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Home My WebLink About046 92 f t , If ¡. r ,. ,i It .I'. ,4 RESOLUTION NO. 46-92 HEARING NOTICE PROPOSED BUDGET EXTENSIONS JEFFERSON COUNTY HEALTH DEPARTMENT WHEREAS, the Jefferson County Health Department has requested budget extensions for their 1 992 budget due to additional funds and expenditures which were not anticipated at the time of preparing their said budgets; and WHEREAS, it appears to the Board of County Commissioners that a need and emergency exists that could not have been foreseen or contemplated at the time of preparing the budget for 1992 to provide the sum of $13,896.00 for a budget extension due to unanticipated fee and grant reimbursements for programs and department services. NOW, THEREFORE, BE IT RESOLVED, that an emergency is hereby declared, and that the extentions be made for the Health Department. BE IT FURTHER RESOLVED, that a public hearing be held on the said emergency extentions and that said hearing be held in the County Commissioners' Chambers, Courthouse, Port Townsend Washington, on the 22nd day of June, 1992, at the hour of 11 :30 a.m., and that notice of said hearing be published in the official newspaper of Jefferson County, and that at said hearing any interested taxpayer may appear and be heard for or against the appropriations for such alleged emergency. SEAL: ATTEST: <I' f" * 13 : 00 6'"'!'ì ....."-1 - _e - \....-......,\.___./>;-7 ,.- "",, ."II"/)?~- "".~. .-".'~' .)¡.""'." .' ,)iA- '. ~~ ~ ; !~ '1 ' " -:', "~.):>'- r.(l~~;< - ',~ ~: )" JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS \ 1820 Jefferson Street P.O. Box 1220 Port Townsend, WA 98368 (206) 385-9160 Gary A, Rowe, P.E., Director Robert G, Nesbitt, P.E., County Engineer MEMORANDUM TO: Board of County Commissioners FROM: Gary A. Rowe .4o.v¡ a'í2~ DATE: May 27, 1992 SUBJ: Heath Department Budget Extension Per your request, I have reviewed the budget extension request for the Health Department. A form entitled .Flscallmpact Statement. was developed for this purpose and was Initiated with this request. David Specter filled out the attached forms on which I have added notes to supplement the Information provided by David. Please note that .other costs. are based on indirect and overhead costs as established on the 1992 Health Department budget and County Cost Allocation Plan. The .direct costs. David provided only account for approximately 60% of the total cost of providing the service. The other costs are In the form of administration, rent, management, etc. Although no Increase in administrative staff has been proposed, additional staffing was requested for 1992 In the preliminary budget but was not funded. Future funding for the Health Department depends on the ability to fund all county programs which could be facing reductions for 1993. As Budget Manager, I am concerned about adding a program that while revenues cover the direct costs, the indirect costs (administration, overhead, etc.) are not covered. 100% Recycled Paper HEALTH DEPARTMENT '92 OPERATING EXPENSE BUDGET 1 DIRECT 2 INDIRECT 3 OVERHEAD 4 TOTAL 5 DlR + OVER 6 DIRECT $635.248.33 $148.696.21 $243.271.46 $1.027.216.00 $391.967.67 $635.248.33 62% 14% } 24% } 100% 38% AS A PERCENT OF TOTAL COSTS (2+3 14) 62% AS A PERCENT OF DI~CT COSTS (5 I 6) ~. . . - - 4SCAL IMPACT STATEMENT Jktf ¿ T1I- Department .AJçw f/R~ Program Budget Page No. Jf- 'II Bars, Une Item c5Ef!1lfIT"CIIFI) ~AFtf CLlNI¿ FfÞ~ CHIUJt1~1(/ Proposal ($ÇtJ#L bAVt,T fMJ 1Ø I(f;N SI G .r; ~ ) FUTURE YEARS ESTlMA TED BUDGET OF PROPOSAL IF ADOPTED (a) (b) (c) (d) (e) Budgeted Proposed Change Proposed Revised 1st Subsequent 2nd Subsequent Amount For In Budgeted Current Year Year ~ Year * Proposal Amount Budget (a+b) Direct Cost ~ $ ..er $ ?¡f13 $ --Z.11L $1",/12 $ J~ ell ~~ A7TJtQ/e , her Costs X I 70 $ $ 5,5&/ $ 5,581 $ /1/ 'Ø~tf $ II" 334 (Detail below) Staffing . It> F.1. E. ./0 For. e.. .1" F.T.6. . 10 F.T. Go . Sources of Revenue for Proposed Change and Subsequent Years: f8;?~ $ -e $~ $~'/~ $ I ~ 'l-fð . $ 1~()8() , $ $ $ $ $ Space-Related Impacts: WIll proposal result In any additional space requirements? Yes €) If yes, how will these requirements be accomodated? (Attach additional sheets as required) f?A~e:p plf.l 7"1IE:- A~"'KlPr/o¡.) rH!l'Í 7)1<. 6c.,4¡~e-n:>trll't,J~ U~t:: 1)0é5 ¡uor 1M PA-~ 7r/1E lA'4> ~ þy 6" A/YI ROOM 5 1=ð It- ~ ::s.e-IQ. \lJc:£ S . Administrative Support & Other Department ImDacts: (Attach additIonal sheets as required) BOCC Budget Goal or Objective met with this Proposal: ~ í5M-A,O ðF ~ At=71d¡Ú 9-2-1-9'2- /?,-,,"6er t5etPt..s AII/O ()~7fveS ,4'iTItc-+}60 ~.J/í/J- J.h6./i /.-I6+tTS Remarks: (Attach additional sheets as required) - 5t~ "'rn9~-- p~~~ ß;,,~ ,f,u~ys, S' - ~ S()OS£(J~ YG1IIl. ¡:;~"vS ¡IV CuIl/lFÑr ~ (; ~ !: 13 - 'I&- Bud... Man.... \ I D::JLt1lfZ& . Date JEFFERSON COUNTY HEALTH DEPARTMENT FIRST QUARTER BUDGET EXTENSION REQUEST DESCRIPTION BUDGET LINE 562,00 10 650 Nurse Hire -:;Þ 562.00 10 120 Occupational Therapist ... 562.00 20 Personnel Benefits 562.00 31 ~ 562.00 35 """562,00 41 ...:'IP562,00 41 562,00 42 562.00 44 20 Operating Supplies Office Equipment 30 Laboratory 25 Physician 10 Postage Advertising c: ILOTVSIBUDGE11 IQEXT. WKI 1992 BUDGET $1,000.00 $0,00 $163,250.00 $31,195.00 $2,620.00 $0.00 $0.00 $5,000.00 $500.00 J,tn=- ClI ~ , (; I cd PI D/~~ ~/ 0/( ¡JtØ' . CU~ s1~ ~1JØ APPROPRIATION REQUIRED EXPL ATION $1,000.00 (a) $690,00 S Board of Health Project, per one time contract (b) ,430. ediatric Sexual Assault Program staffmg $3,093.48 For Child Development Program, per 4/21 Board of Health $143.00 Pediatric Sexual Assault Program nurse part-time at 10% 308.88 Occupational Therapist part-time at 10% $79.65 State Board of Health Project, per one time contract $200.00 Pediatric Sexual Assault Program operating supplies $675.00 WlC Equipment, per Contract Amendment $1,000.00 Pediatric Sexual Assault Program JGH laboratory fees $5,200.00 Pediatric Sexual Assault Program physician fees (Dr. Schneidman) $9.95 State Board of Health Project, per one time contract $144.90 State Board of Health Project, per one time contract I $12,974,86 I $0.00 $163,250.00 (a) (b) $31,195.00 (a) (b) $2,620.00 $0.00 $0.00 $5,000.00 $500.00 14-~y-92 ) CURRENT EXPENSE IMPACT Neutral Neutral to Positive Positive Neutral to Positive Positive Neutral Neutral to Positive Neutral Neutral Neutral Neutral Neutral ) ~-f~ þ-fpAff/111 PS , --'" - - ~Ct ~¿¿'S-/~ - /()L.~S: 92--:'~/N(J i I{.1 ~ ~~/"'ðj ¿¡'I:: ~M' - ~/TV~ +Ið 9ð /)1817< ~ 70 VðLuM~ ~ -- cÞ AJ ~ Q, UtI#..S - - April 17, 1992 TO: Board of Health FROM: David A. Specter SUBJECT: Program Review Analysis: Pediatric Sexual Assault Clinic - Dr. Sydney Schneidman I. BACKGROUND Sydney W. Schneidman, M. D. has proposed the establ ishment of a clinical program at the Jefferson County Health Department for non-emergent evaluations of children suspected of being victims of sexual assault. Dr. Schneidman is a resident of Port Townsend. He is board certified in emergency medicine, with over 10 years experience. He has been the Director of Emergency Services at Jefferson General since 1988 and was instrumental in the development of Jefferson County's paramedic system. Dr. Schneidman is interested in establishing the sexual assault examination program at the Health Department as an alternative to private physician offices and the hospital emergency room. Area physicians are supportive of the concept, as is Jefferson General administration. Dr. Schneidman does not consider the hospital to have adequate or appropriate facilities for this program. Initial patient volume is projected by Dr. Schneidman at four to six cases per month. Dr. Schneidman is requesting to use one exam room and the lab for one half day per week. He would need Health Department staff support including reception, registration, nursing, medical records, billing and scheduling. Reimbursement for the clinical examination, lab fees and a facility charge would be provided through the State Crime victims Compensation Program. Health Department management have met with Dr. Schneidman on two occasions to discuss his proposal. Dr. Geeflofs is well acquainted with Dr. Schneidman and participated in one of the meetings. We have also had conversations with Jefferson General Hospital administrator, vic Dirksen, and various State and local agencies including the Crime victims Program, DSHS and the Sheriff's Department. We have also contacted administrative and clinical staff of sexual assault clinics at st. Peters Hospital, in Olympia, and Cowlitz Family Health Center, in Longview, Washington. 1 - - II. PROGRAM DESCRIPTION There are two types of sexual assault examinations: acute and chronic. Acute cases are those requiring an emergency examination and are conducted in the hospi tal emergency department. Dr. Schneidman's proposed Health Department based program would involve only chronic, or non-emergent examinations, conducted on a scheduled basis. (Acute cases would continue to be seen by Dr. Schneidman in the hospital.) Initially, cases would be restricted to children, with the possibility of expanding to adolescents in the future. Dr. Schneidman is also interested in potentially expanding the program to include physical abuse cases in the future. Although there are different program models, the typical sexual assault examination requires approximately two hours to complete. It includes approximately one hour of interview and one hour of medical exam by a specially trained physician or nurse practi tioner. Interviews are conducted with both the child and the accompanying adult caretaker. In an effort to avoid multiple interviews by various agencies, the interviews may be observed by law officers and/or caseworkers through a one way window and may also be audio taped. (None of the programs contacted use videotape to record interviews.) The medical exam includes a comprehensive physical examination, genital exam, lab specimens for routine STDs, and detailed photography using a high quality macro-lens camera or photocolposcope. The medical exam is conducted in visual privacy, but may be audio monitored. According to the other clinics we contacted, approximately hours of documentation is required for each hour of clinical Al though child sexual assaul t cases rarely go to court, extensive documentation is an important aspect of the protection for the victims. three time. this legal III. PROGRAM NEED AND RELATIONSHIP TO PUBLIC HEALTH PRIORITIES The proposed program would serve clients from Port Townsend, Jefferson County, and potentially adjacent counties. There are currently no other sexual assault clinics west of puget Sound or on the Peninsula. In western Washington, hospital based clinics are located at Harborview Hospital, in Seattle, and st. Peter's Hospital, in Olympia. The program at st. Peters examines 20 children per month and has a six week waiting list. Community based programs are located at the Auburn Clinic, which is affiliated with the Seattle/King County Health Department, Eastside Sexual Assault Center, in Bellevue, and the Cowlitz Family Health Center, in Longview. The Cowlitz center performs approximately 16 examinations per month. Referrals to the proposed program would come from Child Protective Services, law enforcement agencies or private physicians. Because eligibility under the Crime victims Compensation Program requires 2 - - that the alleged sexual assault has been reported to the police, direct requests for examinations from families would not be accepted. This is the standard policy among other programs and also helps to assure coordination among agencies and healthcare providers. Dr. Schneidman estimates the initial case load at four to six examinations per month. Our discussions with the County Sheriff's office and DSHS confirmed this level or higher potential caseload. The Sheriff's office receives an average of three third-party reports of sexual assault on children per week, or approximately 12 per month. The DSHS Division of Family Services indicated an additional four cases per month, not included in the Sheriff's figures, that are referred through CPS for medical examination. Although the Health Department has not yet undertaken its public health needs assessment, statistics on child abuse apparently show Jefferson County as having one of the highest rates of child abuse in the State. The need for a consistent, comprehensive and legally sound approach to medical evaluation of alleged victims of sexual abuse appears to be evident. What is not yet clear is whether the limited Health Department resources should be allocated to this program versus other needs of potentially greater priority to the community. If a decision is made to proceed with the proposed program, it should be on a four to six month trial basis, pending completion of the Community Health Plan for Jefferson County this fall. IV. FACILITY AND EQUIPMENT REQUIREMENTS Dr. Schneidman is requesting to use one to two exam rooms, plus the lab, for one half day per week. One clinic room is required for the examination and, according to the Director of the Cowlitz Heal th Center program, should be "child friendly". If visual observation of the interview is needed, a second room would be utilized. The Health Department's new facility at Castle Hill has a one-way observation window between two clinic rooms. These two rooms are ideal for the program. One of the two rooms is a consultation room and is being set up for the Child Development program in a "child friendly" manner. The other room is a standard exam room, with an exam table and sink. One way observation can occur in either direction between these two rooms. The clinic and lab are currently available on Thursday mornings; this time is used for Nursing staff meetings and no clinical programs are presently scheduled in this time slot. Expansion of the program beyond this half-day schedule would be problematic due to other scheduled uses. Cowlitz Family Health Center indicated a capacity of two to three cases per full clinic day. with one half-day available, this would suggest a maximum case load of two cases per week (eight cases per month) for the proposed program. Equipment and supply needs for the program are minimal: speculums, photographic equipment, exam supplies, culture materials and note 3 - - pads. The equipment would be stored at the Health Department in a lockable rolling cart with drawers. Equipment, including the cart wo~ld be provided by Dr. Schneidman at an estimated cost of , . $2,000 to $3,000. The Health Department would prov1de exam supplies and use of existing microscope and lab equipment as needed. v. STAFFING Health Department staff functions required for the proposed program would include reception, registration, nursing, medical records, billing, scheduling and program administration. Jefferson General has agreed to provide medical transcription services for the program. At the initial caseload of only four to six examinations per month, the Health Department can accommodate the reception, registration, billing, scheduling and administrative support functions without impacting current staffing levels. A thorough orientation for support staff would be essential. Nursing support for the proposed program, however, is not available from existing Health Department staffing. Based on a ratio of one hour clinic setup and coordination time for each hour of examination time, an estimated 12 to 18 nursing hours per month will be required for the initial caseload. Salary expense for nurse hire would be approximately $1,950 for 1992, assuming a mid-June start date, and would require a Health Department budget extension. Nursing support should ideally be a pediatric trained nurse who has completed the sexual assault course offered by Harborview Hospital. This course is offered at no cost. There are several unknown factors relative to staffing. One is the level of support required for the accompanying adult/caretaker during the child's exam, as well as support for the child during the adult interview. One facility we contacted indicated that substantial support could be required for both the adult and the child. This facility mitigates this need for support to some extent by requiring that two adults accompany the child for the appointment, so that one adult is available for support at all times. Even so, the facility has a grant supported social worker available for the program. A second unknown staffing consideration is the potential for the nurse to be called into court to testify, involving substantial addi tional paid time. Our discussion with the other centers, however, indicates minimal potential for this to occur since ninety percent of these cases do not go to court, but are settled out of court. Court appearances can also be avoided by a strict policy that the nurse does not participate in the interview. The Cowlitz center has adopted this policy and has never had its nurse called to testify in court. .. - - VI. FINANCIAL ASSUMPTIONS Dr. Schneidman estimates that approximately $2,000 to $3,000 in startup capital will be required to initiate the program. Approximately half of this amount is needed for photographic equipment, with the balance for other equipment. Dr. Schneidman's intention is to solicit donations from service clubs and other organizations, such as the Hospital District and the state Juvenile Justice Program, which apparently funded the st. Peters program startup. He is not expecting the Health Department or Jefferson County to provide startup funding. Reimbursement for the clinical examination, lab fees and a facility charge is available through the state Crime victims Compensation Program. other centers characterize this reimbursement as extremely dependable. Eligibility for payment under this program requires only that an "allegation" of sexual assault has been made, by the victim having filed a police report. Our review of the applicable procedure codes and payment amounts, as well as conversation with officials at the Crime victims Compensation Program, indicates that we would expect reimbursement of approximately $205 to $265 per exam, plus lab fees. Of this amount, $95 to $160 would represent physician fees that the Health Department would pay to Dr. Schneidman and approximately $110 would represent Health Department reimbursement. At an average of five exams per month during June though December, 1992, Health Department revenue would total approximately $3,300. This revenue would offset direct operating costs (nurse hire, supplies) of approximately $2,100, with an approximately $1,200 contribution to current expense. Lab fees would pay largely for external lab charges purchased from Jefferson General, as applicable. We will need to establish an agreement with the hospital to accept Crime Victims reimbursement as payment in full. Two cautionary notes regarding reimbursement under the Crime Victims Program: In our conversations with Program officials, we found considerable ambiguity regarding the "facility fee" component of the reimbursement, i.e. the Health Department's portion of the reimbursement. Although there is a track record of reimbursement for other Sexual Assault Centers, Crime victim Program reimbursement officials were uncertain about the applicable billing codes and could not specif ically identify the level of reimbursement. In addition, we were advised that new WACs are currently under review that Program officials indicated will change the way the Crime victims Program pays facilities, consistent with DSHS. We do not know what the implications of these changes will be with respect to the above financial assumptions. 5 - - =ISCAL IMPACT STATEMENT ~-m- Department Ú7'"- 1> ~;" If¡( F,v/ Program Budget Page No, 31 Bars, Une Item ~./ () ",:J.. 'CO . J..e> _ac e v~h7()~ A-tr -,- ~/S' ,..... Proposal FUTURE YEARS ESTIMATED BUDGET OF PROPOSAL IF ADOPTED (a) Budgeted Amount For Proposal (b) Proposed Change in Budgeted Amount (c) ~ (d) *~ (e) * ¥r' Proposed evised 1st Subsequent 2nd Subsequent Current Year Year Year Budget (a+b) $ ]vÞJ. 3{.. $ ¿:8'1-./'1 $ ~8'" Ilf $ ~ae.z. $ 't.3'17 $ ~E.97 (se~ ~~ J $ -<;J Other Costs 7tJ ~ $ (Detail below) .=::::>;. $3~.l.3' $ .2,$82., , Staffing Ci.~Y6Wl-} ..#' . /0 f,1:ii:- , 10 F.1. E.., . 10 F.'!:6, dO ;:'7. £, Sources of Revenue for Proposed Change and Subsequent Years: $ $.:J:,Q.ðlJ $ 'U'J.ð/J $ 7t;J-f .()() $ 71)2.'1. 6tJ $ $ $ $ Administrative Support & Other Department Impacts: (Attach additional sheets as required) BOCC Budget Goal or Objective met with this Proposal: - ~ ~1'fU> 6F- /fPf£711 ðc:11dAJ ~ - J./- ,... - B¡,¿1)6-f:r 6e7tt.S AItID ()ß,.n::c7ì vé-S .lYfJ1tc..I:IÆ-D IV I r Ii /-! / b# /./ frI-I{!> Remarks: (Attach additional sheets as required) ~ Set;: 'i>tPn'f¡L ~ 1E1f- BS~lJ~~' ~ðAl IN Cv¡(!,(F/Vr ~c..ufI1S. (¡-/3-fJ-- 4~;;;¡: aK--- ó/Uh1--- Date Budget Ma ager Date / - - JEFFERSON COUNTY HEALTH DEPARTMENT PROPOSED BUDGET FOR OCCUPATIONAL THERAPY POSmON PAYROLL EXPENSE Maximum Hours Per Month: Hourly Rate: Benefits/Hour at 10%: Total Wage and Benefit Per Month: 18 $26.44 $2.64 $523.51 Total Wage and Benefit Per Year: I $6,282.14 I REVENUES (Assuming 12 Billable Visits/Month) Private Insurance (3 Visits @$80.00) PT School District (3 Visits @$55.00, 9 months) Medicaid (6 Visits @$37.00) $2,880.00 $1,485.00 $2,664.00 Total Revenue Per Year: I $7,029.00 I $746.86 I Annualized Contribution to Current Expense / Overhead: 1992 Budget Impact (Assuming 6/15/92 Start) Expenses Wages: 18 hours X 6.5 months X $26.44 = Benefits: 18 hours X 6.5 months X $2.64 = Total Expense: $3,093.48 308.88 I $3,402.36 I Revenue Private Insurance (3 Visits @$80.00 X 6.5 Months) PT School District (3 Visits @$55.00 X 4 Months) Medicaid (6 Visits @$37.00 X 6.5 Months) $1,560.00 $660.00 $1,443.00 I $3,663.00 I C,ILOTUSlBOHlOTPOSlT. WXI ()::;::,v 1/117ðMfr- ~ $r D,,~~t=G" Co~~ JEFFERSON COUNTY HEALTH DEPARTMENT FIRST QUARTER BUDGET EXTENSION REQUEST BUDGET LINE DESCRIPTION 562.00 10 650 Nurse Hire ~ 562.00 10 120 Occupational Therapist 562.00 20 Personnel Benefits ~ 562.00 31 20 Operating Supplies 562.00 35 562.00 41 562.00 41 562.00 42 562.00 44 Office Equipment 30 Laboratory 25 Physician 10 Postage Advertising c: ILaruSIBUDGET\lQE}{T. WKI 1992 CURRENT SUPPLEMENTS ) BUDGET APPROPRIATION REQUIRED EXPLANATION CURRENT EXPENSE IMP ACT $1,000.00 $1.000,00 (a) $690.00 State Board of Health Project, per one time contract Neutral (b) $1,430.00 Pediatric Sexual Assault Program staffmg Neutral to Positive $0.00 $0.00 $3,093.48 For Chüd Development Program, per 4/21 Board of Health Positive $163,250.00 $163,250,00 (a) $143.00 Pediatric Sexual Assault Program nurse part-time at 10% Neutral to Positive (b) 308.88 Occupational Therapist part-time at 10% Positive $31,195.00 $31.195.00 (a) $79.65 State Board of Health Project, per one time contract Neutral (b) $200.00 Pediatric Sexual Assault Program operating supplies Neutral to Positive $2,620.00 $2,620.00 $675.00 WIC Equipment, per Contract Amendment Neutral $0,00 $0,00 $1.000.00 Pediatric Sexual Assault Program JGH laboratory fees Neutral $0.00 $0.00 $5,200.00 Pediatric Sexual Assault Program physician fees (Dr. Schneidman) Neutral $5,000.00 $5.000.00 $9.95 State Board of Health Project, per one time contract Neutral $500.00 $500.00 $144.90 State Board of Health Project, per one time contract Neutral I $12,974.86 I 14-MAy-92 ~ - - . ~SCAL IMPACT STATEMENT ~ 71-1 _ûJlC-. Program Budget Page No. Iff) Bars, Une Item 5'" 2. .f)/J .3r Department ~, 1'1£f{7v, Proposal FUTURE YEARS ESTIMATED BUDGET OF PROPOSAL IF ADOPTED (b) (c) Proposed Change Proposed Revised In Budgeted Current Year Amount Budget (a+b) $'7~ $&'7>" $ 4f72J $ t.f7~ (d) 1st Subsequent Year (e) 2nd Subsequent Year (a) Budgeted Amount For Proposal Direct Cost $'-þ $-{) $ -e- Other Costs jl>'. (Detail below) $ $ $ Staffing Sources of Revenue for Proposed Change and Subsequent Years: ~ .,.- $ -6-- $ '7 S-- $ "7r $ -er $ -e- $ $ $ $ . Space-Related Impacts: Will proposal result in any additional space requirements? Yes G;) If yes, how will these requirements be accomodated? (Attach additional sheets as required) Administrative Support & Other Department Impacts: (Attach additional sheets as required) BOCC Budget Goal or Objective met with this Proposal: ~ber ~L.$ 1'JAi/} PðJ""&:'7/v65 A7TAc.H~ ..,)/7 hi H'irlJ.'-'61J.7~ Remarks: (Attach additional sheets as required) ~~ ~~ Date 4~ (þ K~'f Budget Manager ~/~~L Date r-,J -~t&o-- - - i ~tvJ~ ,¡¡I"TIM \1 I ;[EEIE 'ecretar~ : 20 ., TATE OF vVASHINGTON DEPART¡\;1ENT OF HEALTH OlYmpia. \ \-ashlmuon <.¡H50~ 6 Ú1L ~c ' '\.tí¡~1- <.'1' March 16, 1992 J. Peter Geerlofs, MD Health Officer Jefferson County Health Castle Hill Center 615 Sheridan Port Townsend, WA 98368 Department Dear Dr. Geerlofs: An amendment to your consolidated contract has been initiated to increase your agency's 1992 WIC funding by $675 in the January - June 1992 time period for the purchase of an infant recumbent measuring board, and infant scale, and an adult eye-beam scale. The revised totals are listed below. Also, a print out of the current funding, additional funding and revised totals by time periods is attached. Time Base BF Funds WIC EcroiDment Total Period Allocation Conference Jan-June $14,964 $ 0 $ 90 $675 $15,729 1992 Jul-Sept 7,482 0 0 0 7,482 1992 Oct-Dee 7,482 0 370 0 7,852 1992 Total 1992 Allocation: $31,063 ., The WIC caseload allocation for calendar year 1992 is: AUTHORIZED PARTICIPATING CASELOAD January I - December 31, 1992: 320 ~3 - - J. Peter Geerlofs (cont.) Page 2 If you have questions regarding this information, please contact me. Thank you for your continued support of the WIC Program and I look forward to working with you in 1992. Sincerely, ~~ Dick Court, M.S., R.D. Local Program Consultant Mail stop LC-12C cc: Nancy Gow Debora Taussig Loren Bell Allocation File Agency File Cynthia Walker Kristin Hansen - JEFFERSON COUNTY HEALTH DEPARTMENT FIRST QUARTER BUDGET EXTENSION REQUEST 1992 BUDGET LINE DESCRIPTION BUDGET 562.00 10 650 Nurse Hire $1,000.00 562.00 10 120 Occupational Therapist $0.00 562,00 20 Personnel Benefits $163,250.00 562,00 31 20 Operating Supplies $31.195.00 ...,,562.00 35 Office Equipment $2,620.00 562.00 41 30 Laboratory $0.00 562.00 41 25 Physician $0.00 562.00 42 10 Postage $5.000,00 562.00 44 Advertising $500.00 WI G ff4Þll~ r Ð/~rCøSTS CURRENT SUPPLEMENTS APPROPRIATION REQUIRED EXPLANATION $1,000.00 (a) $690,00 State Board of Health Project, per one time contract (b) $1,430.00 Pediatric Sexual Assault Program staffmg $3,093.48 For Child Development Program, per 4/21 Board of Health $143.00 Pediatric Sexual Assault Program nurse part-time at 10% 308.88 Occupational Therapist part-time at 10% $79,65 State Board of Health Project, per one time contract $200.00 Pediatric Sexual Assault Program operating supplies $675.00 WIC Equipment, per Contract Amendment $1,000.00 Pediatric Sexual Assault Program JGH laboratory fees $5,200.00 Pediatric Sexual Assault Program physician fees (Dr. Schneidman) $9,95 State Board of Health Project, per one time contract $144,90 State Board of Health Project. per one time contract I $12.974,86 I C:ILaTUSIBUDGEl11QEXT. WKI $0,00 $163.250.00 (a) (b) $31,195.00 (a) (b) $2,620.00 $0.00 $0.00 $5,000.00 $500.00 14-A6y-92 ) CURRENT EXPENSE IMPACT Neutral Neutral to Positive Positive Neutral to Positive Positive Neutral Neutral to Positive Neutral Neutral Neutral Neutral Neutral ) - ~rH- Department - .SCAl IMPACT STATEMENT i¡U IIf' J~7I fIf? Program Budget Page No, :N- 'I- f) Bars, Une Item ~ $/~TF ~ /JF- ~ Proposal ?~C-:r- (a) Budgeted Amount For Proposal /'.Irect Cost $ -ð- t~feost~ $ (Detail below) Staffing FUTURE YEARS ESTIMATED BUDGET OF PROPOSAL IF ADOPTED (b) (c) Proposed Change Proposed Revised In Budgeted Current Year Amount Budget (a+b) $ 9,'1. Sf) $ 9z'I.5"0 $ (,,'17 $ '47 (d) 1st Subsequent Year (e) 2nd Subsequent Year $ -l7- $ 0- $ $ Sources of Revenue for Proposed Change and Subsequent Years: G /Jf¡ur $ -ð- $ $~ $ :I'll .ðO . --er ..GJ-' $ $ $ $ $ Space-Related Impacts: WIll proposal result In any additional space requirements? Yes @ If yes, how will these requirements be accomodatad? (Attach additional sheets as required) Administrative Support & Other Department Impacts: (Attach additional sheets as required) BecC Budget Goal or Objective met with this Proposal: $",,"6-£:"1 ~e..s A,.,-P owec.Tlv6:.$ tllN-Afï1t'-JtE:D wff¡J, HI61+Lt6TtTj Remarks: (Attach additional sheets as required) ~ I1J /IJ~/IF() . ~~ S-,/3 "'I.l- Date ~~aZ. Budget Magar 5:"!zt /~ V Date I JEFFERSON COUNTY HEALTH DEPARTMENT FIRST QUARTER BUDGET EXTENSION REQUEST BUDGET LINE DESCRIPTION ~562.00 10 650 Nurse Hire 1992 BUDGET $1,000.00 562.00 10 120 Occupational Therapist 562.00 20 Personnel Benefits $0.00 $163,250.00 ... 562.00 31 20 Operating Supplies $31,195.00 562,00 35 Office Equipment $2,620.00 562.00 41 30 Laboratory $0.00 562.00 41 25 Physician $0.00 .... 562.00 42 10 Postage $5,000.00 ""562,00 44 Advertising $500.00 C:ILOTUSIBUDGE111QÐ(T. WKI ~~/)P~ ~~ þ/t.~T CðS,:> $0.00 $163,250.00 (a) (b) $31,195.00 (a) (b) $2,620.00 $0.00 $0,00 $5,000.00 $500.00 14-MRy-92 CURRENT EXPENSE IMPACT Neutral Neutral to Positive Positive Neutral to Positive Positive Neutral Neutral to Positive Neutral Neutral Neutral Neutral Neutral ~ CURRENT SUPPLEMENTS APPROPRIATION REQUIRED EXPLANATION $1,000,00 (a) $690.00 State Board of Health Project, per one time contract (b) $1,430.00 Pediatric Sexual Assault Program staffmg $3,093.48 For Child Development Program, per 4/21 Board of Health $143.00 Pediatric Sexual Assault Program nurse part-time at 10% 308.88 Occupational Therapist part-time at 10% $19.65 State Board of Health Project, per one time contract $200.00 Pediatric Sexual Assault Program operating supplies $615,00 WIC Equipment, per Contract Amendment $1,000.00 Pediatric Sexual Assault Program 10H laboratory fees $5,200.00 Pediatric Sexual Assault Program physician fees (Dr. Schneidman) $9.95 State Board of Health Project, per one time contract $144.90 State Board of Health Project, per one time contract I $12,914.86 I ~ FO"" -HI!"'" ....SHlMGrOH L- A19 R.. . ~ I I"'. .,ICE VPUCHER Î..--- ::r 110. AGINCY USE ONlY ux:AnoHCOOI! '". Oil .Un!. NO. ~,ò UAb -co I bf I AGENCY NAME I I ¡ /,/ ¡t/"'-,.J ~~ "D. -'<4<) ~¡::; IL.f LTH INSTRUCTIONS TO VENDOR OR CLAIMANT: SubmIt Ihi3 torm W~tf1 "IT) ~ f]r7t' ~ Inp/icattf to ctalm paymtfnt for mattfna/s, merchandIse or ,4/~()V~ Ttl/A t. /1'1,( /(, 8L-i>t, II, L L - J'+ R E C E \ \! E \..Jervlcn Show comptete detalt for each item. tJ¿Ý¡f11J'¡A I ¡'vA 13S"OIf - tX:;e¡lï cr q i 8 ~l1r'\'" r r. L,.' . ' ... Vendor's Certificate. 1 hereby cartlfy under penalty of perjury that the itama and tolals lisled herein are proper chargea for malarlsls, mer. chandise or services furnished to the Slate of Washington, and that all goods furnished and/or sarvices rendered have bean providad without discriminatIon on the grounds of rsce, creed, color, national origin, sex, or age. I VENDOR OR CLAIMANT (Warrant is to be payable to) '1\ ~~ t)1 III hi 'I' I II'~U'\ J~O"; GV;Vrc( ~W7I ~~';¿r~ r ð' (;) :J.. ð tIt:frt I/J A- tV fJc.>IZ.T7'éw,væ-,N"1 t<.-H f'J' j~t! L . BY (SIGN I" ~/dfS~ (TITlE) ..J FEDERAL ID. NO. OR SOCIAL SECURITY NO, (Fe< Reponing Personal S.n"c.. Coo"acl Paymentalo I.R.S. DATE I DESCRIPTION QUANTITY UNIT UNIT AMOUNT FOR AGENCY PRICE USE I :¡:;R. ~ Eft. i./1 æ- S" R eu fÆ1( eo I ;¡ 9~ .00 H Iff - ; I '/ ~ I U ¡u ¡J ;;=æ. ~ ,.,z,+ t:. T I 11/ fl.-I ! AJ II IH IJ:tt. I I ! 170() - 0141 I J I I I I I I ! ! I I I ! I I ' I I I I I I I I I I I I I I I I I , OCUMENT # LIQUIDATION DATE r"et I Sh'pplng Cocument No. i Collect PrepaId - - --.----______L- -_._- ---,--,_. J -.-. [¡'c. :)", ',Uk [,GC '¡U ' HE' é.nc '10 'VEN[H)f< NIIMHeH I No P,ecee I Recr.ed ~y .7' I' oate7Calyed,. ' ' I .cJ. ¡it 't < ,~~?_\_.- , - -;) :;/> ¿, - VE~mOH-MÉs-iAë;Ë-" --------""._-"-:----------. " I!\' !fW', ~:J¡ '.¡¡¡:1 K--OOI~II-Sb . . . ~:- i~-;:- :i; ¡..;." r~! = :;, ¡~. r~~i=' ~:;:-¡;;----=:---,-=- -,: -¡ I O' J_-::O ¡OJeoo J~ _or -~ --JiiÚ1JL - .-- iij~ -~~=-m i i:/ð;;~1 ~=:::-=-_::=~- ! ! ,'-'~~., F~'=~ -~. ' ---~~= ! .: I ._----~-\ . , 1~~ ~~-~:-"---~ ._-----~'-- :. - ------~~-== R=L~J~{ , . tJ,,-~-- .." ,- .... '----"--~; I 'WAHHANT TOTAL WAnHANT NUM8H' ., ~il?' ù \) - . ... .. -_..;. /I .f .--.'_.,u, , , -.----- ---- \ :~_:~=~ ':- =- ~=-~-~~~. . ==-:--: : . 'PP"'ivFO . PAYMf"TA' ;;¡... r! - ~llf/'1z... OATE -~,--_.. --------- ,. - SP,T[ OF WASHINGTON j :: RECEIVt~,~, J DEe /28 J JfBtW CQl:lN+¥ IoiEA l11i !) r: r1"" -'" . '" - 1-.-1-:1', i ;'.1 \ \ (.i ¡;I,lI '!'lr,'I,if', DEPARTMENT OF HEALTH Oil mp/,J. \\J,hinglon "HSt.!-I December 10, 1991 Attention: Peter Geerlofs, M.D. Jefferson County Health Department 802 Sheridan Port Townsend, Washington 98368 RE: CONTRACT/AMENDMENT NUMBER 9700-01611 Dear Contractor: Enclosed is a fully executed copy of the above-referenced contract/amendment between you and the Department of Health for your permanent file. Claims for payment for services rendered under this contract/amendment will be accomplished through the submission of i invoice vouchers supplied to you by the Department of Health. "All i invoice vouchers shall contain your contract/amendment number' and such other information as is required for the departments to determine the exact nature of all charges for services. You are reminded that as a contractor you are required to be in compliance with all applicable local, state and federal licensing and tax registration regulations. Responsibility for determining your licensing and tax registration requirements rests solely with you. For assistance in determining those requirements, contact: Department of Licensing Business License Center Highways-Licenses Building Olympia, Washington 98504 Toll-Free in Washington 1-800-562-8203 ~. ncerely hn To~~ls Officer epartment of Health Contracts/Rules Management EY-16 1300 Quince st. S.E. P.O. Box 47902 Olympia, Washington 98504-7902 (206) 586-6915 Enclosure JT:clw ~~::-.. 3 - -" CO} ~CT NO. 9700-01611 INTERAGENCY AGREEMENT between STATE OF WASHINGTON DEPARTMENT OF HEALTH and JEFFERSON COUNTY HEALTH DEPARTMENT THIS AGREEMENT, pursuant to Chapter 39.34 RCW, is made and entered into by and between the STATE BOARD OF HEALTH, hereinafter referred to as "SBOH," and the JEFFERSON COUNTY HEALTH DEPARTMENT hereinafter referred to as the "CONTRACTOR". IT IS THE PURPOSE OF THIS CONTRACT TO provide town meetings or local forums in order to gather citizen input on the 1992 Washington State Health Report goals. IT IS, THEREFORE, MUTUALLY AGREED THAT: STATEMENT OF WORK The CONTRACTOR shall furnish the necessary personnel and services and otherwise do all things necessary for or incidental to the performance of the work set forth in Exhibit "A" attached hereto and incorporated herein. Unless otherwise specified, the CON- TRACTOR shall be responsible for performing all fiscal and program responsibilities as set forth in Exhibit "A." Page 1 of 5 pages - - TERMS AND CONDITIt All rights and obligation of the parties to this contract shall be subject to and governed by the SPECIAL TERMS AND CONDITIONS contained in the text of this agreement. PERIOD OF PERFORMANCE Subject to its other provisions, the period of performance of this agreement shall commele on Date of Execution, and be ~/" completed on January ~, 1 92, unless terminated sooner as provided herein. IN CONSIDERATION WHEREOF: SBOH shall pay to the CONTRACTOR $946.00 upon completion of the requirements in the Statement of Work, provided herein. BILLING PROCEDURE SBOH will reimburse the CONTRACTOR upon receipt of properly executed vouchers. Claims for payment submitted by the CONTRAC- TOR to SBOH for costs due and payable under this agreement that were incurred prior to the expiration date shall be paid by SBOH if received by SBOH within 120 days after the expiration date. NON-DISCRIMINATION In the performance of this agreement, the CONTRACTOR with the provisions of Title VI of the civil Rights Act of 1964 (42 USC 200d} , section 504 of the Rehabilitation Act of 1973 (29 USC 794) and Chapter 49.60 RCW, as now or hereafter amended. The CONTRAC- TOR shall not discriminate on the grounds of race, color, nation- al origin, sex, religion, marital status, age, creed, vietnam era and disabled veterans status, or the presence of any sensory, mental, or physical handicap in: Page 2 of 5 pages - - a. Any terms or conditions of employment to include taking affir- mative action necessary to accomplish the objectives of this part; and Denying an individual the opportunity to participate in any b. program provided by this agreement through the provision of services, or otherwise afforded others. In the event, the CONTRACTOR noncompliance or refusal to comply with the above provisions, this agreement may be rescinded, canceled, or terminated in whole or in part, and the CONTRACTOR declared ineligi- ble for further agreement with SBOH. The CONTRACTOR shall, however, be given a reasonable time in which to cure this noncompliance. Any dispute may be resolved in accordance with the "disputes" procedure set forth therein. CONTRACT MANAGEMENT The work described herein shall be performed under the coordination of the SBOH Executive Director, and the Contractor's appropriate Program Manager or their successors, who will provide assistance and guidance to the other party necessary for the performance of this agreement. INDEMNIFICATION Each party shall defend, protect and hold harmless the other party from and against all claims, suits and/or actions arising from any negligent or intentional act or omission of that party's employees, agents and/or authorized subcontractor(s) while performing this contract. Page 3 of 5 pages .- - AGREEMENT ALTERATIONS AND AMENDMENTS SBOH and the CONTRACTOR may mutually amend this agreement. Such amendments shall not be binding unless they are in writing and signed by personnel authorized to bind the CONTRACTOR and the Secretary or his/her delegates for SBOH. TERMINATION Except as otherwise provided in this agreement, either party may terminate this agreement upon 30 days written notification. If this agreement is so terminated, the terminating party shall be liable only for performance in accordance with the terms of this agreement for performance rendered prior to the effective date of termination. SAVINGS In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective date of this contract and prior to normal completion, the department may terminate the contract under the "termination" clause, subject to renegotiation under those new funding limitations and conditions. DISPUTES In the event that a dispute arises under this agreement, it shall be determined in the following manner: The Executive Director of SBOH shall appoint a member to the Dispute Board. The CONTRACTOR shall appoint a member to the Dispute Board. The Executive Director and the CONTRACTOR shall jointly appoint a member to the Dispute Board. The Dispute Board shall evaluate the dispute and make a determina- tion of the dispute. The determination of the Dispute Board shall be final and binding on the parties hereto. Page 4 of 5 pages - - ORDER OF PRECEDENC In the event of an inconsistency in this contract, unless other- wise provided herein, the inconsistency shall be resolved by giving precedence in the following order: a. Applicable Federal and state statutes and Regulations; b. Conditions of this Agreement; c. statement of Work; and d. Any other provisions of the contract whether incorporat- ed by reference or otherwise. ALL WRITINGS CONTAINED HEREIN This agreement contains àll the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this agreement shall be deemed to exist or to bind any of the parties hereto. IN WITNESS WHEREOF, the parties have executed this,agreement. WASHINGTON STATE BOARD OF HEALTH DATE Executive Director (7j~JqL ficer JEFFERSON COUNTY HEALTH DEPARTMENT c2£~i~ï7Zfr~¿ iÞ/7'1?¡ I I DATE state of Washington Department of Health l~ DATE Page 5 of 5 pages - - EXHIBIT A INTERAGENCY AGREEMENT WITH LOCAL HEALTH DEPARTMENTS/DISTRICTS STATEMENT OF WORK The purpose of this interagency agreement is to complete a minimum of one town meeting or local focus group in your community to offer the opportunity for and gather broad-based citizen input for the 1992 Washington state Health Report. To accomplish this, the local health department/district shall: * Identify liaison to coordinate activities with the Board staff and follow-up on meeting results; Disseminate information about the purpose of .the state Health Report and citizen data collection efforts to ensure understanding of local health department/district managers and staff; * * Invite the participation of the local board of health in local focus group planning or, at a minimum, provide advance notification of the local focus group(s) to them; * Work with state Board office to cover a target group mailing list of health and human service agencies, community ethnic groups, and individuals for notification; * Identify appropriate citizens and local citizen groups to participate in the meeting and other approved equivalent collateral data-gathering opportunities for broad-based citizen input; * Notify local legislators and elected officials in advance of the community meeting(s) to permit opportunity to participate or otherwise provide input; Identify volunteer facilitators from the local health department/district staff or from the community to lead and assist at focus group meetings or other approved equivalent collateral data-gathering opportunities for broad-based citizen input; * * Identify and work with local media to aid in advance publicity of focus group meeting(s); answer media questions; and provide local data and information for media articles as related to the state Health Report, e.g., supply radio stations with meeting notice PSAs; * Notify the public in advance of the community meeting(s) date(s) and report extent of public notification effort to the state Board of Health; - - Exhibit A statement of Work Page Two * Conduct a minimum of one meeting, with state Board of Health staff assistance or other approved equivalent collateral data-gathering opportunities for broad-based citizen input; Arrange for facility and other physical necessities; * * Provide sign-up sheets for all participants' names, addresses, affiliations; and submit same to state Board of Health office; * For each Priority Health Goal, identify with citizen participants, Action strategies recommended for implementation at the state level using the Board's criteria for Selecting Action Strategies; * For each Priority Health Goal, identify with citizen participants Action Strategies recommended for implementation at the local level using the Board's criteria for Selecting Action Strategies; * Record, collate and summarize results of the forum; identify on materials from which local health department/district material is submitted and date(s) of group meeting(s); * Provide Board office with copies of newspaper or other articles relating to the citizen meetings or other approved equivalent data-gathering opportunities for the state Health Report; Assist state Board of Health staff in providing appropriate feedback to forum facilitators and participants; * * Return results of all state Board of Health 1992. meetings and all other work to the I in Olympia no later than January~, 3 DP~~ I ~ - 1992 Budget Goals and Objectives I. Community Services "to maintain and enhance the present and future environmental, cultural, physical and mental health quality of life in Jefferson County. " A. Enviromnental Protection 1. Water Quality Protection . Continue with water quality basin programs. . Coordinate all water quality programs to develop efficiency. 2. Stonn/Surface Water management . Develop funding strategy . Develop storm water strategy for integration with other water quality programs. B. Enviromnental Health 1. Solid Waste . Close existing landfill cell prior to end of 1992. . Implement septage treatment program through private vendor contract . Obtain proposals for long haul of refuse to regionalfacility, . Develop financial plan for closure/post closure of solid waste landfill, . Adopt new rate structure to finance solid waste programs, 2. Hamrdous Waste Protection . Continue to implement hazardous waste plan based on grant support for program. . Provide hazardous waste collection days through the county. . Develop drop-off site for moderate risk waste. . Provide public education on proper handling, storage, and disposal of hazardous waste, 3. Septic System management . Develop a system for management of septic systems in conjunction with septage treatment, 4. Water system mamagement . Continue work with water purveyors in update on coordinated water system plan. ~ . Establish small water system pr.ogram. ~ Health & Human Services t Public Health . Support APEX program and implementation of recommendations, . Emphasize improvements in health care programs. ~ ~ . Establish client information system. C. t:f/?f 2. Mental health . Support privatization of mental health program through regional support network. D. Community Development 1. Growth Management . Continue to meet requirements of Growth management legislation 2. Public Involvement . Establish funding for facilitation or ombudsman. 3. Housing . Participate in affordable housing project with Community Action Council. 4. Regional Planning . Continue strategic planning efforts for Jefferson 2000, . Participate in regional transportation planning,