolescent Pregnancy and Childbearing" and "Unintended Pregnancy" from the Washington State Department of Health. These and other handouts are also available through their website. After introducing Family Nurse Practitioner Susan O'Brien, Ms. Baldwin introduced Kellie Regan, who explained the five-year report of Family Planning Services, which she based on the client visit record (AHLERS). Ms. Regan noted that the information is presented in the BRFSS data format, similar to that which the Board has received over the past few months. The report consists of data for the first six months of the Take Charge program, which began in July 2001. Target populations were ages 15-19 and 20-24. She stressed that 2002 data is still incomplete, which is reflected in the graphs. Roberta Frissell asked whether there have been or will be cuts in family planning hours due to the budget crisis? Jean Baldwin responded that there were clinic closings, but not hour cuts. When the Hadlock clinic was closed, hours were added at the Health Department. A person was cut and the Department has been using on-call and other staff to fill the time slots. However, a concern is whether Staff can adequately continue to serve the steadily increasing numbers of clients. So far, the Department has been able to meet the same number of people with current staff levels. In response to Roberta Frissell asking whether the Health Department continues to see the same clients from the Hadlock clinic, Kellie Regan referred to Figure 5, which reflects nearly 60% of clients live in 98368. Jean Baldwin noted that this percentage was no different even when the clinic in Hadlock was open. Staff is now seeing a higher number of clients from South county than in the past because Staff is there weekly, although there is still outreach to do in that area. Sheila Westerman expressed discouragement that the figures did not increase with a Hadlock clinic. Ms. Baldwin added that because word of mouth is the only way numbers of clients grow, consistency of service and location is important. Kellie Regan reported that already in 2002, Family Planning has served 161 continuing teen clients, which is 118% of the 2001 total. Jean Baldwin commented that word of mouth has brought numbers up significantly and more clients are coming in because they are state-insured. While she is cautious about increasing outreach without assuring consistent staffing and client management, she noted that the revenues generated by Take Charge could be used for increased staff. The more clients you see, the more you can charge. Noting that there is a five-year Federal waiver on using Medicaid money to decrease pregnancies on people who are likely to end up on welfare, the program will only be renewed if it is successful. August 15,2002 Discussion Notes Page: 8 Sheila Westerman said she believes family planning is fundamental to Health and Human Services. The more unwanted pregnancies you have, the more money you wil1 need for law and justice. She would hope that during this year's budget process, the Board of Health could weigh in on this issue. She recognized the tendency to cut department budgets equally, but this may not make sense when considering the long-term impacts. Jean Baldwin recognized this is a complicated program. The BRFSS data for 18-34 year olds show that they have problems with access to healthcare, but when you look at who comes to family planning clinics, you realize they are at least being seen in some way. This puts an additional burden on Family Planning in that it is not just reproductive health, but primary care screening. Roberta Frissell spoke favorably about this report and the data. She was happy to see the increase in clients despite local funding decreasing. She agrees these are some of the Health Department's most important programs. Dr. Locke said that, in terms of public health problems - STD prevention, prevention of unintended pregnancies, and access to healthcare - family planning is essentially the gateway to the local system. He added that the fundamental role of the Board of Health is to look at the impact of program cuts, the unmet needs, and to have jurisdiction over the health of the community. The Board of Health must consider the fates of effective programs that may be adversely impacted by a statewide recession. Instead of spreading the pain, it is appropriate for the Board of Health to ask what programs to cut last. Susan O'Brien said she sees a wide range, from 12-14 yr olds to peri-menopausal women, from those with private insurance coverage to those without additional coverage. Over the last year, she has seen that the majority of the Take Charge clients come from the 18-20 age group. Over the years, through good outreach and education in schools, a lot oftrust has been built. Teenagers often prefer the Health Department to their primary care physicians because of concerns of confidentiality. To cut the program would be like going backwards in time. Jill Buhler asked why these women would not go to their primary care providers? Susan O'Brien responded that only about half have a primary care provider. Sheila Westerman said that this program, which took years to build, would not be able to be rebuilt in a year if funding were cut. Recognizing that there may have to be further program cuts, she wants to focus support on programs that offer "the most bang for the buck" instead of imposing an across-the-board 2 or 3% cut. Commissioner Titterness explained that there might be misperceptions about how next year's budgets are being developed. From a County budget projection, departments have been asked to bring back a budget that would fit those programs. There would then need to be other discussions. Larry Fay added that the budget is being approached differently than it has in the past - by looking instead at functional clusters in the County and doing projections on what money is available for those clusters. Health and Human Services is a little different because it is a separate fund. Staff is being told what it can expect to receive from the County, based on projections. August 15,2002 Discussion Notes Page: 9 Geoff Masci clarified that as a policy-making body, the Board should be issuing policy statements based on the data that Staff brings forth as to the efficacy or effectiveness of the programs. He has heard in the discussion today that Family Planning is one of the keystones of our operation. It is an integral part to how we do a lot of business and the Board would like to see this program continue and continue at the same or greater levels because of Take Charge. Jean Baldwin said while Take Charge has helped us in the budgeting process, she is concerned about the workload and the comp time and overtime involved. In the 2003 Hcalth and Human Services budget, Family Planning does not have any cuts. However, there were some in June and in January of2002. Because of the County's cap on "new hires," she will approach the BOCC about rehiring. She is still worried about the overtime and the potential for burnout from sustaining this workload. She said this may be an issue where the Board of Health policy would conflict with a policy of the BOCC. Geoff Masci stressed the need for the Board to have that policy discussion if this is how the budget is going to be formulated. An alternative might be for the Commissioners to sit out of the discussion and listcn to thc Board. Jill Buhler asked whether the Department is working in collaboration with the clinics at the hospital to develop an STD screening program? Jean Baldwin agreed that additional training and outside expertise is something that needs to be pursued more, and she and Dr. Locke have been talking about it. She agreed to take this issue back to the hospital. Jill Buhler asked again about contacting Commissioner Huntingford. Jean Baldwin said Staff was continuing to try to reach him and were to interrupt the meeting if successful. Geoff Masci asked about the Department distributing its in-take/screening form to practitioners so as to standardize screening and collect the data? Jean Baldwin agreed to talk with the hospital clinic coordinator about standardizing the forms, but there could not yet be a sharing of information. However, bio-terrorism money is forthcoming for active surveillance with disease outbreaks. There was discussion and interest in holding a special meeting to continue the Public Hearing on the Civil Penalties Ordinance at a date to be determined. Dr. Tom Locke noted that, pursuant to the By.laws, a special meeting can be called with the consent of two-thirds of the Board members. It was noted that there would not have to be an additional hearing notification, given there are no substantive changes to the ordinance. Larry Fay reported that Staff has sent letters to the City Police and County Sheriff to discuss Civil Penalties Ordinance procedures. He believes there may first be a staff level meeting that returns recommendations to the Board, which may not be ready by the September meeting. JEFFERSON COUNTY BOARD OF HEALTH Thursday, August 15, 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 July 18, 2002 III. Public Comments IV. Old Business and Informational Items 1. Civil Penalties Ordinance - Public Hearing and Potential Adoption V. New Business 1. Jefferson County Seawater Intrusion Policy ~ Public Health Implications and Responsibilities 2. 2001 Jefferson County Sexually Transmitted Disease Report 3. Jefferson County Family Planning Program Report VI. Agenda Planning VII. Next Meeting: September 19, 2002, 2:30-4:30 PM Main Conference Room, JHHS Larry Larry Lisa, Tom Kellie Jean, Tom JE:tfERSON COUNTY BOARD OF HEALTH DR-þ.f' MINUTES .. Thursday, July 18,2002 Board Members: Dan Titterness, Member - County Commissioner District # 1 Glen Huntingford, Member - County Commiuioner DÙtrict #2 Richard Wqjt, Member - County Commissioner District #3 Geoffrry Mam; Vice Chairman - Port Townsend City Coundl Jill Buhler, Member - Hospital CommÙsioner DÙtrict #2 Sheila Westerman, Chairman - Citizen at Lz1Ee (CiM &berta Frimi/, Member - Citizen at L:z1Ee (CounM Staff Members.' Jean Baldwin, Nursing Services Director LArry F'Ð" Environmental Health Dir/1ctor Thomas Locke, MD, Health qfficer DRAFT 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 Tittemess 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 l~wful 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 Sheriffs 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 Washington 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 Tittemess 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 HIP A 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 more 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. Jefferson Countv 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) HEALTH BOARD MINUTES - July 18, 2002 Page: 6 · · · · · · · · · · · · 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 in 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 - .Tulv 8. 2002 Report to Port Townsend Citv 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 Desi2l1ation: 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 Sheila Westerman, Chairman Jill Buhler, Member (Excused) Geoffrey Masci, Vice-Chairman Richard Wojt, Member Glen Huntingford, Member Roberta Frissell, Member Dan Titterness, Member Memorandum To: Jefferson County Board of Health /)0~ ¡J0~" From: Larry Fay, Environmental Health Director Date: August 6, 2002 Re: Civil Penalties Ordinance Attached for your review and consideration is the most recent draft of the civil penalties ordinance. This draft incorporates changes recommended by the Board during the July meeting. Changes are shown in italics. The first change noted in Section I is intended to clarify the somewhat confusing language contained in the first draft. This makes it clear the implementation of the ordinance is discretionary. David Alvarez suggested the specific language. The second change is contained in Section IV where the term offense was changed in favor of violation. By consistently using the term violation through the ordinance the necessity for definitions is eliminated. Again, David Alvarez reviewed the change. Legal notice ofthe hearing and proposed regulation was published in the Peninsula Dailey News on Tuesday, August 06, 2002, 10 days prior to hearing. Staff recommendation is to adopt the ordinance as written. ...;.. STATE OF W ASINGTON County of Jefferson Authorizing Environmental} Health Civil Enforcement } ORDINANCE NO. WHEREAS, the Jefferson County Board of Health wishes to establish civil penalties for violations of public health laws, regulations andlor ordinances adopted by the Washington State Legislature, Washington State Board of Health, Washington Department of Health or the Jefferson County Board of Health; and, WHEREAS, all conditions which are detennined by the Health Officer to be in violation of any public health law, regulation and/or ordinance shall be subject to the provisions ofthis ordinance because they are detrimental to the public's health, safety and welfare; WHEREAS, all violations of public health laws, regulations andlor 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 fÌ'om the harmful effects of violations, will aid in enforcement, and will help reimburse the County for expenses of enforcement; WHEREAS, enactment of this Ordinance promotes the health, welfare and safety of the citizens of Jefferson County; and WHEREAS, the Jefferson County Board of Health enact this Ordinance pursuant to the authority granted them by various state statutes, including, but not limited to, those codified at Ch, 7.48 RCW, Ch, 7.80 RCW and Ch, 70.95 RCW. NOW, THEREFORE, BE IT ORDAINED by the Jefferson County Board of Health as follows: Section I Purpose: It is the express purpose of this ordinance to provide for and promote the health of the general public and not to create or otherwise establish or designate a particular class or group of people who will or should be especially protected by the terms of this ordinance. It is the,.specifi«purpose of this ordinance to place the obligation of complying with its requirements upon persons, businesses or companies required to meet provisions of the health regulations. Enactment of this Ordinance and its terms and provisions does not impose any duty upon the Jefferson County Health and Human Services Department or any of its officers or employees unless a duty is imposed on such officers or employees by the express terms of this Ordinance. Implementation or enforcement of this ordinance by County officers or employees shall be discretionary and not mandatory. Page 1 of3 Section II Authority This ordinance is promulgated under the police power granted to the Jefferson County Board of Health, including, but not limited to, authority granted to them by Ch. 7.48 RCW, Ch. 7.80 RCW and Ch, 70.05 RCW to protect the public health, safety, and welfare ofthe people in Jefferson County, including those County residents residing within the City of Port Townsend. Section III Applicability Provisions of this ordinance apply to violations of the following statutes, regulations and/or ordinances as they now exist or as they may hereafter be amended: Chapter 70-90 RCW 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. Desifnation of Civil Infractions Any violation ofthe laws, regulations and ordinances specified above in section III (induding any future amendments to those statutes, regulations and ordinances) shall constitute a civil inftaction. Each (twenty-four) 24-hour period when a violation is found to exist shall constitute a separate and distinct violation. The owner or Lessor of any real property shall be and is jointly and severally liable with any tenant, occupier or user of real property for any violation alleged against that property or alleged to have occurred on the owner's property. The legality or illegality of the use or occupancy of the land by a person or entity shall not be a defense available to the owner of said property if it is alleged a violation of this Ordinance occurred on that property. A first violation shall be a Class 3 civil inftaction as established in Chapter 7.80 RCVt A second violation shall be a class 2 civil infraction as established in Chapter 7.80 RCW. A third violation shall be a class 1 civil infraction as established in Chapter 7.80 RCW. Page 2 of3 Section V. Processinu: and Adjudicatin!! Civil Infractions: Such inftactions 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 Inftactions and the Washington State Rules for Courts of Limited Jurisdiction, which shall be paramount to the terms and obligations of this Ordinance if this Ordinance conflicts with state statutes or court rules. Upon a determination that the County has met its burden of proof regarding any contested inftaction alleged against a person or entity pursuant to this Ordinance, the County may seek to obtain attorney's fees against the violating party or entity pursuant to RCW 7.80.140. Utilization ofthe 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 ofthis Ordinance. Nothing in this Ordinance shall prevent the Judge hearing these civil inftaction matters ftom 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 of this ordinance shall be the date of its adoption. APPROVED AND ADOPTED this day of ,2002. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair SEAL: ____________________,~elnber ~c ArrEST: ____________________,MClnber Loma Delancy, C~C Clerk of the Board ____________________,~enlber Page 3 of3 Memorandum To: Jefferson County Board of Health From: Larry Fay, Environmental Health Director Date: August 6, 2002 Re: Sea Water Intrusion Attached for your review are copies ofthe newly adopted county policy and ordinances addressing seawater intrusion. While these ordinances have been adopted under county planning authority there are implications for the Board of Health and Health and Human Services. Briefly, the ordinance establishes three categories of seawater intrusion protection zones. Within these zones there are limitations on use of ground water that are largely voluntary in "coastal" and "at risk" zones but become mandatory in "high risk" zones. Within all zones anyone proposing to build will be required to connect to public water if public water is available. Within low and at risk zones, individuals proposing to build will be able to drill wells and use the wells if the water quality is OK. They may be subject to ongoing monitoring by the PUD. In high-risk zones, new wells will only be allowed ifthe Department of Ecology issues a waiver allowing the applicant to drill within 100 feet of sources or potential sources of contamination. (The county is maintaining that its designations of seawater intrusion protection zones constitute "salt water intrusion areas" as identified in 173-160-171 WAC thus obligating the Department of Ecology to restrict well drilling in those areas). If public water is not available and a person cannot obtain a waiver to drill no building pennit will be approved unless the person uses a so-called alternative water supply. Under the UDC these include but are not limited to rain water collection systems, hauled .water ~ direct withdrawal from marine waters. ...; The challenge for HH&S and the Board of Health is identifying where minimum standards for alternative water supplies are necessary and adopting them so that a basic level of public health protection is maintained. At a minimum the alternative systems should offer no greater risk of disease or illness than the source that is being restricted, salty groundwater. The Board adopted standards for rainwater catchment in 1997. These ought to be reviewed. We have no standards for hauling water or for storing water. We have no standards for desalination of marine waters. An adequate supply of potable water is fundamental to the maintenance of personal hygiene and the protection of public health. It is appropriate for the Board of Health to establish minimum quality and quantity standards necessary for the promotion of a healthy community. Staff is proposing that we begin a review of the strengths and limitations of so called alternative water supplies and offer potential policy direction for Board consideration. Because the ordinance becomes effective by the beginning of October there is a relative urgency for some basic policy direction. I would expect that we could have in place background information and policy framework by our October meeting. Issues I would anticipate opening include the appropriate role of alternative water supplies with new development, costs of implementing a program (including staffing needs) to oversee compliance with the adopted standards, other potential water sources, and examples of policies from other jurisdictions. .; .< JEFFERSON COUNTY ADOPTED NEW REGULATIONS TO COMPLY WITH A GROWTH MANAGEMENT HEARINGS BOARD ORDER TO PROTECT AQUIFERS FROM SEAWATER INTRUSION WHAT IS HAPPENING AND WHY? Jefferson County is designating all coastal areas within Y4 mile of the marine shorelines, and all islands, as "Seawater Intrusion Protection Zones", or SIPZ. If ground water quality (measured by chloride) is slightly degraded, indicating potential seawater intrusion, then it is designated as an "At Risk" SIPZ. If ground water quality (measured by chloride) is degraded, indicating likelihood of seawater intrusion, then it is designated as a "High Risk" SIPZ. Jefferson County's development regulations (the Unified Development Code, or UDC) were appealed by the Olympic Environmental Council and Shine Community Action Council. The Western Washington Growth Management Hearings Board upheld the appeal and ordered Jefferson County to adopt protections for ground water from seawater intrusion. These regulations are the result oftechnical and public input to satisfy the requirements ofthe Hearings Board Order. HOW WILL THESE NEW REGULATIONS IMP ACT MY DEVELOPMENT PLANS? Most of the County is NOT experiencing problems with seawater intrusion, so most likely it will not impact your development plans. But, if you are near the coast or on an island, seawater intrusion may be impacting the aquifer that you intend to draw from. . WILL THESE REGULATIONS STOP ME FROM USING MY PROPERTY? NO. These regulations do not stop you from developing and using your property. Connection to an approved public water system provides proof of potable water for a building permit. Jefferson County REQUIRES the use of an approved public water supply if a public water system can provide water to your parcel. Therefore, even though the new regulations may limit the use of individual water supplies in severely impacted areas in Jefferson County, property owners can still connect to an approved public water system to provide proof of potable water for a building pennit. A~_a condition of your building permit, Jefferson County may require extension of an eXIsting publiê water system, creation of new public water system, or use of an alternative water system in severely impacted areas. Areas without public water supplies can always Wilize ATtérnativë: Water Supplies which are ALLOWED under the new regulations. Therefore you have several options to develop your property. HOW DO THESE REGULATIONS AFFECT MY EXISTING HOME AND WELL? If you are NOT building a new home or structure requiring potable water, then the new regulations DO NOT APPLY TO YOu. WHAT HAPPENS IF I WANT TO DRILL A WELL ON MY LAND? Already, under the current law, the owner or well driller is required by the Department of Ecology (DOE) to submit a notice of intent to DOE. DOE currently uses the marine shoreline as the definition of the "sea-salt water intrusion area". According to the Well Drilling Regulations (W AC 173-160-171) wells must be 100 feet from a sea~sa1t water intrusion area. The new designations under these regulations mean that if the well is in a "High Risk", then it will be interpreted by the DOE to be a "sea~salt water intrusion area". Thus, DOE may not allow the well to be drilled if the DOE determines the well would violate the state administrative code. In sum, a property owner would have to get approval from the DOE before drilling the well (just as they do now). The major change is that a "sea-salt water intrusion area" now includes the "High risk" SIPZ. CAN I ORT AIN AN ONSITE SEWAGE DISPOSAL (SEPTIC) PERMIT? If you are not building a new home, then the new regulations DO NOT APPLY TO YOu. There are no regulations that are triggered at the time a landowner applies for an onsite sewage disposal permit. I ALREADY HAVE A WELL. WHAT HAPPENS IF I WANT TO BUILD A HOUSE? At the time that you apply for your building permit, you are required to provide "proof of potable water". If you are located near the coast or on an island, your property may be within an "At Risk" or "High Risk" SIPZ, and then new regulations would apply to you. In the "At Risk" zones, owners are required to enter into a well monitoring program approved by the County. This is similar to the monitoring agreements that are required when the County issues a pennit with an alternative onsite sewage disposal system. There may be a charge to cover the costs of the monitoring. Additionally, the applicant is required to install a flow meter and is ENCOURAGED to use drought-tolerant landscaping and conserve water. In the "High Risk" zones, owners will be required to conduct a hydrogeologic assessment to indicate that their water use will not degrade water quality in the aquifer. If such an assessment can prove that there would not be degradation, then the applicant can use the well with conditions to install a flow meter and submit a water conservation plan to Jefferson County; otherwise, the applicant will be required to use another water source for their building. .- 1 HAVE AN EXISTING HOME AND WELl,. WHAT HAPPENS IF I REMODEL? I (yòu are not "building a new home, then the new regulations DO NOT APPLY TO YOU. There are NO re~~lations required for home remodels. :.; - I HAVE AN EXISTING HOME AND WELL. WHAT HAPPENS IF I WANT TO DRILL A NEW WELL? The regulations under Scenario #2 (above) would apply. STATE OF WASHINGTON County of Jefferson RECEIVED AUS¡ 02 2002 - Jefferson CijUnty Environmental Health -..---.,.--....,.. IN THE MATIER OF ADOPTING A COUNTY POLICY WITH RESPECT TO SEA WATER INTRUSION } } } RESOLUTION NO. 44-02 WHEREAS, the Board of Jefferson County Commissioners ("the Board") has, as required by the Growth Management Act, as codified at RCW 36.70A.010 et seq., adopted the Jefferson County Comprehensive Plan (the "Plan"), a Plan that was originally adopted by Resolution No. 72-98 on August 28, 1998 and subsequently later amended, and; WHEREAS, in furtherance of the Plan, the County adopted its GMA~derived development regulations, known locally as the Unified Development Code (or "UDC"), in December 2000 to be effective as of January 16, 2001, and; WHEREAS, the UDC, upon its adoption, was timely challenged through means of not less than five Petition For Reviews ("PFRs") filed with the Western Washington Growth Management Hearings Board (or "WWGMHB"), and WHEREAS, another of the five PFRs was filed by two citizens' groups: the Olympic Environmental Council and the Shine Community Action Council; and " ~ " _ W.Hl~lUi~.AS, the PFR filed by these citizens' group proceeded through to fihearing on the Merits before the WWGMHB in December 2001; and WHEREAS, the WWGMHB ruled against the County on all but one issue (that one issue being the sufficiency of protections offered critical areas with respect to the Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion ,.--.- --.---'--.'--- . installation of asphalt batch plants) by publishing a Final Decision and Order (or "FDO") in January 2002 that mandated this County to undertake and implement six distinct steps; and WHEREAS, that FDa listed as mandate or directive #1 that this County enact as part of the UDC the four housekeeping changes listed in the Response Brief of the County and discussed at the Hearing on the Merits; and WHEREAS, Ordinance #04-0422-02, adopted April 22, 2002, put the County in compliance with mandate #1 of the FDa; WHEREAS, a distinct Ordinance enacted on this date amends the UDC so that it reflects and includes the changes the County was required to make in order to gain compliance with directives #2 through #6 of the FDO; WHEREAS, the elected County Commissioners and staff discussed possible routes to compliance, including adopting ùDc amendments, after the FDa was issued, specifically in meetings open to the public during February and March of 2002; WHEREAS, staff presented in writing possible routes to compliance in early March 2002~ But the County Commissioners wanted to open this discussion about seawater intrusion to the entire populace of the County; WHEREAS, in the spirit of the GMA, which requires "early and continuous" ...;- - participatibn oy all who are interested and/or expressly or potentially affected by any proposed GMA-derived regulations, the County Commissioners decided to empower a stakeholder group to discuss the issues of seawater intrusion and return to them with a report within 30-45 days; Page 2 of 4 Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion . ..--..--,..-.".--... ..----...--"".. WHEREAS, the County Commissioners took the formal step of empowering the stakeholder group On April 8, 2002. The stakeholder group was specifically informed that the task before them was not whether or not this County should impose regulations to protect impacted regions from seawater intrusion but instead was to determine the how and the what of the regulations that would be put in place; WHEREAS, the stakeholder group consisted of nine persons, including the representative of the Petitioners. The stakeholders met four times and an outside consultant was present at all the meetings to facilitate the process. A non-voting County representative was present at the meetings not to offer opinions but to simply offer information; WHEREAS, the stakeholder group made its report to the elected Commissioners in late May 2002; WHEREAS, the recommendations of the stakeholder group, as memorialized in a document entitled "Coastal Seawater Intrusion Policy" prepared by the County's Natural Resources Director, were discussed and reviewed by County staff in another public meeting of the elected Commissioners on June 10, 2002; WHEREAS, the policy document prepared by the County's Natural Resources Division Manager describes the "adaptive management practices" that will be undertaken, enacted and implemented by the County Commissioners if data collected indicates, via scientifically valid methods, a "statistically significant degradation of water -0 quality- in a .particular region of the County due to seawater intrusion;" WHEREAS, because the policies and plans outlined in the document attached to this Resolution are not appropriate for inclusion in the County's UDC because they are policies and plans rather than rules and regulations that are found in the typical GMA- Page 3 of 4 Resolution No. 44-02 re: County Policy with Respect to Seawater Intrusion derived development regulations to regulate specific land use applications and processes, this distinct Resolution became necessary; and WHEREAS, adoption of the policy document via a Resolution serves to place this County in partial compliance with a portion of FDO Directive #4; and WHEREAS, this Resolution is adopted as part of the County's Compliance with the FDO issued in January 2002 in WWGMHB Cause No. #01-2-0015. ND.W, THEREFORE, BE IT RESOL VED as followed by the County , Commissioners in and for the County of Jefferson: 1. That the attached document entitled "Coastal Seawater Intrusion Policy" be and hereby is adopted by the County Commission of Jefferson County as official county policy pursuant to the Growth Management Act and this County's Comprehensive Plan. Approved and adopted thîs 23rd day of July 2002. .;" , ll! . ..':Æ-- ct (Y\I';{p...& ~ ellen Huntingford, M Lorn"Ðelaney,CMC ~ Clerk of the Board Richard Wojt, Chair ~ ;. Dan Tittemess, Member 4¡lf~ Page 4 of 4 BOARD OF COUNTY COMMISSIONERS Coastal Seawater Intrusion Policy July 23, 2002 Goal: Jefferson County intends to protect groundwater quality from further degradation due to seawater intrusion, primarily through land use regulatory authority under Revised Code of Washington (RCW) 36.70A. A corollary goal is the promotion of public health through encouragement of public water system use throughout the county. Elements: Designation of affected areas, voluntary and mandatory measures (implemented through Unified Development Code - UDC - and Environmental Health regulations), other policy elements, public outreach and education, monitoring and adaptive management. Desi2DBtion: Seawater Intrusion Protection Zones (SIPZ) include aquifers and land areas overlying aquifers at some level of vulnerability to seawater intrusion, as defined either by proximity to marine shoreline or by proximity to groundwater sources that have demonstrated high chloride readings. A1lland area within ~ mile of marine shorelines and on all islands is classified as a coastal SIPZ, a subcategory of a Critical Aquifer Recharge Area. Additionally, areas within 1000 feet of a groundwater source with a history of chloride analyses above 100 milligrams per liter (mg/L) are categorized as either "at risk" (between 100 mg/L and 200 mg/L) or "high risk" (over 200 mg/L). High risk SIPZ shall be considered "sea-salt water intrusion areas," which are among the "sources or potential sources of contamination" listed in Washington Administrative Code (WAC) 173-160-171, implementing code for the Water Well Construction Act. In some cases, high chloride readings may be indicative of connate seawater (i.e., relic seawater in aquifers as opposed to active seawater intrusion). When best available science or a hydrogeologic assessment demonstrates that high chloride readings in a particular area are due to connate seawater, the area in question shall not be considered an at risk or high risk SIPZ. (The Chimacum valley is an example of this type of area.) When the status of an area is in question, the UDC Administrator is responsible for making the determination based upon recommendation from the Department of Health and Human Services. Geographic Information Systems (GIS) maps of designated SIPZ will be periodically updated using data from permit applications, well monitoring, and other available information. Voluntary and Mandatory Measures: Activities to be conditioned and regulated include well drilling, subdivision approval, and issuance of building permits. General information is provided, followed by voluntary and mandatory measures specific to coastal, at risk, and high risk SIPZ. _; 1. Well Drilling: The Washington State Department of Ecology (Ecology) is responsible for regulation of well drilling under RCW 18.104. Per WAC 173-160-171, proposed wells must be sited at least 100 feet from "known or potential sources of contamination," which include "Sea-salt water intrusion areas." Ecology provides a procedure for applicants to obtain a variance from a regulation or regulations of Chapter 173 WAC" ... [w]hen strict compliance with the requirements and standards of this chapter are impractical" (WAC Coastal Seawater Intrusion Policy Page 1 7/23/02 BOARD OF COUNTI' COMMISSIONERS -"-.'-..'..',.--- ..--.---- 173-160-106). Though certain types of wells, including the standard individual well for domestic purposes, are exempted from the need to obtain a permit from Ecology, all wells are subject to State laws and administrative code. According toW AC 173-160- 106, Ecology response to a variance application is given within fourteen days. 2. Subdivisions: Applications for land division (UDC Section "0 in any SIPZ when the average net density proposed is less than five acres per dwelling unit must include specific and conclusive proof of adequate supplies of potable water through a qualifying hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) that demonstrates that the creation of new lots and corresponding use of water will not impact the subject aquifer such that water quality is degraded by seawater intrusion. All subdivisions in Jefferson County that create more than six new lots are subject to the acquisition of water rights (per State Attorney General opinion). 3. Issuance of a building permit: RCW 19.27.097 states, "Each applicant for a building permit of a building necessitating potable water sh811 provide evidence of an adequate water supply for the intended use of the building. Evidence may be in the form of a water right permit from the department of ecology, a letter from an approved water purveyor stating the ability to provide water, or another form sufficient to verify the existence of an adequate water supply. In addition to other authorities, the county or city may impose conditions on building permits requiring connection to an existing public water system where the existing system is willing and able to provide safe and reliable potable water to the applicant with reasonable economy and efficiency." Evidence of potable water may be an individual well, connection to a public water system, or an alternative system such as rainwater catchment. Whatever method is selected, the regulatory and operational standards for that method must be met, including Jefferson County Health Code and Washington Administrative Code. Public water systems shall be preferred from a public health standpoint to other alternatives, such as the importation of water or an individual surface or rainwater catchment system, though those alternatives are allowable subject to appropriate and established design and operational criteria. Public water systems are subject to Washington State Department of Health (DOH) saltwater intrusion policy and all applicable safe drinking water standards. DOH and Ecology regulate public water systems to protect against water quality degradation. The Jefferson County seawater intrusion policy therefore concentrates on water supplies that are not regulated as public water systems by DOH and Ecology. Jefferson County shall encourage DOH and EcolQgy to ~ consider amenl1ing licenses and water rights for public systems in areas where there is evidence of seawater intrusion in the public water source or as a result of groundwater withdrawal such that no additional connections to or expansions of the affected systems are permitted. All types of building permits that require proof of potable water use are subject to this policy, specifically building permits for new single-family residences (SFRs) or other structures with plumbing that are not associated with an existing SFR (Le., shops or garages with a bathroom). Coastal Seawater Intrusion Policy Page 2 7123/02 BOAIW OF COON1Y COMMISSIONERS Proof of Potable Water on Existing Lots of Record Voluntary and mandatory measures of the Jefferson County seawater intrusion policy apply to well drilling proposals and building permit applications on existing lots of record within the coastal, at risk, and high risk SIPZ in the following manner; COASTAL SIPZ (i.e., all islands and area within % mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet) VOLUNTARY: · Water conservation measures. · Installation of a flow meter. · On-going well monitoring for chloride concentration. · Submittal of monitoring data to County. MANDATORY: · For proof of potable water on a building permit application, applicant must utilize DOH- approved public water system if available. · If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: 1. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. AT RISK SIPZ (Le., within 1000 feet of a groundwater source showing chloride between 100 and 200 mg/L) VOLUNTARY: · Water conservation measures. MANDATORY: · For proof of potable water on a building permit application, applicant must utilize DOH- approved public water system if available. · If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: 1. Chloride concentration of a laboratory-certified well water sample submitt#l with . 15uilding permit application. 2. Installation of a flow meter. 3. On-going well monitoring for chloride concentration. 4. Submittal of flow and chloride data to the County per monitoring program. Coastal Seawater Intrusion Policy Page 3 7/23/02 BOARD OF COUN?T COMMISSIONERS --'''. --.--- HIGH RISK SIPZ (i.e., within 1000 feet of a groundwater source showing chloride concentrations above 200 mgIL) MANDATORY: · Water conservation measures (per list maintained by UDC Administrator). · For proof of potable water on a building permit application, applicant mus't utilize DOH- approved public water system if available and if public water is unavailable, a qualifying alternative system may be used as proof of potable water; an individual well may only be used as proof of potable water subject to the following requirements: 1. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160- 106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (Le., within 11 00 feet of a groundwater source showing chloride concentrations above 200 mg/L); or for an existing groundwater wen, applicant must provide evidence through a qualifying hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) that subject aquifer will not be degraded by the proposed use of the well. 2. Chloride concentration of a laboratory-certified well water sample submitted With building permit application. 3. If chloride concentration exceeds 250 mg/L in a water sample submitted for a building pennit, then the property owner shall be required to record a restrictive covenant that indicates a chloride reading exceeded the U.S. Environmental Protection Agency secondary standard (250 mg/L) under the National Secondary Drinking Water Regulations. 4. Installation of a flow meter. 5. On-going well monitoring for chloride concentration. 6. Submittal of flow and chloride data to the County per monitoring program. Other Policy Elements: · Continue County approval of qualifying rainwater catchment systems as an alternative to individual wells (Environmental Health regulations). · Develop policies to approve the importation and storage of water in certain problem areas (Environmental Health regulations). · Strengthen approval and monitoring requirements for public water systems to ensure that chloride testing is an element of DOH monitoring for systems which have sources located within a SIPZ (Coordinated Water System Plan-CWSP-and DOH). · Strengthen protections of aquifer recharge areas through adoption and implementation of Ecology 2001 Stormwater Management Manual/or Western Washington, promoting on- site infiltration of stonnwater (UDC regulations; amendment anticipated 2002). · Eliminate off-site disposal of surface or sub-surface water (stormwater tightlines..and . 'Curtain -dnûns) unless exceptional circumstances justify off-site disposal and appropriate mitigation is proposed and implemented; adjust current regulation so that affected area extends from 500 feet to Y4 mile from marine shorelines (UDC regulations). · In order to limit well construction and protect public health, continue promotion of public water systems as preferable to individual wells and other alternative water supplies; continue requirement for connection to existing public water systems when proposed development location is within approved public water service area boundaries. Coastal Seawater Intrusion Policy Page 4 7/23/02 BOARD OF COUNTY COMMISSIONERS ---..--.... · Continue application of Uniform Plumbing Code (UP C) requirements with regard to low- flow faucets and other mandatory water conservation measures. Public Outreach and Education: · Conduct education and outreach program through Washington State University (WSU) Extension; establish Memorandum of Understanding (MOU) with WSU for program. · Encourage water conservation measures countywide; mandate water conservation measures in high risk SIPZ. · Send letter to néw Jefferson County residents/property owners regarding groundwater use and protection; implement other means of public notice, as resources allow. Monitorin2: · Enter into MOD with Public Utility District #1 (PUD) regarding the monitoring program. · Standardize chloride sampling in a manner that assures quality control. · Establish other well monitoring locations, as resources allow. · Coordinate data interpretation and application through Water Resource Inventory Area (WRIA) Planning Units operating in Jefferson County per the Watershed Planning Act. · Seek grant funding for additional research and encourage State and Federal partners to conduct research related to the issue of seawater intrusion in Jefferson County. Adaptive Mans2ement: for aquifers with degrading water quality due to seawater intrusion. Jefferson County will rely on technical input from the PUD, WRIA Planning Units, and others, as appropriate, in annual review of well monitoring data, building permit data, and other relevant data on groundwater quality and quantity in order to determine whether water quality vis~à-vis seawater intrusion is degrading. The Department of Health and Human Services and/or the Department of Community Development will report to the BOCC annually on the status of seawater intrusion in Jefferson COUIity. Every five years a comprehensive analysis will be conducted and report generated summarizing results. If the Board of County Commissioners determines that actions under the Jefferson County seawater intrusion policy prove insufficient to protect groundwater in at risk and high risk SIPZ from seawater intrusion (Le., analysis of the monitoring data for a defined area using appropriate methodology 1 shows statistically significant degradation of water quality due to seawater intrusion), Jefferson County will immediately: 1. Adopt a moratorium in the affected area on the issuance of building permits for which individual groundwater wells are proposed as proof of potable water until such time as area water quality improves or a plan is developed with the objective of improving area water quality. 2. Adopt a moratorium on subdivisions in the affected area that propose individual , - groundwater wells as proof of potable water until such time as area water qualitý' improves or a plan is developed with the objective of improving area water quality. 3. Establish an aquifer protection district via public vote (RCW 36.36) or, if necessary, petition Ecology to form a groundwater management area (per WAC 173-100). 1 Appropriate combination of accepted scientific methodology for evaluating seawater intrusion impact. as described in Pacific Groundwater Group study (1996), Washington Administrative Code, United States Geological Survey protocol, and other contemporary examples and approaches. Coastal Seawater Intrusion Policy Page 5 7/23/02 STATE OF WASHINGTON County of Jefferson RECENED iAUG 02 2002 - Jefferson County Environmental Health IN THE MATTER OF REVISIONS AND } ADDmONS TO THE COUNTY'S UNIFIED } DEVELOPMENT CODE ASSOCIATED WITH} A HEARING BOARD FINAL DECISION AND } ORDER ENTERED IN CAUSE NUMBER } 01-2..0015 AND RELATING TO SEAWATER } INTRUSION ISSUES [MLA #02-00314] } ORDINANCE NO. 07-0723-02 WHEREAS, the Board of Jefferson County Commissioners ("the Board") has, as required by the Growth Management Act, as codified· at RCW 36.70A.010 et seq., adopted the Jefferson County Comprehensive Plan (the "Plan"), a Plan that was originally adopted by Resolution No. 72-98 on August 28, 1998 and subsequently later amended, and; WHEREAS, in furtherance of the Plan, the County adopted its GMA-derived development regulations, known locally as the Unified Development Code (or "UDC"), in December 2000 to be effective as of January 16,2001, and; WHEREAS, the UDC, upon its adoption, was timely challenged through means of not less than five Petition For Reviews ("PFRs") filed with the Western Washington Growth Management Hearings Board (or "WWGMHB"), and WHEREAS; another of the five PFRs was filed by two citizens' groups: the Olympic Environmental Council and the Shine Community Action Council; and WHEREAS, the PFR filed by these citizens' group proceeded through to a Hearing on the Merits before the WWGMHB in December 2001; and WHEREAS, the WWGMHB ruled against the County on all but one issue (that _ . - - ~- - one issue being the sufficiency of protections offered critical areas with respect to ~ the installation of asphalt batch plants) by publishing a Final Decision and Order (or "FDO") in January 2002 that mandated this County to undertake and implement six distinct step~; and < , ORDINANCE NO. 07-0723~02 re: Seawater Intrusion u___.______....._ --------.,. WHEREAS, that FDO listed as mandate or directive #1 that this County enact as part of the UDC the four housekeeping changes listed in the Response Brief of the County and discussed at the'Hearing on the Merits; and WHEREAS, Ordinance #04-0422-02, adopted April 22, 2002, put the County in compliance with mandate #1 of the FDO; and WHEREAS, this Ordinance amends the UDC so that it reflects and includes the changes the County was required to make in order to gain compliance with directives #2 through #6 of the FDO. NOW, THEREFORE, BE IT ORDAINED by the Board of County Commissioners that they approve the following revisions and additions to the UDC and; BE IT FURTHER ORDAINED by the Board that they make the following general Findings of Facts applicable to these revisions and additions to the UDC: Section 1 - General Findings of Fact for Revisions and Additions to the UDC: 1. The County adopted its Comprehensive Plan in August 1998 and its development regulations or UDC in December 2000. 2. The Growth Management Act, which mandates that Jefferson'County generate and adopt a Comprehensive Plan, . also requires that there be in place a process to amend the Comprehensive Plan. 3. These amendments to the County's UDC are being made in order to resolve certain litigation before the WWGMHB, specifically the PFR, timely filed by two citizens' groups, the Olympic Environmental Council and the Shine Community Action Council. 4. ,The elected County Commissioners and staff discussed possible routes to compliance, including adopting UDC amendments, after the FDO was issued, . specifical1y in meetings open to the public during February and March of 2602.' 5. Staff presented in writing possible routes to compliance in early March 2002. But the County Commissioners wanted to open this discussion about seawater ' intrusion to the entire populace of the County. 2 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion 6. In the spirit of the GMA, which requires "early and continuous" participation by all who are interested and/or expressly or potentially affected by any proposed GMA-derived regulations, the County Commissioners decided to empower a stakeholder group to discuss the issues of seawater intrusion and return to them with a report within 30-45 days. The County Commissioners took the formal step of empowering the stakeholder group on April 8, 2002. 7. The stakeholder group was specifically informed that the task before them was not whether or not this County should impose regulations to protect impacted regions from seawater intrusion but instead was to determine the how and the what of the regulations that would be put in place. 8. The stakeholder group consisted of nine persons, including the representative of the Petitioners. The stakeholders met four times and an outside consultant was present at all the meetings to facilitate the process. A non-voting County representative was present at the meetings not to offer opinions but to simply offer infonnation. 9. The stakeholder group made its report to the elected Commissioners in late May 2002. 10. The recommendations of the stakeholder group, as memorialized in a document entitled "Coastal Seawater Intrusion Policy" prepared by the County's Natural Resources Director, were discussed and reviewed by County staff in another public meeting of the elected Cominissioners on June 10, 2002. 11. Proposed UDC amendments, reflecting the substance and content of the policy paper prepared by the County's Natural Resources Division Manager, were prepared by County planners and, with the approval. of the elected County Commissioners, sent to the County Planning Commission for review by that advisory body. 12. A public hearing on the proposed UDC amendments occurred before the Planning Commission on July 10, 2002. 13. The Planning Commission prepared a written recommendation and sent that reco~endation to the elected County Commissioners. ~;; 14. The policy document prepared by the County's Natural Resources Division Manager describes the "adaptive management practices" that will be undertaken, enacted and implemented by the County Commissioners if data collected indicates, via scientifically valid methods, a "statistically significant degradation 3 of 11 ORDINANCE NO. 07~0723-02 re: Seawater Intrusion .. .------------- of water quality in a particular region of the County due to seawater intrusion." They are: · Adopt a moratorium in the affected area on the issuance of building permits for which individual groundwater wells are proposed as proof of potable water until such time as area water quality improves or a plan is developed with the objective of improving area water quality. · Adopt a moratorium on subdivisions in the affected area that propose individual groundwater wells as proof of potable water until such time as area water quality improves or a plan is developed with the objective of improving area water quality. · Arrange for a public vote to form an aquifer protection district (RCW 36.36) or petition Ecology to form a groundwater management area (per WAC 17.3-100). 15. The policy document is being adopted by this County Commission separately but simultaneously as a Resolution of this elected body. 16. Adoption of the policy document via a Resolution serves to place this County in partial compliance with a portion of FDO Directive #4. 17. All types of building permits that require proof of potable water use are subject to this policy, specifically building permits for new singleMfamily residences (SFRs) or other structures with plumbing that are not associated with an existing SFR, e.g., shops or garages with a bathroom. 18. The attached UDC amendments serve to "classify and designate vulnerable seawater intrusion areas," as is required by FDO Directive #2, by classifying three types of USeawater Intrusion Protection Zones," or uSIPZ's." .19. The first type of SIPZ is known -as a "Coastal" SIPZ. A Coastal SIPZ is found on all islands within the County and any other area within 1;4 mile of a shoreline as long as there is no history of any individual well having a chloride reading in excess of 100 mg/L or parts per million ("ppm") within 1000 feet of any new well or any well that is to be used as a source for potable water. The landowner must undertake certain mandatory and voluntary measures if the land in question falls within a Coastal SIPZ. 20. -. The second kind of SIPZ is known as an "At Risk" SIPZ. An At Risk SIPZ Ü¡ found within 1000 feet of any groundwater source showing a chloride reading between 100 and 200 ppm. Again, the landowner must undertake certain mandatory and voluntary measures if the site of the well in question falls within or creates an At-Risk SIPZ. 4 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion 21. The final type of SIPZ is known as a "High Risk" SIPZ. A High Risk SIPZ is found within 1000 feet of any groundwater source showing a chloride reading in excess of 200 ppm. Much like with the "At Risk" SIPZ, certain protective measures will be mandatory for new wells or wells newly needed for proof of potable water if that well is located within or creates a High Risk SIPZ. 22. Note well that not until potable water has a chloride reading that exceeds 250 ppm does that potable water exceed the United States Environmental Protection Agency secondary standard promulgated pursuant to the National Secondary Drinking Water Regulations. In Jefferson County any individual well with a chloride reading in excess of 250 ppm will require a "Notice to Title" to be recorded wìth the County Auditor's land records indicating that the well water contains unacceptable (according to the US EPA) salinity. 23. All of the numbers listed in paragraphs #19 through #22, both in terms of a) distances and b) categorizing risk levels by the chloride readings found in the water of any particular well, are based upon the 'best available science' found and described in various reports placed before the Jefferson County Commissioners during the last seven years, including, but not limited to, the Washington State Department of Ecology Bulletin #59 [relating to Marrowstone Island,] the Hong West report and the 1996 report of the Pacific Groundwater Group. 24. However, in some cases, high chloride readings may be indicative of what is called "connate" seawater (Le., relic seawater in aquifers as opposed to active seawater intrusion). When best avillable science or hydrogeologic assessment -demonstrates that high chloride readings in a particular area are the result of -connate seawater being present then the 'area in question shall NOT be considered to be an "At Risk" or "High Risk" SIPZ. The Chimacum valley is an example of this type of area. If the status of a region or area is in question, then the UDC Administrator is responsible for making the determination based upon a recommendation from the Department of Health and Human Services. 25. The stakeholder group was familiar with and used these same BAS reports when deciding on distances and the categorization of risk according to the quantity of chloride found in any particular well water sample. 26. _The~e 1)DÇ amendments also reflect the County's "develop[ment] and adOp1:[ion] (of] protection standards for CARA's, based on BAS, to prevent further groundwater degradation from seawater intrusion," the mandate of item #3 listed in the FDO handed down by the WWGMHB. 27. While all the protection standards will not be listed here since they are found in the UDC amendments and the distinct "polict' document, the protection standards 5 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion ...--'.---....'. implemented by the County include mandating that no new well be built within any category of SIPZ if that residence or business can instead be hooked up to a public water system. 28. Most, if not all of the protection standards are mandatory in any High Risk SIPZ. The MANDATORY protection standards within a High Risk SIPZ include water conservation measures, installation of a flow meter, ongoing well monitoring for chloride concentrations, submittal of that monitoring data to the County and a waiver (permission) ftom the State Department of Ecology for the installation of any well that is within 1,100 feet (1,000 feet zone and 100 foot buffer) of another well showing chloride concentrations in excess of 200 ppm. 29. In situations where there is a lesser risk of seawater intrusion into the groundwater, i.e., well locations found inside either the "At Risk" or "Coastal" SIPZ's, certain of the mandatory protection standards become voluntary. 30. But for any individual well in an "At Risk" or "High Risk" SIPZ, the ongoing monitoring of the chloride levels found in that well's water is and shall remain mandatory. Also mandatory is the reporting of that data to the appropriate officials in order to monitor that well for potential degradation of the aquüer it is attached to and/or the area within 1000 feet of that well. 31. The UDC, as a GMA-derived development regulation, is not well~suited to answer many of the procedural and substantive questions about the monitoring of chloride levels that the County intends to pèrfonn in order to gather the data that will allow it to take a scientific approach to "regularly evaluat[ing] the effectiveness of adopted performance standards, as is mandated by FDO Directive #4. 32. . . But certaiÎl other steps that the County has agreed to do put this County in compliance with FDO Directive #4. These are some of the other action steps the County has promised to undertake in order to protect any and all groundwater sources, as reflected in the adoption of the "policy" Resolution simultaneously to the adoption of this Ordinance: · Enter into a contract with PUD No.1 of Jefferson County with respect to a monitoring program and data exchange; · . StandaFdiZe chloride sampling in a manner that assures quality control; .. · Establish other well monitoring locations, as resources allow; · Coordinate data interpretation and application through the Water Resource Inventory Area (WRIA) 17 Planning Unit; and · Seek grant funding for additional research and encourage State and Federal partners to conduct research related to the issue of seawater intrusion in Jefferson County . 6 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion 33. Jefferson County also intends to do outreach and education programs for the citizens to increase awareness about the need to protect groundwater sources. Listed below are items this County intends to pursue with respect to public education programs: · Conduct education and outreach programs through Washington State University (WSU) Extension; · Establish Memoråndum of Understanding (MOD) with WSU for the education/outreach program; · Encourage'water conservation measures countywide; · Mandate water conservation measures in high risk SIPZ; and · Contact new Jefferson County residents/property owners regarding groundwater use and protection or implement another means of public notice, as resources , allow. . 34. The County also intends to strengthen protections for aquifer recharge areas through adoption and implementation of the rules and regulations laid out within the document known as the 2001 Stormwater Management Manual for Western Washington, a document promulgated by the Washington State Department of Ecology . 35. Adoption of this amending language (which alters the UDC) promotes the health and welfare of the citizens of Jefferson County. 36. Adoption of these UDC amendments was made necessary by the FDO issued by theWWGMHB on January 10,2002. These UDC amendments and the "policy" document attached to the distinct but simultaneously-enacted Resolution place Jefferson County in compliance with the FDO. 37. Although the substance of these amendments, if not the particular language chosen, has been mandated by a quasi~judicial body, making these amendments extraordinary and not necessarily suitable for the usual UDC-driven analysis, it remains wise to make certain findings that would otherwise be made with respect to any UDC amendments adopted without the mandate of a quasi-judicial body. 38. 'Pur~uant tQ Section 9 of this County's Unified Development Code, all propôsed amendments to the GMA-derived development regulations should be analyzed, in part, through the "filter" of the seven growth management indicators (or "GMI") listed at UDC §9.5.4(b), although those GMT represent only some of the criteria that the County Commission must use when deciding whether to adopt or reject a proposed UDC amendment. 7 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion 39. Because of the general nature of the GMI, each and every GMI will not be applicable or apropos for each and every amendment that this County Commission has considered. 40. However, the County Commission, in order to comply with UDC Section 9, should and must make generalized findings of fact with respect to the seven OM! listed there and do so now. 41. With respect to UDC §9.5.4(b)(1), the County Commission fmds, as an example of numerous fmdings they might make with respect to (b)(1), that in the short-tenn the population of this County has not increased as quickly as the Comprehensive Plan envisioned, but this short-term decline in the rate of population growth does not necessarily mean that the County's current population is not, in certain regions of the County, already causing stress on groundwater sources. 42. Regardless of the possible fluctuation in the rate of population growth that does occur or might occur in this County the adoption of these UDC amendments supports GMA goals to further protect groundwater resources. 43. With respect to UDC §9.5.4{b)(2), the County Commission finds that the capacity of the County to provide adequate services has not changed, although expected continued severe pressures on the County's budget may alter this picture in the coming years, thus suggesting that it is wise to protect groundwater resources now. 44. With respect to UDC §9.5.'4(b)(3), "the County Commission finds that while sufficient 'urban' land is designated and zoned within this County to meet projected demand and need pursuant to the agreed-upon population allocation in Joint City and County Resolution No. 17-96, that conclusion will, by definition, be revisited and reconsidered as the County considers establishing an urban growth area in the Port Hadlock and Irondale neighborhoods. If this County creates additional UGA's, then the protection of groundwater will be of paramount concem~ 45. With respect to UDC §9.5.4(b)(4), the County Commission finds that while most of the assumptions that supported the policies and goals of the 1998 Comprehensive Plan remain valid, there are at least two assumptions that need _ .rev.isiting. .;; ~ - - 46. The first assumption of the 1998 plan worthy of reconsideration comes about because of the documented need for additional rural commercial and industrial land as indicated by the Regional Economic Analysis and Forecast of January 1999 prepared by Richard Trottier, which suggests the County can expect to see a growth in jobs of some 7,000 to 9,000 in the next decades and must accommodate 8 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion them with additional commercially and industrially zoned land not currently in existence. This commercially and industrially zoned land must not be allowed to impose any additional stresses on the groundwater sources, and thus these UDC amendments do further one or more GMA goals. 47. Secondly, the County always intended to revisit its conservatively-drawn boundaries around the rural commercial districts, known formally as "limited areas of more intensive rural development" or "LAMIRD' s" and has new definitions of "built environment" provided to it by the Western Washington Growth Management Hearings Board to work with as it does that redrawing. Again, the presence of rural commercial land on the County's zoning map cannot be allowed to additionally stress the groundwater sources of this County. 48. Each of these new assumptions makes protecting groundwater resources and, more generally, critical areas, of that much greater importance. 49. With respect to UDC §9.5.4(b)(S), the County Commission finds that recent election results indicate not necessarily a change in the attitudes of the County's citizenry, but certainly a reprioritization of those basic vàlues with an emphasis now placed on economic opportunity and a healthy economy. This reprioritization becomes particularly important in the face of increasing unemployment and our current national recession. While this shift in priorities does not necessarily require. wholesale changes to the goals of the plan, it does and will require some modification of the plan in order to better achieve opportunity for improving the economic base in a manner that is consistent with GMA and the County's Plan, which do and will continue to mandate the protection of critical areas and groundwater resources so that this continues to be an attractive place to live. 50. With respect to UDC §9.S.4(b)(6), the .County Commission finds that the County has undergone changed circumstances with respect to the worsening of the gap between the median income of a citizen and the general unavailability of housing that is affordable based on such a salary, the listing of salmon species as "endangered" pursuant to federal statute, new development regulations adopted by the County to implement the GMA and the County's Plan and additional Hearings Board decisions which illuminate what the state laws permit or do not permit. Such changed circumstances may make amendments to the Plan appropriate. or ;. 51. With r'espect to UDC §9.5.4(b)(7), the County Commission finds that any inconsistencies between the County's Plan and the GMA exist because Jefferson County was found to be out of compliance with respect to the protection of critical areas and groundwater resources. 9 of 11 ORDINANCE NO. 07-0723-02 re: Seawater Intrusion ......--.-----.... 52. With respect to UDC §9.8.1(b), another portion of the UDC which the County Commission should consider when adopting amendments or revisions to the UDC, the County Commission finds at least two of the three criteria listed there inapplicable in these circumstances, specifically circumstances where the UDC is being revised to implement the written mandate of an FDO published by the WWGMHB in January 2002 directing this County to undertake and complete six distinct actions. 53. With respect to the criterion listed at UDC §9.8.1(b)(3), the County Commission fmds that there has been much public testimony and concern on the issue of seawater intrusion during the entire GMA era of this County and that therefore there is interest in this issue among the general public. 54. Adoption of this amending and revision language to the UDC, this County's GMA-derived develqpme~t regulations, and simultaneous adoption of a Resolution (with an attached "policy" document) places Jefferson County in compliance with the January 2002 FDO published by the WWGMHB with respect to the PFR filed by the Olympic En~ironmental Council and the Shine Community Action Council. 55. On June 7, 2002, the Jefferson County Department of Community Development generated and mailed an "Integrated GMNSEP A Document & Notice ot" Hearing." This document simultaneously served three purposes: 1) it notified the Washington State Office of Community Development of this County's intent to amend its GMA-driven development regulations, 2) notified the world that existing documents would be adopted in lieu of a distinct SEPA-driven environmental review and 3) informed the world that elected County Commissioners would hold a public hearing on this topic on July 22, 2002. Section 2 - Lansn¡ae:e Revisions and Additions to the UDC: The language of the attached Exhibit, consisting of 7 pages, is hereby adopted as the detailed revisions and additions to the UDC. .. .. Sèction 3 ~ Sectiån 3 - Severability: If any section, subsection, sentence, clause, phrase, or figure of this ordinance or its application to any person or circumstances is held invalid, the remainder of the ordinance or the application to other persons or circumstances shall not be affected. 10 of 11 ORDINANCE NO. 07-0723v02 re: Seawater Intrusion ..-...------..... Section 4 - Effective Date: This ordinance shall become effective 60 days from adoption by the Board of County Commissioners, also known herein as the County Commission. APPROVED AS TO FORM: ~~ '/2Z.)Ot- JEFFERSON COUNTY BOARD OF COMMISSIONERS ~) :) Dan Tittemess, Member ...;:. 11 of 11 BOARD OF COUNTY COMMISSIONERS -------------- UDC groundwater protection/seawater intrusion amendments In conjunction with Coastal Seawater Intrusion Policy dated July 23, 2002 Section 2 Definitions Alternative Water System Anv source of water for an Individual sinale-familv use that is not a leaallv constructed well that produces more than 400 callons per day or an approved public water system that can provide adequate water for the intended use of a structure. Critical Aquifer Recharge Areal (for reference; no amendment proposed) Selected watersheds and critical aquifers where resources are potentially threatened by salt water Intrusion or primary ccmtamlnantQ ot limited due to poor recharge. (p.2.6) Seawater Intrusion (See "Salt Water Intrusion") Salt Water Intrusion (for reference; no amendment proposed) The underground flow of salt water Into wells and aquifers. (p.2.20) Source of Contamination A facility or dlsposat or storage site for material that Impairs the quality of ground water to a degree that creates a potential hazard to the environment, public health, or Interferes with a beneficial use. Or In reference to well drilllna. a specific area or source as defined ¡nWAC 173. 160·171. (p.2-22) Section 3 Land Us. Districts 3.6 Overlay Districts 3.6.5 Critical Aqul1er Recharge Areas. a. Classification. Critical Aquifer Recharge Areas are naturally susceptible due to the existence of permeable solis or a seawater wadas In coastline aquifers. Certain overlying land uses can lead to water quality and/or quantity degradation. The following . cl~~iflcatlons define Critical Aquifer Recharge Areas. ~" (1) . Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. For the purposes of this section, unless otherwise determined by preparation of an Aquifer Recharge Area Report authorized under this section, the following geologic units, as Identified from available State of Washington Department of Natural Resources geologic mapping, define Susceptible Aquifer Recharge Areas for east Jefferson COunty: UDC seawater intrusion amendment Exhibit B; MLA02-00314 7/23/02 Page 1 BOARD OF COUNTY COMMISSIONERS ----..". ...".-.."'.-.------.--. I. Alluvial fans (!:ia', II. Artificial fill (Hx', ill. Beach sand & gravel (Hb', Iv. Dune sand (Hd), v. Flood plain alluvium (Hf), vi. Vashon recessional outwash In deltas and alluvial fans (Vrd', vII. Vashon recessional outwash In meltwater channels (Vro" vIII. Vashon Ice contact stratified drift (VI), Ix. Vashon ablation till (Vat), x. Vashon advance outwash (Vao), xl. Whldbey formation (Pw), and xII. Pre-Vashon stratified drift (Py). (2) Those areas meeting the requirements of Susceptible Aquifer Recharge Areas (above) and which are overlain by the following.land uses as Identified In this Code are subject to the provisions of the protection standards In this Section:. I. All Industrial Land Uses II. All Commercial Uses III. All Rural Residential Land Uses A. requiring a DlscrØtlonary Use or Conditional Use Permit or B. with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit Iv. Unsewered Planned Rural Residential Developments v. Unsewered resløentlal development with gross densities greater than one unit per acre . (3) . Specla. Aquifer Recharge Protection Area. Include: I. Sole Source Aquifers designated by the U.S. Environmental Protection Agency In accordance with the Safe Drinking Water Act of 1974 (Public Law 93-523) . II. Special protection areas designated by the Washington Department of Eco- logy under Chapter 173-200 WAC. III. Wellhead Protection Areas determined In accordance with delineation methodologies specified by the Washington Department of Health under authority of Chapter 246-290 WAC. Iv. Ground Water Management Areas designated by the Washington Department of Ecology In cooperation with local government under Chapter 173-100 WAC. (4) Seawater Intrusion Protection Zones (SIPz) are aaulfers and land overlvinq ~_ . -: aQuifers with some dearee of vulnerabllltvto seawater Intrusion. SIPZ are defined either bv proximity to marine shoreline or bv proximity to aroundwater sources that have demonstrated hlah chloride readlnas. All Islands and land area within 1/4 mile of marine shorelines and associated aauifers toaether compose the coastal SIPZ. Addltlonallv. areas within 1000 feet of a t!roundwater source with a history Of chloride analvses above 100 mllllt!rams per liter (mall) are cateaorized as either at risk (between 100 mall and 200 mQ/l) or hlah risk (over 200 mail) SIPZ. Hlah risk SIPZ shall be considered ·seaÞsalt water intrusion areas,· which are smont! the UDC seawater Intrusion amendment Exhibit B: MLA02-00314 7/23/02 Page 2 BOARD OF COUNn/ COMMISSIONERS "sources or potential sources of contamination" listed in Washinaton Administrative Code (WAC) 173- 160- 171. implementina code for the Water Well Construction Aqt. In some cases. hiah chloride readinas may be indicative of connate seawater (Le.. relic seawater in aauifers as opposed to active seawater intrusion). When best available science or a hvdroQeoloaic assessment demonstrate that hlah chloride readinas in a particular area are due to connate seawater. the area in Question shall not be considered an at risk or hiah risk SIPZ. When the status of an area Is In Question. the UDC Administrator Is responsible for maklna the determination based upon recommendation from County Department of Health and Human Services. b. Designation. Jefferson County shall prepare and exhibit a-dated Critical Aquifer Recharge Area map§ which wUl-demonstrate the approximate distribution of the Susceptible Aquifer Recharge Areas,,. -aRd-Special Aquifer Recharge Protection Areas-, and Seawater Intrusion Protection Zones. The Critical Aquifer Recharge Area map.§ shall be periodically revised, modified, and updated to reflect additional Information. c. Applicability. (1) The following land use activities are considered high Impact land uses due to the probability and/or potential magnitude of their adverse effects on grouhdwater and shall be prohibited In Susceptible Aquifer Recharge Areas and Special Aquifer Recharge Protection Areas. In all other areas of the County outside of Susceptible Aquifer Recharge Areas and Special Aquifer Recharge Protection Areas, these activities shall require an Aquifer Recharge Area Report pursuant to this Section. I. Chemical manufacturing and reprocessing; II. Creosote/asphalt manufacturing or treatment (except that asphalt batch plants may be permitted in Susceptible Aquifer Recharge Areas ONLY If such areas lie outside of Special Aquifer Recharge Protection Areas and ONLY If best management practices are implemented pursuant to sections 4.24.8d ad 6.17 of this Code and an accepted Aquifer Recharge Area Report); iii. Electroplating and metal coating activities; Iv. Hazardous waste treatment, storage and disposal facilities; v. Petroleum product refinement and reprocessing; vI. Underground storage tanks for petroleum products or other hazardous materials; vII. Recycling facilities as defined In this Code; viiI. Solid waste landfills; Ix. Waste piles as defined In Chapter 173-304 AC; x. Wood and wood products preserving; xl. Storage and primary electrical battery processing and reprocessing. (2) All other land uses shall be subject to the protection standards contained In this Section and mitigating conditions Included with an Aquifer Recharge Area Report, where applicable. ...;:. .(3) -: Seawater Intrusion Protection Ar-vuZones. Marine shorelines and Islands are susceptible to a condition that Is known as seawater intrusion. Seawater Intrusion is a condition In which the saltwater/freshwater Interface In an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface Is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology Is the.QR!.y..agency UDC seawater íntrusion amendment Exhibit B: MLA02-00314 7/23/02 Page 3 BOARD OF COUNnl COMMISSIONERS with statutory authority to regulate groundwater wIthdrawal for Individual wells In Jefferson County. Thgrefgr8, new New development. redevelopment, and land use activities on islands and in close proximity to marine shorelines In particular should be developed In such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that It recharges the aqulfer._ To Aelp prevent seawater from ¡ntNgIRQ landward iRt9 I.IRdergr:oblRd aquifers, all FlS',V d9Velopmønt OR MarrQv/8tgne ¡¡I::aRg,' lf1dlan 1I.IQ:)d 3A" with/:) 500 'fogt of SRY mar/FIe sf::tgrellRg ;l:1all be rg'llolir:sd to Infiltfatg all s:tQlrnWat9r R./Roff, to the maxlmlolm sxteflt praçtlQaÞle. QRli:lts. LProtectlon Standards. (1) General. The following protection standards shall apply to land use activities In Susceptible Aquifer Recharge Areas and Special Aquifer Protection Areas, and when soeclfied In Seawater Intrusion Protection Zones, unless mitigating conditions have been Identified In a Critical Aquifer Recharge Report that has been prepared pursuant to this section. (2) :Stormwater Disposal. I. Stormwater runoff shall be controlled and treated In accordance with. best , 'management practices and facility design standards as Identified and defined In the Stormwater Management Manual for the Puget Sound Basin, as amended and the stormwater provisions contained In Section 6 of this Code. II. To help orevent seawater from Intrudlna landward Into underaround aaulfers. all new develooment activltv on Marrowstone Island. Indian Island and within 1,4 mile of any marine shoreline shall be reauired to Infiltrate all stormwater runoff onslte. The Administrator will consider rSQuests for excectlons to this polley on a case~bYo.Qase basis and may rSQulre a hydroaeoloalc assessment. (3) On.stte Sewag. Disposal. I. All land uses Identified In Section 3.6.5.a and Special Aquifer Recharge ' Protection Areas that are also classified as Susceptible Aquifer Recharge Areas (as defined In this Section), shall be designated Areas of Special Concern pursuant to Chapter 246~272~21501 WAC. A. Such designation shall Identify minimum land area and best management practices for nitrogen removal as design parameters necessary for the protection of public health and groundwater quality. B. Best Management Practices (BMPs) shall be adopted by action of the Board of Health. II, As new Information becomes available that would classify an area as a Special Aquifer Recharge Protection Area or an Area of Special Concern' under this Section, said area may be designated as such by the County. Any additional Areas of Special Concern designated through this process shall receive the same protections identified In Subsection (3)I.A and B above. (4) Golf Courses and other Turf Cultivation. Golf courses shall be developed and operated in a manner consistent with MBest Management Practices for Golf Course -- Qeveiopment and OperatlonM, King County Environmental DMslon (now: Depai1~' , ment of Development and Environmental Services), January 199:3. Recreationaleand InstlMlonal facilities (e.g. parks and schools) with extensive areas of cultivated turf. shall be operated In a manner consistent with portions of the aforementioned best management practices pertaining to fertilizer and pesticide use, storage, and disposal. (5) Commercial Agriculture. Commercial agricultural activities, Including landscaping operations must be operated In accordance with best management practices for UDC seawater intrusion amendment Exhibit B: MLA02-00314 7/23/02 Page 4 BOARD OF COUNTY COMMISSIONERS fertilizer. pesticide, and animal waste management as developed by the Jefferson County Conservation District. (6) Above Ground Storage Tanks. Above ground tanks shall be fabricated. constructed. Installed. used and operated In a manner which prevents the release of a hazardous substances or dangerous wastes to the ground or groundwater. Above ground storage tanks intended to hold or store hazardous substances or dangerous wastes are provided with an impervious containment area, equivalent to or greater than 1 00 percent of the tank volume, enclosing and underlying the tank, or ensure that other measures are undertaken as prescribed by the Uniform Fire Code which provide an equivalent measure of protection. (7) Mining and Quarrying. Mining and quarrying performance standards containing ground water protection best management practices pertaining to operation, closure, and the operation of gravel screening, gravel crushing, cement concrete batch plants, and asphalt concrete batch plants, Where allowed. are contained In Sections 4 and 6 of this Code. (8) Hazardous Material.. Land use activities that generate hazardous waste, which are not prohibited outright under this code, and which are conditionally exempt from ·regulation by the Washington Department 01 Ecology under WAC 173-303-100, or which use, store, or handle hazardous substances, shall be required to prepare and submit a hazardous materials management plan that demonstrates that the development will not have an adverse Impact on ground water quality. The hazardous materials management plan must be updated annually by the facility owner. [9) Well Drllllna. Land Division. and Bulldlno Permits In Seawater Intrusion Protection Zones. I. Well Drillina: Proposed wells must be sited at least 1 00 feet from "known or potential sources of contamination,· which Include "Sea-salt water intrusion areas" (WAC 178-160-171). unless a variance Is obtained from the Washinçrton State Department of EcolOQY per WAC 173-160.106. il. SubdIvisions: Applications for land division (UDC Section 7) when the averaoe net densltv proposed is less than five acres per dwelllnQ unit must Include specific and conclusive proof of adeouate supplies of potable water throueh a QualifvinQ hvdroQeoloolc assessment (relevant components of an Aouifer Recharee Area Report per UDC 3.6.1 O.e) that demonstrates that the creation of new lots and correspondlna use of water will not impact the subject aouifer such that water Quality Is decraded bv seawater intrusion. iiI. Buildino Permits: A. Evidence of potable water may be an individual well, connection to a pUblic water system. or an alternative system. Whatever method Is selected, the r6Qulatory and operational standards for that methOd must be met. includina Jefferson County Health Codes and WashlnQton Administrative Code. B. AU es of buildln ermits that re ulre roof of otable water use are subject to this pOlicv. specifically buildina permits for new sinele-faml V residences (SFRs) or other structures with plumblna that are not associated with an existlna SFR (i.e.. shops or aaraaes with a bathroom). iv. Voluntarv and mandatory measures of the Jefferson County seawater intrusion polley apply to development proposals within the coastal. at risk. and high risk SIPZ In the followino manner. in addition to aU existing applicable Health Codes: A. COASTAL SIPZ UDC seawater Intrusion amendment Exhibit 8: MLA02-00314 7/23/02 Page 5 BOARD OF COUNTY COMMISSIONERS ----.-..-. '-".... .. --..--..-.-- ,_.. VOLUNTARY ACTIONS: 1. Water conservation measures. 2. Installation of a flow meter. 3. On-coinc well monltorlna for chloride concentration. 4. Submittal of data to County. MANDATORY ACTIONS: 1. For proof of potable water on a bulldlno permit application. applicant must utilize DOH-approved pUblic water system If available. 2. If pUblic water Is unavailable. an IndIvidual well may be used as proof of potable water subiect to the followlna reoulrements: o Chloride concentration of a laboratory-certified well water sample submitted with bulldina permit applicatIon. 3. If public water Is unavailable. a Quallfvlna alternative system may be used as proof of POtable water. B. AT RISK SIPZ VOLUNTARY ACTIONS: 1. Water conservation measurès. MANDATORY ACTIONS: 1. For proof of potable water on a bulldlna permit application. apPlicant must utilize DOH-aporoved pUblic water svstem If available. 2. If pUblic water Is unavailable, an Individual well mav be used as proof of POtable water sublect to the followlno reoulrements: o Chloride concentration of a laboratorv-certt1ied well water sample submitted with bulldlno permit application. o Installation of a flow meter. o On-aoino well monltorlna for chloride concentration. o Submittal of flow and chloride data to the Count\' per monitor/no pl'OQram. 3. If public water Is unavailable, a QuallMno alternative SYstem may be used as proof of POtable water. C. HIGH RISK SIPZ MANDATORY ACTIONS: 1. Water conservatIon measures (per list maintained bv UDC Administrator) . 2. For proof of potable water on a bulldlno permit aopllcatlon, applicant must utilize DOH-approved public water system if available. 3. If pUblic water Is unavailable. an individual well may onlv be user/as proof of potable water sublect to the followlno reauirements: o Variance from Chapter 173 WAC standards oranted bv Ecolooy per WAC 173-160-106 for a new oroundwater well within 100 feet of a sea-salt water IntrusIon area per WAC 173-160-171 (I.e., within 1100 feet of a oroundwater source showino chloride concentrations above 200 mo/L); or for an existlno oroundwater well, aoplicant must provide evidence throuQh a hvdrooeoloaic assessment (relevant comoonents UDC seawater Intrusion amendment Exhibit 8: MLA02-00314 7/23/02 Page 6 BOARD OF COUNTY COMMISSIONERS of an Aquifer Recharqe Area Report per UDC 3.6.1 O.e) that subject aquifer wîll not be deqraded by the proposed use of the well. o Chloride concentration of a laboratorv·certified well water sample submitted with bulldlnq permit application. o If chloride concentration exceeds 250 maIL in a water sample submitted for a building permit, then the property owner shall be required to record a restrictive covenant that indicates a chloride readlna exceeded the U.S. Environmental Protection Agencv secondary standard (250 mail) under the National Secondary Drlnklna Water Regulations. o Installation of a flow meter. o On-goina well monltorina for chloride concentration. o Submittal of flow and chloride data to the County per monltorina pro~ram. 4. If pUblic water is unavailable. a Quallfvlna alternative system may be used as proof of potable water. M(10) Mitigating Condition.. The Admlnlstratormay require additional mitigating conditions, as needed, to provide protection to all Critical Aquifer Recharge Areas to enSUre that the subject land or water use action will not pose a risk of significant adverse groundwater quality impacts. The determination of significant adverse groundwater quality Impacts will be based on the Antldegradatlon policy Included in Chapter 173-200 WAC. ++0+(11 ) Authority for Denial. The Administrator may deny approval If the protection standards contained herein or added mitigating conditions cannot prevent significant adverse groundwater quality Impacts. Section 4 4.24 Minerai Extraction, Mining, Quanylng and Reclamltlon. 4.24.8. The following performance standards are required for mining, quarrying and asphalt/concrete batch operations located within a designated Cr:itlca/ Aqui:før Recharge Area Susceptible Aquifer Recharae Area or Special Aaulfer Recharae Protection Area... Section 6 6.17 Mining, Quarrying and Asphalt/Concrete Batch Plant Best Uanagement Practices In Critical Aquifer Recharge Areas. The following shall be considered minimum development standards necessary ONLY for mineraI extraction, quarrying and asphalt/concrete batch operations located In Crtt.lcal Aq",lfgr Rechar-gg ~ Susceptible Aoulfer Recharae Areas or Special AQuifer Recharae Protection Areas as defined In Section 3.6.5 of the UDC... Section 6 6.18 On-Site Sewage Disposal Best Management Practices In Critical _0. Aquifer Rechlrge Areas. The following best management practices (BMPs) are required to meet minimum on site sewage standards within Cr:ltlcal Aquifer Rec:f':1ar-ge Areas Susceptible Aoulfer Recharqe Areas or Special Aquifer Recharge Protection Areas, as identified In Section 3.6.5 of this Code... UDC seawater intrusion amendment Exhibit B: MLA02-00314 7/23/02 Page 7 Sexually Transmitted Diseases, Jefferson County 2001 Report Sexually Transmitted Diseases Reported to Washin ton State De artment of Health b Jefferson Count 2001 2000 2001 2000 2001 2000 10 15 13 17 23 32 1 0 0 0 1 0 Herpes 4 0 5 0 9 0 5 philis 0 1 0 0 0 1 *2001 reported chlamydia cases include 19 females and 4 males Chlam Cases Rate Cases Rate 1997 16 60.8 9,523 169.8 1998 15 56.6 10,998 193.4 1999 35 131.5 11 ,964 207.8 2000 32 121.1 13,066 224.5 2001 23 88.1 13,631 228.1 Jefferson County Chlamydia Rates for Females in High Risk Age Range: Chlamydia Rate per 100,000 Population, Females A e 15 - 24 Years, Jefferson County 1997 477 er 100,000 1998 546 er 100,000 1999 1,382 er 100,000 2000 1,686 er 100,000 2001 1,163 er 100,000 2001 Chlamydia Rates, Jefferson County and Washington State Females a e 15 ·19 Females a e 20 ·24 Total Po ulation 170 er 100,000 A e 15 ·19 A e 20 ~24 Sexually Transmitted Diseases (Syphilis, Gonorrhea and Chlamydia) Summary Syphilis Syphilis is the oldest recognized sexually transmitted disease, and its prevention has been an historic focus of public health activity. Cases of primary and secondary syphilis (P & S), the infectious stages of disease, decreased steadily in Washington State during the first half of the 1990s to all- time lows. Syphilis has recently re-emerged among certain populations. In Washington in 2000, 66 cases of P & S syphilis were reported for an annual case rate of 1.1 per 100,000. Untreated P & S syphilis infection can have serious health consequences including heart abnormalities, mental disorders, blindness, neurological problems, and death. Among pregnant women, trans-placental transmission of syphilis is a potential cause of congenital abnormalities and fetal loss. Gonorrhea In 2000, 2,419 cases of gonorrhea were reported among Washington residents; the rate was 41.0 cases per 100,000. OveraH, gonorrhea incidence in Washington decreased dramatically over the past decade from a high of 112 cases per 100,000 in 1990. However, the annual rate has increased from a low of 34.1 cases per 100,000 reported in 1998. Untreated gonorrhea infection is a major cause of pelvic inflammatory disease (PID) among women. The Health of Washington State Washington State Department of Health Definition: Three of the over 25 diseases spread primarily through sexual activity. Syphilis (ICD~9 codes 090-091), gonorrhea (ICD-9 code 098), and chlamydia (ICD-9 code 099.5) are all caused by bacteria (Treponema pallidum, Neisseria gonolThoeae, and Chlamydia trachomatis, respectively). For syphilis, symptoms are divided into four stages: primary and secondary (highly infectious), latent, and late (no longer contagious). Primary stage symptoms include one or more painless indurated lesions (chancres), and secondary stage symptoms include rashes, swollen lymph nodes, and flu-like symptoms. For gonorrhea, symptomatic women often have abnonnal vaginal discharge or painful urination; approximately 50% do not experience symptoms. Men usually have discharge from the penis and urination that can be severely painful. For chlamydia, approximately 70% of infected women have few or no symptoms; symptoms are often mild or absent in men. If symptoms occur men and women can have abnonnal genital dicharge or pain during urination in the earty stages. Women can also experience abdominal pain. Chlamydia Chlamydia is the most commonly reported sexually transmitted disease (STD) in Washington. In 2000,13,066 cases (9,582 females and 3,484 males) were reported; the incidence rate was 221.7/100,000. Selective screening efforts focused primarily on women, including the federally-funded Infertility Prevention Project, contribute to the observed difference in cases reported among females and among males (2.8 to 1). Untreated chlamydia infection is a major cause of pelvic inflammatory disease (PID) among women. PID can lead to infertility and ectopic pregnancy. Women who become infected witb chlamydia while pregnant can transmit it to their infants resulting in neonatal eye infections and pneumonia. In 2000, 18 such neonatal infections were reported. Time Trends Syphilis Over the last two decades, epidemic infectious syphilis has emerged in several distinct populations in Washington. In the early 1980s, P & S cases were diagnosed primarily among men who have sex with men (MSM). Behavioral changes in this community, largely in response to the HIV epidemíc, led to a dramatic decrease in cases among MSM by the late 1980s. As P & S cases decreased among MSM, the epidemíc shifted to affect heterosexuals, with cases in the late 1980s related to illicit drug use and prostitution.1 This epidemic phase peaked in 1989, and P & S cases fell steadily to a low of 9 cases reported in 1996. Since that time, however, cases of P & S have again risen precipitously among MSM, Sexually Transmitted Diseases updated: 07/23/2002 concentrated primarily in Seattle and urban King County. It has been estimated that the annual rate of infectious syphilis among MSM increased from zero in 1996 to 200 per 100,000 in 19992. Based on review of clinical records, 70% of all syphilis cases in King County occur in MSM infected with HIV and the annual infectious syphilis rate among HIV- infected MSM was estimated at 1,500 per 100,0002. This epidemic continues: 50 cases of P & S syphilis were reported from King County in 2000, accounting for 76% of all cases statewide. Primary & Secondary Syphilis Reported Annual Incidence 25 --------- --- - </} ¡:; ~ 20 <I) 0. g 15 o c5 o ..--- :¡; 0. "* a: _.,n_-.. 10 : ~n ,,\:: ,.; ,~~ ~ g ~ g ~ g 2 ~ m m m moo 0 ~ ~ ~ N N N c_- --::2000-GOal - - Ä ~: 201~--~oal I Gonorrhea National and state gonorrhea rates have fallen dramatically since the early 1980s. However, this decrease in rates reversed in 1999; both the national and state annual incidence rates increased sli§htly in 1999 and 2000. There is mounting evidence that rates of gonorrhea infection are increasing among specific Gonorrhea Reported Annual Incidence </} ¡:; o !!! <I) 0. o o o c5 o .... 350 300 ~: - ~-~-~- - -- 150 ~~ ':_~~-.. .. o L""r'"T"T""""Tï""II".'I"TTTI' rT-r-r-lr 'f"""TT"T""IT" r~ LO 0 "" 0 LO 0 g¡ g¡ m 8 g 0 'I"""" 'I"""" ~ N C\I C'\ I .::2000 Goal _Ä'- ~:~O~ O~~ __ u___ _."._,,"_. "._ ~ <I) ¡¡; a: ffi Sexually Transmitted Diseases updated: 07/23/2002 at-risk populations, such as men who have sex with men (MSM) and people with HIV infection 4. Recent increases observed in annual gonorrhea rates in Washington, whiJe not large in comparison to the decline noted over the previous decade, highlight the continuing need to reach populations at risk with intensified and expanded prevention, treatment, and partner services. Chlamydia Chlamydia became reportable in Washington in 1987 and became reportable nationally in 1994. The lowest chlamydia case rate reported in Washington was 167.4 cases per 100,000 persons reported in 1996. Since then, chlamydia rates have increased steadily. Several factors might have contributed to this increase including more sensitive laboratory tests, an increase in routine screening, improved surveillance, and a potential increase in sexual risk-taking behaviors. Chlamydia Reported Annual Incidence 300 ---- '_. --- "-., ---_.--"- </} § 250 !!! ~ 200 o o â 150 o ::: 100 <I) 0. ~ 50 - ---\IT-7~ - _n___~ .---.- '-.,..'-. --- .-. ".'- ",--"",_._-,,,,,._,."_.,-, "-.... ._,,,, , .-- ."--".'--_.'.'-,,,,".'- o T 1 '-I""""T"TL 'f'''f"I""""T"""l- ¡."TI""TT' C·TTï'"'T'-I·'''"T"""T""r''r'I-'rT"ì o a:> m .... o o o N o ~ LO o ~ LO a:> m o m m LO 0> 0> - c:-- __n___ --- ----~ _WA _US _ HP2000Goal ...-.. '-- --, ..-."..-. '-- Year 2000 and 2010 Goals Syphilis Washington has met the Healthy People 2000 goal of 4.0 or fewer P & S cases per 100,000 (1995 Midcourse Revision). However, this apparent success disguises the fact that rates continue to be considerably higher for specific populations such as MSM. The goal established by Healthy People 2010 of 0.2 cases of P & S syphilis or less per 100,000 reflects the national intention to eliminate syphilis transmission entirely. In 2000, the most recent year for which reporting is complete, 66 cases of P & S syphilis were reported statewide for a case rate of 1.1 cases per 100,000. A greater than five-fold reduction in cases will be necessary to achieve the Healthy People 2010 goal. 2 The Health of Washington State Washington State Department of Health Gonorrhea Washington has achieved the national goal for gonorrhea incidence (100 cases per 100,000) set in Healthy People 2000 (1995 Midcourse Revision) as well as the state goal of fewer than 60 cases per 100,000 for 2000. In Healthy People 2010, CDC has set an aggressive national goal of 19 or fewer cases per lOO,OOO. To reach this goal, Washington needs to expand prevention interventions to specific at-risk groups, such as MSM, African Americans, and people with HIV infection. Chlamydia Incidence rates nationally have increased in each of the five years for which data are available and have exceeded the Healthy People 2000 goal of reducing incidence to 170 per 100,000 persons. Washington reached the Healthy People 2000 goal in 1996 and 1997, but since that time, chlamydia incidence has risen. An overall population-based goal for the reduction in chlamydia incidence was not included in Healthy People 2010. However, there is a goal to reduce the overall chlamydia infection rate for people 15 ~ 24 years old to 3% at STD and family planning clinics in Washington. Expanded screening and treatment among women and an increased effort to improve partner treatment as well as screening of selected, high-risk groups of young men - such as those in correctional settings - will be required to meet this goal. Geoaraphic Variation Syphilis In 2000, 76% of the cases ofP & S syphilis were reported from clinics in Seattle and urban King PRIMARY & SECONDARY SYPHILIS 1998 - 2000 Average Annual Crude Incidence per 100,000 1°'0 .. 0,1 to 0,9 1,0 to 1.5 1,6 to 2.9 State Rate: 1,1 National Rate: 2.5 (1999) P:oð;J~(!d t¡y n~RM GiS The Health of Washington State Washington State Department of Health County, reflecting the epidemic among MSM. Cases reported from adjoining counties might be related, as travel for sexual contact to urban centers is common, Case rates are not statistically reliable in counties in which the population is small and the number of cases is low. Only four counties (King, Pierce, Yakima, and Kitsap) reported more than one case ofP & S syphilis in 2000. and 29 counties reported having no cases. Gonorrhea Washington's three-year average rate (see Technical Notes) for gonorrhea between 1998 and 2000 was 37,6 cases per 100,000, This is almost a quarter of the national rate. 133.2 per 100,000, Twenty-one counties in Washington had a rate greater than eight cases per 100,000, The highest average rates were in King and Pierce counties (62 and 75 cases per 100,000, respectively). These two counties have experienced significant recent increases in morbidity, but both rates are considerably below the Healthy People 2000 goal of 100 cases per 100,000. GONORRHEA 1998 - 2000 Average Annual Crude Incidence per 100,000 ii 08,01 tto 277·97 State Rate: 376 , 0 . National Rate: 133,2 (1999) 27.8 to 61.6 61.7 to 74. 7 r~.~(j~oo(j by tYW>r1 GfS Chlamydia Statewide, the three-year average incidence rate (see Technical Note) for 1998 -2000 was 206.4 per 100,000. Chlamydia infections were reported from all counties in Washington, which in part reflects the wide availability of screening through the Infertility Prevention Project. Chlamydia infection is widely distributed among sexually active populations regardless of geography, The highest case rates for 1998-2000 were in Franklin, Yakima, Pierce, and King counties. 3 Sexually Transmitted Diseases updated: 07/23/2002 CHALMYDIA 1998 ~ 2000 Average Annual Incidence Rate per 100,000 iii 33.6 \0 139.2 State Rate: 208.6 '. :: 142.6 to 201.2 National Rate: 377.1 (1999) 209.3 to 236.2 282.0 to 370.2 Produc"" b, VRM GIS Urban and Rural Syphilis Rates ofP & S syphilis are higher in Washington counties in closest travel-time proximity to large urban centers. The most prominent factor contributing to the observed differences in recent P & S syphilis rates between rural and urban areas is the higher concentrations of MSM in population centers in western Washington. Greater prevalence of disease in specific urban populations contributes to increased exposure risks; the presence of sex workers and anonymous sex venues in urban areas magnifies this effect. Primary & Secondary Syphilis Urban and Rural Reported Average Annual Incidence WA State, 1998 - 2000 Urban 1.2 Large Town! Mixed Rural Small Town! Rural o 0.5 1 15 Rate per 100,000 persons 2 Gonorrhea Gonorrhea rates are significantly higher in urban counties in Washington. Multiple factors contribute to differences in gonorrhea rates between rural and Sexually Transmitted Diseases updated: 07/23/2002 urban areas, including higher concentrations of younger people and particular at-risk groups in urban areas. Gonorrhea Urban and Rural Reported Average Annual IncIdence WA State, 1998 - 2000 Urban I 43.4 Large T own/ Mixed Rural Small Town! Rural 10 20 30 40 Rate per 100.000 persons 50 Chlamydia Chlamydia rates are higher in urban counties in Washington. Multiple factors contribute to the observed differences in rates between rural and urban areas, including higher concentrations of younger persons in urban areas. Greater prevalence of disease in specific urban populations contributes to increased exposure risks; the presence of sex workers and anonymous sex venues in urban areas might magnify this effect. Chlamydia Urban and Rural Reported Average Annual Incidence WA State, 1998 - 2000 Urban 220 Large Town! Mixed Rural Srrnll Town! Rural o 50 100 150 200 Rate per 100,000 persons 250 Age and Gender Syphilis Males accounted for 88% of all P & S syphilis cases reported in 2000. The male-to-female ratio of P & S syphilis cases in 2000 was 7.3 to 1, clearly reflecting the fact that the current epidemic is concentrated among MSM. Among men, the highest average annual incidence 4 The Health of Washington State Washington State Department of Health rate of P & S syphilis between 1998 and 2000 was among those 25 to 34 years of age, 6.0 cases per 100,000. Primary & Secondary Syphilis Age and Gender Reported Average Annual Incidence WA State, 1998 ·2000 65-74 55-64 45-54 35-44 25-34 15-24 ~ 8 o 2 4 6 Rate per 100,000 persons [~_Fema~= _ Mãïel Gonorrhea There are significant differences in gonorrhea rates by gender and age. Males had a higher gonorrhea rate (46.3 per 100,000) than females (36.9 per 100,000) in 2000. The highest rates are in women age 15 to 24 years, 183.0 cases per 100,000. These cases accounted for 29% of total gonorrhea morbidity in 2000. Among males, the burden of disease is distributed more evenly among those 25 and older. Gonorrhea Age and Gender Reported Average Annual Incidence WA State, 1998·2000 85+ 75-84 65-74 55-64 45-54 3544 25-34 15-24 5-14 1-4 <1 . - 9 -------- ... ...-- o 50 200 100 150 Rate per 100,000 persons ¡;-Femal~__~~~_~~ Chlamydia Chlamydia infection is disproportionately reported among women and younger people. In 1998-2000, incidence was highest among 15 - 24 year old The Health of Washington State Washington State Department of Health women. Factors that might contribute to this pattern include selective screening of young women, higher levels of sexual activity in this age group among both men and women, increased susceptibility to infection due to cervical ectopy, and the absence of immunologic experience with chlamydia which may result in partial immunity. The overall rate of chlamydia among females in 2000 was 328.0 per 100,000 while the male rate was almost a third of that, 120.2 per 100,000. Males diagnosed with nongonococcal urethritis (NGU), a principal indicator of chlamydial infection in men, are often treated presumptively without laboratory confirmation of disease. Only laboratory-confirmed cases of chlamydia infection are required to be reported to the local health jurisdiction and the Department of Health. For this reason, chlamydia might be significantly under- reported among males. In light of this practice, true chlamydia morbidity might be much closer to I: 1 for males and females. Chlamydia Age and Gender Reported Average Annual Incidence WA State, 1998·2000 85+ 75-84 65-74 55-64 45-54 35-44 25-34 -. 15-24 5-14 1-4 <1 o 1500 2000 500 1000 Rate per 100.000 persons ~em-äl~ ~ Maie] Race and Ethnicity The 2000 US census allowed reporting of more than one race per person, but until 2001, the STD surveillance system only recorded one race. For this reason, current SID incidence rates by race were not developed for this report. However, other reports have been developed by the Department of Health using census estimates (Annual Communicable Disease Report, 2000; SID Disease Morbidity Report, 2000). Incidence rates for sexually transmitted diseases are higher for some racial and ethnic minorities. Income and Education Case reports for these three STDs do not include information about income and education. 5 Sexually Transmitted Diseases updated: 0712312002 Other Measures of Impact and Burden HIV Co-morbidity: Infection with bacterial sexually transmitted infections facilitates sexual transmission ofHIV infection5. A recent study ofHIV/SID co- morbidity found that among people with P & S syphilis in Washington, 23% were reported as HIV- positive in 1999, and 29% were HIV-positive in 20003. Among people with gonorrhea, the minimum prevalence of HIV infection among reported GC cases was slightly less than 3%; for all people reported with STDs, the minimum prevalence of HIV infection was approximately one half of one percent of all STOs reported. As HIV reporting becomes more complete, surveillance for co~morbidity will more accurately reflect the extent of co-infection. Studies based on clinical records, rather than surveillance data, suggest that the prevalence of HI V infection among SID patients might be considerably higher. One such study recently found that 70% of syphilis cases were also infected with HIV6. Pelvic Inflammatory Disease (PID).- About 20% of women with untreated gonorrhea infection will develop PID, and approximately 10% of women with untreated chlamydia will develop PID 7. PIO causes inflammation of the female genital tract, especially the fallopian tubes. In 20% of cases, PIO causes intermittent fever, severe abdominal pain, vaginal discharge, and potential tissue damage resulting in infertility. Ectopic pregnancy is strongly associated with PID. One hundred nineteen cases of gonococcal PID and 325 cases of chlamydial PID were reported in Washington State in 2000. The actual incidence of PID is difficult to estimate because of the relative complexity of diagnosis and a more recent shift from inpatient to outpatient treatment, and incompleteness of reporting. Screening for chlamydial infection has been shown to reduce the incidence ofPID. Late-stage Manifestatiom,': Serious disability or mortality rarely results during primary or secondary syphilis infection. However, untreated syphilis can lead to serious complications including central nervous system and cardiovascular involvement and skin, bone, and viscera lesions. These complications can shorten life, impair health, and lead to disability. Infant morbidity and mortality: Among pregnant women with untreated syphilis infection, infection of the fetus can occur in utero with subsequent risk of infant mortality, brain damage, blindness, and/or developmental abnonnalities. Gonorrhea and chlamydial infections have been identified as possible causes of premature birth. Maternal gonococcal and chlamydial infections can be transmitted to infants during birth causing Sexually Transmitted Diseases updated: 07/23/2002 conjunctivitis and chlamydia pneumonia. In 2000, 18 such neonatal infections were reported in Washington. Risk and Protective Factors Sexually transmitted disease risk behavior cannot be viewed as merely the result of conscious choices. Sexual health and the practice of responsible and sustainable sexual behaviors is a complex issue influenced by a wide array of biological, social, emotional, interpersonal, and spiritual issues. Specific behaviors can be identified which facilitate the transmission of STDs, but factors influencing these behaviors are not generally amenable to simplistic explanation. Unprotected vaginal and anal intercourse is the primary method of transmission for STDs. Abstinence or delay in the onset of sexual activity is an effective protective measure for preventing the transmission of all STOs. Among people not practicing abstinence, mutually monogamous relationships provide a protective measure against STDs. Avoidance of multi-partnering and anonymous sex venues can also significantly reduce the risk of infection with STDs. Correct and consistent use of latex condoms during penetrative sexual activity constitutes an equally important protective behavior to prevent transmission of bacterial SIDs. High Risk Populations Adolescents and young adults: Young people between 15 and 19 years of age account for 40% of chlamydia infections nationwide and account for 36% of all chlamydia morbidity in Washington. Among sexually active women prevalence can exceed 5% and might reach as high as 10% among teenage girls3. Females are over- represented in chlamydia reporting, and the incidence among males is more likely similar to that of females in this age group. Men who have sex with men (MSM): P & S syphilis infections in MSM reported from Seattle-King County have increased precipitously since 1997. Multiple par1nering and sexual activities in anonymous sex venues represent significant risk factors for syphilis infection in the MSM population. Gonococcal infections in MSM reported from the Seattle-King County Harborview STD clinic more than doubled from 1997 to 1998. It has been estimated that the rate of gonococcal infection in MSM in King County increased from 180 per 100,000 in 1997 to 363 per 100,000 in 2000 (projected from data through September 2000). In contrast, the rate among presumed heterosexuals in King County was projected to be 57 per 100,000 in 2000.8 Racial/ethnic minorities: Evidence suggests that African American MSM are disproportionately affected by P & S 6 The Health of Washington State Washington State Department of Health syphilis infection and gonorrhea, and racial and ethnic minorities are disproportionately affected by chlamydia infection. There is no scientifically valid reason to expect STD rates in some groups to be different from those of others. Race and ethnicity do, however, correlate with socioeconomic and geographic factors that contribute to recognized disparities in access to health services. Race and ethnicity may be salient characteristics defming sexual networks; more constrained sexual mixing might, in part, help explain observed differences in STD rates.9 STD case reporting may also be biased toward more complete reporting from publicly- funded STD clinics than from private medical providers. Surveillance data might under-represent infection among people seeking care in privately funded settings thus heightening the observed disparity in infection rates by race and/or ethnicity. Repeat infections: People with multiple episodes of gonorrhea infection in a given 12-month period represented 6.7% of gonorrhea cases in 2000, and people with multiple episodes of chlamydia infection in a given l2-month period represented 9.3% of chlamydia cases in 2000. These figures are based on surveillance data and may underestimate the impact that a relatively sman group of persons may have in facilitating HIV transmission. Recent studies in King County and elsewhere have shown that 12% of women infected with chlamydia are infected when retested 3-5 months after treatment. Repeat infection is also a risk factor for infertility among women. Those with multiple episodes of STDs can also interact regularly with 'core transmitters' of disease in the community and so deserve additional preventive emphasis. Intervention Strategies Three key factors combine to detennine ongoing transmission of STDs: 1) the rate at which uninfected people have unprotected sexual contact with infected people (exposure), 2) the probability that an uninfected person will become infected if exposed (transmissibility), and 3) the length of time an infected person is infectious and able to transmit the pathogen (duration). Reducing the incidence of STDs requires creating programs to engender behavior change both at the individual and population levels to impact one or more of these factors. For non-vaccine preventable STDs, only exposure and duration factors are amenable to public health intervention. Limiting the rate of individual exposure can be accomplished by programs that encourage people at risk to adopt preventative strategies such as The Health of Washington State Washington State Department of Health abstinence from sexual activity. consistent and currect use of latex condoms, regular screening if sexually active, and prompt treatment if infected. Prompt identification and treatment of infected people reduces duration, which consequently reduces the infected person's sexual partners' risk of exposure. When people are screened and STD infection is detected, public health approaches to STD control, such as prompt treatment with antibiotics, interviewing infected individuals to identify people potentially exposed through sexual activity, and contacting these exposed partners are an effective foundation for limiting the spread of disease. Timely identification and prompt response to STD outbreaks by the public health community can also interrupt the chain of transmission in sexual networks and limit the extent of the outbreak. While often resource- intensive, these interventions can be highly effective. In light of the mounting evidence that inflammatory and ulcerative STDs can facilitate transmission of HI V infection, STD control efforts also provide an additional opportunity to prevent HIV transmission especially among people at greatest risk for infection. See related chapters on Sexual Behavior, Social D~terminants of Health, and fjIVIAIDS. Data Sources Sexually Transmitted Disease Morbidity 2000, Washington State, Washington State Department of Health, Infectious Disease & Reproductive Health STOtTS Services Section & IORH Assessment Unit. This reporl contains surveillance data on legally reportable STDs in Washington State. Sexually Transmitted Disease Surveillance 1999, United States Department of Health & Human Services, Centers for Disease Control and Prevention, 1999. This report contains surveillance data and analysis for STDs reportable to CDC in 1999. For More Information Washington State Department of Health, Infectious Disease & Reproductive Health, STOtTS Services Section, 360-236-3460. Endnotes 1 1990 Annual 8m Progress Report, STOrTS Services Section, Infectious Disease & Reproductive Health, Washington State Department of Health. 2 Resurgent Bacterial Sexually Transmitted Disease Among Men Who Have Sex With Men ~ King County, Washington, 1997-1999, MMWR WeeklY, 48(35); 773-777, Centers for Disease Control and Prevention, Atlanta, Georgia, September 1999. 7 Sexually Transmitted Diseases updated: 07/23/2002 3 COC, Tracking the Hidden Epidemics: Trends in STDs in the United States, 2000. 4 Courogen M, Stenger M, unpublished data from the Washington State Department of Health OASIS Project, 2000. 5 Fleming DT, Wasserheit JN, From Epidemiological Synergy toPublic Health Policy and Practice: the Contribution of Other Sexually Transmitted Diseases to Sexual Transmission of HIV Infection, Sex Trans Dis 1999;1:3-17. 6 Golden, M. Unpublished data from Public Health - Seattle & King County STD Program, January 2002. 7 Westrom L, Joesoef R, Reynolds G, et al. Pelvic Inflammatory Disease and Fertility: a Cohort Study of 1,844 Women with Laparoscopically Verified Disease and 657 Control Women with Normal Laparoscopy. Sex Trans Dis 1992;9:185~92. 8 Whittington W., Celum C. Sleepless in Seattle: Risk Behaviors among HIV+ and HI V- MSM; STD Prevalence; Implications for Prevention, Unpublished Report, December 2000. 9 Laumann EO, Youm Y. Racial/Ethnic Group Differences in Prevalence of Sexually Transmitted Diseases in the United States: A Network Explanation. Sex Trans Dis 1999;26 (5):250- 261. Sexually Transmitted Diseases updated: 07/23/2002 8 The Health of Washington State Washington State Department of Health BOH 8/02 Packet FINAL 8/8/02 A Five Year Perspective, 1997-2002 Family Planning Services-Jefferson County Health Department Prepared by Kellie Ragan, M. A. This is an evaluation of the Family Planning Program within the Jefferson County Health Department. Within the context of clinic services, this comparative analysis examines target populations (females 19 and younger and females 20-24), client-specific areas (unduplicated clients, total visits, new clients and continuing clients), payment sources, ZIP Code of residence, and staffing levels. Family Planning services encompass annual exams, reproductive health and risk reduction education, FDA approved prescriptive birth control methods, devices and supplies, non- prescription over-the-counter products (male & female condoms, contraceptive cream, film, foam, gel and suppositories), authorization and referrals for sterilization (vasectomy or tubal ligation), abortion and other reproductive health issues. The goal of the Family Planning Program is to reduce unintended pregnancies. Primary target populations are women 15-19 years old and women 20-24 years old. The Health Department began providing comprehensive family planning services in 1994 through the Family Planning Program (Family Planning). In July 2001, the Health Department implemented the Take Charge program (a federally funded Family Planning Waiver Program). The Present: January 1 through June 30 2002 Family Planning has experienced rapid growth in demand for services due to the Take Charge program. Family Planning serves the target audiences outlined by the CDC- specifically teens and 20-24 year old females. The Take Charge program is minimizing the cost barrier for reproductive health. Based on Census 2000, approximately one-third of the primary target populations are accessing family planning services. Unduplicated client numbers have increased, total visits are up, new clients are requesting services, and continuing clients are returning. From January 1 through June 30, 2002, Family Planning: · Served 738 total clients-71 % of the 2001 total (Figure 1). · Served 230 unduplicated teen clients (19 and younger)--77% of the 2001 total (Figure 1). · Served 166 unduplicated clients age 20-24-66% of the 2001 total (Figure 1). · Completed 1239 visits-61% of the 2001 total (Figure 2). · Completed 469 visits with teens-67% of the 2001 total (Figure 2). · Completed 268 visits with 20-24 year 0Ids-54% of the 2001 total (Figure 2). · Served 233 new clients-53% of the 2001 total (Figure 3). · Served 69 new teen clients-42% of the 2001 total (Figure 3). · Served 48 new clients age 20-24-56% of the 2001 total (Figure 3). · Provided services to 505 continuing clients-85% of the 2001 total (Figure 4). · Provided services to 161 continuing teen clients-118% of the 2001 total (Figure 4). · Provided services to 118 continuing clients age 20-24-70% of the 2001 total (Figure 4). SOH 8/02 Packet FINAL 8/8/02 · Provided services to 738 total clients-of those 59% resided in ZIP Code 98368,38% resided in All Other East Jefferson County ZIP codes, and 3% resided in All Other WAlUS ZIP codes (Figure 5). · Billed for 1239 client visits-of those 54% qualified for Take Charge, 23% qualified for Medicaid and 3% qualified for sliding scale (Figures 6 & 7). · Clinics were staffed with 3.65 FTE-this includes all clinical and support staff (Figure 8). The Future: 2002 Preliminary calculations estimate that Take Charge program revenue is likely to pay for expanded services to accommodate increased demand. The following 2002 clinic projections (based on data from the past 12 months of Take Charge) are anticipated in Family Planning: · Serving 1150 total clients-111 % of the 2001 total (Figure 9). · Serving 96 clients each month-111 % of the 2001 total (Figure 9). · Completing 2390 total visits-117% of the 2001 total (Figure 10). · Completing 199 visits per month-117% of the 2001 total (Figure 10). · Serving 458 new clients-1 04% of the 2001 total (Figure 11). · Serving 38 new clients per month-103% of the 2001 total (Figure 11). · Providing services to 800 continuing clients-135% of the 2001 total (Figure 12) · Providing services to 67 continuing clients each month-137% of the 2001 total (Figure 12). The Past: 1997-2001 The utilization of Family Planning services has steadily increased. · In 1997, Family Planning served 730 unduplicated clients. In 2001, Family Planning served 1033 unduplicated clients; this is 42% increase over four years with an annual average increase of 9% (Figure 9). · In 1997, Family Planning saw an average of 61 clients per month. In 2001, Family Planning saw an average of 86 clients per month; this is 42% increase over four years with an annual average increase of 9% (Figure 9). · In 1997, Family Planning completed 1341 visits. In 2001, Family Planning completed 2040 visits; this is a 52% increase over four years with an annual average increase of 11 % (Figure 10). · In 1997, Family Planning completed 112 visits per month. In 2001, Family Planning completed 170 visits per month; this is a 52% increase over four years with an annual average increase of 11 % (Figure 10). New Clients New clients consume more clinic staff time than continuing clients due to program requirements. These requirements include client assessment, risk reduction and method education, and frequently-crisis intervention. 2 BOH 8/02 Packet FINAL 8/8/02 · In 1997, Family Planning served 372 new clients. In 2001, Family Planning served 440 new clients; this is an 18% increase over 4 years with an annual average increase of 5% (Figure 11 ). · In 1997, Family Planning served an average of 31 new clients each month. In 2001, Family Planning served an average of 37 new clients each month; this is a 19% increase over 4 years with an annual average increase of 5% (Figure 11). ContinuinQ Clients Continuing clients may require visits ranging from one time/month to one-time/6 months, depending on the birth control method, and other clinical, medical and personal factors. · In 1997, Family Planning served 358 continuing clients. In 2001, Family Planning served 593 continuing clients; this is a 66% increase over 4 years with an annual average increase of 14% (Figure 12). · In 1997, Family Planning served an average of 30 continuing clients each month. In 2001, Family Planning served 49 continuing clients each month; this is a 66% increase over 4 years with an annual average increase of 14% (Figure 12). TarQet Populations · In the early 90's, the teen birth rate peaked to above 30 per 1000 females age 15-17 (Figure 13). · In 2000, Family Planning served an estimated 34% of the 15-19 year old females in Jefferson County (Figure 14). · In 2000, Family Planning served an estimated 35% of the 20-24 year old females in Jefferson County (Figure 14). Clients 19 and vounaer Pregnancies among young women age 15-17 are associated with lifelong negative social and economic consequences for the mothers and their children, and reducing these pregnancies is a state and national pUblic health goal. · In 1997, Family Planning served 207 teens (19 and younger). In 2001, Family Planning served 300 teens; this is a 45% increase over four years (Figure 1). · In 1997, Family Planning completed 447 teen visits. In 2001, Family Planning completed 699 teen visits; this is a 56% increase over four years (Figure 2). · In 1997, Family Planning served 102 new teen clients. In 2001, Family Planning served 163 new teen clients; this is a 60% increase over four years (Figure 3) · In 1997, 105 continuing clients were teens; in 2001 Family Planning served 137 continuing teen clients; this reflects a 30% increase among continuing teen clients over four years (Figure 4). 3 BOH 8/02 Packet FINAL 8/8/02 Clients aQe 20-24 Women age 20-24 have one of the highest rates of unintended pregnancy of any age group. · In 1997, Family Planning served 191 adults age 20-24. In 2001, Family Planning served 253 clients age 20-24; this is a 32% increase over four years (Figure 1). · In 1997, Family Planning completed 345 visits with adults age 20-24. In 2001, Family Planning completed 499 visits with clients age 20-24; this is a 45% increase over four years (Figure 2). · In 1997, 89 new clients were age 20-24. In 2001, Family Planning served 85 new clients age 20-24; this is a 4% decrease over four years (Figure 3). · In 1997, 102 continuing clients were 20-24 year aids. In 2001. Family Planning 168 continuing clients were adults age 20-24; this is a 65% increase over four years (Figure 4). ZIP Code of Residence Clients within ZIP Code 98368 utilize Family Planning in greater numbers than All Other East Jefferson County ZIP Codes. · In 1997,401 residents of ZIP Code 98368 (55%) utilized Family Planning as compared to 280 residents of all other East Jefferson County ZIP codes (39%) (Figure 5). · In 2001, 598 residents of ZIP Code 98368 (59%) utilized Family Planning as compared to 378 residents of all other East Jefferson County ZIP codes (37%) (Figure 5). · For the years 1997-2001, approximately 6% of clients reported residences outside of East Jefferson County (Figure 5). Payment Sources Since it's implementation, Family Planning has relied on a variety of payment sources to maintain financial solidity. Medicaid reimbursement, private insurance, and full fee/other payment sources have seen relatively little change from 1997-2001. · Since 1997, sliding scale payment schedules have encouraged heavy program usage. From 1997 through 2000, over 60% of clients qualified for sliding scale fees (Figures 6 & 7). · From 1997-2000, Medicaid reimbursement has been consistent (Figure 6). Medicaid reimbursement has increased due to coordination of benefits with the Take Charge program. Staffing Levels Staffing levels within Family Planning have increased from 2.16 FTE in 1997 to the current 3.65 FTE. · The 1997 clinic staffing level was 2.16 FTE (Figure 5). The 2001 clinic staffing level was 3.19 FTE; this represents a 42% increase over 4 years with an annual average increase of 12% (Figure 8). 4 Figure 1. Total clients, by age, Family Planning,1997-2002 Jefferson County Health Department AHLERS data Total Clients by Age Group Year <20' 20-243 25-29 30-34 35+ Tota1 1997 207 191 104 79 149 730 1998 239 213 139 84 172 847 1999 258 218 128 87 228 919 2000 276 221 114 91 244 946 2001 300 253 139 111 230 1033 2002* 230 166 103 73 166 738 2002 I 2001 % Change 77% 66% 71% 4 YR % Change 45% 32% 42% * data available through 2nd quarter only -... ---.-.-.'''.--.---.---..---"--.-- ---...--...---.-.."'. ...-.-- Figure 1. Total clients, by age, Family Planning- Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 1200 " - .-----------..---...--.- 200 [] 1997 11II1998 o 1999 [] 2000 .2001 m 2002* 1000 800 - II) ~ >. .CI VI - 600 s:: .! 0 ]9 0 I- 400 -_._-~-- o <202 20-243 25-29 30-34 35+ T ota1 ,. -,.._..,'~"...,,', ,-,._..,--",.~"",~,_., .... .,..,.. .'-,..._----~.~_.,--,..._"'- -----.-,. ",",..,.---... I I I ! --~ 'T alai Clients-Served 71 % of 2001 total in first S months of 2002; 42 overall increase 1997-2001. 'Total Clients <20-Served 77% of 2001 total in first 6 months of 2002; 45% overall increase 1997 to 2001. 'Total Clients 20-24-Served 66% of 2001 total in firstS months of 2002; 32% overall increase 1997 to 2001. 8/8/02 FINAL Figure 2. Total client visits, by age, Family Planning,1997-2002*. Jefferson County Health Department AHLERS data Total Visits by Age Group Year <202 20-24~ 25-29 30-34 35+ TotaJ1 1997 447 345 172 150 227 1341 1998 473 416 245 142 267 1543 1999 578 415 241 149 400 1783 2000 557 435 237 161 390 1780 2001 699 499 263 213 366 2040 2002* 469 268 165 120 217 1239 2002 I 2001 % Change 67% 54% 61% 4 YR % Change 56% 45% 52% * data available through 2nd quarter only .- '-..'.". .,.' ,-,_._--~-_.._._---,--------_._-,-~,.,._.. --"._'.,--- ~',....~.,.,., "0_- ...___ Figure 2. Total Client Visits, by age, Family Planning.. Jefferson County Health Department, 1997..2002* Source: Jefferson County Health Department AHLERS data 2500 -~_.""'--".'.' 500 m 1997 11IIII1998 [J 1999 [] 2000 .2001 !ill 2002* 2000· ~ 1500 c:( >- .0 1/1 .. .¡¡¡ 5 1i'i Õ 1000 I- o <202 20-24~ 25-29 30-34 35+ TotaP 'Total Vi$it$~Completed 61% of 2001 total in first 6 months of 2002; 52% overall increase from 11997-2001. 'Total Visits <20-CompJeted 67% of 2001 total in first 6 months of 2002; 56% overall increase 1997 to 2001. 'Total Visits 20~24-Completed 54% of 2001 total in first 6 months of 2002; 45% overall increase 1997 to 2001. "'--".,_..."~"'--'_.~-,.,~. ..~,.--,_.,,~,...-. 8/8/02 FINAL Figure 3. New Clients, by age, Family Planning, 1997-2002*. Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* <2Q2 102 150 133 126 163 69 2002 I 2001 % Served 4 YR % Change 42% 60% * data available through 2nd quarter only New Clients by Age Group 20-243 25-29 30-34 89 59 39 84 81 47 85 50 36 70 42 41 85 56 47 48 28 20 35+ 83 98 121 115 89 68 Total' 372 460 425 394 440 233 53% 18% -. .,-----~- ---- Figure 3. New Clients, by age, Family Planning.. Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 56% -4% 500 I 450 rID 1997 400 11III1998 EJ 1999 350 EJ 2000 300 11I2001 S s;: § 2002* Q) .- U 250 :¡: Q) Z 200 100 50 o <202 20-242 -.".' ~ :::-.::::::::.: . .......,....,... '" -,- .. 25-29 30-34 'New Client Total-Served 53% of 2001 total in first 6 months of 2002; 18% overall increase 1997 to 2001. 'New Client <20-Served 42% of 2001 total in first 6 months of 2002; 60% overall increase 1997 102001. 'New Client 20-24-$erved 54% of 2001 total in first 6 months of 2002; 4% overall decrease 1997 to 2001. 8/8102 FINAL 35+ Total' .".--"-.,--...,- Figure 4. Continuing Clients, by age, Family Planning,1997-2002*. Jefferson County Health Department AHLERS data Age Group Year <202 20-24~ 25-29 30-34 35+ TotaP 1997 105 102 45 40 66 358 1998 89 129 58 37 74 387 1999 125 133 78 51 107 494 2000 150 151 72 50 129 552 2001* 137 168 83 64 141 593 2002** 161 118 75 53 98 505 2002/2001% Served 118% 70% 85% 4 YR % Change 30% 65% 66% **data available through 2nd quarter only Figure 4. Continuing clients, by age, Family Planning- Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 700 600 m 1997 11II1998 [] 1999 [J 2000 .2001* [J 2002** 500 11'I .... c: CI.I 400 .- () C) c: ::;¡ c: ~ 300 c: 0 U 200 100 o <202 20~24~ 25-29 30-34 35+ Total' 'Cant. Client Total-Served 85% of 2001 total in first 6 months of 2002; 66% overall increase 1997 to 2001. 2Cont. Clients <20-served 118% of 2001 total in first 6 months of 2002; 30% overall increase 1997 to 2001. 'Cant Clients 20-24-Served 70% of 2001 total in first 6 months of 2002; 65% overall increase from 1997 to 2001. - -----------"'- ,~,.._. .'..'._-"_.. 8/8/02 FINAL Figure 5. ZIP Code comparison, Family Planning Clinic, Jefferson County, 1997-2002 Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* 98368 401 55% 499 60% 531 58% 559 59% 598 58% 435 59% Clients Served by ZIP Code All Other East All Other WAlUS Jefferson County ZIP Codes ZIP Codes 280 39% 44 6% 285 34% 54 6% 310 34% 76 8% 331 35% 56 6% 378 37% 57 6% 278 38% 25 3% Total 725 838 917 946 1,033 738 * data available through 2nd quarter only r-~-i~ure 5. ZIP Code Comparison, Family Planning Clinic, Jefferson I County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 1000 __m___ ______mmm__ __m_____mum______ --------------------------. -------.--............... ---_._-........_._-_..........................-..-....----.----------------------, 900- ~ :3~:~:~ East Jefferson County ZIP Codes J--------- 00 All Other WAlUS ZIP Codes ".. --....----........----. - ... ...-. ~.,-,--_._'_.--- 800 700 598 '0 600 Q) > .... Q) en 500 lJ c: Q) .- e 400 300 200 100 o 1997 1998 1999 2000 2001 2002* 8/8/02 FINAL Figure 6. Payment Source, Family Planning, 1997-2002* Jefferson County Hearth Department AHLERS data Payment Source Sliding Scale'" Title XIX (Medicaid) Take Charge Private Insurance Full fee/Other Totals 1997 1998 1999 2000 2001 2002*' 897 67% 1038 68% 1147 64% 1104 62% 665 33% 40 3% 245 18% 245 16% 284 16% 309 17% 405 20% 289 23% 579 28% 670 54% 117 9% 181 12% 221 12% 198 11% 278 14% 182 15% 82 6% 70 5% 127 7% 172 10% 113 6% 58 5% 1341 100% 1534 100% 1779 100% 1783 100% 2040 100% 1239 100% * data available through 2nd quarter only I Figure 6. Payment Source, Family Planning-Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 1400 1200 ....-... ,. - " ,. Sliding Sc Ie ,,;"" 1000 ,. " ,. II) / " - ïñ > ñi 800 - " 0 r- " 600 T ke Charge Medicaid ,. 400 - - _...- .. - .. 200 Private Ins o I Full Fe/Other .,'--- 1997 1998 1999 2000 2001 2002*' '2002-54% total visits qualified for Take ChEV"ge, 23% qualified for Medicaid.3% qualied for sliding scale. '1997-2000--65% of total visits (based on annual average) qualified for sliding scale payment options I -.----J 8/8/02 FINAL Figure 7. Payment Source, Family Planning, 2001-2002* Jefferson County Health Department AHLERS data Payment Source Sliding Scale Title XIX (Medicaid) Take Charge Private Insurance Full fee/Other 2000 2001 2002 QTRI QTR II QTR III QTRIV QTRI QTRII QTRIII QTRIV QTRI QTRII 304 263 266 263 278 307 48 32 22 18 87 78 66 78 81 83 117 130 158 131 0 0 0 0 0 0 257 322 359 311 47 53 42 56 58 80 67 77 81 101 24 44 44 60 36 22 26 29 19 39 * data available through 2nd quarter only I Figure 7. Payment Source, Family Planning, Jefferson County Health Department, 2001-2002* Source: Jefferson County Health Department AHLERS data 400 50 Priva :JI)~lJ~a e "" , ,....:.. " 350 300 '" , " , , , , ".' J!! '- .- ". , -". '/ii 250 , 5= J9 , 0 , I- 200 150 "./ ... .. 100 Medi aid ....... .. "'"""'- ". - .. ....... ..:..-:<~'" \, ... ... .. o r--·-·-····- 2000 2001 2002 8/8/02 FINAL Figure 8. Staffing levels, Family Planning,1997·2002. Jefferson County Health Department Budget, 1997·2002 Year 1997 1998 1999 2000 2001* 2002** FTE Total' 2.16 2.31 2.15 2.25 3.19 3.65 2002 /2001 % Change 4 YR % Change Average Annual % Change 14% 48% 12% **·data available through 2nd quarter only ___·"_.u_.',_ ...-..--.."'.------ _.---" Figure 8. Staffing Levels, Family Planning-Jefferson County Health Department, 1997-2002* Source: Jefferson County AS 400 Data System 5- 4 3 2 1 - o FTE Total' 3.65 ............... ............... ............... .............. ............... ............... ............... .............. ............... ............... ............... .............. ............... ............... ............... .............. ............... ............... ............... .............. ............... ............... ............... .............. ............... ............... ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... ............... ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... ............... ............... .............. ............... .............. ............... .............. ............... .............. ............... .............. ............... ............... ............... ............... ............... .............. ............... .............. ............... .............. ............... .............. .~..... 1 Staffing level-48% overall increase 1997 to 2001; 14% increase from 2001 to 2002,12% average annual increase_ -.,.-... ."._-,~ ---,._.~..~-~..--_.._. 8/8/02 FINAL œ 1997 11I1998 Q 1999 OJ 2000 .2001* f8 2002** ,.__.,...-.-....~,~.. Figure 9. Total clients & mean (average) number clients per month, Family Planning,1997-2002. Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* Total Clients1 730 847 919 946 1033 1150 Average # clients/month2 61 71 77 79 86 96 2002 1 2001 change 4 YR (97-01) change 4 YR mean (average) annual change 11% 42% 9% 11% 42% 9% * Staff projection-data available through 2nd quarter only _____"..,··____.._._.'_n__ --..---.,,--..'.-.'-.-.,'"---.'.',"--.,,"- .'------,. Figure 9. Total clients & (mean) average number clients per month, Family Planning-Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 1200 1150 1100 1000 900 800 600 738 Total Clients Jllin..June 2002 500 Ð 1997 o 1998 11III1999 11I2000 .2001 m 2002* 400 300 200 o 77 79 86 96 100 Total Clients1 Average # clients/month2 , Total Clients-111 % of 2001 total; 42% overall increase 1997 to 2001. 9% ænual average change. 2 Total Visits/month-111 %f 2001 total; 42% overall increase 1997 to 2001, 9% annual average change. .'..'''....-~.'''.~,.~_. .,__,_........n ..__.,._,-,-~~~--~",., 8/8/02 FINAL Figure 10. Total client visits and mean (average) number visits per month, Family Planning, 1997-2002. Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* Total Visits' 1341 1543 1783 1780 2040 2390 Total visitslmonth'" 112 129 149 148 170 199 2002 / 2001 change 4 YR (97·01) change 4 YR mean (average) annual chang 17% 52% 11% 17% 52% 11% * Staff projection·data available through 2nd quarter only ---....".---.. ""--". ._._.-._,"-.,-----_.._-_._~--,.,-..'._-,------'- Figure 10. Total client visits and mean (average) number client visits per month, Family Planning..Jefferson County Health Department, 1997-2002* Source: Jefferson County Health Department AHLERS data 2390 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 o - Total Visits' -",._--"_-,~."--,. 1,239 total visits Jan-June 2002 rn 1997 11I1998 [] 1999 D 2000 82001 ffi'J 2002* ..,~_.._--,. 199 Total visits/month'" 1 Total Visits- 117% of 2001 total; 52% overall increase 1997 to 2001. 11 % annual average increase. 2 Total Visits/month-117% of 2001 total; 52% overall increase 1997 to 2001.11 % annual average increase. ,-,_.~-,~---". 8/8/02 FINAL .,",--.--..-,.. --".'--.'--, "---,,--.,,"'---.-.' Figure 11. New Clients (Family Planning), Jefferson County Health Department, 1997-2002*. Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* Total New Clients1 372 460 425 394 440 458 Average new clients/month2 31 38 35 33 37 38 2002 / 2001 change 4 YR (97-01) change 4 YR mean (average) annual change 4% 18% 5% 19% 6% 5% * Projection-data available through 2nd quarter only ._._.~-,.",.. -'--"---' '.-..-.--..,...,'"--..".----..----,-."-- '--' -"-','--'---, '.'-.'-."'-. --"-------.-,. Figure 11. New Clients, Family Planning-Jefferson County Health Department, 1997..2002* Source: Jefferson County Health Department AHLERS data 1200 1100 1000 900 800,· 700 600 J!} 500 s::: Q) Õ 400 ~ Q) z 200 100 0 tm 1997 o 1998 111III1999 II 2000 [] 2001 o 2002* 233 New clients Jlln-June 2002 31 38 35 33 37 38 ~ ...:';"':~"q'. :¡:H;E:::\~;.......: -----..---.-----." . Total New Clients' Average new clientslmonth2 · Total New Clients-104% of 2001 total; 18% increase from 1997 to 2001, 4% average annual increase. 2 Total New Clients/month~103% of 2001 total; 18% overall increase 1997 to 2001,5% average annual increase. ...,"-'~._'~--,'-'-~' ..^~--,,',-'....--~._'.,'~.__... _.._----,'-_.~._'-,.- 8/8/02 FINAL Figure 12. Continuing Clients & mean (average) number continuing clients per month, Family Planning, 1997~2002*. Jefferson County Health Department AHLERS data Year 1997 1998 1999 2000 2001 2002* Continuing Clients' 358 387 494 552 593 800 Average # continuing clients/month2 30 32 41 46 49 67 2002/2001change 4 YR (97-01) change 4 YR mean (average) annual change 35% 66% 14% 37% 66% 14% * Projection-data available through 2nd quarter only ..--..-.,'-- .-.,--'--"".'. -"'--"---"."---" --',.".__....._""-~~'._-_._----,,,.. Figure 12. Continuing clients & Average number continuing clients per month, Family Planning-Jefferson County Health Department, 1997 -2002* Source: Jefferson County Health Department AHLERS data 1000 . 900 800 800 700 600 - 593 ::::::::::: 500 505 continuing clients Jan-June 2002 m 1997 o 1998 11I1999 II 2000 I] 2001 [12002* 400 300 "'-~~-'.- 200 o 49 67 100 Continuing Clients' Average # continuing clients1month2 1 Total Continuing Clients-135% of 2001 total; 66% overall increase 1997 to 2001.14% average annual change. ~~ota/ N~ Clients~~~~~-137% of 2:01 tot:; 66% OV_~a/1 increase 1997 to 2001. 14% av~age annual chan=-________J 8/8/02 FINAL Figure 13. Births per 1,000 females ages 15~17, Jefferson County & Washington State, 1980~82 through 1998~2000. Period 1985-87 1986·88 1987·89 1988-90 1989-91 1 990~92 1991-93 1992·94 1993·95 1994·96 1 995~97 1996-98 1997-99 1998·2000 Jefferson County1 15.9 13.1 16.3 21.6 29.3 35.8 36.6 32.2 26.0 19.1 19.5 18.1 21.7 22.2 Rural Counties Washington State Healthy People 2010 34.2 32.4 31.8 30.4 28.8 27.7 29.1 27.6 26.1 24.5 23.1 21.8 45.0 45.0 45.0 45.0 45.0 45.0 ~., ~--" ..'.---- Figure 13. Births per 1,000 females ages 15-17, Jefferson County, Rural Counties and Washington State, 1993-95 through 1998-2000. Source: Washington State Department of Health Vital Statistics; Washington Health Foundation 50.0 State and National Target " 45.0· )( )( )( )( X )( .... , It' 40.0 .... en Q) ~ 35.0 en .! 30.0 CI:I E æ. 25.0 = g 20.0 .... æ 15.0 c. ~ 10.0 m 5.0 Rural Counties Jefferson County 0.0 _n~"f. I I . "..-t- I -..+ I ..+ I d" I .+------1 r- oo CD C .... iN (\') ~ 10 cø r- eo CD c co co eo CD ø CD CD CD CD CD C» CD C» C , , ,:.. , , 6 , N , .t , , ,:.. = It") to eo CD .... (\') In to iN co CIO eo co co CD en CD en CD ø CD CD , en C7I CD en C7I CD CD CD CD CD C7I CD C7I eo .... .... ~ ~ .... ~ .... ~ .... ~ .... .... ~ CD CD ~ '1990-92 through 1992-94·Births among 15-17 yeel olds greater than 30/1000; decrease seen in in 1993-95 rate (26/1000). 8/8/02 FINAL --~."_.~-_.'.",.. . --'.~-------" .-- Figure 14. Female Population comparison, Family Planning clients and Jefferson County Females, 2000 Population. Jefferson County Health Department AHLERS data Age Group 15-19 20-24 25-29 30-34 Female Clients 245 132 96 80 % Female Pop. 34% 35% 22% 14% __."'______.,._ _.n__.._ __ .___.____ Total County Females 727 378 433 590 ._----"._-,_."-~._~,,.~..,--,---_.'-, .-.... --~ Figure 14. Female Population Comparison-Family Planning clients and county residents, by age, Jefferson County Health Department, 2000 Source: Jefferson County Health Department AHLERS data; Census 2000 1000 nmmm..wwwm.·._ ..n_."_."__._W____m__mm____mm.mm__m_mm___mnmnmm_..n..nn._nn_nn___m.mn_nn__ t: 600 o :¡:J CI :;¡ a. o 500 D.. Q) -¡¡; E (f 400 8/8102 FINAL 900 800 727 700 300 - 245 200 100 o 15-19 . Female Clients . ·'·~.·n....N_u_·N~_______ _n. . un _..__.. ""P_.,__..____._._._.. o Total County Females 378 132 20-24 Age Group ~-,_. -".,-~-,-----",.-- 590 433 96 80 ---i 25-29 30-34 __~~~'M·, "0""___ Adolescent Pregnancy and Childbearing Summary Adolescent pregnancy is a complex issue influenced by many factors including individual, family and community characteristics. Its consequences negatively affect the health, social and economic well being of the teen, child and society. In 1999 in Washington State, the adolescent pregnancy rate among 15 - 17 year-olds was 39 per 1,000, the lowest rate in 20 years. Washington has achieved the Healthy People 2000 goal for teen pregnancies of no more than 50/1,000. While declining rates of adolescent pregnancy call for cautious optimism, US rates remain higher than in other developed countries. No single approach for preventing adolescent pregnancies is appropriate for all adolescents in all circumstances. Some approaches, such as youth development programs, show promise in reducing pregnancy rates. Other approaches, such as abstinence-only programs, require further evaluation. Coordinated and sustained interventions from all sectors of society will be needed to ensure the declining trend of adolescent pregnancy rates continues. Background Note The primary sources of data for adolescent pregnancy are birth certificate data, abortion data, and fetal death certificate data from the Center for Health Statistics at the Washington State Department of Health and data from the First Steps Database at the Department of Social and Health Services. Almost 60% of teen pregnancies in Washington result in live The Health of Washington State Washington State Department of Health Definition: In this section, 'adolescents' or 'teens" are 15-17 year-olds unless otherwise indicated. Analysis was restricted to 15-17 year -olds because they are school age. Pregnancy among teens younger than 15 are a rare event and teens older than 17 are at lower risk for poor birth outcomes. Adolescent pregnancies are estimated by adding together reported births, induced abortions, and fetal losses for females age 15-17. Spontaneous abortions (miscarriages) occurring prior to 20 weeks gestation are not included because there is no way of accurately estimating their number. births. Where possible, in the following sections we provide characteristics of all teen pregnancies. In some instances, we have provided data only on live births due to the unavailability of data on all pregnancies. Time Trends Adolescent Pregnancies. The rate of pregnancy among 15 - 17 year-olds in Washington decreased during the early 1980s to a low of53/1,000 in 1984 and then increased to 59/1,000 in 1989. The rate declined to 39/1,000 in 1999, which is the lowest rate in the 20-year period of 1980 - 1999. For every year between 1980 and 1996, the pregnancy rate among 15 - 17 year-olds in Washington was well below the national average. Adolescent Births. Washington's birth rate for 15 - 17 year-olds began rising steadily after 1986 and peaked in 1992 at 33/1,000. After 1992, the rate decreased to 22/1,000 in 1999, the lowest rate in the 20-year period between 1980 - 1999. National studies suggest adolescent birth and pregnancy rates might be declining because fewer teens are having sex and those who do engage in sexual activity are more effective contraceptive users. 1 Adolescent (Age 15-17) Pregnancies 100 g80~' ~ 60 ~ x ~ . .æ 40 '" cr: 20 O"'r'-~-T'-r'-rT""""T""TT""ì""r!III'1'-r-,'-~ o IX) 0) .... lO IX) 0) ..... o o N o o o N lO ~ g 0> lO 0) 0) r---WA------==-us -----1 _ X HP 2000 Goal . HP 2010 Goal ¡ '-----.--... '-""'.,..--"' ,_._~ 1 Adolescent Pregnancy and Childbearing updated: 07/23/2002 Adolescent Abortion. Washington's abortion rate for 15 ~ 17 year-olds steadily decreased from 30/1 ,000 in 1989 to 17/1,000 in 1999. Year 2000 and 2010 Goals Washington's year 2000 goal for pregnancies among 15 - 17 year-olds was no more than 45/1,000. The Healthy People 2000 and 2010 goal for adolescent pregnancies was no more than 5011,000 and 45/1,000, respectively. Washington has already achieved both the state goal and the 2000 and 2010 national goals. The state rate for adolescent pregnancies among 15 - 17 year-olds from 1997 through 1999 was 42.5 per 1,000. Geoaraphic Variation For the 1997 - 1999 period, teen pregnancy rates at the county level varied from a high of78/1,000 in Franklin County to a low of 12/1,000 in Whitman County. The counties with the highest average teen pregnancy rates were Grays Harbor, Skagit, Yakima, Okanogan, Grant, Adams and Franklin. The lowest rates were in Whatcom, San Juan, Island, Kittitas, Klickitat, Lincoln, Stevens, Spokane and Whitman counties. ADOLESCENT (Age 15-17) PREGNANCIES 1997 - 1999 Rates per 1.000 i 12,3 to 35.6 35.8 \0 41.7 43.3 10 50.7 52.a to 77.7 . In Columbia. Garfield and Wal1kiakum counties IIIe counta are IOOsmab \0 generate ·a rala. Staw Rate: 43.Q Proeu,,"d by DIRM GIS Urban and Rural Adolescent birth rates for 15 - 17 year-olds in 1999 were lower in urban locations compared to rural locations or large towns. Adolescent Pregnancy and Childbearing updated: 07/23/2002 Births to Women 15-17 Urban and Rural WA State, 1999 Small T own/ Rural Large T ownMixed Rural Urban o 10 20 30 Rate per 1,000 40 Race and Ethnicity Race infonnation on abortion reports in Washington is frequently missing. Additionally, the 2000 US Census allowed people to choose more than one race, but multiple race as collected by the birth certificate in Washington is of uncertain quality and completeness. Therefore, we cannot currently calculate pregnancy rates by race for adolescents in Washington. National data available from 30 states indicate that pregnancy rates for 15 - 19 year- olds in the 1995 - 1997 period were higher for blacks than for whites.2 Age In the 1997 - 1999 period, adolescent birth rates for 15 - 17 year-olds rapidly increased with maternal age. Seventeen year-olds had the highest birth rate, at 38 births per 1,000 adolescents. Births by Mother's Age WA State. 1997-1999 17 Q) !1 16 o 10 50 20 30 40 Rate per 1.000 Adolescent Women 2 The Health of Washington State Washington State Department of Health Income and Education Research suggests that early parenthood is a challenge to teens trying to complete their high school education. In the United States, parenthood is a leading reason teen girls do not fInish high school.3 Nationally, less than one-third of teens who gave birth before age 18 ever completed high schoo1.4 The high school completion rate for teen girls would increase by 40% if p-regnancy and births by teens could be prevented.5 Teen childbearing leads to adverse economic consequences. Studies have indicated that not completing high school is more likely to result in welfare dependence and low earnings.5 Nationally about 80% of teen mothers eventually become welfare recipients. I Teen mothers are more likely to have repeat pregnancies and to spend more of their adult years as a single parent than women who delay childbearing.4 As a result, more children must be supported on a limited income. Other Measures of Impact and Burden Adult Fathers of Children born to Adolescent Mothers. Fathers involved in teen births are frequently not teens themselves. Nationally, about 29% of sexually active female teens age 15 - 17 have partners three to five years older, and 7% have partners six or more years 01der.6 These data suggest the issue of teen-adult sexual activity has important legal, economic, and public health implications that require further investigation. Cost of Teen Births. According to data from the First Steps database, nearly 88% of births to 15 - 17 year- olds in Washington ûom 1997 - 1999 were paid for by Medicaid. In 1999, the mean cost for prenatal care ~~ delivery was .$5,~90 "per :,oman for all MedicaId covered dehvenes. This figure may differ when limited to teen deliveries. Outcomes for Teen Births. Teen childbearing can result in several adverse outcomes for both mothers and their children. It is unclear to what extent the age of the adolescent mother versus pre-pregnancy behaviors and risk factors contribute to poor childbearing outcomes among teens.4 Thirty-four percent of 15 - 17 year-olds who delivered in Washington in 1997 - 1999 did not receive first trimester prenatal care. According to the Centers for Disease Control and Prevention (CDC) national data suggest that in 1999, for all age groups of mothers 15 years and older, 15 - The Health of Washington State Washington State Department of Health 19 year-olds have the highest rates for smoking during pregnancy at 18%.8 Smoking during pregnancy is associated with intrauterine growth restriction, low birth weight, and infant mortality. Children of teen mothers are more likely to be born prematurely and be low birth weight than children born to women who delayed childbearing beyond their teen years.4 Low birth-weight increases the likelihood of infant mortality, blindness, deafness, respiratory difficulties, mental illness, retardation, and cerebral palsy.4 The chances of being later diagnosed with dyslexia and hyperactivity are more than doubled among low birth weight infants.4 Children of teen parents are more likely to repeat a grade, and less likely to complete high school than children born to older mothers. Sons of teen parents are 13% more likely to enter prison and daughters of teen mothers are 22% more likely to become teen mothers themselves.4 Risk and Protective Factors National research studies among 15 - 19 year-olds are used here to identify common risk factors and protective mechanisms that impact adolescent pregnancy. These can be viewed from the individual, family and community leveL Individual Factors. The likelihood of an adolescent becoming pregnant increases with eady alcohol and drug use, early sexual activity, early challenging behaviors in kinder~arten through grade 3, and physical or sexual abuse. Low expectations for the future also place adolescents at risk for pregnancy. 10 Delaying sexual activity and limiting alcohol and drug use as well as developing good communication skills have been identified as effective strategies for reducing adolescent pregnancies.9 Family Factors. An adolescent's family plays an important role in detennining risk for adolescent pregnancy. Frequent conflict in the family, illness or addiction of a parent, and lack of parental supervision are significant risk factors fOf adolescent pregnancy.9 Adolescent child bearing has been statistically associated with low levels of education in the family, and previous family eXfcerience of adolescent pregnancy by a parent or a sibling. 0 Families with open and positive communication have been identified as a vital protective factor for adolescents. Providing youth with clear rules and boundaries and opportunities for involvement in family activities and duties are important protective mechanisms.9 Community Factors. Teens living in communities with high poverty, crime, unemployment, divorce, and 3 Adolescent Pregnancy and Childbearing updated: 07/23/2002 ·. adolescent birth rates and low educational levels appear to be at risk for adolescent pregnancy. 10 A feeling of connection to adults in the community, availability of schools providing support and respect to youth, and constructive after-school activities and organizations such as clubs and youth centers act as protective factors for adolescent pregnancy.9 High Risk Populations Adolescents who give birth. Many adolescents who give birth have another pregnancy within two years. In 1999,17% of all births to adolescents under 20 in Washington were repeat pregnancies. Adolescents at high risk for a repeat pregnancy might not use contraceptives consistently after the birth of their first child.11 A positive attitude about adolescent pregnancy and ambivalence about postponing further childbearing beyond adolescence are associated with . 11 repeat pregnancIes. Adolescents experiencing difficult life situations. Research suggests that the likelihood of pregnancy increases with adolescents facing difficult life situations. In a recent review of at least 250 studies, the National Campaign to Prevent Teen Pregnancy (NCPTP) identified more than 100 "antecedents" to teen sexual activity, pregnancy, and child bearing. 12 These antecedents fall under categories such as economically disadvantaged families and communities, "risky" characteristics ofteens, family, and peers, and partner attitudes and beliefs that support adolescent pregnancy. Intervention StrateQies Adolescent pregnancy is a complex problem influenced by a multitude of factors. Because the reasons leading to adolescent pregnancy vary, no single approach can be expected to reduce adolescent pregnancy. Effective approaches are more likely to focus on several identified "antecedents" to 12 adolescent pregnancy. Approaches to address adolescent pregnancy prevention need to consider the following: Support abstinence as the safest choice for teens and promote correct and consistent use of contraceptives for sexually active teens. The NCPTP study emphasized that the above approach neither increases sexual activity nor decreases contraceptive use.12 While the few rigorous evaluations of abstinence~only curricula completed to date do not show any overall effect on sexual behavior or contraceptive use,12 abstinence is the safest choice to prevent pregnancy in adolescents. Further evaluation Adolescent Pregnancy and Childbearing updated: 07/23/2002 is required before using an abstinence-only approach alone in adolescent pregnancy prevention programs. Eighty-three percent of teen pregnancies are unplanned. 13 A lack of individual commitment to specific pregnancy prevention methods (i.e. abstinence, contraceptive use), ambivalence about child bearing, and confusion about prevention appears to result in the high rates of unintended pregnancy rates among adolescents.4 Promoting conect and consistent use of contraceptives for sexually active teens can lead to reduction in unplanned 13 pregnancy rates. Help young people develop their skills and abilities. Interventions addressing skills and competencies of adolescents can help increase their motivation to avoid pregnancy, child bearing, and other related problems. Examples of these interventions include youth development programs, which asswne that adolescents must develop basic competencies and skills to become a successful adult. These basic skills and competencies for adolescents include a sense of belonging, self-awareness, 5 self-worth and a sense of mastery and competence. Evaluation of youth development programs show varied results in reducing adolescent pregnancy rates. Youth development programs such as vocational education programs do not appear to have any impact on pregnancy or birth rates at follow up.12 However, service-learning programs can reduce actual adolescent Rregnancy rates while youth participate in the program. 2 While some youth development programs appear to show promise in reducing adolescent pregnancy rates, further evaluation is required to determine the most effective approach. See related chapters on Unintended Pregnancy, Low Birth Weiqht, Prenatal Care, Infant Mortality and the section Maior Risk and Protective Factors. Data Sources Washington State Adolescent Pregnancy Data: Pregnancy & Induced Abortions 1999. Center for Health Statistics, Washington State Department of Health. Washington State Department of Health, Center for Health Statistics, Washinqton State Births, 1980-1999 CD-ROM released February 2001. First Steps DataBase. Research and Data Analysis Division. Department of Social and Health Services. 2001 "Intercensal and Postcensal Estimates of County population by Age and Sex: 1980-2001". August 2001. Forecasting Division. Office of Financial Management. 4 The Health of Washington State Washington State Department of Health For More Information Washington State Department of Health, Division of Community and Family Health, Office of Maternal and Child Health, Child and Adolescent Health/Child PROFILE Section at (360) 236-3531. Endnotes 1 The Annie E.Casey Foundation. When Teens Have Sex: Issues and Trends. A Kids Count Special Report. 1999 2 Centers for Disease Control and Prevention. National and State Specific Pregnancy Rates among States, 1995-1997. MMWR July 14,2000: 49(27): 605-611 3 Alexandria V A. Policy Update: The Role of Education in Teen Pregnancy Prevention. Policy Information Clearinghouse. National Association of State Boards of Education. 1998 4 The National Campaign to Prevent Teen Pregnancy. Whatever Happened to Childhood? The Problem of Teen Pregnancy in the United States. 1997 5 National Association of State Boards of Education. The Impact of Adolescent Pregnancy and Parenthood on Educational Achievement. A Blueprint for Education Policymakers' involvement in Prevention Efforts.2000 6 Darroch JE,Landry OJ and Oslak S. Age Differences between Sexual Partners in the United States. Family Planning Perspectives. 1999; 31(4):160-167 7 Washington State Department of Social and Health Services. Medical Assistance Administration. State of Washington Pregnancy Related Expenditures, Fiscal Years 1988-2001. 8 Centers for Disease Control and Prevention. Smoking during pregnancy in the 1990s. National Vital Statistics Report. August 28, 2001. Vol 49, No 7 9 Kirby D. Looking for Reasons Why. The Antecedents of Adolescent Sexual Risk-Taking, Pregnancy and Child Bearing. The National Campaign to Prevent Teen Pregnancy. 1999. 10 Kirby D. No Easy Answers. The National Campaign to Prevent Teen Pregnancy. 1997. 11 Stevens-Simon, K L and Singer O. "Preventing Repeat Adolescent Pregnancies with Early Adoption of the Contraceptive Implant" Family Planning Perspectives Vol 31, No:2. 1999. 12 Kirby D. Emerging Answers. The National Campaign to Prevent Teen Pregnancy. 2001. 13 Henshaw S.K. Unintended Pregnancy in the United States. Family Planning Perspectives. 1998; 30(1): 24-29 The Health of Washington State Washington State Department of Health 5 Adolescent Pregnancy and Childbearing updated: 07/23/2002 Unintended Pregnancy Summary An estimated 53 % of all pregnancies and 38% of all births in Washington State in 1999 were unintended at the time of conception. Rates have remained relatively unchanged since 1994. While young women, poor women, and some minorities have the highest rates, unintended pregnancies occur in all segments of society. When pregnancies are begun without planning or intent, there is less opportunity to prepare for an optimal outcome. Unintended pregnancies are associated with adverse maternal behaviors such as delayed entry into prenatal care, poor maternal nutrition, cigarette smoking, and use of alcohol and other drugs. Women whose pregnancies arc unintended are more likely to have infants who are low birth weight and are less likely to breastfeed. Their infants are more likely to be abused and die in their first year. Other negative social outcomes such as reduced education and career attainments of parents, increased welfare dependency, divorce, and domestic violence are associated with unintended pregnancy. About half of unintended pregnancies end in abortion. Access to quaJity family planning information and services is an important factor in planning for healthy pregnancies and preventing unintended pregnancies. Background Note National data on intention status comes from the National Survey of Family Growth (NSFG). That survey asks questions of a random sample of all The Health of Washington State Washington State Department of Health Definition: Pregnancies that are identified by the mother as either unwanted or mistimed (occurring earlier than wanted) at the time of conception. women of reproductive age about their pregnancies. whether they were intended, and the outcome of the pregnancy (live birth, miscarriage, abortion). Most of the Washington-specific data on unintended pregnancy in this chapter describe births from unintended pregnancy because these data come from the Pregnancy Risk Assessment Monitoring Surveillance system (PRAMS), a survey sent to a sample of women who have given birth. (See Technical Note 1.) Overall rates of unintended pregnancy in Washington are only estimates, derived from a formula combining PRAMS data on births from unintended pregnancy and vital statistics data on abortion. (See Technical Note 2.) These estimates allow some analysis of overall rate, trends, and age distribution but cannot be used to assess variability by race/ethnicity, geographic units, income, education, or measures of impact and burden. Limitations of both the abortion data and using a fonnula that combines population and survey data restrict fin1her analyses of these characteristics. Time Trends Unintended pregnancy has been monitored in Washington since 1994 using PRAMS data and vital statistics data on births and abortions. No significant reduction in the percent of pregnancies that were unintended is evident in this time period. In 1994, an estimated 55% of all pregnancies were unintended, and 39% of all births were from unintended pregnancies. In 1999, an estimated 53% of all pregnancies were unintended, and 38% of all births were from unintended pregnancies. Year 2000 and 2010 Goals At the national level, the Healthy People 2010 goal is to increase to at least 70% the proportion of pregnancies that are intended. According to the 1995 Institute of Medicine report on unintended pregnancy, The Best Intentions, the US goal has already been achieved by other industrialized nations (p.253).1 If that goal had been reached in Washington in 1999, almost 6,400 fewer births would 1 Unintended Pregnancy updated: 07/23/2002 have been unintended at the time of conception and nearly 2,100 fewer pregnancies would have resulted in abortion. The Department of Health and the Department of Social and Health Services have a joint performance measure to reduce the rate of unintended pregnancy by 3% each year over the next two biennia. Achieving a 3% reduction in 2000 would have resulted in over 900 fewer births from unintended pregnancies and 300 fewer abortions. Geographic Variation Because of the small number of respondents for some counties in PRAMS, county comparisons are not available. Urban and Rural PRAMS data for 1997 - 1999 do not indicate a statistically significant difference in births from unintended pregnancies in urban core, suburban areas, towns, rural large towns, or rural small towns. National data for pregnancy intention in urban/rural areas are not available. Age Based on data from PRAMS and records of abortions, unintended pregnancies occur in all age groups. Women aged 19 years and younger had the highest percentage of unintended pregnancies, 81 % (1; 6%). The percentage of unintended pregnancies for women aged 20 - 24 was estimated to be 64% (± 4%), for women 25 - 29, 46% (± 4%), and for women aged 30 - 34, 39% (± 4%). (See Technical Note 2.) The actual number of births from unintended pregnancies among women ages 20 - 34 account for most of the state's unintended births because more women in that age group become pregnant. Unintended Pregnancies Age of Mother WA State PRAMS, 1997·1999 35+ 81% 30-34 ~ 25-29 20.24 <20 0% 20% 40% 60% 80% 100% Unintended Pregnancy updated: 07/23/2002 Race and Ethnicitv According to PRAMS data, in Washington, rates of births from unintended pregnancies were higher for women of some racial minorities. Black women reported 59% (± 3%) of their pregnancies were unintended, as did 52% (± 3%) of Native American women, 39% (± 3%) of Asian/Pacific Islander women, and 37% (± 2%) of white women. Thirty-nine percent (± 3%) of births to Hispanic women were from unintended pregnancies; this is not statistically different from non-Hispanic women, whose rate was 38% (± 2%). Births from Unintended Pregnancies Race and Ethnlcity WA State PRAMS, 1997-1999 Am Indian/ Alaska Native Asianl'acfiç Islander :>. :2 i w ~ .. a: Blaçk f&fo White ------ Hispaniç Non-Hispaniç 0% 25% 50% 75% 100% Income and Education Birth rates from unintended pregnancies are strongly associated with income level. In the PRAMS survey, Medicaid status is one indicator of low income. Women who qualify for publicly funded medical services through Medicaid tàlJ into two main groups: (1) those who receive both Medicaid and cash assistance (Grant Recipients), and (2) those who receive oilly Medicaid Services (Medicaid oilly). Grant recipients reported 66% (± 5%) of their pregnancies were unintended, and Medicaid oilly recipients reported 50% (± 4%) were unintended. Among women without Medicaid coverage for their deliveries, 27% (± 2%) of births were from unintended pregnancies. Washington PRAMS data indicate that unintended pregnancy rates decrease as mothers' education increases. Among women with 6 - 11 years of education, 52% (± 4%) of pregnancies were unintended; among women with 12 years of educatÎon 42% (± 4%) were unintended; and among women with 13 or more years of education, 28% (± 3%) of pregnancies were unintended. 2 The Health of Washington State Washington State Department of Health Births from Unintended Pregnancies Income and Education WA State PRAMS, 1997-1999 G rant Recipients c o -~ o ~ V UJ fBfo Medicaid Only ~ o .& Non-Medicaid -------- ----. Q. 11 Years J2Years Bt Years 0% 25% 50% 75% 100% Other Measures of Impact and Burden Abortion: According to the The Best Intentions, about half of all unintended pregnancies end in abortion. Thus, abortion is one of the primary consequences of unintended pregnancy, and reducing unintended pregnancy would decrease the incidence of abortion (p. 51 ).1 In 1999, there were 25,965 abortions reported for women living in Washington. This is a decline of about 5% since 1994. According to the Institute of Medicine (10M), long-term medical or psychological consequences from abortion are few. However, abortion poses difficult moral and ethical questions, and it continues to be a controversial procedure. Complications nom abortion increase with increasing pregnancy duration. Most abortions (86%) are obtained before 12 weeks gestation when there is less risk of complications. Abortions obtained after 12 weeks gestation are accessed at disproportionately higher rates by younger women: Among women who had an abortion in 1999, almost 10% of those age 15 - 19 had the procedure after 12 weeks gestation compared to 8% of women 20 - 24,6% of women 25 - 29,6% of women 30 - 34,5% of women 35 - 44. The percentage for women 45 and older is not calculated due to small nwnhers. Morbidity and Mortality: Unintended pregnancy limits the opportunity for the mother or couple to participate in preconception risk assessment and intervention that can mitigate many serious medical conditions. Strict metabolic control of maternal diabetes and phenylketonuria reduces the risk of congenital malformation of the fetus. Neural tube defects can be reduced through dietary folic acid supplementation before and during the early months of pref:,'l1ancy. The Health of Washington State Washington State Department of Health Unintended pregnancy is associated with delayed entry into prenatal care. PRAMS data indicate that 54% (± 5%) of Washington women with unintended pregnancies had late or no prenatal care. Relative to women whose pregnancies were intended, they were more likely to have used drugs or alcohol during their pregnancies, to have smoked in the three months prior to pregnancy, and were less likely to breastfeed. Maternal and Family Stress: PRAMS data show an association between pregnancy intention and indicators of maternal and family stress. Washington women with unintended pregnancies are more likely to be divorced or homeless and to have lost a job themselves or to have husbands who lost jobs in the twelve months preceding their births than women whose pregnancies were intended. Abuse: Washington women who have been physicaUy abused more frequently report that their pregnancy was unintended. PRAMS data indicate that women who were in a physical fight within 12 months of the current birth were almost twice as likely to report that their pregnancy was unintended (71 % ± 9%) compared to women who were not in a fight (36% ± 2%). Women who have becn abused by their husbands more frequently reported their pregnancies were unintended (66% ± 9%) than women who were not abused (37% ± 2%). Economic Costs: There are financial burdens for unintended pregnancy as weU. At an average cost of $5,639 for prenatal care and delivery in Washington, the annual cost to federal and state government for births fro~ unintended pregnanc~es ~aid for by Medicaid is estImated to be $97.6 milhon. Healthy People 20]0 estimates that the pregnancy care cost for a woman who does not intend to be pregnant yet is sexually active and uses no contraception is about $3,200 annuaUy in a d . 3 manage care settmg. Risk and Protective Factors Contraceptive Use: One determinant of pregnancy and birth rates is use of contraceptives. A woman who is sexually active throughout her reproductive years and wants only two children will need contraceptive protection for more than 20 years.4 National data indicate about half of unintended pregnancies occur among the 3.9 rrùllion women who are neither using contraceptives nOr seeking to become pregnant. The other half occurs among the estimated 21.2 million women using reversible contraception. In Washington, PRAMS data indicate that 28% (± 3%) of women who said their pregnancies were unintended were not using contraception while 72% (± 4%) reported using contraception at the time of conception. Preh'l1ancies occur among some contraceptive 3 Unintended Pregnancy updated: 07/23/2002 users because some methods are of limited effectiveness even when used correctly, and some methods fail because of difficult compliance regimens. Healthy People 2010 cites numerous studies indicating a disturbing degree of misinfonnation about contraceptive methods and reconnnends increased public education efforts and improved accuracy in the media. J The Institute of Medicine (10M) study cites the reasons for the high rates of unintended pregnancy in the US compared with other countries. These include: gaps in reproductive knowledge and information; lack of high quality instruction on sexuality and contraception; the wide range of personal feelings, cultural values, and attitudes regarding sexuality; expensive, often complicated access to birth control; public policies and institutional practices such as insurance coverage of abortion but not contraception; administrative barriers causing delays in service; and the sexual saturation of the media (p.2_3).1 Contraceptive Access: Although a variety of family planning services are available across the state the Alan Guttmacher Institute (AGI) estimates tha; fewer than half of Washington women in need ofpublicll funded services are served. They rank the state 16 in the provision of contraceptive services to women in need.4 Health insurance provides limited coverage of contraceptives in Washington. While a large percentage of private insurance plans cover gynecologic, maternity, reproductive cancer screening, and STD and AIDS services, nearly half do not cover any kind of contraceptive method. 5 Only 22% of eligible enrollees have coverage for the five FDA-approved reversible methods of contraception.6 A new rule promulgated by the Insurance Commissioner will require companies to provide coverage for most forms of birth control as of January 2002. High Risk Populations Data in The Best Intentions indicate that although unintended pregnancies occur in all subgroups, women at either end of the reproductive age spectrum, poor women, uneducated women unmarried women, some minorities, and w¿men who do not use contraception are at higher risk of unintended pregnancies (p. 47).1 Intervention Strateaies According to the Institute of Medicine report, achieving a new social norm where all pregnancies are consciously and clearly desired at conception Unintended Pregnancy updated: 07123/2002 would require a long term effort to educate the public on the social, economic, and public health burdens of unintended pregnancy and stimulate interventions to reduce such pregnancies. The 10M reconnnends that efforts be structured around the following five goals: (1) Improve knowledge about contraception and reproductive health; (2) Increase access to contraception; (3) Address the roles attitudes and motivation play in avoiding unintended pregnancy; (4) Develop and evaluate local initiatives, and (5) Stimulate research on contraceptive methods, organizing services, and the detemúllants and antecedents of unintended pregnancy (p.254).1 The National Association of City and County Health Officials published a set of action steps for local health departments based on the goals of the 10M report.7 Improving Access to Family Planning: The 10M report and Healthy People 2010 both call for more reproductive health education and access to clinical reproductive health services. Federal and state dollars provide subsidized family planning services in 31 of the state's 39 counties. Medicaid provides family plaIming services for T ANF clients and has expanded coverage to provide free family planning services for men and women up to 200% of the federal poverty level for five years through a federal waiver of Medicaid eligibility. Data from a Medicaid report on birth spacing in a population qualified for family planning services for one year after delivery showed the two-year subsequent birth rate was two to three times higher for women who did not receive family plalll1ing services compared to those who did.8 One strategy advocated by the 10M is to increase the range of health professionals and institutions which promote and provide contraceptive services. Five state agencies initiated a novel pilot project in Western Washington to enable pharmacists to prescribe emergency contraceptive pills (ECPs) directly to women through col1aborative drug agreements with doctors. During the project period, more than 1,000 phannacists and 140 phannacies provided about 12,000 prescriptions in 16 months of service, potentially preventing 700 or more W1Ïntended pregnancies (assuming a 10% pregnancy risk and 75% method effectiveness).9 A clinic in the Kaiser Pennanente system in San Diego made reducing unintended pregnancy a strategic goal and reduced the number of abortions in their practice by 25% over a three- year period. Strategies included educating providers and staff about unintended pregnancy, fmding opportwrities to educate patients, prescribing birth control and following up on use, increasing access to emergency contraception, 4 The Health of Washington State Washington State Department of Health and reducing administrative barriers to family I· . 10 P anmng appomtments. See related chapters on Adolescent Preanancy and Childbearinq, Prenatal Care, and Sexual Behavior. Data Sources Washington State Department of Health, Center for Health Statistics, Washinqton State Deaths, WashinQton State births, 1980-1999 CD-ROM released November 2000 Preqnancy Risk Assessment Monitorinq System (PRAMS) 1996-1998 Washington State data. (See Appendix B for description. ) Washington State Abortion Data: Pregnancy & Induced Abortions 1999. Center for Health Statistics, Washington State Department of Health. Washington State Department of Social and Health Services, Research and Data Analysis. First Steps Database, 2001. For More Information Washington State Department of Health Office of Maternal and Child Health (360) 236-3502; Maternal and Child Health Assessment (360) 236-3558; Office of Infectious Disease and Reproductive Health 360) 236-3444; Family Planning and Reproductive Health (360) 236-3471 Technical Notes Technical Note 1: The Pregnancy Risk Assessment Monitoring System (PRAMS) is a population-based surveillance system that uses birth certificates to survey new mothers who are representative of all registered births to Washington residents. PRAMS data in this chapter are from surveys collected in 1997-1999. Confidence intervals presented are 95% for all point estimates. Technical Note 2: Percentages of births from pregnancies that were unintended at the time of conception are derived from PRAMS data. To estimate the total number of pregnancies that are unintended, the percent of live births identified by PRAMS respondents as unintended are combined with the number of abortions from vital statistics for that year. This definition excludes ectopic and molar pregnancies as well as fetal deaths at less than 20 weeks gestation, which are not reportable. This estimate also assumes that all reported abortions are due to unintended pregnancies though a small percentage might be medically indicated. The Health of Washington State Washington State Department of Health Endnotes 1 Institute of Medicine, The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families, National Academy Press: Washington, D.C. 1995 2 Cawthon, L, Salazar, E, and Lyons, 0: County Profiles: Birth and Unintended Pregnancy Statistics, DSHS, Research and Data Analysis, February, 2001 3 U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 4 Alan Guttmacher Institute (AGI): Facts in Brief, Contraception Counts: Washington Information, Washington D.C. 1999. 5 Kurth, A, Reproductive and Sexual Health Benefits in Private Health Insurance Plans in Washington State, Family Planning Perspectives, Volume 33, No.4, July/August 2001. 6 Office of the Washington State Insurance Commissioner, Reproductive Health Benefits Survey, September 1998 7 National Association of City and County Health Officials, Unintended Pregnancy: Prevention Strategies for Local Health Departments, Spring 1996. B Cawthon, L, First Steps Database: Post-Partum Family Planning Services, Department of Social and Health Services, Research and Data Analysis, June 2001 9 Program for Appropriate Technology in Health, Quarterly Update for Collaborating Prescribers, Seattle, 1999. 10 Kaiser Permanente Medical Group, Things a Department Can Do to Reduce Unintended Pregnancy, San Diego, CA. December 1999. 5 Unintended Pregnancy updated: 07/23/2002 ¡i~ 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, Vice Chair, Jefferson County Board of Health Sheila Westerman, Chair, Jefferson County Board of Health August 8, 2002 Kristen Anderson Chief of Police City of Port Townsend 607 Water Street Port Townsend, W A 98368 Dear Police Chief Anderson: The Jefferson County Board of Health is considering the adoption of an environmental health civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement of existing public health laws, including those that address nuisances detrimental to public health. The Board is asking for the active participation of law enforcement officials in its rule making process to assure that the final product of the Board's deliberations fully meets its goal of improved public health protection. The statutory basis for public health code enforcement is addressed in both the Port Townsend Municipal Code and Washington State statute. Section 9.08.100 of the Municipal Code states: The chief of police shall be the executive officer to execute and carry out the orders and directions of the health officer, except when othenvise provided by ordinance or the orders or directions of the health officer RCW 43.20.050(4) states: All local boards of health, health authorities and officials, officers of state institutions, police officers, sheriffs, constables, and all other officers and employees of the state, or any county, city, or township thereof, shall enforce all rules adopted by the state board of health. In the event of failure or refusal on the part of any member of such boards or any other official or person mentioned in this section to so act, he shall be subject to a fine of not less than fifty dollars, upon first conviction, and not less than one hundred dollars upon second conviction. Although this statute refers specifically to State Board of Health rules, it has been interpreted by the courts to also cover supplemental rules adopted by local boards of health and enforcement orders issued by the health officer. The civil penalties enforcement ordinance being considered by the Jefferson County Board of Health would create an alternative to current criminal enforcement procedures for violation ofthese rules. For the ordinance to be effective, we must clearly define the roles and responsibilities of all public officials with enforcement responsibilities. Please consider this letter as an invitation to meet with the Jefferson County Board of Health in the near future to discuss your department's role in public health code enforcement. We are particularly interested in any comments you may have about the draft ordinance. Jefferson County Environmental Health staff will be contacting you in the near future to arrange a meeting time. Sincerely, iJ ~~ W.10<f4 Wb---- Sheila Westennan Chair, Jefferson County Board of Health Although this statute refers specifically to State Board of Health rules, it has been interpreted by the courts to also cover supplemental rules adopted by local boards of health and enforcement orders issued by the health officer. The civil penalties enforcement ordinance being considered by the Jefferson County Board of Health would create an alternative to current criminal enforcement procedures for violation of these rules. For the ordinance to be effective, we must clearly define the roles and responsibilities of all public officials with enforcement responsibili ti es. Please consider this letter as an invitation to meet with the Jefferson County Board of Health in the near future to discuss your department's role in public health code enforcement. We are particularly interested in any comments you may have about the draft ordinance. Jefferson County Environmental Health staff will be contacting you in the near future to arrange a meeting time. Sincerely, tJ~'Î4- LÙÚ7~ \tAb--- Sheila Westerman Chair, Jefferson County Board of Health ~~ ~-~~ 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, Vice Chair, Jefferson County Board of Health Sheila Westerman, Chair, Jefferson County Board of Health August 8, 2002 Kristen Anderson Chief of Police City of Port Townsend 607 Water Street Port Townsend, W A 98368 Dear Police Chief Anderson: The Jefferson County Board of Health is considering the adoption of an environmental health civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement of existing public health laws, including those that address nuisances detrimental to public health. The Board is asking for the active participation of law enforcement officials in its rule making process to assure that the final product of the Board's deliberations fully meets its goal of improved public health protection. The statutory basis for public health code enforcement is addressed in both the Port Townsend Municipal Code and Washington State statute. Section 9.08.100 of the Municipal Code states: The chief of police shall be the executive officer to execute and carry out the orders and directions of the health officer, except when otherwise provided by ordinance or the orders or directions of the health officer RCW 43.20.050(4) states: All local boards of health, health authorities and officials, officers of state institutions, police officers. sheriffs. constables, and all other officers and employees of the state, or any county, city, or township thereof, shall enforce all rules adopted by the state board of health. In the event of failure or refusal on the part of any member of such boards or any other official or person mentioned in this section to so act, he shall be subject to afine of not less than fifty dollars. upon first conviction, and not less than one hundred dollars upon second conviction. 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, Vice Chair, Jefferson County Board of Health Sheila Westerman, Chair, Jefferson County Board of Health August 8, 2002 Sheriff Pete Piccini 81 Elkins Road Port Hadlock, W A 98339 Dear Sheriff Piccini: The Jefferson County Board of Health is considering the adoption of an environmental health civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement of existing public health laws, including those that address nuisances detrimental to public health. The Board is asking for the active participation of law enforcement officials in its rule making process to assure that the final product of the Board's deliberations fully meets its goal of improved public health protection. The statutory basis for public health code enforcement is addressed in Washington State statute. RCW 43.20.050(4) states: All local boards of health, health authorities and officials, officers of state institutions, police officers, sheriffs, constables, and all other officers and employees of the state, or any county, city, or township thereof, shall enforce all rules adopted by the state board of health. In the event offailure or refusal on the part of any member of such boards or any other official or person mentioned in this section to so act, he shall he subject to a fine of not less than fifty dollars, upon first conviction, and not less than one hundred dollars upon second conviction. Although this statute refers specifically to State Board of Health rules, it has been interpreted by the courts to also cover supplemental rules adopted by local boards of health and enforcement orders issued by the health officer. The civil penalties enforcement ordinance being considered by the Jefferson County Board of Health would create an alternative to current criminal enforcement procedures for violation of these rules. For the ordinance to be effective, we must clearly define the roles and responsibilities of all public officials with enforcement responsib ili ti es. Please consider this letter as an invitation to meet with the Jefferson County Board of Health in the near future to discuss your department's role in public health code enforcement. We are particularly interested in any comments you may have about the draft ordinance. Jefferson County Environmental Health staff will be contacting you in the near future to arrange a meeting time. Sincerely, L)WlL ~4u~ Sheila Westerman Chair, Jefferson County Board of Health Please consider this letter as an invitation to meet with the Jefferson County Board of Health in the near future to discuss your department's role in public health code enforcement. We are particularly interested in any conunents you may have about the draft ordinance. Jefferson County Environmental Health staff will be contacting you in the near future to arrange a meeting time. Sincerely, tJW-k ~~~ Sheila Westerman Chair, Jefferson County Board of Health 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, Vice Chair, Jefferson County Board of Health Sheila Westerman, Chair, Jefferson County Board of Health August 8, 2002 Sheriff Pete Piccini 81 Elkins Road Port Hadlock, W A 98339 Dear SheriffPiccini: The Jefferson County Board of Health is considering the adoption of an environmental health civil penalties enforcement ordinance. The purpose of this ordinance is to improve enforcement of existing public health laws, including those that address nuisances detrimental to public health. The Board is asking for the active participation of law enforcement officials in its rule making process to assure that the final product of the Board's deliberations fully meets its goal of improved public health protection. The statutory basis for public health code enforcement is addressed in Washington State statute. RCW 43.20.050(4) states: AZZlocal boards of health, health authorities and officials, officers of state institutions, police officers, sheriffs, constables, and all other officers and employees of the state, or any county, city, or township thereof, shall enforce all rules adopted by the state board of health. In the event of failure or refusal on the part of any member of such boards or any other official or person mentioned in this section to so act, he shall be subject to a fine of not less than fzfty dollars, upon first conviction, and not less than one hundred dollars upon second conviction. Although this statute refers specifically to State Board of Health rules, it has been interpreted by the courts to also cover supplemental rules adopted by local boards of health and enforcement orders issued by the health officer. The civil penalties enforcement ordinance being considered by the Jefferson County Board of Health would create an alternative to current criminal enforcement procedures for violation of these rules. For the ordinance to be effective, we must clearly define the roles and responsibilities of all public officials with enforcement responsibilities. Jefferson County Health and Human Services JULY ~ AUGUST 2002 NEWS ARTICLES 1. "Goldsmith faces county budget woes", P.T. LEADER, July 17,2002 2. "County salary rollbacks mean lower filing fees", P.T. LEADER, July 17, 2002 3. "Kicking the Smoking Habit", Peninsula Daily News, July 21,2002 4. "County OKs law on salt in wells", Peninsula Daily News, July 24,2002 5. "County OKs new well regulations", P.T. LEADER, July 24,2002 6. "Community members talk sexual abuse issues", P.T. LEADER, July 24, 2002 7. "Area bioterror responsè plan in the works", Peninsula Daily News, July 26, 2002 8. "Clallam commissioners OK funds for human service agencies", Peninsula Daily News, July 31, 2002 9. "Celebrate World Breastfeeding Week August 1-7", P.T. LEADER, July 31,2002 10. "County-by-county health study released", Peninsula Daily News, August 2, 2002 11. City of Port Townsend newsletter enclosed with August city billings (2 pages) 12. "Northwest Kiwanis Camp a unique experience", P.T. LEADER, August 7, 2002 13. "Suspected meth maker busted after son's call", P.T. LEADER, August 7, 2002 .... 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'" Q,ca "" cø :::l- ab 0:::1 M ..Q, 'QþO eCL "fÕ >." .1:2; ~ 'lie r:. ..... If. :¡CL ;!l Oca E. enca ~ '" 0 ~.~ II [1! , ~B .-; jJ rg ž i'". f;~ .~~ g. ';!;~f& E iSii CI CÞ CI c:( ··'1'··2:'; >' ..,::",<. :',:: ¡:~:i'::":,:::~ ;;.~~;:, 1"" ',,:";'.:.,: .~ I"i; Ã 'ð'-; f .'~. '.\':-- ':1';','°' ··:t~.~':, .. .- .:;. - J CONTINUED FROM Al There are roughly 13,700 smokers ifl Clallam COUflty and 5,700 ifl Jeffersofl COUflty. In the battle agaiflst smok- ing, health officials in Jeffer- son and Clallam counties are particularly cOflcerned about fighting high smoking rates among young adults, ages 18 to 34, and pregn!U1t woman. Ofl Thursday, Jefferson County health officials pre- sented the results of a nine- month survey contairung delaJled data on tobacco use. A similar yearloflg study, known a¡¡ the Behavioral Risk Factor Surveillance Survey, will be started in Clallam County in January. The good news is that the overall percentage'·of cw;r."nt adult srnokers·iJ:ll:J~trers9Ì1 County is low compárediWith the state - 16 percent versus 21 percent statewide. In Clallam County, the per- centage of smokers is 21.2 per- tent, slightly about the statewide average. But 28 percent of those ages 18 to 34 in Jefferson County are current smokers, compared with 24 percent statewide. "That's the group we need to target," said Kellie Ragan, tobacco prevention specialist for the Jefferson County Depw-tment of Health "It's significantly worse than the state. " The number of smokers in Clallam County in that age group was slightly higher than the statewide rate at 25 per- cent, based on four-year-old data. Not getting the message Ragan said she is concerned that younger adults aren't get- ting the message about the habit that may wind up killing them decades later. That's despite a multimil- lion-doliar state campaign against smoking that began 18 months ago and increaæd money distributed to counties to help fund local anti-smoking programs, the result of a 1998 national tobacco lawsuit settle- ment, Smokers are also starting younger, according to the Jef- ferson County report. The average age young adults in Jefferson County began smoking was 13, accord- ing to the study- That's com- pared with the starting age of 16 for those who are now between 35 and 64. Recent studies show that many younger adults don't make regular visits to a doctor - because of lack of health- care coverage and a general absence of medicaJ problems - and therefore miss out on "brief interventions" from doc- tors, Ragan said. Turnout for smoking cessa- 1-~I-Or- SUNDAY SHOWCASE tion classes for teenagers, young adults and pregnant mothers has also been low in ClalJam County, said Joanne Dille, director the Health and Human Services Department. "We've been offering classes regularly but they're not weli attended," ·she said. About 40 percent of Amer· ica's 50 million smokers will try to kick the habit at least once this year. One in 10 will succeed. U sualJy takes seven tries to quit permanently. . But Ragan said she was encouraged by Jefferson County statistics,."(~", 76 percent of curvanb,B¡;¡>oJ<l,j¡¡¡,,'.,? tried to quit smokingfur~o~''''' or more <Ùìys during the PBBt· year. That's much higher thWl the 49 percent rate for Wash- ington state. Pregnant mothers In Clallam County in recent years, much of the focus has been on mothers - particu- larly pregnant mothers - who smoke. According to 2000 statistics, 24.9 percent of mothers smoked during pregnancy in Clallam County. In Jefferson County, 25.5 percent of mothers smoked during pregnancy. "It's really concerning to us," Dille said. Other data culled from the recent Jefferson report were more positive. Seventy-rune percent of those polled in Jefferron County said they do not allow smoking inside their homes. "That's phenomenal," Ragan said of the number. The number was pre- dictably higher for non-smok- ing households - 43 percent of currently smoking adults prohibit smoking in their home as compared with 86 percent of those who don't. Educational and geographic factors were also examined in the report. Twenty-eight percent of those with a high school educa- tion or less are current smok- ers, compared with 15 percent of thoae with some post-high school education and 8 percent with four or more yellr5 of col- lege. The percentage of smokers in Port Townsend was 11 per- cent, lower than the county figure of 21 percent. Quitting takes work Taking the steps toward a smoke-free life takes work. Meyer begWl smoking while in college, uncon8CÌoua!y lIB a way to control weight, she said. The small habit would sprel1d to most parts of her life ~ her definition of addiction. "For me, it was really hard to drink coffee without a ciga- rette," she wd. "They were like salt and pepper" But Meyer said she was building up resolve to quit. Over the next two years, several things pushed her in the right direction, she said. A new job was in an office where there was a "no smok- ing" policy. She rented a house where she would pay less if she didn't smoke. And there were the children in the psychiatric hospitaJ where she worked in Phoenix. "I worked with them with drug and alcohol abuse," she said. "They said smoking isn't really good for you, either. They put a lot of pressure on me," Barbara decided to attempt to quit cold turkey Jan. 1, 1988. Going cold turkey Meyer went from two pack!; a day to zero. She and a relative holed up in a house playing solitaire for three straight days. "I had to keep I hands busy," Meyer said. "The fIrst couple of days were hella· cious." The initial detoxification period was over after three days. During the next several months, the blood vessels that were constricted due to smok· ing reopened, leading to " flood of repressed emotions. "When you smoke, you are clamping down on your anger," she said. "I was really angry for a while" A 12-$tep smoking cessation program wa¡¡ instrumental in helping her quit, she said. It was a similar story for her husband, Gene, who smoked two pack!; " day from age 16 to age 49, when he had a heart attack. His doctor attributed the heart attack in part to the con- stricting of arteries caused by smoking. He eventually had four bypass surgeries starting in 1994. Three weeks in a hospi- tal prompted him to quit all at once. ;0'); ~ rJ :f ~ '"t) (J) ~ .~ (\$ CfJ OJ C · ,..... ~ v '"t) · ,..... ~ bfJ bfJ C .~ ~ o ..¡....J .~ c o ~ .. .. · .. ca ;: .~~;¡¡¡g ~.1J~ ~ .~ ~.E -E § § ~]~ §'g ~~-g ~ë 8.~4J~ .~~]~:Š'ê .~ ¡j ..., -E ~ ~.... '" ~ ~ 0 ~ 'g <d bô.~ .....§ ä ª 6í¡ ~ ~ ~ § å. 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CI:I ~.w~...,-~". r: ~. ~ G ~ rt \ \:' Community members talk sexual abuse issues 0. ;,.;..,.. By Helen Hollister Leider Staff Writer domestic violence while preg- According' to the nant give birth to babies who have high levels of cortisone, More than 38 people gathered survey 1200 1 which indicates stress. She tries to engage in dialogue concern- tQ develop a trusting, therapeu- ing domestic violMce and Sexual BehaviQral Risk tic relationship with the family abuse July 16 at the Pope Marine 17' to prevent such effects. Park Building. raètor Bill NeSmith, supervisor of JES Schumacher, community Surveillance the Department of Child and education coordinator 'with the Family Services and also a mem- DomesticViolence/SéxualAssault System], 25 ber of Organized Response to PrognunofJeffersonCoWlty;said Child Abuse (ORCA), spoke she was pleased with tbetWnout percent of about ORCA's efforts in investi- In her introduction she was quiçk T, e,l+.e1"so, ,n' Cou'nty gating reports of child abuse. He to point out the împortance of J j '.1P I I mentioned the substantial fighting, against 4ømestic via- "" esidents,renorte,, ,d amount of collaboration among lence and,sexual abuse on a 10- .. 1:' the different offices in the area, ca1level, even 'though it is "not ' at leastÓne abuse suchas Domestic Violerice, the imrnedi~ly aæarqnt in our de- 1 . . ,Port Townsend Police Depart- lightful tomt!~~ ,¥,,~:'" , ._ : ..';~;~er;lence'tN ':'. ment and the',Jeffersón~:Þ>m#" Topics of diléûsSIÇ1ii:such as' ,v.: childhooa:z" "-" Sheriff's Offi¢e: prevention, the, criminal' justice Hilary Metzger, 'a nurse, and process, programs Ül schools, health educator with Jefferson victitn advocacya:nd ,sWistics County Health and Human Ser- were tOuched. on by1:he evemng'sship between experiencing vices,spolœ about the connectiOn five speakers, all of whom deal ' sexual abuse'as'a child and hav- between sexual abuse and teen with sexual abuse issues profe~-' ing recuÍringpoor physical and pregnancy. She has been work- sionally. men~ he,a1th into adulthood. ing inatea schools in prevention LiannePèrrOn-Kossow, a vie- Qu~ll Zorrah, a public health progiaros with children in grades tim witness advocate in the nurse with Jefferson .county 5 and up. Metzger said she has Jefferson County Prosecutør's Health and Human Services, ,noticed a positive change in'the Office, díscussed the iinportance spoke onthe Nurse- FamilyPart~ level of awareness in the schools. o,f providing support for viêtims nership and the Best Beginnings In telms of providing a sOlid base and their fanrilies as they go program, which works with low· of sex education in schools" she through the criminal justice pro- income, first:.tiine mothers-to-be, said the Port TownseQd commu- cess, for various sexual assault providing support and reinforc· nityhas been supportive com- crim/$.' mgheaIthy behavior. pared to other communities. HealthEducatbr Kellie Ragan The program, which has only After the five presentations, of the Jefferson County Health .two nurses working with be· Schumacher encouraged every- Department distributed selected tween 30 and 35 cases at a given one to split up into smaller results from the 2001 Behavioial'· ~e, fOCllScson long-term pre-, groups and discuss ideas, Risk Factor SurveiJÞ.lncéSystem ,vention. projects, goals, and concerns to ,at the meeting. According to the "It's a parallel process," help further awareness about survey, 25 percent of county Íesi.,;; Zorrah said; "What I do with the sexual assault issues. One group dents reported at least one abuse motÏlcr, I want her to do with her was involved in discussiOÌt untiÌ experience in childhood, which baby." She described the after- almost 10 p.m.; its memb6-s now is significantly worse tb8n the shocks of sexual abuse as "com- plan to meet monthly, with their 1997 state rate ~f20 percent-The m~cable diseases," explaining next meeting scheduled for 7 pm. survey also pointed to a relation- ~t mothers who are victims of Aug. 13 at the DV /SA office. 1-2{-t) 2- Area bioterror response plan in the works Official says federal funds aren't enough PENINSULA DAILY NEWS WANTED: three emergency response coordinators for Jef- ferson, Clallam and Kitsap counties, one epidemiologist, one surveilJance coordinator, one administrative assistant. DUTIES: Make sure that the three counties are ready as they can be for a flu pandemic, smallpox outbreak or any 'other kind of bioterror an unknown, unseen and immoral enemy might throw this way. The first of $20 milJion in federal bioterrorism funds ~e flowing into Washington; with "$500,000 designated for plan- ning and coordination in the three-county region under the authority of Scott Lindquist, director of the Kitsap County Health District Because of Sept. 11 and the anthrax scare, Lindquist also now wears the title of regional "bioterrorism health officer," one of 10 in the state. One of the first things he must do is hire the emergency response coordinators and fill the three other slots. Not enough A half-million dollars is not quite enough, Lindquist said last week when he met with representatives from about 20 agencies whose duties now include bioterrorism response. The Kitsap health district will kick in an additional $30,000 to meet standards and deadJines set by the state Department of Health, which funnels federal money to the regions and tells them what to spend it on. Lindquist said the federal government is likely to offer more funding in the future and its commitment to bioterror· ism preparedness is Jikely to last at least five years. First on the local agenda is an assessment of each county's ability to respond to a bioter- rorism event, identify weak- nesses and fix them. Lindquist, a national authority on bioterrorism when he took the health dis- trict job last year, said he already knows about one. "The biggest weakness in any biological preparedness system is the hospital system and the lab system," he said. Hospital facilities Lindquist already has begun conversations with Harrison Hospital in Bremerton to add more showers and isolation rooms. He plans similar talks with Olympic Memorial Hospital in Port Angeles and Jefferson General Hospital in Port Townsend A major goal of the response program is to make sure each of the three counties will be able to back up the others, keeping service stable and available, no matter who needs it. "Remember, the only county in the country that's ever caught a terrorist before the event was Clallam County," said Lindquist, referring to the capture of would-be bomber Ahmed Ressam by U.S. Cus- toms agents in Port Angeles. The state has set deadlines for each step needed to create a workable response plan, with the final version required in 13 months. 1 ", '~tJ 1-:lb-O d---- (/) C1) .- (.) c :0 co Q) (.) 1- > "- C1) (/) c CO E ::s J: "- 2 (/) -c c .2 :=s:: o (/) "- Q) c: o I- t/) (/) I- E E o (.) E ctS - - ctS - (.) ~ .s .~ ~r~ ò"d ~ '" '"t:I 0; 50;- ~ '" '"t:I .~ ~ ~ 11 8- tal:: 5o:!:!i!l:S'" I:: '" ~ ~ '" ~ I:: os>, 8 .9 <0:0 0 0 '" 1i ~.13]~~ 11"=':::2 ....ª.z~;a ::s~'" ~eEt,c §.''"t:I2~8'9.~.z ....- I:: p.,..c '" <!>.c .2"i;:l ~ U.c h.....J! o~.8 Q..ctj.¡..) CJ':+-J . ~ŠŠ].5t~~~l ~..2 ..8 ~ ~¡:¡ Q¡,ß I:: -a g s f¡.c b Þ] _ 0.... I:: bD;:I .~;> uô~~ g 8 '§'v 'õ;; O .91: p., E g ~ ~;> ..... is e'" .... ã!." U "'...~ ° :-;:::;> ~1] '" OlIt:U UI §'ii)." 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Celebrate World Breastfeeding Week August 1-7 --- --"~---'----'k- . -~' f ¡:'\;: Laur. Sh"w..... IBClC (Int.rnatl""aj Boord C.rtJf.d loctotl,," C"nlult.nt) and Carol Hardy. IBClC. Breastfeeding: Healthy Mothers and Healthy Fabies Breastfeeding is a powerful process that has been shown to be of significant benefit to both mother and child. While fostering maternal attachment. breastfeeding is also the "ultimate prevention" of potential physical and emotional ailments. Current studies show that women who breastfeed demonstrate decreased risk of breast and ovarian cancer, anemia and osteoporosis. Breastfed children have fewer and less serious childhood illnesses and allergies. They also show a reduced risk for Sudden Infant Death Syndrome, some childhood cancers and diabetes. "Having the support of all of our community is importarIC il1 order to ensure the health of our communicy mochers and babies. And World Breascfeeding Week is che perfecc time for us all co demonscrale chis support" In an effort to protect, promote, and support the well-being of mothers and to encourage breastfeeding for healthier babies and children, the Jefferson County Breastfeeding Alliance has formed. Members include Jefferson General Hospital, Jefferson County Health & Human Services, the La Leche League, the local healthcare community and private citizens. The goal of this alliance is to ensure that every mother in our community has the opportunity to be successful with breastfeeding. Carol Hardy, head of Jefferson County's Lactation Program, in collaboration with Laura Showers, head of JGH's Lactation Program and T.J. Plastow, local La Leche League leader, has organjzed a: Community Picnic in celebration of World Breastfeeding Week at Chetzamoka Park on Wednesday, August 7 from Noon-3pm, .~ The community is encouraged to attend. Jefferson General Hospital "Caring people, caring for you" (360) 385-2200 or (800) 244-8917 834 Sheridan Ave, Port Townsend www.jgh.org q' 1-:11 -0';;-- i Dw County-by-county health study released BY STUART ELLIOTT PENINSUlA DAILY NEWS Jefferson County students are less likely to drop out of school than their peers in Clal- lam County and statewide. And births to teenage moth~ ers in both counties are much lower than the rates of other rural counties in Washington state. Thope are parts of fmdings of a county-by-county health study recently released by the Wash- ington Health Foundation. The annual report by the Seattle-based health organiza- tion looked at a variety of health factors, including educa- tion, income, population and birth and death statistics. The report found that the percentage of dropouts in Jef- TtJ g-2- ()'~ ferson County was 2.1 percent of all public school students in the ninth through 12 grades. That compares with 4.2 per- cent statewide, and excludes those leaving school for unknown reasons. In Clallam County, the per- centage of dropouts was slightly higher than the state average, with 4.3 percent of all students in those grades dropping out of school. Teen births Teenage birth rates in both counties were considerably bet- ter than other rural counties. The teen birth rate in Jeffer- son County was 22.2 per 1,000 births, better than other rural counties in the state, where the average was 27.7, and slightly worse than the overall state average. which stood at 21.8. The teenage birth rate in Clallam County was· 21.5, bet- ter than the rural and statewide averages. Other findings included: . Babies born weighing less than 5.5 pounds decreased in Jefferson County, from 4.9 per- cent of all births ,from 1997 to 1999 to 3.3 percent of total births from 1998 through 2000. In Clallam County, babies born weighing less than 5.5 pounds decreased slightly to 4.9 percent of all births, better than the statewide average of 5.7 percent. . The report said mothers smoked during ,pregnancy in 20.6 percent of all births in Jef- ferson County, compared with 14 percent statewide. That number was worse in ClalIam County, with 26.3 per- cent of mothers smoking dur- ing pregnancy. . Heart disease was less of a problem in Jefferson County than elsewhere in the state, accounting for 200 deaths per 100,000 persons versus 214 statewide from 1998 through 2000. Clallam County was closer to the state average, with a rate of 215 deaths per 100,000 persons from 1998 to 2000. The county health profIles were prepared by the nonprofit health organization to provide insight into the health of Wash· ington state residents, said Greg Vigdor, president of the . foundation. The report can be viewed online at www.whforg. -._~~~-~ City of Port Townsend /; .~~.,.=...·~¡·F~-~.. ~.: ~-;,.:::,~~-~_ ·-'T'+~}.l~¡¡:g~~~t.;;Z~;': '. c,~::i~>~~;:~~i~ ;,' ¡'!:.;~.~::.: _~.~.=-. fI"~'i/'/.i"/.. ..A;y..-:-::~ . ',~ - n~ ,~-, m·,. ,'.' ", "......4~fli.~" . .......0... .7"", . f"---m:.¡.. . ;"~.~,'.,·,:;-:-~",~,,!.·!,~.:,,,:---.~.;~~>i~:: ;;~~~~ ~~i'tZ-.~:~e~~ ~~-::;1~;::.~~.- ~~f.:;:~~:~~..~· cr:~~:, ~~~.._~ ~..:~'.:. :.- (360) 379-5047 (email: citycounciI@ci.port-townsend.wa.us) www.ci.port-townsend.w~us August 2002 Council News: Q By Kees Kolff and Geoff Masci ~ CITY PARTNERSHIPS The Health of Our Citizens On July 8 your City Council received a detailed report on the health of local residents from Dr. Christiane Hale, an epidemiologist. and Jean Baldwin. Director of Health for Jefferson County. Information from the 2000 Census and a recent Behavior Risk Factor Survey (BRFSS) gave us a mixed message. Some highlights include: 1. Fully 25% of County adults reported sonie type of abuse in their childhood. This rate rose to 33% in households with children under 18. 2. Although 16% of adults reported currently smoking, and this is the nation's goal for 2010, 24% of households with children under 18 smoked. 3. Though only 17% of adults were heavy drinkers J5 or more drinks at one time) and this is lower than the state average, this rate rose to 28% in households with children under 18. .4. Children'under 18 and female-headed families in the County had poverty rates higher than the state average. 5. Two-thirds of the childbirths in this COlmty are paid for by Medicaid. Are our children at risk in this county and in our city? The State has cut public health funding for the counties. To balance the budget without raising taxes. the COWlty is cutting some critical services. Reductions in family planning programs, immunization clinics and supplemental nutrition programs for Women, Infants and Children (WIC) could be costly and affect future generations for years . tô rome.· . . ' " . -: - . What is our vision for the health of people in this community? What benchmarks should we use? What is our role in the funding of critical public health programs? We hope to address some of these questions in the fall. To help understand the complex issues that face our City, there is a need to partner with other governments. agencies, boards and conunittees. 'No man is an island" and therefore the City Manager. staff and Council attend meetings outside of city business to bring up to date information to the decision making process in order to make well-informed decisions. Some of this partnering becomes quite intensive, depending on the issue at hand. It ranges from interlocal agreements, to fmancial suPPOrt. to sharing infoffi1ation and office space. The following are examples of the agencies that maintain working relationships with staff and council members: Jefferson. County Economic Development Council JeffCo Animal Shelter Fire District 6 . JeffCo Technology Alliance Main Street Port of Port Townsend Law & Justice Committee Arts Commission Port Townsend SD 50 PTTV Fort Worden Advisory Board Solid Waste Advisory Board WSU Small Business Development YMCA Northwest Maritime Center Regional Transit Board OLYCAP JeffCo Historical Society Marine Science Center Wooden Boat Foundation ChwnberofConunerce Centrum Volunteer Firefighters Association North Olympic Resource Council & Development (continued on back) ...;, LEOFF Board Association of Washington Cities JeffCo Board of Health Conservation Futures Advisory Committee Data Steering Committee/BRFSS Developmental Disabilities Board Distressed County Infrastructure Committee Ferry Advisory Board Higher Education Coordinating Committee HUD Loan Committee Intergovernmental Elected Officials JeffCo Alcohol & Substance Abuse JeffCo Water Resources Advisory Council JeffCo Healthy Youth Coalition Jefferson Transit Board Joint Growth Management Steering Committee Peninsula Development Committee Boiler Room United Good Neighbors Domestic Violence Program Farmers Market To these and all our other partners... TIfANK YOU! .' CHIP SEALING The County and City will be chip sealing City streets the first part of August (weather permitting). While they are busy repairing the streets, there will be traffic delays. Also, residents along those streets will be .," requested to remove all vehicles off the shoulders of the road. The City will be notifying residents at least 24 hours in advance of the wOrk. Chip sealing consists of putting down a layer of hot asphalt emulsion oil and then covering the oil with crushed rock (1/2"-1/4"). The oil is water based and sets up to hold the rock in it. The workis done in two phases approximately one week apart. After the first application sets, the roadway is swept and then the second application is applied. The finished product will end up looking like most of the other streets in the Ci~. . The roads schèduled for work are: Street Thomas 3151 McClellan Gise 56th from/to Hastings to 25th, Hancock to Thomas, 3151 to 32nd, 55th to 57th, Jackman to Wilson, If. 55th Gise to Wilson, 29th Hendricks to Sherman, Shennan 29th to 30th, 30th Shennan to Hendricks, Hendricks 30th to 31 SI, 25th Hendricks to Sherman, Sherman 251h to Hastings, Hancock 25th to 27'h, 151 Grant to the end, U Spruce to Redwood, Spruce Center to U. TO FACILITATE THIS ROAD WORK AND TO EXTEND THE LIFE OF THE NEW ROADWAYS, THE CITY REQUESTS THE FOLLOWING: >- DRIVE SLOWLY for the first few days after paving; >- REFRAIN from making excessively sharp turns or accelerating suddenly; ,.,. PARK A WAY from the streets being chip and sealed; ,.,. and REMEMBER, vehicles will be towed if left on the street after being notified of the scheduled work. THANK YOU FOR YOUR COOPERATION. If you have any questions regarding these projects, please call John Freitas at 379-4435 or John Merchant at 379-4432. r~ ANIMAL CONTROL During the summer months, as citizens and visitors use our public beaches and parks more frequently, we receive phone calls asking for stricter enforcement of dog control. Some children and adujts have a natural fear of dogs and feel threatened by their presence even when they are being supervised. The Port Townsend Municipal Code 8.04 Animal Control and 8.08 Dogs- Objectionable Waste Removal address these issues concerning our pets. .; We can enjoy our public areas together by being courteous and responsible dog owners. Please remember to clean up after your dog and keep himlher under control when you are visiting a public area. We need to respect the different views people have about dogs and especially to keep our parks and beaches safe, clean and sanitary for everyone to enjoy. 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E ~=~o.¡:;",·~~i~",~~o"..c::~~~0~~~~.c::~~~S8 ~~g~~~~~a§.~~~]~~~Z~a~~~!B.!~o~ ~.... r,'j CJ t--' .- ~ ..... -1'-+ ",,'-.t:: (U..... u 5 ~ J:: t) 0 ~ ~ ~",~~~~t3~950~~>.¡¡¡.§t· ~'2]jE6i~"~ ~~J~W~~5~~~;·~·~~¡t"01~~-~~~~~j·~e ~ ~.5 ~ ~ ~ ~ ~ ~ ! ~ ~ t~ oQ ~ ~ ~.:2, -Š .š. ~ ~ ~ ~ E' ~ .~ .ê (; ü "E ¡:: ~ E 'É ¡t ~ ~ ~.£ ~ .6" ~ .~ '5 ~ E- E ~ ~ ~ v .~ ß gf _ ª æ t; ~æ~~~~~ ].~~¡¡~~3 ~~16]-š'!!-š]'3~~~ ... .. ~ ~~ Q:;: J: J'3 c: '" ~~ J: " """ ",--' . c: ~ 11..- e ¡'Ø ðu:£ .!! 8 c c: J!I 1 -1! ~§", i~~ - <:> '" .c: ~1Q. ~j ¡~ c: J; o e ~~ ã! ... æ ~ ~ ß è".s '" - . .c =g> JI co -;:... '" .c 01 III 010:: ~ £ . 5 g. ~ JI III ~ -:2'5 ~~o Suspected meth maker busted after son's call By Philip L. Watness leader Staff Writer When the 13-year-old son of Brian S. Hughes. 36, of Quilcene discovered a glass pipe at his father's home, he decided he had to do something. The boy and Hughes' ex-wife contacted the Jefferson County Sheriff's Office on July 30 and provided enough information for a search warrant for drugs and guns. Sheriff's deputies and detec- tives raided Hughes' rental home at 1743 Dabob Road on the Coyle Peninsula the next day, July 31. They found suspected drugs and a 9 mm handgun, then discovered chemical ingredients for the manufacture of methamphet- amine. That prompted Detective Dave Miller to get an expanded search warrant. call in the Wash- ington State Patrol's Statewide Incident Response Team (SIRT) , and inform the county health de- partment of the possibility of a cOhtaminated residence. Hughes faces charges of meth- amphetamine production with in- tent to sell. felon in possession of a firearm. and endangerment of a child with a controlled substance. Because he has a previous convic- tion for meÙlamphetamine posses- sion, Hughes could serve a maximum of 20 years and pay a $50,000 fine under the first count alone. The gun charge carries a maximum penalty of five years and/or $10,000 fine, while the Ùlird count, endangerment, carries a lO-year maximum sentence and! or $20,000 fine. While Ùle officers didn't find an operational meth lab, they did reportedly find enough evidence to substantiate Ùle meth produc- tion charge. Among the items found was a propane tank Ùlat had a brass fitting that had turned blue, a clear indication Ùlat anhydrous ammonia, a primary ingredient in meth production, had been in the tank. according to Miller. Offic- A deputy In action during execution of the search waffant. ers also found empty cold medi- cine packages, starting fluid, a .two-burner camp cookstove, and white powder which will be tested to determine wheÙler it is meth- amphetamine. Miller said Hughes probably had beén recently making meth- amphetamine. "One thing that tells us it is re- cent is the dry ice we found," Miller said. "It's not very common in manufacruring meth, but it is used. There was' still some dry ice in a bucket that had not evapomted yet, so [Hughes was producing meth) within days, anyway. We also found numerouS buckets with multi-layered liquids, and some of the layers tested positive for an- hydrous ammonia and others had muriatic acid. We also found lots of rock salt." The Jefferson County Health Department on Aug. 1 placed a "no occupancy" order on the rental house as well as a storage build- ing betllhd it. The property own- ers must have the buildings tested for toxic residues and have those chemicals cleaned up before the health department lifts the order. Environmental Health Director Larry Fay said the cost of prop- erty cleanup could be in the thou- sands of dollars. On Monday, Superior Court Commissioner Marianne Walters set bail for Hughes at $50,000 cash. He is scheduled to be ar- raigned on the three charges at 8:30 a.m. Friday, at which time he is expected to enter his plea. Both Hughes' son and his ex- wife are expected to testify against him should the matter go to trial. so Walters prohibited Hughes from having any contact with them. The lab bu.st was the county's second one in;2002.The sheriff's office had previously discovered a lab March 21 in Quilcene. That was the first meth lab discovery since Dec. 16,2001. Undersheriff Ken Sukert said the suspected meth lab might have caused environmental damage outside of the house and shop where the chemicals were found. 'The potential for significant environmental impacts is there," Sukert said. "We found five-gal- lon buckets that tested acidic. in- dicating waste products from previous cooks, and that stuff was such that it appeared it had been Ùlere awhile and rain had filled the buckets and they were overtlow- mg." Miller said the evidence taken by the SIRT members will be ana- lyzed at the Washington State Pa- trol Crime Lab in Tacoma to detennine its chemical composi- tion. l?J . ~.-1~oL