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Home My WebLink About10 October JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 17, 2002 Board Members.' Dan Titterness, Member - County Commissioner Distrid # 1 Glen Huntingford, Member - County Commissiomr District #2 RÙ'hard U7 qjt, Member - County Commissiomr Distnd #3 Ge~y Masâ, Vice Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commissiomr DistrÙ1 #2 Sheila U7esterman, Chairman - Citizen at LArge (City) Roberta l<nssell, Member - Citizen at LArge (CounM Star/Members: Jean Baldwin, Nursing Seroices Director Larry FC!)', Environmental Health Director Thomas Locke, MD, Health Officer Vice Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exceptions of Chairman Westerman and Commissioner Titterness. There was a quorum. APPROVAL OF AGENDA Member Buhler moved to approve the agenda as presented. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. APPROV AL OF MINUTES Commissioner Huntingford moved to approve the minutes of September 19,2002. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Status of Meetine Minutes for Aueust 15. 2002: Staff distributed a legal opinion from Deputy Prosecutor David Alvarez in response to the Board's question as to whether an official meeting could be held absent a quorum. Because the August meeting was conducted without a quorum, the "discussion notes" of that gathering would stand as such. To the question whether the Board could begin a meeting awaiting a quorum to be formed, such a meeting would not be official until a quorum is established. When a quorum is lost, the meeting can continue until such a time as a member calls for a count of the quorum, at which time if a quorum is found to be absent the meeting should end. Dr. Tom Locke said generally, meetings of Boards can continue after a quorum is lost, but they take no further action. HEALTH BOARD MINUTES - October 17, 2002 Page: 2 NEW BUSINESS Local Health Jurisdiction Reoru:anization - JHHS Bud~et History and Forecasts: At the request of Vice Chairman Masci, Jean Baldwin and Dr. Locke briefed the Board on Staffs research into health districts. They noted that the agenda packet included cites from the Revised Code of Washington (RCW) and the Washington Administrative Code (WAC) that distinguish between a health district and health board. Dr. Locke talked about the independent legal authority of the Health Board, which is uniquely different from the tract of other departments who receive their authority by the Board of County Commissioners. While a Health District would remain the fiscal responsibility ofthe County, its liability would be reduced - 47 employees go away, leaving the Health District and the County both with smaller, easier-to-manage governments. Ms. Baldwin talked about the challenges of being tied to County budgeting. A win-win situation for the County would be for a district to receive a finite amount from the County, City, hospital, etc., from which the Department can do the work. With many rural counties in financial crisis an ongoing, stable funding source is needed. Three funding plans are currently before the legislature. Vice Chairman Masci, reasoning that management of the Health District would then become the purview of the Board, asked if the voting requirement of needing at least two County Commissioners would still hold true? Larry Fay noted that under RCW 70.46 the resolution or ordinance establishing the district would create the membership and voting. Referring to the listed RCWs, Commissioner Huntingford said he does not see what the County would gain from a district except for the release of liability. What types of checks and balances are there other than possibly the Health District saying that they need more money? How are we going to negotiate and what are the state guidelines? Dr. Locke noted that, due to lack of use, those guidelines were eliminated 3-4 years ago as part of regulatory reform aimed at cleaning up the WAC. The reason for repeal was that, in reality, the way that it works is through negotiations between the Health District and the County. Commissioner Huntingford noted there would still need to be a source of funding. Jean Baldwin said that with many additional cuts expected, a district would give the Department the flexibility in delivering health services as well as flexibility to make adjustments such as lending staff to Clallam County. Because the Health Department is unique within the County, it would also be easier for some who interact with the Health Department - such as the Auditor, the Treasurer, etc.- if the Department were an outside contractor. Member Frissell asked what a change such as this would mean to the people who use the services? Jean Baldwin said it shouldn't impact services to clients of Environmental Health or nursing, as it is a governance and budgeting issue. Substance abuse would be different in that the Department would have to contract with the County Commissioners. Vice Chairman Masci asked about the concept of accountability. In a district scenario, a service package would be presented to the County Commissioners? The district does not have any barriers to contracting for additional services, such as with the City, which could be individually negotiated. Who ultimately would be in charge, the Board of Health or the County Commissioners? Jean Baldwin noted the Board of Health would be in charge of the District. Larry Fay noted that the accountability to deliver public HEALTH BOARD MINUTES - October 17, 2002 Page: 3 health service would rest directly with the Board of Health and, ultimately, with the County Commissioners because they are the ones with responsibility for ensuring public health delivery systems are in place. As far as the District negotiating a contract with the City for services peculiar to the City, this is something to be investigated. Dr. Locke noted that the lnterlocal Agreement Act permits the City to contract for specific public health services with the County or any other Country or Tribe. Member Buhler asked how the Hospital District enters into the picture? Dr. Locke noted that the County's legislative authority - the County Commissioners - sets up Health Districts and defines membership of the Board. So the Commissioners would playa dual role in a district; they could be the entire Health District board or part of a larger body (e.g., the current seven member board). In any case, the budget would be developed within the department, approved by the Board of Health and thus pre- approved already, or at least pre~discussed substantially by three Health Board Members it would then go to the County Commissioners for formal adoption. Jean Baldwin said that Health Districts are not unusual in small counties. One of the other confounders that make us look different from other county departments is that while 20% of the Department's budget is the County general fund, the majority of funding comes from State and federal government and from fees. The goal of getting the Department ongoing funding is to decrease the dependence on local funding and to let the County concentrate on law and justice issues. Vice Chairman Masci noted that if there were a move to a district, the County Commissioners would have to acquiesce to it. He suggested Staff prepare a chart of the advantages and disadvantages to clearly see how the shift could be justified to the public. Commissioner W ojt asked how a district would help save the Health Department from being party to the fact that the County cannot come up with the funds to fulfill its obligations when it balanced the budget? Commissioner Huntingford said the stable funding source, if it happens, would come from the State, but the County would still be a partner. If the County has to reduce budgets, the County's funding mayor may not be stable. Dr. Locke agreed that a district structure does not assure stable funding. Health Districts in Washington State are having the same problems as County Departments. The overall problem is the trend toward the downsizing of County governments. Although demand for service is increasing, revenue sources are decreasing. Public health in the State is being dismantled piece by piece and is now in extreme jeopardy. There are some areas of the State that are measurably less safe because of cutbacks in restaurant inspections and drinking water programs. Jean Baldwin noted that the State Department of Health is grappling with whether they now need to go into those Counties. MaryAnn Preece addressed the question of stable funding. A benefit of a district would be the ability to partner with other areas and look to other jurisdictions in the region for sources for financing. It might also be able to partner with Clallam for west end services in order to be more effective and efficient. There are many ways to be more fiscally sound. Jean Baldwin clarified that the Health District would not have any taxing authority. Commissioner Huntingford agreed that a chart might be helpful in comparing the advantages and HEALTH BOARD MINUTES - October 17,2002 Page: 4 disadvantages of a district. While it sounds appealing to split off the Health Department, he is concerned about responsibility, accountability and liability. MaryAnn Preece explained that the State Auditor would audit a district separately from Jefferson County. Other County services, such as County Attorney, would have to be negotiated. Larry Fay added that most of the options that would be available to a district could be done through a continued contract with the County paying the same rates as we have now. Jean Baldwin recognized there is a list of details associated with a Health District that will need further consideration and investigation (e.g" employee benefits, liability insurance, etc.). She noted that in many ways the Health Department is already very different from other departments. Vice Chairman Masci asked to better understand whether the cost of transition would be a big obstacle to a changeover? Dr. Locke recommended Staff first outline the pros and cons of a Health District for the Board's review before costing out the reconfiguration. Commissioner Wojt moved to direct Staff to gather more information on Health Districts. Member Buhler seconded the motion, which carried by a unanimous vote. National Smallnox Vaccination Plan: Dr. Locke reported that the County is in the process of developing a smallpox vaccination plan and briefed the Board on the two types of smallpox vaccinations: pre-event and post-event. There is no disagreement that post-event vaccination is essential; typically the vaccine can be effective if people are vaccinated within three to four days after exposure. There is concern, however, about the number of people that should be vaccinated before exposure. He then talked about some of the reactions to the pre-event vaccination where the risks ofthe vaccine are high enough that only those most at risk for the disease should be vaccinated. This has become a political issue since the White House and Health and Human Services is considering a plan to vaccinate anywhere from ~ to 10 million people. What is most worrisome is that people who have been vaccinated can spread the infection to those unvaccinated for a period of up to 19 days. While the population under 30 is the most vulnerable, everyone is susceptible to smallpox. He then talked about those who should not receive the vaccination, such as those with immuno-deficiencies, because of their susceptibility to complications. From a national defense standpoint, it would make strategic sense to have as many people vaccinated as possible, but the issue is the price for this coverage. He noted that any plan would be implemented at the local level by the local Health Department. Vice Chairman Masci asked how quickly a local policy would need to be established? Dr. Locke said it would likely be necessary to be decided in reaction to national policy and guidelines. He believes most of the public health community would support the Advisory Committee on Immunization Practices (ACIP) recommendations, which are that vaccinations at this point should be very limited, with a focus on a plan to vaccinate quickly in response to exposure. It would be hard to justifY thousands of deaths in response to a theoretical concern. Asked by Member Buhler about identifYing exposure, Dr. Locke said that while people are minimally infectious until the rash appears, the clock starts ticking from the point of exposure. Jean Baldwin talked about the difficulties of vaccine distribution. She noted staff has gone to trainings about how to get immunization going. Dr. Locke pointed out that the process of vaccinating a population is complicated by the necessity of a detailed screening process. HEALTH BOARD MINUTES - October 17, 2002 Page: 5 Vice Chairman Masci asked if the Board could receive any information from the ACIP so they could look at who might be considered central personnel such as fire district, emergency room personnel? Mr. Fay noted that JPREP would be receiving a briefing on smallpox from Communicable Disease Coordinator Lisa McKenzie. There was additional discussion of the complications due to vaccinating first responders and the risk of complications from the vaccine. Dr. Locke noted that we live in an era where we believe the risks of vaccines should be close to zero and for this vaccine it is not very close. Newer, safer smallpox vaccines are under development, but would not be available for three to five years. Israel has an ambitious generalized vaccination program and Great Britain has embarked on a healthcare worker vaccination program. Jean Baldwin, noted that smallpox is just one ofthe possible agents in bio-terrorism preparedness. The Hospital and JPREP did a bio-terrorism surveillance survey last Friday. The Health Department did theirs the week prior. All survey results will be rolled up into a regional evaluation. West Nile Virus Response Planninu:: Dr. Locke reported that the West Nile Virus has made its appearance in the bird population of Washington State. The two human cases in Washington State were contracted in other states. The speed with which this virus has spread across the United States was greater than expected. Four of the mosquito vectors that are favorable for transmission of this virus are present in Jefferson County. Environmental Health response is doing active bird surveillance. Once it spreads into the bird population, it will start jumping into humans, but only about lout of 150 people get sick and of those, 50% would never fully recover and have permanent neurological injury. Commissioner Wojt asked if the symptoms in the majority of those infected are mild, how are they detected. Dr. Locke responded that this is done with antibody testing of a population. The incubation period is a fairly short 7-10 days and the most sensitive test is actually of spinal fluid, which does little good because there is currently no treatment. In the future, West Nile is something that should be vaccine preventable. Jean Baldwin noted that Environmental Health's partners in this issue are local veterinarians. Mr. Fay said that to-date, all results on the many birds tested under the County's bird surveillance have been negative. It is likely that next year Environmental Health will expand its bird surveillance activities to more active surveillance of adult and larval mosquitoes while working to identify and minimize their breeding areas. Noting that some people have already asked about the County's plan for mosquito abatement, he said the County would struggle with differing expectations within the community about environmental protection and the local risk to this disease. The response he has seen across the country has been mostly in the way of public information about minimizing exposure to mosquitoes using insect repellant and reducing breeding areas. While there are known human implications, it is not known how this will impact the bird populations. Public Health Fundin~ Reform: A Proeress Report: Dr. Locke reported that all said district reorganization would not solve the central problem currently challenging all counties and all health districts in the State. Stable, dedicated funding for public health disappeared in the early 1970s and ever since, it has been a scramble from year to year to cobble together funding from a variety of different sources. Public Health appears increasingly ill suited to the current situation where we have a crash national program to rebuild our public health infrastructure with new problems coming all the time. We HEALTH BOARD MINUTES - October 17, 2002 Page: 6 are likely to see the roles of the uninsured and those lacking access to medical care swell as healthcare financing problems get worse, which will then cause different types of health problems. There appear to be serious discussions leading toward action going on in Washington State. Noting that the agenda packet included a resolution from the State Public Health Association describing the various issues, he said a more useful resolution from the State Medical Association recently passed was committing them to supporting our legislative proposals. And that is really where this is going to go. The Washington State Association of Counties (WSAC) and Washington Association of County Officials (WACO) have adopted as their top priority the issue of pushing the legislature to find a dedicated statewide funding source this year. There are three different funding proposals being circulated: additional property tax authority, a combination of "sin" taxes, and a utility tax. While the plan is to bring a proposal to the legislature this year, the legislature will likely try to pass it on as a referendum to the people in the next election rather than act on it. Vice Chairman Masci asked if the Board should pass a resolution for forwarding to WACO, who would be doing this lobbying. Commissioner Huntingford said that in order to speak as one voice, he recommends first getting more information from WSAC and WACO. Member Frissell suggested asking legislators for face-to-face meetings with local boards of health. Jean Baldwin noted that a forum involving Clallam, Grays Harbor, and Jefferson Counties might be a possibility. There was Board support for Staff exploring this idea. Data Steerinu: Committee Update: Jean Baldwin reported that after the last Data Steering Committee meeting, Staff arrived at the "Blueprint for the Future of Assessment and Evaluation" with Community Health as the center. The idea is to create a web page similar in format to the diagram, where citizens can access specific data. Rather than providing links to other sites, Staff would plan to download pieces into this format. Currently, the City is considering how much they might be able to contribute to this website development project, which is now reaching $24K. She explained how the information would be presented in order to provide it in context. She recommended the focus groups, which were discussed after the last meeting, be put on hold until after a prioritization of projects. It is also likely another data steering committee meeting would be needed before focus groups are organized. A hard copy of the data should be available this fall Member Frissell suggested that the web page provide a mechanism for public feedback and ask questions. Member Buhler suggested there be a search function. AGENDA CALENDAR I ADJOURN November Agenda Items: Health District versus Health Board, Review Summary of Upcoming Environmental Health issues, December Meeting with Legislators. Jean Baldwin noted that Staff also agreed to draft a letter from the Board of Health recommending the Health Department and Hospital offer a breast-feeding in-service. Commissioner W ojt noted that table talk at the Rotary meeting this week was that drug use is prevalent and openly tolerated among the kids at all three district schools. Jean Baldwin noted that the local schools would be conducting a survey in October. Previous surveys have indicated that Jefferson County has had a higher initiation of drug use and a pretty open acceptance of it, but not significantly more than · . ....'-. HEALTH BOARD MINUTES - October 17, 2002 Page: 7 other rural districts. Clinical services employees are hearing that there continues to be a lot of methamphetamine use. She noted that the Department recently received another $100,000 grant to continue education in schools. The meeting adjourned at 4:00 p.m. The next meeting will be held on Thursday, November 21,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH (Excused) Sheila Westennan, Chaínnan @ ç.? eof. y Masci, Vice-C.pai . an - /j[ Glen Hunting ord, (Excused) Dan Tittemess, Member JEFFERSON COUNTY BOARD OF HEALTH Thursday, October 17, 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 September 19, 2002 III. Public Comments IV. Old Business and Informational Items 1. Status of meeting minutes for August 15,2002 v. New Business 1. Local Health Jurisdiction Reorganization JHHS Budget History and Forecasts 2. Data Steering Committee Update 3. National Smallpox Vaccination Plan 4. Public Health Funding Reform: A Progress Report 5. West Nile Virus Response Planning VI. Agenda Planning VII. Next Meeting: November 21, 2002, 2:30 ~ 4:30 PM Main Conference Room, JHHS Jean/Tom Mary Anne Jean Tom Tom Tom JEFFERSON COUNTY BOARD OF HEALTH MINUTES OR~f1 Thursday, September 19,2002 Board Members: Dan Titterness, Member - County Commissioner District # 1 Glff{ Huntingford, Member - County Commissioner District #2 Richard W 0/1; Member - County Commissioner District #3 Geoffrry Masci, Vice Chairman - Port Townsend City Couna} ]ill Buhler, Member - Rospital Commissioner District #2 Sheila Westerman, Chairman - Citizen at LArge (City) Roberta Frissell, Member - Citizen at LArge (County) StatfMembers.· Jean Baldwin, Nursing Services Director Larry Fqy, Environmental Health Director Thomas Locke, MD, Health Officer DRAFT Chairman Westennan called the meeting to order at 2:35 p.m. All Board and Staff members were present, with the exception of Commissioner Huntingford. Vice-Chainnan 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 Chainnan Westennan noted that the August 15, 2002 meeting minutes reflect that the items scheduled for discussion were ,postponed to the next meeting due toa 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 W ojt 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 IDPP A was HEALTH BOARD MINUTES - September 19,2002 Page: 2 corrected; on Page 5, paragraph 8, the first sentence should read".n 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. Chainnan Westennan 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 ofbiosolids 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. Chainnan Westennan 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 pennitting 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 Bearinu: 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 FrisseU 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 Backu: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 Westennan 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 Westennan 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 of the 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 Chainnan 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 :trom water use records from municipalities and water use for sewage treatment purposes across the country. Vice-Chainnan 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-Chainnan 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 pennit. 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. ViceøChainnan 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 Breastfeedin2 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 ofbreastfeeding 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 attaclunent between mothers and babies, resulting in better protection of the 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 staffmg 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 :trom obesity and diabetes. Vice-Chainnan 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. Chainnan Westennan 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. Rio-terrorism and Health Emeru:encv 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 of 2000. 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% of their 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 nonrecurring. 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 fimction 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 of the 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 corrunand. 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 of the 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 ClaIlam 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 Department Bude:et 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. CommunicabJe 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 of the 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 perfOImance 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). LaITy 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 Westennan 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 of those 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 ~ 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 perfonnance 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 commm1Ìties 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 Chainnan Westennan 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 perfonned on public health standards, one of the things that the consultants were thrilled with was the environmental health perfonnance indicators. It is fundamentally different than how we have done things. While they may be good in tenns 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 Westennan proposed the Board discuss the topic of perfonnance-based budgeting in more detail at the next meeting. AGENDA CALENDAR/ADJOURN Environmental Health reu:ulatory 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 Plannin~: 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 STD 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 Sheila Westennan, Chainnan Jill Buhler, Member Geoffrey Masci, Vice-Chainnan Richard W ojt, Member (Excused) Glen Huntingford, Member Roberta Frissell, Member Dan Titterness,Member ,. Chapter 7UAb.UJ I KCW - The WashIngton ~tate Legislature yage I ot I J,,ªgt~JªtLJrªJi_ºrnª Abº_ytJ)~} _E_:MªjLl.J.!;?t~ s.ªªrçt1 t:h~.tQ RC'vV T!TLES »TITLE '70 » CHAPTER ¡'OA6 »SECTION 70.46031 PrinL\(ersion 70.46.020 « 70-46031 » 7046.060 RCW 70.46.031 Districts of one county - Health board - Membership. A health district to consist of one county may be created whenever the county legislative authority of the county shall pass a resolution or ordinance to organize such a health district under chapter 7Q,Q§ RCW and this chapter. The resolution or ordinance may specify the membership, representation on the district health board, or other matters relative to the formation or operation of the health district. The county legislative authority may appoint elected officials from cities and towns and persons other than elected officials as members of the health district board so long as persons other than elected officials do not constitute a majority. Any single county health district existing on *the effective date of this act shall continue in existence unless and until changed by affirmative action of the county legislative authority. [1995c43§11.] NOTES: *Reviser's note: For ''the effective date of this act" see note following RCW 70.Q5"Q~º. Effective dates - Contingent effective dates - 1995 c 43: See note following RCW Zº--,ºQ,Q,~Q. Severability - 1995 c 43: See note following RCW 4J,ZºJ~IQ. hup://www.leg.wa.gov/RCWfmdex.cfìn?fuseaction=section&section=70.46.031 10/10/02 L..napter IU.~O.uou ~L.. vv - 1Ilt: vvaSlllugLUl1 ",Utlt: LCgt:>UIlUll;; . 45'" I. V. .I. L"Ggi$IªJJ.JIª..HQffiª AÞQJJt.lJ$.. E-=MßiIJ"j~_t;¡ SªªfG.D HªJp RC\/V TITLES »TITLE 70 »CHAPTER 7046» SECTION 70.46060 Print Ver§iC)n 70.46.031 «70A6 060 »'70.46.080 RCW 70.46.060 District health board - Powers and duties. The district board of health shall constitute the local board of health for all the territory included in the health district, and shall supersede and exercise all the powers and perform all the duties by law vested in the county board of health of any county included in the health district. [1993 c492 § 248; 1967 ex.s. C 51 § 11; 1945 C 183 § 6; Rem. Supp. 1945 § 6099-15.] NOTES: Findings-lntent - 1993 c 492: See notes following RCW 432Q·_Q§.Q· Short title - Severability - Savings - Captions not law - Reservation of legislative power - Effective dates -1993 c 492: See RCW 43.7Z_:_ª_19 through 43]Z,~1.Q. Severability -1967 ex.s. c 51: See note following RCW 7.Q-,-Q§,Q.1Q. http://wwwJeg.wa.govIRCWfmdex.c:fìn?fuseaction=sectìon&section=70.46.060 10/10/02 'LoUap~IO' IV.~V.VOV .L,,"'LoYY - .LHIO YYa;)1J.H15'VU >.J~a~.. .........5'-310.Ul.... .......ð"'... v.&..1 Legislature HOû1ª -------. .,.........,""---.-------...... AhQJJLLJ$_ ~::MªU_ _L,t$t~ SE:¡_ªIÇO HE:¡!p F(,CW TITLES » TITLElO » CH,L\PTER 7(}46 » SECTION 70.46_080 PrífltVersiol1 /046060 «7046080 » 7046,085 RCW 70.46.080 District health funds. Each health district shall establish a fund to be designated as the "district heatth fund", in Vlr'hich shall be placed all sums received by the district from any source, and out of Vlr'hich shall be expendèd all sums disbursed by the district. In a district composed of more than one county the county treasurer of the county having the largest population shall be the custodian of the fund, and the county auditor of said county shall keep the record of the receipts and disbursements, and shall draw and the county treasurer shall honor and pay all warrants, Vlr'hich shall be approved before issuance and payment as directed by the board. Each county Vlr'hich is included in the district shall contribute such sums towards the expense for maintaining and Qperating the district as shall be agreed upon between it and the local board of health in accordance with guidelines established by the state board of health. [1993 c 492 § 249; 1971 ex.s. C 85 § 10; 1967 ex.s. C 51 § 19; 1945 C 183 § 8; Rem. Supp. 1945 § 6099-17.] NOTES: Findings-lntent -1993 c 492: See notes following RCW 4~~2º_,Qqº. Short title - Severability - Savings - Captions not law - Reservation of legislative power - Effective dates -1993 c 492: See RCW 43,Z2,ª10 through 4~,]2,ª1º. Severability - 1967 ex.s. c 51: See note following RCW 79. Q§J21Q. http://www.leg.wa.govIRCWlindex.cfin?fuseaction=section&section=70.46.080 10/10/02 '--"I'GY"~" I V~"""V.VUJ ..'\..'-"..... - .1.11"" ".., (I.~I.u.l..l5"\...II.I· ULUL'" ......,,,f)A..:u....u......"" ~ -0- - -~ ~ L\9gi$lªlYHLtlQ.ffi\9 AººJJLUs E_:Mª,iLLiêì§ ~iE2ª{çl) tls;1 P RCVV TITLES »TITLE 70 » CH/'\¡;"TEF:¿ /046 » SECTION 70.46 085 Print Version 7'0.46080 « 7046085 » 70.46090 RCW 10.46.085 County to bear expense of providing public health services. The expense of providing public health services shall be borne by each county within the health district. [1993 c 492 § 250; 1967 ex.s. C 51 § 20.] NOTES: Findings-lntent -1993 c 492: See notes following RCW 4;?,~Q,ºP_Q· Short title -- Severability - Savings - Captions not law - Reservation of legislative power - Effective dates - 1993 c 492: See RCW4:3J2.91 Q through 1~,.z4,.~:l5. Severability -1967 ex.s. c 51: See note following RCW 7Q,_Q§,Q1Q. Expenses of enforcing health laws: RCW ZQ,Q5.13Q. http://www.leg.wa.gov/RCW/index.cfin?fuseactÎon.....section&section=70. 46. 085 10/10/02 Jefferson County Health & Human Services Blueprint for the fub.lre of Assessment and Evaluation " ,.ç',,:r_i.lii.Ullity A HII, ,0'b Physical Environment Prepared by Kellie Ragan, M.Ä. October 4, 2002 , i I L..,.._...~W~^=~' __'~_N~_'~~'='='MW'__"_""""''''''' "-,.~""--_'__"'=" "'-'--_..~',','^ W···" ._._.',~,=',""""_~~",,=""_'_'_'~'^ '~~~'"'~N,~,,~,~,"~.__....~^m_...__.__...=~'_'_·__'~w Jefferson County Health & Human Services Virtual (web-based) Library Proposal Brief Assessment and Evaluation People want to know: · how the government spends funds · if tax dollars are being wisely spent · that programs are making an impact This development of a virtual library proposal utilizes information technology to provide local and regional agencies, taxpayers, and consumers (adults and children) with a profile of strengths and challenges that we, as a community, experience. Community Health is 'the universe' that we are proposing to monitor. Within the universe of community health, this project constructs three distinct domains, socio- economic, personal and family health, and physical environment. Within these three domains, content areas are identified. These content areas are based on scientific knowledge and public perception. Because of the availability of data and the level of sophistication of computer users, JCHHS proposes the development of a Virtual Library that houses commonly used data derived from indicators. Indicator data is available on the web. However, it is not centrally located, and in many cases, is challenging to access (e.g. Uniform Crime reports bog down computer systems due to their complexity, county level data is often hidden in charts and tables-Governor's Juvenile Justice Advisory Committee). The benefits of a Virtual Library · Provide a higher level of accessibility regarding county-specific data · Provide a greater level of accountability by providing indicator data related to the use of tax dollars · Readily-accessible socio-demographic indicator data for use in grant applications. Socio-economic data plays a cornerstone in all human service grant applications. (FYI: Jefferson County, through various partnerships-JCHHS, Jefferson Mental Health, has recently been awarded $260,000 in grant funding). A thumbnail draft of the proposed virtual library is outlined on the following pages. This project will require significant start-up staff time from JCHHS and a commitment of Information Services to design a consumer-friendly library. Attachment A is a statement of work for the 2003 fiscal year. Attachment B is a list data sources-and although not exhaustive, gives an idea of what is available in the virtual world that could be centralized on a Jefferson County Virtual Library and updated on a regular basis. Content Areas .0. Access to Healthcare Section 1: Personal & Family Health Page 1 10·04-02 DRAFT Insurance Status I....·..···.......·.·..··.....··.···....,J , ..................:::::.., I ............. ...... , Unmet Need .,. ........ ~ ......... ..... Usual source of care I Indicators .0. Late Stage CA dx Family Planning utilization 1 I Late PNC I Senior Assistance Datasets .0. BRFSS 2001 I Cancer Registry 1 I AHLERS-JCHHS I I Birth Certificates 1 ~································I 1·································1 1·································1 1·································1 ~································I ~································I Content Areas .IJ. Individual Health Section 1: Personal & Family Health Page 2 10-04-02 DRAFT Indicators .IJ. Datasets .IJ. Ado!. Preg/birth 1..···....·..··...·....·....:::::::::::,,1 Birth Certificates 1 Low Birth Weight I·······..··········..··· Home Health Care Need Disability Status 1..··........··..·············..·,1 BRFSS 2001 ............. , Self-reported Health Status ,.......... Pregnancy Intention Child Death Review I Immunization Status Senior Assistance MPSI JCHHSIDOH Child Profile ~································I 1·································1 ~································I /·································1 /·································1 ~································I Content Areas ,(J. Injury & Violence I ~................ 1 BRFSS 2001 . . ...... . . ~ . . .. . . '. ':....... ~ ..:.....~........-.;:.:.:... ...¡.:.;.... -.. -. ·'::.··..1 MPSI I I JCSD Section 1: Personal & Family Health Page 3 10-04-02 DRAFT Indicators ,(J. Mortality ~--... ~::::......... -- ... ~ - - - - - - :...·::~IUCR --- ",...""" I -- ",...""" - ",... I",............. ",... Assault Arrests Violent Crimes Property Crimes Domestic Violence Child Abuse/Neglect ORCA Hx of Abuse Firearms in home SeatbeltlCar Seat Use ~································I ~································I 1·································1 ~································I 1·································1 Datasets ,(J. 1 CHARS DCFS Referrals Accepted/Open Cases Content Areas ,/J. Mental Health Substance Abuse* Tobacco Use Section 1: Personal & Family Health Page 4 10-04-02 DRAFT Indicators ,/J. I Suicide (death) ! So ¡o¡de (hospitalizations) I ____________I 'I Mental Health Days !.~.".... I Alcohol Use ~"'':'''''' -............ ................'!J --.~.., ...---....~.~~-:..~ I l ........~ '.. ........ Drug Use I .... .:~.... ......:..:::::. J I t .............. ...~.~.""·;...."···'1 Tobacco Use .~.....".......".. ....... I ' , .._.._"._.........~ ¡School-baSed programs 1..·......·..·...·....·..·1 Children in Foster Care I··· ................ ....:J ..' Victims in Accepted Child Abuse Referrals 1·································1 1·································1 J·································I 1·································1 1·································1 1·································1 ~································I 1·································1 1·································1 1·································1 '" Section 1, page 8 for dctailed substance abuse content areas Datasets ,/J. Death Records CHARS Target HYS BRFSS 2001 MPSI OESD DSHS Content Areas JJ. Morbidity & Mortality Section 1: Personal & Family Health Page 5 10-04-02 DRAFT Indicators JJ. Leading Causes of Death CD Outbreaks , Bioterrism Motor Vehicle Deaths 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 ~································I Datasets JJ. Death Records PHIMS WTSC Content Areas .I). Risk & Predictive Behaviors Section 1: Personal & Family Health Page 6 1 O~04"()2 DRAFT Indicators Datasets .I). .I). I Tobacco Use ~................. . .. 1-' ............ . Physical Activity....··..··..·.................·...:::.......... I "''':::::::((111·1 BRFSS 2001 Heavy Drinking ....................~..:~::::::>....... Overweight I ...... " .... 1·································1 ~································I 1·································1 1·································1 1·································1 . . . . . . . .. . . . . . . . . . . . ~. . . ~. . . .. . . . . .. . . .. . ... . .. . .. . . . .. . . . . . . . .. . . .. . . ... . .... . . . . . '" . . .. . .... . . .. . .. . . . .. . .. . . .... . . . . . . . . . . .. . . " . .. .. . . .. . . . . . .. . . . .. . .. ... ... . . .. . . .. . . .... .. .. . . . . . Quality of Life 1 Risk/Predictive ~,......... 1 Self Reported Health Sta~~~' r..····......:::....:::::::::::::::::. I Disability 1..·..........··..·...·.·.·.:-.::::::::::::ßII·1 BRFSS 2001 I Physical/Mental Health Days 'T Utilization of Public Recreation Facilities .....·..·1 JCREC/ONP/USFS/PT 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 1·································1 Content Areas .I). Consumption Section 1 : Drug and Alcohol detail Page 1 1 O"()4~02 DRAFT Indicators .I). I Youth Use I Adult Use Syringes Exchanged Liquor Licenses Liquor Sales Tobacco Retailers ~································I 1·································1 ~································I 1·································1 ~································I ~································I Datasets .I). HYS BRFSS LCB I Content Areas I .!J. Section 1: Drug and Alcohol detail Page 2 10-04-02 DRAFT Indicators .!J. Datasets .!J. +........................................................................................................................................................................................ Intervention & Treatment Adult Inpatient Outpatient Treatment Admissions Juvenile Inpatient Outpatient Treatment ____I Target I OESD I Student Assistance Programs Employee Assistance Programs ~································I 1·································1 1·································1 1·································1 I································· 1·································1 Content Areas .I). Law & Justice Section 1: Drug and Alcohol detail Page 3 10-04-02 DRAFT Indicators Datasets .I). .I). Drug Arrests ~... ........ ........... .......... ..... ................ ~ URC Seizures 1....··....·...·....·..··......·....·1 Customs/Coast Guard Meth Lab Clean.up 1··............···......··........···........·1 DOE DUI Citations 1 1 Law Enforcement Deferred Prosecution Tracking 1 Juvenile Diversion Juvenile AID Arrests GJJAC Juvenile Property Crime Arrests Juvenile At.riskfTruancy 1 Juvenile Violent Crimes I ~································I 1·································1 1·································1 1·································1 1·································1 1·································1 I Content Areas .IJ. Morbidity Section 1: Drug and Alcohol detail Page 4 10-O4.()2 DRAFT I Indicators 1 ~ ...... ........ r...····.....·:....::···..···.... I I '::::::::::·.:::;w.. . . . . ,,' . . ~. . . . . . .. " . . ~. . . Datasets -0. -0. I HIV/AIDS I Hepatitis 1 Hospitalizations CHARS ~································I ~································I ~································I 1·································1 ~································I ~································I ......................................................................................................................................................................................... Mortality I I Motor Vehicle Deaths I Drug Deaths I I Natural Causes VS WTSC Coroner ~································I ~································I ~································I ~································I ~································I ~································I Content Areas .(). Demographics Section 2: Socio-economics Page 1 10-04-02 DRAFT Indicators .(). I Age Composition I Life Expectancy I Population Growth School Enrollment i,···· .. ..·T:::····· ..... " '. .... '.. ::"::::..:::..( I ............................. . ........ ~································I Households wlw no children < 18 ~.......·.......··..·I 1·································1 1·································1 /·································1 ~································I 1·································1 1·································1 Datasets .Q. OFM/Census I OSPI I / I I I I I I Census/BRFSS Section 2: Socio-economics Page 2 10-04-02 DRAFT .{} Indicators {). I J............... '."............,..........,... ·1 I 1 Content Areas Datasets ij. Economics I Transfer Incomes I Poverty status I Median Household Income Median Wage I Living Arrangements of Children 1 OFM/Census Low Income Service Utilization* DSHS/OSPI 1 Births to Single Mothers ~....................... ··1 Birth CertiflcatelMPSI Property Tax Exemption 1·............·1 JC Assessor 1 1·································1 1·································1 ~································I ~································I 1·································1 1·································1 *Food Stamps, T ANF, Reduced/Free school meals Content Areas I .!J. Education Section 2: Socio-economics Page 3 10-04-02 DRAFT Indicators Datasets .!J. .!J. ~ I Educational Attainment I School Enrollment WASUITBS Scores I...... .......................... Birth Certlficate/MPSII I....................... BRFSS/Census I·································: :·:·:·:·:·="~·:·:·~··i .QSPI 1 .....-::::..... High School Drop out fa;:..... :..:......:.:..::: :...... Special Ed. Services . College Enrollment I.............·........... f Colleges & Universities 1·································1 1·································1 1·································1 ~································I 1·································1 ~································I Content Areas JJ. Employment Section 2: Socio-economics Page 4 10-04·02 DRAFT Indicators JJ. Unemployment Rate Datasets JJ. I I Businesses Licenses I 1 ESD OFM 1·································1 . . . ... . . .. . . ..... ~.. . " . . .... ... . .... . .. . . . . . . '" . . . . . . '" . .. . . . .. . .... . +. . . .. . . ... . . . . . . . .. . .. . . ... . ... . . .. . . .... .. .. . ... . . . . . . . . . . . . . .. . . ... . . .. . . .... . .. ..... . .. . . ... . .. . . .... . 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Datasets ij. 1 Property Crimes 1 Violent Crimes 1 Domestic Violence I· .. ... ~~ ::: :·::~·:·:··I }........... 1···············1 1···············1 1···············1 UCR 1···············1 1···············1 ......................................................................................................................................................................................... Social & Community Support I Arts & leisure I Utilization of Public Recreation I Senior Utilization of college classes 1 Senior meals 1···············1 ,............... 1···············1 I··············· 1···············1 1···············1 1···············1 J···············I 1 l 1 1 Content Areas J.). Environmental Health Section 3: Environmental Health Page 1 10-04-02 DRAFT Indicators J.). I Indoor Air Quality Water Quality Outdoor Air Quality Home Heat Source Sewage Disposal Solid Waste Disposal I Respiratory related illnesses I Utilization of Hazardous Waste Utilization of Recycling Facilities Datasets J.). BRFSS CHARS/School Nursing Utilization of Solid Waste Facilities I I I I I Public Works Annual Reports I I I J J ,. Content Areas .!). 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It is a "pox"-type virus related to smallpox. When given to humans as a vaccine, it helps the boc:Jy to develop immunity to smallpox. The smallpox vaccine does not conloin the smallpox virus. What Is a -live virus" vaccine? · A "live virus" vaccine is a vaccine that contains a "living" virus that is able to give and produce immunify, usually without causing illness. · Because the virus in the vaccine is live, it can be transmitted to other parts of the body or to other people. · For most people with heahhy immune systems, live virus vaccines are effective and safe. · Sometimes a person getting a live vaccine has mild symptoms of the virus in the vaccine. · Other live virus vaccines used in the United States indude measles, mumps, rubella, and chickenpox. Facts about Vaccinia · The vaccinia virus, the virus in the smallpox vaccine, is another "pox".type virus. · The vaccinia virus may couse rosh, fever, and head and body aches. In certain groups of people, complications from the vaccinia virus con be severe. Who Should NOT Get the Smallpox Vaccine? · The smallpox vaccine is not recommended for people who hove weakened immune systems, including people with leukemia or human immunodeficiency virus (HIV) infection or people undergoing treatment with certain drugs or with certain skin conditions. In rare cases, people who foil into these groups con hove serious complicotions from the vaccine. · Individuals in any of these groups, should not get the smallpox vaccine unless they ore exposed to the smallpox virus. · Individuals in dose contact with people who fall into any of these groups should not get the smallpox unless they hove been exposed to the smallpox virus. For more infonnotion, visit www.cdc.qov/smolloox. or coli the COC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY). October 5, 2002 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER· HEALTHIER· PEOPLE'" · SMALLPOX VACCINE OVERVIEW The Smallpox Vacåne The smallpox vaccine is the only way to prevent smallpox infection. The vaccine is made from a virus called vaccinia which is another upox"~type virus related to smallpox. The smallpox vaccine helps the body develop immunity to smallpox. It contains the "'ive" vaccinia virus not dead virus like many other vaccines. For that reason, the vaccination site must be cared for carefully to prevent the virus from spreading. Also, the vaccine con hove side effects (see below). The vaccine does not contain the smallpox virus and cannot give you smallpox. Currently, the United States has a big enough stockpile of smallpox vaccine to vaccinate all Americans in on emergency. Production of new vaccine is underway. Length of protection Past experience indicates that the first dose of the vaccine offers protection from smallpox for threè to five years, and sometimes os long os 10 years or more. If 0 person is vaccinated again later, immunity lasts even longer. Historically, the vaccine has been effective in preventing smallpox infection in 95 percent of those vaccinated. In addition, the vaccine was proven to prevent or severely lessen infection when given within a few days of exposure. It is important to note, however, that at the time when the smallpox vaccine was used to eradicate the disease, testing was not as advanced or precise as it is today, so there may still be things to learn about the vaccine and its effectiveness and length of protection. Receiving the vaccine The smallpox vaccine is not given with 0 normal hypodermic needle. It is not a shot as most people hove experienced. The vaccine is given using a bifurcated (two-pronged) needle that is dipped into and holds 0 droplet of the vaccine. The needle is used to poke the skin about 15 times in 0 few seconds. The poking is not deep, but it will cause a sore spot and one or two droplets of blood to form. The vaccine can be administered in the upper arm, or on the thigh. If the vaccination is successful, a red and itchy bump will develop at the vaccine site in three or four days. In a week, the bump becomes 0 large blister and fills with pus and begins to drain. During week two, the blister begins to dry up and 0 scab forms. The scab falls off in the third week, leaving a small scar. People who ore being vaccinated for the first time have a stronger reaction than those who ore being revaccinated. The following pictures show the progression of the site where the vaccine is given. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER·HEALTHIER·PEOPLE~ · . Smallpox vaccination site Days 4 through 21 ~¡:J Post-vaccination care After the vaccine is given, it is very important to follow instructions to care for the site of the vaccine. Because the virus is "live," it can spread to ollier ports of your body, or even to othet- people. The vaccinia virus {the live virus in the smallpox vaccine} may cause rash, fever and head and body aches. In certain groups of people {see below}, complications from the vaccinia virus can be severe. Benefit of vaccine following exposure Vaccination within 3 days of exposure will completely prevent or significantfy modify smallpox in the vast majority of persons. Vaccination 4 to 7days after exposure will also likely offer some protection from disease or modify severity of disease. Smallpox vaccine safety The smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus; however, the vaccine does hove some risks. People most likely to have side effects are: women who are pregnant; people who hove now, or have ever hod, skin conditions, {especially eczema}; and, people with weokenedimmune systems, such os those who hove received 0 transplant, are HIV positive, or ore receiving treatment for cancer. Historically, rates of complication for people receiving the vaccine for the first time ore such that for every 1 million people who receive the vaccine, about 15 will hove life threatening side effects. The death rote is about 1 or 2 persons per 1 million people vaccinated. Smallpox vacàne availability Routine VOèCinotion of the American public against smallpox stopped in 1972 after the disease was eradicated in the United States. Until recently, the U.S. Government provided the smallpox vaccine only to a few hundred scientists and medical professionals who worked with smallpox and similar viruses in o research setting. DEPARTMENT OF HEALt"H AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER· HEALTHIER· PEOPLE'" After the events of September and October, 2001, however, the U.S. Government took further actions to improve its level of preparedness against terrorism. One of many such measures - designed specifically to prepare for on intentional release of the smallpox virus - included updating and releasing a smallpox response plan. In addition, the U.S. Government ordered production of enough smallpox vaccine to immunize the American public in the event of smallpox outbreak. In the event of smallpox outbreak the U.S. Government has prepared emergency guidelines to quickly vaccinate and contain a smallpox epidemic. The government policy for pre-event vaccination is under consideration, but as of October 4,2002, no decision has been made. For more infonnation, visit www.OOc.gov/smoflpox. or coli the CDC public response hotline at (888) 246-2675 (English). (888) 246-2857 (Espoñol). or (866) 874-2646 (T1Y). October 5. 2002 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER· HEALTHIER. PEOPLE'" WSPHA Draft Policy Resolution - 1013102 Public Health Funding for a Safer, Healthier Washington Whereas, the people of Washington State expect, deserve and require a safe and healthy Washington where essential programs improve health, with information that works to protect everybody every day from disease and injury, environmental threats and impacts from potential biological, chemical and nuclear terrorist threats, and Whereas, the general welfare, business and economic climate, and societal stability of the State of Washington is dependent upon protection from these same threats, and Whereas, the 2000 Public Health Improvement Plan for Washington State set as a goal "Stable and sufficient financing for Public Health", and Whereas, Washington State's public health services are integral to the state's health system, providing essential communicable disease control services, epidemiological functions, emergency response capabilities, health promotion and education services, and environmental health protection, and Whereas, public health services such as control of vaccine-preventable and other communicable diseases, maternal and child health home visits, protection of food, water, soil and air from contamination and promotion of safe disposal of hazardous wastes are among the most cost-effective programs ever devised, and Whereas, national, state, and local health systems are experiencing an unprecedented demand for rapid development of biological, chemical and nuclear response systems, protection from emerging infectious disease epidemics, control of antibiotic-resistant bacterial infections, and Whereas, effective provision of the above services requires long-term investments in science-based disease surveillance, prevention and control capabilities, information systems, and a highly skilled and regularly trained professional workforce, and Whereas, the use of recent federal funding for the development of an emergency response system does not provide support for other basic and essential public health services, and Whereas, the state's public health system is precariously funded by a non-stable mix of funds vulnerable to the effects of economic recession, political changes and intense competition with other governmental programs, and Whereas, in the face of critical health threats, high unemployment, expanding public health needs, and growing problems with access to essential health services, local governments in both urban and rural areas throughout the State are under intense budgetary pressures leading, in some cases, to dismantling or severe constriction of local public health programs, and Whereas, loss of essential public health services at a time when the need for them grows ever more critical will inevitably cause an increased burden of preventable disease for medical care providers, increase the costs of medical care by cost shifting for the care of the uninsured and further strain an already over-burdened system for providing health care access to low-income populations, Therefore be it resolved that the Washington State Public Health Association supports enactment of a stable, sufficient, dedicated and equitable public health funding source to support essential public health services that are always working for a safer and healthier Washington for every man, woman and child who lives, works and recreates in Washington State, wherever that may be. .: West Nile Virus Page 1 of2 < ~ ..S! ,""':; <~'<Íf:'<" ~'"é·'···s·~s~~·· West Nile ~-' ,., - 't' ,",',.' c .. If '" ,,\ '.,-, I, ;~,~ ;,Iëi;;c~:iJ;: -....- ~ ~ . -~ ,--~ - ~ West Nile Virus Soon to Become a Reality in Washington State Tom Locke, MD, MPH, Clallam County Health Officer West Nile Virus (WNV) is named for the West Nile district of Uganda where it w~ first discovered in 1937. It belongs to a farrùly of viruses that can cause illness in humans, horses, birds, and other "vertebrate" animals. In the past decade, WNV h been expanding to Europe, Asia, and the South Pacific. In 1999 the virus made it~ appearance in North America, causing an outbreak that resulted in 62 know cases deaths in New York City. Since this time, the virus has been spreading relentlessl) across the United States. As of September 16,2002, 1,460 cases of the illness hav- been reported for the year including 66 fatalities. The virus has been detected in 4 different states. The first case ofWNV infection in Washington was diagnosed in August of this year in a traveler who appears to have acquired the infection in Louisiana. Bird species, especially "corvids" (raven~ cro~jays, and magpies) are the princi] target of this infection. Humans and horses are also at risk for developing serious illness. Mosquitoes serve as the "vector" which transmits the viral infection ftom ( animal to another. Human to human transmission, or direct transmission ftom an infected animal to a human appears to be very rare and require extreme circUIDSta: such as organ transplantation. Most people who develop WNV infection experien only mild. flu-like symptoms lasting several days. A small percentage of WNV infections will, however, progress to a life-threatening brain infection ('encephaliti: Muscle pain and weakness are also predominate symptoms in WNV infection with residual weakness persisting for over a year in up to 50% of cases. People over th of 50 are at increased risk for the serious complications of WNV infection. The progression ofWNV across the United States is unstoppable. If the infection to make its unwelcome arrival to Washington state this year, it is almost certain it· become established by 2003. What can we do to protect ourselves and our familie As with most viral infectio~ PREVENTION is the name of the game. Preventiot WNV starts with educating ourselves about the infection and its symptoms. Preve mosquito bites is a very effective way to avoid infections spread by these annoying insects. Helpful tips are available at the Web Sites listed below. And finally, it is important to realize that WNV is but one of many global infectious disease threats must cowont. Advances in transportation, international trade, and leisure travel!: made virtually every comer of the world accessible in less than a days time. Disea causing microorganisms have also become global travelers. In the final analysis, it only a stron& effective public health system that stands between each of us and tht disturbing array of microbes that can rob us of our health and, sometimes, our live Washington State West Nile Virus Web Page þttp:/ /WWWA9_h,:Wf.!.,g9yL~hp/ts(ZooLWNYJW'ßV. hL1111 http://www.clallam.netJHealthServiceslhtmllhhs_topic_westnile.htm 10/10/02 -' West Nile VlfUS '~.' r~. . """""" '..1IIt ~t"1 ,~i Tlb Health rage 1 01'" E.·.·.·.l.J.viIp;lWß,l1taIWea1thPra,Œ,loalns ."::.;":':'..:...':"'.'''.'.'..;":"''''.::,.',', ':.:..-::..::..,":',":":,.:.,.;".C.,' ",,,~.:,,.:.:,:.,.~,:: . ... (i)~(j",Qí li~vi'¡QI.~~ß.~ "fiQ;1., _t 8iít~. ~_'H:Ç.b I EmDlo~ You are here: DO!, Ho_~~ » ~.tl.!:'! » EHS » Zoo_'!~ti~Djf!~i!'~_~ Pf~~ » West Nile Virus Site Directory . Zoonotic Dise_ª?~ p[wªm ·I;HStt()m~ ·ç.tt~P_~þl içatiOD? · çt!~J~~lªt_~~ite~ · Finçl_Y9_IJL1QÇ,ªI~ªJth ºe-RM1~nt · Eß~_~_AçmÞªLB~ªº~r~J,º yj~\~\LøiLftle? · Atlemate _fJt~_formªt I nformªl!ºÐ · beªm,ffiQre_ªbout ~nY1[ºnm~mtªt_He_¡,,-ltb PrQ.ßL'MJ1S & Serviçe~ ~/:.~.... W;¿>st Nile Virus What was expected has arrived...West Nile virus West Nile virus, which has been steadily spreading across the United States, has reached Washington. A raven collected in Pend Oreille County as part of a statewide dead bird surveillance effort tested positive for the virus~the first detection of West NIle virus in our state. Currently, we have received no reports of human or horse cases. Transmitted by mosquito bites to humans, the virus has proven itself a public health threat. As of October 7,2,736 cases of the illness have been reported to the Centers for Disease Control and Prevention for this year, including 146 fatalities. The Washington State Department of Health coordinates surveillance throughout the state for the virus and mosquitoes that potentially carry the virus. However, all of Washington residents can help prevent outbreaks. Below are tools, resources, and information for the general public, health care providers, veterinarians, local health departments, and mosquito control districts. 4'~~st News: Q'I!Ia4i)i~_ct~ufvemanc;e:1III9_fKdetects W~tNile virus inJ~'~_2Is~ingto!!, information for the Public W~1 Nilt;;_VjßJ~_º&A Answers to common questions about West NIle virus and what's being done in Washington. Mosquitº~~- Take the Bit~,Out of the Bug! Tips on protecting yourself against mosquito bites and possible contact with diseases they can carry. Mº_squitº_PfQhl~I!lS _Start ª-tJ:Jºm~ Simple steps you can take to reduce the number of mosquitoes around your home. Ih~J~lgz:::?::::~=-~..ºn_W~~t.Nile..Vif!J~.~_çl;m~r$Jºr. Pi.~~ª~~Çºmml..aDð preventíoQ Kids can read the latest in Disease Detectives - Trackin' & Case Crackin' at COC. Here, they will learn about West Nile virus and http://www.doh.wa.gov/ehpltslZoolWNV/WNV.html 10/1 0/02 West NIle VIruS Page 2 01"4 ways to protect themselves. flow DQJRepwt-ª- DeªºJ}jrd? Reporting of dead birds can help detect the presence of West Nile virus in your community. Here is how you can place a report. BowlQ U1>~_JIl~~s~t.ß~-p~11ªnt¡¡._£ªf~_,--ILS.,.En.yjrol1JmmtªLPLQ1~.ºt!.ºº Ageng Environmental Protection Agency's (EP A) recommendations on how to select and apply insect repellents. EP Å.!md.MQ.sQµÎ1Q_çQntrQt .U,~LJ~nyjIQM1çmªl.P[ºt~_çÜºn_Ågçnçy EP A's information about pesticides used to control mosquitoes. Nç_wß__R~I.t~ª~~~_..º-!lc_W~_~t_:N.ilç.'yirlJ.~ Department of Health's news releases regarding West Nde virus. Information for Physidan$ a VE'terinariam Jnfol]11aþº11. tÞI.li~ªlth_Ç-ªJç:p[Qvider5 oll_:w.ç~tNile 'yÜm General information on West Nile virus for health care providers. Bow to R~Qxt_Sµ~PJ~.cted Ca~~~ ()fW~_$t Nile VimsJ)jsease and S\.lÞmiJ Ç.tinkªL Specjm~1}~J()LLabo@JoŒ-I~~ting Physicians are now required to report unexplained critical illness or death of potential infectious etiology. Reporting this condition will aid in the surveillance of new and emerging infectious disease, such as West Nde virus. ÇJimç~J}uiºAm~_ç,Ççnt~r~_fºLºi~çªsç. çQl11I.ºLf!nºPr~YJIDtion CDC offers health and public health professionals West Nde virus- related clinical infonnation and guidance. Insect _Ritl1ßllents ContainingDEET, U. S. EuyironmentaI PIQJ.~ion Agençy Infonnation on EPA's action concerning DEET, which is used in many insect repellents. IntÞ.rillª1!mJ Jor .Y~t~rinarians _QnW ~st. Nik_Yiruª Veterinarians are encouraged to report cases of equine encephalitis and to vaccinate horses prior to the arrival of West Nile virus in our state. PrevemiQ1lª.n.d_r-ºntrol of W est.t{il~ YimsJnfection iIl.EgJ}..ip~.ßnd Other Liv~_stock ºLPQl!JtlJ'"JJ,s,._n_~partmç111ºf&griçmlure USDA's recommendations on reducing exposure to West Nde virus in horses, poultry, and other livestock. !nform<tbon for Local Health Jurisdkh~r'$ 8: Mosquito Control Di!ítrkts http://www.doh.wa.gov/ehp/tslZoolWNVlWNV.html 10/10/02 west l'llle VIrUS Page 3 of4 "-'_"'._"_,, ...._...11<_....._.. Insect .R~p~U~lJl;tÇol1tainingºÞßI>jL_S,J~nyifQmnel1tªl PrQlectiol1 Azçm:y Infonnation on EP A's action concerning the DEBT which is used in many insect repellents. P~~tiçi_d~~.an1:LIQ::<;iç-ºJQgy~_NaÛºI1l\L,~~~lkid~IDÍQ_[ffiªÛºº-J::~!1t~r National Pesticide Infonnation Center, West Nile Virus Resource Guide section on health concerns about insect repellents and insecticide used to control mosquitoes. ÇliniçalGillçlanc~,_ç~ºt~s. fQr Diseas~_C9!rtr9}_i'IDçlJ?rçventiQ-º- CDC offers health and public health professionals West Nile virus- related clinical infonnation and guidance. SurveiUance Information & Tools West Nile Vif!.1~_ Surveillance in_Wa,~hington, January 2QQ~Report Findings of the 2000 and 200] West NIle virus surveillance activities in Washington. Mº~gµitº_IrªIming R~pºrtiºg..F OITll Reporting fonn used to track mosquito trapping events. D~ªdBirdRçpQ!1itlz-fPJ:m Reporting fonn used to track dead bird events. Educational Materials Mº-~gJ!itº~~m= T.,*~ lh~ªit~_º_!'!Lºflh~ªµ-£l Camera-ready art for a tri-fold brochure on protecting against mosquito-borne disease through bite prevention and habitat reduction. Mosquito Pröblçm:tStart at Home Camera-ready art for a bookmark, 8" xl] " flyer, and 11" x 17" poster addressing steps on reducing mosquito habitat around your home. Web Resources ð.m~riçª,Mºsquito _CQ!1tr.Q.lAssociation Centers tQcQisease C0l1trQta,n9 Prevention-,-)~[þºyiral Encephwitide~ Centers fOl:J;:!isease CQntmLªºd PreventiQn~~NJ<>SH Update.=_"WªYªJº AyºiQ__W_~§1___Ni1e Yh1!~__ßi~kiº_-ºll~Øº_º_LWm:.k_ ç~nl~I.$_.fQL_º.is_ea_~_eÇºJltmLa,nº. PreY~ntiQl1~.w~s~ NiJe}'irns ÇQ[11ellt)!}iY_ÇŒt-y~.Wbª-tJJoing__on_withJhe West NileYil}J~1 NªÛº-I1ªI.P~stiçiº~Jnfonnation C<mtef'----W~st Nil~.YÌ1v~LRe~our~~ GlJiQ~ t{9_rj:hw~~t -Mps9.IJilº-__1lIlQ .Ye<::tpLCQ!1tml. Â$s_Qçiªl!ml USI:>~pªItment.Qft\-gri~ultl!r~->_WestNïle VÌI1t~ US._ElJvirºmn~nt~ ..Prºt~çliºI)Ag~nçy~_EPA_ªnº...MºsŒJitº-_ÇmltrQl USJJeoI9giçal_SlJryey-,,__NalÜmªLWilºlifeJj~ªhhÇentª WestNiJe YirLls PrW.Ql http://www.doh.wa.gov/ehp/tslZooIWNVIWNV.html 10/10/02 Jefferson County Health and Human Services SEPTEMBER,- OCTOBER 2002 NEWS ARTICLES I. ~~If terrorism strikes, we'll get popular", Peninsula Daily News, September 15, 2002 2. "County stuck in budget malaise", Peninsula Daily News, September 24,2002 3. "County's draft budget proposes 1% increase in property tax revenue", P.T. LEADER, September 25,2002 4. "AIDS Walk focuses on teens", P.T. LEADER, September 25,2002 5. "County adopts saltwater rules", P.T. LEADER, September 25,2002 6. "SOS is working for environment", P.T. LEADER, September 25,2002 7. "Fewer young offenders facing court", Peninsula Daily News, October 1,2002 8. "Plan B prevents unwanted pregnancy', P.T. LEADER, October 2,2002 9. "County sponsors septic workshops", P.T. LEADER, October 2,2002 10. "County's flu shot clinics lost with budget cut", P.T. LEADER, October 2,2002 11. "Jamestown tribe to build dental clinic open to all', Peninsula Daily News, October 3, 2002 12. "West Nile Virus confirmed in state", Peninsula Daily News, October 3, 2002 13. "County budget hearings help commissioners decide direction", P.T. LEADER, October 9, 2002 14. "Flu clinics are ready", P.T. 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E S 8.. ~ &. Ii -... ~ it 11 "..c:: E :f.g ""\! ... 'i " ,.g 15 ~.~ j~sg.j:¡E~§Ji~ -5q ..c::ï¡:o;~f2t¡Ec::~8~=~ ]ðE Ž ~ -a j Ji ~ fo j l.; t. .~¡ N ~ o~ OQ) N>-. .8 .~ Q.) Q.) c:: c: obfJ '"d .8 . bfJ ~ c:: ,_ '"d c:: c: ~.~ ~8 .- Q.) "T \-¡ ...,) -- Q.):-;:::: ~~ ..al'õ~ ~b .~"'g-g __. c'ii iII~ ." oS,,! li~ r[ ~ -i ~ fob Þ:~] ~1! 1.&Ê ~1 e: -=...è. a. § · '" .,., t' Þs :! ... .. .5 ] § o"j. ! i ~ ,~ e. '; -5 8ii:g~c1."· ;U c:l!!-5~i .¡[ !; 8. i '::J.- ..c:: ~ ] =J~~ i~~~"§t~ i .5" ~ ':.... ]' i! oS ~ i 8;-- ~ ,.¡.-ð,.D ~.a .,...~ ø. -! 'it.:! 'Xi! n·ö'" ~j"íI ..ar!-S~", å o~l~lii.~ ~'i .1;'¡...,.,o"j ...~hs <::¡_,-c ,;"s- §. ~ 8·¡¡î~§t~ ~.~~ â ",'" s.5 §.g " d mmiltf1 ~! ',,"8 ,<>~~1t", ,.r'. Port Townsend & Jefferson County Leader ,...., r '1-;1.S -()J- cÐ County's 'draft budget proposes 1 % increase in property tax revenue By Barney Burke leader Staff Writer Officially, Jefferson County's preliminary budget for 2003 was published on Monday, Sept. 23. Trying to get a clear under- standing of the county's overall budget situation is another matter. Available in the auditor's office is a single public copy of a 2-inch- thick, three-ring binder containing organizational charts, mission slatements, performance mea- sures, and revenues and expendi- tures for each department. AJso available is a 257-page computer printout, again by de- partment, showing line-item rev- enues and expenditures. But the ;'big picture," the whole enchilada, is hard to find. How m,l)ch for maintenance and opera- tions altogether? Capital projects? Where do all the revenues come from. and what are the trends in county revenues and expendi- tures? Are taxes going up? Those questions can't be eas- ily answered by the budget docu- ments released so far. A five-page transmittal memo from COUnty Administrator David Goldsmith highlights some key points in the draft budget but also neglects to hazard a guess at the totals. Nor does the Sept. 20 memo say if an increase in propeny tax revenues is recommended. Budget, tax revenues up The total of expenditures in the draft 2003 budget, Goldsmith re- poned, is $38,914,433, up 2 per- cem from the revised 2002 budget of $38,305,538. Most of that in- crease is for new road projects, he explained. The general fund por- tion of the total, $ J 1,043,478, is down 9 percent from the 2002 level. As proposed, the budget calls for a I percent increase in prop- eny tax revenues, according to Goldsmith. That works out to about $45,000, he explains. . Last year, the commissioners voted against increasing property tax revenues. Goldsmith confumed that a 1 percent increase in property tax revenues does not mean that ev- ery person's property tax bill is going up I percent. Tax bills are also affected by the fluctuations in the value of the entire tax base. New propeny revenues gener- ated by development are not part of the I percent revenue increase, Goldsmith noted. Hearing scheduled Public hearings on the budget are scheduled for 2 p.m. Monday, Oct. 7. and 11 a.m. and 2 p.m. Thesday, Oct. 8. Goldsmith said he would make sure that summary copies of the budget are available to the public prior to and during the hearings. Once the budget is adopted later this fall, a summary form of the final budget will also be published, he said. "That's a really good idea," he agreed. Goldsmith's memo indicates that the $800,000 in budget cuts implemented in the middle of 2002 helped set the stage for a "balanced" 2003 budget with "modest enhancements to address pressing operational needs." As drafted, the 2003 budget restores a 4 percent: CUt in em- ployee compensation enacted this year. However, a new labor con- tract period in March 2003 and ris- ing healthcare costs are going to be an issue next year, according to Goldsmiili. It is proposed that one FTE (full·tÎme equivalent staff) be added to the community develop- ment depanment. The building official position is to remain va- cant, a plans examiner position would be created, and an admin- istrative assista,nt position. would be restored in iliat departm~nt, the memo indicates. The actual FfE number was 93.39 in 2000, 93.44 in 2001. In 2002, the county originally bud- geted for 100.72 FI'Es and later reduced that number to 89.72, Goldsmiili said. The draft 2003 budget.calls for 90.72 employees. Goldsmith's memo proposes a one-time $25,000 contract for an economic devel'opment strategy and ombudsman services from the Jefferson County Economic De- velopment Council (EDC). Not included in the budget is ilie establishment of an enforce- ment officer in community devel- opment. The current backlog of such cases has been mentioned at recent meetings of the plaruùng conunission and board of conunis- sioners. The draft budget has $3 mil- lion in capital improvements, in- cluding $40,000 to complete concrete work and other amenities associated with a Rotary Club pro- posal for a pavilion in H.J. Carroll Park, $75,000 for preparing a sewer plan for the Tri-Area and $57,000 to purchase an upgraded fingerprint machine for the sheriff's office. Goldsmith's memo identifies two policy issues in the budget. One is wheilier t,O use I percent of the gas tax for regional trail main- tenance, including the Larry Scott Trail. The oilier is wheilier to bond for two capital improvements aI. ready under way: the sheriff ad- ministration building and E-911 center, and the Casùe Hill office complex. The real estate excise tax could be used for this purpose, and inter~st raWs are his.tprically I,Ow, according to Goldsmith. Port Townsend & Jefferson County leader C!±) Two Blue Heron Middle School preteens carry the banner for Jefferson AIDS Services - with 8 little help from 8 dog _ during Saturday's AIDS Walk In Port Townsend. Photo by Janet Huck AIDS Walk focuses on teens By Janet Huck Leader Staff Writer distant in Jefferson County. Now there is one case of an HIY-positive teen here. So this year, Jefferson AIDS Services (JAS) officials decided to try to raise awareness of the life· long disease among teens at their AIDS Walk last Saturday, Sepl21. ''Teenagers were born into a world of AIDS, so they don't fear it anymore," said AI Hernandez, JAS chainnan, at his pre-walk speech. "We want them to fear it. They think they can take the AIDS cocktail and they will be tine, but they are looking at a lifetime of pills with honific side effects." Hernandez hoped the teens , and their parents listened. Saturday's walkers were gen- erous. The 2002 walk was a fi- nancial success, one of the three best in the last 10 years, raising more than $6,000. Many AIDS organizations, in- cluding JAS, have faced dwin· dling fundraising in recent years. In the last year, JAS saw its fund- Across the country, 50 percent of the new HIY cases are young people between the ages of 13 and 25. That's been true for sev- eral years, but the statistic has always been theoretical and 9-:;¿s-o?-- ing go down 2 percent while ils client base increased 40 percen!. Officials had to cut some pro- grams in order to keep donations to each client at $500 a year for rent, utilities or medicines. "Now, thanks to the great gen- erosity of the people of Jefferson Count, we can restore lost pro- grams and increase the life-sup- port payments to the clients:' said Hernandez. Every dollar raised goes to JAS clients, except for some small fundraising costs for the all-volunteer organization. "We are trying to soften the blow for people with AIDS ," said Hernandez. _ 7 _..__~, ,,-.. County adopts saltwater rules Barely eight hours after a new saltwater in- trusion ordinance took effect Monday morning, the Jefferson County Board of Co~ssioneI"S .' replaced it with an interim ordinance;'; . . The interim ordinance followed several con- ference calls last week among county cominis- sioners and staff andpersonnelfromthe~tate Department of Ècology (DOE);'Uncterthé ()rQi. . nance that had been slated to take effect Sept. 23, persons drilling a well within 1,000 feet of a well with a chloride level in excess of 200 paÎts per million would be refeITed to DOE fôràpos. sible variance. . Monday, the commissionersrcducedthahadius to 100 feet People drilling within that range will still need to go to DOE, and those between 100 and 1,000 feet will be required to submit a "char. acterization study" to the county under the interim or<tinance, county staff explained. The cost of such studies was estimated at $2,000 to $1O,(X)() each. The interim ordinance was adopted 2.I,with Glen Huntingford voting no. Huntingford said '" .'_ i 9-,), ~-O?--- L-fiA1)f¡~ he had reservations yviththe ordinance '~ it ex- isted, and the changésdidnotréij.eve his con- cerns. "Everything we dò tends to add another . $2,()OOto $10;000 to the c()st of that house," he said of families trying tòbecome hom~owners" Dan Tiµ~m~ss commented that the County was bemgiisked by "the state to do something it "dóesri~t~ve the authority to do."He noted that DOE drafted å policy 10, years ago suggesting thè 1,000 foot radius, butitwas never adopted, 'Back on July 23,the county adopted the ordi- nance (with a provision that it would take effect in 60 days) in order to comply with an Order from the Western Washington Growth Management Hearings Board. Acting ORan appeal brought by the Shine Community Action Council and the Olympic Environmental Council, the hearings board required the county to take steps to protect underground aquifers. The hearings board's conference call hearing at 9 a.m. Thesday, Oct. 15c'áii be observed by the public in the commissioners: chambers; Œ) ^. ~ =: ~ E: =: ~ ·5 ~ =: ~ ~ ~ ~ ~ ~ ~ .~ CIJ C CIJ ..¡.J ~ c.¡:: Q.. ~ ..v) 0 ~ Þ-& ~ C..¡.JV") ~ C c: o·¡::·- UQ..~ I I ""O~I Icn0G.) IU t I p.(f.£,,¢, ~~ ¡::~~~o££~ £'~e~~~~ ;ic ~;::It::sVJS"OO Co.<.=: ':>ü co ",0" . co.......o "';> ¡,;¡:; ......u¡::ª>'-."'«j~ oo..¿.......ç;: 0) .......2tï.:3 o' "Sr¡." =..c::¡:o«<.,jg ;: P 5 '2 ã g¡ 0.5 .5 .ã 11.,j «< ~ ~ '" õ..'~ 0-. 5 .~ .!:i ..... í:3 Ta u;E ~ P d) ..... "0 ;;> C " en '6.. E: " .;;= ,E 80.. ~ >..D ~ ~ 'to § ~ .,g ª ~ ] 0 .wd)t;¡::~ 58"Oo~ o_-E~en ~ ~ t>JJ ~ .... _ ~ § g ¡s.§ I .~ ....... ï§ gf 0) "' _ .!P"O ~ -"" (1 co'..... .... c ;>., I 0 S ..... 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'., " October 1, 200¿' Fewer young offenders facing court Juvenile crime cases halve in past 3 years niles will be charged this year in Jef- ferson County. The decline in juvenile court cases follows a decline in juvenile arrests. Arrests have declined in Jefferson County from 433 arrests in 1999, to 364 in 2000 and to 304 in 2001, records show. BY STUART ELLIOTI' PENINSULA DAILY NEWS Fewer juveniles are seeing the Clallam County juveniles inside of a courtroom as a defendant That's not the case in Clallam in Jefferson and Clallam counties. County, where more juveniles are According to statistics released being arrested, but fewer are head- last week, the number of felony and ing to court. misdemeanor charges filed against Arrests have increased from 678 juveniles in Jefferson County is pro- in 1998 to 845 in 1999 to 831 in jected this year to be less than half of 2000, Clallam County Juvenile Ser. what it was three years ago. vices figures show. "It's been a fairly noticeable Figures weren't available for last trend," .- said Jefferson County P . A year. Deputy rosecutmg ttorney In Clallam County, there were Michael Haas, who handles juvenile 657 charges filed against juveniles in cas;~e number of charges brought 1998, compared to 546 in 1999,450 in 2000, and 434 last year in Clallam against juveniles last year were at County. the¥h~o:~~~::l :~n~~i~:4dropped Haas credits Jefferson County's from 196 in 1999, to 167 in 2000, decline to aggressive preventative down to 133 in 200] I according to P~~I amths. I t t th . court records. . . .n e as wo or ree ye~s. 10 h f th . partIcular, there has been a slgnifi- . - And tree-quarters 0 e.w.a,y-"--;."1'-'f1ì~- r - èd . - I . te "through this year -,- at the end of. ~¡..e 0.." p ~c . on' ear y ,~n rve.n- Âugust - there'had been only 55 . ·~lOn,m fartuly and schools, ~e 88.Id. charges filed against juvenile offend. We ve also h~d an aggressIVe tru- ers. court records show. ancy program. . At that rate, fewer than 75 juve- TuRN TO JuwNILE/A2 (1) Juvenile: Crime CONTINUED FROM Al Some of those progrl1mJ! to deter crime - including cOm- munity-based detention facili- ties like the Proctor Home in Port TOWIUl8nd and a mentor- ship program in Quilcene ~ were to be funded through a 0,1 percent increase in sales tax. But that measure was trounced by 54 percent of Jef- ferson County voters in the Sept. 17 primary election. A similwo measure in ClaJ- lam County failed with 53 per- cent of voters opposed to a pro- posed 0.1 percent sales tax increase. Preventative progr,ams Despite the Jefferson tax measure's defeat, Port Townsend Police Chief Kristen Anderson-Post said she. too, believes preventative n~grams areDUlkingj( diff~:~ . She cited orgànizations like JOIN, which holds a monthly meeting between mental health, school, juvenile services, legal workers and others to diB- cuss coordinating services to help" at-risk" children. Port Townsend School Board Superintendent Carol Andreasen agreed. "A lot of people are attribut- ing it to early intervention," she said. Haaa said he doesn't see shifting demographics - the poasibility of leas juvenilea in the county - as a reason for the decline. "We would see schools clos- ing" if we had a juvenile popu- lation declining at the same rate arreøta and filings are, he said. In Clalliun County, Juvenile 8eTviCOi!$ Director Pete Peterson said it's hwod to say what's causing changes in juvenile crime rates. "It's really hard to make a black and white statement that this is how it is," he said. Statewide arrests Statewide, juvenile arrests are at a 20 year low, according to statistics released earlier this month by the Governor's Juve- nile Justice Advisory Commit- tee. Carol Webster. who heads· thè committee, said the changes are a result of early intervention program¡¡ started in the late 19808. "The prevention and early intervention programs are now bearing fruit," Webster SBid. "People in the school arena and elsewhere know what works. It's more of a science than before. " Haas traced the recent decline in Jefferson County to the Legislature's passage of the "Becca" bill in 1995. To supplement the "Becca" bill, state lawmakers toughened the truancy law to include stu- denta who woe disruptive. sus- pended. expelled or who consis· tently refuse to attend schooL "It beefed up the laws regarding truancy," Haas said. "Before, no one was enforcing it." F~mlly counseling Family programs have also helped make a difference, Haase added. , He cited a state Child Pro- tective Services family reconcil· iation program as an example. Therapists used to believe "one-on-one" counseling with juveniles was sufficient, Haas said. "But if you don't involve entire family, you might as well flush. money down the toilet." Haas said. "We're lewoning what works." Services like the family rae' o~ciJiation program are in dan- ger .of ~ing cut back or elimi- nated· because of county and state'budget woes, Haas said. Clallam County Detective Sgt. Steve Snover said law enforcement is supportive of preventative progrwns. "There are different reasons kids do what they do," he said. "In most cases, there WOe underlying reasons that can be addressed. "There's a need for educa- tion and intervention." Drugs and alcohol Snover said the most com· mon juvenile offenses are pos· session of alcohol or drug¡;, thefts, minor assaults. and bur· glaries. "We're not seeing serious crimes," he said. Snover said most of the ille- gal substances used by juvenile offenders in Clallam are not "hard drugs," but marijuana and alcohoL He cited Ii study by Clallam County Juvenile Services ear- lier this year that tracked 119 children booked into the Port Angeles youth detention center. According to the study, 89 percent tested positive for alco- hol and 70 perœnt for mari· juana. Only 3 percent tested posi· tive for methamphetamine. "It's a lot more disruptive," he said. "And a lot harder to hide from one's parents." Port Townsend & Jefferson County leader Plan B prevents unwanted pregnancy " I have heard of a pill that can possi- bly stop me from getting pregnant but doesn't abort afetus. Can youfill me in? The emergency contraception pill, or ECP, is a safe, effective method to pre- vent a pregnancy. It first came on the market about five years ago but is still not widely used. . When this drug, caned Plan B, is taken within 72 hours of unprotected sex, it can prevent unwanted pregnancy. Plan B is the most popular emergency contracep- tive because it's the most effective and has the least side effects. To be effective, women have to phone their health care providers right àfter hav- ing unprotected sex, and this can some- times be difficult or uncomfortable. The American College of Obstetricians and Gynecologists is encouraging providers to write prescriptions in advance so women will have access when they need it. Many health care providers encourage younger people to talk with their parents, but parental permission is not required to dispense Plan B. The health department will give a male Plan B to take to his partner if she has concerns about asking for it herself. Many people cohfuse Plan B with RU 486, the "abortion pill." ECPs such as Plan B will not work if you are already pregnant. Taking them will not harm a fetus. Plan B may prevent preg- nancy by temporarily stopping the release of an egg from a woman's ovary or, in some cases, preventing fertilization. The overall success rate for Plan B is 89 percent. This is not as high as for other contraception methods such as the pill (95-99.9 percent) or condoms (up to 97 percent), so they should not be used as regular birth control. ECPs are available by prescription, or at a clinic where you can get the pill. At www.getthepill.com. for a $24.95 fee, a doctor will call in a prescription to any pharmacy, seven days a week. Washington state allows pharmacists to sell ECPs di- rectly if they have prescriptive credentials. The number of phar- macies that offer ECP in Washington has grown from 40 in 1998 to more than 250 in 2002. Contrast this to England, where women, even minors, can obtain it free from certain grocery and drug chains. Efforts are under way in the United States to offer ECP over the counter to all. Plan B can be obtained locally at' · Port Townsend: Jefferson County Health Department. 615 Sheridan; phone 385-9400; 9 a.m.-4:30 p.m. Monday through Friday. · Port Hadlock: QFC Pharmacy; phone 385-1900; IS-minute walk-in visit, no appoìntment necessary. · Quilcene: Quilcene Family Planning Clinic behind south county clinic; 12:30-4:30 p.m. Wednesday only. Many payment options are available, from private and state insurance to sliding fee scale. Not being able to pay should not be a barrier. Call the Health Department for special pro- grams for low. income people. (T"I ,. :. '·lr."}j-'l .; Ji.a b' '.;''' ,1.- n.FF. ",Cl. ~a~! lr~I~.,'f,.scn. ..~ ,.;~en pqc-~ v,r '1i""''\..~'YJ((Sqn ....,...UlIty "!edical: ~orrm,~nity (or.2l) y~ars. She is p?-st director. of clini- cal services for Jefferson General Hospital. where she is cur- rently working on a special project.) Dear Dana By Dana Michelsen . CD (0-;2-0;)- (J) County sponsors septic workshops ," Sludge. Effluent. Septage. Flush. Sound líke a sanitarians' Scrabble game? In fact, most homeowners in ruml Jefferson County ¡'flush" to a "sludge/effluent/septage" sys- tem that treats and disposes of . their household wastewater, ac- cording to' Molly Pearson of the county Environmental Health Dep¡u1ment. These septic systems are meant to be effective, long-last- ing wastewater treatment sys- tems, explains Pearson. "The homeowner who knows the his- tory and location of the septic system uses that" information when making important deci- sions such as where to locate porches, decks, additions and landscaping," she adds. The Environmental Division of the Jefferson County Health and Human Services Department plans a series of three free work- shops to help homeowners. un- derstand the workings of their systems and help them be trouble-free. The workshops are from 6:30 to 8 p.m. at: . Quilcene - Thursday, Oct. ?w Î ~ LGA:f)E~R- ID--7.-ù 2- 10 at the Masonic Hall. . Brinnon - Wednesday, Oct. 16 at the Booster Club. . Port Ludlow - Thursday, Oct. 24 at the fire hall on Oak Bay Road. Learn tools fór operating and maintaining your system. Find out what impact your landscap- ing practices have on your sys- tem. Discover what you can do to prolong its life, and learn to recognize the signs of a failing or overtaxed system. Like almost. anything else, improper use of a septic system can cause damage, warns Pearson. "Using a garbage dis~ posal, for example, subjects the system to more accumulating solids in the tank, necessitating more frequent pumping," she says. "Water use is one of the most critical ways that a property owner can affect the septic sys- tem. One family can easily over- load the system with excessive water use," notes Pearson. For more infonnation about the workshops, call the Environ- mental Health Department at 385~9444. County's flu shot clinics lost with budget cut é) Wednesday, October 2, 2002 . A 11 Clinics: Cost Continued from Page A 1 Baldwin also said, "I would very much like to restore it on' a limited basis for seniors." She says she plans to meet with the doctors employed by Jefferson General Hospital around the end of November to see if they were able to absorb the cost through Medicare reimburse- ments and other fees. The cost of buying flu vac- cine, Baldwin said, is about $30,000. After April of each year, vaccine is no longer avail- able at the public health rate, she said. In addition- to paying for the vaccine, the county has paid for the malpractice insur- ance and nursing costs associ- ated with flu vaccinations. By Barney Burke Leader Staff Writer It looks as if the fiI:st victim of this year's flu season is the vaccination pro- gram funded in part by Jefferson County. Reductions to the health and human services budget of $90,000 in January 2002 and $150,000 in June 200h \e- sultedin"ihëelimination of flu shotijin- ics, the Port Hadlock family planning clinic and other expenses, says Jean Baldwin, community health director. Last year, flu shots from the county cost $10 each, Baldwin said. Although flu shots won '{ be available through the county this year, they are available through private physicians and some local grocery stores. Upcoming ÿditions of the Leader will have listings of flu shot availability in Jefferson County. The draft health and human services ,- budget for 2003 is $3.2 million, Baldwin said, much of it from state and federal funding sources, plus fees paid by cli- ents and their insurance companies. The county general fund contribution to health and human services programs has been "flat" for about 10 years, Baldwin estimated. "I did not put it [flu vaccination] in the budget" for next year, Baldwin notes. "If it works that they can get their flu shots, then we'Hlet it stay [private]," she said. Shots recommended It is not expected that there will be any delay in availabil- ity of vaccine this year, accord- ing to Jane Kurata of Health and Human Services, "but state and federal health officials are asking that people who are at high-risk for complications of influenza, or children getting flu shots for the first time, be immunized during October, and that healthy adults and children wait until November or later to See CLINICS, Page A 11 get their shots." An important change to this year's recommendations for flu vaccine is the encouragement that parents consider getting flu shots for children ages 6 months through 2 years old. said Kurata. Young children who catch the flu are just as likely to need hospitalization as the elderly. Children under age 9 receiving flu vaccine for the fIrst time need two doses given one month apart, she explained, High-risk people who should be immunized in Octo- ber include: · Anyone 65 or older. · Children and adults with chronic diseases such as heart or lung conditions, asthma, dia- betes, kidney disease or sup- pressed immune systems. · Residents of long-term care facilities. · Children receiving long- term aspirin therapy. · Women who will be moret than three months pregnant dur- ing the flu season. · Medical providers who provide direct care to any of the above persons. · Children under age 9 re- ceiving flu vaccine for the first time. ® Jamestown tribe to build dental clinic· ÓpenHto· 31·1 By JIM MANDERS PENINSULA DAlLY NEWS BLYN ~ The Jamestown S'Klal~ lam tribe is about to embark on a building project that wiJ] mark the tribe's entrance in the field of dental care. The tribe will use $348,055 of fed- eral Housing and Urban Develop- ment funds to construct a dental office on the bottom floor of a build- ing at the tribal headquarters on Old Blyn Highway, project coordinator Cindy Lowe said Wednesday. The top floor of the building will house a community center, shè said. The tribe is providing the funding for that part of the construction, Lowe said. The tribe has targeted late 2003 as the opening date for the tribal dental clinic, which will be open to both nOn- tribal residents and tribal members. Eventually, Lowe said, the tribe plans to combine medical and dental services in a building in downtown Sequim. TURN TO TIuBE/A2 Tribe: Dentistry project CONTINUED FROM Al A new building housing the services will probably be located near other medical facilities on North Fifth Avenue downtown, she said. The tribe originally planned to open the dental clinic first, but changed direc- tions when seven doctors decided to leave Virginia Mason Clinic Sequim earlier this year. Three of the seven Virginia Mason doctors joined the Jamestown S'Klallam tribal clinic when it opened in April. Two more doctors were added to the clinic staff in / 'D - '?-; -02. "OUf plans for the dental clinic were put on hold when the need fOf a medical clinic came up." CINDY LOWE project coordinator June and Lowe said a sixth is doing some work at Olympic Medical Center in Port Ange- les. "Our plans for the dental clinic were put on hold when the need for a medical clinic came up," Lowe said. The tribe initially plans to hire a dentist and hygienist to provide treatment 4 Or 5 days a week, she said. Specialists will be under contract to pro- vide oral surgery, orthodontics and other services. Lowe said a number of den- tists and specialists have shown an interest in working at the tribal clinic. Some of those are retired dentists who have moved to the Peninsula and are looking for something to do. Lowe said tribal clinics are attractive for retired dentists because they can avoid the high cost malpractice insur- ance. @ West Nile virus confirmed in state THE AssocIATED PRESS OLYMPIA - The West Nile virus has been detected for the first time in Washington state, in a dead raven found in Pend Oreille County, the state Department of Health said Wednesday. Tests at the National Wildlife Health Center Labora- tory in Madison, Wis., Con- firmed the discovery near Newport in northeastern ,- I () -"3._~ 0 2- PON, Washington, found during a 'state-run surveillance pro- gram. No humans have contracted the mosquito-borne infection in Washington state. Two cases of the potentially fatal virus have been reported in Washington, both acquired in other states. Neither patient developed a serious illness. "West Nile virus is moving west . . . so we have been expecting it to arrive in Wash- ington," said Jack Lilja, the health department's West Nile surveillance program managt:;r. Nationally, 43 states have detected. the virus this year, and 2,477 caSes have been reported to the Centers for Disease Control and Preven- tion -124 of them fatal, health officials said. Only about 20 percent of those bitten by an infected mosquito sþow symptoms of the disease, typically a mild fever. About 1 percent develop brain swelling or meningitis, which can be· fatal. The virus is carried long dis- tances by birds which are then bitten by mosquitoes. At least six mosquito species in Wash- ington state can carry the virus, state officials said. "The risk of West Nile ill- ness is low," Lilja said, "and taking precautions to protect against mosquito bites can help reduce your risk." ·~. Port Townsend & Jefferson County Leader ® County budget hearings help commissioners decide direction;, By Barney Burke Leader Staff Writer The Jefferson County Board of Commissioners conducted a series of public hearings on the draft 2003 budget Monday and Tuesday. The commissioners are slated to give preliminary di- rection to staff at 10:30 a.m. Thursday, Oct. 10. Final adop- tion of the budget hasn't been scheduled but might occur as late as December, Deputy County Administrator Gary Rowe said. Rowe's last day on the job is Friday, before he be- comes Skagit County's new administrator. The commissioners haven't made too many telling com- ments thus far in the process, but Glen Huntingford made a point to scrutinize $568,500 set aside for the purchase of 14 cars, truckš-and other vehicles. All three .commissioners ex- pressed interest in hearing from county employees about their ideas for saving money, Some- thing the employees requested when $800,000 was cut from the budget earlier this year. Public comments While some of this week's hearings drew little or no com- ments from the public, it was standing room only at Tuesday morning's hearing on public services. Sherry Kimbrough, chair- woman of the Jefferson County Substance Abuse Services Advi. sory Board, and Dick Gunderson, the county's sub- stance abuse coordinator, shared their concerns over the possibil- ity that the state Legislature might cut treatment funding in the next biennium. "We just have, to find money to make services happen," Gunderson told the commissioners. "We just have to. find money to make servìces happen," Dick Gunderson substance abuse coordinator Jefferson County Kimbrough explained that the county has been relying on state funding, and the state budget picture could mean tl),at "People who don't have the re- sources - they're not going to get services." Currently, the county contracts with priyate service agencies to treat people with alcohol, methamphet- amine and other substance abuse problems. Laurie Hampton was one of several speakers concerned about maintaining funding for Jefferson County 4-H pro- grams. Katherine Baril of Washington State University Cooperative Extension said that county funding of 4-H has been a wise investment in tenns of reducing law and justice eX- penses. The only county employee who came forward to address the commissioners as an indi- vidual was Dåvid Alvarez,. chief civil deputy prosecutor. Alv~ez urged that the commis- sioners approve the l' percent increase in tax revenues bè~ cause employees are working hard. He also suggested that another effort be made to fund law and justice services follow- ing tbe September defeat of a one-tenth of I percent sales tax for that purpose. Starting with the 2003 bud- get; a riumberof activities that were previously part' of the county's general fund budget have been placed in their own funds, including community development, cooperative ex- tension, and parks and recre- ation. Rowe said that the new funds "give the board an easier way to manage funds over the long tenn." R,Qwe" said that the long- , tertIi plan is for'these special ' funds' to receive' less general fund revenue, and to replace that revenue with grants and fees. He also mentioned that there is moneyín the parks and recreation budget to study the . possibility of creating an i~de- pendent, taxpayer-supported park and recreation district next year. By the numbers General fund expenditures are pegged at $11,043,478 for next year, down $1.1 million from the original 2002 budget and close to the revised 2002. . budget of$ll ,35 1,5 16. How- ever, these numbers aren't en- tirely comparable, due to some expenditures being transferred out to the new funds, Rowe said. The draft budget shows that adding the general fund and all other funds, projected expendi- tures are $40,070,717, up from. 2002's $38,221.361 (the 2002 figure is the original budget number; a co~parable. number for the mid-year revision in 2002 was not available Tues- ID-1-{J~ day). That represents about a 5 percent increase in spending. The proposed 2003 budget includes a 1 percent increase in both the general fund property tax levy and the road levy. Un~ der 1-747, locàl governments àre entitled to collect the addi- 'tional 1 percent, which does not include revenues from new construction, without a vote of the people. However, those in- creases' won't boost every in- dividual taX bill by 1 percent because of the growth of the tax base, CountY.Assessor Jack Westennan IIJ has explained. Total revenues for 2003 are projected at $39,140,769, up from the original 2002 estimate of$35,300,025. These numbers are not entirely comparable ei- ther, Rowe pointed out, as they include inter-fund transfers plus $2.9 million in bond pro- ceeds for the proposed sheriff administration building. But even though expenses arc up, staffing levels are down. Next year's budget calls for 288.84 full-time-equivalent (FrE)· employees, down 4.04 from this year's 292.88 (the revised 2002 figùre Was lower but couldn't be obtained Tues- day). In 1999,2000 and 2001, FI'Es were 268.08, 266.78 and 273.34, respectively. (Editor's note: The FTE numbers reported in the Sept. 25 Leader referred only to gen- era/ fund employees. Other buq,getnumbers in this story ref/ect updates and c/arifica~ tions provided this week.) ./ '" Flu clinics @ are ready Flu vaccine clinics will be tak- ing place in a variety of locations in Jefferson County in the com- ing weeks. People with a high risk for complications if they catch the flu are encouraged to get immunized early. High-risk people who should be immunized in October in- clude: · Anyone 65 or older. · Children and adults with chronic diseases such as heart or lung conditions, asthma, diabe- tes, kidney disease or suppressed immune systems. · Residents of long-term care facilities. · Children receiving long- term aspirin therapy. · Women who will be more than three months pregnant dur- ing the flu season. · Medical providers who pro- vide direct care to any of the above persons. · Children under age 9 receiv- ing flu vaccine for the first time. Parents of children ages 6 months through 2 years are en- couraged to get their children flu shots. "Young children who catch the flu are just as likely to need hospitalization as the eld- erly," says Jane Kurata of Jefferson County Health and Human Services. November and December are not too late for others to be vac- cinated in order to reduce their chance of catching the flu. Flu vaccination clinics · Dr. Richard Lynn, 1136 Wa- ter St., Port Townsend: Mondays through Thursdays, 3-5 p.m.; es- tablished patients only. · Jefferson General Medical Group, 834 Sheridan St., Port Townsend: Saturday. Oct. 26. 9- II :30 a.m. Medicare patients please bring your Medicare cards. All others p~:t~lP; 119. .in~;. surance will be billtJ! _. _.~ .-- · Olympic Frimary Care. 1010 Sheridan St., Port Townsend: Saturdays. Nov. 9 and 23. 9 a.m.-noon. Medicare pa- tients please bring your Medicare cards. All others pay $10; no in- surance will be billed. · Port Townsend Family Phy- sicians, 934 Sheridan, Port Townsend: Saturdays. Oct. 19, Nov. 2 and 16, 9-11 :30 a.m. Medicare patients please bring your Medicare cards. All others pay $10; no ins\.lrance will be billed. · QFC Phannacy hosts several clinics throughout the county this month, at a cost of $20. Pneumo- nia shots are also available. Medicare and Medicaid clients are asked to bring their Medicare. cards or Medicaid coupons. No- vember clinic dates will be an- nounced later.' ,Port Hadlock QFC Store: Thursday, Oct. 17,9 a.m.-5 p.m. Brinnon Booster Club: Fri- day, Oct. 18..10 a.m.-5 p.m. Quilcene Community Center: Thursday. Oct. 24. 10 a.m.-S p.m. Port Hadlock QFC Store: Fri- day, Oct. 25, 9 a.m.-5 p.m. · Safeway Pharmacy, 442 Sims Way. Port Townsend: Fri- days and Saturdays, Oct. ) 1-) 2 and 25-26, 1) a.m.-5 p.m. while supplies last. Flu shots cost $20; pneumonia shots cost $30. Medi- care will be billed; bring your Medicare card. · South County Medical Clinic, 294843 Highway 101, Quilcene: Mondays through Thursdays. 8-9 a.m. and 5-6 p.m. Please call first. FI u shots cost $10. Medicare patients please bring your Medicare cards. 'R L6ltDEK ID - 9-02-