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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, August 21, 2003
Board Members:
Dan Tittemess, Member - County Commissioner District # 1
Glen Huntinlford, Vice Chair - County Commissioner District #2
J udi Mackey - County Commissioner District #3
Geoffrey Masci, Chairman - Port Townsend City Council
JiD Buhler, Member - Hospital Commissioner District #2
Sheila Westerman, Member - Citizen at w1J!,e (City)
Rbberta Frissell, Member - Citizen at w1J!,e (County)
Sta'Members:
Jean Baldwin, Healih & Human Services
Director
wrry F'!)', Environmental Health Director
Julia Danskin, Nursing Services Director
Thomas Locke, MD, Health Officer
Ex-o~cio
David Sullivan, PUD #1
Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present.
There was a quorum.
APPROVAL OF AGENDA
Member Frissell moved to approve the agenda with the addition of Informational Item - Dissolved
Oxygen Report, and New Business Item 5 - OSS Licensure. Commissioner Huntingford seconded
the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Commissioner Titterness moved to approve the minutes of July 17,2003. Member Buhler
seconded the motion, which carried by a unanimous vote.
PUBLIC COMMENT
Dale Wurtsmith referred to his August 12,2003 letter to Chairman Masci (also copied for the rest of the
Board), in which he requested that his company, EnviroCheck, be issued a Permanent Operations and
Maintenance license based on their working knowledge, training and experience in the business of
evaluating existing on-site septic systems. He reminded the Board that they had issued him a Provisional
License two years ago while he waited for the Washington On-Site Sewage Association (WOSSA) and
other agencies to develop a standardized statewide test for operation and maintenance - a test that has
yet to be created. Citing the difficulty in attracting business partners with just a provisional license, he
asked to be grandfathered and issued a permanent license. He went on to recommend that anyone with
two years experience with operation and maintenance also be grandfathered.
Member Westerman asked about Mr. Wurtsmith's willingness, as ongoing education, to take a test when
it becomes available as a part of issuing a permanent license? When Mr. Wurtsmith asked why a
HEALTH BOARD MINUTES - August 21, 2003
Page: 2
permanent license would be dependent on a test, she said she sees this as different than issuing a
provisional license.
Commissioner Huntingford asked if relicensing every two years would be required once a test is in
place? Larry Fay clarified that WOSSA is working on association-based testing and voluntary
certification program that the County has said it would recognize as meeting the requirements of
licensure. He does not think the discussions amount to any momentum for a statewide licensing program
for Operation and Maintenance. In response to questions, Mr. Wurtsmith reviewed the types of ongoing
education he has taken - basics of monitoring and maintenance, and troubleshooting as well as those of
particular interest to him (design, soil sampling, and soil analysis classes), but added that the classes do
not conclude with an exam. He did stress that continuing education is critical if you have employees,
because of liability issues.
Asked by Member Frissell if operating under a provisional license is hampering his business in any way,
Mr. Wurtsmith said that it is hindering his search for investors to help expand the business
OLD BUSINESS AND INFORMATIONAL ITEMS
Findin!!:s of Fact/Conclusions of Law for Julv 17. 2003 ADoeal Hearin!!:: Member Buhler expressed
confusion regarding the language under Item B, Conclusions of Law, which lists punitive options but
does not seem to include the option chosen by the County, which was to do nothing. She suggested
adding language similar to what was in the Staff memo from the previous meeting describing actions
taken.
Larry Fay explained that the action taken was specified in 8.15.150(1) - Issuing a Notice of Violation,
which advised Peterson/Roberts that they would not receive any subsequent permits until they resolved
the violations. Despite the appellant wanting the County to take more aggressive action, the County
decided against doing so.
Without objection from Member Buhler, Chairman Masci suggested clarifying Page One by changing
Items C and D to subsets of Item B.
It did not seem to Member Westerman that the action taken presented much of a disincentive for people
to do similar things. Larry Fay responded that there is a variety of violations, each with a variety of
potential consequences - Staff tries to tailor the response to the severity of the problem and
recommended not wasting prosecutorlcourt time over such issues.
Commissioner Huntingford moved that the Chair sigo Findings, Conclusions and Decisions as
amended above. Member Frissell seconded the motion, which carried by a unanimous vote.
Ouasi-Judicial Aooeal Procedures: Chairman Masci asked if there was Board support for adopting
the protocols for hearings as modified for use during last month's hearing. Member Frissell pointed out
corrections needed on page 4 under the Appearance ofFaimess Doctrine. In paragraph (b), references to
HEALTH BOARD MINUTES - August 21, 2003
Page: 3
the City Council should instead be Board of Health and the last sentence relating to Street Vacations
could be deleted.
Member Buhler moved that the Quasi-Judicial Appeal Procedures as amended above be adopted
as part of the Jefferson County Health and Human Services Procedural manual. Member Frissell
seconded the motion, which carried by a unanimous vote.
Cruise Shin: Larry Fay said that the agenda packet, pursuant to direction by the Board as last month's
meeting, included a draft letter to the State Board of Health documenting the Board's concerns about
infectious waste discharges. Regarding the State Board of Health's role in safeguarding the Health of the
State, the Board is asking them to investigate the regulatory structure for cruise ship operations and
consider whether the acceptable practices are genuinely going to be protective of the health of people of
Puget Sound. As a result of recent conversations between Commissioner Huntingford, Dr. Locke and the
Clallam County Board of Health, the final version of the letter will also include a signature line for the
Chair of that body. Mr. Fay noted that another letter to Washington State Department of Ecology has
been drafted and would be reviewed by Chairman Masci and Dr. Locke. Commissioner Huntingford
mentioned that when he raised this issue at a recent State Board of Natural Resources Retreat, five
people expressed interest in supporting these efforts.
Commissioner Huntingford moved to approve the draft letter to the State Board of Health
regarding sewage releases from cruise vessels, to be signed jointly with the Clallam Board of
Health, with minor modifications as recorded by Staff. Member Westerman seconded the motion,
which carried by a unanimous vote.
Letters to and from State Board of Health Dele!!:ation: Dr. Tom Locke noted that the Board had
received a letter from the State Board of Health following their visit last month. AI; directed by the
Board, the packet also contained a draft letter of thanks from the Health Board for their visit.
Commissioner Huntingford moved that the Chairman sign the letter of thanks to the State Board
of Health, with minor modifications as recorded by Staff. Commissioner Titterness seconded the
motion, which carried by a unanimous vote.
Letter from Jefferson County Prosecutor Re: Child Death Review: Jean Baldwin referred to
Juelanne Dalzell's letter in the Board's packet communicating her concern about the disbanding of the
Child Death Review Team. Given the good participation and low cost to resume, Staff would like to
keep the team going.
Dissolved Oxv!!:en Renort: Commissioner Titterness reported on his attendance at a meeting today
organized by the Hood Canal Salmon Coalition to inform attendees about the potential causes of oxygen
depletion in Hood Canal. A sizeable portion of the discussion centered on failing septic systems and the
flow of effluent into streams and the canal. He heard the opinion expressed that while we test for
bacteria, we do not design to prevent nitrates from being released into the aquifer. There was also some
discussion at that meeting about asking the legislature to implement some kind of nitrate treatment.
HEALTH BOARD MINUTES - August 21, 2003
Page: 4
Larry Fay said that since 1995, the County has had special treatment requirements in critical aquifer
recharge areas that address nitrate reduction from on-site sewage systems. It is also a topic of general
statewide concern, although standards are not yet forthcoming through the state regulatory process.
There was mention of other potential contributors to the dissolved oxygen problem, such as lawn
fertilization along the shoreline or other natural or forestry-related actions as well as a discussion of
nitrate treatment alternatives for on-site sewage systems.
NEW BUSINESS
Performance Measures and 2004 Bud!!:et Narrative: Jean Baldwin noted the inclusion in the packet of
performance measures for Community Health, Environmental Health and Administration. There was
also an overview of the Department and its financial structure. She pointed out that in terms of
administrative and fiscal responsibilities, Health and Human Services provides the infrastructure for
many departments. She noted that while these performance measurements are used in their budget
request, it has not yet been finalized. Similar reports would be given to the Board of County
Commissioners and the Board of Health every six months.
Member Westerman pointed out that on the page for Administration performance indicators under
"Number of birth and deaths in Jefferson County as handled through requests in the Jefferson County
Health and Human Services," it says "baseline" instead oflisting figures, which Staff said might need to
be rephrased. Regarding the organizational chart, Member Westerman asked to understand how the
"Policy" line differs from the "Advisory?" Jean indicated that it is based on the RCWs and the WAC,
but recognized that the chart needs to be revised to reflect a policy line from the Developmental
Disabilities and Substance Abuse Boards to the County Commissioners. The Board of Health should
also indicate a direct policy line to the Health Officer and Director. Dr. Tom Locke recommended
eliminating the "Advisory" line from the Board of Health to the County Commissioners, reminding that
there are two jurisdictions - County government that has to do with County Departments, and the Board
of Health that has to do with all the legal authorities involved in public health code creation and
enforcement. Staff agreed to modify the chart.
Member Frissell pointed out that the chart on Page 2 of the Environmental Health On-Site Sewage
Programs reflects a decreasing number of educational workshops and participants, which is bothersome.
Larry Fay explained that with a two-year grant from Ecology, County was able to initiate and implement
the Operations and Maintenance (O&M) Program and conduct the very popular workshops. While some
of the funding is carrying over to this year, essentially, the workshops would not be able to continue
because staffing in the on-site sewage program was cut back. However, the Department will have
revenues to allocate about one-quarter of Linda Atkins' time to ongoing O&M.
Staff pointed out that figures (and, therefore, Staffing) in the Food Program is similar to that of Mason
County - which is three times larger - because of our tourist industry and special events.
Chairman Masci asked if the lack of change in performance indicators from 2003 to 2004 is reflective of
a flat budget? Staff confirmed there is the same expectation of funding and services. Asked if there is
any provision in anyone of those indicators for a crisis, Staff said there is a minimal buffer.
HEALTH BOARD MINUTES - August 21, 2003
Page: 5
David Sullivan asked about the basis for the reduction in the number of projected complaints in the On-
site Sewage Program? Larry Fay agreed to check with Staff, but it might be that they felt that
enforcement/compliance position that we created this year has been successful in resolving past
complaints with the result that fewer will be coming. A question under the Drinking Water Program was
whether the 2004 objective to inspect at least 50% of new wells could be higher. Larry Fay responded
that the agreement with the State Department of Ecology is to inspect 50%, but in the past, and quite
possibly this year, it would be more.
Under On-Site Sewage, Member Westerman asked if the County would also be working with private
individuals to get into O&M inspections. Larry Fay said that with respect to alternative systems,
individuals would receive a notification stating that three years has passed since their installation and
that their system is due for inspection and would also list the individuals who could conduct those
inspections. Once the inspection is done, a report would be submitted. Currently, the PUD is tracking
that information. Since the ordinance was only adopted in 2000, the County is just entering the initial
cycle of notices. The County should begin receiving some figures next year.
Member Buhler asked whether a permit or just an application is required to construct a well. Larry Fay
responded that anyone wanting to construct a well is required to file a notice to both the County and
Department of Ecology. Department of Ecology acknowledges receipt of the notice and the County
ensures they are not proposing to drill inside a water service area, but does not issue a permit. She asked
if a permit process would lead to being able to enforce or inspect. Mr. Fay explained that due to
Department of Ecology's lack of inspectors, the County has agreed to conduct field inspections and
report any deficiencies. Department of Ecology, as the agency who licenses the drillers, would take
enforcement action.
Jean Baldwin explained that the requested budget is flat based on the 2002 County contribution.
However, 2003 saw a reduction in facilities and Health and Human Services is now paying its full share
of rent and asking for County General funds to go back to the 1994 pre-belt tightening level.
West Nile Virus on the Move National Activitv and First Renorted Washinl!:ton State Case: Jean
Baldwin provided two handouts from the Centers for Disease Control. Dr. Locke said West Nile is on
the move and is progressing across the country faster than last year. This is the time of year that the most
surveillance was anticipated. In Washington, there have not yet been any animal cases - it is monitoring
horses, but has yet to have a positive bird specimen. He noted that a Yakirna resident developed a mild
case of encephalitis and while his spinal fluid initially tested positive for West Nile antibodies, those
tests are not confirmatory because West Nile is closely related to three other viruses. He noted that they
are testing for the immune response in humans. Explaining the "Guidelines for a Phased Response"
included in the agenda packet, Dr. Locke noted we are currently at Alert Levell. The County's current
focus is on public information and personal protective approaches to preventing mosquito bites.
Jefferson County Health and Human Services Emereencv Response Plan - Tableton Traininl!:
Exercise Renort: Jean Baldwin, Julie Danskin and Dr. Locke reviewed today's County tabletop
exercise of the Public Health Plan, which is part ofthe Emergency Management Plan. Participants were
the EMS response team, hospital, public health, state representatives and several from the Regional
Emergency Management Team, as well as the Local Emergency Response Coordinator, Lisa McKenzie
HEALTH BOARD MINUTES - August 21, 2003
Page: 6
(who had also attended Kitsap's and Clallam's exercises). The exercise scenario is now a public
document. Staff felt the simulations and conducting the three County exercises at the same time with all
the participants were extremely helpful in identifying systemic flaws in the plan. The exercises have very
much to do with communicable disease response in general rather than bio-terrorism specific and
provide increased clarity each time they are held.
Multi-Countv Communicable Disease Cross Covera!!:e: Risk Pools. Health Officer and Draft
Protocols: Dr. Locke reported on the effort to create regional commnnicable disease capacity in Kitsap,
Clallam and Jefferson, which is associated with the bioterrorism planning. They are establishing a "duty
officer," who would be the single point of contact for any medical provider, or anyone who has a
communicable disease report or concern and who would activate the system. The best hope of getting
additional emergency capacity is the ability to tap into other health departments. This system would be
the first in the state - a system of standardized investigations and disease-specific protocols. The Board
of Health would have to appoint the Deputy Health Officer and Staff has just begun looking at the
liability and legal issues of these cross appointments. Because there are two large risk pools, a joint
agreement has been drafted for cross coverage, based on mutual aid agreements for law enforcement and
firefighters use. The draft agreement was included in the agenda packet. It was noted that nursing staff,
which would be going between counties, are also in separate risk pools so the insurance aspect is more
complex than the financing. Staff would be coming back to the Board with recommendations.
Chairman Masci asked whether the Board would be required to issue a Request for Qualifications prior
to appointing someone? Dr. Locke said the choices would be limited to currently appointed Health
Officers in Washington State (20 people). In theory, the Board could appoint someone who met the legal
criteria yet lacked an understanding of how the system works.
Commissioner Huntingford asked if the County would be required to pay the appointed Health Officer if
the designated Health Officer was on a two-month leave of absence? Dr. Locke said that since this is a
voluntary, reciprocal agreement, the County would instead pay the Deputy Health Officer, not both.
ass Licensure: Larry Fay, responding to the request by Dale Wurtsmith, said he is unaware of any
problems with Wurtsmith's work. Because a state exam is not on the immediate horizon, the County
could let an individual sit through a King County exam, for instance, (administered by WOSSA) and
proceed with licensure. Over the last several years, he has been working with the Board of Registration
for Professional Engineers on their On-site Designer Licensing Advisory Committee and working with
the State Department of Licensing. The exam is a competency-screening tool. The idea of licensure is
that it is your performance after the exam that determines your ability to continue to practice. If we were
to provide a license - conditioned on passing an exam - to someone whose four-year history in the field
met or exceeded the minimum standard but who then failed the examination, we might be challenged if
we threatened to revoke that provisional license. He suggested that our regulations might contain a
potential remedy, which could prevent a blanket waive of the requirement. Mr. Wurtsmith could apply
for a waiver from the requirement to be examined, his rationale for which is contained in the body of
work that he has provided.
HEALTH BOARD MINUTES - August 21,2003
Page: 7
Chairman Masci pointed out that grandfathering of existing practitioners has been allowed in other
licensed activities. He sees no problem with grandfathering to permanent status until a certain date such
as January 1, 2005 as long as the County constructs the mechanism and standards for its own test.
Member Westerman suggested creating a process that would serve not only this individual, but also
other individuals in similar circumstances.
Chairman Masci said most Boards, whether disciplinary, educational or other, have continuing education
requirements, which we could use as models and accelerate or expand the requirements as needed.
Member Westerman asked whether another County might already have something that could be
adapted? Larry Fay said that at the same time we were considering creating our own standards and
examination process there was state movement to create an industry-driven certification program. We
presented the latter to the Board, but it has not been realized. If the County were to create its own
examination, it would need to consider how to handle it administratively. Several Counties have
examinations in place and WOSSA is talking with Pierce and King Counties about contracting to
administer their exam. We could fmd their exam meets our needs and the individual could go to
WOSSA and take the King County exam and that certification would meet our requirement. Mr.
Wurtsmith's concern is that, despite building a creditable history of experience in the field over two
years, he could somehow fail the exam and be told he could no longer do this work. Assuming WOSSA
had an acceptable testing procedure in place by, say, January 1, 2004, we would probably have to tell
those to whom we had issued a provisional license that while we might want them to take the exam,
their license is not in jeopardy (unless some sort of disciplinary hearing had cast doubt on the
competency of their performance).
Chairman Masci said we could make the license contingent upon the completion of x number of hours of
continuing education. Mr. Fay pointed out that we already have this in our licensing requirement and
said the County runs classes periodically to create opportunities for folks in the field to get their CEs.
David Sullivan suggested considering the administrative responsibility for and cost of licensing. Staff
responded that spelled out in our code are the pieces from initial qualifications, work experience and
education, examination, continuing education, complaint procedure, disciplinary process, hearings, fees,
etc. The critical thing has been the structural exam, the entry exam.
Member Westerman surmnarized that first we said that anyone in the County could have provisional
licenses with the understanding that they would take an exam the minute it became available from
WOSSA. But now you are saying that if we go out and find an exam that we think can substitute for the
WOSSA, we can't ask those provisional licensees to take that exam. Mr. Fay said we would need legal
counsel's input on this, but added that we would fmd ourselves on shaky ground legally if we took away
a license of someone who had been practicing and meeting industry standards solely on their inability to
pass the exam. Member Westerman said then we should not have made that a condition. Mr. Fay said it
seemed reasonable at the time because we thought the exam was going to appear during what was, in
effect, a probationary period. Had the exam shown up in three or six months, it would not have been the
same strategy as the person who can demonstrate the work experience. She asked if anyone with two
years experience would be vested? Larry Fay said we do need to decide whether WOSSA is moving with
its process rapidly enough for us to continue to work with them or are we going to go develop our own
exam? Ifwe decide to develop our own, we would try to borrow it from another County, but then we
HEALTH BOARD MINUTES - August 21, 2003
Page: 8
would need to get into its administration. Once our exam is in place, any new applicant would have to
complete and pass that exam? The policy question is whether anybody we had licensed previously who
might still be in a probationary period could reasonably be required to pass the exam. If they are past the
probationary period when the test is offered, we would say that, having performed up to our standards
thus far, we are going to waive the exam requirement and grandfather your license.
Chairman Masci suggested that the process might be facilitated if Staff were to develop a flowchart of
the options on which the Board might then make policy statements at each of the steps.
Commissioner Huntingford reminded the Board that this is not a real big issue for us to try and decide, it
sounds like we have some controls over this process as we go forward. Mr. Fay is responsible for review
to ensure these individuals are doing their job - providing education and checks and balances. If Staff
wants to develop the chart and make some calls to other counties and if we are not having a problem,
how we want to deal with it is probably more of a housekeeping issue.
Mr. Fay said that if someone came in tomorrow and applied and met the qualifications, we would issue
the same kind of provisional license. Although there are fewer and fewer, the County is still doing
inspections. There is some concern that a private sector person who also is licensed to do maintenance
has an incentive to fmd something wrong, so they choose to call the County.
Member Westerman reiterated her request that we provide a solution for everyone, not just this
individual.
Chairman Masci proposed that Staff get back to the Board with its recommendation and then we could
notice the affected individual. Mr. Fay said he would target getting the issue resolved before it comes
time to talk about license renewals next year.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS
Survey: Commissioner Titterness reviewed the results contained in the packet, which indicate good
participation. The purpose was just to get a general sense of how the public felt and to see where we
could make some improvements. Because of how services were prioritized, it appears citizens feel the
County is spending money where it should. Commissioner Huntingford said there were internal
suggestions as to how to do it differently in the future. For example, determining their recent use of these
services. They found it surprising that no one considered Park and Recreation neutral. It was noted that
since citizens often confuse CitylCounty services, there might be a need to specify that this would be for
County-provided services.
AGENDA PLANNING/ADJOURN
Joint Board Meetinl!: - SeDtember/October: The Board discussed the possibility of rescheduling its
September meeting because Staff and some of the Board have conflicts. It was thought to be important to
hold the Joint Board Meeting where the Civic Engagement Committee would present separate from
either of the Board's regular meetings. Dr. Locke noted that this would not only be a presentation, but a
priority-setting exercise by the Joint Boards. Tentative dates were as follows: September 25th for the
HEALTH BOARD MINUTES - August 21, 2003
Page: 9
regular Board meeting (2:30 - 4:30) and the Joint Board meeting in October replacing the regular Board
of Health meeting. Upcoming agenda items were noted as follows: Maternal Child Health, Budget
Issues in September.
Roberta Frissell asked that the Board schedule a meeting with legislators before they return to Olympia
in January. Commissioner Huntingford suggested the County Commissioners take responsibility for
scheduling this and other meetings as part of a day-long visit to discuss various issues.
At 5:30 p.m. today, there would be an open house of the Child and Family Resource Center.
The meeting adjourned at 4:34 p.m. The date and time of the next meeting is to be determined.
ad/6~
)tl ~uhler. Member
S~~~~
Sheila Westerman, Member
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/r:;/t~ta. ;;(;;,f,4.4.e:f t
Roberta Frissell, Member
Judi Mackey, Member
JEFFERSON COUNTY BOARD OF HEALTH
Glen Huntingford, Jefferson County Commissioner
Dan Titterness, Jefferson County Commissioner
Jill Buhler, Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masci, Chair Jefferson County Board of Health
Sheila Westerman, Vice Chair, Jefferson County Board of Health
July 31, 2003
State Board of Health
11 02 SE Quince St.
P.O. Box 47990
Olympia, W A 98504-7990
RE: Sewage Releases from Vessels
Dear Members of the Board:
In the last several months Jefferson County residents and the Jefferson County and ClaIlam County Boards of Health
have become increasingly concerned about possible impacts from sewage releases from vessels passing through
Admiralty Inlet and the Strait of Juan de Fuca. These concerns stern from the growing presence of cruise ships
hailing from the Port of Seattle and were highlighted by the sewage release that occurred off our shores last May.
Each of these vessels is, in effect, a floating city but unlike a city the regulatory authority over discharges is
somewhat clouded. As the Port of Seattle actively recruits more cruise ship business there is greater potential for
more of these kinds of releases and the possibility of marine water contamination of public health significance
increases.
Both of our counties have expended tremendous resources to protect and enhance marine water quality within our
jurisdictions. Our cities have spent huge sums to upgrade wastewater facilities. We have embarked on
implementation of new stringent stormwater standards. We do these things because they are the right thing to do yet
are afraid that our efforts could be jeopardized by a haphazard regulation of sewage discharges from vessels.
Questions that come innnediately to our minds following the May release include; Why do vessels routinely release
sewage within the straits? Why not ouly in the open ocean? Why was necessary for this vessel to begin discharging
so soon after leaving Port? Weren't there shore facilities that would have enabled them to pwup out before leaving
port? Is the level of training and oversight of onboard wastewater technicians up to the standard required of our
municipal operators?
We bring this matter to the attention of the State Board of Health because we believe that the Board is in a unique
position to investigate and evaluate whether the existing practices and regulatory framework are adequate to provide
public health protections and to preserve our valuable shel1fish resources. RCW 43.20.050(1) authorizes the Board
to conduct hearings and explore ways to improve the health status of the citizens of the state. We respectfully
request that the Board exercise this authority with respect to sewage discharge standards and practice from vessels
plying our waters.
We would welcome the opportunity to address the State Board at a future meeting.
Thanks you for your attention to this matter.
Geoff Masci
Chair, Jefferson County Board of Health
JEFFERSON COUNTY BOARD OF HEALTH
Glen Huntingford, Jefferson County Commissioner
Dan Tittemess, Jefferson County Commissioner
Jill Buhler, Jefferson General Hospital Commissioner
Roberta Frissell, Citizen at Large
Geoffrey Masc, Chair Jefferson County Board of Health
Sheila Westerman, Vice ChairJefferson County Board of Health
August 14,2003
Don Sloma, Executive Director
Carl Osaki, Member
Washington State Board of Health
1102 SE Quince Street
PO Box 47990
Olympia, W A 98504-7990
Dear Mr. Sloma and Mr. Osaki:
I am writing on behalf of the Jefferson County Board of Health to express our appreciation for
you presentation to the Board on July 17, 2003. We enjoyed your thoughtful review of the issues
the State Board is currently engaged in and appreciate the high priority the State Board has
placed on forging partnerships with local boards of health.
The issue of cmise ship infectious waste discharges is an important one for the Jefferson County
Board of Health. Recently, the Clallam County Board of Health has also expressed concern over
this practice, its potential public health consequences, and the poorly defined authority to
regulate such discharges in the marine waters of Washington State. You will be receiving a
letter regarding this issue cosigned by chairs of both the Clallam and Jefferson County Boards of
Health in the near future. Thank you for your prompt attention to this matter.
Again, it was our pleasure to host your visit and we look forward to future opportunities to fulfill
our mutual responsibilities to protect and improve the health of Washington state residents.
Sincerely,
GeoffMasci, Chair
Jefferson County Board of Health
STATE OF WASHINGTON
/
WASHINGTON STATE BOARD OF HEALTH
1102 Sf Quince Street. PO Box 47990
Olympia, Wouhington 98504-7990
August 1,2003
Jefferson County Board of Health
615 Sheridan Street
Port Townsend, W A 98368
Dear Chair Masci,
Thank you and the other members of your board of health for allowing Don Sloma and me to
come before you recently to learn more about your priority areas of concern.
We heard three primary areas of concern during our visit: the dumping of gray and black water
from cruise ships into Puget Sound waters within Jefferson County; enforcement authority and
resources for on-site sewage rules and for other environmental health programs; and medical
service access disparities.
We found the discussion about cruise ship dumping to be most animated and enlightening as you
and your fellow board members and staff shared the results of your investigations. All of the
issues you raised, including the adequacy of training, the adequacy of existing federal policy and
procedures for cruise ships and the consistency oflocal, state and federal programs for the
regulation of sewage on land, on small pleasure craft and on commercial vessels bear further
discussion. We look forward to further communication from you on these subjects. I can assure
you, this is an item I will raise for the state board's consideration. I hope to have some specific
answers for you in the coming months about some of the questions you raised, as well as a
determination by the state board of their willingness to pursue this subject in further detail.
We heard your board's concern about increasing demands and declining resources for public
health infrastructure in your commnnity to perform even routine monitoring and enforcement of
long stand public health programs such as on-site sewage regulation. This is a recurrent theme in
our meetings with local boards of health this year, together with the lack of capacity across our
state's public health system to pursue emerging threats to public health from the environment. It
is part of the larger issue often raised about the absence in our state of an adequate, stable
financing base for public health. Our discussion with your board leads me to wonder about the
need for a higher priority in state public health financing discussions on environmental health
infrastructure. Thank you for sharing your insights.
Finally, I want to acknowledge the excellent points made at the end of our discussion by your
Administrator, Jean Baldwin, regarding the growing medical care access disparities in rural
areas. Her comments about unmet needs for alcohol and mental health treatment, as well as the
concerns she expressed about the continued financial viability of primary medical care and even
some hospital care in rural areas are well taken. The board views with alarm the state's apparent
Working for the Health of Washington and Its People
@~la
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Jefferson County Board of Health
August 1,2003
Page 2 of2
determination this year that subsidies for access to needed medical care for the poor and other
minorities was not of sufficient priority for government to continue them at historic levels in our
current economic climate. Her comments served to strengthen our resolve to continue speaking
out on this important public health issue.
Our meeting with your board was very helpful to our ongoing efforts to learn more about
community perspectives on public health issues. As I mentioned during our discussion, we
intend to use the information we receive from you and other Boards of Health in our 2004 State
Health Report. By law, the state Board must produce this report biennially, together with
recommendations for state health priorities for the ensuing biennium. Although we distributed
copies of the 2002 State Health Report at our meeting, you may also view that report on our web
page at htto:l/www.doh.wa.gov/sbohlPubs/2002SHR.ndf
If you would like to provide additional information, other community perspectives or other
suggestions for statewide health priorities, please feel free to call or write. We will be accepting
additional input from local boards of health for the state health report until September 30, 2003.
We are open to hearing from you about emerging issues at any time.
If you have any further questions or requests, please call the Board office at (360) 236-4110 and
one of our staff would be happy to assist you in anyway possible.
Again, thank you for allowing us some time with you in your busy schedules.
~J.a~
Carl Osaki, Member
Washington State Board of Health
Cc: Jefferson County Board of Health Members
Jean Baldwin, Jefferson County Health and Social Services Department
Washington State Board of Health Members
Don Sloma, Executive Director, State Board of Health
Juelanne Dalzell
JEFFERSON COUNTY PROSECUTING A'ITORNEY
Courthouse-P.O. Box 1210
Port TOWDSeJld, Washington 98368
Telephone (360) 385-9180 FAX (360) 385-0073
Jill Landes, Depnty Prosecutor
Miehael Haas, Depnty Prosecutor
David w. Alvarez, Depnty Prosecutor
Tracey Lusus, Depnty Prosecutor
Lianne Perron-Kossow, Victim Services
MEMORANDUM
TO: Board of County Commissioners
.
FROM:
Jue1anne Dalzell
Prosecuting Atto
DATE:
July 29,2003
RE:
Child Death Review
.~--'--...,,~
--------------------------------------------------------------------------------------------------
In its infinite wisdom, the state has cut off ftmding to Jefferson County for all
child death review team assessments.
In spite oflack of ftmding, I would like to continue holding these team
assessments as the need arises.
Fortunately, we do not have many children die in our county, so the team rarely
meets. When we do meet, though,. .the information gathered may prove useful to
the county.
To my knowledge, no team member bills the county for their presence nor for
their expertise. The information gathered may prevent future child deaths.
Occasionally, we are able to identify areas that can be enhanced so future loss
may be minimized. I can give you specific examples if you wish to contact me for
more information.
Thank you.
RECEIVED
JUl 3 1 2003
J6B0n~
HeaIlh & Human Servlces
JD\acb
bee'. Jo\ \a.- 'Oo.t15~~
.
Jefferson County Health and Human Services
2004 Performance Measures
COMMUNITY HEALTH
Family Support Programs
BUDGETIPROGRAM: Commnnity Health: Family Support Programs
Maternal Child Health (MCH) including newborn follow-up, Child Birth education and Breast
Feeding Support, Integrated Maternity Support Services (MSS)/Infant Case Management, Best
BeginningslNurse-Family Partnership (NFP), Children with Special Health Care Needs
(CSHCN), Women Infants and Children (WlC), and the Child Protective Services (CPS)
Contract Programs: Alternative Response System (ARS), Early Intervention Program (EIP), and
Passport.
MISSION:
The purpose of the Family Support Programs is to provide health and parenting education, skill
building, support, and referrals to community resources to pregnant women and families with
children. Services also include voluntary home visits to prenatal, post partum families, and
families at risk of Child Protective Services involvement. These services are provided so county
babies are born with the best opportunity to grow and thrive, the impact of health problems are
minimized, and children receive the care and nurturing they need to become functional adults.
GOALS FOR FY2004:
I. All newborns and their families will receive Newborn Health Screening to identify needs
for Family Support Services including: intensive home-visiting, case management,
lactation support, special health and child development support, nutrition education and
parenting education.
2. Maintain the current number of clients served through the Family Nurse Partnership
Program (Best Begirmings) for Jefferson County residents.
3. Monitor Nurse Family Partnership Program replication by tracking data on program
fidelity.
4. To assess the percentage of pregnant and parenting women receiving JCHHS services, in
which depression is an issue.
5. Continue to provide breastfeeding education and support so that all county mothers can
provide their children with the physical and emotional benefits of breast feeding.
6. Prevent nutritional related problems for pregnant women and children under five in
Jefferson County.
7. Identify children with special health care needs in Jefferson County and assist families
with health and development interventions and referrals as needed.
8. Provide services and information in Jefferson County aimed at preventing Child Abuse
and Neglect.
9. Increase awareness and support of the Family Support Program mission and services
among local health care and other service providers.
1
OBJECTIVES FOR FY 2004:
1. PHN's will provide Universal Newborn Screening to all Jefferson County families of
new babies through telephone calls and office or home visits in order to identify early
intervention needs and offer services and referrals.
2. Support the Nurse-Family Partnership PHN's maintaining caseload intensity by
providing opportunities for ongoing support and education both within JCllliS and
through other offerings such as the Washington State Consortium for Nurse-Family
Partnership.
3. Send client data monthly to Nurse-Family Partnership program head office for
assessment and evaluation. As part of the Office of Juvenile Justice Department Grant-
Preventing Delinquency Early we are conducting an analysis of the MSS/MCM,
Universal Newborn Screening, and Nurse-Family Partnership programs by collecting a
variety of client specific data over the next year. Dr. Rebecca Kang, a professor at the U.
of Washington, has been contracted to help design the assessment and analyze the data
4. Depression screening and education will be offered to all pregnant and parenting women
who are participating in JCHHS programs and appropriate referrals will be made for
those who have a positive screen.
5. Through universal screening of newborns and their families identify those who may need
referral to breastfeeding tea party or lactation consultation telephone, office or home-
visits. Ongoing collaboration with JGH stafffor lactation support will help ensure all
families receive the services they need.
6. Provide WlC nutrition education and support to all eligible county women and children.
7. Through universal newborn screening, other JCHHS programs and community outreach to
providers and the schools children with special health and development needs will get referred for
evaluation and intervention services
8. Awareness and assessment of risk for child abuse and neglect is an integral component of all
Family Support Service Programs. Referrals to CPSIDCFS will be made as appropriate and
services will be provided to families at risk or involved in CAIN through the ARS and EIP
contracts.
9. Staff will meet with local health care and other service providers to share information about
program goals, services, referral process, and to offer collaboration in care and services to
Jefferson County families.
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Proiected Planned
I. Number of denression screenings completed 60 70 70
2. Number of newborn screened 120 120 120
3. Number of those screened receiving continuing Family 60 70 70
S Services (2002 no MCH add)'
4. Number of Home and Office visits provided for BB, MSS, 1500 1500 1500
MCM, MCH and Breastfeeding consultation
5. Yearlv renort from Fami1v-Nurse Partnershin ** ** **
6. Total number of women infants and children served by 900 900 900
WIC in Jefferson County (from CIMS renort)
7. Number of children with special health care needs 60 60 60
receiving Public Health Nurse intervention through JCHHS.
8. Number offamilies served through CPSIDSHS contract. IS 15 15
** report yearly
2
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
2003 Jefferson County Health report published in May 2003 confirmed what the staffin the
Family Support Programs have observed in their work in the community: 'families with young
children are very vulnerable'. Multiple factors contribute to this status: poverty, mental illness,
substance abuse, and family abuse/violence. For many families these challenges have been
transmitted across generations and now the newborns are vulnerable to these risk factors. Over
the years of providing services through programs such as MSSIMCM, WIC, and for the last 4
years, Nurse-Family Partnership, staff have worked to increase knowledge and skills in a
committed effort to prevent and reduce the effects of these conditions. We are now able to
effectively serve clients and families who previously were resistant, or too entrenched in
complex psychosocial problems to accept services. Working effectively with these families
requires a high degree of skill and support. These families, with multi-generational challenges,
respond best to consistent, intensive services delivered over a long period of time. The program
assessment project will increase our knowledge of this specific population and demonstrate that
the positive outcomes shown in the national program are also being achieved in Jefferson
County. Washington State Department of Health and DSHS are redesigning the First Steps
programs MSS and MCM into Integrated Maternity Support Services and Infant Case
Management expanding the eligibility criteria and documentation requirements but reducing
reimbursement.
3
Jefferson County Health and Human Services
2004 Performance Measnres
COMMUNITY HEALTH
Targeted Community Health Services
BUDGETIPROGRAM: Targeted Community Health Services
Family Planning, Breast and Cervical Health Program, and Foot Care
MISSION:
The purpose of the Targeted Commnnity Health Services is to provide outreach, access, health
education, support treatment to specific populations in Jefferson County in order to improve the
health of the community.
Specific program purposes are:
. Family Planning: to provide reproductive health, clinics, outreach and education for
Jefferson County residents in order to promote health and well-being and reduce unintended
pregnancies.
. Breast and Cervical Health Program: provide public education and health screening
services to women age 40-64 with low incomes and no or limited health insurance in order
to assure early detection and treatment of breast and cervical cancer.
· Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent
health complications.
GOALS FOR FY 2004:
I. Insure access to breast and cervical health exams to women age 40 to 65 years old.
2. Decrease nnintended pregnancy rates in Jefferson County (measure) I Assure Family
Planning Services are provided in every community
3. Support seniors' independence by maintaining their mobility
OBJECTIVES FOR FY 2004:
1. Track Family Planning usage patterns and produce annual report
2. Maintain breast and cervical health program in Jefferson County
3. Emergency contraception to be provided under standing orders, 5 days per week, and
expand commnnity education and clinical services
4. Maintain the current level of community foot care and continue expanding into home
care
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Proiection Planned
Number ofunduplicated clients served in Family 1,500 1,500 1,600
Planning
Number of adolescents under 19 served in Family 330 330 330
Planning
Number of Breast & Cervical screening exams 65 80 70
Number of foot care contacts 2,500 2,500 2,500
I
SUMMARY OF KEY FUNDING / SERVICE ISSUES:
Preventing unintended pregnancies is a local, state, and national Public Health Goal. JCHHS
provides the only Family Planning program in east Jefferson County. Family Planning is
considered a Critical Health Service by the State Board of Health. In July 2001 Washington
State started a 5-year federal waiver program called Take Charge which increase funding and
clients for Family Planning Services in Jefferson County. The number of clients served increase
dramatically the first year of Take Charge. JCHHS anticipates maintaining the increased
numbers of clients with only minimal increases now. The Breast and Cervical Health programs
addresses the need for Cancer screening and early treatment to decrease deaths from Breast and
cervical Cancer in Jefferson County. JCHHS increased outreach efforts in 2003 with an increase
of clients coming in for services. Demographics in Jefferson County are showing an increase in
the over 85-year-old population. JCHHS foot care program help this population maintain
independence and mobility in a rural community.
2
Jefferson Connty Health and Human Services
2004 Performance Measures
COMMUNITY HEALTH
Population and Prevention Programs
BUDGETIPROGRAM: Population & Prevention Programs
Raising Healthy Community Grant (HC), Tobacco (TP/C), School Health (S/H), Childcare
health and Safety (CC), Peer-In (PI) and Oral Health (OR)
MISSION:
The purpose of the Population & Prevention Programs is to provide health education and public
health interventions to county residents in order to prevent disease and unintentional injury,
improve the quality of life and reduce disparities in health.
GOALS FOR FY 2004:
1. Improve identified social and health indicators for school-age youth (S/H)
2. Improve indoor air quality for Jefferson County residents (TP/C)
3. Enhance the quality of child care provided in Jefferson County (CC)
4. Enhance the overall health & safety of Jefferson County children (PI) and (OR)
5. Improve Healthy Youth Coalition functioning (HC)
OBJECTIVES FOR FY 2004:
1. Maintain delivery of school in-service/trainings, student health screenings, student health
consults, student health care referrals (S/H)
2. Increase number of restaurants participating in smokefree campaign, develop baseline of
smoke-free overnight accommodations; number of mothers who do not smoke during
pregnancy (TP/C)
3. Maintain child care provider consultation re: health, inununizations, safety and child
development (CC)
4. Peer educators will provide school health classes to middle & high school students and
health education classes will be provided to elementary, middle & high school students
(PI) and increase awareness Oral Health prevention interventions.
5. Maintain number of Healthy Youth Coalition meetings annually
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projected Planned
Number of student health screenin!!s 2,400 2,400 2,300
Number of restaurants offering 100% Indoor Smoke Free 62 62 62
Dinin!! (TP/C)
Number of overnight accommodations offering 100% Smoke NA NA 15
Free lodltin!! (TP/C)
Number of Peer-In educational oresentations 10 10 50
Number of school health classes 50 50 175
Number of phone calls to W A State Tobacco Quit line from 80 80 80
Jefferson County
Number of Healthv Youth Coalition Meetin!!s 8 8 8
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
A specific Juvenile Justice grant funds Healthy Communities with in-kind services from the
community agencies involved. Healthy Communities grant provides intervention and prevention
programs to identified children in vulnerable families. Besides the Healthy Communities grant,
the above programs provide universal prevention programs available to all in the community.
State prevention health services monies come with extensive evaluation components. Tobacco,
Peer-In and Healthy Communities funding have community specific goals and measures that
must be met to maintain funding. School funding is based on State School Nurse corp funds and
contracts with school districts. School enrollment is decreasing slightly anticipating less health
screening.
2
Jefferson County Health and Human Services
Community Health 2004 Performance Measures: Communicable Disease
BUDGETIPROGRAM: Community Health Communicable Disease
TB, Communicable Diseases, Inununization, Travelers Inununization, Sexually Transmitted Disease,
HN, Syringe Exchange Program.
MISSION: Communicable Disease
The purpose of the Communicable Disease Health program is to protect Jefferson County residents
from serious communicable diseases by providing disease surveillance, investigation and reporting,
along with education, screening, treatment and immunization services. The program interacts with
community members, medical providers, the Washington State Department of Health and other
agencies while working toward this purpose.
GOALS FOR 2004
1. Maintain the low rates of active TB in Jefferson County (TB)
2. Timely investigation ofreportable conditions (CD)
3. Support universal access to State supplied vaccines for all children (Inun)
4. Continue to support immunization registry in Jefferson County, promoting use by all
immunization providers (Inun)
5. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in
Jefferson County (STD)
6. Providers will be informed about current communicable disease trends and new communicable
disease control recommendations '
7. HN testing and counseling clinic resources are focused on persons at risk for HIV infection
(HIV)
8. Case management services will be easily accessed by new HIV clients who seek these services
(HIV)
9. Prevent the spread of blood borne communicable diseases among injecting drug users and their
partners (SEP)
10. Annual report to BOH for CD, TB, Inununization Programs, STD
11. Develop bioterrorism response capacity
OBJECTIVES (INTERVENTIONS) FOR 2004
1. Encourage appropriate screening &treatment for latent TB infection (TB)
2. Develop & update protocols for investigation of reportable conditions (CD)
3. Maintain an efficient system for supplying State supplied vaccine and vaccine recommendation
up-dates to private Health Care Providers in Jefferson County (Inun)
4. Continue to provide training on the Child Profile Inununization Registry to private Health Care
Providers
5. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia (age
criteria) will be screened for Chlamydia (STD)
6. Provide updates, outreach and training to providers about local, state and national
communicable disease outbreaks and disease control recommendations
7. 75% of clients who receive HIV testing will be high risk (HIV)
8. 95% of new HIV clients who seek case management services will have an assessment within 1
week of the date requested (HIV)
9. Promote utilization of syringe exchange program services (SEP)
1
10. Develop regional bioterrorism plan, coordinating with regional bioterrorism partners, local
emergency response agencies and Jefferson General Hospital
PERFORMANCE INDICATORS: 2003 2003 2004
Planned Projection Planned
(TB) Number of clients started on preventive therapy for latent 8 3 3
TB infection
(CD) Number of communicable disease reports confirmed, 62 75 62
interventions applied and processed for reporting to the state
(Inun) Number of doses of publicly funded vaccine, 3500 3500 3500
administered by private health care providers and Public Health
clinics, supplied and monitored through Public Heath' s
immunization orogram
(Inun) Number oflocal immunizations providers (clinics) 3-6 2 2
provided information and training on the Child Profile
immunization recistrv
(Inun) Number of providers participating in the Child Profile 4 3 5
inununization recistry
(Inun) Number of Jefferson County children <6 in Child Profile 80% 80% 85%
system
(STD) Percent of at risk FP and STD clinic clients at risk for 100% 100% 100%
Chlamvdia screened (age criteria 14 - 24)
I (HIV) Number of persons counseled and tested for HN infection 60 60 60
(HIV) Percent of persons counseled and tested for HIV infection 75% 75% 75%
that were in high-risk cate!!orv
(HIV) Percent of new HIV clients seeking case management 90% 95% 95%
services who have an assessment within 1 week of the date
requested
(SEP) Number of clinics 100 100 100
(SEP) Number of visits to SEP 15 25 25
(SEP) Number of syringes exchanged 1000 2000 2000
eSEP) Number oforeventionleducational materials provided 15 15 15
eSEI') Number of referrals to other services 5 5 5
031') Develop bioterrorism resoonse plan 1 1 I
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
These programs address locally identified and defined local public health problems. Communicable
disease prevention is a locally funded program since the county milage was returned from the state to
counties for TB control. Inununization funds from the state have been primarily in the form of vaccine.
County funded Services are important in the Strategic Plan to promote healthy communities by having
the infrastructure to maintain a professional staff preventing, identifying and responding to disease
outbreaks. Substantial staff time is spent on responding to public requests for information about
communicable diseases and screening for reportable illnesses in the process.
HIV services are funded from the state and federal government to provide basic communicable disease
prevention, HIV positive client case management, testing and counseling to high-risk community
members, and focused high-risk interventions. Funds are highly programmatic and based on federal
case numbers, which may not represent Jefferson County epidemic profile. Volatile program funding is
based on formulas re-negotiated with Region VI AIDSNET every year
2
.
In 2002 federal funding was received for developing the capacity for bioterrorism response. This
response capacity is being developed in coordination with our bioterrorism regional partners, Kitsap
and Clallam Counties, our local emergency response agencies, Jefferson General Hospital and other
health care providers. This project involves completing a Local Health Department Emergency
Response Plan in 2003 and giving it a trial through a tabletop exercise. A Regional Emergency
Response Plan and a regional tabletop are due in 2004.
Increased funding will support the development of a Regional Emergency Response Plan and
exercising it through a regional tabletop. Increased funding will also allow for increased
Communicable Disease surveillance, outreach and resource development with the Health Care
Providers in the community.
Decreased funding would result in scaling back on services. The Board of Health would be involved in
deciding which services would be impacted.
3
Jefferson County Health and Human Services
2004 Performance Measures
ENVIRONMENTAL HEALTH
Drinking Water Programs
MISSION: The mission of the Drinking Water Program is to assure that the residents and
visitors to Jefferson County have access to the best quality drinking water that is reasonably
available in order to minimize the threat of waterborne disease.
GOALS FOR FY 2004:
1. Assure that all new wells are constructed in accordance with reqnirements established by
the Washington Department of Ecology.
2. Provide technical assistance when requested so that individual water supplies are safe.
3. Limit public exposure to water systems with known deficiencies.
4. Integrate water adequacy review information with Natural Resource water quality
database
OBJECTIVES FOR FY 2004:
1. Inspect at least 50% of all new wells constructed and 100% of all wells being de-
commissioned.
2. Increase compliance with state well drilling regulations.
3. Review all building permits and project applications to assure that potable water supplies
meet basic public health standards as well comply with state statutory and regulatory
requirements.
4. Provide technical guidance to any residents requesting assistance with their individual or
small water systems to deliver safe drinking water.
5. Establish appropriate policies for alternative water supply systems.
6. Continue contracting with DOH for public water supply projects as long as adequate
funding is provided.
PERFORMANCE INDICATORS: 2000 2001 2002 2003 2004
Actual & Planned
Estimated
Number of well applications received & reviewed, includes 88 75 119 157 165
carry forward from previous years (USR's)
Number of new wells start notification (drilled) N/A 43 101 84 88
Number of wells abandoned 7 2 7 31 33
Number of applications with no well drilled (carry forward) N/A 30 11 42 44
Number of new wells inspected (start notification received) N/A 36 45 63 66
Percent of new wells (starts) inspected N/A 84% 46% 75% 75%
Number of abandoned wells inspected N/A 2 N/A 31 33
Percent abandoned well inspected N/A 100% N/A 100% 100%
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Increased tracking will be done within existing databases such as permit plan and the food
service database. Databases, including the water quality database, will be updated as necessary
to add new fields to track performance indicators.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
. Protecting and enhancing natural resources
. Addressing local public health problems
2
Jefferson County Health and Human Services
2004 Performance Measures
ENVIRONMENTAL HEALTH
Food Program
MISSION: The mission of the Food Program is to minimize the risk of the spread of
disease from improperly prepared, stored or served foods handled in commercial settings.
GOALS FOR FY 2004:
1. Provide classroom food safety instruction for all food service workers.
2. Assure minimum sanitary standards are observed in all food service
establishments.
3. Provide basic food safety information to the general public.
OBJECTIVES FOR FY 2004:
1. Offer food safety training at a frequency and in locations convenient to food
service workers.
2. Review all new food service establishments for compliance with state and county
requirements.
3. Inspect all food service establishments at a frequency adequate to assure
compliance with state and local regulatory requirements.
4. Offer educational materials and technical assistance to non-regulated community
groups and organizations where requested.
PERFORMANCE INDICATORS: 2000 2001 2002 2003 2004
Actual & Planned
Estimated
Number of food workers trained 1,044 1,008 1,090 1,306 1,500
Number of food worker classes at Health N/A 51 60 62 60
Dcoartment
Number of food worker classes at other N/A 13 18 29 30
locations
Number of food establishment permits N/A N/A 251 248 260
Number of required inspections completed 352 247 293 300 300
Number of inspected establishments that 33 22 21 20 20
required repeat inspections due to critical
violations.
Number of establishments receiving 41 55 48 48 *
Outstandin!! Achievement Awards
Number of temporary food service permits N/A 72 65 75 78
Number of complaints received and N/A 26 46 22 *
resolved
* Not able to project, will report at year-end.
1
Jefferson County Health and Human Services
2004 Performance Measures
ENVIRONMENTAL HEALm
ON SITE SEW AGE PROGRAMS (OSS)
MISSION: The mission of the Onsite Sewage Program is to minimize the threat of surface and
ground water contamination from failing or improperly designed, installed or maintained onsite
sewage systems.
GOALS FOR FY 2004:
1. Educate homeowners, builders, real estate personnel, banks, installers, designers and
onsite system maintenance personnel in the proper operation and maintenance of onsite
sewage systems.
2. Assure a high quality-monitoring program.
3. Implement and enforce state and local rules and regulations goveming the installation and
use of onsite sewage systems.
4. Investigate action requests and complaints in a timely manner to reduce the threat of
human contact with untreated wastewater.
5. Assure high quality customer service.
OBJECTIVES FOR FY 2004:
I. Develop written informational materials for public distribution and conduct workshops
for community groups addressing onsite sewage system operation and maintenance.
2. Provide training to community groups to increase awareness of regulatory requirements
for onsite sewage systems.
3. Review monitoring and inspection reports and provide timely follow up.
4. Utilize existing data systems to track action requests and complaints.
5. Develop and implement a system forroutinely surveying customer service.
6. Assure that site inspections in response to permit applications are conducted within 14
days of receipt of application.
PERFORMANCE INDICATORS: 2001 2002 2003 2004
Actual & Planned
Estimated
Number of systems repaired/upgraded not associated 7 21 22 25
with a violation or building application.
Percent of existing systems receiving regular 3'" party 13% 14% 16% 20%
monitorim!:.
Percent of system failures less than 5 years in use 55% 14% 16% 15%
Number of complaints received 83 60 24 30
Percent of complaints requiring enforcement action. 17 21 18 20
Number of septic permit applications 248* 318* 329* 345*
Number of permits <14 days to initial inspection 132 147 180 190
Number of permits >14 days to initial inspection 44 48 35 30
1
Percent of permits issued with clock stoppers that 48% 52% ** 30%
delav PfOCessinll time
Average days to process permits 23 14 ** 14
Percent of pennits applications pending 68 65 ** *
Number of evaluations of existing system (EES) 277 210 230 200
Percent ofEES resulting in reqnired significant 1.8% 30% 26% **
maintenance or repair.
Percent of failures/major maintenance 1% 2.9% 1.7% **
Number of educational workshops 15 18 5 5
Number of workshop participants 624 431 100 100
* Number of applications does not equal approved permits
** Not able to calculate until year-end.
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Tracking will be done with existing data systems to evaluate effectiveness of monitoring
programs. With the completion of the DOE non-point source pollution grant, ongoing O&M
activities will need to be funded through permit and inspections fees. Implementation will focus
on coordination with the PUD to set up systems for scheduling and tracking inspection activities
and conducting community outreach to increase awareness of the new requirements.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
· Addressing local public health problems
· Protecting and enhancing natural resources
2
Jefferson County Health and Human Services
2004 Performance Measures
ENVIRONMENTAL HEALTH
Solid Waste Programs
MISSION: The mission of the Solid Waste Enforcement and Education Program is to assure
that solid waste in Jefferson County is managed in a way that is consistent with state regnlatory
requirements, avoids harm to the environment, is protective of the public health and promotes
goals and objectives for solid waste reduction and recycling consistent with the Jefferson County
Comprehensive Solid Waste Management Plan.
GOALS FOR FY 2004:
1. Reduce the occurrence of promiscuous dumping.
2. Increase the awareness of small quantity generator and household hazardous waste
disposal requirements through education and outreach efforts.
3. Promote construction and demolition waste recycling in order to reduce illegal dumping
and to see a decrease in the annual tonnage of solid waste.
OBJECTIVES FOR FY 2004:
1. Finish updating local solid waste regulations.
2. Conduct workshops and teclmical consultations with SQG's
3. Begin green business program as envisioned in the Jefferson County Solid Waste
Management Plan and within available funding.
PERFORMANCE INDICATORS: 2001 2002 2003 2004
Actual & Planned
Estimated
Percent of illegal dumps closed and cleaned up 100% N/A * *
Pounds of litter and illegally dumped waste 1.2 N/A * *
collected per capita nounds/can
Number of complaints/reports received about 37 78 37 *
illel!all!arbal!e and waste dumping and storal!e
Number of complaints that were resolved without 17 45 34 *
issuance of a Notice of Violation
Number of illegal dumping complaints resolved 9 27 16 *
after a Notice of Violation was issued
Number of illegal dumping complaints unresolved N/A N/A 10 *
(nending)
Number of illegal dumping complaints unresolved N/A N/A 3 *
waitin" for legal action
Number of EnviroStars Businesses - Note: there N/A N/A 6 10
are 100 EnviroStars eligible businesses in
Jefferson County
Pounds of Recycled Material at Electronics N/A N/A Il,3281bs *
Recyclinl! Event (began in 2003)
*Not able to calculate until year-end
1
SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Generally there has been very few compliance problems associated with permitted solid waste
facilities in Jefferson County. However, illegal dumping and neighborhood nuisance conditions
continue to be a problem. Use of general funds and tipping fee funding to match DOE Solid
Waste Enforcement and Solid Waste Education Grants will enable the division to maintain
staffing at current levels. This level of staffing will enable the department to complete the solid
waste regulation revisions, increase capacity for compliance activities and conduct regular
community outreach programs.
LINKS TO COUNTY STRATEGIC OBJECTIVES:
. Protecting and Enhancing Natural Resources
. Addressing local public health problems
. Sustaining economic development
2
..
Jefferson County Health and Human Services
2004 Performance Measures
ADMINISTRATION
GOALS FOR FY 2004: ADMINISTRATION
I. Assure accurate and timely fiscal reports
2. Assure teclmical support in assessing the basic health needs of Jefferson County
communities
3. Assure administrative, teclmical and financial support for all Health & Human Services
contractual agreements.
4. Provide administrative, teclmical and financial support to Inter -local agencies that
contract for fiscal services with JCHHS.
5. Assure accurate and timely teclmical and clerical support to each department within
JCHHS in serving the residents of Jefferson County.
6. Provide certified birth and death certificates to the Community with accurate and timely
information of births and deaths
OBJECTIVES FOR FY 2004
1. Provide quarterly fiscal reports to each Health and Human Services department.
2. Provide teclmical support and leadership assessing the basic health needs of Jefferson
County communities through analysis of vital records and data and working with
community leaders to make prioritizations and program goals and objectives.
3. Provide administrative and financial support to meet required reporting, invoicing, and
tracking of contractual agreements with Federal & State agencies, inter-
local/departmental agreements and MOD's held by Health & Human services.
4. As fiscal agent provide administrative and financial support to meet quarterly reports and
contractual agreements as required by Federal & State agencies for all contractual
agreements held by agencies who contract with JCHHS.
5. Provide supervision, training, assistance and evaluation of the systems that provide the
business service support to the various Public Health services provided to the residents of
Jefferson County.
6. 90% of requests for birth and death certificates will be processed with 5 working days
PERFORMANCE INDICATORS: 2003 2003 2004
Pro.iected Actual Proiected
100% compliance of all fiscal contractual 100% 100% 100%
agreements
Data study groups have a statement of work * Quarterly and
identifying indicators for Health and Human annual report to the
Services of Jefferson Countv BOH
98 - 100% compliance on State / Federal Audits 100% 100% 98-100%
Number of birth and deaths in Jefferson Co. as Baseline Baseline Baseline
handled though reQuests in JCHHS
Number of days to process birth and death Baseline 5 days 5 days
certificates
.
SUMMARY OF KEY FUNDING/SERVICE ISSUES: Funding for public health services
continues to plague the stability of technical support for basic health needs in Jefferson County.
The majority of the technical support that JCHHS provides to the community includes internal
support to the departments and is dependent on external funding. The department recognizes
the inter-relationships between the county and city and the importance of continued support from
each. Categorical funding limits the ability of HHS adrnin to provide support for the whole
department and to objectively meet community needs.
2
!
,
JCJDIS 2004 Budget Summary
In keeping with the Jefferson County Resolution establishing the 2004 Budget Goals, Jefferson County Health &
Human Services has identified how each program meets county strategic objectives on the enclosed perfonnance
measures. The department mission adopted by the County Board of Health is ''to protect the health of Jefferson
County residents by promoting healthy communities and environments." Protecting and enhancing natural
resources promotes a healthy community, prevention progrll111'l serve a viable law and justice system, and local
public health problems nmst continue to be identified and addressed
. TIris budget submittal represents essentially no change in overall Health and Human Services staffing
levels; some minor program reassignments do not impact the budget. .
. Expense increases are a reflection of salary, benefits and rent increases.
. The general fund contribution to JCHHS was reduced in 2003 in conjunction with the reduction of
expenses to Facilities. The additional space, Health Department Annex and Natural Resources Department,
acquired in 2003 has caused and increase of expenses to Facilities. This budget reflects restoring the
general fund contribution back to the original 2003 amount in order to cover new increase.
Planned and expected changes in 2004 funding (or Nursing Services
. Elimination of Child Death Review from Washington State ($3,000 loss) to assessment process.
. Decrease in Breast and Cervical Health Program funds. Anticipated 19% cut in Federal dollars. Unsure on
how much the grant will be decreased within the local contract.
. Washington State Medical Assistance fees being limited and/or decreased. JCHHS is unsure how much
funding will be lost.
. Maternity Support Services and Matemity Case Management being redesigned by DSHS to be finalized by
Oct. 2003. Some fees will be eliminated, other fees being increased. Anticipated loss in Local Funds,
JCHHS unsure how much and what services will be changed. In 2004-2005 the OJJDP grant will stabilize
funding for maternity services.
EH 2004 Budget Summary
. The only significant change is that a program code for zoonotic diseases has been added. While we have
always done some zoonotic disease response, the emergence of West Nile Virus and more recently the
monkey pox episode have higWighted the need to track our time to that program. However, we have not put
new money into zoonotic disease. Rather we have shifted county general fund within ER.
. A workload analysis of Environmental Health staff will be completed in 2003. It may impact EH
budgeting.
Animal Services 2004 Budget Summary
. TIris budget submittal reflects no changes in Animal Services duties. The main change is an increase in
building rent and Facilities no longer providing grounds maintenance. The Shelter Staff are currently
maintaining the grounds around the shelter. TIris will require an increase of $4,029 from the County general
fund.
. In October of 2003 the regional services contract for 2004 will be negotiated and at that time the
city/county formula will be reviewed.
Drug and Alcohol Services 2004
. The addition of the Criminal Justices Treatment Account (CITA) increases the funding for alcohol and drug
treatment services for clients in the Justice system This is an overall increase in treatment money available
for Jefferson County citizens. As a new program there will be some start up difficnlties.
Administration Budget 2004
. Contracts management, community prioritization and community Boards policy/development work is
expensive tasks and not covered in individnal contracts and grants.
. The cost of the County Health Officer was moved from Administration to the programs that he is legally
responsible for.
Developmental Disabilities Budget 2004
. There are no significant changes in the Developmental Disabilities 2004 budget.
,
NATURAL RESOURCES 2004 Budget Summary
Natural Resourees Budget 2004
. The Natural Resources budget is FTE neutral from the 2003 budget-that is no FTE's were added, nor were
reduced. However, there were programmatic shifts that accommodated different projects and grants to ftmd
those projects. Changes include:
. Completion ofFish and Wildlife Habitat, Refugia, Site Hazard Assessment, Channel Migration Zone Study,
and services for WRIA 17 Planning
. Continuation of stream gauging
. Beginning stream flow measurements and habitat protection projects
· Depending on service demands and the availability of grant ftmding to help meet those demands, Natural
Resources may need to add FTE's on a project by project basis in 2004.
.'
Health & Human Services 2004 FTE by Revenue
6.34
.GRANTS -18.02 FTE
5.10
18.02
. FEES - 8.52 FTE
DOTHER - 5.10 FTE
. OPERATING lRANSFER-
6.34 FTE
This chart identifies how revenue resources support our FTE's. Our FTE's continue to be
primarily supported by grant, fees, and other revenue. "Other" is compiled revenue such
as taxes, interfund charges, carry-forward, and miscellaneous revenue. Approximately
17% of operating transfer, 13% other revenue, 22% offees, and 47% from grant revenue
cover our 2004 FTE's.
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