03/03/2004
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New Hanover County Health Department
Revenue and Expenditure Summaries for January 2004
Cumulative: 58.33% Month 7 of 12
Revenues
Current Year PriorVear
ypeof Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remalnln Amount Earned Remalnln
Federal & State $ 1,954,958 $ 1,203,262 751,696 $1,550,484 441,364 $1,109,120 28.47%
C Fee. $ 570,161 $ 369,154 201,007 $ 533,044 331,781 $ 201,263 62.24%
Medicaid $ 1,044,080 $ 319,918 724,286 $1,012,934 514,732 $ 498,202 50.82%
Medicaid Max $ 273,333 $ 273,333 $ 165,773 165,n3 $ 100.00%
EH Fee. $ 300,212 $ 118,027 182,185 $ 312,900 147,247 $ 47.06%
Health Fee. $ 113,850 $ 106,223 7,627 $ 127,850 106,060 $ 82.96%
Other $ 2,340,815 $ 1,522,158 818,657 $1,532,210 835,461 $ 54.53%
Expenditures
ypeof
Ex endlture
Current Veer
Expended Balance
Amount
Prior Year
Expended Balance
Amount Remalnl"
%
Budgeted
Amount
Budgeted
Amount
Summary
Budgeted Actual %
FY 03-04 FY 03-04
Expenditures:
Salaries & Fringe $10,021,623 $5,165,343
Operating Expenses $1,683,027 $749,657
Capital Outlay $369,863 $89,562
Total Expenditures $12.074,513 $6.004.562 49.73%
Revenue: $6,597,409 $3,638.742 55.15%
Net County $$ $5,477,104 $2,365,820 43.19%
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Revenue and Expenditure Summary
For the Month of January 2004
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NHCHD BOARD OF HEALTH APPROVED GRANT APPUCATION STATUS FY 03-04
Date (SOH) Grant Requested' Pendlna Received Denied
2/412004 No activity to report for January 2004.
Cape Fear Memorial Foundation- Funds needed to
enhance health education in 4 areas other than
11712004 Diabetes (an enhancement to Diabetes Today Grant). $20,000 $18,500 $1,500 .
121312003 No activity to report for October 2003.
Cape Fear Mamorial Foundatlon- Funds naeded to
cover dantal services for naedy children as Identified by
11/512003 School Health Nursas. $3,000 $3,000
NC Medical Foundation - Through the Good
Shephard Ministrias for nursing services to the
population frequenting the shelter. $25,000 $25,000
Duke Unlverslty- To provide 10 hours of nursing
services for TB Outreach. $10,388 $10,700 -$312
NC Tobacco and Control Branch, DHHS-
Continuation of Tobacco Prevention Program. $100,000 $64,093 $35,907
10/112003 No activity to report for October 2003.
New Hanover County Safe Schools- Uniting for
You1h 'U4Youth"(fundlng will be received over a
9/312003 3 year grant period) $49,000 $49,000
Safe Kids Coalltlon- Fire Prevention (Please note
this grant was pullad- coalition not able to meet
deadllna for request) $2,500 $2,500
,
8/612003 NC DHHS- OPH Preparedness and Response $82,350 $31,950 $50,400
Smart Stert- Partnership for Children (Grant
71312003 Increase for Part Time Nurse Position) $5,523 $5,523
Cape Fear Memorial Foundation - Diabetes
Today (two-year request; $42,740 annually)
(Racelvad $25,00 year 1 and $20,000 year 2) $85,480 $45,000 $40,480
Duke University Nicholas School of the
Envlronment-Geographic Information Systems
Grant (Env Health) $10,000 $10,000
Safe Kids Coalition- Safe Kids Mobile Car Seal
Check up Van $50,000 $50,000
Safe Klda Coalltlon- Risk Watch Champion
6/412003 Team $10,000 $12,500
Smart Start- Partnership for Children: Child
51712003 Care Nursing Program (Preliminary Approval) $171,977 $172,500
Smart Start- Partnership for Children: Health
Check (Preliminary Approval) $41,035 $41,747
UNC-CH: Child Care Health Consultant $62,849 $64,495
Capa Fear Memorial Foundation (through
Partnership for Children): Navigator Program $178,707 $180,000
4/312003 No activity to report for April 2003.
3/512003 No activity to report for March 2003.
2/512003 No activity to report for February 2003.
1/812003 NC DHHS- OPH Preparedness and Response $115,950 $33,600 $82,350
12/412002 No activity to report for Decamber 2002.
As of 2/1712004
, NOTE: Notification received since last report.
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NHCHD SOARD OF HEALTH APPROVED GRANT APPUCATION STATUS FY 03-04
NC Health and Wellness Trust Fund-Teen
Tobacco Use Prevention & Cessation Program
111612002 ($100,000 per year for 3 years) $100,000 $100,000
Safe Kids Suckle Up Program-North Carolina
101212002 Safe Kids $5,000 $5,000
Developing Geographic Information Systems
(GIS) Capacity In Local Health Department In
Eastern North Canollna-Duke University
Nicholas School of the Environment and Earth
Sciences (NSEES) $18,000 $18,000
I No actlv ty to report .or ..eptemoer lOU..
I No activ ty to report .or AUgust .uo..
INo activity to report .or ~UIY .OU'.
Totals $1,146,759 $49,000 $736,085 $368,348
4.27%
Pending Grants 1 5%
Funded Total Request 11 52%
Partially Funded 5 24%
Denied Total Request 4 19%
Numbers of Grants Applied For 21 100%
As of 2/1712004
. unT'C. ......~.~ ........iv.... ..ln~.rAnt"t
64.19%
32.12%
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:D Consent Meeting Date: 3/22/04
Agenda: ~
Department: Health Presenter' Janet McCumbee
Contact:Janet McCumbee or Cindy Hewett
Sub'ect: Re uest for new osition, funded b BOE
Brief Summary: We have received approval from AI Lerch, with the NHCS, to use
lapsed salary in the 03-04 school health budget to hire an administrative support!
Information Systems Support Technician position to support the 35 school nurses with
clerical duties and IT support. This position will be added to the school health budget for
04-05 as a ear round osition to be aid for b the BOE, in our school health contract.
Recommended Motion and Requested Actions: To use $9,361 oflapsed salary in the
school health budget to hire an Information Systems Support Technician to support the
school nurses for the remainder of this FY, and that this position be added to the 04-05
school health budget, as supported by AI Lerch, NHCS. Also, to approve the change to
the 04-05 school health budget (increase of$46,336). No budget amendment needed this
FY, since there is la sed sal
I Funding Source: NHCS
Will above action result in:
~New Position I-Number ofPosition(s)
DPosition(s) Modification or change
ONo Change in Position(s)
Explanation: An Information Systems Support Technician will be hired, to begin May
2003, to provide administrative and IT support to the school nurses, and this will continue
as a year round position as long as there is funding through NHCS.
I Attachments: Letter from AI Lerch; Justification fonn from Janet and Cindy
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SUSAN
PAGE 82
:II.LI:I4I:Oqq.30:lll!:
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NEW
HANOVER
C-.J
SCIlOO1.S
01\. D. JOHN MORRIS, JR
S/lPflf/nlent*t
DR. AlFIl.EO H. LEROl, JR.
A#islant ~hltt;,w.,4.
5'lutknt Support 5etvkes
6fId Federal Prognms
February 11, 2004
To: Board of Health
FI'OIll; AI Lerch 6Y--
Re: Management supportliniormation technology services addition for scl1ooll\UfJc8
You have our permission to add an administrative support person for May and June, 2004
out oflapse salary for the current year and add that position in the contract for the 2004-
2005 school year.
c:
Dr. lohn Manis
..10 ar.Ii.. _ Road _.llp, He -,u ...... (910).......ZG6.... (910) U4-4352 -..........1lCs.1I12.nc.us
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
.2/13/04
Justification For New Administrative Support/Information Technology Position
AI Lerch of NHCS has given approval (see letter) for the addition of management
support/information technology services to the school health budget. We have identified
enough lapsed salary in the current FY budget to hire an administrative support person
for May and June 2004 Then the position will be budgeted for next FY-04-05. The 35
school nurses need general clerical support and IT support year round, and the
program/staff have grown so that the Health Department cannot support the
administrative needs any longer. Nurses are doing clerical work regularly.
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Support needs for 35 school nurses and iustification of position:
General clerical duties-'typing, data entry, word processing of policies and procedures,
completing forms and statistical reports, minutes of team meetings, making copies,
sending faxes, and requesting information from health care providers, preparing and
updating community resource lists, maintaining supplies by monitoring stock levels and
replenishing as necessary; compiling results of customer satisfaction surveys, audits,
and quality assurance reports; assisting school nurses with making health education
materials. Information Technology - support in use of equipment, computers and
related software.
The cost for this current FY to add the Information Support Technician will be $9,361,
which includes salary, fringe, personal computer & software, mileage and some training.
AI Lerch was made aware that there is sufficient lapsed salary in the school health
budget to cover this for May and June.
The cost for next FY (04-05) for a full 12 months will be $46,336... that includes salary,
fringe, mileage and training. The school health budget will need to be increased by this
amount for next year. AI Lerch is aware of that, and has approved this as a year round
position for next year.
e
Respectfully submitted,
"q~ /)'}cc.-.e-..
~~et McCumbee
~~nal ealth Services Manager
~Hwe
Business Manager
15
"Healthy People, Healthy Environment, Healthy Community"
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Meeting Date: 03/22/04
Sub'ect: Additional CDC TB Aid-to-Counties State Grant Funds $10,000
Brief Summary: The New Hanover County Health Department will receive an additional
$10,000 from the General Communicable Disease Branch as additional support for the
Tuberculosis ro am. These funds must be ex nded b Ma 31, 2004
Recommended Motion and Requested Actions: To approve and accept the additional
CDC Aid-to-Counties State funding in the amount of $1 0,000 and associated budget
amendment.
Funding Source: North Carolina Department of Health and Human Services, Division of
Public Health, Communicable Disease Branch.
Will above action result in:
[]New Position Number ofPosition(s)
DPosition(s) Modification or change
[8'JNo Change in Position( s)
I Explanation:
I Attachments: Supporting documentation.
16
NORTH CAROUNA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
ISSUED TO: NEW HANOVER COUNTY
Public Healtb DepartmentIDistrkt
FUNDING SOURCE: 5369614552
NAME OF PROGRAM: CDC TB Control
INITIAL ALWCATION
FUNDING
AUlHORIZA liON
STATE FIscAL YEAR
FROM: July 1,2003 tbrough june 30, 2004
EFF'ECTlVE
DATE
07101103
542,000.00
SO.OO
PRIOR ADJUSTMENTS YEAR TO DATE,.. INCREASE (DECREASE)
INCREASE (DECREASE) THIS AUTHORlZATI9N
NET ANNUALAU.OCATlON
GRANT INFORMATION
Service Montbs
June-Dee
Oct-May
JaB-May
lob)'
Local Healtb Director
..
1
Local finance omeer-
Payment Montbs
July.June
Nov.June
feb-Juae
.- .~--.~ .-:,
Jiu-./f. d-n
AUTHORIZED SlGNA11JRB
DHJIS..CO
7-81
510,000.00
552,000.00
Codes
14516173 NIl
14516173 NIl
14516174 NIl
Amount
521,0??.oo
510,000.00
521.000.00
$52,000.00
--......
DATE: 11115/03
AUTBII
2
CFDAtI
93.116
9U16
".li6
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5112-
DIVISION OF PUBLIC HEALTH
AGREEMENT ADDENDA
SFY 2003 - 2004
11 10000
i
,
65 NEW HANOVER COUNTY HEALTH
DEPARTMENT
Contractor Name
Epidemiology
Sectlou
General Communicable Diseases Branch
Branch
4552 CDC TB Ald-to-Counties
Activity Number and Title
TB Prevention and Control
Unit
October I, 2003 - May 31.2004
Effective Period (Beginning and Ending Date)
02
Revision #
12/01/2003
-Date
CDC- TUBERCULOSIS AID-TO COUNTIES OBJECTIVES FOR SFY 2003 - 2004
This revision (# 02) awards supplemental CDC funds for TB Prevention and Control activities for your
county. Approved uses of these funds include:
. Purchase ofx-ray film, film developing solutions and related supplies
. Purchase of office supplies to support TB Control activities
T!3 Nurse salary and benefits
. Payment for interpreter services
. Minor equipment(scanner, fax machine, printer) used to support TB Control activities
. Expenses for temporary DOPT outreach (travel, temp salaries)
Please contact your TB Nurse Consultant if there are any questions.
:,-
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Page .1. of.l.
Rev 01/1012003
/I,tIl9iJF03
,
County Health Director Signature and Date
18
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Meeting Date: 03/22/04
De artment: Health
Contact:Cind Hewett, ext 6680
Subject: NC Safe Kids Buckle Up Program Grant Funding ($3,500) for New Hanover
Coun Health De artment, Health Promotions Pro am
BriefSllmmary: The New Hanover County Health Department will receive a $3,500
Child Safety Seat Grant from the NC Department of Insurance Office of the State Fire
Marshal to purchase child safety seats for use in the NC Safe Kids Buckle Up Program.
These seats must be urchased and invoiced b A '1 30, 2004.
Recommended Motion and Requested Actions: To approve and accept the $3,500 grant
funding from the NC Department of Insurance Office of the State Fire Marshal to
urchase child safi seats and to a rove the associated bud et amendment.
I Funding Source: NC Department ofInsurance Office of the State Fire Marshal
Will above action result in:
[]New Position Number ofPosition(s)
DPosition(s) Modification or change
1ZJN0 Change in Position(s)
I Explanation:
I Attachments: Supporting documentation and budget amendment
21
I
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" ,...
_ ,a
- .
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.,
we SAFE KIDS
Up
Insurance Commissioner Jim Long, Chair
North Carolina Depanment of Insurance
Office of State Fire Marshal
PO Box 26387, Raleigh NC 27611
North Carolina Hospital AsscC/atlon, FoundlnEf Sponsor
February 12,2004
New Hanover County Health Department
Federal Tax ID # 566000324
RE: NC SAFE KIDS Buckle Up Child Safety Seat Grant
Geotf Zuckerman,
Congratulationsl Your agency has been selected to receive a Child Safety Seat Grant from the NC
Department of Insurance Office of State Fire Marshal to purchase child safety seats for your county, based on
the budget summary submitted to our office. Each participating NC SAFE KIDS Buckle Up county, who
applied for this grant, was awarded a grant based on county population, county need, and timely quarterly
reporting by a primary contact who is a Certified Child Passenger Safety Technician. The total amount
awarded is $ 3.500.00. You may nurchase seats based on the budl!et summarY outlined beiow:
e
10 infant only
45 convertibles
30 combinations
Your grant check is currently being processed by our office and will be mailed out within the next few weeks.
After purchasing your child restraint seats, please submit to our office an original or notarized copy of each
invoice received by Friday, April 30th, 2004.
Please do not hesitate to contact me if you have any questions regarding this grant a1919-661-5880 ext. 314 or
1-800-634-7854. Thank you for your efforts and involvement in the child passenger safety program in your
community . We look forward to your continued participation. Again, congratulations on receiving this grant.
Sincerely,
Kelly Ransdell, lnjwy Prevention Supervisor
Office of State Fire Marshal
Cc: Deb Stout, Office of State Fire Marshal, Assistant Director
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Following are specifications that must be met for child restraint systems (CRS) purchased with funding
by the State of North Carolina:
Rear Facing Only (Infant Seats) Models
1. With the exception of comfort and convenience items', CRS must be ready to use out of the box
with no assembly required.
2. Hamess adjustment must be visible and accessible when installedz.
3. Hamess adjustment cannot require back-threading (re-Iooping) in order to lock the hamess length.
4. Hamess may be either 3-point or 5-point. No shields or hamess shield combinations allowed.
Convertible Models
1. Upper weight limit for the rear-facing position must be at least 30 pounds.
2. With the exception of comfort and convenience items', CRS must be ready to use out of the box
with no assembly required.
3. Hamess adjustment must be visible and accessible when installedz.
4. Hamess adjustment cannot require back-threading (re-looping) in order to lock the hamess length.
5. Hamess may be either 5-point or T-shield.
6. Must be equipped with an attached tether with a tilt-iock adjustment for the tether. Single or double
O-ring tether adjustments are prohibited.
Combination Models
1. With the exception of comfort and convenience items', CRS must be ready to use out of the box
with no assembly required.
2. Hamess adjustment must be visible and accessibie when installedz.
3. Hamess adjustment cannot require back-threading (re-iooping) In order to lock the harness length.
4. Harness may be either 5-polnt or T-shield.
5. Must be equipped with an attached tether with a tilt-lock adjustment for the tether. Singie or double
O-ring tether adjustments are prohibited.
6. Shoulder beit guide must be open loop or other design that does not restrict the movement of the
shoulder belt through the guide.
High Back Belt positioning Booster
1. With the exception of comfort and convenience items', CRS must be ready to use out of the box
with no assembly required.
2. Shouider belt guide must be open loop or other design that does not restrict the movement of the
shoulder belt through the guide.
Backless Belt Positioning Booster
1. With the exception of comfort and convenience items', CRS must be ready to use out of the box
with no assembly required.
2. Must be equipped with a shoulder belt guide.
NOTES
, Comfort and Convenience Items
. Detachable bases for Installation of rear-facing only restraints. Bases that cen be removed for use as a front.
facing restraint are not Included In this exclusion.
. Sunshade canopies
. Cup holdere
. Head positioning accessories provided with the restraint
Z Hamess adjustment visible and accessible when Installed, not out of sight or Inside a compartment. When the
CRS Is used front facing, adjustment cannot be behind the CRS.
TXpscenter.wlfiIpoIic/etN:td purchese specifications rev. 12-30-03.wpdJpdf
NC CPS Training Committee
Page 1 of 1
December 30, 2003
23
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Geoffrey ZuckelTllan
0211812004 11 :53 AM
To: Cindy HewelllNHC@NHC
cc: (bee: archive)
Subject: Cer Seat Grant Aw.rdll- BOH budget amendment needed
Cindy,
Below is the $3500 we were awarded for SAFE KIDS to buy car seats. Jennifer Smith for the FD applied
for SK and they will send us the check since I am the coordinator. Pat suggested that we put the money In
Revenue 3515,5182,4210 subobject 86,
Thanks
Geoff
_ FOIWerded by Gaoffrey Zuckerman/NHC on 02118/04 11 :50 AM -
tit "AIIIBon Cummings"
,,' <Acummlng@ncdol.ne
,.' to
02112/04 07:10 PM
To: <GZuckerman@nhcgov.com>
ee: (bee: archive)
Subjecl: Car Seat Grant Awardll
Please note Invoice due date: April 30th, 2004. Also note that only seats specified In the attached crd
specifications are eligible to be purchased with this grant money. Thanksl '
Allison Cummings
Office of State rue Marshal
1202 MaD Service Center
Raleigh. NC ,17699-1202
1-800-634-7854 ext. 314
919-662-46'70 (fax)
II
1I
crd purchase specifications rev. 1-05-04 NewHanover-Car Seat Award lettar-2004
24
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26
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
To: NHC Board of Health
From: Janet McCumbee, Personal Health Services Manager ~
Subject: Position Reclassification
Disease Intervention Specialist (DIS) to Public Health Nurse (PHN)
Date: 2/18/04
-
This is a request to reclassify the DIS position in the Personal Health Services-Clinic
Team, Effective on April 1 , 2004, Bobby Waters, D1S, will retire. His current position of
DIS (Disease Intervention Specialist) is classified as PT 06, at the starting rate of
$43,888 per year, This position was created many years ago at a time in New Hanover
County communicable disease history when we had a high rate of syphilis that required
a full-time individual to provide disease surveillance, tracking and follow-up.
The NC DHHS now assigns DIS workers to regional offices across the state.
Wilmington has a regional office with numerous DIS workers. BettyJo McCorkle has
spoken with the regional and state offices (HIV/STD Branch), and they are prepared to
provide anyJ:UV and Syphilis disease surveillance, tracking and follow-up needed in
New Hanover County, They are preparing a written statement to that effect. Our lab
and clinic staff will work directly with the regional office to notify them of cases identified
'through the health department.
We have reviewed the current DIS position duties and feel the DIS position should be a
Public Health Nurse, The DIS duties have evolved over the years to include primarily
clinic services, working in all STD clinics and doing HIV counseling and testing, A PHN
would be even more effective in the clinic, with the DIS duties handled by regional
workers,
e
Therefore, as of April 1 , 2004, we are requesting to fill the vacant DIS position with a
PHN position that will function most effectively as a clinic nurse in our open access
clinic, providing family planning, STD, and immunization services, The PHN position is
a NUZ I class at the same pay rate as the DIS class ($43,888). There will be no
additional costs to the county. This reclassification request will be reviewed by Human
Resources to go to the County Manager for approval, and will not need County
Commissioner approval (since PHN is an existing class). Thank you for consideration of
this request.
27
"Healthy People, Healthy Environment, Healthy Community"
FOR STD ONLY. 0 VOL 0 EPI 0 SCREEN_
N C Department of Health and Human Services - Division of Public Health
-
NORTH CAROLINA COMMUNICABLE DISEASE REPORT CARD ,
"- ,
"----,~ FOR ALL REPORTABLE DISEASES EXCEPT CANCER-REPORT ONLY ONE DISEASE PER CARD - ,
Patient's Name I Sex I ~SN
Last First Middle/Maiden OM OF I I
I ] Was this I Hospitalized
Date ot Renort I I DateotOnset I I Disease Fatal? DYes 0 No ForthisDisease? DYes ONo
.II. Patient's Address: Street or RFD No. Phone
ENTER CODE Race Ethnic Origin I -
FOR DISEASE o White 0 American Indian or Alaska Native o Hispanic
REPORTED City I Zip County
(see other side) o Black 0 Asian or Pacific Islander o Non-Hispanic
Birthdate I Age ; I Site of Care: 0 Active Military Location Where Acquired (if other than county of residence)
I I Years OR Months 0 Public 0 Private o SAME
'Required Information for Codes Parent or Guardian (of minors)
6,9,13,23,25,27,38,54,55,58,61,68,200, T8: Patient IS:
Causative Organism: o Child or Worker Reported By (Full Name and Title)
[Encephalitis, arboviral (9), Other Foodborne Disease (13). Viral mDayCare
Hemorrhagic Fever (68)] o Parent of Child Agency and Address
in Day Care
Serotype: o Foodhandler
{Vibrio cholera (6), Hemophilus influenzae (23), Meningitis, Pneumococcal (25), o HeallhCareWorker Attending Physician (if not individual reporting case)
Meningococcus (27), Salmonella (38), Vibrio, other (55)] o None of Above
Slteoflnfeetion: Address Phone
[Hemophilus influenzae (23), Meningococcus (27), Vibrio vulnificus (54), Stat&'lHD Use Only: I
'VRE' (58), Group A Strep. (61), Chlamydia (200), TuberculOSIS (T8)] outbreak related: Surveillance Form I Case Investigation No.
COMMENTS Dno Dyes: o Completed 0 Not Required
specify: Local Health Director's Signature or Stamp I Clinic No.
DHHS 2124 (Revised 7/03} EPIDEMIOLOGY
n-suTVemonceFot/l>D~'luited
PLEASE ENTER CODE NUMBER IN BLOCK ON FRONT OF CARI'--.
'Add'llnlormolionRequiredonOtherSideofCard
,
(DC: B101DUl0R1SM IIRYA OTHER REPORTABLE (OMMUNIUlLE DISEASES (wntlnued) SUUALLY TRAIISMlnED DISEASES
REPair IMMEDIArELY .. COlI, SHIGA TonH- HEPATITIS C, ACUTE 60 s.A.u. (COfOIfflvirus inledion) 7/ REPORT WITHIN 24 HOURS
TO LOCAL HEALTH DEPARTMENT ,I/OO/IC/H' IH'fmOll HIVINFmlON 900 SHIGEllOSIS 3. S"""US
AlTHRAll . (ind.fling Leo'; O157:Hn 53 PRIMARY (lesion presenl) 710
lEGIONELLOSIS 18 STREPTOCOCCAL INFECTION,
ROtuUSM ,. EHRUCHIOSIS, GRANULOCYTIC 571 SECONDARY {skin or
lEPTOSPIROSIS " GROUPA,INVASIVEDISEASE '61
P!AOOE .. EHRlICHIOSIS, MONOCYTIC Um.,OSIs 64 mlJcosollesions) 720
SIUIJ.POI 69 (E.{haffeensis) 572 TETANUS 40 EARlYlATENT(< 1 yr) 730
tuLAREMIA .. ENCEPHALITIS, ARBOVIRAl lYMEOISEASE 51 TOXIC SHOCK SYNDROME 41
lATENT, UNKNOWN DURATION 740
VIRAl HEMORRHAGIC FMI 068 (CAl.m,WNV.OTHER) " MALARIA 21 TOXIC SHOCK SYN., STREPTOCOCCAL 6S
lATElATENT(> 1yr) 745
OTHER REPORTABLE ENTEROCOCCI, Vancomycin- MfASUS .. TOXOPLASMOSIS, CONGENITAL 62 lATE WITH SYMPTOMS 750
resislont("VRE"), from
COMMUNICABLE DISEASES normally slerile site '5S MENINGITIS, PNEUMOCOCCAL '25 NEUROSYPHILIS 760
TRICHINOSIS 42
ACQUIRED IMMUNODEFICIENCY fOOIBO.IIE IISUSf: MfH'HGOCOCW DlSUSf '.7 CONGENITAL 790
5VNDROME(AID5) '50 fUBE'CU10SlS oTB
C."em;ngell$ " MOIIllErPOX 77 GOIIOIIHIA
BRUCEllOSIS 5 STAPHflOCOCCAI " ffPllOlD, ACIIff 44 GENITO URINARY (non PID)
OTHER 01' UIIllllOWN "3 MUMPS 28 300
CAM'PRflBAC1I.,lIfEmOll 5. HUO, PAlWmc 30 TYPHOID CARRIER 144 OPHTHALMIA NEONATORUM 345
HANTAVIRU51NFECTION 67
CI/01fRA '. HfMOI.mC U'EMIC PSITTACOSIS 31 TYPHUS, EPIDEMIC (Iouse.borne) 46 CHANCROID 100
TRANSMISSIBlESPONGIFORM ""HOME 5. QFEVER 32 VACCIIIIA 7. GRANULOMA INGUINALE 500
ENCEPHALOPATHIES (UDlvUD) 66 HEMOPHIUIS l.nUEIIlAf, "'.RlO IHnmOll, OTHfl '55 OTHER STDs REPORT WITHIN 7 DAYS
INVA5IVf 0ISf/l5f 023 'ABIES, HUMAII 33
CI'fP1OSPOIlIDlOSIS 56 CHLAMYDIA LlIbtonlirmed '200
Hf'AflflS A /4 ROCKY MOUNTAIN SPOTTED FEVER 35 "'.RlO WINlflCUS '54
Cfa_A51S 63 LVMPHOGRANUlOMAVENEREUM 600
Hf'AflflS I, ACUff /5 .UafllA U WHOO".6 COUGH OlherlhonlllbtonfirmedCHlAMYDIA
DENGUE 7 HEPATITIS B CARRIER I1S RUBEllA CONGENITAL SYNDROME 37 (l'flfUssrS) 47 NONGONOCOCCAL URETHRITIS (NGU) 400
DIPHTHERIA . HEPAOnS B, PERI.ArM "' SAlMONEllOSIS '38 VElLOWFEVER 48 PELVIC INFlAMMATORV DISEASE 490
Renort within 24 hours for diseases in Bold It.li($ ond 7 days for 011 other diseases.
Characteristics of Suspicious
Letters / Packages
Inaoorooriate or unusuallabelin~: excessive postage,
no return address or unfamiliar return address, hand-
wrinen or poorly typed addresses, misspellings of com-
mon words, not addressed to a specific person, marked
with restrictions (such as "Personal" or "Confidential"),
marked with threatening language, etc.
Ap.pearance: powdery substance felt through or
appearing on the package or envelope; oily stains,
discoloration, or odor; lopsided or uneven envelope;
excessive packaging material (such as masking tape,
string, etc.).
Other Susoicious SilffiS: excessive weight, ticking
sound, protruding wires, etc.
If a package or envelope appears suspicious, DO NOT
OPEN IT. IMMEDIATELY CALL 911.
.....~
.~,-,-<:t-,>_~.
.~,
,
')
-'
Guidelines for Handling Suspicious
Packages or Envelopes
Do not handle the letter/package or allow others to
handle it. DO NOT OPEN IT.
2. Isolate the letter / package in a room or area, leave the
area, and close any doors. If possible, shut off the
ventilation system.
3. Ensure that all persons who have touched the
letter/package wash their hands with soap and water,
4. Call 911 to activate the local emergency response sys-
tem and notify your local law enforcement authorities.
5. List all persons who were in the room when the let-
ter/package arrived and give the list to the authorities.
6. Place all items worn when in contact with the suspect-
ed letter/ package in plastic bags. As soon as possible,
shower with soap and water.
What Can I Do To Protect My Family
and Myself from Terrorism?
Control unwarranted fears that help terrorists accom-
plish their goal of spreading panic.
o Report any suspicious activity or persons to your local
law enforcement agency. --,
Currently, there is no need to be vaccinated against ~
anthrax or smallpox or to stockpile medications, such
as antibiotics.
o Take the same basic precautions you would take to
prepare for a natural disaster, like a hurricane. For
example, assemble a disaster supply kit that includes
food, bottled water, infant formula, first aid supplies,
medications, battery powered radio, copies of impor-
tant documents, etc.
. Be familiar with characteristics of suspicious packages
or letters.
o Listen to local authorities. They will provide you with
the most accurate information and tell you specific
actions you may need to take.
Imoortant Local Resources
. Brunswick County Health Department:
.(910) 253-2250
. Carteret County Health Department:......................(252) 728-8550
. Columbus County Health Department:
o Duplin County Health Department:
.(910) 640-6614
.(910) 296-2130
o New Hanover County Health Department:............(91O) 343-6500
. Onslow County Health Department:
. Pender County Health Department:
.(910) 347-
~
.(910) 259-1230
Other National Resources
COCo
.www.bt.cdc.l!ov
U.S. Department of Health and Human Services:........www.hhs.J:ov
U.S. Department of Homeland Security: ......................www.dhs.llov
Federal Emergency Management Agency'
.www.fema.l!ov
American Red Cross:
www.redcross.om/services/disaster
N.C. Office of Public Health Preparedness & Response
(NC OPHP&R): www.eoi.state.nc.us/eoi/ohoT
Public Health Regional Surveillance Team:
. www.ohrst2.oll!
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North (arolina PUblic Hco:111 Prcparedness& ResDonsc
REGIONAL SURVEILLANCE TEAM
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910-343-6760
www.phrst2.org
2029 South 17th Street
Wilmington, N.C. 28401
Developed by
Epidemiology Team
Onslow County Health Department
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David E Rice
0212712004 12:33 PM
To: c1ofgren@charter.net, donblake@aol.com, eweaver@ec.rr.com,
hickmonj@bellsouth.net, jstunstall@andrewandkuske.com,
freemanm@wrightcorp.com, MCSpeck@bizec.rr.com,
ppsmithsr@aol.com, bgreer@nhcgov.com, iamsmiles@bizec.rr.com,
aquamedic9@aol.com, Health
ce: Pat MelvinlNHC@NHC
Subject: Public Health Task Force 2004 - Information
Board Members and Staff:
Please visit the following web site to review the North Carolina Public Health Improvement Plan with draft
recommendations. This plan, when completed, will have a substantial impact on the future of our Health
Department. The good news is we're ahead of the curve by completing the accreditation process. Thanks
for your help this week with the Site Visit Team.
htto:/ /www.dhhs.state.nc.us/doh/taskforce/taskforce.htm
Thanks, Dave
FYI, I currenUy serve on the Public Health Task Force 2004 and its Accreditation Committee.
.
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NC Public Health Task Force
Centers for Dtsease Control
and Prevenhon (CDCllln~s
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.___ ._T......_
P.ublic Health Task Force aOO4
Due to strong interest in the General Assembly and among public health
leadership, a North Carolina Public Health Task Force was established in
mid-2003 to study public health in North Carolina and to devise an action plan
to strengthen public health infrastructure, improve health outcomes, and
eliminate health disparities. The Task Force's report will be submitted to the
General Assembly in May 2004.
Membership on the Task Force is broad and includes legislators, community
leaders, public health professionals from state agencies and universities,
local health directors, other healthcare providers, and representatives from
minority communities.
The six committees of the Task Force reflect the Task Force's six focus
areas: accreditation of state and local health departments; public health
structure and organization; public health funding (finance); workforce
development and training; improving public health planning, resources and
health outcomes; and quality improvement and accountability
Public Health Improvement Plan
Preliminary Recommendations (.pdf, 357kb)
Committee Reports and Supplementary Materials (.pdf, 405kb)
Charge to the Public Health Task Force 2004:
. To improve the quality and accountability of the state and local public
health system.
. To improve health outcomes and eliminate health disparities.
Committees
Accountability
Accreditation
Finance
Organization and Structure
Planning and Outcomes
Work Force Preparedness
Task Force Reference Documents
Committee Charges (.pdt) I Committee Co-Chairs (.pdt) I Committee
Membership (.pdt) I Task Force Membership (.pdt) I Senate Bill 672 (.pdt)
Task Force Presentations
Funding Overview
Intersection of Environmental Health and Public Health
Population Health and Personal Healthcare Services
Preventing Chronic Disease
Task Force Meeting Schedule
IDate ITime
11.'10,'9] Q 1:60
ILocation
lJ!:alle MeElieal ~enter (Ali!;;!;:)
http://www.dhhs.state.nc.us/dphltaskforce/taskforce.htm
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NC l'ubl1c Health 1 ask l'orce
ragt: "- 01 "-
92~I3JQ1 40!-& 'Afalts MeElieal CeRter ~-\H~~)
04120/04 12-5 Wake Medical Center (AHEC)
05/15/04 N/A Report Due to NC General Assembly
Last Modified: Friday, 27-Feb-04 11'48:02,
DHHS Disclaimer
http://www.dhhs.state.nc.us/dphltaskforce/taskforce.htm
2/2712004
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Professional space in motion
FEA TURfS
FOR WILMINGTON NC NEW HANOVER HD V3
$373.79315 THE ESTIMATED PRICE
2124104. OnIyi_below lI8inc1uded "quolaIion.
TRACTOR.......................................................................................
Tractor not included in Quotation............................................................. 1
TRAILER....................................................................................... 1
Axles: 5 in round 22.500 Ib, capacity. 77'1. in. trad< widths.................. 2
Brakes. 16'1. in. x 7 in. x % in. non-asbestos air operated...................... 1
Bumper. bend and twist resistantlCC bumper tube...........,................... 1
Crossmembers. 4 in. hiQh tensile l-beams. 80.000 psl........................... 1
Drums. outboard hub.and drum assemb/'y.............................................. 1
Eiectrical. trailer to traclor. 7 -way AT A 12 volt sealed wirinQ system..... 1
Floor. fastened with heat treated torQue head screws............................ 1
Front wall. extruded aluminum comer pOst at 45 di"llonai 1
Fuel tank. DOT'-<:ertified 150 oal............................................................ 1
Heioht. exterior. 13'1.ft............................................................................1
KinQ pin: 36 in. seltinQ. crosshead type. AAR approved. 1
LandinQ oear. front manual 2-speed with sand shoes 1
Uohts. rear. all sealed beam. recessed ............................... 1
Rail. bottom side. heavy duty aluminum 6061-T6................................... 1
Roof bows. anti-sn"ll on 24 in. centers. 1 in. deep ............................... 1
Roof sheet. .040 aluminum. one piece. stretched fQrtension ............. 1
Side panels. .048 thick prepainted white panel attached on 2 in cente" 1
Side pOsts. 16 oa. hioh tensile. 5 in. wide on 24 in. centers ............. 1.
Subframe. friction slider welded in place to prevent movemenl..............l
Suspension. air ride,................................................................................ 1
Suspension. heavy duty tandem 44.000 lb. capacity.............................. 1
Tires. 11:00 X 22.5 steel-belted radial tires. 14 ply................................. 8
Top rail. extruded aluminum 6061.T6..................................................... 1
Tractor connections. recessed swivel mount offset Qladhands. .. 1
Upper coupler. 3-3/16 in deep assembly. AAR tested and certified 1
Wheels. 8.25 x 22.5 disc .............................................................. 8
Width. exterior. 8Y. ft. ...................................................................... 1
REAR CABIN....................................................................................... 1
Alaon. burolar. with rear panic button..................................................... 1
Awnino. recessed into body side wall........:............................................ 1
Awnino. acrylic. 11Ovac. 9% ft coveraoe. with anemometer................... 1
Cabinets. Midmark with solid surtace counlertops.................................l
Celli no. acoustical................................................................................... 1
Chart holders. acrvllc.............................................................................. 3
Door. interior & exterior (exceprwhl chr)................................................. 7
b-rinQ hulTicane tie down........................................................................ 4
Electrical. healthcare wirillQ (NEC 517).................................................. 1
Electiical. telemedicine for owner's eoulpmenL.................................... 1
Exlinouisher. fire. underrounter.............................................................. 2
Fan.lab-ulllitv. heavy duty 150 cfrn. exhaust.......................................... 2
Floorino. acoustical sub-fioor.................................................................. 1
Floorino. elastomer profiled tile............................................................... 1
FreiQht & delivery charoes....,...............................,................................. 1
Generator. aCoustic baffle....................................................................... 2
Generator. diesel. Kohler 20 kw.............................................................. 1
Generator. enerQY manaoernent system................................................. 1
Generator. exhaust extension fiex hoses (20 It.) 2
Graphics. exterior. custom yinyl (to allowance)...................................... 1
HeiQht. rear cabin. inside. 81t. 0 in. (nom.I............................................. 1
Hook. clothinil. patr................................................................................. 3
HVAC - air oonditionino 3 ton.......................................................:.......... 1
HVAC - heatino. diesel hydronic.............~.....................;........................ 1
Insulation. rear cabin. triple foam by Ddti ......,................................. 1
Insulation. winterizinQ. underfloor....................:...................................... 1
Landino oear. 4 pI. bi-axis. hydraulic push button.................................. 1
Lavatorv. whowel. soap disp. mirror................:....................................... 5
Len!llh. rear semitrailer inside - 51% It.................................................... 1
UQhtino. cellino. rear cabin. fluorescent .................................1
Uohtino. exterior. scene. 110vac fluorescenl.......................................... 3
UohtillQ. task. over oounter.....................,..................:............................ 8 ..
Prices nallowances, irK!
subject 10 change without notice.
Uterature rad<. 6 oocl<et. clear acrylic.............................................,...... 5
Manual. operatino................................................................................... 1
Radio. AMlFMlCD. w/ceilino speakers................................................... 1-
Receptacle, 110 vac, exterior................................................................. 1
Refrioeratorlfreezer. 4% d-l10vac. MidMark........................................ 1
Rest room, incl. low flow toileL.............................................................. 1
Rooms built with interiocl<ino panels....................................................... 1
Seat.draffillQ........................................................................................ 1
Seat, flip.up, vinyl. sinole........................................................................ 2
Service availability. nationally . .................... 1
Seat. OJstom vinyl, for patient educ........................................................ 2
Shore pOWer cord, 50 It........................................................................... 1
Shore pOWer, electrified reel & box.,....................................................... 1 ..
Smoke detector, batlerv............................................................,............. 1
Stairs. entry. manuaL............................................................................ 1
StoraQe compartment. undercalTi"lle..................................................... 1
Telephone, land line connection............................................................. 1
T rainino, on-sile......................................................... ............................. 1
TVNCR. flat screen 6 in.. custom mount wIDVD-VCR & hdphns........... 2
TVNCR. fiat screen 17 in.. custom mount wNCR.................................. 1
Undercoatino, entire chassis................................................................... 1 _
Wall. slide oul....................................................................................... 1 _
Water heater, undercounter................................................................. ... 1
Water level monitorino syslem................................................................ 1
Water tanks & pump:aa oal. e1l.............................................................. 1
Wheelchair lift. undercalTi"lle................................................................. 1
Wheels. deluxe aluminum outside, steel inner....................................... 4
Wheels. rear lire inflation extenders....................................................... 2
Windows, safety olass.................................................................:.......... 9
X-ffiY, electricai stubbed in for X-ffiy...:................................................... 1
X-ray, wall suPoort for x-ray.................................................................... 1
DENTAL EQUIPMENT (all are allowances) 1
Amaloamator. Kerr OQtimix..................................................................... 1
Assistant's instrument, A-<lec 7115......................................................... 3
Compressor, Air Star 30.......................................................................... 1
Control panel for air and evac................................................................. 1
Curino lioht. Patterson LED..................................................................... 1
Dental eouipment technician travel-Columbus,OH................................ 1
Deotal smallware allowance................................................................... 1
Evacuation system. Air Technioues ST8-3............................................ 1
Fiberoptic oouoler...................................................:............................... 2
Handpiece cleaner. A-<lec Assistina 301................................................ 1
Handpiece oad<"lle, A-<lec Hyoiene....................................................... 1
Handpiece, A-<lec operatorv Oacikaoe.......................................,............. 2
Handpiece, lab. BeaverState A-Q50........................................................ 1
Lathe, Handler model 26......................................................................... 1
Pacl<"lle. A-<lec Radius, per operatorv.................................................... 3
Scaler, Dentsply Cavitron SPS ....._.................................. 1
Slerilizer. Scican Statim 5000................................................................. 1
Ullrasonic cleaner, Whaldent UC300 wI SS tray.................................... 1
Water and air utiity runs for lab eouipment. by LileUne.......................... 1
Water distiller, Tuttenauer 9000..............................._.............................1
Water filler and solenoid, DentalEz WC-ll0.......................................... 1 _
X-Ray, lead apron' . 3
X-Ray. Planmeca Prostvle intraoral DC w/shorler aon........................... 3
X-Ray. Processor Peripro III w/dayliohtloader....................................... 1
X-Ray, view box, Rinn univerSal........................................................... 3
WARRANTEES (see written warrantee information) 1
Air conditioner - 2 year. unlimited miles .............................~....... t
Corrosion - 5 year. unlimited miles 1
Frame rail corrosion - 5 year. unlimited miles ............... 1
Generator. 1 ,000 hours. unlimited mileS................................................ 1
Suspension - 2 'y~r. unlimited miles ..................:... 1
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711 Page Street
Clayton NC 27520
February II, 2004
David E. Rice, Health Director
New Hanover County Health Department
2029 South 17th Street r
Wilmington, NC 28401
"'" D'.. PIP.'! ~
The Shellfish Sanitation and Recreational Water Quality Section of the Die'SiO of -Jd~~1</
Environmental Health initiated a rulemaking process during the s~r~ P" PJ ~
develop rules for the Recreational Water Quality Program. Copi s JU oposed rule y v- ______
were mailed to you along with a notice of public hearings for the les, requesting your ~
comments and input to the content of the rules.
As a result of comments received, the proposed rules were amended several times before
being adopted by the Commission for Health Services in November 2003 The rules
have now been fully adopted, codified as 15A NCAC 18A .3400, and are now effective.
A copy of the codified rules is enclosed for your use.
I appreciate your involvement in the rulemaking process. I believe the rules as codified
will protect the health of the public from swimming in waters that are unsafe. When
water conditions are found to be in violation of the rules, please know that the program
will take steps as outlined in the rules to warn the public of the risks of swimming. When
the conditions have improved, the program will follow-up quickly with additional steps
to inform the public that the waters are now safe for swimming.
My role in this project is now ending. I truly appreciate your assistance over the last
eighteen months. Working with you to explain the program in public meetings,
conducting meetings with commissioners or other public officials to inform them of the
program, and holding public hearings for the rulemaking process have all been rewarding
to me. Your help in accomplishing what I hoped we could do was invaluable. Thank
you for your support and assistance.
If you need additional information concerning the rules or the Recreational Water Quality
Program in general, please contact Mr J.D Potts at 252-726-6827 or by email at
i.d.potts@ncmail.net
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Sincerely,
.)J.d~
Malcolm Blalock RS MPH
Recreational Water Quality Program Consultant
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND
NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL HEALTH
SHELLFISH SANITATION AND RECREATIONAL
WATER QUALITY SECTION
lSA NCAC 18A .3400
COASTAL RECREATIONAL WATERS MONITORING,
EVALUATION, AND NOTIFICATION
.
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SECTION .3400 _ COASTAL RECREATIONAL WATERS MONITORING, EVALUATION, AND
NOTIFICATION
15A NCAC 18A .3401 DEFINITIONS
The following definitions shall apply throughout Section 18A .3400 of this Subchapter:
( I ) "Enterococcus" means a gram positive coccoid-shaped bacteria that is found in the intestinal tracts of
wann.blooded animals that include Enterococcus faecalis. Enterococcus [aedum. Enterococcus
avium. and Enterococcus gal/inarium.
(2) "Geometric mean" means the mean of"n" positive numbers obtained by taking the "n"th root of the
product of the numbers with at least five samples collected within a 30 day period.
(3) "Point source discharge'" means the discharge of liquids through a pipe, drain, ditch or other
conveyance into a swimming area.
(4) "Primary contact" means an activity in water in which a person's head is partially or completely
submerged.
(5) "Storm water discharge" means any natural or manmade conveyance of rainwater or the resultant
runoff into recreational waters.
(6) "Swimming advisory" means a notification to the public that recommends no primary contact withthe
water in a specific area for public health reasons but does not close a swimming area to the public. A
swimming advisory shall include a sign posted at the site ofthe advisory and a press release to notify
the public of the risks of swimming in the area.
(7) "Swimming alert" means a notification to the public by media contact including a press release to warn
the public of risks of swimming in an area that exceeds bacteriological swimming area levels.
(8) "Swimming area" means a coastal recreation area that is used for primary contact located within
waters classified by the Division of Water Quality as SA, S6, or SC.
(9) "Swimming season" means from April I through October 31 of each year.
(10) "Tier [ swimming area" means a swimming area used daily during the swimming season, including
any public access swimming area and any other swimming area where people use the water for
primary contact, including all oceanfront beaches.
(II) "Tier II swimming area" means a swimming area used an average of three days a week during the
. swimming season.
(12) "Tier 111 swimming area" means a swimming area used an average of four days a month during the
swimming season.
(13) "Winter season" means from November I through March 31 of each year.
e
Histmy Note:
Authority G.S. /30A-233./,
EjJ. February /, 2004.
15A NCAC 18A .3402 BACTERIOLOGICAL LIMITS FOR SWIMMING AREAS
(a) The enterococcus level in a Tier [ swimming area shall not exceed either:
(I) A geometric mean of 35 enterococci per 100 milliliter of water, that includes a minimum of at least
five samples collected within 30 days; or
(2) A single sample of 104 enterococci per 100 milliliter of water.
(b) The enterococcus level in a Tier II swimming area shall not exceed a single sample of 276 enterococci per 100
milliliter of water.
(c) The enterococcus level in a Tier 111 swimming area shall not exceed two consecutive samples of500 enterococci per
100 milliliter of water.
History Note: Authority G.S. /30A-233./,
Eff. February 1,2004
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ISA NCAC 1M .3403 PUBLIC NOTICE OF INCREASED HEALTH RISKS IN SWIMMING AREAS
(a)Tier 1 Swimming areas:
(I) A swimming advisory shall be issued by the Division when samples of water from a swimming area
exceeds a geometric mean of35 enterococci per 100 milliliter during the swimming season.
(2) A swimming alert shall be issued by the Division when a single sample of water from a swimming
area exceeds 104 enterococci per 100 milliliter and does not exceeg 500 enterococci per 100 milliliter
during the swimming season. -
(3) A swimming advisory shall be issued by the Division when a sample of water from a swimming area
exceeds a single sample of500 enterococci per 100 milliliter during the swimming season.
(4) A swimming advisory shall be issued by the Division when at least two of three concurrent water
samples collected at a swimming area exceeds 104 enterococci per 100 milliliter during the swimming
season.
(b) Tier 11 swimming areas:
(I) A swimming alert shall be issued by the Division when a single sample of water from a swimming
area exceeds 276 enterococci per 100 milliliter and does not exceed 500 enterococci per 100 milliliter
during the swimming season.
(2) A swimming advisory shall be issued by the Division when a single sample of water from a swimming
area exceeds 500 enterococci per 100 milliliter during the swimming season.
(c) A Tier III swimming area with a water sample result of 500 enterococci per 100 milliliter or higher on the first
sample shall be resampled the following day. If the laboratory results of the second sample exceed 500 enterococci per
100 milliliter a swimming advisory shall be issued by the Division.
(d) Signs posted pursuant to this Section shall be placed or erected in open view where the public may see the sign(s)
prior to entering the water.
(e) Signs shall convey the following:
ATTENTION: SWIMMING IN THIS AREA IS NOT RECOMMENDED. BACTERIA
TESTING INDICATES LEVELS OF CONTAMINATION THAT MAYBE HAZARDOUS TO
YOUR HEALTH. THIS ADVISORY AFFECTS WATERS WITHIN 200' OF THIS SIGN.
OFFICE OF THE STATE HEALTH DIRECTOR.
History Note: Authority G.S. /30A-233./,
EIT. February 1,2004.
ISA NCAC I8A .3404 SWIMMING ADVISORIES FOR POINT SOURCE DISCHARGES INTO
SWIMMING AREAS
(a) A wastewater treatment plant that discharges into swimming waters shall be posted by the Division with at least one
sign until the discharge is removed. The sign(s) for a wastewater treatment plant discharge shall convey the following:
ATTENTION: THESE WATERS MAY BE CONTAMINATED BY HUMAN OR ANIMAL
WASTE. SWIMMING IS NOT ADVISED IN THESE WATERS BECAUSE OF THE INCREASED
RISK OF ILLNESS. OFFICE OF THE STATE HEALTH DIRECTOR.
(b) A swimming advisory shall be issued by the Division and at least two signs shall be posted at a storm drain or storm
water discharge that is actively discharging into a swimming area. Signs shall be placed to advise the public as they enter
the area impacted by the drain. The signs for a storm drain or storm water discharge shall convey the following:
SWIMMING IS NOT RECOMMENDED BETWEEN SIGNS. WATERS MAY BE
CONTAMINATED BY DISCHARGE FROM PIPE. OFFICE OF THE STATE HEALTH
DIRECTOR.
(c) A swimming advisory shall be issued by the Division and at least two signs shall be posted at a storm drain where
flood waters are being pumped into a swimming area. The signs shall remain posted for at least 24 hours after the
pumping of flood waters has ceased. The signs shall convey the following:
SWIMMING IS NOT RECOMMENDED BETWEEN SIGNS. WATERS MAY BE
CONTAMINATED BY DISCHARGE FROM PIPE. OFFICE OF THE STATE HEALTH
DIRECTOR.
3
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(d) A swimming advisory shall be issued by the Division and at least two signs shall be posted at an area receiving
dredge material on a swimming beach when the dredge material is being pumped from an area closed to shelllish
harvesting. The signs shall convey the following:
SWIMMING IS NOT RECOMMENDED BETWEEN SIGNS. WATERS MAY BE
CONTAMINATED BY DISCHARGE FROM PIPE. OFFICE OF THE STATE HEALTH
DIRECTOR.
I
,-
History Note: Authority G.s. /30A-233./,
Eff. January I. 2004.
15A NCAC 18A .3405 RESCINDING A SWIMMING ADVISORY OR SWIMMING ALERT
(a) A Tier I swimming area advisory shall be rescinded when two consecutive weekly water samples and the geometric
mean meet the bacteriological limits in Rule 18A .3402(a) ofthis Section. A swimming alert shall be rescinded within 24
hours of compliance with Rule 18A .3402(a)(2) of this Section.
(b) A Tier Il or Tier III swimming area advisory or alert shall be rescinded after water samples meet the bacteriological
standard in Rule 18A .3402(b) or (c) ofthis Section.
(c) A swimming advisory resulting from a point source discharge or the discharge of dredge material shall be rescinded
24 hours after the discharge has ceased.
(d) When a swimming advisory or alert has been rescinded, the Division shall issue a press release to announce the
lifting of the advisory or the alert and the sign(s) shall be removed immediately by the Division.
History Note: AutllOrity G.S. /30A-233./,
Eff. January 1,2004.
-
I5A NCAC 18A .3406 DESTRUCTION OF SIGNS
A person shall not mutilate, deface, pull down, destroy, hide, or steal any sign posted pursuant to this Section.
Hist(}1Y Note: Authority G.S. J30A-233. /,
Eff. January I, 2004.
15A NCAC 18A .3407 APPLICABILITY OF RULES
The rules of this Section shall apply to all marine recreational waters in coastal North Carolina.
History Note: Authority G.S. /30A-233. /,
EfT. January 1,2004.
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______J
N~'\'\I Hh!~I)\IFr;, CUlIfHY
H~P,LTH Dtpr,;; i L1~i\!T
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I~~le COP'i
NE~FF~?~~AS<?,,~NTY * 8-
320 CHESlNUT STREET, ROOM 309 l
WILMINGTON, NORTH CAROLINA 28401-4095
TELEPHONE (9/0) 34/-7/ 53
FAX (9/0) 34/-4/70
WANDA M. COPLEY
Counly Attorney
KEMP P SURPEAU
Deputy County Al1om<y
E. HOLT MOORE, III
Assistant County Attorney
February 5, 2004
Mr, Howard Loughlin
Mrs. Monica V. Loughlin
138 Mohawk Trail
Wilmington, NC 28409"
RE: Himalayan Black Bears
Dear Mr, and Mrs. Loughlin:
At its February 4, 2004 meeting, the New Hanover County Board of Health
determined that your Himalayan Black Bears were "Carnivores" within the definition of
Section 1 of the Regulation adopted February 11, 1994. As such, the animals are
prohibited within the County. The Board further ruled that compelling interests of public
heath and safety preclude Cilny variance or exemption in this case.
-- --The-Beard--aoes~--the -great-affeetion-and-care--you-have1avished on
your bears, but cannot accommodate your exemption request.
Sincerely,
/rt~ J! g~tZU..
Kemp p, Burpeau
Deputy County Attomey
KPB/kc
cc: Jean McNeil, Animal Control Director
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NEW HANOVER COUNTY
ANIMAL CONTROL DIVISION
180 DIVISION DRIVE
WILMINGTON, NORTH CAROLINA 28401
TELEPHONE (910) 341.4197
FAX (910) 341-4349
DAVID E. RICE
Health Director
JEAN P. McNEIL
Animal Control Director
TO: The New Hanover County Board of Health
FROM: Dangerous Dog Determination Hearings
CONCERNING: The cases heard---2003
NUMBER OF CASES HEARD-------91
DECISIONS:
POTENTIALLY DANGEROUS-------76
NOT Guilty-------5
Euthansia-------10
AGE OF VICTIMS-------child-8
adult-38
animal-27
REQUIRED MEDICAL ATTENTION------all animals and people if skin
broken or scratched.
NOT UNDER CONTROL------all
NOTES:---18 cases involved dogs that had already been declared
and the owners were not obeying the regulations.
Cjjou't dfEalt~ - <Du't P'tio'tit!}
MAKING AOIFFERENCE IN DIABETES WITH TIMEt V INFORMAT.OMFOR THE CITIZENS OF NEW HANOVER COUNTY
- -.....- .. ~,-,~'.-.-..-
You can decrease
your risk for diabetes
by 580/0!
.
.
Fight The
Fat
w;en Philadelphia
was labeled the
flabbiest city in the
country, the mayor ordered it
to diet. When 383 people in
Dyersville, Iowa organized and
lost 3998 pounds in ten weeks, '..
it became known as The ToWn That Lost a
Ton. Help make history in Wilmington. Join
Fight the Fat.
Fight the Fat is a ten week program using the
buddy system to help people meet their weight
loss goals. It is open to those with diagnosed
diabetes and those at risk. for diabetes (see test
on the back cover to find out if you are at risk).
Participants will:
. Set a personal weight loss goal of I to 2 pounds
per week
. Attend Fight the Fat fitness and nutrition
sessions three times per week
. Commit to 30 minutes or more of physical
activity 6 times per week.
Fight the Fat will include weekly nutrition
sessions, and twice weekly classes with a
personal trainer. The $20.00 fee includes the
use of a pedometer for 10 weeks, a log book,
and all classes and materials. The full fee will
be refunded to all those who reach their weight
loss goal.
(continued on pg2)
Did you know that almost
90% of all people with newly
diagnosed type 2 diabetes
are overweight?
The Centers for Disease Control and Prevention
have released serious news about diabetes.
One in three Americans born in the year
2000 will develop adult onset diabetes, a worsening
epidemic that disproportionately affects women and
minorities. "These rising rates of diabetes are directly
related to the increasing incidence of obesity among
Americans," says researcher K M. Venkat Narayan.
The data shows that nearly 7 percent of U.S. adults
, had diabetes in 1999, up from less than 5 percent a
decade ago. The disease impacts the body's organs,
can cause blindness; and often leads to kidney and
heart disease.
But there's positive news. You cap prevent or delay
diabetes with changes that are within your control.
Recent studies have shown that those at risk can reo
duce their risk by 58% with modest weight loss and
modest physical activity. If you have already been
diagnosed with diabetes, weight loss and physical
fitness will help you better control your blood sugar
level, reduce blood pressure and increase your "good
cholesterol. "
r
How Much Weight ?
How Much Exercise?
MARK YOUR
CALENDAR
March 9
Deadline for mail registration for
Fight the Fat
March 10
Register in person for Fight the Fat. See
chart on page 2.
March 15
Fight the Fat Kickoff breakfast at 8:30
a.m. at Wilmington Family YMCA.
Pre-registration required.
Thesday, March 16. 1:00 PM
Diabetes Support Group. Foot Care Do's
and Don'ts with Dr. Kevin Bachman,
podiatrist. Senior Center, 2222 South
College Road.
Thursday, April 15. 1:30 PM
Diabetes Support Group. All You
Ever Wanted to Know About Diabetes
Medicines with Hal King, pharmacist,
at 2:00 PM
Saturday April 24, 9 AM - 1 PM
Diabetes Self-Management Class at the
New Hanover Community Health Center,
925 North Fourth Street, Wilmington.
Register at 343-0270 ext. lt9.
Thursday, May 20.1:30 PM
Diabetes Support Group. Eating Right
with Heidi Kaufman, RD,CDE,
at 2:00 PM
FOR MORE
INFORMATION OR TO
REGISTER, CALL 343-6758
Diabetes Today is a special publication of the New Hanover County Diabetes Today Coalition which provides the editorial content. The Diabetes Today Coalition was formed in 1999 to advocate
for
diabetes care and prevention in New Hanover County. The Coalition is supported by a grant from Cape Fear Memorial Foundation. Editor: Trish Snyder
~
~ The recommended goal for weight loss is
5 - 10% of body weight. If you weigh 200
. pounds, that's 10 -20 pounds.
The recommended goal for physical activity
is 30 - 45 minutes daily. This doesn't mean
wearing skin tight leotards and exercising to
a driving disco beat, but rather adding daily
routines that can boost your activity level.
" "
(
~
Diabetes TOe March 2004
r---
\.......,;
/:)
Page2
If It Looks Like a DUe....
DUC stands for Diabetics Under
Control and it's what we call the
group that meets monthly on
the third Thursday at the Senior
Center, It's a support group,
an information exchange, an
educational opportunity, and a
program' of the New Hanover
Diabetes Today Coalition,
What does a DUC Look
Like?
DUCs come in all shapes and
sizes. They are black and white;
male and female; working and
retired, They're former dentists, teachers, copywriters,
advertising execs, and homemakers. They're from Germany,
India, New Jersey and other exotic places. Some have even
grown up in Wilmington, No two DUCs are alike.
If It Sounds Like a DUC...
DUCs say thing like, "Let me tell you about this great deal
on diabetic shoes," "Have you attended a diabetes educa-
tion class?" "Are you on the pump, too?" "Have you tried
Splenda?" "Is a serving of pasta really just a half cup?" They
know what their Hemoglobin Al C is; they know what the
goals are for self-monitoring, They're pretty smart DUCs.
To Be a DUC, however...
,the numbers have to be right,
according to Dr. John Parker,
endocrinologist with Hanover
Medical Specialists, Dr, Parker
spoke at a recent DUC meeting
about keeping your diabetes in
good control. For the person with
diabetes, it's the key to staying i
healthy, He concluded his pre-
sentation by asking questions,
and replying to many questions
from the audience, Following are some of his questions,
answers...and numbers.
'I
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Q: What is hemoglobin AIC?
A: Checking your"blood sugar levels at different times of the
day shows how well your diabetes is in control over a period
of a few hours, but it doesn't give you the whole picture,
Another blood test that is recommended for checking diabe-
tes control'over lQllger periods of time is hemoglobin AIC,
also referred to as HbA\c, or AIC., it tells the average blood
sugar for the past 2 to 3 months,
Q; What is the goal for the hemoglobin Al C?
A: The American Diabetes Association recommends 7%, I
like to encourage my patients to work towards 6-7%. With
proper management, it's possible.
Q; H my doctor checks my Al C every 2 to 3 months,
then I don't have to check my sugar at home, right?
A, Wrong! You need to check your blood sugar levels at
different times of the day to 'make sure your diabetes plan
is working,
Q: How often should I check my blood sugal-?
A: If you're on an insulin pump, you'll want to check 5 to 6
times a day. If you're taking pills, you'll want to check at least
twice a day. In Type 2 diabetes, fasting testing tells us a lot
I suggest at least one fasting testing a day and then rotating
your testing times -- pre-lunch, pre-supper, bedtime and two
hours postprandial.
Q: What are the goals for self-monitoring?
A: Pre-meal (preprandial) blood sugars should be between
90 - 130, Two hours after a meal (postprandial), blood sugars
should he kept helow 180. Ideally, I'd like to see blood sug-
ars under 140 for tight control.
Q; What about blood pressure?
A: Check it regUlarly and keep it under 130/80.
Q; How about cholesterol?
A. HDL ("good cholesterol") should be 40 or above. LDL
("bad cholesterol") should be less than 100, Triglycerides
should be under ISO. Weight loss improves the lipid profile.
Q; Can you describe the perfect patient?
A: The perfect patient is the one who lives without the
complications of diabetes. He lives longer, doesn't lose his
lifestyle, and lives better, It's hard work to control your blood
sugar and the cO';Ilplications of diabetes, but it's worth it
(continued from page I)
The program begins on March 15 at 8:30 a.m.
with a kickoff breakfast at the Wilmington Family
YMCA and a group weigh-in on a giant scale. At
the end of the 10 week program on May 24, 2004, ,
everyone will weigh in again to determine how
much weight was lost collectively. Can Wilmington
lose a ton?
Pre-registration is essential. Enrollment is litDited
to the first 100 who register. Register in person
on Wednesday, March 10 at one of three sites
(see chart) or clip the coupon on the back page
and mail it with your $20.00 check made payable
to the New Hanover County Health Department,
2029 South 17th Street, Wilmington, NC 2840L
Please indicate your preferred site on the memo
portion of your check: YMCA, Senior Center,
Grace United. Mail registrations must be received
by Tuesday, March 9 Your mail registration will
be confirmed by telephone.
Schedule for FIGHT THE FAT
Site Days and Activity Register
Times
People with diabetes are encouraged to attend this stte; nutrition
Senior Center sessions will be taught by a certified diabetes educator.
2222 South Mondays 8:30 - 9:30 AM Fitness Wednesday, March 10
College Road Wednesdays 8:30 - 10:30 AM Fitness and Nutrition 8:30 - 9:30 AM
Senior Center Lobby
Grace United Mondays 10 - 11 AM Fitness Wednesday, March 10
Methodist Church Wednesdays lOam - 12 Noon Fitness and Nutrition 10-11 AM
4th & Grace in the church lobby
Wilmington Family Tuesdays 12 Noon- 1 PM Fitness Wednesday, March 10
YMCA Wednesdays 12 Noon - 1 PM Nutrition 12 Noon -1 PM
2710 Market Street Thursdays 12 Noon - 1 PM Fitness in the YMCA lobby
Call 343-6758 for more information.
llJ1
, . ington Health Associates
cal Cenre, Drive wilmington, NC 2840t
, Bryson Ley, M,D" FACP, FAqJi;;'..~~
Kimberly Pugh, M.D. " ..
Deborah Duchesneau. NP . Jean Denn8;C~$,
f'< ~
,.,fiI~elping yo"u;~re
JDt'flu ll1ti1$! '11#. jove. .
,$c" 375
(Your Certified Diabetes Shoe Fitter)
M1uuJy Woofnl t:m1ifi1tkd
adwnad training on wowuJ_
& cotlImIIlIivt 1lUloogement of
diobeUs, Lit her expertise put you
in tht right ,/we!
Medical Center
~il.
HoiM Care
SUMMIT
PODIATRY
Glaser Foot &
Ankle Clinic
1717 Shipyard Blvd.
791-1300
908S.16thSt
762-7007
Hours:
M-F 8-5:30
Boyan Georgiev, M.D.
INTERNAL MEDICINE
Tammy Melger, P1<.C
'ACCEPTING NEW PATIENTS'
I' you're dl.....le,
your 'eet .eed .pecl.' ."e.tlo..
. INFECTION. FOOT ULCERS' NEUROPAlHY
. VASCULAR DISEASE. BONE PROBLEMS
Board Certified in Internal Medicine,
Special interests in cardiology, diabetes
and cholesterol disorders.
342-9969
CAROUNA PRIME
1908 Meeting Court (off Hospital Plaza Drive)
www.medicalcentemomecare.com
)~
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Diabetes TOe March 2004
o
)
Page3
c
Guidelines
for Healthier
Eating
There are some very simple things you
can do every day to making sticking to
your eating plan easier:
Plan your meals so that you eat healthy
food, not just whatever is easiest.
Think before you eat instead of raid-
ing the refrigerator every time you get
hungry_
Use a smaller plate, so that you can't
heap on much more than you really
want or need.
Chew slowly and completely, savoring
every mouthful, instead of packing in as
much as you can as quickly as you can.
The following guidelines are a little more
complicated but well worth the effort.
EAT LESS FAT
Cut down on meat. Eat more fish and
poultry instead. When you do eat red
meat, choose the leanest cuts.
Roast, bake or broil instead of frying.
Trim the fat off meat and the skin off
poultry, and avoid adding fat in cooking.
Beware of sauces and gravies. They often
contain lots offat.
Eliminate or cut down on high fat foods
such as cold cuts, bacon, sausage, hot
dogs, butter, margarine, nuts, salad
dressings, lard and shortening.
Eat less ice cream, cheese, sour cream,
cream and other high fat dairy products/
Check for low-fat versions in the grocery
store. Drink skim or low-fat milk instead
of whole milk.
INCREASE FIBER
1. Switch to whole grain breads and
cereals
2. Eat more vegetables - raw and cooked.
Instead of fruit juice, eat fresh, whole
fruit.
3. Sample high fiber foods that may be
new to you - like bran, barley, bulgur,
brown and wid rice, dried beans, peas
and lentils.
What is Fiber?
Also kno~ as roughage, fiber is part
of plant food your body cannot digest.
Fiber relieves constipation, lowers blood
cholesterol levels and apparently slows
down the rate of carbohydrate digestion,
reducing carbohydrate-induced eleva-
tions of blood sugar. -
REDUCE SODIUM
Don't add salt in cooking and try not.to
add salt to your food at the table.
Cut down on high salt foods like canned
soups, ham, sauerkraut, hot dogs and
pickles. Food that tastes salty probably
is salty_
Eat fewer conveuience foods and try to
avoid fast food restaurants. Even when
they don't taste salty, these foods are
often loaded with sodium.
REDUCE SUGAR
1. Don't eat table sugar. If you're used
to adding sugar, substitute an artificial
sweetener that has no calories, like sac-
charin or aspartame.
2. Avoid honey, syrup, jam, jelly, candy,
sweet rolls, regular gelatin, cake with
icing, and pie. Instead of fruit canned in
syrup, chose fresh fruit or fruit canned in
natural juice or water.
3. Drink diet soft drinks. One twelve-
ounce can of regular cola contains uine
teaspoons of sugar.
. HANOVER MEDICAL SPECIALISTS, >A
H and the ( Division of Endocrinology )
1515 Doctor's Circle,
Wilmington, NC 28401
omCE HOURS
BY APPOINTMENT
TELEPHONE
(910) 763-6332
,
~.;j
L.J
Paul C. Michael S.
Whiteslde"Jr. M.D. McGarrity, M.D.
Amy G. Gaweda, FNP-C
-
John C.
Parker, M.D.
How Much
Food Should
I Eat?
You don't need to cut out your favorite
foods to lose weight or maintain it. You
just need to cut back on the serving size.
What is a serving size? It's a lot less than
you think.
Bread = 1 slice
Cereal = 1 cup
Vegetables = 1 cup raw; 1h cup
cooked
Fruit = 1 medium piece , 4 oz.
Juice
Meat=3-4oz.
Dairy = 1 - 8 oz. Glass of milk;
1 - 8 oz. Yogurt
Here are some tips to help you estimate
a serving size:
A one cup serving of carbohydrates,
including fruit, vegetables, pasta or rice
is about the size of your fist.
One three-ounce serving of protein, such
as meat, fish or poultry, is about the size
of a deck of cards or the palm of your
hand.
A one-ounce serving of cheese is about
the size of your thumb.
A one cup serving of milk, yogurt or
fresh greens is about the size of a tennis
ball.
"I'D. missed more tIum 9000 shots In my
car.... I'D. lost almost 300 gama. 7Wenty-
sIJ< limes, I'De been /rusUd /0 lake /he gallUl
UJ/nn/ng shot and missed. I'De folled- ooer
and DOer again In my life. Andlhol ts why
Inu:t:eI!dJ"
M/duul]ordotl
1414
Medical Center Drive
763.7363
Ext: 12
Are }f)u Healthy?
Non-Invasive
Screenings
Peripheral Arterial
Testing' for Leg Disease
$35
. Same Day Resulu
, Accredited V....Jar Lab
, Screening! for Cartoid Artery
! Ahdomlnal Aorta
also available
......
W~ht loss and weight gain are
affected by:
Food Consumption
(cawries consumed)
Energy Expended
(activity such as exercise)
,-
One pound of body weight is equal to
3500 calories. Lose I pound of weight
each week by reducing food consumed
daily by 250 calories and increasing
energy expended by 250 calories for
a total daily calorie deficit of 500. Five
hundred calories per day x 7 days per
week = 3500 calories, or one pound
weight loss per week.
Weight loss occurs when you decrease
calories consumed or increase calories
used. Select a healthy meal plan and get
into the habit of exercising 30-45 min-
utes every day.
The goal of long term weight loss is best
accomplished by adopting eating and
exercise habits that you will stick with I
every day. Gaining weight doesn't occur ...1-
overnight and neither does losing it Do '
not become discoUraged, stay focused on
your goal and know that it takes time_
When weight loss occurs, you will be
able to move better, breathe better, and
resting heart rate will decrease making
exercise a bit easier to accomplish each
day.
Benefits of weight loss and physical fit-
ness are numerous. Just a few of these
benefits are better control of blood sugar
levels, reduction of blood pressure, and
increased "good cholesterol"
FooT & ANKLE SURGERY' DIABETIC FOOT CAREàSPRAINS & FRACTURES' AMBULATORY SuRGERY
INGROWN NAlLS' ENOOSCOPIC SURGERY
SECONO OPINION CONSULTATIONS' X-RAY FAOLmES
COASTAL CAROLINA FOOT CENTER
1602 Doctor's Circle' Wilmington 343-8889
~~r!~'JQ2T. ~~~~
:E Insurance accepted and nted to
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Know
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Find out if you are at risk for diabeteS. Write in the points next to each statement
that is true for you. Then add your total score.
Yes 1_ 1 am a woman who has had a baby weighing more than nine pounds at birth.
Yes 1_ 1 have a sister or brother with diabetes.
Yes 1_ 1 have a parent with diabetes.
Yes 5_ My weight is equal to or above that listed in the chart.
Yes 5_ 1 am under 65 years of age and I get little or no exercise.
Yes 5_ I am between 45 and 65 years of age.
Yes 9_ I am 65 years or older.
_ Total
If you scored 10 or more points you are at high risk for diabetes. Keep your risk low by losing weight
if you are overweight, by being active most days, and by eating low-fat meals that are high in fruits
and vegetables, and whole grain foods. ~
r--------~-----------~.
I If you want to reduce your risk, lose weight, and improve your health, please join us. Clip this coupon and mail it to: I
Diabetes Today, do New Hanover Health Department, 2029 South 17th Street, WIimington, NC 28403.
I I
I Name I
I Addr~s I
I City/State/Zip I
I~ ~ I
L_____________________~
At-Risk Weight Chart
Height Weight
(in feet and inches (in pounds
without shoes) without clothes)
4'10" .. .. ..129
4' 11" . .133
5'0" .138
5'1" ... .143
5'2" .147
5'3" ... ..152
5'4" .......... .157
5'5" .......... .162
5'6" .167
5'7" .172
5'8" .177
5'9" .182
5'10" ..188
5'11" ......... .193
6'0' .... .. .199
6'1" .204
6' 2" .210
6'3" .216
6'4" . .221
If you weigh the same or more than
the amount listed for your height
you may be at risk for diabetes.
\
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\ Vhen Wounds Won't Ileal
Con/roUing Diabetes isn '/ a Pi<<e of Cake
IF YOU ARE 18 YEARS OR OLDER,
AND HAVE BEEN DIAGNOSED
WITH TYPE 2 Diabetes Mellitus,
then you may be eligible to participate in
a medical research study of an
investigational drug for diabetes.
For more information call
New Hanover Medical Reoearch
910-799-5500
T H ,
~
WOUND CARE
Diabetic '
Retinopathy
Board Certified In Ophth8Jmology
Igor Westra, MD . Erik van Rena, MD
1801 New Hanover Medical Pari<. Dr. . Wilmington, NC
1703COUIltfyClyi:i Rd. SUIte 104 . JacksonVIlle, NC
:4OOQHig~Y:~E, Su;te 240 . Utile River, NC
WWW;~AAbfcoastalcarollna.com
.
Committed to a Healthy Community
For advertising information on upcom-
ing issues of our Health & Medicine
Guides, Diabetes Today tabs and other
health publications...
Call Medical Marlceting CoorditUltor,
Cae Emerson, 343-2289
CEN1ER.
IT;6 WElLINGTON AVENUf WilMINGTON
910.815.0005
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NEW HANOVER COUNTY
HEALTH DEPARTMENT
e
ANNUAL REPORT
2002/2003
-
fjVew Hanover County Health Department Board of Health
2002 Outstanding Local Board of Health
W Edwin Link, Jr., RPH
Chair
\Phillip P Smith, Sr., MD
Physician
Melody C. Speck, DVM
Vice Chair
Robert G. Greer
County Commissioner
John N. Tunstall, PE
Engineer
Donald P Blake
Public Member
Gela N. Hunter, RN, FNP
Chair
Edward Weaver, Jr.
Optometrist
2 NEW HANOVER COUNTY HEALTH DEPARTMENT
Henry V. Estep, RHU
Public Member
Sandra L. Miles, DDS
Dentist
Janelle Rhyne, MD
Medical Consultant
Director's Message
As Health Director of the
New Hanover County Health
Department, I would like to
welcome you to our Annual
Report for Fiscal Year 2002-2003
Our mission is to protect the public
health and environment, promote
healthy living and optimize the
quality of life through preventive,
restorative, environmental, and educational services.
This is accomplished through assessing the health needs
of the community and establishing health objectives to
maintain essential personal, family, community and
environmental health services. We have a dedicated
staff working to assure the health and well being of
our county's residents and visitors. The New Hanover
County Health Department works in partnership with
other health care providers, contractors and agencies
in an integrated and coordinated effort with the goal of
optimizing resources.
During Fiscal Year 2002-2003, the Health Department
axperienced many challenges and opportunities,
~cluding:
. Organizational Analysis
. Strategic Planning Retreat
. Smallpox Vaccination Clinics
. Outstanding Local Board of Health Award
. Distribution of Potassium Iodide
With the support of the community, we will meet
the current and future health needs of New Hanover
County as we experience the rewards and satisfaction
of practicing public health. For a more detailed account
of our Health Department, please visit our website at:
http://www.nhchd.org
. ~
I David E. Rice, MPH, MA
.. Health Director
Management Team
Assistant Health Director
Lynda F. Smith
Animal Control Services Director
Dr. Jean P McNeil
Business Manager
Cindy Hewett
Dental Health Director
Dr. David W McDaniel
Environmental Health Director
Dianne M. Harvell
Personal Health Services Director
Janet B. McCumbee
Physician Epidemiologist
Dr. Thomas Morris
Our Mission and Vision
The mission of the New Hanover County
Health Department is to assure a safe and
healthy community.
The VISIOn of the New Hanover
County Health Department is: Healthy
People, Healthy Environment, Healthy
Community.
Motto
"Your Health - Our Priority"
"From the Northeast River to Federal Point, and
from the Cape Fear to the Sea-City, Suburb,
Village and Farm-we are one people striving
for healthful and useful living. "
3 NEW HANOVER COUNTY HEALTH DEPARTMENT
Highlights
e Organizational Analysis and Strategic Planning
Organizational Analysis
Staff and consultants of the North Carolina Institute for Public
Health (NCIPH), School of Public Health at the University
of North Carolina at Chapel Hill conducted a comprehensive
organizational analysis ofNHCHD during the period July I I
to October 26, 2002. This analysis included detailed program
reviews of each division of the department, focus group
discussions among employee groups that cut across division
lines, interviews with individual staff, an on-line staff survey
and personal interviews with selected officials from county
government, present and former Board of Health members, and
executives from other organizations in the community This
process provided evidence of a department with exemplary
strengths, but also in definite need for change.
Despite the obvious attributes of the NHCHD and its favorable
rank among local public health organizations within the state
and the country, there remain notable opportunities for
improvement. Among the most significant issues are the
overall administrative structure of the Department, a need
.. for improved integration within the divisional structure, the
.. proportion of s.upervisory positions to line staff, the need for
improvement In scheduling and management of meetings
at all levels, and the diffusion of budgetary and financial
management responsibilities. These all represent concerns
that can be managed within the limits of existing resources and
policies. There are, of course, a number of other issues facing
the Department that relate directly to the budgetary situation,
especially the loss of key positions, the inability to recognize
excellent performance with meaningful salary consideration,
and the crucial inadequacy of working space in some areas
of the Department. The following eleven recommendations
address many of these concerns.
e
Reduce the number of administrative levels between
the health director and the line staff.
2. Strengthen the central administrative staff of the
Health Director's Office.
3 Promote an internal and external image of the
NHCHD as a single organizational unit.
4. Adopt a team-oriented management style.
5 Improve strategic and management planning
systems.
6. Provide for greater unity, flexibility, and
coordination of nursing and related personal health
service programs.
7 Consolidate finance, budgeting, and billing systems.
8. Strengthen information systems management and
resources.
9 Centralize and strengthen health education, staff
training, and communications capabilities.
10. Conduct a comprehensive review of personnel
(human resources) policies and procedures and
develop a written handbook of them that is interpreted
and applied consistently throughout the organization.
II. Review current space allocation and use and explore
alternatives for improvement given existing funding
and resources.
This effort had an important two-fold potential: to provide the
NHCHD with the benefit of outside review and recommendations
for improving its organizational effectiveness and efficiency; it
provided the NCIPH with a model that can have value to other
local organizations. Implementation and consideration of the
recommendations is an ongoing process.
Strategic Planning
A Strategic Planning Retreat was held in March 2003 to serve
as a follow-up and update to the comprehensive process con-
ducted in the Fall of 2000. Participants included the Board
of Health, Management Team, and several staff representing
a cross section of the Department. Consultation and assistance
was provided by Bill Herzog and staff from the North Carolina
Institute for Public Health. Updated information on Provision of
Services, Health Statistics, and Demograhics was distributed to
participants prior to the retreat, as well as progress-to-date on the
priorities established in 2000. During the retreat, work groups
were assigned the tasks of revising the priorities and developing
achievable goals that relate to the revisions. Participants elected
not to rank these priorities, in an effort to prevent assigning
levels of importance. Also revised were the Mission and Vision
Statements for the Department.
Revised Strategic Priorities:
I. Emerging Health Risks
2. Access to Health Care
3 Staff Development and Continuing Education
4. Facility Utilization
5 Preventive Services
6. Information Technology
4 NEW HANOVER COUNTY HEALTH DEPARThlENT
Highlights
Board of Health Recognition
The New Hanover County Board of Health received the
Outstanding Local Board of Health Award for 2002, given by
the Association of North Carolina Boards of Health at the Annual
Meeting in January, 2003. The Board of Health has been an
institutional member of the Association since its inception. Some
of the Board of Health's oustanding contributions to public health
in 2002 are listed below'
. Approval for the North Carolina Institute for
Public Health to conduct an Organizational
Analysis of the Department, including contributions
for organizational effectiveness and efficiency
. Approval for NHCHD to participate in the N.C.
Center for Public Health Preparedness Project
. Participation in the Strategic Planning Retreat
. Approval for four teams to attend the Management
Academy for Public Health at UNC Chapel Hill
. Approval for NHCHD to host one of seven Public
Health Regional Surveillance Teams (PHRST)
. Board member attended FEMA course Managing
the Emerging Consequences o/Terrorism in Mt.
Weather, Virginia
David Rice, Health Director. and Edwin Link, Jr., RPh, receive the
Outstanding Local Board of Health Award from Dr. Rachel H. Stevens,
past President of ANCBH.
Potassium Iodide Distribution
NHCHD and NHC Emergency Management worked together
to distribute Potassium Iodide (KI) tablets to county residents
who live or work within 10 miles of the Brunswick Power Plant.
In the event of a radiation release from the plant, the pills are
taken to prevent the thyroid gland from absorbing radioactive
iodine. Staff distributed the KI in Carolina and Kure Beaches,
and residents could also obtain the pills at the Department at no
cost. Information was shared in English and Spanish.
Smallpox Vaccination Clinics
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David Rice, Health Director. receives a smallpox vaccination.
The Public Health Regional Surveillance Team-2 pilot
vaccination clinic took place on February 25, 2003, with
17 people from New Hanover County receiving vaccination
(I4 Public Health, 2 Hospital, I Other). Preliminary results
showed no adverse reactions. The NHCHD clinic tookl;e
on March 7, 2003, and included media coverage of
Directors David Rice and Don Y ousey (Brunswick Co )
receiving vaccination.
Barcoding
A long term goal of renovating and updating the Medical Records
area was finally completed during FY02/03. The last stage was
implementing a barcoding system that allows for electronic file
tracking. This system
allows users to locate
charts throughout
the building, meets
HIPAA compliance
guidelines for record
security, and creates
an audit trail to track
chart movement.
The process has
allowed for improved
customer service
and efficiency, and
ensures consistent
document placement
within each chart. All
of the data and chart
conversion occurred
during weekends and
evenings, with no
disruption to services.
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5 NEW HANOVER COUNTY HEALTH DEPARTMENT
Weekend "Conversion Team" at wor1<.
Administration
e
The Administration Division is responsible for the administration, operation, and fiscal management
of the New Hanover County Health Department.
Division Goals
. Assure a positive public image and serve the citizens of New Hanover County
. Provide assistance in administrative, financial, personnel, and vital records
. Support the Board of Health, Health Director, Assistant Healtb Director, Division Directors, and Staff
. Monitor, maintain, and purchase computer equipment and provide Information Technology expertise to Staff
. Prepare Property Management work orders and assist with scheduling of Healtb Department maintenance
Vital Records
Goal
Assure vital records are filed as required by Chapter I 30-A of North Carolina General Statutes and are submitted to
the North Carolina State Division of Vital Records and New Hanover County Register of Deeds within the required
time period.
North Carolina General Statutes 130-A requires the Health Department administer the Vital Records Program under the
direction of the Health Director.
tiputy Registrars are appointed by the Health Director to process birth and death certificates for New Hanover County
e hospital is responsible for filing birth certificates, and funeral directors are responsible for filing death certificates
th local Health Department Deputy Registrars.
Certified copies of birth and deatb certificates are available at the New Hanover County Register of Deeds or from the
North Carolina Office of Vital Records. Fees are charged for certified copies of the cerbficates.
Personnel
Goal
Provide personnel services for approximately 189 Health Department employees and serve as liaison between the New
Hanover County Department of Human Resources and the Health Department
Personnel services include processing payroll and personnel action form~ orientation to new employees regarding poli-
cies and procedures; annual open enrollment for county personnel benents; and the maintenance of personnel records
and the New Hanover County and Health Department Personnel Policy and Procedures manuals.
New Hanover County FY 1998/99 FY 1999/00 FY 2000/01 FY 2001/02 FY 2002/03
Birth Certificates
3,604
3,446
3,592
3,547
3,426
eath Certificates
1,972
1,923
1,939
2,045
2,023
6 NEW HANOVER COUNTY HEALTH DEPARTMENT
Animal Control Services
Animal Control Services (ACS) is mandated to do
surveillance and follow-up on rabies exposure situations.
ACS protects our community's citizens and their companion
animals from this viable zoonotic disease through prevention
means, raising public awareness, and diligent education
methods. Pet licensing is also mandated on the county
level, as a means of effective policing of companion animals.
Successful adoptions and proper pet care are also other areas
of keen interest to the division, though they are not mandated
functions.
Goals
Increase the positive public image of the duties
performed by the division in service to the community
by increased measures of education and raised public
awareness.
Increase successful adoption rates and decrease
euthanasia rates of surrendered animals.
Build an on-site spay/neuter facility and outdoor
exercise play area.
Assess and improve methods of rabies exposure and
prevention.
The highlight of our start for this
fiscal year was gaining approval
from the County Commissioners
to build an on-site spay/neuter
facility with adoption play area.
The Animal Control Services
Management Academy Team
took their prepared business
plan document before upper
management, and received ap-
proval on the consent agenda at
the August 19, 2002, meeting.
The structure will be built some
time during the next fiscal year.
County Commissioner Chair-
man Ted Davis, Jr., assisted
Advisory Committee Chairman,
Joyce Bradley, in the honor of
breaking ground for the addition
on April 14, 2003
Staff participated in the
Organizational Analysis
process by attending a series of
meetings based on area of work
within the division. This study
will be continued into the next quarter with focal groups and-
department meeting to review the final recommendations. S.
filled in for the absence of one shelter attendant for the bulk of
the fiscal year, while she was out on medical leave.
Disturbing news of rabies activity came during the first part of the
fiscal year. A cat that had been currently vaccinated for rabies,
displayed neurological signs that tested positive for the virus.
There is no way to determine why the cat was not protected,
except that it may have been immunosuppressed. In Franklin
County, TN, a thirteen-year-old boy died from the virus in late
August. The boy had handled a bat several months prior to the
first show of symptoms, but he had failed to mention that he
might have been exposed. These cases demonstrate the need for
continued vigilance in educating and protecting our community
from this disease.
Animal Control Services also did preliminary work on ordinance
revisions in working with the county attorney and the advisory
committee. Information to be placed in an adoption packet to
distribute to new pet owners is in the p1arming stages. It was
noted that there was a trend in decreased adoptions over the last
few months, perhaps due to the depressed economy and the loss
of jobs in our area. Sadly, the numbers of animals surrendered to
the shelter continues to be an area of concem. Several activiti..
are plarmed for the upcoming months to increase awareness.,
animal needs in our community
Groundbreaking for Animal Control Services on-site
SpaylNeuter Facility
7 NEW HAN()\"ER COL,NTY HE:\UH DEPARTIlEI'\'T
We held our second Public Health
Conference in October 2002
The meeting was scheduled for
evening hours to accommodate a
larger group of area veterinarians
and their staff. Our Inner City
Rabies Clinic sponsored by the
ACS Advisory Committee was
held in early November to rabies
vaccinate pets of those living in the
downtown area of Wilmington. We
condncted successful fund-raisers
to replenish the trust fund by
selling "Peanut" the floppy puppy
and doing a pet photo shoot in the
fall for holiday gift giving.
On November 22, 2002, ACS
staff assisted by Wilmington
police officers and SWAT team
members seized sixteen pit bulls
from two houses at Princess Pl.
Drive and North 30th Street. Fi
defendants were ultimately charg
and arrested. Four of the five were
found guilty of animal cruelty,
one in ajury trial in conjunction with Assistant District Attorney,
Ben David. The fifth one accused pled guilty to charges of dog
..ting and fighting. Final verdicts were not accomplished until
y 2003, which was six months after the animals were seized.
ountless staff hours were devoted to this important task to
meticulously document all evidence for the successful outcome
that we achieved and house and care for the affected animals.
Staff training was highlighted throughout the fiscal year, including
the Chameleon Training Conference in November 2002 and
completion of the 7 Habits course in June for all in active
duty for Animal Control Services. Jean McNeil taught county
classes for Adult First Aid with Standard AED on three separate
occasions. Delisa Derseraux headed up the Health Department
Holiday Celebration in December 2002. A video earmarking
the progress of ACS was part of the entertainment. Mark Boyer
and Eric Peterson with county public information compiled the
segment, which later aired for general viewing on NHC-TV
Professional Recovery Consultants closed the ACS account for
collections in December. This necessitated searching for and
moving our records to another follow-up agency to maintain
the integrity of the program. After extensive research and
collaboration, we were able to solicit the County Legal Department
to handle the collections claims. An additional position was added
to their staff utilizing revenue generated from the collection
process. Everything has come together well, which is necessary
to achieve our high level of compliance with licensing.
Public Health Month included discounted rabies vaccinations done
at area veterinary hospitals and a free rabies clinic at our shelter
one Saturday afternoon. A full hour of time was done on WAAV
Radio for the occasion, and by request, a second hour for follow-up
was done for additional questions. Another animal cruelty case
occurred this month, which garnered a barrage of media attention.
Our year ended quietly after the whirlwind schedule that preceded
the changeover of fiscal years.
Dental Health
Goal
To promote, protect, and assure the optimal Oral Health of the
citizens of New Hanover County
~ New Hanover County Dental Program continues to
onstrate the excellent cooperative efforts of the North Carolina
al Health Section, the New Hanover County Health Department,
the Wilmington TriCounty Dental Society, the North Carolina
Dental Society, Cape Fear Community College Dental Programs,
the New Hanover Community Health Center, as well as many
other community groups. The Dental Health Division utilizes
numerous strategies to improve the oral health of our citizens
which involve a) Increased Use of Dental Sealants, b) Periodic
Dental Assessments with Referral, c) Dental Health Education, d)
Community Water Fluoridation, and e) Promotion of Community
Efforts to Improve Access to Dental Care.
the New Hanover County Dental Program, the North Carolina
Dental Health Section, and Cape Fear Community College
worked together to sponsor many activities in our community
Local activities included local Dentists providing preventive and
restorative care for needy low-income children. Additionally,
a "Seal Out 2003 Clinic" took place on Friday, February 21 at
Cape Fear Community College. The "Seal Out 2003 Clinic" was
extremely successful with 42 children receiving exams, x-rays,
prophylaxis, as well as 176 sealants. "Give Kids a Smile" was a
huge success with well over $15,000 of dental services donated
to underserved children in our area.
1","-
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Fiscal Year 2002 - 2003 was an extremely exciting and productive
period for the Dental Health Division. Over 7,100 children
and adults received Dental Health Education from our staff.
Additionally, 1,600 plus children received Dental Assessments ~
" I'
with follow-up of referrals.
The New Hanover County Dental Program has been involved in
many access to care activities during the Fiscal Year 2002 - 2003
During the Winter 2002 - 2003, Dr. David McDaniel met with
the President of the Wilmington TriCounty Dental Society and
others in order to design local activities for the "Give Kids a
~'le" Program. "Give Kids a Smile" is a national umbrella
dental access activities which took place across the country
. g February, with Dentists and Staff providing educational
outreach, screening, preventive care and treatment to millions of
underserved children. The Wilmington TriCounty Dental Society,
"
;
Seal-Out 2003 Clinic
8 NEW HANOVER COUNTY HEALTH DEPARThfENT
Exciting work has occurred this year in the area of Dental Health
Education and Prevention. During February 2003, the New
Hanover County Dental Staff celebrated National Children's
Dental Health Month with various dental activities conducted
throughout the community The Dental
Staff produced an interesting display
located in the Health Department clinic
reception area entitled "Seal A Terrific
Smile" In addition to the display, the
Dental Staff distributed sealant literature.
/'
On numerous dates throughout February, t.-.
the Dental Staff conducted educational
sessions at preschools, daycares, and after
school eurichment programs on various
topics such as nutrition, brushing, flossing,
and the benefits of sealants. Celebrating
National Children's Dental Health Month
is another important way to encourage
both children and adults to keep a terrific
smile.
Other exciting programs and activities
conducted by the New Hanover County
Dental Staff this year included "Oral
Health Care ... For You and Your Baby"
Y.
Parenting Programs, "Community Smiles" After School and
Summer Enrichment Programs for At-Risk Children, "Lifetime
of Smiles" Head Start, Preschool, and Daycare Programs, _
"Take a Look at Dentistry" Dental Careers Programs for ~.w
~ I H_,~ c..m" S<wI~ m"'''''
the New Hanover County Dental Program
. 'J was pleased to serve as a Dental Pubhc
. 'I Health orientation site for 25 Dental As-
":- ,sisting and Dental Hygiene Students from
Cape Fear Community College. The Den-
tal Assisting and Dental Hygiene Students
were introduced to the Public Health De-
partment as well as completed numerous
experiences in Dental Public Health.
"Give Kids A Smile", "Seal Out 2003
Clinic", National Children's Dental
Health Month, as well as other various
Dental Health Education, Prevention,
and Access To Care Programs, once
again demonstrate how the New Hanover
I County Dental Program collaborates
with numerous community groups and
organizations to assure optimal oral health
for the citizens in our community
Dental assessment being performed
Environmental Health
Many aspects of human well-being are influenced by the
environment, and many diseases can be initiated, promoted,
sustained, or stimulated by environmental factors. The
interactions of people with their environment are, therefore,
critical components of public health. The Environmental
Health Services division (EHS) protects the public health and
environment through the provision of a diverse group of services
in the community Services include the evaluation of: all types
of food operations; body art establishments; child care facilities;
foster care homes; institutions including hospitals, nursing
homes, and private and public schools; lodging facilities; public
swimming pools; other recreational waters; wastewater systems;
and water supplies. EHS assesses air quality, identifies/mitigates
environmental hazards including lead and applies control
methodology for potential disease vectors such as mosquitoes
and ticks. During disaster response and recovery, many services
and supports are offered to facilitate the restoration of normalcy
in the everyday lives of citizens. The following highlights some
of the past year's environmental health activities.
Food Safety Program
Achieving a 100% coverage rate of establishments/facilities
under inspection by the Division is critical to assuring food
safety practices and reducing the risk of foodborne illness in the
population. This translates as conducting an evaluation of each
restaurant on at least a quarterly basis or four times yearly A
e
minimum frequency of inspection is established for the various
types of establishments/facilities in North Carolina General
Statute and Administrative Code. Changes in statute and code
brought greater focus to facilities that operate tern porarily often
as a venue for nonprofit entities to raise funds in support of civic
organizations and projects. The critical point for consideration,
however, was not the legislative action generating scrutiny of
philanthropic enterprises, but was the tenet that microbes with
the propensity to cause foodborne illness are irrespective of such
periphery issues. Food microbiology/science principles are always
reliable for evaluating risk associated with product processing
and consumption whether the facility or menu be expansive or
simple. The improvisational design of temporary food facilities
alone is sometimes a stretch for the consistent practice of safe
preparation and cleaning procedures without regard to the high
volume sales potential posed at large public gatherings such as
athletic events and festivals. Nonetheless, many additional staff
hours were and continue to be dedicated to making contact with
prospective vendors and assuring that their plans for operation
are unlikely to result in foodborne tranmission and disease
outbreak in the community Long established events like Azalea
Festival and Riverfest require all of EHS staff to evaluate~
permit operations as well as conduct follow-up monitoring
conclusion. Many other weekends throughout the year we
logged for much smaller scale activities and netted a record total
issue for the year of 271 temporary food facility permits.
9 NEW HAl\OV'ER COVNfY HEALTH DEPARThlE!'IT
Temporary food facilities completely fill one side of downtown Water
Street during a recent Azalea Festival.
Environmental Health Services has participated in a pilot project
since its 1998 initiation using large numbers on a posted card to
advise the public of restaurants level of compliance with health
laws and standards rather than the traditional ABC letter grades.
The NC Department Of Environment And Natural Resources
(NCDENR) over the past two years struggled to develop a
consensus relative to proposed changes that evolved from this
project, however, was successful only when it was conceded
that both a prominent letter grade in addition to a prominent
~eric score would be used on the new card. This change will be
plemented in late summer of the forthcoming year, tentatively
eginning August 2004. During the interim, NCDENR staff and
representatives of some local health departments will design a
strategy to educate the public relative to food safety and the new
grade/score card. EHS staff will be represented among this group
and anticipate contributing substantially to this opportunity to
enhance environmental/public health awareness.
High demand from the local food service industry for training
and certifying their employees continues as a strong indicator of
the value placed on compliance with regulatory standards. Food
service establishments with at least one full-time employee in
a supervisory status who has attended an accredited course and
has been certified through successful completion of a written
examination are awarded two bonus points on their sanitation
score. A perfect score plus two bonus points means that the
sanitation score could actually exceed the 100% mark toI02%.
Through a joint venture with Cape Fear Community College
(CFCC), EHS staff instructed two sessions (107 students)
of the National Restaurant Association's Serving Safe Food
Certification Course. More than 95%, 102 students, obtained
the certification credential.
.bliC Swimming Pool Program
e eateries, swimming pools have a strong presence throughout
e county. Public swimming pools include virtually every kind
of constructed recreational water facility except those found in
residential backyards. Growth experienced in the program this
year led to a record setting issue of35 7 permits and 783 inspections.
So as to meet the same proficiency standard established for
pool operators, staff complete "Certified Pool Operator"
(CPO) training. This consists of formal classroom instruction
and an acceptable score on written examination. Staff must
also demonstrate application and knowledge in the field to
obtain authorization from the North Carolina Department Of
Environment And Natural Resources (NCDENR) to enforce
state laws and rules.
Vector Control Program
By fall 2002, West Nile virus was identified in avian, equine and
human populations throughout much of the United States. Human
cases were concentrated in Illinois and Louisiana most frequently
occurring among the elderly EHS staff seized every opportunity
to encourage the public to protect themselves from exposure to
mosquitoes. By mid-summer, Vector Control Program staff was
averaging at least one media contact weekly. Fortunately, the
prevailing local weather from spring through fall was extremely
dry with far less than normal precipitation. This alone contributed
to a significant reduction in the mosquito population as compared
to the norm of many prior years. Nonetheless, a strong adulticide
campaign was implemented and carried into the month of
November by Vector Control Program staff. Upon appeal to
the NHC Commissioners, approximately $50,000 in additional
funding was appropriated to our Vector Control Program to
allow the purchase of necessary equipment and materials.
Beginning, early in the calendar year 2003, alternative methods
of procuring adulticide product were meticulously explored due
to the substantively increased level of treatment required during
the prior season. The answer was to purchase in bulk and mix
adulticide product just prior to filling the ultra low volume
application machines as routes were begun in the evenings. While
this sort of change may not sound dramatic, it did bring about
much necessary attention to safety issues and the development
of more rigid protocols in the interest of protecting staff from
unnecessary personal exposure to pesticide.
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David Jenkins examines flssuras on dredge spoil disposal site to
determine the effects of an earlier larvicide epplication.
10 NEW HANOVER CUUNfY HEALTH DEPARfMENf
Water Quality Program
The protocol for determining if a site proposed for development in
areas not served by municipal or other central sewer systems can
support an on-site soil absorption wastewater collection, treatment
and disposal system has evolved further to protect the ground and
surface waters of the state. Added criteria for determining the soil
wetness condition yielded concern that few properties especially
those of the coastal plain would qualify for the permitting of
conventional or modified conventional septic systems under
newly established standards. New Hanover County, however,
being geographically small in land mass and densely populated
throughout much of its area has options that will not be viable
for many other communities in this state. As the local economy
grows so does the ability to develop wastewater infrastructure
and lessens the demand for permitting and constructing on-
site septic systems. The surrounding Cape Fear River and its
tributaries also offer what some other coastal communities lack
by providing a reasonably manageable source for discharging
treated wastewater. For those properties that outlie the feasibility
of being served by municipal or other central sewer systems, the
technology to mitigate site/soil limitations and support the use
of soil absorption systems continues to advance at a rapid pace.
Categorized by North Carolina statutes and administrative co~_
as experimental and innovative by design, provisions are availaw
in many cases for using complex pretreatment components to
assure the protection of ground and surface waters.
Recreational water quality monitoring is primarily a function
of the N C Department Of Environment And Natural Resources
(NCDENR) Shellfish Sanitation Branch with some periodic
aid from local health departments. A more rigorous sampling
and testing program was introduced at the beginning of this
spring/summer tourist season in response to a mandate of the
US Environmental Protection Agency. Temporary rules are
proceeding through a review process to become the permanent
quality standard for recreational water along North Carolina's
coast. EHS staff assisted NCDENR in the conduction of
public hearings and small group meetings with elected officials
representing county and all municipal governments. EHS staff
will continue to be an important information source to local
citizenry and tourists, and will lead efforts to identify any sources
of pollution to our fragile ecosystem.
Personal Health Services
(previously the Divisions of Child Health, Communicable
Disease, Community Health, Laboratory, Nutrition,
and Women's Health)
Introduction
The Organizational Analysis (OA) recommended that the
Health Department combine the four Nursing Divisions into one
Division, and that consideration be given to include other clinical
services. The four Nursing Divisions had been multidisciplinary
divisions, including staff for management support, nursing,
social work, and health education. In December 2002, the
Health Director appointed a Personal Health Division Manager
and the merging and reorganization began. Work groups assisted
with developing new teams within the Division, and six nursing
teams were established. The OA also recommended a decrease in
numbers of supervisors and levels of supervision. Meetings with
human resources yielded input relating to supervision of teams,
and the new Personal Health Services Division was born. The
Laboratory and Nutrition teams were added to the Division later
in the year. Health Promotion was moved from under Nursing to
a new Division to be headed by a Health Programs Administrator.
The Business Manager was charged with reorganization of
management support staff; however, they remained part of
Personal Health until June 30th This report is very different this
year with summaries of programs, rather than by Divisions.
Child Health Services
The Child Service Coordination Program (CSCP) had a
challenging year, due to Medicaid billing changes and a new
in-house medical records system. On October I, 2002, the
Division of Medical Assistance changed reimbursement for CSCP
services. Services are now billed in 15-minute (unit) increments
with a cap of 6 billable units per month. CSCPhas been suppo~
by Medicaid billing; however, the new reim bursement units h
made it more difficult to bring in the needed revenue to suppo
the nurses and social workers providing the case management and
home visiting services. One halftime nurse position was not filled
due to lack of sufficient revenue. Children are enrolled based on
their social, emotional, and developmental needs, regardless of
income. Referrals were received on 517 children, with a total of
5,947 contacts completed for the year. Referrals continue at35-50
children per month, with an average of 400 clients on the caseload
every month. All CSC medical records had to be converted and
bar coded in the second quarter of FY02/03
e
I I NE W HANOVER COlMfY HEALTH DEPARTMENT
Mother and infant receiving child health services
The NAVIGATOR Intensive Home Visiting Program (IHV)
reclassified a position from a Public Health Nurse to Social Worker,
~etter meetthe needs of the Family Assessment Coordination
ices. This position is half time Intensive Home Visitor and
time Family Assessment Coordinator (FAC). Currenlly, the
Navigator IHV program is serving 106 clients (moms and babies).
For the year, 905 home visits were completed. Nursing students
from UNC-W assisted the FAC in updating the resource database
for the Universal Screening Tool, enhancing the infonnation being
sent to participants of the survey. 2,878 surveys were distributed
with 2,394 being returned (83%). NAVIGATOR is funded by a
combination of a Cape Fear Memorial Foundation Grant through
Smart Start, and Medicaid revenues.
Health Check Clinic was put on hold October 1, 2002 due to
the decrease in the number of clients and the change in the
reimbursement status from DMA for CSCP Nurses assigned
to that clinic were needed to maintain the CSCP program. The
Health Check Clinic staff assisted families with obtaining medical
services from other health care providers. Future planning
includes re-establishing these well child appointments through
the open access clinic.
NHCHD has two Sudden Infant Death Syndrome (SIDS)
Counselors. There were no new reported SIDS deaths in New
Hanover County this year; however, the counselors continue to
work with families with SIDS deaths from previous years.
tle New Hanover County Child Fatality Prevention Team
reviewed 15 deaths this fiscal year, chaired by a health department
social worker. No significant trends were noted, and no specific
actions taken. Child Fatality funds purchased Child Safety Seats,
which were distributed to 41 families by CSC staff according to
our Child Passenger Safety Program guidelines.
The Childhood Lead Poisoning Prevention Program (CLPPP) is a
joint effort of the Personal and Environmental Health Divisions.
During FY02103, the health department lab processed 1,787
blood lead tests. Currenlly, CLPPP staff have been following
approximately 27 children with elevated blood lead levels,
providing home visits, education, additional testing, follow-
up with physicians, assessment of hazards, developmental
monitoring, school planning support and referrals. CLPPP
staff collaborate with private providers, housing officials, and
community to increase and extend CLPPP's outreach efforts. The
CLPPP coordinator works closely with the regional Environmental
Health Specialist to offer clients voluntary health inspections and
accompany health inspectors on all lead investigations, whether
voluntary or those mandated by law. The local CLPPP Policies
and Procedures Manual underwent a major overhaul in FY02/03,
IIII..d the CLPPP is under the direction of a new coordinator.
.alth Check Coordination, Smart Start funded for the fifth year,
has continued to provide assistance to families with Medicaid
eligible children with access of preventive health care, dental
care, and the application process for eligibility. The Health
Check Coordinator also provides outreach and education on
Health Choice child health insurance, and participates in the
local Health Choice Coalition. The State goal for Health Check
participation (Medicaid children receiving well check ups) is 80%.
New Hanover County is at 72%. The 3132 contacts for FY02/03
included phone, clinic, and home visits.
Maternal Health
Maternity Care Coordination (MCC) services were provided to
over 800 pregnant women during FY02/03 Despite the change in
the Medicaid billing procedure and reimbursement rate, the NHC
Maternal Health Team surpassed their annual budget goal. The
Medicaid billing was changed from a set fee for service to being
billed by units of 15 minutes. Two Maternal Outreach Workers
(MOW) continue to compliment the MCC and CSC programs.
These paraprofessionals provide additional support through home
visiting services, under a plan developed by the families' nurse
or social worker. The MOW program experienced a major shift
this year in reimbursement limitations. Contacts began being
measured in 15 minute units. While the rate per unit seemed
substantial, the state placed limits on the number of units of service
the MOW can bill for each patient per month. The state also
restricted care coordinators and MOW's from billing for services
on the same day These changes resulted in increased caseload
sizes that still do not allow the MOW's to make full revenue.
The changes did not result in less service to patients, as many units
of time were provided that were not billable. The caseload size
does impose challenges to the MOW's as they prioritize which
patients' needs are met first. Another limiting factor was that one
MOW was out on leave for 3 months. Caseloads have increased
from 25-30/month to 30-35 patients/month.
The Baby Bucks Boutique reopened thanks to an increase in
donations from local agencies and organizations. This is an
incentive program for pregnant patients, which encourages them
to seek prenatal care early and reach certain goals to promote
a healthy pregnancy Staff also continue to have a monthly
drawing for a free Child Passenger Safety Seat (car seat) for a
teen client. The pregnant teens must meet certain criteria in order
to be eligible for the drawing. The car seats are donated by the
Women's Auxiliary Club.
Women's Preventive Health
Women's Preventive Health provides Family Planning Services to
women of childbearing years. This year we provided an additional
new birth control method, the Ortho Evra Patch. The clinic served
882 new clients and provided 4324 clinic visits for FY 02103 year.
The age of routine Chlamydia screening increased from age 19
to age 24, thereby increasing the opportunity to treat more young
women for asymptomatic or previously undetected infection and
prevent reinfection or spread. The availability of state family
planning outreach money allowed NHCHD to provide services
at the Department of Social Services on a part-time basis.
12 NEW HANOVER ColMI'Y HEALTH DEPARTMENT
Male Sterilization was provided free or at reduced rates to 18 men
this year. Family Planning and Health Promotion staff provided
the education, counseling, and scheduling for vasectomies
through arrangements with a local urological group and the
Regional Vasectomy Program in Greensboro.
Stafffrom the Breast and Cervical Cancer Control Program (FNp'
Health Educator, and RN) sponsored a program in January on
Human Papilloma Virus, featuring Dr. Greg Henderson as guest
speaker. Dr. Henderson is a local pathologist who specializes
in cancers of the female reproductive system, and is also the
author of Women at Risk: The HPV Epidemic and Your Cervical
Health. This program was presented to NHCHD staff and other
area health professionals.
Community Health Services
The New Hanover County School System contracts with
NHCHD for health services in the counties' thirty-seven
schools. Student enrollment is over twenty-two thousand.
The employment of six additional school nurses in late 2002
enabled NHCHD to increase school services and coverage. The
high schools, middle schools, and eleven elementary schools
were assigned full-time nurses. The other elementary schools
have a half-time nurse. School Health services increased by
twenty-one percent. Students with chronic medical needs have
increased to sixteen percent and students on medication are at
nine percent. Since student's medical needs are increasing, the
goal is to have a full time nurse in every school. As part of the
larger Potassium Iodide (KI) distribution, the school nurse at
Carolina Beach Elementary worked with the Communicable
Disease staff and Board of Education to implement a system
for KI storage for the children and staff, parental/staff education
and receipt of permissions.
A Public Heaffh Nurse in every school
Well Baby Clinics provided clinic services offsite in the county
in several churches. The clinics offered physical exams,
developmental evaluations, immunizations, TB screeni.
laboratory testing, nutritional counseling, injury prevent
information, referrals and follow-up as needed. Evening clin.
were held to accommodate working parents and the physicians
who volunteered.
Kindergarten Health Assessment Clinics provided physical
assessments, immunizations, TB screening, laboratory testing,
hearing and vision screening, counseling and referrals as
indicated. The clinic served non-Medicaid children, according
to the mandate that indigent patients have access to this service.
Decreased attendance is attributed to the increased participation
in the Health Choice insurance program, resulting in access to
private care.
The Neurology Clinic provides diagnosis and treatment of related
diseases, coordination of care, referrals for testing, assistance with
medications and counseling to encourage healthy lifestyles. Five
local Neurologists volunteer their services to provide care and
treatment of patients in this clinic. Referrals are accepted from
medical providers from New Hanovcr and surrounding counties.
The purpose of this clinic is to serve those unable to access medical
services elsewhere.
The Orthopedic Clinic provides diagnosis and treatmejt
coordination of care, education and referrals as indicated. A 10
Orthopedist volunteers his services or donates payment to forth
the program activities. This clinic serves patients who cannot
access medical services with insurance or Medicaid. The Rotary
Club of Wilmington continues to support the clinic through some
funding and member volunteers.
Community Adult Health Clinics offer health assessment and
monitoring, coordination of care, treatment, immunizations,
disease management and education and counseling of healthy
lifestyles. During the summer and fall, staff was able to attend
health fairs and provide flu shots at sites where clinics had
previously been held. The Ministering Circle Chore Program
is administered by program staff and is a valuable resource
for homebound patients. Adult Day Health Monitoring is a
state mandated service for Adult Day Health centers, which
are evaluated quarterly for the provision of health care. Public
health nurses provide assistance with compliance issues to ensure
mandates are met.
Jail Health
During FY02/03, New Hanover County began working on the
process to contract Jail Health services to a private company
A committee with representation from the health departm.
finance, budget, legal, county manager's office, and sheri
department developed the Request For Proposals and went throu
the bid process with potential contractors. Prison Health Services
(PHS), Inc. was chosen and awarded the contract by the County
13 NEW HANOVER COUhTY HEALTH DEPARTME!\'T
Commissioners. PHS will provide jail services to include medical,
pharmacy, dental, and mental health. NHCHD ceased providing
.' Medical services June 30, 2003, with over 7,500 clinic visits
vided in FY02/03 The Health Director will continue to review
e medical protocol annually and Department communicable
disease staffwill work with PHS to ensure that reportable diseases
are handled appropriately The Health Department utilized a
Reduction in Force plan to transition eligible county employed
Jail Health staff into the main building to appropriate positions.
Communicable Disease
The mission of the Communicable Disease programs continues
to be the promotion of health and quality of life by preventing
and controlling communicable diseases. Early identification and
treatment, prompt reporting, contact investigation, education on
healthy behaviors that prevent acquiring or transmitting disease
and preventive medicine are strategies used by the communicable
disease staff.
North Carolina law requires the reporting of 66 diseases and
conditions. Effective May 16, 2003, Severe Acute Respiratory
Syndrome (SARS) and Vaccina were added to the reportable
disease list. Both SARS and Vaccina require surveillance and
reporting to be done within 24 hours. Six (6) cases of Pertussis
were reported for the FY02/03 After completion of field
investigation and follow-up surveillance, no link was established
etween these cases.
Reportable Communicable Diseases
(diseases with more than I case reported)
AIDS 46
Campylobacter 18
Chlamydia 664
E Coli 0157:H7 4
Gonotrhea 311
Hepatitis A 4
Hepatitis 8, Acute 11
Hepatitis 8, Chronic Carrier 27
HIV Infect/on 79
Legionel/osls 2
Lyme Disease 6
Pertussis 6
Rocky Mountain Spotted 5
Fever
Salmonel/a 127
Shigella 9
Streptococcal Infection,
roup A Invasive 4
yphllls, Latent and Late 13
Vancomycin Resistant
Enterococci (VRE) 11
Tuberculosis (TB) Program
Fiscal Year 02/03 was busy for the TB program. Total number
of TB cases was 10, well above the projected state and national
rates. The majority of the cases had common similarities of sub-
stance abuse and homelessness, making follow-up very difficult
attimes. One of the reported cases deceased before he was to be
discharged from the hospital. Contact investigation of the cases
has been extensive, requiring investigation at a local soup kitchen
as well as overnight shelters for the homeless.
Over 150 people were started on therapy for latent TB infection
during the year, many of those contacts to the cases. Current
guidelines recommend directly observed therapy for children,
substance abusers, HIV positive individuals, and any individual
who has demonstrated non-compliance. The result has been well
over 1,000 home visits by the TB staff for directly observed
therapy
The prevalence of cases and people infected with latent TB in
the homeless population has precipitated some partnering with
these agencies in planning for future services. It has increased
awareness in the population as well as those who serve them
about the risks and needs of this group of people.
Staff continues to work closely with Duke University in clinical
studies regarding genetics and new drug therapies and hope to
continue this relationship as opportunities arise.
Emerging Infectious Diseases
The Communicable Disease staff responded to the Severe Acute
Respiratory Syndrome (SARS) outbreak by providing education
and resource assistance to the citizens of our community In
addition, a SARS information packet was complied which
included the most current CDC guidelines for triage of suspected
SARS patients, SARS screening, infection control guidance,
specimen collection and handling for potential cases, biosafety
guidelines and the latest case definition. This packet was furnished
to ambulatory care facilities in our community, as they are
sometimes the first point of contact for an ill patient. In addition,
developing and implementing SARS screening guidelines for
commercial vessels arriving at our port established collaboration
with the U.S. Coast Guard and the maritime community
In February 2003, NHCHD began vaccinating staffin coordination
with the Pre-Event Smallpox Vaccination Program. NHCHD
trained 19 staff as certified smallpox vaccine administrators and
vaccinated 16 health care providers and support staff against
smallpox disease. New Hanover County developed a local
smallpox plan with medical standing orders.
General Immunizations
In the past year, children and adults received 14,410 doses of
vaccine in 10,913 visits in our General Clinic. This includes
vaccines that are required by law for our infants and children,
while others such as influenza, hepatitis A, adult hepatitis B,
14 NEW HANOVER COUNTY HEALTH DEPARTMENT
pneumonia and tetanus are recommended. New Hanover County
Health Department continues to monitor vaccination compliance
for children up to 24 months of age. The percentage of children
appropriately immunization by 24 months was 82% which is
a 5% increase from last year. During the influenza campaign,
4,358 people received the flu vaccine and 149 received the
pneumonia vaccine. We continually strive to increase by
community awareness and outreach the number of people who
receive the influenza and pneumonia vaccinations each year.
Influenza continues to be a major vaccine preventable disease
in our country with high morbidity and mortality.
The Sixth-Grade School Site Hepatitis B Immunization Initiative
for the school year 2002-2003 was completed in May 2003
There were 857 eligible sixth-grade students and 664 of these
students started and completed the three dose series during
this initiative. This represents a 90% completion rate. The
participation rate of those students determined to be eligible
was 55%. The overall county vaccination rate of sixth-grade
students who completed the Hepatitis B series in New Hanover
County was 51%.
Sexually Transmitted Disease
The Sexually Transmitted Disease (STD) Program provides
physical examinations, counseling, testing, treatment and
education on STD's to include gonorrhea, syphilis, herpes,
chlamydia and many others. There were 2,574 STD clinic
visits in FY02/03, which remains steady as compared to the
2,586 visits in FYOII02.
In New Hanover County, identification of HIV and AIDS cases
has increased for the past two years. This year there were
2,038 HIV tests completed in our clinics as compared to 2,119
tests done in FYO 1102. This year there were 79 cases of HIV
identified as compared to 45 HIV cases last year. In addition, 46
AIDS cases were identified as compared to 34 AIDS cases last
year. It is felt that this increase in numbers is a result of increased
HIV testing efforts and increased community education on early
detection and treatment.
Laboratory Services
The laboratory provides technical support and testing to health
department programs. It is governed and licensed by the Federal
Clinical Laboratory Improvement Amendments (CLiA) of 1988
through the North Carolina Division of Facility Services and is
designated to perform testing of moderate complexity
During FY02/03 over 54,000 procedures and approximately
8,800 venipunctures and skin punctures were performed at
the Department. Another 6,700 samples were processed and
submitted to reference laboratories. The areas of clinical
testing include hematology, microbiology, serology, chemistry
and urinalysis.
Bacteriological testing of water is available to the Environmental
Health Division. The Water Bacteriology Program is licensed
by the North Carolina State Laboratory of Public Health. a
One of the highlights of the past year has been Participatin~
as a "referee lab" for the quality assurance program of the
Laboratory Improvement Section of the State Laboratory Other
collaborations came at the request of the Region VII Disease
Intervention Specialists and Cure AIDS. From two Cure AIDS
outreach clinics, the laboratory staff screened I I 8 clients for
syphilis and prepared and forwarded serum samples to the State
Laboratory for HIV screening.
Laboratory Procedures
July I, 2002 - June 30, 2003
Urinalysis 14%
e
Serology 8%
Water Bacteriology 1%
Chemistry 5%
Nutrition Services
Women, Infants and Children (WIC) Program
WIC provides nutrition education and supplemental foods to
prenatal, postpartum, and breastfeeding women, as well as
infants and children up to 5 years of age. The supplemental
foods are high in protein, vitamins, and minerals (particularly
Vitamin C and iron), to prevent anemia, to increase the birth
weigh of infants, and to permit maximum mental and physical
development.
The New Hanover County WIC Program served an average of
2,862 participants each month during the year, 101.6% of the
state assigned WIC caseload. WIC nutritionists completed 5,759
WIC certifications and 3,128 additional nutritional assessments.
WIC management support staff also provided 1,833 "mini'A
nutrition lessons for low risk WIC participants. _
IS NEW HAN()VER CC)UNTY HEALTH DEPARTMENT
WIC continues to promote breastfeeding. The WIC Program
encourages breastfeeding as the feeding of choice for
MjIltts. Breastfeeding equipment and supplies are available
Wbreastfeeding mothers and their babies. During the past
year, 82 mother-baby pairs borrowed one of the program's
25 electric breast pum ps. Mothers with infants still in the
neonatal intensive unit and mothers who want to continue to
exclusively breastfeed their babies after returning to work or
school benefit greatly from this service.
Many federal changes to the WIC vendor program were
implemented on July I, 2002. The new regulations require
mandatory vendor selection criteria including competitive
pricing and price imitations and business integrity
standards.
General Nutrition
The registered dietitian in the General Nutrition
Program provides individual nutrition counseling and
presents nutrition programs to many groups throughout
the community During FY02/03, individual contacts
included 123 at Coastal OB/GYN prenatal clinics, 11 0 at
the NICU follow-up clinic, 30 at community well baby
clinics, and 133 sessions at the Health Department. Referrals
for individual nutrition counseling come from other Health
Department programs, area physicians, and self-referrals. New
.aEover cou.n.ty citi~ens call and ask questions about many
.erent nutnlion tOpiCS.
Nutrition Education
Thirty-one nutrition programs were presented to a wide variety
of community groups including retirement and senior centers,
Nutritionist meesures child for W1C progrem
school classes ranging in age from Pre K through community
college, child care facilities, parenting groups, school nurses,
and social service agencies.
The general nutrition program is partnering with the NHCHD
Health Promotion Coordinator and NC Cooperative Extension
Service to train day care workers in the "Color Me Healthy"
curriculum for 3 and 4 year olds. The focus is on good nutrition
and increased physical activity
Public Health Regional Surveillance Team (PHRST) - 2
In response to the nation's Bioterrorism preparation effort,
seven Public Health Regional Surveillance Teams CPHRST)
were formed throughout North Carolina in early 2002. The
Public Health Regional Surveillance Team - Region 2 CPHRST-
2), hosted by the New Hanover County Health Department,
has been in operation for over a year and serves the following
counties in Southeastern North Carolina: Brunswick, Carteret,
Columbus, Duplin, New Hanover, Onslow, and Pender.
PHRST-2 works within its region, as well as statewide, to
strengthen public health infrastructure in order to detect, identify,
investigate, and control illness due to biological, chemical, or
nuclear terrorist attacks. By working with health organizations
and first responders in its region, PHRST-2 is aiding disaster
~aration efforts through planning, education, investigation,
~sultation, and surveillance.
By the end of January 2003, the PHRST - 2 became fully staffed.
Since agro-terrorism and Bioterrorism are issues facing the state,
a cooperative partnership with the North Carolina Department
of Agriculture and Consumer Services (NCDA&CS) was formed
bringing Daniel Wilson, DVM, Field Veterinarian to the team. He
participates in many of the exercises, meetings, presentations, and
training sessions with the team.
Smallpox
Under the directive of the Centers for Disease Control CCDC), public
health departments across the nation began preparing to inoculate
health care workers for Smallpox. Phase I of Pre-event preparation
was to begin in January, 2003 This effort is critical for smallpox
preparedness planning, within the context of broader terrorism and
emergency response planning. PHRST-2 aided its counties with
Smallpox preparedness efforts including reviewing surveillance
for early detection of possible smallpox cases, procedures to
investigate possible smallpox cases and to institute immediate
control measures to contain disease, plans to provide for the care
of smallpox cases in the event of an outbreak, and plans for mass
vaccination oflarge population groups up to the entire population in
a short period of time. Activities included training of public health
and health care response teams as well as personnel who would
16 NEW HANOVER COUNTY HEALTII DEPARTMENT
staff mass vaccination clinics, educational materials directed at
many groups including the general public, amassing supplies and
equipment, and vaccination of health care workers and public
health response teams necessary to respond to and investigate
an event. PHRST - 2 augmented the LHD's preparation for
delivering vaccine by developing screening protocols, reviewing
infection control procedures, and educating Public Health RNs
on how to vaccinate people and how to interpret what a positive
response ('take') would look like.
PHRST-2 helped facilitate smallpox pre-event and and mass
vaccination planning with health departments, hospitals, and
emergency management organizations within its region. The
North Carolina Office of Public Health Preparedness and
Response (NC OPHP&R) received Dryvax @ vaccine (the
vaccinia vaccine for smallpox) in January 2003 and disseminated
to each of the PHRST teams throughout the state. PHRST-2
conducted the first smallpox vaccination cliinice on 25 February
2003 Table 1 breaks down all the vaccinations given in Region
2 during the first half of2003 The total number of people given
vaccinations was 180; 8 people did have an initial take. New
Hanover County did not have any adverse events reported or
secondary transmission.
Table 1
County Total Number Vaccinated
Brunswick 14
Celteret 71
Cotumbus 6
Duplin 6
New Henover 30
Onslow 57
Pender 4
Total 188
Management officials requested potassium iodide pills for
residents living within the I O-mile EPZ of the four nuclear power
plants affecting North Carolina. PHRST-2 worked with public
health and emergency management officials from these countie.
to plan and coordinate the distribution of Kl pills to residen
and businesses within the 10-mile EPZ. PHRST-2 participate
in the distribution points for NHC residents, and also tabulated
the number of NHC residents receiving KI tablets. Table 2
indicates the distribution of Kl tablets by County
Table 2
Residents Number of KI
County Receiving KI Tablets Distributed
Tablets
Brunswick 9.745 19,490
New Hanover 4,848 8,470
Total 14,593 27,960
Aid to Counties Funding
In late 2002, the North Carolina Office of Public Health
Preparedness and Response (NC OPHP&R) announced the
availability of approximately $2 million in state grant funds to
help upgrade local public health departments' preparedness and
response to Bioterrorism, outbreaks of infectious disease, and
other public health threats. NC OPHP&R enlisted each PHRST
team to assist its health departments in applying for these grant
monies and reviewing their proposals. Under the direction of
the NC OPHP&R, PHRST-2 reviewed each ofits counties gr~
proposals and submitted them to the state. A total of $189,90.
was awarded to all seven counties in Region 2 in midspring
2003 (FY 02-03).
SARS
Severe acute respiratory syndrome (SARS) is a viral respiratory
illness. SARS was first reported in Asia in February 2003 Over
the next few months, the illness spread to more than two dozen
countries in North America, South Amcrica, Europe, and Asia.
Initially, it was not known whether SARS was a Bioterrorism-
related public health threat or not, thereby proving to be a
beneficial real-life exercise in disease surveillance, detection,
and containment; the Public Health Response for SARS was a
good exercise for an actual intentional event because many of
the same issues (isolation and quarantine laws, designation of
health care facilities for placing patients, active surveillance and
education aware) were evident during SARS. PHRST-2 traveled
Potassium Iodide (KI) Distribution throughout the region meeting with officials from the United
Recent terrorist events have many people concerned about States Coast Guard, commercial shipping lines (Wilmington
potential future attacks using radioactive materials. Taking is a State Port), U.S. Customs, and CDC Quarantine Station
potassium iodide (KI) tablets after an incident involving ensuring the region's preparedness to deal with a person or
radioactive materials may or may not limit the risk of damage persons who might be infected with the SARS virus. The team
to a person's thyroid gland from ionizing radiation. The also gave SARS-related presentations and in-service training on
Brunswick Nuclear Power Plant in Southport, North Carolina, infection control to health care workers in Region 2. The SAR_
is located within Region 2, and its I O-mile Emergency Planning activity also brought the NC OPHP&R and the PHRSTs in activW
Zone (EPZ) falls within Brunswick and New Hanover Counties. cooperation with the local health departments and hospitals.
The Nuclear Regulatory Commission (NRC) supplied Kl pills By June 2003 the SARS epidemics world-wide was slowing.
free-of-charge to states wishing to make it available to people in Region 2 did not have any SARS cases identified; NC had 9
the IO-mile EPZ. North Carolina Public Health and Emergency suspect cases and I lab-proven case in 2003
17 NEW HANOVER COUN'TY HEALTII DEPARTMENT
In addition to maintaining and transporting the vaccine throughout
the region as well as facilitating pre-event vaccination clinics,
PHRST-2 provided educational and training opportunities to
health care workers in the area of Smallpox and Bioterrorism.
The team worked with the CDC to enter Smallpox vaccination
and follow-up data into the CDC Pre-event Vaccination System
(PVS) database, as well as provide PVS training to other PHRST
teams in the state.
Exercises / Events
One of the best ways to measure preparedness
and response capabilities is through exercises.
PHRST-2 participated in an Incident Command
.ioterrorism Tabletop Exercise at New Hanover
"egional Medical Center. A "Dirty Bomb" exercise
in Onlsow County proved to be great learning
experience for the team. PHRST-2 also attended
drills in conjunction with Brunswick County
Emergency Management, Brunswick County
Schools, and Brunswick Community Hospital
(multi-agency drill testing the response protocol
for smallpox and SARS in the hospital Emergency Room).
PHRST also participated in Bt-related tabletop exercises in the
Region.
The team's consultation with officials at the University of North
Carolina at Wilmington (UNCW) augmented investigations
of two separate occasions of possible suspicious substance
incidents. Although both incidents were not bio-terrorrelated or
proven toxic even, they proved to be valuable "real-time" lessons
for the team. The team was also called upon for consultation
regarding a positive Eastern Equine Encephalitis (EEE) case
within the County early in the EEE epidemic.
Making its presence known is an on-going process for PHRST-
2, which will enable the team to be better utilized in the event
of an actual Bioterrorism or public health crisis. Letters and
information were sent to numerous stakeholders and health
~e providers throughout the region. The PHRST-2 web
te is a valuable resource for information at www.ohrst2.org.
edla contact has been another method of making the public
aware of PHRST-2's presence. PHRST-2 team members have
conducted numerous interviews with regional radio, television,
and newspaper media.
Presentations/In-Service
Readiness is certainly an important part of
Bioterrorism preparedness, and PHRST-2 took
~1] the task of making its presence known in the
wregion with a series of presentations and in-service
trainings on topics including: SARS (surveillance
and what it is), Smallpox (vaccine, inoculation
and takes), Vaccinia Adverse Events and
Reporting Procedures, Bioterrorism preparedness
(covering the 6 Category A agents). PHRST was
also interested in other topics of Public Health
importance, including: mosquito-borne diseases,
infection control, roles and skills of the PHRST
(Epidemiology, Medical Consultation, and .',
Industrial Hygiene), in-services on epidemiology
& surveillance to student nurses at UNCW, and ~
monkeypox. Topics of presentations given to
groups of physicians, pharmacists, and health
care workers throughout the region. PHRST-2
participated in the Cape Fear Community College
Health Fair and also hosted a regional EPI Info and
HAN in-service.
f ----
Allison Stockweather. Industriel Hygienist.
pelticipstes in HAZWOPER Treining
Summary
The PHRST of Region 2 was fully staffed in January 2003, and
has kept busy with numerous activities starting with smallpox
vaccination clinic preparation. The PHRST also made several
presentations on topics centered on Bioterrorism preparedness &
response, but also was involved in other matters of Public Health
eonsequence, usually an infeetious agent and its surrounding
issues. Members of the PHRST have visited all the Counties of
Region 2 for presentations and participations, particularly on the
topie of smallpox. The team has strived to make contact with
all health departments and first responder agencies (Emergency
Management, Police, Fire, and Emergency Medical Services
(EMS)) to make themselves known and what services they can
do to help them prepare for an intentional event. This was a
very busy year for PHRST, and the next year looks to be even
busier.
18 NEW HANOVER COUNIY HEALTH DEPARTMENT
Health Promotion
Health Promotion strives to improve the community's health
by providing educational programs to prevent disease and
injury and to enhance the community's ability to solve health
problems through informed decision-making. The section
provides programming in the areas of injury prevention; tobacco
prevention, control, and cessation; women's health; and promotes
state initiatives to reduce chronic disease. Health Promotion
provides health education consultation to all divisions ofNHCHD
and assists with coordination of events such as public awareness
campaigns, outreach activities, community health assessments,
and corresponding media coverage. Health Promotion staff began
reporting to the Assistant Health Director position, in response
to suggestions issued in the Organizational Analysis.
fifth annual TobaccoAwareness Week, a program to raise awarencss
about the consequences of tobacco use among school-aged youtilil
and continued collaboration with the Wilmington Sharks Baseb.
Team. The Sharks, a summer collegiate league, attract many
community members and youth to their games. Activities with
the Sharks included setting up display booths and activities during
games, announcements of tobacco statistics, recognition of area
youth who are dedicated to tobacco prevention, and a permanent
anti-tobacco billboard in the outfield.
Duringtheyear, the Women's Health Educatorwasofficiallymoved
into the Health Promotion Team, to allow for more interaction
among the health educators on staff. This position is responsible
for coordinating the Teen
Education sessions
for Family Planning,
coordination and
management of the
Baby Bucks Boutique
incentive program,
and for disseminating
general women's health
education information in
the community Details
about these health
education programs c_
be found in the personw
Health Services section.
The Injury Prevention
program focuses on
major risks for injury and
coordinates the local Safe
CommunitieslSAFE KIDS
Coalition, partnering with
local and state agencies,
law enforcement and
schools to encourage safe
enviromnents and behavior
change. A primary focus
was the Child Passenger
Safety Program, which
provided opportunities to
increase and improve the
use of child safety seats.
Through the Governor's
Highway Safety Program
(GHSP), approximately
40 seats were distributed
to low-income families
and to agencies that serve
them during the latter half
of the year. Seven child
safety seat checks were held, with over 125 seats examined
for proper installation, positioning and recall status, revealing
that (locally) 80-90% of seats examined were incorrectly used.
Classes were also conducted to educate parents about proper
use of seats, and many "walk-in" seat checks were completed
at the Health Department. Other progress includes securing
funding for the Risk Watch Program, a curriculum that integrates
several areas of injury prevention into basic standards of study
for North Carolina schools. This program is expected to expand
. .
ID upcomIDg years.
Early in 2003, NHCHD
was awarded grant
funding from North
Carolina March of Dimes
to address maternal
smoking cessation in the
community Originally
applied for through
Women's Health Care, the
grant award was switched to Health Promotion for supervision
and implementation. Recruitment for a part-time health educator
began over the summer, with the intention of implementing
smoking cessation classes for pregnant women and their family
members in early 2004. This initiative will involve members of
the Maternity Care Coordination, Maternity Outreach Worker, and
NAVIGATOR teams, both for referrals and early intervention.
A young health fai, attendee was interested in "Bob", an interactive drowning
prevention game developed by the Injury Prevention Educator
The Project ASSIST Coalition works to reduce death and
disability related to tobacco use. Local coalition initiatives focus
on youth prevention, youth and adult cessation, and clean indoor
air. Despite a vacancy in this position for a significant portion of
FY 02/03, program volunteers maintained Coalition activity in
New Hanover and Brunswick Counties. Events included the
The Health Promotion Team continues to provide prevention
education on a wide variety of topics in the community Seasonal
information on sun safety and heat safety continue to be popular
requests for area summer camps and outdoor businesses. ~
Team also assists in facilitating the "Color Me Healthy" e
child nutrition and physical activity program, and other initiativ
promoted through state health promotion offices.
19 NEW HANOVER COUNTY HEALTH DEPARTMENT
.
Financial Management
~e New Hanover County Health Department Amended Budget (Adopted Budget plus any amendments that were processed dur-
~g the fiscal year) for FY02/03 was $11,526,899 Actual expenditures for FY02/03 was $10,498,849 The Health Department's
budget is composed of 36 individual programs. Division Directors submit a line item budget for each program within their re-
spective divisions. The Health Director and Business Manager review all budget requests. Budget hearings are conducted and a
Budget Workbook including all programs with line item narrative justifications is prepared and submitted to the Board of Health
for approval.
The Health Department's Business Manager is responsible for preparing expenditure reports to ensure billing and receipt of
the Health Department's state grant funds. The Health Department complies with New Hanover County Financial Policies and
Procedures that includes an annual audit.
Figure 1 illustrates how the Actual Expenditure Budget is divided among Salariesl Fringes, Qperating and Capital Outlay items.
Operating:
$1,875,408
18%
I
Capital Outlay:
$135,106
1%
I
e
Salaries and
Fringes:
$8,488,336
81%
Total Actual Expenditures for Fiscal Year 2002-2003
Figu re 2 illustrates the breakdown of the Health Department's total earned revenue ($5,313,123) through Health Fees, Medicaid,
Environmental Health Fees, Animal Control Fees, and Other (including miscellaneous grants and school contributions). It also
shows Federal and State Grants through the North Carolina Department of Health and Human Services ($1,478,542 which is
included in the above total revenue figure) and County Appropriations ($5,185,72 7). (Note: Of the $1,131,890 in Medicaid Revenue,
$273,333 is Medicaid Cost Settlement Funds.)
Medicaid:
$1,131,890
11%
Animal Control Fees:
$573,089
5%
-
Environmental
Health Fees:
$280,796
County
Appropriations:
$5,185,727
49%
Other:
$1,684,866 -
16%
Health Fees
$163,940
2%
Federal & State:
$1,478,542
14%
Total Revenue Earned Fiscal Year 2002-2003
20 NEW HANOVER CUUNTY HEALTH DEPARTMENT