12/03/2003
.
New Hanover County Health Department
Revenue and Expenditure Summaries for October 2003
Cumulative: 33.00% Month 4 of 12
Revenues
Cu,",nt Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remalnln Amount Earned Remalnln
Federal & State $ 1,688,857 840,486 $ 848,371 278,654 $ 1,426,554 16.34%
nimal C!Jntrol $ 570,161 218,840 $ 351,321 186,394 $ 401,550 31.70%
Medicaid $ 1,044,080 82,425 $ 961,655 179,573 $ 855,813 17.34%
Medicaid Max $ 268,833 0.00%
EHFees $ 300,212 $ 228,986 27 46%
Health Fees $ 113,850 52.87%
Other $ 2,307,095 32.57%
Expenditures
e
ype of
Ex ndlture
Budgeted
Amount
Cu,",nt Year
Expended Balance
Amount Remalnln
%
Budgeted
Amount
Prior Year
Expended Balance %
Amount Remalnln
$2,570,912 $6,560,616 26.15%
$ 532,462 $1,393,384 27.65%
$ 2,606 $161,140 1.42%
Summary -
Budgeted Actual %
FY03-04 FY03-04
Expenditures:
Salaries & Fringe $ 9,938,494 $ 2,620,963
Operating Expenses $ 1,498,835 $ 442,229
Capital Outlay $ 340,363 $ 21,758
Total Expenditures $ 11,777,692 $ 3,084,950 26.19%
Revenue: $ 6,293,088 $ 2,140,934 34.02%
Net County $$ $ 5,484,604 $ 944,016 17.00%
.
Revenue and Expenditure Summary
For the Month of October 2003
10
.
e
.
NHCHD BOARD OF HEALTH APPROVED GRANT APPUCATlON STATUS FY OU4
Date (SOHl Grant Reouested Pendlna. . Received Denied
Cape Fear Memorial Foundation- Funds needed to
cover dentalll8lYk:es for needy children as Identified by
11/512003 School Heallh NuI\l8S. $3,000 $3,000
NC Medlcal Foundation. Through tile Good
Shephard Ministries for nursing eervlces to tile
population frequenting the sheller, $25,000 $25,000
Duke Unlveralty- To provlde.10 hours of nursing
eervlces for TB Outreach. $10,388 $10,388
NC Tobacco and Control Branch, DHH8-
Continuation of Tobacco Prevention Program. $100,000 $100,000
101112003 No acIIvIty to report for October 2003.
New Hanover County Safe Schools- Uniting for
Youth 'U4Youth'(fundlng will be received over a
91312003 3 War grant period) $49,000 $49,000
Safe Kids Coalition- Fire Prevention (please nota
this grant was pullad- coalition not able to meet
daadllna for requast) $2,500 $2,500
81612003 NC DHHS- OPH Precaredneas and ResPOnse $82,350 $31,950 $50,400
Smart Start- Partnel8hlp for Children (GI8nl
71312003 Increal[l8 for Part TIme Nurse Position) $5,523 $5,523
Cape Fear Memorial Foundation. Diabetes
Today (two-year 18quest; $42,740 annually)
(Reoalved $25.00 year 1 and $20,000 year 2) $85,480 $45,000 $40,480
Duke Unlvel8lty Nicholas School of the
Envlronment-Geographlc Information Systems
Grant (Env Health) $10,000 $10,000
Safe Kids Coalltlon- Safe Kids Mobile Car Seat
Check up Van $50,000 $50,000 .
Safe Kids Coalition- RIsk Watch Champion
6/4/2003 Team $10,000 $12,500
Smart Start- Partnel8hlp for Children: Child
51712003 Cere Nursing Program (Preliminary Approval) $171 977 $172,500
Smart Start- Partnel8hlp for Chlldl8n: Health
Check (preliminary Approval) $41,035 $41,747
UNC-CH: Child Care Health Consultant $62,649 $84,495
Cape Fear Memorial Foundation (through
PartnershIp for Chlldrenl: Navloator Pnoal8m $176,707 $160,000
4/312003 No activity to report for April 2003. .
3/512003 No activity to report for Msrch 2003.
2/512003 No sctlvlty to report for February 2003.
11812003 NC DHHS- OPH Precaredness and Resconse $115,95O $33,600 $82,350
12/412002 No activity to repori for Dacember 2002.
NC Health and WellnessTrust Fund.Teen
TobaCCXl Use Prevention & Cessation Progl8m
111612002 ($100,000 per year for 3 vears) $100,000 $100,000
Safe Kids Buckle Up Program-North Carolina
101212002 Safe KIds $5,000 $5,000
f
As of 11/1712003
. NOTE: NotIIIcation received 81noa last report.
11
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 03-04
Developing Geographic Infonnatlon Systems
(GIS) Capacity In Local Health Department In
Eastem North Carollna-Duke University
Nicholas School of the Environment and Earth
ScIences (NSEES) $18,000
oa ty repo or ep
oa tytorepo r g
oa ty report r u
Totals $1,126;759 $187.388
18.63%
Pandlng Granta 5 25%
Funded Total Reouest 8 40%
Partlsllv Funded 3 15%
Denied Totel ReQuest 4 20%
Numbers of Grants ADolled For 20 100%
As of 11/1712003
" NOTE: NotIIIcation racalvad since last report.
$18,000
$614,792
54.56%
$331 2Q
29.40%
.8
e
.
12
~~~,\'lJ;;,,;\
"~'.""""'~
~J ~:t~~
fA ';~~'._;l.:'~! .
~,~:
93.~~'"
-:(~.:ilr;rl< >~
November 25, 2003
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 soum 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341.4146
To: New Hanover County Board of Health
From: Cynthia W. Hewett, Business Manager~
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 Justification
Needed
Addition 99172 $30.00 Establishing fee for Vision Screening (color) procedure provided in Child Health
Services
Addition No code $27.00 Establishing fee for Ortho Evre birth control patches
ee Change 11977 $193.14 Medicaid Reimbursement increased from $190.30 to $193.14 for Removal!
Reinsertion ofNorplant
Fee Change 46900 $179.37 Medicaid Reimbursement increased from $179.07 to $179.37 for Destruction of
Anal Lesion(s)
Fee Change 96152 $22.19 Medicaid Reimbursement increased from $13.25 to $22.19 Intensive Psychosocial
Counseling
Fee Change 90676 $160.00 Medicaid Reimbursement increased from $120.00 to $160.00 for Rabies
Vaccination
Fee Change 99001 $18.00 Increase in Handling Fee from $15.00 to $18.00
Deletion 84479 26 No fee Lab Service sent to State Lab: T3 or T4 (State no longer providing this service)
Deletion 84443 26 No fee Lab Service sent to State Lab: Assay Thyroid Slim Hormone (State no longer
providing this service)
The following needs to be included in the Medications Available for NBC Employees Section:
Addition No CPT $12.00 Ortho Evre
Code
e
13
"Healthy People, Healthy Environment, Healthy Community"
,
..
,
'"
.
e
.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Meeting Date: 12103/03
Subject: Request for approval to accept additional Bioterrorism funding for use in the
Public Health Bioterrorism PHRST-2 bud et in the amount of$71,880.
Brief Summary: New Hanover County Health Department will receive an additional
$71,880 funding from NC Department of Health and Human Services, Division of Public
Health, Public Health Preparedness and Response Branch to be used to support the
Re ional Bioterrorism Pro am.
Recommended Motion and Requested Actions: To approve receipt of additional state
funding to be used to support the Regional Bioterrorism Program in the amount of
$71,880 and associated budllet amendment
Funding Source: NC DHHS, Division of Public Health, Public Health Preparedness and
Response Branch.
Will above action result in:
[]New Position Number ofPosition(s)
DPosition(s) Modification or change
o Chan e in Position s
Explanation: These funds will be used to support the daily operations of the PHRST-2
Team hosted by the New Hanover County Health Department. Due to this Team
traveling extensively to other areas within the region and state, the majority of these
funds will be bud eted in trainin and travel for PHRST-2 Staff.
I Attachments: Copy of Contract Addenda.
14
.
"
t
,
e
I-
Z
w
:i:
c
z
w
:i:
c(
I-
W
C)
C
,
W
D..
><
W
.
i
Iil
~
;r;
;;j
..
15
z
o
o
I-!!l~ 0 0 0 0 0 0 0 0 CXl
0 0 0 0 0 0 0 0 CXl
~O~ 0 q 0 0 q 0 0 It) ~
N ...... ...... M N ...... 0 ......
oL ...... It)
:::!Ez8
c(C
+ ... I + + + + + + + + +
0
01-1-
WWZ
OO(,')::l
500
W::l~
O:::CD<(
1-1-1-
zwz
w(,')::l
0:::00
O:::::l~
::lCD
U
I- 00
U ~
W W z
ii3 00 u 00 I- 0
Z I- ::l 00 ii: ...J
0 W W Z W
W Z 0::: (,') ::; W ~
a. W I- :E ii:
~ :E 0::: a.
o!l <( a. a. u
Q: 0 J: ::l :5 00 I-
W ::l I- U 00 0 CD o!l
Z 0 ::l 0 ::l
0 (,') W 00 (,')
J: 00 W <( Z Z ~ z
a. 0 , , i= <( o!l Z
W 0::: 0::: ...J 00
...J 15 o!l o!l Z W LL W ~
W ~ ii: ::l (}j ::l
I- :E ~ a. LL 0 I-
0 00 0 0 0 0 0 0 0
~ ~ N ..... 0 ltl ..... 0 0
00 00 m m ~ N ; .... N
..... ..... ..... ..... v v V ltl
~
~
~ 0 0 0 0 0 0 0 0 0
0 0 0 0 8 0 0 0 0
0 0 0 0 0 0 0 0
N N N N N N N N N
"'oz
o 0
!::g:~
z!ia:
=> II.
,
-z
U l::l l::l N l::l l::l l::l l::l l::l l::l
N
~ ~ ~ ~ ~ ~ ~ ~ ~
ltl ltl ltl ltl ltl ltl ltl ltl ltl
Z a.
0 ...J
~ W
J:
E
In
'"
~
~
~
iii
w .<:
-
~ 1ii
Q)
J:
~ ,Q
~ :is
:::I
W a.
~
z
w
~ 0
~
ltl
C
Z
=> 0
...
~
~
~
lu
8~
=>
CD
~
::;
Cl
Zc
~o
=>0:
8~
~
~a:
Ww
::;CD
~~
~
z
w
~
CD
W
Z
0
I=w
~8
r
01-
WW
CIlCl
-0
[[j::l
a::lD
...J
~
e
~
~
~
SS!
1Il1ll'"
000
~
~
Q)
E
In
."
g
~
:is
1ii
l:
o
'~
.!!!Q)Q)
:t:::';:I~
1-i=1=
15
e
I-
Z
w
:i
c
z
w
:i
c(
I-
W
C)
C
.
W
~
.
~
!l:
i
0
CXl
I-!!l~ CXl.
ZO~ ......
g~ .....
~~8
+ .. I +
0
oliil-
W Z
oot')::l
-00
iii::l:E
O:::CD<(
I-liil-
z Z
Wt')::l
0:::00
O:::::l~
::lCD
U
Ww
::;)0
i!i
g
I-
z
~
t')
W
!;(
I-
00
V
N
~
I 0
0
0
N
.J.Z
U N
N
~
ltl
Z ~ i
0
~ W
J:
E
In
."
~
~
~
iii
.<:
w -
~ 0;
Gl
J:
~ .Q
:is
:::I
W a.
~
z
w
~ 0
~
ltl
C
Z
:::> 0
...
~
~
~
lu
8~
:::>
CD
i
~
~8
::t12
8~
~
~a:
Ww
:liCD
:::>:li
0:::>
8z
~
z
w
~
CD
a:
z
0
fjw
~8
r
;r;
;;!
..
15
z
o
c
~
~
.9!tDG)
maim
000
~
~
Gl
E
In
'l:
g
~
01- :is
WW 0;
CIlCl
-0 l:
[[j::l 0
a::lD l'~
~ 1::
e 8.
c.
:::I
In
GlGlGl .9
:e:e~ E
I-i-i= j
a.
E
..
'l:
g
J!!
0
iii -g
~ 'fi
~
E l:
,g ,g
al ~
,~ Q)
~ E
8
..
'C 'C
l: '"
.;! l:
:e
0; Ii
l:
0
:e
'C 00
GlGl" -g Z
EEEJ!! '" 0
III III 01 III l:
ZzzO "" !;i
Gl
.. .. '"
0;......,0; 'C ~
e~~e :::I
CD 0
c.al ~ u..
c. c. Z !l
~~~~ 0 ~
.l!l '0 !;(
l: O'jjj
Gl ' ..
E CD- S 0
1:: E E
III E
c. 0 l~ ~
Ql U
16
.
I
NORTH CAROUNA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
FUNDING
AUlHORIZA liON
ISSUED TO: NEW HANOVER COUNTY
STATE FISCAL YEAR
PubliC Healtb DepartmentJDistrlet
FROM: July 1,1003 througb June 30, 1004
FUNDING SOURCE: 536961 4513
NAME ~F PROGRAM: PH Regional Response Team
EFFECTIVE
DATE
07/01103
AUTII#
1
INITIAL ALLOCATION
5109,811,50
PRIOR ADJUSTMENTS YEAR TO DATE. . . INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORIZATION
$0.00
S331,!JI8.oo
NET ANNUAL ALLOCATION
5441,730.s8
GRANT INFORMATION
nd Service Months Payment Months Codes
ederal June-May July-June 1451 5685 EN
Federal Sept-May Oct-Jane 15612688 ET
Federal Sept-May Oct-June 1561 1681 ET
Total.
Amount
CFDAtI
93.183
93.183
93.183
5109,81z.so
$11,170.00
5310.648.00
5441,730.s8
-44 \ 130
57.)
3:;,Q 5'"$)
".-'-
D 71 ,iiSD
13''''ar'~l
_ :.IJ....
-5l>
JTf)Je
........... ,,-
".--' _.~---...'
"
AUTHORIZED SIGNATURE
-Ji.u.,( d-n
DATE: 10Jn103
DHHS-CO
7-41
17
"
,)
I
I'
.
.
e
.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 12/03/03
A enda: [8J
D artment: Health Presenter: Cind Hewett
Contact: Cind Hewett, Business Manager, ext 6680
Subject: Request for approval to accept additional Bioterrorism funding which have
been made available to local health departments to further assist counties in continuing to
strengthen local public health infrastructure and capacity, and to effectively respond to a
possible bioterrorism event.
Brief Summary: New Hanover County Health Department will receive $137,863 of
funding from NC Department of Health and Human Services, Division of Public Health,
Public Health Preparedness and Response Branch to be used to support the local public
health department in its efforts to build strength and capacity allowing it to effectively
respond to a possible bioterrorism event. These funds will be used to fund a new
"Planner" position for coordinating local bioterrorism efforts, temporary IT staff to assist
with added technology requirements, computer equipment, printing charges, operational
supplies and trainim! and travel for staff.
Recommended Motion aild Requested Actions: To approve receipt of state funding to be
used to support the local public health department in its efforts to build strength and
capacity allowing it to effectively respond to a possible bioterrorism event. in the amount
of$137,863 and associated budget amendment
Funding Source: NC DHHS, Division of Public Health, Public Health Preparedness and
Response Branch.
Will above action result in:
[8JNew Position (I) Number ofPosition(s)
DPosition(s) Modification or change
DNo Chan e in Position s
Explanation: These funds will be used to fund a new "Planner" position for coordinating
local bioterrorism efforts for New Hanover County, temporary IT staff to assist with
added technology requirements within the health department, additional computer
e ui ment, rintin char es, 0 erational su lies and trainin and travel for staff.
I Attachments: Copy of Contract Addenda.
18
'"
".
...
z
w
:E
Q
Z
w
:E
c(
...
w
C)
Q
ei
w
ll.
><
W
.
g
~
c
w
~
.,
li
:l
u:
b
z
8
I-~- ; 0 C') r-- <0 C') 0 0 0 0 0 0
0 co r-- .... <0 0 co 0 0 0 0
ZO~ co q C\!. 'It. 0 0 CC!. 0 0 It) 0
6~ a) N N .... cD 0 .... C"i 0 N a)
N N N .... .... N
:!:~g
c(-
+ ... . + + + + + + + + + + + +
0
o~~
wwz
(l)C)::>
-00
~::>~
O::lXl<(
~~~
zwz
wC)::>
0::00
O::::>:i!
::>lXl
u
w
W
9
Q. W ~
~ (I) z
w z w
~ w w (I) ~
~ (I) Q. W Q.
U W ~ U ::; 5
~ z (I)
w (I) ~ C) ~ W Q. @
.., W W (I) Q. W
lXl ..J (I)
C) 0:: ~ U Z (I) ::> ..J
0 ~ ~ ~ z ::> w w (I) ~ z ,
~ (I) ~ w ~
ca 0 ~ Q. ..J Q.
0 it: ..J ~ ~ ~
~ ::> ~ ~
z ~ ::> (I) z ~ ~
<( u z ~ w U all 0:: ::>
::; z w
(I) ~ w w ~ w 0
(I) ~ ..J iii 0 C) C) ~
w ~ ca J: Z ~ ~ ..J
it: ~ ..J W ::> ~
~ 0:: Q. i= 0:: Z Q.
~ ~ u ~ is is w ~ ~ ~ ~ ~
..J
ca W 0 w !:i w 0:: W 0
~ (I) 0:: ~ ~ Q. 0 ~ u
0 lil 0 0 0 0 0 0 0 0 Ol 0
0 0 - 0 - - 0 - 0 en ~
0 0 - N '" '" ex> - N ~ '"
- ... N N N N '" ..,. ..,. CD
I 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 l'il 0
N N N N N N N N N N N
LLOZ
o 0
t::g:~
z~a:
::> II.
...z
U ... ... ... ... ... ... ... ... ... ... ... ...
'" '" '" '" '" '" '" '" '" '" '" '"
... ... ... ... ... ... ... ... ... ... ... ...
It) It) It) It) It) It) It) It) It) It) It) It)
Z Q.
0 ..J
~ W
J:
c:
w 0
~ ~
-
U)
~ '2
'E
w ~
~
w
~ 0
...
It)
0
Z
::> 0
LL
...
...
~
Iii
8~
::>
III
~
::;;
~
Zo
~O
::>;;:
8~
<(
ffia:
::;;:ll
::>::;;
82
~
w
~
III
W
Z
0
~w
~8
r
ct;j
~(!)
~g
a:lXl
~
~
{
~
-::::::
SCDJj
maili
000
CDQl"
EEE~
"'''''''0
zzz
19
.
.
...
z
w
:E
Q
Z
w
:E
c(
...
w
C)
Q
:::)
m
-
w
~
a::
.
~
fil
l
li
;j
...
b
z
o
c
<0 CO <0 C')
It) <0 <0 r--
...~- 0 0 <0 0
ZO~ 0 ..t .0 as
6~ It) r--
~~g
+ .. I + + + +
0 otii~
w z
(I) C)::>
-00
~::>:i!
a:lXl
~tii~
z z
wC)::>
a:OO
a:::>:i!
::>lXl
U
-
c:
CD
E
U)
(I) U)
CD
ffi ~
z
~~ 0 all
W c:
Za: a: 0
U ~ :;::l
rl
w '2
a:: '"
Q. E
~ E
(I) 0
it: u
0 E
a: U)
'C:
a: g
w
15 ~
iii iii
N ;:Ii
'"
It) It)
'" '"
I 0 0 0 0
0 0 0 0
0 0 0 0
N N N N
"'z
U - - - -
'" '" '" '"
- - - -
It) It) It) It)
Z Q.
0 ..J
1= w
\;! J:
c:
w 0
:;::l
~ ~
~ '2
'E
w ~
~
Z
W 0
~ -
It)
0
Z
::> 0
lL
-
-
~
Iii
8~
::>
III
~
::;;
~O
~O
~~
!Ea:
Ww
::;;1Il
~~
~
Z
w
~
III
a:
Z
0
II
"n
~ ~
~
~ ~
SS~ E
U)
'C:
'" '" g
000
~
:c
-
c:
CD
~
[
CD
"
E
'"
CD
Clii .s::;
~(!) ~
-0
jlj::>
a:lXl
~
~
~CDCD
j-EE
~~
Q.
E
U)
'C
g
~
iii
S '
~~
CD U
=~
E c
,g ,2
al~
~ ,2: CD
~ ~
U) g
""
c
~~
'"
c
~ '"
,,(1)
"
CD CD .' '" u
",EE~ _z
CDO
z~~o "j:
"'oe
.. .. .&J:E
1& ".:..:1&
e~~e {!!.a::
0
Q. al CI. ...
.2' ,., .2'< uz
z_
-~ c ~~
.l!I '0
c 0,-
~ ai'~ j~
[ 8 Q
CD u
20
NORTH CAROUNA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
FUNDING
AUTHORIZATION
ISSUED TO: NEW HANOVER COUNTY
STATE FISCAL YEAR
Public Health DepartmentIDistrIct
FROM: Jnly 1,2003 through Jnne 30, 2004
FUNDING SOURCE: 536961 4519
EFFECTIVE
DATE
07101/03
NAME OF PROGRAM: Bioterrorism-Smallpox
INITIAL ALLOCATION
$78,073.00
PRIOR ADJUSTMENTS YEAR TO DATE. . . INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORIZATION
$0.00
$0.00
NET ANNUAL ALLOCATION
$78,073.00
GRANT INFORMATION
TvDeofFnnd Service Months Payment Months Codes
ederal Sept-May Oct-June 1563 2680 ET
Federal Sept-May Oct-June 1563 2681 ET
Federal Sept- May Oct-June 1563 2686 ET
Federal Sept-May Oct-June 1563 2687 ET
Federal Sept-May Oct-June 1563 2688 ET
Total
Amount
$1,181.00
$68,295.00
$893.00
$869.00
$6.835.00
$78,073.00
_ ~S 130
Lo
AUTHORIZED SIGNATURE
~..,J( d-n
DATE: 10123103
Daas-co
7-01
AUTII#
1
CFDA#
93.283
93.283
93.283
93.283
93.283
21
NORTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
FUNDING
.
AUTHORIZATION
ISSUED TO: NEW HANOVER COUNTY
STATE FISCAL YEAR
Public Health DepartmentIDlstrlet
FROM: July 1, 2003 through June 30, 2004
FUNDING SOURCE: 536961 4514
EFFECTIVE
DATE
07/01/03
AUTH#
2
NAME OF PROGRAM: BT Preparedness and Response
INITIAL ALLOCATION
5750.00
PRIOR ADJUSTMENTS YEAR TO DATE. . . INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORIZATION
SO.OO
$49,306.00
NET ANNUAL ALLOCATION
$50,056.00
GRANT INFORMATION
ofFnnd Service Months Payment Months 9!!1!!
Federal June-May July-June 1451 5685 EN
Federal Sept-May Oet-June 1561 2680 ET
Federal Sept-may Oet-June 1561 2681 ET
Federal Sept-may Oet-Jine 1561 2687 ET
Total
Amonnt
CFDA#
5750.00
$8,190.00
$36,473.00
$4.643.00
$50,056.00
93.283
93.283
93.283
93.283
JT&~123
AUTHORIZED SIGNATURE
~./t d-n
DATE: 10123103
DHH8-CO
7-01
22
NORTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
FUNDING
AUTHORIZATION
ISSUED TO: NEW HANOVER COUNTY
STATE FISCAL YEAR
Public Health DepartmentlDistrid
FROM: July 1, 2003 through June 30. 2004
NAME OF PROGRAM: Bloterrorism Communications and Risk Assessment
EFFECTIVE
DATE
07/01103
AUTH#
2
FUNDING SOURCE: 536961 4515
INITIAL ALLOCATION
$0.00
PRIOR ADJUSTMENTS YEAR TO DATE... INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORIZATION
$0.00
54,068.00
NET ANNUAL ALLOCATION
$4,068.00
GRANT INFORMATION
e or Fund
Service Months Payment Months Codes
Amount
CFDA#
ederal
Federal
Total
June- May July..June 1451 5688 EN
Sept-May Od..June 1561 2686 ET
$0.00
$4.068.00
$4,068.00
93.283
93.283
Reeewed ~eed ;;&
h Director
~
I .
Local Finance Officer
AUTHORIZED SIGNATURE
.Ji.o./t d-n-
DATE: 10123/03
DJIHS.CO
7.01
23
NORTH CAROUNA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
ISSUED TO: NEW HANOVER COUNTY
Public Health DepartmentJDistrict
FUNDING SOURCE: 536961 4518
NAME OF PROGRAM: Bloterrorism-SNS
INITIAL ALLOCATION
FUNDING
AUlHORIZA liON
STATE FISCAL YEAR
FROM: July 1, 2003 throngh Jnne 30, 2004
EFFECTIVE
DATE
07101/03
$5,666.00
$0.00
PRIOR ADJUSTMENTS YEAR TO DATE. . . INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORIZATION
NET ANNUAL ALLOCATION
GRANT INFORMATION
of Fund
Service Months
Payment Months
Sept-May
Oct-June
to by
J7-f)~:>
Ith Director
~
" ,)
Local nce Officer
.Ji.oc/t dn-
AUTHORIZED SIGNATURE
DHllS-CO
7~1
$0.00
$5,666.00
Codes
Amonnt
1562 2688 ET
$5,666.00
DATE: 10123/03
AUTH#
1
CFDAII
93.283
24
.
,t'
-
e
e
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Meeting Date: 12/03/03
Subject: Request for approval to accept additional Family Planning funding for use in
the Tern 0 Assistancefor Need Families ANF bud et in the amount of $2 1,408.
BriefSunrmary: New Hanover County Health Department will receive $21,408 funding
from NC Department of Health and Human Services, Division of Public Health,
Women's and Children's Health Section to be used for family planning approved
ex es.
Recommended Motion and Requested Actions: To approve receipt of additional state
funding to be used to support Family Planning in the amount of$21,408 and associated
budget amendment
Funding Source: NC DHHS, Division of Public Health, Women's and Children's Health
Section
Will above action result in:
DNew Position Number ofPosition(s)
Dposition(s) Modification or change
o Chan e in Position s
Explanation: These funds will be used to support salary and fringe of public health
nursin staff rovidin above listed services.
I Attachments: Copy of Contract Addenda.
25
I
,
-
I-
Z
w
:E
Q
Z
w
:E
<C
I-
W
C)
Q
:)
ei
w
~
~
e
I
III
~
'"
0;
::l
u:
Ii
z
o
o
ClO
0
I-~~ ""-
Zol:! ....
5~~ N
~~8
+ .. I +
0 Cl-I-
WWZ
CIlC):::>
-cO
[jj:::>:;;
It:1ll<(
I-liil-
Z Z
WC):::>
It:co
It::::>:;;
BIll<(
Ww
=>0
Za:
~5
a:0l
I-
Z
~
C)
W
~
~
N
C"l
~
~ 0
0
0
N
-'-z
U ClO
'"
~
'"
Z 11.
0 ...J
i= w
~ X
II>
,!!
'E
1II
u.
>-
al
CIl
z
~
,g
CIl
0
c:
~
'iij
Ol
W <(
i ~
e!
~ 8-
E
CIl
w l-
t
Z
w
~ 0
~
'"
0
Z
:> 0
u.
~
~
~
Iii
8~
=>
III
i
I!)
Zo
~~
8~
0(
!ia:
~~
:>::!
82
t
Z
w
~
III
a:
Z
0
[3w
CliO
i8
f!
~ ~
CIl
~
~ I
~
!1.!!,! 0
1II111111 Ig
Ccc
'E
c:
1II
a:
,?;
E
1II
U.
1::
I~
::>
II>
otii .s
~C) E
-0 IJ
~:;)
a:al
~ 11.
i!
0 Sl
l-
X
CIl
CIlCllCll ~
leE::> c:
I-i-i= CIl
~
11.
II>
"c:
CIl
E
~
i ai
CIl i
CIl
:6
E c:
,g 0
""
al ~
,~ CIl
~ E
::>
II> 8
"tl i
c:
.2 c:
'E
'iii i
c:
0
;e
"tl CIl
CIlCll" al :Z
EEE~ -
11 0
1II111111c ~
zzz "tl
::>
~;tll .c ~
0
I- 0
c. al c. u.
~~~ :Z ~
Eli/: c: 0 ~
'0 ~
c: c-
~ ai'~ j 0
E
II g I~ c
CIl (,) C
26
-
I-
Z
w
:E
Q
Z
w
:E
<C
I-
W
C)
Q
:)
.
w
a-
><
w
e
~
~
III
~
0;
;;!
"-
Ii
z
8
I-~~ ClO
0
ZO~ -.t_
5~ ....
N
~~8
+ .. I +
0 cliil-
w Z
C/lC):::>
-co
[jj:::>~
It:llJ
1-1-1-
zwz
wC):::>
It:co
It::::>~
:::>llJ
(,)
t;
W C/l
a3 w
C)
0 ~
c
z
<(
C/l
w
1i:
:5
~
0
0
0
~
~ 0
~ 0
0
N
U.oz
oa:o
t:1I.~
z!1(a:
::> II.
-'-z
U ClO
'"
....
'"
z 11.
0 ...J
~ W
:t
~
oe
1II
U.
>-
1
z
~
.g
8
c:
1II
1ii
"iii
w ~
i ~
e!
~ 8-
E
CIl
w l-
t
z
w
~ 0
~
'"
0
z
~ 0
~
~
~
Iii
8~
::>
III
i
I!)
z
~8
::>-
@~
0(
!ia:
Ww
::!Ill
::>::!
82
t
z
w
~
III
W
Z
0
[3w
CliO
i8
01-
WW
wC)
-0
>:;)
~al
...J
~
o
I-
~
~
,
~
~
CIl
~
o
!
::J
o
.!!G>S
co as co
Ccc
Oe
1II
U.
1::
8-
0.
::J
Ul
.s
c:
i
~
m
:t
~
c:
~
11.
Ul
Oc:
CIl
E
~
s
i7l]
CIl 0
:6:ll!
E 1II
,gj
al c:
o~ CIl
~ ~
Ol g
...,""
c:
~~
1II
c:
o
:E::J
...,C/l
...,
1II '0
_z
CIlO
-g~
.0:&
Olt:
E!...,.., I- 0
0. co Ii.
q.!l!.o. .. z
oCt CIl 0.0<( Z -
-~<(c:O...l
.l!l "0 - <C
c: COin!:; Z
Q) '(1)-'
E llJo- ~ Q
1:: E :::J I:
II g II. C
CD (,)
CIlCllCll
;e-~
1-" "" =
1-1-
27
.
,
,
. Distribution of FP "Bonus" and Outreach Funds
e by LHD or District
October, 2003
e
COUNTY/DISTRICT FP COUNTY/DISTRICT FP COUNTY/DISTRICT FP
01 ALAMANCE $ 35.777 35 FRANKLIN $ 4,213 67 ONSLOW $ 1,875
214 ALBEMARLE $ 15,195 36 GASTON $ 12,299 68 ORANGE $ 5,480
02 ALEXANDER $ 4,359 38 GRAHAM $ 1,875 69 PAMLlCO $ 3,288
04 ANSON $ 6,649 221 GRAN-VANCE $ 5,650 71 PEND"ER $ 4,311
204 APPALACHIAN $ 20,482 40 GREENE $ 4.457 73 PERSON $ 1,875
07 BEAUFORT $ 15,124 41 GUILFORD $ 1,875 74 PITT $ 16,391
09 BLADEN $ 1,875 42 HALIFAX $ 1,875 76 RANDOLPH $ 2,216
10 BRUNSWICK $ 1,875 43 HARNETT $ 7,964 77 RICHMOND $ 2,947
11 BUNCOMBE $ 52,631 44 HAYWOOD $ 18,972 78 ROBESON $ 10,448
12 BURKE $ 1,875 45 HENDERSON $ 4,798 79 ROCKINGHAM $ 1,875
13 CABARRUS $ 8,207 209 HERT-GATES $ 4,627 80 ROWAN $ 1,875
14 CALDWELL $ 32,757 47 HOKE $ 4,213 216 R-P-M $ 5,625
16 CARTERET $ 3.434 48 HYDE $ 2,313 82 SAMPSON $ 9,328
17 CASWELL $ 4,603 49 IREDELL $ 1,875 83 SCOTLAND $ 5,528
18 CATAWBA $ 17,852 50 JACKSON $ 1,875 84 STANLY $ 6,990
19 CHATHAM $ 2,995 51 JOHNSTON $ 2,021 85 STOKES $ 11,520.
20 CHEROKEE $ 1,875 52 JONES $ 2,411 86 SURRY $ 10,740
22 CLAY $ 2,460 53 LEE $ 2,216 87 SWAIN $ 1,875
23 CLEVELAND $ 48,052 54 LENOIR $ 1,875 205 TOE RIVER $ 8,548
24 COLUMBUS $ 18,680 55 LINCOLN $ 4,798 88 TRANSYLVANIA $ 13,127
25 CRAVEN $ 1,875 56 MACON $ 9.425 90 UNION $ 13,127
26 CUMBERLAND $ 69,484 57 MADISON $ 8,841 92 WAKE $ 72,651
28 DARE $ 1,875 218 MAR-TYR-WASH $ 10,447 93 WARREN $ 2,460
29 DAVIDSON $ 1,875 60 MECKLENBURG $ 47,127 96 WAYNE $ 3,921
30 DAVIE $ 2,216 62 MONTGOMERY $ 7,964 97 WILKES $ 2,703
31 DUPLIN $ 1,875 63 MOORE $ 1,875 98 WILSON $ 1,875
32 DURHAM $ 23,210 64 NASH $ 6,064 99 YADKIN $ 1,875
33 EDGECOMBE $ 1,875 65 NEWHANOvER '$ 2f.408 $ 875,000
34 FORSYTH $ 42,256 66 NORTHAMPTON $ 1,875
e
5151-wksht-RNC-bonus-OR(rev10-23-2003)
28
Page 1 of 1
-
e
e
Animal Control Services
Advisory Committee Members
The ACS Advisory Committee make-up is as follows:
Group One (end 151 term 2002)
Member-@-large - Joyce Bradley
Friends of Felines - JoE Needham (replacement)
Kennel Operator - Sylvia Hall
Group Two (end 1"1 term 2003)
Hanover Kennel Club - John Boozer
Azalea Dog Club - Patrice Kaizer (replacement)
Cat Interest - Jeannie Leonard
Group Three (end first term 2004)
Member-@-large - Jewell Ann Diehn
Member-@-large - Gretchen Colby
Humane Society - Martha Raynor
Note: The veterinarian position is currently filled by Dr. Melody Speck from the
Board of Health.
Those in service as Group Two are seeking reappointment to serve for three more
years on the committee.
Thank you,
Jean McNeil
ACS Director
29
~,~~\\\,j!;t".."
"~" """'s:.'~.~'l,/.
.i,~ ...,,;~~.
,,~ ":'l,. ~..
~,_ ..- -' L ,-..'
.,.~"..
"f;~-:~'>
'~l~'
NEW HANOVER COUNTY
BOARD OF HEALTH
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
W. EdwIn IJDk, Jr., RPh, ChaIrman
Melody C. Speck, DVM, V1..chalrmo
DcmaldP. Blake
Henry V. Estep, RBU
MarvID E. Freemllll, Sr.
Commissiooer Robert G. Greer
GeIa N. Hunter, RN, FNP
SaIIdra L MIles, DDS
PbWp P. SmIth Sr~ MD
Jobn S. T1mstaII, PE
Edward Weaver, Jr., OD
DavId Eo RIce, MPB, MA
Health Director
2004 Meeting Dates
etW];~
e
. January 7, 2004
. February 4, 2004
. March 3, 2004
. April 7, 2004
. April 8, 2004 - Staff Appreciation Luncheon
. May 5, 2004
. June 2, 2004
. July 7, 2004
. August 4, 2004
. September 1, 2004
. October 6, 2004
. November 3, 2004
. December 1, 2004
. December 9, 2004 - Holiday Celebration
e
30
"Healthy People, Healthy Environment, Healthy Community"
y
e
e
e
David E Rice
11/21/2003 08:36 AM
To: donblake@aol.com. eweaver@ec.rr.com. IInkrx@aol.com.
gelajim@hotmail.com, hankestep@ec.rr.com,
jstunstall@andrewandkuske.com, freemanm@wrightCOlJl.com,
MCSpeck@bizec.rr.com, ppsmithsr@aol.com, bg..-@nhogov.com.
iamsmiles@bizec.rr.com, Health
00: Allen O'NeaIlNHC@NHC, Pat MelvlnINHC@NHC,
leah.devlin@ncmail.net
Subject: Pilot for Accreditation
NHCBH Members and NHCHD Staff:
I am pleased to announce that NHCHD has been selected as one of six health departments in NC to pilot
the accreditation process. As you can read in the attached amail, we have the opportunity to be one of
the first to demonstrate our excellence in assuring the safety and health of our community. Thanks in
advance for your help with the accreditation process.
Dave
- Forwarded by David E RiceINHC on 11/21/2003 08:15AM-
a
'"
Joy Reed
<Joy.Reed@ncmall.net
>
To: drice@co.new-hanover.nc.us
cc: Sheila Pfaender <spfaende@ernall.unc.edu>, (bee: archive)
Subject: Pilot for Accreditation
11/20/2003 07:27 AM
This is to notify you that your agency is one of the six selected to
participate in the pilot ,for the Accreditation process. We greatly
apprecate your agency's willingness to participate in helping us refine
this system. Dr. Devlin has committed to providing 3 DPH consultation
staff to work with each of the 6 local health departments to assist them
with pulling together or preparing evidence that standards are met;
developing drafts (if needed) of policies and procedures; conducting
surveys, assessments and compiling data; preparing the initial draft of
the self-study; and coordinating with the consultants assigned to other
pilot agencies to assure consistent interpretation of the standards.
You, of course, can feel free to tell us that you do not need this
resource but we want to make it available.
In the next few days you will receive the following additional information:
1) the names of the 3 DPH staff assigned to your agency, designating one
as your primary contact for coordination;
2) PRELIMINARY timeline for the process and drafts from the subgroups of
the standards and documentation (NOTE that these have not been seen and
reviewed by the full Accreditation Committee so they are not the final
standards, but we want you to have as much advance information as possible.)
We will be establishing training dates on the
your staff as well as the consultation staff.
place in December and you will be notified of
are finalized.
standards and process for
That training will take
the dates as soon as they
Again, thank you for volunteering. We look forward to working with your
agency to successfully pilot an accreditation process which will
dochment and improve the overall quality of public health services in
North Carolina.
,
I
,
J
\
.
~,
.
'-
,
The University of North Carolina at Chapel Hill '
HEALTH LAW
Number 81 November 2003
THERULEMA~GAUTHORITYOFNORTH
CAROLINA LOCAL BOARDS OF HEALTH
. Aimee N. Wall.
State Jaw authorizes local boards of health in North Carolina to adopt mles neocssary to
protect the public's health. 'Ibis statutory grant of authority is further defined by two
relative1y recent court decisions. 'Ibis bulletin summarizes the statutory rolemaking authority
oflocal boards of health as well as the judicially-imposed limitations placed on that authority.
Statutory Authority
State law requires counties to provide public health services. I Each county may provide these
services in one of five ways. 2 The county may opeIlIte a county health department, participate
in a district health departmeoI, 3 establish a consolidated htnnan services agency,4 establish a
public health authority,' or contract with the state for the provision of public health services. 6
. The author is an Inslitule of Government facully member who specializes in public health law.
1. N.C. Gal. Stat. 13OA-34(a) (hereinafterG.s.~
2. G.B. 130A-34(b)(stating four oflbe methods for providiDg public health services); 130A4S
(stating that lbeJlUlllOSC ofCbapter 130A, I'lIrt IB is to "povide ana1temative method for COlDlties to
provide public health services" through the aeation of a public hea1th authority).
3. A distric1 health departmeo1 is one that provides public health services to two or more counties.
G.B. 130A-36.
4. A county with a population over 42S,OOO may elect to establish a consolida1ed h1lDlllll services
agency and boaJd to oversee public health, social services, menta1 hea1th and other human services or
have the boaJd of COUIl\y COmmissiOllClS 8SS1DDC all oflbe statutorY powers and timclions oflbe boaJd of
health. G.B. IS3A-77; 130A43.
S. A public health authority is a 1egal entity that is CIC8Ied for the specific pwpose of providing
public hea1th services in a defined geographiealllllllL G.S. 130A4S., WI. For a discussion of the
powers of public health authorities, see A Fleming Bell, n and Warren Jake Wicker, eels. COIIIl!y
Govemment In North Carol;1ID, ". ed. 637-639 (Chapel Hill, N.C.. Inslitule of Govenunent, The
Univer1lity of North Carolina al Chapel Hill, 1998).
6. G.s. 130A-34.
Health Law Bulletin No. 81
Each county, agency, district or authority has a boaId
of hea1th that is the "policy-making, ru1e-making and
adjudicatory body" for the department, agency or
authority.'
These boards of health have "the responsibility to
prolect and promote the public health" and are
specifically authorized by statute to "adopt roles
neocssary for that purpose."s There are three statutory
limitations on this genetal rul.....1cillg aUlhority. First,
if the Commission for Health Services or the
Environmenta1 MlIIUlgr.m<:nl Commission (EMC)
adopts a role, that state rule will prevai1 over any more
lenient role adopted by a boaId ofhealth. However, a
boaId of health may adopt a role that is more stringent
than a CO,jesjX>uding state role when, in the boaId's
opinion, a more stringent role is necessary to protect the
public health.' Second, a boaId of health is not
authorized to adopt any roles reIaIing to the grading.
opeIlIting or permitting of food and lodging 1itciIiIies.10
Fina1ly, a boaId ofhea1th may adopt roles governing
wastewater collection, treatment and disposal systems
that are not """igTIed to discharge eftIuent to the land
surlilce or surliIce waters. Such roles may be adopted,
however, only when the state has reviewed the local
rules and determined that the local roles are at least as
stringent as the roles adopted by the EMC and are
sufficient and DllCeSl'8ry to safeguani the public health.11
In addition to the geuera1 rol.....lrillg authority "to
prolect and promote the public health," boards ofhealth
are, in a few instances, specifically authorized or
requiJl:d to enact roles in a few in...nces For example,
although state SlaIutes and EMC reguIaIioDs govern the
CODSII11Ction of we1ls, local boards of health are
specifically authorized to adopt by reference the EMC
rules and then adopt more stringent rules "wbcn
Del: mn'}' to prolect the public health. "12 Also, local
boards ofhealth are requiJl:d to adopt roles governing
adminislJaIive peua1ties for violations of any local roles
governing wastewater collection, treatment and
disposal 13
7 G.s. 13OA-35(a)(COIDlty boards of health); 130A-
37(a)(distriet boards of health); 130A-45.1(a) (public hea1th
authority boaJd~
8. G.8. 130A-39(a) (local boards ofhea1th); 130A-39(a)
(district boards of health); 13OA-45.3(aXl) (public health
authority).
9. G.S. 130A-39(b~
10.Id.
I!. Id.; G.8. 13OA-33S(c).
12. G.8. 87-96(c~ See al.so G.S. 87-83 .t .eq.(We1l
Construction Act); 15A NCAC 02C .0101 .t WI. (EMC
regulations governing well c:onstruetion).
13. G.s. 13OA-22(h~
.'
November 2003
~.
.
Court Decisions
Two coort decisions within the last decade have defiued
and nanowed the leg;d authority oflocal boards ofhealth
to adopt mles Jdated to public health.
City of Roanoke Rapids v. Peedin
In City afRoanoke Rapids v. Peedin, the North
Carolina court of appeaJs invalidated Halifax County's
boaId of health rules relating to omnlrillg in public
places, restauIl1nIs, and p1aces of employmentl4 The
roles generally prohibited smoking in public p1aces but
provided for several exceptions. For example,
restaurants with a seating capacity of thirty or more
patrons were required to designate a noncmo1cing area
comprising a certain percentage of the dining area
while bars and restaurants with a seating capacity of
fewer than thirty patrons were permitted to choose
whether to offer a nonomn1cillg area. U The conrt
invalidated the rules as eyrwlillg "the genera1
limilations imposed upon rule making powers of
boards of health. "16
For the first time, the court identified a five-part
test for determining wheu a board of health has acted
within its rul......1ci1lg authority. The court stated that a
boaId of hea1th acts within its aUlhority wheu it enscts
a role that
.
. is re1ated to the promotion or protection of
health;
. is reasonable in light of the health risk
addressed;
. does not violate any law or constitutional
provision;
. is not discriminatory; and
. does not make distinctions based upon policy
concerns uaditiona11y reserved for legislalive
bodi17
es.
The court explained that this five-part test was "based
upon previous holdings in re1ated areas, as well as the
holdings of courts in other jurisdictions. "IS
14. 124 N.C.App. 578, 478 8.E.2d 528 (1996~
IS.Id. at 583, 478 S.E.2d at 53!.
16.Id. at 587,478 S.E.2dat 533.
17.Id.
18. Peedin, 124 N.C. App at 587, 478 8.E.2d atS33. The
court cited sevem1 eases as support for its five-part test. StJJte
v. CUrliI, 230 N.C. 169, 171, 52 S.E.2d 364, 365 (1949)
(cited as support for the conclusion that boards of health do
not have authority to make distinctions based on policy
'0
2
"
,
,
.~"
.
.
.
.
November 2003
The court did not provide any additional guidance
reganling the inlerpnUtion and application of the first
four parts of this test, ins1ead choosing to iDvaIidate the
board of health roles based on the fifth part of the test.
The court reasoned tb8I in order to achieve the roles'
stated purpose of miniminllg the public's exposure to
environmental tobacco smoke, the boaId was required
to establish aanss the boaId requirements tbat "tre8I
similarly situated patrons and employees of all
restaurants eqnally. "I' The court noted tbat the
distinctions drawn by the boaId in the ro1es, such as the
distinction between 1arge and small restaumnIs,
"involve the holoncillg offill:tors other than health. H2O
The court conc1uded that, absent express statutmy
authority, a boaId ofhea1th may consider notbing but
health when adopting roles; it may not consider issues
such as economic bmdship or difficulty of
enfon:ement 21 The court emphoOi7M tb8I 0Dly
legislative bodies, such as the General Assembly or a
board of county commissioners, are authorized to
make such policy-based distinctions. 22
Cnig v. County of Chatham
In CraIg v. County afChatham, the North Carolina
supreme court iDvaIidated board of hea1th roles
regulating swine farms. 23 The roles adopted by the
boaId of health required swine farms to comply with
certain specifications regan1ing permitting, setbacks,
buffers, and other re1ated issues.
conc:ems lnIdilionally rescned for lesisJative bodies);
C",,*.. CharlDIt', 11ft:. v. Hrmter.261 N.C.222, 229, 134
S.1!.2d 364,369(1964) (cited as support for the conclusions
th8t rules musl be n:asonahle IIIICI must not be
discriminatmy); CooIri. " DiMr. 1m:. .. Col_1nu BoanJ qf
Health, 65 Ohio Misc.2d 65, 74, 640 N.E.2d 1231, 1236
(1994) (cited as support for the concllllions th8t rules must
be _W... must not be discriminalllly, must not violate
of any law or constituIional provision, and must not maIce
distilu:tions based on policy conc:ems lnIdilionaDy rescned
for 1egisIative bodies); Weber v. BIllIn Cty. Bd. qfHealdr,
148 Ohio St 389,396,74 N.E.2d 331, 336 (1947) (_);
BoreaItv.A2wIrod, 523 N.Y.8.2d 464,468, 517N.E.2d
1350,1353 (cited as support for the conclusion th8t boards of
health do not have authority to maIce distinctions based on
policy concerns lnIdilionally rescned for lesisJative bodies}
19. Peedin, 124 N.C. at 588, 478 S.E.2d at 534.
20.1d.
21.ld. at 589, 478 S.E.2d at 534.
22. Id. at 588-89, 478 S.E.2d at 534.
23. 356 N.e. 40, 565 S.E.2d 172.
Hea1th Law BulletIn No. 81
The court of appeals determined tb8I '-?'$C the
state had enacted the "Swine Farms Siting Ac('24 and
"Animal Waste MOl1llV"""'t Systems" taws2' which,
like the local roles, imposed comprehensive
requirements on swine farms relative to permitting,
setbacks, buffers, and other related issues, local
regulation of swine farms (with the exception of
zoning regulation in limited circumstances) was not
allowed. 26 The court held tbat the boaId ofhealth roles
were preempted by state law because the state bas
already provided "'a complete and iDtegJated
regulatoty scheme' of swine tlum regulations. w'J.7
In afIlrming the ~Io'" court's pI.,.,..~~1on
decision, the supreme court """",inod stale Sl8Iutes and
regulations govemiDg the siting of swine farms and
animal waste ~ as well as the exprlnl~
JlUIPOSC, intent, breadth, and scope of the staIutes. The
court articulated three jI.stifications for concluding tb8I
the local roles were pr.oe..~~e.1 First, ftom the --
ofpmpose ~...~_..1iDgthe Swine Fann Siting Act,
the court concluded tb8I the GenetaI Assembly in......i"ll
to Slrike a balance between JlIlllectiD3 the ri&bts of
landowners and suppmting the swine tlum indusby
because it is "iwpudlwl to the pWnOnric stability of the
state. n2sThe court stated that regulation by both the
stale and the county was conttary to this intent because
it "wou1d pIeseal an excessive bunIen on swine flmners
and the potk production iDdusby as a whole. n29
Second, the court recognized tbat one pmpose of
the animal waste ...........~ law was to "promote a
cooperative and COOJdin8Ied approach to animal waste
1IllInlli""'-llIIIOII8the ~es of the Slate......30 The
court explained that dual regulaticm was conttary to this
pmpose because if "each county _ allowed to enact
its own waste 1IllI...,...- 1'm..1i-. there could be DO
statewide 'COOJdin8Ied 8JlI'aoacb. m31
The third justification for cIeterminin& that the
local roles were I"........tod was based on the breadth
and scope of the state's regulation. The court
concluded tb8I the "staIuleS are so comprebensive in
scope tb8I the General Assembly must have inle~
24. G.s. 106-800 - 805.
25. G.S. 143-21S.10A-215.1OM.
26. Ovig v. Cootnty ofClralhom. 143 N.C.App. 30,40,
S45 S.E.2d455, 461. 'Ibeno is a specific: -.tmy provision
th8t pamits c:ounties to adopt zoning (lJIfinon.- governing
swine farms in 1imited cin:unlIIImlles Id. (citing G.S. 15lA-
340(bX3)).
27.1d. 8140, S45 S.E.2d at 462.
28. Cnzlg, 356 N.e. 8147, 565 S.E.2dat 177.
29.ld. at 48, 56 S.1!.2d at 178.
3O.ld.
3Ud.
3
Bea1th Law BulletIn No. 81
that they comprise a 'complete aud integmted
regu1atmy scheme' on a SlaIewide basis... ."32 Based
on this review, the court concluded that the board of
health ndes were invalid because the state had in place
a "complete and integmted regulatmy scheme" for
swine farms and intended to preempt, or OYeJricle, any
local regulation of swine farms.33
The court did recognize that dual regulation may
exist in some situations ~'se, in addition to their
genera1 ruI_1ci1lg authority,locaI boanIs of health are
authorized to adopt more stringeot regulations than
those of either the ('........i";l)II for Hcalth Services or
the EMC when more stringeot roles are "'required to
protect the public bealth. -34 Tbc court reviewed the
applicable EMC regulations aud coocIuded that the
board of health roles were more stringent in some
reprds. The c:ourt. however, fOlllld that the roles were
still JlI"""'IPled because the board of health simply
included a .....em-t asserting that more sIIingaII rules
were I'~ to protect the public health aud did not
indnde"any I8liona1e or basis for making the
restrictions in f'hothom County more rigorous than those
applicable to aud foI1owed by the rest of the state. 03'
Summary
The statuIOIy gmnt of genera1 rul.......1ci118 authority to
boards ofhealth is rather broad: the boanIs are
authorized to adopt ndes nee I 'i to protect aud
promote the public's hea1th. They are also specifically
authorized to adopt more slringatt ndes in aress
,..- by the Commi..;oo for Hcalth Services or the
EMC if more slringatt ru1es are _ ry to protect the
public health. Two receot court clecisions, however,
have limited local boards' authority in tIuee basic ways.
First, a board of bealth is acting within its
ruJemalcil1g authority only if the role:
. is re1ated to the promotion or protection of
health;
. is reasonable in light of the health risk
addmud;
32 Craig. 356 N.C. at SO, 565 S.E.2d at 179.
33.ld. at 52, 56 8.E.2d at IllO-lll. The pnurindPr of the
llIIJlIe1IIe court decision 1"""1tl";7M one limited statutory
exception to this preemption. The slate law permits counties
to adopt zonins ozd;"""..... governing swiDe farms in limited
cin:umatanc:ca.ld. at 54, 56 S.E.2d at 181 (citiDg 0.8. 153A-
340(bX3)}
34.ld. at 51, 56 8.l!.2datl79 (cilina O.S. 13OA-39).
35.ld. at 52, 56 S.E.2d at 180.
,
.
November 2003
, 1.
"
.
. does not violate any law or constitutional
provision;
. isnotdiscriminatory;aud
. does not make distinctions based upon policy
concerns traditionally reserved for legislative
bodies.
.
1Wo11"" of the last requirement described above, a
board of health may not adopt roles based on the
consideration offill:tors other than health.
Second, the local board ofbealth ndes may be
pl'OOlIlpIcd if the state has already provided "a
complete and integmted regulatmy scheme" of
regulation, such as in the field of swine farms.
1bird, if the board of health adopts ndes that are
more stringent than roles adopted by the Commission
for Health Services or the EMC, the board must
express1y demonstJate that more stringeo1 ndes are
-ry to protect the public's hea1th.
.
11da ~ Is pabIlshed by the SdlocI ol Govemmenl
lo.ddJo. _ ol_1o govemmeI1l oifIdal& PabIlc:
offIdela IlIlIY prtnI ou. or phoIooopy the baIIetIn U11der the
foIIowtna coouIWono: (1) It Is c:opIed In lis entIJety; (2) It Is
c:opIed ooIeIy for _tton 10 other pabIk: olfIdaI8,
empIoyeee. or oteffll1l!ll1ben; 0I1d (3) oopIee "'" not ooId or
used for amunelde! poupcoeo.
AdcIItlonaI prI11IecI oopIee of this bulleltn may be
pwdwed &om the School ol Covemmenl. To pIaal an order
or _ a catalog olSchool ol Government publk:atkmo,
pleue vfslt theSchool'. Web site athttD::/ Iwww.8Df n..........~
or contact the Pub1k:atkmo SeIea OffIce. SdlocI of Govenmumt,
CBl3330 Knapp Bullclls& UNC Clape1 HlII. Clapol HlII. NC
~.......n oaIeoOIogmaIUogUDC.edu; te1ephone (919)
966-4119; or fax (919)962-Z1U7. Por genend l11qulIlea,caIl the
School 01 eo....~.t'. malnnumber. (919)~.
Tho SdIooI ofOovemmenl of Tho Uaiwnity ofN_
CaroIius 01 CIIspeI Hill bu primed .lclts1 of 41 0 copies oftbis
public _entol. _ ofS 74.9\ or liS _ Thoso &_
iDdude cm1y the _ -. ofreproduClioo. They do DOl iaoh1do
pnpsntiOll, bsndIia& or dilllributi... colis.
C2OO3
School ol Government. The UnlYeIllIty ol North CaroUna
at Clapol HlII
PrIn1ed In the UnIted Sta... of Amerlca
11da pub1k:atton Is prI11IecI on pennanent, llCid-&ee paper In
a>mp\lsn<e with the North CaroUna Genersl Statu...
.
4
I \,.
"
''\
I ),
I "
1-
e
e
g.."^".~
~ ,,- ),,~
~. ,.. ~~
~. ~
."",~~
North Carolina Department of Health and Human Services
Division of Public Health - Women's & Children's Health Section
1917 Mail Service Center. Raleigh, North Carolina 27699-1917
Tel 919-733-7752 . Fax 919-715-6781
Michael F Easley, Governor
Cannen Hooker Odom, Secretai)'
November 26, 2003
To:
Local Health Directors
Loca] Health Department Nursing Supervisors
Universal Childhood Vaccine Distribution Program (UCVDP) Participants
Beth Rowe-West, RN, BSN, Head~
Immunization Branch
From:
.
,
Re:
Influenza Alert
The purpose of this memo is to provide you with two essential documents - (I) press release entitled State Health
Director Strongly Advises Children and Pregnant Women to Get Flu Vaccine, and (2) Request for
Information: Acute Encephalopathy Associated with Influenza Virus Infection in U.S. Children. This is in response
to a recent Centers for Disease Control and Prevention (CDC) announcement that the 2003-04 flu season is
expected to be severe; numerous cases have already been reported across North Carolina and the nation.
Reminder
The North Carolina Immunization Branch provides flu vaccine to UCVDP participants for children 6 to 23 months
of age, 6 months through I 8 years of age with chronic health conditions, children under 9 years old who have not
had their first influenza vaccination, and pediatric contacts of high-risk individuals. The Branch also provides state-
supplied influenza vaccine to local health departments to be administered to any non-Medicaid recipient during her
second and third trimester of pregnancy, regardless of age, during the second and third trimester of pregnancy as
long as influenza vaccine is available. Medicaid enrolled prenatal patients> 18 years of age should receive privately
purchased influenza vaccine.
Please urge all staff in your agency to be vaccinated against influenza. The CDC estimates that only 37 percent of
health care professionals have received flu vaccine. It is strongly recommended that every health care professional
who interacts with patients receive an annual flu vaccination as soon as possible.
If you have questions, please contact your regional immunization consultant or call the Branch's central office at
(919) 733-7752.
Cc:
Dr. Jeffrey Engel
Sheila Cromer
Immunization RIes
Carol Schriber (Office of Public Affairs)
Immunization Central Office Staff
SMT
* LocatiOll; 1330 St. Muy's Street . Raleigh, N.C. 27605
An Equal Opportunity Employer
.'
Michael F. Easley
Governor
Carmen Hooker Odom .;
Secretary ~
-
State of North Carolina
Department of Health and Human Services
For Release:
Contact:
Immediate
Laura Leonard 919/715-6762; Carol Schriber 919/733-9190
State Health Director Stronl!Iv Advises Children and Prel!nant Women
to Get Flu Vaccine
Date: November 25, 2003
RALEIGH - With the eenters for Disease Control and Prevention (CDC) warning of an early and potentially severe
influenza season, pregnant women in their second or third trimester of pregnancy should receive a flu shot as soon as
possible, say North Carolina State Health Director Dr Leah Devlin and North Carolina O~stetrical and Gynecological
Society President Dr Robert Littleton. Children under 9 years old who are not already imriiunized against flu, and
especially those ages 6 through 23 months, should also get their flu shots now
The beginning of this year's flu season is earlier than usual, and North Carolina, like the rest of the nation, has
identified multiple cases of the disease. "It takes two weeks to develop immunity to the flu virus after getting a flu shot,
so it's a good idea to get vaccinated now," Dr Devlin said. The flu season can last through March.
Numerous cases have already heen reported of influenza-related hospitalizations among pregnant women in the United _
States. "Because pregnant women are at a higher risk of flu-related complications, it is important for them to get flu _
shots immediately," she said. "Flu can be a serious illness. Each year, 114,000 people are hospitalized and 36,000
people die in the United States as a result of the flu."
Dr Littleton supports vaccination of pregnant women. "For every 1,000 pregnant women vaccinated, an estimated one
to two hospitalizations could be prevented," said Dr. Littleton. "Studies have shown that there is an increased rate of
illness and death in pregnant women who contract the flu. It is much better to be vaccinated than to risk getting the
disease."
"Children also face many complications from flu disease," Dr Devlin said. "A primary flu-related complication in
children is brain damage, known as encephalopathy, which has been reported this year in the United States and in
Europe. I strongly encourage those at risk, including women during their second or third trimester of pregnancy and
children, to get the flu vaccine at their physician's office or local health department," she added.
The flu vaccine is safe and is the most effective way to prevent the disease and its complications. "Get a flu shot; it's
that simple," Dr Devlin said.
With the holidays approaching, college students will be coming home, children will be out of school and families will
gather together, creating an environment which allows the flu virus to spread rapidly
Although many of the influenza cases diagnosed this year have been found to be a strain somewhat different from
those contained in this year's version of the flu shot, the vaccine is believed to be cross-protective. It is still necessary
to be vaccinated against the disease, Dr Devlin said, since this year's vaccine protects against many varieties of the flu a.
VIrUS. _
---More---
Public Information Office
200 I Mail Service Center, Raleigh, NC 27699-200 I
(919) 733-9190
FAX (919)733-7447
Debbie K. Crane
Director
@
t,
,
\
. Flu Shots, 11/24/03, page 2
6
The Advisory Committee on Immunization Practices (ACIP) also recommends that the following people get flu shots.
. Adults aged 50 or older;
. Infants and children aged 6 months through 23 months;
. Anyone aged 2-49 years who is at increased risk for influenza-related complications;
. Children under 9 years old who have not had their first influenza vaccination;
. Pregnant women who will be in their second or third trimester during flu season;
. Healthcare workers; and
. All household contacts of persons at high risk for influenza.
Dr. Chuck Willson, president of the North Carolina Pediatric Society, reaffums the CDC's decision to encourage flu
vaccination for children. "Children are more likely to spread this virus because of their close proximity to one another
and their active nature. It is important to remember that ch11dren are more susceptible to iJItluenza-re1ated
complications because of their developing immune systems. The best thing a parent can do to protect their child this flu
season is to vaccinate as soon as possible against the flu disease," Dr. Willson said.
As in any flu season, Dr Devlin urges everyone to take basic precautions to help prevent influenza. Avoiding contact
with ill persons and frequently washing your hands can reduce the risk of infection. People who cough or sneeze
should cover their nose and mouth with disposable tissues or a handkerchief to limit spread of the virus.
.. Flu symptoms begin suddenly..and may include fever, severe headache, body aches, sore throat and cough. Flu can
_make a person more susceptible to pneumonia, an illness that puts a severe strain on the heart and lungs, which can be
especially dangerous to people who already suffer from heart and lung disease.
Those who develop flu-like symptoms should drink fluids, rest and stay home to avoid spreading the infection. Flu-
sufferers may also take over-the-counter drugs such as acetaminophen and ibuprofen, but aspirin should be avoided
because taking it for some forms of flu has been associated with Reye's Syndrome, a seriClus disease in children that
can occur following a viral illness and that causes swelling of the brain. Prescription drugs are also available to treat
flu; they are most effective if taken within two days of developing symptoms. Antibiotics are not effective against viral
diseases like flu.
For information regarding local-area flu vaccinations, contact your local health department or the state Immunization
Branch at (919) 733-7752, or North Carolina flu clinic locations can be found on-line at http://www.mrnc.orglfcfl.
#1#1
e
Request for Information: Acute Encephalopathy Associated with Influenza Virus
Infection in U.S. Children
Since the mid-I 990s, several hundred cases of acute encephalopathy have been reported
in Japanese children with influenza. These illnesses have been characterized by fever and
rapid onset of encephalopathy, resulting in a high frequency of neurologic sequelae and
mortality. Most of the children have had laboratory-confirmed evidence of influenza
virus infection. Reports of influenza associated encephalopathy have been uncommon in
the United States.
To determine if a similar pattern of influenza-associated encephalopathy is occurring in
the United States, the Centers for Disease Control and Prevention (CDC) is requesting
information from health care providers on any patient with acute encephalopathy
meeting the following criteria:
,
. < 18 years old
. Altered mental status, or personality change in patient lasting> 24 hours and
occurring within 5 days of the onset of an acute febrile respiratory illness
. Laboratory or rapid diagnostic test evidence of acute influenza virus infection
. Diagnosed in the United States
Please report any suspected cases to either Dr. Tim Uyeki (404-639-0277;
trnuO@cdc.gov) or Dr. Niranjan Bhat (404-639-2893; nib9(a)cdc.gov) at CDC.
~ t '\:!I'!
Request for Information: Influenza-associated Deaths in U.S. Children
CDC would like to receive reports about any deaths in patients < 18 years old, with
evidence of influenza virus infection.
We would like the following informatiaGon fatal cases in the U.S.:
. Clinical summary with history of illness
. Laboratory results, including documentation of influenza virus infection
. Autopsy report if available
Please report any fatal influenza-associated pediatric cases to either Dr. Tim Uyeki (404-
639-0277; trnuO(a)cdc.gov) or Dr. Niranjan Bhat (404-639-2893; nib9(a)cdc.gov) at CDC.
,~ I
J.
~
e
e
-
November 2003 New Hanover County Health Department Betsy Summey, FNP, 343-6531
Influenza - children with encephalopathy given before repeating it. If
Are We Protected? Please notify the Health you prefer, you can perform
Department if you see serologic testing to check for
A long with other regions suspected flu activity or immunity.
in the U.S., North Caro- cases of flu-associated
Iina is experiencing early flu pneumonia in pregnant Think TB
activity this season. Sentinel women or encephalopa-
sites at college and university thy in children. N ew Hanover County
student health exceeded the na-
centers have Vaccine Questions tiona! and state rates of
noted clusters tubercu.
of fl u cases. F or medical care pro- losis last
NCSU in Ra- viders who give im- year. The
leigh has re- munizations, these ques- current Sta-
ported an outbreak since No- tions occasionally arise: tistics indi-
vember II Soon these stu- cate the
e dents will be dispersing for Q: Is it required to use a vac- same may occur this year-
the holidays carrying the vi- cine information statement and by a greater number. To
ruses to many other areas. (VIS) in an emergency room date, New Hanover
when T d is given to a patient! County has had 15 cases
All isolates statewide are A: Yes. The National Child- of tuberculosis disease this
type A1H3N2 and samples hood Vaccine Injury Act re- calendar year, with a sus-
have been sent to the quires that a VIS be given to pect currently hospital-
CDC for strain identifica- persons of any ized. Of note, two of the
tion (Panama vs. Fujian). .. ~re~ J(D cases did not survive their iII-
Type AlH3N2IPanama is in receive a d?se ) 0 ness-having received medical
the current vaccine but it is of any vaccme attention too late in the
not known whether it will included in the course of the disease. One
protect against the Fujian Act. Tetanus case is INH resistant.
strain. Vaccination is still en- and diphtheria toxoids are in-
couraged because there may c1uded in the Act. If the pa- A change in the Administra-
be cross-protection. The vac- tient is unaccompanied and tive Code is currently being
cine will protect against the unable to clearly read and un- proposed which will require
other two viruses AlH I N II derstand the information in laboratories who cultivate M.
New Caledonia and type BI the VIS, this should be noted tuberculosis to submit the iso-
Hong Kong. Immunity oc- in the patient's chart. late to the State Laboratory of
curs in two weeks after Q: What should be done if a Public Health for genotyping.
vaccination, so it is impor- dose of expired vaccine is We have been able to access
tant to vaccinate now. given to a patient! this capability by special re-
A: The dose should be re- quest and found that several
e Texas has reported increased peated. If the dose is a live of our cases have the same
morbidity in type AlH3N2 virus vaccine, you must wait genotyping. This came as no
cases in pregnant women with at least four weeks after the big surprise when we found
pneumonia and in school aged previous (expired) dose was continued
the contacts of the cases over-
lapping time and time again.
We do appreciate your contin-
ued awareness of the problem
of tuberculosis in our commu-
nity, and hope that you will con-
tinue to think TB.
CDC Health Advisory
Pursuant to a CDC Health
Advisory regarding the pos-
sibility of anthrax being identi-
fied in the Ana-
costia Naval
Postal Sorting 0
Facility, clinicians
are urged to re-
view the signs and symptoms of
anthrax and consider the diag-
nosis with their patients.
Inhalation anthrax starts
with a nonspecific pro-
drome (i.e., fever, dyspnea,
cough and chest pain) fol-
lowing inhalation of infec-
tious spores. Approximately
2-4 days after initial symptoms,
and sometimes after a brief pe-
riod of improvement, respira-
tory failure and hemodynamic
collapse ensue. Inhalation an-
thrax also might include tho-
racic edema and a widened me-
diastinum on chest x-ray
Cutaneous anthrax follows
deposition of the organism
onto the exposed skin. An
area of local edema becomes a
pruritic macule or papule,
which enlarges and ulcerates
after 1-2 days. Small, 1-3 mm
vesicles may surround the ulcer
A painless, depressed, black es-
char usually with surrounding
local edema subsequently devel-
ops. The syndrome may in-
clude lymphangitis and painful
lymphadenopathy
Any suspected case of an-
thrax should be immedi-
ately reported
to the appropriate local or
state health department.
Final Issue
This will be the final issue of e
the EPllnformation news-
letter Takingits ~
place will be a news-
letter with a more
comprehensive view
of health department ~"
activity and written by "i\.~~-i
our Health Promo- (,,,
tion Division staff. In
the search for topics of interest
for EPllnfonnotion, I have
learned much, and I hope
there's been a pearl or two for
you as well!
\e
Communicable Disease Statistics
New Hanover County
July 1, 2003 - October 31, 2003
AIDS .........................................19
Campylobacter .......................... 5
Chlamydia.............................. 172
Ehrlichiosis, Monocytic ............1
Gonorrhea................................ 88
Haemophilus Influenza,
Invasive ................................. 0
Hepatitis A .................................1
Hepatitis B (acute)..................... 1
Hepatitis B (chronic carrier)..... 8
Hepatitis C (acute)..................... 0
HIV Infection ............................19
Legionellosis ............................. 0
Listeriosis .................................. 0
Lyme Disease ............................ 3
Meningitis Pneumococcal............O
Meningococcal Disease ...............0
Pertussis .......................................3
Rky. Mtn. Spotted Fever...............2
Salmonellosis .............................46
Shiga-Toxin Producing Infection
(formerly E. coli 0157:H7)..........2
Shigellosis ....................................1
Strep, Group A, Invasive ..............1
Syphilis..........................................6
Toxic Shock Syndrome ................0
Tuberculosis .................................5
Typhoid (acute).............................O
Vancomycin Resistant
Enterococcus ............................4
.
e
j
I MAKtl(Ci:A Dt~FERfNCEIN DIABETES WITH T1MELY,INfOIlMAtlQNfORTHECITIZENS. OF NEW HANOVER COUNTY
L_~_~__~~,,-,-~~_~_____~~...,;.____,~_~~,_.____~~_,___~.____,"~....;.."-' _ ~ '___,...__~.~,.~_~_____,.________.~.~______________.~...$
Where to Go for Help in If You Have Diabetes,
New Hanover County a Flu Shot Could Save
Your Life
For people with diabetes, the flu can be more
than aches and pains, Diabetes can make the
immune system more vulnerable to severe
cases of the flu - which can mean longer ill-
ness, hospitalization, even death.
Consider the odds:
During flu epidemics, deaths among
people with diabetes increase 5 - 15 %.
People with diabetes are 6 times more
likely to be hospitalized with flu complica-
tions and 3 times more likely to die with the flu or pneumonia.
Each year up to 30,000 deaths among people with diabetes are
associated with influenza and pneumonia.
Flu vaccines are available at the New Hanover County Health
Department, doctor's offices, clinics and pharmacies - and
Medicare, Part B, covers them.
Diabetes is a complicated disease and adequate management
requires access to many resources.
Most patients rely on their primary care doctor to both
monitor and educate them about the disease. Additionally,
those with -diabetes are encouraged to see their
ophthalmologist and podiatrist on a yearly basis to monitor
potential long-term complications.
Optimally, all diabetics should see a diabetes educator and
nutritionist. Diabetes educators teach patients about their
disease and cover issues such as blood glucose tesling,
insulin pump education and dietary counseling. The diabetes
educators at Wilmington Health Associates and Hanover
Medical Specialists work with patients who are referred to
their endocrinology department
Liberty Home Care offers outpatient diabetes education.
Nutritionists, such as Heidi Kaufman, counsel diabetics
about special dietary neecls. Medicare and some private
insurance companies pay for diabetes education.
Patients may be required to first meet an annual
deductible and/or pay in advance for services.
The New Hanover Diabetes Today Coalition
offers self-management classes for those who
do not have insurance to cover diabetes
education. For those who do not have a
doctor, the New Hanover Community
Health Center accepts new patients.
Indigent patients with no insurance are
eligible for the free walk-in diabetes clinic
at Tileston. The outpatient department at
New Hanover Regional Medical Center
offers a diabetes clinic with physician
referral.
N
'is.the' j
I lower lege: :- ~ '
Heart -dfs~s,; aill"Stroke. People with
diabetes aw.,,2-4 Ii,nes more .
Iikel to liilvj'lieaif disease and
Y . . _"', "..' .
2-4 funes~1iketY to SUffer a
stroke. ~,
v.,:', l~ '
xOU: :
. Kfep
· Bra: aC
:y "
. Eat loW jat' '
vegetables lU)
For more information, please call-
New Hanover Community Health Center: 343-0270
Wilmington Health Associates: 251-2093
Hanover Medical Specialists: 763-5182
Wilmingion Endocrinology: 254-9464
Heidi Kaufman: 343-7087
Liberty Home Care: 815-4353 extension 274
New Hanover Regional Medical Center: 343-7001
Tileston Outreach Clinic: 343-!1736
wer your risk:
trot> ,
f the week_
, ' are high in fruits,
~;giafu foods.
c:;- -. _ ,- ~
..,
For additional information on resources in southeastern
North Carolina, www.dmpartnership.org
For information about the New Hanover Diabetes Support
Group, email DiabetesToday1@aoLcom
MARK YOUR CALENDAR
Diabetes Self-Management Classes
Tuesdays November 3, 10, 17 and 24
3 to 5 PM at Cape Fear Community College
Phone 343-6758.'$15 registration fee.
Diabetes Self-Management Qass
Saturday, November 15
9 am - 1 PM at New Hanover Communi!}' Health Cittr.
Phone Nella at 343-0270 x 119 to register.
Spanish Translationavailable
Free for Health Center patients.
Diabetes Support Group'
November 20
EndocrinologistJohn Parker, MD
How to Successfully Manage Your DIabetes
1:30- 3:00 PM at the New Hanover Senior Center
Phone 343-6758 for information.
Free Foot Screenings
November 8 at Brunswick County Airport,
phone 457-4789
November 15 at Second Wind Fitness Center in
Hampslead, phone 259-5451
November 22 in Wilmington,
phone 343-2470 for details
Diabetes Today is a special publication of the New Hanover County Diabetes Today Coalition which provides the editorial content. The Diabetes raday Coalition was formed in 1999 to advocate
for
diabetes care and prevention in New Hanover County. The Coalition is supported by a grant from Cape Fear Memorial Foundation.
f.
Diabetes Tc",:j; November 2003
Diabetes?
i
I
tes es una emeJ?l1edad silenci~ i
tenerla 'jnuchos alios ~X i
Ia padece. ' usted no sliI:jem J' I
:J:~~e la enferm . ta. misma Ie eslli I
do sus ojos, SUB nimoios y SUB riiiones
conslantemente. I
Ceguera: Diabetes es Ia principal causa de
nuews casos de ceguera en personas entre' r
lal!~de2()'27 '
, ad de los ' . 'biabetes'es.lae)
causa de terminal: de"" e'
',,f-~':':P .,!
. <'ii;"'" ,...,
edad de los NerviOs y Amputaciones:
Diabetes .es la causa principal de
EX:~ed:d:sdeC:dioe=es y Paros
Ca(dlacos: Las personas con diabetes son
'2 -0 4: veces mas pro a sufrir
~dades car . es
0' dehioraz6n asi CO!D<t . bien
ataques del coraz6n.
EI 'rie.sgo de contraer Diabetes
au~~ta con la ed~ ~_!,Bted pelll
mas.~de,lo normal 0 Bles sedentario 0
se~a. La dillbet.e$ es'llllis comnn
entre los Africanos Americanos,
Latinos, Indigenas AmericanOB y
).si3ticos Americanos. Algunos de los
factores que aumentlln !as posibilidades
.de contraer la enfermedad..son:
1 Pr~6n ;Uta de mas, 5)
2 Teller historia de Ia tamill.a.
\j~'llmer diabetes . ~l embarazo oe
~' dad.o.a luz II un itlilo de mas de 9
libl1lS:
i
,
i
I
I
I
i
i
1
I
i
i
I
i
I
I
I
I
I
I ~ste,.lpuede hllCer ci~ !Xlsas pam reducit
I - supeso "
j - i. .. .' >... ,. ngase activo dillriaOumte
: - COOsurila alimentos altoll en fibra como
I v~~ y blljOB en grasay ca1orias.
0,;'
C:Que puede Hacer?
G
c.D6nde pueclo obtener
ayuda en el condado
de New Hanover?
La diabetes es una enfermedad complicada que
requiere de un tratamiento adecuado asi como de
. '
acceso a diferentes recursos para lograr un buen
control. La mayoria de pacientes COMan en su
medico para que les administre y eduque acerca
de su enfermedad. Es muy importante que los
diabeticos visiten el oftalm61ogo ( doctor de la vista)
y el podiatra (doctor de los pies) por 10 menos una
vez al aiio para asegurarse que se encuentren bien.
Idealmente, todo diabetico debe reunirse con un
educador de la diabetes y nutricionista para obtener
consejeria sobre aspectos c1aves en el manejo de su
enfermedad tales como medir el nivel de azUcar
diariamente, c6mo usar la bomba de insulina asi
como aspectos relacionados con la nutricion. Lugares
como Wilmington Health Associates y
Hanover Medical Specialists trabajan
con los pacientes que son remitidos por
los departamentos de endocrinologia
AIgunas compaiiias de seguro privadas
pagan por estas sesiones.
Nutricionistas como Heidi Kaufman
aconseja a los diabeticos con
respecto a sus necesidades dieteticas
individuales. Medicare y algunas
compaiiias de seguro medico
privadas cubren estas c1ases de
educacion de la diabetes. Puede
ser que los pacientes tengan que
pagar un deducible anual 0 pagar por
adelantado por estos servicios.
La Coalicion de Diabetes Today ofrece c1ases para
el control propio para aquellas personas que no
tienen seguro medico. Una muy buena opcion para
aquellas personas que no tienen seguro medico es
el New Hanover Community Health Center que
cuenta con un"programa de descuento familiar y que
ofrece c1ases de diabetes totalmente gratis. Tambien
Tileston, ofrece una clinica para diabeticos sin seguro
. medico y acepta pacientes sin cita. Finalmente, el
Hospital de New Hanover ofrece una c1inica para
diabeticos con recomendacion del doctor.
Para mas informacion por favor llame a:
New Hanover Community Health Cntr:
(910) 343-0270
ControYing Diabetes isn't a Piece of Cake . HANOVER
MEDICAL
IF YOU ARE 18 YEARS OR OLDER, H SPECIAUSTS, P.A.
AND HAVE BEEN DIAGNOSED WITH
TYPE 2 Diabetes Mellitus, then you may and the Division of Endocrinology
be eligible to participate in a medical Paul C. Whitesides,Jr., M.D.
research study of an investigational drug Michael S. McGarrity, M.D.
for diabetes. John C. Parker, M.D.
For more information call
New Hanover Medical Research 1515 Doctor's Circle, Wilmington, NC 28401
(910) 763-6332
910-799-5500 Office Hours By Appointment
-r
,
o
Page2
Wilmington Health Associates:(910) 251-2093
Hanover Medical Specia.lil!ts (910) 763-5182
Wilmington Endocrinology' (910) 254-9464
Heidi Kaufman, MS, LDN, CDE. (910) 343-7087
Liberty Home Care.(91O) 815e4353 extension 274
Tileston Outreach Clinic:(910) 343-8736
Para mas informacionpvisitor la pligina web
www.dmpartnership.org
Para mas informacion con respecto !li gropo de
apoyo: Puede enviar un correo electronico a
DiabetesToday l@aol.com
Si usted tiene Diabetes, la
inyecciOn contra Ia gripe Ie
puecle salvar la vida
Si usted tiene Diabetes, la inyeccion contra la
gripe Ie puede salvar la vida
Para las personas que padecen de la diabetes,
la gripe puede significar mas que dolores de
cabeza y cuerpo. La diabetes Qace que el sistema
inmunologico sea mas vulnerable a casos severos
de la gripe 10 que puede significar enfermedades
por largos periodos de
tiempo, hospitaIizaciones y
hasta la muerte.
Considere las condiciones:
Durante epidemias de gripe,
el porcentaje de muertes
entre diabeticos aumenta
entre un 5-15%.
Las personas con
diabetes son seis veces
mas vulnerables a Ber
hospitalizadas con
complicaciones relacionadas con la gripe 0
neumonia. Cada aDo, entre 10, 000 a 30,000
muertes estan asociadas con la infiuenza 0
neumonia.
Usted puede vacunarse contra la gripe a un costo
reducido en lugares ~es como EI New Hanover
Community Health Center, el Centro de Salud,
oficinas de doctores privadas, farmacias. La
mayoria de los seguros medicos cubre la acuna
contra la gripe, asi como Medicare y Part B.
Dial> itter !
Ma1ll1j W. "'" rompklld '
advanad training in TIIlnuk, lVJ on
wourul care & """"",,live
manogement of dUlhetes. Let her
exptrtise puI you in 1M rigid sIwe!
Medical Center 7~~7~
A W Hours:
~~. .:..~. . M-F 8-5:30
Home Care www.medicalcenterhomecare.com
FooT & ANKlE SURGERY' DIABETIC FooT CARE
SPRAINS & FRAOURES . AMBULAlORY SURGERY
INGROWN NAIlS . ENDOSCO~C SURGERY
SECOND O~NION CoNSULTATIONS' X-RAY FAOUT1ES
&o~~2~sl~! .~Q!~~~1~~
\Ys~~~~~l~~9l C2~~~
_ Insurance accepted and liIed Ilk I
,I
II
\
I
I
I
I
I
;j
II
,
I'
Ii
I
\
!'
,
II
, \
Diabetes TOd~ovember 2003 ~
Mexican American .Cooking
By Marisa Warrix
The Mexican diet oftoday is rich in a variety offoods and dishes that represent
a blend of pre-Columbian, Spanish, French and more recently, American
culture. The typical Mexican diet is rich in complex carbohydrates, which
are provided mainly by corn and corn products, beans, rice and breads. The
typical Mexican diet contains an 'adequate amount of protein in the forms of
beans, eggs, fish and shellfish, and a variety of meats including beef, pork,
poultry and goat.
Because of the extensive use of frying as a cooking method, the Mexican diet
is also high in fat. Try cooking in canola or vegetable il to avoid saturated
fat. The nutrients most likely to be inadequately provided are calcium iron,
vitamin A, folacin, and vitamin C.
Marisa Warrix, Family and Consumer Sciences, Ohio State University
Spanish Style Rice _with Chicken-
Ingredients
1 tablespoon canoIa oil
2 medium onions, chopped
4 garlic gloves, minced
2 stalks celery, diced
2 medium red or green peppers, chopped
1 cup chopped mushrooms
1 3-1b chicken, cut in 8 pieces, skin removed
pinch of salt
3 'h cups chicken broth, fat removed
4 cups water
pinch of saffron for color
3 medium tomatoes, ch6pped
1 cup frozen peaS
1 cup frozen green beans
Olives for garnish (optional)
This dish is low in fat and chock full of healthy vegetables. The substitution
of brown rice for white rice also makes this recipe high in fiber.
Preparation:
Heat oil over medium heat in nonstick pot. Add onion, garlic, celery, green
pepper and mushrooms. Cook over medium heat, stirring, for about 3
minutes or until tender.
Add the rice, saute for 2'3 minutes, stirring constantly until it begins to
brown.
Add the chicken, salt ,broth, water, saffron and tomatoes. Bring the water to
a boil, then reduce beat to medium low and let simmer.
Cover the pot and let simmer until the water is absorbed and the rice is
tender, about 25-30 minutes. Stir in the peas, corn and beans and cook for 8
- 10 minutes. Garnish, if desired. Serves 8.
I
I
I
I
I
I
I
I
I
I
Get Real! You don't have to eat like this
to prevent diabetes.
Over 45 and overweight? Talk to your health care
provider about the small steps you can take to prevent
diabetes. For free information about preventing diabetes,
call 1-800.438-5383.
slate of North Carolina
Deparbnent of Health and Human Services
Division of Public Health. Diabetes Prevention and Control Branch
www.nc;diabetes.org
~~'ll'['
.
~,-,.l;"*,,,.
...-
-"",-
- --
~A([
North Carolina DllIbeta Ad"*"Y Councll
.
I
,
Page3
.
Arroz con PolIo
Ingredientes:
1 cucharadas de aceite de canola
2 cebollas medianas
4 dientes de ajo, picaditos
2 tallos de apio, en cubitos
2 pimientos verdes/rojos cortados en tiras
I taza de bongos
2 tazas de arroz
I polio de 3-libras, cortado en 8 piezas, sin la piel
I cucharadita de sal
3 112 tazas de caldo de pollo, quitele la grasa
4 tazas de aqua
Azafran, si 10 desea
3 tomates medianos, cortados
I taza de guisantes (petit.pois) congelados
I taza de maiz congelado
I taza de guisantes verdes (habicbuelas tiernas)
Aceitunas para adornar, si 10 desea
Preparacion:
Caliente el aceite en una cacerola gue no se pegue. Anada la cebolla, el ajo, el
apio, el pimiento verde, y los hongos. Cocine a fuego mediano, removiendo
a menudo, por cerca de 3 minutos or hasta que esten tiernos.
Anada el arroz y sofria por 2-3 minutos, moviendo constantemente hasta que
coimienze a dorar.
Anlida el polio, la sal, el caldo de polio, el agua, el azafran y los tomates.
Espere hasta que el agua hierva, entonces baje a fuego mediano y deje que
continue hirviendo.
Cubra la cacerola y deje que hierva hasta que toda la agua se absorba y el
arroz este tiemo (25-30 minutos).
Agregue los guisantes, el maiz y los guisantes verdes y cocin~ de 8 - 10
minutos. Adorne, si 10 desea. (8 porciones)
.-\1'.....-
LA COMIDA AMERICANA-MEXICANA
Por Marisa Warrix
La dieta mexicana es muy rica en una variedad de platos que representan
una mezcla'de tradiciones pre-colombinas, espaiiolas, francesas y mas
recientemente de la cultura Americana. La tipica dieta mexicana es rica en
carbohidratos de los cuales la mayoria proviene del maiz y productos del.
misnlO, asi como de los frijoles, el arroz, y el pan.
La tipica dieta mexicana contiene una cantidad adecuada de proteina en.
la forma de frijoles, huevos, pescado y unavariedad de mariscos, carnes,
cerdo,.pollo etc. ' , <.
La dieta mexicana es alta en grasas debido a que la forma mas popular de
cocinar los alimentos es friendolos. Para reducir el contenido de grasas en
las comidas pruebe el aceite de canola para evitar el consumo de grasas
saturadas. Los nutrientes que esta dieta no proporciona adecuadamente son
el calcio, hierro, vitamina A, encontrados en 10s alimentos son el calcio, el
hierro, la vitamina A, acido folico y vitamina C. I
Marisa Warix Ohio State University
Family and Consumer Scienc~. i
1787 Neil Avenue, Columbia, OH 43210 I
SUMMIT
PODIATRY
Glaser Foot &
Ankle Clinic
1717 Shipyard Blvd.
791-1300
llJ1
ington Health Associates
NEW LOCATION:
1501 Medical Center Drive
W~mington. NC 28401 F
Our Board Certified !
Endocrinolo ists Are Here TdJUlp
~. '" '1tlm~ ugh. M.D. J
~lllil'$!jil}~1!tIl'; DeDe Warmg. M.D.
.. ~~ 375 I ,
for
If you're diabetic,
your.... need lpeclal attention.
-INFECTION - FOOT ULCERS - NEUROPATHY
- VASCULAR DISEASE - BONE PROBLEMS
-
J 'l... r---
Diabetes C.J, Nov 2003
~ ,
('
'-
:)
page4
,
,
,
,
,
,
,
,
How-to Enjoy'-Your Holiday Season and Still Eat Healthily by MindySaenz,RD,LDN,CDE
Food is.one of the pleasures of parties, holiday festivities, 1/2 pound (1 stick) unsalted butter, left at room thigh piece (1/2 hen) on each plate.
and other social gatherings. Any food, even traditional temperature until just soft-about 15 minutes. . Remove the Herb Butter from the freezer. Unroll the
holiday treats, can fit into a healthful eating plan. The Corirlsh Hens wax paper. slice 8 coin-sized slices equal to about I
secret is moderation and balance. Here are'some tips to 4 Cornish game hens (fresh or frozen; if frozen, teaspoon each, If you want to remove t1ie skin from the
help you make it through the holiday season. allow to defrost fully in the refrigerator before hens, do so now. Before serving, place a coin of Herb
WIlen you go to a party, focus on visiting with friends be2inning the recipe) Butter on top of each portion. It Will melt and enhance
and faffiily and set )'ourself as far away from the food 3/4 tap salt the flavor of the dish.
table as possible. Otily go through a buffet line once and 1/2 tap white pepper Rewra, p the remaining stick of herb butter and return it to
only take small amounts of fOOdS you really want. You 1 ounce (5 tsp) olive oU the fi:~r. f~.~ter ':l~~'_~ '-- __'---- _' _ ___
I don't have to taste everything to enjoy yourself. If you 8 tap Herb butter (one tap per portion) WIilJlpeiJ SweefPOtitoes WitliCiii'iiijieuzecl5liimo~
are asked to bring something, make sure you take a low To prepare Herb Butter. In a medium size bowl, combine MaJ<es.S-seiVings.--.------.------------
fat item. That way you'll know there is at least one thing the thyme, sage, and r,!-semary; with the unsalted butter. This recipe takes about 60 minutes to prepare and cook.
i al}owed on your meal plan. (You can work the Spices into the butter with the back of a' 3113 ounces raw shallots, including sliin
~r _ J!e realistic. Trying to lose weight during the holidays is spoon). Set the Herb Butter 1~l!gtliwise on a 1 foot length 1 'tsp olive oU
1 probably an impossible goal. ft may be better to decide of waxed paper, I inch form the edge of the paper. Roll 1 pound fresh sweet potatoes, peeled
to just not gain any weight. the Herb Butter in the waxed.paJ>er to make a cylinder. 2 quarts water
I Try to stiel< with your normal eating schedule as much Crimp both. ends of the papei"anil tape it shut so it does 1 tap salt (most wUlbe thrown out with the water)
I as possible. Studies have found that J>eople who skip not unroll. Place the cylinder of Herb Butter in the 3 ounces Ja bit less than 1/4 cup) evaporated, not
meals end up snacking or eating more later on. It can freezer. Allow it to chill there for at least 2 hours. (It can condense skim milk
I even lower your metabolism so you don't burn as much be stored for up to 3 months.) 2 tbsp margarine
energy. To J>repare hens. Discard the giblets and rinse out the lf4 tsp white pepper, or to taste
Eat slowly. Really enjoy the taste of the food. It takes insiile of the hens. Preheat the oven to 350 degrees F. 1/4 tap cinnamon or nutmeg, or to taste
about 20 minutes for your stomach to signal your brain Season each hen by robbing it with the salt and white To caramelize the shallots: Peel the shallots, slice' them
that you are full. If you p;u)p everything down, you can pepper inside and out. Now rob the olive oil onto the into 1/4 inch pieces. Take a medium size saute pan or
eat more than you need oefore your brain has a chance entire outer surface of each hen. Place a saute pan or nonstick skillet and heat it on medium.high heat. Then
to figure that out. nonstick skillet over medium-high heat. When the pan is add the olive oil.
It is usually better to eat a small serving or just a bite of fairly hot, place two of the hens in the pan and sear them Now add the shallot pieces and saute until the shallots
some of your high-calOrie food than to avoid it for so long to a golden brown. Then turn them over, and repeat on turn golden, about 3 to 5 minutes. Take the shallots out
that you end up pigging out on it. Eat a small bite and go the other side. This will take about 30 seconds on each of the pan and reserve them for later use.
on with life. side. To prepare the sweet potatoes: Dice the peeled sweet
Balance your holiday meals with other meals during the (Note: Searing each hen not only turns the skin a potatoes into I inch pieces. In a medium size sauce pan
day. Eat lower calorie meals during the day so you can golden color, but also begins the cooking process. It's a bring 2 quarts of water to a boil. Add the salt and diced
enJoy your celebration foods without feeling guilty. It's necessary steJ> for the recipe, even if the high-fat skin is sweet potato to the water. Allow the water to continue
your total calories for the whole day that maller, not the later discardeil. Roasting the hen in the oven then makes boiling gently until the sweet potatoes are fork tender,
calories in one meal. Drink sparkling water with a twist it tender and helps keep the meat moist.) about 10 to 15 minutes. Drain the sweet potatoes and
of lime or a diet soda instead of alcoholic beverages. If If possible, also stand the narrow sides of each hen in place them in a medium sized bowl. Using an electric
you do drink alcohol, only have one or two drinks and the pan, and let each side sear for 30 seconds. (This will hand mixer, combine the sweet potatoes, half of the
I!!:YlL.drink and drive. Remember that ,alcohol has ensure that the cooking process begins evenly on all four caramelized shallots, and the rest of the ingredients
almost as many calories as fat so be careful. sides, helJ>ing the hens to continue cooking evenly after until they are thoroughly mixed. Place this mixture in
Stop eating when you leave the table. Avoid the urge to they are place\! inside the oven.) a serving dish. Garnish by J>lacing the other half of the
nibble as you are cleaning uJ> the leftovers. Set the two seared hens aside, and repeat the searing carame~d shallots on top. Serve bot.
Remember to HAVE FUN! Sharing food is part of many process with the remaining two hens. J,TeBh~e:Peiii Qmtn~ I
celebrations, but ~njoying a traditional holiday meal or a Place the 4 seared hens o.n the rack of a roasting pan. Makes 8 servings
p~ food doesn t need to rum the healthful food hab.ts Place the uncovered roasting pan m the preheated 350 This recipe takes about 30 minutes to prepare
you ve worked on all year long. degree F oven, until hens are fully cooked. (The hens are 1 medium Red Delicious apple, unpeeled
To help you plan a healthful holiday meal he~e are cooked when an instant-read thermometer inserted in the 1 Granny Smith apple, unpeeled
reciJ>es created by Chef Chris Smith, "The Diabetic breast, reads 170 degrees F, inserted into the thigh reads 1 medium Bartlett pear
a1i~~~~~:~::::: ~~g!d~~~~~;~~:;c;;;;;:~;nf~ r~~~ir~!~:n:rangejwce
wiili Cliidren or tUrkey tooT minutes. 1/4 tsp cinnamon
This recipe-using fresh or defrosted hens-takes about an To, c.arve the hens: Split each hen in half len~wise by 5 fresh mint leaves, finely chopped
hour and a half to prepare ~d cook. pl~mg the hen ~n a solId ~urface ,such as a cutting bo~d. Core the apples and the pear. (Wash the fruit well, and
The Herb Butter takes 15 mmutes to make and 2 hours WIth the breast "de up, usmg. a sharp knife, carefully slice leave the skin on. It wilf add color and fiber) Dice the
to chill from the breast bone fength~se down thebreast, keep~g apples and the pear into 1/2 inch cubes and place them
Herb Butter the knife next to ,the bone. WIth the tip of the kirife, in a medium size bowl.
1/2 tsp. fresh thyme finely chopped (or 1/4 tap. f~llow. throu~ around the underside of the hen. Now,' Add the rest of the ingredients (raisin, grated orange rind
dried) still usmg the tip of the knife, cut the breast away from the orange juice vanilla extract, cinnamon ahd mint leaves!
1/2 tap fresh sage finely chopped (or 1/4 tsp. dried) rest of t1ie hen. Finally, cut the leg and thigh piece away. Mix well. ' ,
1/2 tsp fresh rosemary, finely chopped (or 1/4 tap This will complete one portion. Cover the mixture and place it in the refrigerator for
. I ,.dried) After carving all 4 hens, arrange I breast' and I leg and about 3 hours. Serve chilled.
-r
,,'
it
.
;~
,
. ,
, ,
1
I
.,
I (
!
,
Diabetic - .
Retinopathy
BoardCtirtified In OphthaJmology
Igor W~"MD . Erik van Rens. MD
1801,NowHarKMlI'..t.lledical Park Dr. . Wdmioglon, NC
f703~Q4!:i.Rd Suite 104 . JacksorlVine. NC
4QOllJtrg~~E. Suite 240 . Utile River. NC
~~OfcoastaJcarolina.com
.. .
f II .
~".
~
WOUND CARE
Ghobad Azizi, MD
~LMINGTON
Endocrinology, P.A.
SpeclaBzed Mediclne . F'9rson8Ilzed Care
Board Certified in
Internal Medicine, Endocrinology,
Diabetes and Metabolism
Welcoming ExIsting PaUents, New PaUents and
Physlclsn Referrals
For Appointments (910) 254-9464
1776 Wellington Avenue, Suite 2
Wilmington, NC 28403
Ji
~, " ";;a;'-'''~-'''CC'-c,
W" -~ ',Qt~o
'l:i:l"c,:., - - '.~..-" _ 00' _ -"". ,.,'., ".
Meter Conversion Day
Call (910) 686-2988 to find out how
~afreemeter.
" Ie' Nov. 5th
---- Retirement Uvinp Showcase
, World', Smallest Sample'Siz CoastlJ Convention Center
. Approved for Alternate Site Wilmington, NC
Testi Nov. 6th
Johnson Home Medical
Porter.; Neck Shopping Coo.
8207Marl<etSl &
Wilmington, NC
(910) 686-2988
\\ 111:'11 \\\)1I11,b \\l)ll'll.k,li
CINft'f<.
1m WlU'N.CIOti A\'lNUl ' WU.MtNGl"ON
910.81S-000s
I
I
-.-i