HomeMy WebLinkAbout10/02/2002
New Hanover County Health Department
Revenue and Expenditure Summaries for August 2002
Cumulative: 16.66 % Month 2 of 12
e
Revenues
Cunent Year Prior Year
Type of BUdgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Fed/State 1,692,429 113,684 $. 1,578,745 6.72% .$ 1,294,050 26,876 $ 1,267,174 2.08%
AC Fees 533,044 89,922 $ -443;122 16.87% $ 533,044 93;936 $ 439,108 17.62%
Medicaid 1,035,386 76,988 $ 958,398 744% $ 961,934 94,441 $ 867,493 9.82%
Medicaid Max #DIV/O! $ #DIVlO!
EH Fees 16.18% $ 312.900 268,205 14.28%
Health Fees 27.67% $ 112,850 23.16%
Other 16.32% $ 1,249,681 5.50%
Expenditures
e
Current Year FY 03
Prior Year FY 02
Type of Budgeted
Expenditure Amount
Expended
Amount
Balance
Remaining
%
Expended
Amount
Balance
Remaining
%
12.37%
8.48%
Note: County Appropriation is not calculated above. The County appropriation is the difference between the total amounts on the
program expenditure report and the totals on the program revenue report.
The budgeted amount for County appropriation for FY 02-03. $10.787,097-$5.013,610)=$5.773,487.
The expended amount for County Appropriation FY to date is ($1.405,632-%579.054) $826,578.
Budgeted Actual %
FY 02.Q3 FY 02-03
Expenditures:
Salaries & Fringe $ 8,798,590 $1,183,481 13.45%
Operating Expenses $ 1,839,543 $ 220,134 11.97%
Capital Outlay 148,964 $ 2,017 1.35%
Total Expenditures $10,787,097 $ 1,405,632 13.03%
Revenue: $ 5,013,610 $ 579,054 11.55%
e Net County $$ $ 5,773,487 $ 826.578 14.31%
Revenue and Expenditure Summary 9
For the Month or August, 2002
Date (BOH) Grant Reauested Pendinll Received Denied
Safe Kids Buckle Up Program-North Carolina
10/212002 Safe Kids $5,000 $ 5,000
Developing Geographic Information Systems
(GIS) Capacity in Local Health Department In
Eastern North Carolina-Duke University
Nicholas School of the Environment and Earth
Sciences (NSEES) $18,000 $18,000
9/4/2002 No activity to report September,2002
81712002 No activity to report for August 2002
7/3/2002 No activity to report for July 2002,
Prenatal Health Education and
Information/Referral Services- March of Dimes
6/5/2002 Community Grant Program $49,975 $49,975
5/112002 No activity to report for May 2002.
4/3/2002 No activity to report for April 2002.
31612002 No activity to report for March 2002.
2/6/2002 No activity to report for February 2002.
11212002 No activity to report for January 2002.
Diabetes Education, Management and
12/5/2001 Prevention - CFMF $60,000 $30,000 $30,000
Youth Tobacco Prevention Project- Robert
111712001 Woods Johnson Youth Center $11,800 $11,800
Teens Against Tobacco Use (TATU)-Health
Action Council of NC $350 $350
Healthv Carolinlans- NC DHHS $10,000 $10,000
Family Assessment Coordination- March
9/5/2001 of Dimes $16,500 $16,500
Folic Acid Prolect- March of Dimes $16,618 $3,000 $13,318
Safe Kids Coalition- State Farm"Good
Neiahbo~' $500 $500
TB Elimination and Prevention - CDC,
8/1/2001 NCDHHD, DPH, TB Control Proaram $10,000 $ 9,200 $800
Teen Aids Prevention ITAP)- CFMF $45,500 $25,000 $20,500
Diabetes Today - Diabetes Prevention & Control
7/1112001 Unit, NCDHHS $10,000 $10,000
Lose Weight Wilmington - Cape Fear Memorial
Foundation $75,000 $75,000
Totals $329,243 $54,975 $117,850 $156,118
, .
NEW HANOVER COUNTY HEALTH DEPARTMENT
BOARD OF HEALTH (BOH) APPROVED
GRANT APPLICATION STATUS FY 02-03
e
e
16,70%
35,79%
e
Pending Grants 2 14%
Funded Total Request 6 43%
Partially Funded 4 29%
Denied Total Request 2 14%
Number of Grants Applied For 14 100%
As of 912112002
. NOTE: Notification received since last report,
4742%
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" _ Betty Creech
;;IJiJJ!:0912312oo2 03:22 PM
To: David E Rice/NHC@NHC
ee: Lynda SmithlNHC@NHC, (bee: archive)
Subject: Nurses
The request below is in addition to the one full time nurse request I sent on September 12, 2002. This
makes the school system's request for five and one-half nurses. The earlier request was to enable us to
have full time nurses at two more elementary schools. The new request below is to enable us to have
full time nurses at all middle schools. The request is based on the fact we have students with fragile
conditions related to heart disease, diabetes, seizures, cerebral palsy, injuries and other chronic
conditions. In one school we are dealing with a Do Not Resuscitate order The students' conditions are
very unstable, frequent assessment is necessary, care provision is complex and school staff, with good
reason, worry about litigation and exposure to infectious materials. Please request that these positions
be established.
The Budget
Expenditures: $165,768
Salary
FICA
Ret
Ins
Dis
Supplies
Uniforms
Milage
Training
126,731
9,695
6,273
19,158
267
825
2,294
200
325
Revenues: $165,768
- Forwarded by Betty Creech/NHC on 0912312002 03:01 PM-
. "ALFRED H LERCH"
'. . <alerch@nhcs.k12.nc.
". us>
0912312002 12:14 PM
To: <bcreech@nhcgov.com>
ee: (bee: archive)
Subject: Nurses
Please increase our nurses contract by four and one half nurses effective
after the October Board meeting. Funding is from our medicaid account.
31
B9/BB/2BB2 B4:46 91B2544352
SUSAN
PAGE Bl
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COUH1Y
SCIDU
DIt D. JOHN MORRIS. JR.
s.,..'11l!dde1ll
llII. AlRIEIl H. LEIlCII, JR.
AII/JIInI s.,e._tIIIII
- SIJ/IIIlIfI p.......
-,.,..., -.,
MEMORANDUM
TO: Betty Creech
FROM: fIJ Lerch (Jl
RE: Nu.... Request
DATE: September 12, 2002
ID: FY03#04
Plesse consIder thllletter al a request for 2 additional half time nursing
position..
One half time position would be at Pine Valley and the other half time
would be at Holly Tree. Both schools have severe diabeUc children enrolled who
need to be monitored.
Thank you for your eooperetion.
c: Tony Lopah
Dr. Norm Shearin
e410c-... _ FlooD'_"""" c-...211412' _ (010) 2Il1 1aQe' F.. (810)2Il4 41112
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New Hanover County Health Department
CPT Codes and Fees
e
Rates for New Codes Replacing Y and W Codes
(Y and W Codes are State-created codes which have been in use
by Local Health Departments for billing Medicaid)
New Codes and Rates Effective October 1,2002
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New Hanover County Health Department
CPT Codes and Fees
CPT/
New Medicaid NHCHD
Clinic / Service Code Codes CPT / Medicaid Description Fees
11976 Remove Norplant $19711
11977 Remove/Reinsert Norplant $553.00
57170 Diaphragm Fitting $89.00
58301 Remove Intruterine Device $95.00
CD: 87164 Dark Field Exam $41.00
56501 Destroy Vulva Lesion (s) $132.00
54050 Destruction/Lesion/Condvloma $120.89
46900 Destroy Anal Lesion(s) $162.26
Y2013 STD and Y2012 T8 Control, combined into one code T1002. Max is
4 units dailv (in 15 minute increments).
CD: Medicaid Code 11002 Y2013 STD Control Treatment $80.00
T8: 86580 TB Intradermal Test $5.00
18: Medicaid Code 11002 Y2012 TB Control Treatment $89.00
X-Rays: 71010 Chest X-Rav/PA $40.00
71020 Chest X-Ray/PA & Lat $70.00
71021 Chest X-Ray/Lordotic $40.00
Child Health: 96110 Developmental Tesll Limited $168.00
92551 Pure Tone Audiometrv, air $30.00
93770 Blood Pressure Check NC
CH: Medicaid codes 59442 W8203 Childbirth Education classes $87.00
W8010 & W8016: Child Hlth Screening Periodic & Interperiodic combined into 1
numeric codes, aQe specific and based on New or Established Patient.
99381-99385 & 99391-99395 W8010 Child Health Screenina Periodic $90.00
99381-99385 & 99391-99395 W8016 Child Health Screenino Interperiodic $90.00
11016 Y2155 Child Service Coordination $89.00
99502 Y2048 Newbom EPSDT Screen Home Visit $65.00
MH: Medicaid Codes 11001 W8204 Maternal Care Skilled Nurse Home Visit $88.00
W8201 MCC Initial, W8202 MCC Subsequent, & Y2044 MCC Home Visit combine
one code for Initial, SubseQuent, or Home Visit with Max 6 units per month.
11017 W8201 MCC Initial $110.00
11017 W8202 MCC Subseauent $55.00
11017 Y2044 MCC Home Visit $72.56
Same W8205 Parentino Education classes $74.59
99501 Y2046 Postpartum Assessment Home Visit $60.00
96152 Y2049 Intensive Psvchosocial Counseling $40.00
99502 Y2047 Newborn Assessment Home Visit $60.00
New
Fees
$19.50
FR
$19.50
FR
FR
FR
$21.50
o
$90.00
&90.00
$21.00
$65.00
$88.00
d into
$12.00
$12.00
$12.00
$60.00
$13.25
$60.00
Legend:
AF Administrative Fee
NC: No Charge
HF Handling Fee
LC: Lab Corp
FR: Flat Rate (sliding fee scale does not apply)
Revised 09/24/02
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New Hanover County Health Department
CPT Codes and Fees
CPT/
New Medicaid NHCHD
Clinic / Service Code Codes CPT / Medicaid Description Fees
Y2525 MOW Brief, W2526 MOW Standard, & 2527 MOW Extended combined int
one code S9445. No separate code based on length of contact.
59445 Y2525 MOW Brief $20.00
59445 Y2526 MOW Standard $55.00
59445 Y2527 MOW Extended $85.00
IMM: 90700 52 DTAP vaccine 1M $13.71
90702 52 DT vaccine 1M $13.71
90707 52 MMR virus vaccine SC/jet $13.71
90707 MMR virus vaccine SCliet $35.00
90716 52 Chicken Pox Vaccine $13.71
90716 Chicken Pox Vaccine $50.00
9071252 Oral poliovirus vaccine $13.71
9071352 Poliomyelitis vaccine SC $13.71
90647 52 HIB vaccine, PRP-OMP, 1m $13.71
90632 HEP-A vaccine, adult, 1M $25.00
90633 HEP A Pediatric / Adolescent $25.00
9074452 HEP-B Vaccine PED/AooIIM under 11 $13.71
9074552 HEP-B Adolescenll Ped High Risk (11-19) $13.71
9074652 HEP-B vaccine, over 201M $13.71
90746 HEP-B vaccine, over 201M $40.00
90281 52 Immune Globulin $13.71
90665 Lvme Disease vaccine, 1M $55.00
90782 Iniection CSC) / (1M) $5.00
95115 Immunotherapy, one iniection $5.00
95117 Immunotherapy injections $10.00
90657 52 Flu vaccine $13.71
90657 Flu (Child - 6 - 35 months) $12.00
90658 52 Flu vaccine $13.71
90658 Flu (Adult/ 3 years+) $12.00
90732 Pnueumococcal vaccine $20.00
90732 52 Pnueumococcal vaccine $13.71
90676 Rabies vaccine $78.00
90733 Meninaococcal Vaccine (Private Stock) $65.00
GOO08 Medicare Administration Fee (FLU) $4.00
New
Fees
o
$11.00
$11.00
$1100
FR
FR
FR
FR
FR
FR
FR
FR
FR
FR
FR
FR
FR
FR
Legend:
AF Administrative Fee
NC: No Charge
HF Handling Fee
LC: Lab Corp
FR: Flat Rate (sliding fee scale does not apply)
Revised 09/24/02
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New Hanover County Health Department
CPT Codes and Fees
(,;t'TI
New Medicaid NHCHD
Clinic I Service Code Codes CPT I Medicaid Description Fees
GOO09 Medicare Administration Fee (Pneu) $5.00
90471 IMM Administration Sino Ie Dose $20.00
90472 IMM Administration( Single charge for all add. dose $10.00
IMM: Medicaid Codes 90471 W8012 Immunization Update $20.00
90472 W8012 Immunization Update-> 1 with EP modifier $0.00
00124 Adult Drug Injection (Medicaid) $2.35
House Lab: 82465 Assay Serum Cholesterol $15.00
House Lab: 81001 Urinalvsis, auto, w/microscopic $12.00
81003 Urinalysis, auto, without microscopic $8.00
85027 Coulter Hematologv Profile $13.00
850180W Hemoglobin $10.00
86592 Serologv, qualitative (trust) $18.00
86593 Seroloov, ouantitative (trust) $15.00
87081 GC Culture $20.00
87210 Wet Smear $15.00
87205 Gram Stain $15.00
36415 Venipuncture/Fingerstick $14.00
GOO01 Venipuncture CMedicaid) $3.99
84450 SGOTI AST $15.00
84460 SGOT AL T $15.00
82247 Bilirubin, Total $15.00
82565 Assay Creatinine $15.00
82947 Glucose, quantitative $13.00
82962 Glucose, blood reaoent strip $20.00
83615 Lactate (LD) (LDH) enzvme $15.00
84075 Assay Alkaline phosphate $15.00
85651 RBC SED rate, non-auto $20.00
82270 Test Feces BloodlOccult Bid) $10.00
81025 Urine Pregnancv Test $1100
87070 Throat culture $34.00
87086 Urine Culture, platina and colony count $15.00
Referred Labs: 8718426 Urine Culture (Identification) and
Susceotibilitv Studies LC
87077 26 Nose, throat, bacteria culture HF
83655 26 Blood Lead HF
8015626 Assav Carbamazeoine NC
New
Fees
$20.00
FR
Legend:
AF Administrative Fee
NC: No Charge
HF Handling Fee
LC: Lab Corp
FR: Flat Rate (sliding fee scale does not apply)
Revised 09/24/02
38
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Highlights of the Family Assessment
Coordination Open House
<"?,.,.
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September 12, 2002
History of Family Assessment
(cont'd)
. In January, 2001, private funding was
secured to initiate Family Assessment
Coordination services in Southeastern North
Carolina
. Other 'Universal Screening' models were
looked at to develop a 'Best Practices'
approach
Development of Universal
Screening
. Decision was made to make Universal
Screening 'self-reported' (no interviewer or
chart review)
. Screening Forms were designed to be 'user
friendly' and simple to complete
. Personalized booklets: Resource
information is matched with each client's
eligihility information and survey responses
to produce a customized directory
History of Family Assessment in
New Hanover County
- In 1998, the need for a 'Universal
Screener' was documented at the NC
Dept. of Health and Human Services
- In 2000, a pilot program of 'Universal
Screening' was initiated in 3 counties
(Nash, Onslow, and Buncomhe)
Design of the Universal
Screening Tool
. The Screening tool includes 52 items from
10 categories
. Each item is designed to assess high-,
medium-, and low- risk factors associated
with the early parenting experience
. Based on models used by Healthy Families
America, and NC DHHS guidelines
Community Resources
./368 resources in the database:
'" 186 Local Agency Listings
'" 182 Pamphlet, Website, and Specialized
Information listings
'" 23 Listings for Spanish-speaking clients
"'Over 1,300 listings when cross-referenced
with related Survey items
1
Oirections:
.". t..u.t",w"".tMi_/mpfNWIttD,.."../wMthr,"-'nt.ml1y.
Slmp/yput.dJ.amMt"'l/II'fIhInfIlMt__~OF"""'tD,...,.
PNgflllnc:Y_.QfptN6".".IfJ'lllll_IIOt,..""."rlO
1:1 This.. my first preg..ncy
o I'Ve bMI probleml wItb. pregMncy before
1:1 l.m afnIkll won't 1M18 -good-lMrent
o I'm afraid my IIIdIW won't be e good IMrent
o I'm not SUN wMt to do ebout thll ,....llIIncy
o I.... thEnIdag ebout ""!nO e" nortloll
o I em thinldag ebout glvbtO my Nby upfor edoptlon
o My boyfriend, husbalnd, or pllrents don't ..lit me to
h..,.tt1l1b11by
I'dlibtofIrlclOllt_oboUL
o .weightpEn during pregllllncy
o ...mlng sIg.. to.ntch _ for
o ..dMIlng with-morning skknea"
o .breast or bottler.lleUng ... which II blatter7
o .wblttoexpec:t:wlMn Igo Into labor
o ..cuttIng bIIck on smoldag whDe I em pregnent
o .medlcatlons tt1d eN ..... for me to tlIktl whU. I
em ,......nt
Food/Nutrition (I hG~ quutions obaut_)
o .!tow mudllhould my bilby/child ut?
CI .Itowdo I knoW If my bIIby II getting
enOlllhto eaU
o .getttng free or low coft foocl for me end my
bIIby (Wle end other progrllml like It)
lob/Employment (I'd lib to ~ __ obout...)
o .f1ndlng e Job
o ,Job lkUlI trlllnlng
o .wtult type of Job would be good for me7
o .tlme orrfrom work when someone En my
fIlmlty II lick (f'eml1y Medical LellVeAct)
Mo....y (Check If you would lib to ~ IIlON obaut_l
o .pIIylngorroldblUs
Q .f1Ungforchlldlupport
Q ..MttIng e budget you can live on
Q .epptyl... for money to help IMY for everydey
needs (house, food, heat, phone. etectrtclty)
Implementation
. In June, 2001, Universal Screening was
initiated at New Hanover Regional's
Family Birthplace, and 2 area OB
clinics
. Presentations were made to other area
DB and Pediatric clinics
Children (I weuIclllb rllf~ ebeut_)
o .wn,. to dlldpllne my dllld
o .tMChlng my cblld to rud
Q .heIp wIttI ftndl.. child caN
a ..chlld-proofing my home
o .uslngCllrSeetJproperty
Q ..If my child's growth. sIdIIs or belie..r ere DOnnel
(1--
. ~ :.~~-' ';,:
~'lt.~.
Clothing (PIeose eheek if any of these ore true)
a I need more clothes that nt my child
Q I need Mltemlty dotItes tblt wIJl nt me
a We don't Ilave enough clothes for every _n
Educ:otiOll(I'dlikemareinfarmotianaboutm)
o ~toflnlshlllghschoolorgeteGED
[]~ngetredelldloolorcot....
o Grants (money) to help me go to ldlooI
Me.dieal (CMc:k tile Bole If you MH...) 1:,
a .HeIp paylng for lIulttl c.re
a .Reguler lleatth or ......1 care
D....'. "..,......... f.".. ."..,,1111' _ : ~
Support (PI- elleek OIly of the.. ttlat _ tNl)
[] I get: streued or worried e lot
o I gill: Ingry end 10M my temper e lot
o Sometimes I feel 10 hope\ea tlld I..... willi I
wasn' allYe
o I don't "'we .ny friends or fIlmlly wllo Cllre about me
o I'm efnIld someone J know wID lIult me or my blby
a J don't Iwlve anyo... I can blk to ebout my protllems
CI I'd like help ftndlng e church where I 1'''' comfortable
[] I'd like Infonnetlon.bout IMrent IUpport groups or
d...
Transportation (please ctlack ony thot opply)
o Idon't"'wereJlabletraftS9Ol"bltlon
[] I CIIn barely' afford thIl transportation I h... now
[] I cIon't......IIIl.IIU to get to tt1estore or
.pjXlMtmentl;
Current Status
. 7 out of 9 area OB clinics are offering
Universal Screening to their clients
. Over 225 screenings are conducted
monthly
. Plans are being made to expand
Universal Screening to the Pediatric
Setting
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I-Year Statistics
Total Births (est): 3600
Screenings offered 3150
Screenings completed 2250
% of Births offered screening 78.0%
% Screenings Compleled 71.4%
Top Ten Responses (Overall)
~.... ,.. -
1 F1Ddihloutllmych1ld'.arowlb,lldllaordenloplBelll 597
al"1!llOnDlIl
2 How do limo.. lhay IW>r ulettu. -uab to cat! 434
3 Howllludltbouldlll)'baby/cblldw1 380
4 .lea<:blDamy cblldto read 366
5 ......yl10 dildplln.lilY c:bUd 349
6 ..nnlllokdp_F10 tdoool 345
7 ..pplyl"lforllloneyIo.....ppay ror"".rydayAeedl 345
8 .plllll8 rn.e or low-cod food for Die aDd my baby 339
9 .chlldprooftqIlly holDe 334
10 .hclpwUhnndmaehlldtllR 329
Overview
. 10 Items on the Universal Screening Tool were
identified as presenting significant risk for
Domestic Violence, or Abuse/Neglecl
260 clients from New Hanover, Pender, and
Brunswick counties were identified as having
significant risk factors.
. Demographic tables showing Age, Marital
Status, Income, and Number of Children are
being reviewed to see if demographics are
predictors of at-risk status
1-YearStats
(cont'd)
. Tolal Responses: 8802
. Screenings compleled 2250
. Avg. Number of Responses 4.6
. % of Surveys with I or more 74.8%
response
'Red Flags' - At-Risk
Clients
Questions used 10 Identify At-Risk Clients
-I get stressed or worried a lot
-I don't have anyone I can talk to about my problems
-I'm afraid someone I know will hurt me or my baby
-I don't have any friends or family who care about me
-Sometimes I feel so hopeless that I wish I wasn't alive
-I get angry and lose my temper a lot
-I'm not sure whallo do about this pregnancy
-I'm thinking about having an abortion
-I'm thinking about giving my baby up fOf adoption
-My boyfriend, husband, or parents don't want me 10 have
this baby
3
Future Plans
Futur~~ns: :. . ,
,,^' '. .;i~t?W"; ,;~,;,: ~"':;, ~;/;_~;',
'M"""-'""".",,,,,;
"'.""._",""
. Exanrineexpanmonof
Universal Screening to the
entire Southeastern NC
region
Look at Sustainability
considerations
Future PIlJ,lls
Initiate Community
Assessment Project with
UNC- W School of Nursing
. Develop a plan for
collaborative Case
ManagementlFollow.Ups
. Phase-In Database
Upgrades
Questions/Ideas ???
Brett Schoen, RN, BSN
2029 S, 17'" Street
Wilmington, NC 28401
(910) 343-6717
8schoen(ci)nhcaov.com
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STRATEGIC PLANNING PRIORITIES
September 24, 2002 Update
I. Access to health care
(Issues #7, 11 & 5)
-+ Based on family income, some can access kindergarten health assessment cheaper in the
community that through the health department clinic
-+ Volunteers have become essential to the provision of services. Child Health is presently
using 3 volunteers to perform clerical functions and client outreach.
-+ Vision Screening: The New Hanover County Diabetes Coalition and the Cape Fear Lions
Club are sponsoring a Free Vision Screening on October 11, 2002, from 1 Dam til 4pm. The
screenings will be conducted in The North Carolina Lions Vision Van in the parking lot of the
New Hanover Community Health Center
-+ Foot Screening: The New Hanover County Diabetes Coalition along with local health
agencies is sponsoring a foot screening will be from 9 am - 12 noon at the Senior Center So far,
there are two podiatrists who are volunteering. There will be various information/screening
stations around the big multi-purpose room. John Rader is providing a massage therapist and
perhaps a nurse. Carol Bottoms, Health Department Nutritionist, will provide some basic
nutrition info for people with diabetes and folks can get a one on one 10 minute counseling
session and maybe a short talk to a small group.
-+
II. Preventive services & lifestyle-related risks
(Issues #12 & 15)
-+ On August 19 and 20, 2002, Donna Forsythe, Public Health Dental Hygienist, presented a
program at four area Head Start Centers entitled "Lifetime of Smiles" "Lifetime of Smiles"
focused on good nutrition, brushing, flossing, sealants, and the need for regular dental visits. In
addition, good oral health practices such as proper brushing and flossing were demonstrated.
"Lifetime of Smiles" is an important part of our Community Dental Health Education Outreach
Program.
-+ School Nurses using age appropriate info to train students regarding blood borne pathogens
-+ Several Child Health staff are participating with other community professionals, who work
with special needs children, in transition discussions. These professionals are trying to insure
that children, birth to age five years, are receiving all needed services from community agencies
and are transitioned smoothly during the preschool period.
-+ On July 30, the laboratory began testing for fecal occult blood on clients 35 years of age and
older in Women's Preventive Health.
-+ ACS staff pursued completion of an adoption packet to go home with all new pet owners.
This was identified as an area of concern from local veterinarians, when people adopted pets.
They felt that the owners needed additional information on proper pet care.
-+ Child Safety Seats: An instructional presentation was made to NHC Transportation Drivers
regarding proper installation and use of child passenger safety seats. NHCHD, with help from
Cape Fear Area United Way, provided several convertible seats, and hi-back and low-back
booster seats.
-+ Carbon Monoxide Detectors: Mary Piner has worked with the Fire Department to get carbon
monoxide detectors for our clients' homes with gas appliances.
-+ Control Measure Violators: Warrant issued for control measure violator who has previously
served two years in prison on same charge. Another control measure violator in jail, and working
with court-appointed attorney, DA's Office. and Sentencing Options program to have long term
drug treatment as part of the Judge's sentence. Substance abuse treatment is essential to
compliance with health laws.
-+ Flu Vaccine: Influenza vaccine kick-off scheduled for October 14, DendinD receiot of
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vaccine.
-+
III.
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Communication, education & marketing (promotion>
Issue #1 & 4 in art
-+ Carol Bottoms, RD, presented two sessions on "Five a Day" to Cape Fear Community
College faculty. She also spoke to residents at Kelly House on eating disorders and helped
teach "Color Me Healthy" curriculum to daycare providers.
-+ The end of year Child Fatality Prevention Team report has been passed to David Rice to
share with the BOH and County Commissioners. Twenty Two deaths were reviewed, with 86%
being attributed to prematurity or other congenital problems at birth. No trends were identified.
-+ The health department received an invitation from the Safe Kids Buckle Up Program to
apply for a $5,000.00 grant to purchase child passenger restraint seats. Collaboration with
referral and distribution will be carried out through assistance by neighbor agencies to include
childcare facilities, United Way and DSS
-+ ACS started another year of their Paws To Recycle campaign. Recycle cans are collected
for three months from September through November each year Last year ACS won the wild
card drawing to receive $500 for the animals.
-+ Articles appeared in the August and September issues of Paw Prints Magazine featuring the
quest for the ACS spay/neuter facility addition.
-+ Postage Stamp: A postage stamp for Spay/Neuter awareness will be issued by the US
Postal Service on September 20.
-+ Chickens for Sale: ACS collected forty hens from a residence at Fort Fisher Beach this past
week. The co-owner of the property requested pick up of the flock, when his partner left the
house. The birds will be available for the general public on Wednesday, September 18, 2002.
-+ Health Fairs: Staff will be participating in a health fair on Saturday, 9/21/01 at St. Andrews
Episcopal Church. We will be providing women's health information. The Harvest Time
Christian Center is having a Fall Festival on Saturday October 5. They have requested
information pertaining to child health, chronic disease prevention, promotion of NHCHD
services, and injury prevention. Please contact Elisabeth Constandy if you have any information
that would be pertinent for this group. If you desire additional information or would like to be
present at this event, please call Diane Lucas at 371-0259 or Ramona Covington at 794-1859.
-+
IV.
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Facility utilization & Information technology
Issues #6 & 4 in art
-+ Meeting with several members representing NHHN to discuss possibility of improving
reporting to NHCHD through use of electronic reporting. Committee established to work toward
this goal. Improving public health infrastructure is component of bioterrorism preparedness.
-+ Committee formed to evaluate readiness for implementation of new internet based NC
Immunization registry, to be piloted within few months.
-+ On August 19, 2002, the Board of County Commissioners gave a unanimous okay to build
the on-site spay/neuter facility with adoption play area. The item was on the consent agenda,
and no questions were given for discussion on the project. Property Management will not be
able to fit us into their schedule until some time in 2003.
-+ NHCHD Website: Elisabeth Constandy is maintaining our website. All changes should be
sent to her Dave Rice and Alene Mabry will assist her
-+ We have purchased the domain name, NHCHD.org. In the near future, we will be able to
access our site via this address, rather than nhcgov.com/HL TH/HL THmain.asp.
-+ Several of our web pages have "hit counters." The NHCHD Website had 745 visits. For the
month of August, our top five web pages were:Animal Control Services (268), Environmental
Health (148), Department Information (135), Board of Health (96), and FAQs (85).
-+ Expenditure Report Payment: We have received notice that within 3 business days our
account will be deposited electronically with $123,441.92. As soon as the State payment report
comes with the breakdown L nda will do the de osit sheet to dis erse this revenue into the
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appropriate revenue accounts and this will show up on the county's Greenbar Report A203
Detailed listing of Revenue vs Budget Report for September and the Financial report going to
the Board of Health in November for September's financial activity
.. Medicaid Cost Analysis: There is some Urgent Dated Material that Lynda will be getting
back to Carol Chandler, NC DHHS Office of the Controller by September 16, 2002 In the next
couple days, program specific information with a deadline will be copied to those Division
Directors involved in this data collection. Good News: This year only one time period is
required instead of the usual three periods. Carol and Steven Garner have worked hard with the
Division of Medical Assistance (DMA) to allow us to change our cost reporting from Federal to
State fiscal year
.. County Mail Room: Has been moved to the first floor of the NHC Administration Building on
Chestnut/4th Streets.
.. Operable Partitions: Still waiting installation of several missing partitions. Contacted
Precision Walls regarding final installation of missing partitions, and hope to have a final date
shortly
.. Impact Printer' This printer in the computer room is being retired. Based on age,
maintenance costs, operational and paper costs, noise levels and periormance problems a
decision was made to purchase a high speed laser printer and produce all output using 8 1/2 X
11 paper The impact printer is no longer attached to the AS400.
.. Electronic Calendars: Related to a discussion at previous meeting, steps have been taken
to implement a lotus notes electronic calendar for the Thomas Fanning Wood Conference
Room. Specifics are being worked out to pilot the Wood Conference Room.
..
V. Water quality, storm water management & drainage; & Air
aualitv (Issues #3 & 8)
.. Lead Paint: NHCHD Staff have worked with New Hanover County Schools regarding lead
paint present at Forrest Hills Elementary A supportive editorial was in the September 17
Wilmington Morning Star
.. VectQr Control Program Ramps Up For West Nile Virus: The NHCo Commissioners
appropriated $100,000 from the contingency fund to support increased mosquito control as the
first human case of West Nile virus in North Carolina was confirmed. A part time temporary
employee has been an added resource for applying larvicide and adulticide since early August.
However, rains during late August and early September periected the late summer environment
for mosquito eggs to hatch and mature. An Environmental Health Specialist position and
additional pesticide treatment products were among the items approved.
..
VI. Emerging health risks
(Issue #13)
.. Bioterrorism Update: Meetings with the Community Coalition are scheduled for September
16 and 30. A meeting regarding potassium iodide (KI) distribution was heid on August 23 with
Dr Greg Smith from the State, Brunswick County Health Department, and NHC Emergency
Management. EpiTeam training with Brunswick County Health Department has been scheduled
for August 28-29. A meeting has been scheduled on September 17 in Raleigh with the infectious
disease physicians (Dr Charles Schleupner, Dr Jan Rhyne, Dr Greg Steinkraus, Dr John
Sanders), Dr Bill Atkinson, Dr Steve Cline, and Dr James Kirkpatrick.
.. West Nile Virus Update: State will no longer test dead birds once 5 from a single county
have been determined positive for West Nile Virus. Resources at that point should shift entirely
to control and prevention activities. We are establishing a contact mechanism for the public to
use during weekends if they encounter dead birds. Staff are advised to familiarize themselves
with recommendations on use of personal protective products such as DEET Updated news
releases have been distributed to Staff and Board of Health.
-+ Meningococcal Disease: COD received report of 64 year old woman hospitalized with
meningococcal disease. Family members (close contacts) were prophylaxed.
-+ Diarrheal Illness: Physician called to report an increase in patients seen with diarrheal
illness. State lab has agreed to test some serology and stool to identify causative organism if
possible. State lab reports lots of enteroviral gastroenteritis statewide. Handwashing can never
be overstated...remind your family and friends!
-+ Subtropical Storm Gustav' Is beginning to take a turn to the north and is expected to turn to
the northeast later today The center is located about 130 miles south of Cape Hatteras and is
moving to the north at 9 mph. Maximum sustained winds are at 60 mph. A tropical storm
warning is posted from Cape Fear, N.C. to Parramore Islands, Va.
-+ Bioterrorism Update: State training for PHRST on October 6. Public Health Grand Rounds
on Bioterrorism on September 27 BTL Team met with PHRST on September 17 to work on the
revision to NHCHD's Emergency Response Plan.
-+
VII. Population growth & diversity
(Issue #2)
-+
VIII. Discontinued services picked up by Health Department
(Issue #9)
-+
IX. Staff Development & continuing education
(Issue # 14)
-+ On August 28 and 30U', the lab interim director attended the Bioterrorism Preparedness and
Epidemiology Training hosted by PHRST - 2.
-+ Communities That Care: Janet attended the Communities That Care quarterly meeting last
week. SPINNC, with UNCW, will have some trainings on use of the internet, and how to use
their site for community information, volunteer opportunities, and funding strategies. UNCW is
really pushing volunteer hours with students in all degrees, with many also being required to do
internships. They are all free volunteers, except computer science students, who get paid to
work in the community. SPINNC would like to limit their first series of classes to 1 person per
agency, since it will be hands on in a computer lab. Classes start 9/19.
-+ Grant Writing: Also, the Center for Research at UNCW (in SW department) will help
community agencies with grant writing and are charged with helping with collaborative grants.
-+ Volunteer' Child Health has a new volunteer, Susan Holland, starting today. Another SW
student will start next week.
-+ Volunteers: The pursuit of volunteers continues as we navigate through changes with
delivery of our services. The following volunteers are being utilized within the WHC Division:
Ophal Midgett - Social Worker, and a Work First Client.
-+ We will be working with an RN student to provide public health experiences.
-+
X. Evaluation of services
I (Issue #16)
-+ On August 15, Emma Barbosa, of the UNC School of Public Health, spent the day
interviewing WIC staff and Latino WIC clients. Infonmation gathered will be combined with
information from 10 other WIC programs across the state and recommendations will be made
for actions the state and/or local agencies can take to improve/enhance the quality of the WIC
Program services offered to the Latino community.
-+ COD reviewing staffing for essential and mandated services, some staff assignments
changed to accomodate needs.
-+ ACS staff consulted the county attorney's office to evaluate better methods of gaining rabies
certificate surrender comnliance bv several countv oroanizations.
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-+ Organizational Analysis Update: Meetings with Divisions and Staff are ongoing. Due to a
delay in the UNC Institutional Review Board (IRB) approving the survey and focus group
process, the target date for processing has been moved to the week of September 9. The target
date is tentative and is based on IRB approval.
-+ NCALHD Meeting: Dave Rice attended the North Carolina Association of Local Health
Directors meeting on August 22. Items discussed were: State budget concerns regarding case
management and Medicaid, proposed changes in communicable disease law, flu vaccine
availability, clustering/collaborative proposal (accreditation, best practices, and demonstrations
committees formed), WCH streamlining progress, community fellows proposal focusing on
health disparities, and the Leadership Masters in Public Health Program (information at:
http://www.sph.unc/phlp).
-+ Tax on Cigarettes: At least 15 NC local boards of health have approved resolutions
requesting increases in cigarette taxes.
-+ HIPAA. The HIPAA Entities Subcommittee has completed the Business Associate
Agreement and it has been discussed with and sent for review by legal. On Monday 8/26/2002,
the compliance extension electronic form was reviewed with Holt Moore, Assistant County
Attorney Holt is working on the Extension Compliance Form for the County, but NHCHD will
send a separate compliance form. The Extension Compliance Form will be submitted by the
end of this week. The compliance extension gives us until October 15, 2003 to become
compliant with HIPAA Electronic Health Care Transactions and Code Set Standards. We still
have to the April 2003 compliance date for privacy standards.
-+ Workfirst: Janet McCumbee attended a Workfirst Plan review meeting yesterday at DSS.
The county plan must be sent to Raleigh by November In order to assist Workfirst clients with
finding jobs, the Employment Security Commission has 2 workers out posted at DSS. The good
news is that most are getting jobs, the bad news is that these are low paying and part time jobs,
and transportation is still a problem. Other services in place are a SEC substance abuse
counselor stationed at DSS, and job readiness classes through CFCC.
-+ Child Health Division: Reviewing year end data for the annual report revealed that even
though the Child Health Division lost a position, visits and contacts were up from the previous
year This was crucial for revenue to sustain other positions; however, staff feel they are
comprising quality for quantity Some other notable accomplishments: Health Promotions and
Child Health provided 226 car seats to low income families, Child Care Nursing reviewed 2923
immunization records in child care facilities with F/U of 404 delinquents, Health Check
participation county wide continues to increase yearly, over 2000 prenatal and post partum
surveys were completed.
-+ Strategic Planning Retreat: Elisabeth Constandy and Bill Herzog have developed a
preliminary plan and agenda for the October Strategic Planning retreat, and are awaiting BOH
Personal Health Committee and NHCHD Management Team approval to proceed. "Pre-work"
will include surveys of those who plan to attend in regard to: 1) the update of the 2000 Strategic
Plan process, and 2) Review and discussion of the draft report from the Organizational Analysis.
A short telephone survey will be conducted with some of the same stakeholders identified in the
2000 process. The Health Statistics, Demographics, and Provision of Services will be updates
and distributed prior to the October 26 retreat. The Strategic Planning Priorities 2000 will be
updated to include major achievements of the past 2 years, impact of staff and budget
reductions, and future needs and priorities.
-+ Organizational Analysis Update: The NHCHD Survey has been distributed to Staff. The
"Quick Scan"questionnaire should be completed by September 12. All Staff are encouraged to
participate. The Focus Groups will be conducted September 10,11 and 12.
-+ Health Choice: The Health Choice enrollment freeze has been delayed, at least a month.
Our Health Choice Coalition, through Smart Start, has received a grant to provide additional
outreach. Smart Start will be hiring a part time outreach worker
-+ Child Fatality Prevention Team: Joyce Hatem is submitting the annual Child Fatality
Prevention Team reoort to Raleioh. It must also be submitted to the BOH and Countv
II
..
Commissioners. The team reviewed 22 deaths this year, with no significant trends noted. 86%
of the deaths were related to prematurity or congenital problems in newborns. The mothers all
had prenatal care.
-+ Organizational Analysis Update: The NHCHD Survey has been distributed to Staff. The
"Quick Scan"questionnaire should be completed by September 12 (93 questionnaires
completed). The Focus Groups will be conducted September 10,11 and 12.
-+ Medicaid Cost Study: Carol Chandler will be here on January 14, 2003 for the Medicaid
Cost Study Packets of information which need to be filled out and returned by October 31,
2002 have been distributed to Division Directors involved in the study
-+ Y and W Codes: The Health Department received notification of new coding and
reimbursement rates for Y and W codes which will be effective 10/1/02. Reimbursement will be
converted to units with maximum allowable amounts. We are in the process of evaluating the
conversion and determining how and/or if we can continue providing some services.
-+ Organizational Analysis Update: Approximately 120 questionnaires were completed by
NHCHD Staff Focus Groups were held on September 10, 11, and 12. Attached is an electronic
memorandum from the NCIPH Team to all NHCHD Staff.
-+ HIPAA Compliance Extension: Electronic Health Care Transactions and Code Sets
Standards Compliance Extension for New Hanover County Health Department was sent
electronically September 12, 2002.
-+ Medicaid Fee Changes: Y and W Procedure Code Changes will go to Board of Health on
October 2, 2002. We are working with programs regarding specific info which will be entered in
the QS charge and procedure tables to make these changes effective October 1, 2002. We are
also working with programs regarding the changes to the billing form (encounter forms), so
these can be revised.
-+ HIPAA Video Conference: Kim Roane and Lynda Smith (or Cindy Hewett) will be attending
this HIPAA Video Conference in Fayetteville on October 21
-+ Family Assessment Coordination: Brett Schoen hosted an Open House - annual review of
Family Assessment Coordination (part of the NAVIGATOR Program)- Thursday September 12.
Approximately 25 community professionals came through to view his displays and power point.
He will repeat his presentation for the BOH in October and again for staff in Child Health and
Women'~ Health soon. We are looking at the year's data on needs of prenatal and post partum
families and will be making program revisions based on this.
-+ Lead Program: The Lead Program is revising nursing protocol and will distribute this to
appropriate divisions by November Changes are necessary to reassign duties of staff to shift
resources to CSC, to accommodate the new billing system.
-+
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1M __ David E Rice
q ~ 1010112002 12:22 PM
To: annerowe@beIlsouth.nel, eweaver@ec.rr.com, Iinkrx@aol.com,
gelajim@hotmail.com, hankestep@isaac.nel,
freemanm@wrighlcorp.com, ppsmilhsr@aol.com,
bgreer@co.new-llanover.nc.us, wsteuer541@aol.com,
wojewell@aol.com, Heallh_ManagementTeam
ee: cgrubb@nc.rr.com, Janel_A1exander@unc.edu,
penny- whileside@unc.edu, sheilaJlfaender@unc.edu,
bherzog@intrex.nel
Subject Strategic Planning Retreat
NHCSH / NHCHD Strategic Planning Retreat Participants:
Attached is the advanced wor1l for our October 26 Strategic Planning Retreat. Please review the
instructions in the "Participant Lette'" and complete the attached surveys.
iii
1M
1M
Participant Letteu EXPECTATIONS SP.r EXPECTATIONS OA.r
Thanks,
David E. Rice, Health Director
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
Phone (910)343-6591 Fax (910)341-4146
drice@nhcgov.com
http://www.nhchd.org
-- Forwarded by David E RicelNHC on 10/011200212:13 PM-
Elisabeth K Constandy
0913012002 05:38 PM
To: David E RicelNHC@NHC
ee: (bee: archive)
Subject: strategic Planning Retreat
Attached please find the 2 pre-surveys to be completed by SOH, Team, and other participants (have
they been ID'd yet?). I have also done a cover letter explaining the process, due dates, why we are
doing this, etc. The retreat binders will not be ready until the week before the retreat, so that they can
include the OA results. The only other "pre" wor1l that might need to be done would be for DO's
only....possibly identifying the "most Important" highlights from the past 2 years of SP updates...1 need to
chat with Sheila about that before I know a definite on that aspect. There will not be any other
"homewor1l" for SOH or other members, however
iii
iii
iii
Participant Letter.do EXPECTATIONS SP.do EXPECTATIONS OA.dc
I will weit until Team mtg tomorrow before fOlW8rding this to Team and SOH with email access. I will
also have print versions available to distribute.
Elisabeth
.
,
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500, FAX (910) 341-4146
-_._.
DAVID E. RICE, MP.R, MA.
Health Director
LYNDA F. SMITH, MP.A.
As.btsnt Health Director
October 1, 2002
Dear Strategic Planning Retreat Participant,
We are reaching the final stages of planning for the October 26th retreat, and the time has arrived for your input!
Please take a few moments to complete the following "homework" assignment, to address your expectations for
both the Strategic Planning and Organizational Analysis components of the retreat. Many of you were involved
in the October 2000 retreat, and will recognize some similarities in these advance surveys. It is our hope to
compare the results of the 2000 process with the results of our current efforts. However, for those of you that
have not had the pleasure of experiencing a planning retreat, we still ask that you complete these surveys to the
best of your abilities.
~ease complete the two surveys, entitled "Expectations from Strategic Planning Process" and "Expectations
m Organizational Analysis Process", and return them to Elisabeth Constandy no later than Friday, October
1 th Results will be compiled and inserted into the retreat binder, to be distributed prior to the retreat. Please
feel free to complete these and submit them in the format you are most familiar with (printed hardcopy,
handwritten, or email).
Your retreat binders will also include updated health statistics and provision of services, a follow-up phone
survey with Key Stakeholders, and an updated version of the Strategic Planning priorities that were generated
during the 2000 process. The results of the Organizational Analysis will also be discussed during the retreat.
Thank you in advance for your input and participation. Please feel free to address any questions or concerns to
Elisabeth at any time, 343-6658 or econstandv@nhcllov.com.
On Behalf of the Planning Team,
Elisabeth K. Constandy, MS, CHES
Health Promotion Coordinator
-
" Your Health - Our Priority"
e
-
.
EXPECTATIONS FROM STRATEGIC PLANNING PROCESS
1 What does the concept of "strategic Planning" mean to you?
2. If nothing else, what one or two things would you like to see achieved during the strategic
Planning component ofthe October 26"' retreat?
3. What are your primary concerns about the Strategic Planning effort, as you understand it?
4. How successful has New Hanover County Health Department been in implementing and
following through on ideas from the retreat of Odober 2000?
.,
e
e
e
5. Please describe 3 successes or achievements from the Odober 2000 effort.
6. What changes, if any, of your own role or program resulted from the October 2000
retreat?
7 What barriers or limitations most impeded successful implementation of ideas generated
during the 2000 strategic Planning Process?
Thank you for taking the time to complete this survey" The results will be
compiled and shared with "Strategic Planning 2002" participants prior to
the retreat.
'J
e
e
.
EXPECTATIONS FROM ORGANIZATIONAL ANALYSIS PROCE~~
1 In what ways have you been involved in the Organizational Analysis process?
2. In what ways do you anticipate being involved in implementing ideas developed as a
result of the Organizational Analysis process? (Roles, etc?)
3. What are your primary concems about the Organizational Analysis process, as you
understand it?
a.) Initial concems?
b.) How well have your initial concems been addressed as the process has
developed?
e
-
.
4. How successful do you believe that the New Hanover County Health Department will be in
implementing and following through on ideas developed during the Organizational
Analysis process?
Thank you for taking the time to complete this survey. The results will be
compiled and shared with "Strategic Planning 2002" participants prior to
the retreat.
,
.~
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TIlSTREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500, FAX (910) 341-4146
Everywhere. Evcryday. Everybody.
DAVID E. RICE, M.P.H., M.A.
Health Director
LYNDA F. SMITH, M.P.A.
Assistant Health Director
New Hanover County Child Fatality Prevention Team
Year End Summary 2001-2002
I.
Purpose and Responsibility of Local Teams
e
The New Hanover County Child Fatality Prevention Team is a group comprised of
community representatives from diverse agencies and disciplines. Our team currently has
17 members each appointed by their agency board or by the County Commissioners. We
currently have two vacant memberships. The mission of the New Hanover County Child
Fatality Prevention Team is to promote the development of a community wide approach
to understanding the causes of childhood deaths, identify deficiencies in the service
delivery of public agencies to children and their families, and to make and carry out
recommendations for changes to prevent future child deaths. The New Hanover County
Child Fatality Prevention Team meets on a quarterly basis in the following months:
August, November, February, and May. Several members of this team also participated in
two state fatality reviews initiated by Department of Social Services, separate from the
routine reviews below.
II.
Trends Identified
During the fiscal year of 2001-2002, our local team reviewed 22 child deaths. Of these
deaths, 86% were due to extreme prematurity or complications associated with
congenital problems of the newborn. In these deaths appropriate prenatal care was
obtained. Of the remaining deaths reviewed, we saw one due to closed head injury, the
perpetrator was tried and convicted. One death involved a hit and run with a bicycle, that
perpetrator was also charged and convicted. The third was a death due to a medical
condition, this child w.as under a doctor's care and was receiving consistent medical
follow up. In this fiscal year there were no child death patterns or trends identified.
III.
Training Needs Identified
e
The Team Review Coordinator and the representative Health Care Provider attended a
state CFPT update via teleconference in Brunswick County in October 2001. The
information from that training was shared with the rest of the team at the next quarterly
meeting. There are no current training needs that have been identified.
" Your flealtlt - Our priorit'!"
,
e
e
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.
"
IV.
Team Activities and Accomplishments
The New Hanover County Child Fatality Prevention Team used its budget to purchase car
seats that were distributed to local low income clients. Ipecac syrup was also purchased
to distribute to all families with children, served in Health Department programs, along
with Poison Control Center contact information.
The CFPT chairperson attended the local press conference for Dr. Marcia Herman-
Giddens regarding her book Not Invisible, Not in Vain and read a vignette to the
audience.
During this past fiscal year the New Hanover County Child Fatality Review Team has
worked to improve its member participation, which was seen in increased attendance at
the quarterly meetings, as well as follow up from members who were not able to attend.
We have not been able to obtain a medical examiner for the team in several years.
The Health Department Child Health Staff continues to work with local fire departments
to distribute smoke detectors to low income families with children. The fire departments
still have a supply of smoke detectors purchased with CFPT funds in years past. Staff
have also started a new initiative with the local fire department to put carbon monoxide
detectors in homes with gas appliances, with a focus on prenatal and early childhood
periods.
Respectfu ly Submitted,
~e atem, CSW
Review Coordinator
September 6, 2002
.~
" .
SANITATION TIPS FOR FOOD WORKERS
FALL 2002
Also in this issue...
A Security Checklist
Page 2
A New Foe-Some Salmonella
resist antibiotics Page 2
E. coli 0157:H7-Portrait of a
killler
( Page 3
About those long fingernails
Page 3
Know Your Enemy-A guide to
the major food pathogens
Page 4
1-1Jb: f rl~l,~ e[
(" -0' I
f_ ~
r- <') <BW> as \
\ 0 /0 \ 0
"'"
"Guess it's too late to ask if your
chef had food security training!"
Copyright 2002
Pike & Fischer. Inc.
800-255-8131
Food Security: What Can You Do?
Food security-protecting food against deliberate contamination-has
become a very real concern for public health and law enforcement officials. The
rise of terrorist activity in the United States and abroad, and the availability of
information over the Internet on how dangerous agents can be spread by air,
water or food is fueling their concern. As food service operators develop plans
to respond to outbreaks of food borne illness, they should also think about how
to cope with threats of terrorism.
Bioterrorism is typically directed at food and water, according to U.S. Air
Force Colonel Larry Barrett, chief of the State of California division of health
services and chief of food, drug and radiation safety, who spoke at the Food
Safety Summit in Washington, D.C., earlier this year. Of the top 10 bioterrorist
agents, six are foodborne, he said.
Bioterrorst attacks are likely to focus on foods that
are consumed quickly, "so people consume them
because they don't know others have gotten sick;'
Co!. Barrett said.
In a separate presentation at the Food Safety
Summit, security expert Roger Viadero of Ernst & Young, a
former inspector general in the U.S. Department of Agriculture,
warned that access to the food is the key and that security
plans should focus on this issue.
Deliberate contamination of food is rare, but it does happen. Back in 1984,
followers of a religious cult in Oregon who were having problems with the local
planning commission wanted to swing a key vote in their favor. To keep voters
from. the polls, they sprinkled Salmonella typhimurium on foods in 10 local
restaurant salad bars. More than 750 people came down with salmonellosis. It
wasn't until a year later, when a former cult member confessed to the plot, that
local health officials learned the cause of the outbreak.
Stay Alert
The National Restaurant Association believes that the threat to the nation's
food from terrorism is lower than the threat to individual companies from either
activist groups or disgruntled employees. The restaurant association recom-
mends a TEAM (threat evaluation, assessment and management) approach to
food security. That basically involves developing a plan and identitying who's
responsible for doing what The main advice from the security experts is to be
alert to the possibility of deliberate contamination of food. So don't, for ex-
ample, let unidentified individuals wander around food preparation areas.
What else can you do in the workplace to prevent deliberate contamination?
You should take all threats of biological or chemical contamination of food or
water seriously. If a threat is received, you should contact local law enforce-
ment or public health authorities immediately.
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FOOD TALK
FALL 2002
Know Your Enemy!
BACTERIA COMMON SOURCES INCUBATION PERIOD SYMPTOMS
Salmonella Raw and uncooked foods . Symptoms appear 6-48 Abdominal pain, diarrhea,
~O such as poultry, eggs and houl3 after eating nausea, chills, fever and
meal, and unpasteurized milk. headache
" tJ tJ Can spread through cross- . May last 1-8 days
contamination.
StaphylococcuS Found on skin, in cuts and . Symptoms appear 30 Abdominal pain, nausea,
pimples and in nose and minutes-8 hours after vomiting and diarrhea.
aureus throat. Spread by improper eating Occasionally followed by
o - IB _ food handling. fever, weakness, headache,
.- @53-..~ dizziness, and chills.
. , CD
Campylobacter Raw meat, poultry or shellfish . Sy~ploms appear 2-10 Fever, headache and muscle
jejuni / and unpasteurized milk days after eating pain followed by nausea,
abdominal pain and diarrhea
.~~ . . May last 1-10 days
~)>
Listeria Milk, leafy vegetables, . Newborns: 4 days Sudden onset of flu-like
monocytogenes unpasteurized dairy products, symptoms such as fever,
especially son cheeses, . Adults: I-several weeks headache. backache and
_c~) processed meats and sometimes abdominal pain
sandwiches. Poses the and diarrhea. ComplicatIOns
greatest problem to immune- can include respIratory
compromised people and distress in newborns;
pregnant women. miscarriages and still births
Escherichia Raw or rare ground beef, . Symptoms appear 3-9 days Severe abdominal cramps
coli O157:H7 unpasteurized milk, aflereating followed by diarrhea, nausea,
contaminated water and diny vomiting and occasionally a
V\J hands . May last up to 10 days low grade fever. Complication
is hlo:molytic uremic syndrome
~~ (HUS) in children.
'\
J
Source: u.s. Dept. of Agriculture, Food SafaJy& Inspection Service
and the Food Research Institute, University of L-Visconsin - Madison
)uaW)ludaa 411uaH
lOpal!a 411uaH
a;)nl p!AUa
lNlW1MVdlO HllVlH AlNnm mONVH MlN
IO~8l IN 'NOI9NIWlIM
LHlIlS HlL I HlnOS 6l0l
NOISIAIO HI1YlH lYINlWNOlllANl
INlWll1YdlO HI1YlH AlNnOl lIlAONYH Mll
it >IlV.L 000::1
Jaded papkJaJ uo pajuPd
,
e
e
September 2002
New Hanover County Health Department
West Nile Virus Update
The media has kept the general public
well up-to-date on the progression of
West Nile Virus throughout the na-
tion. As of September 10. 2002. there
have been 1.086 total human cases.
with 45 total hu- ~
man fatalities. f\~J" j))
Thirty-two states - / ".
have reported ~
--- ,-
human cases, /
from the East to
the West Coast. The first human case
in North Carolina was reported Sep-
tember 18. 2002.
Since human disease for West Nile
Virus does not peak in the U.S. until
late August or early September. we
may well see new cases for a while.
Physicians should suspect West Nile in
people over 50 presenting with acute
febrile illness. headache. confusion. and
weakness (including flaccid paralysis
resembling Guillain-Barre syndrome).
West Nile Virus has been confirmed in
birds from 13 North Carolina coun-
ties. prompting continuing efforts to
educate the public on prevention.
Sharing the information on page 2 with
your patients will help the effort, espe-
cially with the frequent questions re-
garding safety of insect repellants.
Influenza Vaccine
New Hanover County Health Depart-
ment (NHCHD) will be offering influ-
enza vaccine beginning October 14.
2002. Despite some early concerns
about a delay in vaccine production
and consequent delay in getting the
vaccine to providers, vaccine ordered
from the state will begin arrivi ng the
first week of October; the full order is
anticipated by the end of October
In early September. the FDA approved
a preservative-free influenza vaccine
for pediatric use. The vaccine is manu-
factured by Aventis. will be available in
limited quantities in November. and
can be obtained by calling Aventis at 1-
800-822-2463.
Hepatitis B Vaccination in
Schools
The July 2002 issue of Epi Information
reported that the Hepatitis B vaccina-
tion program for middle school stu-
dents was cancelled this year due to
staff reductions. Thankfully two nurs-
ing positions were approved for refill
after several months on hold. The
Health Department will again go to the
schools to administer Hepatitis B vac-
cine. Although beginning later in the
school year than usual. all three doses
will be administered by the end of the
school year
North Carolina Immuniza-
tion Registry Update
The Division of Public Health. Immuni-
zation Branch. is attempting to bring
full functionality to the new North
Carolina Immunization Registry
(NClR). as well as expand the use of
the registry beyond the public sector.
The new system adapts the Wisconsin
Immunization Registry (WIR) for use
in North Carolina. This system is a
web-based clinical tool that complies
with all core Centers for Disease Con-
trol and Prevention (CDq functional
registry requirements. The system
also cracks vaccine inventory and fulfills
all state accountability requirements
Betsy Summey. FNP, 343-6531
for providers. It will be a secure Inter-
net-based system.
Four pilot counties have been identi-
fied as the first counties to implement
the new NCIR. Cabarrus. Chatham.
Henderson, and Pitt counties were
chosen based on existing participation
in the Vaccination for Everyone initiative.
Currently each health department in
North Carolina is assessing its readi-
ness to implement the new registry.
NHCHD is working on its plan to be
ready to convert to the new registry at
the first opportunity. NHCHD will
share information with medical provid-
ers about their participation so that
the immunization information will be
more accessible to everyone who pro-
vides state-supplied vaccine.
Think TBI
New guidelines from the CDC and the
State TB Control Program are ex-
pected out
this fall. The
guidelines are
expected to
offer more
options in the
treatment of TB, and in many cases,
shorten the length of therapy.
- 'lr..~;'"
?
,Me,.
-",'.
~/?~~~ .)
. ,..;.1 ~
One significant change will include the
option for once a week directly ob-
served therapy with isoniazid and rifap-
entine for TB patients who are HIV
negative and have non-cavitary disease.
The Health Department will keep pro-
viders abreast of all the changes as
they become available.
~------------------------------------------------,
I
I
I
I
I
I
I
I
I
I
I
I
North Carolina Division
of Public Health
West Nile Virus
Repellant
Guidelines
Insect repellants containing DEET
(N.N-diethyl-m-toluamide) and
related compounds are
the most effective mos- ,..Q...,
quito repellants on the H
market. When used 101
properly along with
other steps such as U
wearing light-colored
long sleeved tops and long pants.
avoiding mosquito-infested areas
and staying indoors at dawn and
dusk. repellants are a good way to
minimize the risk of mosquito
bites. As with any such products,
precautions are in order to en-
sure personal health and safety.
Always read and follow label di-
rections and precautions carefully.
. Use other methods of protec-
tion like dressing infants in long-
sleeved shires and pants and
placing mesh covers over stroll.
ers.
Children Aged 6 Months to 2
Years
. Use only one application per
day of a DEET product made
for children (10% DEET or less)
and only in situations where
there is a risk of getting insect
bites.
. Apply repellant sparingly.
. Do not apply to child's face and
hands.
. Avoid prolonged use.
. After returning indoors. wash
the child's treated skin with
soap and water
Children 3 to 12 Years of Age
. Use a DEET product made for
children containing 10% DEET
or less.
. Do not apply more than three
times per day.
. Apply repellant sparingly.
. Do not apply to child's face and
hands.
. After returning indoors. wash
the child's treated skin with
soap and water
.
Children 13 Years of Age or
Older and Adults
. Use products containing 30%
DEET or less.
. Apply repellant sparingly.
. To apply to face. spray on
hands first and then rub on
face. Do not spray directly on
to face.
. After returning indoors. wash
treated skin with soap and wa.
ter
People should check around their
homes and empty any containers
holding water such as tires. bird-
baths, and flowerpots. Screens
should be used on doors and win-
dows to prevent mosquitoes from
entering homes. People who are
using rain barrels to collect water
during the drought should be sure
the barrels have screens that fit
tightly to prevent mosquito
breeding.
e
Children Under 6 Months of
Age
. DO NOT use personal insect
repellents on babies under 6
months of age.
I
~------------------------------------------------
eommunicable Disease Statistics
II New Hanover County
July 1, 2002 - August 31,2002
AIDS.....................................8
Campylobacter....................2
Chlamydia .........................74
Gonorrhea .........................21
Hepatitis A...........................1
Hepatitis B (acute)..............3
Hepatitis B (carrier) ............0
Hepatitis C (acute) ..............0
HIV Infection........................9
Legionellosis.......................O
Listeriosis ...........................0
Lyme Disease......................1
Meningitis
Pneumococcal................1
Meningococcal
Disease ...............................1
Pertussis ...............................1
Rky. Mt. Spotted Fever .........1
Salmonellosis...................... 32
Shigellosis............................. 0
Strep, Group A Invasive ....... 0
Syphilis.................................. 1
Tuberculosis .........................0
Typhoid (acute) ..................... 0
Vancomycin Resistant
Enterococcus .................... 0
-
'Un ited 'We Stand
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Published for Members of Local Boards of Health
August 2002
~~oo
President's Message
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As I started to write this article I thought of the many things
that have happened since our last NewsBrief. On the 12~ of
April, Marie Fallon and I spent the day in Baltimore, Maryland
looking at possible sites for the 2003 Annual Conference. It was
a hard decision because all the sites had positive things offer
However, the NALBOH Board of Directors decided on the
Wyndham Inner Harbor for next year's conference and
preparations have already begun.
@~~
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On June 20th, those who have worked on the performance
standards met in Washington DC to kick off the program. Marie
Fallon, Ted Pratt, Shepard Cohen, Harvey Wallace and I
represented NALBOH at this landmark meeting. The many long hours that have gone into this
program now seem worthwhile. Those who worked on the project were rewarded for their efforts.
Marie, Shepard, and Harvey were presented certificates of achievement. It was a great opportunity
to meet with the representatives from APHA, ASTHO, NACCHO, PHF, and our other partnering
organizations who were in attendance. The performance standards documents are available on our
website. See page 12 for more details about this meeting and the performance standards.
11:ID Iil:!m ~
~~
On the 9~ of July, the NALBOH Board met in a strategic planning session. We spent the entire day
looking at five different areas that will help move our organization ahead in a positive manner The
areas are education, technical assistance, advocacy, membership, and organizational infrastructure.
It is our goal to work on each of these areas over the next three to five years. We will be assigning
these five areas to the different committees that now exist. We will be looking to our membership
for additional help to accomplish this strategic plan.
r
Continued on Page 2
Local Public Health and the West Nile Virus
Ronald C. Burger
Chainnan, Rockdale County Georgia Board of Health
State Affiliate, NALBOH
The West Nile virus (WNV) has traveled quite a distance since its introduction into the United States
by way of New York City in 1999. At the time of this printing, WNV has been identified in either
birds, mosquitoes, horses, and/or humans in 37 states including the District of Columbia. That's
every state west to a line from Texas up to the Dakotas. There are predictions that WNV will soon
reach the Pacific coast.
WNV was first isolated from a febrile adult woman in the West Nile District of Uganda in 1937 The
ecology was characterized in Egypt in the 19S0s. The virus became recognized as a cause of severe
human meninoencephalitis (inflammation of the spinal cord and brain) in elderly patients during an
outbreak in Israel in 1957 Equine disease was first noted in Egypt and France in the eariy 1960s.
So, WNV is an old disease, but it is new to the USA. As of August 15, 2002, the total number of
reported cases of WNV disease in humans was 160. Historically in the USA, there were 62 cases in
1999, 21 in 2000, and 66 last year
WNV is just one of many "arboviruses" or arthropod-borne virus. Arboviruses are maintained in
nature through transmission between susceptible vertebrate hosts by blood-feeding arthropods
Continued on Page 3
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[NALBOH'S lith Annual conferencelt,
,
p
i
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July 16-19, 2003
Wyndham Baltimore Inner Harbor
Baltimore, Maryland
,---
,
I
For more information contact the NAlBOH office by phone: (419) 353-7714; fax: (419) 352-6278
e-mail: <nalboh@nalboh.org>, or visit our website at <www.nalboh.org>
National Association of local Boards of Health
1840 East Gypsy Lane Road
Bowling Green, OH 43402
E-mail: <nalboh@nalboh.org>
Website: <www.nalboh.org>
NON PRom ORG.
U.S. Postage
PAID
Bowling Green, OH
Permit No. 47
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