Kim Barker

The Spokane Regional Health District is trying to work with restaurants to avoid declaring a hepatitis A emergency that could cost businesses thousands of dollars. Restaurant representatives met with district staff members Monday to find some way to stem the virus' spread. Dr. Kim Thorburn, the district's health officer, said she didn't yet need to declare a formal emergency. "The alert has been sounded," she said. "It is an emergency, and people are responding to it." Together, the health district and restaurant representatives hope to post fliers in grocery stores and schools about hepatitis A and also decide which types of food workers should be vaccinated. About 13,000 work in Spokane County's bars and restaurants. An official meeting between restaurant representatives and the district is scheduled for Dec. 5. Last week, Thorburn announced she planned to call a health emergency because of the county's high rate of hepatitis A, a liver disease that is spread by poor hygiene and fecal-oral contact. Thorburn wanted to declare an emergency so she could require vaccinations for anyone who works in the food industry, intravenous drug users and jail inmates. She wanted to be able to order hospitals, insurance companies and restaurant owners to help pay for the vaccines. The move was controversial because of the cost. The first shot costs $42; the second shot another $42. As of Monday, 123 cases of hepatitis A have been confirmed in Spokane County, including one child who is now in the hospital. That number compares to 20 cases for the same period last year. For every confirmed case, at least three others are probably infected without being diagnosed. The virus is spread by infected people who don't wash their hands after using the restroom. "We can't stress handwashing enough," Thorburn said. "It's very simple, what your grandmother always told you: When you use the bathroom, wash your hands." The disease is infectious from about two weeks before symptoms begin until about two weeks after. Symptoms include yellowing of the eyes or skin, fatigue, diarrhea or nausea and loss of appetite. About one-third of this year's cases are in IV drug users, and many involve those who've recently been in jail. Only one restaurant worker - at Sunset Junction, 1801 W. Sunset Blvd. - has been publicly identified as having the virus. Another worker who served food at a church event at the Spokane Valley United Methodist Church was also infected. No cases have been tied to either food server, Thorburn said. But that could change, because the virus incubates for weeks before symptoms show. Thorburn on Monday acknowledged that people were probably at a greater risk for infection from food served at home than in restaurants. In fact, the Centers for Disease Control and Prevention don't even consider restaurant workers to be a high-risk group for hepatitis A. Those high-risk groups include an infected person's household members or sexual partners; international travelers; and people living on Native American reservations, in Native Alaskan villages and other regions with endemic hepatitis A. During outbreaks, other at-risk groups include day-care workers and children, sexually active gay men, and injectable drug users. The immunization practices advisory committee of the CDC recommends hepatitis A vaccinations for people who plan to travel to countries with high or intermediate disease rates, for sexually active gay and bisexual men, for drug users, and for people with chronic liver disease. Although Spokane's rate of hepatitis A is unusual for this area, it's not that high compared to other communities. High-rate communities have outbreaks of as high as 2,000 cases per 100,000 people per year. Intermediate-rate communities have rates of between 50 and 200 cases per 100,000 people per year. Spokane County's rate so far this year is only about 30 cases per 100,000. That rate could increase before year's end. Large national outbreaks of hepatitis A happen about once a decade. The last outbreak happened in 1989, but the number of cases have been increasing recently. More than 125,000 people come down with the virus every year in the United States. About one-third of Americans get the disease sometime during their lives. Hepatitis A costs about $200 million a year in medical bills and work loss. Only about 100 people die every year in the United States from hepatitis A, the least fatal of all five types of hepatitis.

Nurses assistant Crystal Radcliff takes Sandra Tate's temperature before Tate's surgery at Deaconess Medical Center. Photo by Liz Kishimoto/The Spokesman-Review

Former Coroner Graham McConnell and Causna Albin in 1994. File/The Spokesman-Review

More than $10 million was spent this year on initiatives regarding gums, guns, gays, grass and, well, the provision of services by designated health-care providers. Voters didn't bite on any of it, shooting down all five initiatives on Tuesday's ballot. The results have some experts questioning whether Washington's initiative process still works.

She thought she had helped torture and kill people and animals as part of a satanic cult. Robin Avis also thought she had given birth to a stillborn baby. The baby was supposed to be sacrificed but was instead fed to dogs. She now thinks her former counselor gave her false memories, through hypnosis and suggestion. Avis is suing that counselor, John Laughlin, and the Chelan hospital where Laughlin still works.

For 20 years, Jenilee Whitney has paid the price of picking her own doctor. She's visited her chiropractor regularly, and not one of the five insurance companies she's belonged to has covered his services. Whitney, who is 59, would like to change that. She supports Initiative 673, also called the patient-choice initiative.

Family matters. The IRS wants up to $60,000 in back taxes that it says a dying Jack Vandagriff owes on his long-term disability plan. He says that money is for his 16-year-old daughter Stephanie's education. Photo by Dan McComb/The Spokesman-Review

National grants of more than $1 million will help link rural hospitals to Spokane's high-tech health care. The money will help Eastern Washington hospitals hook up with TeleHEALTH, a joint telemedicine project that Spokane hospitals set up earlier this year. Telemedicine combines powerful computer technology and telephone lines. It allows health-care workers in a rural hospital to see a well-known lecturer in another city. It also means that specialists in a larger city can help rural doctors diagnose patients.

Spokane motel blues 1. Baby Ryan, who turns 3 today, is never far away from high-tech medical gear or the attention of his parenets, Nghia "Jack" and Darla Nguyen, even as the family has become homeless. Photo by Christopher Anderson/The Spokesman-Review 2. Darla Nguyen kisses son Ryan while the family was living in a Spokane motel room recently. Photo by Christopher Anderson/The Spokesman-Review

Frazier

1. Katherine Tuttle 2. Mark Frazier 3. Leo Obermiller 4. Mary Anne McDonald

By the time you finish reading this sentence, about $3,650 in Medicare money will have disappeared due to fraud, waste or abuse nationwide. About $23.2 billion in taxpayer money is lost every year - $16 million a day, or 14 percent of all Medicare costs. That's a large chunk of the more than $100 billion in health-care dollars the government estimates is misspent every year, including money from Medicare, Medicaid and private insurance.

'Let's see if we've got an answer'. "There's a chance we have a cure," says diabetes sufferer Drake Cazier, right, walking with son Nicholas, who doesn't have the disease, at their Spirit Lake, Idaho, home. Photo by Christopher Anderson/The Spokesman-Review

The dental hygienist initiative may draw yawns from voters compared with drug and gun measures on the same statewide ballot. But Initiative 678 is drilling holes in the relationship between hygienists and dentists. After 18 years of unsuccessfully pushing their cause in the state Legislature, hygienists are taking it to the voters. They want to be able to do their jobs - cleaning teeth - without a supervising dentist.

Neglected children in Spokane can now crawl through a new jungle gym of services - three floors of them. The Casey Family Partners center, which aims to give cutting-edge help to vulnerable children and their families, opens officially today at 613 S. Washington.

The ailing children and their families will wait at an Ethiopian hospital next week for a team of 24 Spokane health care workers. Only a few will be picked, and the others could die. Some of the children will have walked hundreds of miles over rough terrain and difficult roads. Their families will sleep on mattresses in hospital hallways or camp and cook meals outside.

An Oregon research group wants to help people stop chewing tobacco. Or sniffing it, spitting it or even sticking a pinch between the cheek and gum.

Authorities are investigating the death of a disabled woman whose body was found in her bathtub at Lakeland Village. Billie Jean Klossner, 41, died Sunday in her cottage at Lakeland, a state institution for the developmentally disabled in Medical Lake. A pathologist said Klossner probably had a seizure. But authorities also are investigating whether she drowned in the bathtub while she wasn't being watched.

After considerable debate, this controversial ad was shelved by the Spokane Health District Board.

Some people welcomed the region's first sex survey, while others thought it was a little too racy. Here are a selection of comments people made: "We live in a society of anything goes as long as it doesn't 'hurt' anyone else. But it does damage kids who aren't ready for the responsibility and don't realize they aren't ready." "Abstinence should be made to look cool instead of prudish."

Spokane teens first have sex at 15 or 16, in the back seats of cars or in their parents' homes after 9 p.m. They listen more to their peers about sex than to their parents. At least, those are the opinions of people who responded to the Spokane Regional Health District's first sexual attitudes and beliefs survey. The unscientific survey raised eyebrows at health board meetings earlier this year. On Thursday, board members looked at the results of the quiz, which tackled what people think about teenage sexual behavior, sexually transmitted diseases and premarital sex.

Lay reader Richard Davis talks with Iaian Adams of Newcastle, England, following a memorial service Friday at St. Stephen's Church. Photo by Dan McComb/The Spokesman-Review

A year ago, the Spokane County Domestic Violence Consortium was a volunteer army with only one paid employee and a picayune annual budget of $35,000. Now, nine people work full-time jobs. And the consortium is running on a three-year, $2.5-million grant - one of three national sites selected for the money by the Centers for Disease Control and Prevention. "We've been busy," said Jennifer Pearson Stapleton, the consortium executive director, explaining why the group waited a year before announcing the money.

Dale Fox said he's receiving death threats for a fire he didn't start. The 44-year-old man said he's had to move his son and wife to an Idaho campground since the Tum Tum fire, which chewed through 1,155 acres in six days earlier this month. "We had to leave our home," Fox said. "We had death threats."