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08/03/2005
NEW HANOVER COUNTY HEALTH DEPARTMENT REVENUE & EXPENDITURE SUMMARY FOR JUNE 2005 CUMULATIVE: 100% MONTH 12 OF 12 REVENUES: Current Year Prior Year Type of Budgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remaining Federal & State $ 1,968,297 $ 1,745,323 $ 222,974 88.67% $ 2,025,590 $ 1,677,363 $ 348,227 82.81% 21 $ (87,660) 115.02% AC Fees $ 580,161 $ 690,271 $ (110,110) 44 Medicaid $ 1,138,039 $ 764,870 $ 373,169 37 $ 250,343 76.02% Medicaid Max $ 344,007 $ 344,007 - 17 $ (64,384) 123.56% EH Fees $ 300,212 $ 305,582 $ (5,370) 78 $ 21,534 92.83% Health Fees $ 113,545 $ 181,451 $ (67,906) 72 $ (45,722) 135.87% Other $ 3,125,654 $ 2,706,113 $ 419,541 96 $ (48,291) 102.02% Totals $ 7,569,915 $ 6,737,617 $ 832,298 84 $ 374047 EXPENDITURES: Type of Budgeted Expended Balance % Budgeted Expended Balance % Expenditure Amount Amount Remalnln Amount Amount Remaining Salary &Fringe $10,301,405 $ 9,621,296 $ 680,109 93.40% $10,016,261 $ 8,994,518 $ 1,021,743 89.80% Operating $ 2,257,314 $ 1,765,581 $ 491,733 78.22% $ 1,853,204 $ 1,521,259 $ 331,945 82.09% Capital Outlay $ 594,572 $ 69,896 $ 524,676 11.76% $ 351,870 $ 240,933 $ 110,937 68.47% Totals $ 13,153,291 $ 11,456,773 $ 1,696,518 87.10% $ 12,221,335 $10,756,710 $ 1,464,625 88.02% SUMMARY: Budgeted ACTUAL % FY 04-05 FY 04-05 Expenditures: Salary & Fringe $ 10,301,405 $ 9,621,296 Operating $ 2,257,314 $ 1,765,581 Capital Outlay $ 594,572 $ 69,896 Total Expenditures: $ 13,153,291 $ 11,456,773 87.10% Revenue: $7,569,915 $6,737,617 89.01% NET COUNTY: $5,583,376 $4,719,156 84.52% • Revenue and Expenditure Summary 8 For Month of June 2005 NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-05 Date BOH Grant Requested Pending Received Denied 7/6/2005 No activity for Jul 2005. NC Dept of Insurance- Office of State Fire 6/1/2005 Marshall- Risk Watch Continuation Grant $ 25,000 $ 25,000 HUD (partnership with City of Wilmington) Lead Outreach and Education Program (3 ,year funding) $ 275,000 $275,000 Ministering Circle- Good Shepherd Ministries Clinic supply & Equipment $ 15,000 $ 15,000 $ No acUvi for May 2005. Cape Fear Memorial Foundation- Living 4/612005 Well Program $ 20,000 $ 2-0,0-0-0- $ National Safe Kids Coalition- Mobile Van for 3/2/2005 Car Seat Checks $ 49,500 $ 49,500 $ Smart Start- Child Care Nursing Program $ 239,000 $ 170,000 $ 69,000 Smart Start- Health Check Coordination Program $ 43,800 $ 43,800 Smart Start. Navigator Program $ 155,000 $ 44,000 $111,000 2/212005 No activity for February 2005. Champion McDowell Davis Charitab e 1/5/2005 Foundation - Good Shepherd Clinic $ 56,400 $ 56,400 12/112004 No activity for December 2004. March of Dimes- Maternity Care Coordination • Program educational supplies and incentives 11/7/2004 for pregnant women. $ 3,000 $ 3,000 $ 10/6/2004 No activity to report for October 2004. 9/1/2004 No activity to report for September 2004. Office o the State Fire Marshal- NC Department of Insurance- Risk Watch 8/4/2004 continuation funding 3 ears $ 25,000 $ 25,000 NC Physical Activity and Nutrition Branch- Eat Smart Move More North Carolina $ 20,000 $ 20,000 March o Dimes Community rant Program- Smoking Cessation- Program did 7/7/2004 not apply for rant. $ 50,000 $ - $ - $ Wolfe-NCPHA Prenatal Grant- Diabetic Supplies for Prenatal Patients $ 5,000 $ 5,000 Totals $981,700 $300,000 $426,700 $206,000 30.56% 43.47% 20.88% Pending Grants 2 15% Funded Total Request 7 54% Partial) Funded 2 15% Denied Total Request 2 15% Numbers of Grants Applied For 13 100% 9 As of 7116/2005 NOTE: Notification received since last report. NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: July 11, Agenda: ® 2005 Department: Health Department Presenter: Cindy Hewett, Business Manager Contact: Kim Roane, 343-6522 Subject: Budget Ammendment in the amount of $15,932 for Medicaid Maximization Cost Settlement Funds Brief Summary: The New Hanover County Health Department has received notification from the Division of Public Health that an additional $15,932 in Medicaid Cost Settlement funds has been awarded to be used to support programs in the department which earn Medicaid revenues (spending plan to be developed at at later date). This amount is in addition to previous cost settlement monies already received. • Recommended Motion and Requested Actions: To accept and approve the $15,932 additional State funds to be used to support the New Hanover County Health Department programs which earn Medicaid revenues, and the associated budget ammendment. Funding Source: State Department of Health and Human Services, Division of Medicaid Assistance Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Explanation: No Count match is required for receipt of these funds. Attachments: Budget Ammendment and supporting documentation. • 10 Cf) o~ Z Q ¢ r o } 00 2z0 m«« c ~MC uci c } O , } O O U m aHH o Z L) U co0m p >00 l~um¢ W Z Z U) N z 0. 0) LLI 00 0 m UmQ Jm { Q f9 LU W = z C 0 2 ~ .~0 ¢ Z 9 C W Q O r a F C7 ~H~ m 0 m z o ~ LL O m z C > z w ru Z6 m co 4 w o z LL S rz o x m ma x x 8 a LLI Z, a ~ 'o U w w co ~ c z m mMm to m m U r= O zzz~ z Q z CD a Q N c m> Q ~ O qnv 2Q LL o y o Q'TaQ Z Z ZF= M yQc 0~ O png c aZ ¢w z E roE z0 0 -1 z c~ e H g~ a x d U X O 11 F- w M ?ON Lei C 03g r \ n A, ui + c + m«« w 00O Cc E d w ria z m (0 Li Z) y >oo 9 2 o $ ~ co U zHF ww U It00 z w d Um¢ jr Co N w Z ~ T Z m F W w z 40 x m Q U O w v Q < ~FF m z° co a LULL o V W • w d LLI a o ~ x N W m 2 cd ~ W 06 0 a m L z w z o o o m Qua ° x w cm 2$ a c Q O w~ S U m U o > !0 U~ a o r "o g z N M odo m a) E m xS,m o Z r0. ZZZm Z:°. ~ za- ¢ a 5 aa > > ~i t °m>F?~ a0 W O l a a m q ~ Z 0 C-4 «cYQ00ODQ E i 8 p w 0 CL 8 < x Uxao 12 nl$nTr aX O/1V/LVVO 0:6.Y rHVr. t/1 na gas u'o.n TO: 47001631 NEW HANOVER 2029 S 17TH ST WILMINGTON no 25401 Direct deposit notification 14 Within three businass days, panding agency funding approval, your bank account will receive a dliroot deposit o 15,932.42 for payment number 25FT0001010637 These funds were paid by the following agency: DHSS CONTROLLERS OPTICS (25PT) AP - DMA 2019 MAIL SERVICE CENTER RALEIGH, NO 27699-2019 AGENCY CONTACT PHONE: 919-715-8985 Please direct all questions ragardln4g this payment/deposit to the agency contact phone number listed diractiy above. This Agency maintains information regarding your payment records. Any questions concerning payment amount and invoice information/documentation should be directed to the agency's Accounts Payable office and they will be happy to assist you with your inquiries. PLEASE DO NOT REPLY TO THIS EMAIL. CONTACT THE PAYING AGENCY AT THE NUMBER LISTED ABOVE. - Your Invoice No Type Inv Date Invoice Amount Discount Taken Net Amount HLTH DEPT SETT05 06/09/05 $15,932.42 $0.00 $15,932.42 HEALTH DEPT COST SETTLEMENT 2005 TOTAL: $15,932.42 This notification was sent from the North Carolina office of the state controller. ~f this notification has boon received in error, please contact the agency Ssted above to make corrections. 13 • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 06/28/05 Agenda: Depart ment: Health Presenter: Cindy Hewett, Business M Contact: Cindy Hewett, Business Manager, ext 6680 Subject: Changes in the New Hanover Count Health Department Fee Policy Brief Summary: The New Hanover County Health Department is proposing to.change its current Fee Policy, so that Medicaid may be billed for the Menactra (meningococcal) vaccine (private stock vaccine). Currently, our fee policy states: (Section I, General Guidelines, Item J) Payment in full is required at the time of service for vaccines not supplied by the State, with the exception of flu and pneumonia vaccines provided to Medicaid and Medicare Part B recipients. Insurance companies will not be billed for these vaccines except for Blue Cross Blue Shield due to Cost Wise reimbursement (Cost Wise requires us to bill for vaccines). Patients will be provided a receipt for billing their insurance company. Proposed Change: Payment in full is required at the time of service for vaccines not • supplied by the State, with the exception of flu and pneumonia vaccines provided to Medicaid and Medicare Part B recipients, as well as, Menactra vaccine provided to Medicaid recipients. Insurance companies will not be billed for these vaccines except for Blue Cross Blue Shield due to Cost Wise reimbursement (Cost Wise requires us to bill for vaccines). Patients will be provided a receipt for billing their insurance company. Recommended Motion and Requested Actions: To accept and approve changes to the New Hanover County Health Department Fee Policy as resented. Funding Source: Medicaid Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ZNo Change in Position(s) Explanation: The New Hanover County Health Department is requesting to adjust its current Fee Policy resulting from the Menactra vaccine now being available for adolescents and adults 11-55 years of age. Many of the children who are now eligible to receive the Menactra vaccine are Medicaid recipients and would, otherwise, not be able to pay for the vaccine (Menactra fee is $92.00, of which, Medicaid will currently reimburse $62.11). • Attachments: None 14 } • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 06/28/05 Agenda: Department: Health Presenter: Cindy Hewett, Business Manager Contact: Cind Hewett, Business Mana er, ext 6680 Subject: Changes in the New Hanover County Fee Policy- Fee Changes Brief Summary: The New Hanover County Health Department is proposing to change its current Fee Policy to accomodate recent changes in Medicaid Reimbursement rates, as well as to implement a change in processing Laboratory procedures. Recommended Motion and Requested Actions: To accept and approve changes in the New Hanover County Health Department Fee Policy as resented. Funding Source: Medicaid, Private Pa Patients, Sliding Fee Scale • Will above action result in: New Position Number of Position(s) Position(s) Modification or change ®No Change in Position(s) Explanation: Please see attachment for specifics. The New Hanover County Health Department is requesting approval to change its fee policy based on recent changes in Medicaid Reimbursement rates for services provided within our Clinic and Home Visiting Programs. Additionally, approval is requested for changes occurring in our Laboratory processing procedures. Previously, several laboratory procedures were processed internally, but with the need to replace expensive, costly equipment, it was determined that it will be more cost effective to send these procedures to a reference lab for processing Attachments: Fee Polic Revisions • 15 NEW HANOVER COUNTY HEALTH DEPARTMENT • 2029 SOUTH 17' STREET b' WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500 FAX (910) 341-4146 HEWN MOVER COUNTY NEMC°' N Jun 28, 2005 To: New Hanover County Board of Health From: Cynthia W. Hewett, MSIS Business Manager Subject: Changes in the New Hanover County Health Department Fee Policy 1. We are requesting approval for the following changes in CPT codes and fees. Change CPT Code Current Proposed Justification Needed Fee Fee • Add Code 90471 EP $20.00 $27.42 Add CPT Code and Fee for Immunization and Fee Administration Single Dose Increase Fee 99201 $60.00 $63.00 Increase in TXIX Reimbursement for New Patient Level I- Minimal Visit Increase Fee 99202 $90.00 $94.00 Increase in TXIX Reimbursement for New Patient Level II- Problem Focus Visit Increase Fee 99203 $128.00 $133.00 Increase in TXIX Reimbursement for New Patient Level III- Expanded Visit Increase Fee 99204 $188.00 $195.00 Increase in TXIX Reimbursement New Patient Level IV- Detailed Visit Increase Fee 99205 $236.00 $245.00 Increase in TXIX Reimbursement for New Patient Level V- Comprehensive Visit Increase Fee 99211 $33.00 $35.00 Increase in TXIX Reimbursement for Established Patient Level I- Minimal Visit Increase Fee 99212 $55.00 $57.00 Increase in TXIX Reimbursement for Established Patient Level II- Problem Focus Visit Increase Fee 99213 $76.00 $79.00 Increase in TXIX Reimbursement for Established Patient Level III- Expanded Visit Increase Fee 99214 $118.00 $123.00 Increase in TXIX Reimbursement Established Patient Level IV- Detailed Visit • Increase Fee 99215 $176.00 $183.00 Increase in TXIX Reimbursement for Established Patient Level V- Comprehensive Visit As of 06/28/05 16 Change CPT Code Current Proposed Justification Needed Fee Fee Add Code 90465 EP n/a $27.42 Add CPT Code and Fee for Immunization and Fee Administration Fee for Children under 8 years of age Increase Fee T1016 $21.00 $21.74 I Increase in TXIX Reimbursement for CSC Services Delete Code 87081 $20.00 $0 Procedure code will no longer be used. and Fee Procedure will be captured using CPT Code 87070 (Culture) with a fee of $34.00 (this is current] in our fee policy). The following are laboratory procedures that previously have been processed in house. It has been determined that it is more cost effective to send these procedures to a Reference Laboratory for processing. When sending laboratory procedures to a reference laboratory for processing, a modifier of 1190" must accompany the CPT Code. We are estimating that with proposed changes in laboratory services the agency will not experience any changes in revenue. Change CPT Code Current Proposed Justification Needed Fee Fee Add 80061 90 $0 $0 Lipid Panel. Previously a no charge service. Modifier This will now be sent to reference lab for processing. Add 82247 90 $15.00 $0 Bilirubin, Total. This will now be sent to Modifier & reference lab for processing Delete Fee Add 82465 90 $15.00 $0 Assay Serum Cholesterol. This will now be Modifier & sent to reference lab for processing Delete Fee Add 82947 90 $15.00 $0 Glucose, quantitative. This will now be sent Modifier & to reference lab for processing Delete Fee Add 82565 90 $15.00 $0 Assay Creatinine. This will now be sent to Modifier & reference lab for processing Delete Fee Add 83615 90 $15.00 $0 Lactate (LDH) enzyme. This will now be Modifier & sent to reference lab for processing Delete Fee Add 83718 90 $15.00 $0 Lipoprotein (HDL). This will now be sent to Modifier & reference lab for processing Delete Fee Add 84075 90 $15.00 $0 Assay Alkaline phosphate. This will now be Modifier & sent to reference lab for processing Delete Fee As of 0628/05 17 • • Change CPT Code Current Proposed Justification Needed Fee Fee Add 84450 90 $15.00 $0 SGOT/AST. This will now be sent to Modifier & reference lab for processing Delete Fee Add 8446090 $15.00 $0 SGPT ALT. This will now be sent to Modifier & reference lab for processing Delete Fee Add Code 84478 90 N/A $0 Triglycerides. This will be sent to reference lab for processing. Add Code 80053 90 N/A $0 Comprehensive Metabolic Panel. This will be sent to reference lab for processing. Add Code 80051 90 N/A $0 Electrolite Panel. This will be sent to reference lab for processing. • • As of 06/28/05 18 I y • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: 1 Consent Meeting Date: 08/15/05 Agenda: [D I Department: Health Presenter: Cindy Hewett, Business Manager Contact: Cindy Hewett, Business Manager, ext 6680 Subject: Document Archiving Policy for NHC Health Department Brief Summary: The New Hanover County Health Department is requesting approval to adopt the Document Archiving and Destruction of Original Records Duplicated by Electronic Means Policy. Recommended Motion and Requested Actions: To accept and approve the Document Archiving and Destruction of Original Records Duplicated by Electronic Means as presented. Funding Source: none • Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ZNo Change in Position(s) Explanation: The New Hanover County Health Department is seeking approval to adopt the Document Archiving and Destruction of Original Records Duplicated by Electronic Means Policy as it is outlined in the following attachment. The purpose of this policy is to establish guidelines for document archiving and for destroying original records that are duplicated electronically through imaging. This policy reflects guidelines set forth in the North Carolina Department of Cultural Resources publications, (1) North Carolina Guidelines for Managing Public Records Produced by Information Technology Systems and (2) Records Retention and Disposition Schedule, (a) County/District Health De artments and b County Sheriff's Office. Attachments: Document Archiving and Destruction of Original Records Duplicated by Electronic Means Policy. • 19 MIAI NEW HANOVER COUNTY HEALTH DEPARTMENT Policies and Procedures 0 NEW N/XOVER COUNTY XE.VX~ Subject: Document Archiving and Destruction of Original Records Duplicated by Electronic Means Date of Origin: 7/26/05 (Draft) Date Revised: Policy Number: GS-ADM-055 PURPOSE AND SCOPE: The purpose of this policy is to establish guidelines for document archiving and for destroying original records that are duplicated electronically through imaging. This policy reflects guidelines set forth in the North Carolina Department of Cultural Resources publications, (1) North Carolina Guidelines for Managing Public Records Produced by Information Technology Systems and (2) Records Retention and . Disposition Schedule, (a) County/District Health Departments and (b) County Sheriffs Office. Established guidelines for reproduced records will likewise enhance their admissibility and acceptance by the judicial system as being trustworthy. Records are considered to be the property of the New Hanover County Health Department and maintained for the benefit of agency use in delivering services and in documenting agency operations. Privileged or confidential information will also be protected by this • policy. HIPAA privacy and security rules and regulations will be followed. CHANGE SUMMARY: None. Original Document. POLICY and PROCEDURE: As defined in the North Carolina Department of Cultural Resources publications, Records Retention and Disposition Schedule, (a) County/District Health Departments and (b) County Sheriffs Office the following groups of records may be imaged and stored on optical disk, read only memory or on any other form of permanent, computer readable media, so long as the medium is not subject to erasure or alteration: (1) Administration and Management Records; (2) Budget and Fiscal Records; (3) Legal Records; (4) Office Administration Records; (5) Patient Clinical Records; (6) Personnel Records; (7) Program Operational Records (to include inmate medical records as specified in the publication for County Sheriffs Office); and (8) Public Relations Records. Destruction of the original paper record (and copies thereof) will be processed following imaging and quality control assurance. Paper records identified as permanent records by the North Carolina Department of Cultural Resources and published in the Records Retention and Disposition Schedule, County/District Health Departments will not be purged unless a microfilm preservation duplicate is created prior to the destruction of such records. New Hanover County Health Department staff will prepare the original paper record (and copies thereof) for burning. Documents will be boxed for burning, with boxes clearly labeled and properly secured. Boxes, identified for burning, will be transported to the county . incinerator by New Hanover County Property Management staff. Optical disks containing imaged records will be maintained for the specified retention periods as defined in the North Carolina Department of Cultural Resources publication, Records Retention and Disposition Schedule, County /District Health Departments. Security back-ups of all imaged documents will be generated nightly and maintained off-site with the New Hanover County Information Technology Department. An index of all records imaged will be kept in electronic format along with a listing of purge 20 "Healthy People, Healthy Environment, Healthy Community" dates. All records stored on optical disk will be considered the official agency record. Any hard copy • generated from the optical disk will be considered the agency's duplicate working copy. New Hanover County Health Department staff will be trained in the correct procedures required for imaging, viewing, and reproducing records. Documentation for all imaging activities will be maintained through audit trails built into the imaging system to protect the New Hanover County Health Department from potential fraud or any other unauthorized acts as well as for maintaining record authenticity. Imaged records will be audited periodically (by the agency's Quality Assurance Committee) for accuracy, readability, and reproduction capabilities. An audit report will be prepared indicating the sampling of records produced, along with any procedures that will be followed if the expected level of accuracy was not identified. Detailed procedures will be maintained by the agency that will describe the process followed to produce and reproduce an automated record. This documentation will be updated as needed and will include a description of the system hardware and software. A current procedural manual will be maintained to ensure the most current processes are followed. Documentation will also be maintained for the distribution of written procedures, attendance of staff at training sessions, dates of these occurrences as well as other relevant information. User and operational documentation describing how the system operates from a functional user and data processing perspective, including records documenting data entry, manipulation, output and retrieval and records concerning the development and / or modification of data will be maintained for three (3) years after discontinuance of the system and after all data (records) created by the system has been destroyed or transferred to a new operating environment. Such documentation is needed in order to ensure the accessibility of imaged records and have value as long as the electronic records (data) are retained. OTHER INFORMATION: • A detailed listing of the specific types of records, identified in the following categories: (1) Administration and Management Records; (2) Budget and Fiscal Records; (3) Legal Records; (4) Office Administration Records; (5) Patient Clinical Records; (6) Personnel Records; (7) Program Operational Records; and (8) Public Relations Records are available in the North Carolina Department of Cultural Resources publications, Records Retention and Disposition Schedule, (a) County /District Health Departments and (b) County Sheriff's Office. REFERENCES: http://www.ah.dcr.state.nc.us CHANGE HISTORY: version Date Comments A 7/26/05 Original Document • 21 GS-ADM-055 NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 8/15/05 Agenda: Depart ment: Health Presenter: David Rice or designee Contact: Janet McCumbee Subject: Wolfe-North Carolina Public Health Association (NCPHA) Prenatal Grant -Application- FY(s) 05-07 Brief Summary: Need approval to submit a Prenatal Grant to NCPHA (Ann Wolfe Endowment) for $5,000 to provide assistance to diabetic prenatal patients. This money will be used to pay for diabetic supplies for prenatal patients with no source of payment for those supplies. These patients are identified by our Maternity Care Coordinators. Recommended Motion and Requested Actions: To approve the Prenatal Grant application to NCPHA for $5,000; to accept the funds if awarded and approve any associated budget amendment for FY 05-06 and 06-07 ( grant period is 11/01/05 - • 05/01/07. Funding Source: Ann Wolfe Endowment with NCPHA Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Ex lanation: Funds all for payment of diabetic care supplies Attachments: Grant Application Cover Sheet/Bud et Sheet • 22 I• 2005 Wolfe Mini Grant Application Grant Application Cover Sheet ate of application: July 19, 2005 Organization Information New Hanover County Health Department Name of organization 2029 S. ir. Street Wilmington, NC 28401 56-6000324 Address City, State, Zip Employer Identification Number (EIN) (910) 343-6500 (910) 343-4146 Phone Fax David Rice Health Director (910) 343-6591 drice@nhcgov.com Name of Director Title Phone E-mail Panza McNeill RN BSN (910) 343-6564 pmcneill@nhcgov.com Name of contact person regarding this application Title Phone E-mail Proposal Information • Give an abstract of the project and request. Many of the pregnant clients that are diagnosed with gestational diabetes are not eligible for Medicaid. While home blood glucose monitoring is essential for these women to continue with a healthy pregnancy, the enormity of the funds needed to purchase the needed supplies to check their blood sugars four times a day, coupled with their inability to comply with physician's orders is overwhelming. This, compounded by not only the negative physical effects on the health of the mother during the pregnancy, but also the associated sadness and guilt they bear in the knowing that they are harming their unborn child only complicates the picture. Being able to provide the needed supplies not only erases the barriers and guilt, but reduces both maternal and fetal complications both during and after pregnancy as well as lowers the rate of infant mortality. Data Statement - What is the Infant Mortality Rate for your county? Total 3.4 White 1.9 Non-White 8.3 Project dates: November 1, 2005 - May 1, 2007 Budget Dollar amount requested: $ 5,000.00 Authorization Name of Health Director: David Rice Signature 23 2005 Wolfe Mini Grant Application TARGET POPULATION , Identify who will benefit from the proposal. Indigent pregnant women who have been diagnosed with gestational diabetes who are uninsured and do not qualify for Medicaid for pregnant women. A large percentage of these women are of Hispanic, Indian, Native American, and Chinese origins. In addition, there are a smaller number of Caucasian and African American women who have some income and perhaps insurance, however, their insurance does not include prenatal care or cover these supplies, but their income prohibits them from receiving Medicaid. Hispanic women are medically under-served in general and have found to be at greater risk for developing gestational diabetes. These women reside in New Hanover, Brunswick, Pender, Columbus and Bladen counties. They have been referred by their physician to the'high risk' obstetrical clinic at Coastal OB/GYN located at New Hanover Regional Medical Center. This clinic is staffed by both health department and hospital personnel. PROBLEM STATEMENT Describe the need to be addressed. These medically under-served patients are unable to obtain the necessary diabetic supplies to check their blood sugars as ordered by the doctor. Without insurance or Medicaid, the woman faces the need to purchase her own supplies at an average cost of $400.00. If she does not have the resources for such a large expenditure she compounds the risks that uncontrolled gestational diabetes can have on both her and her unborn child both during and after the pregnancy. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset of first recognition during pregnancy. Approximately 4% of all pregnancies are complicated by GDM. However, the prevalence may range from 1 t0 14% of all pregnancies, depending on the populations studied. The presence of fasting hyperglycemia may be associated with an increase in the risk of intrauterine fetal death during the last 4-8 weeks of gestation. Furthermore, GDM increases the risk of fetal macrosomia and other neonatal morbidities including hypoglycemia. GDM is associated with an increase frequency of maternal hypertensive disorders and the need for cesarean delivery. The goal in the treatment of women with GDM is to decrease the risks to the fetus and this is best accomplished through careful monitoring and the use of insulin if indicated. This cannot be accomplished without the needed supplies and medications being made available to every woman who is in need of them. 24 2005 Wolfe Mini Grant Application GOAL & OBJECTIVES List the project goal and objectives. Have the objectives be realistic and measurable and timeframed. Example - 'By June 30, 2005, 50% of all women seen at the XYZ Health Department will receive their first prenatal visit in the first trimester." By September 1, 2006, 100 percent of all pregnant women found $o have gestational diabetes will be able to monitor their blood sugars and if needed, inject insulin to control their disease process and ensure a healthy pregnancy outcome. This would be measured by ascertaining the number of uninsured and non-medicaid eligible gestational diabetic women and providing them with the equipment and supplies they need throughout their pregnancy. • PLAN OF WORK Describe how the objectives will be met. List the responsible individuals. Define a project timeline. The public health department RN provides weekly new patient interviews which included a complete medical history. During this process, the RN explains the role of public health throughout their prenatal course at New Hanover Regional Medical Center. During the assessment, the RN identifies needs and risks and provides education and referrals as indicated. The medical staff also refers patients back to the RN as indicated following the initial physical exam and the monthly revisit process. The registered dietician is a public health department employee who provides routine and high risk nutritional counseling and follow-up as indicated through physician referral, public health staff referral and as noted through individual record reviews. Patients who are referred to the RN and/or dietician receive services within the clinic setting, by phone and by home visit as indicated. The RN and dietician work closely together to meet the needs of the patients. The hospital employs a bilingual staff person who speaks Spanish and is able to interpret for the Latina population who do not speak English. The qualifications of the RN and Dietician are as follows: The RN in the program is in her 13'x'. year of nursing with an Associate's Degree in Nursing from Robeson • Community College. Her experience includes working with DM in hospital (2 years), home health (4 years), and skilled facility (5 years) which afforded her the greatest opportunity to teach diabetic patients. She has also been certified in wound VAC and IV therapy. This afforded her the greatest opportunity to teach diabetic patients. 25 I 2005 Wolfe Mini Grant Application Plan of Work - Continuation The dietician has a Bachelor of Science in Home Economics and Nutrition from the University of North Carolina At Greensboro with a Master of Science in Public Health Nutrition from Case Western Reserve. She is a registered Dietician with the American Dietetic Association and a Licensed Dietician/Nutritionist with the North Carolina Board of Dietetics/Nutrition.. Since the process of interviewing and assessing patients is already occurring within the prenatal clinic setting, the timeline for this grant proposal will not include anew service. We will continue to provide the services outlined above, but will add the step of provision of supplies and enhanced education utilizing the new resources that will be available through the grant. We will begin offering the supplies immediately upon receipt of the funds. ICI EVALUATION Describe the process to evaluate how successful the project met its objectives. We expect the outcome of this proposal to be the reduction of barriers to care and services related to diabetic teaching and needed supplies for those who do not have the resources. The success of the proposal will be measured through the identification of women in need of diabetic supplies and education and the number of women who receive it. Positive changes will occur as women receive one-on-one education and teaching based on the disease process as well as specific instructions for self-monitoring and insulin injections. These patients will gain abetter understanding of their disease and implications for the pregnancy and will be better able to communicate with their physicians. Evaluation will be carried out by the public health staff (primarily RN and dietician) daily through an ongoing log which will document the patients who are identified and the supplies/services provided to each. Monitoring and evaluation will also be included through the use of a software program we are currently utilizing which graphs blood sugars throughout the use of the patient's home glucose monitor. This will enable us to graph the patient's progress for educational review and for control by the physician. 401 26 2005 Wolfe Mini Grant Application • PROJECT BUDGET EXPENSES Item Amount Syringes $ 500.00 Lancets $ 500.00 Blood glucose test strips $ 3,450.00 Ketostix $ 150.00 Insulin $ 400.00 $ $ $ $ $ $ $ $ $ $ • Total Requested $ 5,000.00 BUDGET NARRATIVE Include a budget narrative explaining your requests. 90 days of Diabetic Supplies for one patient. * Test strips for glucose monitor (8 bottles) $296.00 * Lancets (4 boxes) 500.00 * Urine Ketostix (4 bottles) 43.00 * Insulin (3 - 4 vials) 84.00 * Syringes ( 2 boxes) 32.00 TOTAL A (if insulin-dependent) $ 477.00 TOTAL B (if NOT insulin-dependent) $ 368.00 • 27 2005 Wolfe Mini Grant Application Dr. Ann F. Wolfe Endowment • 2005 Mini Grant Application Dear Local Health Department, We are pleased to introduce the inaugural Wolfe Mini Grants for Child Health and Infant Mortality. Two grants of $5,000 will be awarded. STRATEGIES FOR SUCCESSFUL REQUEST 1. Type the proposals. 2. Answer all the questions completely in the space provided. 3. Submit the original and 8 copies to Deborah Rowe at the address below. 4. Obtain proper signature on the proposal. 5. Submit your proposal by the deadline stated. CRITERIA • Must be a Local Health Department in North Carolina as the primary applicant. • Successful applicants must present a project report during the NCPHA Annual Educational Conference following completion of project. . • Project year begins November 1 and is for up to 18 months • Application is limited to the pages provided. Supporting documentation and letters of support are not necessary and additional materials will not be considered. • Grant funds cannot supplant local contributions. • The data statement on the cover page must be completed. • Type proposal using a minimum 10 font. • Do not extend proposal components beyond the space provided. DEADLINE Proposals are due on August 15. The proposals MUST be RECEIVED by that date. Proposals will be accepted by mail only. Proposals (original plus 8 copies) should be mailed to: Deborah Rowe NCPHA P.O. Box 41487 Raleigh, NC 27629-1487 • 28 r' • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 8/15/05 Agenda: Department: Health; Health Programs Presenter: Elisabeth Constandy, Erin Administration; Health Promotion Team Cummings Contact: Elisabeth Constandy 343-6658 (Health Education Supervisor) Erin Cummings 343-6548 Health Educator Subject: North Carolina Alliance for Health (NCAH) - Secondhand Smoke/ Local Control Initiative Brief Summary: The NCAH is applying for funding to the Robert Wood Johnson Foundation, and are looking for support from New Hanover County in this effort. NCAH is seeking funding to hire a full-time director, who would provide technical assistance and training to local health departments working toward establishing smoke free ordinances. and whe-are e s e woke. NHCHD would allocate $5000 CDC grant funded) Project ASSIST monies towar preemptiory irkpreve local se on n s eerdifle~eess Current state law prohibits local • boards (health or co is ' ners) from creating and enforcing stringent clean indoor air / smoke free olicies. Mal lic cannot supersede state policy. Recommended Motion and Requested Actions: BOH approval of our allocation of $5000 matching funds to the NCAH grant application to Robert Wood Johnson. BOH approval to challenge preemption clause at state level that prohibits local boards from establishing stringent clean indoor air laws to protect public health. Funding Source: NCAH is applying to Robert Wood Johnson Foundation Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Explanation: NHCHD Health Education Supervisor and NHCHD Health Educator will allocate time to this effort, which meets action plans goals for both Tobacco Prevention and Control and Statewide Health Promotion. Attachments: 1.) "Ina Nutshell": The Impact of Preemptive Legislation on Tobacco Control 2.) Current summary of NHC Smoking Pollution Control Ordinance (eff Oct 1990, supplanted • 1995, reinstated 1997 due to preemption). 3. Past summa eff 1995, rescinded 1997 29 IN A NUTSHELL... The Impact of Preemption Legislation on Tobacco Control AlWate Le islation Carolina's "Smoking in Public Places" legislation,' enacted April 15, 1993, allows a complete ban of smoking in some state-controlled buildings but requires the rest of state-controlled buildings to reserve at least 20% of the interior space for indoor smoking, unless physically impracticable.3 Preemption of Local Ordinances a Starting October 15, 1993, the legislation prohibited local governments from imposing smoking restrictions more stringent than the state's limited rules, even in non-state-controlled buildings, with a narrow list of exceptions.' O Prior to October 15, 1993, the legislation permitted local governments to enact restrictions that exceeded the smoking regulations in the state's Smoking in Public Places legislation, but such ordinances were still required to stay within certain pre-existing state law parameters. Exempted Buildings Certain buildings are not subject to the legislation at all: primary and secondary schools (except teachers' lounges), childcare centers (except teachers' lounges), public school buses, hospitals, nursing homes, local health departments, nonprofit agencies whose primary purpose is to discourage tobacco use, tobacco processing and administrative facilities. Exempted buildings do not have to reserve an indoor smoking area, and local governments are free to impose more stringent smoking restrictions than those provided in the state legislation. Window of Opportunity After the legislation was enacted, but before October 15, 1993, many North Carolina counties took advantage of a chance to enact smoking regulations that would otherwise have been preempted. Lawsuits In November 1993, several companies sued the local boards of health in four counties to contest the new local smoking ordinances that were passed before October 15, 1993. Guilford Co. b Under threat of suit, the local board of health withdrew its ordinance without contest. Buncombe Co. b The local board of health litigated and won its case at the local level. Wake Co. b The local board of health suspended enforcement of its ordinance. Halifax Co. b The local board of health lost its case and its ordinance was declared null and void. [The Halifax District Court held that the Halifax Board of Health had the right to pass only "health-related" rules, and that it had exceeded its authority by taking economic factors into consideration when it enacted the ordinances. After the Court's ruling, the Board of Health was unable to enact revised rules, because October 15, 1993 had already passed.] Impact The state's preemptive legislation and the threat of lawsuits against local health boards have become a barrier that impedes local health departments' efforts to enact or enforce smoking regulations in public places, such as bars and restaurants. Possible Response Strategies 1. Pursue new, more stringent smoking legislation at the state level to supersede the old legislation 2. Remove the preemption language in the existing legislation 3. Repeal the legislation or request a sunset provision 4. Expand the list of buildings that are exempt from the legislation 5. Reopen the "window of opportunity" 6. Expand the category of buildings in which reserving 20% of the interior space for an indoor smoking areas is "physically impracticable" N.C. Gen. Stat. § 143-595 at seq. (2003). 2 Public libraries, public museums, and educational facilities primarily involved in healthcare instruction may be 100% smoke-free. 3 Even when full compliance is physically impracticable, if part of the building is designated as non-smoking, the person in charge of the facility is required to provide "an adequate smoking area within the facility as near as feasible to 20% of the interior space." 4 Local governments may exceed state restrictions when regulating: buildings owned or leased or occupied by local government, public meeting places, auditoriums and arenas, and public transportation owned or leased by local government. 30 , 4.~ - SUMMARY OF NEW HANOVER COUNTY'S AND WILMINGTON'S SMOKING POLLUTION CONTROL ORDINANCE • Adopted: July 23, 1990 Effective: October 1, 1990 1. Smoking Prohibited in: a. Public areas of retail stores with 25 or more employees b. Service lines c. Elevators d. Public restrooms e. Polling places II. Restaurants Requires that 25% of indoor seating capacity be designated as non-smoking. III. B-201 All Bars must post a sign that says one of the following: a. "We DO NOT Provide a Non-Smoking Section in the Bar" b. "Nonsmoking Section Available in the Bar" • C. "No Smoking" IV. Places of Employment Employers must provide smoke-free work areas for non-smokers. However, employers are not required to incur expense to make structural or other physical modifications in providing these areas. V. Sale of Tobacco Products to Minors Prohibited Retail stores selling tobacco products must post sign which state, "Its The Law - We Do Not Sell Tobacco Products To Persons Under 18". VI. Posting of Signs Required "No Smoking" or other appropriate signs must be clearly and conspicuously displayed where smoking is regulated by this ordinance. *Supplanted by: New Hanover County Board of Health's Smoking Control Regulation (Adopted October 6, 1993; Effective January 1, 1995) • * Reinstated May 7, 1997 on recommendation of the New Hanover County Board of Health NHCHD - 05-29-97 31 SUMMARY OF NEW HANOVER COUNTY BOARD OF HEALTH'S SMOKING CONTROL REGULATION Effective January 1, 1995 (Including Amendment Effective April 5, 1995) 1. Smoking prohibited in: a. Public places 11. Places of Employment Any and all smoking areas in places of employment must be: a. Outside of the facility b. Serviced by a separate and adequate heating, ventilation and air-conditioning (HVAC) system • III. Restaurants a. Requires that 50% of indoor seating capacity be designated non-smoking by January 1, 1996. b. Requires that 100% of indoor seating capacity be designated as non-smoking by January 1, 2000. Note: An eating establishment may designate a smoking area provided a separate and adequate heating, ventilation and air- conditioning (HVAC) system provide a smoke-free environment for the non-smokers. IV. Bars All bars must post a sign that says one of the following: a. "We DO NOT Provide a Non-Smoking Section in the Bar." b. "Non-Smoking Section Available in the Bar." C. "No Smoking." V. Retail Tobacco Stores Smoking is permitted in retail tobacco stores. co ve-ol-) October 25, 1996 32 VI. Sale of Tobacco Products to Minors Prohibited Retail stores selling tobacco products must post a sign which states, "It's The Law - We Do Not Sell Tobacco Products to Persons Under 18." VII. Exclusions The following places shall not be subject to the Smoking Regulation: a. Bars b. Private Residences and Private Clubs C. State and Federal Facilities d. Retail Tobacco Stores e. Bingo Facilities VIII. Posting of Signs Required "No Smoking" or other appropriate signs must be clearly and conspicuously displayed where smoking is regulated. Robert S. (Bob) Parker, Health Director • New Hanover County Health Department 2029 S. 17th Street Wilmington, North Carolina 28401 Phone: (910) 343-6591 October 25, 1996 • 33 gharris@co.wake.nc.us To drice@nhcgov.com 07/16/200511:11 AM cc boc Subject NC Alliance for Health Grant Proposal History: q~ This message has been forwarded. Dave: I got your message. I am glad that you are willing to consider participating in this project. Attached is the info that you requested. I will be on vacation next week but will check in with you when I get back. If questions, you can call Annie Butzen at the NC American Cancer Society in Raleigh. i > Annie Butzen > (919) 834-8463 (Raleigh ACS office) > (336) 376-5506 (Home office) > (336) 512-1318 (Cell phone) > butzen@email.unc.edu (See attached file: RWJF05 v3 AYB.doc) (See attached file: RWJFOS-PledgeForm.doc) > (See attached file: RWJF05-RequestForFunds.doc) Gibbie Harris, MSPH, FNP Director, Community Health Wake County Human Services 919.250.4516 gharris@co.wake.nc.us "Never doubt that a small group of thoughtful citizens can change the world. Indeed, it's the only thing that ever has." Margaret Mead RWJF05 v3_AYB.doc RWJF05 PlWgeFormdoc RWJF05 ReamalForFundLdoc 34 • David E RicetNHC To donblake@aol.oom, eweaver@ec.rr.com, • 071182005 02:14 PM jstunstall@nkteng.cem, fresmanm@wrightcorp.com, iamsmil3s@bizec.rr.com cc gharris@comake.nc us, sharrelson@nhcgov.com, Elisabeth K ConstandyMHC@NHC, Pat MehdNNHC@NHC bcc Subject Fw: NC Alliance for Health Grant Proposal NHC Confidentiality Notice This email message contains confidential material. Please take the appropriate steps to ensure that the material in this email message remains confidential. NHCBH Executive Committee, Every once In a while, I receive a hot potato that is worthy of consideration. I have been contacted by Gibby Harris, Wake County Health Director and member of the NC Alliance for Health. They are pursuing a grant from the RWJ Foundation to address the issue of pre-emption as it relates to tobacco products. This grant will possibly include Mecklenburg, Wake, Buncombe, and New Hanover counties. I have copied the short-term goals of this proposal for your Information. Further information can be found in the attachments. Short-Term Goal One., Mobilize local communities to advocate for permissive legislation: • • 1. Develop coalitions actively working to restore local control in four regionally and demographically diverse counties. a. Educate the constituency, opinion leaders and decision-makers about SHS, preemption and local control through paid media b. Increase local business, especially restaurant, pressure to support smoke-free environments as a business interest c. Work with county attorneys to develop skills and experience in developing bullet-proof local rules and ordinances d. Gain the support of editorial boards in each lead area e. Gain the support of Local Health Director's Association f. Gain the strategic support of County Commissioners 2. Gain the support of NC DHHS to make permissive legislation and adding to the list of exemptions a legislative priority in 2007. Short-Term Goal Two: Adding to the list of agencies and venues exempted from the state law.' 1. Develop list of candidate agencies and venues interested in exemption to passing strong policies. Both Short-Term Goals: 1. Broaden state-wide coalition to include a greater number of and more diverse partners a.. Meet with potential partners, including the League of Municipalities, NC Pride, General Baptist State Convention and others 2. Develop strategic plan about "What ifs'=legislation that is not solicited yet applies to the Alliance's mission a. Hold Mid-West Academy Training to develop strategic Communication Plan, Legislative • • Advocacy Plan and Other Options Legislative Plan 3. Educate legislators about SHS, preemption and local control 35 a. Develop and distribute education materials b. Meet with legislators to establish relationship, share materials and assess interest in permissive legislation Based on my conversation with Don Blake, I'll include this as a discussion item on the July 26, 2005 NHCBH Executive Committee agenda. Thanks, Dave - Forwarded by David E Rice/NHC on 07/18/2005 01:59 PM - David E Rice/NHC 07/1812005 01:44 PM To Elisabeth K Constandy/NHC or sharrelson@nhcgov.com, Marilyn Roberts/NHC@NHC Subject Fw: NC Alliance for Health Grant Proposal Elisabeth, Please prepare an agenda item for the NHCBH Executive Committee. Dave - Forwarded by David E Rice/NHC on 07/18/2005 01:42 PM - gharris@co.wake.nc.us 07116/2005 11:11 AM To drice@nhcgov.com oc Subject NC Alliance for Health Grant Proposal Dave: I got your message. I am glad that you are willing to consider participating in this project. Attached is the info that you requested. I will be on vacation next week but will check in with you when I get back. If questions, you can call Annie Butzen at the NC American Cancer Society in Raleigh. > Annie Butzen > (919) 834-8463 (Raleigh ACS office) > (336) 376-5506 (Home office) > (336) 512-1318 (Cell phone) > butzen@email.unc.edu (See attached file: RWJF05-v3 AYB.doc) (See attached file: RWJFOS-PledgeForm.doc) > 36 (See attached file: RWJF05_RequestForFunds.doc) • • Gibbie Harris, MSPH, FNP Director, Community Health Wake County Human Services 919.250.4516 gharris@co.wake.nc.us "Never doubt that a small group of thoughtful citizens can change the world. Indeed, it's the only thing that ever has." Margaret Mead 119~ RWJF05 v3_AW.doc RWJF05 PkdgeFamdoc RWJF05 Reqje#orFwxh.doc 37 Cultural, Socto-economic and Policy Assessment Centuries old social, economic and political traditions in North Carolina, the nation's leading tobacco producing state, are giving way to the knowledge gained in recent decades about the health effects of tobacco use and secondhand smoke, and to policies and programs that have been proven to be effective. The 2005 session in the NC General Assembly is more active with tobacco and health related legislation than any time in the state's history. HEM now There are many factors that contribute to this political and cultural shift regarding tobacco in North Carolina. A major underlying reason for change is that North Carolina is in the midst of shifting away from a tobacco farming and manufacturing economy to a technology and information-based economy. A second factor in this change in the social and political environment is the education of decision-makers regarding the impact of tobacco on health and health care costs, which are a rising concern in North Carolina. A final factor contributing to the changing environment is the investment of $15million in MSA funds for teen and young adult tobacco prevention and control, resulting in the involvement of diverse geographic community and school groups in educating about the public health problem and effective solutions. 38 The Community Guide to Preventive Services [CITATION] strongly recommends restrictions in public places as a comprehensive tobacco prevention strategy which reduces initiation, increases cessation and reduces exposure to secondhand smoke. In North Carolina, there is growing interest in policies to eliminate smoking in public places, at the local and statewide level, despite the fact that the state has a preemptive state law that restricts municipalities from passing ordinances and a court decision that prevents local health departments from enforcing existing ordinances. Local, state and national advocates have labored to address policies at the most local of levels=at the individual business and have successfully established smoke-free policies in the majority of white-collar worksites. Advocates have also addressed policy at the state level by passing legislation that add to the list of exemptions to preemption and establish new polices in public places. These activities have set the foundation to restore local control and increase the number of public places required to be smoke free. North Carolina's preemption law - GS 143-595-601,which health advocates call the "dirty air law," is a confusingly worded state law that requires state controlled buildings to set aside 20% of interior space for smoking (as is practicable), and preempts local governments from passing stricter regulations. Certain buildings are allowed to be smoke free; these include mostly buildings that are smoke free by federal law. This is coupled with another barrier, a District Court ruling in Halifax County in 1994 that suspended most other local rules activity and overturned those that had been passed by Boards of Health before the preemptive bill took effect. 39 Despite the legal and policy barriers, significant voluntary progress has been made in recent years, particularly in private smoke free policies in white-collar worksites. More than 78 percent of the North Carolina indoor workforce is covered by a nonsmoking policy for public and work areas at their worksite, compared to less than 33% of the state's workforce that was smoke-free in 1992. Although consistent progress has been observed in the effort to protect workers from job-related secondhand smoke in the state, some workers are less protected than others. Blue collar workers in the service and manufacturing industry are significantly less protected from exposure to secondhand smoke by workplace policies. With increasing knowledge about secondhand smoke and health, several state and local initiatives have recently been enacted that expand the list of public places that can be smoke-free or are required to be smoke free. Three types of legislation have been introduced in past the two legislative sessions (2003 and 2005Hegislation that restores the authority of local decision-makers to implement smoke-free policies and legislation that sets a statewide minimum standard for policies related to smoking and finally, legislation that both sets a minimum standard and restores the authority of local decision-makers to pass stronger policies. Expanding the Authority of Local Decision-Makers In 2005, the NC Local Health Directors Association requested legislation (H239) to exempt any building that houses a local health department, including the grounds surrounding the building, from the statewide preemption law, allowing local health departments to declare their building and 50 feet of surrounding grounds smoke-free. 40 I J Not only did this bill become law in 2005, but it also prompted H 1482 - a replica bill to allow local social services to declare their buildings and 50 feet of surrounding grounds smokefree - to pass the House and Senate and now awaits Governor's signature. Also in the 2005 session, Greensboro Arena policy makers requested a bill (S482) which expanded the list of state-controlled buildings that are exempted from the requirement that 20% of interior space be set aside for a smoking section to include large arenas. The bill has been passed by both the Senate and House and awaits the governor's signature. The Mecklenburg County Commissioners voted 6-1 in January 2005 to ask the delegation representing the County to request exemption from the state's preemptive law (H840), thus restoring local control to Mecklenburg County. A citizen-led group, Smoke-free Charlotte, garnered strong grassroots support, media support and a legislative champion, their bill ultimately did not make it out of the House. The group continues to build local capacity to support strong legislation in 2007 and is a collaborator on this grant. Minimum Standards In 2003 the NC Legislature created rules to make the House floors smoke-free while legislators are in session; these rules were readopted and expanded to include the Senate floor in the 2005 session. Also passed into law during the 2003 session was a bill to allow UNC college campuses to implement smoke-free policies in dormitories. As a result of this legislation, many college campuses have built coalitions to address tobacco on 41 campuses and two, the University of North Carolina at Chapel Hill (UNC-CH) and North Carolina Central University (NCCU), have implemented smoke-free policies in dorms and on grounds. In the 2005 legislative session, S1130 requiring correctional facilities to phase in smoke-free policies due to health care cost concerns passed into legislation. The bill passed the Senate and is now awaiting a hearing in the House. Additionally, H76 was filed as a statewide smoking ban in restaurants; a compromised version, supported by the NC Restaurant Association, requires 50% nonsmoking areas. An amendment to require separate ventilation got a be vote in the House, and the bill failed on a vote of 58-62 to pass second reading. Restoring Local Authority and Setting a Minimum Standard One important piece of legislation passed during the 2003 session that both expanded local authority and set a minimum standard for tobacco-free schools, requiring schools to be smoke-free while students were in classes and allowing the campuses system to enact smoke-free campus policies, and giving dear authority to local school boards to make NC schools 100% tobacco free. As a result of this legislation, more than half of NC's school districts have 100% tobacco free campuses Project Outline The NC Alliance for Health, a statewide tobacco policy advocacy organization, has three tobacco policy priorities for the 2005/2006 session of the General Assembly: to substantially increase the state's tax on tobacco, currently at 5 cents, work to restore 42 j Short-Term Goal Two: Adding to the list of agencies and venues exempted from the state law: 1. Develop list of candidate agencies and venues interested in exemption to passing strong policies. Both Short-Term Goals: 1. Broaden state-wide coalition to include a greater number of and more diverse partners a. Meet with potential partners, including the League of Municipalities, NC Pride, General Baptist State Convention and others 2. Develop strategic plan about "What ifs"-legislation that is not solicited yet applies to the Alliance's mission a. Hold Mid-West Academy Training to develop strategic Communication Plan, Legislative Advocacy Plan and Other Options Legislative Plan I Educate legislators about SHS, preemption and local control a. Develop and distribute education materials b. Meet with legislators to establish relationship, share materials and assess interest in permissive legislation Project activities specific to secondhand smoke policy advocacy in Year One of this grant will focus on community education and coalition building, statewide coalition building, media, legislative education and fundraising. Activities in Year Two will include the development and introduction of legislation to restore local control and a grassroots, 44 grasstops and legislative strategy to support and pass this legislation. A program logic model and strategic action plan have been developed and are available upon request. Partner Organizations The Alliance has by-laws and an Executive Committee consisting of officers (Chair, Vice Chair, Secretary and Treasurer) and chairs of the three policy committees (Excise Tax, Master Settlement Issues, and Secondhand Smoke). The Advocacy Director of the American Heart Association serves as Chair, the Health Policy Director from the American Cancer Society serves as Vice Chair, a representative from the Governor's Institute on Alcohol and Substance Abuse serves as Secretary, the Exec. Dir. of NCPSF serves as Treasurer, Medical Review of NC's Dir. of Government Relations chairs the Excise Tax Committee a retired physician and author of a NC Medical Journal article "The Case for Increasing the NC Cigarette Tax' is Chair of Master Settlement Issues Committee, and the former Director of the NC Department of Family Medicine's EnTER program (Environmental Tobacco Smoke Training Education and Research) and the Community Health Director for Wake County co-chair the Secondhand Smoke Committee. The Head of the Tobacco Prevention and Control Branch of the NC Department for Health and Human Services serves as a nonvoting liaison and members of the Branch staff and Branch funded local coalitions serve in educational roles at the Alliance's request. The Alliance has become the focal point for tobacco-related policy advocacy for a broad range of large influential national, state and community partners, including the Campaign for Tobacco Free Kids, the Americans Nonsmokers' Rights Foundation, the 45 Tobacco Control Resource Center, the Centers for Disease Prevention and Control, as well as the voluntary organizations, NC GASP, the Local Health Director's Association, I the Association of Local Boards of Health, the University of North Carolina Department of Family Medicine, the Department of Health and Human Services Tobacco Prevention and Control Branch, the Health and Wellness Trust Fund and dozens of local, community-based coalitions around the state. The Alliance has also reached out to new, non-traditional partners that are new to this issue. These partners include NC Pride, the NC Council of Churches, (more faith organizations], State Employees Association of NC, NC Association of Educators, American Association of Retired Persons, the Covenant with NC's Children, the League of Women Voters, El Pueblo (a statewide policy advocacy organization for Hispanic/Latino populations), and the NC Justice Center's Health Access Coalition (a large, diverse, and very active 60 member advocacy coalition) just to name a few. Alliance representatives have worked hard to build strong relationships with legislative partners, including recruiting sponsors for legislation and advisors to legislative strategy. History of Community Organizing and Policy Advocacy The Alliance has come to stand as the leading advocacy organization for tobacco prevention legislative issues in North Carolina due to its vision of and commitment to a healthier North Carolina, achieved through genuine collaboration with local, state and national partners. The short-term, 2005/2006 policy activities of the Alliance include: 1) an increase of at least 75 cents in NC's cigarette excise tax; 2) support the use of 46 Tobacco Settlement Funds for programs and policies aimed at preventing and reducing tobacco use and to increase to CDC's minimum "Best Practices"; and 3) eliminate exposure to secondhand tobacco smoke by advocating for dean in-door air policies and repeal of the state law that prohibits local governments from passing effective local dean air policies (eliminating preemption). In a campaign funded by Robert Wood Johnson Foundation, the Campaign for Tobacco Free Kids, private donations, fundraising and tremendous in-kind support from Alliance partners, ion 2004- 2005, the Alliance has focused mainly on obtaining a significant increase in the excise tax on tobacco. The Alliance developed a strategic plan to work with key legislators to introduce legislation raising the tax and through a coordinated grassroots advocacy effort aimed at getting legislators to vote for a tax increase. Activities were planned in coordination with advocacy organizations and included paid media campaigns, earned media campaigns (including the endorsement of the tax by every single major newspaper in the state), organization of advocacy day, legislative advocacy and the distribution of a resolution for a 75-cent increase signed by more than 527 individuals and 107 organizations, including faith organizations, NC Pride, local boards of health and medical societies. The Governor's budget calls for a 45-cent increase over 2 years; the Senate budget calls for a 35-cent increase in 2005- 06, and the House calls for 25-cent increase in 2005-06. As of this writing . The NC Alliance for Health grew out of an informal coalition that came together to assure that MSA dollars were dedicated to tobacco prevention and control. The Health and Wellness Trust Fund was created with MSA funding and now allocates $15million per year for teen and young adult tobacco prevention and control. Currently the 47 Tobacco Settlement Issues Committee serves to monitor the spending of MSA funds and serve as liaison to the Health and Wellness Trust Fund Commission. The Alliance has worked on secondhand smoke education and policy development at the legislative level. In a 2004 strategic planning session developed and facilitated with the assistance of ANRF, the SHS Committee detemuned two short- term policy goals to focus on: working with state agencies to continue to add to the list of state-controlled buildings exempted in the state law and to work with one community to assist them in a request for exemption to preemptive clause in the state law. In addition to these goals, representatives from the Alliance were responsible for monitoring unsolicited legislation, and creating relationships with potential legislative allies. Policies achieved in the 2005 legislative session include introduced rules, introduced legislation and passed legislation. Both the House and Senate rules include provisions that smoking is prohibited on the floor while in session. An exemption for health department directors to implement smoke-free policies within health departments and on grounds, within a 50-foot perimeter of entrances and windows. This bill was introduced on behalf of the Health Directors Association, heard in committee with little debate and signed in to law in April 2005. This led to a similar bill exempting social service agencies; this bill has passed a vote in the House and will be heard in the Senate this summer. Additional legislation was introduced to implement smoke-free policies in prisons ; this bill has passed a vote in the Senate and will be heard in the House later this summer. 48 Monitoring and liaison activities and successes include working with House representatives to address the shifting and compromised language of HB 87, A Bill to Ban Smoking in Restaurants. Representatives worked to educate the bill's sponsors and co-sponsors after the bill had been amended in such a way that it no.longer held any notable public health benefits. The bill and an amendment to require separate ventilation failed. Representatives have subsequently met with the bill's sponsor to renew their support to develop comprehensive language and local support for such a measure in the years to come. Applicant Strengths (Fiscal Management, Community Assets, and Policy Success) The Alliance is a dynamic, independent coalition consisting of public, private, professional and nonprofit organizations, businesses and individuals working together to promote tobacco use prevention and cessation policies at the state and local level. With modest financial support from the RWJF (via the Southern Neighbors Policy Initiative), the CTFK, much new in-kind support, and several small individual cash donations, the Alliance has brought together over 35 organizations and numerous individuals dedicated to tobacco use prevention and control policies in an attempt to coordinate activities and provide a strong independent voice on tobacco issues in NC. AHA blurb here 49 ~ I Staff Skills, Experience, Leadership In Policy Advocacy and Connection to Influential Leaders at Community and State Levels A relatively new organization, after only three years, the Alliance is already being recognized for its strengths in the broader public health and political communities. In 2004 it won both the NC Public Health Assoc. "Distinguished Group Award° and the NCPP "Coalition Excellence Award" and the Americans Nonsmokers' Rights Foundations "Outstanding Advocacy Award". Pam Seamans, MPP, is the Executive Director of the Alliance; she has held this position since Jan. 2003 when NC was funded by RWJF through the Southern Neighbors Policy Initiative. Her primary responsibilities (with assistance from Executive Committee) include: staff/lead monthly Alliance meetings and executive committee meetings; assist subcommittees in the development and implementation of the policy agenda; develop and maintain operating procedures; address policy-related and organizational member concerns; recruit new members; groom relationships with elected and executive branch officials and other coalitions; lead press conferences; organize strategic planning meetings. Ms. Seamans has a master's degree in Public Policy from Duke Univ. and previously served as Chair of the Covenant with North Carolina's Children, Raleigh, NC. S 50 Long-Term Vision for Tobacco Control Advocacy The North Carolina Alliance for Health is a statewide coalition promoting tobacco use prevention and cessation policies for a healthier North Carolina. The primary purpose of the NC Alliance for Health is to promote the approval of policies at the state and local levels to reduce tobacco use and its impact on the health and economic well being of North Carolinians. Long term, five-year progress expectations include: continued advocacy for further significant increases in the excise tax, ensuring that a portion of new tax revenues are allocated to evidence based tobacco prevention and control programs bringing NC in line with CDC Best Practices minimum of $42.6 million and the enabling of local government officials to protect the public's health by banning smoking in public places. s Independence from Tobacco Industry Funding Yadda yadda yadda 51 Aforth t:aroUno XUAftiance 1H Date Dear So and So, Every eight hours in North Carolina, a nonsmoker des because of exposure to someone else's tobacco smoke. We can do something about it! Secondhand smoke is a Class A carcinogen, causing the deaths of as many as 65,000 Americans a year, and the illness of millions more. Short-term exposure is so toxic that the CDC now recommends that anyone at any risk of heart disease should avoid any indoor exposure to secondhand smoke. Children are especially affected by exposure, causing bronchitis, asthma, and an increased likelihood to begin smoking. Here in North Carolina we have a "dirty air law," which prohibits local communities from passing their own ordinances restricting smoking in public places. While we have done tremendous work on getting businesses to voluntarily adopt smoke-free policies, our most vulnerable populations- young people and blue-collar workers who work in restaurants, bars, bowling alleys and factories-are still exposed every day. It is time.to restore local control and let communities act to protect people from exposure to secondhand smoke. (The NC Alliance for Health is a statewide coalition of health advocates, focused on addressing tobacco-related legislative policy. Members include the American Heart Association, the American Cancer Society, the NC Pediatric Society, UNC Department of Family Medicine, the Department of Health and Human Services, the Local Health Director's Association, SAVE and hundreds of individual members. Legislative priorities include increasing the excise tax on cigarettes, restoring local communities the authority to pass ordinances and monitoring the Master Settlement Funds. More information is available at www.ncallianceforhealth.ora. ) The NC Alliance for Health is building a campaign, funded by a grant submitted to the Robert Wood Johnson Foundation, which will mobilize local coalitions to advocate for local control to pass their own ordinances as well as educating legislators about the importance of this issue. We need your support as we write this grant. RWJF is offering a match for every dollar we raise. If you have considered making a tax-deductible donation to the health movement this year, now is the time to get the greatest bang for your buck. We have set a fundraising goal of $50,000, $30,000 of which has been secured. Donations have ranged from large organization donations of $10,000 to individual donations of $100. We need a donation or letter pledging your support by July 22. Please make checks payable to our fiscal agent, the NC Pediatric Society Foundation. A pledge form is enclosed for your convenience. We also need your ideas and feedback in developing our advocacy campaign! If you are interested in becoming more involved in this movement, please contact Annie Butzen, Co-Chair of the Secondhand Smoke Committee of the NC Alliance for Health, at butzen(a)email.unc.edu or (336) 512-1318, for more information. In any case, please make a donation today, helping us to maximize the effect of our campaign so that we can continue the important work of restoring local control and eliminating exposure to secondhand smoke. Alliance for Health 313 737 RDU Center Suite 100 . Morrisville, NC 27560 www.neallianceforheaM.org nca Ilia nce(cb, hea rt.orct 52 VMth Thank you for your support! [Name] Lynette Tolson Pam Seamans Chair, NC Alliance for Health Executive Director, NC Alliance for Health NC Alliance for Health 3131 RDU Center Suite 1 DO Morrisville, NC 27560 www.ncallianceforheallh.org nca Ilia ncea, hea rt.orq 53 - North CarroBna Alliance PMEHealth Pledge Form Every eight hours a nonsmoker dies of exposure to secondhand smoke. You can do something about it! The North Carolina Alliance for Health appreciates your tax deductible donation to our campaign to restore local control so that communities can act to protect people from exposure to secondhand smoke. Organizational Pledge Amount: $5,000 $2,500 $1,000 $500 Other Individual Pledge Amount: $1,000 $500 $100 $50 $25 Other Name: Organization: Address: Phone: Email: We need your pledge by July 22, 2005 and receipt of funds by September 15, 2005. Please make checks payable to our fiscal agent, the NC Pediatric Society Foundation, NCPSF Tax ID Number, 31-1657902. Mail to: NC Pediatric Society Foundation Attn: Steve Shore 1100 Wake Forest Road, Ste. 150 Raleigh, NC 27604 NC Alliance for Health 3131 RDU Center Suite 100 Morrisville, NC 27560 www.ncallianceforheath.org ncalliancea,heart.oro 54 Animal Control Services: Operations Overview Dr. Jean McNeil, ACS Manage Animal Control Services, S ACS Manager • Administrative Shelter ACS Supervisor Support Supervisor Supervisor 2 Fiscal Support 7 Animal & 31/2 3~ Control Administrative Awe pScps Support Techs Our Mission Statement " The mission of New Hanover County Animal Control Services is to protect the public from the throat of rabies virus exposure, and to ensure proper animal care, through prevention, public perception, and education.. • 1 Divisional Responsibilities • Shelter facility • Licensing of animals • Neularing animals • Citizen complaint amiable for adoption response • Section Five: • Fmergency msponse NHC Cade- availability- Animals & Fowl imbdivg after-boors and disaster situations Potential Complaint Requ • Fowl -chickens, dttcks,gcese • Reptilian - iguanas, bearded lizard • • Large animal - cows & pigs • Smaller large animals - pot-bellied pigs • Wolf-hybrids • Asiatic Himalayan bears • various wildlife Some Hallmark Cases • Rose Avenue - 68 animals seized r • Pit bullfighting scenario - five defendants, with one going to jury trial • Fairford Road - 47 dogs & 53 birds • Santa Ana - 73 assorted beasts • Camellia Lane -137 Dachshunds, 2 birds, 8 cats, & 8 kittens • Next?l • 2 Progress is Being Mnde • ACS generates approximately 2/3 of` expenses to function, including salary , fringe, and benefits • Adoption rates are increasing (last check by as much as 2M) • Increased public awareness and collaboration (animal cruelty cases) Continuing Endeavor„s • Seek to edacaft the general public for. • success in firhrre , generations ; • Improve the quality of life for all companion ao®als and the peopk they co4iabitate wllh. 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The memorandum explains that Medicaid maximization funds must be utilized for the activity that generated them and shall not reduce or replace locally appropriated funds. According to Health Director, David Rice, the statutory requirements noted in this memo are still in place. In FY 04-05, the estimated revenue for Medicaid maximization was budgeted in an amount equal to the cost of three Environmental Health Specialists. Internal adjustments were made in the Heath Department allowing Medicaid maximization funds to be budgeted and expended in the eligible divisions. In FY 05-06, the County is funding the positions that were added in FY 04-05. On June 6, 2005, the County Commissioners approved a budget amendment for FY 04- 05 Medicaid maximization funds that states a plan will be developed for the use of the funds. The funds could be carried over to FY 05-06 to increase revenue in the amount of $87,594 - the cost of two Environmental Health Specialists. It is possible for the Health Department to make adjustments within the department so revenue is recognized and funds expended in the eligible organizations (as they did when the FY 04-05 budget was adopted). • The Health Department would prefer to use the Medicaid maximization funds for the spending plan approved by the Board of Health on June 1, 2005 (attached). i 4 ~jorm01, North Carolina 110 G~ Dep tment of Health and Human Services 101 Blair Drive • Post Office Box 29526 • Raleigh, North Carolina 27626-0526 (919) 7334534 • Courier 56-20-00 James B. Hunt Jr., Governor H. David Bruton, M.D., Secretary February 25, 1998 MEMORANDUM TO: Local Health Directors FROM: Chris Hoke, J.D. Deputy State Health Director SUBJECT: Statutory, regulatory and contractual requirements I am writing to remind you of the statutory, regulatory and contractual requirements that local health departments are subject to with regard to the budgeting and use of Medicaid earnings, including the recent Medicaid maximization funds. In general, these. requirements mandate that local health departments use Medicaid and other fees to • further the goals and objectives of the programs or activities that earned them. The specific requirements governing how local public health agencies may budget and use fees are as follows: Statutory Requirements G.S. 13_ 0A-39(g) - A local board of health may impose a fee for services to be rendered by a local health department... the fees collected under the authority of this subsection are to be deposited tot he account of the local health department so that they may be expended for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act. G.S. 130A-4.1 W - All income earned by local health departments for maternal and child health programs supported in whole or part from state or federal funds, received from the Department of Health and Human Services, shall be budgeted and expended by local health departments to further the objective of the program that generated the income. Contractual Req IIYP nents Section ..'t_a- of the Consolidated Contract between the State of North Carolina and County and district health departments-States that "all payments from persons • North Carolina: Host of the 1999 Special Olympics World Summer Games I I and public or private third party payers, shall.be utilized for the activity that • generated the revenue and shall not reduce or replace locally appropriated funds... Section C.3.b. of the Consolidated Contract - "All earned income must be. budgeted in the program where earned, except that income earned by a program . which has no activity budgeted in a program approved by the State." Section C.3.c. of the Consolidated Contract "All fees collected shall be used in the current year or succeeding fiscal years." Section C.3.g. of the Consolidated Contract - States that "A local account shall be maintained for unbudgeted/reported Title XIX (Medicaid) fees. Accounts shall be maintained in sufficient detail to identify the program source generating the fees." Regulatory Requirements Title 45 Part 74.42 of the Code of Federal Regulations - Requires that recipients of federal financial assistance use grant related income to further the goals of the program that generated them. Title 15A. Subchapter 21B. Section .0109 of the North Carolina Administrative Code - "Client and third party fees collated by the local provider • for the provision of maternal and child health services must be used, upon approval of the program, to expand, maintain, or enhance these services." In summary, there are statutory, regulatory, and contractual requirements which mandate that local health departments establish and maintain the accounting mechanisms necessary to document the budgeting and use of Medicaid and other earnings for the particular program or activity that generated them. Health departments may utilize program earnings in the year in which they are earned or in succeeding fiscal years. Payments from persons and third party payers may not be used to reduce or replace local appropriations. The Department of Health and Human Services views failure by a county to adhere to these requirements as noncompliance and grounds for suspending the disbursement of state and federal funds. • • New Hanover County Health Department • Medicaid Cost Settlement Spending Plan May 19, 2005 Hearing Screening Equipment for Child Service $ 3,800 Coordination Program OS Consultation services to assist IT staff with appointment $3,000 scheduling system enhancements and data management for re ortin needs of department. Mobile shelving for medical Records inactive file storage $17,000 room to increase storage capacity AED Automated External Defibrillator $3,500 Annual maintenance agreement cost for Smeadlink $3,000 Barcodin software Medical Records CPR Trainin E ui ment $2,000 Laborato Software Pro ram $7,000 Pharmacy and Su I Invento Software Pro ram $10,000 Color copier and regular copier to replace old unit to $22,000 im rove roductiv' PAS stem for Clinic $10,000 Cubicle furniture enhancements (shelves, desk extensions, $5,000 • eta for Child Service Coordination staff MCC Budget addition of $7,500 in salary/fringe to replace $7,500 state funds for continuin best ractice MCC/MOW ro ram Computers, laptops & Sprint Treos (palm $40,000 ilots/ hone/la to combinations Vaccines and Contrace tives $58,607 TOTAL $192,407 • RAGSDALE @ LIGGETT CONFIDENTIAL PROFESSIONAL LIMITED LIABILITY COMPANY LAWYERS POST OFFICE BOX 31507 CROSSPOINTE PLAZA TELEPHONE: (919) 787-5200 RALEIGH, NC 27622-1507 2840 PLAZA PLACE, SUITE 400 FACSIMILE: (919) 783-8991 RALEIGH, NORTH CAROLINA 27612 Drnecr DuL (919) 881-2239 MARK S. DECICCO E-Men.: mdee1eeo®rl4awx0m July 25, 2005 Ms. Anne Brown - Risk Manager Mr. David Rice - Health Director New Hanover County New Hanover County Health Department P.O. Box 607 2029 South 17" Street Wilmington, North Carolina 28402 Wilmington, North Carolina 28401 Ms. Susan Barfield Ms. Penny Raynor 624 Cobblestone Drive 9080 Old River Road Wilmington, North Carolina 28405 Burgaw, North Carolina 28425 Ms. Janet McCumbee Mr. Allen Honigman 234 Island Creek Drive ACE-USA - Medical Risk Department Wilmington, North Carolina 28411 140 Broadway, 40' Floor New York, New York 10005 • Ms. Gaysheron Bell 2125 Shirley Road Wilmington, North Carolina 28405 Re: Mediation Hilarie Scarbro v New Hanover County Health Department et al. USDC No.: 7:03 CV 244 FL Dear Clients and Counsel: Please find enclosed Pre-Mediation Report in the above-referenced case. This letter also serves as a reminder that the mediation in the above-referenced case is scheduled for August 4, 2005 in Fayetteville. If you have any questions, please feel free to contact our firm at the above-referenced telephone numbers. Sincerely, £ Mar S. cco, • Paralegal to Gregory Brown t PRE-MEDIATION REPORT INSURED: New Hanover County Health Department ACE USA CLAIM NUMBER: JY04J0004103 BY: Gregory W. Brown (lead counsel) and Hannah Bissette DATE: July 24th, 2005 SUMMARY: This wrongful death case raises civil rights and medical malpractice causes of action. The biggest threat to our case is the fact that a person who is a gentle town drunk shouldn't usually die in prison where he was being held because he didn't fulfill his community service obligations stemming from a drunk driving incident. Nevertheless, the testimony thus far contains NO suggestion of wrongdoing by our clients. We have a strong likelihood of prevailing on the civil rights claims at the summary judgment stage based upon qualified immunity. Then, we will proceed to defend the wrongful death claims in earnest. Our experts and witnesses are strong on those claims as well. Presently, this case neither presents a serious threat of significant exposure nor should it • generate a large settlement value. If settlement is pursued, we should focus primarily on nuisance or cost of defense values only, assuming that our clients and their carrier desire to settle at all. FACTUAL BACKGROUND: This is a civil action arising out of an incident involving the death of an inmate while incarcerated by the New Hanover County Sheriff's Department. On January 1&, 2003, Mr. Gary Eugene Rummer was arrested for failure to perform community service that was sentenced as a result of a former drunk driving incident. When he was arrested he was very intoxicated A known "drunk" in the community, Mr. Rummer began to experience symptoms of delirium tremens ("DTs') over the next couple of days and on January 14th, 2003 at 7:00am he was seen by Susan Barfield, RN, at her request, for treatment of these symptoms. During this examination, he walked without problem and sat on the table. Barfield noticed his hands were shaking slightly. She gave him 100 mg. of Vistaril for treatment of the DTs and he was sent back to cell 423. Later that morning, around 10:00am, his fellow inmates were complaining of his disruptive behavior and two deputies responded to the call that he was to be moved. Deputies Melody Grimes and Billy Ray Hudson went to cell 423 to transfer Rummer to cell 419. When Rummer resisted being handcuffed, Deputy Hudson performed a "take down" and "led" him to the floor. During this movement, Rummer allegedly hit his head and his glasses broke. After Deputy Hansen and Sergeant Hatch arrived to assist, they escorted him to 419 where someone noticed a surface scratch over his right eye and consequently he was sent to the infirmary. In the infirmary, he was treated again by Susan Barfield, RN. Also present was • Gaysheron Bell, LPN. His condition was noticeably different from his prior visit three hours • earlier. When Rummer arrived, he was trying to slide out of the wheelchair, was confused and disoriented, and had urinated on himself. Barfield attended to his scratch, checked his vitals and coordination, and examined his head. After initially resisting trying to take more medication, saying he "needed to feed the dogs", he took 100 mg of Librium and 300 mg of Dilantin. She advised that he be sent back to his cell to rest and recommended he be transferred to Central Prison for safekeeping. Mr. Rummer remained "asleep" and non-responsive during the entire transport to Raleigh. Sometime after arriving at Central Prison, he was transported by ambulance to the hospital and was pronounced dead on January 16, 2003. The autopsy report stated that he died as a result of an acute subdural hematoma caused by a blunt force head trauma. Expert Opinion of Dr. Robin Wilfon¢ MD (Neurosureeon) We have retained and designated Dr. Robin Wilfong, a neurosurgeon who has practiced in New Hanover County. It is expected that Dr. Wilfong will testify that the New Hanover County Health Department, Susan Barfield, and Gaysheron Bell, as well as all other Heath Department personnel involved acted appropriately at all times and adhered to all applicable standards of care. He will also testify that any damages suffered were not a result of any act or admission of the same. More specifically, Dr. Wilfong stated that Barfield acted in a medically appropriate manner under the circumstances. In his view, when Rummer appeared disoriented when he arrived in the infirmary for the second time, it seemed logical that Rummer could have been • suffering from DTs. Incontinence is a symptom of both seizures and DTs, not hematoma. When I asked him about Rummer's change in behavior from 7:00am to 10:30am he replied that it was not uncommon for a one going thin DTs to experience such a severe change in behavior and appearance in such a short time. Most interesting was that he informed me that, "without a doubt," he did not believe that Rummer was suffering from an acute subdural hematoma at the time that Susan Barfield examined him the second time. First, a symptom of an acture subdural hematoma is not being able to talk to or respond, as Rummer was doing when Barfield saw him. Next, the neurosurgeon who examined Rummer stated in his notes that there was evidence of both a chronic and acute hematoma, even though the pathologist's notes only mentioned the acute hematoma. He suggested we confirm with the neurosurgeon about what he saw and noted Interestingly, Dr. Wilfong added that it is common knowledge that alcoholics get chronic hematomas "all the time," and that it could take only a turn of the head to cause an acute hematoma. , Dr. Wilfong stated that his main concern was why Barfield did not ask anyone what had happened to Rummer beyond whether he had suffered a seizure. He believes that her best defense is that she followed nurse protocol and that this should be corroborated by Dr. Pence (which has been). Another notable item is that the pathologist found a fractured vertebrae in Rummer's spine. His first concern is how the pathologist discovered this because there were no copies of x-rays of the fracture. Secondly, he believes that it could have been a pre-existing fracture because he never complained of any pain and it is a well known that alcoholics fall frequently. In summary, Dr. W ilfong believes that even IF Rummer had an acute subdural hematoma • at the time he was seen by Barfield, she still acted in a medically appropriate manner. Y Deposition Testimony • Susan Barfield. RN - In addition to the facts I have stated above, Ms. Barfield testified that she followed protocol when she treated Gary Rummer on 1/10/03. First, she asked the deputies whether he had suffered a seizure because he had urinated on himself. They replied that they did not know. The deputies, including Hudson, never told her that he had hit his head or gave her any reason to suspect a head injury. She also testified that nurses never diagnose and that she was following protocol by giving Rummer the medications for his symptoms of DTs. Had she had reason to suspect a head injury she would have called the ambulance. Gavsheron Bell, LPN - She testified that as an LPN her job is primarily to assist the RN and that the RN is the one to make the decisions about medications and whether to call a doctor. She also essentially corroborated the testimony of Susan Barfield with regard to her treatment of Gary Rummer. Below are summaries of the depositions of most of the law enforcement personnel who have been named in this suit. Deputy Hudson - Billy Ray Hudson was asked to go to Cell Block 423 to find out about the noise in that cell block. He looked into the cell and saw Rummer standing in the cell and there was trash on the floor. Rummer was mumbling to himself when Hudson entered the cell. Hudson took Rummer from the bench to the mats. Rummer did not give any signs of injury or pain. No part of Rummer's body hit any the floor that was not covered by a mat. Sergeant Hatch and Deputy Hanson took Rummer to cell #419. Hudson next saw Rummer laying on his side in a fetal position in cell #419. Hudson never saw a scratch over Rummer's eye until it was noticed in cell • #419. Deputy Keyes attended to the scratch. Rummer was then put in a wheelchair. When they took Rummer to the nurse's station, Ms. Barfied checked Rummer for any injuries. She gave Rummer pills, and he was pushing them back out with his tongue. After the medication, Rummer was taken back to cell #419. Rummer was standing in cell #419 on his own. Hudson next saw Rummer when he was being transported to Central Prison. Hudson was not informed of Rummer's cause of death. Deputy Grimes - She stated that she was told by either Sgt. Hatch or Deputy Hudson to assist in removing Rummer to cell 419, a padded cell. She stated that someone told her that Rummer was banging his head against the wall (this was not corroborated by anyone else). Dep. Grimes walked with Dep. Hudson to 419 and remained at the door while Hudson tried to handcuff Rummer who resisted and she called for assistance. During the "struggle" they "fell to the floor" but she was not concerned because it was a common occurrence. Sgt. Hatch and Dep. Hansen responded to Grimes' call and moved Hudson out of the way and assisted Rummer to his feet and led him to ce11419. Once in 419 she noticed a scratch over his eye and that his jumpsuit was wet with urine. She told "medical" to come down to assist with his eye after they had radioed with no response. Medical replied to have Rummer brought up to the clinic. Stated that Susan Barfield was working at that time and that it was not unusual for the nurse to refuse to come to the cell (because the medical supplies were in the clinic). Sgt. Hatch radioed again but did not hear the conversation and Deputy Ward came down with the wheelchair. That was the last of her contact with Rummer. Deputy Marlow - He stated that he saw Gary Rummer while he was in cell 2D and that he was acting out of touch with reality and stating that he had been kidnapped by Housing and Urban Development, a federal agency. Dep. Marlow assumed that Rummer was suffering from delirium tremens. • • Deputy Vernon - She assisted Deputy Marlow in moving Rummer from cell 2D to 423 without incident. Deputy Morton - He transported Rummer to Central Prison on January 14, 2005. The first contact with Rummer occurred when Cpl. Fuss told him to transport Rummer because he had a safekeeping order. Rummer was snoring "in a deep sleep" in cell 419 (this was after he had visited the infirmary to attend to his cut) when Morton entered by himself to remove Rummer in preparation for transport. Although the SBI report states that Morton admitted to doing a sternum rub in an unsuccessful attempt to wake him, he stated in his deposition that he does not remember this although he could have forgotten. He then asked Dep. Hudson to assist in removing Rummer and they picked him off the floor and in the wheelchair that Cpl. Fuss had brought. He stated that he believe Rummer was heavily medicated because medications were listed on the safekeeping order. Fuss, Hudson and Morton removed Rummer from the wheelchair and placed him in the transport van and strapped him in to keep him from falling to one side. Another inmate was also transported and fell asleep shortly after the trip began. He also stated that although it was against policy to stop the van while on a transport, he stopped twice to check on the two inmates because they were both too quiet. Each time they were snoring and he resumed driving. He advised Sgt. Jackson at Central Prison. Cpl. Fuss - He was the corporal in transportation. He prepared the safekeeping order when the medical staff called and told him that someone needed to be transferred for safekeeping. He received the information on the cover letter regarding the medical facts of Rummer from either Susan Barfield or Sherry West. He stated that the medications that were listed on the cover letter were taken from the 3 x 5 index cards kept for each patient in the clinic. He stated he never saw • Rummer's medical chart or see anyone give Rummer any medications. He stated, "he had been medicated prior to my involvement " Sgt. Hatch -Hatch had trouble recalling many of the facts and stated repeatedly that he did not remember much. He stated that he didn't remember what he told "medical" when he called to get assistance for Rummer's eye in cell 419. Just remembered that "she wasn't coming down." Stated that Rummer "stumbled" over the other inmate in 419, Bridges, enough to warrant medical attention. He also generally corroborated the other deputies statements regarding the incident in cell 423. De utv Hansen - He was a deputy-in-training that day and was running an errand when he heard a female deputy say she needed assistance. He ran to the control room and then he and Sgt. Hatch ran to cell 423 to assist. They saw Hudson on the floor with Rummer trying to handcuff him while he was continuing to resist. They ran to Rummer and helped handcuff him and then helped him to his feet and led him to cell 419. Hansen was instructed to take Rummer to medical. He stated Rummer was "slumped in the chair on the way to medical." Susan Barfield was waiting for them and while Rummer stayed in his wheelchair she inspected and cleaned his eye, felt his head, and took his pulse. He didn't recall any details about the medications and does not remember what was said between Susan and Rummer. Inmate Cline - He suffers from a mental illness which seems to have been very severe at times. He stated that Rummer was not violent in any way and that the deputy gushed him on the ground to put handcuffs on" and "his head hit the cement" and "Rummer screamed a horrific scream." His testimony was limited to the events in cell 423. Deputy Ward - She was the augmentation officer whose duty was to escort inmates from cells to • medical. At 7:00am she escorted Rummer to medical per Susan's request. He was coherent and cooperative at that time and was, examined and given medications. She took Rummer back to cell • 423 with no problems. She later heard Sgt. Hatch twice request medical staff to come to 419 and Susan responded for Rummer to be brought up to the clinic. She was told to get a wheelchair to take down to 419 and although this was not a "normal" procedure she does not remember who instructed her. She assisted Hudson and Hansen in wheeling Rummer to medical. Rummer was not talking to Susan Barfield but was mumbling and incoherent. She didn't recall if Susan asked her what had happened but that Susan checked his pupils and coordination and felt his head Susan told Ward that she didn't find anything and Ward stated that she knows nothing about the medications given. Ward also stated that she didn't recall Susan giving her any instructions other than to return Gary Rummer to his cell. PARTIES There are numerous parties in this action. Plaintiff is Hilarie G. Scarbro, Administratrix of the Estate of Gary Eugene Rummer. Defendants from the New Hanover County Sheriffs Department include: Sidney A. Causey, J.T. Leonard, B. Borton, B.R. Hudson, T.L. Fuss, D.E. Keyes, Mr. Hansen, J.P. Hatch, M. Grimes, MR Ward, S. Jones, W. Thomas Parker, Clarence A. Hayes, Angela Goebel, Dennis Kutrow, Deputy Sheriff Drakos, Deputy Sheriff Frink, John Doe I, and John Doe H. The insured include the New Hanover County Health Department; Susan Barfield, RN; Gaysheron Bell, LPN; Penny Raynor, FNP; David Rice, Health Director of the New Hanover County Health Department; and Janet MCCumbee, Personal Health Director of the New Hanover County Health Department. PLEADINGS/PROCEDURAL HISTORY • Plaintiff filed the fast Complaint on December 22, 2003. She then filed another Complaint on January 14, 2005 involving the same set of facts and circumstances but naming some additional Defendants who were allegedly also involved. This second Complaint added Gaysheron Bell of the New Hanover County Health Department, and some other Deputies. On June 14, 2005 the Court entered an Order consolidating the two actions into one. Additionally, on May 5, 2004 the Court entered an Order granting Defendants' Motion for Limited Stay of Discovery. This ruling allowed a bifurcated discovery schedule in which the parties are permitted first to conduct discovery on the issue of qualified immunity, and second to conduct discovery on the remaining issues in this case, including damages. We have engaged in fairly extensive discovery, with the Plaintiffs counsel deposing many of the employees of the New Hanover County Sheriff's Department and Susan Barfield, RN and Gaysheron Bell, LPN. Mediation is currently set for August 4, 2005. JURISDICTION The Eastern District of North Carolina is considered the most conservative district in the state and therefore, is very defense friendly. Similarly, Judge Flanagan is also considered to be extremely fair and conservative as well. Overall, we could not be happier with our venue. If a verdict is reached and appealed then it will be heard by the NC Court of Appeals located in Raleigh. • ALLEGATIONS/LEGAL CLAIMS AGAINST INSURED Plaintiffs fast claim against one of the insured is a Federal Civil Rights claim of 42 U.S.C. § 1983 that Susan Barfield, RN acted under color of state law and in conscious and deliberate indifference to Rummer's serious medical needs, by failing to provide Rummer with adequate medical care, attention and treatment; to perform an adequate physical examination; order appropriate diagnostic tests; consult with other medical professionals; or transport him to the hospital in a timely manner. The next 42 U.S.C. § 1983 claim involves the New Hanover County Health Department, Penny Rayner, David Rice, and Janet MCCumbie and alleges that the polices and procedures that these parties were responsible for were a direct and proximate cause of the wrongful and unconstitutional conduct that resulted in Rummer's death. Lastly, Plaintiff alleges two state law claims of medical malpractice and wrongful death against all of the insured. INSURED'S DEFENSES The insured Defendants deny any liability. A 42 U.S.C. § 1983 claim is a hard standard to prove. The Fourth Circuit Court of Appeals in Turner v. Kight, 121 Fed. Appx. 9, 2005 WL 32826 (4"' Cir.(Md.)) (2005) stated that, "An Eighth Amendment violation occurs where treatment is "so grossly incompetent, inadequate, or excessive as to shock the conscience or to be intolerable to fundamental fairness." Moreover, the law is clear that a negligent failure to diagnose does not demonstrate deliberate indifference and that the Plaintiff must establish that the • medical provider actually knew of the serious medical condition itself, not just the symptoms of a serious medical condition. The actions of Susan Barfield, RN and Gaysheron Bell, LPN do not meet this high burden. First, it is not clear whether Rummer was suffering from an acute subdural hematoma at the time he was seen by Barfield and Bell. Next, even if the Plaintiff was able to convince the jury of this, there is no evidence that Barfield and Bell knew of his condition. Lastly, they acted in a medically appropriate manner by treating Rummer's scratch, checking his vitals and coordination, and by giving him the appropriate medication. The state law claims of medical malpractice and wrongful death present the greatest risk of a jury verdict for the Plaintiff. One theory Plaintiff is pursuing is that the applicable standard of care required Ms. Barfield to immediately refer Rummer to a hospital for diagnosis and treatment. This will become more of an issue in the second phase of discovery, involving the policies and practice of the New Hanover County Health Department. An important aspect of the wrongful death claim is that in North Carolina the damages are only recoverable by the decedent's heirs. Here, Rummer's only heir is Betty Rummer, his 80 year old mother who lives in Ohio. This is important because it limits the amount of damages that could potentially be recovered under the wrongful death statute. The damages would be significantly greater if Mr. Rummer had children or family that relied on his support. There is no evidence of a close relationship between Rummer and his mother and no evidence that he was giving her financial support. DAMAGES/MEDIATION STRATEGY This case does not appear to have the potential for very large damages. First, the court dismissed Plaintiff's claim for punitive damages against New Hanover County Health • Department and Defendants Barfield, Rayner, Rice and McCurnbee in their official capacity. Accordingly, punitive damages are limited to those against Barfield, Rayner, Rice, McCumbee and Bell individually. Damages available to beneficiaries of Rummer's estate include loss of • decedent's income, mental shock and suffering, wounded feelings, grief and sorrow, loss of society and companionship, and deprivation of the use and comfort of Decedent's society. Because Rummer had a relatively low income and his only beneficiary is his 80 year old mother in Ohio, the potential damages are not as high as they could be. Damages available to the Estate of Gary Eugene Rummer include all provable damages for the pecuniary injury resulting from the injury to and death of Gary Eugene Rummer, including past medical expenses, physical pain and mental anguish, lost earnings, and loss of consortium. Because Mr. Rummer worked at odd jobs his lost wages are difficult to assess but we can assume that they are quite low. Further, the only evidence of actual monetary damages suffered by Ms. Betty J. Rummer, the decedent's mother, are burial expenses of $319.50 for the headstone, $86.40 for the Foundation, and $6147.70 for funeral expenses. As mentioned above, Rummer's 80 year old mother lived in Ohio and there is no evidence that they had a close supportive relationship that would warrant large damages for loss of consortium and society or deprivation for the use and comfort of decedent's society. Once the discovery goes into the second phase, we would like to consider retaining Mr. Woodside, or some similarly qualified economics expert. Overall, we feel confident that we will prevail at the summary judgment or trial stages of this case. However, as mentioned above, the claims that present the most problems are the state law claims of medical malpractice and wrongful death. The claims of negligence are not as difficult a hurdle for the Plaintiff and the jury could feel sympathetic towards Mr. Rummer who appears to have been a gentle, likeable man who drank too much. Again, the potential damages • in this case are more limited than other similar cases of this nature. As far as settlement value is concerned, you must each consider whether settlement is even an option you wish to consider. If it is, then we would recommend employing a nuisance or "costs of defense" settlement value. This could be as little as several thousand dollars or as high as the expected amount we will spend to conclude the case. As health care professionals, each of you must decide whether a settlement will require reporting to the national practitioner databank or not. Here that may not be the case. Usually, "nuisance" settlements in wrongfid death cases range from $10,000 to $50,000, simply because someone died. Please understand that we are ready to complete the defense and try the case if necessary. WHAT REMAINS TO BE DONE Assuming the case does not settle at mediation, there is still much work to be done. All of the experts from the first phase of discovery will need to be deposed. Additionally, should this case extend into the second phase of the bifurcated discovery, Plaintiffs counsel have expressed their desire to depose Penny Raynor, Janet McCumbee and David Rice. We would also like to consider retaining additional experts as needed. CONCLUSION Again, we feel confident of the potential for this case to conclude with a defense verdict. However, you should keep in mind that this sorry creature may engender sympathy from the jury if the case ever gets that far. It is important to remember that regardless of how confident we are • • in the law and our facts, we can never predict what will affect a jury. In any event, we possess strong defenses. M • f+ • yR ~ / ~ W KID S • R SAFE o.~QP New Hanover County unveils our new Mobile Car Seat Check Up Van tomorrow! NE ANOVER COUNTY HEA0% I SAFE KIDS New Hanover County unveils our new Mobile Car Seat SAFE KIDS New Hanover County is part of the National SAFE KIDS I Check Up Van July 15 at a free car seat inspection at Jeff Gordon Chevrolet Campaign, the first and only national nonprofit organization dedicated in Wilmington. The new van, valued at approximately $50,000, was solely to the prevention of unintentional childhood injury - the number one recently awarded to SAFE KIDS New Hanover County through a nationally killer of children ages 14 and under. More than 300 state and local SAFE competitive process. The van will enable the local coalition to provide car KIDS coalitions in all 50 states, the District of Columbia and Puerto Rico seat inspections throughout New Hanover County and the region. The make up the Campaign. SAFE KIDS New Hanover County is New Hanover County Health Department is the lead agency for the local one of only 25 state and local SAFE KIDS coalitions to be SAFE KIDS coalition, which is a collaborative effort of many agencies and awarded a new van this year. (The national organization dedicated volunteers. is keeping three additional vans for use at special events and training.) Motor vehicle "crashes are the leading killer of children under 14. "Under North SAFE KIDS BUCKLE UP is a national program Carolina law, all children under 8 years or 80 developed by the National SAFE KIDS Campaign pounds must be restrained in an appropriate and sponsored by Chevrolet and General Motors > seat - whether in the family car, traveling to educate parents and caregivers about the with friends or relatives, or in a rental car or importance of properly restraining children taxi," says Renae Lopez, Injury Prevention on every ride. Educator/SAFE KIDS Coordinator with New Hanover County Health Department. • According to the National Highway Traffic Safety Administration, approximately 73 percent of all child passenger restraints (more i than 80 percent of car seats and about 40 percent of booster seats) are used incorrectly, more than tripling the risk of serious injury or death in the event of a crash. "We'll show you how to install your child's car seat and adjust it for your child," says Ms. Lopez. "Our trained members and volunteers have already inspected hundreds of car seats, but the Mobile Car Seat Check Up Van will give families easier !i access to our services." The van, one of 28 joining a nationwide fleet of 91, is equipped with custom-designed tents, signage and supplies to organize a car seat inspection, capable of serving several hundred families in a single day. NEW HANOVER COUNTY Hours of Operation for Main Office: ~ W Office Hours: Monday-Friday, 8:00 a.m. - 5 p.m. HEALTH DEPARTMENT BOARD MEMBERS ~s Clinic Hours: Monday - Friday, 8:00 a.m. - 4:30 p.m. Se Habla Espanol Donald P. Blake, Chairman, Public Member NEW HANOVER COUNTY HEA'11 O Servicio de Interprete Gratis Edward Weaver, Jr, OD, Vice Chairman, Optometrist Marvin E. Freeman, Sr, Public Member New Hanover County Offsite locations: James R. Hickman, RPh, Pharmacist 'health Department Cheryl Lofgren, RN, Nurse Animal Control Environmental Sandra L. Miles, DDS, Dentist 2629 South 17th Street Services Health Services Nancy H. Pritchett, County Commissioner WlhnMgton, NC 28401 180 Division Drive 230 Marketplace Drive Robert M. Shaksr, MD, Physician phone 910.343.6500 Wilmington, NC 28401 Wilmington, NC 28403 John N. Tunstall, PE, Engineer fax 910.341.4146 910-341-4197 910-798-6667 Stanley G. Wardrip, Public Member (located in County Annex at G. Robert Weedon, DVM, Veterinarian www.nhchd.org - Market Place Mall) Janelle Rhyne, MD, Medical Consultant Health Director's Message After participating in a rigorous environmental, and animal control Department the best it can be. pilot program, the New Hanover services helps to achieve it. We The servicesprovidedatyourHealth; County Health Department became live in a world where public health accredited on May 28, 2004. This threats range from access to health Department are comprehensive, up- landmark achievement was a care to emerging health risks like to-date, and reflect the very best and direct result of the hard work and bioterrorism and avian influenza. most current practices expected of dedication of our staff. With 125 In order to overcome these threats local health departments. Our staff" ` years of public health service in it is imperative that we have a is highly qualified and focused on New Hanover County, our mission professionally trained workforce. promoting health and preventing has always been to assure a safe disease. Our staff believes very and healthy community. Assessing Our Health Department is strongly in what we do and why the public health needs and setting committed to equipping our staff we do it. Your health is truly priorities to maintain essential so that we can better serve you. We our priority! personal, family, community, are dedicated to making the Health David E. Rice, MPH, MA Health Director New Hanover County Health Department is the Oldest in the State! (Wilmington, NC) On February time of his death in 1892. County Board ofHealth was officially Our roots run deep with many 12,1877, Dr. Thomas Fanning Wood On June 14, 1879, a group met in consolidated on April 1, 1913. milestones along the way. There combined a dream with $100, and New Hanover County and organized have been many added functions the North Carolina Board of Health the first local Board of Health in The Health Department could to the role of public health over was formed. Dr. Wood, a noted North Carolina. The decision was not have come at a better time. As the years, but our foundation Civil War surgeon and resident of made to have a "committee" form evidenced by a 1912 Communicable remains essentially the same. For Wilmington, was named Secretary- of organization. The committees Disease Map of Wilmington generations, New Hanover Cony Treasurer and the first State Health appointed were: drainage and created by Dr. Charles Nesbitt, Health Department has Officer of North Carolina. water supply, epidemics, sanitary diseases such as typhoid, measles, promoting health and preventing conditions of public buildings, and diphtheria, scarlet fever, smallpox, disease, and we will continue for Dr. Wood is known as the public nuisances. The New Hanover malaria, pneumonia, tuberculosis generations to come. "father of public health" in North County Board of Health continued and pertussis (whooping cough) Carolina. He attended public to function until 1911 when a Special were common throughout the city. Our motto says it all: school in Wilmington, served in Charter was passed in the General Although most people are unaware, "Your Health - Our Priority." the Confederate Army Medical Assembly, resulting in the formation their lives are touched every day Corps, and practiced medicine in of the Consolidated City and County by the accomplishments of Wilmington from 1865 until the Health Department. New Hanover public health. Over 30years of helpingyou Wilmington Health Associates has been taking care ofyou,your I care for the onesyou love. parents, your children and your + Tarheel Physicians Supply ' ' friends for over thiryyears. With s congratulates a$ ten state-of-the-art facilities i Y OttiWWy n PUtyOUr r~ New Hanover County Mfr[[Fly fllSt. t 1 t, Wilmington, Leland. Carolina Beach and Porters Neck, our I Health Department he-%'reyour number k ' r , staff and physicians are ready to ~ne,p[t0[lEy y° for 125 years of continually improving provideyou andyour family with U 4 f E , tk healthcare in our county! % r ,+f the most comprehensive medical i Of, 1010E1 there's >4 i~,°~ care in the area. ' 'ncUre!i©helpyou. We're committed to beingyour r:c»--"~nr° - partner in healthcare for many • years to come. Call our main ~ - v office for a complete listing of I 910.341.3300 physicians and office locations or 1934 Colwell Ave • 763-5157 1 ~ F r www.wilmingtonhealth.com visit us on the web. { a New Hanover County Health Department Phone 910.343.6500 t MM IYIpM~CWMIY Nl~M~' Your Health, Our Priority r . The year was 1968, August 31st, to comprised our daily activities. made huge steps in reducing infant In New Hanover County the oe exact. "Surely I have died and gone mortality, maternal deaths and health increasing homeless population and to heaven," I thought as I bounded into And then there were the "worries". care for children. Integration of their lack of health care resources had the back door of a little OLD brick How do you get this child with the other disciplines (social services, become a significant public health building on North 4th Street that was draining car infection medical care? nutritionists, and health educators) problem. In partnership with Good then New Hanover County Health When 80 year old Miss Daisy way has made great differences in our Shepherd Ministries we established a Department. Maybe not. Plaster up at the northern border of the ability to attend to the whole person nurse/nurse practitioner clinic at ti e doesn't fall in Heaven! As I turned county has symptoms, how do I tell and the entire family. Nurses not only Good Shepherd Shelter in January the corner to climb the steps to the first whether she's sick enough to call an practice the "laying on of hands" on 2004, and see our efforts returning to floor, there in front of me was a freshly ambulance or can she be managed at people but also on the computer! a medically indigent population with fallen pile of plaster, and over it a hole home? When the Union strikes and many and varied needs. in the ceiling about 4 feet in diameter! the. benefits expire, how does this Little did we know the new public It had fallen just an instant before I family make it? When this family health issues we'd face, such as HIV Our own little community has walked in that door! has no running water or sewer, where disease and its many ramifications for changed dramatically in the past can they go? public health professionals. We never 37 years, but the role of the public I was lucky, not only in that I imagined that public health would be health department has held steady. wasn't knocked senseless by falling It was that very year that big a lead agency in planning for response Just as I never imagined that my day plaster, but in that I had a job as a changes began. Our agency became to events of bioterrorism...we didn't would be as it is now, I cannot begin Public Health Nurse in New Hanover a certified home health agency even know the word! Unheard of was to think what the nurses thirty-five County. A position as a public health by Medicare, the one and only in the notion that you could manage years from now will be facing. What nurse in New Hanover County was our community. Medicare would tuberculosis pdtients at home, not I do know is that they will meet hard to come by in those times, there reimburse the health department in a sanitorium, and that you would the challenge. being only 15 positions. I had been for services to patients who had deliver each and every dose of their informed when I made application, Medicare, but then, we had to medication for the duration of their ,that the only positions that became charge ALL patients the same. DO treatment, however long it should ( 'available were those of nurses who WHAT??? No, no, Mr. Federal be. Unheard of was the thought -''died or retired. Luckily, no one died Government, you don't understand! that there would be hundreds of day but one did retire, and I got a job in a Public health nurses don't charge for care centers and nursing homes, a city by the beach! our services! But we did, and life by-product of the dissolution of the went on...with more federal money extended family. And unimaginable I trailed along behind the best of coming into our agency. was the thought that our population « the best public health nurses learning would almost double in this period ' my role... establishing a presence in Our little antique health of time multiplying the numbers of "my district", a geographic area for department building on 4th Street restaurants, swimming pools, houses, which we were responsible. Wearing was no longer adequate... not to and automobiles with their own Betsy Summey, RN, FNP one of two acceptable styles of mention the fact that it was falling problems of accidents, pollution, uniform, and a suspiciously military- down! A beautiful new building was road rage, and general stress... all looking hat, (in fact it was called an built beside the new hospital, and all ultimately issues that affect the "overseas" hat), we did very little of the staff except me, moved in. Just public's health. work within the confines of the main prior to that time, I decided to return health department building... half an to school to a new-fangled program hour in the morning planning our called the family nurse practitioner day, and half an hour in the afternoon program. The program was designed doing the paperwork. Imagine that! to teach nurses physical assessment Just half an hour doing paperwork! skills, diagnosis and treatment, with _ Making home visits to assure children the thought of providing care in r • f had their immunizations, doing baby underserved areas. That training led . t clinics in the neighborhoods for well to the establishment of a clinic for the sr II childcheck-ups,sometimes going out medically indigent in the inner city in "the country" to give a patient the area and our wish for better access The Special!St behin \ ,i bad news they had tuberculosis and to primary care for our uninsured the micr osco te. t ~tvould have to go to the sanitorium, citizens was realized. A laboratory at the, forefront skilled bedside nursing procedures, of patent care. and teaching little children to wear Change has been fast and furious n~ their shoes (if they had any) lest since that time! State and federal they get the "creeping eruption", governmental programs have YA2VY - Ompg9 H M MD..MD. FCA.P..PASCP D1m MAUI i&y MD. CAC.P, l1MIMIIh IM1MM1 I Ch mpM.DMCK Y M.D. RC .AP.. FASC.P. li CShim, M.D. RACP FASCP. MN•IIkK 1111, F M. DA Ru11 N o., MU., FC.A P kM F lkM T MO. 1a ~ CA.P. New Hanover County Health Department Phone 910.343.6500 Yf W MrMOYY• COUYtt X4l~M~'Y . 1. Back to School Already? What parents need to know about vaccinations and physicals for their children Larry Grimsley and Cynthia Withrow Believe it or not, the start of the immunizations and verification of vaccine. Students may also receive and developmental screening. traditional school year is approaching the last vaccine given and the date of a privately paid meningococcal These physicals are appropriate fV faster than you think! And many the next vaccine to be given must be vaccine that will provide protection children and adolescents aged birth young adults are planning on going provided. from ' some forms of bacterial through 20 years. Payment options away to college for the first time. meningitis through adolescence include: Medicaid, insurance, The New Hanover County Health If students are entering school for and college years, beginning at age credit card, and self-pay. Sliding ' Department would like to remind the first time and are seven years 11. All other vaccines are state scale fees apply as indicated. parents and guardians of school age of age or older, a catch-up vaccine supplied and free of charge, and no ; children that all students must present schedule is available. appointment is necessary to receive The following child physicals are a certificate of immunization before immunizations at the New Hanover they may attend any grade (Pre-K thru County Health Department. If your 12), and to provide some information child has received any vaccinations o on other available services for children in the past, please bring a copy, PrOch6ol and adolescents. of their shot record to the health Pre -kind6ingarten Kinder6cirfen cough (DIP) department to be reviewed during their appointment. flitis A certificate of immunization must be presented on the student's first day ~Ummer camp of school attendance. If no certificate In addition to school-required ~68 O's . - immunizations, the health is provided, the parent/guardian will ltpve 30 days to complete the required Hepatitis department also offers Well Child immunizations and must show proof • Physicals. These appointments do of completed immunizations. If the require an appointment, 'and are Please call theNewHanoverCounty required immunizations cannot be Tetanus and diphtheria toxoids offered Monday through Friday Health Department to schedule an completed in the allotted 30-day (Td) is recommended at 11-12 years beginning at 8 a.m. Physicals appointment for a child physical, or period, the student must be in the of age, if at least 5 years have elapsed include (when indicated) vision and to receive answers to any questions process 'of completing the required since their last tetanus and diphtheria hearing screening, lab work (lead you may have. We look forward to testing, hemoglobin, urinalysis), seeing you! Safe Fun in the Sun the focus being on "not getting a sunburn" Noelle Esquire is an intern at the New In fact, the words "skin cancer" are not even Hanover County Health Department. She Noelle Esquire the mentioned until grade 4. is currently studying journalism at New age of 18. One or two severe sunburns York University. before the age of 18 greatly increases, and Ten area elementary schools currently It's a hot one this summer! By running may even double, the risk for developing have the Sun Sense program curriculum through the sprinklers, swimming in the melanoma later in life ( HYPERLINK are Alderman, Bellamy, Bradley Creek, Sun Safety Tips: neighbor's pool, or spending a day at one "http://www.sdhw.info" www.sdhw.info). CarolinaBeach, Codington, Eaton, Johnson, of the local beaches, people are finding all And it isn't only the fair-skinned, freckled, Parsley, M.C. Williams, and Wrightsville Avoid outdoor activities during peak sun sorts of ways to cool off. While having fun blonde and blue-eyed children that are Beach. The Alderman, Bradley Creek, intensity hours - loam to 3pm. in the sun this summer, please be sure to be at risk. Children of all skin types should and Wrightsville Beach schools began safe. In fact, why not be safe with the sun be protected from over exposure to the implementing the program Spring 2005. If you must be outdoors between loam and all year long? That's the aim of the New sun. The health department is currently The year-round elementary schools - 3pm, use shade or find shaded areas. Hanover County Health Department! collaborating with New Hanover County Eaton, Johnson, and Codington - plan to Schools on a project that targets area begin implementation when school reopens Stay covered: wear clothing that covers the Did you know that skin cancer is by far children, as a means of promoting life-long later this summer. The other four schools most skin, such as long-sleeve shirts with the most common cancer in North Carolina skills for skin cancer prevention. intend to begin using the program during collars and long pants, socks and close-toed and the United States, with more than one the 2005-2006 school year. shoes. million new cases every year nationwide? The NHC School System received grant Approximately one in every six people funding last year to implement a sun safety Sevenofthese schools will also be receiving Wear darker, tightly knit fabrics that absorb will develop some form of it during their awareness program in the county. "Sun 20x20 foot shade structures, priority being UV light better than lighter colors. lifetime.. According to the NC Central Sense" uses the Sunny Days, Healthy given to the year round schools and those F.3ncer Registry in 2003, New Hanover Ways curriculum, which meets both the already implementing the Sunny Days, Guard your face: wear a hat and UV- County has one of the highest rates of NC standards for school curriculum and Healthy Ways curriculum. These shade blocking sunglasses. melanoma in the state (21.5 per 100,000), Centers for Disease Control Guidelines for structures are meant to help limit excess sun which is well above the state average of 13.7 School Programs to prevent skin cancer. It exposure to kids while playing outside. Use sunscreen every day of the year, in per 100,000. Melanoma is a serious type of may be taught to children in grades K-5, It is a mission of the New Hanover addition to cover-up clothing, and under skin cancer than must be detected early to providing an average of eight hours of sun County Health Department to encourage insect repellant and make-up. avoid spreading to other parts of the body. safety instruction per grade in the form of prevention and to increase knowledge health, science, language arts, mathematics, about preventable diseases such as skin Choose a water-resistant sunscreen with an According to the American Academy of geography, social studies, and fine art cancer. The Sunny Days, Healthy Ways SPF (Sun Protection Factor) of at least 15 Dermatology, children receive 80% of their content and activities. The program teaches curriculum has been a fun and interactive that blocks both UVA and UVB rays. lifetime sun exposure before they reach children positive sun protection habits with way of accomplishing that goal! 1 n New Hanover County Health Department gr Phone: 910.343.6500 «rwnY w•Yn ~an^'d'