HomeMy WebLinkAbout02/02/2000 BOH Minutes & Agenda Packet - Exhibits
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NEW HANOVER COUNTY BOARD OF HEALTH
Dr. Thomas Fanning Wood Memorial Conference Room
New Hanover County Health Department
AGENDA
Date:
February 2, 2000
Time:
8:00 A.M.
Place:
Dr. Thomas Fanning Wood Conference Room
New Hanover County Health Department
Presiding:
Mr. William T Steuer, Chairman
p/J-~e5 Invocation:
I -- -::r Minutes:
Dr Michael Goins
January 5, 2000
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Recognitions:
- Mr William T Steuer
Chairman
SUDer Staff Award
Carol Drummond, Clerical Specialist, Community Health
Personnel
New EmDlovees
~ Yolanda (Kaye) Hitko, Physician Extender, Community Health/Jail
~ ANCBH Director Emeritus Members
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Carl ~urham (Post.hurnous) - Jt9A r'\ t.tJ/J~r ~ ~
Dr. Michael E. GOInS \,
_ ;rJa-II'; f/~
Amaryllis Rehder '.l.. / ..L
~ .5qt"Q Nq,.1t I EC..{-{. '5fuclPl1/l 11l1~rll
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Departmental Focal:
Food Establishment Permits
Ms. Dianne Harvell
Envirz~~~
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NHCBH Agenda
February 5, 2000
Page 2
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Monthly Financial Report:
j December 1999
Ms. Cindy Hewett
Business Officer
Committee Reports:
/V - J.-?- ^ Budget Committee (Budget Review and Approval) - Ms. Anne Braswell Rowe
1J( { . Budget Committee Chairman
*fu;;::;~ ~(~~'j~""WHIi=TS""~
Unfinished Business:
Generators/Hookups at Emergency Shelterel rilr ~ )/
. ?3 Board of Health Committee Appointments
~:B"t;iJ ifll~l~
Comments:
- Mr William T Steuer
- Mr. William Steuer
Board ofHealth Members 1ttttlfh IAre~t j ~. ttf. J.fEfJ ~ ~f€1> -'#/f1tfrR...
Health Director ~~ J-
~. ^~ \:'It' - Mr. David E. ~'j........k.
O I State Health Di~t rs NCLBIt Meetings - January 20-21 ,2000 fh...o~ ~.fr- rr-'....
~~ 2. "Doctor To The Front"lDr. Thomas Fanning Wood Presentation - faiillii'ty 7, 2000
vyu 3 Disaster Preparedness Meeting - January 12,2000 {lItC (;/
4 Cape Fear Area United Way Allocations Team If- A ~ \
5 Staff Appreciation Luncheon-'h,ct.OO ' · . ,f'5 U. t. f' /./' f 5' 'fCjC, \
· fV(;.,fL 'f). ~'XJI'tIIf?h. "'...MI/,c.../
· F{)ori EdrtC4-a~ p~oA /
Other Business: 0' frtJCtJl1 Olio:roe.'.:> CI.fJ. III
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Adjourn:
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Mr William T Ste er
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Mr. William T. Steuer, Chairman, called the regular business meeting ofthe New Hanover County Board
of Health to order at 8: 15 a.m. on Wednesday, February 2,2000.
Members Present:
William T. Steuer, Chairman
Wilson O'Kelly Jewell, DDS, Vice-Chairman
Henry V. Estep, RHU
Michael E. Goins, 00
Robert G. Greer, Vice-Chair, County Commissioners
Gela N. Hunter, RN, Nurse Practitioner
W. Edwin Link, Jr., RPH
Anne Braswell Rowe
Philip P. Smith, Sr., MD
Melody C. Speck, DVM
Estelle G. Whitted, RN
Members Absent:
Others Present:
Mr. David E. Rice
Lynda F. Smith, Assistant Health Director
Frances De Vane, Recording Secretary
Invocation:
Mr. William T. Steuer gave the invocation.
Minutes:
Mr. Steuer asked for corrections to the minutes of the January 5, 2000 New Hanover County Board of
Health meeting. The minutes of the January 5, 2000 Board of Health meeting were corrected and
approved by the Board of Health.
Recognitions:
Super Staff Award
Mr. David E. Rice, Health Director, presented Carol Drummond, Clerical Specialist, Community Health,
recipient of the Semi Annual Super Staff Award. Ms. Drummond received the award in recognition of
her public health service. She was nominated by her peers and selected by the Executive Committee of
the Board of Health.
Association of North Carolina Boards of Health (ANCBH) Directors Emeriti
Mr. Rice announced three former members and one current member of the New Hanover County Board
of Health were recognized as Directors Emeriti of the ANCBH Annual meeting on January 20, 2000.
The Director Emeritus members recognized were Dr. Michael Goins, Mr. John Coble, Ms. Amaryallis
Rehder, and Carl Durham (Posthumous). This is an honor bestowed to public health leaders who have
served on the ANCBH Board of Directors. Mr. Steuer recognized Dr. Goins, Director Emeriti, for this
honor and a round of applause followed.
Personnel
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Student Intern
Department Focal:
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Mr. Rice introduced Ms. Sara Nutt, East Carolina University Intern, who is serving an internship in the
Nutrition Division of the health department.
Food Establishment Permits
Ms. Dianne Harvell, Environmental Health Director, presented a department focal on Food Establishment
Permits. She gave the definitions, types of food establishment permits, and exemptions. Ms. Harvell
explained permits are issued by the type of establishment and governed by food service establishment
regulations.
Ms. Harvell advised restaurants are governed by North Carolina General Statute 130-A-248. Private
clubs are exempted from the foodhandling regulatons. Upon a transfer of ownership, a transitional permit
is issued to any food service establishment. This permit gives the health department an opportunity to get
100% compliance and the new owner an opportunity to meet sanitation requirements. Ms. Harvell
explained a great amount of staff time is spent on the review of plans and equipment for food service
establishments. Food service facilities are restaurants, foodstands, drinkstands, push carts, mobile food
units, school lunchrooms, meat markets, and temporary food establishments. Local Board of Health
regulations govern foodstand facilities at public festivals. The North Carolina Department of
Agriculture governs curb markets.
Ms. Harvell emphasized due to the growth in New Hanover County, the Environmental Health workload I
has significantly increased. Restaurateurs pay an annual fee of $25 to the N.C. Department of
Environmental Health and Natural Resources, Division of Environmental Health. The state statute
prohibits local fees for services related to the permitting and grading of restaurants.
Dr. Goins advised the cost of foodhandling inspections and permits are largely county funded. Mr. Steuer
asked if the Board of Health would like to confer with local legislators regarding the feasibility of
charging higher user fees to foodhandling facilities. Mr. Greer inquired whether the health department
receives any of the $25 fees. Ms. Harvell responded Environmental Health receives approximately
$10,000 annually. Ms. Hunter concurred state legislators should be asked to review the $25 foodhandling
facility fee based upon cost for services. Mr. Greer suggested the Board review this request with Mr.
John Coble, Past President North Carolina Restaurant Association, and to ask Mr. Coble to review the
fee request with the restaurant association.
MOTION: Mr. Greer moved and seconded by Ms. Hunter to present a request to Mr. John Coble for the
consideration of the North Carolina Restaurant Association to increase in the $25 annual foodhandling fee
or to request the support of a petition for legislators to change the state statute to allow the establishment
of local user fees for Environmental Health foodhandling services based upon cost.
Mr. Steuer requested Mr. Rice prepare a letter to Mr. Coble regarding the above proposed fee increase or
petition for a change in state statute to allow the local user fees for Environmental Health foodhandling
services.
Mr. Steuer thanked Ms. Harvell for her presentation.
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Monthlv Financial Report - December 1999
Ms. Cindy Hewett, Business Officer, referred the Board to a chart and a summary of the December
Revenue and Expenditure Reports. She reported the monthly reflects the expenditure and revenue line
items are on schedule.
Committee Reports:
Budeet Committee
Budeet Review and Approval - FY2000-2001
Mr. Steuer recommended from the Executive Committee for the Board of Health to approve the FY 2000-
2001 New Hanover County Health Department Budget as presented. He explained the Executive
Committee endorsed purchasing a 4x4-conversion van for Animal Control Services instead of a 4x4 pickup truck
at a cost increase of $500. This change is included in the budget request.
Ms. Cindy Hewett, Business Officer, gave a Power Point summary of the Health Department FY2000-
200 I Budget Request ($10,192,451). A projection for salary market adjustment or merit were not
included. The budget overview included summaries of expenditures, capital outlay requests, projected
salary and fringe for 20 new positions and 1 position increase from part-time to fulltime, and projected
revenue.
Ms. Hewett presented Program Expenditure Changes from FY 1999-2000 excluding Salary and Fringe
Benefits. The total increase in expenditures is $286,534 (14%). The Capital Outlay request is $594,334,
a 6% decrease from FY 1999-2000. Computer Equipment Requests are ($215,350). Other Capital Outlay
requests ($454,934) include 2 mowers, 2 trucks, 2 conversion vans, 1 electronic gate, 2 generators, 1
transport unit, 1 storage unit, 1 concrete patio, 1 partition for auditorium, 1 fire/smoke alarm suspension
system, 12 workstation cubicles, 1 paper tray for copier, 2 copiers, 1 audiometer, 1 case management
module, and 9 workstation cubicles.
Mr. Greer inquired why the Administration budget increased approximately $140,000. Ms. Hewett
explained all computer requests and building improvements were placed in Administration budget
request. She advised that she consulted with the New Hanover County Information Technology
Department to assess health department computer needs to provide a more comprehensive computer
system. The Computer Support Specialist new position request is to provide technical support for the
personal computer based environment.
Ms. Hewett reported Projected Salary and Fringe ($644,171) includes 20 new positions and one part-time
to full-time position. The county appropriation ($247,779) is for 8 new positions and I part-time
position.
Ms. Betty Creech, Community Health Director, advised the Board of Education will fund 9 Public Health
Nurse and 1 clerical position requests. Dr. Goins endorsed the need for additional School Health Nurses.
Ms. Creech informed the Licensed Practical Nurse position is needed in the Jail Health Program that is
not meeting state requirements. The National Commission on Correctional Health Care identified
additional nursing staff is needed for the Jail Health Program. Ms. Hunter stated speaking from
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experience it is a disservice to Hispanics not to provide an interpreter and that the new interpreter position
will be cost effective.
Mr. Steuer stated new positions requests are essentially what is needed to perform agency duties. He
expressed the budget request is a minimum request. Mr. Greer stated he knew the positions and requests
were probably needed. He expressed concern regarding the possible expiration of grant funding, the fast
growth of government services, and budget expansion every year. He reported the County
Commissioners will have a retreat this weekend and address the county's growth and needs.
Ms. Hewett gave the following Budget Summary Report:
Total Cost to New Hanover County
Salary and Benefits
Operating Expenses
Capital Outlay
$ 7,857,281
1,741,399
594.334
Total Expenditures
$10,192,451
Difference from FY99-00
$ 930,698
Total State/Federal Revenue
$ 4,402,776
Difference from FY99-00
$ 486,768
Total Increase to County
$ 443,930
Ms. Hewett explained the net county increase ($443,930) is an 8.30% increase. She presented the
following projected Revenue Report:
Summary of Projected Revenue
State Money
Fees
Medicaid
Other
($ 55,884)
2,500
71,663
468.489
Total Increase in Revenue
$486,768
Ms. Hewett reported the projected revenue ($486,768) is a 12% increase.
Ms. Rowe thanked the Budget Committee and health department staff for their work on the budget. The
Board of Health Budget Hearing will be at the County Commissioners meeting on May 15,2000.
Mr. Steuer thanked Ms. Rowe for serving as Chair of the Budget Committee, the Budget Committee, and
Ms. Hewett for her budget presentation.
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MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to approve the FY
2000-2001 New Hanover County Health Department Budget as presented. Upon vote, the MOTION
CARRIED UNAMIOUSL Y.
Executive Committee
Mr. Steuer, Chairman, Executive Committee, reported the Executive Committee met at 7:00 a.m. prior to
the Board meeting on Wednesday, February 2, 2000. Items are listed under New Business on this
agenda.
Unfinished Business:
Generators/Hookups at Emereencv Shelters - Meetine February 21
Mr. Steuer reported by June 2000 according to the project timeline electrical transfer switches will be
installed in the schools used for disaster shelters. A meeting is scheduled for February 21, 2000, to
address generator/hookups expenses.
New Hanover County Board of Health Committee Appointments
Mr. Steuer appointed the New Hanover County Board of Health Committees for the Year 2000. The committee
assignments are as follows:
Executive Committee
Mr Wilham T. Steuer, Chairman
Dr. Wilson O'Kelly Jewell
Mr. Henry V. Estep
Mr. W. Edwin Link
Ms. Anne Braswell Rowe
Personal Health Committee
Mr. Henry V. Estep, Chairman
Dr. Wilson O'Kelly Jewell
Ms. Gela N. Hunter
Ms. Estelle G. Whitted
Dr. Melody C. Speck
Budeet Committee
Ms. Anne Braswell Rowe, Chairman
Animal Control Services Advisory Committee
Dr. Melody C. Speck
Environmental Health Committee
Mr. W. Edwin Link, Chairman
Ms. Gela N. Hunter
Dr. Michael E. Goins
Ms. Anne Braswell Rowe
Dr. Philip P. Smith, Sr.
Association of N. C. Boards of Health
Dr. Michael E. Goins
Mr. Steuer thanked the members for accepting Board of Health Committee appointments.
New Hanover Board of Health Compensation
Mr. Steuer recommended from the Executive Committee for the Board of Health to consider the concept
of increasing the monthly allowance for the Chairman and the Board of Health members with the amount
of the allowance to be determined after accessing the compensation of other comparable boards. He
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confirmed the monthly allocation for Board members is currently $20 and for the Chair is $25 and has
not been increased since 1982.
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A discussion followed on the considering a monthly increase for the Board Chair and members. Dr.
Speck expressed she views serving on the Board a community service and not monetary. Dr. Smith and
Ms. Whitted concurred with Dr. Speck. Dr. Goins suggested if the allocation is raised, there should be a
greater differential between the allocation increase for the Chairman and the Board members. Mr. Steuer
stated his concern was not compensation; however, increased compensation might be an incentive to get
qualified people to continue to serve on the Board of Health.
MOTION: Mr. Steuer moved from the Executive Committee for the Board to consider the concept of
increasing the monthly allowance for the Chairman and the Board of Health members with the amount of
the allowance increase to be determined after accessing the compensation of other comparable Boards.
Upon vote, the MOTION CARRIED UNAMIOUSL Y.
Mr. Steuer requested Mr. Rice submit a report to the Executive Committee on the compensation of other
Boards of Health and comparable agency boards.
Health Director's Performance Appraisal
Mr. Steuer distributed Performance Appraisal forms for the evaluation of Mr. Rice, Health Director. He
requested the appraisals be completed and returned in the self-addressed envelopes by February 15, 2000. I
Mr. Steuer explained there is a rating scale of 1 to 5.
The rating scale is as follows: 1. Exceptional, 2. Above Expected, 3. Expected, 4. Needs Improvement,
and 5. Unsatisfactory.
Dr. Goins stated the evaluation process is a valuable tool. It lets the employee know areas of good
performance and improvement. Mr. Greer advised expected is standard norm. Mr. Steuer emphasized
the importance of a fair evaluation. The Board of Health was asked to comment on how they scored. Mr.
Estep emphasized the importance of obtaining a quantitative value since it could be mean the difference
between being awarded or penalized. Mr. Greer stated this is a very valid statement, since you don't want
the rating to look anymore or less than it is. The Board of Health agreed to submit comments on all
ratings other than 3 (Expected). Based on a better understanding of the rating scale, it was
acknowledged that the Health Director's performance would be rated higher compared to last year's
process.
Comments:
Board of Health Members
,or. Smith encouraged Board members to obtain flu shot prior to the next flu season.
Mrs. Rowe announced the Health Department Budget Hearing with the County Commissioners is
scheduled for May 15, 2000. Ms. Smith will notify the Board of a definite time to attend the morning
meeting.
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Health Director
State Health Directors/ANCBH 14th Annual Meetine: - January 20-21.2000
Mr. Rice reported Dr. Jewell and he attended the Annual Association of North Carolina Boards of Health (ANCBH)
and Annual N. C. State Health Director's Conference held on January 20-21, 2000, in Raleigh, North Carolina.
The State Health Directors focused on "Emergency Preparedness - How Well Are We Prepared?" The
ANCBH topics were Dental Health Access in North Carolina: "Where is the Tooth Fairy?" and County
Dental Health Access Experiences". Dr. Jewell reported the demands for dental access is a statewide
Issue.
"Doctor to The Front: Dr. Thomas Fannine: Wood Presentation - January 7. 2000
Ms. Rowe, Ms. Smith, and Mr. Rice attended the "Doctor To The Front"/ Dr. Thomas Fanning Wood
Presentation on January 7, 2000, held at the Cape Fear Museum. Mr. Donald Koonce presented it on his
grandfather, Dr. Thomas Fanning Wood. Dr. Wood was known as the Father of Public Health in North
Carolina.
Disaster Preparedness Meetinf: - January 12. 2000
Mr. Rice, Ms. Betty Jo McCorkle, Women's Health Director; and Ms. Dianne Harvell, Environmental
Health Director, attended a Disaster Preparedness Conference for Health Directors held in Greenville,
North Carolina. The focus of the meeting was to explore how state and local agencies can work together
in future hurricanes. Press releases are to be prepared in advance.
Cape Fear Area United Way Allocations Team
Mr. Rice reported he plans to serve on the Cape Fear Area United Way Allocations Team.
Staff Appreciation Luncheon
A tentative date of April 6 was proposed for the Health Department Staff Appreciation Luncheon. Since
April 6 is Azalea Festival, another date will be selected and announced.
Animal Control Services Update
Ms. Jean McNeil gave an update on the Animal Control Services (ACS) concerns. She expressed her
appreciation for the new ACS positions. Ms. McNeil reported the backlog of data from June 1999 -
December 1999 has been entered, reminder cards were sent to residents, and pre-citation letters for
November 1999 licensing were mailed on January 21,2000. The ACS staff is working with a collection
agency to process delinquent account citations. Ms. McNeil advised approximately 600 field citations
dating back to August 4, 1998 will be processed by a collection agency.
Mr. Rice advised Mark Boyer, New Hanover County Public Information Officer, will prepare press
releases for ACS. Dr. Speck requested media releases are sent to local veterinarians.
Board of Health Information
Mr. Rice referred the Board to information in their packet on ACS Update, NCALHD Resolution
(Brunswick, Davidson, Rowan and Watagua Counties), Food Education Packet, and a Roster of ANCBH
Directors Emeriti.
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Other Business:
There was no other business.
Adjournment:
Mr. Steuer adjourned the regular meeting ofthe New Hanover County Board of Health at 10:35 a.m.
//~ (/ ~
William T. Steuer, PE/RLS, Chairman
New Hanover County Board of Health
David E. Rice, M.P.H.,M.A., Health Director
New Hanover County Health Department
Approved: March 3, 2000
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Health Director
Coastal AHEC Board of Directors
Ms. Smith announced Mr Rice was selected to serve on the Board of Directors of the Coastal Area
Health Education Center
NCALHD Plannin!! & Policv (Le!!islative Committee)
Ms. Smith advised Mr Rice was appointed to serve on the Policy and Planning Committee of the N. C.
Association of Local Health Directors.
ANCBH 14th Annual Meetin!! - January 20-21,2000
The Annual Association of North Carolina Boards of Health (ANCBH) meeting will be held on January 20-21,
2000, in Raleigh, North Carolina. The topics are Dental Health Access in North Carolina: "Where is the Tooth
Fairy?" and County Dental Health Access Experiences" A reception will be held on Friday, January 20 at the
Sheraton Capitol Center Hotel.
The Annual N. C. State Health Director's Conference - Januarv 20-21. 2000
The Annual N. C. State Health Director's Conference will be held in conjunction with the ANCBH meeting. The
topic is "Emergency Preparedness - How Well Are We Prepared?" It will be held at The McKinnon Center in
Raleigh, North Carolina.
Board of Health members were invited to register and attend the ANCBH 14th Annual Meeting and the Annual
N.C. State Health Director's Conference.
Blood Drive
Ms. Smith reported the Winter County Blood Drive was held yesterday, Tuesday, January 4 Board of Health
members may donate blood at the Red Cross Center through January 21
Danl!erous DOl! Determination Hearinl!s Reoort
Ms. Smith referred the Board to the Animal Control Services Dangerous Dog Determination Hearings Report in
their Board packets.
Time Caosule
Board members were invited to a Millennium Time Capsule Ceremony to be held at 8:15 a.m. on January 6, 2000,
at the Health Department. A Millennium Memories Time Capsule containing items from each division will be
buried at the Administration front entrance to mark the Health Department's entrance into the new millennium.
Museum Pro!!ram 1/7/2000 on Dr. Thomas Fannin!! Wood 11 a.m.
Ms. Smith announced Mr. Donald Koonce, scholar and Wilmington native, will present a program on his research
on Dr Thomas Fanning Wood, known as the Father of Public Health in North Carolina, at 11 a.m. on January 7,
2000 at the Cape Fear Museum. Dr. Wood was the founder and organizer of the first North Carolina State Board of
Health located in Wilmington.
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New Hanover County Health Department
FY99-00
MONTHLY REVENUE REPORT
As of December 31, 1999
Summary lor the New Hanover County Health Department
Cumulative % 49.98% Month Reported Month 6 of 12 Dee 99
CuneD! Year Prior Year
Type of Budgel8d Revenue Balance % Budgel8d Revenue Balance %
Revenue Amount Earned Remaining Amount Eamed Remaining
Federal & State 1,333,781 632,196 701,585 4740% 1,365,798 607,138 758,660 44.45%
AC Fees 516,453 174,260 342,173 33.75% 493,100 175,760 317,340 35.64%
Medicaid 852,684 324,703 528,181 38.07% 624,754 294,460 530,294 35.70%
Medicaid Max 192,301 192,301 100.00% 250,066 250,065 1 100.00%
EH Fees 312,900 108,768 34.76% 238,000 114,223 121,n7 48.40%
Heakh Fees 109,515 65,611 59.91% 98,065 55,472 42,593 58.57%
Other n5,ln 396,489 51.15% 566,457 323,4n 242,980 5711%
Note: County Appropriation is not calculated above. The County appropriation is the dlfferance between the tolalamounts on the
program expendfture report and the totsls on the program revenue report.
The budgetad amount for County Appropriation for FY 99 - 00 Is ($9,379,936 - $ 4,093,006) c $ 5,286,930.
The expended amount for County Appropriation for this FY (year-to-<late) is ($3,9n,098 - $1,894,348) c $ 2,062,750.
Revenue Summary
For Month of December 1999
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New Hanover County Health Department
FY99-00
MONTHLY EXPENDITURE REPORT
As of December 31,1999
Summary for the New Hanover County Health Department
Cumulative %
49.98% Month Reported Month 6 of 12: Dee-99
Current Year Prior Year
Expended Balance % Budgeted Expended Balance %
Amount Remaining Amount Amount Remaining
Typa of
Expenditure
Budgeted
Amount
Salary & Fringe
Operating
Capftal Outlay
Expenditure Summary
For Month of December 1999
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e.
DAVID E. RICE, M.P.H., M.A.
Health Director
To:
From:
Date:
Subject:
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500, FAX (910) 341-4146
Evaywherc. Everyday. Everybody.
LYNDA F. SMITH, M.P.A.
Assistant Health Director
New Hanover County Board of Health Executive Committee
Cynthia Hewett, Business Officer~
January 19,2000
Budget Workbook Fiscal Year 00-01
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Enclosed is your Budget Workbook for Fiscal Year 2000-2001. The first 12 pages provide summaries
of the information contained within the workbook.
Our total Budget Request FY 2000-2001 is $10,191,951. This is an increase 0[$930,198 from the
Approved Budget FY 00 amount of$9,261,753. A significant portion ($644,164) of the increase is due
to the request for 20 new positions, along with, the increase of one position from part-time to full-time
status.
Revenues through federal and state grants, fees, Medicaid, and other sources show an increase of
$486,786. The net increased cost to the county is $443,430 (8.30%). The budget request does not
include a projection for salary market adjustment or merit.
Our Budget Request FY 2001 is due to the County Budget Office on February 15,2000; for review by
the County Manager, Allen O'Neal, and his Budget Committee. In May we will receive the County
Manager's Recommended Budget FY 2001 for the Health Department. Any revisions to our original
Budget Request will be presented to you at a later date. On May 15,2000, a Pubic Hearing on budget is
scheduled and you will have an opportunity to appear before the Commissioners to discuss budget
matters.
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c: Board of Health Budget Committee
David E. Rice, Health Director
Lynda F. Smith, Assistant Health Director
Health Department Management Team
MWOiH' ~ - 'l1k~M
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~l.\.dqE;+ WOR.kbod<...
TABLE OF CONTENTS
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Index
Summary of Expenditures and Revenues
Salary and Fringe for Requested New Positions
Temporary Salaries and Overtime' On-Call
Capital Outlay Requested
Summary of Computer Requests
Operating and Capital Outlay
Revenues
Organization Line Items and Revenue Requests
5111 Environmental Health
5112 Vector Control
5114 Animal Control
5121 Laboratory
5131 Administration
5132 Board Members
5133 Child Health Services Coordination
5141 Women, Infants and Children
5142 Nutrition
5151 Epidemiology
5152 Tuberculosis
5153 Teen Aids Prevention
5154 Intensive Home Visitation Program
5155 Child Health Child Care Consultant
5156 Komen Grant
5158 Temporary Aid to Needy Families
5159 Maternity Care Coordination
5160 Health Check
5161 Personal Health
5162 Maternal Health
5163 Family Planning
5165 Breast and Cervical Cancer Control Program
5166 Partnership for Children
5167 Child Health
5168 Dental Health
5169 School Health
5172 Neurology
5174 Jail Health
5178 Children's Special Health Services
5180 Risk Reduction 'Injury Prevention
5181 Project Assist
5182 Health Education
5183 Safe Communities
Temporary Salaries
Overtime' On-Call Salaries
New Position Requests
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1
2
3
4
5
6-10
11
12
13-420
13
34
52
79
89
110
116
129
143
153
176
191
200
213
222
230
238
246
257
270
285
302
309
320
333
342
355
365
377
389
398
408
419
421
431
441
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NEW HANOVER COUNTY BOARD OF HEALTH
Committee Assignments
2000
Executive Committee:
Mr. William T Steuer, Chairman
Dr. Wilson O'Kelly Jewell
Mr. Henry V Estep
Mr. W Edwin Link
Mrs. Anne Braswell Rowe
Bndl!et Committee:
Member Division
Mrs. Anne Braswell Rowe, Chairman Administration
Mr. William T. Steuer Animal Control Services
Mrs. Gela N. Hunter Child Health Services
Dr. Melodv C. Soeck Communicable Disease
Dr. Philip Palmer Smith, Sr. Communitv Health
Dr. Wilson O'Kelly Jewell Dental Health
Mr. W. Edwin Link Environmental Health
Mrs. Estelle G. Whitted Laboratorv
Dr. Michael E. Goins Nutrition
Mr. Henrv V. Estep Women's Health Care
Envlroumeutal Health Committee:
Mr. W. Edwin Link, Chairman
Mrs. Gela N. Hunter
Dr. Michael E. Goins
Mrs. Anne Braswell Rowe
Dr. Philip Palmer Smith, Sr.
Personal Health Committee:
Mr. Henry V Estep, Chairman
Dr. Wilson O'Kelly Jewell
Mrs. Gela N. Hunter
Mrs. Estelle G. Whitted
Dr. Melody C. Speck
Animal Control Services Advisorv Committee
Dr. Melody C. Speck
Association of NC Boards of Health
Dr. Michael E. Goins
23
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-===fAWgjgJ~
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1999
l\.oster of I!Hrectors <!emeriti
(or tbe
~!)!)ociation o( ~ortb Q[arolina jBoarb!) o( ~ealtb
c
The Director Emeritus is an honor that is bestowed only on those leaders
in public health who have served on the ANCBH Board of Directors.
Directors Emeriti are entitled to:
. Attend all Board of Director meetings and functions
. A lifelong subscription to the ANCBH newsletter
. Receive the ANCBH annual meetings at no charge
. Be guests of honor at an annual reception
. Be represented on the current Board of Directors
(The retiring ANCBH past president will automatically serve as the
Directors Emeriti representative.)
Margery Adams Suzy Conner
Catawba County Davidson County
( 1986-1987) (1991)
Lee Barro, M.D Shirley Cooper C
Gaston County Cumberland County
(1995-1997) (1986-1987)
Ruth Brandon F Payne Dale, M.D
Buncombe County Pitt County
(1986-1991 ) (1986-1991 )
Bill Buchanan, CPA Jane G. Doughton
Nash County Appalachian District
( 1993-1997) (1991-1994)
Walker Campbell, M.D Hattie Ellis
Wayne County Wilson County
(1986-1987) (l988-1992)
Moses Carey, J.D Howard Fitts, Ed.D
Orange County Durham County
(1989-1991) (1988-1994)
Donald Carney Judith French
Iredell County Caldwell County
(1994-1996) ( 1986-1988)
Carolyn Carpenter Michael E. Goins, OD
Cabarrus County New Hanover County
(1992-1995) (1991-1992)
Paula Chewning-Bass Jean Gosnell
Pender County Davidson County
(1992-1996) ( 1986-1987)
Dolores Clement Mozelle Hall
Durham County Yadkin County
(1986-1991 ) (1990-1991 )
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aLftf,David E Rlc:e
T'fr 01/27/2000 11:17 AM
'.
~~"..,~",~:-~;:,.." ~~;;' "'" 'H;<I~,\r"'~<
..~~~~"!:" "\<IIIlta,'I'....~,;,,,k>...t<"';~..'-""',.:"~~q'~"-'.,..
To: Pat Melvin/NHC
cc: Lynda Smith/NHC, Jean McNeil/NHC, wsteuer541@aol.com
Subject: Re: Animal Control Services Update
Pat,
Attached is the requested update for the Board of County Commissioners, I will give this update
to the NHCBH at its meeting on February 2,
Thanks for all your help, Dave Rice :.)
til
, 999-?000 lie!! t
.......___......___... Forwarded by David E RicelNHC on 01/27/2000 11:26 AM .---......---.---.....---..
Jean McNeil
01/27/200010:35:28 AM
To:
cc:
David E Rice/NHC@NHC
Subject: Re: Animal Control Services Update
The following is a copy of the information we discussed concerning ACS's implementation of the
new Chameleon software and the county licensing fee process,
at
r.hmr.t.vr.om
New Hanover Countv Health DeDartment
Animal Control Services UDdate
Representatives from Health, Finance, Information Technology, Legal and the County
Manager's Office have been meeting regularly to implement and resolve Animal Control
If' Services (ACS) concerns.
Many thanks to the Board of County Commissioners for adding new positions to the
(i ACS staff. The Accounting Technician II's have already been utilized to bring the
\J backlog of licensing data to current status. They will also be instrumental in
implementing the licensing procedures.
.
. Thanks also to the County Commissioners for approving the new software system,
Chameleon, which is being utilized to maintain licensing and rabies information on
county residents. The ACS staff worked diligently to learn the new program, and
ACS went live with the software on October 4, 1999. (Some Chameleon users in
other states were not able to utilize the licensing portion of the program for six
months to one year after going live.)
. The backlog of data from June 1999 until October 1999 was brought to current
status in December 1999 by county staff and temporary help. The Accounting
Technician II positions are continuing with data entry.
. Reminder cards have been sent to residents on a monthly basis to give them an .
opportunity to update their animal's licensing information. These will soon be
reformatted to letterform, so the general publiC more easily understands the
reminder.
. November 1999 rabies data will be the first order of business in dealing with
computer- generated letters, citations, and subsequent collections or small claims
court,
. Pre-citation letters for November 1999 licensing data were mailed out on January
21, 2000. These letters will be utilized to cleanse the system of inaccuracies in the
data. Those residents that fail to bring their account to C\.IITert ~tatus wi" be mailed
citations in mid to late February 2000. " , .
. ACS staff met with a representative from Reilly-Gregory Collection Agency on
Wednesday, December 15,1999. The Legal Department and ACS will collaborate
with the collection agency to process delinquent account citations,
. There are approximately 600 field citations dating back to August 4, 1998, which will
be turned over to the collection agency for processing as a test group of delinquent
accounts.
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l~U1\.l n \..;/U\.ULll"lf\. f\.~.h3\.J\....1.t\.11Vl"t vr LU\....J-\L nr...t\.L 1 n .LIll'\.n\.... 1 VA.3
ri:tgt:: 1 UJ.J
MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Executive Committee Meeting
tJirt~ fJ
~ 10 'RfJIf
~~~
~6:r~
~d~O
CALL TO ORDER - President Maggie Dollar called the meeting to order a : 10 am
and announced that the Association would need to fmd other m ting room
arrangements next year. (See Attachments, Attendance Roster.)
November 18, 1999
Wake Co. Public Health Center
Raleigh, MC
APPROVAL OF MINUTES - Wayne Raynor presented the minutes of the October
20. 1999 Full Association Meeting. Minutes were approved as submitted with two
corrections "formally" instead of formerly and "slate" instead of state.
TREASURER'S REPORT - Wayne Raynor presented the Treasurer's Report which
was approved as presented. (See Attachments)
ANNOUNCEMENTS
Dr. Ann Wolfe gave an update on Department cuts/revisions mandated to assist
counties adversely affected by Hurricane Floyd.
Jim Baluss thanked everyone for all the support rendered to Edgecombe County
during recovery from Hurricane Floyd.
President Dollar announced that funding for Health Check positions was never
approved.
COMMITTEE ACTION ITEMS
. Education 61 Awards
Curtis Holloman encouraged members to nominate individuals for the Ham
Stevens Award which is to be presented at the January 2000 State Health
Director's meeting. Nominations must be received by December 31, 1999.
. Nominating 61 Bylaws
http://ncalhd.comlncalhd/I999/nmII1899.htm
01124/2000
l"tUK 111 L.f\..KULll'li\. 1\.~~UL.ll\.llVl"l vr LV\....J-\.L n.r..J-\.L 1 n U.l.lU::,"-' 1 V~
.1 G!;~ ~ V.1 J
,
No Action Items.
.
. Environmental Health Committee
No Action Items.
. Epidemiology Committee
No Action Items.
. Hospital Association Network
No Action Items.
. Managed Care 61 Reimbursement
No Action Items.
. Policy 61 Planning
No Action Items.
. State 61 Local Relations
No Action Items.
.
. Technology
No Action Items.
. Women's 61 ChUdren's Health
Wanda Sandele provided an update regarding minors consent to health
services. She discussed a resolution that came from Commissioners in
Rutherford County (not passed by that board) was mailed to all County
Commissioners urging them to pass it and forward it to the Commissioners'
Association. The resolution calls for the Legislature to repeal the statute that
protects the confidentiality of minors seeking birth control at Health
Departments. The resolution was passed by Davidson County without the
item requiring the Health Department to prepare a position paper in support
of the resolution. Wanda presented a resolution "Access to Preventive Health
Care for Minors" (See attached Resolution). Some discussion ensued
regarding the timeliness of presenting the resolution to the legislature.
Motion: It was agreed that the NCALHD should take the position at
present but proceed no further with regard to formally taking the issue .
to the MCACC at the present time. Motion passed.
http://ncalhd.comlnca1hd/I999/nmII1899.htm
01124/2000
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-. .- -- -- -- --.......-.-.-
NOR.TH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
RlI'JilOL1JTION
ACCESS TO PREVENTIVE REALm CAllE FOil MINORS
WHEREAS minors in the state ofNortb. Carolina have had the legal rigb& to ..
preventive health eare services without parental COllSllDt since the passage ofGS 90-21.5
in 1971, and this rigbs appears to have coJdribuIeCl sipiticamty to lmproveme:J'tJlln the
health status ofyouIl& people- partiGl1larly In the rdudiou of North CaroliJl&'s teeD
pregnancy ~ and
WHERE.AS the North Carolina MIlO_on of Local HAlthDirectorB IJI'!lClI its membm
who serve minors to rounseI JDinors to involve their puentaln decisions about their
health care rat1u:r than requiring such involvement.
WHEREAS many minors do IIlJt have eitbm'the suppcnt or &dvico of their parents on
seeking preventive services and are thus at high-risk of poor health outc:omea inducting
preguancy and 'O"lIally trBDsmitted diseud; and
WHBllEAS statistks OIl teeD 88lWal behavior iJpHeote that teeD8 typically are sexually
active for approximately one year before .-lnng reproductive beaIth care thus diaptoviDI
the IISIUsnption that prD\'ld1ng sud! care e.nc:ourapll teeDI to bet1oIDI' 88lWally active; and
WHEllEAS statiatica also indicate that the rca:nt reductions in teen pregnancy rates are
largely the result of teens Ilrilizi1lg efl'ective CClIItlUllpIive matbocls which are available
only with prescriptions thus RqUiriDs a c1IIIIca1 vi~ II!Id
WHBltBAS t_ pregIWICiea often resuh In economic and hea1tb problems both for the
YOUDg parents II!Id the babies involved; IlIId
WHEREAS denying minors the right to _It preventive servicea without parental
IlODSent snay resu1t in the Ion of approltimately SS million _""ony in Federal Title X
funding for fiunily rl.....l"g-thus severely limiting access to tlIlnIly planniDB to low-
ineome adults as well as to minors; now therefbre be It
RBSOL VED that the North CarolIna Assoaiatiou of Local Bea1thDireCtOrs qrp the
North Carolina GcnenI Assembly to maintAin Icgia1ation wbicb p.utelllS the abilily of
snlnDrs to seek preventive health care; IlIId be iJ further.
Margaret B. Dollar
President
/.-8
.
I
NEW HANOVER COUNTY HEALTH DEPARTMENT
WINTER 1999
c
Norwalk virus: A major
microscopic menace.
Also in this issue...
Illness Reporting-It's better to
be safe than sorry
Page 2
Virology 101- The dirt on
Norwalk and hepatitis A viruses
Page 2-3
Hepatitis A-A good news/bad
news organism
Page 3
Hands Oll?- The bare facts
about handling food
Page 4
(
\
Copyrighl1999
Pike & Fischer, Inc.
800-255-8131
Meet the New Public Enemy #1
Do you know the leading cause of foodborne illness? No, it's not Salmonella
or E. coli 0157:H7 The culprn is a group of organisms you may have never heard
of before, but you or one of your co-workers may have had a hand in helping it
earn its top billing. Norwalk-like viruses (NLVs) were recently identified by the
COC as being-by far-the biggest known cause of foodborne illness. COC
estimates that NLVs (sometimes called caliciviruses or small round structured
viruses) in food make over nine million Americans sick each year wnh viral
gastroenteritis-that yucky "stomach flu" that includes watery diarrhea and
vomning. Gastroenteritis is second only to the common cold as a cause of illness.
How are NLVs spread?
Quite easily, thank you, by that unpleasant fecal-oral route. The feces of
infected individuals may contain millions of viral organisms, only about 10 of
which are required to make someone sick, according to Dr. Stephan Monroe, a
viral disease expert at COCo Just because you can't see feces on your fingers
doesn't mean it's not there, he said, noting, "Food workers need to keep stool
material out of the food they're serving customers by paying rigorous attention to
personal hygiene." Some NLV outbreaks are blamed on shellfish and produce
contaminated before harvest, but often the contamination occurs right before the
food is eaten when it is touched by an ill food worker. When FDA looked into all
recent outbreaks linked to food worker contamination of food, 60% were caused
by viruses, and almost all involved a sick food worker. Close to 90% of the
outbreaks occurred in food service settings.
If NLVs are so common, why haven't we heard of them before?
Only in the last 10 years or so have we had the detection tools needed to
easily detect these viruses. The Norwalk virus, part of the NLV family, is named
after Norwalk, Ohio. That's where, in 1968, 100 elementary school children and
their teachers fell ill with a mystery illness. It took four years for researchers to
identify the agent, marking the first time a virus turned up as a cause of
gastroenteritis. Because NLVs cause relatively mild and fleeting symptoms, the
illnesses are often not reported or diagnosed. It was only this year that COC
included NLVs in its disease statistics and estimated they caused a whopping
67% of all foodborne illnesses and 7% of the foodborne-related deaths.
What can food workers do to stop the spread of NLVs?
Most importantly, ill food workers must not be allowed to handle ready-to-eat
(RTE) foods or come inlo contact with food prep surfaces. All workers, even if
they feel fine, should avoid touching RTE foods with their bare hands by using
gloves or other utensils, and they should wash their hands frequently. The Food
Code stales that food workers should telllheir employers if have diarrhea,
fever, vomiting, or jaundice. It is the manager's job to make sure sick empioy-
ees are either sent home or assigned to tasks that don't involve food contact.
Sometimes food workers have no symptoms but may still be shedding disease-
causing organisms in their feces. "That's why good personal hygiene is critical
at all times," Monroe said, "whether a food worker is ill or not."
FOOD TALK
WINTER 1999
IL
'---/
Better Safe Than Sorry
Your new shift just came on duty and you realize you're short two employees.
Just 20 minutes into the shift, one of your best employees comes to tell you that
she's not feeling well. She tells you her stomach is cramping and she feels nause-
ated. What do you do? Tell her to go home? Or keep her on duty because you are
shorthanded? The "cure" is to play it safe-send the employee home or to a doctor.
It's much better to ask your customers for patience because you are short- handed,
than to risk an outbreak.
Keep in mind, the FDA states in the 1999 Food Code that an
employee should be "excluded" from work if he or she is
diagnosed with an illness due to:
. Salmonella Typhi,
. Shigella spp.,
. E. coli0157:H7 or
. Hepatitis A virus.
Employees should be restricted from handling food if
they have the following symptoms:
. Diarrhea,
. Fever,
. Vomiting,
. Jaundice or
. Sore throat with fever.
Food workers should feel obligated to tell their bosses when
they are sick, and employers should feel obligated not to risk
the safety of their customers or employees, according to
Tim Weigner, manager of food safety programs for the
Food Marketing Institute. Instilling this sense of obligation
is the job of top management, he said. The price to a business for keeping sick
food handlers on the job, particularly if they are later found to have a communicable
disease, can be quite steep, he said.
But how do you getan employee to report illness? "That's the $64,000 question,"
according to David McSwane, food safety training specialist at Indiana University.
"The illness reporting policy has to be fair-you do not want to penalize workers for
admitting they're ill," he said. "Workers do not want to lose the income associated
with not being able to work. It may be to management's advantage to pay an
employee not to become ariskrather than payout a settlement after'an outbreak."
What do you do with an employee showing mild symptoms? A practical solution
is to reassign that employee to non-foodhandling tasks. It's also important to
reinforce proper handwashing with employees. "Good hygiene can cure a lot of ills,"
McSwane said. Keep in mind the cost of a foodborne outbreak on your customers,
your employees, your bottom line, your reputation, and your survival in the busi-
ness. It is better to be safe than sorry.
,
Estimated Annual Food-Related Illness and Death In the U.S.
AGENT
Bacterial
(e.g., Salmonella, Campylobaetef)
Parasitic
(e.g., Giardia, Cryptosporidium)
Viral
(e.g., Norwalk.like, Hepatitis A)
ILLNESSES HOSPITALIZATIONS
DEATHS
4,175,565
36,466
1,297
357, 190
3,219
383
9,282,170
21,167
129
Total: 13,814,924 60,854 1,809
Source: CDC's "Emerging Infectious Disease Journal: Sept./Oct. 1999.
WHAT YOU NEED
Norwalk-Like
Viruses
Agent: Norwalk-like viruses
are a family of small round
structured viruses, including
the Norwalk virus, that cause
gastroenteritis.
Symptoms/Onset: The
symptoms of gastroenteritis
(nausea, vomiting, diarrhea
and abdominal pain) usually
develop 24-48 hours after
contaminated food or water is
consumed. Symptoms are
relatively mild and last for 24-
60 hours. However, the virus
may still be shed for 48 hours
after symptoms disappear.
Common Causes: NLVs are
spread fecal-orally, often b"-'.
contaminated food or watEi
Raw or inadequately steamed
shellfish and salad ingredi-
ents are the foods most often
implicated in Norwalk out-
breaks. Other foods are
contaminated by ill food
handlers.
Those At-Risk: Anyone who
ingests the viruses can get
sick, though NLVs are more
likely to cause diarrhea in
adults and older children.
Treatment: Symptoms can
be treated, but there is no
vaccine. Once people are
infected with NLVs, they are
not likely to get sick from the
same or similar strain for up
to two years.
Prevention: Thorough
handwashing, particularly
after using the bath-
room, adequate
cooking of
shellfish and
use of
potable
water can
help control
spread of
NLVs.
WINTER 1999
/.
FOOD TALK
I
TO KNOW ABOUT:
Hepatitis A
Agent: Hepatitis A virus,
which infects up to 200,000
Americans a year, is a highly
contagious virus that attacks
the liver.
Symptoms/Onset: A month
or more may pass before
someone infected with
hepatitis A shows symptoms;
these initially include fever,
fatigue and nausea often
followed by jaundice. Infected
individuals can unknowingly
infect others two weeks prior
to feeling ill themselves. Up to
22% of adult Americans who
contract hepatitis A require
hospitalization.
,;:qmmon Causes: Hepatitis
C ' 1 spread by the fecal-oral
" "LIte, and contamination of a
variety of foods by infected
workers in food processing
plants and food service
facilities is common.
Those At Risk: About 15% of
reported cases involve
children or employees at
daycare settings. Hepatitis A
is also common in institutions
or crowded living areas where
poor sanitation allows water
supplies to become contami-
nated.
Treatment: Hepatitis A
vaccines are available and
are recommended for chil-
dren and other high-risk
individuals in areas where the
virus is more common.
Immune globulin shots can be
given within two weeks after
exposure to prevent infection.
Most people who contract
the infection develop a
life-long immunity to
reinfection.
Prevention: Wash
hands and practice
good personal
hygiene and avoid
raw seafood.
Hepatitis A Is Bad News
An Italian restaurant at Sea World in California made national news recently. So
did a steakhouse in Smithfield, NC, and a popular restaurant in St. Louis. Each
of these restaurants got some unwanted publicity because one of their food
handlers was found to be infected with the hepatitis A virus. Once a worker is
diagnosed with hepatitis A, everyone who may have consumed foods prepared by
the worker must be notified immediately so that they can receive an immune
globulin shot before the infection spreads. The larger the restaurant, the wider the
~ publicity, and what business
K needs that kind of press?
/: -I:=; I ^""'.........A~"
/ ~ destroy an establishment, even if
g'/Y. c.~ no one falls seriously ill. One
" /t / recent hepatitis A outbreak
~r-.' _(.: blamed on an infected food
i /. / handler ran up costs of over
, $800,000 including the price of
;Y.<Y....) ,l1l. ~ giving immune globulin shots to
, \ ..'-~ some 5000 customers who could
L1- have been exposed. Restaurants
./1/- . want their customers to have
1"-e:l<<;5 memories of a pleasant dining
experience; not of a painful shot
\ in the arm. How doyou protect
\ ~ ~L1t\ ~. . 1'\1<E.S A ~'\' 1..&\1' f~ your food service establishment
. from such a nightmare?
And now for the good news:
The good news is hepatitis A is preventable. A few years ago, two vaccines
against hepatitis A came on the market. The vaccines are not cheap (with a two-shot
series running as high as $150), but food service establishments can work with their
local health departments to shave about $100 off that price. Compared with the cost
of an outbreak, foodworker vaccination can be a very wise investment.
Having food workers vaccinated "is like taking out an insurance policy," noted
Steve Grover of the National Restaurant Association. His group supports voluntary
vaccinations of food workers against hepatitis A, particularly in areas where the
disease is widespread. CDC recently identified several states where hepatitis A
rates are high enough to justify routine vaccination of children. Those states
include: Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma,
Oregon, South Dakota, Utah and Washington.
CDC is not currently calling for all food workers to be vaccinated against hepati-
tis A. Foodborne outbreaks of hepatitis A are not all that common compared with
those in other settings, CDC notes, and food handlers are not at particular risk of
contracting the disease on the job. CDC recommends vaccination be considered
for foodservice employees "who work in areas where community-wide outbreaks
are occurring and where state and local health authorities or private employers
determine that such vaccination is cost-effective."
Before vaccinating food workers, a few factors should be considered. First, if the
rate of hepatitis A infection is high in the community, there's a greater chance a food
handler will bring the disease to work. Second, once someone has had hepatitis A
(roughly a third of the U.S. population), they develop a lifelong immunity, so not all
foodworkers need to be vaccinated. A simple blood test can determine if the vaccine
is needed. Third, strictly following good hygienic practices, like handwashing and no
bare-hand contact of foods, helps reduce the risk of a hepamis A outbreak. For more
information, call the Hepatitis Foundation International hotline at 800/891-0707, or
visit the group's web site at <www.HepFI.org.>
FOOD TALK
WINTER 1999 ,
'.
Bare Facts
About Hands
Should the bare hands of
food workers and ready-to-
eat (RTE) foods ever meet?
That was the question FDA re-
cently put to the members of the
National Advisory Committee on Microbiological Criteria
for Foods, who advise FDA and USDA on food safety
matters. After a thorough review, the panel concluded:
. Bare-hand contact of RTE foods can contribute to
the spread of disease.
. Disease spread can be interrupted by keeping ill
food workers away from RTE foods and food sur-
faces, and making sure workers wash their hands
regularly and thoroughly; and
. While bare-hand contact of RTE foods should be
avoided, most members of the panel felt there wasn't
enough science to support a bare-hand ban.
To help the NACMCF in its discussion, FDA devel-
oped a document summarizing what's known about
bare-hand contamination of food by food workers and
practices or products that control the spread. Some
highlights:
. Handwashing for 10 seconds appears to be just as
effective as washing for 20 seconds, provided proper
handwashing technique is followed.
. The verdict is still out on whether there are any clear
advantages to using antibacterial products.
. Rings and artificial fingernails may interfere with
handwashing or trap food debris and microorganisms.
. Gloved hands can spread disease-causing organ-
isms, and gloves should be changed regularly with
adequate handwashing before and after.
FoOD TALK ~
New Hanover County Health Department
Environmental Health Division
2029 South 17th Street
Wilmington, HC 28401
DAVID RICE
HEALTH DIRECTOR
HEALTH DEPARTMENT
Printed on recycled paper
You'd Better Wash Your Hands
--'\
I .
.-J
(Inspired by The Beatles' "I Want to Hold Your Hand")
Oh yeah, /'11 tell you something
I think you'll understand
For the sake of sanitation
You'd better wash your hands
You'd better wash your hands
You'd better wash your hands
Before and after meals
And when you use the can
Soap and water for 20 seconds
Should be part of your plan
That's how you wash your hands
That's how you wash your hands
And when you're finished you'll feel happy inside
Washin'so thorough that microbes
They can't hide, they can't hide, they can't hide
Make sure you clean your nails
And dry with towel or fan
Prevent those nasty microbes
From spreadin' 'cross the land
You'd better wash your hands
You'd better wash your hands
(Repeat 3'" and 1" verses)
Put your hands together for that
wacky singing professor, Dr. Carl
Winter of the University of
California, Davis, who included
this little musical morsel on his new
CD, "Sanitized forYour Consump-
tion." To hear his latest food safety
tunes or to order his CD for free (though Winter does
welcome donations for singing lessons), go to his web
site at <http://foodsafe.ucdavis.edulmusic.html>
'J
v
NEW HANOVER COUNTY
HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
2029 SOU1ll17'" STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6667, FAX (910) 772-7810
j .
t1
II~
. ).
~ ..
~~~
.
--..-.
DAVID E. RICE, M.P.H., M.A.
Health Director
LYNDA F. SMITH, M.P.A.
Assistant Health Director
MEMORANDUM
TO:
Food Service, Child Care Facility, Institution And Other Retail
ManagerslEmployees
Dianne Harvell, Environmental Health Director ~
DATE: January 12, 2000
FROM:
SUBJECT: Hepatitis A Vaccine and Preference Survey - Serving Safe Food
Certification Course
. Hepatitis A Vaccine
Literature published by one of the hepatitis A vaccine manufacturers,
SmlthKllne Beecham, is included in this packet of materials. SmlthKllne Beecham
has also produced an informative video about hepatitis A. We have copies
available for establishment managers/employees interested in learning more
about this highly infectious disease. You may get a copy of the SmlthKllne
Beecham hepatitis A video by calling our office at 910-343-6667.
The health department administers hepatitis A vaccine Monday, Tuesday,
Wednesday and Friday between 8:15 a.m. and 4:30 p.m., and also on Thursday
between 8:15 a.m. and 6:45 p.m. Appointments are not required. The cost is
$25.00 per immunization with the need for a booster at six to twelve months.
During the forthcoming "Serving Safe Food Certification Course", students will be
offered the immunization at a reduced rate of $17.00. Further information about
hepatitis A immunization can be obtained by contacting Ann Lawrence, RN at 910-
343-6523 or Cammie Marti, RN at 910-343-6532.
Preference Survev - Serving Safe Food Certification Course
-
We have taught several sessions of the National Restaurant Association's
"Serving Safe Food Certification Course" annually for the past four years. In
January 1998, Cape Fear Community College partnered with us in this initiative to
enhance food safety knowledge within the local food service industry. As an
II,.. ~'1r/d-~~"
~
incentive, Cape Fear Community College's Department Of Continuing Education
and the New Hanover County Board Of Health began awarding in 1998, a special
plaque of recognition to establishments that have five or more employees attend
and successfully complete a session of the certification course. The plaque is
presented during a Board Of Health meeting. McDonalds, New Hanover Regional
Medical Center, the University Of North Carolina At Wilmington and Clarence
Foster's Restaurant are all recipients.
... ~',;Y~'f;;,.;C""~"{'''-;'' ~.
.
j;
.
Brian Fleishman of Clarence Fo_s
Restaurant displays a plaque of
recognition presented at the PEc:eluber
1,1_ New Hanover County Board Of
Health meeting. Bryan and four of his
employees __ the July 1_
Serving Safe Food Corti_on
Course. Pictured left to right are:
Allison Rankin, Associate Dean, Center
For Business, Industry And
Government, Cape Fear Conmunlty
College; Brian Fleishman, Manager,
Clarence Foster's Restaurant; Alicia
Pickett, Envlronmentel Health Program
Specialist, New Hanover County Health
Peparlment: and, Isabel Charlelon,
Director Of Corporate Training, Cape
Fear Community CoIIep.
Additionally, a business regulated under state "Rules Governing The
Sanitation Of Restaurants And Other Foodhandling Establishments" qualifies for
"a credit of two points on its score for each inspection if a manager or other
employee responsible for operation of that establishment and who is employed
full time in that particular establishment has successfully completed in the past
three years a food service sanitation program approved by the Department.
Evidence that a person has completed such a program shall be maintained at the
establishment and provided to the Environmental Health Specialist upon request.
An establishment shall score at least 70 percent on an inspection in order to be
eligible for this credit".
The first session of the certification course to be offered this year is
scheduled for January 25 and 27, and February 1 and 3 from 4:00 to 8:00 p.m.
You may register by contacting Cape Fear Community College's Department Of
Continuing Education at 910-251-5696. Cost and textbook information can be
found on the enclosed bulletin from Cape Fear Community College. It may be
beneficial to begin reading the textbook before the first day of the course.
To create greater opportunities for participation in the certification course,
we need a better indicator of suitable daysltimes. Please answer and return to us
at your earliest convenience questions on the enclosed survey card. We will use
your response to schedule future sessions. If you require any additional
information, please feel free to contact us at !U0-343-6665.
-
WHAT IS HEPATITIS A?
.
. An infectious liver disease
. It attacks the liver and can make you very sick
WHAT ARE THE SYMPTOMS OF HEPATITIS A?
HEPATITIS A
Symptoms of hepatitis A include':
. Fever
. Fatigue
. Loss of appetite
. Nausea
. Abdominal discomfort
. Dark urine
. Jaundice (yellow coloring of skin and white part of eyes)
WHAT PEOPLE
WHO HANDLE
FOOD SHOULD
How SICK CAN HEPATITIS A MAKE YOU?
KNOW
Most people are sick for less than 2 months; 10% to 15%
of people with hepatitis A start to feel better, only to get sick
again.' Their symptoms may continue on and off for up to 6
months.' Infected adults on average lose more than 5 weeks
of work, resulting in $2600 in lost wages."
.
Hepatitis A can be serious in adults; 11 % to 22% of infect-
ed adults require hospitalization' and some even die.3
Average hospitalization costs are $2800 per adult case.'
How CAN YOU BECOME INFECTED
WITH HEPATITIS A?
Hepatitis A Vaccination Plus More
The virus is most often passed from person to person, most-
ly through fecal contamination and then hand-to-mouth con-
tact-but it can also be spread through contaminated food
and water.' The virus can even survive incomplete cooking
and freezing, and can live for up to 10 months in water'"
After infection, people are contagious for about 2 weeks
before showing any symptoms.s Infected food handlers can
pass the virus on to other~ven before they know they are
sick themselves.
.
WHO IS AT RISK OF GETTING HEPATITIS A?
It is estimated that up to 134,000 people are infected each
year in the United States.' People who live in, work, or even
travel to places where the disease is more common are at a
higher risk of getting the virus.'
How CAN YOU PROTECT YOURSElF?
Good hygiene including careful handwashing is very impor-
tant in protecting yourself and others against hepatitis A. .
But you can't be sure that other people practice good
hygiene, so the best protection is vaccination.
HEPATITIS A
Hepatitis A vaccines stimulate your body's immune system,
protecting you if you are exposed to the virus. To make your
protection last longer, you will need two shots-the first and
then a "booster" shot.'
WHAT PEOPLE
WHO HANDLE
The hepatitis A vaccine is considered safe and effective.
It uses an inactivated (killed) virus, so the vaccine will not
give you the disease.'
FOOD SHOULD
Vaccination will protect you at work and if you travel to any
areas where hepatitis A is endemic, including Mexico and
parts of the Caribbean.'
KNOW
For more information, talk to your employer about the
A+ program-a hepatitis A prevention program for people
working in food service.
.
Hepatitis A Vaccination Plus More
Provided as an
educational service by
sn SmrrhKlme Beecham
References: 1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable
Diseases. The Pink Book. 5th ed. January, 1999.2. Hadler SC. Global impact of hepatitis A virus infection: .
Changing patterns. In: Hollinger FB, Lemon SM, Margolis HS, eds. Viral Hepatitis and Liver Disease. Ballimor
MD: Williams & Wilkins; 1991 :14-20. 3. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance
Program, 1993. In: Atlanta, GA: April 1996:1-17 4. Battegay M, Gust 10, Feinstone SM. Hepatitis A virus. In:
Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. New York: Churchill
Livingstone; 1995;1636-1638.5. Centers for Disease Control and Prevention. Prevention of hepatitis A through
active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Motbidity and Mortality Weekly Report (MMWR). 1996:45(No. RR-15):1-31.
HAl096 Sept. 1999
flSmithKline Beecham, 1999
(j Printed in U.SA
.
EPllnformation
January 2000 New Hanover County Healtll Department Betsy Summey, F N P Editor
.
Meningococcal vaccine
is now being offered
at New Hanover County
Health Department. This
occurred after the Advisory
Committee on Immunization
Practices (ACIP) of the
Centers for Disease Control
CCDC) changed its
recommendation to endorse
giving the vaccine to certain
high-risk groups, especially
college freshmen living in
dormitories.
Components
The vaccine contains
antigens from Group A, C, Y,
and W-135 from Neisseria
meningilidis. It will not
protect against other etiologic
agents, including N.
meningilidis, serogroup 8,
that cause meningitis.
Protective antibody levels
may be achieved within 7-10
days after vaccination. As
with any vaccine, 100% of
those immunized may not be
protected.
.
The vaccine will not be
administered to patients
under 2 years of age as
clinical trials have shown it
ineffective in that age group.
Protection wanes after 3-5
years, making re-
vaccination of those who
continue to be at great risk
for meningococcal disease a
consideration.
Routine vaccination is
recommended for the
following high-risk groups:
I) Deficiencies in the
complement components
C3, C5-C9
2) Functional or actual
asplenia
3) Persons with laboratory or
industrial exposure to N.
meningitidis aerosols
4) Travelers to and residents
of sub-Saharan Africa
5) College students,
especially those living in
dormitories
Households or institutional
contacts of persons with
meningococcal disease, and
medical and laboratory
personnel at risk for exposure
should be considered for
vaccination, although it
should not be considered as
treatment for disease.
!11111"i'llilil~flll
Salmonellosis continues
to be an ongoing
problem in New Hanover
County with 2 cases
occurring in the same child
care facility during
December Public health
officials continue to caution
us about reptile-borne
Salmonella, and its
possibility as the source of
some of the infections.
A large outbreak here in early
fall, where many of the cases
were of the same rare
serotype (Javiana) continues
to cause puzzlement since no
common source was
identified. The J aviana strain
is associated with reptiles and
even though a reptile was not
present in households of ill
patients, indirect
contamination is possible
through a visitor in the
household.
Carriers
Several case studies
conducted by the CDC in
Atlanta have depicted very
severe cases of Salmonella
infection, some being fatal,
where the source of infection
was indirect. Commonly the
patient was infected by a care
giver who handled a reptile
and did not conduct proper
handwashing afterwards. In
fact, many families are
unaware that turtles and
rep,tiIes can be carriers. For
most of the affected families,
iguanas and snakes were the
source.
Subsequent surveys by the
CDC to state health
departments revealed only a
very few states had
regulations for the sale of
reptiles or distribution of
information about
salmonellosis. Pet store
owners are in a unique
position to educate because
customers get most of their
information about their pet
from pet store personnel.
The CDC and the Pet
Industry Joint Advisory
Counsel have developed
educational posters and
brochures for use by
veterinarians and pet store
owners on safe pet-reptile
handling.
The CDC has developed
recommendations for
preventing transmission of
Salmonella from reptiles to
humans.
. Pet store owners,
veterinarians, and
pediatricians should
provide information to
owners and potential
purchasers of reptiles
about the risk of acquiring
salmonellosis from
reptiles.
. Persons should always
wash their hands
thoroughly with soap and
water after handling
reptiles or reptile cages.
. Persons at increased risk
for infection or serious
complications of
salmonellosis (e.g.,
children aged <5 years and
immunocompromised
persons) should avoid
contact with reptiles.
. Pet reptiles should be kept
out of households where
children aged <I year and
immunocompromised
persons live. Families
expecting a new child
should remove the pet
reptile from the home
before the infant arrives.
. Pet reptiles should not be
kept in child care
facilities.
. Pet reptiles should not be
allowed to roam freely
throughout the home or
living area.
. Pet reptiles should be kept
out of kitchens and other
food-preparation areas
to prevent contamination.
Kitchen sinks should not
be used to bathe reptiles or
to wash their dishes, cages,
or aquariums. Ifbathtubs
are used for these
purposes, they should be
cleaned thoroughly and
disinfected with bleach.
.'
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As was mentioned in a
previous EPI Info, a
new tuberculosis control
manual has been issued by
the state. Please contact
Ginger Clegg, RN, at 343-
6689 for an update to the
1992 edition.
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Copies of the Rabies
Manual published by
New Hanover County Health
Department are still
available. The manual
contains valuable information
on definitions for exposures,
treatment for exposures,
preventive treatment, and
resources. A copy may be
obtained by contacting
Anne Lawrence, RN, at
343-6523.
-.
Communicable Disease Statistics
New Hanover County
July 1, 1999 - December 31, 1999
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