05/07/2003
New Hanover County Health Department
Revenue and Expenditure Summaries for March 2003
Cumulative: 75.00% Month 9 of 12
e
-Revenues-~
Type of
Revenue
Budgeted
Amount
Cummt Yea,
Revenue Balance
Earned Remalnln
Federal & Slale
e Fees
Medicaid
Medicaid Max
EHFees
Hea~h Fees
Other
873,364 $ 835,337
389,282 $ 198,662
605,762 $ 429,624
204,085
Expenditures
e
Current Yea'
Expended Balance
Amount Remalnln
ype of
Ex ndlture
Budgeted
Amount
Prior Year
Budgeted Revenue Balance
Amount Earned Remalnln
%
51.11%
66.21%
58.51%
0.00%
65.22%
106.06%
75.87%
$ $ 852,997 45.41%
$ $ 112,449 78.90%
$ $ 400,291 60.48%
$ 100.00%
$ 68.14%
97.23%
72.22%
%
Budgeted
Amount
Prto,Yea,
Expended Balance %
Amount Remalnln
Summary
Budgeted Actual %
FY 02-03 FY 02-03
Expenditures:
Salaries & Fringe $ 9,221,703 $ 6,364,571
Operating Expenses 2,050,712 1,355,520
Capital Outlay 208,427 54,733
Total Expenditures $11,480,842 $7,774,824 67.72%
Revenue: $ 5,557,325 $ 3,557,432 64.01%
Net County $$ $5,923,517 $ 4,217,392 71.20%
e
Revenue and Expenditure Summary
For tbe Montb of Marcb Z003
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NEW HANOVER COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH (BOH) APPROVED
GRANT APPLICATION STATUS FY 02-03
Date (BOHl Grant Reauested Pendlna Received Denied
Smart Start- Partnerahlp for Children: Child
4/29/2003 .. -- - Care Nursing PrOgrajjf(preliminaryApproval)~ '-$203;500 $203,500' ~-----
Smart Start- Partnership for Children: Hea~
Check (Preliminary Approval) $41,747 $41,747
UNC-CH: Child Care Health Consultant $62,849 $62,849
Cape Fear Memorial Foundation (through
Partnership for Children): Navioator Program $179,643 $179,643
41312003 No activity to report for April 2003.
3/512003 No activity to report for March 2003.
2/512003 No ectlvity to report for February 2003.
1/812003 NC DHH8- OPH Preoaredness and Response $115,950 $33,600 $82,350
12/412002 No activity to report for December 2002.
NC Health and Wellness Trust Fund-Teen
Tobacco Use Prevention & Cessation Program
11/612002 ($100,000 per year for 3 years) $100,000 $100,000
Safe Kids Buckle Up Program-North Carolina
101212002 Sate Kids $5,000 $5,000
Developing Geographic Information Systems
(GIS) Capacity In Local Health Department In
Eastern North Carolina-Duke University
Nicholas School of the Environment and Earth
Sciences (NSEES) $18,000 $18,000
INOle report,or eptemll8r zuuz.
;NO acav , to repollTor ugua. zuuz.
INOlCOY , to repollTor uly
PROJECT STOP-Prenatel Health Education
and InformatlonlReterral Servlces- March of
Dimes Community Grant Program (lhlo-"'"
Inter4 to eppIy for $49,975- the ectuaI application for lhiI epwt went
6/512002 thI'tll.91ln October 2002. tM amau"II ch8rQed to ISO,OOJ) $50,000 $48,280 $1,720
NO aCUvllV to report lor May ZUUZ.
No aCUvltV to report IOE
NO acavltV to report lOr Marc
NO a report lor fillruary .
Noa report lofTanuary zuoz.
Diabetes Education, Management and
12/512001 Prevention - CFMF $60,000 $30,000 $30 000
Youth Tobacco Prevention project- Robert
11n12oo1 Woods Johnson Youth Center $11,800 $11,800
Teens Agalnat Tobacco Use (TATU)-Health
Action Council of NC $350 $350
Healthv Carollnlana- NC DHHS $10,000 $10,000
Family Assessment Coordlnatlon- March
9/512001 of Dimes $16,500 $16,500
FOliC Acid Prolect- March of Dimes $16,618 $3,000 $13,318
Safe Kids Coalltlon- State Farm"Good
Nelahbor" $500 $500
rB Elimination and Prevention - CDC,
8/112001 NCDHHD, DPH, TB Control Proaram $10,000 $9,200 $800
Teen Aids Prevention /TAP)- CFMF $45,500 $25,000 $20,500
As of 4/2212003
. NnTl=' Nntifif'j:iItinn MNIlivAtt ~inNllIJll!ll.t l'Aoort.
11
NEW HANOVER COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH (BOH) APPROVED
AOD"C '~~ATUl'\ FY n7.ll~
Dlabetaa Today - Diabetes Prevention & Control
7/1112001 Unit, NCDHHS $10,000 $10,000
Lose Weight Wilmington - Cape Fear Memorial
Foundation $75,000 $75,000
----- n _
Totals $1,032,957 $487,739 $204,730 $340,188
Pending Grants 4 20%
Funded Total Request 7 35%
Partially Funded 6 30%
Denied Total Request 3 15%
Number of Grants Applied For 20 100%
Aft. I")f 412212003
47.22%
19.82%
32.93%
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 South 17th Street
Wilmington, NC 28401-4946
Telephone (910) 343-6500, Fax (910) 341-4146
, ,.,'~
-
E...,.......E~.E'ICI)'lood)o.
DAVID RICE, M P H, M A
Health Director
LYNDA F. SMITH, M P H
Assistant Health Director
April 28, 2003
To:
New Hanover County Board of Health
Cynthia W Hewett, Business Manager ~
From:
Subject: Changes in CPT Codes and Fees
We are requesting approval for the following changes related to the New Hanover County Health Department Fee Policy.
CPT Codes and Fees:
Change CPT Code Fee Justificalion
Needed
Addilion 99173 $30.00 Establishing fee for Vision Screening procedure provided in Child Health Services
Deletion 90665 $55.00 Lyme Disease Vaccine is no longer being manufactured.
Rale Change GOOOI $4.06 Medicaid reimb!JfSemenl rate changed from $3.99 to $4.06.
Addition 87880QW $40.00 Establishing fee for Strep A Kil (used for Throal Cultures)
CPT Code 8718426 No Fee Lab Service referred to Lab Corp: Susceplibility Studies (Being separated from
Change Urine Culture)
Addition 87086 26 No Fee Lab Service referred to Lab Corp: Urine Culture (Being separated from
Susceptibility Studies)
Deletion 87270 26 No fee Lab Service sent to State Lab: Chlamydia trach ag, OF A (Method Changed at
State Lab)
Addition 87320 26 No Fee Lab Service sent to State Lab: Chlamydia trach ag, EIA (Method Changed at State
Lab)
Deletion 87045 26 No Fee Lab Service sent to State Lab or referred to Lab Corp: will begin using an existing
CPT Code (87077 26)
Deletion 86360 26 No Fee Lab Service sent to State Lab: T-Cell Count /Ratio (State no longer providing
service)
'AWlitioo 86709 26 No Fee Lab Service Sent to State Lab: REP A Igm (Antibody)
Addition 82760 26 $15.00 (HF) Referred Lab: Newborn Service- Implementation of Handling Fee
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Deletion W8203 $74.59 Code no longer being used for Parenting Education Classes (replacement code
W8205)
Addition W8205 $75.93 Parenting Education Classes (replacing code W8203)
Fee Change TlOl7 $29.30 Medicaid Reimbursement increased from $12.00 per unit to $29.30for Maternity
Care Coordination Home Visits
Deletion- 90712 52-- -Administration-Fee Gode-no-longervalid for Oral Poliovirus Vaccine (Using existing code 90713 52)
($13.71)
Deletion 9064752 Administration Fee HIB Vaccine,PRP-OMP, 1m no longer available
($13.71)
Addition 90648 52 Administration Fee HIB,PRT-T (ACTHib) Vaccine
($13.71)
Fee Change GOO08' Administration Fee Medicare reimbursement decreased from $4.00 to $3.60 for administration of Flu
vaccine
Deletion 90472EP No Fee Code no longer required for billing or reporting ofImmunization Updates
Deletion QOI24 $2.35 Code no longer needed for Adult Drug Injection
The following need to be included in the Medications Available for NHC Employees Section:
Addition No CPT $8.00 Alesse (per cycle)
Code
Addition No CPT $8.00 Ortho Novum 1/35 (per cycle)
Code ~
Addition No CPT $8.00 Micronor (per cycle)
Code
General Guidelines: Additions are shown in bold print:
Section II.
Item B.
Program Specific Information
Women's Preventive Health
4. Unemancipated minors seeking confidential services are "a family of one" and are to be considered on
the basis of their own resources. In such cases, the minor's income must still be reported through
the patient data system. Third-party sources ( e.g. Insurance, Title XIX) should be billed the
established fee if eligibility criteria are met unless the breach of confidentiality statement is
signed by the patient requesting that third party billing not occur (Authorization and
Assignment of Benefits Form, Page 32). Charges to emancipated minors will be based on the
local fee schedule.
Attachments / Forms:
The Authorization and Assigmnent of Benefits form should be replaced with the revised version dated
04/04/03.
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New Hanover County Health Department
Authorization and Assignment of Benefits Form
Patient Information:
Patient Social Security ##
Last Name Fint Name I
MiddlelMaiden
Medicare ID# Medicare Name I
Subscribers Name
Insurance Co Name Insurance Co. Number
& Address
Secondary Ins Co Secondary Ins Co. Number
Name & Address
I request that payment of authorized Medicare/3'. Party Payer benefits be made on my behalf to New Hanover
County Health Department (NHCHD) for any services provided. I authorize any holder of medica I information
(to include HIV information / Substance Use / Mental Health and Social Data) about me to release to the
Health Care Financing Administration (HCFA) and its agents any information needed to determine these
benefits payable for related services.
I understand that my signature will serve as legal "signature on File" for purposes of filing my insurance claims
and payment of benefits to the NHCHD for services rendered.
I understand that my insurance company will send an Explanation of Benefits (EOB) to the address provided
on the HCF A form when any claims are processed for services provided.
I agree to repay the NHCHD any mo~ey I receive from insurance for services that the Health Department
provided for me. I further agree that failure to repay assigned insurance benefits to the NHCHD is a reason for
denial or restriction of future services until such amounts have been repaid.
Date
Relationship of Authorized Representative
Signature of PatientIParentl Authorized
Representative
Representative's Address:
Reason Patient is unable to sign:
o I do not authorize billing of my insurance company for services provided or release of information for
services provided (to include HIV information/Substance UselMental Health and Social Data) due to breach of
confidentiality with notification of claims processing on the Explanation of Benefits.
Relationship of Authorized Representative
Date
Signature of PaticntIParentl Authorized
Representative
Representative's Address:
Reason Patient is unable to sign:
NHCHD 04/28/03
15
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New Hanover County Health Department Organizational Analysis
Department responses; and positioning the Department to garner community support
and recognition. As a routine schedule, the Management Team should meet either
every other week or twice monthly.
Amona the manv aaenda items for the Manaaement Team. we believe that decisions
reaardina service orovision and resource allocation. oarticularlv as thev involve service
exoansion or cuts and staff deolovment. currentlv made within Divisions should be
routinelv reviewed and olaced in the context of the Deoartment orior to imolementation.
Items for Board of Health for Review, Discussion, and Action
The current working relationship between the Board of Health and the Health Director
appears excellent; still some questions were raised in interviews about the
appropriateness of issues that are taken to the Board for action. This is often a difficult
problem for the boards of many public and non-profit organizations. Clearly, the role of
an organizational board is to deal with major policy issues, not with the management and
operational issues that the organization's executive is hired to handle. The problem is in
the definition of what are "major policy issues" and what are not. Boards and executives
often disagree on this and the members of many boards do not agree among
themselves. This has not appeared to be a pressing issue in the case of the NHCHD,
but because the issue has been raised we believe that the Health Director. in concert
with the Board of Health. should delineate a demarcation of "oolicY" and "ooerational"
decisions in order to clearlv identifv the aoorooriate ranae of decision-makina authoritv.
Generally, The Health Director is responsible for on-going operational decisions
regarding the functioning and performance of the Health Department. The Board of
Health is a policy making body that should have extremely limited operational
responsibility.
Several years ago the NHCHD began assigning Board of Health members responsibility
for helping Health Department program leaders prepare their budget requests. Although
this process may help get the Board involved in the budget early in the process and
assure that they have greater knowledge of what is involved, it also leads to Board
members developing a certain loyalty to and investment in the particular program area to
which they have been assigned. This process runs the risk of putting the Board
members in an advocacy role for their assigned Division, further reinforcing a partitioned
view of the priorities and services of the Department. Furthermore, the practice does not
contribute to Board examination of the organization's budget as a whole. We believe
that the oractice of Board assistance in develooina oroaram budaets should be
discontinued. Alternatively, Board members could be "assigned" to different program
areas and become "experts" in those areas. Their expertise would then become a ready
resource to other Board members about the role and function of the Health Department.
At present, the Department budget is more like the aggregation of the individual Division
budgets than a manifestation of Department policies, priorities, and programs.
Many individual leaders and staff in the Department have developed personal
acquaintance and working professional relationships with individual Board members,
sometimes as part of organizational contact and sometimes through community or
church activities. This is appropriate and can often contribute to improved mutual
understanding. However, both groups should be careful to avoid crossing the invisible
line that separates the Board role in policy decisions from organizational leadership and
The North Carolina Institute for Public Health
16
New Hanover County Health Department Organizational Analysis
staff responsibilities to manage and direct the organization within the overall policy
framework. We suaaest that the Board of Health adoot a soecific oolicv that refers anv
concerns brouaht to individual Board members to the Executive Director of the Health
Deoartment for follow-uo and resolution with a "reoort" back to the Board.
Recommendation 3: Promote an internal and external image of
the NHCHD as a single organizational unit.
The Pros and Cons of Strong Divisions
The individual Divisions and programs of the Health Department are unquestionably
among the major strengths of the organization, and the sense of pride and
accomplishment they build among staff and the public they serve must be maintained.
The Environmental Health, Animal Control, and Nursing Divisions, to name a few, each
have individual staff and community advocates. The image of expertise and public
service that the staff and leadership of these Divisions enjoy contribute to the overall
credibility of the Department. To a degree, work group pride and loyalty can build a
healthy element of competition among Divisions and increase the enthusiasm and
productivity of team members, so long as it is accompanied by an even stronger pride
and loyalty in the overall organization. All staff, but particularly the top leadership, need
to be aware of the importance of strengthening visibility, staff loyalty, and organizational
pride for the Department as a whole. It is only with this broader outlook that the common
aims of greater public support, funding, and resources will be realized. In this respect,
the individual Division-level newsletters emphasize the partitioned nature of the
Department, fail to capitalize on opportunities to widen awareness and knowledge
among both employees and community interest groups, and consume more resources
than are necessary in duplication of effort and costs. We believe that Division-level
emphases should be continued only as sub-sections of a broader Department-level
Newsletter.
Although the individual Divisions and pride of accomplishment serve the Department
well, we are convinced that the Divisions in the Health Department have evolved to a
point where the Division lines are demarcations that significantly limit collaboration,
cooperation, and communication across the Department. There does not appear to be
any regular mechanism in place that systematically reviews initiatives and assignments
within individual Divisions in the context of the needs and priorities of the Health
Department. If an individual Division needs assistance and requests it from another
Division, that Division makes a decision to assist or not based solely upon its view of the
situation. Individual employees in one Division have been admonished not to assist
employees in another Division on even routine questions like how computer software
works. On the Staff Survey 60% of respondents disagreed or strongly disagreed with
the statement: "Communication between different job levels in this organization works
well."
Significantly, more than 60% of management and more that 65% of supervisors
disagreed or strongly disagreed with that statement.
The North Carolina Institute for Public Health
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Ii, laucoma is a group
of diseases that can
" lead to damage to
i I 0
. pamphlet
u the eye's optic nerve
is designed to and result in blindness.
help people
with glaucoma Open-angle glaucoma, the most
and their common form of glaucoma,
families and affects about 3 million
friends better Americans-half of whom don't
understand the know they have it. It has no
disease. It symptoms at first. But over the
describes years it can steal your sight. With
the causes, early treatment, you can often
symptoms, protect your eyes against serious
diagnosis, and vision loss and blindness.
treatment of
glaucoma. It is 0 VOl;
mainly about
open-angle
glaucoma, the
most common
kind in the
United States.
'J
1
/
!
Glaucorrya
has ~~
warning
signs~
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If you are a person:
/
,
· Who is Africa;;
American.:nd age 50
/
and older
· Wit~ family history
/
qf glaucoma
· With diabetes
~-
.~
Vou are at higher risk for
I
C' 'lcoma'/a/leading
cause of vision loss.
,
Check out the new
,.
Medicare benefit.
~ N:,:Jnal
.. Eyel
InJl:itute
UTIONAllMI!lTUmOfHEALTN
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,
Get a dilated eye
\
exam ev~ry year.
For more information
call:
1-800-Medicare "
(1 -800-633-4227)
www.medicare.gov
For a referral to an
eye care professional,
call:
American Academy
of Ophthalmology
1-800-391-3937
American Optometric
Association
1-800-262-3947
www.nei.nih.gov/
glaucoma
For more information
on glaucoma:
National Eye Health
Education Program
2020 Vision Place
Bethesda, MD
20892 -3655
1
What is the
optic nerve? 0,
The optic nerve is a bundle of
more than 1 million nerve fibers.
It connects the retina, the light-
sensitive layer of tissue at the
back of the eye, with the brain
(see diagram). A healthy optic
nerve is necessary for good
vision.
Conjunctiva
Lens
Sclera
Retina
Cornea
2
.2
'I
How does
glaucoma
damage the
optic nerve?
In many people, increased
pressure inside the eye causes
glaucoma. In the front of the eye
is a space called the anterior
chamber. A clear fluid flows
continuously in and out of this
space and nourishes nearby
tissues.
Fluid Forms Here
Fluid Exits Here
Cornea
Iris
Angle
3
.3
The fluid leaves the anterior
chamber at the angle where the Q
cornea and iris meet (see
diagram). When the fluid reaches
the angle, it flows through a
spongy meshwork, like a drain,
and leaves the eye.
Open-angle glaucoma gets its
name because the angle that
allows fluid to drain out of the
anterior chamber is open.
However, for unknown reasons,
the fluid passes too slowly
through the meshwork drain. As
the fluid builds up, the pressure
inside the eye rises. Unless the CI
pressure at the front of the eye is
controlled, it can damage the
optic nerve and cause vision loss.
4
Who is
at risk?
Although anyone can get
glaucoma, some people are at
higher risk than others. They
include:
. Blacks over age 40.
. Everyone over age 60.
. People with a family history of
glaucoma.
.4
What are the
symptoms of
glaucoma?
At first, open-angle glaucoma has
no symptoms. Vision stays
normal, and there is no pain. As
glaucoma remains untreated,
people may notice that although
they see things clearly in front of
them, they miss objects to the
side and out of the corner of
their eye.
5
Without treatment, people with
glaucoma may find that they 0- I
suddenly have no side vision. "-
It may seem as though they are
looking through a tunnel. Over
time, the remaining forward vision
may decrease until there is no
vision left.
5
How is glaucoma
detected?
Most people think that they have
glaucoma if the pressure in their
eye is increased. This is not always
true. High pressure puts you at (I
risk for glaucoma. It may not
mean that you have the disease.
Whether or not you get glaucoma
depends on the level of pressure
that your optic nerve can tolerate
without being damaged. This
level is different for each person.
6
Normal vision.
The same scene as it might be viewed
by a person with glaucoma.
7
Although normal pressure is
usually between 12-21 mm Hg, ~
a person might have glaucoma tJ
even if the pressure is in this
range. That is why an eye
examination is very important.
To detect glaucoma, your eye
care professional will do the
following tests:
. Visual acuity: This eye chart
test measures how well you
see at various distances.
~ I
. Visual field: This test
measures your side
(peripheral) vision. It helps
your eye care professional find
out if you have lost side ~
vision, a sign of glaucoma.
. Pupil dilation: This
examination provides your eye
care professional with a better
view of the optic nerve to
check for signs of damage.
To do this, your eye care
professional places drops into
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the eye to dilate (widen) the
pupil. Mter the examination,
your close-up vision may
remain blurred for several
hours.
. Tonometry: This standard
test determines the fluid pres-
sure inside the eye. There are
many types of tonometry. One
type uses a purple light to
measure pressure. Another
. type is the "air puff" test,
which measures the resistance
of the eye to a puff of air.
.6
Can glaucoma
be treated?
Yes. Although you will never
be cured of glaucoma, treatment
often can control it. This makes
early diagnosis and treatment
important to protect your sight.
Most doctors use medications
for newly diagnosed glaucoma;
however, new research
9
findings show that laser
surgery is a safe and effective
alternative. 0
Glaucoma treatments include:
Medicine: Medicines are the
most common early treatment
for glaucoma. They come in the
form of eyedrops and pills.
Some cause the eye to make less
fluid. Others lower pressure by
helping fluid drain from the eye.
Glaucoma drugs may be
taken several times a day.
Most people have no problems.
However, some medicines can
cause headaches or have side
effects which affect other parts C
of the body. Drops may cause
stinging, burning, and redness
in the eye. Ask your eye care
professional to show you how to
put the drops into your eye.
In addition, tell your eye care
professional about other
medications you may be
10
.
taking before you begin glaucoma
(jeatment.
Many drugs are available to treat
glaucoma. If you have problems
with one medication, tell your
eye care professional. Treatment
using a different dosage or a new
drug may be possible.
You will need to use the drops
ap.d/or pills as long as they help
to control your eye pressure.
This is very important.
Because glaucoma often has no
symptoms, people may be
tempted to stop or may forget to
take their medicine.
rQaser surgery (also called laser
trabeculoplasty): Laser surgery
helps fluid drain out of the
eye. Although your eye care
professional may suggest laser
surgery at any time, it is often
done after trying treatment with
medicines. In many cases, you
11
will need to keep taking
glaucoma drugs even after laser C
surgery. .
Laser surgery is performed in an
eye care professional's office or
eye clinic. Before the surgery,
your eye care professional will
apply drops to numb the eye.
I
As you sit facing the laser
machine, your eye care
professional will hold a special
lens to your eye. A high-energy
beam of light is aimed at the lens
and reflected onto the meshwork
inside your eye. You may see
flashes of bright green or red
light. The laser makes 50 to 10<0
evenly spaced burns. These
burns stretch the drainage holes
in the meshwork. This helps to
open the holes and lets fluid
drain better through them.
12
Your eye care professional will
r?'11eck your eye pressure shortly
i Yterward. He or she may also
! give you some drops to take
home for any soreness or swelling
inside the eye. You will need to
make several followup visits to
have your pressure monitored.
,
I
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Once you have had laser surgery
over the entire meshwork, further
laser treatment may not help.
Studies show that laser surgery
is very good at getting the
pressure down. But its effects
sometimes wear off over time.
1\vo years after laser surgery, the
pressure increases again in more
Clan half of all patients.
Conventional surgery: The
purpose of surgery is to make a
new opening for the fluid to leave
the eye. Although your eye care
professional may suggest it at
13
any time, this surgery is often
done after medicine and laser
surgery have failed to control
your pressure.
a
Surgery is performed in a clinic
or hospital. Before the surgery,
your eye care professional gives
you medicine to help you relax
and then small injections around
the eye to make it numb.
The eye care professional
removes a small piece of tissue
Conjunctival
and Scleral
Flap Is
Raised
14
from the white (sclera) of the eye.
~his creates a new channel for
Ue fluid to drain from the eye.
But surgery does not leave an open
hole in the eye. The white of the
eye is covered by a thin, clear
tissue called the conjunctiva.
The fluid flows through the new
opening, under the conjunctiva,
and drains from the eye.
.,.
Sclera
Fluid Exits
Through
New
Opening
15
You must put drops in the eye f9"'0
several weeks after the operatioU
to fight infection and swelling.
(The drops will be different from
the eyedrops you were using
before surgery.) You will also
need to make frequent visits to
your eye care professional. This
is very important, especially in
the first few weeks after surgery.
In some patients, surgery is
about 80 to 90 percent effective
at lowering pressure. However, if
the new drainage opening closes,
a second operation may be
needed. Conventional surgery
works best if you have not had 0
previous eye surgery, such as a
cataract operation.
Keep in mind that while
glaucoma surgery may save
remaining vision, it does not
improve sight. In fact, your vision
may not be as good as it was
before surgery.
16
Like any operation, glaucoma
~urgery can cause side effects.
\l,/hese include cataract, problems
with the cornea, inflammation or
infection inside the eye, and
swelling of blood vessels behind
the eye. However, if you do have
any of these problems, effective
treatments are available.
What are some
other forms of
glaucoma?
Although open-angle glaucoma is
the most common form, some
people have other forms of the
Oisease.
. In low-tension or normal-
tension glaucoma. optic nerve
damage and narrowed side
vision occur unexpectedly in
people with normal eye
pressure. People with this form
of the disease have the same
types of treatment as open-
angle glaucoma.
17
. In closed-angle glaucoma. the
fluid at the front of the eye
cannot reach the angle and
leave the eye because the
angle gets blocked by part of
the iris. People with this type
of glaucoma have a sudden
increase in pressure.
Symptoms include severe pain
and nausea as well as redness
of the eye and blurred vision.
This is a medical emergency.
The patient needs immediate
treatment to improve the flow
of fluid. Without treatment, the
eye can become blind in as
little as one or two days.
Usually, prompt laser surgery 0
can clear the blockage and . .
protect sight.
. In congenital glaucoma.
children are born with defects
in the angle of the eye that
slow the normal drainage of
fluid. Children with this
18
problem usually have obvious
r1"'1 symptoms such as cloudy
V eyes, sensitivity to light, and
excessive tearing. Surgery is
usually the suggested
treatment, because medicines
may have unknown effects in
infants and be difficult to give
to them. The surgery is safe
and effective. If surgery is done
promptly, these children
usually have an excellent
chance of having good vision.
. Secondary glaucomas can
develop as a complication of
other medical conditions. They
are sometimes associated with
o eye surgery or advanced
cataracts, eye injuries, certain
eye tumors, or uveitis (eye
inflammation). One type,
known as pigmentary
glaucoma, occurs when
pigment from the iris flakes off
and blocks the meshwork,
slowing fluid drainage.
19
A severe form, called neo-
vascular glaucoma, is linked to
diabetes. Also, corticosteroid
drugs-used to treat eye C
inflammations and other
diseases-can trigger glaucoma
in a few people. Treatment is
with medicines, laser surgery,
or conventional surgery.
8
What research
is being done?
The National Eye Institute (NEIl
is the Federal government's lead
agency for vision research. The
NEI is supporting many research
studies both in the laboratory 0
and with patients. This research .
should provide better ways in the
future to detect, treat, and
prevent vision loss in people with
glaucoma.
20
For instance, researchers
recently found a gene that
causes a form of glaucoma that
Carts at a young age. This is the
first glaucoma gene ever located.
This finding could help us learn
more about how glaucoma
damages the eye.
The NEI is also supporting
clinical studies that will tell us
more about who is likely to get
glaucoma, when to treat people
with increased pressure, and
which treatment to use first.
-9
What can you
do to protect
your vision?
If you are being treated for
glaucoma, be sure to take your
glaucoma medicine every day and
see your eye care professional
regularly.
21
You can also help protect the
vision of family members and
friends who may be at high risk
for glaucoma-Blacks over age C
and everyone over age 60.
Encourage them to have an eye
examination through dilated
pupils every two years.
01
I
I
22
For more information about
glaucoma, you may wish to
contact:
(Uerican Academy of Ophthalmology
655 Beach Street
San Francisco, CA 94109-7424
(415) 561-8500
http://www.aao.org
American Optometric Association
243 North Lindbergh Boulevard
St. Louis, MO 63141
(314) 991-4100
http://www.aoanet.org
(The) Glaucoma Foundation
116 John Street, Suite 1065
New York, NY 10038
1-800-452-8266
http.//www.glaucoma-foundation.org/info
Glaucoma Research Foundation
200 Pine Street, Suite 200
c::an Francisco, CA 941 04
-800-826-6693
'- ~15) 986-3162
http://www.g laucoma.org
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
http://www.nei. nih .gov
23
Prevent Blindness America
500 East Remington Road
Schaumburg, IL 60173-4557
1-800-331-2020
(847) 843-2020
http://www ,p reve ntbl i n d ness. 0 rg
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National Eye Institute
National I nstitutes of Health
NIH Publication No 02-651
Revised 9/98, Reprinted 7/02
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Is pamphlet it)
designed to help
people with age-
related macular
degeneration and
their families and
friends better
understand the
disease. It describes
the causes,
o
symptoms,
diagnosis, and
treatment of age-
related macular
I -r:
degeneration.
ge-related macular
degeneration (AMD)
is a disease that
affects your central
vision. It is a common cause of
!iJ
vision loss among people over the
age of 60. Because only the
center of your vision is usually
affected, people rarely go blind
from the disease. However, AMD
can-sometimes make it difficult
to read, drive, or perform other
daily activities that require fine,
central vision.
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The macula is in
the center of the retina, the
light-sensitive layer of tissue at
the back of the eye. As you read,
light is focused onto your
macula. There, millions of cells
change the light into nerve
signals that tell the brain what
you are seeing. This is called
your central vision. With it, you
are able to read, drive, and
perform other activities that
require fine, sharp, straight-
ahead vision.
al blood vesselOJ
Lens
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AMD occurs in two forms:
o Dry AMD affects about 90
percent of those with the
disease. Its cause is unknown.
Slowly, the light sensitive cells
in the macula break down.
With less of the macula
working, you may start to lose
central vision in the affected
eye as the years go by. Dry
AMD often Occurs in just one
eye at first. You may get the
disease later in the other eye.
o Doctors have no way of
knowing if or when both eyes
may be affected.
o Wet AMD-Although only 10
percent of all people with AMD
have this type, it accounts for
90 percent of all severe vision
loss from the disease. It occurs
3
when new blood vessels
behind the retina start to grow
toward the macula. Because 0
these new blood vessels tend
to be very fragile, they will
often leak blood and fluid
under the macula. This causes
rapid damage to the macula
that can lead to the loss of
central vision in a short period
of time.
&5
Wihlo OS ait li'osll\\
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Although AMD can
occur during middle age, the risk
increases as a person gets older.O
Results of a large study show
that people in their 50s have
about a two percent chance of
getting AMD. This risk rises to
nearly 30 percent in those over
age 75. Besides age, other AMD
risk factors include:
4
Gender-Women may be at
Q- eater risk than men, according
o some studies.
Smoking-Smoking may increase
the risk of AMD.
Family History-People with a
family history of AMD may be at
higher risk of getting the disease.
Cholesterol-People with elevated
levels of blood cholesterol may be
at higher risk for wet AMD.
.~
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AM iD)1
Neither dry nor wet AMD causes
any pain. The most common
symptom of dry AMD is slightly
blurred vision. You may need
more light for reading and other
tasks. Also, you may find it hard
to recognize faces until you are
very close to them.
5
1
I
,
As dry AMD gets worse, you may
see a blurred spot in the center
of your vision. This spot occurs 0
because a group of cells in the
macula have stopped working
properly. Over time, the blurred
spot may get bigger and darker,
taking more of your central vision.
People with dry AMD in one eye
often do not notice any changes
in their vision. With one eye
seeing clearly, they can still drive,
read, and see fine details. Some
people may notice changes in
their vision only if AMD affects
both of their eyes.
An early symptom of wet AMD iO
that straight lines appear wavy.
This happens because the newly
formed blood vessels leak fluid
under the macula. The fluid
raises the macula from its
normal place at the back of the
eye and distorts your vision. .
Another sign that you may have
6
Normal vision.
The same scene as it might be viewed
by a person with AMD.
7
wet AMD is rapid loss of your
central vision. This is different 0
from dry AMD in which loss of
central vision occurs slowly. As
in dry AMD, you may also notice
a blind spot.
If you notice any of these
changes in your vision, contact
your eye care professional at
once for an eye exam.
~
[}{]((J)W 05 ~M[Q)
d1eitecitedl?
Eye care
professionals detect
AMD during an eye examinatioO
that includes:
o Visual acuity test: This eye
chart test measures how well
you see at various distances.
o Pupil dilation: This .
examination enables your eye
care professional to see more
of the retina and look for signs
of AMD. To do this, drops are
8
placed into the eye to dilate
(widen) the pupil. After the
o examination, your vision may
remain blurred for several
hours.
One of the most common early
signs of AMD is the presence of
drusen. Drusen are tiny yellow
deposits in the retina. Your eye
care professional can see them
during an eye examination. The
presence of drusen alone does
not necessarily indicate a disease,
but it might mean that the eye
is at risk for developing more
severe AMD.
rrile conducting the
"'eiamination, your eye care
professional may ask you to look
at an Amsler grid. This grid is a
pattern that resembles a
checkerboard. You will be asked
to cover one eye and stare at a
black dot in the center of the
grid. While staring at the dot, you
may notice that the straight lines
in the pattern appear wavy to
9
you. You may notice that some
of the lines are missing. These
may be signs of wet AMD. (See 0
Amsler Grid on page 12.)
If your eye care professional
suspects you have wet AMD, you
may need to have a test called
fluorescein angiography. In this
test, a special dye is injected into
a vein in your arm. Pictures are
then taken as the dye passes
through the blood vessels in the
retina. The photos help your eye
care professional locate and
evaluate leaking blood vessels
to determine whether they can
be treated.
o
10
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ili'eaitedl?
Dry AMD currently
cannot be treated. But this does
not mean that you will lose your
sight. Fortunately, dry AMD
develops very slowly. You may
lose some of your central vision
over the years. However, most
people are able to lead normal,
active lives - especially if AMD
affects only one eye.
Some cases of wet AMD can be
treated with laser surgery. The
treatment involves aiming a high-
energy beam of light directly onto
()e leaking blood vessels. Laser
treatment is more effective if
the leaky blood vessels have
developed away from the fovea-
the central part of the macula.
But even if the blood vessels
are growing right behind the
fovea, the treatment can be of
some value in stopping further
vision loss.
11
I.
I
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C)
Here is what an Amsler grid normally
looks like. and on the next page is how
it might look to someone with AMD.
These grids are reduced in size; ask
your doctor for a full-size grid to use at
home. C
{J
lHIow 05 ~Cill5eli'
5l\Dli'geli'Y
lPleli'~oli'lI1l1leldl?
Laser surgery is performed in
your eye care professional's office
or eye clinic. Before the surgery,
he or she will: (1) dilate your
12
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pupil and (2) apply drops to
numb the eye. In some cases, he
or she also may numb the area
behind the eye to prevent any
F\
vscomfort.
The lights in the office will be
dim. As you sit facing the laser
machine, your eye care
professional will hold a special
1 lens to your eye. You may see
li flashes of light.
13
You can leave the office once the
treatment is done, but you will O.
need someone to drive you home "
Because your pupils will stay
dilated for a few hours, you also
should bring a pair of sunglasses.
For the rest of the day, your
vision may be a little blurry. Your
eye may also hurt a bit. This is
easily controlled with drugs that
your eye care professional can
suggest.
You will need to make frequent
follow-up visits. During each
exam, you may have fluorescein
angiography to make sure that
the blood vessels are not still C.
leaking, or that new blood vessels
have not developed. If the vessels
continue to leak, you might need
more laser surgery. It is important
to realize that laser surgery is
not a cure for AMD. It is only
a treatment to help stop further
vision loss. The risk of new
blood vessels growing back after
laser treatment is relatively high.
14
~"".i; What reseCillli'cihl us
. 0 ,111 being done?
~) "
The National Eye
Institute (NEIl is the Federal
government's lead agency for
vision research. The NEI is
supporting a number of research
studies both in the laboratory
and with patients to learn more
about the cause of AMD. This
research should provide better
ways to detect, treat and prevent
vision loss in people with the
disease.
There is some suggestion that
~rtain vitamins and minerals
,,---,ay playa role in the treatment
of AMD. This treatment needs
much more research before
scientists can know for sure if it
is helpful. The NEI is currently
sponsoring the Age-Related Eye
Disease Study to provide clear
information on whether certain
vitamin or mineral supplements
are of any benefit.
15
Scientists have begun to study
the possibility of transplanting C',
healthy cells into a diseased
retina. Scientists are also
evaluating families with a history
of AMD. This will allow them to
get a better understanding of
the genetic and hereditary factors
that may cause the disease.
In another study, scientists
are looking at certain anti-
inflammatory treatments for
the "wet" form of AMD.
~
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'il:([]) jpm'il:e<C'il: Y([])1l1I1T
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D Dry AMD. If you have dry
AMD, you should have your
eyes examined through dilated
pupils at least once a year.
This will allow your eye care
professional to monitor your
condition and check for other
eye diseases as well.
16
You should also obtain an
Amsler grid from an eye care
o professional to use at home.
This will provide you with a
quick and inexpensive test to
evaluate your vision each day
for signs of wet AMD. It works
best for people who still have
good central vision. You should
check each eye separately-
cover one eye and look at the
grid, then cover your other eye
and look at the grid. You also
may want to check your vision
by reading the newspaper,
watching television, and just
looking at people's faces. If you
. detect any changes, you
o should have an eye exam.
D Wet AMD. If you have wet
AMD, it is important not to
delay laser surgery if your eye
care professional advises you
to have it. After surgery, you
will need to have frequent eye
examinations to detect any
recurrence of leaking blood
17
vessels. Studies show that
people who smoke have a C
greater risk of recurrence than
those who don't.
In addition, you should
continue to check your vision
(at home with the Amsler grid
or other methods) as described
under dry AMD and schedule
an eye exam immediately if you
detect any changes.
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Wihl<<ll'il: lC<<ll1lil YOIl1l (Q]O
D~ YOIl1l ihl<<llve
<<ll~li'e<<ll(Q]y ~os'il:
VDSDOIlil 'il:o ~MlQ)? C
Normal use of your eyes will not
cause further damage to your
vision. Even if you have lost sight
to AMD, you should not be afraid
to use your eyes for reading,
watching TV, and other usual
activities.
18
Low vision aids are available to
(rIp you make the most of your
~maining vision. Low vision aids
are special lenses or electronic
systems that makes images
appear larger. If you need low
vision aids, your eye care
professional can often prescribe
them or refer you to a low vision
specialist. In addition, groups
and agencies that offer
information about counseling,
training, and other special
services are available. You may
also want to contact a nearby
school of medicine or optometry
as well as a local agency devoted
o helping the visually impaired.
19
For more information about low
vision programs, contact:
American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
1-800-232-5463
(212) 502-7600
www.afb.org
Council of Citizens with Low Vision
International
1155 15th Street, NW, Suite 1004
Washington, DC 20005
1-800-733-2258
Lighthouse International
111 E. 59th Street
New York, NY 10022
1-800-829-0500
(212) 821-9200
www.lighthouse.org
National Federation of the Blind
1800 Johnson Street
Baltimore, MD 21230
(410) 659-9314
www.nfb.org
20
c
c
For more information about AMD,
I~tact:
\ri(erican Academy of Ophthalmology
655 Beach Street
San Francisco, CA 94109-7424
(415) 561-8500
www.aao.org
American Optometric Association
243 Lindbergh Boulevard
St. Louis, MO 63141
(314) 991-4100
www.aoanet.org
Association for Macular Diseases
201 E. 64th Street
New York, NY 10021
(212) 605-3719
(The) Foundation Fighting Blindness
Executive Plaza 1, Suite 800
(-4...350 McCormick Road
. )It Valley, MD 21031-1014
1-800-683-5555
(410) 785-1414
www.blindness.org
21
Macular Degeneration International
6700 North Oracle Road, Suite 121
Tucson, AZ 85704 C
1-800-393-7634
(520) 797-2525
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
www.neLnih.gov
Prevent Blindness America
500 East Remington Road
Schaumburg,lL 60173
1-800-331-2020
(847) 843-2020
www.preventblindness.org
o
22
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National Eye Institute
National I nstitutes of Health
NIH Publication No. 02-2294
Revised 1/99, Reprinted 8/02
fL
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liS pamphlei
o
has been written to
help people with
diabetic retinopathy
,
] and their families
, I
and friends better
understand the
disease. It
o
describes the cause,
symptoms,
diagnosis, and
treatment of
diabetic retinopathy.
D
iabetic retinopathy
is a potentially
blinding
complication of
diabetes that damages the eye's
retina. It affects half of all
Americans diagnosed with
diabetes.
,
At first, you may notice no
changes in your vision. But don't
let diabetic retinopathy fool you. It
could get worse over the years
and threaten your good vision.
With timely treatment, 90 percent
of those with advanced diabetic
retinopathy can be saved from
(Jng blind.
lie National Eye Institute (NEIl is
the Federal government's lead
agency for vision research. The
NEI urges everyone with diabetes
to have an eye examination
through dilated pupils at least
once a year.
1
-,
1
What is the
retina?
o
-
I
I
The retina is a light-sensitive
tissue at the back of the eye.
When light enters the eye,
the retina changes the light into
nerve signals. The retina then
sends these signals along the
optic nerve to the brain. Without
a retina, the eye cannot
communicate with the brain,
making vision impossible.
Retina
Retinal blood vessels
0,
Iris
2
How does diabetic
retinopathy damage
the retina?
Diabetic retinopathy occurs when
diabetes damages the tiny blood
vessels in the retina. At this
point, most people do not notice
any changes in their vision.
Some people develop a condition
called macular edema. It occurs
when the damaged blood vessels
leak fluid and lipids onto the
macula, the part of the retina
that lets us see detail. The fluid
makes the macula swell, blurring
oon.
As the disease progresses, it enters
its advanced, or proliferative,
stage. Fragile new blood vessels
grow along the retina and in the
clear, gel-like vitreous that fills
the inside of the eye. Without
timely treatment, these new
blood vessels can bleed, cloud
vision, and destroy the retina.
3
3
Who is at risk for
this disease? 0 C .
All people with diabetes are at
risk-those with type I diabetes
and those with type 2 diabetes.
During pregnancy, diabetic
retinopathy may also be a problem
for women with diabetes. It is
recommended that all pregnant
women with diabetes have dilated
eye examinations each trimester
to protect their vision.
4
What are its
symptoms?
OJ
. ,
Diabetic retinopathy often has no
early warning signs. At some
point, though, you may have
macular edema. It blurs vision,
making it hard to do things like
read and drive. In some cases,
your vision will get better or worse
during the day.
4
View of boys by person
with normal vision.
,
,
View of boys by person
with diabetic retinopathy.
5
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
As new blood vessels form at the
back of the eye, they can bleed (\
(hemorrhage) and blur vision. Th~
first time this happens, it may not
be very severe. In most cases, it
will leave just a few specks of
blood, or spots, floating in your
vision. They often go away after a
few hours.
These spots are often followed
within a few days or weeks by a
much greater leakage of blood.
The blood will blur your vision. In
extreme cases, a person will only
be able to tell light from dark in
that eye. It may take the blood
anywhere from a few days to 01
months or even years to clear
from inside of your eye. In some
cases, the blood will not clear.
You should be aware that large
hemorrhages tend to happen more
than once, often during sleep.
6
How is it detected?
Diabetic retinopathy
f
~ is detected during
an eye examination that includes:
. Visual acuity test: This eye
chart test measures how well
you see at various distances.
. Pupil dilation: The eye care
professional places drops into
_ the eye to widen the pupil. This
allows him or her to see more of
the retina and look for signs of
diabetic retinopathy. Mter the
examination, close-up vision may
remain blurred for several hours.
.
COphthalmoscopy: This is an
examination of the retina in
which the eye care professional:
( I) looks through a device with
a special magnifying lens that
provides a narrow view of the
retina, or (2) wearing a headset
with a bright light, looks through
a special magnifying glass and
gains a wide view of the retina.
.
7
. Tonometry: A standard test that
determines the fluid pressure
inside the eye. Elevated pressure
is a possible sign of glaucomaO.
another common eye problem .
in people with diabetes.
Your eye care professional will
look at your retina for early signs
of the disease, such as: (I) leaking
blood vessels, (2) retinal swelling,
such as macular edema, (3) pale,
fatty deposits on the retina-
signs of leaking blood vessels,
(4) damaged nerve tissue, and
(5) any changes in the blood
vessels.
Should your doctor suspect that
you need treatment for macular 0,
edema, he or she may ask you to
have a test called fluorescein
angiography.
In this test, a special dye is
injected into your arm. Pictures
are then taken as the dye passes
through the blood vessels in the
retina. This test allows your doctor
to find the leaking blood vessels.
8
.
.6
How is it treated?
There are two treatments for
diabetic retinopathy. They are very
effective in reducing vision loss
from this disease. In fact, even
people with advanced retinopathy
have a 90 percent chance of
keeping their vision when they
get treatment before the retina
is severely damaged.
These two treatments are laser
surgery and vitrectomy. It is
important to note that although
lb,ese treatments are very
, \
uccessful, they do not cure
diabetic retinopathy.
.
Laser Sureery
Laser surgery is performed in a
doctor's office or eye clinic. Before
the surgery, your ophthalmologist
will: (I) dilate your pupil and
(2) apply drops to numb the eye.
In some cases, the doctor also
9
may numb the area behind the eye
to prevent any discomfort.
The lights in the office will be
dim. As you sit facing the laser
machine, your doctor will hold a
special lens to your eye. During
the procedure, you may see
flashes of light. These flashes
may eventually create a stinging
sensation that makes you feel
a little uncomfortable.
o
You may leave the office once the
treatment is done, but you will
need someone to drive you home.
Because your pupils will remain
dilated for a few hours, you also Q
should bring a pair of sunglasses.
For the rest of the day, your vision
will probably be a little blurry. If
your eye hurts a bit, your eye
care professional can suggest
a way to control this.
10
'VI
:1
;
The retina prior to focal laser
treatment.
The retina immediately
after focal laser treatment.
I
I
r
11
Doctors will perform laser surgery
to treat severe macular edema C
and proliferative retinopathy.
Macular Edema: Timely laser
surgery can reduce vision loss
from macular edema by half.
But you may need to have
laser surgery more than once
to control the leaking fluid.
During the surgery, your
doctor will aim a high-energy
beam of light directly onto the
damaged blood vessels. This is
called focal laser treatment.
This seals the vessels and
stops them from leaking. C
Generally. laser surgery is
used to stabilize vision, not
necessarily to improve it.
Proliferative Retinopathy: In
treating advanced diabetic
retinopathy. doctors use the
laser to destroy the abnormal
blood vessels that form at the
back of the eye.
12
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Scatter laser treatment.
Rather than focus the light
on a single spot, your eye care
professional will make hundreds
of small laser burns away from
[M center of the retina. This is
'&dIed scatter laser treatment.
The treatment shrinks the
abnormal blood vessels. You will
lose some of your side vision after
this surgery to save the rest of
your sight. Laser surgery may also
slightly reduce your color and
night vision.
13
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Once you have proliferative
retinopathy, you will always be atO
risk for new bleeding. This means
you may need treatment more than
once to protect your sight.
Vitrectomv
Instead of laser surgery, you
may need an eye operation called
a vitrectomy to restore your sight.
A vitrectomy is performed if you
have a lot of blood in the vitreous.
It involves removing the cloudy
vitreous and replacing it with a salt
solution. Because the vitreous is
mostly water, you will notice no
change between the salt solution C
and the normal vitreous.
Studies show that people who have
a vitrectomy soon after a large
hemorrhage are more likely to
protect their vision than someone
who waits to have the operation.
14
Early vitrectomy is especially
[)ctive in people with type 1
diabetes, who may be at greater
risk of blindness from a
hemorrhage into the eye.
Vitrectomy is often done under
local anesthesia. This means that
you will be awake during the
operation. The doctor makes a tiny
incision in the sclera, or white of
the eye. Next, a small instrument
is placed into the eye. It removes
the vitreous and inserts the salt
solution into the eye.
(('~ may be able to return home
~n after the vitrectomy. Or
you may be asked to stay in the
hospital overnight. Your eye will
be red and sensitive. Mter the
operation, you will need to wear
an eyepatch for a few days or
weeks to protect the eye. You will
also need to use medicated eye
drops to protect against infection.
15
7
What research is 0
being done? -
The NEI is currently supporting a
number of research studies in
both the laboratory and with
patients to learn more about the
cause of diabetic retinopathy.
This research should provide
better ways to detect, treat, and
prevent vision loss in people with
diabetes.
For example, it is likely that in
the coming years researchers will
develop drugs that turn off
enzyme activity that has been 0
shown to cause diabetic
retinopathy. Someday, these
drugs will help people to control
the disease and reduce the need
for laser surgery.
16
What can you do
to protect your
vision?
The NEI urges everyone with
diabetes to have an eye
examination through dilated
pupils at least once a year. If you
have more serious retinopathy,
you may need to have a dilated
eye examination more often.
A recent study, the Diabetes
Control and Complications Trial
(DCCTJ, showed that better
control of blood sugar levels slows
the onset and progression of
Cinopathy and lessens the need
for laser surgery for severe
retinopathy.
The study found that the group
that tried to keep their blood
sugar levels as close to normal as
possible, had much less eye,
17
kidney, and nerve disease. This
level of blood sugar control may C
not be best for everyone,
including some elderly patients,
children under 13, or people with
heart disease. So ask your doctor
if this program is right for you.
o
18
For more information about
d)<\?etic retinopathy or diabetes,
~~< may wish to contact:
American Academy of Ophthalmology
655 Beach Street
San Francisco, CA 94109-7424
(415) 561-8500
http://www.aao org
American Optometric Association
243 North Lindbergh Boulevard
St. Louis, MO 63141
(314) 991-4100
http://www.aoanet.org
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
1-800-342-2383
(703) 549-1500
http://www.d iabetes. org
Juyenile Diabetes Research Foundation
l' "~rnational
l~Wall Street
New York, NY 10005-4001
1-800-533-2873
(212) 785-9500
http.//www.jdf org
National Diabetes Information Clearinghouse,
National Institute of Diabetes and
Digestive and Kidney Diseases
1 Information Way
Bethesda, MD 20892-3560
1-800-860-8747
(301) 654-3327
http://www niddk.nih.gov
19
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
http://www.nei. nih .gov
Prevent Blindness America
500 East Remington Road
Schaumburg, IL 60173-4557
1-800-331-2020
(847) 843-2020
http://www . p reventblind ness.o rg
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~
National Eye Institute
National Institutes of Health
NIH Publication No. 02-2171
Revised 9/01, Reprinted 8/02
o
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Healthy Vision 2010 -- Healthy Vision Month
,- --------------------
f
I
!
=?I Healthy Vision 201 0
2010 Healthy Vision Month
i
!
1------------------------------- -- - --------------------------------------
t
Healthy Vision Month 2003
Beginning in May 2003, the National
Eye Institute, one of the Federal
government's National Institutes of
Health, will sponsor Healthy Vision
Month. Each year, Healthy Vision
Month will focus on a different Healthy
People 2010 vision objective. The focus for May 2003 will
be objective 28-4 reduce blindness and visual
impairment in children and adolescents.
Take the lead in your community to increase awareness
of the importance of protecting and preserving vision in
children and adolescents.
What you can do to start planning your event...
Healthy Vision Month 2003 Banners and
Downloadable Materials
Join the Healthy Vision Month 2003 (HVM) Listserv
Order Healthy Vision Materials
Online Event Registry
Healthy Vision School Curricula
For additional information, please send an e-mail
message to hvm@shs.net
Contact Us I Disclaimer I Privacy Statement I Accessibility
National Eye Institute, National Institutes of Health, Department of Health
and Human Services, U.S.A.
L4-4-~ 11._
L_~hL.n :~:.........""1" .............11.."...........,')("::1:1
Page I of I
. Home
. Examinations and Prevention
. Eye Diseases
. Iniury and Safety
. Vision Rehabilitation
. Select Populations
. About Healthy Vision 2010
. About Healthy People 2010
. Resources and Funding
. Special Programs and Events
d1~onoo~
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North Carolina Department of Health and HumanSeni.ces
Division of Public Health. Epidemiology Section
1902 Mail Service Center. Raleigh, North Carolina 27699-1902
Tel 919-733-3421 . Fax 919-733-0195
Mid-lael F Easley, Governor
Carmen H(Xlker Buell, Stuetary
SARS ALERT No.2 April 28, 2003
MEMORANDUM
To:
Local Health Directors
Local Health Departments
Public Health Regional Surveillance Teams (PHRST)
From:
Jeffrey Engel, MD
State Epidemiologist
General Communicable Disease Control Branch
Re:
Severe Acute Respiratory Syndrome (SARS): Exposure Management for School,
Workplace, and Household Settings
Date:
28 April 2003
Local health departments can expect inquiries concerning travel advisories and exclusion
policies for illness related to Severe Acute Respiratory Syndrome (SARS). CDC has developed
exposure management guidelines for close contacts, household, workplace, and school facilities.
Please pay special attention to the attached documents that provide guidance for exposures in
these settings.
The "n-hour Rule'" The CDC exposure management guidelines include
recommendations for those individuals who have been in close contact to a SARS case or meet
the travel criteria and develop fever or respiratory symptoms, but do not meet the suspect SARS
case definition. These people should be isolated for 72 hours to determine if the symptoms
progress. If symptoms do not progress to meet case definition within 72 hours after first
symptom onset, the individual may return to work, school, out-of-home child care, church or
other public areas, and special infection control precautions can be discontinued. If symptoms
progress to fulfill the case definition, then these people should be treated as a suspected SARS
case.
Some of the CDC exposure management guidelines include the following topics:
. Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) for Persons
in the General Workplace Environment (April 25,2003)
htto:/ /www .cdc.gov /ncidod/sars/odf/workolace.odf
@ Lcx<ltioni 225 North McDoool Stred temper Building t Raleigh, N.e. 27603
An Equal Opportunity Employer
. Interim Domestic Guidance on Persons Who May Have Been Exposed to Patients
with Suspected SARS (Apr 25,2003)
htto://www.cdc.gov/ncidod/sars/exoosuremanagement.htm ...
. Interim Domestic Guidance for Management of School Students Exposed to Severe .
Acute Respiratory Syndrome(SARS) (Apr 12,2003)
htto:/ /www.cdc.gov/ncidod/sars/exDosurestudents.htm
. Interim Guidance on Infection Control Precautions for Patients with Suspected SARS
and Close Contacts in Households (April 12,2003) )
http://www.cdc.gov/ncidod/sars/ic-closecontacts.htm
Please share this information with your communicable disease staff
Always refer to the SARS page on the CDC web site www.cdc.g:ov for the latest versions of
these recommendations.
If you have questions, please contact the SARS Public Health Command Center (919-715-0988).
cc: Dr. Steve Cline
Dr. Jim Kirkpatrick
Dr. Jean-Marie Maillard
Dr, Megan Davies
Dr. Greg Smith
e
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,
,
,
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-NEW HANOVER COUNTY BOARD OF COMMISSIONERS
REQUEST FOR BOARD ACTION
Meeting Date: 04121/03
Regular Item #: 10 Estimated Time: Page Number'
Department: Sheriffs Office Presenter: David Rice, Health Director
Contact: Amy Akin, Purchasing Agent
SUBJECT:
Award of RFP # 03-0024 and approval of contract # 03-0024 to Prison Health Services, Inc. for
health care services in the Jail.
BRIEF SUMMARY:
Currently, the health services provided to the inmates in the jail are handled through the Health Department. The service
provided has been excellent however, it is the Health Director's and the Sheriffs opinion that it would be in the best interest of
the County to transfer this service to an outside contractor Transferring this service would move liability issues from the
County to a Contractor
Also, Jail Health Services is a specialized area of health services delivery that requires twenty-four hours a day, seven day a
leek coverage. Right now, the jail does not have twenty-four hour coverage. Having a medical services contractor provi de
is coverage would mean that at 3:00 a.m. when there is a person that needs triage, there will be medical personnel on site
at can make the medical decision of whether that inmate needs to remain in the detention facility or go to the hospital.
The Sheriffs Office, the Health Department, the Finance Office, and the Legal Department collaborated to develop an
extensive Request for Proposal Package (RFP) to address the performance level that would be required by the Contractor
The Request for Proposal procedures were followed and the County received three proposals. The Bidders submitting
proposals were:
Prison Health Services, Inc.
Correctional Medical Services, Inc.
PhyAmerica Correctional Healthcare, Inc.
An evaluation committee evaluated the proposals independently and then as a group. The committee was to determine
which company would provide the best overall package to the County; price was only one consideration. Other items
considered were the completeness of the proposal and the bidders responsiveness to the County's RFP requirements,
experience of the company, company references from agencies of similar size, claims history of litigation brought against the
company, proposed staffing patterns, and the exceptions the bidder took to the requirements of the RFP Additionally, the
proposed contract will be a cost savings of approximately $137,270.00 the first year
Prison Health Services, Inc. stands out as the company to recommend to receive the contract. Attached is the resolution
for award, the pricing sheet as well as a letter from Sheriff Causey recommending the award of the contract to Prison Health
Services, Inc. The award is based on the contract beginning July 1, 2003 with the funds for the contract being budgeted in
the Sheriffs Office budget for FY04.
~ECOMMENDED MOTION AND REQUESTED ACTIONS:
dopt resolution:
/
1
2.
awarding RFP # 03-0024 to Prison Health Services, Inc.
approving Contract # 03-0024 with Prison Health Services, Inc. and authorizing the
County Manager to execute the contract.
34
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FUNDING SOURCE:
'ill above action result in: Position(s) Modification Or Change Number of Positions: e
Explanation: When the Health Services Provider begins to provide services in the Jail, the Jail-Health Section of the Health
Department will no longer be in existence. Some nurses in the Health Department will remain with the County Prison
Health Services, Inc. is interested in hiring existing staff or working with the County in any way to make the transition as easy
as possible. David Rice will address this in the presentation.
ATTACHMENTS:
The resolution and the price summary from the proposals are attached to this transmittal.
~
03.0024 resolution for award.wpd
Health Care Proposal Pricing (revised 4-10).123
The contract draft and the letter from Major Stevenson are being hand delivered to the County Manager's Office.
REVIEWED BY:
LEGAL. N/A
FINANCE: Approve
BUDGET Approve
HUMAN RESOURCES: Approve
COUNTY MANAGER'S COMMENTS AND RECOMMENDATIONS:
As recommended above by Health Department, Sheriff's office and Legal.
.OMMISSIONERS' ACTIONS/COMMENTS:
Approved 4-Q.
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RESOLUTION
OFTHE-- -
BOARD OF COMMISSIONERS
OF
NEW HANOVER COUNTY
,
WHEREAS, after due advertisement, proposals were received and recorded by the Finance Department at 3:00 p.m., on the
6th day of March, 2003, at the County Administration Building, 320 Chestnut Street, Wilmington, North Carolina, and the following
companies submitted proposals for Health Services for the Detention Center of the Sheriffs Office, RFP # 03-0024:
Correctional Medical Services, Inc.
Prison Health Services, Inc.
PhyAmerica Correctional Healthcare, Inc.
AND WHEREAS, the bids were evaluated by a conunittee consisting of representatives from the Health Department, the
Finance Office, the Sheriffs Office, and an independent consultant hired by the Sheriffs Office;
AND WHEREAS, the conunittee's unanimous reconunendation was to reconunend award to Prison Health Services, Inc.,
analysis detailed in attached letter from Major Stevenson;
AND WHEREAS, Major Stevenson and Sheriff Causey are both in agreement to award the contract to Prison Health
Services, Inc.;
AND WHEREAS, Major Stevenson, Sheriff Causey, the Finance Director, the Health Department Director, and the County
Manager reconunend that the contract be awarded to Prison Health Services, Inc., the proponent offering the best overall value to
the County, award to be made based on the Option 3 method as stated in the proposal;
AND WHEREAS, funds are to be appropriated in the jail's budget for fiscal year 2003/2004 in account 110-431-4316-3000-
13700 to cover this contract;
NOW, THEREFORE, BE IT RESOLVED by the Board of County Conunissioners of New Hanover County that the contract
r Health Services for the Sheriffs Office, RFP # 03-0024 be awarded to Prison Health Services, Inc., the proponent offering the
best overall value to the County, award to BE made based on the Option 3 method as stated in the proposal, pricing as stated in the
proposal, contract period to begin July I, 2003, and that the County Manager is hereby authorized and directed to execute
contract # 03-0024, contract form to be approved by the County Attorney
This 21 st day of April, 2003
(SEAL)
Chairman, Board of County Commissioners
A TIEST
Clerk to the Board
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New Hanover County
Sheriff's Office
Sidney A. Causey, Sheriff
20 North 4th Street
Wilmington, N.C. 28401-4591
Phone: (910) 341.4200
FAX: (910)341-4039
April 14. 2003
MEMORANDUM
TO: SheriffS. A. Causey 0 ~ ~
FROM: MajorD. S. Slevensonm\f
RE. Jail Medical Services "1'
Three bids were received in response to the RFP for the Jail medical services. These were from
Prison Health Services (PHS), PhyAmerica Correctional Healthcare, Inc. (PCH), and
Correctional Medical Services (CMS). After thorough review ofthe three bids PHS was clearly
the best choice. Following are brief notes on each:
PHS was the only bidder that was in complete compliance with what was requested in the RFP.
They offered the best staffing plan. PHS went the extra mile to provide all information needed
for us to make an informed decision. This is a division of the company that currently provides
our Jail kitchen and commissary services and we are familiar with their excellent service and
have established a positive working relationship. PHS was not the lowest bidder, however, a
determination was made that the value of services furnished would outweigh dollar amOlmts.
PCH presented a bid package that was incomplete and not in compliance with the requests of the
RFP. It was clear in their presentation and the excessiveness of their price that they were not
interested in contracting with the Jail.
CMS used a lot of "canned" language in their proposal and only submitted three references when
all were requested. The litigation history for CMS was also a concern. Their litigation rate
seemed substantially higher than the other bidders. Although they offered a slightly lower price,
it seemed that they were able to by offering an inadequate staffing plan. CMS also requested
several changes that were unacceptable in the indemnity clause and in proposing the elimination
of performance and payment bonds.
38
,
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
REQUEST FOR BOARD ACTION
Meeting Date: 04/21/03
Consent Item #: 3 Estimated Time: Page Number
Department: Legal Presenter' Kemp Burpeau, Deputy County Attorney
Contact: Kemp Burpeau, Deputy County Attorney and Cindy Kee-MacPherson, Paralegal
SUBJECT:
Request for New Fiscal Support Technician Position
BRIEF SUMMARY:
The Legal Collections Division of our office generates approximately $750,000 in revenue each year through collection of
delinquent debts for the Water & Sewer District, Sheriffs Office, Finance, Inspections, Engineering, Fire Services, Landfill,
Wastec, Library and others. There are currently two Fiscal Support Technicians to maintain all these accounts.
The Animal Control Division (ACD) had to rely on Professional Recovery Consultants (an outside collection agency) for
collection of their accounts and pay them 30% of any revenue collected until ACD was dropped from the vendor's client list.
'outside agency does not have the collection options that our office retains, such as small claim actions, enforcement of
dgments, Equifax Credit Reporting Agency, and Debt Setoff (available only to government entities.) This results in an
reased amount of uncollected accounts. ACD currently has over $725,000 in unpaid citations for violation of our Code of
rdinances. Legal Collections has the potential to collect at least 35% - 45% of this amount in addition to monthly citations
currently being entered in the system.
Violation of Sec. fr7 Rabies Vaccination and Control is a serious offense resulting in danger to the health, safety and welfare
of the citizens of New Hanover County The mission of New Hanover County Animal Control Services is to protect the public
from the threat of rabies virus exposure and to ensure proper animal care through prevention, public perception and education.
It is the responsibility of ACD to enforce all state laws and county health regulations pertaining to domestic animals and the
county animal control ordinance. It is the responsibility of the Legal Collections Division to maintain collection of debts for
ALL county departments.
When citations are issued with no consequences for unpaid debts, the public will not comply with our Code, citations become
useless and revenue is lost. Our goal is to have an additional technician that can generate a substantial amount of revenue
for the County while reinforcing the county code provisions through collection of delinquent Animal Control citations.
RECOMMENDED MOTION AND REQUESTED ACTIONS:
Approve new Fiscal Support Technician position.
FUNDING SOURCE:
Will above action result in: New Position(s) Number of Positions:
IEXPlanation: This position will be self-supporting from the collection of delinquent citation fees. The revenue collected from
is position will cover salary, fringe and operating expenditures in FY03-04. Position expenditures will be absorbed in
isting General Government Budget in FY02-03.
ATTACHMENTS:
39
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--'---'--.:..:,-----~'- '-,: LJ I~ ~j .ra',J{ii\~r,'.~ 'II \, ,,'(7 r.,--78i;~~I-:(jl" ;' I!'.~' ,,~-,,:,-
.,-,', ',?--.fL-~""'L-(L---.-- _~,L:-;-,~";:.'; .' __--LJ~~.II.:~---,_/ If" ff/fL}. ll/ L '/
, " ',' '" ' ~/" ,',,' ,2,003,2004 SESSION ~/, ,.,
Bill Number BILL TITLE NCALHD POSITION
SENATE BILL 672 STRENGTHEN PUBLIC HEALTH OPPOSE AS
INFRASTRUCTURE WRITTEN
HOUSE BILL 1004 STRENGTHEN PUBLIC HEALTH OPPOSE AS
INFRASTRUCTURE WRITTEN
SENATE BILL 907 CERTIFICATION OF WASTEWATER CO NT ACT
SITE EV ALUA TORS COMMITTEE
MEMBERS
SENATE BILL 433 LOCAL HEALTH DIRECTOR OPPOSE AS
CREDENTIALS WRITTEN
SENATE BILL 587 FUNDS FOR PUBLIC HEALTH SUPPORT
SERVICES DEMO PROJECT
HOUSE BILL 634 FUNDS FOR PUBLIC HEALTH SUPPORT
SERVICES DEMO PROJECT
HOUSE BILL 1094 AUTHORIZING LOCAL BOARDS OF SUPPORT AS
HEALTH TO ADOPT RULES DRAFTED .,
CONCERNING ANIMAL OPERATIONS
SENATE BILL 624 MODIFY THE ENFORCEMENT OF OPPOSE AS
LOCAL SANITATION AND ON-SITE WRITTEN
WASTEWATER PROGRAMS BY
AUTHORIZING LOCAL
ENVIRONMENTAL HEALTH
OFFICIALS TO AUTHORIZE LOCAL
ENVIRONMENTAL HEALTH
SPECIALISTS TO ENFORCE
PROGRAM RULES AND TO
ELIMINATE UNNECESSARY
REAUTHORIZATION OR RETRAINING
OF CERTAIN ENVIRONMENTAL
HEALTH EMPLOYEES WITH LOCAL
HEALTH DEPARTMENTS OR WITH
THE DEPARTMENT OF
ENVIRONMENT AND NATURAL
RESOURCES
HOUSE BILL 530 Funds for Interpreter Services/Local SUPPORT
Health Deol.
SENATE BILL 638 PROHIBIT THE PROVISION OF
CERTAIN HEALTH SERVICES BY
LOCAL SCHOOL ADMINISTRATIVE
UNITS AND TO REQUIRE UNITS TO
OBTAIN PERMISSION FROM
PARENTS FOR CERTAIN SERVICES
NC Association of Local Health Directors have asked the Senate Appropriations Subcommittee on
Health and Human Services to eliminate the following cuts:
. Elimination of Medicaid coverage for pregnant women and infants with
incomes between 151% to 185% of the Federal Poverty Limits
. Elimination of Medicaid coverage for individuals age 19 and 20
. Elimination of State Transitional Medicaid Coverage
The elimination of these Medicaid eligibles will dramatically affect local
health departments - either through a decrease in the limited funding that
is presently received and by the increase in the number of uncompensated
care patients that we will be serving once private providers no longer serve
them due to the ineligibility of Medicaid. The local health department is
the true "safety net" for the non-Medicaid and uninsured. We cannot refuse
service. However, we can no longer afford to provide this service without
compensation.
We also asked to return $1 million of "Out of Wedlock Births" funds in the
TANF Block Grant. These funds are for Family Planning Clinics at your local
health departments. This funding had been traditionally included in the
TANF Block Grant until last year. We did receive a small amount of
non-recurring funds in the budget last year for this purpose, but it does
not appear this year.
e
We also asked that Medicaid eligibility for pregnant teens be restored by
discounting parental income if they reside with their parents. That
language in the Special Provisions truly hurts our ability to treat pregnant
teens in the first trimester of their pregnancy when the mother and infant
are the most vulnerable.
These cuts amount to a large sum of money that could easily be raised
through the passage of a cigarette tax increase. In addition to providing
much needed revenue to support health programs, the tax would discourage
young people from smoking; thereby reducing future healthcare costs that our
future generation will have to face and saving many lives.
I urge each to you to make a call this morning to advocate for these issues.
There are other avenues to take other than cutting services. There are
other revenue generating options. Urge our Senator to use these options
other than passing the "buck" to the most vulnerable of our state's
population.
Contact the Senate Leadership, Appropriations Co-Chairs, and Finance
Co-Chairs. You do not need to be a constituent to contact the Leadership-
they need to hear from everybody The list follows below.
-.
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'''Gifts for all your o[J
animal loving friends
'. The Eccentric Cat really is a little eccentric
I " SO you really need to check us out.
You never know what you might find with our always
growing, always changing collections.
A gift from The Eccentric Cat will always be purrrlettly
wrapped and a .visit to our store will be colorful and fun.
Located at Carolina Beach- right over the Snow's Cut
bridge in the Snow's Cut Shopping Center. (910)458-5810
1401 N. Lake Park Blvd.,Caronna Beach, NC 28428
I
I
I
I
I
1t50o"8ring in your pet's
! aO proof of adoption during
~
1
c:F>o
aD
the month of May-
get 20% off any purchase
of $20 or more
01.
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04
od
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I
.CLOTHliJ(;;'.~~'ITW:~J:lli~Pifl':~:~[E.;t\(fJ,TE:s:/. HOUSE "STUFF" .,POT,T'ERY ANO MORE
.,' ~W@QD ~ fl1@ DUD ~~ ~pOi:@g ,])\
@~~ilu@
~@ffi~ilu
I
. Just look at my cute
little cheeks and my
beautiful long
whiskers. Can you
believe that I am
homeless? I'm just so
perfect. My name is
Sampson and I've
already been neutered
and vaccinated. I
have even purrfected
the talent of biscuit
making. If you would like to adopt a quiet boy like me, then why
I don't you give Paw's Place a call at 910-845-PAWS.
/ I am sponsored by Salt Marsh Kayak Co. Thank you, Barbaral
,..
o.
Safe. flO1 Adventures for
tho "1i f""'"
ym~
r..,~ =. -=, J'/y
IIM~~ .'; \I~
,~~K
I
-I
910-509-2989 r<\'
866-65-KAYAK \j) )
www.saltmarshkayak.com
2220ldCausewayDrive.WdghtsvilleBeach,NC 28480
-~.
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The Smallpox Vaccination Program
for NC - Stage I:
Update for the New Hanover County
Board of Health
Thomas Morris, MD, MPH
Public Healtb Regional Surveillance Team
Region 2
Wilmington, NC
7 May 2003
N C Department ofHealtb and Human Services
Division of Public Health
Office of Public Health Preparedness and Response
Public Health Regional Surveillance Teams' Response Areas
1-" I
--.
NC Smallpox Vaccination Plan
~ Pre-event: Stage I, Stage II, etc.
>> Event: Ring 7 Mass Vaccination, SNS
.:. Identification & Training of vaccinators
.:. Clinic Plan: organization and sites
.:. Screening forms & standing orders
.:. "What makes the Take" ,'......,-,."""..........,
.:. Adverse EventslV AERS
& Follow-up
!llTJ<!m. . ,'cl:!l1f@1fi
U._.U
"... ..... ....,.
w...e:
..... """. "",,, '
~~~I
ia.~
...
The PHRST Roster (Jan 2003)
~ Thomas Morris, MD, MPH
- Pbysician Epidemiologist
>- Judy Agner, RN, BS
- RN Epidemiologist
>- Allison Stockweather ....
- Industrial Hygienist
~ Alene Mabry
- Administrative Assistant
~ Daniel Wilson, DVM
- Veterinary Epidemiologist (NC DA&CS)
Smallpox Vaccinations Totals
. 7 May 2003
PH
Region 2 71
NHC 14
HOSD Other Re-vax Total Doses
102 7 8 188
1 2 2 19
NCstate
USA (25 April 03)
Fl.
\;'. ,fo. 'r
.~ . ....
.".".. ,. .'
..," . 1/~T,~
-1209
34,541
NO Adverse Events!
1
New Hanover County's
Preparation and Response
>>Developed New Hanover County Health Department
(NHCHD) Smallpox Pre-event Vaccination Plan
};. Designated posltloDS identified to rec:eive vaccination
r Notified designated staff
;, Provided education. written Illerature, and vaccine election
form - voluntary
Three categories:
1. Accept vaccine
2. Medical exemption - medical contraindication for
self/household member
3. Optional deferral
)- Record vaccinations with dressing changes (took photos)
>> Take observations and documentatloD at seven da}'1
}- Data reported to Public Health Regional Surveillance Team
(pHRST) - Forwarded to NC DPH (Raleigh)
};- Symptom log (developed from military form by Judy
Agner, RN) to collect data
). Collaboration with New Hanover Health Network (NHHN)
to Include medical providers in Stage 1 and Stage 2
, Arranged medical consultaClon for employees wlCh concerns
abouC contraindicaCions
r WroCe slanding order - signed by Dr. Rhyne
};> Trained vacclnaCors in adminlsCraCion, recording Cakes,
reporClng advene evenCs
, ReeelpC, sCorage, and handling of vaccines and supplies
,. Vaccination clinics
, SCaCions
1. Required CenCers for Disease ConCrol and Prevention
(CDC) video
2. Review of CDC written materials - medical
history and rule out medical contraindications; obtain
Informed consent
3. Administer vaccine; apply dressing
4. Site care and supplies - caught site care to prevent
transmission to others
Future Directions
Level of threat difficult to determine and
affecting interest and participation
Liability Coverage is in place (HSA sect 304)
Smallpox Compensation Bill signed last week,
but not yet Implemented
NC has not set a date to end Pre-Event Stage I
or begin Stage II vaccination
Training & Education of MDs & HCWs about
smallpox and otber BT agents will continue
(such as at Coastal AHEC).
Continue with AE monitoring
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