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Home My WebLink About11 November JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, November 22,2000 Board J\;lembers: Dan Hmpole, l'Vlember- COllnty CommiJ.rioner DiJtrict #1 Glen Huntingford, Member - C()un~y CommiJJioner DiJtrid #2 Richard Wqjt, Alember - County Commi.r.rioner Di.rtlict #3 Geoffrry MaJ.i, Member - Port TownJend City Coumil Jill Buhler, Vice-Chairman - HosPital Commissioner Di.rtrid #2 Sheila We.rterman, Citizen at urge (City) Roberta FriJSell, Chairman, Citizen at urge (Coun(y) StaffMember.r: .lean Baldwin, NlIrsi1{g Services Director urry Fqy, En/Jironmental Health Director ThomaJ Locke, MD, Health O.fficer Chairman Frissell called the meeting to order at 1:30 p,m, All Board and staff members were present, with the exception of Member Masci. The agenda was revised to include an update on the Ray and Liann Vines Ruling. APPROVAL OF MINUTES Member Buhler moved to approve the minutes of the October 19, 2000 meeting. Member Westerman seconded the motion, which carried by unanimous vote. OLD BUSINESS UPDATE ILLEGAL DUMPING ACTION - LINDA SEXTON: Prosecutor Dalzell has recommended that the Board hold an Executive Session to discuss enforcement procedures and options. Chairman Frissell proposed that this item be discussed at the Health Board meeting in December. It was suggested that the County Administrator be included in this discussion. Staff agreed to follow up and confirm the availability of the Prosecutor's Office and County Administrator. NEW BUSINESS RAY AND LIANN VINES RULING: Larry Fay said that the Department issued a permit this week after the Superior Court ruled in favor of Mr. Vines. Larry Fay agreed to provide the Board with a copy of the opinion. Procedurally, the Health Department and Board of Health's actions were in line. The Court looked to whether the zoning code was clear and explicit and agreed with Mr. Vines' attorney that the Planning Department should not have considered the opinion offered by the hearing examiner in another case. In the absence of an explicit policy in the zoning code, there was no prohibition for withholding the permit. He indicated that while there was a violation of covenants, the neighbors would have to pursue the case as a civil issue. HEALTH BOARD MINUTES - November 22, 2000 Page: 2 Commissioner Harpole suggested that while the County will not try to overrule covenants, he believes the County should at least have the ability to recognize them. There was discussion about the need to revise the zoning code in the Unified Development Code (UDC) to provide for explicit rather than implicit direction. A question was whether the County would specify in the UDC that an off-site drain field crossing zoning boundaries is a conditional use. If so, then a process needs to be set for considering it. Larry Fay proposed documenting some objectives so the Board can see processes and make sure this policy would be clear. He noted that when the County did the Comprehensive Plan, including an analysis of the commercial land requirements in the County, it assumed an on-site sewage system. If the County suddenly starts going off-site with sewage, it increases the commercial capacity of the land. Commissioner Huntingford said if the land is in the Urban Growth Area (UGA) zone and there is a desire to increase the commercial capacity, then maybe off-site community drain fields are appropriate. Commissioner Wojt said he would find it helpful for the Board of Health to make a recommendation on this issue to the Board of County Commissioners. Member Westerman supported the addition oflanguage in the UDC to reflect what she understood to be the Board's desire to keep commercial uses and commercial drain fields within the zoning boundary. Exceptions may be sought through an appeal process where people can apply for a conditional use permit. There was general agreement that the zoning code needs to explicitly state that an off-site drain field crossing a zoning boundary is a conditional use. Commissioner Harpole suggested that there may be merit to looking at conditional use and an appeal process including notification of adjacent property owners. There was general support for reviewing the applicable UDC section and talking to the planners about the Board's concerns and vision. Larry Fay said his recollection of the court's decision hinged on the fact that the Planning Department said it is not allowed under zoning. The Board exercised its authority on the on-site sewage regulation based on the zoning code. He recommended the Board deal with the public health and technical issues of the on-site sewage regulation and make sure the policy is clear and predictable for both the County and the applicant. The planners would then handle the rural centers and urban growth boundaries and address how intensely owners can develop their property. He also believes that when we are looking for consistency between health and planning policies, where possible, Health Department policies should not promote sprawl. He agreed to relay to the Planning Department the Board's discussion. HEALTH BOARD MINUTES - November 22,2000 Page: 3 LEGISLATIVE ISSUES: WSALPHO/WSAC PRIORITY ISSUES: Dr. Tom Locke reviewed the top four legislative priorities that originated with Washington State Association of Local Public Health Officials (WSALPHO) and were approved by the Association of Counties. The first priority is maintenance of funding $1.056 million for local health jurisdictions. Priority two is the State Drinking Water Program and affects Group B water systems in Jefferson County. The State Department of Health is proposing that money from the general fund be benchmarked to support community water systems with $1.4 million going to local health jurisdiction that regulate Group B systems. Commissioner Wojt left the meeting 2:00 p.m. The third priority is the Maintenance of the Universal Immunization Program. The system is unable to keep up with the introduction of new vaccines. The goal is to come up with an additional $12 million for the next biennium to add one new vaccine and provide additional immunization infrastructure. The fourth priority is maintenance of the Tobacco Prevention and Control Plan. Currently only $15 million of the $100 million has been committed for tobacco control or cessation activities. There was discussion and support for scheduling a meeting with the legislators when they are here to meet with the Law and Justice Council. Staff agreed to follow up with the Law and Justice Chair. LEGISLATIVE ISSUES: 2001-03 STATE BUDGET FORECASTS: Jean Baldwin reviewed the cuts outlined in the November 8, 2000 Reproductive Health Report provided in the agenda packet. She indicated that there is a 3-5% Department of Health cut to meet the initiatives, which would affect budgets beginning in June 2001. One issue surrounding teacher pay increases is that compensation for all union positions, not just teachers, will have to be reviewed. Chairman Frissell asked about the $100,000 reduction in the Teen Pregnancy Prevention Program. Jean Baldwin responded that this reduction was proposed by the State Department of Health when they were asked to identify additional budget cuts. While Jefferson County is one of the funded sites, to keep the service component of the Share program at Blue Heron, there would be a reduction in the research component. She said she would be trying to change the statement of work to continue to serve the same amount of youth (50). NOTIFIABLE CONDITIONS RULE REVISION: Dr. Tom Locke reported that a recent dental provider open house was a good opportunity to meet providers and inform them of the new revisions in the notifiable conditions reporting codes. He reviewed the changes to the list of conditions, which had not been comprehensively revised since the 1950s. Among the added conditions were chronic Hepatitis Band C, which were not previously reportable. HEALTH BOARD MINUTES - November 22, 2000 Page: 4 Jean Baldwin said the open house included approximately eight providers and was funded with Tobacco Control dollars. Staff played the four commercials. Providers not attending will get the information packet and a visit from staff. In response to a question about how decisions are made to take items off the list, Dr. Locke said that a clause in the reportable disease conditions states that providers can report anything strange or unusual. The items removed were either rare or failed to meet the 12 criteria (e.g., there may not be a public health argument for collecting the information). CHILDREN WITH SPECIAL HEALTH CARE NEEDS: Jean Baldwin provided an update on the project led by Marty Johnson, the goal of which is to meet with, offer guidance, and provide referrals to daycare providers in handling special care needs. Governor Locke's desire with this funding was to increase the quality of day care centers through education and to intensify provider training. This program is also meant to support day care providers so that they can continue to accept children from families with mental health issues. A recent idea was to develop a health care "passport" tracking system similar to what is provided to foster parents. To reduce burnout and turnover, daycare providers need to know what services, funding and training are available to them. Member Buhler recommended that providers use an intake form when they enroll a new child. There was Board support for proceeding with the grant. HEALTHCARE INDICATORS WORKSHOP - JANUARY 25-26: Jean Baldwin discussed the scope of the workshop, which is to review the updated communicable disease, violence, substance abuse and vital records statistics to better identify data gaps and better understand where we are with respect to these issues. Of the organizations invited, it was suggested that the Community Network be included. Ms. Baldwin noted that while the Kids Count information included in the agenda packet has broad data, it does not provide enough information to do detailed program analysis. Dr. Locke said the 2000 County Health Profile for Jefferson County included in the packet is a publication of county-based health indicators. There was a comparison of the reported rural as compared to state figures. The Board asked to receive more workshop information and it was suggested that the Law and Justice Council also be invited to attend. Jean Baldwin agreed to follow up with an invitation to the Council and the press. Chairman Frissell announced that she was invited to attend the Washington Health Foundation's first colloquium on the Future of Rural Health Care to be held on Monday, January 29, 2001. The objective is to work on proposals for long-term restructuring of healthcare financing and delivery systems. She will report on this event at the February meeting. HEALTH BOARD MINUTES - November 22,2000 Page: 5 HUMAN GENOME CONFERENCE: Dr. Locke said that he included the conference information because of the 2001 Board of Health agenda item "Program Measures (Genetic Research and Public Health Implications)." He reported that the Dean of the School of Public Health at the University of Washington visited the department last week to discuss training opportunities and how the university might be able to better serve local public health. The Dean frequently referred to the book "Betrayal of Trust, " which is described as an encyclopedic account of the collapse of international public health. INTERNAL ASSESSMENT: Chairman Frissell said the Health Department was asked to do an internal assessment by the end of this year. The questionnaire is currently being tabulated and a report will be available next month. Jean Baldwin said this data - staff input on the management structure, internal needs and system - will be available to and discussed by staff on November 30. Dr. Locke and the management team put the survey together. It is hoped this information will reveal how the department and staff are functioning without a director. The Board of Health and the County Administrator will receive the results and there will be a discussion about how to move forward with the management structure in the Department. PENINSULA SYRINGE EXCHANGE PROGRAM: Jean Baldwin said this program began on September 18 and has been open twice a week in Jefferson County and once a week in Clallam County. The program is not being used heavily, but regularly. Jean Baldwin said customers have said they are exchanging needles for their friends. Dr. Locke said the Department would share information on this program when more data is gathered. JEFFERSON GENERAL HOSPITAL: Vice Chairman Buhler said a press release from the State Department of Health indicated that Jefferson General had signed their agreement. A change being implemented for quality assurance purposes is the addition of a part-time Chief Operating Officer / Clinic Manager. At a staff meeting last week, there was an explanation of how to report problems to the Performance Improvement Council. The Council is also working on a more responsive system to receive complaints from the doctors. A bigger concern for the hospital is that Virginia Mason in Sequim and Port Angeles has quit accepting new Medicare patients because reimbursements are so low. The hospital is unsure how this will impact our community. There was some discussion about the difficulty getting KPS reimbursements. It was also mentioned that KPS is going to raise their rates. State Group Health also raised their rates by approximately 20%. Jean Baldwin said counties need to begin talking about a rural health clinic. HEALTH BOARD MINUTES - November 22,2000 Page: 6 AGENDA CALENDAR/ADJOURN Larry Fay reviewed the draft policies that Staff will bring before the Board for review next month: . Revision of Minimum Land Area for On-site Systems . Design standards for Elevated Fixed Media Filters . Applicable Treatment Standards for Previously Installed On-Site Systems where no Building has occurred 2001 AGENDA ITEMS: 1. CONTINUED STABLE FUNDING TO REPLACE :MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFOR1\L\NCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) Commissioner Harpole thanked the Board, especially its citizen members. The Board in turn thanked him for his efforts. Meeting adjourned at 3:30 p.m. The next meeting will be held on Thursday, December 21 at 2:30 p.m. JEFFERSON COUNTY BOARD OF HEALTH ;,) . " /~(UzQ .d:tld-~(t Roberta Frissell, Chairman ~\(~ It; '\JC~J(... ^'.~ .. Buhler, Vice-Chairman G~nlD or, - ) (Excused Absence) Dan Harpole, Member NOTICE OF MEETING CHANGE JEFFERSON COUNTY BOARD OF HEALTH The Jefferson County Board of Health will be meeting on Wed- nesday, NOvember 22,2000 from 1 :30 p.m. to 3:30 p.m, at the Jef- ferson County Health Depart- ment, 615 Sheridan Avenue, Port Townsend, WA 98368. Next month. the regularly scheduled meeting date will be resumed which is the third Thurs- day of each month. 2498m 11/15 Affidavit of Publication STATE OF WASHINGTON) SS COUNTY OF JEFFERSON) SCOTT WILSON, being sworn, says he is the publisher of the Port Townsend Jefferson County Leader, a weekly newspaper which has beeri established, published in the English language and circulated continuously as a weekly newspaper in the town of Port Townsend in said County and State, and for general circulation in said county for mora than six (6) months prior to the date of the first publication of the Notice hereto attached and that the said Port Townsend Jefferson County Leader was on the 27th day of June 1941 approved as a legal newspaper by the Superior Court of said Jefferson County and that annexed is a true copy of the November 22, 2000 meeting change as it appeared in the regular and entire issue of said paper itself not in a supplement thereof for a period of one OClasecHB weeks, beginning on the--15..thday of Novemhf'r ,20.DO-, & ending on the -1..5..tl:Pay of N ovp.m hp. r , 20~, and that said newspaper was regularly distributed to its subscribers during all of this period. That the full amount of $ 1 R. 00 has been paid in full, at the rate of $9.50 ($9,00 for legal notices re- ceived electro . tion, Publisher Subscribed and sworn to be10re me this~day of November r~otary Public in and for the State of Washington residing at Port Hadlock JEFFERSON COUNTY BOARD OF HEALTH Thursday, November 22,2000 1:30 - 3:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Minutes of Meeting of October 19, 2000 II. Public Comments III. Old Business 1. Linda Sexton Case: Meeting with Jefferson County Prosecuting Attorney re: enforcement strategies. Possible Executive Session. Larry (30 min) IV. New Business 1. Legislative Issues: WSALPHOIWSAC Priority Issues 2001-03 State Budget Forecasts 2. Notifiable Conditions Rule Revision Medical and Dental Provider Open House 3. Children with Special Health Care Needs Possible Action Item 4. Jefferson County Health Indicators Workshop Jan. 25-26,2001 5. Information Items: Human Genome Conference 1/05/01 (5 min) Book Review: Betrayal of Trust, the Collapse of Global Public Health Tom (10 min) Jean (10 min) Tom (10 min) Jean (10 min) Jean (20 min) V. Agenda Planning 1. Draft Policies for December Meeting A. Revision of Minimum Land Area for On-site Systems B. Design Standards for Elevated Fixed Media Filters C. Applicable Treatment Standards for Previously Installed On-site Systems where no Building has Occurred VI. Adjourn Next Meeting: December 21, 2000 (?) JEFFERSON COUNTY BOARD OF HEALTH -c- MINUTES Db . OR~f \ Thursday, October 19, 2000 .rAFt Board LVlembers: Dan Hapole, lvlember - Coun!.'y Commissioner Distl1ct #1 Glen Huntingford, jVfember - Count)' Commissioner Distrid #2 Ricbard Irqjt. L'vlember - County Commissioner District #3 GeojJrey Masd, Member - Port Townsend Ci(y Coundl ]ill Buhler.. l'ice,Chairman - Hospital Commissioner District #2 Sheila If,'"'-estennan, Citizen at Lar;ge (Ctry) Roberta Frisse/l, Chairman, Citizen at Large (Coun()) Stat! j\;[ embers: Jean Baldwin.. Nlming Servim Director La17)' Fqy, Environmental Health Diredor Thomas Locke, AID, Health O.fficer 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 and Commissioner Harpole. APPROVAL OF MINUTES Commissioner Wojt moved to approve the minutes of the September 21,2000 meeting. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. OLD BUSINESS On.site Sewa2e Code: Larry Fay said the adopted version included in the agenda packet incorporates all changes discussed at the last meeting as well as minor editorial changes. The ordinance was then circulated for Board signatures. He announced that individual workshops are being held with real estate agencies and three workshops will be scheduled for installers and designers. Another workshop focusing on the actual permitting process will include the Home Builders Association and individuals involved in real estate land development. Part of that workshop will involve identifying and addressing their concerns and customer service problems with the Department's process. Part of the grant awarded by the State Department of Ecology will be directed towards public education and outreach in the form of workshops with various homeowners and community organizations. A plan has not yet been developed for reaching the rest of the community. Ille2al Dumoin2 Action - Linda Sexton: Larry Fay reviewed communications to date with the County Prosecutor's Office regarding enforcement action against Linda Sexton. She has been cited for operating a recycling or disposal facility without a permit and has failed to present a solid waste compliance plan. In the correspondence, Prosecutor Dalzell outlined two suggested approaches for. moving forward: 1) beginning a new criminal investigation and issuing a citation; or 2) injunctive relief to enforce the order from the Board. He asked for the Board's direction on how to proceed? HEALTH BOARD MINUTES - October 19, 2000 Page: 2 Commissioner Huntingford questioned why the Board's action to date has not resulted in getting Ms. ~exton before a judge? Larry Fay said while he believes he has presented a case for seeking injunctive relief, it appears Prosecutor Dalzell feels that starting over with a new investigation may be the best opportunity to get Ms. Sexton into court. If there is a finding in the Board's favor, the failure to comply results in contempt of court. Commissioner Huntingford wondered whether the concern about moving forward with the Board's requested action relates to the significant amount of time that has passed since she was originally cited. The court may ask what is the emergency health issue. Member Masci suggested that Prosecutor Dalzell be invited to the Board of Health meeting to present strategies for proceeding. Dr. Locke said the Board of Health has already taken action and at this point it is a law enforcement issue. He suggested that if Prosecutor Dalzell does not wish to pursue prosecution, she should propose an alternative to the Board. Member Masci moved that Staff contact the Prosecutor and communicate the Board's desire to proceed with prosecution for the existing violations. If the Prosecutor has a suggested alternative, she should present that proposal to the Board of Health. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. NEW BUSINESS Washington Restaurant Association Food Worker Card Program: Larry Fay reviewed Jefferson County's history of issuing food handling cards and outlined staff time and cost involved in the current program (roughly $10 per card). New state food safety regulations require participation in a food safety class before taking the exam. While the new training program currently complies with these regulations, the costs associated with administering the exam exceed the statutory limit set at $8 per card. A new certification program proposed by the Washington Restaurant Association would certify qualified restauranteurs to conduct training classes and proctor exams. The aim of the program is to assist the Departments who may otherwise have difficulty conducting classes. A staff concern with this approach is ensuring all training classes are equivalent. Member Masci recommended an approach where the administrative cost of issuing food handler cards becomes part of the trainer certification program through the Washington Restaurant Association. Larry Fay talked about the difficulty of measuring the success of training. Environmental Health Specialist Susan Porto feels an indirect benefit of the County's training program is getting to know and developing relationships with the workers that she sees during regular inspections. The question facing the Department is how to provide a good training program at the least cost to the County? HEALTH BOARD MINUTES - October 19. 2000 Page: 3 Commissioner Huntingford commented that successful training depends largely upon restaurant management providing the resources to protect public health. Larrv Fav stated that staff is interested in whether this new training program will offer the public a more flexible training opportunity. Another benefit of the Restaurant Association Program is that it offers training in different languages. There was Board support for keeping the process as simple as possible and not changing the current system if it is working for the County. County Administrator Charles Saddler asked what percentage of people taking the test pass the first time? Larry Fay responded that while he didn't have the actual figures, the Department is running at a much higher success rate than when there was not a training program. After further discussion Larry Fay agreed not to pursue the training option and leave it up to the Restaurant Association to investigate whether there is demand from their constituents. State Department of Health 2001 Reauest Legislation: Dr. Locke reviewed a legislative agenda outline from the State Department of Health that will be submitted to controlling executive agencies. He reviewed what he believes are the significant issues. Additional comments are noted with each item. Proposals for 2001 Agency Request Legislation: .:. Department of Health Funding Authority (the opportunity to partner with the public sector). .:. Drinking Water Programs (currently being reviewed for cutbacks or changing the focus to save money); Larry Fay commented that some of the 15% will be used as pass through to local health departments to fund the Group B water programs currently not funded. .:. Health Professions Account Interest (movement to allow the fund to keep its own interest). .:. Water Recreation and Bathing Beaches (the State may propose pulling this item and . leaving it as a local option.) Larry Fay said an agreement currently exists with the State to address pools and spas, but not bathing beaches, through the Water Recreation Program. However, State funding for that program ceased and, in his opinion, eliminated the "partnership." Options for 2% Budget Reductions in 2001-2003 Biennium: .:. Drinking Water Laboratory Testing (water quality testing is handled adequately with the number of private labs. The issue is making sure the State has oversight over the quality of the lab work). .:. Teen Pregnancy, Family Planning, and HIV/AIDS. Jean Baldwin indicated these reductions would result in cuts of about $1,800 and $3,000 per program in Jefferson County. .:. Toxicologist Support. Larry Fay said the State provides critical support in specific instances such as the Norwalk virus. HEALTH BOARD MINUTES - October 19, 2000 Page: 4 Member Masci moved that the Board of Health send a letter to Mary Selecky of the State Department of Health stating its opposition to reductions in the budoet that constitute reductions oin funding for local health. Commissioner Wojt seconded the motion: which carried by a unanimous vote. Budget Enhancement Proposals for 2001-2003 Biennium: .:. Child Health Enhancement (the escalating cost of existing vaccines and the addition of new and costly vaccines is destabilizing the system. Child Profile is also a part of this request.) Of the $14.7 million, the cost of Prevnar is in excess of $12.6 million. In response to a question about the rate of infection and mortality. Dr. Locke indicated the Pneumoccocal infections are more an individual health issue rather than a population- based issue. Eleven major new vaccines are being developed in the United States. .:. Shellfish Testing. Larry Fay said growers are responsible for monitoring and testing. For Jefferson County, Vibrio has been a significant issue in the past. Dr. Locke said Vibrio, while naturally occurring in the marine environment, is in the same family as cholera and is dangerous. Dr. Locke mentioned other significant items on the list are: .:. Hepatitis C Surveillance .:. Recreational Water Quality .:. Capital-related enhancements and infrastructure to improve efficiency .:. Death Records Document Management (to fund imaging of records before they deteriorate) Chairman Frissell asked about the extent to which the County is involved in the mooring buoy situation at Mystery Bay? Larry Fay responded that the Board of Health discussed this issue some time ago. The State Department of Health made the County aware that due to the number of mooring buoy permits being issued that the area was approaching the density of a marina. The question that is hard to define is at what point does an area qualify as a marina because of its impact under the Federal shellfish sanitation guidelines? Access to Critical Health Service: Local Health Jurisdiction Roles: Dr. Locke indicated that the Proposed Standards for Public Health included in the agenda packet is additional information for the Board's discussion of critical health services with the Hospital Board. This information will become part of the Public Health Improvement Plan to be published and submitted to the legislature in December 2000. Dr. Locke reviewed the standards which are meant to identify the basic level of-health services that should be available to Washington State residents. He believes Standard 3, Plans to Reduce Specific Gaps in Access, is the most challenging. The rest of the information describes the criteria for determining critical health services, proposes a scheme by which local health jurisdictions can measure access, and lists critical health services by type. Member Buhler questioned why prescription services are not listed? HEALTH BOARD MINUTES - October 19. 2000 Page: 5 Dr. Locke responded that he believes prescription medicines are a component of other categories of care. While the affordability of prescription medicines might be an appropriate issue to add, it can remain a . critical health service in Jefferson County and not be included on the list. Member Buhler suggested that other jurisdiction might recognize it as a problem if it is listed. Dr. Locke said another item missing from the list that may be included is Hospital Services. It is hoped that these standards will provide Boards of Health with a self assessment tool for the health programs they oversee. This list is a starting point for discussion and local Boards of Health will be asked to provide input later. AGENDA CALENDAR/ADJOURN .. Continued Stable Funding to Replace MVET .. Access Health Care .. Program Measures (Genetic Research and Public Health Implications) .. Methamphetamine Summit .. Performance Standards & Community Assessment .. Tobacco Prevention And Coalition .. Fluoride .. Transit And Public Housing .. Bioterrorism Readiness & Plan .. Aging Population .. Water .. Maternal Child Prevention Goals (0-3) Meeting adjourned at 3:30 p.m. The next meeting will be held on Wednesday. November 22 at 1:30-3:30 p.m.. at the Health Department. There will be no Joint Board Meeting in November. 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 (Excused Absence) Dan Harpole, Member ~~/U~/UU nnu ~u;~~ rnA ~v~ ~~~ ~~I~ .a".v. vU~.&.UU.LU.a''''''',a''- Legislative Steering Committee . Oclober27.2000 LEGISLATIVE POLICY AREA: HEALTH & HUMAN SERVICES SUB.JECT: Maintenance of Funding - $1.056 Million for Local Health Jurisdictions Background/Issues: The original 1999-01 State Biennial Budget included a cut of around $700,000 in Local Capacity Development Funds (LCDF) in the Department of Health's budget. Local Capacity Development Funds are allocated to local health jurisdictions to spend on priority public health activities determined at the loeallevel. To offset the loss of these funds, the Legislature made a one-time appropriation of $1.056 million from the Public Health Services Account (a subse~ of the' Health Services Account) to the County Public Health Account. From the County Public Health Account, the Department of Community, Trade and Economic Development {DCTEO} distributed the funds to local health jurisdictions on a per capita basis. Without the.re-appropriation of those funds in the 2001-03 biennium, local public health will lose $528,000 in each of fiscal years 2002 and 2003. The source of funding for the $1.056 million this biennium was unexpended dollars in the Health Services Account (HSA). In addition to the overall loss of MVET in .excess of 10%, the loss of this $1.056 million represents an additional cut to local public health equivalent to about 6.6% of Local Capacity Development Funds (one of the' few state revenues that allows for local priority setting). The Washington State Association of Local Public Health Officfals . (WSALPHO) is asking for WSAC support to seek re-appropriation of the $1.056 million . . in the 2001-03 State Biennial Budget. Recommendation:WSAC support the'WSALPHO request to seek reappropriation of $1.056 million to be allocated to local health jurisdictions on a per capita basis in the 2001-03 State Biennial Budget. ~~ "1';' ,~ .-, '~~.' ;; -,.' ~ . 11/01/00 WED 10:13 [TX/RX NO 7601) .J.~/U.1./UU nc.u .LU..L..J rn.A OV;;' v"t~ Ovl'" Legislative Steering Committee October 27,2000 LEGISLATIVE POLICY AREA: HEALTH & HUMAN SERVICES SUBJECT: State Drinking Water Program Background/Issue: Washington State, through the Department of Health, has mai~tained regulatory authority over the Safe Drinking Water Act as delegated by the EnvIronmental Protection Agency. This Act applies to more than 12,000 regulated public water supplies in the State. The Department of Health has been notified that the . list of contaminants subject to monitoring will grow from the present 84 to 103 by the year 2002. In order to maintain this increased level of support for the larger public supplies (the Group A Systems), the Department of Health is proposing legislation that would provide funding from the general fund bench marked at 15% of the water utility distribution tax. This would generate about $3.9 million per year. Of that amount, DOH is proposing that approximately $1.4 million would be given to local health jurisdictions via contracts for the purpose of regulatory support activities over the smaller public water systems - specifically the Group B systems providing 5 or more. connections. The legislation proposes to continue properly siting, designing, constructing and testing Group B systems. but limit ongoing water quality monitoring and routine oversight for systems with 5 to 14 connections. This would provide some regulatory relief for the smallest public water systems serving four and fewer connections. The rest of the funding would be utilized to carry out the state's Group A water regulatory program, particularly implementing new.Safe Drinking Water Act requirements. '.,/'; Local health jurisdiction involvement in the Group B water systems is voluntary and has been carried out through Joint Plans of Operation between DOH and the individual local health jurisdiction. This proposed legislation would, for the first time, provide some funding to local health jurisdictions choosing to provide Group 8 oversight within their jurisdiction. " '.' The proposed legislation is based upon the recommendations of the Water Supply Advisory Committee. The Water Supply Advisory Committee includes representatives from the water utilities, small public water systems, municipal water utilities, local public health and other stakeholders. WSAC staff have also periodically attended the Water Supply Advisory Committee meetings. The Washington State Association of Local Public Health Officials (WSALPHO) considers safe drinking water a top public health responsibility and priority. Since involvement in Group 8 Water System oversight is local option, WSALPHO supports the agency request legislation in concept and would propose to continue working with the Department of Health on the details of the legislation and its implementation - including th~ funding proposal. WSALPHO is seeking WSAC support for the proposed legislation 11/01/00 WED 10:13 [TX/RX NO 7601J ~~/U~/UU n~~ ~U~~O rnA ~u~ ~~~ ~~,~ .....v. VU.l1l..Jl&.&.UU.L""'&"~""- . .. in concept and to continue working with DOH around the specifics of carrying out the proposal. Recommendation: WSAC support WSAlPHO's request to support the legislation in concept and to continue to work with DOH on the specifics of carrying out the proposed legislation including the funding proposal. +,,1 >. ~<' :.; " ...t." ~ ':' . ~ '. 1",' . ':i ,. ;'i;.~ ~(~ 11/01/00 WED 10:13 [TX/RX NO 7601) --::f."""'........... _......-....~ _........~- October 27. 2000 LEGISLATIVE POLICY AREA: HEALTH & HUMAN SERVICES SUBJECT: Maintenance of Program: Immunizations - Access & Funding Background/Issues: Legislation proposed by the Department of Health would codify the state's program of universal access and distribution of childhood vaccines. The bill defines a state duty to provide equal access to immunizations and establishes a program that includes surveillance to identify at-risk populations, distribution and accountability, promotion of immunizations, measurement of vaccination coverage and quality improvement. The proposed legislation includes a funding measure to support universal access to the new federally approved conjugated pneumococcal vaccine. Additionally, it would provide additional immunization infrastructure, like CHILD Profile (which was supported by WSAC in the last legislative session). Equal access to childhood vaccines and efforts to ensure an adequately vaccinated population is one of the most effective tools for the prevention of and protection from disease. Wrthout an adequately immunized population, we see reemergence of childhood diseases affecting not only the children and their families, but also schools, businesses and the community at large. Washington has historicaily been a universal access state. This proposed legislation codifies current practice. The Washington State Association of Local Public Health Officials (WSALPHO) supports Universal Access and Distribution of childhood vaccines and its supporting infrastructure including surveillance, accountability, measurement and quality improvement. WSALPHO is asking WSAC to support the DOH proposed legislation co.difying the state's program of universal access and distribution of childhood vaccines. Recommendation: WSAC support the DepartrrJent of Health Proposed Legislation.to codify the state's program of universal access and distribution of childhood vaccines and its (unding request for universal access to the new federally approved conjugated pneumococcal vaccine and additional immunization infrastructure including some funding for CHILD Profile. . l 11/01/00 WED 10:13 [TX/RX NO 7601] .L.J..I U.1.1 vv nuu..LV..L I .I. ,,~~ ....,,-.1 "'a'" .......... legislative Sleering Committee October 27. 2000 LEGISLATIVE POLICY AREA: HEALTH & HUMAN SERVICES SUBJECT: Maintenance of Program: Tobacco Prevention and Control Plan Background/Issues: In the 2000 Legislative Session WSAC supported placing $100 million of the Tobacco Settlement dollars into the Tobacco Prevention and Control Account to support a multi-year Tobacco Plan designed to reduce the overall use of tobacco products. Additionally, WSAC supported pl;:lcing the remainder of Tobacco Settlement dollars into the Health Services Account for use exclusively on health related programs (which in this biennium includes MVET replacement funding for local public health). The 2000 Legislature maintained the $100 million from the Tobacco Settlement in the Tobacco Prevention and Control Account and authorized expenditure of $15 million by the Department of Health during the current fiscal year. The Tobacco Prevention and Control Plan for this fiscal year includes a minimum of a $20,000 base for each county to spend on coordinated tobacco prevention and control programs designed to address tobacco use in their communities. Within each county significant community collaboration, including local public health, has mobilized to utilize that funding to address tobacco prevention and control. The state Tobacco Prevention and Control Plan is based upon programs designed, tested and shown to deliver results in other states. Studies have shown that to be effective, tobacco prevention and control programs must be effectively targeted and must be on-going. . Reducing tobacco use among youth is a major focus of the Plan and an on-going effort is necessary to reach new kids every year. Because tobacco use is the number one preventable cause of death, the Washington State Association of Local Public Health Officials (VVSALPHO) supports the original $100 million investment as the minimum amount needed to have an effective statewide tobacco prevention and control plan. WSALPHO is asking WSAC to reaffirm its support for maintaining the current funding in the Tobacco Prevention and Control Account. Recommendation: WSAC reaffirm its support for maintaining the current funding in the Tobacco Prevention and Control Account to ensure an effective statewide tobacco prevention and control response. 11/01/00 WED 10:13 [TX/RX NO 7601] Page 1 of 4 Jean Baldwin ._._ ......_...._... .__u._ "__ .. ....._.8... _. From: Theresa Connor [tmconnor@email.msn.com] Sent: Wednesday, November 08, 2000 8: 10 AM To: Carol Villars; Carole Moehrle, R.N.; Denise Schmidt; Dian Cooper; Dianne Waldermarson; Dorothy McBride; Jean Baldwin; Kathy Luch; Kim Carson; Lenore Morrey; Lenore Whitecar; Marni Marvin; Melinda Read; Michelle Howe; Peg Wehrle; Theresa Rundel; Yvonne Bicchieri; Carroll Twiss; Gary Miller; Don Skinner; Janice E. Tilley (JET); Jon Bartholomew; Kristen Glundberg-Prossor; Larry Clinton; Leigh Rosenwald; Linda Coleman; Linda McCarthy; Lori Gendron; Marilyn Knight; Mary Grinnell; Maura Roche; Michael Romo; Patty Butler; Roberta Riley; Sally Lust; Lois Backus; John Nugent; Gwen Chaplin; Chris Charbonneau; Susan Edgar Subject: Reproductive Health Report Plaimed Parenthood Affiliates of Washington Reproductive Health Update November 7,2000 PRESIDENCY UNDECIDED WITH 25 ELECTORAL VOTES AT STAKE. DEMOCRATS APPEAR TO HAVE CONTROL OF GOVERNOR'S OFFICE, HOUSE, SENATE AND STATE INSURANCE COMMISSIONER'S OFFICE Key statewide offices: Governor Locke won re-election by 58%. Mike Kreidler won the Insurance Commissioner's race with 53% of the vote. The Senate appears to have a 25 to 24 Democratic Majority. Democrats lost Ways & Means Committee chair Sen. Valoria Loveland in the 16th District. Loveland was defeated by Mike Hewitt 53 % to 46%. Sen. Lisa Brown (D-Spokane) will likely be the new chair of Ways & Means. Democrats also lost the 49th District Senate seat vacated by Sen. Al Bauer. Republican Don Carlson defeated Democrat Ben Gassaway 53.27% to 46.72%. In the 25th District Democrat Jim Kastama leads Republican Joyce McDonald 49.91 % to 47.51 %. 11/14/00 Page 2 of 4 In the 28th, Sen. Winsley defeated Clinton Lowry 68% to 31.99%. The House appears to be controlled by the Democrats by a 50 to 48 margin. 'For more details see http://www.vote.wa.gov/vote2000/results/leg sum.tpl IMPACT OF 2000 ELECTIONS ON STATE BUDGET V oters approved several ballot initiatives that have a major impact on the state's operating budget and, therefore, will our legislative efforts to protect family planning funding and secure new funding for STD diagnosis and treatment services. 4 Initiative 713 (animal Trapping) passed by 54.320/0 4 Initiative 722 (Tax Repeal/Limits) passed by 56.790/0. While the courts will likely strike down 1-722 on the same basis that 1-695 was struck down, OFM estimates that 1-722 would result in the following tax/revenue reductions: County Property Tax: $15.6 million Other county taxes, fees and charges: $9.4 million City Property Tax: $15.1 million Other city taxes, fees and charges: $45.5 million Other Property Tax Districts: $ 20.8 million 4 Initiative 728 (School Class Sizes) passed by 71.630~. 1-728 redirects $470 million in State General Fund revenue in the 2001-30 Biennium to provide dedicated funding for education. t Initiative 729 (Charter Schools) failed by 48.29% OFM had estimated 1-729 would cost the State General Fund $8-$16 million. 4 Initiative 732 (Teacher Salaries) passed 62.25% OFM estimates that during the 01-03 Biennium 1-732 will cost $302 million for K-12 and $21 million for Community and Technical Colleges. t Initiative 745 (Transportation Funding) failed by 42.3% 1- 7 45 would have reduced state revenues by approximately $42 million 11/14/00 Page 3 of 4 annual, and local governments' revenues by $11 million annual. The exemption in Sections 4 and 5 could have resulted in the additional loss of $50 million in annual state and local sales tax revenues paid by federal . contractors. F or more information see http://www.ofro.wa.gov/initiatives/2000initiatives.htm STATE AGENCY BUDGET REDUCTIONS In the wake of yesterday's election, state agencies will be asked to identify additional proposed budget cuts. The Department of Health (DOH) has responded to Locke's request for a 2% budget reduction with a proposed: ~ $100,000 reduction in the DOH Teen Pregnancy Prevention Program and a ~ $250,000 proposed cut in the Family Planning Program. T The Department of Social and Health Services (DSHS) had identified $86.1 million in reductions within the Medical Assistance Administration's (MAA) budget to achieve the agency's 2% reduction target. MAA had proposed an initial reduction of: ~ $72.3 million in adult dental services (which eliminated 84% of the adult dental program and limited care to emergency and pain management services) ~ $41.4 million in savings by expanding the Hospital Pro-share Program and replacing GF -S with federal Medicaid funds. ~ $8.5 million in reductions by eliminating eyeglasses and vision care for adults ~ $6.6 million in savings by implementing a therapeutic substitution program for drugs and a pilot project for disease management for high-risk clients. ~ $550,000 in savings by expanding estate recovery to all medical services provided to long-term care clients and increasing recovery staff. RISING HEALTH CARE COSTS IN STATE-FUNDED HEALTH PROGRAMS Rising costs and restricted funding are causing serious health plan shakeups in the Medicaid Healthy Options program. By the end of CY 2000, nearly a 11/14/00 Page 4 of 4 quarter of the program's 450,0000 patients could be displaced as some of the state's largest health insurers, including Regence Blue-Shield, leave the program because they can't cover the cost of seeing these patients. Budget . leaders will also be assessing how to provide sufficient dollars to cover rising costs in public employee health plans. State funded health program will provide health care coverage for over 850,0000 people per month this year at a Public cost of $1.4 billion. MEDICAID HEAL THY OPTIONS 200,000 family members on or begin diverted from T ANF $ 677 premium cost 8,500 pregnant women under 185% of poverty 228,000 children under 200% of poverty SUBSIDIZED BASIC HEALTH PLAN 130,000 persons under 200% of poverty not on Medicaid $ 195 premium cost PEBB $ 456 state's premium cost 235,000 active state and higher ed employees and dependents $ 40 state's share of premium 61,000 retired state and higher ed employees and dependents Anticipated 2001-03 rate increase for Active employees = 10% - 14% OTHER LEGISLATIVE HEALTH CARE EFFORTS In addition to the impact of the voter initiatives and rising state health care costs, our legislative efforts will be influenced by the efforts of other advocacy groups lobbying for Basic Health Plan funding and a federal way to provide health coverage to the parents of children enrolled in the Children's Health Insurance Program. 11/14/00 Washington State . ._ "'_" .' Revised Notifiable Disease Reporting Requirements - Effective September 2000 Health ~are Providers List . Immediate Notification to Local Health Department of the Following Suspected or Confirmed Conditions: Notification Within 3 Work Days to Local Heafth Department for the Following Confinned Conditions: r,' \.,...... "'.' ,. .... 1',_1 .itf..'I' .-..Il. .,...,'. ~ Animal Bites (excluding bites from rodents) Botulism (Foodbome, infant, and wound) Brucellosis (Brucella species) Cholera Diphtheria Disease of suspected bioterrorism origin (including, but not limited to): · Anthrax · Smallpox Disease of suspected foodborne origin (disease clusters only)- Disease of suspected waterborne origin (disease clusters only) Enterohemorrhagic E. coil (such as E. coil 0157:H7 infection) Haemophilus influenza (invasive disease, children <age 5) Hemoiytic uremic syndrome Hepatitis A (acute infection) Listeriosis Measles (rubeola) Meningococcal disease Paralytic shellfish poisoning Pertussis Plague Poliomyelitis Rabies (and use of post-exposure prophylaxis) Relapsing fever (borreliosis) Rubella (including congenital rubella syndrome) Salmonellosis Shigellosis Tuberculosis Typhus Yellow fever and Other rare diseases of public health significance Unexplained critical illness or death Acquired Imm~n~deflciency Syndrome [AIDS] Campyfobacteriosis .... Chancroid ....~..~'"....'~.'c: '.f' Chlamydia tracliOiiJatls infection CryPtosporidlosl~',;"~:.' . '...' , Cyclosporias~s . ;~~k..' . '. , .. encephalitis, ~i~,.~!,,~ J,';~' 'f" ;"" Giardiasis. "7-.' r", . Gonorrhea..'/;,;~',,~r~l:"~ :::,:, ";;: _,. Granuloma inguinale Hantavirus pulmonary syndrome Hepatitis B (acute Infection) . , ;. ._ , Hepatitis 8 surface antigen+ pregnant women Hepatitis (Infectious), unspecified ':" Herpes simplex, neonatal and genital. _' (initial Infection only) .,., , "... ' Human immunodeficiency virus (HIV) infection Legionellosis . , ;.. . " leptospirosis r' .;:.';,:r.... Lyme Disease Lymphogranuloma venereum Malaria Mumps Psittacosis Q Fever Serious adverse reactions to immunizations Streptococcus, 'Group A, Invasive (Indicated by blood, spinal fluid, or other nonnally sterile site) Syphilis Tetanus Trichinosis Tularemia Vibriosis Yersiniosis Conditions (Suspected or Confirmed) Notifiable to WA State Deoartment of Health Immediately: Pesticide poisoning (hospitalized, fatal, or cluster) Conditions (Confirmed) Notifiable to WA Stat~ Deoartment of Health within 3 Work Days Pesticide Poisoning (other) Conditions (Confirmed) Notifiable to WA Stat~ Deoartment of Health on a Monthlv Basis Asthma, occupational Birth Defects - Autism Birth Defects - Cerebral Palsy Birth Defects - Fetal Alcohol Syndrome/Fetal Alcohol Effects Notification on a Monthlv Basis to Local Health Department of the Following Confirmed Conditions: Hepatitis B (chronic) -Initial diagnosis, and previously unreported prevalent cases Hepatitis C - Initial diagnosis, and previously unreported prevalent cases Communicable Disease Reporting Jeffersoil'- Coiifl'4!- Health and Human Services 385-9400 New Notifiable Conditions Regulations Effective September 2000 Newly Notifiable Conditions Health care providers are required by Washington State regulations to report certain health events to local or state health departments. Reporting of notifiable COn'ditions by health care providers is the foundation of communicable disease surveillance and control programs. Timely reporting enables rapid recognition of outbreaks and enhances the efficacy of disease control interventions. Disease report data are used to understand changes over time in disease manifestations, incidence and populations affected by conditions under surveillance; to identify new diseases of public health importance; for program planning and resource allocation; and to obtain State and Federal resources to address community needs identified by analysis of surveillance data. For the past two years, the Washington State Departments of Health and Labor & Industries and the State Board of Health have been working to update the system for tracking notifiable diseases and conditions. This process has yielded revised regulations that comprehensively integrate into a single system the nine sets of regulations previously used by Washington's public health authorities. The list of notifiable conditions has been revised and the State Board of Health approved the regulations for adoption at their July meeting and they became effective in Seotember 2000. The new regulations are available at: htto://WWW.doh.wa.oov/oS/OoIiCV/246_101.htm. Please remember that our State law reouires health care Draviders reoort notifiable conditions even ~en the condition is also reoortable bv the clinical laboratory. This is because the clinical laboratory report does not contain complete demographic, clinical and epidemiologic information. What has Changed far the Health Care Provider? Instead of the previous system's ten different time frames for reporting notifiable conditions, there are now three time frames for reporting: · Immediately (certain suspected or confirmed cases) · Within 3 work days (certain confirmed cases) · Monthly (certain confirmed cases) - ....i . ~t Cryptospradfosis, cyclosporiasis, chronic hepatitis B (including swface antigen positive pregnant women), acute and chronic hepatitis C, hantavirus, animal bites and use of poste~posure prophylaxis, hemolytic uremic syndrome, invasive group A streptococcal disease, occupational asthma, diseases of suspected bioterrorism origin, . unexplained critical illness or death, fetal alcohol syndrome/effects, and autism. . ~ '". ,c. ~ ..~ . .' ."~ ," On the other hand, 'the following conditions are no longer notifiable: amebiasis, Kawasaki syndrome, leprosy, non-gonococcal urethritis, acute pelvic inflammatory disease, Pseudomonas folliculitis of suspected waterborne origin, Reye syndrome, rheumatic fever, RockY Mountain Spotted Fever, tick paralysis and toxic shock syndrome.. . "'-. . ... Other notable changes include: . .. A change to reporting of all enterohemorrhagic E. coil (EHEC) . . · Addition of reporting of chronic hepatitis .B and chronic C cases (including hepatitis B surface antigen-positive pregnant women) · Addition of immediate reporting of suspicion for diseases of potential bioterrorist origin, emphasizing the importance of a high index of suspicion for this event by health care providers · Addition of immediate reporting of unexplained critical illness or death · Conditions requiring immediate notification include suspected cases. Reporting of HbsAg+ pregnant women is now a legally notifiable condition, and should be reported for each . pregnancy. There are three ways to report these cases: . 1. Phone in a communicable disease report, call 385-9400, or 2. Fax a copy of the current prenatal hepatitis B screening lab results, with the mother's demographic data and EDC to 385-9401, or 3. Mail a copy of the lab results with the mother's demographic data and EDC to our Communicable Disease program within 3 days. The State Immunization Program provides HBIG and hepatitis B vaccine for the infant and screening and vaccination of household contacts if susceptible. If you have questions please contact Lisa McKenzie, at 385- 9400. JEFFERSON COUNTY HEALTH & HUMAN SERVICES Community Health Services, Programs and Contact Numbers - November, 2000 Tom Locke, MD, MPH, Health Officer - Jean Baldwin, MSN, Community Health Director Larry Fay, MS, En"ironmental Health Director COMMUNICABLE DISEASE PREVENTION PROGRAMS . Communicable DiseaserrB Program - Consultation, investigation and reporting of communicable diseases within Jefferson County; TB screening, diagnosis and treatment. Lisa McKenzie, Public Health Nurse (PHN), MPH, Program Coordinator, 385-9422 Denis Langlois, ARNP, 385-9421 Thomas Locke, MD, MPH: Jefferson County Health Department (360)385-9448 ;Clallam County Health Department (360)417-2437; After Hours (360)683-9152; Cell Phone/Pager, (360)808-3333 . Immunization Program - Immunization Clinic hours: Mondays and Fridays 9 to noon; Tuesdays 1 to 5:30; Wednesdays and Thursdays 1 to 4. No TB testing on Thursdays. Sliding fee scale. Lisa McKenzie, PHN, MPH, Program Coordinator, 385-9422 Jane Kurata, PHN, State Supplied Vaccine Program Manager, Influenza Clinics, 385-9443 . International Travelers Clinic - Immunizations and travel health recommendations available by appointment Mondays and Wednesdays with Lisa McKenzie. Call 385-9400 for an appointment one month before departure. . STD Program - Provides confidential services including: diagnosis and treatment; prevention education; partner notification and referrals. Sliding fee scale. Call 385-9400 for an appointment. Denis Langlois, ARNP, 385-9421 Lisa McKenzie, PHN, MPH, 385-9422 . HIV/AIDS Counseling, Testing and Case Management - Professional services include testing and counseling, case management and prevention services. Confidentiality maintained. Anonymous and confidential testing is offered only to high risk individuals. On sight AZT not available, no needle stick referrals. Call 385-9400 for appointment. Denis Langlois, ARNP, HIV/AIDS Case Manager, 385-9421 . Peninsula Syringe Exchange Program - Anonymous walk-in syringe exchange clinic at the Health Department on Mondays from 10 to 12 and Thursdays from 3 to 5. Services include exchange of new syringes for used, secondary exchange, education and supplies for safer injecting, healthcare referrals, HIV counseling and testing, hepatitis screening and referral. Kellie Ragan, MA, 385-9446 TARGETED COMMUNITY HEALTH SERVICES . Family Planning Clinic - Provides GYN exams, birth control information and supplies, pregnancy testing and counseling, emergency contraception (ECP), STD screening and treatment. Sliding fee scale. Medical coupons accepted. Daily clinics at the Health Department. Hadlock clinic at Kively Center on Wednesdays only, 1 to 5 by appointment and walk-in. Call 385-9400 for appointments. Kathy Luch, LM, Clinic Coordinator, 385-9426 Susan O'Brien, ARNP, FNP, 385-9437 Wendy White, ARNP, PNP, 385-9412 Marly Yourish, ARNP, CNM, 379-4460 Denis Langlois, ARNP, FNP, 385-9421 . Vasectomy Referral Program - State grant provided for eligible men who must be at least 21 years old, without insurance that covers vasectomy, and within the income guidelines. Initial consultation, then a 30-day waiting period from the time the consents are signed to the procedure. Clients are then referred to one of four providers. Kathy Luch, LM, Program Coordinator, 385-9426 . Breast and Cervical Health Program (BCHP) - Free Women's Health Exams with mammogram and Pap test are available for women over 40 with limited incomes that are underinsured. For an appointment with one of three local providers, call 385-9400. Julia Danskin, PHN, BCHP Outreach Coordinator, 385-9420 . Foot Care Program - Provided to seniors at homes, senior centers and other facilities throughout the county. For appointments in Tri-area call 732-4822, for appointments in Port Townsend call Margaret at 385-1772. Myrtle Corey, RN Program Coordinator and Provider JEFFERSON COUNTY HEALTH & HUMAN SERVICES Nursing Services, Programs and Contact Numbers - November, 2000 Page 2 FAMILY SUPPORT SERVICES . Women, Infant, Children (WIC) - A nutrition education and supplemental food program for eligible low income and nutritionally at risk pregnant and breast feeding women, infants, and children under 5. Services provided at the Health Department and satellite clinics in Chimacum, Quilcene and Brinnon. Call 385-9400 for appointment. Julia Danskin, PHN, WIC Coordinator, 385-9420 Kathy Anderson, Nutritionist, 385-9400 . Maternity Support Services (MSS) and Maternity Case Management (MCM) - Provides maternity support and case management for pregnant high-risk mothers and their children up to age one. Social workers, dietitians and PHN's provide support and education. Home visits, transportation and child care may be available. Women must meet income eligibility requirements. All women on First Steps qualify. Call 385-9400 for appointment. Carol Hardy, MA, LM, IBCLC, Maternal Child Health (MCH) Coordinator, 385-9419 Julia Danskin, PHN, 385-9420 MaryJo Mackenzie, PHN, 385-9425 Yuko Umeda, PHN, 385-9416 Quen Zorrah, PHN, IBCLC, 385-9424 . Breastfeeding Consultation - Education and assessment provided to pregnant women and after hospital discharge. Electric breast pumps available for medical problems. Call 385-9400 for information. MSS and MCM staff as listed above. . Tea Party for Pregnant Women and Breast Feeding Mothers - Wednesdays, 1 :30 to 3 at the Health Department. Drop in for tea, meet other mothers, and have questions answered. Nursing infants and children welcome. . Child Birth Education Classes - Classes are offered six times per year at the Health Department. Call 385-9400 for schedule and fees. Carol Hardy, MA, Licensed Midwife, 385-9419 . Best Beginnings - An intensive home visiting program serving first time mothers on First Steps who are identified as having greater needs. Starting in early to mid pregnancy and until the baby turns two, home visits, parenting support and education based on a relationship model are provided. Research by Dr. D. Olds has proven this program to make significant and lasting positive impact on the lives of mothers and their children. Carol Hardy, MA, MCH Coordinator, 385-9419 Yuko Umeda, PHN, 385-9416 Quen Zorrah, PHN, 385-9424 . Children with Special Health Care Needs - Provides service coordination and case management for children with chronic health conditions and their families. Marty Johnson, PHN, 385-9442, for children living in the Chimacum, Quilcene and Brinnon school districts. Hilary Metzger, PHN, 385-9417, for children living in the Port Townsend school districts. . Foster Care Passport Program - This statewide program is provided through collaboration between DSHS and local public health. The goal is to improve the health and educational status of children residing in out-of-home placement. A comprehensive medical history and treatment plan is updated bi-annually and follows the child throughout their placement in foster care. Karen Perry, PHN, Program Coordinator, 385-9415. . Sudden Infant Death (SIDS) Program - Provides education, information, and limited counseling. Julia Danskin, PHN, 385-9420 . Child Protective Services Public Health Nursing Contracts - Health screening, advocacy, parenting education and home visits with referrals from the Division of Children and Family Services, only. Denis Langois, ARNP, 385-9421 MaryJo Mackenzie, PHN, 385-9425 JEFFERSON COUNTY HEALTH & HUMAN SERVICES Nursing Services, Programs and Contact Numbers - November, 2000 Page 3 POPULATION SERVICES AND PREVENTION PROGRAMS . School Health Services - Provided at schools on a limited basis. Services include assessment and care planning for children with health conditions; vision, hearing, scoliosis screening; immunization review; medication administration training; health consultation for staff, students and parents; Health Education. Marty Johnson, PHN, 385-9442, for Chimacum, Quilcene and Brinnon school districts. Hilary Metzger, PHN, 385-9417, for the Port Townsend school district. . Share and Peer-In Program - School based prevention programs. Kellie Ragan, MA, 385-9446 Hilary Metzger, PHN, 385-9417 . Child Care Health Consultation - Provides health education and resources to licensed child care providers. Site visits and phone consultation. Marty Johnson, PHN, Child Care Health Consultant, 385-9442 . Tobacco Prevention and Control Program - Provides outreach and education to increase public awareness of Secondhand Smoke; supports implementation and delivery of the Washington State Tobacco Prevention & Control program; and facilitation the Jefferson County Tobacco Prevention & Control Council. Kellie Ragan, MA, 385-9446 . Health Care Access Program - Provides outreach to Medicaid and Basic Health Plan eligible population. Applications, assistance and information available at Jefferson County Health Department. Julia Danskin, PHN, Medicaid Outreach Coordinator, 385-9420 . Child Death Review Program - Coordinates the Child Death Review (COR) community team. Reviews all unexpected child deaths ages 0 through 18 in Jefferson County, according to Washington State law, with the long term goal of child injury prevention. Julia Danskin, PHN, COR Coordinator, 385-9420 . Vital Statistics - Provides certified copies of birth and death certificates. Birth Certificates $13, Death Certificates call for fee. Applications available at the Jefferson County Health Department. Retha Larson, Deputy Registrar, 385-9400 OTHER COMMUNITY COORDINATED PROGRAMS . Substance Abuse Program Coordination - Contract oversight for community substance abuse treatment and prevention providers. Dick Gunderson, Program Coordinator, 385-9445 . Developmental Disabilities Program - Provides planning, coordination and evaluation of community services for people with developmental disabilities and their families. Anna McEnery, Program Coordinator, 385-9410 ;:,-0 ;..- -' ~~:: ''''~:; c:;~) ,C12:) ~~r1 0~1;9 ?l ?i;~) ~( ;?-( c?-.-:- d1 J21 J2;J ~) c:;1 ~~f 0~< ,~ d'J __ jd ' Id W "lid lAd bI'd W ti\d W hilld W ,ld tJl:l v6\j v6\j ~ ~' e ct: __ 0/ ~/ ~,r "t: Jefferson County Health & Human (Services ~ W ~ 0?1 i!d )2;' V1 f/ fJd ~ ~ ~ Who: ~ When: ~ 4i Where: ~' fl? What: W ~ ~ i!d ~ lI'd ~ W 01 ~' ec o~ ~ ~ ;Ai RSVP: Q<; 1J' 0;9 o Info: 611d )2-;) '1, ' :it! r:) "'1 ~, b~ Medical and Dental Providers Thursday, November 16,2000 Noon to 2:00 Jefferson County Health Department 615 Sheridan, Port Townsend 12:00 to 12:45 Lunch and Open House Program displays, brochures and opportunity to meet staff 12:45 to 1:15 Tobacco Prevention & Control Update-State and local campaigns 1:15 to 2:00 Open House-continued Dr. Locke presents new format Reportable and noninfectious diseases Please return the enclosed card by November 2 to let us know if you will be attending. Jean Baldwin, Community Health Director, 385-9408 Julia Danskin, Public Health Nurse, 385-9420 0/ /-/ ;~ " The Health Department offers a diverse number of services. We welcome the opportunity to meet with you. ,\ "1t:: .,...;..; /' , , ~tj 2-) ::) 0_ :~1 ;;1-' ~ ,'eJ ,\' '", ".::-:::: :,t;i >-.I..... () ,,1 Q,,-:,,1, .::) ",A O. _=:) "" ~' :::),~1 r--_~ ~)" :;:::--/ ~--:/ /-'." r. ..j) ~.., " >: ~ ~ :.v,.......1 I :Jt: I::tj Vel -- ;..- ~..<; 21 / 6-1 , ~ , ;Jt:! ,;'.~../(" \' _t:! ;..- - ~-. ;..- ;..- ~' /' - ;..- :;.. ~_. /"'-' "" ,- /"'-' "" /",-', "", ~' /' ~' ;..- / ,...::::..< ;..- ~ ~ ;..- - / ;..- r' "" r' "", /"'-:' "", ___..J' / >, Jefferson County Health and Human Services - Nursing Services Staff November 2000 Name Phone # Position Tom Locke 385-9448 Health Officer, Jefferson County one day a week Clallam County Health Department (360) 417-2437 two days a week, After Hours (360) 683-9152: Cell Phone/Paaer, (360) 808-3333 Jean Baldwin 385-9408 Community Health Director Larry Fay 385-9436 Environmental Health Director Name Phone # Proarams Carol Hardy 385-9419 Maternity Support Services, WIC, Best Beginnings Maternity Case Management, Breast feeding Consultation Child Birth Education Classes Denis Langlois 385-9421 Communicable Disease/TB control, Family Planning Clinic STD Proqram, HIV/AIDS, CPS Public Health Nursinq Contracts Hilary Metzger 385-9417 Children with Special Health Care Needs School Health Services, Health Education, Peer-In Jane Kurata 385-9443 Immunization Proqram, Influenza Clinics Julia Danskin 385-9420 Breast and Cervical Health Program, WIC, Maternity Support Services, Maternity Case Management Child Death Review, SIDS, Health Care Access Proqram, Karen Perry 385-9415 Foster Care Passport Program, HIV/AIDS, Immunization Proqram, Safe Kids Kathy Anderson 385-9400 WIC, Maternity SUDDort Services Kathy Luch 385-9426 Family Planning Clinics, Vasectomy Referral Proqram Kellie Ragan 385-9446 Peninsula Syringe Exchange Program, Tobacco Prevention and Control Share (School based prevention proqram) Lisa McKenzie 385-9422 Communicable Disease/TB control, Immunization Program, International Travelers Marly Yourish 379-4460 Family Planning Clinic Marty Johnson 385-9442 Children with Special Health Care Needs, School Health Services Child Care Health Consultation MaryJo Mackenzie 385-9425 Maternity Support Services, Maternity Case Management, WIC, Hispanic Resource Coordinator, CPS Public Health Nursina Contracts Myrtle Corey 385-9400 Foot Care Program Quen Zorrah 385-9424 Maternity Support Services, Maternity Case Management, Best Beqinnings, WIC Susan O'Brien 385-9414 Family Planning Clinic, Breast and Cervical Health Program Wendy White 385-9412 Family Planninq Clinic, Port Hadlock Family Plannina Clinic Yuko Umeda 385-9416 Maternity Support Services, Maternity Case Management, Best Beqinnings, WIC DSHS CHILD CARE GRANT UPDATE Building Child Care Capacity for Children with Special Needs Through Public Health Partnerships Purpose DOH would like to provide you an update on the status of the child care grant we received from DSHS. The purpose of this grant is to build child care capacity for children with special needs. This grant is part of the ongoing work of Healthy Child Care Washington and offers to extend LHJ work in child care health consultation to include Children with Special Health Care Needs Programs in order to provide a team approach to serving this population. Eligibility · DOH will be asking each LHJ to voluntarily participate in this activity. · All counties/LHJs except the following are eligible to participate: Clark Kitsap King Snohomish Spokane Pierce · These counties are not eligible to participate because local programs in the county received funds through the DSHS grant. Funding from DOH will be available for services to Skamania County in SW Washington Health District. Allocations · Allocations for each LHJ are based on the amount of money we received, information regarding population in the county, activities with the babyltoddler initiative, child care need in the county, and the number of children with special health care needs. · Each of the 29 LHJs eligible to participate can receive a maximum of$20,000 over the life of the contract. Five of these LHJs are eligible to receive a maximum of$30,000: Chelan- Douglas Benton- Franklin Thurston Whatcom Yakima Timeframe · The contract period is October 1, 2000- June 30, 2001. You may bill for work completed in October once your contract is signed. · Our intent is to have this contract renewed with DSHS next year so this work will be on-going. In order to have our contract renewed, we must provide documentation of outcomes to DSHS that will be identified in the statement of work. LHJ Contracts and Billing · As you may have read in an email earlier from Rhonda Reinke, we are asking LHJs to bill actuals for services delivered through this contract. · LHJs can bill across activities as needed as long as the maximum consideration for the LHJ ($20,000 or $30,000) is not exceeded during the contract period. · This contract will not be part of your consolidated contract but a separate contract between the LHJ and DOH. We are doing this due to the need to track activities for purposes of reporting to DSHS and the timeline ofthe funds. Next Steps · DOH is in the process of signing our contract with DSHS. · Once the contract is signed, you will receive a copy ofthe standardized statement of work and will be asked to respond if you would like to participate in this project and receive funds. · DOH will be planning regional meetings to answer questions. · More information will be forthcoming as implementation details become available. · Please feel free to contact either Lorrie Grevstad at 360-236-3560 or Debbie Lee at 360-236- 3522 for more information. .:\:\13] } 0 J10 joo . C A J Institute for Public Policy and Management HUMAN SERVICES POLICY CENTER :c: {j HSPC is a collaboration of the: Graduate School of Public Affairs . College of Education School of Communications . School of Social Work School of Public Health and :ommunity Medidne School of Nursing at! 1< JecUJ'v ;jomV CtViJuj University of Washington Box 353060 Seattle. WA 98195-3060 RECEIVED NO VOl 2000- Jefferson County Health & Human SefVices j"'-'. --. ;;~; ~. ::. OCT S 0 '7r,nn L..1.lU"; _ n - .. .'. ...... ...., , . ~~i : 1 . -. ~"~'~<,<~-f,~.:(~.' Jefferson County Courthouse 81 Elkins Road Port Hadlock, W A 98339 October 2000 Dear Commissioners Harpole, Huntingford, and Wojt: Please find the enclosed County Profile of Child and Family Well~ Being, 2000 for your county. This report was produced by the Washington Kids Count project at the Human Services Policy Center at the University of Washington's Evans School of Public Affairs under the direction of Dr. Richard Brandon and Dr. Hoai Tran. If you would like to download a copy, please visit our web site at www.hspc.org. Or if you would like a hard copy, please ca1lour. .publications line at (206) 685-7613. Sincerely, 'd~~~ Sarah Bruch Coordinator of'Programs Phone: (206) 685-3135 . Fax: (206) 616-5769 . E-mail address: hspcnews@u.washington.edu . web site: htto:/ jhspc.org/ ," "!~k.:'\ ~~ / '- ;'l'c"" 1M Jefferson County kids COUNTY PROFILE OF CHILD AND FAMILY WELL-BEING, 2000 .~Statewide Summary This has been a year of solid economic growth in Washington. but disparities in all realms of child well-being continued at 1998-99 levels or grew worse. Growing wealth, growing disparities in children's well-being Annual wages increased in Washington . Average annual wages bet\.veen 1997 and 1998 increased 5.6% in Washington. However, the greatest growth occurred in King County (8.3%). while the growth rate in the remaining counties was at or below 4.2%. Many of Washington's children live in families with inadequate income . In 1988, 34% of children in Washington, and 46% of children in the Western Region lived in families with annual income that is inadequate to meet their needs.l Disparities in children's health . The rate of low birthweight babies for children of color is 5.7%. slightly higher than low birthweight for Caucasian children in the Western Region. . Thirteen percent of children in Jefferson County were born with inadequate prenatal care in 1998. . purteen percent of children in the Western Region who live in households with inadequate income lack health msurance. Disparities in children's education . Although more seventh graders met state reading and math standards, the disparity between the percent of children of color and that of Caucasian children meeting standards for both tests did not change between 1998 and 1999 in the state of Washington. During 1999, the Westem region, children of color passed the reading test at only 70% of the rate at which Caucasian children, and only 50% on the math test. . Disparities in children's access to technology . Almost twice as many of Washington's children in families with adequate income have home computers (80% vs. 46%) and home access to the Internet (56% vs. 24%) as children in low income families.1 Indicators of Economic Disparity - Percent of children (birth to 17) in households with adequate vs. inadequate income' who live in households with.. . WESTERN REGION STATE CMrEd h:rre , I l' >:,t;~M:r;'i'a%tfuWiNt~N:::p.@gr~~~' , I I I I 1 1 , , I I I I 'Wl~#B.}.';':>:":~: , I I I I 1 I :~ I , I o adequate income [Wi inadequate income 1 health in::uan::e J ",,;;;{:,. Otvred ture I perro1al ccnpuler J- interret ccmectX:ln ~ , I' ..,.., .'''d ' tmth i"s.Ja'l:e . I ....,.:,..:,1':..;F8..:.I: I : 1 I , p3I9TeI c:arpJ:a- iian::t 00 n:dia I o 50 Percent 100 o 00 Percent 100 i~J:~~.~" :::.: ,.,' )~<. Washington Kids Count tracks the conditions of children and families on a broad range of measures. We present heJ.e...,in,formation regarding a specific county or city. A more comprehensive picture is presented in the State of Washington's ChJI~~en -2000 . -,- ~/ <1~~:;:'> WASHilS10I rPI'I For more information contact kids Washington Kids Count at (206) 685-9109 mmiD The average wage rose by almost 3% between 1997 and 1998; however, the wage amount in 1998 was the second lowest in this region. Jefferson County 2000 Profile Economic Well-Being Family Structure and Economic Well-Being (Western Region)- The percent of children living in one-, two-, and three-adult households with adequate or inadequate income! WESTERN REGION STATE 100 80 60 40 20 o 1 adult 2 adults 3+ adults Average Ann.ual Wages * Levels (and percent change from previous year) adjusted for inflation to 1998 dollars. County State 1995 1996 1997 21,154(-2.1) 21,023(-0.6) 20,663(-1.7) 30,499(-1.4) 30,579(0.3) 31,234(2.1) Child Care Burden2 - The percentage of a typical two-parent, one earner family's after-tax income required to pay full-time child care costs for one preschool child. 100 80 60 40 20 o adequate income III inadequate income o 1 adult Trend . Better 1998 21,258(2.8) 33,071 (5.6) Trend No Change Average Costs as Change childcare % of after-tax in cost wages burden 1998 1997 1998 1997 -1998 County 4,056 22.7 22.7 0.0 State 5,208 19.2 18.7 -0.5 2 adults 3+ adults II) E o u .E )( Jll .. II) 4:: Cll ... o ~ f ~ '0 'C g Q) CD ~ -County -State 5000v -------------- 40000 -------------- 30000 . . . -~-- 20000 ... -. . ..~- 10000 -------------- o 25% I] county o state 20"10 .y,;;,;: :t'$.'; "ii%: w;~ ~11 ':~@ 15"10 10% 5% O"k :s::<:". 1997 1998 *A 2-parent, 1-child family with the working parent earning the average wage for that county, filing as married filing jointly and taking the standard deduction and Earned Income Tax Credit. if any. on federal income taxes. ' For further explanation of data, see notes on page 4. J!~ ~ ~ The low birthweight rate decreased by near(v 5% between 1997 and 1998, the most significant decrease in the state. 'RASIliISfoN For more information rI'I'I contact Washington Kids countkicls at (206) 685-9109 mmm:J Health and Safery: Lack of Prenatal Care - The number of babies born (and percent of all babies born) to mothers who received no prenatal care. or prenatal care delayed past the vulnerable first trimester of pregnancy. County State Benchmark: 1988 47(20.3) 16,030(22.1) Year 1: 1997 24(11.2) 11,816(15.1) Year 2: 1998 26( 12.6) 12,243(15.4) Change 1.3 0.3 Trend · Worse · Worse Low Birthweight - The number of babies born (and percent of all babies born) with birthweights below the healthy birthweight of2500 grams (5.5 pounds). County State Benchmark: 1988 15(6.5) 3,813(5.2) Year 1: 1997 17(7.9) 4,381(5.6) Year 2: 1998 7(3.4) 4,545(5.7) Change -4.6 0.1 Trend . Better · Worse Low Birthweight by RacelEthnic Group - The number of babies born (and percent of all babies born) by race/ethnic group with birthweights below the healthy birthweight of 2500 grams (5.5 pounds). Region State African American NA(NA) 296(10.8) Hispanic 15(4.1) 493(4.9) . Native American 21 (8.2) 138(7.8) Asian American NA(NA) 366(6.8) Caucasian 241 (5.3) ~075(4.6) Teen Pregnancy - The total number of girls (and percent of all girls) age 15 to 17 who became pregnant. Benchmark: 1988 Year 1: 1997 Year 2: 1998 Change Trend 10(2.9) 19(3.7) 20(3.9) 0.1. Worse 5,525(5.8) 5,359(4.6) 5,107(4.3) -0.3 . Better County State Child Abuse and Neglecf - The number of children (and percent of all children) age birth to 17 referred as possible victims of abuse or neglect (TR), and judged to merit an investigation after initial screening (AR). Benchmark: 1994 Year1:1998 Year 2: 1999 Change Trend County TR 309(5.5) 379(6.2) 745(12.3) 6.1 . Worse AR 153(2.7) 196(3.2) 351(5.8) 2.6 . Worse State TR 56,477(3.8) 52,415(3.5) 77,033(5.2) 1.7 . Worse AR 36,636(2.5) 37,938(2.5) 57,633(5.6) 3.1 . Worse Juvenile Arrests4 - The number of children (and percent of all children) age 10 to 17 who were arrested. Benchmark: 1988 Year 1: 1997 Year 2: 1998 Change Trend 140(8.4) 248(8.6) 299(10.3) 1.7. Worse 43,465(8.9) 52,203(7.9) 53,955(8.0) 0.2. Worse County State Education Percent of 7th Qrade students meeting adequate reading and math standards on the Washington Assess- ment of Student Learning (WASL) tests. WESTERN REGION STATE Reading Reading 1998 1999 Change Trend 1998 1999 Change Trend Overall 39.0 40.2 1.2 . Better Overall 42.1 46.2 4.1 . Better Children of color 26.7 29.9 3.2 . Better Children of color 27.1 32.4 5.1 . Better Caucasian children 41.2 42.5 1.3 . Better Caucasian children 46.5 50.8 4.3 . Better Disparity Ratio. 0.6 0.7 0.1 . Better Disparity Ratio& 0.6 0.6 0.0 No Change Math Math 1998 1999 Change Trend 1998 1999 Change Trend Overall 17.4 21.3 3.9 . Better Overall 22.0 27.5 5.5 . Better Children of color 9.1 11.4 2.3 . Better Children of color 13.4 16.9 3.6 . Better Caucasian children 18.7 23.4 4.7 . Better Caucasian children 24.5 31.0 6.5 . Better Disparity Ratio& 0.5 0.5 0.0 No Change Disparity Ratio& 0.5 0.5 0.0 No Change Notes: . For Lack of Prenatal Care, Low Birthweight, Low Birthweight by Racel Ethnic Group; Teen Pregnancy, we are not reporting if thenumber is less than five. . The Western Region indudes Clallam, Cowlitz. Gra~ Harbor, Jefferson, Klickitat, Lewis, Mason, Pacific, Skamania, and Wahkiakum Counties, from he 1998 State Population Survey. . Trend refers to cha!'ge in differences in percent, rate, or level over the previous year. The following minimum thresholds were useQ below which change was considered insignificant Prenatal Care, Teen Pregnancy, Child Abuse, and Juvenile Arrests, 3.0 percentage points. 1 Adequate income is defined as yearly household income at or above 200% of the federal poverty threshold; inadequate income isbelow 200% of the federal poverty threshold. In 1997 (the year the State Population Survey was conducted), 200% of the federal poverty threshold was $2153 a morth for a three person family. 2 Childcare burden is based on a 2-parent, 1-child family with the working parent eaming the average wage for that county, filng income taxes as married filing jointly, and taking the standard deduction and Eamed Income Tax Credit, if any, on federal income taxes. 3 Trends in child abuse and neglect referrals may not reflect actual changes due to changes between 1998 and 1999 in the way DSI-6 reports referrals. Total Referrals (TR) and Accepted Referrals (AR) do not reflect double counting. · Juvenile arrest data may include incidents involving the same individual arrested by police for different episodes. . · WASL test scores for students receiving special education, Section 504 Accomodations, and/or Title 1 for BilinquaVESL educaton services are excluded from these analyses. · Disparity ratio is the percent of children of color divided by the percent of Caucasian children meeting state standards on he WASL tests. Data Sources: Indicators of Economic Disparity; Family Structure and Economic Well-Being: Slale Populalion Survey, 1998 (OFM). Annual Wages: Washington State Employment Security and OFM. Childcare Cost; Child Abuse and Neglect DSHS: Office of Research and Dala Analysis.. Chi/dren's Administration. Prenatal Care; Teen Pregnancy; Low Birthweight Department of Health Statistics, State Department of Health. Juvenile Arrests: Juvenile Justice Advisory Commission. WASL Reading and Math Scores: Superintendent of Public Instruction (OSP/). Data for counties with small populations should be interpreted with caution Drawings contributed by students at local preschools and schools. This report was produced by Incho Lee, Adam Nelson, Michael Bence, Hoai Tran, and Richard Brandon of the University of Washingon Human Services Policy Center, Evans School of Public Affairs, as part of the Washington Kids Count Project Washington Kids Count receives funding tom the Annie E. Casey Foundation and the Boeing Company, with special projects funded by the United Way of King County, the Washington State Department of Socicl and Health Services (DSHS), Division of Alcohol and Substance Abuse. For Statewide data, request The State of Washington's Children - 2000. For further information contact Washington Kids Count at (206) 616-8797. Web site: http://hspc.org Washington Health Foundation 2000 COUNTY HEALTH PROFILE FOR JEFFERSON COUNTY WA State Jefferson Rank Population. 1998 5.685.300 26.500 17 Percent of population change: 1990.1998 16.8 29.9 2 Percent of change due to net migration 10.5 30.5 I Percent of change due to net natural increase 63 (0.6) 35 Population density: Persons per square mIle. 1998 8q In 29 Population in incorporated areas. 1998 ('0 I ,; "' 3l.5 30 Personal income per capita. 1997 ~6...l~ I 22.104 12 Average net earnings per worker. 1997 .,5.182 28.980 12 Taxable retail sales per capita. 1998 I ;.1\ X 8.875 21 Registered businesses! 1.000 population. 1998 "'77 '5 1220 Real property value per capita. 1998 68.612 86.367 Property tax levy per caplla. 1998 831 973 Resident civilian labor force as percent of populauon. 1998 53.5 37.4 37 Unemployment: Percent oflabor force unemployed. 1998 4.8 6.7 21 10/98 Enrollment in public schools with child nutriuon pm~rams 962.021 3.652 Percent applied lor free or reduced-price luncli 31.9 32.1 27 Grades 9-12 enrollment Oct. 1996 287.059 1.230 Percent of dropouts (exc\. unknowns). 1996-97 44 1.7 38 Percent of Students Meeting Reading Standard, 1999 7" ," '" 'v 1H ,,, WA State Rural Jefferson 04lh Graders k3171h Graders 1lI11llh Graders Birth Rates by Place of Residence, 1994 -1998 '6 c: o :s :; Q. o a.. o o q. '4 12 10 8 ------ <h .s:: 1:: iii 6 ~ ~ ~ ~ ~ 1- W A State .-Rural - - Jefferson I ;l~':l '- Sources of Personal Income, 1997 70 60 ><, ~ <.> 4.. :;; a.. 30 20 10 Net Eamings Dividends, Interest & Rent Transfer Payments lOW A State -Jefferson I if, Free and Reducetl..price Meal-.licatioll$, 1998 en en en c: <n ~! .~ i ~I ~ <= ' 11 ~I ~i ~1 a:> a> o c: '" .E <3 ::: UJ 15 C '" I:! '" a.. en ~ c: <n a ~ .~ ~ <= c ~ z :E :e u ~ " o <n Live BittttS to ~...,t'7 ~ "" ~ <n .. ..... ~ ~ <= . ... ..., :r: '" a a 00 <t 00 <h en '" ~ <<i e E ~ ~ 0 0 as q .!lSl - so, <h <ng: .s:: ~ff: 1:: ii5 ~ " 0 en 10 ~o ,,, WA Slale Rural Jefferson <S " <= <= .. :r: a c 00 '" 6 "'''' "'''' ~Ci3 €.91 Cia: sri i3~ ~~ ~ " o (Jl Deaths by Selected causes M Place Of Residence, 1998 u '" <= E C( '" :Ei en ~ Sl e ;,; 15 o en 40 - - - - - .. - , - / - - - - - - , , , , , / - 35 30 25 20 '5 10 5 M ~ % W ~ I-W A State -Rural - - Jefferson I Di...... of the H..rt Malignant Neoplasms Cerebrovascular Olse_e. COPO Accidents & Adve.... Effect 20 3~ !DVlA State ~Rural .JetTerson I Percent of Total Deaths .. " c:: <= ... :r: a a g 6 gJ", :;~ ='" 1.'l~ co"" .!lri t5~ ~t5 ~ is (Jl Indicator Population ~ar;in:tuwnf'lT.c.n~["iT'" Number oflive binhs Binh rate (Births per 1.000 population) Binhs per 1.000 females age 15-17 Mothers with I sttrimester prenatal care (%) Maternal smoking during pregnancy (%) Binh weights less than 2500 grams (%) Infant deaths per 1.000 live binhs ** IIMm n:!IltWi'\ flTol..n iI':!t'm r~ no[' Number of deaths Death rate (deaths per 1.000 population) _IMmn:!l'l"'"1~llNNlI[li\ll"'" Diseases of Hean (%) Malignant Neoplasms (%) Cerebrovascular Diseases (%) Chronic Obstructive Pulmonary Diseases (COPD) (%) Accidents & Adverse Effects (%) Pneumonia/Influenza (%) Diabetes Mellitus (%) Suicide (%) Diseases of Hean (%) Malignant Neoplasms (%) Cerebrovascular Diseases (%) Chronic Obstructive Pulmonary Diseases (COPD) (%) Accidents & Adverse Effects (%) Pneumonia/Influenza (%) Diabetes Mellitus (%) Suicide (%) Diseases of Heart (%) Malignant Neoplasms (%) Cerebrovascular Diseases (%) Chronic Obstructive Pulmonary Diseases (COPD) (%) Accidents & Adverse Effects (%) Pneumonia/Influenza (%) Diabetes Mellitus (%) Suicide (%) Jefferson Rural W A State Jefferson Rural W A State Jefferson Rural W A State JetTerson Rural W A State JetTerson Rural W A State JefTerson Rural W A State Jefferson Rural W A State JetTerson Rural W A State Jefferson Rural W A State Jefferson Rural W A State Jefferson Rural W A State 94 95 96 97 98 24.300 25.100 25.700 26.300 26.500 912.700 932.200 951.500 966.900 974.600 5.334.400 5.429.900 5.516.800 5.606.800 5.685.300 214 216 199 214 207 12.122 12.585 12.558 12.420 12.757 77.368 77.240 77.874 78.141 79.640 8.8 8.6 7.7 8.1 7.8 13.3 13.5 13.2 12.8 13.1 14.5 14.2 14.1 13.9 14.0 20.9 23.6 10.2 21.6 19.3 32.9 35.0 32.5 31.9 30.4 29.6 28.8 26.6 25.3 24.0 82.2 87.0 85A 85.5 84.5 77.9 76.5 77.6 76.1 73.8 78.1 76.5 76.9 75.7 74.9 23.4 22.2 18.6 20.6 21.3 20.2 19A 19.1 17.2 18.0 16.6 15.6 15.3 13.9 13.8 7.5 5. J 8.0 7.9 3A 5.1 5.0 5.3 5.3 5.6 5.3 5.5 5.6 5.6 5.7 23.4 6.9 5.6 7.5 5.6 7.1 6.2 5.8 6.0 5.6 5.7 254 241 267 255 282 8.534 8.653 9.164 8.899 9.113 39.906 40.729 42.248 41,429 42.585 10.5 9.6 lOA 9.7 10.6 9.4 9.3 9.6 9.2 9.4 7.5 7.5 7.7 7.4 7.5 25.6 27.0 24.7 27.5 32.3 335 31.1 29.2 31.8 22.7 11.8 8.3 6.4 10.6 7A 7.9 4.1 5.6 4.7 5.3 2.4 3.3 4.5 3.1 6.4 0.8 2.5 5.2 3.9 2.5 0.8 1.2 4.5 1.6 2.1 2.0 1.2 1.1 0.8 2.1 29.5 29.0 28.9 27.4 27.9 24.2 24.9 23.2 24.1 23.7 8.1 8.1 9.1 8.3 8.5 6.0 5.9 5.5 5.8 6.0 5.0 5.1 5.2 5.3 5.6 3.5 3.8 4.1 4.1 3.9 2.4 2.6 2.7 2.7 2.6 I.7 2.0 1.8 1.6 1.6 28.1 27.8 27.9 26.8 26.9 24.6 24.6 24.1 24.3 24.1 7.9 8.1 8.4 8.1 8.0 5.7 5.4 5.3 5.7 5.6 4.3 4.5 4.5 4.6 45 3.7 3.8 3.9 4.0 4.0 2.6 2.6 2.8 2.7 2.8 1.9 1.9 1.9 1.8 1.6 ** Rate not calculated if number of deaths was less than 5. Why these indicators? Conununity health is determined by so~i~l, eco- nomic and environmental factors. TradItional stand~rds for measuring health such as morbidity (illness) and mortality (death) do not address the. factors that contribute to the health of a conunumty; at best, they serve to point policymakers toward things that are going wrong. A broader look at what contributes to community health leads us to broaden our measurement tools: Demographic data provide clues to individual and conununity health. The elderly and the ve~ young. are the most common users of medical servIces, so It is helpful to know how those age groups figure in a county's population. Population density and land use data are valuable indicators of individual and family isolation. Economic data such as income, employment, and poverty status indicate the capacity of a county's . residents and local governments to create change In their conununities. Educational perfonnance is an indicator of how the public schools and their conununities are meeting the academic needs of students and preparing the future workforce. Data on free and reduced price lunch applications reflect the numbers of children in low income families and are closely associated with performance on reading and other skills tests. Birth, death, and illness data provide specific informa- tiort about the health of individuals. They can focus attention and provide a spark for action, and are often used to measure progress over time. Environmental health indicators. Though there is wide- spread agreement that the air, water, and food supply-physical environment-are critical con- tributors to individual and conununity health, adequate measurement systems have yet to be developed. Local health departments and districts are the most up-to-date source of information about local environmental concerns. Pen.;.cnt '" '" , _ l ~ I ~ I ~I '" . ~l .i I ;; , ~l Q. I ~! 8! 11 II 0, $ I l!l I ~J 0, !\ il \(1 ::u III 0-9 10-19 20-64 65+ IOWA State ~Rural .JetTerson I 11IiRg$ m III wilti thiS ~ " Share it with your employees, supenJisors and board members. " Start a conversation about it with your local health department or hospital. " Use it as a reference document for talking to media or grant writing. " Bring copies to your next Rotan) or senJice club meeting. " Share it with health senJice pYO'uiders in your communihj. " Give copies to your state and federal elected officials. Note: For these Profiles, counties that include no Standard Metropolitan Statistical Areas (SMSAs) are defined here as "rura1." Counties that include SMSAs are classified as "urban." Urban counties include: Benton, Clark, Franklin, Island, King, Kitsap, Pierce, Snohomish, Spokane, Thurston, Yakima and Whatcom. All others are "rural" for purposes of this publication. Washington Health Foundation 300 EllioIl Avenue West SuHe 300 Seattle, WA 98119-4118 Phone 206-285-6355 Fax 206-283-6122 www.whf.org D]~AFT Learning to Live with the Human Genome: Well Reasoned Prudence or Future Shock? Sponsored by The Washington State Board of Health Department of Health Department of Social and Health Services, Division of Developmental Disabilities Office of the Insurance Commissioner Supreme Court University of Washington School of Public Health and Community Medicine-Institute for Public Health Genetics and Center for Ecogenetics and Environmental Health In Partnership with March of Dimes, Washington State Chapter The recent announcement of the nearly complete mapping of the Human Genome has led to an avalanche of assertions and proven fact about the links between genetics, human health and human characteristics. The explosion of facts has opened doors to advanced diagnostic tools, advanced medical and public health treatments, a world of profitable new medical products and services, revolutionary improvements in the quality of evidence in legal proceedings and the potential for ever more precise and widespread discrimination. This new information has left us all potential prey to ~information overload.' Many unanswered questions have led some to call for comprehensive application of long standing medical privacy principles to every circumstance where genetics information is collected, analyzed, stored or used. What has genetics actually enabled us to do in diagnosing, preventing and treating illness, in estimating environmental risks, and in changing the genetic futures of our children and grandchildren? What realistic hopes and fears should we have about its potential? And how should all of this figure into public policy, private enterprise and our personal lives? This conference will review the most recent developments in the genetics revolution. Our goal is to broaden our appreciation of both the value and of the challenges it poses. 8:30 Introduction and Welcoming Remarks Speakers: Washington State Governor Gary Locke [invited] Chief Justice Richard P. Guy, Washington State Supreme Court Draft Conference Agenda, 11/07/00, Page 1 Dl~AFT 9:00 Keynote Address 'M1at Are the Best and the Worst Destinations for Society on our Map of the Human Genome? How Can Privacy Help Lead the Way? Speakers: · Paul Billings, MD, PhD, Co-founder, GeneSage, Editor in Chief GeneLetter · Lee Hartwell, PhD, Director, Fred Hutchinson Cancer Research Center 10:30 Break 10:45- Morning Session 12:30 Select from one of the Sessions outlined below 12:30- Lunch 2:00 Lunchtime Panel Discussion: Examining the Public Dialogue on Genetics Moderator: John Hamer, Director of Washington News Council Panelists: · Gail Geller, SeD, Johns Hopkins Medical Institute · KING Healthlink Reporters Jean Enersen [invited] · Seattle limes Health Reporter Carol Ostrom 2: 15- Afternoon Session 4:00 Select from one of the Sessions outlined below 4:00- Closing Remarks 4:30 .Ree Sailors, Health Policy Analyst for Washington State Governor Gary Locke · Dave Knutson, Senior Research Analyst, Washington State House Health Care Committee · Joan Mell, Counsel to the Washington State Senate Health and Long Term Care Committee Sessions 1. Genetic Discrimination Like any information, genetic information has the potential to be misused or misinterpreted in many settings, particularly in employment and insurance. The most frequent and popular policy response to this threat has been the widespread support of strong privacy protections for genetics information. What are the existing rules that seek to protect against discrimination? Are they adequate? Does genetics information privacy provide the protection it is widely believed to? Are there circumstances where genetic based susceptibility to certain environmental threats warrant limiting exposures to them? Moderator: Draft Conference Agenda, 11/07/00, Page 2 Dl~AFT Aaron Katz, Director, Health Policy Analysis Program; Senior Lecturer, University of Washington School of Public Health and Community Medicine, Department of Health Services Panelists: · John Conniff, Deputy Commissioner, Washington State Office of the Insurance Commissioner and Former Chair, National Association of Insurance Commissioners Privacy Working Group · Jeny Sheehan, JD, Washington Chapter, American Civil Liberties Union · {Representative from American Council of Life Insurers} [invited] 2. Research, Public Health and Privacy Storing human samples for future research is increasingly common. One issue that arises is whether an individual can give truly informed consent for future research on a sample. Some, but not all, genetic research can use samples whose unique identifiers have been either partially or completely removed from the sample. Is there any public interest justification for compromising absolute patient privacy of their genetic information? How can we strike a balance between respecting the privacy of the individual in a way that permits genetics research and the advancement of legitimate public health interests? How do strong privacy policies governing the exchange of genetics information affect both clinical and public health research? Moderator. Wylie Burke, MD, PhD, Associate Professor, University of Washington School of Medicine, Division of Medical Genetics; Associate Professor, School of Public Health and Community Medicine, Institute for Public Health Genetics Panelists: · Lee Hartwell, PhD, Director, Fred Hutchinson Cancer Research Center · Paul Billings, MD PhD, Co-Founder, GeneSage, Editor-in-Chief, GeneLetter · Elizabeth Ward, RN, MN, Chief Executive Officer, Foundation for Health Care Quality 3. ComputerslTechnology The huge advances that computer technology has made in the last fifteen years have allowed us to obtain and use genetic information in many ways. Gene Chip technology may make the idea of 'genotyping' populations of people a reality. The advent of personal computers, the internet and ever more powerful computing technologies have combined with these advances, not only to quicken the pace of research and the rate of new genetics discoveries, but also potentially to place genetic information in the hands of nearly anyone. What has the synergy between computer technology and genetics produced, what may be coming, and how can the beneficial potential of these advances be secured without risking the detrimental effects that can come if privacy is not adequately protected? Moderator. The Honorable Richard P. Guy, Chief Justice, Washington State Supreme Court Panelists: · Thane Kreiner, PhD, Vice President, Business Operations and Public Affairs, Affymetrix, Inc. · Lisa Vincler, JD, Assistant Attorney General in the University of Washington Division, Faculty Associate, University of Washington School of Medicine, Department of Medical History and Ethics · Representative from WBBA [invited] Draft Conference Agenda, 11107/00, Page 3 Dl~AFT 4. Genetics and Medicine: Privacy and the Duty to Disclose Genetic information is an important part of the medical record. It can be critical in the diagnosis and management of complex diseases. Because of the potential for discrimination, individuals may opt for completely anonymous genetic testing. However, difficulty in obtaining genetic information may compromise care by limiting the amount of information the health care provider can use in planning the course of treatment. In addition, a patient's genetic information can be valuable to the family of the individual. What duty does the health care provider have to disclose genetic information to promote coordinated health care and disease management and to provide important information to the patient's family about the patient's or the family's health risks? What duty does the patient have to contact his or her family? Moderator. Debra Lochner Doyle, MS, CGG, State Coordinator for Genetic Services, Washington State Department of Health Panelists: · Susie Ball, MS, CGC, Yakima Valley Memorial Hospital, Children's Village · Sharon Davis, PhD, Investigator, The ARC, Washington DC · Geoffrey MacPherson, MD, Medical Director for Quality Assurance, PacifiCare · Richard Sharp, PhD, Biomedical Ethicist, National Institute for Environmental Health Science 5. Human Tissue or Intellectual Property? Whose genes are they, anyway? What are the implications of allowing genes to be patented? How does privacy playa role in this context? Moderator. · Anna C. Mastroianni, JO, MPH, Assistant Professor, UVV School of Law and School of Public Health and Community Medicine, Health Services and Institute for Public Health Genetics Panelists: · Clark Shores, JO, PhO, Senior Assistant to Vice Provost, University of Washington, Office of Research, Assistant Attomey General · Charles Hart, PhO, Senior Director of Business Development and Strategic Planning, ZymoGenetics · Brad Popovich, PhO Oregon Health Sciences University · Patricia C. Kuszler, MD, JO, Associate Professor, University of Washington School of Law, Adjunct Associate Professor School of Medicine and School of Public Health and Community Medicine, Institute for Public Health Genetics 6. Primary Prevention or Eugenics? Mankind has long sought to improve the quality of its next generation. As of today, scientists have developed many genetic tests that, with varying levels of certainty, can predict human health and developmental futures for children that have yet to be conceived or borne. Should these tests and related technologies be used to improve the genetic make up of future generations? If so, how will we decide what constitutes improvement? Should we use any sort of genetic information for the purposes of reproductive decision-making? If so, what limits should be observed on the use of the information? Who should determine these limits and how should they be communicated and enforced? What role does privacy play in promoting the best use of genetics information in this context? Draft Conference Agenda, 11/07/00, Page 4 D RA.F'r Moderator. Asha Singh, MD, Superintendent, Fircrest School Panelists: . Larry Jones, PhD, JD, Chair of the ARC of Washington Trust Foundation . Robert Resta, MS, CGC, Swedish Hospital, Division of Perinatal Medicine . Edith Cheng, MD, UW School of Medicine, Department of OBGYN Draft Conference Agenda, 1 i/07/00, Page 5 Feeling O.K.? Just Wait ~~1.\cP Nastier bugs are on the way, a journalist reports. BETRAYAL OF TRUST " The Collapse of Global Public Health. By Laurie Garrett. 754 pp. New York: HyperiolL $30. By Fitzhugh Mullan IN the early 1990's, in the waning days of the Soviet Union, I served as a member of a United States delegation that visited Moscow to talk with the Ministry of Health about health policy. During our visit one of my colleagues, who firmly held down the left wing of our contingent, searched constantly - and in vain - for a poster of Lenin to take home. "Lenin Lenin. He's got to be here somewhere." was ~ mantra. On our last day in Moscow, sev- eral other members of the group arrived back at 'the hotel and with much fanfare told him that they had found his poster. A street vendor in the Metro had sold it to theIl). Gleefully they unfurled the life-size portrait - of John Lennon. The warp speed transition from the Commu- nist Lenin to the free spirit Lennon in the former Soviet Union is one of several looming threats to the health of humanity that Laurie Garrett de- tails in "Betrayal of Trust The Collapse of Glob- al Public Health." The book follows her 1994 vol- ume. "The Coming Plague," in which she argued that despite the seeming health of the developed world and the continuing advance of technology, we are in trouble. The robust biology of microbes - aided by polhition, corruption, war and indif- ference - is in a position to put human well-be- ing into reverse quickly and definitively. In "Be- trayal of Trust" she applies her thesis to new parts of the globe and argues it on a higher level - pUblic health. the covenant between the indi- vidual and the government in matters of health. is bro:e::... Tha tr~t 15 ~t:a:f--ed "Betrayal" is an Imax of a book, with five gi- gantic screens playing sequentially, presenting pictures of moldering health systems in the for- mer Soviet Union, India, central Africa and the United States, and outlining the substantial threat that bioterrorism poses to the world These are lurid, disturbing and well-documented images that are not easily dismissed as alarmist. Today's Russia inherited the dilapidated com- mand-and-control system of the old CommUnist order, replete with poorly trained personnel and a research apparatus tethered to long disproveD theories. To that dangerous brew the last decade has added depleted treasuries, corruption, sexu- allicense and the overuse of antibiotics. In c0n- sequence, death rates in Russia are rising rapid- ly and lile expectancy is falling. The breakdown of the country's public health infrastructure _ including clean water supplies, surveillance teams. infectious disease laboratories and vacci- nation programs - means that scourges like AIDS. diphtheria, typhOid fever and drug-resis- tant tuberculosis (which is particularly lethal and exportable) are also on the rise. India and Congo are two other troubling im- ages on Laurie Garrett's big screelL In 1994, plague broke out.in Sural. a coastal city on the Arabian Sea north of Bombay. Absent from India for 30 years, it caused panic in both the local p0p- ulation and regional public health authorities. The result was an exodus by Suratis, who fled their homes in epic numbers, and a fumbling, re- criminatory response by Indian and World Health Organjzation officials. After 6,500 d0cu- mented infections and 56 deaths, organized sur- veiI1ance and antibiotics stopped the epidemic, but the incidekIi demonstrated the frailty of the C01D1try's public health infrastructure. Indeed. privatization and fiscal "reforms" had drasti- cally reduced India's public health spending from the previous decade. In Congo (formerly Zaire), poverty aug- mented by kleptocracy - chronic, systematic government corruption - makes outbreaks of lethal hemorrhagic fevers locally devastating and globally worrisome. Garrett details a 1995 ". outbreak of Ebola fever in the city of Ktkwit that despite the heroic efforts of doctors and nurses claimed 296 lives, four out of five of those infect- ed. Kikwit dramatized the struggle facing local public health workers in battling an infection that could have gone global But it is Garrett's observations about the United States that are the most disturbing. De- spite our extraordinary wealth and scientific ca- pab~ty. public health is supported in an erratic and 1D1derfinanced way in this C01D1try. By most measures. the United States ranks in the lowest tier of developed nations, and death rates are 011 the rise from infectious diseases. Antibiotics are being overused in ways that guarantee the emer- gence of "superbugs." Our defenses against biotelTOnsm. '!.."l! rl~"..stre1m!y wask. Th", :c.ct that more than one in six Americans is uninsured is both part of the problem and a symbol of it. Concepts like sanitary reform and disease pre- vention that enjoyed more currency earlier in our history have been supplanted by a medical ethic that promotes individualism and medical- izatiOIL The result is the world's most expensive health care delivery system and a public health . bureaucracy that is ill prepared for the chal- lenges it will face in the 21st century. (OVer) Fitzhugh Mullan is a professor of public health and pediatrics at George Washington University and an editor of the journal Health Affairs. His new book, "Big DoctoriDg: prlniary Care in America," will be published next year. .. Jefferson County Health and Human Services OCTOBER 2000 NEWS ARTICLES 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. "Expect better from Jefferson General" - Editorial, P.T. LEADER, October 11,2000 2. "JGH responds with plans" - Letter to the Editor, P.T. LEADER, October 18, 2000. 3. "Jefferson County Residents Advised to Boil Drinking Water" - W A State DOH News Release, October 12,2000. 4. "Kala Point water woes come back" - Peninsula Daily News, October 13, 2000. 5. "Anti-tobacco coalition forms" - Peninsula Daily News, October 13, 2000 6. "Kala Point water needs chlorine" - P.T. LEADER, October 18,2000. 7. "Kala Point water OK again" - P.T. LEADER, October 25,2000. 8. "Public flu clinics postponed until late November" - P.T. LEADER, October 25,2000 A. 6 . Wednesday, Oct. ", 2000 Ofl Editorial l?xpectbefterjTonl Jefferson General The news about our local hospital has not been good in recent weeks. Worse is the sense that while specific problems are being addressed, there remains less than full disclosure and full acceptance of responsibility for the problems facing'what couId be one of the nation's finest small hospitals. A sharply critical inspection report from the Washington State Depart- ment of Health this summer pointed to a wide variety of serious prob- lems. some of them directly related to the quality of patient care. The critical report came three years after state hospital regulators told Jefferson General Hospital administrators that they must tighten up on quality control or they would face just this kind of report. The report noted, among otber things: . lack of decent record-keeping in terms of medications and, appar- ently, blood transfusions; . lack of control and oversight over certain drugs; . sanitation problems in the hospital kitchen in which dust and grime pointed out one day were still untouched three days later; · lack of a written quality improvement plan; and . a design flaw in the $12 million facility that brought the exhaust from helicopters landing on the roof into the operating room ventilation system. The medical staff's only possible response was to shut down the external ventilation when the chopper was on site. JGH Administrator Vic Dirksen is a caring, cOIpII1itted man guided by a capable board. Yet their collective response to the findings of the report has been to argue interpretations even as they get busy fixing the specif- ics. It is not just a medical business On the ridge above downtown Port Townsend. It is a public hospital, and one into which the residents of this county voted in 1993 to invest $12 million of <?ur tax dollars to turn into an exceptional facility that opened its doors amidst much hoopla in 1995. The public has the right to expect not just excellent care but also excellent outreach during a time of questions and doubts, This is such a time. Dirksen has moved to address the specific complaints, and the steps included hiring a quality control professional. The elected hospital commission has great faith in Dirksen. Because they are all non-medical people, they rely heavily on him to navigate the increasingly complex politics and economics of the medical environment But if JGH were a baseball team, it's clear the ownership would be telling the manager to get back to basics. to tighten up the game and to pull back from outside commitments. According to the state report and other signs. this is an institution in need of active, day-to~day. focused management on better systems. higher standards; more consistent quality' care,' and 'on a flow of information to a p~bii~ 'that needs to be able to cou~t on this facility and its staff. Public trust is second only to public health and safety as the key issues now facing JGH. JGH has a long history of holding some of its cards close to the vest. Now is a good time to lay the cards out for a public that needs to know it's getting the best service possible. -Scott Wilson -' -----:~ ) --./ JGH responds fWJg-'oO Letters with plans" /tlf/O/I Editor, Leader: A response is in order to the Oct. 11 Leader editorial "Expect better from Jefferson General." We, as the electid governing board do not take our respon- sibilities lightly, and want the residents of Jefferson County fully infonned of actions underway to correct the deficien- cies cited following the Washington State Department of Health's inspection. Inunediately upon receiving the writ- ten list of charges, the commission went into session with administrator Vic Dirksen and key management staff to develop a corrective plan of action, to tighten and improve our hospital's qual- ity improvement systems. At the recommendation of the' state, we engaged"expert help to assist us in developing a rapid response plan. We had already entered intlll an agree. ment wi th "the" Jefferson .county"Health Department to immediately conduct unannounced inspections of the food preparation area. In addition, tighter su- pervisory controls were initiated. Im- proper food handling conditions at JGH will not happen again. With the leadership and counsel of the consultant, we fonned a perfonnance improvement council of commissioners, the administrator, certain managers, and physicians; and fonned committees of staff to address areas cited. These com- mittees are developing action plans. We are" reviewing options for reassigning' certain responsibilities to provide bet- ter oversight of all hospital functions, and to insure that the very highest stan- dards of patient care are the nonn. The state specifically noted that in no instance were there bad patient out':' comes as a result of not having had a better quality improvement process in place. On Sept. 6, the state resurveyed the hospital, and stated that they were satisfied with our action plan and impressed with our progress. Regarding the Leader's assertion that the hospital holds "its cards close to the vest," every commission meeting is open to the public, with the exception of ex- ecutive sessions as mandated by state privacy laws. Come ask questions and offer comments. We have" also been in constant contact with community leaders including our local board of health. We have made ourselves available to mem- bers of the media and our constituents. We recognize instances where JGH failed to meet patient needs or desires. We regret these and hope our corrective actions will address their concerns. But at the same time, we are proud of the good care afforded most of our patients by a highly professional, dedicated staff. And post-hospital-stay surveys and in- terviews say most patients describe their care as capable, sensitive and loving. As commissioners, we place great confidence in hospital administrator Vic .. Dirksen, recognizing that he is a health care leader of great vision, with an ab- solute commitment to his work. This past year he was honored by his peers when elected to serve as chainnan of the board of the Washington State Hospital Association. In closing, we have learned a difficult lesson, but we do assure county residents that our hospital/health care systems Will be measurably stronger, and will continue to serve the residents of JefIerson County with a high standard of care. We also pledge to you that in the near future we will provide a comprehensive report of significant successes in health care services. "' I ." eHUCK RUSSBLL~;:AlNmdNY ,';""" DeLEO,' JILL Bt9BLER; KArrHtY HILL, JOSEPH WHEELER Jefferson County Public Hospital District No.2 Commissioners OCT-12-2000 THU 02:09 PM SOUTHWEST DRINKING WATER FAX NO. 3606648058 P. 02 ,I', ~ fI~ H~~1th News Release For Immediate Release: October 12, 2000 (00.1 12.dtm) Contacts: Sandy Brentlinger, Division of Drinking Water Janice Keller, Environmental Health Programs 360- 754.5090 360-236-3098 Jcffer~on County Residents Advised to Boil Drinking Water OL YMPIA - About 800 residents of a small community in Jefferson County arc being advised today 10 boil their water before drinking it afier tests showed the presence of fecal coliform bacteria in the community's water supply. The state Department of HeaHh instnlcted the Kala Point Water System, located near Port Townsend, to advise its customers to boillhei.r water or take other precautions to protect their heaith. This is the second boil water advisory issued to this system in the past five months. Water system and state health officials are working together to determine the source of the problem and to disinfect tho system. No illnesses related to the community's dlinkillg water have been reported. "Advisories like these are one way to wam consumers and prevent them from getting sick," said Gregg GnmenfeJder, director of the department's division of drinking water. "Kala Point officials have been very cooperative in testing and spreading the word about the advisory," The boil water advisory includes several precautionary steps that Kala Point Water System customers should take, These include boiling water tor three minutes, or using bottled water for any water that might be consumed. For example, boiled water or prop<:r1y treated bottled waler should be used for brushing teeth, preparing food and making ice, as well ac; for drinking. Grunenfelder said the advisory would remain in effect until state off1cials are confident there is no longer a threat of illness. ## ! '.. .....-...... Kala Point water woes come back Boil water advisory issued again " "BYAnRlJUtA-JANOVICH ..... PENINSULA DAlLY NEWS KALA POINT - About SOO residents of a private Jefferson County community are boiling . their drinking water for the sec- ond time this year. A state Department of Health boil advisory toolt effect at. Kala Point late Wednesday after tests showed traces of E. coli and total coliform bacteria in the privately owned water system. Boiling water is not new to Kala Point residents, who experi- enced a similar advisory for two weeks in June after traces of E. coli and fecal coliform were found in the system. The system serves 461 house- holds just north of Port Hadlock, plus Old Fort Townsend State Park. rpbJ /0,-/3 ._()O Under state law, zero tolerance of coliform bacteria is allowed. Source 'Investigated Water system and state Depart- ment of Health officials are work- ing together to determine the source of the contamination and disinfect the system, state Divi- sion of Drinking Water Director Gregg Grunenfelder said. No illnesses related to Kala Point's drinking water have been reported, he said. '~dvisories like these are one \. way to warn consumers and pre- 'xent them from getting sick," Grunenfelder said. . "Kala Point officials have been very cooperative in testing and spreading the word about the advisory. " However, based on this inci- dent and contamination in June the state will require installation of a permanent disinfection sys- tem, said Sandy Brentlinger of the state Southwest Division of Drinking Water. "We're giving them 30 days," Brentlinger said. TURN TO WATER /A2 Water I I I' CONTINUED FROM Al Kala Point Utility Co. President Bill Lindeman agreed with the order. "1 don't want this to happen again," he said. . Lindeman expects the boil-water advisory to last about a week. 'The state recommends that citi- zens boil their drinking water for at least three minutes or purchase bottled drinking water. Boiled or bottled water should be used for brushing teeth, preparing food and making ice as well as for drinking. Lindeman received notice of the failed water tests Tuesday. Traces of fecal coliform and E. coli were present in samples. Wednesday, three of seven. sam- ples showed traces of to~ colifo~ contamination. No E. coli bactena were present in the follow-up ~- pIes. City of Port Townsend officials loaned; Kala Point Water system offici'B.1s disinfection equipment; , including a pump and an injectOr. Notices to residents have been hand-delivered and will also be mailed. "They've been very responsive," Brentlinger said. "They've posted signs on all bUlletin boards and started their telephone tree. We jumped right on it. A lot was done in a few hours." A previous Kala Point directive took effect June'S after a May 31 sample tested positive for E. coli and a June 5 sample showed traces of fecal coliform. Follow-up tests show no E. coli or fecal coliform, but total coliform. That advisory was lifted June 21. While officials believe the cause of the June contamination might have stemmed from construction to install pipes for a new water tank, they are uncertain what caused the latest contamination. For more information, contact the state Division of Drinking Water at 360-664-0768. j Anti-tobacco l coalition forms PENINSULA DAILY NEWS The Washington Department of Health has launched a statewide tobacco education media cam- paign, featuring two advertising messages. One is aimed at youth in grades 4 through 12 and focused on prevention; the other is aimed at adults and focused on quitting. In conjunction with' the statewide campaign, Tobacco-Free Olympic Peninsula continues its "get involved" program in Jeffer- son and Clallam counties. In Jefferson County, a local coalition is forming, focused on raising community awareness about the dangers of second-hand smoke. Information is available at the Jefferson County Health Department. In Clallam County, efforts are concentrated on supporting adults who want to quit smoking, increas- ing the percentage of mother who are smoke-free during pregnancy and raising community awareness of second-hand smoke. For further information, con- tact Kellie Ragan in Jefferson County, 360-385-9446, or Helen Glad-Spector in Clallam County, 360-417-2352. fDtJ ~D /1'3/00 00 ~.~ SQ) .0 ~ Q) ~ ~.s ~Bo ~. C\j ~ ~ ~ u ~ _~ !? c ~ ~ _t .~ ~ >. t 'tl ~ , cd cv,,,,..Q .ot;:: _ c: ~ ~--o-UCi')-cG StcScU< "'o~U:.c:t)~",~ ;:;:l~-<D e.c: I 'tl ~ S ","".VJ 0 _ B'~ fill VJu"Suu-::I:ut) I:",I:Q. E ~ 'U ~ ~ 0 t .:: .- > u - u 0 u E! u:.2 Q .c: . & 'C :E II: ~~~e-s",,-,,:u cGQ.:J~ u '0 u ~ ......0 ~.c: :I..c Ol u .. ic( ".s.s0l'tl;;>':::lX)~ ~.sB~ 8 ......"'1:....: e UVJOl! ,.I( 0 ~ u ..:- ~ . _ .s B .~ 00 ,c:= "'Cj 0.. V u ..... c:;; cG .... VJ C I:~.s llII...:.= u >=;.. Q, "- 'tl u 01 >..5 0 ... .s ... 8. u .5 b u VJ.o -= _'0 c: ~ o-S & ~ .s .~ .8 ! fi 8. 0 ~ ~ '5 S VJ >..:l >. a:l E VJ.!!l u t- .- "'" ~o.oecu t:>-v.!v_..c: '" - ... u ~ >.....::: 1! ~ :a ~ E ~~ ~ ~::. -g c..c; o..-....J :-~ ..c~o OI~:Ie~ o~ 0I:>t) CI}.....C'UI: U", ~ 15 .~ :I~ :Z:il: --)9 ~Vl 1\1 ~ _GI >."0 lD .. ~ Port Townsend & Jefferson County Leader Water: Permanent fix sought Continued from Page A 1 resort community, was notified lhatlts system tested positive for E. coli and total coliform. The DOH issued an advisory Oct. 10, Instructing residents to bailor huy their drinking water until the system was completely disinfected by chlorine. There have been no confmned illnesses from the water-borne hacteria, according to David Christensen, environmental health specialist for the Jefferson County Department of Health and Human Services. It was the second time in five months the private water "ystem's samples registered E. coli. So the DOH mandated, on Oct. 16, that Kala Point in- stall a permanent disinfection system within 30 days. "We have given them no choice," said Brentlinger. But Kala Point officials weren't unhappy with the man- date. "We can't have this happen- Ing over and over again," said Kala Point Utility Co. President Bill Lindeman, who has already slarted organizing the installation of a permanent system with the help of the City of Port Townsend Public Works Department. I The Kala Point system also provides water to Old Fort Townsend State Park, but the park uses a continual chlorina- tion system so it was not affected by the contamination. Although DOH regional en- gineer Mark Toy toured the Kala Point water system last Friday, he was unable to pinpoint the infection's source. According to Brentlinger, the department sus- pects the infection has come from one of the two reservoirs. Toy found some lady bugs floating in a reservoir, which isn't unusual. But Toy told Lindeman that en- gineers very seldom find the exact contamination cause. Kala Point residents don't ap- pear to be. as frustrated as they were last June when a boil re- quirement was in effect for weeks, Brian Belmont, general man- ager for the Kala Point Owners' Association, said. ''I'm sure they weren't happy, but there have been fewer complaint calls. Maybe people are feeling re- lieved there are measures being taken to deal with the problem permanently." Last June. the boil advisory was in effect for some three weeks after the water tested posi- tive May 31 for E. coli, fecal coliform and total coliform. Kala Point's contamination then likely occurred when a utility crew was installing pipes for a new 200,000 gallon tank. Subsequent tests showed only total coliform, a much less serious contamination, After "shocking" the system with chlorine, two consecutive samples came out negative for any contaminants, and the advi- sory to boil water was rescinded June 21. Although the utility com- pany acted ahead of state timelines for notification, last June the company didn't notify the residents for two days, Many residents. including some who have compromised immune systems. were critical of the delay in notification. This time Lindeman and the utility company officials notified the residents quickly and in a variety of ways. On Oct. II, as soon as samples taken to confirm the first test results came back with persistent contamination. they posted notices on 10 bulle- tin boards throughout the com- plex and activated the telephone tree, which worked effectively. The next day. Thursday, rep- resentatives hand delivered a copy of the state's seven-page report to every Kala Point home. And they mailed a three-page summary on the same day. "My impression was the phone tree worked well on Wednesday so the majority of the residents were notified by Wednesday evening," said Bel- mont. "Of course .there were some gaps," This time, the utility was no- tified the afternoon of Oct. 10 of a problem. As a result of a rou- tine test, E, coli and total coliform was found in the water system. Utility officials immedi- ately took seven more samples. Four of the samples were satis- factory, but three still tested posi- tive for total coliform. On Thursday. they borrowed a chlorine injector pump from the City of Port Townsend that has the capability of continually in- jecting a calibrated amount of chlorine into a system. And last Friday, they began to chlorinate the system. "We are going to continue to chlorinate the system perma- nently," said Lindeman. Once the chlorine reaches a certain stable residual level, of- ficials can take new samples. Unfortunately, the water samples on Monday and Tuesday were up and down, reported Mike Lan- gley, the water system's manager. "[t hasn't settled down to a certain level yet," said Langley. "It's a slow process to reach the exact point." Langley is hopeful they will reach that level on Wednesday, Thursday or Friday. Then two consecutive sets of five samples can be taken. "If they are clean, then we anticipate the state would remove the boiling ban," said Lindeman. P..T LtAOCrz /0- I:? - DO A 2 · Wednesday, Oct. 25, 2000 Kala Point water OK again By Janet Huck Leader Staff Writer It was a good weekend at Kala Point, thanks to the lifting last Friday of the ban on drinking from the private water system's tap. The state department of health (DOH) lifted the advisory to boil Kala Point wa- ter at 5:30 p.m. Friday, Oct. 17. By 6 p.m., Kala Point officials had posted notices on all 10 bulletin boards around the gated community, instructing the residents that they could ~gain safely drink their tap water. "We really didn't want the residents to go through the weekend boiling their wa- ter," said Bill Lindeman, president of Kala Point Utility Co., which serves 800 people at 461 homes. "We were greatly relieved at the Friday afternoon notification." On Oct. 11, the DOH issued an advi- sory instructing the residents to boil or buy their water until the system was com- pletely disinfected by chlorine. Kala Point Utility CO. Wll$ notified the day before that its system tested positive for E. coli and total coliform. Confirmation tests taken the same day showed only total coliform, a less serious contamination. There have been no confirmed illnesses from the water-borne bacteria, according to David Christensen, the environmental health specialist for Jefferson County De- partment of Health and Human Services. The Kala Point system also provides water to Old Fort Townsend State Park, but the park uses a continual chlorinating system so it was not affected by the contamination. As a condition of lifting the boil water advisory, a permanent disinfection system must be designed, approved and installed by Nov. 19, according to the DOH. The temporary chlorination system - using the City of Port Townsend's injector pump will remain in place until this condition is met. It was the second time in five months the system's samples registered E.coli. So the DOH mandated, on Oct. 16, that Kala Point install a permanent disinfecting sys- tem within. 30 days. Lindeman said they are gqing to send the engineer's specifica- tions to the DOH by the end of the week, and he hopes to install a permanent sys- tem by the middle of November. "If we install the permanent system, we shouldn't have any more problems because the chlorine should effectively kill all the bacteria," said Lindeman. The DOH officials haven't been able to pinpoint the source of the contamination, but DOH water specialist Sandy Brentlinger said it was probably coming from one of the two reservoirs. When the Kala Point water system was contaminated last Jtme with E. coli, fecal coliform and total cQliform, the source was probably unsanitary repair work. The June boil-water advisory was in effect for three weeks, frustrating and angering some residents. This time the residents seemed to be simply relieved there were measures be- ing taken to deal with the problem perma- nently, said Brian Belmont. general man- ager for the Kala Point Owners' Associa- tion. The drinking water division of the state health department commended the Kala Point Water Co. staff for its quick response and a professional approach to solving the water quality problem. "Residents of Kala Point community may resume water consumption with con- fidence," reported the state's Bill Liechty. Wednesday, Oct. 25, 2000 · B 11 Public flu clinics postponed until late November The previously announced schedule for Jefferson County Health and Human Services flu vaccine clinics has been changed, reports public health nurse Jane Kurata. While there will not be any shortage of flu vaccine this year, Kurata said, shipments from some sources will be later than expected. Unfortunately, she ex- plained, the department's sup- plier is one of those sending par- tial and delayed shipments. "Because we' are unsure at this time of the exact dates we can expect to receive our vaccine, Jefferson County Health and Human Services will be starting our flu clinics later in Novem- ber," said Kurata. "The revised clinic schedule will be an- nounced when we have more in- fonnation on vaccine delivery." Many local physicians do have influenza vaccine for their patients, however, and some have scheduled special clinics. Local supennarkets also expect to hold flu clinics, said Kurata. Persons who are at high ri~k for complications from influenza should receive the flu vaccine, advised Kurata. These include: · persons age <i5 and older. · residents of nursing homes. · adults and children, includ- ing pregnant women, who have chronic heart, lung or kidney dis- ease, diabetes or other serious chronic health problems, includ- ing asthma. . persons who are less able to fight infection because of HIV infection, other immune system disorders, long-term treatment with steroids or can- cer treatment. · children and teenagers on long-tenn treatment with aspirin, who, if they catch influenza. could develop Reye's syndrome. · women who w'fij'be in the : $econd,:-;QIlJthird.trim,estet .of pregnancy during the flu season (beyond three and one-half months pregnant). Health care providers and close friends and family of per- sons at high risk for flu should be immunized to reduce the pos- sibility of spreading the flu to these persons. Physician-sponsored clinics . Jefferson General Medical Group, 834 Sheridan St., Port Townsend: For established pa- tients only, Friday, Nov. 3 and Monday, Nov. 6 from 9 a,m.- noon and 1-3 p.m. · Jefferson Medical Associ- ates, 617 Sheridan St.. Port Townsend: For established pa- tients only, Tuesdays and Thurs- days from 1-5 p.m. beginning Nov. 2. Please call first. · Dr. Lynn, 1136 Water St., Port Townsend: Established pa- tients only. . Olympic Primary Care, ]010 Sheridan St., Port Townsend: For established pa- tients only on Oct. 25. · Port Townsend Family Phy- sicians, 934 Sheridan St., Port Townsend: For established pa- tients only, Saturdays. Nov. II and 18. 9-1 ] :30 a.m. · South Cqunty Clinic, 294842 Highway 101, Quilcene: For established pa- tients over 65 and high-risk only. Please call first.