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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, September 21, 2006
Board Members:
David Sulh'van, Chairman - County Commissioner District #2
Patrick M. &dgers, Vice Chairman - County Commissioner
District #3
Phil Johnson- County Commissioner District #1
Jill Buhler- Hospital Commissioner District #2
GeoffAlasci - Port Townsend City Council
Sheila lVesterman - Citizen at Large (City)
Roberta Fri.mll- Citizen at Large (County)
StqfMembers:
Jean Baldwin, Pubh'c Health Services Director
Juh'a Danskin, NutTing Programs Director
Thomas Locke, MD, Health Officer
Mike McNickle, Environmental Health & Natural
Resources Director
Meeting was called to order at 2:35 pm on September 21, 2006 by Vice Chair Rodgers in
the conference room of Jefferson County Public Health. All Board members were
present with the exception of Chair Sullivan. All staff members were present. A quorum
was present.
APPROVAL OF AGENDA
Vice Chair Rodgers moved to approve the agenda to reflect the following changes:
New Business - adding Substance Abuse Nominations and Old Business and
Informational Items - adding an update to the Mandatory Health Care Worker
Vaccination Resolution to WSMA. Board Member Frissell seconded the motion to
amend the Agenda, which carried by a unanimous vote.
APPROVAL OF MINUTES
Board Member Masci moved to approve the minutes as written. Board Member
Johnson seconded the motion, which carried by a unanimous vote. Member
Westerman commented that she would like to have seen more detailed information
around the Budget discussion.
PUBLIC COMMENTS
Two local restaurant owners testified concerning enforcement ofInitiative 901 which
amended the Washington Clean Indoor Act to ban smoking in public places and places of
employment. Questions were raised regarding the manner in which complaints are
received and the enforcement steps that follow a complaint. Concerns were expressed
regarding the "business owner" becoming the enforcer of a government regulation and
possible inaccuracy of the time line referenced in a complaint letter.
The fairness of the enforcement ordinance was questioned. Penalties for retail businesses
and food service establishments differed with the latter facing possible suspension or
their food service permits. The restaurant owners also felt there was no way to verify that
a business was carrying out its responsibilities.
A suggestion was made for the Board to revisit the enforcement guidelines.
OLD BUSINESS
First Confirmed Human West Nile Case in Washineton
Lisa McKenzie, Communicable Disease Program Coordinator, gave the Board an
updated DOH News Press Release, which confirmed 3 additional cases of horse
infection, last week, and 1 new magpie infection, bringing the total in Washington to 1
human, 4 horses and 1 bird showing positive for WNV. The West Nile Virus Newsletter
was also given to Board as an informational item.
Dr. Locke spoke concerning the first confirmed human WNV contracted in Washington
State. There is evidence that the virus is in Washington State but at very low levels. We
have over 300 birds that tested negative and none of the mosquito pools have tested
positive to date. There is approximately 1 'is months left of the mosquito season, with
September and October being the peak months for WNV transmission. Therefore, what
we are seeing is either something that is very isolated or the beginning of a localized
outbreak in Western Washington.
Member Westerman requested JCPH put out a press release informing the public we are
still in the midst of mosquito season and to continue to use precautions such as turning
over buckets and frequently cleaning bird baths and pet dishes.
Lisa McKenzie also talked about the E. coli outbreak in spinach. To date there is 146
cases, 76 hospitalizations and 1 death due to the outbreak. In Washington there has been
2 confirmed cases, one in Cowlitz Co. and the other in Island Co. Several other potential
cases are still being investigated. There has been extensive investigation in the Salinas
Valley in CA but there is still no determination as to how the spinach may have become
contaminated. Whether it's a factor of flooding the fields with stream water that was
contaminated further upstream by animals or using manure fertilizer that wasn't cured
enough or possible contamination during the packaging process has yet to be determined.
Recalls are continuing.
Beneficial Use of Biosolids in Jefferson County
Mike gave a brief overview of Biosolids and stated that Biosolids are an excellent reuse
of material. Biosolids are used locally by the Port Townsend Composting Facility. He
pointed out that Jefferson County does not regulate the use ofbiosolids in the county
rather it is overseen and permitted by the Department of Ecology. Biosolids that are used
for fertilizer undergo continual monitoring by the DOE and meet the maximum
contaminate level standards in ground water level testing.
Mike McNickle pointed out that Jefferson County ships nearly 42 million pounds of solid
waste to Roosevelt Regional Landfill, over 300 miles away, at a cost of over 1 million
dollars, some of which can be reused. He expressed the need to expand our recycling
capabilities to materials such as green glass and construction material and food waste.
These issues are being looked at the by the Solid Waste Advisory Committee. JCPH,
partnering with Public Works, is looking into pharmaceutical waste reduction.
Mieratorv Bird Testine Results
Wildlife biologists have been watching Alaska as a probable entry point for high
pathogenic Avian Influenza into the United States and the possible of co-mingling of
Asian wild fowl with N. American wild fowl. To date there have been no detected cases.
Hopefully this will give us at least another year to prepare for an Avian Influenza as a
potentially deadly disease for poultry operations.
Washineton Smokine Rate Drops
Washington has made a huge investment in smoking reduction with a return investment
of a 21 % drop in smoking rates. Weare the 5th lowest in the country with the goal to
become the lowest, which equates to about 1.8 billion in health care costs.
Update - Mandatorv Healthcare Worker Vaccination Resolution to WSMA
Dr. Locke updated the Board on the Mandatory Healthcare Worker Vaccination
Resolution. Although initially not met with a positive reception, the Health Officers were
able to get the Resolution through the Washington State Medical Association's House of
Delegates. The next step is the State Board of Health involving the State Legislature and
the Governor.
NEW BUSINESS
Initiative 901: Jefferson County Responds
Kellie Ragan, Program Coordinator, gave an overview presentation covering Initiative
901 - Clean Indoor Act. The purpose of this Initiative is to protect citizens of the State of
W A, including workers, from the risks of second-hand smoke. In November 2005, 1-901
passed by decisive majority of voters. In December 2005 the amended Clean Indoor Air
Act became effective. In February 2006, Jefferson County Board of Health passed
Ordinance 04-0216-06. Kellie touched on the smoking prohibitions regarding "Public
Places" and "Places of Employment" as reflected in the Attorney Generals FAQ.
According to the 2005 BRFSS, 1 out of 8 citizens in Jefferson County are current
smokers. Kellie walked the Board through the steps involved with education/outreach,
enforcement through citations, food permit suspension and revocation. Kellie pointed out
that 17 educational packets were mailed out, 8 official complaint notices were sent or
hand delivered, and there were 3 site visits. Out of the 11 complaints there was no action
taken. One variance was applied for and denied.
Jean Baldwin briefly explained the variance process and informed the Board that variance
packets are available to anyone who wanted to view them.
There was a general discussion regarding enforcement. It was pointed out that complaints
are not proof of a violation. An incident has to be witnessed by a JCPH staff member to
be considered an enforceable violation. Kellie pointed out that a letter of complaint
should not be construed as a citation.
Other Tobacco Prevention highlights include the review and update ofthe County
Tobacco Strategic Plan and an announcement that the Secondhand Smoke Task Force
will convene within the next six weeks to plan future cessation efforts.
The Board discussed public comments that had been made earlier in the meeting with
respect to 1-901 enforcement. Vice Chair Rodgers expressed his desire to have the legal
counsel present at an upcoming board meeting for a more in depth explanation of the law
surrounding 1-901. In response to discussion regarding anonymous complaints, Mike
McNickle explained that we do not accept anonymous complaints but we do let food
establishments know that complaints have been made and offer technical support at that
time. Anonymous complaints do not prompt inspections or notices of violation.
Member Masci indicated there was confusion around the complaint letters being sent to
food establishments. It was suggested that the letter be revised to make them more reader
friendly. In addition Member Masci suggested, in regards to complaints, that the Board
consider that downtown restaurants/bars will be more likely to have a higher volume of
observed or anonymous complaints because of the tourist trade or visitors unaware of
county laws. He also suggested that if a restaurant/bar has clear signage that should be
considered proof of compliance and expressed his concerns over restaurantlbar owners
having to become the police.
Member Westerman reminded the Board that food establishments who choose to expand
their business by providing outdoor seating are responsible for compliance with regard to
that seating area. Member Buhler raised a question as to the extent an owner of a food
establishment has to go to be in compliance with the law. Is posting a sign enough or do
they have to take further actions to assure that customers observe smoking restrictions?
Jean Baldwin emphasized that the Attorney General's 1-901 enforcement guidance
document that has been used to clarify legal questions concerning roles and
responsibilities of the various parties affected by 1-901. To assure statewide consistency
in 1-901 enforcement, we are following this guidance as closely as possible.
It was recommended that the letter be rewritten clarifying definitions of complaints and
citations and owners responsibilities as relates to I-901 compliance. Vice Chair Rodgers
asked for any of the Board members who wanted to make changes to the compliance
letter, submit their changes to Jean Baldwin. The letter, with revisions, will be brought
back at the next meeting for further discussion.
2007 Performance Measures
Jean Baldwin reported that these were the Performance Measures that were submitted
with the budget. Performance Measures are the deliverables connected to various grants
and contracts, which fund a variety of services provided by Jefferson County Public
Health. Jean referred to the graph, which indicates revenue, expenses and categorical
justifications.
Member Westerman suggested that the Goals for On-Site Sewage Programs Performance
Measure be rewritten to clarify education of builder and installers/designers and clearly
state that we are providing technical assistance not education.
State Association of Local Boards of Health Proposal
Dr. Locke referred to the letter from King County Board of Health. Julia Patterson, Chair
of King County Board of Health, is proposing that Local Boards of Health convene as a
state organization. In the letter, Chair Patterson is asking ifthis Board wishes to express
interest. Interest was shown but questions were raised regarding funding.
Member Masci proposed contacting Chair Patterson and expressing interest but share
concerns and suggest private subscription funding, a tiered or general assembly, and
organization that is devoted to education and training of Health Board members.
Member Westerman stated lobbying for ongoing predictable funding would be crucial.
In conclusion a letter will be drafted expressing interest and stating Board member
concerns.
Report to City of Port Townsend
Jean Baldwin referenced the 2006 Report to the City asking the City for prevention
money only, which by the formula estimate of Substance Abuse Prevention money
should be $34,000. This report was mailed to David Timmons and Mark Welch on
September 15th. It was further pointed out that the Substance Abuse money goes to three
programs, Prevention Coordination and Activities, Nurse Family Partnership and Healthy
Communities - Big Brothers Big Sisters. Jean will submit a formal request to the City
asking to participate in a workshop on Board of Health needs and the upcoming BRFSS.
Substance Ahuse Advisorv Board Nomination
The Board received the resignation of Linda Pfafman from the Substance Abuse
Advisory Board and received a letter of interest from Connor Dailey.
Member Westerman motioned to appoint Connor Dailey to the Substance Abuse
Advisory Board. Member Buhler seconded the motion, which carried by unanimous
vote.
Activity Update - Co-Occurrine Disorder Inteerated Treatment Trainine-
October 2. 2006
Madrona Institute in conjunction with Jefferson Mental Health Services and Safe Harbor
Beacon of Hope will be conducting a one-day training to learn about Jefferson County's
new treatment program for Co-Occurring Mental Illness and Chemical Dependence.
Madrona Institute has a contract with the County and receives 1/IOth of 1 % from County
Mental Health tax, which will subsidize this training. This outreach is open to the public.
Meeting adjourned at 4:25 pm.
Next Board of Health meeting is October 19, 2006.
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Patrick M. Rodgers, Vice Chair Sheila Westerman, Member
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Roberta Frissell, Member .
Excused
David Sullivan, Chairman
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street. Port Townsend. Washington. 98368
www.jeffersoncountypublichealth.org
August 25, 2006
SUBJECT: Clean Indoor Air Act (RCW 70.160)/lnitiative 901 Compliance
Dear Jefferson County Food Establishment Owner,
We the undersigned members of the Jefferson County Board of Health are writing to
remind all owners and managers of Jefferson County Food Establishments of their
obligations under Washington State's newly amended Clean Indoor Air Act. When a
63% majority of Washington state and Jefferson County voters approved Initiative 901
in November of 2005, the law was changed to prohibit all indoor smoking in public
places and places of employment. In January of this year, the Jefferson County Board
of Health passed an ordinance that establishes detailed enforcement procedures for
these new legal requirements. Repeated violations of the county ordinance may result
in fines, court appearances, food establishment permit suspension or, in extreme cases,
permit revocation.
We acknowledge that changes enacted by voters by adoption of 1-901 have a major
impact on food service establishments that previously allowed smoking by patrons. We
also know that fewer than 1 in 5 Jefferson County residents are current smokers, that
tobacco-related illness is the Nation's leading cause of preventable death, and that
environmental tobacco smoke ("second hand smoke") is a significant risk factor for
heart disease, lung disease, and cancer.
Jefferson County Public Health is responding to potential violations of the Clean Indoor
Air Act on a complaint-driven basis. If your establishment is being contacted, it is
because a complaint has been filed. If, after careful investigation, it is determined that
smoking is being allowed within a prohibited indoor area or within 25 feet of a window,
door, or air intake, we are empowered to take enforcement action to protect the health
of the public.
Maintaining a smoke free environment for your workers and customers not only makes
sense from a public health perspective, it is a legal responsibility. We strongly
encourage you to take a proactive approach in assuring compliance with these laws.
This may include firm reminders to patrons, visible signage, and strictly enforcing non-
smoking requirements in outdoor seating areas (within 25 feet of doors or windows).
COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
MAl N: 360-385-9400
FAX: 360-385-9401
PUBLIC HEALTH
ALWAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNITY
ENVIRONMENTAL HEALTH
NATURAL RESOURCES
MAl N: 360-385-9444
FAX: 360-385-9401
Page 2 of 2
Food Service Establishments-RCW 70.160
August25,2006
While these measures may seem burdensome, failure to comply with the law carries
significant penalties - fines start at $513.00. Food service establishment owners can
face suspension or revocation of their operating license as a result of repeated
violations of the law. And worst of all is the failure to protect workers and customers
from the very real dangers of environmental tobacco smoke.
Thank you for your cooperation in this matter.
Sincerely,
Jefferson County Board of Health
Background Information: Initiative 901 (1-901) passed by voter majority throughout Washington State and
became law on December 8, 2005. 1-901 amended the Washington State Clean Indoor Air Act (RCW
70.160) and now prohibits smoking in all public place and within 25 feet of doors, windows that open and
ventilation intakes. Local Health Departments are charged with enforcement of RCW 70.160.
To view RCW 70.160 or Jefferson County Ordinance 2006-04-0216-06 visit:
htto:/Iwww. ieffersoncountvoublichealth .oralindex. oho?tobacco
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King County
August 18, 2006
Julia Patterson
METROPOLITAN KING COUNTY COUNCIL
District Five
Roberta Frissel
Jefferson County Board of Health
615 Sheridan St
Port Townsend WA 98368
Dear Ms. Frissel,
As a member of a local Board of Health, you are well aware of the
health challenges facing not only your region, but other areas around
the state. Declining revenues, increasing demands, growing diversity
of programs and clients, and rising trends in accountability and
outcomes have all contributed to struggling public health departments
and districts, as well as declining health outcomesfor health issues like
obesity, diabetes and heart disease.
I have recently been in contact with the Health Administrator from
Yakima County, Dennis Klukan, and have received information from
him and from the National Association of Local Boards of Health
(NALBOH) on potentially forming a Washington State Association of
Local Boards of Health.
State Associations of Local Boards of Health (SALBOHs) can serve as a
convener and an advocate for all Boards of Health. For many years,
Public health has not been given the attention and resources needed to
provide services and improve programs. Even though King County is
large and well-staffed, our health department lacks a strong voice in
Olympia. In order to improve health statewide, Boards of Health, as
spokespersons for their health department or district, should have the
opportunity to have their voice heard by the legislature, the Governor,
and the Department of Health. By forming a SALBOH, we can work in
concert to have a strong, unified voice when influencing policy and
working with decision-makers.
King County Courthouse. 516 Third Avenue. Room 1200. Seattle. WA 98104-3272
(206) 296-1005 TTYlfDD (206) 296-1024 FAX (206) 296-1050
email: julia.patterson@metrokc.goY www.metrokc.gov/patterson
o4lE!t"."..@
Other benefits of a SALBOH are: coordination and information sharing
on emerging disease preparedness, best practice exchange with regard
to code and regulation changes, shared Board of Health member
resources, training and leadership, and statewide conferences for
networking and information exchange.
I have enclosed information about SALBOHs, but I write solely to
gauge interest of other Board of Health members. If it is clear that
there is widespread receptiveness, we can engage further, in concert
with our health departments and districts, in a collaborative
conversation about how best to proceed.
I appreciate the work you do for the public's health, and hope. to hear
your input about forming a SALBOH. Please contact me via email:
Julia.Patterson@MetroKC.Gov or telephone: 206.296.1005.
Sincerely,
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Julia Patterson
King County Council member
King County Board of Health Chair
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street. Port Townsend' Washington' 98368
www.jeffersoncountypublichealth.org
September 15, 2006
David Timmons, City Manager
City of Port Townsend
250 Madison Street
Port Townsend, WA 98368
Subject: Port Townsend Liquor Excise Tax (PTLET)
Dear David:
As you know, Jefferson County Public Health (JCPH) has contracted directly with the City to provide
substance abuse prevention programs in Port Townsend. These are part of the Regional Support City-
County contract. Enclosed you will find a summary of 2006 service delivery, 2007 service plan, and service
description.
JCPH submitted a 2007 Prevention Budget including $34,921 from the City of Port Townsend. This amount
was derived by using the current formula outlined in the Regional Service Agreement for the allocation of the
PTLET.
The PTLET annual contribution is the only money the City of Port Townsend contributes to public health.
JCPH is the only provider of public health services to Port Townsend citizens. JCPH has the infrastructure in
place to assess community needs, plan effective interventions, influence services and evaluate prevention
programs. All programs within JCPH have extensive reporting requirements and are part of national, state,
local and regional service plan & delivery of services.
PTLET funds are used by two specific programs within the array of services offered everywhere in the
county, Project Alert and Big Brothers Big Sisters. Both services have been rigorously researched and are
nationally recognized Best Practices for school aged children. They fill a documented need derived from
local community health assessment data.
A snapshot of services received by Port Townsend youth and families from September 2005 through June
2006:
. Project Alert served 199 Blue Heron students during 64 sessions
. Big Brothers Big Sisters provided 1672 menta ring hours through 796 mentoring contacts.
As you may recall, PTLETfunds are included in the required match of the 5-Year Federal Drug Free
Community grant. Year 5, which supports Big Brothers Big Sisters and the Healthy Youth Coalition, begins
October 1, 2006.
The core mission of Jefferson County Public Health is prevention. Prevention, simply stated, keeps bad
things from happening to individuals, which in tum contributes to overall community health.
We look forward to ongoing collaboration in 2007 with the City of Port Townsend. Please notify me if there is
a conflict of the 2007 budget assumption of $34,921.
Thank you for attention to this very important matter.
Sincerely,(\..17 ~~
Jean Bald~v -
Director, Jefferson County Public Health
cc: Jefferson County Board of Health
Mark Welch, Mayor City of Port Townsend
John Fischbach, Jefferson County Administrator
COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
MAIN: 360-385-9400
FAX: 360-385-9401
PUBLIC HEALTH
IJ.WAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNITY
ENVIRONMENTAL HEALTH
NATURAL RESOURCES
MAl N: 360-385-9444
FAX: 360-385-9401