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NEW HANOVER COUNTY BOARD OF HEALTH
Dr. Thomas Fanning Wood Memorial Conference Room
New Hanover County Health Department
AGENDA
Date:
AprilS, 2000
Time:
8:00 A.M.
Place:
Dr. Thomas Fanning Wood Conference Room
New Hanover County Health Department
Presiding:
Mr. William T Steuer, Chairman
Invocation:
Mr. Henry V Estep
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Minutes:
March I, 2000
Recognitions:
- Mr. William T Steuer
Years of Service
Five Years
Vivian Mears, Public Health Nurse, Communicable Disease
Ten Years
Mary Piner, Public Health Nurse, Women's Health Care
Ken Sholar, Vector Control Manager, Vector Control/Environmental Health
Fifteen Years
Sylvia E. Brown, Social Worker, Women's Health Care
Personnel
New Emolovees
DeAnne A. Chryst, Health Educator I, Women's Health Care
David G. Howard, Health Educator II, Women's Health Care L
Doris B. Sanders, Animal Control Officer, Animal Control Services ;)~ rJ;3~.
Departmental Focal:
The Women's Health Care Division
Ms. Betty Jo McCorkle
Women's Health Care Director
Monthly Financial Report: February 2000
Ms. Cindy Hewett
Business Officer
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NHCBH Agenda
AprilS, 2000 - Page 2
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Committee Reports:
Executive Committee
Environmental Health Committee
Unfinished Business:
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Generators/Hookups at Emergency Shelters vJ;,.
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New Business:
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N.H.C. Plan to Establish A Drainage Program
Post Hurricane Floyd Water Sampling Project
Appointments to Animal Control Services Advisory Board
Skin Cancer Screening Grant APPlicatio-~el5', ()Of) - ~ 1\
lie :"3, 6'5...,..'::J
N.C. Healthy Start Foundation Grant Application
Fiscal Year 2000-2001 Budget Update
ONC Institute for Public Health
Comments:
- Mr. William T. Steuer
- Mr. W. Edwin Link
Chairman
- Mr. William T Steuer
- Dr. Wilson O. Jewell
Vice-Chairman
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- Mr. David E. Rice
(f j(ing Mackerel and Mercury ~
vWest Nile Virus Isolated from Mosquitoes ~ , 1.I,k?> t-
Organizational Capacity Assessment Update 1?XJj/~'J j 0 ~ r:e.s~~'-/
NHHN/NHCHD Senior Management Meeting - March 6, 2000 a--. ~
~CW Adult Scholars Presentation - March 9, 2000 'JtI /I(J>J,;.~
FY2000-01 Budget Meeting with County Manager - March 22, 2000...,0' '(p "tf. ~
Healthy Carolinians Task Force - March 24, 2000 ~ It(v~ ...:}/I.I- ·
vN.C. Institute for Public Health Meeting - March 29, 200fY12". ~ ~'I"""l pp:,. ) IJ9
Staff Appreciation Izuncheon - April 13 \ l!~1 wJ jl/b., th:::
Il:M -~IDIV -/:30 ')q,.li+j )
s: 10. ((1l6ft.tA. i 1\ ~ c.. ({~ ') ~~~'b) Mr William T. Steuer
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Adjourn:
Mr William T Steuer
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Dr. Wilson O. Jewell, Vice-Chairman, called the regular business meeting of the New Hanover County
Board of Health to order at 8:00 a.m. on Wednesday, April 5,2000.
Members Present:
William T. Steuer, Chairman
Wilson O'Kelly Jewell, DDS, Vice-Chairman
Henry V. Estep, RHU
Michael E. Goins, 00
Robert G. Greer, Vice-Chair, County Commissioners
Gela N. Hunter, RN, Nurse Practitioner
W. Edwin Link, Jr., RPH
Anne Braswell Rowe
Philip P. Smith, Sr., MD
Melody C. Speck, DVM
Estelle G. Whitted, RN
Members Absent:
Others Present:
Mr. David E. Rice
Lynda F. Smith, Assistant Health Director
Frances De Vane, Recording Secretary
Invocation:
Mr. Hank Estep gave the invocation.
Minutes:
Dr. Jewell asked for corrections to the minutes of the March 1, 2000 New Hanover County Board of
Health meeting. The minutes of the March 1,2000 Board of Health meeting were approved by the Board
of Health.
Recognitions:
Service Awards
Mr. David E. Rice, Health Director, recognized employees receiving Service Awards.
Years of Service
Five Years
Vivian Mears, Public Health Nurse, Communicable Disease
Ten Years
Mary Piner, Pubic Health Nurse, Women's Health Care
Ken Sholar, Vector Control Manager, Vector ControllEnvironmental Health
Fifteen Years
Sylvia E. Brown, Social Worker, Women's Health Care
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A round of applause followed in recognition of the Service A wards recipients and for the years of public
health service to the community.
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Personnel
New Emplovees
DeAnne A. Chryst, Health Educator I, Women's Health Care
David G. Howard, Health Educator II, Women's Health Care
Doris B. Sanders, Animal Control Officer, Animal Control Services
Mr. Rice welcomed the new employees. Ms. Saunders is a former health department employee who
worked with Animal Control Services for two years.
Student Intern
Mr. Rice introduced Ms. Susan Hannah, MPH Intern from UNC @ Chapel Hill.
Department Focal:
The Women's Health Care Division
Ms. Betty Jo McCorkle presented a department focal on the Women's Health Care Division of the New
Hanover County Health Department. The programs of the division are Women's Preventive Health, I
Maternal Health, and Health Promotion.
Ms. McCorkle explained the Women's Preventive Health activities include Family Planning Clinics for
adults and teens, pregnancy testing, Temporary Aid to Needy Families (T ANF), cancer screening
(breast/cervical), sterilization (vasectomy, tubal ligation, and male station), health education, community
outreach, and marketing. Maternal Health activities are Maternity Clinics, Maternity Care Coordination
services support pregnant women, and health education (Baby Talk, Prenatal Classes). Health Promotion
activities include staff training (OSHA, CPR, First Response, Hazardous Communications), Community
Assessment, Healthy Carolinians, Injury Prevention (Traffic Safety), Residential Injuries, Recreational
Injuries, Firearm Safety, ViolencelIntentional Injuries, and Tobacco Prevention (Project Assist). Tobacco
Awareness Week is this week.
Ms. McCorkle stated the Women's Health Care Division consults and works with other Health
Department Divisions, Coastal OB/GYN Center, Carolina and Cape Fear OB/GYN, New Hanover
Community Health Center, New Hanover Network, Coastal Family Medicine, and the Department of
Social Services. She invited the Board to visit the Button Chair displayed at the entrance of the Health
Department.
Dr. Jewell thanked Ms. McCorkle for her presentation.
Monthly Financial Report - February 2000:
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Ms. Cindy Hewett, Business Officer, presented the February Health Department Financial Summary
Monthly Revenue and Expenditure Report that reflects an expenditure remaining balance of $3,992,927
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(58.42%), an earned revenue remaining balance $1,451,418 (65.43%), and a cumulative percent of
66.67%. She stated this year is a baseline year. Ms. Hewett advised the $174,590 Medicaid Cost
Settlement (October 1997-1998) funding is reflected in the report and is being spent. Thirty (30)
personal computers and computer equipment have been ordered.
Committee Reports:
Executive Committee
Dr. Jewell reported the Executive Committee at 6:00 p.m. on Tuesday, March 28, 2000. Items are listed
under New Business on the Board of Health Agenda.
Environmental Health Committee
Mr. Link, Chairman, Environmental Health Committee reported the Environmental Health Committee
met on Wednesday, March 8,2000.
Unfinished Business:
Generator Hookups at Emere:encv Shelters
Mr. Steuer, Chairman, asked Mr. Rice to give an update on the generator hookups for emergency
shelters. Mr. Rice reported the Board of Commissioners approved the contract for the School Retrofit
Project. Plans are to install manual electrical transfer switches at Dorothy B. Johnson, Trask, Eaton,
Noble, and Codington Schools, the central office, and the museum. The project should be completed 90
days from the Notice to Proceed. Mr. Steuer suggested the contractor attempt to expedite the project and
possibly complete the project by the end of June. He informed a 15k generator is available for the Animal
Control Services Shelter.
New Business:
Mr. Steuer asked Dr. Jewell to present the New Business items on the Board of Health Agenda.
New Hanover County Plan to Establish A Drainal!e Proe:ram
Dr. Jewell recommended from the Executive Committee for the Board of Health to approve for the
Health Department to continue to partner by sharing equipment with other agencies as much as possible
but would like for the County to establish a Drainage Program.
Mr. Link, Chairman, Environmental Committee, reported at the request of the Board of Commissioners,
Mr. Weaver, Assistant County Manager, addressed the Environmental Health Committee to determine the
feasibility of the Health Department Mosquito Control Program expanding to include a county drainage
program. Two scenarios were presented to the Environmental Health Committee requiring Health
Department involvement in the drainage projects. Dr. Speck referred to and inquired about the two
scenarios regarding the establishment of a Drainage Program. She expressed as complicated as the
drainage issue is; it would appear the county should establish its own drainage department. Mr. Rice
advised the County Commissioners have decided not to establish a separate county drainage program at
this time.
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Mr. Greer stated New Hanover County has many drainage issues and problems. He understands the
county could spend $1,500,000, and it would not assure a solution to the flooding and drainage problems. I
He informed the County Commissioners are addressing and are trying to make a decision regarding the
drainage. The present drainage options are to provide funding and to join with the Health Department,
to contract with a private company, or to establish a separate district or department for the drainage work.
Mr. Link stated the Health Department equipment is used most of the time by its mosquito control
program. Mr. Steuer added the Vector Control equipment generates revenues from the Core of Engineers
to eliminate mosquito-breeding areas on Eagle's Island. Mr. Rice informed the Health Department can
assist and share equipment during the winter months.
Mr. Steuer concurred drainage throughout the county is an extensive, complex problem that requires
expertise. Mr. Link expressed Vector Control is currently assisting with drainage. Dr. Goins added the
Environmental Health Committee had reservations about more Health Department involvement in
drainage. He stated Vector Control's main mission is mosquito control. It would be difficult to know
how to establish priorities to remove staff from mosquito control to drainage problems. Dr. Goins
emphasized the drainage program is a tremendous undertaking.. He expressed during hurricanes Vector
Control needs to perform mosquito control duties and not drainage issues.
Mr. Link advised the county has requested Vector Control share mosquito control equipment for
drainage based upon availability. He clarified the Vector Control Program does not have enough
equipment or staff for the county drainage project. Mr. Ken Scholar, Vector Control Manager, advised
the mosquito control equipment is currently shared with other agencies and is also used to run the Beaver
Control Program. The Health Department plans to continue to partner by sharing equipment with other I
agencies based upon availability.
MOTION: Dr. Jewell moved from the Executive Committee for the Board of Health to approve for the
Health Department to continue to partner by sharing equipment with other agencies as much as possible
but wishes the County would establish a Drainage Program. Upon vote, the MOTION CARRIED
UNAMIOUSL Y.
Post Hurricane Floyd Water Sampline: Proiect ($65.250)
Dr. Jewell recommended from the Executive Committee for the Board of Health to accept and approve a
Grant Application for the Health Department to pursue the Water Sampling Project Funding ($65,250)
and to hire two new positions in Fiscal Year Budget 2000-01 with a request for the county continuing
funding those positions in future years because of growth and need of services to provide a high level of
servIce.
Ms. Harvell informed the Health Department has an opportunity to participate in the Water Sampling and
Well Inspection Survey Program and make $65,250 through the Environmental Health Division, N. C.
Department of Environment and Natural Resources. The purpose of the project is to resample 380
positive water samples @ $57,000 and 55 samples for retesting @ $8,250 for a total revenue of $65,250.
She stated the budget request includes the establishment of two new Environmental Health positions (l
Environmental Health Specialist and 1 Clerical Specialist). It will be budgeted in the FY 2001 Revenue
Budget for Environmental Health. Ms. Harvell advised the water sampling project must be completed by I
May 31, 2000 and will take the time of one Environmental Health Specialist. She explained until the
project is completed, the annual inspections of existing Type IV and V water systems could be delayed
without a hardship to customers. A plan for catch-up will be activated after May 31 st.
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Mr. Rice reported the county provides more than 95% funding for the Environmental Health Division.
Ms. Harvell reiterated this is an educational opportunity to follow-up on positive private water samples
and water quality following Hurricane Floyd and to obtain two additional staff members needed due to
increased workload and population growth in our county. She emphasized if New Hanover County does
not participate in the post-hurricane water sampling project; other surrounding counties will accept the
one-time grant funding.
MOTION: Dr. Jewell moved from the Executive Committee for the Board of Health to accept and
approve a Grant Application for the Health Department to pursue the Water Sampling Project Funding
($65,250), to hire two new positions in Fiscal Year Budget 2000-01 with a request for the county
continuing funding those positions in future years because of growth and need of services to provide a
high level of service, and to submit the grant application to the New Hanover County Commissioners for
their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y.
Appointments to Animal Control Services Advisory Board
Dr. Jewell recommended from the Executive Committee the appointment the following applicants to the
vacant positions on the Animal Control Services Advisory Board:
Ms. Timmi Evans, Friends of Felines
Ms. Sylvia Cowan Hall, Kennel Operator
Ms. Jeannie M. Leonard, Cat Interest
Dr. Jean McNeil, Animal Control Services, stated the Board of Health approved the appointment of Ms.
Jewell Ann Diehn for Member at Large at their March meeting. She again advertised and recruited for
applicants for the above vacant positions.
MOTION: Dr. Jewell moved from the Executive Committee for the Board of Health to accept and
approve the appointment of Ms. Timmi Evans, Friends of Felines; Ms. Sylvia Cowan Hall, Kennel
Operator; and Ms. Jeannie M. Leonard, Cat Interest, to the Animal Control Services Advisory
Committee. Upon vote, the MOTION CARRIED UNAMIOUSLY.
Skin Cancer Screenin~ Grant Application ($.1500)
Dr. Jewell recommended from the Executive Committee for the Board of Health to accept and approve a
Skin Cancer Screening Grant Application from The North Carolina Advisory Committee on Cancer
Coordination and Control in the amount of$I,500.
Dr. Jewell advised this grant is identical to the skin care grant that the Health Department participated in
last year. The purpose of the grant is to conduct skin cancer screenings and to promote public awareness
activities.
MOTION: Dr. Jewell recommended from the Executive Committee for the Board of Health to accept
and approve of a Skin Cancer Grant Application from the N. C. Advisory Committee on Cancer
Coordination and Control in the amount of $1,500 and to submit the grant application to the New
Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED
UNAMIOUSL Y.
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N. C. Healthy Start Foundation Grant Application
Dr. Jewell recommended from the Executive Committee for the Board of Health to accept and approve a I
North Carolina Healthy State Foundation Community Grant Application in the amount of $128,845 over
a two-year period.
Ms. McCorkle referred the Board to an Application for The North Carolina Healthy State Foundation
Community Grants Program in the amount of $85,000 for FY2001 and for $43,845 to be included in the
FY2002 Budget. The purpose of the grant is to reduce infant mortality in the state. The priority area is
improved timing and spacing of pregnancies. The grant proposal includes funding for two (2) Maternal
Outreach Workers to be reimbursed by Medicaid. Ms. McCorkle stated the original projected budget
request was $150,000, and the revised total budget request is $128,845.
MOTION: Dr. Jewell recommended from the Executive Committee for the Board of Health to accept
and approve a North Carolina Healthy State Foundation Community Grant Application in the amount of
$128,845 over a two-year period and to submit the grant application to the New Hanover County
Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y.
Fiscal Year 2000-2001 Bude:et Update
Mr. Rice reported he met with Mr. Allen O'Neal, County Manager, and Ms. Cam Griffin, Budget
Director, and Budget Office staff members to review the Health Department Fiscal Year 2000-2001
Budget Request. Division Directors are to prioritize budget items for Capital Outlay, new positions, and
programs. These priorities will be presented to the County Budget Office.
Mr. Rice referred the Board to reports on the FY99-00 Amended Health Department Budget Request I
($9,435,033) and to the original FYOO-Ol Budget Request ($10,193,749) reflecting a 13.95% increase.
The tentative date for the Budget Public Hearing before the County Commissioners is June 5, 2000, at
6:30 p.m.
UNC Institute for Public Health
Mr. Rice reported on March 29, 2000, Dr. Rachael Stevens, Deputy Director of the North Carolina
Institute of Public Health, UNC at Chapel Hill, facilitated a brainstorming session on developing Strategic
Planning for the Health Department. Mr. Steuer, Dr. Jewell, Mr. Estep, Dr. Goins, Health Department
Division Directors, and Mr. Rice attended the luncheon meeting held in the Wood Conference Room.
Mr. Rice advised Dr. Stevens will assist the Health Department address and identify health issues and
proceed with a strategic planning process. He informed the Health Department will be the first to join
and consult with the N. C. Institute for Public Health on Strategic Planning. Dr. Jewell expressed the
meeting was most productive and that the Institute for Public Health is a tremendous resource.
Dr. Speck thanked Mr. Rice for contacting and securing Dr. Stevens and the Institute of Government as strategic
planning resources. Dr. Jewell and Dr. Smith commended Mr. Rice for assuring the Board of future planing with
Dr. Stevens and the UNC Institute for Public Health. Mr. Estep emphasized the Health Department will save
potential tax dollars and should advise the County Commissioners of the potential.
Comments:
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Board of Health Members
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Staff Appreciation Luncheon
Ms. Rowe reminded the Board members to attend the Staff Appreciation Luncheon on Thursday, April
13, 2000, and to plan to stay and clean-up following the employee luncheon.
Permanent Dates for Staff Appreciation Luncheon and Health Department Christmas Party
Mr. Rice reported that the Management Team recommended the establishment permanent dates for the
following activities:
Staff Appreciation Luncheon - 2nd Thursday in April
Annual Health Department Christmas Party - 2nd Thursday in December
MOTION: Mr. Link moved seconded by Dr. Goins for the Board of Health to approve and adopt the
permanent dates of the second Thursday in April for the Staff Appreciation Luncheon and the second
Thursday in December for the Annual Health Department Christmas Party. Upon vote, the MOTION
CARRIED UNAMIOUSL Y.
Health Director
Kine: Mackerel- Mercurv
Mr. Rice reported a press conference was held on Thursday, March 23, for public awareness of the higher
than normal levels of mercury in large king mackerel caught off the coasts of North Carolina, South
Carolina, Georgia, and Florida. Dr. Luanne Williams, Toxicologist, and state health officials issued a
state consumption advisory regarding the mercury found in large mackerel. It alerted fish processors not
to accept king mackerel over 39 inches long. Mr. Rice stated this will affect fishing and the economy. It
is a public health problem that needs addressing.
Dr. Speck and Mr. Steuer inquired about the mercury level and safety of consumption of other species of
ocean fish i.e. tuna, wahoo, swordfish, etc. Ms. Harvell responded the South Atlantic Fishery
Management Council is responsible for the management of king mackerel from North Carolina through
Florida while the North Carolina Marine Fisheries Commission is responsible for king mackerel in our
state waters. These management groups plan to discuss this issue in the near future to determine if
additional fisheries regulations are needed. Ms. Harvell advised the Environmental Protection Agency
(EPA) is working to control the level of mercury in the environment and trying to get legislators to
support the efforts to identify the risks of environmental mercury. The N. C. Department of Human
Resources is getting information for the public regarding the safety of consumption and mercury levels.
Ms. Harvell informed the processing plants are under the Department of Agriculture.
Dr. Speck suggested sending a letter to legislators addressing the concerns of the Board of Health
regarding obtaining better controls, more research, and more monitoring of mercury levels in the
environment and in fish. She stated this is a global problem. Mr. Steuer emphasized this issue needs to
be better coordinated among governmental agencies.
The Board of Health concurred more information on the mercury levels in fish is needed. Mr. Rice
suggested inviting Dr. Luanne Williams, Toxicologist, N. C. Department of Health and Human Services,
to speak to the Board on mercury levels in ocean fish to the Board of Health. The Board requested Mr.
Rice contact Dr. Williams to address this issue.
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West Nile Virus Press Release
Mr. Rice advised the Centers for Disease Control (CDC) Morbidity and Mortality Week Report
(MMWR) featured an article on West Nile Encephalitis. Mosquitoes collected in New York tested
positive for the West Nile Encephalitis Virus. Health officials are concerned about the possible
introduction of West Nile Encephalitis into North Carolina. Surveillance, prevention, and response
efforts are being addressed locally and by the state. The virus is introduced by birds and transmitted by
mosquito bites.
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Mr. Ken Sholar stated the Health Department Vector Control Program plans to focus on crows and
seagulls especially the seagulls at the county landfill. New Hanover County has checked for eastern
equine encephalitis for years and will get two more flocks of sentinel chickens in May to be tested for the
West Nile virus. He explained that sentinel chickens provide an excellent warning system for detecting
the virus, and the state plans to test blood samples from the flocks every two weeks.
Mr. Sholar informed many counties in the state do not have mosquito control programs; in fact, New
York City does not have a mosquito program. The state is seeking CDC funds to expand and enhance its
West Nile detection and surveillance activities of the West Nile Virus.
Ore:anizational Capacity Assessment Update
Mr. Rice thanked the Board for completing their abbreviated Organizational Capacity Assessment I
surveys. He reported 130 (77%) of 169 employee questionnaires were completed and returned. It was a
volunteer effort. The Accessing, Evaluating, Improving, our Opportunities are Unlimited (AEIOU) Team
will process the information from a summary report being prepared by Coastal Area Health Education
Center. The AEIOU Team is to identify and to analyze strengths and opportunities to improve.
NHN/NHCHD Senior Manae:ement Meetine:
The New Hanover Network and the Health Department Management Teams met on March 6, 2000. The
group addressed health care issues, exchanged ideas, and identified common areas the agencies could
work together on.
UNCW Adult Scholars Presentation - March 9. 2000
On March 9, 2000, Mr. Rice gave a presentation on Public Health Issues to UNCW Adult Scholars at the
UNCW campus.
Healthy Carolinians Task Force - March 22. 2000
Mr. Rice attended the Healthy Carolinians Task Force meeting on March 24,2000. emphasized the New I
Hanover County Healthy Carolinians Task Force has been a force since the early 1900's and was
instrumental in the establishment of Wilmington Health Access to Teens (WHAT). The Task Force
plans to request a one-year extension before applying for recertification.
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Information for Board of Health
Mr. Rice referred the Board to supplementary information in their folders on the following King
Mackerel and Mercury, West Nile Virus, AEIOU, Serving Safe Food, and a County CommissionerlBoard
of Health Directory, a Dangerous Dog Report, EPI Information Newsletter, an article from Commissioner
Buzz Birzenicks, and a copy of the Animal Control Services Advisory Committee Meeting.
Other Business:
Public Health Month
April is Public Health Month. Mr. Rice reminded the Board members to get their Public Health Month Calendars
and Public Health Buttons. He again reminded Board members of the Staff Appreciation Luncheon on Thursday,
April 13,2000. Lunch will be served ÍÌ"om 12 Noon - I :30 p.m. Cooks were asked to arrive by 11 :30 a.m.
Animal Control Services Citations
Dr. Jean McNeil, Animal Control Services Director, reported approximately 1,300 citation letters were
mailed. Follow-up of the citations will be through a collection agency if the violators do not appeal. The
appeal process will start on April 19 with Attorney Andrew Olsen serving as the Appeals Officer.
Dr. McNeil emphasized the public was given ample time to get their pet immunizations and to get pet
licenses. A brochure entitled "Rabies Protecting Your Family and Your Pets" was included in the V al-
Pak coupon mailer and public service announcements were prepared for the media. Pet owners may get
their pets immunized for a $6.00 fee at a Rabies Clinic on April 16th at the Animal Control Services
Shelter.
Rubella in North Carolina
Mr. Rice reported he received a letter from Ms. Beth-Rowe West, Head ofImffiunization Branch, N. C.
Department of Health and Human Services, stating since the first week of March, 14 cases of Rubella
have been confirmed in North Carolina. He advised the cases of Rubella occur primarily in the
Latino/Hispanic population that has not received their Measles, Mumps, Rubella (MMR) vaccination.
Mr. Rice stated the Health Department will be proactive in outreach efforts to increase community
awareness and to provide immunizations targeting the Latino/Hispanic population.
Shi~ella Update
Ms. Gela Hunter inquired about the status on Shigella in New Hanover County. Mr. Robert Keenan,
Environmental Health Specialist on the Epidemiology Team, reported 11 cases were reported this past
month. He advised the Health Department sent letters to day care centers and is visiting the day care
centers to collect samples and make sure precautions and guidelines are being followed. He stated the
disease seems to be under control.
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Adjournment:
Mr. Steuer adjourned the regular meeting of the New Hanover County Board of Health at 10:05 a.m.
¿{~ J~
William T. Steuer, PE/RLS, Chairman
New Hanover County Board of Health
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David E. Rice, M.P.H.,M.A., Health Director
New Hanover County Health Department
Approved:
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New Hanover County Health Department
FY 99 - 00
MONTHLY REVENUE REPORT
As of February 29, 2000
Summary for the New Hanover County Health Department
Cumulative %
66.64%
Month 8 of 12 Feb-OO
Month Reported
Current Year (Through Jan 2000 PrIor Year rough December)
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned RemaIning
Federal & Slate 1,387,878 648,512 539,388 61 14% $ 1,377,269 843,419 533,850 61.24%
AC Fees 516,453 249,769 266,664 48.38% $ 493,100 235,532 257,566 47.77%
Medicaid 852,664 442,721 410,163 51.91% $ 824,754 407,951 418,803 49.48%
Medicaid Max 192,301 388,891 (174,590) 190.79% $ 250,066 401,766 (151,702) 160.66%
EH Fees 312,900 167,771 145,129 53.62% $ 236,000 161,427 74,573 68.40%
Health Fees 109,515 94,683 14,832 88.46% $ 98,085 70,503 27,562 71.69%
other 776,172 526,338 249,834 67.81% $ 566,457 395,717 170,740 69.88%
Note: County Appropriation Is not calculated above. The County appropriation Is the difference between the tolalamounia on the
program expenditure report and the totals on the program revenue report.
The budgeted amoun! for County AppropriatIon for FY 99 - 00 Is ($9,435,033 - $ 4,146,103) = $ 5,288,930.
The expended amoun! for County Appropriation for this FY (year-to-dale) Is ($5,512,108 - $ 2,696,685) = $ 2,815,421.
Revenue Summary
For Month of February 2000
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New Hanover County Health Department
FY 99 - 00
MONTHLY EXPENDITURE REPORT
As of February 29, 2000
Sunvnary for the New Hanover County Health Department
CumulatIve %
66.67%
Month Reportad
Month 8 of 12; Feb-OO
Budge1ed
Amount
Cunent Year
Expended Balance
Amount Remaining
%
Budge1ed
Amount
PrIor Year
Expended Balance
Amount Ramalnl
%
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Expenditure Summary
For Month of February 2000
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.{J Sharon Neuschafer
To; David E Rice/NHC@NHC
cc;
03/09/2000 11 ;02 AM
Subject; Motions EH Committee
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030800 motions.wpd
11
e NHC Plan to Establish a Draina2e Pro2am
Dr. Goins moved, seconded by Mrs. Rowe for the Health Department to continue to partner by
sharing equipment with other agencies as much as possible but wish the County establish a Drainage
Program. Upon vote, the MOTION CARRIED UNANIMOUSLY.
Post Flovd Hurricane Water SamDlin2 Proiect
Dr. Goins moved, seconded by Dr. Smith for the Health Department to pursue the Water Sampling
Project Funding and hire two new positions in fisca1 year 2000-01 with the county continuing funding
those positions in future years because of the growth and need of services to provide a high level of
service. Upon vote, the MOTION CARRIED UNANIMOUSLY.
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March 1,2000
SCENARIO 1
DRAINAGE MAINTENANCE CONTRACTED OUT BY COUNTY
All work will be performed by request from Engineerinw'Drainage to the Health
Department as workload allows, and with private contractors as needed. It may be
more desirable to expand the Heath-Vector Control Program, if possible, rather than
create a Drainage Division under Engineering.
Personnel Requirements
Engineer
. Work with Drainage Committee
. Communicate with public
. Contracts projects
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Technician
. Assists Engineer
. Inspects contractor's work
. Acquires easements
. Acquires necessary permits
1 - Engineer
1 - Technician
$ 45,000
35.000
$ 80,000
Contracted Services $ 274,000
Postage 1,000
Printing Charges 500
Dues and Subscription 500
Employee Reimbursements 3,000
Equipment Rental 100,000
Training and Travel 1,000
Supplies - Pipe, small tools 20.000
$ 400,000
e Capital
Pick-up Truck $ 20,000
Total $ 500,000
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March 1, 2000
SCENARIO 2
DRAINAGE MAINTENANCE BY COUNTY
All work will be performed by the County, either by a drainage crew under the
Engineering Department or by expanding the Health Department-Vector
Control operations. Work would be contracted out only as necessary.
1 - Engineer
1 - Technician
1 - Heavy Equipment Operator
2 - Laborers
Contracted Services
Postage
Printing Charges
Dues and Subscriptions
Employee Reimbursements
Equipment Rental
Training and Travel
Supplies - Pipe, tools, etc.
Equipment Repair
Installment debt on
equipment listed below
Total
$ 45,000
35,000
30,000
48.000
$ 158,000
$ 630,328
1,000
500
500
3,000
50,000
1,000
30,000
30.000
$ 746,328
$ 95.672
$1,000,000
CaDital $ 170.000
Truck-mounted backhoe
Dump truck 80,000
Trailer 15.000
e Tractor 30.000
Side cutter mower 5,000
Rear cutter mower 3,000
2 - Pick-up trucks 40.000
Loader Backhoe 60.000
14
$ 403.000
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-HE Ani-! EXEC.4. TI U~ C DM!)) ~
NEW HANOVER COUNTY BOARD or ~UMMI
REQUEST FOR BOARD ACTION
Meeting Date: e4~3/00
03 '<>>J /~ooo
__r..."._....
~--::.._.. --.
Department: Health Presenter: Dianne Harvell, Environmental Health Director; David Rice,
Health Director
Contact: Dianne Harvell, 343.6665
SUBJECT:
State Water Sampling and Well Inspection Survey Program (Projection for
Revenue Earned is $65,250)
BRIEF SUMMARY:
On March 8, 2000, the New Hanover County Board of Health (BOH) Environmental Health
Committee approved participation in the Water Sampling and Well Inspection Survey Program
through the North Carolina Department of Environment and Natural Resources, Division of
Environmental Health. The committee approved earmarking the $65,250 earned through this
program for the two new positions (Clerical Specialist I and Environmental Health Specialist) and
associated operating expenses (computer/printer $2,500;
Registered Sanitarian Renewal $35; uniforms $500; other supplies $265) for the positions
requested in the Fiscal Year 2001 Budget Request for Environmental Health. (Total Salary and
Fringe $61,950; operating budget for the two positions $3,300=Total $65,250.)
Through participation in this program, we project earning $65,250 in revenue. We will receive
$150 for collection of each sample and completion of legible forms accurately and completely
Please refer to the attached memo dated March 6, 2000, from Dianne Harvell explaining
rescheduling of work which must be done to participate in this program. In order to perform the
requirements of the Water Sampling Program and to earn the revenue, some routine work must
be postponed. In order to perform the postponed work, the two new positions included in the
FY2001 Budget Request become critical.
The revenue, although earned in this FY2000 budget before May 31,2000, would not be
budgeted in this fiscal year, but would be rolled forward into the FY2001 Revenue Budget for
Environmental Health to fund these two positions.
Refer to the attached MEMORANDUM OF UNDERSTANDING (MOU) dated 2/29/2000 between
New Hanover Health Department and NCDENR Division of Environmental Health. The MOU refers
to a contract amount of $57,000, but there will be contract addenda for an additional $8,250 for
an additional 55 samples for re.testing, bringing the total to $65,250.
We request your approval to provide this service, accepting the revenue of $65,250 to fund the
two positions ($61,950) and associated operating expenses ($3,300) in the FY 2001 Budget
Request.
RECOMMENDED MOTION AND REOUESTED ACTIONS:
Approve providing the Water Sampling and earmarking the $65,950 earned revenue in the Fiscal
Year 2001 Budget Request for the two new Environmental Health positions.
FUNDING SOURCE:
State Funding from the North Carolina Department of Environment and Natural
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Resources.Division of Environmental Health
ATTACHMENTS:
Yes, 14 pages (last 8 pages showing statistics and justification for new positions)
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State Water Sampling And Well Inspection Survey Project
Budget
July 1, 2000 - June 30, 2001
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Expenses Income
Environmental Health Specialist DENR Contract I - Resample Positives
Salary + Fringe $35,035 380 Samples X $150/Sample $57,000
Uniforms 500
Registration 35
.................................................................................................................. ....................................................................................
............................-
Clerical Specialist I DENR Contract II - Sample Controls
Salary + Fringe 26,915 55 Samples X $150/Sample 8,250
Computer 2,500
................................................................................................................... ...................................................................................
...............................
Total $64,985 Total $65,250
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL HEALTH
2/2912000
MEMORANDUM OF UNDERSTANDING
Between _Ne.u>~\J'~ealth Department and the
NCDENR Division of Environmental Health
RE: Payment for the Water Supply and Well
Construction Program
This memorandum provides for payments to the local health department for work performed to collect
bacteriological and nitrate samples and to complete Water Sample and Well Construction Survey forms.
Services requested are as follows:
Collection of bacteriological and nitrate
samples, including completion of accompanying
laboratory forms and submission of samples
and forms to the NC State Laboratory of Public
Health as required by standard operating
procedures.
-- Completion of Water Sample and Well Construction
Survey forms and submission of forms biweekly to the
NCDENR Division of Environmental Health
Only one payment of $ 150.00 per well is pennitted. For example, a local health department will receive
$150.00 for collection of samples and completion of legible forms accurately and completely.
For your use, survey forms with names and addresses for the wells in the county are enclosed. If needed name
and address corrections and additions must be made on the heading of the survey form by the local health department.
Water sample collection kits will be provided at no cost to the local health department by the NC State Laboratory of
Public Health. All samples collected pUl1iuant to this program mr.:bt.b~ submitted to the NC State Laboratory of Public
Health. ~7.000.00
The total amount paid to your local health shall not exceecr13i&3pa--without prior approval of the Division of
Environmental Health. The local health department will be paid monthly for work and all accompanying forms
satisfactorily completed. Warer samples and accompanying laboratory forms shall be submitted to the NC State
Laboratory of Public Health in accordance with standard operating procedures. Water Samples and Well Constroction
Survey forms shall be submitted to Stacy Covil, Division of Environmental Health, 1632 Mail Service Center, Raleigh,
NC 27699 on March 15, March 31, April 14, April 28, May 12, and May 31,2000. All water sample collection and
submission of forms must be completed on or before May 31, 2000.
The terms discussed in this memorandum are agreed to and made by:
PLEASE RETURN TWO (2) SIGNED ORIGINAL MEMORANDUMS OF
UNDERSTANDING TO:
Department of Environment and Natural Resources
Division of Environmental Health . In. ,\ I L , tn .r'
1632 Mail Service Center ~UY rrllnil v-U
Raleigh, NC 27699 -1632 d);~partment
Signature Signature ~ 1~1/III4:)
Linda Sewall, Director Health Department Director
-
--.--.-
1830 MAIL SI!RVICE CENTER, RALEIGH, NORTH CAROLINA 27688.1630
PHONE 818.733.2870 FAX 818.718.3280
AN EQUAL OPPORTUNITY I A....IRMATIVE ACTION EMPLOYER. SO% RECYCLED/tO,," POST-cONSUMIl:R PAPER
18
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Memorandum
To:
David Rice, Health Director
Lynda Smith, Assistant Health Director
From:
Dianne Harvell, Environmental Health Director
Date:
March 6, 2000
Subject:
State Water Sampling And Well Inspection Survey Program
A NCDENR representative contacted us last week to inquire about our
participation in the above referenced program, Specifications can be found in an
accompanying February 22, 2000 memorandum from Malcolm Blalock, Deputy Director,
Division Of Environmental Health, NCDENR
The following factors must be considered before making a decision as to whether
or not we participate:
>- single largest amount of state funding ever offered to local environmental
health programs
>- sample and survey private wells that tested positive after Hurricane Floyd
>- 383 samples tested positive in New Hanover County, greater number than any
other county
>- additional 50 to 75 control samples/surveys can also be completed
>- reimbursement is $I50/each well sampled & surveyed
>- must be completed by May 31, 2000
>- due to number (433 to 458 samples/surveys), will take one full time
Environmental Health Specialist (EHS) between now and conclusion date to
implement
>- some routine work will have to be postponed until project completed
>- only work that can be postponed without great hardship to customers is annual
inspections of existing Type IV and V wastewater systems
>- only equipment/material cost is GPS unit, NCDENR will provide sampling
supplies
>- need to advise NCDENR whether or not we will participate immediately
>- if no. neighboring counties (Brunswick and Pender) are prepared to conduct
this project here as well as in their own counties
>- if yes. we will need additional staff after May 31, 2000 to complete postponed
work
>- new EHS position requested in forthcoming budget year can be assigned
wastewater system inspections (three to four months beginning in either July
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or August) to help existing staff recover rather than immediately undertaking
proposed assignments in Food Safety and Indoor Air Quality Programs
>- earnings (>$60,000) from participation earmarked for proposed new EHS and
Clerical Specialist positions (will cover salaries and benefits for one year)
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e ~ Malcolm Blalock <Malcolm.Blalock@ncmail.net>on02/22/200001:14:03 PM
To: "Environmental Health" <ehl@deh.enr.state.nc.us>
ee: (bee: Dianne Harvell/NHC)
Subject: Water Sampling and Well Inspection Survey Program
********IMPORTANT--PLEASE FORWARD THIS MESSAGE TO YOUR
ENVIRONMENTAL HEALTH
PROGRAM****** WE WILL NOT BE SENDING THIS MESSAGE IN HARD COPY
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The Special Session of the General Assembly which convened in
December, 1999
appropriated funds to assist with Hurricane Floyd assessment and
recovery. Of
the funds appropriated, approximately $1,000,000 were earmarked
to address
public health concerns, including monitoring water quality from a
public health
perspective. Part of these funds will be used to fund the
following new
program.
This memorandum is to announce a new program to determine the
impact of flooding
on private water supplies in eastern North Carolina. We are
trying to get
answers to the following questions:
1. Are wells that are properly constructed and located safer than
those that are
not?
2. Are there
connected to
Public Water
3. Are there
contaminated
wells?
clusters
a
Supply?
continuing
of contaminated wells that might be easily
problems with contamination of previously
e
The Water Sample and Well Construction Survey Program will answer
these
questions. We plan to contract with local health departments
listed below to
sample and inspect each well tested positive for coliform
(post-Floyd samples) .
The wells will be sampled for total coliform, fecal coliform, and
nitrates. An
inspection form will also be completed for each well sampled.
The Program will
pay $150.00 for each well sampled and inspected.
21
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We will supply each county with a form with the name and address
of each well we
want included in the program. This information has been
collected from the
State Laboratory of Public Health's database of positive samples.
In addition,
we want to sample a number of "controls" (properly constructed
wells in
counties with a local well construction program) .
Data entry will be provided by the State. However, completed
inspection forms
should be submitted to us bi-weekly so that we can keep up
We plan to contract exclusively with the local health departments
to conduct
this work. We will seek other contractors to do the work in any
counties who
do not elect to participate. This program must be completed by
June 1, 2000 so
that a report of it's findings can be made by end of the fiscal
year, June 30,
2000.
We are contracting with Mr Stacy Covil to manage this program.
He will be
contacting you by telephone soon to begin your participation. In
the meanwhile,
if you are interested in participating, please contact Mr Covil
at:
Stacy Covil
1630 Mail Service Center
Raleigh, NC 27699-1630
(919)715-2863 Office
(910)259-8974 Home
stacy.covil@ncmail.net
If you have any questions, please feel free to contact Mr Covil
or me.
Counties included in this program:
Beaufort Bertie Bladen Brunswick
Camden
Carteret Chowan Columbus Craven
Cumberland
Duplin Edgecombe Gates Greene
Halifax
Harnett Hertford Hyde Johnston
Jones
Lenoir Martin Nash New Hanover
e Northampton
Onslow Pamlico pasquotank Pender
Pitt
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EP"
r"~"-"
! ,"Td
,........-. (L;..v".
1"": .
Dianne Harvell
03/08/2000 08: lOAM
To: Sharon Neuschafer/NHC@NHC
cc:
Subject: Personnel Needs
FYI
Forwarded by Dianne HarvellfNHC on 03/08/2000 08:07 AM
~hl).. .
~"i".r d
f.-.;.. (L.......
, .
r
Dianne Harvefl
03/08/2000 08:09 AM
To: Pat Melvin/NHC@NHC
cco David E Rice/NHC@NHC. Lynda Smith/NHC@NHC
Subject: Personnel Needs
Work that will not be comDleted due to inadeauate Dersonnel in Environmental Health
Division Is Droiected as:
350.400 food safety and sanitation evaluations of food service. child care. Institution.
lodging and public swimming pool facilities will not be com Dieted.
Evaluations that are completed often laell effectiveness because time constraints require
that they be conducted in an enforcement rather than educational mode.
=: 120 physician diagnosed foodborne illness cases will not be thorouGhlv InvestiGated so as
to prevent further occurrence.
A significant percentage of the 500-600 restaurant complaints received annually will not be
InvestiGated & abated.
=:36 children will be diagnosed with high blood lead levels & 36 sources of lead exposure l!l!IIL
not be identified & mitiaated as a result of inadequate time to conduct environmental
surveys of primary/secondary housing. child care facilities. etc.
Several dozen citizens who annually request investigation of Indoor air quality Issues l!l!IIL
not be served.
Development of a geographic data base mapping known locations of groundwater
violations to avert the permitting of drlnldng water wells In contaminated aquifers will not
be com Dieted.
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~ 130A-39. Powers and duties of a local board of health.
(a) A local board of health shall have the responsibility to protect and promote the public
health. The board shall have the authority to adopt rules necessary for that purpose.
(b) A local board of health may adopt a more stringent rule in an area regulated by the
Commission for Health Services or the Environmental Management Commission where, in the
opinion of the local board of health, a more stringent rule is required to protect the public health;
otherwise, the rules of the Commission for Health Services or the rules of the Environmental
Management Commission shall prevail over local board of health rules. However, a local board of
health may not adopt a rule concerning the grading, operating, and permitting offood and lodging
facilities as listed in Part 6 of Article 8 ofthis Chapter and as defined in G.S. 130A-247(1), and a local
board of health may adopt rules concerning wastewater collection, treatment and disposal systems
which are not designed to discharge effluent to the land surface or surface waters only in accordance
with G.S. 130A-335(c).
(c) The rules of a local board of health shall apply to all municipalities within the local board's
jurisdiction.
(d) Not less than 10 days before the adoption, amendment or repeal of any local board of
health rule, the proposed rule shall be made available at the office of each county clerk within the
board's jurisdiction, and a notice shall be published in a newspaper having general circulation within
the area of the board's jurisdiction. The notice shall contain a statement of the substance of the
proposed rule or a description of the subjects and issues involved, the proposed effective date of the
rule and a statement that copies of the proposed rule are available at the local health department. A
local board of health rule shall become effective upon adoption unless a later effective date is
specified in the rule.
(e) Copies ofall rules shall be filed with the secretary of the local board of health.
(f) A local board of health may, in its rules, adopt by reference any code, standard, rule or
regulation which has been adopted by any agency of this State, another state, any agency of
the United States or by a generally recognized association. Copies of any material adopted by
reference shall be filed with the rules.
(g) A local board of health may impose a fee for services to be rendered by a local health
department, except where the imposition of a fee is prohibited by statute or where an employee
of the local health department is performing the services as an agent of the State. Notwithstanding
any other provisions oflaw, a local board of health may impose cost-related fees for services
performed pursuant to Article 11 of this Chapter, "Wastewater Systems," for services performed
pursuant to Part 10, Article 8 of this Chapter, "Public Swimming Pools", and for services performed
pursuant to Part 11, Article 8 of this Chapter, "Tattooing" Fees shall be based upon a plan
recommended by the local health director and approved by the local board of health and the
appropriate county board or boards of commissioners. The fees collected under the authority of this
subsection are to be deposited to the account of the local health department so that they may be
expended for public health purposes in accordance with the provisions of the Local Government
Budget and Fiscal Control Act. (1901, c. 245, s. 3, Rev., s. 4444; 1911, c. 62, s.
9;C.S.,s. 7065, 1957,c. 1357,s. 1, 1959,c. 1024,s. 1, 1963,c. 1087; 1973,c.476,s. 128;c. 508,
1977, c. 857, s. 2; 1981, c. 130, s. 2; c. 281, c. 949, s. 4,1983, c. 891, s. 2; 1985, c.
175, s. 1,1989, c. 577, s. 2; 1991 (Reg. Sess., 1992), c. 944, s. 10; 1993 (Reg. Sess., 1994), c. 670,
s. 2, 1995, c. 507, s. 26.8(c).)
24
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New Hanover Countv
Animol Control Services
Advisory Committee Appointments
The following positions are vacant per the new rotation scheduling and one resignation effective
December 1, 1999:
Member @ Large - filled
Friends of Felines
Kennel Operator
Cat Interest (person would fill the remainder of term; to expire December 2000)
The applications have been received for kennel operator and Friends of Felines.
ACS can re-advertise for the other open position and pursue contact with a possible member of
the cat group to seek their representation on the committee.
03/23/00jpm
25
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NEW HANOVER COUNTY
ANIMAL CONTROL DMSION
220 DMSION DRIVE
WILMINGTON, NORTH CAROLINA 28401
TELEPHONE (910) 341-4197
FAX (910) 341-4349
DAVID E. RICE
HcaUh Director
JEAN P. McNEIL
Animal Control Director
New Hanover County Animal Control Services
220 Division Drive
WilininlJton. N.C. 28401
(910) 341-4197
Aoolication for Aooointment to Animal Control Advisory Committee
Category Interest: <7 s:.L.'V--~ ~ ~~
()~
Name: ~ "-"- "^ \. ~ ~ 0.. to... \ c;.
C <>Y.\ ~ QW '1> c\
.
Address: \. d--. S
C- '-.i'\ \ ,\..~ N Q. '(
\_o..l0e
City: W ... L ^-^- ... N c., \: 0 r0
'..J
)
NL
Telephone: Home: '6 C\ 'd--. - \ ~ ~ -,
Business:
)Q- A.AJ'-O
~ ,,"--'"' J-.j...Q
Why do you wish to serve on the Animal Control Advisory Committee?
OJ """~ ~ "--"---~ ~,,--0 -k-~f'o...Q. '-'-- ~JLQy't N2
~~ ~\.)...O ~"'-'-I..A"'~"- c:YG l'.:J e ~~ c~o
What areas of concern would you like to see the Committee address? ~ C')S:s~,V'-~
. ~.
~,-""'0 ~\~ G'-&\J....I'o..-LCUL~;0 ,\,Q X '\ l'-<~~LcC\'\..."-
-r-'-'--~"--\.. ~'(C'-L~ / ~ Q L'-\::Q.', .~ ~ _) p -<:.-*..
Date: ~/"1-1 0 ()
I .
~~~ ~~
Signature
'YOU/t dfeaftl'z-OlL't fP'tio'ti1!J
26
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238 P01
MAR 22 '00 "6:41
NEW HANOVER COUNTY
ANIMAL CONTROL DrV1SJON
220 DMSION DRIVE
WILMINGTON, NORTH CAROLINA 28401
TELEPHONE.' (9/0) 341-4197
FAX (910) .141-4349
DAVID E. RICE
tlculth Director
Jll:AN p, M<NEll
Animal Control LJil'~('tcr
New H"nnver Coumv Animal Control Services
220 Division Drive
WIhrJ1mon. N.C. 28401
(910)341-4197
Annlication ror ADDointmcnt to Anima1 Contrd Advisory Committee
Category Interest: K{.",-~....L tfl1,.c"'r-J.'-' L ~~
Name: ..:5 V UJ I Fl C O.tu fiN HALL.
Address: :r '1 .:l. '-I Lt-4 ceIl L{J, t..l D I ~r:
City: tJ I L"'" I N Cd TO ,,-I , IN t... ~ g 4D~
Telephone: Home: '1; 0 -"lq'i -1.. flY"
Business: 9 I Q -7'1'1 -;). g 'l r
Why do you wish to serve OD. the Animal Control Advisory Coromittee?_
J-4.-
ftL..t... , .d ......... I ,
5
",-tv,
,\ .
L~____9:,~hL, ,..k...
r~ L'f 'J- ~
'f\_L.U__ R..N~: ..L<J..yQ.J,A/~'-Lt..--) ~L ~) ru.6> r1..--J-.-
,'~ .' . fl.. '.lJ ~ ,'L__ r
~ 1l.4'"}I.4A.V- <.l."1l.Ri .)2-}l..q1L! r>--L ' ~...... ~ If2N"OU. .
What areas of concern would you like to see the om:ninee address" I'd TiT... ~ ~~~;
IILClL f~"f-Lc-"--'_><-L/' ~ c-~t 0-:l.- ~I.-U c..~.
~. ru....~~~.- t '-F ~~Ly.
\
Date: Th "--i ,J^--, .;:l,:2.. )'lJDD
.
c;f)lb.-CV:, fD ~ ~L
Signature
1}01.l.'l. dfEalth -eJl.I.'I. [Pw'tU:!J
27
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.lAd/David E Rice _.. ~
1"y 03/27/2000 02:57 PM ~
~~""""~~-"""""""~+fu~,,,,,~~~:::;,::~,,#\>'~'~;::"!.l,I,<'lJc=~lO;o;,=,#,,,,,,, :o.'~i;l~l;';;:r'~,,,",,~.~c'<'~;;til:~~
To: Jean McNeil/NHC
cc: NHCBH Executive Committee
Subject: Re: ACS Advisory Committee Appointment
Jean,
Please be prepared to present this as a recommendation tomorrow evening.
Thanks, Dave .)
Jean McNeil
Jean McNeil
03/2712000 02:22:37 PM
To: David E Rice/NHC@NHC
cc:
Subject: Re: ACS Advisory Committee Appointment
I received an application for the cat interest position today This is from Jeannie Leonard. a
member of the Cat Adopt Team. I would like to know if I should bring this one along with the
other two to the Executive Meeting of the Board of Health tomorrow evening, or wait until next
month. This position would fill the last vacancy on the committee.
28
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NEW HANOVER COUNTY
ANIMAL CONTROL DIVISION
220 DIVISION DRIVE
Wll..MINGTON, NORTH CAROLINA 2840]
TELEPHONE (910) 341-4197
FAX (910) 341-4349
DAVID E. RICE
Health Direetor
JEAN P. MeNEIL
Animal Control Director
New Hanover County Animal Control Services
220 Division Drive
WIhniIllrton. N.C. 2840]
(910) 34]-4]97
Application for Appointment to Anirna1 Control AdviSory Committee
{At J;tu~
\'Q ~t"d
Address: ~ l1 \.3 &o..\Q i:t&Lto.N...
City: \..0; \1"I\,/"\~..}on r-Je. ~4' ~
Telephone: Home: O~ -15 a 1 Business:--.B9 d.. '\30.5
Why do you wish to serve on the Anirna1 Contr<;l] Advisory Committee? _~ ~i6:i-
{4 CDrvlPlrHe-L i/"\ ~'~'0A5 IOhic.h 0.[0(.(.,+ ~
Category Interest:
Name: ""S"~ onnlt....
Q.OlfV'\~\ ~ 10. +; 0 V')
What areas of concern would you like to see the Committee address?
Date:
t3~ (J)
<yOU.'t C#ealtfz -<DlL't P'tLo'ti1!J
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NEW HANOVER COUNTY BOARD OF HEALTH
EXECUTIVE COMMITIEE
REQUEST FOR BOARD ACTION
Meeting Date: 03/22/00
Department: Health
Presenter: Betty Jo McCorkle, Women's Heahh Director
Subject: Mini-Grant Application for Skin Cancer Screening ($],500)
Summary:
The North Carolina Advisory Committee on Cancer Coordination and Control has invited
local Heahh Departments to apply for mini-grants to conduct skin cancer screenings and
public awareness activities. We are requesting the full $1,500 to conduct a cancer
screening at one of our local beaches, and to purchase educational materials and
incentives to distribute to people on the beach.
We will be collaborating with the Coastal Care Van from New Hanover Regional
Medical Center, the American Cancer Society, and WiJmington Heahh Access for Teens,
(WHAn. The Care Van will provide a private area to conduct skin cancer screenings,
with the assistance of a local dermatologist that volunteers her time for these activities.
The peer educators from WHAT will be available to distribute pamphlets and incentives
to beach-goers. The American Cancer Society will assist in providing educational
materials.
The bulk of the grant funds will purchase materials and incentives. The only other
expense may be approximately $400 to pay for the expense of the Care Van for a one day
screening.
Recommended Motion and Requested Action:
Approve grant application to be forwarded with approval of budget amendment for
$1,500 if grant is awarded
Funding Source:
NC Advisory Committee on Cancer Coordination and Control - no matching funds
required.
Attachments:
Yes - 2 pages (copy ofJetter and application form)
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Application for Skin Cancer Screening
Date: J 11'l1f~tfO
HoUth_~"" /fr' ~~~CL
Director's Signature: ~
,
Please answer the following questions in two or three hriefsentences (attach additional pages if
necessary to include any information that would help in the selection process):
I. Describe the components of your proposed skin cancer screening event.
The New Hanover County Health Department proposes to offer free skin cancer
screening at one of our area beaches, most likely Wrightsville Beach. Screenings will be
offered during peak sun hours, during the first or second week of June. New Hanover
Heahh Network's Coastal Care Van will be on site to provide a private area for screening
and consultation with nurses and a dermatologist.
2. Describe any partner organizations you would involve and their role(s).
New Hanover Health Network will be providing the Care Van, and arranging for a
dermatologist to provide screening.
The American Cancer Society will provide educational materials and incentives to offer
to the public on the day of the event. An ACS representative will be present.
Peer Educators from Wilmington Health Access for Teens (WHAT) will provide
incentives and information on the beach during the event, to recruit people to come to the
Care Van for information and screening.
3. How many people do you anticipate being screened?
We are hoping to have a dermatologist on site for at least 4 hours (hopefully 5).
Allowing for approximately 15 minutes per person, we hope to screen between 15 and 25
people.
4. Describe any preventive activities you would include?
The Peer Educators from WHAT will provide prevention and early detection information
to sunbathers on the beach. We will also provide the same information at the Care Van,
and samples of sunscreen
Please mail or fax completed applications by March 27,2000 to:
Fax Number: (919) 733-0488
Christine Klein
NC Advisory Committee on Cancer Coordination & Control
DHHS - Division of Public Health
1915 Mail Service Center - Raleigh, NC 27699-1915
30
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p;; North Carolina Advisory Committee
~ on Cancer Coordination and Control
Joseph S. Pagano, MD, Chair H. David Bruton, MD, Vice Chair ,4/)0 B
-"'~"._~"~'- fJ~
Mm.h9,20" ft!!jJ
Mr. David E. Rice
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
Dear Mr. Rice:
As you know, despite the fact that approximately 80% of all skin cancers are preventable, skin cancer is the
most common malignancy in the United States today and also has the highest rate of increasing incidence. The
Advisory Committee in the Division of Public Health is expanding support of skin cancer screening in local health
departments. This effort began two years ago with successful screenings in 10 health departments. This year's
goal is to partner with 30 local health departments to conduct skin cancer screenings and prevention activities
during the latter part of May - to coincide with Skin Cancer Awareness Month.
Your health department is being invited to apply for participation based on your county's incidence and
mortality rates or prior involvement in skin cancer-related projects. To encourage participation, each selected
health department will be provided $1,500 to conduct their activities. Statewide advertising will outline screening
locations and provide a toll-free inquiry number.
Innovative and diverse programs contributed to the success of earlier skin cancer screenings. Health
departments built on their strengths and resources. These included innovative partnerships, prevention education,
and media coverage. If you have infonnation from prior screenings you could share, it would be helpful for those
health departments undertaking screenings for the first time. Johnston County graciously agreed to provide the
enclosed "tips" -lessons learned from their events - to assist you in conceptualizing your application and event.
If you wish to be a part of this project, please complete the attached application. To allow adequate selection
and contract processing time, we must have your proposal by March 27, 2000. If you have any questions, please
contact Christine Klein, Project Coordinator, via e-mail at christine.klein@ncmail.netorcall her at (919) 715-
5642.
The Advisory Committee is very pleased to be able to offer funding to address this important issue. I look
forward to receiving your screening proposal.
Sincerely,
. I
~..UPL s LU!uk
Marion S. White, MSPH
Executive Director
Enclosures
31
]9]5 Mall Service Center. Raleigh, North Carolina 27699.1915
Voice: 9]9.715-3337. Fax: 919.733-o4B8
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New Hanover County Board of Health Executive Committee Meeting
Request for Board Action
Meeting Date: 03/28/00
Department: Health Presenter: Betty Jo McCorkle, Women's Health Care Division Director
Contact: Betty Jo McCorkle
Subject: 1185,(1)0 r~ (JOE) '1'f3/e'l? r~ ~()
Grant Application for North Carolina Healthy Start Foundation Community Grants Program
(Amount $159,900 over 2 years - beginning July 1, 2000)
Brief Summary:
The North Carolina Healthy Start Foundations (NC HSF) is offering funds through their
Community Grants Program to reduce infant mortality in the state. The aim is to more
effectively concentrate scarce resources on the populations in greatest need and in the program
areas which have demonstrated effectiveness for improving birth outcomes. The priority area
identified for New Hanover County will be Improved Timing and Spacing of Pregnancies - see
statistics for New Hanover County. Our proposal will include start-up funding for two (2)
Maternal Outreach Workers (MOW). MOW services are reimbursed through Medicaid. The
MOW positions will be 100% self-supporting by the end of the grant period. These positions
will enhance the Maternity Care Coordination (MCC) which are currently based at Coastal
Ob/Gyn @ NHRMC, Coastal Family Medicine, Cape Fear Ob/Gyn, Carolina Ob/Gyn and
Community Health Center. MOW positions are community-based home visiting positions that
are designed to help low income and at-risk pregnant women: (1) make full and early use of the
existing health care system, (2) achieve a substainable reduction in risk factors, and (3) reduce
adverse birth outcomes. The MOW is trained to assist at-risk pregnant and parenting women
with the non-clinical dimensions of pregnancy and infant care. Additional budgeted funds would
include training and travel expenses, mileage reimbursement for in-town driving, uniform
allowance, patient incentives, contract services (childbirth classes, smoking cessation classes,
interpreter services), breast pumps, video and printed educational materials and advertising
expenses.
Recommended Motion and Requested Actions:
Approve grant application to be forwarded to County Commissioners with approval of budget
amendment for $75,000 per year x 2 years if grant awarded.
Funding Source:
NC Healthy Start Foundation - no county funds required
Attachments:
4 pages
32
The North Carolina Healthy Start Foundation
Community Grants Program Announcement
e
The North Carolina Healthy Start Foundation (NC HSF) is pleased to announce the continuation
of its Community Grants Program, The Foundation, in continuing partnership with the North
Carolina State legislature and local business and industry, is working to reduce the State's high
rates of infant mortality in an effort to improve the lives of women, children, and their families.
The Community Grants Program offers resources to reach those at highest risk of poor birth
outcomes in local communities. Agencies are invited to apply for funding to support community-
based projects that address one of three priority areas described below.
Background
The North Carolina Governor's
Commission on the Reduction of Infant
Mortality in 1989 initiated the Healthy
Start Foundation, when North Carolina
was faced with one of the nation's highest
rates of infant death. Since that time,
extensive efforts have been made to
reduce infant mortality through the
combined work of the North Carolina
General Assembly, state and county
initiatives, and public-private
partnerships. Significant legislation,
appropriations, and coordinated
programming have been instrumental in
reducing infant mortality from one of the
nation's highest rates in 1989 - 12.6
deaths for every 1000 babies born, to 9.3
deaths per 1000 births in 1998.
Community coalitions and business
involvement in infant mortality reduction
efforts supported by the Healthy Start
Foundation have been established across the
state. The First Step Hotline provides
essential health and referral information to
thousands of North Carolina residents every
month.
e
We have learned a great deal during the past
decade, and have realized the importance of
focusing scarce resources on the populations
most in need. Coordinated, locally initiated
programs that target high-risk groups are a
key component of this effort to reduce
morbidity and mortality Local communities
know how to address local barriers to
accessing services and how to attract hard-
to-reach populations.
North Carolina has made steady progress
in improving birth outcomes since 1989.
Programs such as Baby Love and First
Step have expanded eligibility and access
to health and nutrition services for
pregnant women and children.
These lessons learned enable the Foundation
to proceed with another year of support for
programs dedicated to improving the lives of
women, children, and their families.
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"
The goal of the Year 2000 Community Grants Program is to continue the work of the Healthy
Start Foundation's efforts to reduce infant mortality in the State of North Carolina. The aim of
this year's Grants Program is to more effectively concentrate scarce resources on populations
most in need and in program areas with demonstrated efficacy for improving birth outcomes.
For this funding cycle, the Foundation is particularly interested in:
. Demonstration projects modeled after projects shown to be effective;
. Projects that could be replicated in other parts of North Carolina; or
. Projects that demonstrate how a relatively small investment in prevention or intervention can
reap significant savings in the future.
This year's Community Grants Program incorporates a few major changes from previous years.
These include:
. Narrowing the focus of the program to three priority topics listed below;
. Supporting fewer projects but at higher level of funding; and
. Extending the duration of the funding period.
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These changes have been made to concentrate our resources and to effect a greater impact on
reducing infant morbidity and mortality in this state. In addition, the application process is
new this year, and will start with three regional workshops to more fully explain the new
direction of the grants program and to provide hands-on assistance to applicants in developing
their program plan.
The Foundation continues to promote programs that address both clinical and programmatic
aspects of reproductive health and healthy pregnancies. This includes increasing access to
services, improving service coordination, and expanding outreach efforts. The focus of the
grants program this year is specifically on enhancing interconceptional health, with the goal that
every pregnancy is timed, intended, and occurring under optimal circumstances. To this end,
the Foundation is concentrating its efforts in the following three priority areas:
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1) Smoking Cessation - Improved smoking cessation strategies - innovative
approaches that help pre-conceptional, pregnant, and post-parturn women
and their household members quit smoking or reduce their use of tobacco
products.
2) Improved Timing and Spacing of Pregnancies - Improved access to services
to promote healthy birth intervals - optimally 24 months - combined with
education about the risks of childbearing "too young, too old, too close, too
soon"; use of mentoring models, care coordination, community outreach
workers to reach those at highest risk.
3) Sexually Transmitted Diseases & Reproductive Tract Infections - Improved
screening, diagnosis, and treatment of STDs and RTIs in high-risk women;
reduction of prematurity and improvement of birth outcomes through
identifying and appropriately managing vaginal infections in pregnancy.
34
,;
.
Please note that the application process has changed for the Y2000 funding cycle.
Eligibility
Your organization is eligible for a Healthy Start Foundation grant if:
. It is qualified for exemption under Section 501(c)(3) of the Internal Revenue Code and
it is not a private foundation (as defined by Section 509 (a) of the Code); or
. It is a public instrumentality, and has:
. a history of collaboration with community agencies involved in services to
women of reproductive age; and
. evidence of commitment to and capability of accomplishing its goals; and
. adequate staff, commitment, and capability to produce administrative data to
document project success.
Grants are not made to individuals.
Guidelines
This year we are soliciting proposals for grants up to a maximum of $150,000 for up to a
two-year period that address the priority areas described above. The funding period for
these grants will begin in July 2000. In addition, a rapid response mini-grant fund is available
A .~o support proposals for smaller grant amounts ($250 - $2,000). A one-page application
40irlr{;-avai:!abltl-from the website listed below. Mini-grants are available year round.
Workshops
The purpose of the three grant workshops is to provide potential grantees with information
about the Foundation's three priority program areas and assist them in developing quality
program plans. Three all-day workshops will be held in March of 2000 in the Western,
Central, and Eastern regions of the state. Attendance at one of the workshops is strongly
recommended.
Participants are encouraged to come as a team for the purposes of collaborating with other
community agencies and developing program plans. Each of the workshops will start with an
overview of the new program requirements and provide background information on the three
priority areas. In the aftemoon, working groups from the same community or region will begin
shaping their program plan with help from NC HSF consultants. Relevant county data will be
provided to each team to assist in developing their plan. The goal of the workshops is for
each group to leave with a solid draft of their program plan.
e
Within three weeks, each group will be expected to submit a Program Plan outlining their
project and estimated budget and project duration. Program Plan forms will be distributed at
the regional workshops and should accompany all subsequent letters of intent. NC HSF staff
and independent consultants will review all program plans. Selected projects will be asked to
work with program staff to further develop their program plans. Funding decisions will be
made in May of 2000.
35
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. :';-,~':' ':;"';:;:1'<": -i"<':",
"<:Jnful\1~'~(;rants P*;~~:;:~':
Y~<tr 2000Awlication for.;Jj'lri1ding
APPLICANT INFORMATION
Name of Lead Organization:
NEW HANOVER COUNTY HEALTH DEPARTMENT
Type of Organization:
COUNTY HEALTH DEPARTMENT
Contact Person:
BETTY JO MCCORKLE
Address:
2029 S. 17th STREET. WILMINGTON. N.C. 28401
Telephone: 910-343-6660
Fax: 910-341-4146
E-mail:
Collaborating Organizations: NEW HANOVER REGIONAL MEDICAL CENTER. WILMINGTON HEALTH ACCESS
County/ies to be served:
FOR TEENS. DEPARTMENT OF SOCIAL SERVICES. TRINITY METHODIST CHURC
CHILD CARE, FIRST BAPTIST CHURCH PARRISH NURSE PROGRAM
NEW HANOVER
Workshop/s Attended:
[J Greenville
D Sanford
D Hickory
Total Amount Requested:
Project Duration (beginning July 1, 2000~,;;;;'~
Signature of Executive Director: ~J,I)'.I7t?t>O
DEADLINES
Applicants are required to submit their Program Plan and Letter of Intent within three weeks of
the workshop they attended. Deadlines are as follows for receipt by 5pm of date listed:
WorkshoD Location WorkshooDate Application Deadline
Greenville Cornerstone BaDtist Church 3/10/2000 3/31/2000
Hickorv - Catholic Conference Center 3/13/2000 4/3/2000
Sanford - DA W Civic Center 3/18/2000 4/7 /2000
Mail four copies of the application to: (no faxes, please)
The Healthy Start Foundation Community Grants Program
The Cecil G. Sheps Center for Health Services Research
725 Airport Rd., CB #7590
The University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7590
Attn: Julie DeClerque
36
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New Hanover County Health Department Application
NC Healthy Start Foundation
Conununity Grants Program
Year 2000 Application for Funding
PROGRAM PLAN
Project Overview
I Priority Areas
- Smoking Cessation
- hnproved Timing and Spacing of Pregnancies
2. Prevalence levels of risk factors
- New Hanover County is higher than the state % for smokers
NH Co. = 15.2%
NC = 14.9%
- New Hanover County is higher than the state % for non-white smokers
NH Co. = 14.2%
NC= 11.2%
- New Hanover County is higher than the state % for short birth interval
tNH Co. = 15.7%
NC = 13.1%
t New Hanover County ranks #2 in the WCHS Region 6 (15 Eastern NC Counties) for
short birth interval (see attached).
- New Hanover County is higher than the state % for non-white birth intervals <= 23 months
NH Co. = 13.8%
NC= 13.7%
3. Overview of project
- In order to provide intensive visiting, mentoring and follow-up beginning in the prenatal
period and continuing throughout the first year of the infant's life, two MOW positions will be
created to enhance the MCC roles and to address the two priority areas identified above. Start-up
funding for the first year would allow time/funding for training and conununity orientation for
the MOW positions. This is essential in order to provide efficiency and effectiveness of these
grassroots, conununity positions. The MOW positions would eventually be self-supporting
through Medicaid reimbursements. A ''team'' of MOWs would create a close peer relationship
and a supportive environment for initiation of this service. The New Hanover County Health
Department provides MCC services at the New Hanover Regional Medical Center/ Coastal
Ob/Gyn Center (in conjunction with their Ob/Gyn residency training program). We also provide
MCC services at 4 additional outlying sites - Cape Fear Ob/Gyn, Carolina Ob/Gyn, Coastal
Family Medicine and New Hanover Conununity Health Center. The MOWs work primarily
through their respective clinical sites, making home visits when appropriate. Their caseloads are
challenging and intense. Assistance from an MOW would provide for more one-on-one follow-
Page -1-
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up with identified needs and would improve compliance and educational efforts among the
pregnant and parenting populations served.
- Contract for smoking cessation classes (individual and/or group)
- Hospital postpartum visitation (to reduce barriers and smooth the transition from
hospital discharge to family planning visit following postpartum exam)
Throughout the two years of the grant, the MOWs would work to network with MOW positions
in other counties to determine "best practices" identified in their individual counties. They
would complete the required and reconunended state training as offered. They would work
closely with the MCC program to assist with the implementation of the established plan of care
and to provide close follow-up of identified needs.
Within their established caseloads, the MOWs would work closely with the women's preventive
health program of the New Hanover County Health Department in order to provide a seamless
transition from postpartum visit to initiation of family planning services. The MOW would
establish an appointment for the patient and provide a "starter pack" of oral contraceptives if
applicable. The health department will establish new appointment slots for postpartum patients
only.
4. Intervention Components
- MOW services/caseloads
- Provide daily postpartum hospital visits immediately following delivery to provide
instructions for family planning follow-up/appointments and starter packs of OCs (either
estrogen/progestin or progestin only - if breastfeeding)
- Establish additional family planning clinic schedule to acconunodate postpartum women
only - for easier access to appointments/times
- Contract Services to include transportation services, interpreter services (for Hispanic
patients), smoking cessation classes and childbirth classes
- emphasis on breastfeeding advantages, including delay offertility - provision of breast
pumps and supplies
- referral for individual smoking cessation classes as identified
- advertising and marketing of MOW services
- conununity outreach
Services and Activities
5 The following services/activities will be provided on behalf of women of childbearing age or
Pregnant women and their babies:
· MOW services
.- referral to smoking cessation classes
· interpreter services as indicated
· transportation services as indicated
· marketing/conununity involvement with MOW services
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· close involvement with health department family planning services
· referrals for prenatal care and management
· postpartum hospital visitation (daily) in order to'establish family planning appointment,
provide supplies/incentives
· contract for individual and/or group childbirth classes if not accessible through already
established hospital classes
6. Who will provide the services
· New Hanover County Health Department MOW staff
· New Hanover County Health Department family planning staff
· New Hanover County MCC staff
· Project Assist, American Lung Association staff
· Wilmington Transit Authority (bus services of Wilmington)
· Yellow Cab (taxi services of Wilmington)
· Amigos Interpreter Services
Target Popullltion
7. Who will be served
The target population will be those women who are at highest risk for poor pregnancy
outcomes:
· inadequate pregnancy weight gain
· late prenatal care
· nonwhite
· smokers
· mothers with 4+ children
· less than 12th grade education
· under 18 years of age
· low income
· previous low birth weight birth
· multiple births
· alcohol and drug use
· vaginal infections
· domestic violence
· unplanned pregnancy
· history of fetal loss
· increased maternal stress
· PATIENTS WITH MULTIPLE RISK FACTORS WILL BE TARGETED
8. How will program participants be identified and recruited
· MCC referrals
- 5 sites
· DSS referrals (esp. TANF position)
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· W.H.A.T./Lakeside Alternative School referrals
· Trinity Methodist Church Child Care referrals
· First Baptist Church Parish Nurse referrals
· UNC- W Student Wellness Center referrals
· School Nurse referrals
· Cape Fear Community College referrals
· CSC referrals
9. Which areas in county will be targeted
28401 zip code - inner city
10. How many participants to be served each month
- 60+ (MOW caseload maximum is 30 at any given time)
- approximately 40 postpartum hospital visits per month
Organizational CoUaboration
11. Organizations, Formal Relationships
· Identification of pregnant women, smoking pregnant women, and women with young
infants who may not be using a method of birth control
- DSS (esp. TANF position)
- UNC-W Student Wellness
- Cape Fear Community College
- WHATlLakeside Altemative School
- MCC sites (xS)
- Trinity Methodist Child Care
- targets NHHS students
- School Nurses
- First Baptist Parish Nurse program
Project Implementation and Impact
12. Main activities for start-up and subsequent phases / timeline
YEAR 1
July, 2000
August, 2000
October, 2000
recruit for MOW position #1
Recruit for part-time clerical position
recruit for MOW position #2
MOW, clerical position on board
Health Department Orientation begins
- Orientation to all MCC sites
- Orientation to Family Planning Services
- Orientation to Maternal Health Services
- Site Visits to Collaborating Agencies
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(?) October, 2000
Formal Training for MOW staff (schedule TBA)
Supervisory training for MOW supervisor
Site visits (Counties with existing MOW staff)
Community Outreach/Marketing
Begin identification of caseload
November, 2000
December, 2000
March, 200 I
YEAR 2
July, 2001 Full-time MOW caseload established
August, 2001 through June, 2002 Continue provision of services/ closely monitor
services and revenue
13. How will you document the impact of your project?
- Established caseload and case reviews of MOWs
- Improved short birth interval rates (NC and New Hanover County data)
- Improved compliance with postpartum and family planning follow-up (health
department data)
- Decrease in the number of pregnant women who smoke (NC and New Hanover County
data)
- Numbers of patients who participate with family planning services, transportation
services, interpreter services, and childbirth classes
14. What is the expected impact of your project during the proposed funding period?
- Improved success rates with MCC-established care plans (due to enhancements
provided by MOWs)
- Firm base established for a successful MOW program
- Marketing of services within the community will provide for improved information
about - and access to - services (maternal and family planning)
- Improved referrals for early prenatal care and follow-up (from collaborating agencies)
- Self-supporting MOW positions
- Improvements in the data related to identified priority areas
- Solid partnerships with collaborating agencies to further enhance future working
relationships and services for patients
Budget
See attached form
Budget Justification
I. Personnel
- 2 Materna1 Outreach Worker (MOW) positions
· includes funding for start-up costs involved in recruiting, training and orienting two MOW
positions.
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- 1 Clerical Specialist I (CSI) position
* to provide clerical support to the two MOW positions. This position will assist with
advertising, marketing, documentation, medical records, etc.
- Interpreter
* includes contract costs for interpreting during home visits, childbirth classes, smoking
Cessation classes, etc.
- Smoking Cessation Classes
* includes contract costs for referral to individual or group classes
- Childbirth Classes
* includes contract costs for individual or group classes as indicated
- Transportation Costs
* includes contract costs for city bus or taxi in order to reduce barriers to services
II. Supplies
- Videos, patient literature, tv/vcr for in-home use, office supplies, patient incentives, office
furniture, breast pumps
ill. Travel
- in-town mileage and out-of-town mileage, training expenses (out-of-town)
lV. Communication
- Telephone installation for personnel
V. Other
- Printing and advertising expenses, uniform allowance for personnel
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WCHS Region 6
. Section A
County
Teen
Pregnancy
Rate
Repeat
Teen
Pregnancy
Rate
Short Birth
Intervat
Out of
Wedlock
North Carolina
21.2
16.5
13.1
32.8
Bladen 23.3 24.4 12.6 45.7
Brunswick 22.8 11.3 11.1 36.8
Carterel 14.3 10.0 13.9 31.0
Columbus 32.0 14.3 12.7 45.8
Cumberland 22.0 19.0 14.0 31.3
Duplin 21.0 19.2 10.3 43.9
Harnett 25.5 17.9 12.3 32.8
Hoke 31.4 17.9 11.4 40.5
Jones 23.7 16.7 11.3 36.6
Lenoir 32.8 17.6 15.9 49.8
New Hanover 17.3 14.5 <IV dW
Onslow 17.2 13.5 15.0 17.1
Pender 21.0 23.1 13.3 33.3
e Robeson 28.9 16.0 13.8 54.5
Sampson 22.6 11.9 12.3 43.6
Region 22.9 16.6 13.7 34.9
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BUDGET Healthy Start - Year 1
Please use the space below or a similar format to outline the budget requestedfor this project.
I. Personnel
Name Position on Base Fringe % Time Other Support HSF Support
(or "To Be Hired") Project Salary Benefits on Available for Requested in
Project this Position this Grant
To Be Hired MOW/MOA 21,753.00 6,331.00 100 Supervisory/Clerical 28,084.00
To Be Hired MOW/MOA 21,753.00 6,331.00 100 Supervisory/Clerical 28,084.00
To Be Hired CSI-50% 10,876.00 1,395.00 100 Supervisory/Clerical 12,271.00
TOTALFTE 2.5
SUBTOTAL 1$ 68 439.00
n. Supplies
Describe Quantity Unit Cost Total Cost
Videos, Patient Literature 800.00
TVNCR, Office Supplies 2,561.00
Patient Incentives 1,000.00
Office Furniture 3 Staff 1,500.00 4,500.00
SUBTOTAL $ 8861.00
e m. Travel
Describe Miles Unit cost (.325/mile) Total Cost
In-town travel 4,000 .325 1,300.00
Out-of.town travel 300.00
Training registrations 700.00
SUBTOTAL $ 2,300.00
IV. Communication (postage, phone, fax)
Describe Quantitv Unit Cost Total Cost
Phone installations 3 100.00 300.00
SUBTOTAL $ 300.00
'Suggested amount is S30.00/month per FfE
V. Other
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Describe Quantity Unit Cost Total Cost
Interpreter Service 100 hours $25.00 2,500.00
Printing 550.00
Advertising 6 Ads 175.00 1,050.00
Unifonn Allowance 2 500.00 1,000.00
SUBTOTAL $ 5 100.00
TOTAL AMOUNT REQUESTED I $ 85,000.00
I 44
BUDGET Healthy Start - Year 2
Please use the space below or a similar format to outline the budget requestedfor this project.
I. Personnel
e
Name Position on Base Fringe % Time Other Support HSF Support
(or "To Be Hired") Project Salary Benefits on Available for Requested in
Project this Position this Grant
To Be Hired MOW/MOA 100 Su....iso"'/Clcrical -0-
To Be Hired MOW/MOA 100 Su....iso"'/Clcrical -0-
To Be Hired CSI-50% II 420.00 I 465.00 100 Sunervisorv/Clerical 12885.00
TOTAL FTE 2.5
1'1: 1') RR<; nn
n. Supplies
Describe Quantity Unit Cost Total Cost
Videos Patient Literature 800.00
Office Sunnlies 1100.00
Patient Incentives I 375.00
Breast Pumns 3 380.00 1140.00
~ A A1< nn
Ill. Travel
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Describe Miles Unit cost (.325/mile) Total Cost
In-town travel 2x500x 12 .325 3 900.00
Out-of-town travel 900.00
Trainin2 remstrations 1200.00
SUBTOTAL $ 6 000.00
IV. Communication (postage, phone, fax)
Describe Quantity Unit Cost Total Cost
SUBTOTAL $ -0-
'Suggested amount is S30.001month per FfE
V. Other
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Describe Quantity Unit Cost T otaI Cost
Intemreter Service 500 hours $25.00 12500.00
Childbirth Classes 18 Particinants 150.00 2 700.00
Smokina Cessation Classes 10 Particinants 40.00 400.00
Advertisinl! 12 Ads 175.00 2 100.00
Printinl! I 000.00
Unifonn Allowance 2 500.00 I 000.00
Bus 36 Books each 7.50 270.00
Taxi 50 Trins averaae each 11.50 575.00
\:1 'I: u-'~nn
TOTAL AMOUNT REQUESTED I $ 43,845.00
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James B. Hunt Jr.
Governor
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State of North Carolina
Department of Health and Human Services
H_ David Bruton, M.D.
Secretary
e
For Release: Immediate
Contact: Debbie Crane (919) 733-9190
Four Southeast States Issue Joint Kin!! Mackerel Health Advisorv:
NC Sets Public Information Meetin!!s To Discuss Advisorv
Date: March 23, 2000
RALEIGH--North Carolina, South Carolina, Georgia and Florida joined together today to issue a joint
health advisory concerning high levels of mercury in large king mackerel.
The state health officials say that king mackerel less than 33 inches fork-length (from nose to where the
tail forks) are safe to eat, but king mackerel over 39 inches should not be eaten. People should limit their
consumption of33 to 39 inch fish; Women of child bearing age and children age twelve and younger should eat
no more than one 8-ounce portion a month and other adults should eat no more than four 8-ounce portions a
month.
"We're working together to protect the public health," said North Carolina toxicologist Dr. Luanne
Williams. "All four states shared data and conducted a joint risk assessment. Our findings were clear--Iarge
king mackerel contain unhealthy levels of mercury and our citizens need to limit consumption of large king
mackerel. "
Williams said that mercury can damage the brains ofunbom babies and young children. "That's why
this advisory is particularly important for children up to twelve years old and women of childbearing age," she
APlained.
_ State health officials in North Carolina became concerned with the issue of mercury in large king
mackerel in 1998 when they attended a national meeting on mercury problems. At that meeting, officials from
the Gulf Coast states discussed their findings in king mackerel from that region. Upon return to NC, Williams
and other state officials asked the NC Division of Marine Fisheries (DMF) to sample king mackerel from NC
coastal waters.
DMF sampled king mackerel from NC waters through 1998-99. "We collected a wide range of king
mackerel from both commercial and recreational fisheries," said Dr. Louis Daniel, with DMF. "The findings
were consistent--large king mackerel contained high levels of mercury. But, fish don't know state boundaries.
The king mackerel population off of North Carolina's coast ranges to Florida."
Based on those findings, North Carolina officials checked with South Carolina, Georgia and Florida
officials. Their data was consistent with North Carolina's findings.
Today's announcement is a fish consumption advisory only. It does not prevent fishermen from landing
fish larger than 39 inches_ North Carolina recreational fishermen are allowed three fish per person, per day with
a minimum-size limit of24-inch fork length. Federally permitted commercial fishermen are limited to 3500
pounds per trip with a 24-inch fork length minimum size_
The South Atlantic Fishery Management Council is responsible for the management of king mackerel
from North Carolina through Florida while the North Carolina Marine Fisheries Commission is responsible for
king mackerel in our state waters. These management groups plan to discuss this issue in the near future to
determine if additional fisheries regulations are needed.
(more)
&g Mackerel Consumption Advisory
Office ofCommWlication
101 Blair Drive, Raleigh, NC 27603
(919) 733-9190
Debbie K. Crane
Director
.ill.
;,....
e
Page 2
This is North Carolina's first fish consumption advisory for ocean waters. The state began issuing
mercury advisories for inland waters in the early 1990s. Mercury in large, long-lived fish is an international
problem Many states have issued advisories in the past decade. Research continues into the cause of the
problem Because high levels have been found in fish from relatively remote areas, researchers suspect that the
mercury, which comes from industrial sources like coal-burning industries, cWorine manufacturing and waste
incinerators as well as natural sources, is often spread through the air and deposited in water. Mercury can also
corne from some mining operations. As bigger fish eat smaller fish, the bigger fish get higher levels of mercury.
The longer the big fish's life span, the more likely that it will accumulate mercury.
North Carolina has set two public information meetings to discuss the advisory. Those meetings are set for:
MARCH 29
6:30 p.m
Crystal Coast Civic Center, Morehead City
MARCH 30
6:30 p.m
601 Auditorium
1IIIIIIIIf!!ape Fear Community College, Wilmington
More information about North Carolina's fish consumption advisories is available on the web at
http://www.schs.state.nc.usIepi/fish/.
###
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=MMMn" March 17,2000/49(10);211
..........'
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Notice to Readers: Update: West Nile Virus
Isolated from Mosquitoes --- New York, 2000
During January--February 2000, three pools of overwintering Culex spp. mosquitoes collected at Fort
Totten, New York, were positive for West Nile Virus (WNV) RNA by real-time reverse transcriptase
polymerase chain reaction (RT-PCR) assay (TaqManTM, Perkin-Elmer Biosystems, Foster City,
California*) (l). Additional testing to detect the presence of intact virus was performed but was
negative as of MarCh to, 2000. Since then, one of the pools that was positive by RT-PCR yielded a
live WNV isolate in a fluid vew cell culture system and confirmed by West Nile-specific monoclonal
antibody staining ofvirus infected cells and virus gene sequencing. Studies of this isolate continue.
Reference
1. CDC. Update: surveillance for West Nile Virus in overwintering mosquitoes---New York,
2000. MMWR 2000;49: 178--9.
* Use of trade names is for identification only and does not imply endorsement by CDC or the U.S.
Department of Health and Human Services.
Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into lITML. This
conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on
this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the
official text, figures, and tables..,An original paper copy of this issue can be obtained from the Superintendent of
Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800.
Contact GPO for current prices.
Return To: I~~ MMWR Home Page CDC Home Page
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
Page converted: 3/1612000
http://www.cdc.gov/epo/nunwr/preview/nunwrhtml/nun4910a4.htm
03/27/2000
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T' '~ 03/08/2000 02:59 PM
-~
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To: Mark Boyer/NHC@NHC. Health_EPLTeam
cc:
Subject: West Nile Virus news release
fyi
...................... Forwarded by David E Rice/NHC on 03/08/2000 02:59 PM ....---.........---........
Bill Furney <BiII.Furney@ncmail.net> on 03/08/2000 11:57 46 AM
~
To: 'Local Health Directors' <Ihd@deh.enr.state.ne.us>
cc: (bee: David E Rice/NHC)
Subject: West Nile Virus news release
The text that follows and that in the attached document are the same.
This release is being sent to statewide media this afternoon. Heads up.
For Release: Immediate Date: March 8, 2000
Contact: Bill Furney 919.715.4174; Bill.Furney@ncmail.com
State Prepares for Possible Influx of West Nile Fever
Raleigh € Concerned about the possible introduction of West Nile
Encephalitis into North Carolina, the DHHS Division of Public Health and
other state agencies are beefing up surveillance, prevention and
response efforts. Although the virus has not yet been detected in the
state, many experts predict that it may only be a matter of time before
the virus, which can be introduced by migratory birds, moves into
Southern states.
The West Nile virus was not known to exist in North America until last
September when a series of bird and human illnesses in New York City led
scientists to discover its presence and that it was being transmitted
through mosquito bites. CDC disease investigators believe that the
virus is a strain that originated in the Middle East and was introduced
to the United States through foreign shipping.
Encephalitis is an inflammation of the brain and can be caused by
viruses transmitted by mosquitoes. West Nile encephalitis is an
infection of the brain caused by West Nile virus commonly found in
Africa, West Asia, and the Middle East. It is closely related to St.
Louis encephalitis virus found in this country.
State Health Director A. Dennis McBride warns that West Nile
Encephalitis will be a much greater concern to the state than existing
mosquito-borne illnesses such as Eastern Equine Encephalitis (EEE).
This is because the mosquitoes that transmit the West Nile virus are
common to the whole state rather than limited to the Coastal Plains area
like the mosquitoes that carry EEE.
€Counties in the western two thirds of the state have to start looking
~
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at mosquito control the same way communities in the coastal counties
have been doing for years,€ Dr. McBride said. €During the next few
months we will be meeting with local health directors, environmental
health supervisors and other county officials to stress just how
important this is and what they need to do to prepare. This is a
classic case of, €an ounce of prevention is worth a pound of cure.€€
One advantage North Carolina has that New York did not, is the existence
of its sentinel chicken flock, Dr. McBride said. The Department of
Environment and Natural Resources€ Division of Environmental Health has
long maintained a number of monitoring stations throughout the east as a
means of detecting mosquito-borne diseases before they reach human
population centers. The state regularly tests blood from the sentinel
chickens. Because chickens are intermediary hosts for the virus, early
detection at this stage can signal the appearance of the virus before it
spreads to,humans.
--more--
Page 2
West Nile
3/8/00
€When the virus started killing birds in New York last year, their
public health officials were caught off guard, partly because they did
not have a standing method of detecting mosquito-borne diseases like we
do here,€ Dr. McBride said. €Sentinel chickens provide an excellent
early-warning system. What we have to do now is expand this program to
any area that may be susceptible to West Nile Encephalitis.€
In addition to education efforts directed toward county officials and
expanding the state€s sentinel chicken flock, the Public Health and
Environmental Health divisions are undertaking additional preventative
steps. These include:
? Holding a conference for local public health staff members in May.
? Alerting state health providers about West Nile symptoms.
? Enhancing mosquito€population monitoring and analyzing.
? Enhancing rapid deployment of local mosquito-control measures in the
event the virus is detected.
? Expanding and increasing pubic education on mosquito control €
including the Tip and Toss tire clean up program and other individual
prevention measures.
? Working with local governments to increase public awareness and
prevention.
? *Expanding State Public Health Laboratory€s capacity to analyze and
isolate the virus.
? Working with the Department of Agriculture to address vector control
measures.
? Working with state veterinarians to help recognize and report symptoms
in birds.
? Posting additional information and links to state maintained websites
as they become available.
"These are good solid preventative steps," Dr. McBride said. "Now is the
time to get started on West Nile prevention. We will continue to study
the issue and may make additional proposals later.€
The CDC€s weekly publication Morbidity and Mortality Weekly Report
(MMWR) is expected to feature an article on West Nile Encephalitis in
its March 9 issue. On-line access to the report should be available on
Thursday at http://www2.cdc.gov/rnmwr/
Anyone seeking additional information about West Nile Encephalitis,
mosquitoes-borne diseases or the outbreak in New York City can find more
information at the following webs~tes.
,
..
.
e
e
Encephalitis & Mosquitoes:
http://wwwocdc.gov/ncidod/dvbid/arbor/arboinfo.htrn
New York City episode overview:
http://www.ci.nyc.ny.us/htrnl/doh/html/public/press99/prB61119.htrnl
West Nile Fever Q&A: http://www.ci.nyc ny.us/html/doh/html/cd/cdwnf html
Pesticides & Mosquito Control:
http://www.epa.gov/pesticides!citizens/rnosquitocontrol htm
* The state is seeking COC funds to expand operations and enhance its
detection and surveillance abilities. If funded, the new activities
will include: 1) surveillance of West Nile Virus-like, central nervous
system (eNS) disease in crows, domestic poultry and livestock: 2)
enhancing passive surveillance of eNS disease in humans; 3) providing a
rapid field response to confirmed virus activity; and 4) providing
training and education for health care providers, mosquito control
program staff, and the general public.
--30n
10. Mareh8.doe
10 . Bill.Furney vel
James B. Hunt Jr.
Governor
H. David Bruton, M.D.
Secretary
.
e
For Release: Immediate
Contact: Bill Furney 919.715.4174; Bill.Furney@ncmail.com
Date: March 8, 2000
State Prepares for Possible Influx of West Nile Fever
Raleigh - Concerned about the possible introduction of West Nile Encephalitis into North Carolina, the DIillS
Division of Public Heahh and other state agencies are beefmg up surveillance, prevention and response efforts.
Although the virus has not yet been detected in the state, many experts predict that it may only be a matter of
time before the virus, which can be introduced by migratory birds, moves into Southern states.
The West Nile virus was not known to exist in North America until last September when a series of bird and
human illnesses in New York City led scientists to discover its presence and that it was being transmitted
through mosquito bites. CDC disease investigators believe that the virus is a strain that originated in the Middle
East and was introduced to the United States through foreign shipping.
Encephalitis is an inflammation of the brain and can be cansed by viruses transmitted by mosquitoes. West Nile
.cephalitis is an infection of the brain caused by West Nile virus commonly found in Africa, West Asia, and
. Middle East. It is closely related to St. Louis encephalitis virus found in this country.
State Health Director A. Dennis McBride warns that West Nile Encephalitis will be a much greater concern to
the state than existing mosquito-borne illnesses such as Eastern Equine Encephalitis (EEE). This is because the
mosquitoes that transmit the West Nile virus are common to the whole state rather than limited to the Coastal
Plains area like the mosquitoes that carry EEE.
"Counties in the western two thirds of the state have to start looking at mosquito control the same way
communities in the coastal counties have been doing for years," Dr. McBride said. "During the next few
months we will be meeting with local health directors, environmental health supervisors and other county
officials to stress just how important this is and what they need to do to prepare. This is a classic case of; 'an
ounce of prevention is worth a pound of cure. '"
One advantage North Carolina has that New York did not, is the existence of its sentinel chicken flock, Dr.
McBride said. The Department of Environment and Natural Resources' Division of Environmental Health has
long maintained a number of monitoring stations throughout the east as a means of detecting mosquito-borne
diseases before they reach human population centers. The state regularly tests blood from the sentinel chickens.
Because chickens are intermediary hosts for the virus, early detection at this stage can signal the appearance of
the virus before it spreads to humans.
--more--
e
Public Affairs Office
2006 Mail Service Center, Raleigh, NC 27699-2006
(919) 733-9190
Debbie K. Crane
Director
..J:A:t,
.
Page 2
West Nile
318/00
"When the virus started killing birds in New York last year, their public health officials were caught off guard,
partly because they did not have a standing method of detecting mosquito-borne diseases like we do here," Dr.
McBride said. "Sentinel chickens provide an excellent early-warning system. What we have to do now is
expand this program to any area that may be susceptible to West Nile Encephalitis."
In addition to education efforts directed toward county officials and expanding the state's sentinel chicken
flock, the Public Heahh and Environmental Health divisions are undertaking additional preventative steps.
These include:
. Holding a conference for local public health stafImembers in May.
. Alerting state heahh providers about West Nile symptoms.
. Enhancing mosquito--population monitoring and analyzing.
. Enhancing rapid deployment of local mosquito-control measures in the event the virus is detected.
. Expanding and increasing pubic education on mosquito control- including the Tip and Toss tire clean up
program and other individual prevention measures.
.& Working with local governments to increase public awareness and prevention.
. "'Expanding State Public Health Laboratory's capacity to analyze and isolate the virus.
. Working with the Department of Agriculture to address vector control measures.
. Working with state veterinarians to help recognize and report symptoms in birds.
. Posting additional information and links to state maintained websites as they become available.
"These are good solid preventative steps," Dr. McBride said. ''Now is the time to get started on West Nile
prevention. We will continue to study the issue and may make additional proposals later."
The CDC's weekly publication Morbidity and Mortality Weekly Report (MMWR) is expected to feature an
article on West Nile Encephalitis in its March 9 issue. On-line access to the report should be available on
Thursday at http://www2.cdc.gov/mmwr/
Anyone seeking additional information about West Nile Encephalitis, mosquitoes-borne diseases or the
outbreak in New York City can find more information at the following websites.
Encephalitis & Mosquitoes: http://www.cdc.gov/ncidodldvbidlarbor/arboinfo.htm
New York City episode overview: http://www.ci.nyc.ny.us/htrn1/doh/htmllpublic/press99/pr861119.htrnl
West Nile Fever Q&A: http://www.ci.nyc.ny.uslhtrn1/doh/htmllcdlcdwnf.html
Pesticides & Mosquito Control: http://www.epa.gov/pesticideslcitizens/mosquitocontrol.htm
... The state is seeking CDC funds to expand operations and enhance its detection and surveillance abilities. If
funded, the new activities will include: 1) surveillance of West Nile Virus-like, central nervous system (CNS)
_sease in crows, domestic poultry and livestock; 2) enhancing passive surveillance of CNS disease in humans;
. providing a rapidfield response to corifirmed virus activity; and 4) providing training and education for
health care providers, mosquito control program staff, and the general public.
--30--
"
~
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 11ffi STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500, FAX (910) 341-4146
"-_._.
DAVID E. RICE, M.P.H., M.A.
Health Director
LYNDA F. SMITH, MoP.A.
Assistant Health Director
Memo
To: NHCHD Employees , !lAP
From: David E. Rice, Health Director fJff'----
0at8: March 2, 2000
Re: Organizational Capacity Assessment Questionnaire
All New Hanover County Health Department (NHCHD) employees are requested to
complete the .6.ssessment Protocol for Excellence in Public Health (APEXlPH)
Capacity Assessment Worksheets. The process of answering the questionnaire
includes two subgroups that concurrenUy carry out the following activities:
. Only supervisors will score the "perceived importance" column of the
organizational capacity indicators.
. Other employees of NHCHD will rate the "current status" column of the
organizational capacity indicators.
The scoring of the organizational capacity indicators is described more in detail
below.
Scoring the "Perceived Importance" column of the IndlcatolS - (SUoervisOIS\
On the Capacity Assessment Worksheets, the supervisors should rate how important
each indicator is for the successful functioning of NHCHD. Assign one of the
following importance ratings to each indicator:
H = High importance
M = Moderate importance
L = Low importance
o = Not relevant
.N~ ~~-t'..?\~~'"
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Some scores of "Not relevanf' are expected because not every indicator will apply to
NHCHD.
The importance rating of an indicator should be independent of its current status in
the Health Department. Care should be given to avoid rating an indicator as
important simply because the Health Department currenUy performs the activity
described by the indicator.
Ratina the "Current Status" column of the IndicatolS - (Other Employees),
On the Capacity Assessment Worksheets, other employees of NHCHD should rate
the current status on each indicator of the Health Department. Assign one of the
following scores to each indicator:
F = Fully met
P = Partially met
N = Not met
o = Not relevant or status unknown
The rating of NHCHD's status on an indicator should be independent of the
importance of the indicator to the successful functioning of the Health Department.
The assessment will be most valid if the group rating current status does not know
how the other group scored the indicators for importance.
The analysis of the Organizational Capacity Assessment Questionnaire will be
performed by the Coastal Area Health Education Center. The Assessing, Evaluating,
Improving, our Opportunities are Unlimited (AEIOU) Team will process the results of
the analysis. AEIOU Team members include: Carol Bottoms, Mitzi Chappell, Dianne
Harvell, Beth Jones, Robert Keenan, Mary Jo Newton, Mamie Nixon-Car1os, Susan
O'Brien, David Rice, Avery Rollinson, Lynda Smith, Marcia Smith, and Bobby
Waters. If you have questions, please contact an AEIOU Team member.
.,1
TeeI Davis, Jr.
Commissioner
ClI)ffiu of
~oar.b of C1Iommissiou.ers
~ e&r ~llno&er Cltollntv
320 Cltqel5tnllt ~treet, ~oom 305
~ilminBton, ~orllt Cltllrolinll 28401-4093
'lllelepqone (910) 341-7149
JIrllX (910) 341-4130
:.
"
W1nlam A. Coster
Chairman
alXcbert G. Greer
_ e-Chalrman
Buzz Blrzenlek.
Commissioner
Charte. R. Howen
Commissioner
Wanda M. Copley
County Attomey
Allen O'Neel
County Manager
Lucie F. Harren
Clerk ta the Board
February 28, 2000
MEMO TO:
Boards, Committees, Commissions, Authorities, Agencies,
and County Department Heads
Buzz Birzenieks f; @
County Commissioner
FROM:
e
The attached magazine article, Rolling Out the Red Carpet/or Employees, is for your information.
While it specifically addresses health care issues, it is applicable to all boards, commissions,
committees, and organizations.
I feel sure you wiIl enjoy reading this article.
BB:lfh
Attachment (I)
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IT'
ROLLING OUT THE
FOR EMPLO
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:-
, ~.
Investing In
Health Care's
Greatest
Asset
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16 Trustee February 2000
.--.-.-..-- -.-" .-.--
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Not long ago, a friend and
fellow writer, Christina
Kosta, was writing a sto-
ry on SoumwestAirline's
legendary CEO, Herb
Kelleher, for a travel publication target-
ed to airline employees. She had request-
ed a personal interview. The response
from me public relations manager was
as anticipated: "I'm sorry. Chris. Ijust
know we can't make it happen. He's so
busy nowadays." But then, an unex-
pected twist. "His office tells us not to
even ask [for interviews] unless it's for
an employee event."
"Three months and dozens of inter-
views wim Southwest Airlines employ-
ees later, I finally understood the real
significance of the reply," says Kosta.
"As chairman, president, and CEO,
requests for Herb's time-from reporters
for interviews to baseball managers
wanting him to throw out the first ball
on Opening Day-pour in by me mou-
sands. But only the countless requests
from Soumwest employee departments
nationwide get Herb's attention. And by
consistently putting employees first like
this, the chain-smoking, Elvis-imper-
sonating leader has become a cOrPorate
icon, national celebrity, and one of me
most-loved CEOs of all time:'
Vicki Shuler, Kelleher's executive
assistant of seven years, conf1!IllS Kos-
ta's take: "It's a fact that Herb won't
change his schedule if a business meet-
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ILLUSTR.~TIO:'i 8\. D.'RRE~ THO)(PSOS
.
,
i
ing comes up that interferes with an
employee event he's promised to attend.
If he makes a commitment to Soumwest
employees, Herb follows through:'
Southwest is not the only airline
investing in its human capital. interna-
tionally, Singapore Airlines is the airline
every other airline talks about. Known
for its outstanding customer service, Sin-
gapore Airlines has made a major invest-
ment in treating its customers
well-primarily by treating its employ-
ees well. Fifteen percent of payroll goes
to employee training (versus only 1.5
percent for U.S. airlines), Singapore's
flight attendants are trained for four
months, while me U.S. industry standard
is a mere four weeks.
Jeffrey Pfeffer, Ph.D., the Thomas D.
Dee Professor of Organizational Behav-
ior in the Graduate School of Business
at Stanford University, Palo Alto, Calif.,
and one of America 95 leading managc6
ment consultants, recently had the opper-
By
Sh([ri I'~ycek
e
February 2000 T1'ust.. 17
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"The challenge for
boards is to ask,
'What is it that we
need to do in our
communities to
become more
valuable?'"
-Brian Wong, M.D,
[unity to observe the inner workings of Singapore Airlines. He
recalls a conversation he had with [he training manager.
"I asked about some of the economic fluctuations the airline
faced-me Asian downturn, the Gulf War--and how the airline
adjusted [employee] training during those times," says Pfeffer.
"She [the manager] looked at me and said, 'I don't understand
your question.' Please note mat her English is better than mine.
It took five times, literally, for her to understand what the ques-
tion meant, and then she said, 'The answer is, we don't. The
only ming that distinguishes us is our culture, our people. \Vhy
would we possibly cut mat out just because we have a tempo-
rary economic downturn?' Then she looked at me and asked,
rather incredulously, 'You mean there are some organizations
that do?""
The training manager of Singapore Airlines was obviously
unfamiliar with me U.S. health care industry. In the wake of
mergers, affiIjations, consolidations, and,
most recently, the Balanced Budget
Act, hospitals and health care systems
nationwide have cut training and edu-
cation for employees and slashed entire
work forces.
Bom Pfeffer and Brian Wong, M.D.,
of Arthur Andersen, Washington, D.C.,
contend that laying off workers and
e1iminating training is me wrong long-
term tactic. With all of me bond-rating
downgrades, healm care olganizations,
wimout question, are in defensive mode.
More than ever, their mindset is
expense-cutting. But are employees
expenses?
Two years ago, Arthur Andersen
introduced the radical idea that while
employees are consistently considered by healm care leaders to
be "assets," they are most often treated-bom on paper and in
real life-as expenses. Andersen has since reconfigured hospi-
tals' historic general accounting framework-assets, liabilities,
revenues, and expenses-into a new value framework com-
prising a four-box matrix of fmancial. physical, customer, and
employee assets.
"The [matrix] is not so much a new accounting model as it
is a conceptual franiework that helps health care leaders identi-
fy what mey might want to invest in in me future," says Wong.
IThis matri."<. says, maybe there's a different way to create value,
maybe mere are omer assets leade~ should be investing in besides
property, plant, and equipment" Such as employees.
'''No-margin, no mission' has become conventional wisdom,
but really it is a death spiral," says Wong. "It is a knee-jerk reac-
tion of management and boards equivalent to income-statement
strategic planning," says Wong. "It's very short-term, not longer
than a fiscal year. And very oriented toward bottom-line issues,
which we argue leads to expense control and cutting more intan-
gible assets. As you cut your expenses, you're impairing your
ability to serve your customers and employees. Complaints rise,
you become less differentiated, people see you as less valuable,
and, because they can't differentiate you, they go for me low-
18 Tru.st.e February 2000
est price. Vihich is the definition of a commodity.
"The challenge for boards is to ask, 'What is it mat We need
to do in our communities to become more valuable?'" Wong
continues. U'\Vhich intangible asset do we need to invest in to
make mat happen? And how can we make sure We have enough
follow-mrough and discipline in our organization so that [our
investment] is not just a tagline, something we say, another fad
of the month"'"
He points to East Jefferson General Hospital, outside New
Orleans. Ten years ago East Jefferson was struggling with how
to differentiate itself and better serve its community. Initially,
the hospital board-as many boards continue to do today-
approved a major construction program.
But men, prior to me ground-breaking, East Jefferson's CEO
had a gut feeling, an intuition that maybe mere was a better way.
That if East Jefferson General Hospital was to become a "des:
tination of choice," it must first become
an "employer of choice." With the
board's support, me construction proj-
ect was deferred for a major invest-
ment in employees. The Disney
Institute was me model.
The institute teaches about Disney's
investment in its employees, its
approach to customer service, people,
and human resource management.
Today, more Disney Institute partici-
pants come from me healm care field
than from anywhere else.
"There are a lot of parallels
between Disney and the health care
industry," says Wong. ''We bom rely
on people to deliver a big part of me
value. We bom require a huge invest-
ment in technology to remain competitive. And what differen-
tiates bom of us is how good me experience is.
"Disney has captured market value by investing in intangi-
bles," continues Wong. "C1eariy, me rides are better at Disney's
competitors. But the experience is better at Disney. Because of
Disney's investment in creating mat experience, because of its
investment in its employees, you fmd mat more people will go
to Disney. More people will return to Disney. And more people
vacationing in Orlando, will spend money at Disney."
Of course there are differences. Disney has stock prices mat
change second to second, while not-for-profit healm care olga-
nizations have no tangible way to show market value. But mat,
too, is changing. Arthur Andersen has recently developed an
"intangible asset methodology" mat evaluates an olganization's
intangible assets-including human capital. .
"If health care organizations had been able to evaluate merr
intangible assets on a regular basis, we [Andersen] mink mey
would clearly have seen that between 1993 and now, mey were
actually destroying value," says Wong, "largely by letting meir
employees go."
"In meory, 1 don't think mere's any resistance [to putting peo-
ple flrst]," says Pfeffer. "Healm care leaders understand mat hos-
pitals are a service business. They understand mat key services
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are delivered by people. They understand and, I think, agree
with the premise that if you get people working more effectively
together and in a better way, hospital operations could be
enhanced substantially. But in order to get better results, lead-
ers have to do things dramatically differently than they have in
the past. And when it comes time to actually make the behav-
ioral commitment, they get scared."
Exactly what type of "behavioral commitment" is Pfeffer talk-
ing about? Embracing the idea of employees as assets-not expens-
es. Incorporating a commitment to employees into the
organization's mission as well as strategic p1an.Allocating resources
toward appropriate training, recruitment, and retention. And com-
mitting to a long-term, organization-wide strategy.
"Intellectual capital is, and will continue to be, the defIDing
characteristic that distinguishes organizations and makes them
successful," says Pfeffer. He offers health care leaders the fol-
lowing guidelines:
. EMPLOYMENT SECURITY: "People ask me how-in a world of
rightsizing, downsizing, outsourcing-I can talk about employment
security. And I say, 'Because I have to. 'It is possible to build an oIga-
nization based on mutual loyalty, even in today's economy, but you
certainly can't do it by treating people as disposable. In healthy adult
relationships, commitment is reciprocal. If I want you to be com-
mitted to me, I must be committed to you.
"So how do you offer employment security? By reducing wages
and hours proportionately when needed. Instead of laying off 10
percent of the work force [across the board], you layoff 100 per-
cent of the work force by 10 percent You reduce outsourcing when
times get tough. And you reassign people to other jobs."
. SELECTIVE RECRUITING, "If you're going to have people around
for a long time, you obviously need to have the right people in the
organization;" says Pfeffer. "Recruiting for lit is even more impor-
tant than recruiting for skill. This requires having many applicants
for each position. A lot of organizations say it takes too much time,
effort, and money to sift through lots of applicants. Last year, South-
.~
west Airlines had about 200,000 applicants for 5,000 openings.
Southwest leaders didn't believe sorting through all those applica-
tions was a waste of time. They understood the importance of hir-
ing people who were going to make them a successful organizatA
. PROMOTION FROM WITHIN, '''This idea is kind of out off"
right now, but it shouldn't be," says Pfeffer. "Many of us think we
can hire talented people [from the outside], and they can immedi-
ately adjust to the organization and manage effectively. NOl the case.
[Long-term] people are working hard, doing a good job in the orga-
nization, and you bring in new people at senior levels. Essentially
you've sent them a very interesting message: 'You're nice, smart.
clever; but you're not quite up to it....
. TRAINING AND DEVELOPMENT: "If you're going to invest in
people and count on them to do great things, then you have to build
their skills," says Pfeffer. "Everybody does training when they have
the budget to do training. And when do you have the budget to do
training? When times are good. So everybody is doing training
when no one has time to be trained. Then, when people have time
to be trained because there's some slack in the system, no one has
the budget: Serious and intelligent organizations invest in their peo-
ple throughout the economic cycle."
. IDGH COMPENSATION, "Do not confuse labor rates with labor costs,"
says Pfeffer. "Do not think you have saved labor costs by cutting
pay. If you have also cut the quality of people in your labor force
and how hard they work and the intelligence and motivation with
which they work, you may have actually raised your labor costs."
. REDUCE STATUS DISTINCTIONS: "I remember going to Aus-
tralia and meeting with the CEO of a large retail organization," says
Pfeffer. "I went into his office, and I didn't know whether to.
out my hand or throw myself on the floor because I was in the
ence of God. I've been in cathedrals that were smaller than this
tleman's office, and I am not exaggerating. There were Picasso
originals on the walls. Status distinctions separate people fr?m one
another. n
. SHARING INFORMATION, "What good does it do to hire brilliant
WHAT DOES IT MEAN TO PUT PEOPLE FIRST?
Putting people first In your organization can begin Immediately and with minimal effort,
You can start by: . Learning the names of employees and acknowledging them . Publicly
emphasizing the Importance of people to the organization's success. Value employees
first, customers second, shareholders last. . Fixing the language. Replace the terms,
"workers" and "employees" with "associates," "team members," or "people." . Giving
everyone access to the organization's leaders. At Virgin Atlantic Records, every employ-
ee has the home telephone number of CEO Richard Branson, Why? Branson would rather
hear about problems from employees than from customers, . Maintaining a commitment
to employee training and ongoing education-despite economic downturns,
20 TI''l1sc.. February 2000
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"In order to get better
results, leaders have to
do things dramatically
differently. And when it
comes time to actually
make the behavioral
commitment, they
get scared."
-Jeffrey Pfeffer, Ph.D.
people and train them if you don't give th~m the dJ.t:J. to mJ.ke good
decisions? People need infonnation," S~l~:S Pfeffer. A c:J.se in poim:
At \Vbole Foods Market, all employees receive so much financial
information that every employee (16.000 people) can walk into the
back of a store, open a black binder and find. by name, every salar:
in the organiz:J.tion. Gasp ... Why would you do that'? \Vc:ll, \\!hole
Foods Market's CEO has a theory' When you give out raises, what
happens? Everybody's too pclite to ask. so everybody hedges. 'How
did you do? Better than last year?' So he [the CEO] said, 'let's get
rid of this. We are an organization based on trust.' \Vhat does it say
to people in your organization if you don't share? It says, 'I don't
trust you with the information.' Or '\ think you're too stupid 10 use
it. Great organizations practice open-book management, share infor-
mation with everyone."
Each of Pfeffer's management principles is based on com-
mon sense. And yet they are easier said than done. Pfeffer him-
self admits that In fact, the management
guru has devoted an entire book, How
Smarr Companies Turn Knowledge
Into Action, to understanding why
common sense tactics do not always
prevail. Two reasons are easy to iden-
tify: smart talk and fear.
"Smart talk" is the notion that
because an idea has been discussed it
is real; and because a mission state.
ment says an organization "puts peo-
ple fIrst," it does, Five frogs are silting
on a log. Four decide to jwnp off. How
many frogs are left sitting on the log?
Still fIve, because deciding and doing
are two different things,
"Fear" manifests organization-wide.
And it is this powerful and incapaci-
tating emotion that Rick Brown, COO of Holy Cross Hospital,
part of Catholic Health East, Fort lauderdale, Fla., is working
overtime to eliminate,
Last spring, inspired by an excerpt from Pfeffer's 1998 book,
The Human Equation: Building Profits By Putting People First,
Brown and Holy Cross CEO John Johnson not only read the
book, they purchased it for all their board members and the entire
senior management team. The concept of valuing employees
fIrst was immediately endorsed by the board as the right thing
to do.
"The nature of the organization, the religious aspects of the
hospital, helped in our decision to truly value our people," says
Brown. As of Trustee's deadline, the board was planning to ush-
er in the new year with a formal "no layoff" policy to be signed
in January. "We asked [Pfeffer] which of his seven manage.
ment principles was the linchpin-the one that if not imple-
mented would cause all the others to crumble," says Brown.
"He said 'employmenl stability.' There was a layoff at t]-.~ hos-
pital about three years ago. Since that lime, we've had an unwrit-
ten policy that we would do anything possible to avoid another
layoff-scale back in certain areas if necessary. retrain people
in other areas. The board's action will formalize that unwritten
policy.
ZZ Trustee February 2000
"With the BBA and Ihe fInancial strains on hospitals, col.
leagues r11ay "...onder why we are investing in training, why we.re
offering employee security," continues Brown. "But for us the
answer is clear. If you want to develop people to their fullest
potential, you need to give them a sense of security that if they
do come up wirh ideas to make things work easier, smarter, bet~
ter~ven to the point of eliminating their own jobs-they will
be given another job. We're talking about looking al the sys-
tems [employees] have been working with for years that you
know they know how to make better-and letting them. We're
taking the fear out of the equation."
With the no layoff policy formally implemented, Holy Cross
is now examining Pfeffer's other management principles, look-
ing at best and worst practices, deciding where the hospital falls
on the spectrum, and implementing action plans for change.
Already, the response has been good. "It's nice to know lIiat
they [administrators] are listening, tak-
ing our opinions seriously:' says one
. nurse-rechristened, as all Holy Cross
employees have been, as an "associ-
ate." "It's nice to Know you are valued.
And encouraged to try new things."
If Southwest Airlines is any indica-
tion of the return on employee invest-
ment, East Jefferson General Hospital,
Holy Cross-and the entire health care
indusny-has much to look forward 10.
Today, Southwest conlinues as the
only consistently profItable airline, and
this year the company was ranked by
Fortune magazine as the second-best
company 10 work for in America.
"Southwest openly admits it puts
employees first and customers second,"
says Christina Kosta. "The philosophy is that if you put your
employees fIrst, they'll lake Care of your customers. Because
Southwest does more than pay lip service to the ideals of team-
work and placing value on employees' ideas, the culture shared
by this tight-knit family is arguably whal made this airline change
the way people think about travel."
ThaI culture can be initiated simply enough. Once asked by
the CEO of another company how he could emulale Southwest's
friendly corporate culture, Herb Kelleher suggested thaI he start
by saying "Hello," after noticing that the CEO neither recog-
nized nor acknowledged two of his own employees as they got
on an elevator \vith him.
Obviously, "hellos" mean a lot. In 1994, 16,000 Southwest
employees paid for a full-page ad in USA Today thanking Kelle-
her for, among other things, remembering their names and help-
ing load baggage each Thanksgiving.
"Employees love Herb Kelleher," says Mickey Schwarz. an
Austin-based ramp agent, "because he's personable, real. A few
years ago I met him during ramp training. Later, during anoth-
er encounter, I met him again, and he remembered my name. If
Herb's met you before, he'll remember your name." T
.............................................................................................................................
SHARt MYCEK is a contributing writer to Trustee.
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
William A. Caster, Chairman (Diane) ..... ........................... 452-1282 Home
310 Brookshire Lane 28409 e-mail: bcaster@co.new-hanover.nc.us 791-1572 Omce
791-1572 FAX
763-5961 Home
791-1572 Omce
619-7879 Mobile
Robert G. Greer, Vice-Chairman (Lou) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1218 Country Club Road 28403 e-mail: bgreer@co.new-hanover.nc.us
Buzz Birzenieks (Jane) ............................................
1145 Tumberry Lane 28405 e-mail:bbirzenieks@co.new-hanover.nc.us
Ted Davis, Jr. (Jane) ............................................ .
1308 Live Oak Parkway 28403 e-mail:tdavis@co.new-hanover.nc.us
Charles R. Howell (Judith) . . . . . . . . . . . . . . . .. ........................
8109 Masonboro Sound Road 28409 e-mail:chowell@co.new-hanover.nc.us
NEW HANOVER COUNTY BOARD OF HEALTH
William T. Steuer, PElRLS, Chairman (Mary). . . .. ....................
5710 Oleander Drive, Suite 110 28403 e-mail:wsteuerS41@aol.com
Wilson O'Kelly Jewell, DDS, Vice-Chairman (Christie) . . . . .. ...........
218 Pine Grove Drive 28403 e-mail:wojewell@aol.com
Henry V. Estep, RHU (Lisa) . . . .
3500 Melissa Court 28409
...... ................
e-mail: hankestep@aol.com
Michael E. Goins, on (Anne)
5030 Randall Parkway 28403
.......................................
02seedoc@wilmington.net
Robert G. Greer (Lou) ........................ .................. .
1218 Country Club Road 28403 e-mail: bgreer@co.new-hanover.nc.us
Gela N. Hunter, RN, FNP (Jim) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
126 Quail Ridge Road 28409 e-mail: gelajim@hotmail.com
W. Edwin Link, Jr., RPH (Laurie)
306 Colonial Drive 28403
.. ................................
e-mail:linkrx@aol.com
256-0074 Home
256-9802 FAX
762-0914 Home
763-6249 Omce
762-5175 FAX
791-6311 Home
791-80070mce
791-8635 FAX
799-2144 Home
395-5585 Omce
395-5586 FAX
791-6113 Home
791-2401 Omce
791-2408 FAX
792-9584 Home
792-0188 Office
792-0188 FAX
392-3445 Home
392-0270 Omce
392-0271 FAX
763-5961 Home
619-7879 Mobile
799-0723 Home
763-2072 Omce
763-1586 FAX
343-1244 Home
763-0845 Omce
763-0846 FAX
Anne Braswell Rowe (Mercer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 762-2425 Home
2216 Acacia Drive 28403 e-mail:annerowe@bellsouth.net
Philip P. Smith, Sr., MD (Nancy).................................... 762-2230 Home
1810 Azalea Drive 28403 e-mail:ppsmithsr.@aol.com
Melody C. Speck, DVM ( Matt) . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. .
4605 Wrightsville Avenue 28403
Estelle G. Whitted, RN (Louis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1611 Rock Hill Road, Castle Hayne 28429
Frank Reynolds, MD, Med Cons. (Marguerite)
1706 Fairway Drive 28403
David E. Rice, Health Director (Linda)
1008 East Primivera Court 28409
.... .............. ............
e-mail: drice@co.new-hanover.nc.us
-888-745-5094 - Pager
0312000
452-0542 Home
799-5587 Office
799-8545 FAX
675-2179 Home
762-4621 Home
791-2092 Home
343-6591 Omce
341-4246 FAX
612-1684 Cell
e
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e
FROM Dl!N-iA BXlTH NEf:IL 2
Mar. Z7 2000 14:36 P2
PHCJt>E NO. 910 458 0233
NEW HANOVER COUNTY
ANIMAL CONTROL DIVISION
220 DMSION DRIVE
WILMINGTON, NORTH CAROLINA 28401
Tfi'J.F.PH()NF. (9/0) 341-41P7
FAX (9/0) UI-4U9
UAVIIII~. Klt:l~
1I..I'h IIh...lor
I
.lEAN I' M<NF.II. I
Aninml C..".rol OIR'('lm" ~
I
TO: The NAW Hanover County Roard of Health
FROM: D~"~erou~ Dog DeLermiu~llo>> He~rlu~~
CONCERNING: The easea heard__January thru March 2000
NUMBER OF CASES HEARD 19
PRCISIONS:
DANGEROUS 3
POTENTIALLY DANGEROUS 13
NOT DANGEROUS 2
(OWNER BITES___new procedures_)
PJC no longer used
PJC REVISED no longer ueed
PJC REVOKED--- 1 -
AGE OF VICTIMS 2 children, 8 adulcs, 9 animals_
REQUIRED MEDICAL ATTENTION all bites
NOT UNDER CONTROL --all
NOTES:
1. The rabies flyers ore gotting to the public. The
epidemic is still a problem and will escalate with
spring and summer.
2. More case a are involving pets being ettacked and also
killed while in their own yards.
You... df4J1f, - cDu.'l rP'Ii.o'f.ity
NEW HANOVER COUNTY HEALTH DEPARTMENT
c
Also in this issue...
2 Be an Egghead-
Get cracking on building
your knowledge of egg
safetv
3 Hard-Boiled Safety-
Make sure the Easter
Bunny doesn't deliver
Salmonella
3 Storage & Handling-
Egg-cellent tips on
handling this most
fragile of foods
4 Scrambled Eggs-
Try your hand at this
puzzler
4 Which Came First?-
The answer to an age-
old question
c
Copyright 2000
Pike & Fischer. Inc.
1-800-255-8131
Cracking a
Big Outbreak
Spring 2000
Investigators suspect that an egg harbor-
ing Salmonella Enteritidis (SEI was a1 the bot-
tom of a big outbreak that sickened 177 pa-
trons and employees of a pancake house outside
of Richmond, V A, last Memorial Day weekend. But the food handling practices of the
staff were so bad and the cross contamination potential was so great, food outbreak
detectives with the Henrico (V A) County Health Department found it impossible to
pinpoint just one food item as the cause of the outbreak.
Topping the investigators' list of factors contributing to the SE outbreak was a stain-
less steel bucket of pooled shell eggs that the employees used as French toast batter
Henrico Health Department Nurse/Epidemiologist Pat Young believes a contaminated
egg or two ended up in the mix in late April or early May, when lab results suggest the
first outbreak cases occurred. Investigators found no proof that kitchen staff ever emp-
tied or cleaned the container Instead, each time the batter supply ran low, more eggs
were added to the mix, which was held at room temperature. Investigators found SE in
the egg batter, and tests done on French toast
prepared by a cook at the request of investiga-
tors was also positive, meaning the dish was
not cooked to a high enough temperature to
destroy the organism.
The more the investigators probed, the more
problems they unearthed. It was like the out.
break wa~ the result of a conspiracy, and "ev-
eryone was in on it," Young said. Less than half
of those made ill reported eating French toast,
but investigators had no trouble identifying how
the pathogen could have been spread to other
foods. When asked by health department inves-
tigators to demonstrate how he prepared French
toast, a cook dipped bread into the batter, then
used his egg-soaked bare hands to place cooked
bacon on a plate. Close to half the employees,
including eight cooks, tested positive for salmo-
nellosis, offering yet another explanation for
cause or spread of the disease. Environmental
testing turned up widespread contamination. Had
the bacteria contaminating the food prep areas
in the restaurant been neon, "that place would
have been so lit up you could have seen it from
a mile or two away," Young said. After a two-
week closure, the restaurant reopened under the
watchful eye of a sanitarian.
What are the lessoRs to be
learned from this outbreak?
1. Shell eggs ore considered 0
potentially hazardous food. That
means they need to be kept
refrigerated and foods prepared
with them need to be thoroughly
cooked.
2. Pooling of eggs is risky_ Just
like 0 bod opple, one contomi-
noted egg con spoil the whole
lot. Substitute pasteurized egg
products in recipes colling for
pooled eggs or for those foods
not thoroughly cooked.
3. Hands, cooking utensils and
food prep surfaces should be
washed with hot water and soap
after contact with raw eggs or
foods containing eggs.
4. III food workers should not be
handling and preparing food_
Food Talk
Spring 2000
Who Wants to Be an Egghead?
Do you want to become an
eggs-pert on eggs? Here are
some answers to common (and
not so common) questions.
Q: What is Salmonella
Enteritidis (SE) and how did it
get into eggs?
A: It was once believed the
inside of the egg was sterile,
and that all but cracked or dirty
eggs were safe. But in the mid-
19BOs, investigators began picking up
on outbreaks in the Northeastern U.S.
caused by a new stealth strain of
Salmonella-Enteritidis. An SE
contaminated egg looks perfectly
normal, but there's a potent pathogen
packed inside. Scientists say the
strain infects the ovaries of seemingly
healthy hens and contaminates the
eggs before the shell is formed.
Q: How big a problem is SE?
A: SE outbreaks are growing increas-
ingly rare thanks to aggressive control
efforts. CDC recently announced the
rate of egg.related SE infections
dropped by over a third between
19ge and 1 998. However, egg-
related SE outbreaks continue, and
most are linked to restaurants and
foodservice operations underscoring
the need for food workers to handle
and cook eggs correctly
Q: What's being done to eliminate SE
and improve egg safety?
A: The problem is being addressed at
the highest levels. In December 1999,
President Clinton announced an Egg
Safety Action Plan designed to
eliminate SE as a cause of human
illness in the next 10 years. Efforts
are focusing on the farm all
/ the way through to the
~ consumer USDA recently
-:: published rules requiring
eggs to be refrigerated
during transport, and FDA
will finalize rules this year
on egg labeling and
-.:::- storage at retail.
\. Q: Do consumers need to be
warned if raw or under<ooked
eggs are served?
A: In some jurisdictions, yes. FDA's
Model Food Code calls for consumers
to be advised of possible risks if, for
example, raw eggs are used to make
Caesar salads. Some states that have
adopted recent versions of the Food
Code have this requirement. Check
with your local inspector to find out if
you need to comply
Q: (an eggs be pasteurized in the
shell?
A: A couple of innovative companies
are trying to improve upon Mother
Nature by pasteurizing eggs while
they are still in the shell. Eggs
marketed by Pasteurizing Eggs LP
recently received the Good House-
keeping Institute Seal of Approval and
should go on sale in East Coast
grocery stores this spring. The
pasteurized eggs, which are run
through hot water baths to kill
bacteria, will cost about 36 cents
more a dozen.
Q: What are the red spots I see in
some eggs?
A: The red spots are blood vessels
inside the yoke that were broken as
the egg was formed. They are not
dangerous.
Q: What is the difference between
white-shelled eggs and those with
brown shells?
A: The color of the shell is determined
by the breed of the bird that laid the
egg. Chickens with white feathers lay
white eggs, chickens with red
feathers lay brown eggs. There is no
difference in the nutritional values of
different colored eggs.
Q: Should I wash eggs?
A: ND! Eggs are washed, sanitized
and coated with a mineral oil (for
added protection) before they are
placed in the carton. If you wash
them, you will remove this protective
coating and could increase the chance
of cross contamination.
Q: Why do scrambled eggs turn green
when I hold them on the buffet?
A: The green color is a natural
chemical reaction that occurs when
eggs are held warm for too long. Use
fresh eggs, cook in small batches
(the American Egg Board recom-
mends three quarts or less), and
don't hold eggs for more than one
hour Using a liquid egg product may
also help.
Q: What is the greenish gray ring
around the yolk of my hard-boiled
eggs?
A: That is also a natural chemical
reaction, caused by boiling the eggs.
Eggs should be simmered, not boiled.
Q: What is the rope-like white thing in
an egg, and is it sofe to eat?
A: The chalaza anchors the yolk to the
shell to keep it in the center of the
egg and is perfectly safe to eat.
Source, COC, FSIS, FDA, Egg Nutrition Cenfer
I in 20,000 I in 10,000 I in 84 I in 50 I in 20
1'.
What' " The chance an The chance an Frequency (in The chance an The chance a
egg carries SE egg carries SE in years) an average average con- batch of 500
are the (nationally) affected areas * consumer would sumer will eat pooled eggs will
encounter a one contami- be contaminated
Odds? contaminated nated egg per with SE in
egg (nationally) year in affected affected areas *
areas*
*Affected areas include the Northeastern and Western U.S. where SE rates in flocks are higher.
\
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Spring 2000
Food Talk
....,'~.:'.~1:~'l"'.
~"i;~~r.?~1"-:,r~ ';;'-:1;. <. .~ ~
.",~. .j' >;':#..;
Boiling Down Easter Egg Safety Tips
Dying eggs for Easter is not simply
a modern tradition. The practice is
in fact, older than Christianity
Early peoples celebrated the
return of the sun and new life in
the springtime, Eggs were dyed
and celebrated as a symbol of
this renewal.
But, with present-day con-
<1 ~ 4 t:7 cern over contamination in
eggs, are Easter eggs safe to
eat? Hard-boiled eggs were the cause of two recent
outbreaks of serious illness, and laboratory research
published early this year showed that Salmonella can
survive in eggs after boiling. However, with proper
handling, Easter eggs can be a safe holiday tradition.
COOKING
. Place eggs in room temperature water and bring to a
rolling boil. Remove pan from the heat and simmer for
15 minutes.
COOLING
. Cool eggs immediately in cool water
DYEING
. Color eggs only with food safe dyes.
. Do not color cracked eggs.
HIDING AND EATiNG
. Hide eggs where they are protected from contamination
from animals, birds, and lawn chemicals.
. Don't eat cracked eggs
. Don't eat eggs that have been out of refrigeration for
more than two hours. (Total time, including cooling,
dying, hiding, and hunting.)
. Eat or discard within one week after cooking.
c Egg Storage and Handling
The shell of the egg was designed to protect a chick
as it developed, and as such is a good structure for
protecting the egg against contamination. However,
because Salmonella Enteriditis contaminates the inside
of the egg before the shell is formed, and because
bacteria can grow rapidly after the egg is cracked, you
must handle eggs properly
RECEiVING
. Buy only as many eggs as you know you will need
for one or two weeks.
. Accept only clean, unbroken, refrigerated eggs (450F
or below).
STORAGE
. Hold eggs at 41 0 F or colder Refrigeration not only
slows the growth of bacteria, if any are present, but
it also helps keep the eggs at a higher quality
. Rotate your stock. "First in, First out."
. Do not store eggs near foods with strong odors, for
example, apples, onions, or fish. The eggs will absorb
the odors.
PREPARATION/COOKING
. Cook eggs thoroughly Whole eggs should be cooked
until the white is completely set, and the yolk has
begun to thicken (at least 1450F). Scrambled eggs
are done when there is no liquid egg left.
. Use a thermom.
eter to ensure
that egg mixtures,
such as custard,
casseroles, quiche, or lasagna
have reached at least 1600F
. Wash your hands after handling
raw eggs.
. Wash and sanitize all pots, bowls, utensils, etc.,
which have touched raw eggs.
. Use pasteurized egg product whenever possible. You
must use pasteurized eggs for such foods as: Caesar
salad, hollandaise or bernaise sauces, mayonnaise,
eggnog, and others that may not reach 1450 F during
cooking.
.. Use pasteurized eggs if you are serving the elderly,
young children, or other immune-compromised
people.
. Do not break large numbers of eggs and hold lor
"pool") before cooking. If you must combine many
eggs, cook them immediately after breaking them.
SERVICE
. Hold any products containing eggs at 1400F or
above, or at 400F or below
. Don't combine newly cooked foods with those
already on the steam table.
.s'loeJO 841 46noJ41 lie! ^181es 18110U 00 .J8MSU\f 81zznd J81qweJOS
r
Food Talk
Scrambled Eggs
Unscramble each of the clue words. Copy the letters in the
numbered boxes to the boxes below with the same number
NELSOLMALA
31
3 28 17 18 10
HENCICK ITIIITIJ
32 20 29 33 7
TEMHERROTME
13 25 2 12 8
TERFIRGAIRONE
30 15 2. 19 .
RETERUTMEPA
HNHINSADAGW
34 27
RYF ITIJ GSGE ITIIJ KYOL ITIIJ
11 21 9 ,. 22 6
ITJ ITIJ ITIJ CIIIIIJ
1 2 3 4 5 6 7 8 9 10 11 12 13 14
ITIIJ ITIIITIJ ITIJ
15 16 l7 18 19 20 21 22 23 24 25 26 27 28
CIIIIIJ (Answer on bottom of page 3)
29 30 31 32 33 34
looking for more information about eggs? Call. toll-free.
FDA's Food Information Hotline at 888/SAFEFOOD, or USDA's
Meat and Poultry Hotline at 800/535-4555. Online, visit the
government's food safety web site at < www.foodsafety.gov>
or the American Egg Board's web site at <www.aeb.org>
FOOD TALK ~
NEW HANOVER COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH DIVISION
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401
Printed on recycled paper
Spring 2000
Which Came First? ~
Philosophers, poets ond (omedions
hove deboted the question for (enfu-
ries: Which <orne first, the
(hicken or the egg? Curren!
wisdom, ouording
to Horold M(Gee
in "On Food ond
Cooking: The
Science ond Lore of the
Kitchen," is that it was. . .
(drumroll, pleose) the egg!
Eorly In Eorth's history, obout one billion yeors
ogo, eggs were "invented" by the simple Iifeforms
Jiving in the o(eons ot thot time os 0 (ombinotion
nursery ond "oll-you-(on-eot" buffet. Eggs served
as protection and contained nutrition for growing
ond developing offspring. In loter yeors, os
onimols moved onto dry lond, their eggs formed 0
leothery skin to prevent drying. This skin be<ome
the hord shell we see todoy on birds' eggs.
On the other hond, (hickens ore relotive
newcomers to the world scene. They were firsf
bred only obout four to five fhousond yeors ogo.
History hos nol recorded, however, if these first
(hickens were bred for their eggs or for fheir meot.
Now thot science hos
solved the issue of "Which
come first. . ." can we
expect on answer to
"Why did fhe (hi(ken
cross the road?"
.
e
e
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Cape Fear Community College
Center for Business, Industry and Government
411 North Front Street, Wilmington, NC 28401
Tel. (910) 251-5696 Fax. (910) 251-5947
Serving Safe Food
16 hour Manager's Certification Class
(Certificate is valid for 3 years)
This class is open to managers or responsible persons who work full time. After successfully
completing the course, restaurants are eligible to receive two (2) additional points during
inspections.
The National Restaurant Association Educational Foundation offers cenification to those who successfully
complete this course. New Hanover County Environmental Health Specialists will teach the course.
Dates:
Where:
Cost:
Special
recognition will
be awarded to
establishments
that bave five
(5) or more
employees
attend and
successfully
complete the
course. The
establishment
will be rewarded
a framed
certificate for
display
May 8,10,15,17 4:00pm. - 8:00pm.
*Note May 8, registration starts at 3:30pm.
New Hanover County Health Department Auditorium.
2029 South 17th Street, Wilmington, NC 28401
$55.00 registration fee.
Textbook has been revised by the National Restaurant Association to
include more information and graphics.
Revised textbook cost - $81.41 (includes tax)
Prior to first class participants must purchase the textbook at CFCC
bookstore and read chapters 1 - 4.
"NOTE - Revised textbooks purchased after September 1, 1999 may be re-
usedfor other employees, but each student must have a book. Restaurants
may purchase separately the NRA test for use with these recycled books. This
may also be purchased at CFCC book store for $27 15 (includes tax) per test.
To reserve a place in this class please call 251-5696
This class is offered by Cape Fear Community College and the New
Hanover County Health Department Environmental Health
e
EPllnformation
I'
March 2000 New Hanover County Health Department II Betsy Summey F N P Editor
"
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Pneumococcal disease causes
more deaths per year,
approximately 40,000, than all
other vaccine-preventable
bacterial diseases combined, more
deaths than are caused by AIDS
or prostate cancer, and almost as
many as breast cancer.
Pneumococcal disease accounts
for approximately 500,000 cases
~fbacterial pneumonia, 50,000
Wases of bacteremia, and 3,000
cases of meningitis annually in
the United States.
The Advisory Committee on
Immunization Practices (ACIP)
of the Centers of Disease
Control and Prevention (CDC)
and the American College of
Physicians recommend
pneumococcal vaccination for
individuals 65 years of age and
older, as well as for people 2-64
years of age with certain
underlying disease and
compromised immune systems.
Protect patients from this serious
illness that causes premature
death. Increase pneumococcal
vaccination rates.
..................................................,........,..........,.
.,.'..............,.................................................'...........,....;.-.......
IIIII.II.o
>;IIIOjI1II~~gti~r
On February 17,2000, the
FDA approved the first
vaccine to prevent invasive
pneumococcal disease in infants
and toddlers--manifested often as
bacteremia and meningitis. The
vaccine, Prevnar, manufactured
by Wyeth-Ayerst Laboratories,
will be given as a series of four
doses administered at 2, 4, 6, and
12-15 months.
It is estimated that 16,000 cases
of pneumococcal bacteremia and
1,400 cases of pneumococcal
meningitis occur among children
under 5 each year in the U.S.
Children under 2 are at highest
risk, so for the first time a
highly effective means of
prevention is available for this
age group.
.:.,.:".,.:,:.,.,.:-:-:-,.:.,.,-:.:.,.:.:.,.:.,-.-:.,-,-:-,-,-:.,-:-:-,.,.:.,.,.:.,.,-:.,.,.:.,-:.:,:.,.:.,.:.:,:-,.:-,.:.:".,.:".:.:".,.:".,
.. . .. . .. , .. , .. . .. .. . , .. .. . .. . .. . .. . .. . .. . . .. .. . .. .. ...,.... ............ :..:..~..:..:..:..'.:..!..' i.'.:..:..~.., ~":":'.":":":""'~":"
111'QI~I~i
litlllllllli.llfllllj'
Good doggies view them as
the ultimate reward--
crunchy, chewy treats shaped like
pig's ears, snouts, or hooves--
which indeed they are! Many
slaughterhouse dried and baked
products have become staples in
over one third of dog owners'
homes. Recently they were the
suspected source in 30 otherwise
unrelated cases of Salmonella in
Canada. Many cases were in
children and after eliminating any
other commonalities, handling
pig's ears seems to be the
culprit.
Health Threat
Contamination may be the result
of inadequate heat treatment of
the products, or more likely, cross
contaminated after processing.
Manufacturers not realizing the
product could be a source of
human illness "did not always
handle the product well."
Sampling the product for bacteria
in wholesale and retail
establishments is taking place,
with "drastic action" promised if
contamination is found.
Prevention
In the U.S., the FDA issued an
advisory instructing pet owners to
handle the products carefully
Anyone coming in contact with
products is advised to wash his or
her hands carefully with soap and
water afterwards. The elderly,
children, and immuno-
compromised individuals
should avoid handling these
products altogether. While the
initial reports and cases came
from Canada, the FDA noted
EPllnformation
"subsequent examination of
similar products in the U.S.
indicate that all pet chew products
of this type may pose a threat."
1111111':""",
;:::::::;:,:::::::::,:::
iii?!?=i:i=i;:::;
New case reports of
tuberculosis in New Hanover
County decreased in 1999, a trend
prevalent in North Carolina and
nationwide. The same trend led
to what many perceive to be the
resurgence ofTB beginning
about 15 years ago following a
general complacency regarding
its presence and threat.
What keeps us on our toes are
reports such as the one from
Cabarrus County, North Carolina
oftwo concurrent cases in
children in the school system,
requiring the skin testing of over
150 children in shared class space
with the sick children. In New
Hanover County, two new cases
have been reported in the
current month, again indicating
2
that TB has not been
eradicated. Keeping diagnostic
skills sharpened and the index
of suspicion for tuberculosis
high in the face of decreasing
caseloads is the challenge for
clinicians.
. "............ ..............................
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~;
?;:::::~::::~:~ :::;::.::;::~:;, ;:;:}:;:;:;:;:;:;:;;}:}:;:;?: =;=;:'-":';:;:;':":;':';:":';":';':?::;:":;::';:;;::::::::::::::::::::::~:r
Cases of human papilloma
virus (HPV) seen in the
Health Department's sexually
transmitted disease program
continue to increase. All but one
of the 51 newly diagnosed cases
in the current fiscal year were in
the 15-34 year old group. Some
frequently asked questions are:
"Will I be able to have children?"
and "If! have a baby, will the
baby have these warts?"
A study reported in the April
1999 issue of Obstetrics and
Gynecology may provide better
news than originally thought
regarding mother to infant
transmission. Seven hundred .
eleven women with no previous
signs ofHPV were tested for
HPV DNA at the time they were
admitted to the hospital for
delivery Of these women, 37
tested positive for HPV.
Eleven babies born to these
positive women had HPV DNA
on samples taken by swabbing the
babies' skin, indicating a 30
percent mother to infant
transmission rate. All babies
had the same type HPV as their
mothers and were born vaginally
and more than two hours after
rupture of membranes.
Five weeks later, all 11 babies
were tested again for HPV DNA
and had cleared the virus. The .
babies were tested again at 6, 12,
and 18 months with none testing
positive for HPV. Researchers
suggest the babies had infected
cells from the mothers on their
skin only and were able to clear
the virus without being infected.
Communicable Disease Statistics
New Hanover County
July 1. 1999 - February 29.2000
.............,. .;.;.;,;.;.;.;.;., ......" .'.....................",.".,.,.,.,.,.,.,.,.,.".,.,.,.;.,.,.;. . "W' .....................................................................,
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ACS Advis01'\l Committee
Meeting of November 16, 1999
Present:
Donna Booth-Neal (Chairman)
Dr. Melody Speck
Cheryl Fiste
John Boozer
Joyce Bradley
Absent:
Eddie Spencer
Maryann Waldron
The meeting was held in the Health Department conference room at 7:30pm.
The new spay/neuter program is going very well. October saw a record number of adoptions of
64 animals, even though the prices were increased to $60 to accommodate the veterinarians.
Some staff concerns included added strain on the ACO's to transport the animals. Several years
of statistics may be needed to evaluate the need to pursue building an on-site clinic to neuter
adoptive animals.
Star News editor, Charles Reis, will accept articles for publication. (243-2000)
IC3 update - subcommittee of the Emergency Management Group
Donna Booth-Neal to man the center during storms.
Need a telephone network to activate in case of an emergency.(Jean & Joyce)
A list of veterinary phone lines (back lines) is needed. (Melody)
Some horses in county, a few livestock. (Joyce)
Problem w/ Nature of Things flooding out - need backup plan w/ alternate boarding.
Damage to kennels; wind & water. (John)
Don't leave pets tied out or in crates during storm.
Need increased coverage by media.
Project Impact discussion Thursday @ UNCW.. Donna to go to Washington for three days in
December for a State Hurricane Conference. Will share our fliers and info. - this is the first time
ani,"" 1" to be represented.
Inner City Rabies Clinic - vaccinated 80 dogs and 24 cats.
,
The Homeless Interagency Council has concerns over homeless people that will not stay in
shelters, because their dogs cannot also stay. WaIter Vincent is a contact person. (251-6440)
Need to work on a place to house the dogs, so the people don't freeze to death, as a man did two
years ago.
Donna is working on a list of protocols for service dogs in arrest situations.
The Humane society & Hanover Kennel Club raised $14,000 to vest law enforcement canines.
'.
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The advertisement for advisory committee replacements has been out. The new people will
probably not take their new positions until after the January Board of Health Meeting. The open
slots are:
Kennel Operator
Member @ Large
Friends of Felines
Cat Interest(completion of the term vacated by Maryann Waldron to Dee 2000)
Present members need to recruit for the vacant slots.
ACS to sponsor an Open House at the end of January (projected). Chose a date of January 29, to
allow time to plan.
Volunteer program going well
Need a new Appellate Board member for Dangerous/Potentially Dangerous Dog hearings. John
Boozer volunteered.
4/2/00jpm
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