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JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
Thursday, July 19,2007
Board Members:
Phil Johnj'on-- County CommiSJioner District #1
David Sullivan - County CommiJ'Jioner Distrid #2
John .Austin, l/ice Chairman - County CommiJsiotler Distnd #3
Jill Buhler - HOJpital CommiSJioner District #2
GeoffMaj'd - Port TownJend City Counlil
Sheila Westerman - Cilizen at Large (City)
Roberta FriJ'Jell, Chair- Citizen at Lorge (County)
Stafflvlembm:
Thomas Locke, MD, Health Officer
Jean Baldwin, Public Health Services Diredor
Julia Danskin, Nursing Programs Director
Mike lvlcNickle, Environmental Health &
Water Quality Director
Meeting was called to order at 2:30 pm on July 19, 2007 by Chair Frissell in the
conference room of Jefferson County Public Health (JCPH). All Board members were
present with the exception of Member Westerman. A quorum was present.
APPROVAL OF AGENDA
Board Member Buhler moved to approve the agenda as written. Member Johnson
seconded the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Board Member Masci moved to approve the minutes of May 17,2007, as written.
Board Member Sullivan seconded the motion, which carried by a unanimous vote.
PUBLIC COMMENTS
None
OLD BUSINESS
July 2007 Rel!ion 2 Public Health Newsletter
Jean Baldwin commented on the Region 2 Public Health Newsletter, which is distributed
to physician offices. The newsletter strives to keep pertinent local issues in front of
doctors. The July newsletter highlights West Nile Virus (WNV) awareness and testing
and Tuberculosis control issues.
Chanl!e in Health Professional Shortal!e Area Desil!nation: East Jefferson County
Dr. Locke reported that federal officials have approved our area as a geographic primary
care health professional shortage area (HPSA). Previously the designation for the Port
Townsend area was a low-income health professional shortage area (inadequate
healthcare providers for low-income populations) and now meets the criteria for a more a
more severe provider shortage area. South County has been a geographic HPSA, in the
past, as is western Clallam County (Forks area). He explained that while this
Jefferson County Board of Health, July 19, 2007
Page] of?
demonstrates that the health professional to population ratio in Jefferson County has
worsened, the designation makes the county eligible for certain services such National
Health Service Corps physicians, continued Rural Health Clinic Program status, and
allows a higher reimbursement level for Medicare patients.
There was further clarification and discussion about the data sheet. There was discussion
about the application process for a National Health Service Corp provider.
Member Masci moved that the Jefferson County Board of HeaIth recommend to
Jefferson County Hospital District #2 that they pursue application for assignment of
a National Health Service Corp doctor for the rural and poverty areas of Quilcene
and south county. Vice-Chair Austin seconded the motion. The motion carried with
Member Buhler abstaining.
Board Correspondence
There were no comments.
NEW BUSINESS
Port Ludlow Yacht Club (PL YC) Public Health Hero Recol!nition
Glenda Wetherbee, Chair of the Port Ludlow Yacht Club (PL YC) Women's Group
presented a check for $4,014.48 to the Board as a donation to benefit the Jefferson
County Breast and Cervical Health Program (BCHP). Ms. Wetherbee spoke about how
the idea for raising funds had started, evolved, and eventually led to their cookbook
project. With the help of numerous volunteers from the PL YC Women's Group, A
Culinary Cruise with the Port Ludlow Yacht Club cookbook has been a huge success, is
now in its third printing, and they are pleased to be able to make this contribution to
BCHP in the interest of women's health care. (Cookbooks are $20 and available only
through Yacht Club members.)
Jean Baldwin presented a Public Health Hero Award to the four representatives in
attendance from the PL YC Women's Group (Glenda Wetherbee, Maggie Brown, Jan
Ditmar and Anne Jennings) in recognition of their fund-raising efforts and generous
contribution to the Jefferson County Breast and Cervical Health Program. She noted that
this money will be combined with funds raised by the Main Street "Girls Night Out"
event and used towards providing more mammograms.
Public Hearinl!: Jefferson County Septic Code
Chair Frissell called the public hearing for the Jefferson County Septic Code to order.
There were no members of the public in attendance wishing to testify. Copies of the line-
in/line-out version of the Code were provided. Mike McNickle explained that
Environmental Health (EH) staff had met with a technical advisory group three times and
had held four public meetings in all geographic areas of Jefferson County (Brinnon,
Quiicene, Port Ludlow and Tri-Area). Comments from those meetings were incorporated
and culminated into the final draft of the Septic Code 8.15.
Linda Atkins distributed clean copies of the final draft and a sheet of comments received
from the Washington State Department of Health (DOH) requesting minor changes.
Jefferson County Board of Health, July 19,2007
Page 20f7
Chair Frissell congratulated the EH team for ajob well done and the successful
groundwork that was laid by the hearing process. Mike acknowledged the many hours of
work done by Linda Atkins, Daniel Nidzgorski and the whole On-site group. Mike noted
that a very thorough review was done and basically represents an adoption of the State
Code. Mike and Linda answered questions and clarified points for the Board. Discussion
followed. With no further comments or questions, Chair Frissell closed the hearing.
Member Masci moved that the Board accept the revision of the Jefferson County
Septic Code 8.15 with the revisions proposed by the Department of Health. Member
Johnson seconded the motion. There was no further discussion and the motion
carried by unanimous vote.
Pre-adoption Briefinl!: Jefferson County On-Site Sewal!e System Manal!ement Plan
Mike McNickle noted that the newly adopted Code requires that all Puget Sound counties
have a Sewage Management Plan. He then proceeded to brief the Board on related issues
in preparation for the upcoming hearing on the Jefferson County On-site Sewage System
Management Plan.
o The plan requires that Puget Sound counties, working with a Health Officer, must
report to DOH on various issues. Section 4 is about Marine Recovery Areas
(MRAs) as defined by H.B. 1458, requiring that Health Officers designate areas
as MRAs under certain circumstances. EH staff has worked on the definition of an
MRA under the legal authority of the Health Officer. The Hood Canal Watershed
in Jefferson County has been identified as our MRA. Mike noted that the
document describes what we are planning to do including several projects that are
already underway.
o The main requirement of the plan is development of a database that records how
many septic systems are in the Hood Canal Watershed and how we are going to
inspect, document, and monitor them.
o The plan also addresses operation and maintenance requirements for on-site septic
systems. Jefferson County already has an operation maintenance program in
place, which will be enhanced in the next round.
o Some elements ofthe plan meet requirements of the revised State On-Site Sewage
WACs which take effect this month. These codes require that the Board of
Health review the plan and a public hearing be conducted before adoption. Once
the plan is adopted, DOH will release $100,000 to Jefferson County Public
Health.
Discussion followed. Member Masci expressed concerns about only focusing on the
Hood Canal and not other water areas in the county. There was extensive discussion.
Dr. Locke provided some historical background, noting that we are operating under
several different legislative and administrative requirements. He spoke about the process
and development of the State On-site Code (Dr. Locke was serving on the State Board at
that time). He noted that the operation and maintenance of on-site systems were some of
the most contentious sections of the code. What is now in the State Code is the final
compromise reached by the various stakeholders. The Legislature later added in another
piece about MRAs with some additional funding, and assigned it to the Health
Jefferson County Board of Health, July 19,2007
Page 3 of7
Department to come up with this plan. It is not actually a requirement of the Board of
Health. He noted that it makes more sense that this all be together as one comprehensive
plan adopted by the Board of Health.
Member Austin raised the issue of accelerating the schedule on adoption to secure the
$100,000 more quickly. Mike responded that this was being brought at this time to the
Board of Health in order to have a public hearing and adoption on the August agenda,
which would be acceptable.
Member Sullivan moved that a public hearing be scheduled for the next Board of
Health meeting for the Jefferson County On-site Sewage System Management Plan.
Member Johnson seconded the motion. There was no further discussion and the
motion carried by unanimous vote.
Citizen Petition Re: Port Townsend Air Ouality Concerns
Jean Baldwin made comments concerning petitions and a letter of complaint submitted to
JCPH in regard to air quality (as it relates to the Port Townsend Paper Mill). The
Department of Health, Department of Ecology and the Olympic Region Clean Air
Agency (ORCAA) have become involved. Health indicator survey work will be done and
they will also be looking at some of the existing data that we have.
Dr. Locke noted that the comments ofthe petitioners (and their wish that we could do
health studies and link them up with human outcomes such as cancer) are a reasonable
thing for someone to think - until you become aware of the many unsuccessful studies of
this type. He explained that it is virtually impossible to make that link using the data
available. He related a similar situation that occurred in the 1980s in Port Angeles with
the Rainier Mill - it was common knowledge that there were human health impacts, but to
be able to prove it was an incredibly difficult task. Dr. Locke believes that the data will
not be sufficient to establish a cause and effect relationship with any disease or health
issue and recommends that efforts be made to assure that plant discharges have been
adequately analyzed and are within the permissible legal limits. Discussion followed.
Jefferson County Nursinl! Shortal!e: Impacts on Public Health Staffinl!
Marjorie Boyd (JCPH, Public Health Nurse) addressed the Board to provide information
and perspective regarding the current state of JCPH medical staffing issues. She
commented on the shrinking medical staff (Nurses, Nurse Practitioners) resulting from
budget cuts and non-competitive wages. She pointed out that this is an issue of concern
especially in light of potential emergency situations. She spoke about needs that are now
being seen in the community which are not only going up in numbers, but also in the
level of acuity. The needs are more intense, demand is going up, but staffing is declining.
She encouraged the Board members, as the visionary leaders of the Health Department,
to look at this situation and consider what direction to go.
Hilary Metzger spoke about her personal 20-year history at the Health Department and
her involvement over the years in programs that have not been traditional public health
programs (i.e. family planning, school health and education). She spoke about the support
she has also received to be active in these areas on a statewide level; her personal pride in
Jefferson County Board of Health, July 19, 2007
Page 4 of 7
Jefferson County Public Health; her upcoming move to the staff ofthe hospital; the aging
work force and absence of young people due to economics. She feels it is a crisis. She
reiterated her pride in JCPH and expressed her appreciation of the support she has felt for
her work. Those present responded with appreciative applause for her 20 years of service.
Member Frissell commented on her own involvement and struggles in years past while
trying to establish family planning services in this county. She was very grateful when
the Health Department agreed to take on family planning and that she does not want to
see the community without it.
Member Buhler suggested that it may be time for the hospital and JCPH to get together
again and look at what kind of services might be shared. Jean Baldwin agreed that we
need to have that conversation; there needs to be some kind of partnership planning in the
long run to retain staff and services.
Member Masci spoke about the City of Port Townsend's opposition to and avoidance of
committing funds to the Health Department throughout the years. He made comments
about the BOCC and challenged them to make the decision and take the responsibility to
set priority in favor of nurses.
Member Sullivan responded with explanation that funding alone is not the answer to the
whole problem. The picture is much more complex, due to union issues. He believes the
support by the BOCC for nurses is there in principal, and promises to work on it.
Dr. Locke commented that this might be a context in which to renew a discussion with
the Board of Health on legal options for local health jurisdiction organization. A
comparison analysis was done 5-6 years ago, looking at a county department vs. health
district model. Under Washington state law, a health district can be set up by the County
Commissioners and they create the district, they can dissolve it, and they continue to
serve on the Board of Health. Becoming a health district would bring new responsibilities
for the Board of Health, such as budgeting.
Jean Baldwin noted that she had brought up the health district idea to County
Administrator, John Fischbach. She feels that in looking at current Jefferson County
infrastructure costs and what JCPH pays for various things, it might be a good idea to
reconsider being a district. She eXplained that according to the statute right now, counties
are fiscally responsible for health districts or county health departments. She has talked
to a couple of consultants about bids to perform this analysis and will continue with that
process. Jean would like to bring this topic forward again in September for evaluation.
ACTIVITY UPDATE
Dr. Chris Hale Public Health Hero Award
Jean Baldwin proposed the creation ofa new "Public Health Hero Award" bearing the
name of the late Dr. Christiane Hale, in recognition of her many achievements and
Jefferson County Board ofHeaJth, July 19, 2007
Page 5 of7
contributions to our community. Jean had prepared a letter and created the award for the
Board's approval and signature. Jean read the message on the award certificate and
excerpts from the letter to the group. There will be a memorial service on Saturday, July
28, 2007 and Chair Frissell and Member Masci will be attending. Jean asked that Chair
Prissell present the award to the family and read the letter on behalf of the full Board.
Member Sullivan moved to establish the Dr. Chris Hale Public Health Hero Award
and to sign the letter of tribute. Vice-Chair Austin seconded the motion, which
carried by unanimous vote.
Hospital Commissioners Announcement
Member Buhler announced that the Hospital Commissioners have voted to rescind their
offer on the Sheridan Clinic Building. They are instead looking at other alternatives to
free-up clinic space and make maximum use and efficiency by extending clinic hours.
She explained that this decision was made because they learned that their ultimate
remodeling plan was going to trigger major retrofitting and code issues, and would have
been cost prohibitive. They are also contemplating putting a clinic in the Port Hadlock
area.
AGENDA PLANNING
Follow-up June Board of HeaIth Retreat
Dr. Locke explained that this item was included on the agenda to serve as a reminder of
the questions raised and discussions that occurred at the July Board of Health retreat. He
asked if the Board wants to revisit any of those issues or ifit raised any ideas to include
on future agendas.
Jean Baldwin commented on the retreat discussions and asked for direction on the next
steps. She pointed out that there were several attendees who expressed interest in
continuing to review data. She noted that it sounded like another Data Steering
Committee (that group looked at different health indicators and various health data banks
to provide needed statistics, and then shared that data as a work group - then the group
decided what would go out to the public). Chair Frissell commented that they saw a lot of
people becoming aware of what kind of information was out there and were asking where
to get more. She thinks that it is a good catalyst for people and very useful. Jean will
continue to meet with Demographer Siri Kushner (Kitsap County Health District) on
healthcare access.
Al!enda Planninl!
. On-site Sewage System Management Plan. Public Hearing (August)
. Health district information (September)
. Review of Hep A outbreak emergency (August)
Vice-Chair Austin moved to adjourn the meeting. Member Buhler seconded the
motion, which carried by unanimous vote.
Jefferson County Board of Health, July 19,2007
Page 6 of7
.Te#e~n CoI.H\~
W: DfPj ff./; Pq13l..iC; ttEAL-i~
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May21,2007 . U 15' '5~e.l'id~ s+.
Port Townsend, Washington . TJor+ Tow\'\.S€hd I LJA qr3'?
To Whom It May Concern:
We, the following citizens, are sending these petitions to you in order to register
our complaint about the air quality in Port Townsend, and to respectfully request help
from our tax supported public agencies.
We believe our health and quality of life are being negatively impacted by the
emissions from the Port Townsend papermill.
We respect the fact that many people in our community depend upon the mill for
their employment, yet at the same time, we also desire, and have a right and obligation
to, protect the health and wellbeing of ourselves and our families.
We believe solutions to the problem exist that will benefit everyone, but they
require acknowledgement of the problem, and concerted, collaborative efforts toward
resolution. For example, we are aware that approximately 10 years ago, Clallam County
converted their Port Angeles kraft papermill to a mechanical process that significantly
reduces air pollution, yet still employs local residents.
We are convinced by our own investigations that ongoing scientific
monitoring, enforcement of existing air quality regulations, and tracking and
analysis of resident illness and complaints by neutral agencies, are essential
parts of the solution.
The signatures on these petitions were gathered on one single day at a recent,
yearly, outdoor event in Port Townsend. Many more petitions will be sent as signatures
continue to be gathered. Many individual testimonies and letters documenting negative
health impacts are available in the public record.
Please acknowledge and respond to our letter, and inform us of the course of
action upon which you decide.
Sincerely,
Port Townsend Air Watch
POS 1653
Port Townsend, WA 98368
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JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street . Port Townsend . Washington . 98368
360-385-9400 Fax 360-385-9401
www.jeffersoncountypublichealth.org
May 30,2007
Port Townsend Air Watch
POB 1653
Port Townsend, WA 98368'.
RE: PETITION REGISTERING COMPLAINT ABOUT AIR QUALITY
To whom it may concern:
Jefferson County Public Health (JCPH) acknowledges receipt of your petition to
register a complaint to this department about air quality in Port Townsend being
negatively impacted by the emissions from Port Townsend Paper. In
acknowledging this complaint, JCPH wants you to know that we are very
concerned about the health, safety and welfare of every person residing in and/or
visiting Jefferson County.
Please know that JCPH will refer this complaint to the Washington State
Department of Ecology (Ecology). As you may know, air pollution control in
Washington is based on federal, state and local laws and regulations. The
federal Environmental Protection Agency, Ecology and local clean air agencies,
all regulate air quality. Ecology also has jurisdiction over pulp mills, like Port
Townsend Paper.
Since Ecology has jurisdiction over the air pollution generated by Port Townsend
Paper via an air quality permit, JCPH defers all questions and concerns from
Jefferson County citizens to Ecology. Additionally, JCPH as well as most other
small rural health jurisdictions do not have the knowledge, expertise, or
- equipment to perform any ambient air quality monitoring. Ambient air quality
monitoring for Port Townsend paper's permit would be conducted and analyzed
by Ecology. If Port Townsend Paper was out of compliance with their air quality
permit, Ecology would most likely seek means to assure Port Townsend Paper
complied with the provisions of their permit in a timely fashion.
In conclusion, JCPH is willing to work with you to refer your air quality concerns
to Ecology, and assure that Ecology responds appropriately. JCPH also
recommends that you contact Ecology directly at the following address/phone/fax
number:
COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
360-385-9400
PUBLIC HEALTH
ALWAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNITY
ENVIRONMENTAL HEALTH
WATER QUALITY
36G-385-9444
Southwest Regional Office
300 Desmond Drive
PO Box 47775
Olympia, WA 98504-7775
(360) 407-6300
Fax: (360) 407-6305
Please note that JCPH will partner with the Washington State Department of
Health to assess any measurable impact of citizen health from air quality. The
three variables mentioned in your petition are difficult to measure and relate to a
single health issue. Asthma and other respiratory illness are not reportable
diseases and are therefore difficult to track through the local emergency room.
But we will look into this issue and analyze the available data.
If you have any additional questions or concerns, please feel free to contact me
at 360-385-9400. or Mike McNickle at 360-385-9444.
Best regards,
~
JJan Baldwin
Director
Jefferson County Public Health
615 Sheridan Street
Port Townsend, WA 98368
Cc: Jefferson County Board of Health
John Fischbach, County Administrator
Dr. Tom Locke, Health Officer
Washington State Department of Ecology, Southwest Regional Office
Washington State Department of Health, Epidemiology Section
Olympic Region Clean Air Agency
STATE Of WASH1NGI0N
DEfJ;\RTMENT OF HFALTH
Oi~~'rtJp;d, W,ubington 98504
May31,2007
Port Townsend Air Watch
PO Box 1653
Port Townsend, W A 98368
Dear Petitioners.
I received your faxed petition on May 25, 2007. I have shared it with Wayne Clifford, Director
of the Office of Environmental Health Assessments at the Washington State Department of
Health, and with Matt Kadlec, Toxicologist at the Department of Ecology Air Quality Program.
We are talking among ourselves, with the Olympic Regional Clean Air Agency, and with
Jefferson County Public Health to detennine what might be feasible and useful in assessing
health in relation to air quality in Jefferson County.
The Washington State Cancer Registry (WSCR) has the data for tracking cancer and we supplied
some of these data to Ecology previously. We can revisit those assessments. However, cancer
might not be a productive health outcome to investigate. Cancer can take years to develop and
this poses two problems. First, we tend to be a mobile society with many people moving in and
out of areas over time. Thus, some people developing cancer while livingin Jefferson County are
likely to have been exposed to carcinogens before they moved in. Because WSCR includes only
address at diagnosis, we cannot exclude these people from Jefferson County cancer statistics.
Conversely, some people who might have been exposed to carcinogens in Jefferson County
might have moved outside the county before developing cancer. Again, because we have address
at diagnosis only, we cannot include these people in Jefferson County statistics. Unless the
numbers of people included and excluded are equal, the analysis could be misleading. Second,
because cancer can take a long time to deyelop, even if we found higher rates of cancer among
people living near the mill or under the plume, it would not be clear whether the current air
emissions from the mill might be problematic. It might be that historical practices (i.e., air
emissions in years past), not current practices, were problematic.
In addition to the long amount of time it takes cancer to develop, cancer might not be the best
health outcome to study, because most types of cancer have not been associated with exposure to
air pollution. Before assessing cancer patterns, it would be most productive to narrow the scope
to include only those types of cancer that have been associated with specific air pollutants known
to be emitted by paper mills in general or this paper mill in particular.
Port Townsend Air Watch
May 31,2007
Page 2
Compared to cancer, heart and lung disease and asthma are likely more relevant outcomes to
investigate. They are more strongly associated with outdoor air pollution and they often occur
closely in time to air pollution episodes. However, unlike cancer, data on heart and lung disease
and asthma are limited. We have information on deaths and hospitalization due to these events,
but we generally do not have data on emergency department or other outpatient visits. Studying
these outcomes for events less severe than death or hospitalization likely requires either
extensive review of paper-based medical records in local hospitals and clinics or setting up a
population-based surveillance system. Additionally, these events can be caused by many types
of exposures, such as exposure to mold or pollen, and these factors would need to be considered.
It would likely not be productive to track health events independent of information on plume
direction, but that depends on the air shed, how pollutants disperse, etc. At this point, the
Washington State Department of Health has limited knowledge of these factors.
Thus, we need to seriously consider whether we can address the three items requested in the
petition and if so, whether the time and effort will be productive in terms of improving health in
Jefferson County. We will continue exploring options so that by the end of June we can provide
you with an initial assessment of what might be feasible and useful.
Sincerely,
~0 l\dU~~~
Juliet VanEenwyk, PhD
State Epidemiologist for Non-lnfectious Conditions
Washington State Department of Health
PO Box 47812
Olympia, W A 98504-7812
Ph: 360.236.4250
Fax: 360.236.4245
Email: juliet.vaneenwyk@doh.wa.gov
cc: Jean Baldwin, Jefferson County Public Health ,/
Wayne Clifford, W A Department of Health
Matt Kadlec, W A Department of Ecology
'f,J<;j(~~r;'$
o
~
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
Olympia, Washington 98504
July 3, 2007
Port Townsend Air Watch
PO Box 1653
Port Townsend, W A 98368
Dear Petitioners.
In my letter of May 31, 2007, I indicated that the Washington State Department of Health (DOH)
would continue exploring options on what might be the most productive way to respond to your
health concerns related to air quality. Our goal was to provide you with an initial assessment of
what might be feasible and useful by the end of June. We have learned that the Department of
Ecology has been working with community groups on issues related to your concerns for many
years. As a result, this agency has documentation that we believe would assist us to determine
what might be useful and feasible regarding the health studies requested in your petition. Given
the diverse sources of information and the extent of the work that has already been done in your
community, we concluded that a "Health Consultation" would be a good mechanism by which to
compile and review the information.
A Health Consultation (see attached fact sheet) is a written document that evaluates previously
collected environmental data, health data, and related community concerns. The data are
evaluated to determine whether exposure to chemicals found at a site might cause harmful health
effects. In many cases, existing information is not sufficient to make a firm conclusion about
health impacts on a community; therefore, the Health Consultation is often used as a tool to
identifY data gaps, make recommendations, and prompt further actions. The DOH Office of
Environmental Health Assessments (OEHA) prepares Health Consultations under a cooperative
agreement with the federal Agency for Toxic Substances and Disease Registry (ATSDR).
Elmer Diaz, a health assessor with OEHA, has been assigned as the lead on this Health
. Consultation. Please contact Elmer if you have questions or concerns. He can be reached at 360-
236-3357 or Elmer.Diaz@doh.wa.gov . .
We estimate that a public review draft of the Health Consultation will be available by the end of
September, 2007. We will let you know if changes to this timeframe are needed. At that time we
will want to meet with community members to discuss the Health Consultation and hear their
thoughts about it.
Port Townsend Air Watch
July 3, 2007
Page 2
If you have further questions you feel I should answer, please contact me. I will be available
through early August, after which time I will be on a leave of absence for a year. I have received
a research and lecturing Fulbright Award and I will be working out of the country. I can give you
another contact from the Office of Epidemiology if you would like one.
Sincerely,
// II," 1
',-l )~?_"\U~';"'~l~
Juliet VanEenwyk, PhD
State Epidemiologist for Non-Infectious Conditions
Washington State Department of Health
PO Box 47812
Olympia, WA 98504-7812
Ph: 360.236.4250
Fax: 360.236.4245
Emai1: ju1iet.vaneenwyk@doh.wa.gov
cc: Jean Baldwin, Jefferson County Public Health y'
Merley McCall, Washington Department of Ecology
Elmer Diaz, Washington Department of Health
I})...... 19
o
f-e'i:/("f)"fs .;:').,/'0;'1,1,"(;')
//7t.:) ~'O,"fr(,';;ti.'': it
Health Consultation .
A Health Consultation is an evaluation of sampling
data collected at a hazardous waste and sometimes,
industrial sites. The data are evaluated to determine
whether exposure to chemicals found at a site might
cause harmful health effects. The Health Advisor who
prepares the Consultation looks at past, present and
future exposures. Once the evaluation is completed,
the Health Consultation will have specific recommen.
dations on how to protect public health.
There are three sources of information used to
evaluate a site:
.:. Environmental data: Information on chemicals
found at the site. The Department of Health does
not collect environmental data directly--most
data come from other agencies.
.:. Health data: Information on exposure effects
(toxicology) and community-wide rates of
disease----tompared with national and state rates.
.:. Community health concems Information from
community members about how the site affects
their health or quality of life.
After analyzing all environmental and health site data,
a Consultation should answer these questions:
1. Where is the site located?
2. Who has used the site?
3. What activities have taken place at the site?
4. What are the levels of chemicals found?
5. How might people come into contact with the
chemicals (exposure pathways)?
6. How might the chemicals affect people's health?
7. Would living or working near the site affect health?
8. What can be done to protect people's health?
The Agency for Toxic Substances and Disease
Registry (a federal public health agency) and the
Washington State Department of Health have entered
Into a cooperative agreement to form a team of
specialists that conduct Health Consultations In
Washington State. This team works through the
Department of Health to study possible public heath
problems caused by harmful chemicals released Into
the environment at sites throughout Washington State.
Depending on the conclusions of the Consultation,
other activities may be performed:
Community Involvement: This work involves the
community through: public meetings, health-
fairs, public awareness notices, etc.
Education: This can be for the public or for health
care providers. For example, education may
include special training sessions at hospitals for
doctors and nurses or development and distribu-
tion of fact sheets to affected community memo
bers. Specific educational activities for each site
are planned, based on public health concerns
and potential health effects.
Health Studies: Specific studies of people living
near or working at the site being evaluated
Health studies often make use of past heallh
records, medical tests, and surveys,
Research: Sometimes we do not know enough
about the health effects of a hazardous chemical.
A Consultation may recommend that additional
studies or chemical specific research be done.
Cleanup: All staff work closely with environmental
agencies-recommendlng cleanup actions,
reviewing cleanup plans and communicating
risks and protective measures to impacted
residents.
We want to hear from people who live near or work at
a site we are evaluating. Input from the local commu-
nity helps identify:
. How the site may have affected people's health.
. What health effects people in the community are
concerned about.
. What the community thinks about the clean up
process.
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The Health Consultation conclusions identify whether
there is a public health hazard associated with site-
related chemical exposures. Based on our conclu-
sions, we make recommendations that advise
federal, state. and local agencies on actions to
prevent or reduce people's exposure to any hazard-
ous chemicals released at those sites. Protective
measures are also presented in the Consultation for
affected commumty members to take action to protect
their own health.