05/04/2005
. FINANCIALS/GRANT STATUS
REPORT
NOT AVAILABLE
CONTINUED TO JUNE
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7
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:D Consent Meeting Date: 5/16/05
Allenda: [8J
Department: Health Presenter: Cindy Hewett,Business
Manaller
Contact: Cindy Hewett, Business Manal!er, ext. 6680
Subject: Budget Ammendment in the amount of $2,063 for the Women's Preventive
Health Prollfam.
Brief Summary: The New Hanover County Health Department has received notification
from the Division of Public Health that an additional $2,063 in Women's Health Service
Funds (WHSF) and Title X funds, has been awarded to be used to support the Family
Planning Program for FY 04-05. The funds are to be used for any approved Family
Planning expenditure, including contraceptives, PAP tests or sterilizations.
Recommended Motion and Requested Actions: To accept and approve the $2,063
additional State Grant funds to be used to support the New Hanover County Health
De artment Famil Plannin Pro am, and the associated bud et ammendment.
Funding Source: NC Department of Health and Human Services, Division of Public
Health, Women's and Children's Health Section, Women's Health Branch, Women's
Health Service Funds WHS
Ex
I Attachments: Budget Ammendment and supporting documentation.
8
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Brenda Dunn
<Brenda.Dunn@ncmai
I.net>
To: undisclosed-recipients:;
cc:
Subject: Additional FY 05 Family Planning Funds
04/1512005 07 10 AM
To Directors of Nursing, Nursing Supervisors and Lead Family planning
Clinic Staff
Please note the information below and attachment from Sydney atkinson
regarding end-af-year availability of Family Planning Funds This
information was distributed April 14th to local health directors
To Local Health Directors
Attn Family Planning Coordinators
From Sydney Atkinson, Family Planning and Reproductive Health Unit
Supervisor
Subject: Additional Family Planning Funds
Date April 14, 2005
We are pleased to announce that we have end-of-year family planning
funds available to most local health departments and districts. We have
$85,040 in Women's Health Service Funds (WHSF) that had been earmarked
as match for the Family Planning Medicaid Waiver. Due to the slowness of
the Waiver implementation, this money will now be distributed evenly
among the counties that have received WHSF dollars in the past Because
there was not as much demand for sterilization money in March, we also
have $86,000 available in Title X funds These funds will be evenly
distributed to counties who have received Title X money before
Multi-county health districts will receive this amount for each county
within the district Counties who expended at least 90t of their family
planning funds in state fiscal year 2003-04 are eligible to receive
these funds A budget estimate should be coming to counties receiving
these funds within the next week Attached is a spreadsheet showing the
amounts per Health Department or District These funds may be used for
any Family Planning (Title X) approved expense, including
contraceptives, Pap tests, and sterilizations The funds will need to be
spent by the end of May, 2005 If you have questions, please call your
Women's Health Nurse Consultant or Sydney Atkinson (919) 715-3393
D
Additional FY05 Family Planning Fu
11
. Additional FY05 Family Planning Funds
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COUNTY/DISTRICT TOTAL
01 ALAMANCE $2,063
202 ALBEMARLE REG $12,378
02 AlEXANDER $2,063
04 ANSON $2,063
201 APPALACHIAN $6,189
07 BEAUFORT $2,063
09 BLADEN $2,063
10 BRUNSWICK $2,063
11 BUNCOMBE $2,063
13 CABARRUS $2,063
14 CALDWELL $2,063
16 CARTERET $1,000
17 CASWELL $2,063
19 CHATHAM $2,063
20 CHEROKEE $2,063
23 CLEVELAND $2,063
24 COLUMBUS $2,063
26 CUMBERLAND $1,000
28 DARE $2,063
29 DAVIDSON $2,063
30 DAVIE $2,063
31 DUPLIN $2,063
33 EDGECOMBE $2,063
34 FORSYTH $2,063
35 FRANKLIN $2,063
36 GASTON $2,063
37 GATES $2,063
38 GRAHAM $2,063
203 GRAN-VANCE $4,126
40 GREENE $2,063
42 HALIFAX $2,063
43 HARNETT $2,063
44 HAYWOOD $2,063
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COUNTY/DISTRICT TOTAL
50 JACKSON $2,063
51 JOHNSTON $2,063
53 LEE $2,063
54 LENOIR $2,063
56 MACON $2,063
205 MAR-TYR-WASH $6,189
60 MECKLENBURG $1,000
62 MONTGOMERY $2,063
63 MOORE $2,063
64 NASH $2,063
65 NEW HANOVER $2,063
66 NORTHAMPTON $2,063
67 ONSLOW $2,063
68 ORANGE $1,000
69 PAMLlCO $1,000
71 PENDER $2,063
73 PERSON $2,Q63
76 RANDOL.PH $2,Q63
77 RICHMOND $2,063
78 ROBESON $2,063
79 ROCKINGHAM $2,Q63
80 ROWAN $2,Q63
207 R-P-M $6,189
82 SAMPSON $2,063
84 STANLY $2,063
85 STOKES $2,063
86 SURRY $2,063
206 TOE RIVER $6,189
88 TRANSYLVANIA $2,063
90 UNION $2,063
92 WAAE $1,063
93 WARREN $1,000
96 WAYNE $2,063
12
45 HENDERSON $2,063
46 HERTFORD $2,063
47 HOKE $2,063
49 IRED ELL $2,063
97 WILK
98 WILS
99 YAD
TOTALS
"0
ES $1,000 .
ON $2,063
KIN $2,063
$171,040
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Strategic Planning Retreat
April 16, 2005
Participants: Janet McCumbee, Scott Harrelson, Dr Jean McNeil, Dianne Harvell, Marilyn
Roberts, Don Blake, Dr. Rob Shakar, Nancy Pritchett, Cheryl Lofgren, Dr Bob Weedon, James
Hickmon, John Tunstall, Ellen Hamson, Nikki Todd, Nancy Nail, Nancy Ryan, Tina Ragin, Debbie
Toth, Afthea Johnson, Panza McNeill, Alicia Pickett, Elisabeth Constandy, Erin Cummings,
Renae Lopez, and Dave Rice
Facilitated by: Bill Herzog
Summary
Introductions and Agenda:
Mr Bill Herzog initiated the session with a presentation about the Strategic Planning Process and
anticipated goals for the outcome ofthe day. (see power point "Herzog Intro to SP"). Copies of
worksheets were distributed to participants to facilitate individual identification of issues of
interest, and also to help frame a group oriented identification of tasks and goals. Mr. Herzog
encouraged the flow of individual ideas into group ideas, and then into group prioritization and
task assignment.
.
Introductions were made of assistants for the day, Ms. Erin Cummings and Ms. Renae Lopez.
They are Health Educators on the NHCHD Health Promotion Team, and attended to assist with
group record keeping and reporting.
Presentation of Data and Service Provision:
Ms. Elisabeth Constandy, Health Education Supervisor, presented information on the health
statistics generated from the 2004 Community Assessment process. Information was delivered
on morbidity and mortality statistics, the Behavior Risk Factor Surveillance System, and other
data related to North Carolina, the eastem and/or southeastem regions, and New Hanover
County specifically. (see power point "Heatth Statistics 2005"). Ms. Constandy then shared
updated information about the provision of services for NHCHD. This information reflects the
many changes that have resutted in our Personal Health Services as a result of the changing
clientele of the department, and the changes implemented to the structure of staff as
recommended by the Organizational Analysis of 2002. (see power point "Service Provision
2005"). Ms. Constandy also informed participants that everyone had hard copies ofthe Strategic
Planning Advance Questionnaire, some information related to the recent Accreditation Process of
2004, and a copy of the Service Provision presentation.
Identification of Individual Interests and Group Issues:
At this point, Mr Herzog instructed participants to take some time to identify their personal
interests that they wanted to see addressed during the day, taking into account the information
presented on health statistics and service provision. Group members were asked to complete an
individual Issues Definition worksheet. During this time, group members were also invited to
introduce themselves to their groups, and share their personal roles as related to the health
department. Upon completion of the individual goals, the small group facilitators (Mr. Herzog,
Ms. Constandy, Ms. Lopez, and Ms. Cummings) compiled the individual issues into a list of group
issues.
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14
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Group Issues: ...
1. Access to Care, Marketing, Environmental, WlC, Youth Obesity, Disparities, .
Teen Pregnancy, ITlStaff Development, Sex Ed, Gang Violence, Emerging
Risks, Dental
2. Obesity, Physical Activity, Smoking, Nutrition, Dental, Environmental
3. Self-supporting services, Increased Revenue, Marketing of Service, Prevention
Education, Lifestyle Behaviors (especially youth), Hispanic Population (need
for bilingual staff and cultural awareness)
4. Obesity, Treatment of Children (health services for), Environmental, Staffing,
Early Intervention
At this point, groups were instructed to write their personal interests on Post-It notes and to place
them on the wall. During this process, similar topics were grouped together in an effort to bring
the individual priorities into consensus on some over-arching, larger priorities.
Identification of Larger Priorities:
The process listed above lead to the following identification of priorities, and their related
individual and/or group topics. Once these were identified, participants were given the
opportunity to prioritize them through a voting process. (participants were given 3 round stickers
each, and allowed to place a sticker next to the three issues they felt needed the most attention.
They were not allowed to cast more than one "vote" per issue).
Following is the ranked list of Slrategic Planning Priorities:
~..:j
t~;;;
1. Access to Health Care (16)
2. Obesity (13)
3. Emerging Health Risks (9)
4. Environmental Health Risks (9)
6. NHCHD Internal Issues (8) (incl HR resource development, IT, revenue)
6. Human Sexuality (to be renamed?) (6)
7. Animal Control and Rabies (2)
8. Health Disparities (1)
9. Violence (1)
.
Identification of "Task Groups":
After agreeing on the identification and ranking ofthe priorities listed above, they were divided
into the following for "task group" discussion. Participants were invited to move to the group that
they fell most interested in, or that was most appropriate for their staff role at NHCHD. The
groups were compiled as follows:
Group 1 Emerging Risks, Environmental, and Violence
(focusing on the individual and/or group issues of: emerging risks for all hazards,
response preparedness, elimination of smoking in public places, protecting public health
from environmental risks, the physical environment, updating state laws related to
environmental service, the rise in violence against women, and gang violence)
Group 2: Access to Care, Sexuality, and Disparities
(focusing on the individual and/or group issues of: marketing of NHCHD services,
communication and education related to heallh risks, child health, dental care with
children, oral health, access to preventive care, prenatal care, heallh education, and
access for the uninsured)
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IS
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Group 3: NHCHD Intemallssues and Animal Control
(focusing on the individual and/or group issues of: staff continuing education and training,
working with budget cuts, increasing revenue, reporting of data and services, HIPAA
compliance and security, IT development for staff, IT privacy, rabies control, and animal
issues)
Group 4: Obesity
(focusing on the individual and/or group issues of: obesity related diseases, healthy
youth, increased physical activity, improving nutrition, and reducing obesity)
.
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16
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Regional S~
To.>> Needs
RegionAl Focus Gro'W8
Top Needs
Affordable Healthcare
Affordable Housing
Domestic Violence
Drog Abuse
Dronk Driving
Underage Drinking
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Health/Medical
Youth
Housing
Education
Elderly
Mental Health
Transportation
Employment
Domestic Violence
Childcare
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New Hanover Coun1;y Top Needs
Lack of Affordable Healthcare
Affordable Housing
Crime*
Domestic Violence
Drug Abuse
Drunk Driving
Underage Dtinking
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NEW HANOVER COUNTY
FOClJSGROlJP
TOP 10
1. Health/Medical
2. Housing
3. Youth
4. Education
S. Mental Health
6. Domestic Violence
7. Transponation
8. Elderly
9. Employment
10. Substance Abuse*
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SP 2005 Advance Questions
.
1. Given what you know about the public health situation in New Hanover
County now and for the next five years, what do you believe are or will
be the most important strategic issues that need to be addressed?
HIV I STD, diabetes screening, cancer screening (breast, prostate, colorectal)
Emerging Health Risks (Terrorism, SARS, Avian Influenza, etc.)
Possible new facility, if Hospital purchases 17th Street facility
Preventive Services (Enhancing Open Access, dealing with obesity, etc.)
Information Technology training for employees
Access to Health Care (Health Disparities of African Americans and the Latino population)
Community outreach
Staff development
QA, accountability
Debt set-off in place
Pediatric dental services
Child health Ix in clinic
Bioterrorism is something that I am professionally concerned about. Other conditions that
concern me are the rising incidence of obesity and the prevalence of smoking. I believe New
Hanover County should follow the lead of other major metropolitan areas and ban smoking in
restaurants and bars.
Professionally, I am concerned about the prevalence of rabies in the county Corollary to that, I
am concerned about the problem of pet overpopulation and responsible pet ownership (including
compliance with rabies vaccination requirements).
We must remain current with emerging health risks, such as potential bioterrorism events and
drug resistant biologicals. We must keep service at the forefront to maintain our public health
core values and mission statement.
Immigrant populations are on the increase so we must continue to meets the needs of this group,
as well as remaining culturally relevant and diverse for every portion of the community
We are also expected to do more with fewer people in the workforce, which was already a
challenge in most divisions.
I believe as New Hanover County and the surrounding areas continue to grow and be developed
the most important issue includes providing adequate services to our citizens. This would include
all areas of public health. With the potential purchase of the health department this would be a
perfect time to provide open access health department services within each area of the county
instead of in just one location. We need to provide our services to everyone everywhere. By
providing satellite open-clinics within each area of town, (downtown, Carolina Beach, Military Cut
Off, College Road, Porter's Neck and Wrightsboro) we could possibly be more convent to our
customers and be able to provide more services.
Communication and education to the public is the most important issue .Getting our information to
the public and what we offer is imperative.
Increased need and demand of services, diversity, cultural issues.
.
"
.
Water quality, related to storms, etc.
Continued Bioterrorism planning is needed, with tabletops and exercises; exercising plans is
essential (practice makes perfect);
Chronic disease prevention
Information Technology (HIPAA security issues)
Adding clinical services that are needed in community
Increased Interpreter needs; increased need for indigent care for Hispanics without insurance
Implementation of Immunization Registry
.
Grow1h in population = access to services
New food business/services = safety
Gangs/Drugs
We should choose a significant number (5-10) of the top preventative health issues in our
community and use these as personal health topics to educate the community and to work toward
a healthier environment.
We should work to decrease the number of births to unwed mothers through education in schools
and community centers.
Educate the community to deal locally with natural disasters and bioterrorism.
Population grow1h and diversity-- Rapidly growing Hispanic population; need for more bilingual
staff
Lifestyle risks in light of all the new evidence of childhood obesity
Information technology (staff computer training) Nice computers, but not utilizing them to the
fullest.
Possibility of new HD facility if current facility taken over by hospital-need good planning
The rapidly increasing cost of health care and the diminishing sources and amounts of funding
available.
.
2. In your opinion, what are the most crucial steps that the Health
Department needs to take to make significant inroads on these or any
other strategic issues?
We have done much to accomplish the above stated goals, but more is needed to continue our
work. Staff training is critical to stay abreast of current and emerging processes. Staff morale is
also crucial to keep us motivated and focused on our primary purpose for doing the tasks we do.
Outreach - become the county-wide leader in health promotion efforts
The crucial steps include providing:
Community based open-clinics within each community in the county
Adequate staffing for environmental health
Fees for services are needed for restaurant inspections, re-grades, plan review, transitional
permits and temporary food establishments
Plans for all food establishments being built in New Hanover County should be reviewed at the
county level instead of at the state
Increase staff proficiency with technology
Increase community involvement
.
-
.
.
To be visible and accessible during non crisis situations. We need also to build a rapport with the
public with knowledge of whom and how to get necessary information.
Open communication, Bioterroism, facilities
Continue to coordinate BT planning and exercises with PHRST, local EM, local LEOs, and
hospitals
Partner with other health related agencies to get Chronic Disease Prevention strategies in place
(no money for new programs at health department)
Continue to work with the state, and local IT to put controls in place for HIPAA security, updated
equipment being installed, and staff training needed
Assess need for additional clinical services by documenting requests from public for specific
services not already offered, and investigating the availability of the service in the community
Continue to provide interpreter services and make appropriate adjustments to staffing as needed;
work with other community clinics to assess need for more indigent care for Hispanics
Work with state consultants to implement Immunization Registry; work with local doctors to get
them online as well; rework our Immunization tracking system
Education of services/issues beginning at school age level
Adding more staff
We should educate the community through public service announcements, educating in the
schools and through county and city leadership.
We also need a cohesive and easily understood message that is easy to convey to the public
Communicate goals with staff; prioritize; commitment to work on the plan
Seeking ways to identify and secure additional funding that could support the salary of a grant
writer
Emerging Health Risks (Terrorism, SARS, Avian Influenza, etc.) - Educate staff and community
of the public health mission. Train staff, especially the EpiTeam to respond.
Possible new facility, if Hospital purchases 17th Street facility Stay tuned to County proposal. Be
prepared to work with appropriate people to communicate our needs.
Preventive Services (Enhancing Open Access, dealing with obesity, etc.) Embrace quality
assurance. Plan, prepare, respond, and evaluate. Partner with community
Information Technology training for employees. Make a priority in budget process.
Access to Health Care (Health Disparities of African Americans and the Latino population)
develop culturally sensitive programs to address needs.
I think the Board of Health should seriously consider banning smoking in public areas such as
restaurants and bars. Respecting the obesity issue, other than educating the public, I am not
sure that there is much we can do-I mean we can't ban fast food restaurants, can we?
Respecting the rabies concerns, I believe that New Hanover County Animal Control Services
(NHCACS) does an excellent job with what resources they have in terms of enforcing the rabies
vaccination and county licensing requirements. However, with more man power, I believe they
could eventually move towards being self-supporting. That is to say that NHCACS would be able
to operate off of fees generated and not require county tax dollars to function. Admittedly, that is
a long way off; but it merits striving for
.
.
3. What barriers or limitations will most likely impede or limit the success
in addressing these issues?
Barriers and/or limitations include:
Finding locations to have community based health clinics
Funding needed for additional environmental health staff
State laws would need to be changed to charge for restaurant inspections, re-grades
State laws currently require franchise plans to be reviewed at the state level
I think it would be logistics and coming up with a marketing plan that is universal and consistent in
each and every situation.
Budget restraints, funding
Money
Focused agreement to proceed
Feeling of competition for services (child health)
Money
Overburdened staff
The most significant barrier is finding the right forum and the right method to address or
communicate to the most people.
Money; poor staff morale; "buy-in" from staff
It all depends on money available and budget issues. Financial and Human resources.
Money and personnel continue to be barriers to the implementation of any issue that needs to be
addressed. Staff "buy-in" may still be a problem. Many choose not to voice their true opinions
due to fear of losing their job or having a difficult time from their supervisor They may go through
the motions of doing their work, without any genuine joy in their commitment.
Regarding the smoking issue, I think there will be tremendous public sentiment against it
(interestingly, according to the annual report, only about 1 in 4 county residents smoke-
however, I can imagine that they will be a very vocal minority)
Respecting the rabies concern, coupled with the desire to see NHCACS be more self-funded, I
would like to see the Administrative Support organizational structure modified to include a full-
time Administrative Support person onsite at NHCACS. Since NHCACS is not located in the
Health Department complex, it only makes sense to have them operate in a more autonomous
fashion. They need this person to ensure compliance with licensing requirements and collection
of associated fees.
Job duties and the need of staff to be in the office
4. Looking back at the strategic issues and related goals set in Years 2000
and 2003 (attached): a. What do you believe are the two or three issues
in which there have been the highest levels of achievement?
Providing interpreters for the health department staff
Access to care
Communication, education, and marketing
.
.
.
.
Language barriers for Hispanic and new and emerging health risks are issues where we have
made progress. We are more aware of bioterrorism threats and the notification and involvement
of the HD and the role the community plays..
Utilization offacilities
.
OAS
Emerging health risks
Access to services- 1) open access clinic has increased numbers of appts. Available, with same
day appts., 2)dental grant received with September startup planned for dental unit
School Health- a nurse in every school since 2004
Full time interpreter and additional PT position
Nurses in every school
New clinic hours/procedures
Bioterrorism
Staff development
Addressing the rising Hispanic population
Increasing the use of Informational Technology
Now have 1.5 Spanish interpreters on staff; emphasis on bioterrorism training; increased capacity
for preventative services with success of OAS and clinic at Good Shepherd; mobile dental unit on
order
Staff development and continuing education.
Evaluation of services.
Access to health care.
Emerging health risks, facility utilization and preventive services.
Communication, education & marketing - on-line information, including MT minutes and other
documentation; designation of an individual to do marketing and centralize staff education.
Access to health care - open clinic and consolidation of staff
Emerging health risks - PHRST Teams added statewide; Forensic Epidemiology
Access to health care
Preventive services
.
b. In what two or three issues is there the most work yet to be
accomplished?
Increased demand for services
Satellite Services & New/additional facility
Eval of services
Communication and staff development.
Staff education, technology, trainings
IT
Staff development
Marketing
Environmental hazards: water, vector, animals etc.
Staff develop training (i.e. county subsidized tuition for those wishing to enhance/expand college
- or other - education)
preventive health issues in women and children
having a BOH voice on community boards
Information technology/staff computer training. A needs assessment has not even been done.
Water quality, storm water management and drainage abd air quality
Population growth and diversity
Emerging health risks.
Access to health care, staff development and continuing education, and information technology
Staff development and continuing education
Discontinued services picked up by the HD
Staff development
.
,
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5. If nothing else, what would you like to see accomplished during the April
16th conference?
I would like to see goals and objectives developed for the health department staff to work towards
and to have an idea on what needs to be accomplished and how we plan to go about working
towards our goals.
Communication and marketing of our services. .
Prioritized list of attainable goals
Increased communication and marketing services
Consensus building
List of accomplishments from list of priorities (00 and 03)
Reorder priorities based on list above and added new emerging issues
Make assignments for the next two years (that might mean, for ex., priority #1 goes to Quality
Assurance committee, #2 goes to policy comm., #3 goes to HIPAA comm.. etc.), don't create new
committees.
Developing ways to educate young people (school age) on various issues and problems that
affect them (or their families) now and in the future.
I believe that placing all of these issues that are felt to be important by the Board and Staff on the
table and brainstorming new ideas to advance these issues will be beneficial to the entire
community
Prioritize strategic plan goals
A continuation of the progress begun by the previous two planning conferences.
Revisit and prioritize strategic planning priorities.
Genuine values established for all HD employees to rally behind. We need to re-center staff
under specific core values that focus us as a team united in prevention of public health
threats/diseases. "If you don't know where you are going, any road will get you there." .
believe we follow these guidelines, but they are unwritten at present.
,
.
Regarding the smoking issue, I would like to see discussion about the feasibility of consideration
given to banning smoking in public places such as bars and restaurants.
Respecting the rabies concern, coupled with the desire to see NHCACS be more self-funded, I
would like to see discussion of consideration given to modifying the Administrative Support
organizational structure to include a full-time Administrative Support person onsite at NHCACS.
Since NHCACS is not located in the Health Department complex, it only makes sense to have
them operate in a more autonomous fashion. I believe that they would be able to ensure better
license compliance and fee collection if they had this structure.
Plan created to do more work in the community
6. What are your primary concerns, if any, about the strategic planning
effort as you understand it?
No concerns.
Budgeting, funding
None
I am concerned about their being so many issues and ideas that we fail to set achievable goals
and lose these ideas to follow-up or until the next strategic planning meeting.
Sometimes it seems just like an exercise on paper In 2000, an effort was made to keep the staff
updated on progress. I don't think that has happened since 2003.
None
.
Getting Board and Staff on same page of priorities.
Lack of staff and/or funding to successfully implement proposed changes.
I guess my most exigent concern is that it is all well and good to strategize, however if we do not
have the resources or the staffing to implement proposed changes, how will we do it?
None at this time
.
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New Hanover County
Health Statistics
Strategic PJanning Retreat
April 16, 2005
Infant Mortality
. NC ranks 40"> in nation for infant monality (2003)
. Rate, in NC have declined, but progress has ,Jowed
(no change from 2002 to 2003)
. Minority infant mortality rate continues to drop
overall, but still twice that of white infants
. Latino infant monality increased from 2002 to 2003
. Binh defects, prematurity, and SillS are Jeading
causes of infant death
. Other factors: alcohol and tobacco
Infant Mortality (<1 year)
. NHC data
. NHC rate is lower than NC rate overall (2001-03)
. NHC women are more likely to have late prenatal
cart, or no care at all
. NHC women more likely to smoke while prtgnant,
especially young women
. Minority rates better than state average, still high
compared to US average
. Fetal death rate higher than state average
1
Asthma
. Over 130,000 NC children suffer from asthma
. Leading cause of school absence, ED visits, and
hospitalization
. African American and Latino children are more
likely to be hospitalized, use ED for primaty
care, and die from asthma
. Controlled by reducing exposure to triggers,
proper medication use, education
Asthma
. Eastern NC has higher rates of absenteeism and
hospitalization from asthma than state average
. NHC has lower hospitalization rates than state
and region, for children ages 0-14
. NHC has higher rates of diagnosed asthma,
undiagnosed wheezing, total % wheezing, %
reporring missing school and activities, and % of
students who smoke
Cancer
. 2nd leading cause of death in US and NC
. In 2005, more than 570,000 Americans will die from
cancer (COC); and 1.4 million cases will be diagnosed
. NC is slightly higher than US for newly diagnosed
cancers of lung. bronchus, prostate, female breast,
colon, and rectal cancers
. In NC, African Americans are 35% more likely to die
from cancer than Whites (females from breast and
colon, males from colorectal, lung. and prostate). even
though incidence is similar or lower than White rates
I'
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2
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Cancer
. NHC incidence rates are similar to state rates for
colorectal and lung, and better than state rates
for female breast and prostate
. NHC has 7'" highest rate of melanoma in NC
. NHC total death rates for cancer are slightly
lower than state rate
. Eastern NC mortality rates are higher than state
rates for breast, lung, colorecral, cervical, and
prostate
Cancer
. BRFSS Data 2001: NHC vs NC
. NHC has lower reponed numbers of men who have
had a Prostate Specific Antigen (PSA) blood test to
screen for prostate cancer
. NHC has higher reported numbers of residents who
have used a blood stool kit to screen for coloreaal
cancer
"(these questions not repeated on 2003 BRFSS)
Diabetes
. 7'" leading cause of death in US and NC
. A leading cause of disability and hospitalization
. Estimated \4 of people with diabetes in NC are
not aware of it
. Incidence is 57% higher in African Americans
than Whites; African Americans are 3 times as
likely to die from diabetes than Whites
. More conunon in people over 60
3
Diabetes
. NHC has higher monality rates for total
population, specifically people over age 65,
White Males, and Minority Females (1999-2001
. Monality rate for Minority Females is extremely
high in NHC, compared to NC
. Overall monality rate for diabetes is rising in
NHC
Heart Disease and Stroke
. Heart disease is leading cause of death in NC
and US; Stroke is 3'" leading cause of death
. Our region is the "Buckle of the Stroke Belt";
highest levels in the nation
. NC, and regional residents, have higher
prevalence of leading risk factors: tobacco use,
sedentaty lifestyle, and overweight/obesity
Heart Disease and Stroke
. While Urban areas ofNe have lower death rates
front CVD and Stroke, Eastern region has rates
much higher than state and national rates
. NHC mortality rates for minorities are higher
than state for heart disease
. NHC mortality rates for coronary heart disease
(not incl heart attack) are higher than state rates
~
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4
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Heart Disease and Stroke
o BRFSS2001 Data:NHCvsNC
. NHC residents report similar rate to state data for
having cholesterol checked
. Nl-lC has lower percentage of adults that report
being told they have hypertension
o BRFSS 2003 Data: Eastern NC
. Eastern residents have higher self-reponed family
history of hean disease or stroke. as compared to
Slat.
Overweight and Obesity
o Becoming the leading preventable cause of
death in NC and US
o Type II Diabetes rates climbing rapidly
o NC children are 2-3 times as likely to be
overweight or obese as their US counterpans
o NC elementary school children are being
diagnosed with high cholesterol and
hypenension
Overweight and Obesity
. NHC is lower than state rate for percent of
overweight children seen in health
depanments and schools
. Children ages 2-18, who are in the 95th percentile
for weight
oNHC-14.9 %
oNC-15.6%
5
Overweight and Obesity
. Risk factors for Ovetweight and Obesity
include:
. Education level
. Income
. Ethnicity
. Geographic location in NC (Southeastern region
posing the largest threat)
Nutrition
. In addition to oveIWeight and obesity, other
health risks from poor nutrition include:
. Gall bladder disease
. Sleep apnea
. Osteoarthritis
. Respiratory problems
. Mobility problems
Nutrition
. BRFSS 2003 Data: Eastern NC
. Barely 1/5 of adults report meeting 5-A-Day goal
(21%), slightly low.rthan stat. rat. (23%)
. Similar percentages for 3-5 servings ~r day, 1.3
servings, and less than one serving per day
,
.
.
.
6
,
.
.
.
Physical Activity
. NC girls are less aetive than boys
. Teens are less aetive than younger children
. African American girls are least aetive of all
. TIlls leads to: higher rates of ovelWeight,
obesity, CVD, stroke, and cancer
. Southeastern NC has highest self-reported levels
of no leisure time aetivity in the state
Tobacco Use
. More NC adults smoke than US average
. 2003 Youth Tobacco Survey reports 34% of
high school students currently use tobacco, and
14% of middle school students. TIlls is a decline
since 1999 survey of about 6%.
. Men are more likely to smoke than women, but
female use is declining more slowly for youth
and college age females
Responsible Sexual Behavior
. Early sexual activity leads to higher rates of
STDs, HIV / AIDS, unintended pregnancy,
and cervical cancer
. More NC youth report sexual activity
compared to national average (2003 YRBS)
7
Responsible Sexual Behavior
. Teen Pregnancy and Birth
. NC has hight:r rates for all age brackets, compared
taUS
. While NHC rate is lower than state overall, the
percentage of repeat pregnancies in teens is much
higher than the state (ages 10-17 year:s)
. Over half of NHC high school seniors report having
intercourse three or more times
Sexually Transmitted Diseases
. Over 2/3 of SIDs in NC occur in the 15-24 age
bracket
. In 1998, NC ranked I" in the US for primary
and secondary syphilis cases, and 4'" for primary
and secondary syphilis rate
. Women are at a higher risk, due to being
asymptomatic
. African Americans and Latinos are
disproportionately affected by HJV & AIDS
Sexually Transmitted Diseases
. NHC falls into "1-95 and 1-40" conidor, which
has the highest SID rates in NC
. Risks higher in NHC due to transient
population, tourism, and UNCW
. SID incidence rates in NHC higher than state
rates for syphilis, AIDS, and chlaroydia
. Minority death rate from AIDS higher in NHC
thanNC
,
.
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8
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.
.
.
Oral Health
. Single most common health problem among
children
. Over 40% of NC children have dental disease
. NC has shoItage of dentists and hygienists
. Oral health largely dependent on SES
. Untreated dental disease more conunon among
Nrican American and Latino children
Oral Health
. Urban areas of NC have higher than average rates for
dental visits and cleaning in the past year
. Eastern areas have lower than state average rates
. NHC is higher than state average for Kindergarten and
5th grade children receiving screening and being cavity-
free, and those receiving sealants
. NHC is hi2her for % Medicaid eligible children
receiving dental services (ages 0-20)
. NHC is lower than NC rate for Kinderganen children
with untreated decay
Lead Poisoning
. Leading environmentally caused pediatric health
problem
. Lead affects almost every organ system, and is very
hannful to developing brain and CNS in children
. Prevalence of elevated exp<>sure in African Americans
is more than double that of Whites in NC
. Low income, rural, and Eastern NC communities at
greatest risk for elevated blood lead levels
. NHC has higher than average rate for % of 1 and 2
year olds screened, and lower than average % with
elevated blood lead levels
9
Food Safety
. Food bome illness disproporoonately affects the
immunocompromised, young, old, and
chronically ill
. Determinants:
. Sanitation, food handling practices, infected food
handlers, pre~nce of rodents and insects, cross
contamination, and sanitation of food contact
surfaces
Food Safety
. A number of food bome diseases are gaining
increasing imponance:
. Some are rare but gaining prevalence
. Some are spreading in geographic range
. Some are becoming more difficuh to treat
. Examples: E. coli 0157:H7, salmonellosis, listeriosis
Rabies
. Aher several years of low rabies numbers, there
are rising numbers of rabies cases in NHC
. There were 11 cases in the community last year
. Residents have been handling their pets aher coming
intO contact with potentially rabid animals
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New Hanover County
Health Department
Service Provision
and
Utilization Statistics
Fiscal Years 1998.2004
Strategic Planning Retreat
April 16, 2005
Animal Control Services
Animals Processed
4000 li~fi;'~;!i!!!l\c~\~;!i~~...II:=:~:~md
3000
2000
1000
0 ,#' ,#' "of' 0" 0''' .,#' ,,#
'" '"
Animal Control Services
Rabies Vaedne
;~:::~.1-+-1Y'"
10000' . .... . "'"". '.. .'
;:....,. .;,;.;'.. .;.,. , .. .. ...; .;.;,'i'....;1i0~;.~1..;......... .,
500: '., . !:>; ":: 1~3Y'"
..."",,,,...
...~ ...~ ,\-cY 'l,~ 'l,~ 'l,~ 'l,cY
1
Animal Control Services
. Since 9/22/04, ACS has performed 378
surgeries in their new on-site spay/neuter
facility. (as of 4/12/05)
. Adoptions have increased by
approximately 20%
Child Health
Child Car. Nursing
400
300
200
100
o
__ Centers 'v1sited
-+-Homes'v1siled
1998 2000 2002 2004
Child Health
Health Check Coordination
4000
0000 :::
2000 1__ Total Contacts I
1000
0
2002 2003 2004
RscaIV..rEndlng
. The Health Check Participation Ratio has
increased steadily since inception in 1990's
.
.
.
.
2
,
.
Communicable Disease
Reportable Diseases
700
600
500
400
300
200
100
o
1998 1999 2000 2001 2002 2003 2004
Fiscal Year
__AIDS
__HIV
Chla~a
.><--Gonotrhea
___Salmonelllll
__Shigella
-S~h11s
Communicable Disease
Tuberculosis Control
.
~
~g8
~~~
'sg
,# ,# ,,# ,,<5>' ,,# ,,# ,,#
Fiscal Year
Community Health
_....""acn.n1..
.-
.- /'
.-
.- ' "
- ,
-
-
-
-
-
-
-
..
-
,.. 1000 _ 10M
Ra....,..
.
__18
CaselSusped
-- TB Case
Reported
NewonAni-TB
""",
'-~"-Poslti""PPD's
_tt.....e...""'nnIng
- - - -
,-.,...
3
Dental Health
Preschool- 12 Dental Screening
4000
3000
2000
1000
o
'" ~ ,,<> , " "' ""
,<fP ,<fP ,," ,,<5> ,,<5> ,,<5> ,,<Y
-+- Dental
Screering
___ Referred for
Care
Follow-Up of
Referrals
Dental Health
Adult Dental Screening
250
200
150
100
50
0
1998 1999 2000 2001 2002 2003 2004
Environmental Health
Establishments Graded
400
350
300
250
200
150
100
50
o
,#' ,#' ",# ",oS" -#'''' ",oS>~ ",#
__Semi-AmJa1 Type
-II-ArroaITWe
FestivalPermils
--'--. P1ar5 Reloiewed
,
.
.
.
4
.
Environmental Health
Establishments Graded Conl'd
3000
2000
1000
I--QuarterlyT)Pe1
o
,~<D> ,~<fi> f'<s> f'<>' f'<>'" ",<><>~ f'~
Environmental Health
Environmental Services
_~ol~""",,,,1k>ns
.
900
800
700
800
500
400
300
200
100
o
^" .., .., , '" ~ .
....~ "t:!? '1,,~ '\.t@ '\.~ 'l-* ",,*
__NowS.pllOT_
Appro_
SepijcTM1kR.p""
Permilslnuod
SeptK:T.....
Repoi...""pt<l_
_pn....leW.llS
Appro....d
_SWmm.-.gPool
1_110""
Environmental Health
Environmental Services Cont'd
1600
1400
1200
1000
800
600
400
200
o
,#' ,#' ",.sf' ",<s>' ",<s>'" ",<s>" "'~
Comp_Abaled
_B.-:lIngAd<llions
""proved
MobWHome
--
W_Samplio&
--..
_lNdPlointl",,"cliol'4
.
5
Environmental Health
Vector Control
2000 1~~
1500 1__ Spraying - Man I
1000
Ho'-'"
500
0
,#' #~''''O><I'
" '\.~ '1-~ '1"r;SJ "j,ts fl
Laboratory
On Site Procedures
,~,
Ch'"'lIs",,,
~oo
V.nlpurcUe
~
,~
~
.00...._
c~.
_H."""loIogy
~
~,
=
_S~i._nit'\:l
-
,~
..~_.lJrjnol~.
200~ 2004
Laboratory
Referral Procedures
2500 ~r- '- --~~~
:~~H -+-Chlam)<lia/GC
HIV
".....Lead
: . -II- TB Cultures
2003 2004
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Nutrition
General Nutrition Assessmen __He.lth
and Counseling Cepartment
--- Maternity CUnlc
800 j' .j
600 NICUFolJow.Up
400 eun.
200 .i~ -<<---Well Baby Clinic
0 .. . .
__Gener.INutrttlon
"'## ' " "# Contllc:tsToWl
,<f', ." ",<5' ",<5' ",<3> ."
Nutrition
Wle Participation
3200
3000
2800
2600
2400
... 9 .., , " "
...CJ" ....~ '\.f:Y ",c5J ",I$l '1,~
-+- Year-To-Date
M:mthly~r8ge
N utriti on
we Participation "
'" lli;~'~'~'S'~~!':l
, '"
.. I ~ "'" Parlldpoltion . I
"
.. .'i';,>;,;,;;,,(:<_.c;.-:-,', ",':"'j- .__.,-,,'.
''''' .... '''''' "'"
7
Vital Statistics
.
.
.
II~~MS
: _Deaths
04
h
_P.-
Ci...VI....
No'"__..."....
O.po.P"'_...........
.
Vital Statistics
4000
:~~~E.:::: :~
oE.
1998 1999 2000 2001 2002 2003 20
Women's Healt
Women's Preventive Health
5000
4000
3000 "'-."",,- ~,...
2000
1000
o -,..-~.....,-
4P" 4P~ "," <5" ",'" ",'"
~ ~ ~ ~ ~ ~
~P.pS......
--
~WPH""T..II
_W......P....,.n<yT...........
~_.W...-tlP~T....T.."
Women's Health
Total CliniC Visils
10000 -.~ I-+-~:~~C"""
~~~~ f+-I .
o . '##''''''#
....~... 'V '),~ '\.~.,,~ 'V
.
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Women's Health
Matemfty Care Coorclln8tlon and
Maternal Outreach
''''
= .
- ,
- ii,,"
~
,~ ___MOW
,~
~
,
= ~
9
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North Carolina Local Public Health Accreditation Program
Summary
New Hanover County Health Department participated in the pilot project for the
accreditation program, and received Accredited status in 2004. NHCHD met 39
of 41 standards that were reviewed, and had two areas noted in the process
where the agency did not meet the standards or activities being assessed.
The specific areas identified for improvement are as follows:
1 (Core Functions and Essential Services) Standard 24: Translates
adopted policies into operating program procedures;
· Activity 24.4. Policies and procedures are reviewed annually and
revisions are noted and dated
· Comments and Recommendations: Evidence of reviews, but no
documentation of their being done on an annual basis; Environmental
Health needs more development
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2. (Core Staffing and Training) Standard 3, Activity 3.1: The agency has and
implements a performance appraisal plan that includes identifying the
continuing education needs of the staff.
· Comments and Recommendations: No documentation of continuing
education recommendations and/or requirements was noted in the
performance appraisal documents reviewed. Staff members are
currently restricted on travel and attendance of workshops and/or
meetings held out of county due to budget restrictions. This section
could be strengthened.
Following, please find copies of the Site Visitor's Report, and of the
corresponding pages listing the areas of improvement noted above.
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NCALHD: POLICY AND PLANNING a ./n
WEDNESDAY, APRIL 20, 2005 ~'A1.X. W
10:00 -12:00
1330 St. Mary's Street ~11l\
Room 402 ~
AGENDA
I H900/S902 On-site Privatization Update
2. H795/S665 Public Health Authorities to By-pass
State Medicaid Billing System
3 Field ColIection Data Teams
4. LHD QI&A for PH Improvement Taskforce
Deb Rowe
George Bond
Elaine RusselI
Dennis Harrington
Denise Pavletic
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5 Other bills for update Deb Rowe
a) Local FoodILodging Fees (no bill number) Rep. Wright
b) S803 Community Health Grants (HartselI) $3M to rural health
centerslhealth departments for expansion of comprehensive primary care
services
c) S744 Public Health Incubators (Rand) / S801 (HartselI) $2.5M for public
health incubators
d) S683 Public Health Incubators (HolIoman) $2.5M for public health
incubators
e) S802 Health Department Improvements (HolIoman) $50,000 to accredited
health departments
f) S804 Accreditation (HartselI) $1.25M to implement accreditation over a
period of 8 years starting January I, 2006
g) SI15 Healthy Carolinians (Purcell) $1.075M funding
h) Interpreters $3M to support service in health departments
i) S772 ADAP Funds (PurcelI) $6.5M
j) S776 AIDS Public Health Crisis (PurcelI) $3.3M for risk reduction,
prevention, counseling, and testing activities
k) S769 Americorp Funds (PurcelI) $225,000 funding
I) S771 Health Disparities Initiative (PurcelI) $975,000 to community
focused elimination of health disparities initiative to build capacity of
faith-based and community-based organizations
m) H685 Uniform Regulation of Animal Shelters (Gibson) uniform system of
regulation for private and public shelters
n) SI89 ATV Regulation (PurcelI) restricts age to operate an ATV to 12 or
16 years of age depending on engine capacity
0) SI130 No Smoking in Prisons (Albertson) prohibits smoking in state
correctional facilities
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6. Senate Budget Update
Deb Rowe
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/) ~f~ ""- r~~h.:t r cfl/ c: ~~~
~~0~U~ {JU:~U ((J-R;!~~~V~J
J) ~ -7> rJtd/~ ~1M-/
3) ~;J~4~/J(~H)
if) ~;J~ /I;~ (t:t'~J ~;)J( wJ~
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17m STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
New Hanover County Child Fatality 2004 Year End Summary
I. Purpose and Responsibility Of Local Teams:
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The New Hanover County Child Fatality Prevention Team (NBC CFPT) is a group
comprised of community representatives from diverse agencies and disciplines. Our team
currently has 17 members which are either appointed by their agency board, per the state
addendum, or are appointed by New Hanover County Board of Commissioners. Our team
currently has two openings. The mission of the NBC CFPT is to promote the development of a
community wide approach to understanding the causes of childhood fatalities; identify the
deficiencies in public agencies to deliver services to children and families, and to make and carry
out recommendations for change in system delivery to prevent future childhood deaths. The
NBC CFPT meets on a quarterly basis with meetings in February, May, August and November.
Several teams members also attended 2 state fatality reviews. The attendance this year has
averaged 7 community members and 2 Health Department staff members per meeting. Our team
has had 3 visitors to participate this year as well.
II. Trends Identified
During 2004 the team reviewed the deaths of 16 children. This is compared to 10
reviews in 2002 and 11 reviews in 2003. Of these deaths 5 were due to extreme prematurity and
complications associated with this. Five deaths were due to congenital abnormalities. One death
was due to asphyxiation secondary to obstruction of the airway. Two deaths were determined
accidental ( car accident and motor vehicle-non traffic ). There were 2 deaths that were listed as
undetermined by the medical examiner. These two deaths would have likely been considered
SillS deaths, however, under the criteria were not able to be listed as such. One death was due to
illness secondary to aspiration of food. Of these deaths there were no trends seen in the causes of
death or system problems identified in the county.
III. Training Needs Identified
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There were no trainings held this year for members of th,e team and none offered by the
state. No new members were appointed. There are no training needs identified for the team at
this time. Information was distributed and reviewed regarding the new Safe Surrender Law.
/
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17m STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
IV. Team Activities and Accomplishments
The New Hanover Child Fatality Prevention Team spent $1200 purchasing car seats that
were distributed to low income families. These families were educated on the child safety seat
laws and proper use and installation. Inaddition $200 was spent to purchase Safe Surrender
magnets to distribute to the public and $20 was spent on refreshments. This money was in the
fiscal budget '03-'04.
The New Hanover County Child Fatality team has worked to improve participation of its
members and invite persons related to investigations of child deaths to be a part of the review
process. Attendance has been steady and members share agency information with the
coordinator prior to the reviews when they are unable to attend. The team has worked diligently
to obtain and review needed records and work collaboratively in the processof the actual review
of each child death.
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Respectfully Submitted,
9:r:~
CFPT Review Coordinator
c: attachment
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17m STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
New Hanover County Child Fatality Member List 2004
16 State Required Members:
Heath Director, Janet McCumbee for Dave Rice
DSS Director, LaVaughn Nesmith
DSS Staff Member, Vacant
DSS Board Member, Dallas Brown
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District Court Judge, Pat Laney for Shelly Holt
District Attorney's Office, Maryann Adkins
Law Enforcement Officer, Melissa Perkins (WPD)
Community Action, Addie McCullough
New Hanover County Schools, Michelle Galloway
Mental Health Professional, Judy Wall (SEMH)
Guardian ad Litem, Liz Kachris-Jones
Health Care Provider, Carol Rogers (NHRMC)
Emergency Medical Services (appointed by County Commissioners), Mike Law (NHRMC)
County Medical Examiner, Vacant
Parent (appointed by County Commissioners), Patty White
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Local Child Care Provider, Sarah Norris (Total Child Care)
Additional Members: Dr. Sonja Brown, Carousel Center
Heather Patterson, Domestic Violence Services
Joyce Hatem, NHCHD, Review Coordinator
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24tb Annual Health Directors' Legal Conference
Thursday & Friday, April 21-22, 2005
UNC School of Government
Chapel Hill, North Carolina
Agenda
Thursday, April 21
8:00 Registration & Continental Breakfast
9:00 - 9: I 0 Welcome & Introductions
9: 10 - 10:00 Legislative/Regulatory Update
Chris Hoke, NC Division of Public Health
10:00 - 10:45 Law Affecting Pregnancy Decisions
Anne Dellinger, UNC Institute of Govemment
10:45 - II :00 Break
11:00 - 12: 15 Religious Exemptions to Immunizations
Beth Rowe-West, NC Division of Public Health
Jill Moore, UNC Institute of Govemment
12:15 -1:15 Lunch (provided)
1:15 - 2:15 FLSA Exemptions and Local Health Department Employees
Diane Juffras, UNC Institute ofGovemment
2:15-2:30 Break
2:30 - 3:30 Tort Claims, Authorization Actions, and Local Quality Assurance Programs
Andy Adams, NC Division of Environmental Health
John Barkley, NC Office of the Attorney General
3:30 - 4:00 The Local Health Director's role in the Jail Medical Plan
Jill Moore, UNC Institute of Government
4:00 - 4: 15 Break
4:15 - 5:00 "Stump the Lawyer": Open Question & Answer Period
John Barkley, Chris Hoke, Jill Moore, & Aimee Wall
5:00 Adjoum
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Agenda (continued)
.
24tb Annual Health Directors' Legal Conference
Friday, April 22
8:00 Continental breakfast
8:30 - 8:45 NC Public Health Law on the Internet: Unveiling www.ncphlaw.unc.edu
Philip Young, UNC Institute of Government
8:45 - 10:00 The Rubber Meets the Road: Case Studies in Applying Public Health Law
(1) Shigellosis Outbreak Involving Day Care Centers
. Colleen Bridger, Gaston County Health Director
(2) Environmental Health Powers in Natural Disasters
. George Bond, Buncombe County Health Director
Jill Moore & Aimee Wall, Discussants
10:00 - 10:15 Break
10:15 - 10:45 Public Health Emergencies: Building Bridges Between Public Health & the
Business Community
Gene W. Matthews, J.D.
CDC Foundation & NC Institute for Public Health
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10:45 - 11 :00 Break
11 :00 - 12:00 Concurrent sessions:
(1) Current Issues in Animal Control
. Aimee Wall, UNC Institute of Government
(2) Current Issues in School Health
. Jill Moore, UNC Institute of Government
12:00 Adjoum
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EMPLOYEE RELATIONS TRAINING FOR MANAGERS AND SUPERVISORS
NC OFFICE OF STATE PERSONNEL
APRIL 26, 2005
NEW HANOVER COUNTY DEPARTMENT OF SOCIAL SERVICES
PRESENTERS:
PATRICK MCCOY, ASSISTANT HR MANAGING PARTNER
KEITA CANNON, HR PARTNER
AGENDA
10:00 am General Information
Employee Relations Millionaire
Arrest/Convictions
After Hours Behavior
II :00 am Break
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II:15 am Absenteeisrnfrardiness
II 45 am Lunch (on your own)
I :00 pm Attitudes and Insubordination
2:00 pm Break
2:15 pm Appeals and Grievance Proceedings
Providing References
3'00 pm Open Mike
For information regarding State Personnel local government hurnan resources:
http://www.osp.state.nc.us/ExternalHome/GroupS/LocaIGovmt/index.html
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Budget Department: New Hanover County, NC
Page
New Hanover County
NORTH-:-CAROLII
-. ~-~ .... ~ .- -- y. - - - -- - -~ -
. Home r GO\ler~ment I Economic Devel~pment I leisure I Ed~C_atlOn I Contact Us .
~'IT'_P ,~. .~",._".--V;'~~'-. -
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l:'~l~ h4FJ ~~~;'J-;O:.,'T;~~~,~~c"1 ..
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. 2003-04~Budget
r :: ~:,~f5,:~' - :;i~ment
"I' "~"" "".....-'''0''" ,f.""" !.
1200s~BuJjget calerldar
Page maintained by Norma Troulrn8n.
Last modified on 12/17120047
10:39:55.
Budget Calendar
FY 2005-2006
The Budget Calendar for FY 2005-2006 Is subject to change. Please c
updates periodically.
BUDGET CALENDAR FOR FISCAL YEAR 2005-~
2004
November
Budget Manual Distribution to Departments
December
Begin Working with Department Heads to Develo~
Performance Measures
December 1
Survey of Departments FY 05-06 Budget ConcI
Budget Department
December 20
Capital Improvement (CIP) and Capital Project
BUDGET
2005
January
County Manager Meeting with Department Heads '
BUDGET
Planning Session with Board of County Commlssl.
05-06 BUDGET
January 11
Budget Process Training Session for Interested DePi
January 18
Temporary Salary and Overtime/On-Cali Salary
BUDGET
January 28-29
Board of Commissioners Budget Work Session
http://www.nhcgov.com/BGT/BGTca1endar.asp
4/27/2005
Budget Department: New Hanover County, NC
February 15
February 28
April 14
April 15
April 28
May 12
May 16
June 6
June 20
Page 2
Departmental Line Item Expenditure Requests to Bl
(All requests In except for schools.)
Departmental Revenue Projections to BUDGET
Fee Charts with Adjustments and/or Enhancements
Budget Work Session with County Commissioners
FY 05-06 Goals, Objectives, and Perfonnance Mea!
Budget
Budget Work Session with County Commissioners
(Meeting Ie at 2:00 P.M.)
Budget to Board of County Commissioners (Informal
Recommended Budget Information to Department
County Agencies
County Manager Presents Recommended Budget
County Commissioners Meeting
Commissioners Establish Budget Work Sessions
Public Hearing on Budget (Evening)
Adopt FY 05-06 Budget
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For General Information, e-mail the Public Information Officer.
For Technical Information, e-mail the NHC Webmaster.
Copyrlght@ 2004 New Hanover County, North Carolina.
http://www.nhc~ov.comIBGT/BGTca1endar.asp
4/27/2005
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NEW HANOVER COUNTY
INTER-OFFICE
MEMO
TO:
FROM:
Board of County Commissioners
Allen O'Neal, County Manager
Cam Griffin, Budget Director
DATE:
April 28, 2005
RE:
Update on FY 05-06 Budget
The staff continues to work on the FY 05-06 budget using the existing tax rate.
The following provides you with some basic information on the current state of the
budget, and incorporates changes discussed at the April 14 work session. Changes are
indicated in red.
REVENUE
Ad Valorem Tax
The tax base growth between FY 04-05 and FY 05-06 is expected to be 3.7 percent.
The ad valorem tax base is estimated to be $18.5 billion. Based on this estimate, each
penny of the tax rate will be worth $1.8 million.
Transfer in from Caoital Proiects
An amount of $4.8 million is recommended to be transferred in from capital projects and
will be used to fund a portion of the FY 05-06 debt service.
Sales Tax
As stated in the memo of November 15, 2004. sales tax, especially Article 39, is
expected to exceed the amount budgeted in FY 04-05. Article 39 sales tax is allocated
based on the point of origin.
. Article 39
At this time we are projecting a $2.9 million increase over FY 03-04 actual
receipts in the locally generated one-cent sales tax.
. Article 40 and 42
We are projecting 3 percent growth in the one-half cent sales taxes from FY 04-05
adopted.
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County Commissioners
Update on FY 05-06 Budget
April 28, 2005
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. Article 44
We are projecting a 3 percent growth from the FY 04-05 estimated amount, (this
sales tax was implemented in July 2003).
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We will continue to monitor sales tax projections in FY 04-05 and refine the estimate for
FY 05-06.
Municioal Tax Collection Fees
The proposed rate charged to collect municipal taxes has been decreased from 2 percent
to 1 75 percent. This reduces the projected revenue the County will receive for providing
this service by $105,000
Fund Balance
It is recommended that a fund balance of $5.1 million be appropriated to balance the FY
05-06 budget. Of this amount, the Commissioners approved $2.1 million for school
improvements. The aoorooriation of fund balance at this level will not ieooardize the
stronq financial oosition of the Countv. Unreserved/undesignated fund balance grew by
$4 4 million between FY 03-04 and FY 04-05.
Preliminary projections for FY 04-05 indicate a reduction in fund balance of $2 million.
The County will continue to maintain a strong fund balance as well as its strong bond
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EXPENDITURES
New Hanover Countv Schools
The preliminary amount recommended for the Schools in FY 05-06 is an increase of
$2.6 million in operating and $1 million in capital outlay for a total increase of $3.6
million.
Fund balance of $800,000 is recommended for appropriation in Fund 125 in FY 05-06.
The Board of Education requested an increase of $5.6 million or 11.2 percent in
operating expenses. A $7.2 million request was made for funding the Schools' capital
outlay for FY 05-06. This is an increase of $4.2 million over the FY 04-05 adopted
amount for capital.
Caoe Fear Communitv Colleqe
Funding of $5.7 million is recommended for Cape Fear Community College. This is an
increase of $940,000.
The amount recommended for education (including the $2.1 million transfer for school
improvements) is 33 percent of General Fund expenditures.
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County Commissioners
Update on FY 05-06 Budget
April 28, 2005
Deoartment of Social Services
An increase of $1.6 million in County funds is recommended for the Department of
Social Services due to projected increases in Medicaid and adoption assistance
subsidy.
The County cost of Medicaid is projected to increase $1.1 million or 14.1 percent from
FY 04-05. Based on expenditures-to-date in FY 04-05, we are recommending slightly
less than the state estimate.
Southeastern Center for Mental Health
Funding of $1.6 million remains constant for Southeastern Center for Mental Health,
Developmental Disabilities and Substance Abuse Services.
Sheriff's Office
An increase of $3.4 million in County funding is recommended for the Sheriff's Office.
The increase includes the full-year funding of 37 positions added for the Detention Center
in FY 04-05 - $1.6 million, 16 positions added for the Detention Center in FY 05-06 -
$600,000, and funding for the Gang Task Force, which includes two positions - $91,319.
Also included are increases in health insurance and merit and market adjustments.
Public Safety Communications Center
An amount of $1.3 million is included for improyements to the Public Safety
Communications Center as part of the move to their new location. Wireline and
Wireless funds will be used to offset eligible costs.
Board of Elections
There is an increase in Elections budget of $248,209 because of the potential for five
elections being held in FY 05-06. Reyenue will offset the cost if the municipal elections
are held without County elections.
The North Carolina General Assembly is still considering what type of voting equipment
will be allowable in the future. According to the State Board of Elections, there may be
some state funding available to help with the purchase of equipment. Adjustments may
need to be made in the County Board of Elections budget during FY 05-06 when more
information is available.
Information Technoloqy
A PC replacement program is recommended. This will proYide for a more standardized
PC program and will aid in installation, maintenance and repair. Computers will be
replaced on a three to four year cycle. The program will also reduce the per-unit cost
through yolume discounts. The goal of this program is to replace all obsolete PC
equipment.
County Commissioners
Update on FY 05-06 Budget
April 28, 2005
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Funds in the amount of $110,000 are included to begin the replacement of the County
telephone system. The total cost of the new system is estimated to be $1 million. The
savings realized on recurring costs of operating a new integrated system would repay
the cost of implementation within five years. The system will provide for uniformity in
County telephones and allow for such advanced features as unified messaging and
automated call distribution; features that are currently unavailable or only available to a
select few departments. The purchase will coincide with the move of the remaining
employees from the County Administration Building. The County has been notified that
timely repair will no longer be guaranteed on some of its older phone systems.
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All departmental phone costs are included in the Information Technology budget in
FY 05-06 for more efficient bill processing.
Juvenile Dav Treatment Center
County funding in the Juvenile Day Treatment Center will increase $173,000; this is a
result of state funding being phased out. Three positions are being eliminated, but
funding cannot be reduced further if the Center is to operate in a safe and efficient
manner.
WAVE
Funding in the amount of $149,964 for the contribution for WAVE transportation has
been moved to the Non-Departmental section of the budget. .
Parks
Funds are included for a walking trail at Hugh MacRae Park: - $150,000 Park's capital
expenditures will be eligible for matching funds at a 50 percent retum.
Included in an administrative reserve account in the Non-Departmental division of the
budget is $500,000 to begin implementation of the Park's Master Plan (following the
adoption of the Master Plan).
Museum
Funds of $150,000 are included to implement part of the Museum's Master Plan. This
will include moving the gift shop and creating a new entrance to first floor exhibits.
Propertv Manaaement
Funds are included to replace windows and the HVAC system at the Historic
Courthouse and automate several HVAC systems. Funds are also included for a
generator at the Judicial Annex to keep lift pumps and security cameras activated
during power outages. Also included are funds to expand the parking lot at the
Northeast Branch Library.
Tax
Funds are included to begin the revaluation process.
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County Commissioners
Update on FY 05-06 Budget
April 28, 2005
Fire Services
The Fire Service District budget is balanced with the current tax rate. The ad valorem
tax base in the Fire Service District is estimated to be $7 billion. Based on this
estimate, each penny of the tax rate will be worth $684,000.
Environmental Manaaement
The Environmental Management Fund is balanced with the current tipping fee. Partial
funding for construction of Cell 6C was approved in FY 04-05, with the remainder of
$600,000 being recommended for FY 05-06.
Water and Sewer District
The Water and Sewer District is balanced by budgeting approximately $1 million of
Water and Sewer fund balance.
Non-Countv Aaencies
Funding at the FY 04-05 adopted amounts, with a few changes, will be included for
Non-County agencies. Funding applications for FY 05-06 were not sent to Non-County
agencies (nor in FY 04-05), as funding is limited.
Funds currently budgeted and undistributed in FY 04-05 for General Electric and
Verizon will be carried over to FY 05-06. No additional funds for these companies were
budgeted in FY 05-06.
An increase of $14,500 is recommended for The New Hanover Soil and Water
Conservation District to fund a portion of a position that was previously federally funded.
A $5,000 increase is recommended for The Carousel Center.
Coastal Horizons has requested an additional $98,067 for FY 05-06, the FY 04-05
amount of $44,133 is recommended. In addition to funding, DSS and Southeastem
Center also contract with Coastal Horizons for services and the County provides
meeting space for the agency Southeastern Center contracts with Coastal Horizons for
over $1 million in services and DSS contracts for $100,000 on an annual basis.
Capital Improvement Proaram
Capital requests for FY 05-06 were all valuable projects, though no funding is
recommended because of budgetary constraints.
Emplovees
There is a significant increase projected in the cost of health insurance for County
employees; negotiations are ongoing concerning the contract for health insurance.
There is a slight increase in dental insurance, which will be absorbed in the existing
budget. An amount of $165,000 is included for a wellness program for County
employees, the program is recommended to help reduce the cost of medical insurance.
County Commissioners
Update on FY 05-06 Budget
April 28, 2005
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There is funding included for a 2 percent market increase and 2 percent merit increase
for deserving employees.
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There are 42 new positions recommended for FY 05-06. Of these positions 38 are
recommended in the General Fund.
The General Fund positions are as follows:
. One additional Administrative Support Assistant is recommended to support the
efficient operation of the Engineering department.
. One additional Fiscal Support Technician is recommended in the Legal
Department to improve the collection efforts of the County No County funds are
required for this position; the additional revenue collected will offset the cost.
. Two positions are recommended for the Library to provide automation support.
. Eight additional positions are recommended for Inspections due to increased
building activity in the County; these positions will be funded by revenue from
inspection fees.
. Sixteen additional positions are recommended for the Detention Center to
support efficient operations.
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. Two positions are recommended for the Gang Task Force - there is an offset of
$52,000 in funding from the Schools for these positions.
. Three additional Economic Case Workers are recommended in DSS to assist
with the increasing case load of the department. These positions will receive 50
percent of their funding from federal funds.
. One additional Pretrial Release Coordinator is recommended to help reduce the
inmate population at the new Detention Center.
. One additional Custodian is recommended for Property Management to assist
with maintenance of County facilities.
. One Telecommunicator for Public Safety Communication is recommended to
meet critical service needs.
. Two Parks positions are recommended to keep the increasing acreage in the
County park system up to standards and support efficient operations of the Parks
Department.
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County Commissioners
Update on FY 05-06 Budget
April 28, 2005
The Water and Sewer Fund positions are as follows:
. Three positions are recommended in the Water and Sewer District to meet
critical service needs. Five Fiscal Support positions were approved by the
Commissioners April 18, 2005, and are included.
The Fire Services District Fund positions are as follows:
. One Administrative Support Specialist is recommended in Fire Services to assist
with the efficient operation of the department.
The staff looks forward to working with you during the remainder of the budget process.
Please let us know if there is specific information that would assist in your budget
deliberations.
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e
e
CONFIDENTIAL
RAGSDALE I LIGGETT
PROFESSIONAL LIMITED LIABILITY COMPANY
LAWYE RS
POST OFFICE 80X 31507
RALEIGH, NC 27622.1507
CROSSPOINTE PLA2A
2840 PLA2A PLACE, SUITE 400
RALEIGH, NORTH CAROLINA 27612
TELEPHONE. (919) 787-5200
FACSIMILE: (919) 783-8991
H \:\.' \H HISSI:.TTE
DIRECT DIAL (919) 881-2221
[-\hIL: hbi"~-laW"Om
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April 22, 2005
c;[tf1
(Lt
Mr David Rice
Ncw Hanover County Health Department
2U29 Soutb 17tb Street
'W ilmll1gton. NC 28401
Re: Status of case
Dear Mr Rice:
I hope tillS letter finds you well. Thank you for meeting With me last week to review our
responses to Plaintiffs first set of interrogatories and production of documents.
The case IS progressmg nicely although we are siill in the beginning stages. We have closed the
plcadlllgs. mealllng that we have filed the answers to our clients, includmg the new complaIllt
n<llllll1g Gaysheron Bell. We will be sending our discovery responses to Plaintiffs counsel this
II eek and are cUlTemly reViewing Plaintiffs responses to our discovery We have attended the
depositions of Susan Barfield and Gaysheron Bell, as well as those of Deputy Hudson and
Deputy Goebel. The remaining depositions of law enforcement personnel will be conducted next
week. which I will be attending. As we discussed, both Susan and Gaysheron did very well and
we believe they will prove to be excellent witnesses.
'We have begun our search for a neurosurgeon and a neuro-pathologist who can testify to the
InJunes sustained by the decedent. We are also seeking an expert to testify to nursing standards
ot care. We wlil be III contact with you throughout this process.
Should you have any questions or concerns, please contact me or Gregory Brown at any time.
We remain confident III our case and are optimistic about the outcome. I look forward to
contllluing to work with you towards a positive resolution.
Sincerely,
.1.
RAGSDALEUGGETT PLLC
i'cL~~ .A..-. ~
'HaIinah' Bissette
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