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HomeMy WebLinkAbout09 September JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, September 19, 2002 Board Member:r: Dan Titterom, Member - County CommiJJioner DiJtrict # 1 Glen Huntingford, Member - County CommiJJioner Di.rtrict #2 Richard W qjt, Member - Counry Commi.r.rioner Di.rtrict #3 Ger1fre.y Ma.rci, Vice Chairman - Port TownJend etry Council Jill Buhler, Member - HOJpital CommiJJioner Di.rtrict #2 Sheila WeJterman, Cnairman - ettizen at urge (etry) Roberta Prim/I, Member - Citizen at L~l'l!,e (Counry) StatlMemberJ: Jean Baldwin, Nursing Service.r Director Ltrry F~, Environmental Health Director ThomaJ Locke, MD, Health Officer Chairman Westerman called the meeting to order at 2:35 p.m. All Board and Staffmemhers were present, with the exception of Commissioner Huntingford. Vice-Chairman Masci joined the meeting at 3 :00 p.m. There was a quorum. APPROVAL OF AGENDA Member Buhler moved to approve the Agenda as presented. Member Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Chairman Westerman noted that the August 15,2002 meeting minutes reflect that the items scheduled for discussion were postponed to the next meeting due to a lack of a quorum. Her understanding at the time was that the Board could continue its discussion, absent a quorum, but could not take any official action. She proposed that the cover page be amended to reflect that the Board had discussion but did not take any action due to the lack of a quorum. Larry Fay clarified that he was informed by the Clerk of the Board of County Commissioners, that since the meeting lacked a quorum, the Board has no official minutes, but instead discussion notes. Chairman Westerman asked Staff to get direction from the Prosecuting Attorney whether the Board could have a meeting without a quorum. She noted that the Board has had many meetings with only one Commissioner present and that this change would significantly affect the way this Board conducts its business. There was no objection to postponing action on the August discussion notes until Staff receives a recommendation from the Prosecuting Attorney. Commissioner Wojt noted a change to the August minutes, Page 3, paragraph 5. The first sentence should state that the Critical Areas Ordinance would become effective September 23 instead of September 21. Commissioner Titterness moved to approve the minutes of July 18,2002 as amended. Changes noted at the August meeting were as follows: on Page 5, paragraph 6, the spelling of HIPP A was HEALTH BOARD MINUTES - September 19,2002 Page: 2 corrected; on Page 5, paragraph 8, the first sentence should read "... that some legislators erroneously assume that it costs less to treat patients in rural counties than in urban areas." Commissioner W ojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Charles Chase from 1700 Egg and I Road asked for an update on the Civil Penalties Ordinance. Because of the lack of a septic system on an adjacent property, he remains concerned for the safety and protection of the well that he and his neighbor share. Bob Reed spoke about his concern regarding the biosolids being sprayed on Pope Resource's land over the last 15 years. Referring to correspondence from the Department of Ecology that states Jefferson County is responsible for monitoring biosolids, he is concerned whether this practice is safe for humans and wildlife in the Hood Canal watershed. A friend noted condoms and personal hygiene items in the compost material from the City and he is also concerned that the City's compost product might not be safe. Chairman Westerman thanked Mr. Reed for his comments. Regarding the safety of the City's compost, she referred him to the City of Port Townsend Public Works Department. Mr. Reed said he has already obtained information from the City. Larry Fay identified the sources of biosolids that go on Pope Resource's land as the City of Sequim, Bainbridge Island, Port Ludlow, and Port Gamble. All their wastewater plants sample their biosolids and have records as to the quality of the septage, which is reported to the Department of Ecology. They all apply their biosolids under coverage of the general permits Ecology has issued for land applications and they all operate in conformance with the State and Federal requirements. Ecology has an agreement with the County to conduct site inspections. Chairman Westerman asked Mr. Fay to share with Mr. Reed reports that the County may have of inspections of areas that have been sprayed with biosolids. Mr. Fay noted that Ecology regulates biosolids and has the responsibility for permitting and siting. Bob Hamlin, County Emergency Manager, was present to confirm that the agenda item Bio-terrorism Emergency Health Issues is in fact a regional issue and to point out that there is cooperation in planning on this issue. For the first time, there is resource support for these issues. Referring to the challenges of regional partnerships, he pledged his support to make this as cooperative a relationship as possible while protecting the interests of Jefferson County. OLD BUSINESS AND INFORMATIONAL ITEMS Civil Penalties Ordinance-Public Hearinl! and Potential Adoption: Chairman Westerman solicited comments on the ordinance. Commissioner Titterness moved to approve Ordinance No. 08-0919-02 authorizing Environmental Health civil enforcement. Member Buhler seconded the motion, which carried by a unanimous vote. EnviroStar Award: Member Frissell noted that she represented the Board of Health in presenting Jefferson County's second EnviroStar award to SOS Printing. HEALTH BOARD MINUTES - September 19,2002 Page: 3 Individual Water Systems Standards Back~round: Larry Fay reviewed that in considering alternative water supplies associated with the County's adoption of the Seawater Intrusion Ordinance, he felt it would be good for the Board to have a baseline of local alternatives. Over the next couple of months, he would bring back issues and information on some of the alternatives to then build a prioritization scheme. Member Buhler asked to see standards adopted by San Juan County. Mr. Fay agreed to bring these to a future meeting, noting that they are the only county to have adopted standards for rainwater catchments as well as desalination of marine waters. Chairman Westerman noted that Policy Statement 93-02 - Water Availability Requirements for Building Permits says that individual water supplies are required to provide a minimum of 400 gallons per day. She asked if rainwater catchments fall under individual water supplies? Mr. Fay explained that 93-02 implements the guidelines developed by Ecology and the State Department of Health. Within the guidelines are provisions giving the County discretion to apply lesser quantities than 400 gallons. Policy 97-01 recognizes that rainwater catchments would not produce 400 gallons a day. Chairman Westerman said it was never explained how the rainwater catchment program had been exempted from that requirement. Policy Statement 97-01, page 2, says "alternate sources of supply (including catchments) may be adequate if all other criteria are met. She noted that 400 gallons per day is obviously one of the other criteria. She believes citizens would have difficulty understanding this. Mr. Fay said one ofthe reasons for writing local policy is to explain state regulations. He noted that page 2 of Policy 93-02, which talks about approval of alternative water supplies was inadvertently omitted from the packet. Staff then distributed the missing page. Bob Reed noted that state regulations for installing septic systems require a 10-foot separation between the water and sewer lines. He asked whether Port Ludlow is exempt from this requirement? Chairman Westerman said Port Ludlow is not exempt, but asked Mr. Reed to follow up with Staff to get answers to his questions. Vice-Chairman Masci asked if a minimum of 400 gallons per day should be used if actual water use can be between 50 and 200? Mr. Fay said page 2 of Policy 93-02 allows for less than 400, but sets certain conditions, such as requiring a restrictive covenant on the property stating that the water supply does not meet the minimum water requirements. One problem with quantities less than 400 gallons a day - less than a half gallon a minute - is that it is very difficult to get an accurate well measurement. Since wells around here generally provide more than 400 gallons a day, water quality is generally more of an issue than quantity. However, rainwater catchments are never going to make 400 a day. While 400 gallons is a lot of water, people tend to use what they have available. The question is how far down to push that threshold while still allowing for basic personal hygiene and sanitation? Member Buhler asked about the possibility of drilling deeper to reach another aquifer? Mr. Fay said while there may be a condition where you have restrictive layers that isolate different aquifers where there is a body of fresh water below the saltwater lens, he does not know of anywhere in the County where that has occurred. Responding to a question from Chairman Westerman, Mr. Fay said the figure of 45 gallons a day comes HEALTH BOARD MINUTES - September 19, 2002 Page: 4 from our knowledge of water use on a per capita basis from water use records from municipalities and water use for sewage treatment purposes across the country. Vice-Chairman Masci asked about Policy Statement 93-02, IV. B., which says "water supplies that do not provide minimum volumes shall only be considered adequate when accompanied by a water conservation plan." If water supplies are not adequate and we are below minimum standards why are we not specifying storage? He believes that how the storage plan integrates with the minimum water needs would be more of a public health concern. Mr. Fay said that the rainwater catchment policy recognizes storage as a key element. However, it assumes a consistent, but low volume of water as opposed to high volumes being captured for use in later months. Any storage might be handling 24-hour fluctuations in use and flow. That would be a different kind of stagnation and contamination than trying to hold 5000 gallons of water in a storage tank for six months. Vice-Chairman Masci said a solution to the problem might be to footnote another section that is applicable. Mr. Fay explained that the County is not regulating the water systems or water supply, but simply stating whether a water supply is adequate for the purposes of getting a building permit. The County simply asks for a restrictive covenant on the property that says if the proposed plan is implemented, there would be a minimal supply of water adequate for the purposes of that building. The County also does not inspect to see if an individual hooks up to a well. The only jurisdiction the County has is requiring proof of potable water with each building permit. Vice.Chairman Masci said his concern is the prevention of contamination and disease. Mr. Fay said then an ordinance for monitoring and reporting is something for the Board to consider. He agreed to return with recommendations specific to the rainwater catchments and to such issues as hauled water and the desalination of seawater. NEW BUSINESS World Breastfeedinfl Week-JHHS/JGH Collaborative Efforts: Carol Hardy of the Health Department Maternal Child Health and Laura Showers from Jefferson General Hospital, both Certified Lactation Consultants, talked about events surrounding World Breastfeeding Week. Held the first week in August every year, this event is promoted by the World Breastfeeding Alliance. Ms. Hardy talked about the many benefits of breast feeding in reducing short- and long-term healthcare costs for both the baby and mother. Among them were that breastfed babies not only get held more, but the high cholesterol they receive in breast milk enables them to better utilize cholesterol later in life and that it promotes attachment between mothers and babies, resulting in better protection ofthe baby. Hospital and Health Department staffs are trained in breastfeeding and together they are seeking ways to broaden consciousness and support of breast feeding in the community. The hospital has recently changed its OB staffing method to include not only labor and delivery support but also post-delivery support and education. This year, the Department held a picnic to support World Breastfeeding Week. Ms. Hardy's goal for 2003's event is to close the entire County for one hour for a picnic celebrating this event. Jean Baldwin noted breastfeeding has moved from merely a method of feeding to health intervention. Breastfed children are less likely to suffer from obesity and diabetes. Vice-Chairman Masci asked about the involvement of LaLeche League in Jefferson County? Ms. Hardy said the Department works with this small organization, which meets once a month. Since 1994, the HEALTH BOARD MINUTES - September 19, 2002 Page: 5 Department has also held weekly breastfeeding teas involving roughly 7 to 25 mothers and babies. They not only address baby issues, but talk about relationships and postpartum depression. Ms. Showers noted that antidepressants do not affect nursing babies. In fact, there are few medications that you cannot take during breastfeeding. Chairman Westerman asked if more doctors are encouraging breastfeeding? Ms. Showers said that the American Academy of Pediatrics has for several years been promoting and advocating for breastfeeding. They encouraged physicians to promote it as a standard feeding practice for the first six months, but now recommend a full year. Member Buhler noted that this program has broad ramifications and asked whether our primary care physicians promote breastfeeding? Ms. Showers said that the four physicians who deliver babies advocate breastfeeding. Vice-Chairman Masci asked whether there have been in-services with physician staff and whether there is a cost involved in holding a joint in-service on breastfeeding? Ms. Showers said that cost would not be an issue but that attendance would be the biggest challenge. Vice-Chairman Masci moved to direct Staff to draft a letter from the Board of Health recommending that a breastfeeding in-service be offered to local physicians and patients on a biennial basis. Member Buhler seconded the motion, which carried by a unanimous vote. Member Frissell suggested that the Breastfeeding 101 handout be offered to every pregnant woman in the County. She also asked for the percentage of those breastfeeding in the community? Ms. Hardy agreed the handouts could be distributed to physicians' office and be included in the childbirth class packet. About 75-80% ofWIC mothers in Jefferson County initiate breastfeeding, ranking us first or second in the state. At the hospital the rate is in the high 90s. Ms. Showers noted that the hospital and Health Department are working on childbirth education classes at which they also advocate for breastfeeding. They have also considered adding some classes, including an early breastfeeding class. Jean Baldwin noted that the hospital would host the classes to be sponsored by the Health Department. Bio-terrorism and Health Emereency Preparedness - One Year Post 9/11: Dr. Tom Locke noted that bio-terrorism preparedness started in the 1990s as an unfunded project. There was also a bio- terrorism assessment in Jefferson County in the fall of2000. Following September 11 and October's anthrax scare, locally there was excellent multi-agency cooperation, protocols were established, and much was learned. The state and local health system disseminated information and handled coordination between jurisdictions. Washington was one of the few states that did not find its laboratory functions totally overwhelmed in the testing of specimens. Other state labs received hundreds and thousands compared to 70-80 samples tested in Washington where local Health Departments first screened the submissions and conducted on-site investigations. Despite an aggressive response, the experience revealed an inadequate capacity in the national system for dealing with any bio-terrorism scenarios. The Centers for Disease Control was virtually consumed by what turned out to be four letters. Bio-terrorism funding has triggered much of the preparedness efforts. Washington State was eligible for $18.1 million in the first year. While other states chose to allocate 80% oftheir funds to local jurisdictions, Washington chose an initial 50/50 split, with half going toward building capacity in the state health lab and communication systems and the other half for local Health Departments. Jefferson HEALTH BOARD MINUTES - September 19, 2002 Page: 6 County received $25K for 18 months, but it is nomecurring. Region 2, which includes Jefferson, Kitsap, and Clallam counties, is now in the implementation phase of the bio-terrorism plan, which involves assessing strengths and weaknesses. Based on the assessment, a short- and long-range local and regional plan will be developed to address identified gaps. Ongoing funding would be used to build local and regional capacity. Dr. Locke then introduced the new regional bio-terrorism coordinator, Rick Gunderson, who will playa lead role in developing the regional plan and assisting individual counties develop their plans. The desire is to make the plans as consistent as possible, pool resources, and to develop sophisticated systems that are beyond the capability of the current resources. An example is that this region will be implementing one of the first surveillance systems in the state, which would continuously monitor emergency services and certain hospital activities for syndrome trends. This system is not expected to alert us to evidence ofbio-terrorist attacks but infectious disease activities such as sexually transmitted and food borne infections. Jean Baldwin reported that our region would also contract with the University of Washington for epidemiological services. Communicable disease coordinator, Lisa McKenzie will function as local liaison and will attend regional meetings and identify gaps. Vice-Chairman Masci asked about the organizational chain of command in place today? Dr. Locke said that as a part of the Emergency Management System, there are contingency plans for how public health would interact. The public health component would only come into play if it were a biologic emergency. A natural disaster would also involve health ramifications but the Department would not take a lead role. The immediate job ofthe Regional Emergency Response Coordinator is to help Counties adhere to the timeline to develop draft local and regional plans by the end of January 2003 for finalization by the end of April 2003. Bob Hamlin responded that there would be a unified command approach as opposed to a chain of command. State law specifies how disaster preparedness would be structured, one component of which is health. If health were the primary component of an emergency then health would be the lead within that emergency management system. His concern is that multi-agency involvement would lead to duplication of the existing structure. He noted that the Board of County Commissioners is in charge, with the Emergency Management System (EMS) as their agents and within its charge by state law. He noted that the health component, depending on the danger, could be a major player. Dr. Locke said that some ofthe major challenges, as we embark on the assessment, are state and local budgetary issues. The salaries of the people who will do the response work are paid for by a combination of different contracts, programs, and categorical funding, which is a house of cards. Although resources are very tight, there is a very high level of professionalism, motivation and dedication. He noted that the set of first responders now includes community healthcare practitioners, nurses, and lab technicians as well as postmasters and the opener of the mail. The first responder network changes for each different pathogen or agent involved, creating formidable training challenges. Member Frissell asked about plans to create a list of retired medical health professionals? Dr. Locke said there has been a national discussion of this and even though volunteers would not be a replacement for a core set of responders, there will be a need to recruit as many volunteers as feasible. Certainly with the large retirement populations in Jefferson and Clallam Counties, it would be important to utilize all expertise in the event of an emergency. HEALTH BOARD MINUTES - September 19,2002 Page: 7 Rick Gunderson expressed his excitement about the challenge of working on the plan and will report back to the Board on the deliverables once they are ready. He accepted the challenge of working with the Emergency Management System since there is no interest in creating a duplicate structure. Lisa McKenzie said she would work with Rick Gunderson and her counterparts in Kitsap and Clallam Counties to produce similar plans. She feels it is important to look at a regional approach. She attended a bio-terrorism training at the Northwest Center for Public Health Practice. It was valuable to look at epidemiology techniques for any outbreak and different approaches for bio-terrorism. She noted that during the anthrax scare, the New York media and cartoons made it appear that the Health Department was not responsive, but in fact they could not communicate with the community because of possibly interfering with criminal investigations. Health DeDartment Budeet Briefine and Performance Measures: Chairman Westerman solicited Board questions about the information provided in the agenda packet. Member Buhler asked who determines the goals and objectives. Ms. Baldwin responded that some of the missions came from what is required from the programs; some came from staff and what they see as the mission of the program. Staff wrote all the goals, objectives and performance indicators. The 45 programs are covered under four program topics: Communicable Disease, Targeted Community Health Services, Family Support Services, and Population and Prevention. She noted that for consistency with previous years, she did not overlay the five public health standards with the performance measures. Vice-Chairman Masci suggested marking any new performance indicator with the year it was integrated. Communicable Disease performance indicators, Chairman Westerman asked why only one of three people in the Syringe Exchange Program was referred to another service? Ms. Baldwin noted that of the 15, only five were willing to go somewhere else. Chairman Westerman suggested changing this indicator from "referrals" to "accepted referrals." Family Support Services, Chairman Westerman asked why there was no information on the family nurse partnership? Ms. Baldwin responded that the data omission was an oversight. Under WIC, Vice- Chairman Masci asked Staff to show the number as well as the percentage. Member Frissell said she has difficulty jumping between whole numbers and percentages. She would like to see the total number of infants served by WIC. Under children with special health care needs, it would be nice to see the figure served over the total number. Population and Prevention: Chairman Westerman asked why there were drops in the Peer-In educational presentations and school health classes? Ms. Baldwin said the middle school health program ended in June 2001, and there was an incorrect projection for 2002. There were Peer-In presentations in Chimacum but no student participation. However, even with the drop in Chimacum and Quilcene, she does not understand the figures and agreed to provide an explanation of these figures at a future meeting. Under screenings, Vice-Chairman Masci asked that a subset ofthe diseases, problems or other things detected be shown. Larry Fay explained that Environmental Health programs lack performance indicator data because this type of measure is fundamentally different from how it has historically tracked information. Currently, staff does not have the data systems in place to track conveniently and the reliability of the numbers was so low that they need to be verified. He noted that he wrote the mission, goals, objectives and HEALTH BOARD MINUTES - September 19,2002 Page: 8 performance measures. Although he will try to generate numbers, he asked for feedback on the indicators listed. Drinking Water Program: Chairman Westerman asked about Objective #7 which says "Continue contracting with DOH for public water supply projects as long as adequate funding is provided." Mr. Fay said if there was not adequate funding, he would discontinue contracting with the State Department of Health and the State would directly assume their statutory responsibilities. Solid Waste Program: Chairman Westerman expressed interest in better understanding the scope of the residential sharps issue and also asked Staff to spell out acronyms like SQGs (small quantity generators). Larry Fay said the residential sharp concerns are mostly a transfer station worker safety issue. It was also noted that Kitsap County had worked to raise the tipping fee to address the sharps problem. Vice- Chairman Masci suggested tracking through Caregivers and adult family homes that are dealing with this problem on a residential basis. Mr. Fay said he could use some help with Solid Waste performance indicators. While the pounds of trash generated per capita per year is not listed as an indicator, it should be the measurement used in our education program. If after ten years of education the trash was worse, you would ask yourself if the program should be restructured. Mr. Fay said he arrived at the per capita waste generation by comparing the total tons going across the scale to the population. Ideally, we would see the figure decreasing over the years. On-Site Sewage Program: Mr. Fay then explained that the onsite sewage program has traditionally compared the number of permits processed to the number of applications it receives. The goal of an inspection program would be to see an increase in the percentage, rather than the absolute number, of systems getting inspected. The percent of failures includes natural failure and, since premature failures would indicate a problem with the system, he has indicated those systems less than five years old. Chairman Westerman made several suggestions for making this document easier to respond to: 1) she would like to see several examples of "targeted community groups," 2) under Goals, number 2, "assuring a high-quality monitoring program," she would like to see a list ofthose doing monitoring, 3) it might need to be pointed out, under summary of key findings, whether permit and inspection fees are adequate, 4) she would like to know the effect of the 'h FTE reduction of staff allocated to onsite programs as noted in the last sentence, and 5) what sort of increased tracking will be used to evaluate the effectiveness of monitoring programs. Food Service Program: Member Frissell would like to see the number of complaints received and the percent that resulted in corrective actions. Mr. Fay said he is struggling with the difference between performance indicators and numbers. Vice-Chairman Masci said over time the number of complaints and resolved complaints is going to be an indicator of efficiency. After five years, there is enough information to formulate an expectation to gauge your performance. Mr. Fay responded that he would tend to put those numbers on a population basis in order to create rate-based performance indicators. Hopefully that implies we are improving, but if the population and the numbers show similar increases, that does not tell you much of anything. For comparison, he will try to get other communities to do similar measures, but the numbers are going to be meaningless unless tied to population or on a percentage basis. HEALTH BOARD MINUTES - September 19,2002 Page: 9 Chairman Westerman restated her feeling that without the numbers the Board does not have any idea what it is doing. Jean Baldwin noted that while the Department could utilize the federal goal of public health indicators - Healthy Communities no one has yet done this in environmental health. Mr. Fay noted that in the baseline work performed on public health standards, one of the things that the consultants were thrilled with was the environmental health performance indicators. It is fundamentally different than how we have done things. While they may be good in terms of customer service and responsiveness, they do not tell you much about the effectiveness of your program, which is what he is trying to get at in this report. He can see why numbers are important, but that is fundamentally a different kind of report than what he understands about performance-based budgeting. Chairman Westerman proposed the Board discuss the topic of performance-based budgeting in more detail at the next meeting. AGENDA CALENDAR / ADJOURN Environmental Health re~ulatorv review schedule: Larry Fay reviewed the list of items to be covered over the next couple of months: 1) standard operating procedure for civil penalties ordinance, 2) individual water systems, 3) new federal arsenic standards, 4) solid waste regulations, 5) establishing standardized procedure for Board of Health hearings and appeals, 6) adopt rules and regulations around methamphetamine drug lab clean-up, and 7) performance measures. BOH Calendar Plannine:: Dr. Locke said the purpose of going to a monthly calendar is to give the Board more control over how to space out these issues. Ms. Baldwin said that while there are hot-button issues, items like the SrD and family planning report should be brought to the Board on an ongoing basis. Member Buhler expressed concerned about how the saltwater intrusion ordinance will impact the ability of people to get alternative water supplies. The meeting adjourned at 4:40 p.m. The next meeting will be held on Thursday, October 17,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH S(~ ~~\\,~ Sheila Westerman, Chairman chard W ojt, Member ", / . ,../ , . /Cl'f.i~ &{ .-fA-t-<...-r;t...?(/C' Roberta Frissell, Member , Member JEFFERSON COUNTY BOARD OF HEALTH Thursday, September 19, 2002 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meeting of August 15,2002 III. Public Comments IV. Old Business and Informational Items 1. Civil Penalties Ordinance - Public Hearing and Potential Adoption Larry 2. Individual Water System Standards Background Larry V. New Business I.World Breastfeeding Week-JHHS/JGH Collaborative Efforts Promoting the Benefits of Breast Feeding Carol 2. Bioterrorism and Health Emergency Preparedness -1 Year Post-9/11 Tom 3. Health Department Budget Briefing and Performance Measures Jean VI. Agenda Planning 1. Environmental Health regulatory review schedule 2. BOH Calendar I Planning VII. Next Meeting October 17, 2002, 2:30 - 4:30 PM Main Conference Room, JHHS ., JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, August 15, 2002 Board Members: Dan Tittemess, Member - County Commissioner District # 1 Glen Huntingford, Member - Coun!y Commij"J"ioner Distnt't #2 Richard W'qjt, Member - Coun(Y Commissioner District #3 Geojfrey Masci, Vice Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commi.rsioner DiJtnd #2 Sheila Westerman, Chairman - Citizen at LArge (Ciry) Roberta Frim/I, Member - Citizen at lArge (Coun!J) Staff Members: Jean Baldwin, Nursing Services Director Larry Fqy, Environmental Health Director Thoma! Locke, MD, Health Qfficer 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 Tittemess, 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, which 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 ordinance 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 Connry 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.riskzone" in a 1,000 ft. radius of that well. He noted that "at risk" relates to water quality degradation, but is below any kind ofthreshold 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. GeoffMasci 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 unsuccessfully 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 RCWI9-23-97, 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 well 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 I8-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 Westennan 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 Westennan 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 Sexuallv Transmitted Disease: Jean Baldwin said the purpose of this report is to provide the Board with a program update. In September, Staffwill 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 will likely 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 B and 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 SIDs 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 F~miJv Planning PrO!!ram: 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 will 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 - SID prevention, prevention oiunintended 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 of trust 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 Tittemess 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 Health and Human Services budget, Family Planning does not have any cuts. However, there were some in June and in January of 2002. Because of the County's cap on "new hires," she will approach the BaCC 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 listen to the Board. Jill Buhler asked whether the Department is working in collaboration with the clinics at the hospital to develop an SID 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. .. " ST ATE OF W ASINGTON County of Jefferson Ili~]' 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 and/or ordinances adopted by the Washington State Legislature, Washington State Board of Health, Washington Department of Health or the Jefferson County Board of Health; and, WHEREAS, all conditions which are determined by the Health Officer to be in violation of any public health law, regulation and/or ordinance shall be subject to the provisions ofthis ordinance because they are detrimental to the public's health, safety and welfare; WHEREAS, all violations of public health laws, regulations and/or ordinances are detrimental to the public health, safety and welfare and are hereby declared to be public nuisances pursuant to Ch. 7.48 RCW; WHEREAS, a civil infraction process, established pursuant to Ch. 7.80 RCW, can protect the public from the harmful effects of violations, will aid in enforcement, and will help reimburse the County for expenses of enforcement; WHEREAS, enactment 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 ofthis 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 specific 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 /PJIRJ~~F 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. 70.0'5 RCW to protect the public health, safety, and welfare of the people in Jefferson County, including those County residents residing within the City of Port Townsend. Section III Applicability Provisions ofthis ordinance apply to violations of the following statutes, regulations and/or ordinances as they now exist or as they may hereafter be amended: Chapter 70-90RCW 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. Desi~nation of Civil Infractions Any violation ofthe laws, regulations and ordinances specified above in section III (including any future amendments to those statutes, regulations and ordinances) shall constitute a civil infraction. 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 infraction as established in Chapter 7.80 RCW. 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 lUJ/M/AlWif Section V. Processin2: and Adjudicatin2; Civil Infractions: Such violations shall be adjudicated and any related fines determined in accordance with the procedures established in Chapter 7.80 RCW, the Jefferson County District Court rules for Infractions and the Washington State Rules for Courts of Limited Jurisdiction, which shall have precedence over 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 violation 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 of the procedures and penalties laid out in this Ordinance and the underlying state statutes shall not prohibit this County from utilizing any other lawful means or seeking any other lawful remedies against the person or entity that has allegedly violated the terms of this Ordinance. Nothing in this Ordinance shall prevent the Judge hearing these civil infraction matters from reducing or mitigating the monetary fines that would otherwise be imposed. Section VI Enforcement Officers The Board of Health, or its designated Health Officer, may authorize one or more persons to serve as an "enforcement officer," duly authorized to enforce this Ordinance. Section VII. Severability Should any section, paragraph, phrase, sentence or clause of this ordinance be declared invalid or unconstitutional for any reason, the remainder of this ordinance shall not be affected. Section VIII. Effective Date The effective date 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: , Member ATTEST: , Member Lorna Delaney, CMC Clerk of the Board , Member Page 3 of3 Memorandum F To: JeffiLersonFcountyl~~ardl/~.,..f Health . . rom: any ay it) "-...{ Date: 8/28/02 Re: Individual Water System Standards, Background Materials Following last months meeting of the BOH I thought that it might prove helpful to supply the Board with background information concerning the currently adopted requirements and standards for individual water systems in Jefferson County. It is important to note that Jefferson County has not adopted any rules that establish standards for individual water systems until the recently adopted seawater intrusion ordinance. Rather, the county has established requirements for what needs to be in place in order to obtain a building permit. There are no provisions for regulating an individual water system after the building permit is in place. So, for background you will find: 1) RCW 19.27.097 establishing the requirement that anyone applying for a building permit for a structure that needs a supply of potable water must provide proof that they have an adequate supply of water. The law says proof of adequate supply includes connection to an approved public water system, a water right permit or another form sufficient to verify the existence of an adequate water supply. "Another form" suggests that the county can be as permissive or restrictive as it chooses. 2) Excerpts from Ecology Publication 93-27, "Guidelines for Determining Water Availability for New Buildings" This document was prepared to provide guidance to counties implementing RCW 19.27.097. The guideline provides for alternative sources of water supply including rainwater hauling, rainwater catchment and desalination. However, in all cases it recommends that alternative systems should comply with the quantity and quality. Additionally the guidelines state that desalination should only be allowed if the applicant has a water right permit. The guidelines served as a framework for; 3) Jefferson County Health Department Policy Statement 93-02, "Water Availability Requirements for Building Permits". The Policy was adopted by the Board in 1993 and has been our standard operating procedure since. The policy allows for alternative systems only if public water is not available and a well is not feasible. The policy does not establish standards for alternative systems. In the years since the adoption of the policy probably fewer that 5 alternative systems have been recognized as providing adequate water supplies. These include two desalination systems (one of which was never installed as the applicant was able to connect to an existing well) and one rainwater catchment that I can recall. The rainwater catchment was subsequently replaced with a well. 4) Jefferson County Health and Human Services Policy Statement 97-01, "Rainwater Collection". The policy was adopted by the Board in 1997 in response to the anticipated increased demand for alternative water systems following the adoption of the original seawater intrusion standards contained in the interim critical areas ordinance. The standards were based on the experience gained having reviewed and recognizing the one rainwater system referenced above. The policy is a performance- based approach putting the burden on the applicant to demonstrate how the catchment system will provide sufficient volumes of safe drinking water to meet the basic needs of the structure. While we have received many queries about the policy I cannot recall a single design submittal based on this policy. I don't know why but suspect that there are several reasons. These include the low rainfall that we receive necessitates a large catchment area (several thousand square feet) to meet even a most minimal need, the large storage requirements necessary to address the seasonal nature of our precipitation and the limitations that an alternative water system may place on accessing financing. However, these are speculations and no formal studies have been undertaken regarding the use of rainwater catchment systems. In addition, I have questioned all the other health departments in Washington through our list serve about whether and how they handle hauled water, catchments and desalination. As of today I have heard from only 6 departments. Island, Tacoma Pierce and Thurston Counties do not allow any alternative water systems. Skagit County reports that it highly discourages alternatives and has not developed standards for them. They have allowed one rainwater system (using an approach very similar to the one contained in our policy) and one desalination system. They do not allow hauled water. Klickitat County has developed standards for hauled water, however, Kevin Barry reports that they lack the infrastructure to make it happen at the present time. San Juan County has adopted standards for rainwater catchments, hauling and desalination. alternative systems only if public water is not available and a well is not feasible. The policy does not establish standards for alternative systems. In the years since the adoption of the policy probably fewer that 5 alternative systems have been recognized as providing adequate water supplies. These include two desalination systems (one of which was never installed as the applicant was able to connect to an existing well) and one rainwater catchment that I can recall. The rainwater catchment was subsequently replaced with a well. 4) Jefferson County Health and Human Services Policy Statement 97-01, "Rainwater Collection". The policy was adopted by the Board in 1997 in response to the anticipated increased demand for alternative water systems following the adoption of the original seawater intrusion standards contained in the interim critical areas ordinance. The standards were based on the experience gained having reviewed and recognizing the one rainwater system referenced above. The policy is a performance- based approach putting the burden on the applicant to demonstrate how the catchment system will provide sufficient volumes of safe drinking water to meet the basic needs of the structure. While we have received many queries about the policy I cannot recall a single design submittal based on this policy. I don't know why but suspect that there are several reasons. These include the low rainfall that we receive necessitates a large catchment area (several thousand square feet) to meet even a most minimal need, the large storage requirements necessary to address the seasonal nature of our precipitation and the limitations that an alternative water system may place on accessing financing. However, these are speculations and no formal studies have been undertaken regarding the use of rainwater catchment systems. In addition, I have questioned all the other health departments in Washington through our list serve about whether and how they handle hauled water, catchments and desalination. As of today I have heard from only 6 departments. Island, Tacoma Pierce and Thurston Counties do not allow any alternative water systems. Skagit County reports that it highly discourages alternatives and has not developed standards for them. They have allowed one rainwater system (using an approach very similar to the one contained in our policy) and one desalination system. They do not allow hauled water. Klickitat County has developed standards for hauled water, however, Kevin Barry reports that they lack the infrastructure to make it happen at the present time. San Juan County has adopted standards for rainwater catchments, hauling and desalination. Memorandum To: Jefferson County Board of Health From: Larry Fay -//76....J Date: 8/28/02 f' \./ Re: Individual Water System Standards, Background Materials Following last months meeting of the BOH I thought that it might prove helpful to supply the Board with background information concerning the currently adopted requirements and standards for individual water systems in Jefferson County. It is important to note that Jefferson County has not adopted any rules that establish standards for individual water systems until the recently adopted seawater intrusion ordinance. Rather, the county has established requirements for what needs to be in place in order to obtain a building permit. There are no provisions for regulating an individual water system after the building permit is in place. So, for background you will find: 1) RCW 19.27.097 establishing the requirement that anyone applying for a building permit for a structure that needs a supply of potable water must provide proof that they have an adequate supply of water. The law says proof of adequate supply includes connection to an approved public water system, a water right permit or another form sufficient to verify the existence of an adequate water supply. "Another form" suggests that the county can be as permissive or restrictive as it chooses. 2) Excerpts from Ecology Publication 93-27, "Guidelines for Determining Water Availability for New Buildings" This document was prepared to provide guidance to counties implementing RCW 19.27.097. The guideline provides for alternative sources of water supply including rainwater hauling, rainwater catchment and desalination. However, in all cases it recommends that alternative systems should comply with the quantity and quality. Additionally the guidelines state that desalination should only be allowed if the applicant has a water right permit. The guidelines served as a framework for; 3) Jefferson County Health Department Policy Statement 93-02, "Water Availability Requirements for Building Permits". The Policy was adopted by the Board in 1993 and has been our standard operating procedure since. The policy allows for 1iifif~ , ~~t1rfi.:"'''''' --...l~~l'... Leqislature Home About Us E-Mail Lists Search R~W_nIL.::~~ >>IJT~~..,12>> gjjAPI~8J2:~Z>> SECTION 19.27,097 19.27.095 << 19.27.097 >> 19.27.100 Help Print Version RCW 19.27.097 Building permit application ~- Evidence of adequate water supply -~ Applicability -- Exemption. (1) Each applicant for a building permit of a building necessitating potable water shall 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. An application for a water right shall not be sufficient proof of an adequate water supply. (2) Within counties not required or not choosing to plan pursuant to RCW 36.70A.040, the county and the state may mutually determine those areas in the county in which the requirements of subsection (1) of this section shall not apply. The departments of health and ecology shall coordinate on the implementation of this section. Should the county and the state fail to mutually determine those areas to be designated pursuant to this subsection, the county may petition the department of community, trade, and economic development to mediate or, if necessary, make the determination. (3) Buildings that do not need potable water facilities are exempt from the provisions of this section. The department of ecology, after consultation with local governments, may adopt rules to implement this section, which may recognize differences between high-growth and low-growth counties. [1995 c 39!=l S 9; 1991 sp.s. c 32 S 28; 1990 1 st ex.S. C 17 S 63.] NOTES: Section headings not law --1991 sp.s. C 32: See RCW 36.70A.902. Severability -- Part, section headings not law ~- 1990 1st ex.s. c 17: See r I. ~r_~ ! <l -. .~ f'I .~ . > :~ . '~ : ~i. '~:"--,.- ,O.:'~.I: ~..'{ f..I. :~!;~ (. ':""~ . ". '~T '. ,~~, ;,.C. ~.' '7' ; " .!' .~,~~~,. -- , :';;',.'-'"- "'i ..::>, . ,.~ . , _<;" ,.::,;~O'<!~)~~7&.~~1z;;t?~'~,~~' I ..:. ~"...+""" .~~ "i'~'-~""'~ ___~~'"",,,kw.!,i'?~. ~ ~; ,; ::~'-:~.~.:j:'~~:~ii:;g~~'~.>--'" " "", - ':-' _, ,,;w'''v "-'''''. ~l!O-4:tl- ~ .':::~-:iT~~'-j~~~~~~!}~~~~~~~, _ . _..)..,~..", '......,..~..; -';~f'""",~~~i': ' . : T ~ - ~. >:::~.:.~ -..0:,:. ,.' ." .- - ; 'i,;..... '" ,- '., .~: . ~. . ~.~?':~.-..:~~~:~ ~~::~r~~ ~: : ...,t "'/ . - "\ .~' : ",: / --A ". ": ,- ,~ 'Itt;" .I ""- n;..t .. ~ , .'~ ., .r'_~ -- ...~- '-- :c .--.< ..;.:,. r:' ~ t--.:'" prilltcd onreeVcled pa,rr domestic water supply without treatment. The local permitting authority must consider to this information before proceeding with issuance of additional building permits within such an area. (7) A local permitting authority with concerns about a water source or type of water source the use of which requires a waler right permit may participate in Ecology's water right permitting process. Upon rcceipt of a writtcn n:quest from the appropriate local legislalive body, Ecology will: (a) Rcfer applicants for permits proposing to use water from that source or type of source to the appropriate local permitting authority for consultation prior to processing the application. (b) Provide copies of applications for permits to use water from that source or type of source to the local permitting authority for review and comment prior to making a decision on the applicalion. Section 4. INDIVIDUAL W ATER SUPPLY SYSTEMS. (I) A water supply for a building which requires potable water, induding some limited irrigation, may be considered to be adequate if it: (a) Is capable of providing water to a residential dwelling in the amount of 400 gallons per day. If additional uses of the same water source are contemplated, the local permitting authority should determine the amount necessary to satisfy those additional uses at the time of evaluating the adequacy of the supply. Consideration should be given to a program of aggressive water conservation, including effeclive implementation of the Water Conservation Performance Standards (Uniform Plumbing Code amendments for plumbing fixtures and l111ings). (i) If a source appears to be only marginally adequate, either in terms of quantity yieldcd or quality of the water. the local permitting authority may wish to attach a note to the property title advising futurc owners of that fact. (ii) TIle local permitting authority may require additional testing at the time of resale of the. property to verify the continued adequacy of the water supply. (b) Meets any and all siting criteria established by state regulations and local ordinances, and is conslructed in compliance with state and local regulations. (c) Docs not cause any dctrimental interference with existing water rights and is not detrimental to lhe public intcrest. Invcstigation and idenlitkation of well interference problems and impairment 10 senior rights is the responsibility of Ecology. If the possibility of a problem is suspect<..'d, the local permitting authority should contact Ecology. (2) Syslems which obtain water from surface watcr sources. (a) The use of surface water sources for individual water supplies is generally discouraged due to their potential for. contamination. For purposes of determining treatment options. surface water as used in this subsection includes ground water which is under the direct infiuence of surface water, but does not include springs which have been developed to preclude surface contamination. (b) Any use of surface water, including water from salt water sources, must be authorized by a water right permit or covered by a valid registercd water right claim. (c) Water from the source should conform to water quality Standards contained in the State Doard of Health Drinking Water Regulations and, at a minimum. must be tested for bacteriological quaJity and nitrates. (d) The water used should be treated using a system designed by a licensed professional. using equipment which meets Department of Health ccrtification for point-of-usc/p()int~of-cntry trcatment systcms and is installed in accordance with lhe approvcd dcsign. (e) An operations and maintenance (0 & M) manual for the treatment system may be rcquired by the local health authority for review and approval. A copy of the manual must be provided to the property owner for the treatment system. m A notice should be aUached to the property title which states the requirement for a trcalment system. lbis notification should include a recommendation that the water system be inspected and retested any time the property ownership changes. The notice should include 1 information regarding the potential health risks associated with utilizing surface water as a\- - . _ drinking water sourcc. . (g) The local health authority may require the property owner to contract with a Department of Health-approved Satellite System Management Agency for system operalion. (3) Systems which obtain water from ground water sources. (a) If the total amount of water to be used from the ground water source is in excess of SOOO gallons per day or the area of lawn or noncommercial garden to be irrigated is greater than one-half acre, the use must be authorized by a water right permit or covered by a pre-1945 water right for which a registered water right claim has been filed. (b) If the source is a well which does not require a water right permit. Le. those which use S(XX) gallons per day or less or irrigate one-half acre or less of lawn or noncommercial garden, the water availability notification should be accompanied by a water well report (drilling log) and. at a minimum. the results of a one-hour bailer or air lift test indicating the yield of the well. (i) In many cases. the water well report plus results of a test verifying well yield will provide all the necessary supporting evidence of physical availability of water. However. in arcas where other concerns about water availability may exist (e.g. impact on instrcam flows and senior surface water rights or known well interference). Ecology and/or the local permilling authority may require additional testing to verify the existence of an adequate amount of water. (H) The water well report and test indicate Dilly the physical availability of water. TIley do not indicate the legal availability of water. Such wells. while exempt from the water right permitling process, are still subject to regulation by the Department of Ecology. (c) Additional supporting documents which may be required by the local permilling authority include. but arc not limited to. the following: (i) A water quality laboratory analysis report. . (iI) A copy of recorded notification if public disclosure of a problem is required. (Iii) A copy of an operation and maintenance (0 & M) manual (if required). (Iv) Copies of any other documents which may be required by the local permitting authority. (d) The well must be constructed in conformance with the Water Well Construction Standards. Chapter 173.160 WAC. (e) Water from the source should conform to water quality standards contained in the State Board of Health Drinking Water Regulations and. at a minimum. must be tested for bacteriological quality and nitrates. (i) A lab certified by Health must perform the analyses. (Ii) If the local health authority suspects that a problem may exist in a specific area, the local health authority may also require testing for trihalomethanes. pesticides, radionuclides, volatile organic chemicals and/or other chemical or physical water quality parameters. (Hi) If the weJJ is newly constructed, prior to sampling it should be properly developed (I.e. flushed for a minimum of one hour or until such time as the water runs clear and all chlorine residuals are undetectable. whichever is longer). (iv) Water samples should be collected hy a "qualified individual" as determined by the local health authorily. (v) Follow-up sampling may be required to provide additional data on the level or a specific contaminant in question. If the local health authority determines that several consecutive follow-up samples indicate that the water supply is in compliance wilh the maximum cont<.iminant levels, treatmcnt and public notification requirc:11ents may he waived. (J) Continuous effective treatment should be recommended, and may be requircd. for any water supply which fails to meet bacteriological or primary chemical or physical quality parameters. (I) Continuous effective treatment may be recommended or required, at local health authority discretion, for any other contaminant found in the water. 4 (jj) Treatment should generally be whole house rather than point-of-use. Water used in . any portion of the system. such as the irrigation system. laundry. or other non-coni act plumbing fixturcs. which is isolated from the drinking water system does not have to be treated. (iii) All home treatment equipment should be certified by the Depanment of Health and must be installed in accordance with the approved design. (iv) In cases where treatment is recommended. a notice recommending treatment should be attached to the property title. This notification should recommend that the water system be inspected and retested any time the property ownership changes. The notice should include information regarding the potcntial hcallh or aesthetic effects associated with exceeding the maximum contaminant level. (4) Allernalivc sources of supply. (a) Individuals may obtain water from alternative sources of supply under the following conditions: (i) Hauling water should be allowed only if the applicant can demonstrate that the proposed system will comply with the water quality and quantity criteria specified in these guidelines. (ii) Rooftop collection systcms should be alJowcd only if the applicant can demonstrate that the proposed system will comply with the water quality and quantity criteria specified in these guidelines. (Hi) Desalination systems should be allowed only if the applicant either has or obtains a water right permit and can demonstrate that the proposed system will comply with the water quality and quantity criteria specified in these guidelines. (iv) Other alternative water supply systems should be aJIowed only if the applicant either has or obtains a water right permit. when required. and can demonstrate that the proposed system will comply with the water quality and quantity criteria specified in. these guidelines. (b) A local heaJth authority wishing to permit the use of alternative systems should develop a process to grant waivers from these guidelines which provides for the protection of the public health and safety. . (i) Supply systems using alternative sources of supply may need to be accompanied by any necessary plans and specifications verifying that the system is capable of providing water for the purposes of the building equivalent in quantity and quality to the criteria speciJied in lhcsc guidelines. (5) Lm:al permilting authorities may require additional information concerning the adequacy of a water supply. including potabilily information. beyond that listed above. Section 5. DETERMINATION OF EXEMPT AREAS. A local government may seek to exempt new building construction in an area from complying with the provisions of RCW 19.27.097(1) through the proccss outlined below. Such an exemption would apply only to individual water systems. (NOTE: The Department of Ecology intends to adopt this section as an administrative rule. The remainder of lhe guidelines may be adopted as rules at a later date.) (I) A local government seeking an exemption should assess the potentfal of the area for exemption and prepare a proposal to be submitted to the Departments of Ecology and Health for review and comment. The local government should consult. informally with both Ecology and Health to minimize the effort needed to prepare such a proposal. The proposal need include no more than the following elements: (a) A map of the area proposed to be excmpted. Such an area should probably be cilhcr a watershed or a discrete hydrologic unil. (0) An inventory of current water rights in the area. (c) A summary of existing water well report information for the area. (d) A summary of water quality information for the area. (e) An examination and discussion of other watcr uses. apart from domestic supply. in the area. (I) An assessment of all land uses. induding thc population and building density. of the area to be proposed. 5 (g) An cvaluation of the zoning and growth potcntial of the area. (h) Some form of local review or public hearing process. (i) A plan for tracking and rcporting information about future development in the area. (2) Ecology and Health will revicw the proposal and provide copies to other potentially affccted parties. such as Indian tribcs and fisheries and wildlife agencies. Criteria for revicw includc thc following: (a) The proposal is consistent with any applicable water resources plans dcvcloped by cithcr Ecology or Health. (b) The area has no history of watcr-rclated regulatory problems. (c) Water appears to be available to sustain additional development. (d) Additional development and watcr use in the nominated area would not pose a significant thrcat to existing watcr rights. including instrcam flows. (e) Additional development and water use in thc nominated area would not significantly harm fish or wildlife habitat. (t) Additional development and water use in the nominated area would not cause degradation of the present quality of water. (g) There is no indication that use of the water in any portion of the designated area would pose a health risk to potential users. (3) Ecology and Health will inform the local government that they: (a) Agree with the proposal, (b) Suggest specific changes. or (c) Cannot accept the proposal. (4) If the proposal cannot be accepted by Ecology or Health, the local government may pursue mediation with the Department of Communify Devclopment. If agreement still cannot bc rcached. local governments which arc not planning undcr RCW 36.70A.040 may request that thc Department of Community Development make a final dctermination. (5) Areas will only be exempted for a specified period of time. Such an exemption should not bc construcd to be verification by Ecology and Health that water is available for any individual applications for watcr right permits or that the Water is of suitable quality for drinking. A growth-related trigger mechanism or a specified period for review should be established for any exempted area. (6) Local governments may carry out a program to monitor impacts on water supply and watcr quality in exempted areas. , ' Section 6. PUBLIC WATER SYSTEMS. If the operators of a public water system desirc to prov;dc water to one or more new buildings. they should ensure that such an expansion of service is: (l) Consistent with adopted State Board of Health Drinking Water Regulations. (2) Consistent with adopted county land use plans, development regulations and ordinances. (3) Within the scope and conditions of the system's water rights, including - authorized place of use, limitations on quantity of water allowed for use, and number of connections authorized to bc served. If the system is currently excmpt from water right pennitting requirements, the operators should determine whether the proposed expansion of service will cause watcr usc to excccd 50()() gallons per day or the area of lawn or noncommercial garden irrigated to exceed ()Oc-half acrc. thereby rcquiring a water right permit. (4) Consistent with Department of Health regulations and procedures. including system dcsign standards. 6 JEFFERSON COUNTY HEAL lH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION Policy Statement Number 93.02 Program: Drinking Water Subject: Water Availability Requirements for Building Pennits--Chapter 19.27.097 Effective this date, the following policy shall be adopted concerning proof of an adequate supply of potable water as a prerequisite for a building pennit: I. General Requirements. A. Each applicant for a building permit for a project necessitating potable water shall provide evidence of an- adequate supply of potable water for the intended use of the building, except that those applications for pennits for replacement structures, improvements or additions to buildings that will not result in an increase in water usage, or buildings not requiring a potable water supply are not subject to the provisions of this policy. B. The Jefferson County Building Department shall determine if proof of adequate supply is required. C. The Jefferson County Environmental Health Department shall detennine if the proof provided meets the adequacy and quality (potability) requirements. II. Public Water Systems A. Applicants intending to connect to a public water supply shall provide written notification from an approved water system purveyor stating that the system has the capacity and commitment to provide water. The water system must be in compliance with state water supply regulations and the state surface and ground water codes (Chapters 90.03 and 90.44 RCW). B. The health department shall review the notification supplied by the purveyor as well as the record from the Washington Department of Health to verify that the approved system has the capacity and is in compliance before finding that quantity and quality crlteria has been met. III. Individual Water Supplies. A. Individual water supplies shall be capable of providing a minimum of 400 gallons per day. Page 3 of3, Water Availability Requirements The 1990 Growth Management Act includes provisions requiring proof of an adequate supply of potable water before a building permit can be issued. The law (19.27.097 RCW) authorizes the Department of Ecology to develop regulations to implement the act. The DOE has developed Guidelines for Determining Water Availability for New Buildings and is currently preparing final Guidelines. The guidelines are general in nature and allow for a certain amount of flexibility for local conditions although they do serve as minimum standards. This policy is intended to adopt those guidelines as the county standard for implementing RCW 19.27.097, clarify county procedures, and provide consistent interpretation of the Guidelines. The policy shall remain in effect until amended or repealed by the Jefferson County Board of Health. ISI1. Peter Geerlofs. M.D. Health Officer Date: 5/27/93 /SI Bob Hinton Chairman, Board of Health Date: 5/27/93 JEFFERSON COUNTY HEALTH AND HUMAN SERVICES ENVIRONMENTAL HEALTH DMSION POLICY STATEMENT NUMBER 97-01 PROGRAM: DRINKING WATER SUBJECT: RAINWATER COLLECTION I. Effective this date the following policy shall be adopted concerning the use of a rainwater collection system for proof of water adequacy for a building permit. A. Rainwater collection systems (catchments) will be accepted as proof of meeting water adequacy requirements for a building permit as stated in Chapter 19.27.097 RCW, provided that the conditions outlined in this policy are met. All designs under review shall be submitted for individual catchment systems only. It shall be the applicant's responsibility to demonstrate that the catchment system provides adequate supplies of potable water; Jefferson County assumes no responsibility in the event of failure of the water system to provide potable or adequate supply. B. Requests for review of catchment system designs shall 'be submitted. as a catchment system design report. The catchment system design report shall be reviewed by Environmental Health staff. The report shall, at a minimum, address the following: I) Estimated daily average and annual water demand based on an occupancy of two people per bedroom for residential structures. In the event that water usage is projected at less than 45 gallons per person per day, the report shall document how the use estimates have been derived. 2) Annual average precipitation in the location of the proposed structure. ,. 3) Catchment" area required based on I) and 2) above with allowances for losses in the system and dry years. " -- 4) Required storage volume based on a water balance analysis. 5) Storage tank conceptual design which provides for protection of the water from contamination while in storage. 6) A detailed description of a treatment system that provides for disinfection and filtration sufficient for the removal of suspended solids and cysts such as those of giardia and cryptosporidium. C. In order to receive approval, the catchment system design report must demonstrate that an adequate supply of potable water will be provided. A copy of the report shall be retained with the building permit record. In addition, a notice shall be Page 1 of 2 recorded with the property title. The notice shall identify the water source as a rainwater catchment system and specify the daily capacity of the system. The notice will not make any assurance of continued supply of potable water. A continued supply of potable water is assured only with appropriate operation and maintenance of the water treatment system by the owner, and with sufficient rainfall. . D. A combination system uses both a well and a catchment system to meet water demands. Ifused as proof of water adequacy for a building pennit, a combination system may mix treated catchment water with well water provided that the catchment water is potable and meets all the requirements of Section B, above. E. Combination systems may be constructed, and are encouraged for uses other than proof of an adequate water supply. If used, there shall be no cross-connection between untreated catchment water and potable water supplies, as per universal plumbing code standards. ll. As a part of the Growth Management Act, RCW Chapter 19.27.097 requires applicants for building permits for stmctures requiring a potable water supply to submit proof of an adequate supply of potable water for the intended purpose(s) of the building before a building permit may be issued. State Guidelines developed by the Washington Department of Ecology (DOE) and the Washington Department of Health (DOH) established the following criteria for adequacy of individual supplies: '" '" An adeqUate supply of water is 400 gallons per day for a single family residence. Potable water conforms with state drinking water standards (at a minimum, bacteriological quality and nitrates). Whole house treatment is allowed., and is recommended if water quality does not meet drinking water standards. Alternative sources of supply (including catchments) may be adequate if all other criteria are met. '" '" Jefferson County Resolution 99-90 adopted the guidelines for the purposes of administering RCW 19.~7.097. The JeffersOn County Board of Health adopted Polic~ 93-02, "Water Availability Requirements for Building Permits," which is consistent"With County Resolution 99- 90. However, neither of these policies directly addressed the use of rainwater catchment systems to establish proof of. an adequate supply of potable water. This catchment policy more specifically defines how Jefferson County will interpret the conditions required for alternative sources of supply in the state regulations. ~~~~~ Health Officer ~( '2-tl."t7 ate / / ,.1 ,/~/ ~/~><. /..-- ~ . '....... / . If Chairperson Boar~otHealth 5//?/Cf / / / Date Page 2 of 2 . NATION'S H September 2002 rhe Official Newspaper of the American Public Health Association IBn~as1 is besf Benefits of breastfeeding confirmed in new research FROM decreased cancer risk to . . smarter infants, recent studies underscore the health benefits that breastfeeding can provide to both mother and child. Mothers who breastfeed have a lower risk of breast cancer and are more likely to bond with their children, two recent studies show. Other new research fmlnd that babies who are breast- fed can grow up to be less obese and develop better cognitive skills. "Public health profes" sionals have long worked to spread the message that 'breast is. best,'" said APHA Executive Director Moham~ mad N. Akhter, MD, MPH. "These findings prove that long-term breastfeeding is the right choice for mothers to make." Among the recent find- ings, the research on breast cancer - which found that women who breastfeed have a reduced risk of breast cancer - attracted l::.ii~ Recently released research findings confinn that breasifeeding is beneficial for the health of both mothers and their children. the most public attention. The study, by the Collab- orative Group on Hormonal Factors in Breast Cancer, found that each year a mother breastfed reduced her ri~k of breast cancer by 4.3 percent. The study;s findings, which were .~ublished in the July 20 is:;ue of the Lancet, may explain the much higher rate of breast cancer in developed coun- tries, where breastfeeding is less frequent. The incidence of breast cancer in devel- oped countries in 1990 was five to seven for every 100 women, or double the rate of breast cancer in develop- ing countries, where one to two cases of the disease occur per 100 women, the study said. ''"Ibis collaboration has uncovered the main reason for the large variation in breast canCer incidence around the world," said study researcher Valerie Beral, MD, a professor of epidemiology at the Univer- sity of Oxford. 'I11e cancer rates also reflect the higher birth rate of devdoping countries. TIle study found that each time a woman gave birth, it reduced her risk of breast cancer by 7 percent. In some developing coun. tries, the birth rate was twice that of women in developed countries, lead- ing to an over.llllower breast cancer risk. Women in developing countries also breastfed for longer periods of time. Women in developed coun- tries, on avemge, breastfed for about 3 months per child. Women in developing countries breastted for about 24)months per child. "We have shown that the small number of children women have and the short duration. of breastfeeding typical of women in devel. oped countries alone account for much of the higher rates of breast can- cer in these countries," Beral said. The study, analyzing 47 studies from 30 countries, took into account more than 80 percent of the worldwide data on breast cancer and breastfeeding. "It is now de-.lt that it was necessary to pool results from all over the world to diSt.'ntangle in a reliable way the effects of breastfeeding froffi___other related effects of childbear- ing on breast cancer," said snJdy researcher Gillian See BREASTFEEDING, Page 8 BREASTFEEDING, Continued from Page 1 Reeves, PhD, a statistical epidemiologist at Oxford University. If women in developed countries brea5tfed each child for 6 months longer, there would be 25,000 fewer cases of breast cancer each year, and if women breastfed for 12 months longer, the number of breast cancer cases would drop by 50,000, the study estimated. But Reeves said it is unrealistic to expect women in developed countries to adopt the childbearing and breastfeeding patterns of developing countries. She noted that if women were to breastfeed each child for 6 months longer, 5 percent of breast cancers would be prevented. Even with so many advantages to breastfeed- ing, only 29 percent of American women breast~ feed their infants, said Amelia Cobb, MPH, .a service fellow and public health adviser with the National Women's Health Department of the U.S. Health and Human Services. "Society does not deem it socially acceptable to breastfeed," she. said. "There are too many barriers on public breastfeeding." Hr{~li.Stf\xl, children gain heallh benefit\; Breastfeeding may also protect against childhood obesity, a study published in the June 8 issue of the Lancet suggests. The s"tUdy found that the rate of obesity in children who were breastfed was significantly lower than the rate of obesity in children who weren't breastfed. Breastfeeding in infancy reduced obesity in 3-year- olds by 30 percent, the study found. "The s'tUdy does add to the evidence...to recom- mend breastfeeding as the best approach to infant feeding," said study researcher John Reilly, PhD, a senior lecturer in the Division of Develop- mental Medicine at the University.9f Glasgow Medical Scl)ool. The study followed the feeding patterns of 32,200 Scottish children born in 1995 or 1996 for several years. Obesity in the chil~ dreri was defined as a body mass index score in the 95th percentile. Breastfeeding is an effec- tive public health strategy for dealing with the current obesity epidemic, Reilly said, but is not the entire answer. "It has been suggested that with a protel-tive effect of this magnitude, formula feeding could be held responsible for around 10 percent of cases of adult obesity," Reilly said. Since 1980, the percent- age of overweight U.S. chil- dren and teens has almost doubled, according to fed- eral research. Babies who are breastfed also gain a boost in cogni- tive development, especially if they are smaller than nor- mal, according to a study by researchers with the National Institute of Child Health and Human Devel- opment and Norwegian University of Science and Technology. The study, published in the March issue of Acta Pae- diatrica, found an increase in IQ among small babies who were exclusively breastfed for periods longer than 12 weeks. "We have found that there is a larger benefit in terms of cognitive develop- ment for babies that are very small,".said Malia Rao, MPH. principal investigator and a NICHD staff scientist. Rao stressed the need for mothers of small babies to continue breastfeeding through six months, explaining that many mothers of such babies are cautious to do so because they think that formulas or supplements will speed up infant growth. "When mothers initially wean small babies, there is a small growth spurt," Rao said. "But in the long teml, this early weaning can only hurt the child," At 5 years of age, small babies who were breastfed for 24 weeks scored 11 points higher on IQ tests than did small babies who were breastfed for 12 weeks. Studies have shown that children who were born small perform worse acad- emically than children who were born average size. However,. the snldy found that the IQ of children who were born small and breastfed for more than 12 weeks did not vary from the average lQ of children born normal size. Another recent study suggests that mothers who breastfeed are less likely to abuse their children. The study was presented by Lane Strathearn, PhD, a professor at the Baylor College of Medicine, at the 14th International Con- gress on Child Abuse and Neglect in Denver in July. Stratheam compared data on Australian mothers to the country's child pro- tective services database. He found an association between breastfeeding and nurturing by mothers. The strongest predictor of future abuse was the length of time spent breastfeeding, or whether a mother brcastfed longer than four months, Strat- heam said. Up to four months, there was little to no effect of breastfeeding on abuse patterns. m -Jessica Creighton Your milk is your baby's perfect food . Babies who are breastfed for at least 6 months have fewer health problems than babies who are artificially fed, including: 3 times fewer ear infections 5 times fewer urinary tract infections 5 times fewer serious illnesses 7 times fewer allergies . Because human milk is so easy to digest, breastfed babies spit up less often, and have less diarrhea and constipation. . For every 87 artlficially fed babies who die from SIDS/crib death (Sudden Infant Death Syndrome), only 3 breastfed babies die from SIDS, . Babies who are fed only human milk for at least 26 weeks are 6 times less likely to develop lymphoma (a type of cancer) In childhood. . Babies breastfed for at least one year are only half as likely to develop diabetes. Breastrnilk can begin a lifetilne of good health for your baby . As adults, people who were bn~aslled have: . less asl hllla . It'sS diabetes . kWl'r skin problems, including dermatitis alltl eczcma · !ewer alll~rgit,s . lowewd risk of heart a1tack alltl stroke due \0 lower cholestt'rol kvds . less ulcerative colitis (uln'rs in the large intestine) . less Crohn's <list'ase (chronic diarrhea in some families) . protection frolll cerlain chronic liver diseases . Breaslmilk is hrain food. Studies show that children who were breastfed have higher IQs (by an average of 7 points) than those who were given breastmilk substitutes. Breastfeeding is healthy for mom . WOIlWIl who breilstlt't'd 10wl'I" I I li'i I" risk 01 hreast c.llln'l" Nlllsing lor a \ildilllt' 10Ld 01- . :1. YI'.llS lowt'rs II\(' risk 1)('lof(' 1llt'Il0paust' by /10'\, . ti Yl'.llS 10Wt'l s tll(' rhk 1)('11111' Illl'llOlhlllSl' IIY titi'"" . i YI'<llS lilt' I ish; ot IlIl'asl C<lllll'r Illrollglllllll <I wonl,lIl's liktinll' 10 ;dlllOSt /('1"0. . 111\'aslh't'dlllg .IIso pnlvl(/I'S proll'llioll IrOllll'.1I1Cl'r ot 1111' OV.lrll'S <IS well .IS o~;tl'OI'OIOSIS. .I Il1illllill!~ 01 1111' bOlli's. Affordable health care begins with breastfeeding BREASTFEEDING 101 I. The Canadian Paediatric Society and the American Academy of Pediatrics recommend it. 2. Breasueeding promotes bonding between mother and baby. 3. Breastfeeding satisfies baby's emotional needs. 4. Breastmilk provides perfect infant nutrition. S. Breastfeeding decreases mother's risk of breast cancer. 6. Breastfeeding decreases baby girls' risk of developing breast cancer later in life. 7. Breastfeeding is associated with higher l.Q. 8. Breastmilk is always ready and comes in a nicer package than formula does. Need we say more? 9. Breastfed babies have better motor development. 10. Breastmilk contains immunities to diseases and assists in the development of baby's immune system. II. Breastmilk is more digestible than formula. 12. Baby's suckling helps shrink mother's uterus after childbirth. 13. Baby's suckling helps prevent post-partum haemorrhage in mother. 14. Nursing helps mom lose weight after baby is born. 15. Pre-term milk is specially designed for premature infants. 16. The World Health Organization and UNICEF recommend exclusive breastfeeding for six months. 17. Breastfeeding protects against Crohn's disease. 18. Breastfeeding decreases risk of baby developing diabetes. 19. Breastfeeding baby helps decrease insulin requirements in diabetic mothers. 20. Breastfeeding may help stabilize progress of maternal endometria;is. 21. Breastfeeding decreases mother's risk of developing ovarian cancer. 22. Breastfeeding decreases mother's risk of developing endometrial cancer. 23. Breastfeeding decreases chances of baby developing allergies. 24. Breasrmilk dramatically lowers the risk of baby developing asthma. 25. Breastfeeding decreases baby's risk of ear infections. 26. Breastfeeding decreases the risk of sudden infant death syndrome (8108). 27. Breastfeeding protects baby against diarrhoeal infections. 28. Breastfeeding protects baby against bacterial meningitis. 29. Breastfeeding protects baby against respiratory infections. 30. Breastfed babies have a lower risk of developing certain childhood cancers. 31. Breastfeeding decreases chances of juvenile rheumatoid arthritis. 32. Breastfed babies are less likely to contract Hodgkins disease. 33. Breastfeeding protects baby against vision defects. 34. Breastfeeding decreases chances of osteoporosis. 35. Breastmilk assists in proper intestinal development. 36. Cow's milk is an intestinal irritant. 37. Breastfed babies are less likely to become obese later in life. 38. Breastfed babies have less chance of cardiopulmonary distress while feeding. 39. Breastfed babies have less chance of developing ulcerative colitis. 40. Breastmilk protects against hemophilus infections. 41. Breastfed babies require shorter pre and post-surgical fasting. 42. Breastfeeding results in less sick days for working parents. 43. Breastfeeding enhances vaccine effectiveness. 44. Breastfed babies have less chance of developing necrotizing enterocolitis. 45. Breastfeeding helps delay the return of fei;'tility. 46. Breastfeeding is easier than using formula. 47. Breastmilk is free. 48. Formula is expensive. 49. Formula costs tax payers millions of dollars. 50. Breastmilk is always the right temperature. 51. Breastmilk always has the right proportions of fat, carbohydrates and protein. 52. Breastmilk makes for more contented babies. 53. Breastfeeding makes for happier moms, too. 54. Breastmilk tastes better than formula. 55. Breastfed babies are healthier. 56. Breastfed babies are less likely to die before their third birthday. 57. Breastfed babies require fewer doctor visits. 58. Breastfeeding mothers spend less time and money on doctor visits. 59. Breastfed babies don't leave any garbage behind. 60. Breastfeeding means no bottles to tote. 61. Breastfeeding means fewer cow-induced global greenhouse gasses. 62. Breastmilk doesn't need to be refrigerated. 63. Cow's milk is designed for baby cows. 64. Human milk is designed for baby humans. 65. Breastmilk provides natural pain relief for baby. 66. Breastmilk provides the perfect food for sick baby. 67. Breastfeeding means more sleep for baby. 68. Breastfeeding means more sleep for mom. 69. Breastfeeding means more sleep for dad. 70. Breastfeeding means less equipment to buy. 71. Breastfeeding means less equipment to maintain and store. 72. Breastmilk has never been recalled. 73. With breastmilk there's no need to worry about bacterial contamination. 74. With breastmilk, there's no need to worry about which brand is better. 75. With breastmilk, there's no need to worry about adding contaminated water. 76. Breastfeeding helps reduce cruelty to farm animals. 77. Breastfeeding facilitates proper dental and jaw development. 78. Breastfed babies get fewer cavities. 79. Breastfeeding means less money spent on corrective orthodontia. 80. Breastfeeding means better speech development. 81. Breastfeeding means less chance ofbaby getting eczema. 82. Breastfed babies have great skin. 83. Breastfed babies spit up less. 84. Spit-up breastmilk is easier to clean up than formula. 85. Breastmilk contains no genetically engineered ingredients. 86. Breastmilk contains no synthetic growth hormones. 87. Lack of breastfeeding is associated with multiple sclerosis in later life. 88. Breastfeeding means less chance of inguinal hernia. 89. Breastfeeding means better cognitive development. 90. Breastfeeding means better social development. 91. Breastfeeding decreases risk of baby developing urinary tract infections. 92. Suckling optimizes hand-To-eye coordination. 93. Breastfeeding protects babies against iron deficiency. 94. Breastfeeding moms spend less money on menstrual supplies. 95. Breastfeeding is a self-confidence booster for mom. 96. Breastmilk may help combat eye infections. 97. Breasnnilk may be a good natural antibiotic for wounds. 98. Breastfeeding means no worries about the latest ingredient discovered to be missing from formula. 99. Breastfed babies have much sweeter smelling diapers. 100. Breastfed babies smell fantastic. 101. Breastfeeding is what breasts were designed for! IN FACT Canada 6 Trinity Square Toronto, ON M5G IBl Phone (416) 595-9819 Fax (416) 591-9355 www.infactcanada.ca Adapted from. information provided by Leslie Burby (0 1998~2.001 ProMoMt Inc. All righfS resetved. Jefferson County Health and Human Services 2003 Perfonnance Measures: Community Health BUDGET/PROGRAM: Communicable Disease TB, COnll1mnicable Diseases, Immunization, Travelers Immunization, Sexually Transmitted Disease, HIV, Syringe Exchange Program. MISSION: Communicable Disease The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease surveillance, investigation and reporting, along with education, screening, treatment and immunization services. The program interacts with community members, medical providers, the Washington State Department of Health and other agencies while working toward this purpose. GOALS FOR 2003 1. Maintain the low rates of active TB in Jefferson County (TB) 2. Timely investigation of reportable conditions (CD) 3. Support universal access to State supplied vaccines for all children (Imm) 4. Continue to support immunization registry in Jefferson County, promoting use by all immunization providers (Imm) 5. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County (STD) 6. HIV testing and counseling clinic resources are focused on persons at risk for HIV infection (HIV) 7. Case management services will be easily accessed by new HIV clients who seek these services (HIV) 8. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners (SEP) 9. Annual report to BOH for CD, TB, Immunization Programs, STD 10. Develop bioterrorism response capacity OBJECTIVES (INTERVENTIONS) FOR 2003 1. Encourage appropriate screening &treatment for latent TB infection (TB) 2. Develop & update protocols for investigation of reportable conditions (CD) 3. Maintain an efficient system for supplying State supplied vaccine and vaccine recommendation up-dates to private Health Care Providers in Jefferson County (Imm) 4. Continue to provide training on the Child Profile Immunization Registry to private Health Care Providers 5. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia (age criteria) will be screened for Chlamydia (STD) 6. 75% of clients who receive HIV testing will be high risk (HIV) 7. 90% of new HIV clients who seek case management services will have an assessment within 1 week of the date requested (HIV) 8. Promote utilization of syringe exchange program services (SEP) 9. Develop bioterrorism plan, coordinating with plans ofregional bioterrorism partners, local emergency response agencies and Jefferson General Hospital PERFORMANCE INDICATORS: 2002 2002 2003 Planned Projection Planned (TB) Number of clients started on preventive therapy for latent TB infection 10 5 8 (CD) Number of communicable disease reports confirmed, interventions 56 68 62 applied and processed for reporting to the state (Imrn) Number of doses of publicly funded vaccine, administered by private 3500 3500 3500 health care providers and Public Health clinics, supplied and monitored through Public Heath's inununization program (Imm) Number of local immunizations providers (clinics) provided 7 4 3-6 information and training on the Child Profile immunization registry (Imm) Number of providers participating in the Child Profile immunization 4 1 4 registry (Imm) Number of Jefferson County children <6 in Child Profile system 70% 70% 80% (STD) Percent of at risk FP and SID clinic clients at risk for Chlamydia 100% 100% 100% screened (age criteria 14 - 24) (HIV) Number of persons counseled and tested for HIV infection 90 60 60 (HIV) Percent of persons counseled and tested for HIV infection that were in 75% 69% 75% high~risk category (HIV) Percent of new HIV clients seeking case management services who 90% 100% 90% have an assessment within 1 week of the date requested (SEP) Number of clinics 100 100 100 (SEP) Number of visits to SEP 15 15 15 (SEP) Number of syringes exchanged 1000 1000 1000 (SEP) Number ofpreventionJeducational materials provided 15 15 15 (SEP) Number of referrals to other services 5 5 5 (BT) Develop bioterrorism response plan 1 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Communicable disease prevention is a locally funded program since the county milage was returned from the state to counties for TB control. Immunization funds from the state have been primarily in the form of vaccine. County funded Services are important in the Strategic Plan to promote healthy communities by having the infrastructure to maintain a professional staff preventing, identifying and responding to disease outbreaks. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. HIV services are funded from the state and federal government to provide basic communicable disease prevention, HIV positive client case management, testing and counseling to high-risk community members, and focused high-risk interventions. Funds are highly programmatic and based on federal case numbers, which may not represent Jefferson County epidemic profile. Volatile program funding based on formulas re-negotiated with Region VI AIDSNET every year Developing the capacity for bioterrorism response is a new project. This response capacity will be in coordination with our bioterrorism regional partners, Kitsap and Clallam Counties and our local emergency response agencies, Jefferson General Hospital and other health care providers. 9 September 2002 j Jefferson County Health and Human Services 2003 Performance Measures: Community Health BUDGET/PROGRAM: Community Health: Family Support Services Proeram Maternal Child Health (MCH) including newborn follow-up, Child Birth education and Breast Feeding Support, Maternity Support Services (MSS), Best Beginnings/Nurse-Family Partnership (NFP), Maternity Case Management (MCM), Children with Special Health Care Needs (CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS) Contract Programs: Alternative Response System (ARS), Early Intervention Program (EIP), and Passport. MISSION: The purpose of the Family Support Service program is to provide community assessment, education, skill building, and support to pregnant women and families with children. Services also include voluntary home visits to prenatal, post partum families, and families at risk of Child Protective Services involvement. These services are provided so county babies are born with the best opportunity to grow and thrive, the impact of health problems are minimized, and children receive the care and nurturing they need to become functional adults. GOALS FOR FY2003: 1. All newborns and their families will receive Home Visit screening to identify needs for Family Support Services including: intensive home-visiting, case management, lactation support, special health and child development support, nutrition education and parenting education. 2. Increase the availability of the Family Nurse Partnership Program (Best Beginnings) for Jefferson County residents. 3. Monitor Nurse Family Partnership Program replication by tracking data on program fidelity, from data input 4. To assess the percentage of pregnant and parenting women receiving JCHHS services, in which depression is an issue. 5. Increase ongoing breastfeeding education and support so that all county mothers can provide their children with the physical and emotional benefits of breast feeding. 6. Prevent nutritional related problems for pregnant women and children under five in Jefferson County. 7. Identify Children with Special Health Care Needs in Jefferson County and assist families with health and development interventions as needed. 8. Provide services and information in Jefferson County aimed at preventing Child Abuse and Neglect. OBJECTIVES FOR FY2003: 1. Increase newborn screening to universal screening by to all Jefferson County families of new babies, in order to identify early intervention needs and offer services and referrals. 2. Hire a full time PHN for the JCHHS Maternal Child Health Team to provide increased intensive home- visiting, as well as WIC, and Maternity Support Services, Case Management and Newborn Follow-up. 3. Send client data monthly to Nurse-Family Partnership program head office for assessment and evaluation. 4. To offer a depression screen to all pregnant and parenting women who are participating in JCHHS programs. To provide appropriate referrals for those who have a positive screen. 2002 5. Through universal screening ofnewboms and their families identify those who may need referral to breastfeeding tea party or lactation consultation home-visits. 6. Provide WIC nutrition education and support to all county women and children eligible. 7. Through universal newborn screening and community outreach in the schools and other JCRRS programs children with special health and development needs will get referred for evaluation and intervention services 8. Through screening of pregnant women, families ofnewboms and referrals from DSRS Childrens Services identify families at risk for child abuse and neglect and offer Family Support Services. PERFORMANCE INDICATORS: 2002 2002 2003 Planned Projection Planned 1. Number of depression screenings completed 50 50 60 2. Number of newborn screened 120 100 120 2. % of those screened receiving continuing Family Support 50% 50% 50% Services (2002 no MCR add) 3. Number of Rome and Office visits provided for BB, MSS, 1600 1500 1500 MCM, MCH and Breastfeeding consultation 4. Yearly report from Family-Nurse Partnership ** ** ** 5. % of infants in Jefferson County served by WIC 40% 40% 40% 6. Number of children with special health care needs 60 60 60 receiving Public Health Nurse intervention through JCHHS. 7. Number of families served through CPSIDSHS contract. 15 10 15 ** report yearly SUMMARY OF KEY FUNDING/SERVICE ISSUES: Maternity Support Services that have been provided over the last 11 years have demonstrated the positive outcomes and cost savings from visits supporting and educating pregnant women. The child abuse referrals in Jefferson County increased steadily for ten years until 2001. These rates and juvenile justice numbers have been decreasing with comprehensive prevention programs. In 1999 JCHHS began an intensive research tested home visiting program (David Olds Nurse-Family Partnership Program - Best Beginnings) for first-time parents within Jefferson County. It will be expanded in 2003 with the Office Of Juvenile Justice grant. Depression, another problem for Jefferson County families as identified by JCHHS health indicators work, is demonstrated by brain research to have an impact on the healthy development of a child. So, to prevent depression from being a communicable disease, screening and treatment is necessary The programs JCHHS are providing have demonstrated measurable successful outcomes. The research clearly shows that there is a relationship between the positive outcome and the frequency, dose and duration of visits in the programs. As we increase the frequency, dose and duration of our services we increase the need for stable, consistent funding. The Jefferson County Strategic Plan outlines a need for healthy citizens. Family Support programs assist families' ability to care for children and advocate for them as they grow. Jefferson County Health and Human Services 2003 Performance Measures: Community Health BUDGET/PROGRAM: Population & Prevention Programs Tobacco (TP/C), School Health (SIR), Childcare health and Safety (CC), Child Death Review (CDR) and Peer-In (PI) MISSION: The purpose of the Population & Prevention Programs is to provide assessment, health education and public health interventions to county residents in order to prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2003: I. Improve identified social and health indicators for school-age youth (SIR) 2. Improve indoor air quality for Jefferson County residents (TP/C) 3. Enhance the quality of child care provided in Jefferson County (CC) 4. Enhance the overall health & safety of Jefferson County children (CDR) and (PI) OBJECTIVES FOR FY 2003: 1. Increase delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (SIR) 2. Increase number of restaurants participating in smokefree campaign; number of mothers who do not smoke during pregnancy (TP/C) 3. Increase child care provider satisfaction with consultation provided to them re: health, immunizations, safety and child development (CC) 4. Active participation between child death review team and Peninsula Safe Kids Coalition, and Peer educators will provide school health classes to middle & high school students and health education classes will be provided to elementary, middle & high school students (CDR) and (PI) PERFORMANCE INDICATORS: 2002 2002 2003 Plan Projection Plalmed Number of student health screenings 2490 2400 2400 Number of restaurants offering 100% Indoor Smoke Free Dining (TP/C) 60 62 62 Child care provider evaluations of services provided by JCHHS staff *** % of child death reviews conducted within 6 months after death (CDR) 100% 100% 100% Number of Peer. In educational presentations 50 10 10 Number of school health classes 220 50 50 Number of phone calls to State Quit line from Jefferson County 70 70 80 ***Report SUMMARY OF KEY FUNDING/SERVICE ISSUES These programs are all universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco and Peer-In funding have community specific goals and measures that must be met to maintain funding. July 22, 2002 Jefferson County Health and Human Services 2003 Performance Measures: Community Health BUDGET/PROGRAM: Targeted Community Health Services Family Planning, Breast and Cervical Health Program, and Foot Care MISSION: The purpose of the Targeted Community Health Services is to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. . Specific program purposes are: . Family Planning: to provide reproductive health, clinics, outreach and education for Jefferson County residents in order to promote health and well-being and reduce unintended pregnancies. . Breast and Cervical Health Program: provide public education and health screening services to women age 40-64 with low incomes and no or limited health insurance in order to assure early detection and treatment of breast and cervical cancer. . Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent health complications. GOALS FOR FY 2003: 1. Insure access to breast and cervical health exams to women age 40 to 65 years old. 2. Decrease unintended pregnancy rates in Jefferson County (measure) / Assure Family Planning Services are provided in every community 3. Support seniors' independence by maintaining their mobility OBJECTIVES FOR FY 2003: 1. Track Family Planning usage patterns and produce annual report 2. Increase breast and cervical health program outreach in Jefferson County 3. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2002 2002 2003 Plan Proj ection Planned Number of un duplicated clients served in Family Planning 1100 1400 1500 Number of adolescents under 19 served in Family Planning 320 320 330 Number of Breast & Cervical screening exams 65 65 65 Number of foot care contacts 2500 2500 2500 SUMMARY OF KEY FUNDING / SERVICE ISSUES: JCHHS Family Planning clinical services are funded by 12 funding sources; the federal 10% and state 16% have remained flat for years. Some funding relief became available in 2001 when the Washington State and federal negotiations over Medicaid waiver was approved called "Take Charge." This funding source is available to individuals at various sites in the state and it allows JCHHS another source to bill for client services. July 22, 2002 Environmental Health Program 2003 Budget Assumptions Drinking Water Programs MISSION: The mission of the Drinking Water Program is to assure that the residents and visitors to Jefferson County have access to the best quality drinking water that is reasonably available in order to minimize the threat of waterborne disease. GOALS FOR FY 2003: 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Limit public exposure to water systems with known deficiencies. OBJECTIVES FOR FY 2003: 1. Inspect at least 50% of all new wells constructed and 100% of all wells being de-commissioned. 2. Increase compliance with state well drilling regulations. 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with state statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water systems to deliver safe drinking water. 5. Assure that food service establishments that operate their own water systems are in compliance with federal and state drinking water requirements. 6. Establish appropriate policies for alternative water supply systems. 7. Continue contracting with DOH for public water supply projects as long as adequate funding is provided. 8. Improve accessibility of DOE water well construction reports and other water quality data to county residents and interested stake holders PERFORMANCE INDICATORS: 2000 2001 2002 2003 Projected Planned Percent new wells inspected Percent of inspected wells with construction deficiencies. Number and time spent providing technical assistance. Percent of building permits issued with conditions identifying water supply deficiencies. Percent of building pennit applications denied based on water supply deficiencies. Percent of food service establishments with water system deficiencies. SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done within existing databases such as pennit plan and the food service database. Databases will be updated as necessary to add new fields to track performance indicators. Environmental Health Program 2003 Budget Assumptions Solid Waste Programs MISSION: The mission of the Solid Waste Enforcement and Education Program is to assure that solid waste in Jefferson County is managed in a way that is consistent with state regulatory requirements, avoids harm to the envirorunent, is protective of the public health and promotes goals and objectives for solid waste reduction and recycling consistent with the Jefferson County Comprehensive Solid Waste Management Plan. GOALS FOR FY 2003: 1. Reduce the occurrence of promiscuous dumping. 2. Increase the awareness of small quantity generator and household hazardous waste disposal requirements through education and outreach efforts. 3. Promote construction waste recycling in order to reduce illegal dumping. 4. Increase compliance with residential sharps disposal requirements. OBJECTIVES FOR FY 2003: 1. Finish updating solid waste regulations. 2. Conduct workshops and technical consultations with SQGs 3. Establish baseline estimate of the distribution and disposition of residential sharps. 4. Complete long-term interagency agreement with Public Works for solid waste education outlining agreed upon priorities and funding. PERFORMANCE INDICATORS: 2001 2001 2002 2003 Projected Planned Percent of illegal dumps closed and cleaned up 100% Pounds of litter and illegally dumped waste collected per capita 1.2 IbsJcap Percent of verified nuisances cleaned up SUMMARY OF KEY FUNDING/SERVICE ISSUES: Generally there have been very few compliance problems associated with pennitted solid waste facilities in Jefferson County. However, illegal dumping and neighborhood nuisance conditions continue to be a problem. Use of general funds and tipping fee funding to match DOE Solid Waste Enforcement and Solid Waste Education Grants will enable the division to maintain staffmg at current levels. This level of staffmg will enable the department to complete the solid waste regulation revisions, increase capacity for compliance activities and conduct regular community outreach programs. 2 Environmental Health Program 2003 Budget Assumptions On Site Sewage Program MISSION: The purpose of the Onsite Sewage Program is to minimize the threat of surface and ground water contamination from failing or improperly designed, installed or maintained onsite sewage systems. GOALS FOR FY 2003: 1. Educate homeowners, builders, real estate personnel, banks, installers, designers and onsite system maintenance personnel in the proper operation and maintenance of onsite sewage systems. 2. Assure a high quality-monitoring program. 3. Implement and enforce state and local rules and regulations governing the installation and use of ousite sewage systems. 4. Investigate Action Requests and complaints in a timely manner to reduce the threat of human contact with untreated wastewater. 5. Assure high quality customer service. 6. Reduce permit turn around time. OBJECTIVES FOR FY 2003: 1. Develop written informational materials for public distribution and conduct workshops for targeted community groups addressing onsite sewage system operation and maintenance. 2. Provide training to targeted community groups to increase awareness ofregulatory requirements for onsite sewage systems. 3. Review monitoring and inspection reports and provide timely follow up. 4. Utilize existing data systems to track action requests and complaints. 5. Develop and implement a system for routinely surveying customer service. 6. Assure that site inspections in response to permit applications are conducted within 14 days of receipt of application. 7. Expand use of Laser fiche system to create electronic images of relevant ousite permit data. PERFORMANCE INDICATORS: 2000 2001 2002 2003 Projected Planned Number of systems repaired or upgraded not 7 associated with a violation or building application. Percent of systems inspected that require significant 1.8% maintenance or repair. Percent of existing systems receiving regular 3rd party 13% monitoring. Failure rate of systems less than 5 years in use 0 Number of new system applications and the percent 55% approved without major redesign Percent of complaints requiring follow-up unknown enforcement action. Number of septic permits received 42?17 Number of days to initial inspection 10.23 Percent of permits issued with no clock stops 55% Average days to process with no clock stops 20 A verage days to process all permits 21.3 Percent of permits applications pending 40% Average Number of days to process with clock 23 stoppers EES total 55 Percent of failures/major maintenance 1% 3 Environmental Health Program 2003 Budget Assumptions SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done with existing data systems to evaluate effectiveness of monitoring programs. With the completion of the DOE non-point source pollution grant, ongoing O&M activities will need to be funded through permit and inspections fees. Implementation will focus on coordination with the POO to set up systems for scheduling and tracking inspection activities and conducting community outreach to increase awareness of the new requirements. Staff allocation to onsite programs will be decreased by 'h FTE. 4 Environmental Health Program 2003 Budget Assumptions Food Programs MISSION: The purpose of the Food Program is to minimize the risk of the spread of disease from improperly prepared, stored or served foods handled in commercial settings. GOALS FOR IT 2003: 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments. 3. Provide basic food safety information to the general public. OBJECTIVES FOR FY 2003: 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. PERFORMANCE INDICATORS: 2001 2001 2002 2003 Projected Planned Number of food workers trained and the percent 1,360 trained trained from out of county Percent of required inspections completed. Percent of inspected establishments that required repeat inspections due to critical violations. Percent of establishments receiving Outstanding Achievement A wards Number of complaints received and the percent that resulted in corrective actions or FBI verified. SUMMARY OF KEY FUNDING/SERVICE ISSUES: Food Program activities are largely funded through pennit fees. 5 'The Seattle Times: Let's not get complacent about a serious health foe Page 1 of2 seattletimes.com ~ 'ilIJCS<,,\ttk'i.'-\llltS Friday, August 30. 2002. 12:00 a,m_ Pacific Permission to reprint or copy this article/photo must be obtained from The Seattle Times. Call 206-464-3113 or e-mail resale@~fJi::}tt!fJ.t{'!J~_$,QO--'!! with your request. Let's not get complacent about a serious health foe Offering advice to a Legislature with a $ I-billion hole to fill is a fool's errand, but I have a simple request: Don't skimp on protecting public health. Pressure to cut programs can turn imprudent acts of budget balancing into expedient virtues. Resist the temptation. Compromising public-health programs tampers with the essential infrastructure of government. By law, a lot of public health is a responsibility of cities and counties, but the motor vehicle excise taxes that once helped pay the bills disappeared with the rollback of car-license tabs. In better times, legislators cushioned the blow with extra cash from Olympia, but the money goes away next summer. Counties cobbled together other resources but they are withering as well. Effective, persistent attention to public health tamed a nasty stew of communicable diseases. Tuberculosis is an example of a success, but it represents a latent menace if we pinch pennies and cross our fingers. Two decades ago, the nation dropped its guard on TB and paid a steep price to recover. Tuberculosis is not a significant public-health risk in this state or most ofthe United States. Globally, it is a leading killer, especially among those infected with HIV, and young women of child-bearing age. Washington gets roughly 250 cases a year. King County is in the 150 range. Snohomish County fewer than two dozen. These are active cases that require intensive treatment regimens. The shorthand about TB is upbeat: Most people exposed to the disease do not become infected; few of those infected become ill, and those who do are curable. But treatment is not cheap, and it requires multiple medications taken as prescribed without fail. The key is a disciplined, intense therapy. Dr. Lee Reichman, founder ofthe national tuberculosis center in New Jersey, knows how quickly apparent successes can come undone. I met the doctor through Seattle attorney Robert Dickerson, a volunteer with Results, a respected Washington, D.C.-based humanitarian organization that has made a global campaign against TB a priority. Dr. Reichman has been on "60 Minutes," and published a well-received book on the TB time bomb ticking in the former Soviet Union, especially in its prisons. TB infection rates are high around the world, and immigrants are a primary source of new cases in Washington. Their origins track the ebb and flow of humanity toward our shores. Southeast Asian refugees who fled their homelands carried TB infections along with their hopes and dreams. A half dozen years ago saw an upswing in cases from Eastern Europe and the old Soviet empire. Now, local health departments are seeing a rise in cases from East Africa. Dr. Reichman's time bomb analogy is scary, but his experience with official complacency is just as :The S~attle Times: Let's not get complacent about a serious health foe frightening. Page 2 of2 In the late 1970s and early 1980s, TB was considered a conquered disease in the United States, and federal money and attention went elsewhere. Dr. Reichman was director of TB programs in New York City when the disease, which never went away, exploded. Cases soared, with outbreaks in hospitals, a public~health emergency that had not happened in 50 years. That lesson in humility cost a billion dollars. Corralling TB is never easy. Medications are expensive, cultural problems complicate treatment regimens, and multiple-drug-resistance forms ofTB are complete budget-busters. Such cases are rare, but five cases hit Asotin, Chelan-Douglas and Gray's Harbor counties in 1999, draining entire TB budgets for one patient. King County's experience shows treatment costs can soar from $5,000 to $150,000 per person. TB is a cunning foe. Once a person shakes the early symptoms, they do not feel sick, and typically lose interest in maintaining a demanding pill routine. The most effective therapy, here and abroad, is directly observed treatment. A health worker watches a patient take his or her medicine, for months on end. Snohomish County has used video phones to monitor TB clients, and pays some high-risk clients small cash incentives to visit a clinic and take their medicine. Given the persistent threat to public health, these are cost-effective ways to deal with a known health problem. Organizations such as Results understand prevention begins internationally. Failing to adequately finance public-health programs does not save a dime. The expense and illness end up very close to home. Lance Dickies column appears regularly on editorial pages a/The Times. His e-mail address is ldickie@~eattletimes. com. Copyright @ 2002 The Seattle Times CO.!!lpany Used with permission, Jefferson County Health and Human Services AUGUST ~ SEPTEMBER 2002 NEWS ARTICLES I. ~~Water issues hot topic on Marrowstone", Peninsula Daily News, August 14,2002 2. "Health violations,policy examined", Peninsula Daily News, August 14,2002 3. "Marrowstone residents voice water issues", p.r. LEADER, August 14,2002 4. '''Open Space' proposals due", P.T. LEADER, August 14, 2002 5. "Alcohol is top drug; meth is gaining", P.T. LEADER, August 14,2002 6. "Meth often behind the crimes of Jefferson County Kicker", P.T. LEADER Online, August 14, 2002, 3 pages. 7. ~~Substance abuse marks county's darkest alley", Editorial, P.T. LEADER, August 14,2002. 8. "Delayed shots back on list for kids entering school", Peninsula Daily News, August 16,2002 9. "Suspect in county meth case enters not-guilty plea", P.T. LEADER, August 21,2002 10. "Meth treatment possible - but hard", P.T. LEADER, August 21, 2002 11. "Meth: Alluring, sometimes deadly drug is growing in county", P.T. LEADER, August 21, 2002, 2 pages. 12. "South county has ~free dumping' project", P.T. LEADER, August 21,2002 13. "Residue and risk: Meth destroys property, homes", P.T. LEADER, August 21,2002 14. "Washington prepares for West Nile Virus with Web site", W A DOH News Release, August 27,2002 15. "More women are using family planning in county", P.T. LEADER, August 28,2002 16. ~~Some sexually transmitted diseases increase locally", P.T. LEADER, August 28,2002 17. "Saltwater intrusion meeting clears the air", P.T. LEADER, September 4,2002 18. "Mammograms available", P.T. LEADER, September 4,2002 19. "Health Department invites public to talk ~response''', P.T. LEADER, September 11,2002 Q) c o ...., ~ o ~ ~ CO ~ .1.. c o (.) 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Health '.:violations . policy examine'd: BY StuART ELLIOTI' PENINSULA DAlU' NEWS The Jefferson County Board of Health will hold a public hearing and consider adopting a civil penalties ordinance at its meeting Thursday. The ordinance would crack down on property owners who illegally - stockpile garbage or have ongoing septic violations, among other issues. It would also mean fines and appearances before a judge if f- / '1-0 d-- ./- properties aren't cleaned up. 'We give people an opportu- nity to get problems squared away," said Larry Fay, Jefferson County environmental health director. "But if we have multi- - pIe contacts and no response, we'll move into a ticket writing mode." If approved, the ordinance - which doesn'~ need to be approved by county commis- sioners - could go into effect immediately. The board meets from 2:30 p.m. to 4:30 p.m. Thursday at the Jefferson Health and Human Services office, 615 Sheridan St., Port Townsend. During the meeting, the board will also discuss a report on aexually transmitted dis- eases in the county and a family planning program report. The public health implica- tions of a recently-approved Jefferson County Seawater Intrusion policy will also be dis- cussed. __""m~ Marrowstone residents voice water issues Island golf course use chief among concerns 8y Philip L W~tnfu I.ud@"/ St~ttWrill"f Mal'towHone hland iolf COurse d~...e1oper Wally Barclay IIodmllled Mond.y he i$ u.\P1ni rainWllet 10 imiAle his gtl;:ens wHhcu,1I ill wiler righlS permll tequlred by the Wash. Irlj:1on Slale Dtpallmtnl of Ecology (DOE). Thai dido'l sil well with iOme of ,h~ 165 people who illl:'nde-d In informacion.' meeling .sponsored by Ihe MarTowuone Island Commu- f'Il1y Associalion On a.relly's. Projecl Ind CWO O(her iuucs. The olher issues Were Ihe prQ,." peel ror brin&in&: public Wlter 10 the i.sland and the implet of new Jefferson COYnly rules re- iardiJ'\1 prmeclion or we1l5 iram seawalef inlrU.:5ion. ..Vo.... '...e COn$iSlcnlly lone ahud wi chou' P.yinl In)' II. (c::.~ion lO rulu and tCllJl.- lions," islal'ld reudenl Marly Vln Elltn lold Bucl.y, "You'" b..n "ruUlin. lliiiMllh( Counl)', lhe: stall; and evcrybOdy else. You've just don. as you damn w.1I pl....d. We don'r \l(lnf lhose with power Ind fl)9nc)' 10 '0 On without I$kin&_1 just don't like it." Barclay said h. didn', h.v. POwe.r and mOney 10 inOucnce d~ciiion-mlk:inl' He said lhe DOE didn'l provide him lddi. lion.1 informltion he needed 10 H:d; a wlter riehu permit. I..din. '0 a d.l.y in hi. apply- in, (or the ~rmjt. 'Tvl: had conversllion.s all ,h. way .Ion.:' B.r.l.y ..id. "Ir'ts I vcry slow process, J wish J <;-ould uy I had power and money, My inlentions have bHn to use the CIJWU thll J consid~r a beJuHfullhin&. I'm no, "yin. '0. be.. bully." Bar.l.y ..pp1;inliri<1 nor a water rilhls pennil ~o draw .. m.ch .. 400 cubic r.., or WlIer per miQUIC from ifvcraJ rainwater calchmc:nt,J On the 90,.c," aoll.o.".. Bu, Man. i&t'r Ralph Baker $lid he use:.. just 13.000 ,.UOll" on fwo d.yr of Ihe week and 76,000 on {htee dip ~o Wllet Ihe Mornin,lidc:: Golf COLIne. He $aid rainwater is eolJe"led diU. in& January throuJh Marth (or use in lhe su.mtner months. The. pond> can hold up to 7_5 ",iI. lion iIHon.. he uid. Several ida.nd re..idtnta ex- pressed concern th,t the di\ltr- sion of rainwater to Buelay's holdin, pondJ would r..ull in Ius ""ater reac:hina the i"land's 'quif.". Th. only .our.. for the island's aq\J.ifen i. rainwa_ lU, I~co(dinl Co the DOe:. "I don', beli.v. in my hean that I'm ueaJinl your 'Wa~er,'1 B.,.by laid. "I don't beli.ve 'he: wlter is beiDa rcchulCd. 11'1 hiuinllhe afound ..nd run- ning sideways into lhc: bay," Buclay and Biker also majn~ained ~hll they don't use harmful pesticides and herbj- cides [hal could conu~mina'e neiihborin, wells. They in- vited c:ver)'one to visic the coif COune at 6 p.m, WednesdlY, Aug. 21, lO hl't( . look al the prodlJt:t.li they U5e: l.Od lOul lhe I:Ol.Jf$c. Bucla)' said he phns (0 seek. . reZOne of his propc:t1y ~n hI' 1"111' ,.,,........& _ ____ $en' 10 Ill< Departm.nt of Ecolo,y. SWRO, P.O. Bo. 477n, Olym- p", WA 9a504.n75. Public wal.r system. J.If.""" COWl/)' f'lJblio Util. il)' District I GencnJ Monaaer Jim ParII.r Wl<ed .bout Ill< pr<>cq,! 10 .."bUsh a pubUc Water .)'Stern for MarrowSlOII< Island. H. Slid the PuP had rec.ived . petition ..k. ina for III cnainocrinllOllylis fot a wat.r .yatern and chal the peti. Lion haG """" thlll <no\I&h .iplA. (Urea to require the utilily aaency '0 aQ rorward with the _y. an. ,udience. member ukod ror . .how o( hando 10 oellle the matter Monday, bultha, idea 10''' ended by ....;000" who wlllCOd 10 learn more .bool the prooeu and polentilll c"'" berore mUina up Ch.ir minds. ParII.r <.\plained /hat the PUP will do the .I\iine<rina lOlly... 10 deIennine th. ..timaCOd COO" fur brinaina public Wll.r 10 MlIITOWSlone bland, l!ach """'" eny Owner Ivould b< required 10 p,y '0 hook up to th. 'y"em, should the pup dcl<mlinc lhal Ill< plan is economic Illy feasible, Par\:er wd. Onc. Ill< .....""""" .... <ltabli~ the PUP wooJ<l ao forward with buildin& . water ,y,_ tcm IlIIku more than 51 ptn:enl or Ill< island'. 683 pn>peny own. on <.\pra:s objection to . pr<lpOIed Water .y.tern. "US1 ~t5')"no',ildi~." Park.r .aid. "U 30 pe",<nt laid 'no'. w.'d adj"'t Ill< boundarieo 10 l..v... many ollhoac people Qu' .. w. couJ<I. II oould take . year or two yeon or J"'!ier ber"", w. clecidc wlldher to JO ahead," SevtriJ hoop. need to be: jumped 'hrouah b.(ore ,h.n. Parter .aid he would Ii.... <leIer. mine whelher . public: Wller ')'S- tem wooJ<l be in """Plianoe with the Jeft'eraonCowuy~_ ..iv. Plvl. The /leJI1 Wilt .. l\nd. . ini'.iio'aluoOiiic<:Ukely 10 b<'in th. Tri'Ar.a bee.u.e th. PUD "lnnoI.... ito WI1in& water weIIa which '."ice Irond.,. ror MlIITOW.lOne bland. PUD Co"'mi..ion." K.n MCMiII.n laid h. h.. no in'.r. elt jn build;nll 'Water sysum if reaidenu don 'I wan. one. He en- COura,ed people (0 WOlI( to de. termine whethe.r more than 51 percem of the OWner, wouid Qb.. jec,to lhe plan, "U , 1 j>UC<Ill ..id '00' '0- morrow. We would qu.it tOrnGtr ro",/' be .aid_ "We won'I pu.b some.lhina where: it', no. wanle,t" Robbi. RobiNon ""pre..ed th. opinion lbal the pun wu rOICin, th. public w.rer 'Y'''''' on island n.sidenu,' bUI M.Millen uid lb. pun "'U'I .bide by '....I.w thai say, i( 10 petten, of th. property OWI\erI ..k tor III cnaitlecrin, atudy, the PUD mu" do Ihe "udy. Th. PUD "'''''Illso laU inlO "".ount all properly Owneu, w~C:lher they live on the island or not, he .aid. "The 1.10' "Y' do 'hi.," MCMiII.n laid. "I don', Wan,lo ao to jail by nOl re.pondinl'O . petition we 'ye rc:c:e.ivc:d," P.,l<<r 'aid <he per.houSehold .011 ."uld ran.. from $2,000 '0 $5,000, bUI 'h.. will be de..r. mined as the study ,De. fo,. Ward. D,p.ndin. on lh. projecl's fit\ancina. that tould "I don't believe in my heart that l'm stealing your water. I don't believe the water is being recharged,It's 'lilting the ground and running ~ideways into the bay," Wally~ go/t <OUt><! _Ioper amOunt '0 $10 per 1Il0nth (or 20 years, h. uid. Inaddi'ion, Ih. PUD would chara. . 1Il0n'hly '.rvic. (ee and , per. ..1I0n f... Th. CUNen' feu charaed 10 Tri'Area W'ler us. e" i, $12 per month and $1.60 per 100 cubic re.t or w".r, he said. A new PUD ,IY".m 10 Marrowllone could li..o,poraie Fort I'1.aler S"'e. Psrk, now s.rv.d by an ext.n,ion o( Ih. Tri.Ar.,.w.'er 'y"."'. Wuh. inlton S.ale Park., wanCl 10 improve 'Ut' water $)'llern lO provide be'ter now (or fir. pro. ltction. and officials h.ve di.- cuncd whe'h.r ,he PUD could build. Wiler SIOrJle t..nk chat would tern bolh Ihe park and island fe.tidenu, Saltwller Intrllslon J.rrenon Coun'y Natural R.,ourc.. Man.,., D.vid Cbri"enun brieny reviewed lhe COUnty.', .n.w reaulllions thll u.ek. to protect OXislin. wdb frOIll ..ltwaler intrlllion, · phenomenOn in whic;:h StlWI~ ter rush., inlO welb wh.n 100 mu.h fruh w.t.r hu b..n pu"'ped ou, o( th.lI\. H. uid ,h. reaul,Uon., whi.h t.b er. r..t Sept. 21, will nor .<<.c, currenl bomc:ownC:TI. The more: lltina.n, r.aUlalion. 'pply 10 new cOnatn.lC;lion, he said, Property own." who plan 10 buiJd new hOMel within I quar- ler-mile of the .horeliner will nQI be able 10 let . bu i1dinl pennit wilholJl firat providine proof Ihat warer from any new 'Well doesn'l show elevattd le~. cls or chloride. Iln indication of pOtenlial lUWal(f intrl.L$lon. Reacllon to discussion Manvwllone blllld Commu. nily Association lnaidcn, Garth M.H./tie said the nearly lhru. hour ....ion pnwided rood in. tonn.tion, 'houah h. laid he wished tach iuue could hayc: -been addresaed in ill own .... sion. ~tl,~, said she tell ,he didn', hear direct an. SWen from Bud.l' "Iardinr hi, JOlt COUno. -n..... .... . Ioc o( .onlndiction in the thinrs he 10''' ..yina," she .aid. OWnenti penona/lyobjeclcd to Bali:lay'. Qcv"lopmem pi..... and ahe fel, /hat IIWll' of \be ....u...c.: memo ben held \be ...... Opinion. "MOil' people .... preII)I in. ".nxd .bou, i'," ahe said. R.y Lowrie said he rqerved judamen' on Barcl.y'. pn>ject, '"The ,oil CO<Inc i. !here, and I do have lome Q)nce:rns about wliat i'will do 10 th.aquiter, bu, time will tdI, I ,01 . 101 o( aoed intonnatitin. but the jwy .. .till ouc.n ~ Chtryl BIIlncll< .aid ahe lcela conDic'ed .hau, the '011 courae: p<oj"", bee..... on the one hand, .he doean't wan, more lI'atlic; on the iJland, thou&l> Ihc believe< B....I.y" ....lunento do mote '0 "chara. <he aquircn than ir the .1and..V<I!!.<.la/I rallow'Jillli.; ;..~-;r;:.t:#1 ~ "My aut ....ction i. I don't wanl a commercial coif COurse on the iSland becluse il will brin, more traIlk. bu,llllso be. Ii..... he '. doina more '" t<ehart. the aquifer." she said, . On the public. W'I.<:r 'Y'''''' iss.... Brunene said she thouch' Psrker provided aood. direct an, swen CQ people's quertiOQl de~ spate lhc emotionally chuced subjecl matter. . '1b.i.s is a very emotionaJ is, sue btcaU.$e wlter is nece$sll)' tOf lir.:' .he said. "U you 're lUbJ . to controllin. your Own wa(c=r and Chen someone <<>me> Illona to take il over. mal IS a very lii&l>I.<:nina thina and i, can b< mlddening:" p.r: LLqrpEK 8" -It.f..-o 2- @) 'Open Space' proposals due The Jefferson County Conser- vat.ion Futures program is under way. Conservation Futures tax levy funds are a dedicated por- tion of property taxes in Jefferson County and are available, by stat- ute, only for acquisition of open space lands. Jefferson County is accepting applications until Aug. 30 for projects that involve the perma- nent protection of open space lands through acquisition of con- servation easements or outright acquisition. This year, about $155,000 is available. Applica- tion packets can be obtained by calling Jefferson County's Divi- sion of Natural Resources at 385- 9444. The Conservation Futures program uses a citizen advisory committee to assist in the review of projects and make annual rec- ommendations to the county commissioners for funding pri- ori ties. Committee Chairwoman Sa- rah Spaeth is excited to get the ?.T L.~,4i)G~ g-~ (If-o2-. program rolling. "I hope we re- ceive some high-quality projects so that the community can see the benefit of the program," she said. Because the program was de- layed in starting up, the timing is somewhat unusual this year. The citizen advisory committee must make a final recommenda- tion to the Jefferson County Board of Commissioners before Oct. I. Beginning next year, the funding recommendations will be made before July 1 and the application deadline and project review will be focused in the spnng. Natural Resources Manager Dave Christensen is also excited about the program. "There is such a need to have local fund- ing resources to access state and federal matching funds. I've heard about several great project ideas where the sponsors could not come up with the local matching funding required. I look forward to seeing those projects happen now." -.-.."'",..€ Alcohol is top drug; meth is gaining Putting meth in perspective :>tl T.,....",..,d 611<#"""" County l..d.. Adult Methamphetamine Use, 2001 250.00 200.00 150.00 100.00 50.00 h. ' 0.00 ii~UHmUjUWUJ JfftHIUI~f lUll ~ I~t a~ ~ g ~ ~ e~ ... ' ~ ~ ' Imong .dulls who MOl< aiorYlces from DSHS, .... rate per 100,000 peopI4J who IdenIlly meIh as IhM lIlnl8Iy drug ~ In.61n ~ County, sllOhllY higher ttwI the ..... ...... at 115... lhIa .... .. not -'Y jnCIH _ cNnga In progtJJm$ ""'" ailed how _ people ...1ruIed, ~ some people ~ multiple se<vk:es, K'COIOIng 10 DSHS. ' SolllCfl; WlI$hingtcn Depanmem of SopiaI and HeaJ/tl ~. .Drug Choice Trends 1996-2001 70.00 60.00 50.00 ..0..00 30.00 20.00 10.00 0.00 '" ., :> :> i 1 ! ! l! ~ ! .1 j .,996 .,917 .,. .,. 1112000 o 2001 . . ., i I :l ;! mong people ~ DSHS """lees, eIcohoI .. .... ~ _ choice, _ rWng, MlOIllI MIulIs. lIorlj..- .. !he nurilb<< """ dloIce. _it.lng, MlOng youths. IIeIh ... for both __ ~~ ~ 10 be 1lsIng, and ''''''''''llllduJta. .... di.t. IndIc.tes thIII rnelh,... ~ ....puMd ............ .. Souror: w~ D8paItment of S<<iaI and HeaIItr $clnIices By a.ncy Bum leader ~blf Write< How does methampl)etamine compare 1,0 alco- hol. marijuana, cocaine, heroin and otha substance ebuse problems, and jusl how serious is the meth silulltion in Jeffenon County? "Alcohol is the number one dlug problem (in Wuhing1011)." $ays D.vid Albert, senior planner and policy anaIy51 for the divisiOll of alcohol and subswlce abuse at Wuhin&ton.s Dewtmenl of Social and Health Service$ (DSHS)_ Albat., IIffjce compiles an annual report 011 drvg \I!C in Wuhing1\lll and provided the lAtuk, with the """'I _I data, which DSHS is aboullO publish, "All the other drugs combined do l1\li equal the COSI" IIf dealing with alcohol abuse. Albert main~ tains. Those CO$I5 include 10$1 productivity in the Wori;plllCe, health issues. vehicle ICcidcnl5, child abuse and lleJIecl. and domestic villlence in which alcohol is a faclor, he said. , The data that DSHS e<>Ilects tromthe peopIr; il !efVCS shows that meth is a rtIativdy $ll\a!1 part of the $Wewide panem IIf subsf.anj;e abuse. Nonethe~ less. IIIeIh presents very difficull problems, prima- rily ~ll the impact 01\ individual Ullen and their families. and meth \ab$. which are a growing hazanious waste issue. The data al", IIhow$ thai meth use is increasin8 in Wuhington. The DSHS data $ulllleslS that Jetferson County has a i-elatively small meth lab problem, bullhe consurnptiOll rale aniong adults is slightly above the Slale average. 1ba1 profile appears 10 be com- parable III lllher rural counties in W..hingIOll. --County pattems The I1lO$I recenl dala from DSHS. for 200 I, ~ows thai manufacluring IIf methamphelamine lends 10 be: ooncenualed in more urban counties. while run.! countie$ lend 10 have the highest rates of methamphetamine use. . "ThC lop 10 COllnties for manufacnuin&, bued 011 the number of reported meth labs. are Piau. King, Sp<>kane, ThUfSlOR, Benl\lll, Snoborni,h. Lewis, Clad. Kitsap and Grays Harbor, respec- lively. 1\vo-lhird$ of lhe meth labs reported in W..hington in 2001 were located in Piau, King, Spokaue and Thurston counties. Jefferson County ranked 20th of the 39 coun- ties for meth labs reported in 200 I. with six labs. ac<:ordin& 10 Departmenl of &oIogy (DOE) data included in the DSHS repun. The IOtaI number of known meth labs reponed .!!1_W~ ~ 1,<\49 in,2000 10 1,Ia6iD 2OO1..Thecounty Wlth \he bigelIl increue durin& dlat period "'.. SpckaDe, which went from 137 10 248 labs. As recently.. 1m, ihere were fewer than 100 IDeth-1abs reported in Washington, lICCOI1!in& 10 the DOE data. ' Consumption data The lOp 10 C\IUIIUCS for consumption or melh, bued on 2001 DSHS data, are Klickitat. Cowlitz, Clad, Yakinia, Pierce, Ma$\In, Lewi$, Cla1laIn, Pend OreiUuod Grays Hasbor. respectively. 'Tbi$ ranking is bued on the number of adullS seeking treatmenl from DSHS whll idclltify methampbel< amine u their primary drUg. ' Jefferson Counly ranked 15th or the 39 coun< ties for adults seeking treatment. At a rare of 122.6 adults per l00,OCXl population, JetrersQII Coualy', rate is bi&her than the statewide me of 95.. per 100,000. The dala' for youlhs seeking trulmenl ill Jetfersoa County, 3,8 per 100.000, is ,= than half the .~ .verage IIf 8.8 per 100.000. Alben con- cwred with the <>bservatlon tIw in countil'$ with relatively olderpopulatiom. il iuxpecwl that the youth ralelI for methamphetamine would be IlIwer for thai ~llSOIl. fuur counties rank in the I<lp 10 Slalewide for b<>lh manufa~luring and consumplion: Pierce. Lewis, Clark and Grays Harbllr. Orne cbolces Dala from DSflS .uUe$ts thaI adults and youlh. have differenl preference$ regarding dnlgs ,and alcohol, For adults. alcohol is the primary substance IIf choice bul sbowed steady declines hoot 1996 10 200 I. Adull ralelI for using marijuana and meth- ampbelamine have climbed during that period. with methamphetamine $W'pB$iin& marijuana .. the 11(.(:- on<! choice among adults in 200 I. For youlh.s in the DSHS database, marij_ appean 10 be the $ub$tance or choice, and thaI rate climbed steadily from 199610 2001. A1ooho1 is the ..econd chllice Bmllng youtM, and Ibal raIl' fell $IeadiIy during the wne period. Me\hampllewnine rates ft>r youths are rising bul are slill behind mari- juana rates_ Alben said thai until 1994, alcohol was the pre- feued substance among ywlh.s. He believes thai gruler .vail.bilily IIf marijuana, and ehanging parental anilUdes, may have contributed 10 mari- juana !lccomina the lop Sllb$lanc:e for YOlltM. The rate of \I!C by adults and ywlh.s for all <>!her $UM\lInCe$ as a group - including heroin and c0- caine - has nOI changed markedly in the DSHS data. Meth use rising - The $\atewide rate for adUlts seeking DSHS_- vices who cite meth .. their primary drug grew from 8 petcelil in' 1996 10 16 percenl in 200 I. For yOuths, the $latewide rate rose hoot 3 pen:enI in 1996 10 8 percenl in 200 I. The reported number or ~ County adull5 seddil&.Jreatmenl who use ineth inCreued from 21 in 1996 10 32 in 200 I. For- Jdfenoo CIIwIty yooths, the nopor1ed number was I in bIIIh 1996 and 2001. BCCIIrding 10 DSHS. nata limitations Alben cautiOll5 against making pRcise conclu- sions based on the data hU agency coIlCcts. RJuhct. il dIouId be used .. a barQnleIet of \IVeraII paI- ternS, be ..ys. Data on meth labs can v~ bued on the ~ availa\lfe 10 local law eaforc:emenl and fireIbuardous materials agencies. Some are beaet-equipped 10 find and clean up labs, Albert believeS. ' The data on adull and ywlb drug pauerns is bued only on people who seek. =vice from DSHS. not fiom private _11IpIion$. Alben points oul. and thus \be panem of \be overall popWalioo could be .di,fferent. The fwldin& and matkcting of substanc::e abuse pr<>granl$ can affect the number of people :served, ..y$ Alben. r9 1., 0 I.. UArlR. n ,.ne Wednesday August 14, 2002 Vol. 113 No. 33 Meth often behind the crimes of Jefferson County Kicker: Not used by many I but it controls those who do By Janet Huck Leader Staff Writer A suspect told Jefferson County Sheriff Detective Dave Miller he had abused alcohol and shot heroin and cocaine. But in each case he felt he had control of the drugs. When it came to methamphetamine, his attitude changed. "Meth has taken ahold of me," he confessed to Miller. Methamphetamine's grip is taking hold throughout the country, especially in rural areas with scarce jobs, such as this one. Although alcohol and marijuana cause far more pervasive problems in Jefferson County, the use and abuse of meth are becoming prevalent. People on welfare use it. Wealthy people use it. Women use it in almost equal numbers to men. Not many adolescents have tried it - yet. No matter what their background, users are lured by the raw euphoric rush that can last for 12 to 24 hours. It's cheap - about $20 for a pinch of powder about the size of an aspirin. It's easy to buy because it's manufactured right here in Jefferson and many nearby Washington state counties. The manufacturing process, said Roger Lake, president of the Washington State Narcotics Officer Association, takes less time than does a batch of chocolate chip cookies. "My personal feeling is that we do have a methamphetamine prOblem [here]," said Richard Gunderson, the substance abuse coordinator for Jefferson County Department of Health and Human Services. "It's a damning and damaging drug. It has some awful consequences." Habit turns ugly Although users initially can hold down jobs, go to school and manage their social life, the habit can turn ugly over time. Parents neglect their children. Long-term heavy users can become paranoid and violent. Of the five violent deaths in Jefferson County in the last 10 years, two involved methamphetamine. Nonetheless. the measurable numbers of users in Jefferson County are still small. The reported number of Jefferson County adults seeking publicly funded treatment for meth increased from 21 in 1996 to 32 in 2001, C0J according to Washington Department of Social and Health Services (DSHS). However, the rate of county residents seeking DSHS services in 2001 was 122.6 adults per 100,000 population, slightly higher than the statewide rate of 95.4 per 100,000. Local law enforcement officers feel meth might be a bigger problem than the numbers indicate. Miller, who is in charge of drug cases for the sheriff's office, said there were 33 arrests for meth possession and 16 arrests for manufacturing and selling since July 15, 2000. "' was surprised how low the statistics were," said Miller. "' asked in the jail, and at least half of the inmates said they were doing meth. They weren't arrested for meth, but they Were doing it." Statewide meth problem Jefferson County Prosecuting Attorney Juelanne Dalzell's office won convictions on 44 meth cases from 1999 to 2002, including both the sheriff's cases and the Port Townsend Police Department's cases. Suspects charged with manufacturing and sales often plead guilty to possession charges instead of going to trial on more serious charges. Consequently, there were only five sales and manufacturing convictions. In comparison, the prosecutors won convictions on eight marijuana cases from 1999 to 2002. There were no convictions for other drugs. Washington state as a whole has a meth problem. David Albert, senior planner and policy analyst with the Washington Department of Social and Health Service, declared in a 2001 report on drug abuse trends that Washington state is experiencing a methamphetamine epidemic. In more recent statistics COllected by Albert, the number of meth labs rose from 38 in 1990 to 1,886 in 2001. A U.S. Drug Enforcement Agency report said Washington state had the second highest number of meth labs seized in the nation in 2000. Pierce County has more meth labs than any other county in the country except for one in central California. Two-thirds of the meth labs reported in Washington in 2001 were located in Pierce, King, Spokane and Thurston counties, according to the DSHS report. Jefferson County ranked 20th of the 39 counties for number of meth labs reported in 2001. That year, only six labs were busted . Jefferson County users usually buy from dealers who import their drugs, said Miller. HEven though the numbers are still small [in Jefferson County], meth creates big problems," said Dalzell. Hit is devastating to the user, the user's family and friends, and the user's community.'H It's also a highly addictive drug, said Ford Kessler, administrator and owner of Safe Harbor Recovery Center, that grabs ahold of the person quickly. A prominent Port Hadlock resident told an audience at a March forum on meth that his daughter's personality changed completely when she was midway through her 15th year. She had been a straight-A student involved in sports and other social activities. Within few months, Hshe totally went off the chart. We couldn't even communicate with her," he said. After two years of intensive inpatient treatment, he said his daughter is headed in a good direction. @ All-consuming high Some people can't ever seem to get straight. One woman on meth continued breastfeeding her infant child even though she had been counseled about the dangers and warned she would lose the baby if she didn't stay clean. "We discovered she wasn't using her own urine for the urinalysis," said Robin Biffle, a sergeant with the Port Townsend Police Department. "The mother was counseled, and she aCknowledged the dangers to her child, but she still continued to use at great physical cost to the child." When the addicted child was placed in a local foster home with a specially trained registered nurse, he went through withdrawal. The all-consuming high can supersede food and hygiene. Meth eats the enamel off teeth. Open sores erupt on faces and bodies after heavy use. Though users lose weight, they often lose so many pounds they end up looking like a concentration camp victim. Although meth suppresses appetite and increases physical activity, it can also cause irritability, confusion, tremors, anxiety, paranoia and aggressiveness, according to the National Institute on Drug Abuse. The same report said that users can experience occasional episodes of sudden and violent behavior and intense paranoia. Violent response That explains, in part, some of Jefferson County's most violent crimes in recent years. Quilcene resident Robert H. Froehlich, 30, confessed he had been high on meth for five days without sleep when he stabbed 15-year-old Allison Tornensis 23 times on July 29, 1992. Kevin Bledsoe, 23, after charging a low stone wall in the parking lot of the Port Hadlock QFC and crunching his head, was placed in a "crisis cell" at the Jefferson County Jail, where he died on March 24, 2001. The death certificate said he died from a methamphetamine overdose coupled with a serious pre-existing heart condition, aggravated by the physical restraints needed to use to control the thrashing, spitting, biting and kicking man. According to Ann Marie Gordon, manager at the state toxicology lab, Bledsoe's methamphetamine level was 0.89 milligrams per liter (mg/L), close to the 0.96 mg/L found in 13 deaths attributed to overdoses of the drug statewide. If the addicts hit bottom before they die or kill someone, there is effective treatment available. "Initially, we didn't think traditional treatment could work," said Bill NeSmith, coordinator of the Port Townsend branch of Washington State Children and Family Services. "Now there's hope." Adult meth addicts complete treatment in about the same proportion as other kinds of users. Sixty-five percent of meth addicts complete publicly funded treatment in Washington state; 63 percent of marijuana users complete; 67 percent of cocaine users and 77 percent of alcoholics, according to charts prepared for DSHS' Division of Alcohol and Substance Abuse (DASA). "Treatment works," said John Taylor, administrator of DASA's Region 6, which includes Jefferson County. "If we don't do treatment, welfare use, drug use and crime could go up." (i) Editorial Substance. abuse marks county's darkest alley -1.- What's the cost of drug and alcohol abuse in Jefferson County? It's the insanity of a young mother trying to scratch off her freckles because she believes they are bugs. It's the helpless weave of a drunk driver on a dark county road. It's the allure of a hit of methamphetamine for a teenager whose home life is a mess and who looks at the world through a lens of hopelessness. It's more. It's the theft of tools from someone's garage or of a VCR from someone's house, to pay for a habit. It's the rage of a drunk man who takes his frustration out on his girlfriend. . Amidst all the natural and con'struGted beauty of this comer of the Olympic Peninsula, the substance abuse problem is our county's dark alley, strewn with broken glass, busted furniture and breaking bodies. The cost is staggering, in both human and economic terms. Local law enforcement officials estimate that almost 60 percent of the inmates in the Jefferson County jail in recent years are there because of drug sales or substance abuse. Crimes which bear little resemblance to a drug crime - property theft; domestic violence, abuse of children - can be manifestations of an addiction. Each one of those inmates sitting in our hopelessly overcrowded county jail, the Hadlock Hilton, costs taxpayers $50,000 a year. While the jail will stay the same, county officials are poised to spend $2.8 million more to build new administrative offices for county law enforcement so it can keep pace with its duties. Those duties, any cop will tell you, are. dominated by, substance abuse crimes or their various cousins and in-laws. . The modem plague of methamphetamine is the primary subject of a threewpart series starting in this week's Leader. Reporters Janet Huck, Helen Hollister, Philip Watnessand Barney Burke have fanned out across the county to talk to addicts. to the men and women who arrest and prosecute them, to the men and women who try to treat them back to health, to describe the problem. But at each step along the way, the reporters kept hearing the same refrain. Meth is only the daggeNharp tip of the iceberg. Alcohol abuse, and the abuse of other drugs such as marijuana, are practically pervasive among teenagers in this county, and reflect the true depth of the challenge we face. Don't believe it? Ask anyone of high s~hool age. They know. While they may not participate, it is the social world in which they live. This is nothmg unique for Jefferson County. As in many rural counties with poor prospects for decent employment, wiping away a difficult reality with drugs or alcohol appears to be the easiest way out. It isn't. We all pay. The abusers pay with their livelihoods; some- times their lives. The rest of us pay a handful of dollars every day. For the next three weeks, take a walk down this unfortunate alley with us. It is,'.'.l!t~! ~]J,.ri.ght behind your house. - Scott Wilson 'PT. LEA-O~ R- &-1<1-02 . B ~ .. }~DJ~"> , .. .. .~. .~ ..e,..... . .......'......'.}...'.. ......'.~..1l. ....1.,.,. .,,:i..,."'. i.. . i...'..~..i..... .....~~~....... .:.1. ....'........1................ " .....1..,.......'......'.'.....'...,..;'... ,i:~ . ..' ' ;g'~0: , ........ "".' .... a ..' 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"t:lo..... cv ..,..c.. u tj..c:: '" .., .~ <> :a ~ >"fa E > <II 0:2 '" <> '" e -5 .bI) tl ti ..r;: ~<:.a~ti~ - "'ll;so ~ .:!l ~ o'v @ South county has 'free dumping' project South county residents can mark their calendars for the an- nual Household Hazardous Waste Roundup, 10 a.m.-2 p.m. Saturday, Aug. 24 at the Quilcene drop-box site on Highway 101. The free event - sponsored by the Jefferson County De- partment of Public Works and the Washington State Depart- ment of Ecology - provides a once-a-year opportunity to clean out aUj>csticides, car and house repair products, auto and marine batteries, oil-based paints and Btains, and unwanted household toxics of aU sorts, says Molly Pearson of ~c Wefk&. :JZ!. H W S The event is open to residents ,/ .,- 8 - rIJ-/-O ;}- rptT. LGk{Je~ only, not to businesses, clarifies Pearson. For more information or a complete list.of acceptable materials, call, Public Works at 385-9160. After taking advantage of this free event, residents are ree minded to drop off future Un- wanted hazardous waste at Jefferson County's Household Hazardous Waste Facility, 10. cated inside the Port of Port Townsend, just across from McDonald's. It is open every Fri- day and Saturday for Jefferson and Clallam County residents; phone 379-6911. "Check out the ReUse shelf while you're there - it may have what you neect for a project," sug- gests Pearson. 0V Residue and risk: Meth destroys property; homes By Helen Hollister Leader Staff Writer While methamphetamine abuse can wreak havoc on the mind and body of an addict, its manufacture can also have a pro- found impact on the environ- ment. Ingredients from methamphetamine laboratories are highly toxic, caustic and flanunable. Houses or vehicles that be. come meth labs must often be destroyed. "It's a huge issue," said Carolyn Comeau, a public health adviser for the Washington State Department of Health. "It's wide:;prQlidtbroughouuhe coun- .;. try," - .,- Coraeau said meth producers dump waste materials from their labomtories along roadsides, into septic systems or in nearby streams, The byproducts left over from a meth lab are substantial. For every pound of meth, a lab produces five to 10 pounds of waste. Along with the chemical hazards associated with meth production, Comeau mentioned biohazards such as used needles, blood, feces and the diseases that are associated with those items, as other harmful environmental factors. When a meth lab is busted by authorities, a Washington State Patrol Incident Response Team reports to the scene dressed head- to-toe in protective suits. The team is called in to process the crime scene and collect the meth lab materials before the cleanup crew from the Department of Ecology arrives. Later, the owners of the prop- ~-2../-o 2- This Chevy Blazer was stolen In Port Townsend In 1999 and turned Into a mobile meth lab. By order of the Jefferson County Health Department, It wa, destroyed due to chemical contamination. Photo by Scott Wilson erty are required to hire a certi- fied contractor to come in and clean, removing any furniture or clothing made of porous mate- rial. It can cost up to $30,000 to clean up after a meth lab. Some- times walls are painted over to seal in the vapor, or the walls are ripped out completely, along With the carpets,. The contaminated materials are transported to, a solid waste facility, usually lo- cated in another county. . Not all meth labs are located within a house. They can pop up. anywhere. Some people run meth labs out of the trunk of their car. Larry Fay, environmental health director for Jefferson County Health and Human Ser-' vices, said vehicles used to house meth production often have to be destroyed due to the amount of contamination. He recalled once incident in Jefferson County in the early 1990s involving a van that had been a mobile lab for meth production. He said the sheriff's office impounded it and the van was destroyed after the investigation was completed. A stolen Chevy Blazer used to transport meth materials was deemed not fit for use after con- tamination frommeth ingredi- ents. The Blazer was sent to a wrecking yard and crushed for salvage, Fay said. Physical reactions from expo- sure to the vapors and residue may include headaches, nausea, . burns, eye irritation and upper respiratory infections. Some of the substances involved in meth production include hydrochloric acid, iodine, sodium hydroxide, pseudoephedrine, toluene (paint thinner), anhydrous ammonia, lithium, ether (starting fluid) and red phosphorous. ''They dump their stuff into their backyard or they try to burn it," Comeau said. "We're talking about possibly carcinogenic chemicals. If you have your child out there playing around, there's a lot of hand. to-mouth activity, or if you grow a garden, that soil is contaminated and you're put- ting yourself at risk." '"'\- 09 News Release For Immediate Release: August 27, 2002 (02-142) Contacts: Arme Duffy, Office of Environmental Health and Safety Deanna Whitman, Communications Office 360-236-3372 360-236-4022 Washington prepares for West Nile virus with Web site OL YMPIA - The Washington State Department of Health is on alert for the West Nile virus (WNV), which is spread by mosquitoes and is responsible for serious illness in humans, birds, and horses. WNV is expected to reach the state as soon as this year. In preparation, the agency has launched a Web site featuring a variety of resources and information to educate and prepare Washingtonians for the arrival of the virus. The Web site provides answers to common questions about WNV and what's being done in Washington state to protect the public. Tips for protecting your family are also available, including simple steps to reduce the number of mosquitoes around your home and how to avoid mosquito bites. The site also suggests ways for physicians, veterinarians, local health departments, and mosquito control districts to participate in preparing for the virus. It includes information regarding reporting suspected WNV cases, mosquito trapping, dead bird reporting fonns, and other education. Mosquitoes carrying WNV can transmit the disease to people, horses, and birds. The virus is not transmitted person-to-person or from animals to people. On rare occasions, WNV can cause encephalitis (inflammation ofthe brain) or meningitis (inflammation of the spinal cord and lining of the brain). More information is available on the Department of Health West Nile virus Web page (www.doh.wa.gov/ehp/ts/Zod'WNV!WNV:html). ### Visit the Washington Department of Health Web site at hrto:llwww.doh.wa.~ov fOf a healthy dose of in formation. ,....... Port Townsend << Jefferson County Leader More women are using faniily planning. in county .1 The numbers of women using the Jefferson County Health Departmenf,s family planning clinics are cllinbing steadily. In the first haliof 2002, the clinics served"a total of 738 c1i~ , ents, or 71 percent of the number served in 2001. Hea1thDepart- ment officials. project a total of 1,150 clients in ,2002, Or 111 percent of the 2001 total. These increases happened dew . spite some budgetary setbacks for the program. In January, the Port Hadlock clinic was closed and one family planning position was eliminated, but Jean Baldwin, ~oJ!Ullunity health directOr;. was able to find enough hours from on~ call and part-:time nurses to CODl- " pensate for the cut hours. She also ' increased-the hours ,in the Port To~.c1inic. "We can't do it any Jonger, CPT L~ADt~ f,. u-O 2- that offers free consultation to young women without notifying their parents is credited with the dramatic upsurge in use. . Though ,family planning doesn't collect statistics about pregnancies among its clients, the Sheila Westennan number of births for females ages chairman 15,.10 17 decreased significantly JeffersOn CountY Board of Health: since the early 1~. From 1991 to 1993, births per thousand peaked at 36:5, but the rate fell to 22.2 per thousand from 1998 to 2000. "nus is the population where less pregnancies means less money they would need for other serVices," said Sheila Westerman, chainnan of the JeffersonCounty BoardofHea1th. "It's an effective preventive service. When we are looking for cuts in the future, , maybe we shouldn't cut the [pre- ventive] areas, where we get more ~ang for the buck." :'It's an effective preyentive' service :' though," warned Baldwin. The p!ograIn has targeted teens and womenjntheir early 20s who ~ at risk for unintended pregnan- cies.In 1997, family planning ~erved 207 teens ages 19 and younger, but it served 300.teens in 2001, a 45 percent increase over four years. The inCrease from 1m to 2001 was 32 percent for clien~ ages 20 to 24. ~~new Take Charge program @ -" (8 Some sexually transmitted diseases increase locally In a 200 1 report compiled by the Jefferson County Department of Health, the ,tot8l number of Jefferson County residents who reported sexually transmitted diseases (STDs) stayed exactly the same as the previous year. In both 2001 and 2000, there were 33 cases reported to Jefferson County Health and Human Services. The number of people in. fected by chlamydia, the most commonly reported STD in Washington, decreas~d by, ,about one~third, but the inci~ dence of herpes increased from . zero cases in 2000 to nine cases in 200L There was one case of gonorrhea in 2001; in 2000 there were none.. - Chlamydia reporting in ,,>'..:J,e{fe~so,l\ J~9~!1..tY:Wli,i&en sharply'in the last five years. In 1997 there Were only, 16 cases in Jefferson County, but in 1999 there were 35 and in 2000. 32; The rapid incr~ases are probably due to' more cori1~ rp ~ r. LGt{) E12- ? ,-z.f - () 2- prehensive screening at the we don't know how well we are' health department, said Tom ,tracking down partners." Locke. Jefferson County's pub~" STDs are prevalent incer. " lic health physician. This year tain age groups, said Locke. the number decreased to 23, About 25 percent of young well below the rate for Wash. adults ages 18 to 24 will ex.pe- ington state. rience STDs. "That's one in Untreated chlamydia can four over a period of six years," cause pelvic inflammatory dis- stressed Locke. ease among women and lead to Most STDs are entirely cur- infertility or ectopic pregnancy. able. "We could have eradi- "Are we doing a good job of cated it because we have had stopping the spread?" asked medications for 50 years, but Locke rhetorically. "Our because of social taboos, many screening for STDs is univer- people are unwilling to address sal for everyone who comes in it as a public policy," said ." [to theHealth Department], but Locke. Saltwater intrusion meeting c1ears\the.ai County, DOE, aquifer protection advocates talk problems~ solutions pumpini inORleno minimize ,all- .~o{JdI'.:nonCw.lly. waler intrusion inlo aquif.rs. he ",qol:i'.1Wris aI.o bad I<lQl/: said. : ~~,' ~t rain~ c:oI- Charli. Sherk of Cllarli.'s) Icction; suue:stinllbiz lbe prae- DriUina sIwed in$iplS from his: lice b prohibited ill Wubinitoot. 30 )'eJrs of eJl.perience. He esti- . HoWever; he ~ dIIIIlbe issue malCd lhal 00 Mmows1one bland. I ... ..m:r been enton;ed, acIdiIl& \he oquiferbof1enonly3or4f..., Ihatlbe aaency'; eaSdoad is deep. RI4kina il difticulllO in$laII i such dW it takes 20 yea to FI \he well and ........... il -"'I. a decision; - . . -..-- ...........' SpeakiDj IpIdlic:aDy aboIa!he . Ry~ ~ o{~ En- ~ olManowslooe RSi- ~ did some qUICk calcu- - deni Wally B.day, Hanis said lalions 10 show how rainw'ler dlMhiSllWliclllioludllelhoallOlf ~ ')'SleIrIS are eJl.pensi't1: ooun.ahouIdhedecicledioabout and lIrI1ikdy to - I'JpicaI pc;>- ei,)ll 10 12 mODths because tabIc WaIeI" needs be>caIlse 0{ \he s.day.. aped 10 pay!beCOll r.laliv.ly low rainfall On o{bavincDOE's~pio- Man-owslon. lsllUld and some cealtoobdWfolDOlhta4. Pan r""'O"n<l li< 1""0<100 Coun Lo.der By Barney Burk, Lu,det Stall writer The .onsen.u. of tho.e al. lending an AUi. 29 workshop on ,allwlI.r intrusion .ould prob- ably b. summ.d up in IwO words: Ah hah! Th. work. hop broughl 10 Iighl some differences belw..n how Jefferson Counly IUId the Washinglon D.parlm.nl of &0/0,'1 COOE) approad, the .hall"",. of drillin& wel" where llM:re mipl be a HllWaler inlnl- SiOn problem. Thll discovery .ould lead 10 chanaes in .ounty reaulaliollS. Slaaed II Washinglon SlIle Univ.rsity offices in PorI HadiClCk, Ihc worbhop Was part of a continuing effort 10 resolv. a di.pule belwun Jefferson County and IwO ~ti:eN 'II'OUJl5, Olympic Environmenlal Council IUId Shine Community AClion Council. The IWO &TOUps tiled an appeal with the Weslern Wash- in, Ion Orowlh Mana,emenl Hearin,. Board in December 2000, uscnin, dIIII\he county's developmenl re",lations do nol adequalely prol..1 unde"round aqUifers" I. Aquifer protection Afrer \he hcarin,1 board nded a&ain81 Ihe counly in January 2002. the Counry adopled.new r~aulllions On July 23 10 com- ply with thai order. The board of commi..iollCfI mad~ lIIe n~w rules .ff..liv. Sepl. 23 in order Lo allow lime Iq,~onfer with Ihc counry plannin, .0mmiSSion, m.mben of whi.h allCl\dcd lasl w..k'l mcclin& alon& with \he commissioncn and the citizens' lI'Oups. Under the neW COllllly rules, propcny owner. mllSl oblain a .ariance from DOE if they plan 10 drill . weU within 1.000 feel of an c.li.tina well showin, chlo- rid. .oncemralion., abo.~. .200 maIL (250 m&f1,. is the U.S. En- .uonrncnlal Prorccrion A&cocy'. limit on Hlinity in pallble Wa- ICI"). In addition 10 sueh "hiah rislr: sallw'ler inlrusion proleclion lOne.:' th. n.w rules have pro- cedure. for areas near w~Us OVer 100 milL and for any wells within tOO f..1 of &Shoreline. The counry doc. nOI i..u. penniu for WeUs. Communily D.v~lopmem Director AI Scalf said. bul propeny owners musl demon8lrar~ Ih.1 rhey have . polabl~ wal.r supply, before . buildin, permil can be issued for . new dw.Uina. Misundersumdlng "II sounds liIr.. w~ need 10 ao back and ..view whal we're pul- lins in pl.c.... said Commis- .ioner Oten Huminford al Ih. mcelin&. The lUmina point of !he WOfblrOP carne when J. Mike Hams ot DOE indi..lCd thae hi. aacocy woIIId IlOl bC ,i.inIIUlY variances within ~I.OOO-foot ~II& or. "hi&h rislr:" well. DOE would con.ider well. belween 1.000 and 1.100 f.... Hani..aid. based on how the county ordi- nance """ WIlli.... County commissione.. and staff members poinlcd Oul thai th~ i111...1 of the counlY ordi- nance wu nOl 10 prohibit the eonsideration of n~w well. within 1,000 feci ot I well Wilh . hip RIdin&. only 10 h.~ them reviewed by DOE in an effOrllO avoid makin, the sahwlllCJ inllU- sion JIl'Obl~m wa.... Thecounly policy "presenu - confu.ion for us," Hanis r.- sponded, addin&. ''There prob- .bly will be more me.lin,s" belw..n the IWo ",ene;... Pub- lic Utility Dislrict i Commis- sioner Di.k Shipman. whose .,eney has .,reed 10 help the couney monitor saltwater inlnl- .ion. said. "I can '" dIIII\he Sllle Waler laws need refonnin&." Afle, the mUlin" Counly Commissioner OIUl Tiltcrne.. confirmed tharthere wu a mis- undenrandin, On the inlCrprel'- lion of Ih. ordinance .nd eJl.pressed hope lhal all parties, includin& Ihc ciliuns' UOuJl5, found the m..lin, us~ful. Colenc Koalelec,lhc civil CII- Iinccr ..Pf&&OIIIina Ihc citiZCll&' &roup.. said lire mulln, wu "rcally enll&hlellin," for lire counly. However'- she mainlaillS lhal.lherun;;.lIII.lllbci oJ. i..ue,s dIIII have 10 be worqd OUI be- IWCCI\ her cllCllu and the COIInly. In a briclfiJed Au,. 2& willi the Jrearin&. board, Koaldec as. serts the county was ordered 10 be in compliance by Au,. 7 bul the n.w rules won 'I take effecl until Sep/. 23. any funb.r ...i- sions IIOrwithstandini. Her bri.f . also araue,s tharlhc counry's ac' tions do not JO far CIlOIIp 10 pro. ICCl aquitcn and Ihat !he adopled actions should be incorporated inlO the counly'S comprehcnsi~ plan. nor be jUSl an 0RIinance. No dale has been set yet for \he h...in&s bo.rd to clelermine whether \he COIlIlty'S actions ha~ salisfKtorily implemented the board's previous order. she said YCSlerday. the county commis. sioners decided they wouIc1 c1is- CIISS \he maaer all 0 Lm Tuesday, Sopr. 10. Expert opbslons County oGiciaIs and nearly two dozen members of Ihc PUblic turned oul for the workshop. which included 'Iariou& eJl.pcns 00 HlIWaIer inlnIsion. OQui Kelly. h)'dro&eoloai&l for Island COUl\ly, highlipled how his aacncy monilOR \he issuc u.- in& a sophisticaIcd database. Us. inl wen W'I.r cI.l. conected voluntarily by hlllldreds of pr0p- erty owners. KeUy said il is plI- sible 10 moniror whether inlIUsion b a problem in. specific uu. and whether il is JCIIin& wax. He said the a>N of fire ptOff1lUTI is aboul SI20.000 lII\IIIIaJlY..and annlS to- IaIin& S250,OOO.... pI'JinI for ad- dlticnal SIUdieI. ._ Mike Brewer ot Grundfus Pumpa doInoNtrlIled _1OChooI- "BY whcnby a weU pump Call de- Iel;t riain& Hlinily. Such pIIIIIfI& Call be proarammcd to ~ the now. sound an .Iano or SlOp What can hormone replacement therapy' do? There has been a lot of discussion lately about hormone replacement therapy (HRT) and its possible negative side effects. What about rhis. and are rhere any oprions? The large federal government study on hormone therapy released in July 2002 basically came to the conclusion that Prempro - one of the many fonnulations for honnone thera'py - has risks that out- weigh the benefits. The study was halted because the risk of breast cancer and car- diovascular rrouble were increased. Each woman is unique. She must con- sider her health history and also the medi- cal problems of her relatives. She must examine her symptoms, risk factors fordisease, and quality of life issues. She must also'evaluate her lifestyle, including her diet and amount of exercise she gets. She and her healthcare provider must then together decide the risks and benefits of honnone therapy. It is important to realize that this examina- tion and evaluation process should be done on a yearly basis, as some of these factors can change. The lifestyle factors should not be dismissed easily. It makes no sense to select HRT if a woman chooses not to exercise, is greatly overweight, ignores her diet, and smokes. There is an alternative to synthetic hormones for therapy. They are called bio--identical hormones, and they work differently from synthetics in our bodies. They are strUcturally identical to hor- mones that are naturally produced by the human body. They have effectively controlled the symptoms of menopause, but future studies are needed here too. By working with a healthcare pro- vider and a phannacy, the exact and appropriate dose for each individual can be supplied, and adjusted if necessary. Pharmacy compounding is a way of preparing these hor- mones that are unique, and it uses delivery systems that are not generally available from pharmaceutical companies - for example, lozenges. topical creams, under-the-tongue drops and custom-blended capsules. Don's Phannacy is currently the only pharmacy in the county offering this service. National mail- order pharmacies are also available. If osteoporosis is a woman's main concern, there are new medications that are more specific, with fewer side effects than HRT. for those who are at risk of breast cancer. Because of this latest study. there will undoubtedly be many more studies in the coming months. Reevaluate with your healthcare provider and pharmacist your individual needs, risks and alternatives. Dear Dana By Dana Michelsen . ....,. Mammograms available Dear Dana, Thank you for your column on mammograms. Please let your readers know that for women who do not have insur- ance that COVeT1i marrunograms, or if they cari't 8.fford' me 'del ductible. and they are 'iow~in', come women between the ages of 40 and 64, the Breast and Cervical Health Program (BCHP) can provide them with a free or low-cost mammogram and women's health exam. For more information they can con- tact the Jefferson County Health Dej:lanmenl ri.i385~9400: 1, Thank'yciu fur paS~ing this on, Mlllgie Boyd, RN @ ~ LEA-tE!2. 9 - t./: --O?- Port Townsend & Jefferson County Leader @ Health Departmentii1viteS public to talk'respoI1se' On Sept. 11, 2001" America received a disturbing wake-up call on the threat posed by inter- national terrorists. Shortly after- ward, a biological attack in the form of mailed envelopes. of highly concentrated anthrax spores hit the East Coast. "Over the past year, intensive efforts at a federal, state and 10- callevel to improve public health preparedness and bioterrorism response capability have been under way," reports Dr, Tom Locke of the Jefferson County Department of Health, On Thursday, Sept. 19, a progress report will be made to the Jefferson County Board of Health on what has been accom- , plished in the last year and the ' substantial <;hallerigesthat lie ahead, The board is slated to hear a report on bioterrorism pre- paredness efforts at a local, re-, gional and state level. The public is invited to attend the'meeting, set for 2:30 p.m. at the Jefferson Health and Human Services conference room iri the Castle Hill center, Topics to be covered include: suspicious mail evaluation and re- sponse protocols; regionalization .,. 9.... ((-0 ?- of emergency management and bioterrorisni response cllpabilities; communic;ati9n system ~deve.lop-' ment;' training exercisesf9rs,taff _ and community;-'coordination with state lind' federal, agencies; Washington state bioterrorism preparedness plan - workplans , and timelines; challenges 'for counties - increasing service de- mands/declining revenues; chaI- -lenges for hospitllls -lack 'of' surge capacity; challenges for pub1ic health departments -un- stable funding sources yet con- tinual emerging'diseases and prevention needs.