HomeMy WebLinkAbout06 June
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, June 15, 2000
Board Members:
Dan II arpole, lvlember - CountY Commissioner DÙtrict # 1
Glen I [untingjòrd, Member - CountY Commissioner District #2
Richard IP'ojt, Alember - Coun!)' Con/missioner District #3
c;erf!r~y ¡l¡lasci, Alember - Port Tonmsend Ci!y Council
.fill Buhler, ["ice-Chairman - I lospital CommÏJ:rioner District #2
Sheila Westerman, Citizen at L.m;ge (Ci!y)
Roberta Fjiuell, Cbaim/an, Citizen at Large (Counfy)
Stat! Member.r:
.Jean BaldUlin, Nur.ring S en'ices Director
Ltlrry Fe!y, Em}ironmental Health Director
Thomas Locke, Nfl), Health qlficer
Chairman Frissell called the meeting to order at 1 :35 p.m. All Board and staff members were present,
with the exception of Commissioner Huntingford and Member Masci who arrived after the meeting was
in progress. Chairman Frissell introduced Mary Selecky, Secretary of Health for the State of
Washington and Marie Flake, Liaison for the Local Health Departments with the State Department of
Health. She also introduced Lynne Saddler as the new Director of Health and Human Services for
Clallam County.
APPROVAL OF MINUTES
Commissioner Wojt moved to approve the minutes of the May 17,2000 meeting. Vice-Chairman
Buhler seconded the motion. The motion carried by unanimous vote.
PUBLIC COMMENT
Chairman Frissell noted the letter in the packet from the Jefferson County Oral Health Coalition.
Member Westerman asked for more information about how oral health care fits with the issue of health
care access?
Dr. Tom Locke and Jean Baldwin responded that the factors in oral health care are costs, dental access
to care, willingness of dentists to take certain insurance (e.g. Medicaid), fluoridation, and sealants.
Dr. Locke noted the letter is addressed to both the Hospital Commissioners and the Board of Health to
consider oral health care as one of the dimension of health care access. He believes it is one of the most
critical health care issues with children.
Vice Chairman Buhler reported that recently Jefferson General Hospital received as many as 10
emergency room visits in one month resulting from a lack of dental care.
HEALTH BOARD MINUTES - June 15, 2000
Page: 2
Commissioner Harpole requested that staff acknowledge the receipt of the Coalition's letter, making
them aware of access discussions, and encourage their participation.
OLD BUSINESS
FOLLOW-UP REPORT ON SCHOOL IMMUNIZA TIONEXEMPTIONS: Dr. Locke reported
that in February the Board of Health discussed the fact that Jefferson County had the 2nd highest
exemption rate (8.7%) in the State for immunization of school-age children and staff agreed to look into
the matter for additional findings. He reviewed the State law regarding exemptions and listed the three
exemptions allowed: personal, medical, and religious. Public health nurses Jane Kurata and Ruth
McDougall conducted an assessment of the reported exemptions. The goal was to discover which
children were totally not immunized, partially immunized, and what differences there were in school
programs. The Public Health issues with exemptions are determining which students should be excluded
from school during an outbreak and getting a high enough percentage of people immunized
(approximately 95%) to prevent outbreaks in the community. The goal is to get the children back on an
immunization schedule.
Jean Baldwin said that with no child tracking system in place, the Department made the decision to put
forth the extra effort to go through every school record. Most principals were surprised at the
assessment. One person from each district, with good record keeping skills, was appointed to serve as a
resource to other schools.
Dr. Locke said even though there is not yet a simple system for record keeping on immunizations, the
Board of Health has an enforcement role dictated by the State Board of Health Code.
Commissioner Harpole recommended going back for a second review in October and November. If the
numbers are not changing significantly, then he believes a stronger message needs to be delivered.
Charles Saddler recommended issuing a cut-off date for individual compliance in the schools.
Lisa McKenzie explained that Jane Kurata has been discussing with each school ways they can change
their process to institute an immunization cutoff date. Schools have been reluctant to do that, however
this year she thinks local schools will do a better job.
Member Westerman said this is an important issue. Schools have taken a strong stand on removing kids
with head lice. She believes parents should be informed that until their child's immunizations are
complete, they will not be allowed.
Jane Kurata reported that one of the schools with a fairly high out-of-compliance rate has had an
increased number of children getting their shots up to date because they could not be enrolled in
kindergarten unless they had all of their shots.
Vice-Chairman Buhler said she is concerned how not immunized children will be identified in the event
of an outbreak.
HEALTH BOARD MINUTES - June 15,2000
Page: 3
Jean Baldwin said the schools will receive a packet of information this week and a follow-up packet in
September. Every year, schools receive this same information. She agreed to include in the letter that a
spot check will be done in October. This level of tracking is extremely difficult to do manually because
technology is not currently a part of the tracking process.
Commissioner Harpole said with many new school superintendents, how do we make sure our efforts
become a part of the institution?
Jean Baldwin proposed sending the report to all school board members.
The Board agreed that would be helpful.
Commissioner Wojt said schools are funded on the basis of their enrollment on October 1.
Mary Selecky proposed partnering with superintendents in the month of August, using the local
newspaper, informing parents to make sure their child's immunization record is up to date. The original
issue of the legislation on exemptions was liberty and the burden fell to the school for policing. The 296
school districts agreed to help implement the immunization law, but they argued they did not want to be
the ones to decide whether it is a true medical or religious exemption.
Chairman Frissell summarized the Board's recommendations. The report should be sent to school board
members from the Board of Health and follow up spot checks will be conducted in the fall to gauge
whether a heavier effort is needed.
Vice-Chainnan Buhler said the Board is not saying the children have to get their immunizations, but
that they need to complete the paperwork or keep the children out of school.
Charles Saddler said it appears that, with the number of exemptions there is a public health issue to
address. Making sure the public is truly receiving good information in making an informed decision
about those exemptions.
Lisa McKenzie said immunizations are discussed in the well-child clinic and WIC clinic. There have
always been a significant number of families who are of an alternative lifestyle and feel they are making
the best decision for their children. They do not trust immunizations and feel they are harmful for the
body. This remains one of the immunization clinic's biggest challenges. She indicated there are many
web sites that are anti-immunization.
Jean Baldwin reviewed the efforts to date working with doctors and offices.
Dr. Locke said part of the public education effort could list the high-quality Internet sites that present a
pro-immunization viewpoint.
Commissioner Harpole suggested that in the information packets given to local schools, the cover letter
include a list of resources for good information, either Internet sites or through the Department.
HEALTH BOARD MINUTES - June 15, 2000
Page: 4
Charles Saddler said in other jurisdictions there are advertisements listing the immunizations needed for
particular grades and at the bottom a list of information resources.
Jane Kurata said they will have an ad ready to go in The Leader later this summer.
Member Westerman suggested this information be in The Leader '8 back-to-school issue along with bus
schedules.
Chairman Frissell asked if the schools are provided with printed information?
Jean Baldwin responded that Hilary Metzger a school nurse has met with each district.
Jane Kurata added that copies of a newly-revised booklet that addresses risks and benefits of vaccines
are given to each school.
Lisa McKenzie said the Health Department has many fact sheets and booklets that they distribute and
make available.
Vice Chairman Buhler asked about targeting the doctors with a reminder to ask parents about
immunizations.
Jean Baldwin responded that the Health Department did an update in March with all of the clinic nurses
in the County.
NEW BUSINESS
THIRD PARTY SANITARY SURVEYS OF GROUP A WATER SYSTEMS: STATE AND
LOCAL ROLES: Larry Fay said this item was put on the agenda because of Mary Selecky's presence.
He felt it was a good time to have a discussion about state, regional and local partnerships, programs
and funding. However, because Bill White, the Assistant Secretary for Environmental Health, was not
able to attend the meeting, the discussion will be postponed.
From a management standpoint, Larry Fay said he views third-party sanitary surveys as an effective
program. However, he wonders what level of service are we providing and believes there may be ways
to partner in a multi-county region with the state facilitating some kind of dialogue.
Mary Selecky said she would enjoy and support scheduling and participating in a roundtable discussion.
She said water systems are high on the Governor's agenda.
Larry Fay said the County has an agreement with the State to perform local pool licensing and
inspection. Even though it is a State program, due to recent budget cutbacks the State is no longer a
partner as previously agreed and inspections have fallen solely on local Health Departments.
Commissioner Harpole suggested that once the roundtable discussions are complete, that there be an
opportunity to review the issues with the Board of Health possibly in August or September. He said and
Mary Selecky a!:,Tfeed it is a legislative issue.
HEALTH BOARD MINUTES - June 15,2000
Page: 5
JULY 2Ôl1l BOARD OF HEALTH RETREAT: Chairman Frissell reviewed the list of issues
prepared by her, Dr. Locke and Jean Baldwin. She asked the Board for additions, deletions or changes.
Dr. Locke addressed the issue of emergency preparedness to bio-terrorism as listed on the agenda. He
believes it might be useful for the Board to examine the survey of how well we are doing in delivering
fundamental public health services in the community.
Mary Selecky commented that to date, Public Health, as the third or fourth tier of emergency response,
has not been very involved. She reviewed the level of response and community resources.
Commissioner Harpole recommended rearranging the agenda to begin with the JCHHS Program Review
and that this portion be done during a working lunch.
Commissioner Wojt talked about including others in these discussions such as Bob Minty with the
Jefferson County Department of Emergency Management.
Dr. Locke recommended first collecting information about those relationships with emergency services
and other organizations.
A CONVERSATION WITH MARY SELECKY. WASHINGTON STATE DEPARTMENT OF
HEALTH: Mary Selecky delivered a slide presentation for the purpose of opening dialogue on the
status of public health. Her presentation outline was as follows:
X Impact of the safety of public health
X How fast can my community identify the next infectious disease?
X You will decide which problems to solve and how
X You will decide what policies will lead to better health
X People care about public health and they want results
X Difficulty meeting demands with tighter spending limits
X A Statewide communicable disease network
X A one-day test for E. Coli
X High childhood immunization rates
X Improving retailer compliance for tobacco sales to minors
X More lives saved through statewide trauma planning
X Our population is growing
X Growing population means environmental threat
X Poverty will continue to become a public health issue
X We're now dying from behaviors we can change
X Research in genetics will bring issues we've never seen - ethics
X Microbes will continue to adapt to a changing world - like HIV
X There will be continuing public health challenges - population growth, environmental pressures,
infectious disease, poverty and disparities, unhealthy lifestyles, tighter budgets, genetic research
X lO great achievements in public health since 1900 - vaccination, motor vehicle safety, safer
HEALTH BOARD MINUTES - June 15,2000
Page: 6
work places, control of intèctious diseases, decline and deaths from coronary heart disease and
stroke, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of
drinking water, and recognition of tobacco as a health hazard
X What will be the accomplishment in our life time?
Member Masci joined the meeting at 2:55 p.m.
She complimented the Board for their work on having joint meetings with the hospital. She
complimented the elected officials who said we will enrich our discussions if we add people to the table
- there are only about five or six counties that have followed suit. She complimented the County's
fabulous staff - their initiative in taking leadership roles, bringing their individual contributions, caring
about their work, and their dedication to providing service. She feels human health will be broadened to
focus on environmental health. Mary Selecky said Health's role is to look at human population-based
community health, she believes other departments focus on the bigger picture.
Commissioner Harpole said that in the top 10 list of successes for public health one of the main
practices was washing hands. He asked if counties might consider taking action improving public
awareness?
Dr. Locke said that through food inspection programs work is done with restaurant owners. He agreed
that even though the single most effective solution to infectious disease transmission is hand washing,
infections transmitted by needles and sexual means are among the most deadly of microbes.
Mary Selecky proposed that she and Dr. Locke get the State Board of Health to partner with local
boards of health on a singular issue like hand washing and request that the State to pay the bill for
purchasing cling-on stickers or bumper stickers.
Member Westerman feels that with people living longer environmental health is affecting public health.
She asked whether public health could be broadened to consider environmental affects to the public?
Mary Selecky said environmental health is the impact of the earth, air, and water on humans. She feels
there are issues, although on a smaller scale, concerning the consumption of contaminated water.
Commissioner Huntingfordjoined the meeting at 3:25 p.m.
Chairman Frissell thanked Mary Selecky and Marie Flake for coming today.
HEALTH BOARD MINUTES - June 15,2000
Page: 7
AGENDA CALENDAR / ADJOURN
Board of Health Retreat 12:30-5:30 - July
Solid Waste Ordinance and State Board of Health Update - August
Meeting adjourned at 3 :30 p.m. The July Board of Health meeting is canceled in order to hold a Health
Retreat. The next meeting will be held on Thursday, August 17,2000 at 1:30 p.m.
JEFFERSON COUNTY BOARD OF HEALTH
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Roberta Frissell, Chairman
~U~~-Chairman
L)~ lb- uJ~~Vvth--~~~ ~
Sheila Westerman, Member
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County Health & Human
Erin Lundgren
BOCC Office
PO Box 1220
Port Townsend, WA 98368
Services
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June 6. 2000
To:
Jefferson County Board of Health
JUN 0 9 2000
From:
Tom Locke. :\lD. '¡PH. Jefferson County Health Officer jEFFERSON COUNTY
BOARD OF COMMISSIONERS
Board of Health :\leeting - Thursday, June 15.2000
Subject:
The next meeting of the Board of Health wIll be held on:
Thursday. June 15.2000
1 :30 - 3 :30 P'.\1
Jefferson General Hospital Auditorium
Enclosed are a tentative agenda for this month's meeting, draft minutes of the last Board of Health meeting,
agenda materials and the department's monthly media report.
· Follow-up Reports -- Report on School Immunization Exemptions: In the Fall of 1999 an annual
report was released by the Department of Health that listed rates of immunization exemptions for the
school districts in each county in Washington State. Jefferson County had the second highest
exemption rate, at 8.ì%. among the 39 counties. In January and February of 2000, Jane Kurata,
JCHHS and Ruth :YfcDougall, DOH. conducted a survey of immunization records in all schools in
eastern Jefferson County. Their report and its tïndings are attached.
Inevitably. some parents will object to immunization of their children for religious. medical, or
personal reasons. Statewide this exemption rate has averaged around 3%. Our public health goal is to
assure that every parent has carefully considered the risks and benefits of vaccination and made an
informed choice for their child. Several potential problems in addition to informed exemption were
found in the course of JCHHS' survey. These problems have been communicated to the school
districts and we are actively working to correct them.
· Third Party Sanitary Surveys of Group A Water Systems: State and Local Roles. Jefferson
County and the Washington State Department of Health entered into an agreement to authorize JCHHS
to conduct sanitary surveys of "non-community" Group A water systems (such as those serving
restaurants, grocery stores, campgrounds, and community centers). This project is now complete. The
Department of Health has proposed expansion of this agreement to include community systems up to
100 service connections. Environmental Health Director Larry Fay and DOH's Bill White will discuss
the policy issues involved with Group A \vater system management in rural settings.
· A Conversation with Mary Selecky , Secretary, Washington State Department of Health: The
Jefferson County Board of Health extended a cordial invitation for Secretary Selecky to attend a Board
meeting. She has kindly accepted that invitation. The Washington State Department of Health was
created in 1989. Mary is the Department's third appointed Secretary. She began her tenure as acting
secretary in 1998 and was appointed to full position in 1999. Prior to her appointment, Mary had a
20-,.. year career as Administrator for the ~ortheast Tri-Counties Health District, chair of the
Washington State Assoc. of Health Officials Legislative Steering Committee, and a leader in the
i\'ational Health Officials Organization (X-\CHO). She has been a major architect of public health
reform in Washington State and has worked tirelessly to improve health care access in rural
Washington.
HEALTH
DEPARTMENT
360/385-9400
ENVIRONMENTAL
HEALTH
360/385-9444
DEVELOPMENTAL
DISABILITIES
360/385-9400
ALCOHOL/DRUG
ABUSE CENTER
360/385-9435
FAX
360/385-9401
.
Mary will begin her presentation with an overview of the State's public health system and the
challenges it faces. She will also be joining us for the Joint Board meeting that follows, where the
focus will be on rural health care access. Suggested topics for the Board of Health's discussion with
Mary are: public health reform in Washington State, tobacco prevention and control strategies,
building and maintaining community health partnerships, opportunities for collaboration between state
and local health jurisdictions, strategies for effective advocacy of legislative issues, and budget
forecasts for the 2001-2003 Biennium.
. Board of Health: Enclosed is a draft agenda for the Boards July 20th retreat. Board Chair Roberta
Frissell will host the retreat at her home. Lunch will be served from 12:30-1:30 PM. The work session
will follow from 1 :30 to 5 :30 PM.
If you have any questions regarding the enclosed agenda, or any additions to the agenda. please call Tom
Locke at 385-9448.
JEFFERSON COUNTY BOARD OF HEALTH
Thursday, June 15,2000
1 :30 - 3:30 PM
Board of Health Meeting
3:30 - 5:00 PM
Joint Meeting with Hospital District Commissioners
Jefferson General Hospital Auditorium
AGENDA
I. Approval of Minutes of Meeting of May 18, 2000
n. Public Comments
1. Letter from Jefferson County Dental Coalition
ID. Old Business
1. Follow-up Reports
A. Report on School Immunization Exemptions (20 min) Janerrom
IV. New Business
1. Third Party Sanitary Surveys of Group A Water Systems:
State and Local Roles (30 min) Larry
2. A Conversation with Mary Selecky, Secretary,
Washington State Department of Health (60 min)
3. July 20th Board of Health Retreat - Draft Agenda (5 min)
v. Adjourn
Next Meeting: July 20th, 2000
Draft Agenda
Joint Meeting
Jefferson County Board of Health
Jefferson General Hospital District Commissioners
June 15,2000
3:30 PM - 5:00 PM
Jefferson General Hospital Auditorium
Special Guest: Mary Selecky, Secretary, Washington State Department of Health
Suggested areas of discussion:
1) Rural health care access crisis -- the statewide perspective
2) Rural health care access crisis - the Jefferson County perspective
3) The role of the Department of Health in promoting health care access
4) Strategies for advancing rural health care access issues in the Governors office and
the Legislature.
5) Other areas of interest for Board members
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, May 17,2000
Board lvlembers:
Dan Harpole, J\;lember - County Commissioner District # 1
Glen Huntin¿ford, .\Jlember - County CommÍJsioner DÍJtrid #2
PJchard W'q/!, Member - County Commissioner District #3
Geoffre)l Masci, Member - Port Townsend City Council
Jill Buhler. Vice-Chairman - Hospital Commissioner District #2
Sheila Tf'Úterman, Citizen at Large (City)
Roberta Frissel/, Chairman, Citizen at Large (County)
S tail l'v[embers.·
Jean Baldwin, Nm:ring Services Director
Larry Fq)', Environmental Health Diret"tor
Thomas Locke, MD, Health Officer
DRAFT
Chairman Frissell called the meeting to order at 1:30 p.m. All Board and staff members were present
with the exception of Member Westerman. Commissioners Wojt and Huntingford arrived shortly after
the meeting began.
PUBLIC COMMENT - None
OLD BUSINESS
FOLLOW-UP REPORTS: Smokeless States Grant and Syringe Availability Brochure. See reports.
INFORMATIONAL ITEMS: Public Health Then and Now: Don Quixote, Machiavelli, and Robin
Hood. (See article)
NEW BUSINESS
CRITICAL HEALTH CARE ACCESS PROJECT: Dr. Tom Locke recommended the Board use
the Current Situation Report as a reference and highlighted sections that will be relevant in discussions
with the Hospital Commission. He said it is important for the Joint Boards to review their respective
roles and responsibilities. Thought also needs to be given to defining access and determining the role for
the local Board of Health in ensuring that access. The major factors influencing access are the level of
poverty, percentage of income from transfer payments, and death and birth statistics. The section on the
Health and Medical Care System, beginning on pg. 11, will also be important for joint discussions.
Member Masci questioned whether the COGME standards are a realistic comparison for Jefferson
County? Dr. Locke agreed that the standards do not reflect the real situation nor do they consider
alternative health providers. He believes it is more important to understand the health needs of the given.
HEALTH BOARD MINUTES - May 18,2000
Page: 2
population and determine whether they are being met. For the access project, one of the important goals
is to get the most current data. He believes it will be difficult making policy decisions with the
instability of health care. The rapid changes affect the ability to get good measurements. .
Commissioners Huntingford and Wojt joined the meeting.
Commissioner Wojt asked if the statistics in the current situation report on page 15, referred to bed
usage as opposed to bed availability? Vice Chairman Buhler said the average census is 12 beds and the
hospital projects that number will increase to 17. She said the Hospital Commission determined that its
number of beds is not conducive to going to a Critical Access designation.
Dr. Locke said another area he b¿iiev~s the Joint Board will be dealing within the months ahead is the
financial mechanism for medical care funding (pg. 17). Eighty-one million is spent for medical care
services for Jefferson County, representing nearly 15% of total local economy. Although this figure is
close to the national average, it is still substantially higher than any other industrialized nation.
Medicaid rates in Jefferson County (pg. 19) are below statewide averages even though average income is
also below statewide levels. Health Nurse Julia Danskin reported that between 1997 - 1999 many people
were dropped from medical assistance when they continued to qualify - so it is likely tþ.ose numbers will
rIse.
Dr. Locke said there is a grant proposal before the Washington Hospital Foundation for a workgroup to
come up with detailed options. Most important to the Joint Board will be accurate, up-to-date, and
hopefully, statistically meaningful statements on needs and various options for better meeting those
needs.
Commissioner Huntingford said if individual doctors cannot survive financially, how does the hospital
plan to pay the doctors and continue to provide access?
Vice Chairman Buhler responded that the hospital is trying to increase market share and is looking at
different ways of reimbursement. The hospital will hold on as long as possible with its goal of providing
health access for everyone. She said it is important to understand that the hospital is not subsidizing
physicians, but access to healthcare.
BOARD OF HEALTH LEADERSHIP CONFERENCE REPORT: Dr. Locke's conference report is
included in the agenda packet. He commented that Mary Selecky gave a particularly good presentation
on "The Role of Government in Public Health" and the round table discussions worked well.
Chairman Frissell felt the conference was excellent and well worth the time and encouraged future
attendance. She summarized the presentations given on the second day of the conference. Particularly
interesting was Ree Saylor's presentation on Governor Locke's Health Policy which she highlighted as
follows:
41 Public health takes a systems approach in contrast to the rest of the healthcare system --
double digit inflation is eating up the system.
HEALTH BOARD MINUTES - May 18, 2000
Page: 3
· They anticipate the next budget will require 45 cents of every new healthcare dollar to
maintain the present system as compared to 30 cents in the current budget.
· Creation of healthcare standards.
· Support for more flexibility with funding and fewer restrictions on Federal dollars.
· Universal childhood vaccinations are in jeopardy because of the cost of new vaccines.
· Rising costs of prescription drug for seniors.
· Prescription drugs are now 20% of the health budget compared with a previous 7%.
· No plan yet for a dependable source of funding for public health.
· Public health is the sole survivor of the 1993 Healthcare Reform.
· A positive aspect of the trend of large employers going for defined contribution plans is
that it is moving us toward a prevention focus.
· Budgets are going to get tighter. The Federal Government is giving grants to 10 States for
new blueprints for delivery, although they will not pay for direct services in the grants.
· To build trust, we have to defeat ignorance, especially with State Legislators.
Dave Knudson, Senior Research Analysis for the State House of Representatives Healthcare Committee,
reported the following:
· The budget approved this session was seen as a bridge until after the election.
· Individual health insurance will be available by the end of the year as well as a review of
pharmaceutical drugs.
· Implementation of changes in wages for caregivers will be monitored by the State.
· The House and Senate are reviewing the mental health delivery system.
· The final word on 1-695 has not been written.
· Legislators have not established priorities for spending and have no long-range strategic
plan.
Mr. Knudson recommended that local Boards of Health talk with legislators about local issues, show
them programs in action, have a presence in Olympia, give each legislator a point of contact for
questions and information, offer solutions and identify specific outcomes.
Commissioner Harpole said he found particularly interesting the chart on funding by local health
jurisdictions that it says good things about Jefferson County. Jean Baldwin said the figures are deceiving
and that the County comes out more in the middle when considering the expanse of services.
Chairman Frissell mentioned she has an additional report on the impacts of MVET loss on local public
health department districts.
AGENDA PLANNING AND BOARD RETREAT: Jean Baldwin reported Mary Selecky is
scheduled to attend the next Board of Health meeting on Thursday, June 15 at 1:30 p.m. Legislators and
Ree Saylor have also been invited. She requested input from the Board on structuring the day.
HEALTH BOARD MINUTES - May 18, 2000
Page: 4
The Board discussed various options and agreed that although there is a need to educate legislators, it
was premature to outline specific priorities for them. The Board agreed to use the July Retreat for
priority-setting exercises. It was suggested that when the legislators visit, possibly later in the summer,
that there could be presentations with priorities clearly outlined. Presentations would have added impact
if there was a symmetry on the major issues with other public entities such as the Economic
Development Council, local Chambers of Chamber, Hospital, and Olympic Area Agency on Aging.
Jean Baldwin, Chairman Frissell and Dr. Locke will structure the agenda for the June meeting. The
discussion about local rural healthcare access with Mary Selecky will be in the latter part of the Board of
Health meeting and will include the Hospital Commission.
The Board Retreat will be held on Thursday, July 20 from 1:30 p.m. until 5:30 p.m. in place of the
regular monthly meeting. The location will be Chairman Frissell's residence, with lunch beginning at
12:30 p.m. Dr. Locke, Jean Baldwin and Chairman Frissell agreed to prepare the retreat agenda. Ideas
for retreat topics include local Board of Health priorities for next year in relationship with State funding,
review of rough draft on performance-based budgeting, and the performance, partnerships and catalectic
leadership presentation. There was agreement to cancel the Joint Board meeting in July.
WASHINGTON STATE IMMUNIZATION SYSTEM FUNDING CRISIS: Dr. Locke reviewed
the problem that the State does not have an ongoing source of funding for the mandatory set of
vaccinations available through a universal access system. He reviewed the current funding structure and
the goal of corning up with a long-term strategy. Further complicating the funding problem is the
projected list of new vaccines has increased. The original rationale for public funding of vaccinations
was to protect the public against outbreaks. A number of new vaccines are moving into preventing
diseases which have personal health impacts, but negligible community-wide impact. Prevnar is one
vaccine that is now approved and will cost $240 per child -- more than the current seven mandatory
vaccines put together. There are some vaccines corning beyond 24 months that would address epidemic
diseases. While the rate of vaccination is increasing, the number of distributed doses is decreasing. This
represents a significant achievement in preventing waste. Dr. Locke suggested that by June, the Board
may want to take a position on the immunization issue and present it to Mary Selecky. The State Board
of Health has convened a task force that has nearly completed a long-term funding strategy for
immunizations. They have already agreed on the importance of maintaining universal access and the
federal purchasing plan. They will soon present their proposal to the State Department of Health and
Governor Locke.
INFANT DAY CARE: Commissioner Wojt said it has been brought to the attention of the County that
there is a critical lack of child care providers. The problems associated with the decline in childcare
providers are lack of suitable locations, poor pay, and poor training. He believes this crisis has mental,
physical, and economic ramifications for the community health and that childcare is directly connected
to giving children a good start in life. Jean Baldwin said there is also huge issue of communicable
diseases at daycare. The Health Department has a number of programs to help assist the public that may
need to be better publicized. She said this is a problem where more detail is needed and may be a good
retreat topic. Commissioner Harpole said a strong economy and low unemployment is pushing the crisis.
HEALTH BOARD MINUTES - May 18, 2000
Page: 5
INITIATIVE 725: HEALTH CARE 2000: Commissioner Harpole asked whether this item is going
to be tabled? Chairman Frissell said tabling the item to next month may not be appropriate due to its
timeliness. However, with the absence of Dr. Melanie McGrory this issue will be discussed at a later
date.
APPROVAL OF MINUTES
Member Masci moved to approve the minutes of the April 20, 2000 meeting. Commissioner
Huntingford seconded the motion. Commissioner Harpole noted that on pages 1 and 2, corrections
should be made to reflect that Commissioners Wojt and Harpole were late to the meeting, not
Commissioner Huntingford. The motion was amended to include the corrections on pages 1 and 2 and
the motion carried by unanimous vote.
ANNOUNCEMENTS· None
AGENDA CALENDAR / ADJOURN
Mary Selecky visit, Joint Board Meeting - June
Board of Health Retreat 12:30-5:30 - July
Solid Waste Ordinance and State Board of Health Update - August
Meeting adjourned at 3:40 p.m. The next meeting will be held on Thursday, June 15, 2000 at 1:30 p.m.
JEFFERSON COUNTY BOARD OF HEALTH
Roberta Frissell, Chairman
Geoffrey Masci, Member
Jill Buhler, Vice-Chairman
Richard Wojt, Member
Glen Huntingford, Member
(Excused Absence)
Sheila Westerman, Member
Dan Harpole, Member
J ~,,~ ?~ !) 11~ !J ~Y1 '1 !) t!l 1 ~ ~ !1 ,,~ ~!J!1 ",;~ 'fI
June 8, 2000
Jefferson General Hospital Commissioners
Jefferson County Board of Health Directors
Greetings:
As a representative group of concerned citizens and providers of oral health care, the Jefferson County Oral
Health Coalition is asking for your help. As you deliberate and develop strategies to address future health
care access, we appeal to you to give due consideration to the needs oflow-income and uninsured
individuals and families with oral health care needs. It is our conviction that dental access for many is very
limited or non-existent and is a basic health care need that deserves our full attention.
The Jefferson County Oral Health Coalition has been meeting for the past two years in an effort to identify
and address oral health needs in East Jefferson County. Every effort has been made to capture input 1Ìom
all stakeholders - 1Ìom clients to professionals. Participants have included: Tim Hockett, Maxine
Hoffman and Genaveve Starr from Olympic Community Action Programs (sponsoring agency); Cyndi
Newman, RDH 1Ìom the Clallam County Dept. of Health and HlIDlan Services; Julia Danskin 1Ìom
Jefferson County Health Department; Dr. Tom Hagen, DDS and Dr. Zoe Hagen, .MD; Stacy Quiggle 1Ìom
Dr. Scharf's office, Gordon Maul 1Ìom DSHS, Dana Fiekheisen 1Ìom Head Start, Cynthia RosenbllIDl, a
program participant and several others. The group has received support and participation 1Ìom DSHS, the
State's Health Care Authority, Jefferson General Hospital and Dr. Tom Locke (local health officer).
Our group's perception oflocal dental needs may be summarized as follows:
· a significant number of Jefferson County residents do not receive regular dental care
· among low-income families, dental needs are magnified
· many gainfully employed individuals have no dental insurance
· those with Medicaid coverage often cannot fmd a provider who will accept them
· there are not enough dentists to meet the needs of the community
· many county residents face multiple barriers to access (low-income, no insurance, living in very
rural areas, limited English speaking or developmental disability)
· waiting lists for access to our mobile dental clinics are long
Current steps to address these needs have been successful though limited. Community Action operates two
significant programs. The Oral Health Care Access Program (OHCAP) and the Voluntary Referral
Network (VRN). OHCAP provides hygiene and dental care at various sites using portable equipment. In
1999 the program saw over 1,000 people in both Clallam and Jefferson Counties. Participants were
charged fees based on a sliding scale. In addition to operating daylong clinics at various locations
throughout the North Olympic Peninsula, the program provided dental sealants and fluoride varnish
treatments to various schools and Head Start classes. A special adjunct to this program provided services
~~-
to over 200 people with developmental disabilities. Community Action also coordinates the VRN, a
network of physicians and dentists who agree to see referrals on an uncompensated basis.
These efforts, as good as they are, provide relief to only a small percentage of those in need and reduce,
therefore, only a part of the pressure placed on local professionals and the emergency room to deal with
indigent or low-income people. Area doctors and dentists still receive numerous requests almost daily for
care from people who are unable to pay. Many needy people are either deIÙed or asked to wait weeks or
months for access. The Jefferson General Hospital emergency room also receives a significant number of
dental emergencies each month, which, by the time they reach that stage, are fì.ùl-fledged medical
emergencies.
The Jefferson County Oral Health Coalition embraces a strong consensus that a local medical clinic
designed to provide free or reduced-price services would do well to include two or three dental operatories
whereby these needs could be directly addressed. This solution would stem the flow of dental emergencies
to the emergency room and would provide the oral health access 'safety valve' this community so
desperately needs.
As your partnership moves forward toward solutions to health care access, please remember that oral health
is a significant part of health.
We would very much appreciate the opportunity to participate in your process and are ready to make
ourselves available as resources for this important effort.
Thank you for your consideration.
For the Jefferson County Oral Health Coalition:
- I .~"Lt\
Timothy L. Hockett, Director of Operations
Olympic Community Action Programs (OlyCAP)
802 Sheridan, Port Townsend, 98368
360-452-4726
-=:.
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County Health & Human Services
June 5, 2000
To: Jefferson County School Districts
From: Jane Kurata, PHN and Lisa McKenzie, PHN
Re: Report on School Exemptions
Public Health Concern
The Washington State Department of Health conducts an annual survey of
school immunization exemption rates throughout" the state. Jefferson County was
found to have the second highest exemption rate for school immunizations in
Washington for school year 1998-99. Statewide, 2.8% of students were reported
to be exempt for required immunizations. In Jefferson County, the exemption rate
was 8.7%.
To fully assess the significance of this elevated immunization exemption rate, the
Jefferson County Health and Human Services (JCHHS) sought answers to the
following questions:
· How many students are totally unimmunized?
· How many students are lacking protection for specific diseases?
· Are these underimmunized students were in regular or alternative school
programs?
Response
In January and February, Jane Kurata from Jefferson County Health and Human
Services in collaboration with Ruth McDougall from the Washington State
Department of Health surveyed immunization records in all schools in eastern
Jefferson County. We reviewed Certificates of Immunization Status (CIS) forms
for all students who did not have complete immunizations. These students were
identified through a Washington School Information Processing Cooperative
(WSIPC) "At Risk" report for each school. Data was collected in several areas:
· Exemptions for all immunizations.
· Exemptions for only one dose or antigen.
· Types of exemptions (personal, religious, or medical).
HEALTH
DEPARTMENT
360/385-9400
ENVIRONMENTAL
HEALTH
360/385-9444
DEVELOPMENTAL
DISABILITIES
360/385-9400
ALCOHOL/DRUG
ABUSE
360/385-9400
FAX
360/385-9401
· Students who were out of compliance with immunization requirements but
without a signed exemption.
· School or program these students were enrolled in.
Findings
· 149 students in Jefferson County schools have signed personal exemptions
for all immunizations.
· 117 students are partially immunized with signed personal exemptions for
specific vaccines.
· 7 students have medical exemptions.
· 17 have religious exemptions.
A check of JCHHS immunization records shows some of these students are
immunized, but their parents have chosen not to report the student's vaccine
status to the schools.
The accompanying chart shows the number and percentage of students in each
school who are exempt or out of compliance, i.e. not completely immunized, but
with no exemption signed. These students plus those who are conditional (i.e. in
the process of completing their immunizations) would be considered "at risk" if a
disease outbreak were to occur. "At Risk" numbers and percentages are also
shown. For each school, data is shown as reported on the yearly Immunization
Status Report to the Washington State Department of Health on November 1
1999, and as determined by audit in January 2000. In the lower chart, data for
students in the various alternative programs is shown separately from those in
regular classes.
Highest exemption rates were found in Grant Street Elementary School and in
the various alternative programs. Grant Street's exemption rate was 13%. The
alternative programs, Chimacum Pi Program, Port Townsend ICE Program, Port
Townsend Mar Vista Program, Port Townsend Homeschool students, and
Mountain View Opepo Program together serve 250 students. 22% of these
students have signed exemptions.
Out of compliance rates were highest at Grant Street School, Port Townsend
Elementary ICE Program, Blue Heron Middle School, Chimacum Elementary
School, and Quilcene School. Compliance problems are mainly due to
inadequate records for kindergartners and 6th graders. Accurate compliance
data for Quilcene Schools was not obtained, as only kindergarten and 6th grade
records were reviewed.
Mountain View Elementary in the Port Townsend district and Chimacum Middle
School in the Chimacum district stood out as schools with well-organized records
in compliance with statutes. The staff at these schools is to be commended for
their efforts.
Conclusions
In the event of a disease outbreak, the Health Officer is authorized to exclude
students from school who are not adequately immunized. In Jefferson County, it
would be very difficult to determine which students should properly be excluded
from school. Of special concern are the 196 students who are out of compliance.
40 of these students have had all required immunizations, but the timing of their
immunizations did not meet Washington State standards.
We recognize that some parents are opposed to vaccination. We hope that
exemptions reflect an informed decision made by student's parents, considering
the risks and benefits of immunization.
We are concerned that there are other potential reasons for Jefferson County's
high rate of exemptions and students out of compliance. These could include:
· Low priority placed on immunization record-keeping in some schools.
· Incomplete assessment of student immunization status.
· Low priority given to staff training.
· Unfamiliarity with Washington State school immunization requirements.
· Lack of communication between parents and the schools.
· Signing of temporary exemptions pending receipt of records for
transfer students.
· Schools unwillingness to exclude students lacking proper immunization
documentation.
Recommended actions to address these concerns are included in the separate
reports prepared for each Jefferson County school district.
PORT TOWNSEND SCHOOL DISTRICT
ALL PROGRAMS BY BUILDING
School I Total I Total Percentage No. Out Percentage Total No. Percentage
Student I No. Exempt Of Out of Immunizations Immunizations
Enrollment I Exempt Compliance Compliance Not Complete Not Complete
Grant Street 392
Grades K-3
¡ 1/1/99 40 11.0% 0
2/2000 (+ ICE 1-8) 51 13.0% 52 13.3% 110* 28.0%
Mt. View 319
Grades 3-5
11/1199 35 10.9% 2 0.6%
!/2000 28 8.8% 0 0 28 8.8%
Blue Heron MS 390
Grades 6-8
1111/99 34 8.8% 0
2/2000 33 8.5% 74 19.0% 107 27.4%
Port Townsend HS 660 I
I
Grades 9-12
11/1/99 84 12.7% 0
2/2000 46 7.0% 12 1.8% 58 8.8%
*lncludes 7 conditional students
PORT TOWNSEND SCHOOL DISTRICT
REGULAR CLASSES - 1/2000
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
Grant Street 364 41 11.3% 49 13.3% 97 26.6%
Grades K-3
-
Mt. View 271 17 6.3% 0 0 17 6.3%
Grades 3-5
Blue Heron MS 390 33 8.5% 74 19.0% 107 27.4%
Grades 6-8
Port Townsend HS 512 27 5.3% 9 1.8% 36 7.0%
Grades 9-12
PORT TOWNSEND SCHOOL DISTRICT
ALTERNATIVE PROGRAi'\1S -1/2000
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
OPEPO 48 II 22.9% 0 0 11 22.9%
(Grades 1-5)
ICE 28 10 35.7% 3 10.7% 13 46.4%
(Grades 1-8)
ICE 38 7 18.4% 1 2.6% 8 21.1%
(Grades 9-12)
Mar Vista 52 8 15.4% 2 3.8% 10 19.2%
(Grades 9-12)
Running Start 41 2 4.9% 0 0 2 4.9%
(Grades 11-12)
Home School 13 2 15.4% 0 0 2 15.4%
(Grades 7-12)
---
CIDMACUM SCHOOL DISTRICT
ALL PROGRAMS BY BUILDING
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
Chimacum Elem. 627
Grades K-5
II¡lì99 39 6.2% 20 3.2%
1/2000 33 5.3% 30 4.8% 63 10.0%
Chimacum. MS 408
Grades 5-8
111\/99 50 12.3% 7 1.7%
1/2000 36 8.8% 2 0.5% 40* 9.8%
Chimacum HS 481
Grades 9-12
Total all Dro!!:rams
llì 1/99 26 5.4%
112000 23 4.8% 7 1.5% 30 6.2%
*Includes 2 conditional students
CIDMACUM SCHOOL DISTRICT
REGULAR CLASSES - 1/2000
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
Chimacum Elem. 627 33 5.3% 30 4.8% 63 10.0%
Grades K-5
Chimacum. MS 366 25 6.8% 2 0.6% 27 7.4%
Grades 5-8
Chimacum HS 434 17 3.9% 6 1.4% 23 5.3%
Grades 9-12
CIDMACUM SCHOOL DISTRICT
ALTERNATIVE PROGRAl'1:S -112000
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
Pi 42 11 26.2% 0 0 13* 31.0%
(Grades K-8)
Pi 26 5 19.2% I 3.8% 6 23.1%
(Grades 9-12)
Running Start 21 1 4.8% 0 0 I 4.8%
(Grades 11-12)
* Includes 2 conditional students
SMALL SCHOOL DISTRICTS
School Total Total Percentage No. Out Percentage Total No. Percentage
Student No. Exempt Of Out of Immunizations Immunizations
Enrollment Exempt Compliance Compliance Not Complete Not Complete
Cedarbrook 16
Grades K-8
11/1/99 & 1/2000 3 18.8% 0 0 3 18.8%
Ouilcene 325
11/1/99 17 5.2%
1/2000 IS 4.3% 19* 5.9% 34** 10.5%
Swan 30
Grades K-5
1/11/99 & 1/2000 2 6.7% 0 0 2 6.7%
K-6 only
** Includes exemptions for all grades plus acc for K and 6 only
*
Sanitary Survey Report
Background
The Group A Water System Regulations (Chapter 246-290 WAC) require a "comprehensive
system evaluation" to implement the 1996 amendments to the Federal Safe Drinking Water Act.
The system evaluation, more commonly referred to as a sanitary survey, is an effective tool for
public health protection.
Jefferson County signed an agreement with Washington Department of Health (DOH) in 1999 to
perform sanitary surveys of Group A- Transient Non-Community (TNC) Water Systems and
evaluate the status of each system. The TNC systems are those for things like restaurants,
grocery stores, campgrounds and community centers. TNC systems are characterized by having
periods of intensive use, and periods of low use.
As a part of the contract, DOH provided funding to Jefferson County Health and Human
Services up to a total of $6,000 to survey and evaluate compliance with up to 30 TNC systems in
Jefferson County.
Findings
The list of systems to be evaluated was reduced to 25 systems because state and federally-owned
systems (mainly campgrounds) were not evaluated by Jefferson County. Of the 25 systems to be
evaulated, only one system has not been surveyed, nor has a survey been scheduled. Three
surveys are scheduled for the month of June.
There are three "levels" of compliance, as determined by the water system permit: green (in
substantial compliance), yellow (need further assessment), and red (in substantial non-
compliance).
Summary of Findings
In substantial compliance Need further assessment In substantial non-compliance
9 systems 7 systems 5 systems
The systems in substantial compliance will be issued green operating permits when operating
permits are renewed for 2001. For systems in substantial non-compliance or need further
assessment, DOH will be issuing a Bilateral Compliance Agreement with the purveyor to correct
the identified problems, or complete the additional assessment activities to achieve compliance.
Several of the systems in substantial non-compliance are located in Quilcene. DOH enforcement
actions will concentrate on connecting those water systems to a community system in Quilcene,
if one were to be developed.
Next Steps
The 1996 update to the Safe Drinking Water Act required that sanitary surveys be done .once
every five to ten years, depending on the size of the water system, and the risk of the population
utilizing the water supply.
Jefferson County Health and Human Services will be completing its contractual obligation
within the next couple of months for the Group A- TNC water systems. DOH has proposed an
ongoing program for Jefferson County to continue conducting sanitary surveys, expanding to
include both smaller community (less than 100 connections) and non-community water systems.
There are approximately 50 community and non-community Group A water systems that would
qualify for the proposed program in Jefferson County (i.e., less than 100 connections). Of those
systems, about 15 will need to have a sanitary survey in the next two years, about 15 will need to
have a sanitary survey two to four years from now, and about 20 will need to have a sanitary
survey between four and six years from now. Because of water rights requirements, it is unlikely
that there will be significant numbers of new Group A public water supplies in Jefferson County.
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SCOPE OF WORK: JEFFER~ON COUNTY HEALTH & HUMAN SERVICES
Qualified Third Party Sanitary Survey Program
Back2round:
Sanitary surveys have long been recognized as an important part of public health protection, because
they can help identify problems before significant health risks develop. In addition, many water
managers find the survey helpful for understanding ways to improve their water systems, and how to stay
in compliance with State drinking water regulations.
The Group A regulations (Chapter 246-290 WAC, July 1994) call for routine sanitary surveys for Group
A systems that serve a population of less than 4,101, if they collect less than five coliform samples per
month (WAC 246-290-300 (2)(e)). The term "Comprehensive System Evaluation" is used in the
regulations for a sanitary survey. Many water purveyors have already inquired about having these
inspections done.
DOH started conducting routine surveys during the past few years, but the agency does not have the staff
to inspect all the affected utilities (approximately 4000 water systems statewide). For this reason, a new
program is being developed to make sanitary surveys available for all Group A systems, and to fully
carry out the survey requirement. The focus of this program is on systems that do not have a certified
operator, and are not required to have one "(in general, Community systems with less than 100
connections and Noncommunity systems that use groundwater sources or purchase wat¡;;r from another
Group A public water system)".
Statement of Work:
The goals of the project are to: (1) inspect all assigned Group A systems at least once every five years;
(2) identify and resolve problems or potential problems the systems being inspected may have in
providing safe and reliable drinking water; and (3) strengthen the relationship between state and local
health jurisdictions and develop a model partnership between DOH and Jefferson County Health &
Human Services (JCHHS). The authority to carry-out this program is found in WAC 246-290 which
governs the safety of water systems. It should be noted that while DOH is delegating the responsibility
of conducting these surveys to JCHHS, in the event of significant public health concerns with a system,
DOH may schedule additional joint surveys.
Roles and Resµonsibilities
The goals of this project will be achieved through a collaborative effort between JCHHS and DOH.
There are approximatel& Community and Noncommunity public water systems identified in Jefferson
Coun~ whenba sanitary survey is n~eded in the next five (5) years. In order to accomplish this,
approxImately J..?'surveys per yeaiÀWIll need to be carried out based on a prioritized ranking. Since
Noncommunity systems are generally licensed under other local health programs they will be the focus
initially with a few Community systems being scheduled as is possible each year. Each year DOH and
JCHHS will meet to review and confirm JCHHS system priorities. The review, inspections, evaluation,
and oversight program for both Noncommunity and Community systems win include the following steps
for both DOH and JCHHS:
*~;~~
~
(~5
Qualified Third Party Sanitary Survey Program Responsibilities
JCHHS DOH-DW Div. (SWRO)
JCHHS and DOH to jointlv prioritize svstems for inspection
Send initial letter: survey required,
consequences +/-, purpose, process, time
frame, JCHHS contact person & telephone
number
As per a local process, send out application
and instructions
Receive application & fee
Maintain inspection list/roster
Schedule inspections
Provide file information & water quality info.
File review
Perform inspection
Complete DOH inspection checklist
Prepare report: checklist, summary letter to
purveyor, pictures, supporting documents if
required! as needed
Follow up inspections "informal enforcement"
as requested: for confirmation of minor repairs
or corrections.
Report to DOH; copy to purveyor with DOH DOH to provide letter acknowledging receipt
instructions of checklist with additional instructions:
follow-up actions, notification of coliform
monitoring reduction, "and contact person &
telephone number. Conduct any FORMAL
enforcement required
JCHHS and DOH to participate in quarterly coordination meetings
(mav be conference calls, meetings, or email correspondence)
Participate in quality control surveys & may Conduct quality control surveys & conduct
participate in follow up surveys. follow-up inspections as required for major
deficiencies
Annual review & confirmation of JCHHS Annual review & confirmation of JCHHS
system priorities system priorities
ATT6
7/9/98
EXDected Benefits/Outcomes:
It is anticipated that this project will result in:
A. Improved public health protection for consumers of water systems.
B. Increased water system owner education and consciousness of water sanitation issues.
C. Greater public confidence in water system safety.
D. Increased development of partnerships and resource sharing between state and local
governments.
E. Prevention of expensive and damaging future water system problems through proactive
assessment.
F. Greater appreciation by water system owners of local and state government when
agencies act in a constructive public health role.
Princiµal Points of Contact:
The following individuals have been identified as having responsibility for the oversight of this program.
The principal point of contact for DOH is: Vinnie Wright
DOH Southwest Drinking Water Operations
P.O. Box 47823
Olympia, W A 98504-7823
(360) 664-2203
The principal point of contact for JCHHS is: Larry Fay
Director, Environmental Health
Jefferson County Health & Human Services
Castle Hill Center
615 Sheridan
Port Townsend, W A 98368
(360) 385-9444
ATT6
7/9/98
Draft Agenda
Year 2000 Jefferson County Board of Health Retreat
July 20, 2000
12:30 PM - 1 :30 PM
Lunch
1:30 PM - 5:30 PM
Presentations: Performance Partnerships
Risk Communication Strategies
JCHHS Program Reviews: updates, analysis,
recommendations
Assessing Community Health Needs: the role ofCDC's
Local health emergency preparedness ("Bioterrorism")
assessment process
2000-2001 Jefferson County Board of Health Workplan
Legislative Agenda/Issues
Jefferson County Health and Human Services
MA y ~ JUNE 2000
NEWS
These issues and more are brought to you every month as a collection of news stories regarding
Jefferson County Health and Human Services and its program for the public:
1. "Health Fair provides tips" - P.T. LEADER, May 10,2000
2. "What's love go to do with it?" - P.T. LEADER, May 10,2000
3. Around the State: Port Townsend "County needle exchange will target IV drug users"-
The Olympian, April 24, 2000
4. "Animal shelter staff recovering from devastating vandalism" - P.T. LEADER,
May 24, 2000
5. "Drug-panel members quit" - Peninsula Daily News, May 26,2000
6. "Four resign from drug/alcohol board" - P.T. LEADER, May 31,2000
7. "Group forms for sufferers of Hepatitis C" - Peninsula Daily News, June 4,2000
8. "Escherichia coli (E. coli) 0157:H7 infections among children, Snohomish County"-
Press Release, Snohomish Health District, Communicable Disease Control, June 7, 2000
Education
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A Health Fair attendee enjoys a free massage provided by Sym
Hewitt of Dirksen Physical Therapy in Port Townsend.
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Nancy Obert has her blood pressure checked by Joni Williams
from the Laurel Shade Adult !=amily Home.
Health Fair provides tips
Forty- 5\ e agencies represent-
:ng 69 health and well-being en-
,k~ì\OrS exhibIted their services
t, ~,car:\ ::'~() attendees Saturday
~ll p,'í' T~·.\nsend Community
L~n(~;
Spon,,~red by Soroptimist
Imcrnat.:of1J.l of Port Townsend
anc East! efferson County. me
r:':f"'c,e ct' the tree event was to
;;"".Ilie ,;;¡'crmatIon on many
hC~llé:; an": ....·el1ness issues fac-
ing "\OrT,e;;. 2hildren and me eld-
er: y. .... ¡ t1'. .ln emphasis on taking
re,ponslbllity for one's own
health by knowing what re-
sources Me available in me com-
munity.
:\ wide range of topics cov-
erIng physical. mental. emo-
tlonal and spiritual well-being
\.. en: represented. Attendees re-
2e:\èd b.lgS ot "goodies" from
..arlOUS Jgencies and received
tL:kets for door prize drawings
held every half hour.
Attendees voted for their fa-
Sharron Sherfick and Marilyn Kjosen discuss health care with Grace Chawes. Sherfick and Kjosen
work in Dr. John Barrett's dental office in Port Hadlock. Chawes works with the American Associa-
tion of University Women and Heart Disease Program. Photos by Elizabeth Becker
vorite booths in four categories.
Most Creative went to AAL"\V
for its "Women and Heart Dis-
ease" display. and Monroe
Street :V!edical Clinic was voted
Most Humorous. Jefferson
County Health and Human Sa-
vices took Most Inform:1tive
honors. and the team from
Dirksen Physical Therapy '.vas
voted Friendliest.
Project coordinator :V!ary
Gaboury' extends a hearty thanks
to all the participants and vol un-
teers who made mis such a suc-
cessful event. She joins her
SL1roptimist sisters and me health
care exhibitors in pledging t?
make this an annual event in
\\ hieh the entire community will
tx> invited to participate.
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'What's love got to do with it?'
Computer virus puts temporary hurt on county
By Janet Huck
Leader Staff Writer
Last Thursday morning, SIX
Jefferson County computer users
opened up an e-mail message
that looked like a joke from a
coworker or loving message from
theIr partners. The subject line
read "ILOVEYOC:'
Once the attachment was
opened, the "love bug," one of
the most damaging computer
viruses to date. spread rapidly
through Jefferson County
government's computer sys-
tem. It invaded the user's e-
mail address book, launching
the virus to everybody in the
address book. (The previous
Melissa virus only sent its in-
fected message to the first 50
people in an address book.)
Local county information spe-
cialists have 300 addresses in
their books: individuals can eas-
ily have 200. And the virus
qUIckly mutated into new ver-
sions. including one that was dis-
guised as a joke with an e-mail
attachment reading "Very
Funny." Another malicious twist
on the virus was a Mother's Day
order confirmation.
By some estimates, the mes-
sage infected millions of com-
puters around the world and
cost billions of dollars in lost
productivity.
M:ark Pei! and M:att Lavigne.
the county's network administra-
tors, heard about the rampaging
virus about 7:30 a.m. By 8 a.m.,
they shut do"';'n the entire county
system and the City of Port
Townsend system, which has
been hooked mto the county's for
the last three months. Some 14
hours later. they had the system
up and running.
"It was such a new virus, and
it spread so fast. that the virus
vendors didn't have a fix until the
aitemoon," said Pei!. who started
running Norton Anti- Virus soft-
ware on all the infected files by
4:30 p.m. When they scanned the
"Luckily we lost
nothing. It could
have been a lot
worse."
Mark Peil
Jefferson County network
administrator
e-mail server and all the work
stations. they found thousands of
copies of e-mails with the virus
in it.
"We found it everywhere,"
said Peil.
Nonetheless. there were few
lasting problems. The love bug
virus targeted picture and music
files. "We don't have music
file3 in government machines,"
laughed Peil. But they do have
pictures. The virus deleted
20,000 building photos in the
assessor's office. Peil and
Lavigne thought they had lost
all the images; however, they
were able to recover them from
nightly backup files. The city's
Public Works department lost
its "as-built" drawings that
recorded all pipes and wires
buried underground, said Tyler
Johnson, who is in charge
of geographic information
systems. It too had backups.
"Luckily we lost nothing,"
said Peil. "It could have been a
lot worse. If people in the
assessor's office had to replicate
the images, it would have been a
lot of work. "
The best advice from com-
puter experts was: In the advent
of another virus, don't open
e-mail attachments.
Even though the county's
employees do a lot of their work
on computers, they found other
work to do on Thursday, said
Peil. "They did a lot of filing,"
he said.
At the Jefferson County
Health and Human Services
Department, MaryAnne
Preece-Rushton, administrative
and tinancial manager, said the
shutdown didn' t cause many
problems. Her department has
some stand-alone computer
systems, and the nurses do a lot
of record-keeping on paper.
which is then entered into the
computer. But the department's
computerized appointment cal-
endar was shut down. The re-
ceptionists took names and
phone numbers of clients ask-
ing for appointments and then
returned calls the next day.
Port Townsend City Man-
ager David Timmons lost his
computerized appointment cal-
endar, too:
The Port Townsend School
District encountered only a few
messages. "We didn't have very
many issues because we have
Macintoshes, and Macintoshes
weren't 'bit' so bad," said
Phyllis Marckworth, the district's
technology coordinator.
The virus targeted Microsoft's
e-mail system "Outlook" and
its Internet Explorer browser.
according to information spe·
cialists.
Jefferson General Hospita
either had good planning 01
good luck, said informatiol
systems manager John Nowak
as the love bug virus didn' t in
vade its system. Nowak ex
plained that the hospital has
tire wall that blocks certai
kinds of e-mails, and the 10\
bug's type of attachment ma
have been excluded. "On th
other hand. we may not ha\
received any messages," h
said.
"It was frightening," sa:
Nowak. "It replicated itself·
fast. In this day, we J.re depe
dent on computers for many
the operations we do, so it's ir
portant to protect ourse I ves.'·
lAY 10 ) 00 12: 08PM DOH r1CH
84
Mo,.,day, Apdl 24, 2000 . THE OLYMPIAN ,..'
_/
AROUND
THE STATE
.... .,. . .
PORT TO\\'NSEND
County needle exchange
,rill target IV drug users
The Jeff~rson County Board of
f.1ealth h2.s approved a. n~dle e."ícl'1ar.ge
pt'ogram fer ir.tpIVenous drug U$~rs.
Despite argumem:3 that their ac-
tion was promoting drug use, board
members voted 6-1 to'star-t the ex-
change program as soon as possible.
About 25 county resident$ are ex-
pected to participate it) ehe program.
"The COSt of inaction is rugb.," said
Thomas Locke. health officer for Jef-
ferson and Cìallam counties. 'ISyringe
exchange programs reduce disease
:r~smi5sion, increase ,ublic safety
a.nd lead to increased C\';3tment ~ro-
gram referrals. Failure to t.':\ke effective
action does just the opposite."
Olympian news service!'
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A 12 . Wednesday, May 24, 2000
Animal shelter staff recovering
from devastating vandalism
By Shelly Testerman
Leader Staff Writer
The Jefferson County Animal
Shelter has endured break-ins in the
past. oot none as significant as the
two within the last year and none as
trusrrating as the one perpetrated in
March.
"Before. people would climb
over the fence and cut the chain link
to get their dogs out. That happened
a few times," recalled animal con-
trol officer Sam May. Then. in July
1999. both of the operation's com-
puters were stolen. 'The equipment
was never recovered. oot May con-
sidered that some good came of the
bad. The shelter rook that opportu-
nity to replace the outdated comput-
ers with newer, more efficient
vers¡ons.
Then dawned March I. That
morning the office at 112 Critter
Lane was discovered in a shambles.
Desk drawers were dumped, barrels
of feed were knocked over. obscene
threats were scrawled on a wall and
on the tTont counter. And the new
computers?
'They were destroyed," May
sighed.
In addition to the thousands of
dollars of damage. several items
were stolen. Missing were a digital
camera. a portable radio. a tranquil-
izer gun with darts, and a small
amount of cash.
The sheriff's office had no leads
on suspects until April 9, when of-
ficers responded to a call at 2:41 a.m.
about a suspicious vehicle in the back
parking lot of the Evangelical
Church in Irondale. (Two recent
church break-ins had the caller on
alen.) There, in plain sight in the ve-
hicle. was the stolen tranquilizer gun.
Deputy Brian Graves and reserve
deputies Brian Peterson and Brett
Anglin were aware of the unsolved
animal shelter theft and recognized
that what they saw was "not a com-
mon item."
In the process of searching and
impounding the car. a digital c::un-
era was also found. It was later iden-
tltied as the one taken from the
animal shelter.
.-\11 four juveniles encountered
with the vehicle were arrested for
possession of stolen property in the
second degree{ since the value of the
items found in the car fell between
$250 and S 1.500) and released to
their parents.
Sgt Dale Wurtsmith said that in
the process of following up on one
of the juvenile's statements. he in-
terviewed another young man in
custody at the Jefferson County Jail.
The prisoner, 18-year-old Justin R.
Doyle of Port Hadlock. implicated
himself and 17 -year-old Chaz Rob-
ert Ward of Port Townsend in the
animal shelter break-in. .
Doyle said he had assisted Ward
by being a '1ookout" at the fence line
while Ward had burglarized the
building. The stolen prop6rty had
been placed in a yellow bucket and
buried near Second Street. off Dis-
covery Road. the sergeant was told.
The two suspects were subse-
quently arrested, and both were
charged last month in Jefferson
County Superior Court.
Because Doyle is legaIly an
adult, the two teens will be tried
in separate courts unless a special
ruling declares otherwise. said the
prosecuting attorney's legal assis-
tant.
Doyle was charged on April 19
with second-degree burglary as the
principal or an accomplice and for
first degree theft of property val-
ued in excess of $1,500. Each
charge carries with it a maximum
penalty of 10 years in prison or a
fine of $20,000, 'or both. His bail
was set at $1,500 cash.
Ward was charged on April 14
with one count of second-degree
burglary. His bail waS set at $500
cash.
In his statement on his guilty plea,
Ward was asked to state in his own
words what he did that made him
guilty of the crime. "I brock in to the
dog pound and through aroun some
stuff." he \!,/fote.
The sheriíIs office now cons¡¡;·
ers this to be a closed case. with one
exception. The Motorola porubie
radio is the one pieœ of stolen prep-
erty that has yet to be recovered.
May is relieved but not surprisec
that most of his equipment has been
recovered. "People talk. It's a small
town," he said. Of course. the tran-
quilizer gun may be unavailable un-
til after it has been exhibited as
evidence in the courttoom
The shelter has been limited to
the use of only one computer sinc~
the Y[arch I break-in. "Right no....
we miss our printer and copier." Ma:
said. ''We're having to write things
double," like all the insurance forms
after the burglary and all the adop-
tion and redemption forms for ani-
mals that are united with new or old
owners. "Everything's getting be-
hind." he fears.
Still. May credits his staff with
pulling through these tough Úilles:
Juanita Coyle. Bob Grewell and
Miya Boyd deserve praise. he said.
As do Ted and Erica Springstead
of Port Townsend. who donated a
digi tal camera in the aftelTllath of the
break-in. It has been used to take pic-
tures of animals for placement on the
shelter's website. which is still up and
running.
The news of the recent arrests is
welcome. But crime bust or no, car-
ing fur the animals and getting them
adopted are still the shelter's firsr
priorities. Right now the shelter is
full of needy critters.
"We are usually full:' sighed
May. With only 10 kennels.. that situ-
ation seems to be typical.
But May remains stalwart. He
has installed locks on the inside of
the kennels, shutting off the likely
entry route of the burglars. He can
even laugh about the difficulties he
has surmounted in the past One
summer the water supply was shut
off for a month "and I managed."
chuckled the pragmatic May. "You
gotta do what you gotta do."
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Four resign from
drug/alcohol board
By Shelly Testerman
Leader Staff Writer
Four of the 15 members of the
Jefferson County Alcohol and
Drug Abuse Advisory Board an-
nounced their resignations last
week, including chairwoman
Suzanne Schmidt.
Schmidt, Dr. Phyllis Solomon
and Juelianne Dalzell, county
prosecuting attorney, submitted
resignations midweek, effective
immediately. Barbara Carr
Johnson, Juvenile Court admin-
istrator, will stay on through the
next board meeting, making her
resignation effective June 15.
All four women cited frustra-
tions with the lack of autonomy
of the advisory board due to per-
ceived interference from the
Jefferson County Health and
Human Services department.
The advisory board is respon-
sible for making policy recom-
mendations to the Jefferson
County Board of County
Commissiòners.
"Our recommendations were
never heard," Dalzell wrote in her
resignation letter. "From the in-
ceptionºf.~he,f\¡cRþpl Advisory
Board, the Health Dep¡¡rtment
has run the show by setting the
advisory !loard's agendas."
Jean Baldwin is the health
department's community health
director, appointed in February to
supervise the advisory board.
She took over the role from
health officer Dr. Tom Locke,
who divides his time between
Jefferson and Clallam counties
and who was filling in after the
July 1999 departure of health
department Director David
Specter.
Baldwin was aware of angry
feelings about the previous health
department director and the way
the board had been structured
originally. Schmidt had been in-
volved in the advisory board's
beginnings.
"Suzanne's letter makes me
very sad because she has really ,
been a leader and had a vision,"
said Baldwin.
County COIDnÙssioner Rich-
ard Wojt is the BOCC's represen-
tative to the advisory board.
"It's unfortunate," was his re-
sponse to the resignations. "I do
know that it would've been more
helpful to the [BOCC) and to the
advisory board if they had made
presentations to the county com-
missioners if they felt strongly
something should be done."
Both Wojt and County Ad-
ministrator Charles Saddler are
'scheduled to attend the advisory
board meeting June 14.
Advertisements for the four
vacancies should be forthcoming
soon. Baldwin is anxious to have
them filled. "I think it is very,
very, important to get community
input on substance abuse issues,"
she said.
''Pr LEAD0k.
b- 3/-oð
Group forms
for sufferers
of Hepatitis C
By BILL LINDSTROM
PENINSULA DAlLY NEWS
Just like alcoholism, Hepatitis
C is an insidious disease that
keeps its victims in denial.
At least one Port Angeles resi-
dent wants to do something about
that.
"Alcohol speeds up the disease,
and many people are in denial,
either from alcoholism or Hepati-
tis C," said Kelly Grose. "We
wants to get the message of hope
to people. If they are treated
early, there is help."
She emphasizes that for
Hepatitis C sufferers, "abstinence
is the only answer."
Grose, along with Bonnie Cas-
sidy, owner of Woodlands Har-
mony Place, drug and alcohol
treatment center, 528 W Eighth
St., Port Angeles; are starting a
Hepatitis C support group.
The first meeting is scheduled
Wednesday at 7 p.m.at the Clal-
lam County Health Department
meeting room in the County
Courthouse, 223 E. Fourth St.,
Port Angeles.
Pharmacist to speak
Joe Cammack, pharmacist at
Jim's Pharmacy in Port Angeles
will talk about the medical treat-
ment, prognosis and side effects
of the disease.
Grose was diagnosed with the
disease about two years ago, but
contracted it about 20 years ago.
"It was a tattoo that became
infected," she said.
"I thought I was hit by a train.
I thought my life was over," she
admitted when the diagnosis was
pronounced.
She talks about the severe
depression that accompanies the
interferon anti-viral medication.
"It also gives you flu-like symp-
toms."
But she says "if people get
treatment early, they won't get as '
sick as I did."
That's the message she wants
to share with other sufferers.
Hepatitis C is a viral, blood-
borne infection that often doesn't
show up until 20 to 25 years later,
said Dr. Tom Locke, health officer
for Clallam and Jefferson coun-
ties.
It attacks the liver, yet an esti-
mated 100,000 state residents
don't even know they have the
disease, Locke said.
Acute carriers
Locke told the Peninsula Daily
News earlier this year that, while
there were no full blown diag-
nosed Hepatitis C cases in either
Clallam or Jefferson counties at
the time, "those people who con-
tracted Hepatitis C through
shared needle use in the '60s and
'70s have now become acute car-
riers. "
Grose said she never used IV
needles, but an infected tattoo is '
just as lethal, as are dialysis
patients who received blood
transfusions prior to 1992, as well
as cocaine and other users of
nasal-inhaled drugs.
Left untreated, the disease
leads to liver failure, liver cancer
and death.
"There is some coocern that
there are a lot of people running
around that don't know they have
the disease," Locke said earlier.
And that's Grose's concern.
"We just want to share our expe-
rience, strength and hope," that
people out there don't have to
suffer if they get treatment early.
For more information about
Hepatitis C call Grose at 360-452-
7294, or attend Wednesday's
meeting.
PDtJ
b -tf-åð'
M. Ward Hinds, M.D., M.P.H
Health Officer
Communicable Disease Control
3020 Rucker Avenue, Suite 100
Everett, VVA 98201-3900
(425) 339-5225 Fax: (425) 339-5217
TOO: (425) 339-5252
SNOHOMISH
HEAL 11-1
DISTRICT
Press release
Contact:
Jo Hofmann, MD
Snohomish Health District
425.339.5225
Escherichia coli (E. coli) 0157:H7 infections among children, Snohomish County
SNOHOMISH (June 7, 2000) - Since May 21, 2000, five children in Snohomish County have had bacterial
diarrhea caused by E. coli 0157:H7. Three were briefly hospitalized with bloody diarrhea and abdominal pain;
one child developed mild hemolytic uremia syndrome (HUS), but had no serious complications. Three of the
children visited a "petting farm" in the county several days before they became ill. This farm is a frequent
favorite for school trips to teach children about farms and farm animals. The fourth child, whose case appears to
be unrelated, did not visit the petting farm, but lives on another farm where cattle are raised. The Health
District believes it is likely that three of the children who visited the petting farm were exposed because of the
lack of adequate hand-washing facilities in the area where they interacted with farm animals. Two of the visitors
were infected with identical strains of the bacteria, and testing on the third is pending. An additional case is
currently being investigated.
E. coli 0157:H7 infection causes bloody diarrhea and abdominal cramps with little or no fever.
Symptoms range from mild, brief, nonbloody diarrhea to hemorrhagic inflammation of the colon complicated by
hemolytic uremia syndrome (HUS) that may result in anemia and kidney failure. About 2-15% of those infected
develop HUS, and of patients with HUS, 3-5% die; survivors may develop long-term kidney problems. Children
under five years of age and the elderly are most at risk for serious complications from infection.
The major source of the bacteria is undercooked, contaminated ground beef. Other food sources
have been implicated including unpasteurized milk and juices; sprouts, lettuce, and salami. Cases have also
occurred in association with animal contact (usually cows), and with contaminated, untreated water used for
drinking or swimming. Transmission probably occurs when food or liquid is contaminated with animal feces
containing the bacteria. Person-to-person transmission also occurs via the oral-fecal route, especially among
young children or those with poor hygiene. Preventing spread from animals requires thorough hand-washing
after contact with animal and their environment.
Treatment of this infection with antibiotics is Dot recommended. Antibiotics do not improve the
symptoms of E. coli 0157 :H7 infection; a recent study of children with E. coli 0157 :H7 infection by Children's
Hospital and Regional Medical Center in Seattle, showed that children treated with antibiotics were 17 times
more likely to develop HUS than those who were not.
The petting farm associated with the cases has been extremely cooperative with the
investigation by the Snohomish Health District and the Washington State Department of Health, and has
installed hand-washing facilities to be used by all visitors. Adult visitors to petting farms or zoos should assure
that they and particularly their small children wash their hands thoroughly with soap and running water after
contact with animals. Small children should be cautioned not to place their hands in their mouths after contact
with animals or their immediate environment.
. Healthy Lifestyles, Healthy Communities .