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CITY OF BREMERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
PERMIT NUMBER: 8807 00827
DATE ISSUED: 11/29/2007
345 - 6th Street, Bremerton, WA 98337
(360) 473-5275 Fax: (360) 473-5278
ZONING: EC
PHONE: (360) 613-9550
PHONE:
PHONE: (360) 613-9550
PHONE:
SITE ADDRESS:
ADDRESS:
ADDRESS:
ADDRESS:
ADDRESS:
2701 CLARE AVE
P.O. BOX 928, SILVERDALE, WA 98383
2 WISCONSIN CIR STE 540, CHEVY CHASE, MD 20815
PO BOX 928, SILVERDALE, WA 98383
ASSESSOR NUMBER: 3966-002-003-0108
APPLICANT NAME: HANSON SIGN
OWNER NAME: WC BREMERTON LLC
CONTRACTOR: HANSON SIGN CO
LENDER NAME:
SUBMITTED:
VALUATION:
Building Permit
Plan Review Fee
State Surcharge
TOTAL FEES:
11/08/2007
EXPIRATION: OS/27/2008
STATUS: ISSUED
$2,000.00
$69.00 2211
$44.85 4580
$4.50 0236
$118.35
Sign Permit
HERITAGE NURSING & REHAB CENTER - INSTALL A 6 FT FREE STANDING
SIGN IllUMINATED BY SPOT LIGHTS.
Building Code Edition:
Occupancy Group:
Type of Construction:
Flood Zone:
Setbacks:
Sanitation Method:
Number of Bedrooms:
Square Footage: Bid Price from Applicant
Inspection Requests
DCD: Building Inspections
L&I: Department of Labor and Industries
(360) 473-5870
(360) 415-4000
Fire Inspections
HID: Bremerton, Kitsap County Health District
PW: Department of Public Works
1 TOTAL
(360) 473-5394
(360) 337 -5285
(360) 473-5270
This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned
at any time after the work is commenced for a period of180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required
inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code
requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all
responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of
any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State
Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant
occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy.
SIGNATURE Of OWNER OR
AGENT:
I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws.
PRINTED NAME:
DATE:
//!d9!o'7
CONDITIONS
City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City
I regulations does not necessarily ensure compliance with federal or state laws.
1. (UTILlTY-01)
10. (lU12)
11. (OTHER)
12. (OTHER)
20. (OTHER)
20. (DCD-14)
20. (DCD-22)
locate all buried utilities prior to digging. The property owner shall bear all costs for
damage, repairs or necessary relocation of underground utilities due to his activities.
Signs must comply with BMC 20.52. A separate permit is required for any additional signs.
Pursuant to BMC 20.52.1 OO(b )(4) signs may be illuminated directly, indirectly or internally,
provided the lighting is directed away from other land uses, and away from on-coming
traffic.
Pursuant to BMC 20.52.090(e) all freestanding signs shall have a landscaped island at the
base of the sign equal to, or greater than. the sign area.
Electrical must be approved prior to building
DCD: Approved Plans, Engineering, Site Plan, Permit, and Conditions, Shall remain on
site and be available for inspection.
Building Plan Review:
Code Compliance-All work in the City of Bremerton shall adhere to the current adopted
C/J101
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Page 1 of 2
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CITY OF BREMERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
PERMIT NUMBER: 8807 00827
DATE ISSUED: 11/29/2007
345 - 6th Street, Bremerton, WA 98337
(360) 473-5275 Fax: (360) 473-5278
ASSESSOR NUMBER: 3966-002-003-0108
APPLICANT NAME: HANSON SIGN
OWNER NAME: WC BREMERTON LLC
CONTRACTOR: HANSON SIGN CO
LENDER NAME:
ZONING: EC
PHONE: (360) 613-9550
PHONE:
PHONE: (360) 613-9550
PHONE:
SITE ADDRESS: 2701 CLARE AVE
ADDRESS: P.O. BOX 928, SILVERDALE, WA 98383
ADDRESS: 2 WISCONSIN CIR STE 540, CHEVY CHASE, MD 20815
ADDRESS: PO BOX 928, SILVERDALE, WA 98383
ADDRESS:
SUBMITTED:
11/08/2007
APPROVED: 11/28/2007
EXPIRATION: OS/27/2008
STATUS: ISSUED
version of the following codes:
International Building Code
International Residential Code
International Existing Building Code
International Fire Code
International Mechanical Code
Uniform Plumbing Code
International Fuel Gas Code
WA State Barrier Free Code
WA State Energy Code
WA State Ventilation Code
Bremerton Municipal Code
Check For All Washington State Amendments.
Check For Notes On Plan
MINIMUM INSPECTIONS REQUIRED
To request an inspection, please call (360) 473-5870 and be sure to provide your permit number, name on permit, site address, contact
phone number, and inspection type.
Foundation Footings
Landscaping
Final Inspection - Building
Page 2 of 2
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fjNAl)~VILjjING All of the above II1l1st he approved
OCClljJC;/lCY ajJp';.ovdljiJi' SFR onlv - Commercial slmclures require a sepurate Certificate of
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DO NOT OCCUpy BUILDINGWiTHOllT BlllLDlNG DEPARTMENT APPROVAL
PROJECT THIS CARD FROM THE WEATHER
Rev. August 2007
Print Parcel Search Map
Kitsap County Parcel Search
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CODvriaht@ KitsaD' County 2007-----
DISCLAIMER: This map is intended for display purposes only and is not intended for
any legal representations,
[Click here to Print]
http://kcwppub3.co.kitsap.wa.us/ParceISearch/PRlNT .ASP?CMD=INIT &PID= 14903 58
Page 1 of 1
111/8/2007
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Building Permit Application
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PERMIT CENTER
Dept. of Communi tv Development * 345 - 6th Street Suite 600 * Bremerton * WA * 98337-1873
(360) 473-5275 * Fax (360) 473-5278
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Site Address:
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Phone #: I
Authorized Agent Name: ~II/Ie fV1 ik 'e.. Y' I
Address' . . I
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Phone#: ~~ I
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o COMMERCIAL REPAIR I
o NEW MULTI-FAMILY [f3 [g @ ~ 0 W ~ l[Y
o TENANT IMPROVEMENT 1 ~
o NEW GARAGE/CAR PORT NOV 0 8 2007
o NEW ACCESSORY BUILDING I
rVI NEW SIGN BREMERTON..QEWT. o~
~ COMMUNITY DEVELOHvlENl
o STRUCTURE DEMOLITION I
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o GRADING (Cubic Yards: ) :
o OTHER: .
What is the application for? (Please check one)
o NEW SINGLE-FAMILY RESIDENCE
o NEW DUPLEX
o NEW MANUFACTURED HOME
o RESIDENTIAL REMODEL
o RESIDENTIAL ADDITION
o RESIDENTIAL REPAIR
o NEW COMMERCIAL
o COMMERCIAL REMODEL
o COMMERCIAL ADDITION
IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE?
Garage:
YESD NO b!]
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Decks: I
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Valuation Plan Review Fee Permit Fee Surcharge Total Fees I
VI. ~O ht) (7.)1
'()oo c - - '1'> 0 h~,
Application for which no permit is issued within 180 days following the date of application shall expire by limitation, and Pla~s and other data I
submitted for review may thereafter be retumed to the applicant or destroyed by the building official. The building official may extend the time
for action by the applicant for a period not exceeding 180 days on request by the applicant, showing the circumstances beyond the control of the
applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an applicatioh
after expiration, the applicant shall resubmit plans and pay a new plan review fee.
~M~~O ~,
Applicant's Signature
JI/;/07
Date
CITY OF BREM ERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
Receipt Number: ~
345 - 6th Street, Suite 600, Bremerton, WA 98337-1873
(360) 473-5275 Fax: (360) 473-5278
$44.85
Total:
Total
$ 44.85
$44.85
CREDIT CARD
genpmlrreceipts
Page 1 of 1
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Extendicare Health Services Monument Sign
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Double Sided Sign Panel
Before assembling sign, bunding owner must receive approval from
authorities having localjurisdiction over signage requirements &
restrictions.
Step-I: Unpack & inventory all sign materials from shipping conta
Step-2: Align both sign panels back-to-back. (do not bolt together)
Step-a: Attach (bolt) double sided sign to alumn. angle at each sign
(exposed angle should face side wI the least visual ex.posure
Step-4: Using the newly assembled sign as a template, locate the de
location of the new post holes using marking paint.
Step-5: -WARNING- have a professional verify exact location of
underground utilities berore digging.
.':~. .One Siq~d S~gn Pailel
'2.-0neSidettSlgnlianel
-;t Post Cap ,
.. :4~ Con.tinuous Angle
"5. '8"x 8" Ahilli-l'i.Post
'.6. 6"x 6" Trea,tcq \Vood Thither
*See last page for post installation.
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M!lwoukee, WISconsin
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fax(4141353.6060
-WARNING-
Ifave a professional verify exact location of
underground utilities before digging.
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Step-I: Dig two holes at pre-marked locations
1 '-Oft dia. x 2'-0" deep min.
(verifyexad depth with authorities having jurisdiction)
Step-2: Place sign on ground near holes with
sign face up.
Step-3: Slide wood timbers into alilmn. post
to approximate height.
(remember bottom ohign must be 2'-6" dear:fromgradl
Step-4: Screw a lag-bolt through (l).pre-driiled
hole near bottom of each alllmn. post
(only sc~ bolts~partiaUy at.this,point)
Step--5: Lift and place sign into holes.
Adjust sign level and ground clearanCe b:
remoVing a lag"boltffunt either Alumn.
base ~ timber. Level sign & tighten all
required lag~b()lts.
Step-6: Attach post caps and tighten hardware.
Step-7: Fill boles with quick-set concrete per
manufacturer's recommended quantitif
& meth'ods~
(MaintainleveJ & pJumbSign post during this process)
Step..8: Use paint provided to touch-up any area;
of-the sign damaged during shipping
or installation & any exposed hardware.
Step-9: Properly discard any packaging materia
& store touch-up paint for future repain
-....-.~-.~.,~-.~ ~~..~ '-'. - . '<~'.~" -"'-"'-'~'~" .,. .,>~j,. ',.r _ ......:........,;,._~. _~.~~
",
""
~
CITY OF BREM ERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
Receipt Number: t~~~'i1}1:1~~;::~~:\
345 - 6th Street, Suite 600, Bremerton, WA 98337-1873
(360) 473-5275 Fax: (360) 473-5278
BB07 00827
BB07 00827
3966-002-003-0108 Building Perm it
3966-002-003-0108 State Surcharge
1/2211
1/0236
$69.00
$4.50
Total:
$69.00
$4.50
$73.50
$0.00
$0.00
Total
$ 73.50
$73.50
CREDIT CARD
N1A
BCD-07 -01109 11/08/2007
Plan Review Fee
$44.85 BB07 00827
3966-002-003-0108
genpmlrreceipts
Page 1 of 1
AUG-15-2006 TUE 02:51 PM DSHS RCS/CRU
,
FAX NO, 3607252644
p, 01/15
AGING AND DISABILITY SERVICES ADMINISTRATION
DIVISION OF RESIDENTIAL CARE SERVICES
COMPLAINT INTAKE AND ROUTING FORM
RESIDENTIAL CARE SERVICES ASSIGNMENT
Priority: 45 Working Days
Control Number:(06-08-1797:i)
Facility Name: BREM.ERTON HEALTH AND
REHABILlT ATION CENTER
REFERRALS
This intake form is being referred to the locations below
as required by RCW 74.34. Each office should handle
this referral according to its own internal policies.
Assigmnent Date: 08-15-2006
Initiate investigation within: 45 Working Days
Assignment Comments:
REFERRAL TO:
JANET 'LUNCEFORD
, CITY OF BREMERTON
COMMUNITY DEVELOPMENT
FAX 160-473-5218
Confidential, IDENTIFYING INFORMATION Confidential
Facility I
BREMERTON HEALTH AND REHABILIT A nON CENTER Unit: NF 5A
Address: 2701 CLARE AVENUE Federal Provider No: 505123
City: BREMERTON Telephone: (360) 377.3951
State: WA County: KITSAP Ziti Code: 98310 Fax number: (360) 377-9756
COlllpblinantl
Last name: NORMAN Contact Telephone No; (360) 692-7196
First name: ,KAREN Complainant Typelfitle: Employee - RN
Mailing address: 6877 Bentley Circle NE Remain Anonymous to Facility? Yes
City: Bi"emerton State: WA Zip Code: 98311 Follow-up Report Requested? Yes
Labor and Industries
State Fire Marshall
For questions about this referral, call 1-800-562-6078,
or (360) 725-2330; FAX (360) 725-2644
Alleged Victim I .
Last name:
First name:
., '
Gender: . OOB:
Social'Security Number: _-_-_
Victim Type:
Incidents past 6 months: 0
Primary Medica,l DX: UNKNOWN
Mental Status:.' UNKNOWN
Ambulatory Status: UNKNOWN
I Allefled Perpetrator I
Last name:
first Noone:
Gender: Female DOB:
Social Security Number: _ -_-~
Perpetrator TyPerritle:
Incidents past 6 months (3 years if staff): 0
Primary Medical DX: UNKNOWN
Mental Status: UNKNOWN
Ambulatory Status: UNKNOWN
OBRA Registry Status? Not in Registry Finding? No
Crim Hx Check Date: Conviction?
Confidential.
INTAKE INFORMA TION/AL-LEGA TION DESCRIPTION
Confidential
Date, Time Reported by Caller: 01l-15-2006 14:15
Date and Time of Incident:
CRU Intake Date: 08-15-2006
CRU Intake Worker: ASBURDA
SEE ATTACHED IN~ORMATION.
-~-Original Message-.--
From; Schlemmer, Bett .
August 2006 , ..
PAGE 1
AUG~15-2006 TUE 02:51 PM DSHS RCS/CRU
FAX NO. 3607252644
P. 02/15
Control No. 06.()8..17971
AGING AND DISABILITY SERVICES ADMINISTRATION
DIVISION OF RESIDENTIAL CARE SERVICES
COMPLAINT INTAKE AND ROUTING FORM
Sent: Tuesday, August 15,20062:01 PM
To: Fisher, Mary (DSHS/ADSAlCRU)
Subject: FYI. .
Pat B Will ~y61i;tb make. a new complaint for complainant Karen Nonnan about Bremerton Con.'Nursing Home in
Bremerton. She just called me. .
Please add to this new complaint referrals: SFM & BremeTton Local City Building Code Department. Please add my note to
the intake. .
Note"t6SFM, BremmoriLocat City Building Code Department, and L&I-
SFM .'Referring co~laint to DOH to investigate efficacy of sprinker system in area of building reported as depreciated and of
concern.
Bremerton LocalBuildingCode .. Referring complawt to City to investigate ifbuilding meetS local code due to depreciated
state cOtIiplainant describes in sprinkled areas of building and ventilation systems.
L&I . Please look into how many hours staff are working without breaks that may result in them being tired and yet nursing
homes allows staff to work in unsafe tired condition.
Thank you to all referrals above. Would appreciate a report back to our licensing depa.rtment. Ben Schlemmer Field Manager
contact @253.983.3826 and e.mail schlebj@dshs.wa.gov, Would appreciate coordination of investigations please with
licensing to see if ~y SFM, Local code, and L&I fmdings would result in licensing violations.
August 2006
PAGE 2
AUG-15-2006 TUE 02:51 PM DSHS RCS/CRU
FAX NO. 3607252644
P. 03/15
Pat Bossert, Assistant l>irector
Residential Care Services
Departing of Aging & Adult Services
Department of Social & Health Services
P.O. Box 45600
Olympia, Washington 98504-5600
RfECI!U~IfR1
AIIG 14 2tJ08 If)
.......... :t~.
Dear Ms. Bossert, "
I am sending this to you, because of your involvement in the recent unsafe conditions related to
the sUrVCyissi1es at BHRC~ I am confident you may be of assistance in this matter.
I am a Registered Nurse, currently on medical leave from Bremerton Health and .Rehabilitation
Center in Bremerton Washington. I am Clinical Reimbursement Coordinator, responsible for the MDS
process and Case Mix.. Since the onset of my employment in November, 3004, 1 have witnessed many
ooncerning things in regard to care of residents at this facility. My concerns have escalated, as 1 have
become more familiar with the Extedi.care Corparate philosophy, a philosophy tbat puts residents and staff
at risk. and shows little concem for safety, health or well~being.
These concerns have been (';XJll'essed by numerous other staff members. to superVi$Ol'S and area
and regiOnal manegers. only to be met with personal and professional reprisals. Standards of care have
been towered and policies that encourage open admission allow the mix of vulnerable residents with
predators off the Streets.
Nurses are overworked and undertrained. Due to negligent and itre$pOOSible placement and
~g, ~idents elope from building$. and inappropriately placed residents tfln'Onze the wtnerab1e.
There are many skin issues, infections, medication etTors and State violations, including many shifts where
there is no RN coverage and LPNs ill'C administering IVs, TPN, attending to central lines., etc., without
training Of supervision.
.It is my belief that already compromised residents on the sub-acute unit, as well as the staff that
work in that area, have become medically vulnerable in other ways. as well. Strong, unpleasant odors
emanate from the shower room, tub room and the sink drain adjacent to the nurse's station. Two licensed
nurseS, as well as mysel( ha~ recently become very ill with what has been diagnosed as Hypersensitivity
PneumoJ;litis, triggered by continued exposure to toJdns, from mold and fungus, as well as secondary
. infectionsc.ausing interstitial pnewnonia with cultures indicating MRSA. Candida and Staph. There have
also been ~umerous incidents of skin infections caused by MRSA, infl:mlmatnry diseases and other internal
infection~ most probably related to substandard infection control practices that are rampant in this
.building.
As a Registered Nurse of 28 years with a background in acute, subacute and a past certification in
nephrology nursing, I take the mandate for caring seriously. I can no longer sit by and observe. I have
tried to faCilitate change from within. Now 1 must do all within my power to see that vulnerable residents
and staff have a voice.
1 am forwarding to you. copies of reports I have filed with WISHA, the Kitsap County Health
Department, and, as a Mandated RepoIter, with the State Hotline. I am doing this in hopes you may assist
in my mission. We must do more than complain about a horrific situation. We must try to be a nue force
for accountability.
I am available to be of Itly further assistance necessary and am determined to see this through! I
am unable .to reconcile iri my 11~, the disparity between what being a health care provider really m~
and the Corporate pbilosophyof Extendicare.... l'hat the priority will be Sales and Marketmg. If a facility
AUG-15-2006 TUE 02:52 PM DSHS RCS/CRU
FAX NO. 3607252644
. .
is providing the care deserved by all ofnmses CNA$ and us is the most effi:<:tive :I1l8fketing tool available.
Adequate health care should be a right, not something to be mazketed.
Thank you for any assistance you can provide in this urgent matter.
Sincerely,
-,(~~.
Karen J. Nonnan, R.N., eRe
6877 Bentley Circle N .E.
Bremerton, Washington 98311
360.692.7196 .
P. 04/15
AUG-15-2006 TUE 02:52 PM DSHS RCS/CRU
e9/15/2886 e8;42 2666152gee
"'OWII'\~ ~on
FAX NO. 3607252644
CMS ~GIClN X
P. 05/15
PAGE El4/14
.
ALLEGED 'SAFETY OR
HEALTH HAZARDs
..
I. ColrlllliAt ~
2, Emp aver 1lIIc.
BnmertoD Bedell &: R.ebablUtatiou CeDter
. Sill: LOCItlcXi SIrtet Ci\Y
.2701 ~~.4v~ Bremerto.D
~::.:::- ffl'difftiiiiiii.... ""
~;;~ . ;
Vicky Weddle..IDterim AdllllJ.dstrator
7.1)pe ot:Busb:ii .
SkWedN~F~
I. HIzanl ~ian. DeIClibt &rieilY diO ~ ~)'OIl believe ~t. lllclllde tlM approcciuJatc JaIID(:r of iClQlpI~ ~t.d to or lbnall:uecl
by -Iuanh
Maldple"POrts aad CftCerAI from $bft' _Ubben aDd othen reprdiDl f01l1 oclon comlllg from tile
drain~ .hower I'OO.I:U, Ildllty room :lII.d e.rpetJ ia tlte SubAcute D~ of the hlleU., Jutve beeD made to
admiDlscratioA IiDce tbe start of laY emplO)'llleDt there ill NOftklher, 2004. III. the IWt, floodbag ba.
occ:Urr.ed -ad mc.l~ ael othu fops bas bcea oblel'VeCt ill various area otile llIIit, lDdadlng tile a<<ie,
. tD.b U4llliowcr rooms. Hallway c:arpeb b'\fe been eOlltamia.ted w:ltll blood and budy Ollds lad
eqidpment tor proper dealllDg and biohuard coatatlllDeD.t Iaas bee.wa brokeR or ...elCllt or )lOt roatiady
dOD~Malttplt DtuIlbe.t... of staff have beea dll'OllieaUy ill Now,.t least 2 llllnel, m,&eIf badaded, are
acutelym ~t.h JlypenelUitiYty Pneu._ids as wdl as Iaa.ntltlal PneumOl.lia cawed by mnltiple
oi'ganbmlt iIlcludlDg ~ Caadida, and Staph.. Beea~ of "WOrkplac:e p",.ure, 'We h~ cctndnued to
report to work 118tll.. thepobat of ~pse. Many sWf members have be. chroDlc:aJIy ill with
. reipb'atvry ."'D.n~ MlWe .utJuu ud MIa. pstroiAtestloal bleed"" only to Improve dl"amatitally
after, eltb... trD$fe1'1'lq to I.Other atQ of tile building or Ie.viQg employment at tbiI fa.. Au
em.P.1~ ~ a .eve,e .M'.RSA Jnl'ectIoa of the fate reqairlllg IV _tiblotic treatme.~ filed . report ad
.papeovork for ~bOt' &: lDdutries. However, this paperwork was bever Iablllitil!d by the facility.
Routinely; read.b 'MtA iD.fedio.f ofWOUbc:1s Q"e not tre.tecl mtb ordered dreniags or coverib&s.
resalUng in tZposare by hand tv bad or blll.d t9 s1lrfalle contact. 'I1aese iAelcleatJ have beeR persoully
Wftaeutd aad reported to aunlng adDdaJstratlOJl witla.o acti<tD beiDg.... At I Registered Narse of
Z81"U1, ~tIt · ~JlI bldraroud iD. ae.rte, lUbac-.te and certlfic:atioa .. nephrology .uniDJ, I tal
liceased lty tile State ofWasbl.agtoll aad a Maadated reporter. I have reported by CODceras to tbe
RotUDi..' AWl.ouah la.1n aDd on lUdica1Iea,,~ I ....1Ut do JOlJI.thblg. Tbb co"puy is clau-ged lYith
pati~t care. This can IS SO salutaDdard, lJ4!Opht are letting deker gd are C!OIUtaafly at 11sk. 'llds p~
oftbeb-.Odia.glleeds to be .bat dOWA peadla.g a complete and thoI'01l.I1lb&speeticm. Further barlll IUUIt
"P~ (pleIN lee attathllleat)
:sc.rc , ZlJI+4
WA' 98310
-. zl!"t'4
JL~~=
g. Haf.anl~itlCft- .S);ecIti - ~bqijdiltg (If WO:l't litQ aDd lIle work; lb. 'When: the aUq,;rJ Wl~Oll ~iIUi!
S'IbAade'MaloD of b..sldJqg
Sinkdt'lla; Nunes statIoD;
. Show.: room
Tub 1:'00111'
U~ty teom
CtrDeb
-
STANIiARDS aud INJlOlMInONlCASE PILE COliY
Wl$HA.7.2
'4Js.os~Oalltp;llllll'lt.r<<llli'llltb b~ -1!llalA4a 1:M5
AUG-15-200B TUE 02:52 PM DSHS RCS/CRU
eS/15/2ae6 ee:42 206615208S
~ r-~'" L.J Ut'bodJO\'emflll:llt Ag.:m=y (iw:1M
I 1; PIeMe IlIdlcatC ~ dIilJe:
. Do ll.ot l'I!9Q1 - ~ 1ilc I. M DIUIIlS 1M be revealed ~ Ibc:
, 12. Uadciilpiij: (Miit "'X.. in 0*1" bOx)
if EmpI~' . 0 Felt::tll ~ aod HaIth COlllllU~. 0 El1lpIO)'Cr
o ~ ofEmpltlY~ D Otbw ($PCQlty)
bdiewa Ibu a ~Oii tlfan QQcqpatloaal Safetr or ~ ~ ~~ wllicb is I jo'o Mtecr or Ili6lth ImInt of'1Iu: eslabJNib.mella llIlIIXI! Oil dds
fOl!lil.
"'E?:"'(typc~- . ]~1':r.,;r '.
n._ IS; ..$lrtc Oly ~ %1M
Ci877~CirdeN.E. BnmertoD WA 98310
l~_ ~::::.-:-- ........ . C'.... 7 -..+- AlIo? ~
'". ...,......_...~~.........-......-"""'-_.._-_....,.._....-
IiUe. .
~aDNwe~ ~1IIIt 'l'tdc::
~~(JNLy
19. to .
43. 1lI:!IdI=r Ul
~. T~1g (CIII:iiiiY);
.. 0 foo4etal 05IlA I~ lD
b. 0 SWo' OSH I Rqonhs,g tD
-46: ~on
~ m Val12 T,p:
81
aose~ IW
49. CosmnoIlI$:
~.
~.
FAX NO. 3607252644
0.15 REGION X
P. 06/15
PAGE l!l5/14
llD
'7.
o
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o
o
GmectI
o
o
, $l:riota
o
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31-
39. S8iii11.ctt.:t;:
L BNO~-lWJzIwIJ4C01q11aiQt!l
. . Too.....or__.led.
Reocs~ot~m-=
<DWI ot~CB)! _
. .0 Not_WJSHA>:,jurWictiou
b. 0- No f~ CGI" NQIloku! ClIlIIpIIdal
o Nv~dqer-4lfao~
B We c1_ telsliaa 111) S&Jf .
Not~~lOml"
40.
4~ ~y~
No PrioIiI;r:
Hc:dIh
c, 0 ~7fl1r~lVit!l~D
u ~w fatW
d. 0 ~~lO~
- n ~ltN1!t11e4 W ~ofl1(c))
Co ~t~wi6I.dlw.
O 0 N.,NalRmiL;J4 0 ~orll(o))
f. ~to~(OptioDaI)
J. 0 0IMr(~&>
41.0.
ii,
10
Vilull
47. Total
EJdriGa
f41I-OS2.000~af'<<;YCll'_I!tI~_~iJk 12~
AUG-15-2006 rUE 02:53 PM DSHS RCS/CRU
ee/15/2ee6 e8:42 .2a66152888
~...-._~............... ~ RN "1UU:'dII"'ICS
W2SHA8t,*- DMsIon
FAX NO. 3607252644
o.1S REGION X
P. 07/15
PAGE 06/14
.
ALLEGED SAFETY OR
HEALTH BAZARDS
:CNme r
BrtlDertoll at:tlth " RehabllitatJoa Ceater
3,~~..~ Qy
, - . ,- , 2701 a~ .4:".,. BreIIi~b
., ~li.. AcIdnlIR tlf diftinm:l ~ ~
l't Co~Number ...
s. ZlP+4
"WA 9&UO
s_ Z2foIoI
~~nr~totJidll ~
VIcky WedcUe, IIIterim AdmiDiltrator
7.l)pc ofB..
,SidJIedN~F~
1.!faa04 DcacripIIOIL DUaitiCbrieO;v CIte ~,) ~ you belinll exist. mc'/ul1llllle ~ DlIttlbcr or~_ eICpOmI to OJ' ~
by CIId1,bzard:
Mu1dp1e reportl aDd COD.Cer'U fnun ltaft'member. and otbeQ reprdlq f~ol odon aolDiDI from tile
. dnias, sJao.,.- noms, utility roo. fdld carpets ia the SubAcute uait of the baildla.g kave beou. _de to
. edllWdltratloD lIDee the ..rt Gfmy emplO)'IIlent then fa November, 2004, III the put, DGodlDg hal
otc:w'mlaad mold ad other (1IDpS has ~ observed ill various ... oUhe llDIt, i,bclacUIIg the .ttic,
" tQb'ud dlower rooms.. IbIIwlIlY carpets have beeD colltamlnattd wM blood and body tlaids aDd
, eqalpment for Proper ""m, WI bioh~d c:Go.talnmeJlt _ beaa bAkeD Gr lISelesS; OX' lIot routinely
dOne. MDltiplt .umbers or ltaft'have kea chroDJeaIly ill. Now, lit least 2 DllfHi, ID,Mlfilldaded, are
acu.teIy m With HYpenmsith1y 'ne\UDoDiUt u weB as ..tenutlall.....oJda cauC!d by multiple
otgaalSlu; iuludbir; ~ ~ ...d Staph. Beca~'e of workplace pressure, '" ...8 COllu..ed to
..rt to work utIJ. at tlle point of eoIJapae. Muy staff mcmben have beeD c:h.t'OJdcUly UI with
respitatoi:y a,ihQ~ lel'eR utluaa lad ev.,lstruhatatloaI bleeclblg, only to bnprove dnm.atkally
. , . afterdther trtaJfeniDg to a..ott.or area ~ the b1QJdfal or lea.vIDg em.ploymm It this fadUty. All
~p1oyee with .,avm MRSA mCeetion of the &ee requ1rtna IV IDtlbiotlC treatmellt, .tiled It "port ed
papenvOrk. {or lAbor Ie IadlUtries. Bo-mvel', tIds paperwork 'WU Dever nbmlttecl by the fadllq.
lloatbtd1, relidellts Mth blfcctiou. ofWOllllcb are not U'eatecl witb. ordered dressbap 01' eoverlqs. ,
nsultiq in expoIlU'e by baDd to baud or ba:u.d to I~(:e ~atact. Thfl$O iDcld_ts bave beea pel'SOnaDt
wjta"Mid and reported to raaniDI adalbilrtratloa witb DO acttoll belng taken. A!I a Re&I&terecl Nurse of
28 yean. wItIl. attoug b~d lD acute, lS1I_ate IUld cerdflcatloD in nephrology o.un1Dg.I am
lkeMecl by the ~ ofw.,1J.Jqto1l aDd . Mand..~ nporter. I haw npomd by toQcems to tbe .
Hotline. Altlaougb I am in and. oa tnedieaI lea.." I m.at do something. This colDpally is cbarged with
patkut ClII'e. . Tbis ClQ"O Is .0 lubstaadard, people are get:tJng Sick.- a~d Ire coastabtly at riale. 1his part
oftbe b.uiictiiaz Deeds to be sIlat don pcndiq a c:t)mpltte and thoroagh mspedloJl. Farther b.ann mlllt
. be I)Nvea.ted.(Please lee attachment).
~~~
(360) 377--3951
-
T rbld i.ocatlOD. Spoc:Uy tII,e pan:lcllbt llulIdIDi ar Wll&!k aito lIIld 1hC "'01'\: iih.iftlI wII6te the alkp \'loI=oc exl8tS:
' . S.IJ~ MdI0Jl otb.udiDa
SiDkdraiD,; N~ 1tdGQ;
. SbGR mODI ' .
Tub roo...
Vtility roOIQ. .
~
STAJa)AJU)S Qft4 2NFOllMAnowcASE PII.8 a>py
WlSHA-7-2
foI.l>>S~ aJ~ ~or h..ltIl!wlal'4ll- ~Iilll IUS
AUG-15-2006.1UE 02:53 PM DSHS RCS/CRU
68115/2606 '9B:42 213&61521386
.... . -'OOl 1....1 \1IDtiT (Jl)Vll~1 AAoAov (Gp(I(:j~)
11. PI- ~)'DlII' lk:sW:
. -H':~ :,?;c::t:> -B MY ~!!~1IIlY bo rcvaalod f4 th!: _Ioye.r
621. &n,1O)'OC 0 ~ Safety and HeaIIll c.o.uaunee 0 ~
(J ~1Ilrive~r~ D Olber(~
l:IICI!i.mlhal. yJoWloc olllll 0c:cupad0aaI s.Al;Y at' :R*llItl_tudu<< ~ wlli~ (I . ;AIo.1dt,y or Ilea1fJI t.wll efthc ISCIbliallmom IIUDOd ~ ibis
'fmD. . rv
Ii CompJ"nt NQC (type or'fRiaC) 1T4. TckIIIiiiiNuaabw
~ KaI'Ct! Nonuu ' L!..360) m--7'1Sf
U:A&ktst-SM Clty s.. Z1Pt4
. 6877 BeatJ.y Circle HoE. , . Bmaertoa W A 98310
16.~. -r~ '''''>vu. _ ......... . I17. OllIe 7 .. .ul- I. t:J t'} "
18. It you am ~ ~ feplu=-1i~ OfauplGyllQl ~ 6Y this ooJUpJaild, ~ ~tate lK IIIJ!Ifl of= acpabmloll daat you tq:lI'l:Rllt 1IIIl~
. aGe.
~UoINIIllI:e:
. OfIIrcw.uss 0Nt
19. R-aiDc ID
39.Saia~
.. 0 No~-CotilmlidGlllllpWaw
B. Toowa-4Il"-'-~
b:cra iDspccdoa IX objective ~
(1)n:ot~
o Nolin W1SHA~~ JutiscIkIioa
b. o-No iupeaIiva.-b~l eampJaiQt
D No~du.pr _DO IIllIldard
B Nodkect~~S&H
NO!: CDCUh iabmIIticm to eVIlQMli;
~. DD:: LIti'
042. tt~
~
. 43. n.cCl'tn
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.' '.. Cl Fcda:dOSHA/~Il:D
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a-~- q~ -a-~
49. Coam.iurs: .
.J~~
~.
~
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FAX NO. 3607252644
eMS REGI(}.l X
P. 08/15
PAGE 67/14
-
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J14ls.on.ooo~.lWl(lfIl.~-DSIWll3-05
AUG-15-2006 TUE 02:54 PM DSHS RCS/CRU
08/15/28e6. aa:42 2~66152eee
July 24. 2006
FAX NO. 3607252644
0t15 ~Glct-1 X
P. 09/15
PAGE 08/14
To Whom It May Concetn:
I became I.Q employee ofBremcrton He.ltb 4\ ~bllir.tion C4ta- (BHRC) 1ft !ate November of
2004~ wMre I was hired as the lead CRe (CIiQiQal R.eim.bursemc.;t C~S). J4 a
..':OID....., ~.~eut head.I.a DOt mvGl\'td.ia' direot-patient we:1'b1Vo _ .'HeaJlfiiare
provider fur 28 years 4l1d stiU beliove now what I did then - we oare for people. J have observed
lWbstcadn cite pAotices ficin the boaiuniIls of DlY employmeac IIld wly beHOve that resideJlts
ad ad lU!l beia,g advmsely aft'tcted by pacticcs of BxtaJ,dicare at the BHR.C fdity.
Until asbort tinIe ago my office wu 1oca6d in l"OOal16 OQ the Subtcute unit. ~y another
ltaff'aomber Who l)On$ismuJy worb on that unit aod I 'WeN both diapOliCd 'With nearly ~
. puhnOlWy intections: I:otendtiaJ J*IUIlonia with btcnd1ia1 biopsy nsuJts ofMRSA, Candida
. and Staph Aureus. 'Iben are a number of ocher staff mcm~ Who ha:v.= pI'O'ViotWy \l'IQIbd on
. tb8t wit who have also !lUft'ered pt~ respiratory iIlfectio.os and other illnesses dW did not
· . COIDpICCOly clear bp until they Wln ra.ow4 off'the subactlte unit or lef\: the fioility for
employment ~ With theR cm.6zmed dIagaosis aDd. 'dle libJihood u..a "- illnesses
.ate not oomc"ldO!lc.c but are libly the result of eav.lmnme.u1Bl toxiUs OIl the subecutc _
~ for patiom; ~ being ~1y beoome priority. I have diScussed ~ COI1CemS with
my A~ ~at BlmC. HOVc'e\Ief iD JiglU oftbc f4ct that dlU'il)g tbf.~ tba I
bI.ve bsQ attbia &c.ility 1hett I1ave beeD 6 A~ aDd. 4 Directcrs ofNamiQg aad with.
cOtpQnItc pbilosofllJy 1hat has turned away ftom quality of cce aDd toward ales and marbtUI& I
have $:riousdoubts that a ro&ponsJDIe ad proper in~ 'Will be conducted. leaving
mKk;nts to 1ive in And statfto wode in apotendally hanuful enVironme.ut. This poceatiaI duat to
~ IDd fear of cxqplaoeaCy bas left me little gbaioe but to report these COIIOeCDs to others.
, . These CODca:ns aut ~ on docume~ fact that patiQus riehts are CDIltil:a11OU8ly beimg violated
lind sqft" are forced to work in a toxk eIIViroQmeat. Patieuts and 5taff COfttimae to bocOC1C ill and
~~~ and en~ ~ throusboPtfhefaoilit)', b.ve beeD ~Ol'
.deaicd without little or be) inV'~. Policies 8D.d proctdQRS ue in pbc$, but not ~
Discipline is punitive and not e1l"ect:iw. PaperWork compliance BUd ~ODtaIior:I is cmphuized
and put in p~ but is not an accurate reflection ofwbat _ been ac. Statfeduoatio~
ork:lltati9Q ad niujqg is wicimal ao.d inIdequate. Staff q,uesQOIIS and COIlllCm$ are not
recognized or acknowledged, AU ofthtote issllDS also apply to paticnb lUld 1beir &mil.. This
pbi1o&ophy is pre~ in evety ~t IIJCl at the ~gioaa1 and area levels ofBxt.ndi~.
Sliltts Deparmient (JfHealth.m~ an oo~ iQ~ing CDlDCI:IWI~oomp1aiall al
this facility aad opportunities for ~ and ~ are igIlORd. SUbstaadard practices
and violatiol2s of state ~0I1S i:IesigAed to pot:eet the ~ OODtmue. .
These ~ $Ome of' the iR~ 'that I feel shc:Nld be inVfl$tipted iDuned.ltely to prevemtudhor
j~y to patienrs, tamiIi. and staft'll1embers: .
.1. FOlAl odon have been coming &om: the $ink drain in at tile subacute nurses stadon; the
subac:ute utility toaIn~ the sbowcr 8lld tub room on the sub6cute unit aad fi'oQl the cmpets in
this uuit, The60 have beeD reported nwltiple tiarm. BIOQd ad body fluids are apill.od OlIto
the carpet lnultlplc times dally. These a.re not cltl8ncd and SlDltized lCCOtdiD,1O C<<rect
. poJicics_ C8qJet dcWag eq~t is broken aDd. not.t\mctloniag properly. The faoilfty has
. ~ denied requests to bring equipment up to proper functions. Subsequeotly, carpets
Karen]. Nonnan. R,N.. CRe
I'age 1 of':3
AUG-15-2006 rUE 02:54 PM DSHS RCS/CRU
8S/15/2086 .08:42 2066152088
FAX NO. 3607252644
QotS REGION X.
P. 10/15
PAGE 09/14
. .... vacuumed, sprayed with water or deaner, then scrubbed with.. fIoot bufling pad _
allowioc ~ md toxins to become airiaae and also pushed iiut:hw down _ tho carpet
fibers. & thennU'o fans at both ends of the ha11~y> these toxins ~ tbCll ~ duougbo\4
the wing.
2. Ov~ two--ycaca ago the fire spiblder pipe froze and broke in the ~ wiog. fIoo4iD& the
n . .auic area. l'o..this..day ~fllOld and-nrildew reS&tueiD tIrat'&tl\l1oD ofd1e'~
. . due to a Jac:.k of proper clean up after the incident.
3. Mold is OfteD observed in the shower tOOms duo to improper oleaaln& or 2lO cleluiu& at ldl,.
d~ to 1acIc of staft
. 4.. StaftiD, oumber.i .. predominantly Dunes aM C.N.A's - are often at danga'OQS levels .
exposing ~nts to hanuful conditions and ~ rbk.. Agency StafF have b=- bro,-Pt in
. duriQa dines of sUI'VCy or olMous scrutiny to bri.q Ibo aumbets up to ItiJUbdioo. but
dismissed after moftitoring it coanplete4. Because of iIaffiag ~ ~kl
eDJplO)'Mlare preaswed to W01t;: multiple ~. couseeutive do.yJ w went whee W. I have
penaaally expcrleaccd. workiog-witb staff member$ who In uofit for duty beoausc offatiguo
Ql'iUDea; again fbrtbcr puttias P11ie118 at riek ofbanD secondary to ~jvdpment end
fatip.. .
5.' High.. of.rospiratory complicatioos and i~ skin ia&:tiOD&.III1nary tnQt iufeodoDs
81 well. c.di1f co.Ii$ in micleAtS olthe subec* unit, requiring repeated antibiotic
~ IV and otal. IafectioD comrot practices 4Ue DOt followed ~. S1aft'
cduc:MioQ lUId follow up i() awre compllaDccl is not dane. S18ff ue itHa'vic<<l OG problems
with a sian up sheet aDd a Iwtdout. CoDtimUng edUCi&tion does not ha9P=-
6. ~nacntllioD ofplticlut QI'8 .is 0_ ~ Of dODO ~.Iato fI'IJti:y" apd is. notroflective at
actual batments. fl'edicatioDs:, eb:. Stiff 8l't II$bd to complete iDc.idcot tq:JOfb regarding
things dlat oQclDTed 'WeC1cs or months before, ofteu for issues tbey were ~ ~t for.just
toc:omp1y with papenvor:k requiranents.
7. lncidents of employee illness Of iqjwy ~ 1ho job hitve bee.o. reported by tho employee for
LtI c;lIdms but DeY8l'subIQiu:ed byae t.:ility to tho ~ qene. ~ iD die uafair
.labor IJIIIrctiocs as well as fW:tb.er cover up or~fe ooaditions.
8. ~OYM ate iaformcd ofpmp.- chain ot: <lOmnIand fOr concerns u4 p-ob1ems. ~
. WQCOI'U are tl.ot ~ aad mowd a:p 1b dmin poperly. reprisals ftom ~
b=ome personal and turD to that _loyees ~jusdfiecf or not, .00 tiw
~'-ht ~tl:en becomcs.UIlOOmt'ortabJe fOr,that-employee; Many employees choose to go
elsewbeto resultiug in . 'fay high Ate of tlJJ'Jlowr ofnuming and mltt1~ st:eU. 'those
cmployees who by to rmnain aM work b poWYc cbaDae beoorM UI~ ~ _ qry.
Most of us haw ooQJt to :fCcl po'WCl'lcss but contiaue to try to do our pert to give the residents the
. bostattcntion and otn tbftt We can. As a. Mult oftbe QQUdltiOM we besio. to tbiuk ~ we can
Dot qab.. difre.~oe SO we becc::me oomp~ llnd clbiUusiOlled.. We 1aIk ~ wrso1ves
aboutwbat is wrong. but we do nor bow what to do about itw:l1:b the eanstw lack ofsupport by
AdnUnistrative ad Cxporate Staff. I have made a decision to try.
Kcca J; N~ lit.~" CIte
Pqe20U
AUG-15-2006 TUE02:55 PM DSHS RCS/CRU
e9/15/2006 BB:42 206615209a
People are '" riJt: residenb, 1bcir families 8Dd SCaff members! I would QOt allow &iUIIKOQC: I eaml
~ to bt eared for at mmc. ~ as a UlInB,. lam', allow any patient to receive this
Sub_dud level of cue ancllbusive ttee.tment.
FAX NO. 3607252644
CMS REGION x
P. 11/15
PAGE 10/14
1 am-.mg for a complete aQd morougb inspectiOD Q~ at least, the subawte lDIit In my opiDioa.
' tbcmost etreottve way to assure d1aE it is a safe CDVironmeu.t would be to tanponaily cIoge the
unit and rerno~ the~. 1 believe IlQ im~diate stop PPmeDt of new resl~,j~
, .. '" ,. ,,,:wamm~.pendil1&'O\1t1:omos ot'cultarenmhlirquaJity reports 10 prevent fiiiiier harm to ewrcnt
resideDts et1d staff.. I believe an outside ~ with no bias to ~iClr!l should. to look
It ~ ofpracti,Qe and care.
The BHRC building bas turned to a phibophy that sales and Ibaiketing are the DUal.ber one
priority at Illy cost. W. are in the bU5iness ofbeallh. care. We bave licenses that mD US M'must
do IlI;lt bam4 and requiro taat we take au gatb to assure that. Wo work in these res.ldeats homes for
which they, the sowmmetn: and insur.uIce companies pay BHR.C to ~ for them. satcly aDd
effectively. They have the riSht to 1Mt that BHRC i8 doi-ag just that. Harm is being done and b
nUatil1Dp. I beliew .. full BD.d ~pJtte mvesdgatian ofthi$ ~ will support tb* issues aud
~~. '
J 1haOk)'OQ -tor your tbne and. CODSideratiou ~iUC this malb' ud, wjthout hesitati~ will
. make myKIf available to provide :&rtbcr information or ansWtlf my addlt100al quostiOll$ you may
bIvo ~1hose 18saes., '
With siaccte regard-
~~
M!. Uia 1. Noiman. R.N.. CRe
~877 Beadey Circle N.s.
Bmnerton, W A 98310
(~60)6n. 7796
x.,. f. N~ p,.'N.. eRe
PIgf ;J ot3
AUG-15-2006 TUE 02:55 PM DSHS RCS/CRU
a9/15/2886 68:42 2866152888
'.
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FAX NO. 3607252644
eMS REGI[}.I ><
P. 12/15
PAGE 11114
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AUG-15-2006TUE 02:55 PM DSHS RCS/CRU
0B/15/2aa6 08:42 2066152088
Print.llCl ft'om WWW.hotitMtoz.com
UR ; http://www.hel.lthato;l:.camlheaftfta=1AtozlencY/bYP9l'8l1QeitiVityJmeumonltitJsP
FAX NO, 3607252644
eMS REGION X
P. 13/15
PAGE 12/14
Hypel'$llhVitlvitr pl1eumonftls
Dtnnltion
,.. HypeNen~ti'i6niti$ Teters to .n inflammatiOn of the Iung$ t:ilused by topeated breathing in of a foreign
substancet 8UCh an organlr; dUlt. . fungus, or 8 mold. The body's imtl1t11'1e system I'8f.Cts to these substances,
calfed antigens,. by foITnilg antl:lodieG, moIec:ufes that attack the inYadtng antigen and by kI destroy It The
mblnation.of antigen Md antibody produces acute Inflammation, or pneumonitis (a hyperslltsitMty reectIon),
icl1laW CIn dIveIop into chnmIC lung d"MaSQ that II'npalrs the lungs' ability to take oxygen fi'om the Iir ana
' eliminate carbon dioxide.
DeIscrfpdon
H~ittvlty ~nltis (HP) i$ ~ caJIod "allergic alveoIltis. " "AIlerg~ refers to the anlfoen-
ntibody reecaon. _00 ..~ means an in1Iammetlon oI'lhe tiny air sacstn the fungi wheIe ~ WId
CO! are exdJal'lged. the aIvaoU. It alta Is known .. ~./lefgic 11veo1iti:s. meanIng that the aritIgen ht
up the allergic reaction (.no eallid en e1le1gen) cornet from tht ~ Meet Dfthe anffgene that cawe
18 dI8ease come frQftl pIlutt or animal prgtelne or micIoo!vanisrns. and many ,of1ho8e affec&ld _ e)CpOGed
either at WVI'k ar in lie IJOUI'M of ~ hobby IX' other adMl;y. 1be tht Ia10wn Ifpe of HfI, I'arme(e lung, is
by entJSJen$ from Sny ~nw ~ M ~ hay. HI example ofGlseese conneCfad Ytth.
hobby 1$ PIgeon breedefSlung, e&used b)' inMVng ProCein ~ from bird dropping- or fiatners. After q time.
very liaIe of the UgIt1it: material Is neode<I to set off a re8ction in the lungs.
oug~ one ~ MIY 10,000 persons develops some form of HP. A my&terfOw aspect oftfli$ condiflon is that,
tWen ~h l'r8'ty ~ mI)' b. ~ to a per(tcut. antigen, only a 8ITIiI number of them Will de,veIop
dIse8se. GGnItiO dlfhnces may rMtennlne who beciomes jIl; thi$ rtII_.... unclear. p~ betWel!n 5%
.~ rid 16%.ofalf per$OI'lsWho are 19S1utarty ~'to Ofganicmateriats develop HP. Mostoflhole who dO get it
. do not smoke C8m01cfqg may ~ 1he ~ Cf ciUs that take up antigens and neutrerlZ8 them)_ lhe atnount of
tig&n Is an ~ fIctor In Whether HP Will develop ind ~t fonn it w8I take. SUdden heavy txpClIUl'l can
Produce ~ in a matter of haurs, \Yhen!:as mild but hquent ~ tendb produce a ~ng,
' ' " alnm. HP may be mote IbIy to devtIap In P8l8OI'$'expo$ed to J'.lQfluted'alr or ind~l fumea.
ypiOal ~es occur In tta*lf.tllgs of ~ wfth HP. In the acuf& st;ge, ~ numbers of irllammatoly cells
refound V1rQughout'the tunqs and the air -= may be filled bY a tt1ick fluid mbcId WIth these <:ells. In the
bacute litage, cflSEl&Se exh!m<Ii into'tM.ana1 ~ tubes, or bmnchJoles, Md the ~ cells
' .' ink) t,iny granu," oaIled graritllOrnas. FInally, in the dUon;c 81age of HP, the Pfllviously IntlefMd parts of
'. 'lungs beccriie ~ Md unate b function, ~ ~ ~ftbrosi8. . \
, numb,r of'dfffetenftypes of HP we known, sincle.a wIda range or .f(ergens may produc:e an allergic I"BaCtIon
in ~ ~ I4arl)' oftllem produce similst &y/1lptom$ n abncrmar phyiJcll fi~ bUt some ~ their own
typ~ fa;stu.-. SOme of the more cornmon bnn$ are:
· Farmers Ilmg. Can affect iiUl)" fal1l'lllr who WOI'b With wet hay or other moIdy'dust. Small farmers who
have to clrectry thresh and ~ their hay are most Qt risk. as _Ill tJ'me IMng in r::okI and humid areas
WI1ere~ weather is ~
· P.iGe0fl b..-ecler'e lung. Also callecl"blrd fancier's lung," it is second to fanner'Slq as U. best knOWh
" type of HP. A ~ ha$ been fuund'in pigeon dfOppIngs that may ceuse thet a1lellllo r.obl, but
' , ' 'thwe may be more !tIan Ot1e 8Ueh subttanoi:, Beslcfas plgeQns. ~ dioorder may ronow 8XpOEiUJ'& to
dud<s, geese. phe~l$, end even canaries. Parakeets PJ"Oduoe an especJally sevwe form of d~.
' Most P8tiq afe middl$.oaged women, who USUdy ewe tor bil'(f8 either ~t home Or on bltd breeding
htq:dtwww.bea1tbatoz..ComIhea1thato~ At02'/CbC)'lhypersensitiV,(ty ...P.ncumonitis-Pt,isp 07/1812006
AUG-15~2006 TUE 02:55 PM DSHS RCS/CRU
ee/15/2ee6 'a8:42 2066152088
'I farms.
I
. FAX NO. 3607252644
eMS REGIll'l X
P. 14/15
PAGE 13/14
. .. . e.-1SOSl&. CaU$fld by begasse, a substaAoe prod~ when jui<ie "extracted m Qlgar tane and is
. uaed in n'ulking paper and ~lves. A fungul$ is prgbab1y responsible. Young InI'I mlddlH;ed men
. who WO~ In the sugar fndustly are at riSk.
. · . Byainosl$, A similar condition .d'ectfng worker; who Inhale dust from cotton, flax. '?f hemp.
_...un.... ... ....'. · .:Humkifter-Juns; 'Alrawte farm of Hp.~ by Inhaling Ictf~ the same organisms that cause
. fatmef's lung, Which grow In contamfnated hutnidlftef vents, air conditioners, I'1eItii19 systems, and even
. saunas.
. ent of HP requites kfentll)'lns the otrGnding Mtlgen and ;wafdlng further exposu~ Although It ITIa)'
metillll;lj be ~ fot a Piitient to find iI totally different type of~ Often it is possf\)le to simply P8t1onn
dl1terent dutie$ or 8Witd1 to III WOI'Ic - YIhen= expos. is minimaL In some oases., (Ib pigeon ~ lung).
ng 8muk; can prevent~. If acute ~n$ are~. the patient may be 1reqd will B atemid.
QrmQne for two to .~. This often ~ the infla~ responaelnc1 aDows the lUngs ~~
. recover. In ~. cnronlC stage, _fOld treatment Qim delay ftn1her ~ to the lungs Ind ~p preserve thew
~.
13rog~...
f,ngenemL mOst of the 8)'Jnploms of Hp diseppearwhen the patient is no lOnger elCpOl8(t to the causative .
~Iergen. The aQtual c.fWte8s of COInf*te recovery depend In part on What form of HP is ptesent. Older patjen.
. ,
htt:pV IWWW .hea1~comIhealtbatozl Atozfcnoy/hypersensitivity .....P1X'WnODitis ....PI JsP 07/1812006
eother antigens.. HP ... been seen in P&r$on$ WodcIng with ~. sIk:one, mushrooms, cheeIe,
. wood dust maple. berl<, ~. and fUrs. , .
In the acUte 8~, P8f:ieme WIth HP begin ~bi'l9. ~ f1wer, and note ti9htneMtn the r:he.'5t as W&It as
me tlrtdness and aching, four to eight houl'8 after.... most recent ~UIe. Mast petients are well enre
th..~n between UltW~ (or In~) and their~. After a time. patients may have tRxIbIe
. ..1bey =~ lose their appetite, Ieee weight. and getl8raly feel III FinIIly~ rn the cIwnio stage. It1e
patient wm have trouble bMthlng and may 80metimcIs Yif1ec.. VWh advanced.... the sldrl
. may Ippetr' bkIlSh (beceuSe too Hale ~n Is ~~ _into the bIood). \\ban the pJ.yalcian lIteM., ltIa .
~ chestwilh Il sbatt1oeoope, there may ~ lJI'IQIlUng $OUodS or loud whe8tfftg. In th8 late ... ctul).
. . tnuertlps in, $ign IIat the patiBnt has not been ~ enough ~ tor an ext9ncsed period of time.
DlI9noar.
No 8IngIe test em make a definite lfllgrlOeis of HP. The key Is to MM some specific ~ or activiI)t to
~ CJf sympton.. The chest:ll; ~ may be normaf In the acute 5t8ge, but laler may iIlow a l18i:1
. .. that lo0Io like "9roUOdglaS$. II Them may be linear or rauncIed ~ in the central pam; of the
lungs. stud_ of kmg ftJnctiOn in the acute .. f1picalfy show abrlo~ SRlIJ( lung VOUne. The Bbilyt)
. ~ at. fist rate is.1rnpand. 'Blood fJorlHDlaittiy typicai.1Y .. a lOw level ofO)\}1er1. Lattr. when the lungs
. havtI begun tq scar, the airways; ~ Wbe$} ire Obsbwted GncI the rate of afr& I; reGUced,
' . ~ boliM list 8fdn _rag can help diagnose HP and stlO'fI which pertlcu'aranfJgen Is CQUWig h
Symptoms. SmalIarnoqnbJ of several suspecta1tigens arelqjedad Just beneath the 8UJfaoe of tie sldn, USUally
on tM -.rm or back, iIt1d U'M! reecIion$ 'COInpIred to that ~ by Injecting . harml_ taft soIulion. AnotIM.Jr
0$Ile mat is to place " thin tube "*' the ~ inject a small 'amount of ftuld. and draw it back up
~ lavage). A lfefy large number or cella Dllled ~ "fr'pIoaI Of HP, 8"d rn.t eells, whId1
part Of"" immune sv.rol may also be MeI1. R.reIy, a tissue IMtpIe (bjOpsy) or lUng tisIMa may be I8Mtt
. .1 tube pIaceci In the ~ and eXemined UIldIIr II mtcroscapi RnaIli, II pe.hIt may be ~llIngecr
by ~ inhaling a .-rtfQf.dar .tigenin the. form tit at) ~ and noting Wh81:bW Iq iUnctIon sucJdentj
becan~WOIlIe. This test 18 \l-...Hy rlQt ~ty.
AUG-15-2006 rUE 02:56 PM DSHS RCS/CRU
88/15/28e6 B8:42 2e66152888
d 1ho9& ~ nJPeated!y for IoQg perlod$ lifter InTtialy ~oping symptOms tend to have I POOrer 1on9'~
term Ouuook. The worst outcome '8 that long ~ episode&: of <<l<pOSure WIll cause Ghn:ll'lic lu~
. ... inftammatian. scar the lungs, and permanently make "*' unable to propeny prrmde GKygen to the bIaod.
.. Rarely t a patient will become permanenUy disabIecl. ,
FAX NO. 3607252644
P. 15/15
PAGE 14/14
CMS RE:GIrtl X
Prevention
It Ii ~n fIOtpoGSfbJe to Prevenl initial ~ of HP; becilwae,ti'tere Is'no..., Of ~ng whiCh tndMduals
. -"... un, "".~ ' . "~..,,;R'hlMl an'allergic reaction to I partlcular allergen, Onoe the cannec:tion is made between ;II
type of.~", and definite Il)'pel'8eMltMty symptoms, prevention otfurther episodes Is $Imp/e a$ brig as
~~LUe can be avoided. ,
~ how tQ rwoid t)q)OSlW depends en a person's \\'Ork or actiVItIes and what he or_ IS reactWtg to.
P60pIe with farmer's Iurlg can day hay thoroughly befor9 8Iomg It. For p~eon ~s lung (ana IIIII1Y oller
.cfHP). a maskcen be worn. In many irJdU$lriil settir1gs. ft i$ posslXe to Wa PAlCautic'Jn$ tfurtwiU limit 1he
' mount of 11erger, that workers Will inhate. If It $ not poS$IJJe to aVoid e.'<pOIure lIItogeCher, 8lIpOIUre can be
, and l$bictly mlniml%ed, . ,
" Key Tem.
. Allergen
hi outtid" iUb8'Ianee, 8I.Idl a8 dust or a mold, that, when fnhaled, 8etI off an aaregle
' ~ I9adIon in the funsls. ,
. Fibros.
A rwuIt af tong-GtanCHng irlflarnrnatory diHase In WhidI normal tissue is rtpIaced by 8C8I' tissue
., that 1$ functlanllllly UMleas.
Granuloma
Acolfection of~ calls ~ a ~ lesion, ~ gf'Whicltil8,a'Ca~
throughout the Iq tissue'.ln' ~,WlKi ,have had naIMrou$ ~ 8PiSodes t4 HP.
HyIMOllIlltfviQo
, Mat the body's Immune &ystem athd;s an 0Ytslde invader (such 8$ argenlc Gust or a fungus)
m&r11 u.n.. Bp06Ur9 to E!M1 . tiny amount of this allergen can PfOVClke 8 strong Inllarnmaby
respcnee.
, PMum~
tnftamrnation tA the lung fbaues..
S&lirofd
. '.. A natural body 8UbstInce may be given oraIy or by io}sdlon, and serv&s to dampen Of' even halt
. <. inftlmmaaon anywhere In the bodJ, Indudlng 1htJ lunQ&.
" For ."t0Ur InfonnItIon
~.
'. $moUey, Lawrence 1\., Md Debra F. BI'y8G. BreaIhe Right Now: A CQ~ Guide to
Onclef1landlng and Treating the Most COmmon BnwhJlUw Disorders. New yorft w. W. Norton & Co.,
. 1998.. "_W""II
Qlvan~
· Amel'icao Ll.lng As$Odation. 1740 Braadway. NewYi:Irk, NY 10019. (800) 586-4872.
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