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HomeMy WebLinkAbout071703 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, July 17, 2003 Board Members: Dan TitternesJ, Member - County Commissioner District #1 Glen Huntingford, Member - County Commissioner District #2 Vacant - County Commissioner District #3 Geoffrey Masci, Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Shet/a Westerman, Member - Citizen at LA",e (City) Roberta Frissell, Member - Citizen at La",e (County) Staff Members: Jean Baldwin, Health & Human Services Director LArry l'ay, Environmental Health Director Julia Danskin, Nursing Services Director Thomas Locke, MD, Health Officer Ex-o{ticio David Sullivan, PUD #1 Chairman Masci called the meeting to order at 2:44 p.m. All Board and Staff members were present with the exception of Member Westerman. There was a quorum. APPROVAL OF AGENDA Member Frissell moved to approve the Agenda as presented. Member Buhler seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Commissioner Huntingford moved to approve the minutes of June 19, 2003. Commissioner Titterness seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT -- None OLD BUSINESS AND INFORMATIONAL ITEMS Cruise Ship Waste Dischar!!:e: Larry Fay noted that the agenda packet contained a Staff memo following up on the public comment and Board discussion of the last meeting. Also included was a copy of the State Department of Ecology Action Order sent to the President and CEO of Norwegian Cruise Line. Chairman Masci proposed an addition to the draft ofthe Board's letter to the State Department of Ecology regarding the sewage release in the Strait: A third paragraph could state "We (the Board of Health of Jefferson County) recommend that the Department of Ecology reconsider its four-mile discharge limits given that the four-mile point happens to be at the head of Discovery Bay. Because this bay does not flush well, the recommendation is to instead extend that limit to past Cape Flattery, in unprotected waters, so as not to damage the Olympic Coast Sanctuary". HEALTH BOARD MINUTES - July 17, 2003 Page: 2 Commissioner Huntingford moved to direct Staff to amend the letter as recommended by Chairman Masci. The letter would be reviewed and signed by Chairman Masci. Member Buhler seconded the motion, which carried by a unanimous vote. Threatened Shellfish Area - Jefferson County: Larry Fay noted that the Board received a Staff memo accompanying a press release from the State Department of Health reporting that their Early Warning System lists a threatened shellfish area off the boat landing in Lower Hadlock. He explained that he now has more information about the classification and data collection and analysis. Because of a rolling five- year method of grading, a series of bad water quality results in 1998-99 are causing the County to now be classified as threatened. However, if the current trends in water quality continue, in the absence of any intervention the County might be off the list next year. Nevertheless, Staff would meet with representatives from the State Department of Health's Shellfish Program to further investigate potential sources in Lower Hadlock and see if additional action is needed. He noted that virtually all septic systems along the shoreline have had system upgrades over the last five years. Member Frissell asked whether liveaboards in that area could be contributing to the problem? Mr. Fay said this would be part of Staff s analysis. He added that a party interested in placing more mooring buoys in that area has had a pre-application meeting with the Department of Commnnity Development. Staff has recommended that if an application were made, it should be denied until more information is known about the source ofthe water quality problem. He said he would be providing the Board with a letter from the Pacific Shellfish Growers Association that expresses their concern and their desire for the County to act diligently. A Staff response has been sent. State Bud!!:et Summaries: As a follow-up to last month's legislative budget update, Dr. Tom Locke noted that the Board has received a summary of the major health and medical care portions of the 2003- 05 biennial operating budget as prepared by Don Sloma, Executive Director of the Washington State Board of Health. NEW BUSINESS Washin!!:ton State Board of Health and Local Boards of Health Partnership Initiative: Chairman Masci welcomed Don Sloma and Carl Osaki of the Washington State Board of Health. Executive Director Sloma passed out copies of the 2002 Annual Report from the State Board of Health as well as a 2002 Washington State Health Report. He reported on the Board's desire to get out and visit local Boards of Health to hear about the local health concerns. Board Member Osaki expressed the desire to better understand health threats and issues in Jefferson County so they could be considered during policy making. Mr. Osaki explained his background experience as a former Director of Environmental Health and also spoke of the history of the State Board of Health, which is the longest existing Board in Washington State. With 10 members, it is comprised of two elected officials (City and County), Secretary of Health, a local health officer (Dr. Locke), and four members representing health and sanitation, and two members representing consumers. The Board's primary functions are to: I) adopt rules and regulations; 2) serve as a public forum; 3) gain input on and establish health policy. As part of gaining input, they solicited issues of concern of the Board. HEALTH BOARD MINUTES - July 17, 2003 Page: 3 Member Frissell asked what support the State Board of Health might provide in tightening regulations to prevent future sewage discharges in inland waters? Since the cruise line indicated it was an accidental discharge of black water, David Sullivan said it was an issue of ensuring training in policy and procedure. Commissioner Huntingford added that all discharges should take place outside of the Straits because ofthe issues of the surrounding counties. Chairman Masci suggested action to urge the federal government to negotiate with the provincial government to require secondary or tertiary black water sewage discharge from Victoria (and said there is a relationship between the cruise ship discharge and Victoria's). Mr. Osaki said he believes this is an issue on which they might be able to present a letter of support and he asked for more clarification. Mr. Sloma said he would like to know the justification for differential standards for cruise ships and local individuals or municipalities. Larry Fay called attention to the jurisdictional issues of responsibility, which prevent more directly addressing grey water discharges. Chairman Masci noted that another range of concern related to the discharge of medicinal hormones into the water, which could affect fish health. He believes the State Board of Health has a broad base of data on which to rest. Mr. Osaki recommended two options: I) The Board could write a letter to the State Board of Health about its concerns and specifically state its policy and make specific requests, or 2) this topic could be an agenda item on which the Board could receive a briefing so they can have a broader sense of the issue. Member Buhler noted that the federal government has been concerned enough about the fragility ofthe Straits to have given funding to the counties' Marine Resource Committees to investigate marine impacts. Commissioner Titterness moved that the Board send a letter about its concerns and request that Chairman Masci be given the opportunity to present to the State Board of Health on this issue. The motion was seconded and carried by a unanimous vote. Mr. Osaki noted that if the Board feels this is an issue that it wants to address, they might invite representatives from the Cruise Ship Industry and others to explain some ofthe actions they have taken - or not taken - to protect the health of the people in the State. Chairman Masci said he feels that local law enforcement does not consider the public health violations, such as on-site sewage regulations, seriously enough. He would like the State Board of Health to consider a policy statement that could lead to legislation giving Boards of Health more direct enforcement powers. He added that this cannot be an unfunded mandate. Commissioner Huntingford suggested that since there is a new policy in place and the County has begun to deal with civil infractions, there should be more Board discussion on this issue before asking the State Board of Health to spend much time on it. Dr. Locke said the issue of private property rights has come before the State Board of Health not only with regard to whether a local Board could compel an individual to go through an annual inspection, but also with mosquito abatement. The State Board of Health is trying to bundle these issues together for an opinion from the Attorney General's office. Jean Baldwin said health disparity is a big issue for this County even though the statewide assessment data, relates the problem to racial minorities or those in urban environments. Rural health indicators are not well documented on a state level and most of our state is rural. Rural hospitals, public health departments, and doctors are in trouble. The issues of mental health and drug and alcohol use are separated on the urban model and are a bigger issue in the rural areas' overall health status. Mr. Osaki noted that they also welcome comments at their meetings from local Health Departments and Boards of Health. Anneal Hearinl!: Procedure: The Board reviewed and considered proposed protocols for this and future public hearings of the Board of Health presented by Chairman Masci. The procedures, aimed at HEALTH BOARD MINUTES - July 17, 2003 Page: 4 providing for greater consistency, are based on closed-record appeal procedures for public hearings of the City, even though he recognized that this is not a closed record appeal. He also provided language from an Appearance of Fairness and Conflict of Interest doctrine. If the Board adopted the protocols as interim procedures, the Board could then request County legal review prior to formal adoption so that the terminology will be more appropriate for the Board for future hearings. Member Buhler moved to adopt the Public Hearing Procedures as interim procedures for Board of Health hearings. Member Frissell seconded the motion, which carried by a unanimous vote. ADDeal Hearinl!: PetersonlRoberts Violation SEP85-00045 (Filed bv Dr. David Green): At 3:36 p.m., Chairman Masci informed the group of the standard rules for the public hearing and opened the hearing. He read the Rules of Order and asked if any Board members had any interests, financial or property, to disclose in connection with the matter. Chairman Masci disclosed that he and Dr. Green have had a fiduciary contract/subcontract relationship in the past and have been discussing the possibility of reestablishing that relationship in the near future. He also received a phone message from Dr. Green yesterday and responded likewise, declining to speak with him directly in order to avoid any form of ex parte communication. He has not at any time approached Dr. Green relative to the matters involving this appeal, nor did he have any knowledge of the appeal during prior conversations with Dr. Green. Due to his significant, ongoing involvement with Dr. Green, he is concemed about the appearance offairness. Commissioner Huntingford then led a brief discussion, without Chairman Masci present, of whether Chairman Masci's recusal would be appropriate. The Board concurred that Chairman Masci should recuse himself from discussion or votes on this matter, but could continue to Chair the meeting. There was no audience objection to Chairman Masci's or any other Board member's participation in the proceedings. Staff Presentation: Larry Fay reminded the Board that Dr. Green's appeal is of the action taken by Staff in response to the violation on the Peterson/Roberts property. He reviewed the facts regarding the Peterson/Roberts construction of a deck on their property at 574 Beckett Point Road, which was built over the existing drain field without notification or approval of the Health Department. That action constitutes a violation of the On-Site Sewage Code 8.15.150(1)f. Staff responded to an initial complaint by Dr. David Green and confirmed that the deck had been constructed consistent with their as-built plans in the permit filed and confirmed that the deck was there. Staff, in an opinion based largely on the construction of that system, determined that the impact of the deck's placement over the drain field, is, while not desirable, probably minimal in terms of infiltration into the soil and the field's general reliability. Staff issued a Notice of Violation to Peterson/Roberts on September 25, outlining the specific violation, advising of the action needed to resolve the violation, and identifying the consequences of the failure to do so. Given that Staff classified this as a low-priority violation, the consequences for failure to correct being a possible restriction on future building permits. Staff feels their actions were correct and appropriate. Public testimony and comment: Appellant Dr. David Green circulated photographs taken from his property. He then cited reasons why the system would be prone to fail due to the construction of a new deck over the septic system - 1) prevention ofthe aeration needed for aerobic bacteria; 2) unequal profusion of the soil; 3) the pressure on the drain field from the weight of the deck, the pylon supports holding the deck, and the people on the HEALTH BOARD MINUTES - July 17, 2003 Page: 5 deck, which can alter and clog the drain pipes; 4) the depth of drain field at a level where there is no longer aerobic activity; and 5) the slope ofthe land from the house down toward the road to his property, where drain field effluent could tend to accumulate. Since there would be no room for an alternative drain field, we should best protect what we have now. He noted that while a proposed sewer system in the Beckett Point Fisherman's Club is awaiting approval of appropriate funding, the completion of any sewer system there is 2-3 years away. As he believes that a failure of the existing system would prevent him from occupying his premises, he would prefer a preventative solution. Opponent Almeta Peterson then circulated photographs for the Board's viewing. She noted that this issue comes as a complete surprise to her, having learned of this situation only six days ago. Her last meeting with Dr. Green was during his complaint about his perceived lack of privacy. While she has a consultant, he could not possibly be available on short notice. She said her only mistake was not asking enough questions. She based her actions on the fact that in her initial call to the Department, she was told that an on-the-ground deck did not require a permit. They are snowbirds, so are only up here about six months of the year. She said that they had received the notice calling for no further development until possible adjustments were made. They then left for the south. She does not believe their septic system is a threat to public health. They had the septic tank cleaned and examined by Goodman Sanitation, who reported it to be in tiptop condition. The Tillman Engineering review of the system plan submitted by Mr. Green mentioned no sign of surface effluent, and goes on to say that leach lines are keeping the area wetted. The records show that the system on their property includes a pit system at the depth of eight feet, which rapidly moves the effluent in a downward manner discharging through a fast-rating substrata and is therefore not a surface system. She does, however, use a circular ground sprinkler to water her plants. While her septic design might not be approved any longer, it is still used in houses like hers. Mr. Tillman's documents use a lot of "can," "may," and "if' instead of facts. The letter touches on other things of which she has no knowledge. Finally, having worked for eighteen years for a County Department of Transportation, she respects government authority and regrets the time that has been required on this issue. She would appreciate an opportunity to correct any health hazards that might exist and would like to mitigate this situation, although she does not believe her system is a threat to health. Appellant rebuttal: Dr. Green asked the Board what it intends to do about this situation? Mr. Fay recognized Dr. Green's grasp of the technical function of on-site sewage systems. He is correct that the current standards would not allow an eight-foot deep seepage trench, however, those were the permitting standards in 1985 and it has not been a practice of the Department of Health to ask people to upgrade older systems. The information Staff has on the on-site inspection of the system is that the system is functioning. As far as the consequence of the failure, if the system were to fail the County would be dealing with a Notice of Violation and working with property owners to come into compliance. In a worst-case scenario, ifthere was nothing that could be done to repair the system, there would be two options: put the people on a holding tank or declare the house uninhabitable. Owners of systems would be responsible for the operation and maintenance of their system and bear the consequences ifit were to fail. There are community consequences if the failure goes uncorrected. While Staff would agree that placing a deck over a drain field is not good practice, it is not explicitly prohibited in our regulations and not entirely unprecedented in the County. Given the situation, he believes Staffs low-level enforcement action was appropriate. HEALTH BOARD MINUTES - July 17, 2003 Page: 6 Questions by the Board: Commissioner Titterness asked Staff to clarify that this deck being in this location, in their opinion, poses no health threat. Mr. Fay responded that there is not an immediate or imminent health threat represented by the deck. The placement of the deck could result in a premature failure of that system, but given the construction of that system the risk is not as high as it would be in other situations. Member Buhler asked if the system is on a monitoring schedule, which Staff confirmed is on a three- year cycle. Chairman Masci closed the hearing at 4:08 p.m. Member FrisseIl moved to uphold Stafrs decision on this matter, Member Buhler seconded the motion. During discussion, Member Buhler commented that Stafffollowed policy and assured the Board there was no health threat. Since the system is on a monitoring system, if a problem becomes apparent in the future there are remedies that could be employed. She added that she has questions about the policy, which Chairman Masci indicated could be brought forward at a later date. Staff indicated that a variety of remedies are available under the code, ranging from criminal violations, civil infractions, notices of order to correct and low level enforcement, which Staff felt was most appropriate. Dr. Tom Locke noted that these are the types of judgment calls and decisions anyone involved in enforcement, including law enforcement, has to make. One ofthe important reasons to set priorities and intensity of effort is to allow ourselves the capacity to work intensively on those issues that are imminent threats. He thinks the issue before the Board is an example of how Staff must assign low enforcement priority in order to effectively delegate resources. Member FrisseIl, Commissioner Huntingford, Member Buhler and Commissioner Titterness responded in the affirmative. There were no negative votes and Chairman Masci recused himself. Staff was directed to prepare findings and the decision in this matter. At 4:12 p.m., the discussion on this matter concluded. Child Death Review: 2003 Committee Recommendations. DOH Budl!:et Decision, and Future Planninl!:: Julia Danskin reported that the packet included an announcement from the Office of Maternal and Child Health regarding the end of state funding of Consolidated Contracts for Child Death Review Activities. She reviewed the make up of the Jefferson County Child Death Review Team. Since car accidents rank as one of the main contributors to child death, the CDR team has made recommendations related to traffic safety, in addition to local prevention measures related to substance use and abuse. In 2003, they had only one child death to report to the State. On July 1", $3,000 in funding was cut and Staff is recommending that these review meetings be continued, with County general funds if needed. Commissioner Huntingford expressed concern about unfunded mandates and continuing to support this program through the general fund. Dr. Locke provided a brief history ofthis program and noted that the County is not mandated to do this but if it accepted the funding, it must perform the reviews. HEALTH BOARD MINUTES - July 17, 2003 Page: 7 Jean Baldwin talked about the benefits of building better relationships with the Coroner and the Sheriffs Department through this program. This is a good community debriefing and planning opportunity. Ms. Danskin added that there might be an opportunity to use some of the State MCH block grant funding to support the program. However, in this fiscal year, this money has already been earmarked for other staff time. She proposed tracking Stafftime and costs over six months in order to reassess whether the County can justify the estimated $500 per meeting. Dr. Locke noted that this type of data is pulled from all over the State to determine opportunities for prevention, which is how Sudden Infant Death Syndrome was discovered. The hope in continuing this program is that the legislature would recognize that they have responsibility for funding. Commissioner Huntingford expressed concern that the legislators, after seeing that our dedicated public health Staff are willing to pick up more responsibilities in order to carry these important programs forward, will not see the need to come through with the funding. Commissioner Titterness said he would like to put this on next month's agenda and get a Board of Health recommendation on whether and how it would be funded. Board MembershiD/Terms: Chairman Masci reported that terms for Members Frissell and Buhler expire in August. He urged them to submit a written request for reappointment to the Board of County Commissioners if they desire to continue. Noting that there is not currently a Vice Chair, Commissioner Huntingford volunteered to accept this position. Member Buhler moved to elect Commissioner Huntingford as Vice Chairman. The motion was seconded by Commissioner Titterness and carried by a unanimous vote. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS Civic Ene:ae:emenUCritical Health Services Proiect Update: Dr. Locke solicited the Board's interest in having a joint Board of Health and Hospital Board meeting in September, the purpose of which would be to consider having a community meeting. Much has been done by the work group and a series of recommendation would be presented to the Joint Board about actions to be taken related to various critical health service priorities. There was interest in Staff bringing some information to the Board in August, which could then be reviewed at the joint Board meeting in September. Openine: of the Child and Family Resource Center: Julia Danskin distributed a brochure announcing the August 21st grand opening of the Family Resource Center in a building next to Jefferson Mental Health Services. The Center is funded to provide outreach and service to high need families with identified mental health problems, but would also try to serve all families and are working cooperatively with school districts. They are also establishing a foundation to receive donations from private nonprofits. It was noted that the grand opening ceremony would coincide with the August Board of Health meeting. HEALTH BOARD MINUTES - July 17, 2003 AGENDA PLANNING/ADJOURN Page: 8 Member Frissell suggested that Staff write letters of thanks for the visit by Don Sloma and Carl Osaki of the Washington State Board of Health. Commissioner Huntingford moved to direct Staff to write a letter of thanks to Don Sloma and Carl Osaki of the Washington State Board of Health. Member Buhler seconded the motion, which carried by a nnanimous note. The meeting adjourned at 4:34 p.m. The next meeting will be held on Thursday, August 21 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH (lPb~1~ Jjrt kuhler, Member (Excused Absence) Sheila Westerman, Member W~~ Roberta Frissell, Member Vacant Commissioner District #3 July 7, 2003 Megan White Water Quality Program Manager WADOE mll~1i Olympia, W A. Re: Norwegian Sun Sewage Release Dear Ms. White, The Jefferson County Board of Health is writing to express its concern over the sewage release from the cruise ship "Norwegian Sun" in waters off Jefferson County on May 11 this year. Jefferson County Health and Human Services has worked diligently over the years to develop rules, policies and actions that serve to protect the water quality in the coastal areas surroWlding our commWlity. We have worked closely with the COWlty Board of Commissioners and the Department of Community Development to assure that land use and planning policy reflect a high regard for the quality of our environment and work to protect and enhance our natural resources. Weare troubled when we learn of releases of raw sewage in waters off our shores from entities that have no particular stake in our community and over whom we have no regulatory authority. Weare further concerned when this type of release occurs at a time that the Port of Seattle is actively soliciting the cruise industry to home port more vessels in Seattle and the Puget SOWld. Indeed, large cruise vessels are now virtually a daily occurrence in Admiralty Inlet and the Straits during the summer season. We depend on the Coast Guard and the Washington Department of Ecology to perform the necessary oversight of cruise ship operations in our waters. Weare pleased to see the Order # DE 03WQNR-5538 that was issued against the Norwegian Cruise Lines following the May release but question whether the cruise ship industry has a track record that instills confidence that the order will result in compliance. We urge the Department to employ all the tools available in your arsenal, including levying fines against polluters like Norwegian Cruise Lines and ask that DOE notify the Jefferson COWlty Health and Human Services Department in the event of any future releases. Please feel free to contact me or any other Jefferson County Board of Health member if you have any questions. Sincerely GeoffMasci Chair, Jefferson County Board of Health cc. Tom Fitzsimmons Memorandum Date: 7/10103 To: Jefferson County Board of Health From: Larry Fay Re: Threatened Shellfish Areas The Washington State Department of Health has released its armual report that identifies shellfish growing areas that are threatened from pollution. For the first time a growing area in Jefferson County has been identified as threatened. Station 40, the threatened area is located off lower Hadlock. A map identifying the sample locations in Port Townsend Basy is enclosed. The Department of Health created the Shellfish Early Warning System as a tool to highlight areas that meet national shellfish sanitation program (NSSP) standards but have demonstrated water quality that approaches the upper limits of the standard. The NSSP system establishes a fecal coliform limit of 43/1 OOmI based on a statistical analysis of a number of water quality samples. Waters exceeding 43fc/lOOml will be restricted to harvest. The state's early warning system identifies threatened areas as those with water quality results between 30fc/lOOml and 43fc/100mI. Station 40 is reported at 30fc/lOOml. At this time we do not know the cause of the pollution. Possible sources include stormwater runoff, sewage discharges, or boaters. The raw data needs to be further reviewed and the shoreline in the vicinity ofthe sample location needs to be assessed to determine probable sources. Once we know what to look for a specific action plan can be put into place. A reconnaisance type inspection has been scheduled with DOH shellfish staff and Jefferson County EH and natural resources staff in August. If water quality were to decline further and shellfish harvest restrictions were put in place the county would be forced to establish a shellfish protection district to finance remediation. 615 SHERIDAN . PORTTOWNSEND, WA 98368 . FAX 360-385-9401 Memorandum Date: 7/10103 To: Jefferson County Board of Health From: Larry Fay Re: Green Appeal-Peterson/Roberts SEP85-00045 Almeta Peterson and Eugene Roberts have built a deck on their property located ate 574 Beckett Point Road. The deck is located over their existing drainfield in violation of the Jefferson County Onsite Sewage Code. Environmental Health has issued a notice of violation and order to correct with the consequence of the failure to correct being a possible restriction on future building permits. Dr. Green has filed an appeal essentially requesting that the department order the removal of the deck or at least those portions over the drainfield. Enclosed are Dr. Green's letter requesting the appeal and a report from Tilhnan Engineering commissioned by Dr. Green. The purpose of the hearing is to review the facts ofthe case and determine whether staff actions are consistent with the regulations adopted by the BOH. Possible Board actions include upholding the appeal and remanding to staff, upholding the appeal and ordering the removal of the deck or denying the appeal. COMMUNI1Y HEALTH 360/385.9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 3601385-9444 DEVELOPMENTAL DISABILITIES 3601385-9400 SUBSTANCE ABUSE & PREVENTION 3flO/3Rfi->l400 ~.I 615 SHERIDAN' PORT TOWNSEND, WA 98368 . FAA 360-385-9401 Almeta Peterson Eugene Roberts . .574 Beckett Point Rd. Port Townsend, Wa. 98368 September 25, 2002 Re: Notice of Violation: Deck.built w/o health department approval. ')E::P 'f5~ ciS- Dear Ms. Peterson and Mr. Roberts: fB).~CICIU~.. IJ11 APR 1 8 am /llJ JEFFERSON COUNTY ENVIRONMENTAL HEALTH This letter is intended to serve you official notice that the Jefferson County On Site Sewage Code 8.15.150 (I) f states that you "shall not build any structure in the OSS (On-site Sewage System) area or reserve area without express, prior consent of the health officer." Section 8.15.150 (2) goes on to state; an owner's or occupier's fuilure to fulfill any of the responsibilities in 8.15.150 (I) shall be a basis for a Notice of Violation and for the Health Officer to decline to issue approval for further development on the parcel." In order to correct the violation corrective action must be taken within thirty days of receipt of this notice. Corrective action may include submission of deck plans to this office for review and possible approval or removal of the deck from the drainfield area. Failure to correct the violation may cause the department to deny applications for future development on the property. I wallt to thank you for meeting with me on the 12th of September to discuss the deck and I remain open to other suggestions that you may have to correct the situation. Please feel free to give me a call if you have any questions or if! can be of assistance. Should you feel aggrieved by this decision you may, Pursuant to Article 8.15.210 of the JetTerson County Code, appeals the decision of the Health Officer by providing written request for a hearing with the Board of Health within 15 days of the decision. (c/o JetTerson County Health and Human Services, 615 Sheridan-Street, Port Townsend Washington, 98368) ff::er;j'j ~ ~ I~~v -T Cc: Jeff Avery Acting Building Official ,.,,...r./<"lOl:" nAnn SUBSTANCE ABUSE & PREVENTION ~:u::,n/~A~Q.d.M COMMUNITY HEALiH ENVIRONMENTAL HEALTH NATURAL RESOURCES DEVELOPMENTAL DISABIUTIES 16 April 2003 Mr. Larry Fay Director, Environmental Health Jefferson County Health and HUllllUl Services 615 Sheridan St. Port Townsend, W A 98368 f I:CEI'U~ APR183XB JEfFERSON COUNTY ENvIRONMENTAL HEALTH Dear Larry, My complaint. My uphill neighbors (Gene RobertslA1meta Petersen) have built a deck completely covering their drain field without a permit. (Address: 574 Beckett Point Rd.) Myappeal: Although Randy Marx stated to me that the deck would not have been approved if initially an application had been filed, he essentially did not request its removal when it was after the fuct( exhibit one). Instead in this letter of 25 Sept 2002, he stated that "failure to correct the violation may cause thl; dloj1lu t......nt to deny lIPPlieations fur f4ture develoj)ment on the proj>erty". This is unlikely in that the tOot print of their house plus deck occupy appro)\. 95% of their property. On 13 Oct 2002, the situation was discussed at the Beckett Point Fisherman's Club Board ofTrustee's meeting. As a consequence, a letter (exhibit two) was sent to Roberts and Petersen. There was no response ftom them. On 12 Jan 2003, the Board of Trustees noted that Randy Marx did not require modification or removal of deck or issue of a citation of noncompliance. Therefore, their stance was that the deck would be approved as built The President of the Board of Trustees, Bill Smith, is aware of this appeal. Reasons fur appeal to you: I) The 12'XI8' deck is supported by concrete blocks and covers the 8' deep drain field(exhibit three). a) Randy Marx apparently bas made a judgment that the 8' depth is sufficient to satisfY needs. What literature supports this view? The county bas historically called fur revisions of drain fieWs that are too deep. b) The grass under the deck is dying preventing aeration needed fur the aerobic bacteria. The hei~ of the deck varies from contact to 36 inches above groij1l(J. c) The weight of the deck plus cement blocks plus people on the deck compress the soil (and possibly the drainage pipes) impeding the downward flow of effluent. d) Ryan Tillman evaluated the situation on 12 Sept 2002(exhibit fuur). Recommendation: At least removal of dista19'XI2' section (portion covering drain field) of the deck. Pl~ do not accept a position of"furgiveness rather than permission". ~:n:. November I I, 2002 DIECIEIWIE~ APR 18 _ lW JEFfERSOll COUNT'( lIMROIlMENTAI. HEAlTH Re: Lot Olympic View 5 Dear A1meta and Gene, .. Tbis leuill' is in regard to the deck you built last summer. As you know, your neighbor Dr. David Green hllS registered a complaint with tbe board of the Beckett Point Fishermen Club about the size and the height of the deck and how it affects his privacy. TIie privacy issue the board feels is between the parties involved and not a club issue. Dr. Green also had a lot of papers from Jefferson County about the height of your deck and how it could affect your drain field. In review of the design for a deck that was presented to the Building Committee for approval, the deck was to be built at ground level. This design is what the board approved but isn't what was built. . Since there has been a complaint and the deck wasn't built according to the Plan. the following needs to happen: I. There needs to be a letter from Jetferson County stating that the deck passes all codes and doesn't need a building permit. 2. A letter to the Beckett Point Building committee needs to be submitted along with the paper work from Jefferson County as to what you plan on doing if the deck doesn't pass the county codes. The board needs your response by the next Trustees meeting on January 12th so we can start a follow up on this complaint. TIie response can be mailed to Patti Sahlinger. Almeta andOene. .. hope you realize that no member of the board has a personal view, including myself, but ourjob is to make sure all rules and regulations are followed. Sincerely, William A. Smith, President cc: Patti Sablinger, Secretary 890 Beckett Point Road. Port Townsend, W A, 98368 David Green ...dedicated to the propo~ation, protection, and enjoj'1l;wnt Qf 0111' salmon l'csourcesj;)T over 50 years. . Post Office Box 1657 Port Townsend, Washington 98368 ~ep-12-02 03:46P JLScott*Port Townsend 360 385 4196 P.Ol ii1I!i1IiIrI . ENGINEERING, INe. KIVLfY PROflSSIONAI Cl:.,jTrR lA I OAK fl^Y ~OAI}! P.O. BOX 117.'5 rOllIIIADIOCK, WA~lfIlNGI()r-..: l(B13~; 360]/9.9661 :((~).3nol.,){) 1M. September ! 2. :002 F?,~rY- (/u-/J.) Dr. David Green PO Box 224 Port Townsend, W A 98368 rt5J~(C~nWl~~ lf1l APR 1 8 2003 IJd) RE: Initial Inspection of residence 576 Beckett Point Road Port Townsend. WA 98368 JEFfERSON COUNTY ENVIRONMENTAL HEALTH Dear Dr Green, On August 26, 2002 I inspected a portion of your residence located at 576 Beckett Point Road. The purpose of the inspection was to ascertain, if possible, the impact to your property from relatively recent construction immediately adjacent to your site. Two concems were raised: J. First, you voiced concern regarding the construction of a new deck over the septic system serving the adjacent residence and the impact to your property should that system fail. During our inspection, there was no evidence that this septic system is currently failed or failing. There were no signs of surfacing septic efiluent in the front, downhill side of the home and roadside ditch backslope which would be positive indicators ofa failing system. I did not detect any sewage odors either. This adjacent septic system lies above your front lawn, and surfaced effiuent could migrate onto your lawn in the event of a failure. You indicated that the grass has remained green proximate to that location despite the dry summer conditions, a condition that I observed while onsite. It is possible that this green grass is evidence that the leach lines from this adjacent septic system are keeping that area wetted. It appears unlikely that your own system is contributing to the circumstance due to the distance from the green area, and the dry grass in between. It is my opinion that construction of a deck over a septic system can have detrimental effects to the evaporation of water, mainly through transpiration of water from surface vegetation, wind and sun, from the disposal field area. In addition, piers or footings placed on grade over the drainficld can compress soils and limit their ability to lift water to the surface by capillary pressure. Jefferson County addresses decks over drainficlds on a case by case basis, but in general discourages and on some occasions prohibits such construction for the detrimental effects that they can have on the function and longevity of a system. Jefferson County also requires designation of a reserve area, to replace a failed system, when many residential construction pennits are issued. In general, the Sap~12-02 03:46P JLScott*Port Towns Dr. David Green September 12, 2002 Page 2 6 o ~(c~iW/~.~ APR 1 8 2003 I.W. P.02 E~'fv... (1-"12) JEFFERSON COUNTY H/VIRONMENTAl HEAlTH County has policy that requires compliance with current regulation when expansion of the residence is proposed. Current regulation would require compliance with minimum land area, reserve area designation, together with an evaluation of the existing system. .., The second issue is relative to a discharge onto your property from this same residence. As I understand it, you witnessed a discharge of what appeared to be grey water of some kind crossing the property line and pooling near the corner of the concrete patio. I understand that you called the neighbor upon seeing this discharge, and that the neighbor subsequently quickly stemmed the flow. This discharge caused minor erosion of soil along the property line and a small retaining wall at that location, significantly wetting the soils and area of the patio comer, Upon visual inspection looking across onto the neighbors property, it appears that there is a steel lidded basin between their foundation and your property line. Washed gravel surrounds this 'structure'. I surmise that this may indeed he a grey water system for household uses such as washing machines, bathtubs and sinks. Typically, grey water systems consist of a pit of varying dimension, filled with washed rock. sometimes with a structure in them that serve as a disposal pit for so-called 'grey' waters, Le. not black with feces waste. While not approved for use by Jefferson County, many ofthese types of grey water systems do indeed exist. if this is indeed a system as described, there are several possible detrimental effects. First, grey water can contain pathogens despite the Jack of fecal material. Second, soaking of the ground around your foundation can cause settlements, general moisture can create an envirorunent conducive to growing molds and mildew, and increased water pressure can have a detrimental effect on your septic system drainfield. While on site, I recommended to you a method of providing inspection ports to monitor ground water levels proximate to this area to you. These inspection ports can help you with detennining the extent of water saturation in the soils of the specific area I hope that this short report satisfies your immediate need for this situation. IfI can be of additional assistance or can clarifY any of the issues presented in this leller, please do not hesitate to call me. Sincerely, ~"-- ~ RE. Ryan tillman, P.E. I President ::--- ' . / ~ , ~.....- ~- , - o QQ B ~c..k Rcl, / / ./ // ... ! ill} I I>t)~~t t;a".\-- ~ " ~(~~l'S~) 1~1~1 , ,(), _I K'~ ~ - 6 , =. W' "'. "'e' !!:/ \C':: __ , . ,.:: -1-;;; I 0 I~ I ~. '"" 17' ~ '3 (.)1 i?>eck~t\. rc RJ. . 1 '---..s. E~DL (1-13) ... f; D.'It.,.-t -a.1l Sb........C"'... C-t su....4aa '('lJ-", o~\ ~~ 'f'cc-f .,.......'" c-\f '3wtJ'i -tvc","" J,....~...d'~~\d. J. ;)., · ~) Pi-t -S"/Sl.e",,, , )(!5 j '3.) t'l~rth <(,' ) u.:S.(' u.>d!,k~ \. J."'a.i'f'\. 'C' 0 e.,.\c ""DT f' i i ........"" J.I) (/ O-t ~as\..<!'J d..,.a'..... ~ De. k. .u...J.- () .. f' e. _' - r ~ I t tS) ~>\--a.\l'f\ ~~'t.'tlV' "<"'<!'t,I,.o..;.......c ~\o..... 1:0 ~"W\a 1 '1\speRio",," p le'll ~e ca" W h..."" r-e ady. " ---- . f Ii ,-j "', ! c, ...} l.,"'~ "'-' /' ;'fr ; Ir ., , ..-' /.1 r .:, ". ,'1 "" L<--.t....t-~. " ...., 'I'f - ,/~ , -I- C~ ,': /. -- '"'\ '/ -: ~.) ~-,o.. ., , ~r . '<.. " If" ./ -,,-- If .~ I b ' ( . fl~__~~_) .......---... ..~ . ~.- . f5)~~~~\Yl~~ m1 APR 1 8 2003 IW JEFFERSON COUNTY ENVIRONMENTAL HEALTH FROM: Almeta Peterson and Gene Roberts E ~:IIL (;1.... '3 fi5)1 ~ ~ ~ ~ IW ~ rR\ ml APR 1 8 2003 l!dJ ! TO Building Committee Beckett Point Fishermen's' Club DATE: 7-5-02 JEFFERSON COUNTY EI~VIRONMENTAl HEALTH RE Approval of Proposed Deck at 574 Beckett Point Road Your approval would be appreciated for a simple deck we wish to install on the ground in front of our home as indicated in the sketch below. It would be approximately 21' square, made with !rex, and meeting County setbacks. Thank you for your consideration. " ;;lh~ ~k~ k-.c&~-c-~~~r ,/" .. -. ~ \'- . . ,_ 7-S-C>-:::<' 7-~O2.. rto \.JS~ - I I ,:;:....~ ~ ~i.'f"i.. We.. \t< w~:::I )< ,,"- . ...............l--....~~.",.....- f - ---- &rov>\.d L.e-v~ I I ~ \ ; :; ;~ -~-' - - ------ ---- ---- --) J 1 i ~ .' - . 't\ ~ \ \ \ \, 'l' '7\", !Il ". : I!' : - f '. \ \ i \ ' ' , I :~' \\ \ ~ \ i;, "~ . '\ Ii: . .'.' I;, I' , \~ \:: \ ,: ; I \ i \ \ i; ; : \ \ i \ i j ; \ ; : ; I \ t l' . '; .j ; ; \ \ \ i ' i i; ; " I 1 i ; !! 1 i i t ,..' ;.' .. ,h"1 ( ,/ ~-' ..- ). _"-'__'::- 'ill....)' (r: _ ~.,~- ~ <-7' ,/y;-l.~ '. i ~L ';2:: ," -\:lr ~. ) illv~-- \fl . . .."::;5 f?O'C.I1-"'Tj 7 7nv",_bb..~ - ~\/ U P b ~ ~ ;b"f ;;l I -? --'.>-).."-,,J-e -\-0+ vY\a.-\- c."" C e:><.'\ s-\-', v\ q, W6- \\<. WA:J ' I ---_._-_.-.~--- - -'--~ (' L>~1o clo r-3ec k e-\- + Po',-,-\- R 0<> --\ ;..-- D~ ~ b~ JIll' -....--..---.--.-.--..-- ""'-'-.----- - -.-_. y . ~uu..-- (.> ....,' ....-- \; ~ -t-.-:, \ :"- ~\.: ._----.:;- ,-.... -..,. _._;_u .__ -- r r" '-,-0- . ...... /l, _~/_:. u. t-..;;~ ',> q ~F~ '0 , J-, v - '-~-'-"'-' ---""-----..- - . :; -. .... , ./,-- " gl ....~.-,~-. - :::>} '-', , -' ";-- ,.'. , . G-1"~.:IJI?-~ <:;-'-(7"1'J) - ~ Ii: Ii: Ii: PA Ii: ~ APR 1 8 2003 JEffERSON COUNTY ENVIRONMENTAl HEALTH .- -~ 5e :,) t ~ ~ t .~I- .".... .~-'"'-..~-.._, j ~';';' . . ; .........,. r +- . ,- " '.- -- >" >''::' ~..' ,,:.' .-. '."' -+ c ~;c. ~~ .~< r;Ja- Cf" -zJO 2- pa!~~t tf Q)M 0 p~~~~.~ . ~ ~o.v~1-"#~ ~ hr. !\~io ~ '~:..rJ.a .l--..~' y ~ ~,'fW'"'~ ~ \1)I\~~ bNJlb . July 7,2003 Local Health Jurisdiction: Administrators Nursing Directors Child Death Review Coordinators Dear Contractors; This letter is to provide official notice about ending state funding in Consolidated Contracts for Child Death Review activities. As you know, the recently signed 2004 Washington State budget eliminates the entire budget for the Child Death Review (CDR) program. We have spoken with many of you directly about this decision either by phone, email, list serve, or conference call. Effective July 1, 2003, state funding for LHJ CDR activities is no longer be available. The 33 LHJ's who have CDR funds in their 2003 DOH consolidated contract should expect a contract amendment deleting the statement of work and budget item for Child Death Review as of July I, 2003. The CDR Statement of Work deliverables are: 1. Submit completed data collection tool for every child death reviewed by the CDR team at the beginning of the quarter following the review. 2. Annual report on key findings from reviews For the closeout of your CDR contract, please be sure that you submit the required data and annual report for all deaths reviewed prior to June 30, 2003. Melissa Allen and Diane Pilkey will be in communication with LHJ CDR staff regarding technical assistance for those counties who chose to continue their CDR team without funding from DOH. Thank you all for your patience and understanding during this transition time. If you have any questions, please contact Melissa Allen, at 360 236-3536 or melissa.allen{aJ,doh.wa.gov. We appreciate the commitment you have shown to community based child death review. Sincerely, Jan Fleming, Director Office of Maternal and Child Health y STATE OF WAStllNGTON WASHINGTON STATE BOARD OF HEALTH 1102 5f Quince 51reel .1'0 Bo. 47990 Olympia, Washington 98504.7990 July 9, 2003 To: Washington State Board of Health From: Don Sloma, Executive Director Re: OVERVIEW OF MAJOR HEALTH AND MEDICAL CARE PORTIONS OF THE 2003-05 BIENNIAL OPERATING BUDGET SUMMARY According to Governor Locke's budget proposal released last December, the recession, slow economic recovery and soaring health care costs resulted in expected revenue for the coming two years falling short of expected expenditures by some $2.4 billion in state funds. The Governor called for balancing the budget without a general tax increase by identifYing the results that people expect from state government, raising the bar for scrutiny of all state government activities, and using no more than currently anticipated revenue to fund that subset of current services that most directly contribute to the results. To determine these services, the Governor used a process he described as "Priorities of Government" or POGo On June 5, the Legislature approved a spending plan for the 2003-05 biennium. The Legislature made several adjustments to the Governor's assumptions in preparing the budget, rejected some proposed reductions in DSHS programs, reduced the size of the cuts in the Basic Health Plan, made several new additions to the health and human services budget and shifted the funding of some programs between state general funds, federal funds and state health services account funds in ways that render simple and direct comparisons risky at best. The final budget for health and human services is generally consistent with the Governor's Priorities of Government in that it contains fewer reductions in public health and social service programs for vuloerable children and adults than in programs providing medical care. These reductions were accomplished by applying one or more of the following reduction methods to many programs: . tighter eligibility requirements, . increased verification of those requirements, . higher patient co-pays, deductibles, co-insurance and other cost sharing requirements, . lower enrollment targets, (including some absolute enrollment caps), . assumptions that many will opt out of subsidized care rather than pay a now increased share of total costs, and/or . expanded use of fees for certain public health and other services. It is also notable that the health and human services budget was helped into balance by redirecting new tobacco tax revenues raised under Initiative 773 and earmarked for expansion of the BHP to other health-related spending. Washington State Board of Health July 9, 2003 Page 2 of6 . , In addition, the [mal budget reduced the state share of public employee health benefits significantly through the combination of greater employee cost sharing and reductions in assumed inflation. Despite several increases in specific programs, the final legislative budgets for the Departments of Health (DOH), Department of Social and Health Services (DSHS), and the Health Care Authority (HCA) afpear to fall some $585 million in total state and federal funds below the Maintenance Level identified to keep current programs and services operating as mandated under laws on the books as oflast January. This figure does not include an estimate of savings resulting from reducing assumed inflation and reducing the state share of public employee health benefits. Still, these three state agencies will provide some $19.4 billion over the next two years for our state's medical, social service and public health economy. That amounts to some 43% of the state's total spending of funds it receives from all sources. BACKGROUND AND DISCUSSION The following table summarizes the legislatively approved 2003-05 state operating budget prior to Governor Locke's final action. 2003-05 Omnibus Operating Budget - Conference Report (Dollars in Thousands) Legislative Judicial Governmental Operations Other Human Services DSHS Natural Resources Transportation Public Schools Higher Education Other Education Special Appropriations Total Budget Bill Appropriations in Other Legislation Statewide Total FTEs 828.3 578.4 7,434.6 15,273.2 17,762.2 5,764.4 764.3 282.6 43,803.4 20.8 0.0 92,811.9 2.6 92,814.5 GF-S 129,628 78,492 411,400 1,328,153 6,605,069 297,097 48,834 10,107,136 2,667,245 39,932 1,347,715 23,060,701 1,000 23,061,701 Total 136,394 162,179 2,726,735 3,617,616 15,841,747 1,091,562 123,957 11,909,095 7,400,550 99,594 1,642,651 44,752,080 95,515 44,847,595 I The "Maintenance Level" is calculated by fmding the cost of current programs adjusted for expected changes in the price, intensity and caseload demand for existing services. In the DSHS Medical Assistance budget for example. "Maintenance Level" included many important assumptions such as a 13% increase in the intensity of services to be provided owing to the aging of the population and an increase in medically necessary treatments available as well as a 70,000 person increase in the number of persons eligible for the program under current law. Inflation adjustments were not assumed in the Maintenance Level, but were added as separate adjustments in the budgeting process. They are discussed in the body of this memo. Washington Stale Board of Health July 9, 2003 Page 3 of6 Governor Locke's Proposed Budget - The Priorities of Government According to Governor Locke's budget proposal released last December, the recession, slow economic recovery and soaring health care costs resulted in expected revenue for the coming two years falling short of expected expenditures by some $2.4 billion in state funds. His solution was to propose a biennial budget that limited spending in the state's $24 billion state fund budget by $2.4 billion, including reductions of $2.1 billion in the state's General Fund and $275 million in the Health Services Account. . The Govemor called for balancing the budget without a general tax increase by identifying results that people expect from state government, raising the bar for scrutiny of all state government activities, and using no more than currently anticipated revenue to fund that subset of current services that most directly contribute to the results. To determine these services, the Governor used a process he described as "Priorities of Government" or POG. The Governor's Priorities of Government in health and human services included preserving the safety net for vulnerable children and adults, and strengthening the public health system, but eliminating health care programs less critical in ensuring the health and safety of people most at risk. He suggested that revenue from higher tobacco taxes mandated by a recently enacted citizens initiative to expand enrollment in the Basic Health Plan be used instead to prevent even more severe reductions in that program. The Governor's resulting health and human services budget would have spent $7.5 billion in state funds, but would have saved $543 million in state funds required to maintain current services. Final Legislative Budget-The Disposition of Government Priorities On June 5, the Legislature approved a spending plan for the 2003-05 biennium. The legislature made several adjustments to the Governor's assumptions in preparing the budget, rejected many proposed reductions in DSHS programs, reduced the size of the cuts in the Basic Health Plan, made several new additions and shifted the funding of some programs between state general funds, federal funds and state health services account funds in ways that render simple and direct comparisons risky at best. Legislative budget documents identify the health and human services component of the legislatively approved budget at some $7.9 billion in state funds. When combined with federal matching funds, the resulting appropriation is some $19.4 billion in total funds. This represents some 43% oftotal state spending for the coming two-year period? The following are some highlights of the health and human services portions of the budget. The health and human services portions of a Senate Ways and Means Committee document, "2003- 05 Operating Budget Highlights" is attached for more detail on the items listed below. Also attached are the House of Representatives agency summaries of the budgets for DOH, relevant divisions within DSHS, and HCA. The Big Picture In the main, the Governor's Priorities of Government were reflected in the budget approved by the Legislature. Despite several notable increases, the final legislative budgets for the DOH, 2 The material summarized below is drawn the following state agency sources: httn:/lleaD.leQ.wa. Qovlleao/BudQetIDetaiV2003/00305hiQhliehls 0604.odf httn:llwww.leQ.wa.QovlhouseloDrtaDD/03/0604rs.odf httn:llwww l.dshs. wa.QovlbudQet/dhhmain.shtml , Washington State Board of Health July 9, 2003 Page 4 of6 DSHS and HCA appear to fall some $585 million in total state and federal funds below the Maintenance Level identified to keep cnrrent programs and services operating as mandated nnder laws on the books as oflast January. This figure does not include reductions from "Maintenance Level" funds required for public employee health benefits. The final budget for health and human services contains smaller reductions in public health and social service programs for vulnerable children and adults than in programs providing medical care to some of these same populations. These reductions were accomplished by applying one or more of the following reduction methods to most major programs: . tighter eligibility requirements, · increased verification of those requirements, · higher patient co-pays, deductibles, co-insurance and other cost sharing requirements, · lower enrollment targets, (including some absolute enrollment caps), · assumptions that many will opt out of subsidized care rather than pay a now increased share of total costs, and/or · the expanded use of fees for certain public health and other services. Finally, the health and human services budget was helped into balance by the redirecting of tobacco tax revenues eannarked nnder the terms of Initiative 773 for expansion of the BHP to other health related spending. Public Health Secretary Selecky will address the Board at today's meeting on the public health portions of the budget. These items will not be reviewed here. Some Program Enhancements In addition to restoring dozens of proposed program reductions in the health and human services area, the budget contained several new program initiatives. They included: · A $.75/hour wage increase for Home Care Workers at a cost of$44.9 million in state and federal funds in long-term care programs and $17.3 million in developmental disabilities programs. · A total of $91.7 million in state and federal funds for a 3 percent increase in non-capital nursing home payments, raising the weighted average payment to $147.43 in FY 2005. · A total of $848,000 in state and federal funds for the cost of Medicaid patients to receive the five new State Board of Health recommended newborn screening tests. · A total of$18.6 million in federal funds for Regional Support Networks that identify new sources of qualifying local matching funds. Reductions in DSHS Medical Assistance One of the major thrusts of the budget was to reduce medical assistance payments for the poor and disabled. Some $278 million was reduced from the $2.7 billion state funds required to continue current medical assistance programs in the coming biennium? This will mean that 3 Additions and reductions are calculated from the "Maintenance Level" budget identified in the Legislative Summaries attached. This level is calculated by fmding the cost of current programs adjusted for expected changes in the price, intensity and caseload demand for existing services. In the DSHS Medical Assistance budget for example, "Maintenance Level" included many important asswnptions including that of a 13% increase in the intensity of services to be provided owing to the aging of the population and an increase in medically necessary treatments available as well as a 70,000 person increase in the number of persons eligible for the program under t Washington State Board of Health July 9, 2003 Page 5 of6 some $337 million in total funds will be reduced from the $7.6 billion in total state and federal funds required for current DSHS Medical Assistance Administration operations. The largest of these reductions included: . Replacing the state-funded Medically Indigent Program with two smaller, federally matched programs of direct payments to hospitals . Reducing inflationary increases in payments to managed care plans to 3.3 percent for each calendar year of the biennium . Requiring payment of a share of premiums for Medicaid coverage of families with children whose incomes exceed $1,300 per month for a family of three . Reducing by some 25,000 adults and children those receiving medical assistance through increased efforts at eligibility verification. . Consolidating drug purchasing across state agencies, increasing use of generics and negotiating greater discounts with manufacturers. . . Reducing the scope of adult dental care by 25 percent. · Reducing payments for Durable Medical Equipment by 5 percent in the second year of the biennium. Reductions in The Basic Health Plan A second major thrust was to reduce the cost of the Basic Health Plan (BHP), while redirecting new revenue from a citizen approved initiative that raised tobacco taxes to expand BHP. These changes account for virtually all of the reductions in the Health Care Authority's budget from a Maintenance Level of $916 million to $538 million for the 2003-05 biennium. This was accomplished primarily by the following means: · Repealing Initiative 773's requirement to increase enrollment to 160,000, and immediately capping enrollment at 120,000 · Amending Initiative 773's requirements to maintain a minimum BHP enrollment using existing state funds and to increase that with new tobacco tax revenues to 175,000 by July 2005 . Further reducing BHP enrollment by attrition to 100,000 by January 2004 · Reducing the value ofBHP covered benefits to 82 percent of their current value by increasing enrollee cost-sharing. Reductions in Other Health and Human Services Programs Other significant reductions in health and human services programs included: · Eliminating some $19.8 million in state and federal funds that had been proposed but was rejected by the court to settle a lawsuit brought by ARC on behalf of the developmentally disabled. · Saving some $11.8 million in state and federal funds by reducing the spousal resource retention limits to increase the proportion of personal funds some 500 seniors will have to pay for long-term care services before becoming eligible for Medicaid services. . Saving some $15.8 million in state and federal funds by limiting enrollment in the COPES program to a level that is expected to exclude some 700 people who would otherwise received help from that program. · Saving $5.2 million in state and federal funds by not providing in-home personal care services to some 475 people. current law . Inflation adjustments were not assumed in the Maintenance level, but were added as separate adjustments in the budgeting process. They are noted in the text of this memo. Washington State Board of Health July 9, 2003 Page 60f6 . Saving $13.7 million by increasing scrutiny of those receiving General Assistance- Unemployable (GA-U) to be sure their medical or mental condition has not improved. . Saving $4.2 million when mentally ill children's families with incomes in excess of 100% of the poverty level opt out of the program rather than pay the newly required premium . Saving an additional $4.2 million when mentally ill children's families are found ineligible for the program due to increased scrutiny of eligibility. . Saving $4.6 million by reducing funding for substance abuse treatment through the Treatment Alternatives to Street Crime program, while preserving Drug Courts. . Saving $2.0 million by no longer providing substance abuse treatment for the gravely disabled. Public Employee Health Benefits Notwithstanding earlier speculation that premiums for state, K-12 and higher education employee health insurance benefits might increase by as much as 20% per year, the Legislature's final budget assumed an increase of 15.5 percent per year in 2003-05. The state's cost of this increase was partially offset by: (I) increasing office visit co-pays from $10 to $15; and (2) requiring employees to pay an average of 16 percent of the cost of the benefit, compared to 14 percent this calendar year. At the 16 percent employee share, the state's share will increase to $592 per month during CY 2005 for the average employee's individual and family health benefit coverage, compared to an average of $482 this year. During calendar year 2005, the average employee will pay $111 per month, compared to an average of $72 per month now. The K-12 allocation for monthly employer contribution rates is increased from $457.07 in the 2002-03 school year to $526.03 in the 2003-05 biennium, consistent with the increase in state employer contribution rates per employee. The budget materials used to compile this summary displayed no specific dollar amounts reflecting the "Maintenance Level" funding required for public employee health benefits, and some dispute continues about the appropriate assumptions to use in estimating inflation. However, speculation is that the final budget reduced the state share of public employee health benefits by as much as two hundred million dollars or more for the biennium through the combination of greater employee cost-sharing and reductions in assumed vs. actual inflation.