05/05/2004
e
e
e
New Hanover County Health Department !
Revenue and Expenditure Summaries for March '2004
Cumulative: 75.00% Month 9 of 12
Revenues
Current Vear Prior Vear
ype of Budgeted Revenue Balance Budgeted Revenue Balance %
Revenue Amount Earned Remalnin Amount Eamed Remalnln
Federal & State $ 1,998.125 $ 700.543 64.94% 873._ $ 835,337 51.11%
CFees $ 570.161 $ 76.121 86.65% 389,282 $ 198,662 86.21%
Medicaid $ 1.044,080 $ 568.190 45.58% 605,762 $ 429,624 58.51%
Medicaid Max $ 273,333 0.00% 0.00%
EH FeBS $ 300.212 198.798 86.22% 204,085 65.22%
Haalth FeBS $ 113,850 118.22% 106.06%
Othar $ 2,385,703 85.19% 75.87%
Expenditures
ypa of
Ex ndltura
Budgated
Amount
Current Year
Expended Balance
Amount Remalnln
Prior Vear
Expended
Amount
Balance
Remalnl"
%
%
Budgeted
Amount
Summary
Budgeted Actual
FY 03-04 FY 03-04
Expenditures:
Salaries & Fringe 10,051,016 6,697,949
Operating Expenses 1,733,630 1,058,486
Capital Outlay 377,922 175,131
Total Expenditures 12,162,568 7,931,566
Revenue: 6,685,464 4,633,394
Net County $$ 5,477,104 3,298,172
%
65.21%
69.31%
60.00%
Revenue and Expenditure Summary
For tbe Montb of Marcb 2004
9
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 03-04
e
Date (BOH) Grant Requestad Pending Recalved Denied
Cape Fear Mamorial Foundation- School
4n12004 Health Emergency Dental Services Grant $ 15,000 $ 15,000
Safe Kids Coalltion- Governo(s Hi9hway Safety
program- (Coalition Vehicle Request) $ 16,000 $ 16,000
Safe Kids Coalltion- Safe Kids Buckle Up
3/3/2004 program- Child Safety Seat Grant $3,500 $3,500
2/4/2004 No activity to report for February 2004.
Cape Fear Memorial Foundatlon- Funds needed to
enhance health education In 4 areas other than Diabetes
1n12004 (an enhancement to Diabetes Today Grant). $20,000 $18,500 $1,500
121312003 No activity to report for October 2003.
Cape Fear Memorial Foundation- Funds needed to
cover dental servlces for needy children as identified by
11/512003 School Health Nurses. $3,000 $3,000
Ne Medical Foundation - Through the Good Shephard
Ministries for nursing services to the population
frequenting the shelter. $25,000 $25,000
Duke Unlverslty- To provide 10 hours of nursing
services for T8 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
Youth "U4Vouth"(funding will be received over a
9/312003 3 year grant periOd) $4g,OOO $ 12,702 $36,298 .
Safe Kids Coalltion- Fire Prevention (Pleasa note !
this grant was pulled- coalition not able to meet deadline
for request) $2,500 $2,500
8/612003 NC DHHS- OPH Preparedness and Response $82,350 $31,950 $50,400
Smart Start- Partnership for Children (Grant
7/312003 Increase for Part Time Nurse Position) $5,523 $5,523
Cape Fear Memorial Foundation - Diabetes
Today (two-year request; $42,740 annually)
(Received $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 Klda Coalition- Safe Kids Mobile Car Seat
Check up Van $50,000 $50,000
Safe Kids Coalition- Risk Watch Champion
6/412003 Team $10,000 $12,500
Smart Start- Partnership for Children: Child
5n12003 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 $62,649 $64,495
Cape 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.
10
e
e
As of 4/1 912004
. NOTE. Notification received since last report.
Date (BOH) Grant Requested Pending Received Denied
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 December 2002.
NC Health and Wellness Trust Fund-Teen
Tobacco Use Prevention & Cessation Program
11/612002 ($100,000 per year for 3 years) $100,000 $100,000
Safe Kids Buckle Up Program-North Carolina
101212002 Safe Kids $5,000 $5,000
Developing Geographic Information Systems
(GIS) Capacity in Local Health Department in
Eastern North Carolina-Duke Universily
Nicholas School of the Environment and Earth
Sciences (NSEES) $18,000 $18,000
oaCDVll tv to report lor :teptemDer <t:uuz.
INoacttvll tv to report. Tor ugust 2002.
INOlct to report lor JUlY zuuz.
Totals $1,181,259 $31,000 $752,287 $404,648
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 03-04
2.62%
63.69%
Pending Grants 2 8%
Funded Total Request 11 46%
Partially Funded 7 29%
Denied Total Request 4 17%
Numbers of Grants Applied For 24 100%
As of 4/19120ll4
. NOTE. Notification received since last report.
34.26%
"
e
e
el
11
I"
e
e
e
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
De artment: Health
Contact: Scott Harrelson
Meeting Date: 5117/04
David Rice or desi ee
Subiect: School Based Mobile Dental Unit
Brief Summary: Requesting approval to submit dual grant applications to Cape Fear
Memorial Foundation (CFMF) for $185,000 and Kate B. Reynolds Charitable Trust
(KBR) for $375,000 for a dental office on wheels to serve school children in New
Hanover and Brunswick counties. This type of dental program has been very successful
in other North Carolina counties. The target population would be New Hanover and
Brunswick County children ages 3-18 on NC Health Choice, Medicaid and Uninsured.
The dental unit would be self sufficient tbroullh fee for service.
Recommended Motion and Requested Actions: To approve the School Based Mobile
Dental Unit grant application to CFMF and KBR, to accept the funds if awarded and
a rove an associated bud et ammendment for FY 04-05.
Funding Source: Cape Fear Memorial Foundation and Kate B. Reynolds Charitable
Trust
Will above action result in:
[gINew Position 5 Number ofPosition(s)
Dposition(s) Modification or change
No Chan e in Position s
Ex lanation: Full dental staff 5 new ositions
I Attachments: Letter of intent to CFMF
12
I
.
e
0 0 0 0 0 0
0 g 8l g 0 ...
0 0 II>
iii iii 0 N iii ~
.... co 0 N ..
... .. .. CO
tit tit tit tit tit tit
CD
c E
0 0
;:; U
II .5
" J
w C
:0
U 0
II: IL
e ::l 7i b'
0 ~ c
fI) II 'C :0
0 0
Cl " E :0 U
z '0 CD : 0 ..
is c :IE u CD
Z ~ .. !6 ... ~
::l II: : u c
IL iii IL ii 1 II
U J:
CD CD ;; C ~
- D- E!
II II CD
lIl: U :IE lD Z
ooor 00000000 00 000 000 0
0000 00000000 0> ... 000 000 ...
0000 OLOOOIl)OOO ." II> 000 000 II>
oori- wi ;tcici"':~~--.,; 00 ONN cilli"; ..:
.... .... .... co 00 N N .. .. ...
'" ... .. .. .. .. co
tit tB- tit .. 0tBfBflttB-flt0t1t ... tit ... ... tit ... ... ... tit
'S
e
"-~
.If"C II
~ e e CD
"C ::::..:i2 II
e e . c
fa is :i2 0.5 !.
, :Cl~
fI) l!! '" ;::- ~ ~Ijg- >C
Z 0. ~ W
c~ J ::I - - ~ - ~
W 'XlGl ""~ '" "c ~ "c fI) S
lL 8.::~ .~51- Q)::l .- '00
e t1 GI 0 I- .:: <>lI- E_I- l-
E(/) 0.- -
_ :t 0..5 Q) 8:'5 Q.e ~:ii
0.1:: Qi g.:e
.- GI 2l 0)_::::1 C:::J ~~
::1_ e~(/)~o(/)g> e ~8.
""::Ie c::.c- .c .- e
W c. ~ ~-.lllel1.2le ~ .lll'" ~~
:i:!E::I Oc:: _ as e e
co(/) GI~GI'-QilE~ GI GI e!
::JU.5 l1.WO~UOU l1. 01- l1.11:
13
[~_.
,~,. .
f 1,...;.>
- <
.
..;.f:j- .#,j'~~~!".~9
,1~i;.t t.
i:'"
e
I' , '".JI
II: ~!~ !l-
L_~.t=::~i?-r
o
EI
il-!-_
i :,:.~~~~
1~
>..1 ,~~.~
l? ~;:~
tJ""
CJT
e
e
o
III
LJ.
Fi
,
[]"
, .~
. .,
i
o
I ....,G
I
:IICJ,-
,
ID
ID
ID
ID
ID
III
lD
.,
"
III
lD
III
.~
':~~7-;r ' ~
c
~
~
;3
~
, t5\1l
"!:.;; ....,..,
~=l"~5
1=-0.,2
..:2~~~
~i3uJ<>:> '-....
ce5~~
~~~~~
~::;: ::s:""
Co' 8':;:;
g
E
~
~
- '.f)
<'-"o/I:i
\""'~LflO
g)-~~
C'J'lI;.)~
:;;~~~
x ~
W
"7 -=':~
~8~i--I~~B
~~~~~5~
e-~a;'" ~~
~
;2<.:;.Q~
~f!:!e1
_l..:lfIllJ
~~~~
O~'"
~<
'1") (,.~
'1") -v.
-.
!'S~;:::u"
OiS7.~....
~~~~~
~~~~~
~f5~B
-t.i.:l
>-lii~E;:
J!:'n-I,lJW"
~5E;5~:=
~;:~~~~
i5"'ill....J"""
~~~~~
~-,
i:t:~
~~5~~W
5~aS~~,~
~~~\j~~
~~~:g~fn
t~t'5~
"
'-.... ::.< ~ ,~~
=ffi~ij~
:;~~~~
'3e"''\Z~
B3~fj~
:: S:;EO
,"
~N..-~
~:;;::-"";7-:-''''-:-< "'1;'l'J.
" ~i'
..,.:. ~
.;:'
......= ! "!Q HI
j!:Z&lI hi
=....~ :;; 11-
...i!e: ~~ t
'"'a: ~!l
5~gN i,l
II';}
.......= );> 1"
Ii: =... Ii oil
i!S:5 I It!
g~= \'!
'~_.' c='" Ii ~
i d:
; \.i~ ~ III
i= H
III
;;} ow H.
. &lI::! ;;,~
i' .
a:1D ~ "
....0 ~ jll
j!& Q IiI
Z ;1\
~ '"I
.1
iC ~I
Z
~i'
"
L~~
~.;:)u
~~~~
~~~
~t'w
I-"'\C.l
",I>.'Q
12~~
. ...,
I
- to.< ""~
~~2~;!:!te5
:s:Q<S1.....~>-~
~""~~)-=~
;;~:i~~~~
:;:;::':j:z9f';€
6~8E~i2~
, .- ~ ~~
t
~~~~
,
i.:
~U
c
~
~.
Q",
~~
\,"lJ
~~
cO
i
!fI,
-; I
'\ i
hi
'~~ !
~-l
i
,
'I"
"'1
i
I
I
I
,I
I
14
,----
.
e
L1FELINE
~~
FEATURES
FOR WILMINGTON NC NEW HANOVER HD V3
$373,793 IS THE ESTIMATED PRICE
2124104-0nIy items below nincluded in quotation.
TRACTOR.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Tractor not included in ouotOOon"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
TRAILER""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Axles: 5 in round 22,500 Ib, capacity, 77% in, track widths""""""""" 2
Brakes, 16Y. in, x 7 in, x % in, non.asbestos air operated""""""""""" 1
Bumper, bend and twist resistant ICC bumper tube"""""",,,,,,,,,,,,,,,,,,, 1
Crossmembers, 4 in, hloh tensile I.beams, 80,000 psi""""""""""""", 1
Drums, outboard hub,and drum assembfv""""""""""""""""""""""" 1
Electrical. trailer to tractor, 7"Nav ATA 12 volt sealed wlrino svstem"", 1
Floor, fastened with heat treated toroue head screws"""""""""""""" 1
Front wall, extruded aluminum comer post at 45 diaoonal 1
Fuel tank, DOT'-certified 150 oaL"""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Heioht, exterior, 13% ft""""""""""""""""""""""""""""""""""""", 1
Kino pin: 36 in, seltino, crosshead type, AAR approved, 1
Landino oear, front manual 2.soeed with sand shoes 1
Liohts, rear, all sealed beam, recessed 1
Rail, boffom side, heavy duty aluminum 6061.T6""""""""""""""""", 1
Roof bows, anti.snac on 24 in, centers, 1 in, deep 1
Roof sheet, ,040 aluminum, one piece, stretched for tension 1
Side panels, ,048 thick prepainted white panel affached on 2 in centen 1
Side posts, 16 oa, hioh tensile, 5 in, wide on 24 in, centers 1.
_ ~~~~:~ro~~~;o~d~i~~r~,~,I,d~i~,~I~~,t~,~r~~~".I,~~~~~,~".,t'..:"..','.:..:'.',.1
.. Suspension, heavy duty tandem 44,000 Ib, capacitv""""""""""""""" 1
Tires, 11 :00 X 22,5 steel,belted radial tires, 14 plv"""""""""""""""", 8
Top rail, extruded aluminum 6061-T6"""""""""""""""""""""""""", 1
Tractor connections, recessed swivel mount offset oladhands, 1
Upper coupler, 3-3/16 in deep assemblv, AAR tested and certified 1
Wheels, 8,25 x 22,5 disc 8
Width, exterior, 8% ft, 1
REAR CABIN"""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Alarm, burolar, with rear panic buffon"""""""""""""""""""""""""", 1
Awnino, recessed into body side wall"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Awnino, acrylic, 110vac, 9% ft coveraoe, with anemometer""""""""", 1
Cabinets, Midmarl< with solid suriace countertops"",,,,,,,,,,,,,,,,,,,.,,,,,,,,, 1
Ceilino, acousticaL"""""""""""""""""""""""""""""""""""""""", 1
Chart holders, acrylic""""""""""""""""""""""""""""""""""""""" 3
Door, interior & exterior (excepl'whl chr)"""""""""""""""""""""""", 7
D.rino hurricane tie down"""""""""""""""""""""""""""""""""""" 4
Electrical. healthcare wirino (NEC 517)""""""""""""""""""""""""" 1
Electrical, telemedicine for owners eouipment.."""""""""""""""""", 1
Extinouisher, .fire, undercounter"""""""""""""" ",,""""""""""""''''', 2
Fan, lab-utility, heavy duty 150 cfm, exhaust..""""""""""""""""""""2
Floorino, acoustical sub-floor""""""""""""""""""""""""""""""""" 1
Floorino, elastomer profiled tile"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Freioht & delivery charoes"""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,, 1
Generator, aeoustic baffJe"""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,, 2
Generator, diesel, Kohler 20 kw""""""""""""""""""""""""""""""" 1
Generator, enerov manaoement svstem"""""""""""""""""""""""". 1
Generator, exhaust extension flex hoses (20 ft,) 2
Graphics, exterior, custom vinvllto allowance)""""""""",,,,,,,,,,,,,,,,,,,, 1
Heioht, rear cabin, inside. 8ft, 0 in, (nom,)""""""""""""""""""""",,, 1
~~~ ~~l~:;J;~~~i~Q'3'i~~":::..:',::.',::,,..:::,::."::"":',':.::'....'..':':. ;
HVAC. heatino, diesel hvdronic"""""",~"""""""""",:""""""""",,,,,, 1
Insulation, rear cabin, triple foam bv Do\>i 1
Insulation, winterizino, underfloor""""""""""""""""""""""""""""", 1
Landino oear, 4 pt, bi-axis, hvdraulic push buffon""""""""""""""""" 1
Lavatory, wffowel, soap disp, mirror"""""""""""""""""""""""""""" 5
Lenoth, rear semitrailer inside. 51% ft""""""""""""""""""""""""", 1
Liohtino, ceilino, rear cabin, fluorescent 1
Liohtino, exterior, scene, 110vac fluorescent.."""""""""""""""""""" 3
Liohtino, task, over counter"""""""""",:""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 8
e
Prices CI'8 aJowances, 8ld
sOOject ID cha>ge without notice,
Literature rack, 6 POcket, clear acrylic"""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 5
Manual, operatino"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""'''''' 1
Radio, AMlFM/CD, w/ceilino speakers"""""""""""""""""",,,,,,,,,,,,,,, 1
Receptacle, 110 vac, exterior"""""""""""""""""""",.""""""",,,,,,,,, 1
Refrioeratorffreezer, 4Y. cf.110vac. MidMarl<"""""""""",,,,,,,,,,,,,,,,,,,, 1
Rest room, incl, low flow toilet.."""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Rooms built with interiockino panels"""""""""""""""",,,,,,,,,,,,,,,,,,,,,,, 1
Seat, drafiinp""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Seat, flip.up, vinvl, sinole""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2
Service availability - nationallv ' 1
Seat, custom vinvl, for patient educ"""""""""""""".""""""""""""", 2
Shore power cord, 50 ft""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Shore power, electrified reel & box""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1, "
Smoke detector, baffery"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,:,,,,,,,,,"" 1
Stairs, entry, manual""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,""'" 1
Storace compartment, undercarriace",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Telephone,land line connection"""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Trainino, on..ite"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,'''''''''''' 1
TYNCR. flat screen 6 in" custom mount w/DVD-VCR & hdphns",,,,,,,,, 2
TVNCR. flat screen 17 in" custom mount wNCR.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Undercoatino, entire chassis""""""""""""""""""""""""",,,,,,,,,,,,,,,,, 1
Wall, slide out.."""""""""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,, 1
Water heater, undercounter"""""""""""""""""""""""""""""""""" 1
Water level monitorino svstem"""""""""""""""""""""""""""""""" 1
Water tanks & pump, 88 oal, e~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Wheelchair lift, undercarriaoe"""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Wheels, deluxe aiuminum outside, steei inner""""""""""""""""""",,4
Wheels, rear tire inflation extenders"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2
v.\ndows, safety olass""""""""""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,, 9
X-rav, electrical stubbed in for Hav"""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
X-rav, wall suPPOrt for Hav"""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
DENTAL EQUIPMENT (all are allowances) 1
Amaloamator, Kerr Optimlx",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Assistant's Instrument, A-dec 7115""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3
Compressor, Air Star 30"""""""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Control panel for air and evac"""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Curino iioht, Patterson LED""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,. 1
Dental eQuipment technician travel-COlumbus..OH................................ 1
Dectal smallware allowance,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Evacuation system, Air Technioues STS.3"""""""""""""""""""""" 1
Fiberoptic coupler""""""""""""""""""""""""",:""""""""""""""", 2
Handpiece cleaner, A-dec Assistina 301 """""""""""",,""'''''''''''''''''' 1
Handpiece pac'kace, A-dec Hvoiene""""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,, 1
Handpiece, A-dec operatory packaoe""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,, 2
Handpiece, lab, BeaverState A.Q50"""""""""""""""""""""""""""" 1
Lathe, Handler model 26"""""""""""""""""""""""""""""""""""", 1
Packaoe, A-dec Radius, per operatory""""""""""""""""":""""""",, 3
Scaler, Dentsplv Cavitron SPS 1
Sterilizer, Scican Statim 5000""""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1
Ultrasonic cleaner, Whaldent UC300 wi SS trav"""""""""""""""""" 1
Water and air utlity runs for lab eouipment, bv lifeline""""""""""""" 1
Water distiller, Tuffenauer 9000""""""""""""""",_"""""""""""""",1
Water filter and solenoid, DentalEz WC,110""""""""""""""""""""" 1
X.Rav, lead apron . 3
X.Rav, Planmeca Prostvle intraoral DC wlshorter arm"",,,,,,,,,,,,,,,,,,,,,,, 3
X.Rav, Processor Peripro III w/davlloht loader""""""""""""""""""", 1
X.Rav, view box, Rinn univerSal,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3
WARRANTEES (see wriffen 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 year, unlimited miles 1
15
"~..,\\Wli"'",,,
~'" '.-~. I~~.":-,
fa . ~:,'~li~
~...- ~;';/,.....:
.-,~"",
~~~~<~-,
'~'I;r,,~~..
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17m STREET
VVIL~(;TON,N(; 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
April 20, 2004
Mr. Garry Garris, President
Cape Fear Memorial Foundation
2508 Independence Blvd. Ste. 200
Wilmington, NC 28412
Dear Mr. Garris:
e
Oral health is the most common health problem among children. There are over 12,000 children
up to age 18 on Medicaid in New Hanover County alone. There are also many uninsured and
undocumented children as well Access to dental care for these children is a major issue in our
area. Medicaid reimbursement is low and the patient show rate is notoriously poor, especially
for young children. This leads to little interest among the private providers to provide care for
this population. When you take in to consideration the poor show rates and the sheer number of
low-income children in the region, the demand fur exceeds the available resources.
For this reason, safety net providers and dental professionals from Brunswick and New Hanover
counties have met to discuss a plan to meet this need. The consensus is that a mobile dental unit
would be an excellent method to address the needs of these underserved children. As you are
aware, the mobile dental unit concept has been very successful in other counties. The beauty of
the program is that it can become self-sufficient within the first two years and it can generate a
substantial amount of continual free and reduced care for children in need.
The Brunswick County Health Department and the New Hanover County Health Department
request permission to submit a grant application for the Foundation's next funding cycle to
establish a mobile dental unit that would be based at elementary schools in New Hanover and
Brunswick counties. We respectfully request your consideration.
~
e
David Rice
New Hanover County Health Director
~
Brunswick County ealth Director
16
.
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17m STREET
VVILMIN(;TON, N<: 28401.4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
April 20, 2004
John H. Frank, Director
Kate B. Reynolds Charitable Trust
128 Reynolda Village
Winston-Salem NC 27106
Dear Mr. Frank:
e
Oral health is the most common health problem among children. There are over 12,000 children
up to age 18 on Medicaid in New Hanover County alone. There are also many uninsured and
undocumented children as well. Access to dental care for these children is a major issue in our
area. Medicaid reimbursement is low and the patient show rate is notoriously poor, especially
for young children. This leads to little interest among the private providers to provide care for
this population. When you take in to consideration the poor show rates and the sheer number of
low-income children in the region, the demand far exceeds the available resources.
For this reason, safety net providers and dental professionals from Brunswick and New Hanover
counties have met to discuss a plan to meet this need. The consensus is that a mobile dental unit
would be an excellent method to address the needs of these underserved children. As you are
aware, the mobile dental unit concept has been very successful in other counties. The beauty of
the program is that it can become self-sufficient within the first two years and it can generate a
substantial amount of continual free and reduced care for children in need.
The Brunswick County Health Department and the New Hanover County Health Department
request permission to submit a grant application for the Foundation's next funding cycle to
establish a mobile dental unit that would be based at elementary schools in New Hanover and
Brunswick counties. We respectfully request your consideration.
Sincerely,
e
David Rice
New Hanover County Health Director
Don Yousey
Brunswick County Health Director
17
"Healtby People, Healtby Environment, Healtby Community"
,
e
e
e
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:D Consent Meeting Date: 5/17/04
A2enda: [gI
Deoartment: Health Presenter: Dianne Harvell
Contact: Dianne Harvell
Sub' ect: Re uest for additional Environmental Health S ecialist ositions
Brief Summary: Significant and ongoing growth in the local food service, hospitality and
tourist industries requires additional environmental/public health staff to assure food
safety and protection of the public's health. The (NC DENR) Regional Environmental
Health Specialist conducted an evaluation of staffing in the Environmental Health
Services Division, and determined it would require 5.28 additional Environmental Health
S ecialists to ade uatel rovide essential services, and rotect the ublic's health.
Recommended Motion and Requested Actions: Employ 5-additional Environmental
Health Soecialists
Funding Source: NC General Statute 130A-39 (g) prohibits the charging of fees for
these specific services as New Hanover County Health Department Environmental Health
Services staff are acting/performing as agents of the State. NC DENR funds only a
fraction of the costs for providing these services, and does so on a performance basis, i.e.
if the required number of inspections of restaurants and other establishments is not
achieved, then NC DENR funding is proportionately decreased. Counties are, therefore,
reliant almost exclusively upon other local sources of revenue to cover costs.
Will above action result in:
[gINew Position 5 Number of Position(s)
OPosition(s) Modification or change
ONo Change in Position(s)
I Explanation:
I Attachments: See accompanyinl( Projected Budl(et and Staffinl( Evaluation Reports
18
e
e
e
Environmental Health Services Division
Request For Five (5)
Environmental Health Specialist Positions
Projected Budget Changes I Costs
110 - 510 - 5111
Annual Salarv Benefits # Positions TOTAL
1000 Salaries $33,800 $10,140 5 $219,700
2100 FICA
2210 Retire
2300 Medical
2310 Disability
3810 Phone $240 NA 5 $1200
3815 Cellular
4210 Supplies $800 NA 5 $4,000
5100 Mileage $1,200 NA 5 $6,000
5200 Training $800 NA 5 $4,000
6399 Computers $2,000 NA 5 $10,000
TOTAL $38,840 $10,140 5 $244,900
19
e
e
e
Apr 20 04 09,48a
p..,
'.
North Carolina Department of
Environment And Natural Resources
iliA
NCDENR
Division of Environmental Health
_ F easley, G<NemOr
wuuam G. RIlO8, Jr., Seoretaly
Terry L Pierce, Dlredor
BarI Clmpbel~ Section Chief
April 20, 2004
RE: Staffmg EvalUlllion
Dianne Harvell
Environmental Health Director
230 Markel Place Drive, Suite 140
Wilmington, NC 28403
Dear Ms. Harvell:
Enclosed are the results ofa Staffing Evaluation for the Food and Lodging Program in New Hanover
County.
Staffing Evaluations are completed to determine if the number of staff positions is adequate to carry out
an cff<etive program. Information used in this assessment was provided by you and came &om the
Program Establishment Master List and Environmental Heahh Program records.
The resuks of the calculations show that New Hanover County does DOl have the appropriate number of
EnvirorunenUll Health Specialist positions to carry out an effective program. The results of the evaluation
show that a minimum of 11.28 non-supervisory Envirorunental Health Specialist positions are needed to
carry out the workload. This is 5.28 above the number of non-supervisory positions presently
performing Food and Lodging activities.
I hope this information will he helpful to you in ensuring that the Food and Lodging Program is staffed
adequately. Please feel free to contact me al (252) 756-6716 if you have any questions.
Sincerely,
Ne.", Hano~;,CE:IVE:D
Co. Health De
API? 2 'Pt,
o 2004
EnV/ronme
ntaJ Health
~~~
Christopher J. Smith, R.S.
Regional Environmental Health Specialist
cc: Susan Grayson, Head, Dairy and Food Protection Branch
Bart Campbell, Chief, Environmental Health Sc:rvicc:s Section
Environmontal.....1th Servloes SectIon - DaIry And Food PrvteatIon Branah
1632 U.U Sefyke Ceo.., Ralefgh, Notlh Carolina >>_.1632 Tfiephone 111-733-2105 FAX 11..715-4731
A?R-2C-04 TUE 8'45 AM
, 2 20
Apr 20 04 09,48a
p-"
e
~
N.C. 0epaI1menl. or Environment and Natural Re:;ources -n;w HanOVir ljO. nealln '
Divi$ion of Environmental HeeIth JWI.
Environmental Health Services Section ..
Staffing Evaluation Guide for APR 9 1\ ?nnA
-- Environmental Health Programs
, IU. .....
Data: April 20, 2004 ---.e=__ L==r=c- ICounty: New Hanover
I. Environmental Health Services Enfon:ement Activities
: I Est. Staff
Total # No.
Insp/Yr. No. in Insp. I" I"spec. Days
Type of Establishment Type Each Est. Cou ntv Vear Per day Required
Restaurants i 01 , 4 . 535 = 2140 I 4 = 535.00
02 4 , 127 508 - I 5 101.60
Food Stands = =
Mobile Food Units 03 4 . 6 = 24 I 4 = 6.00
-
Push Carts 04 4 . 4 = 16 I 6 = 2.67
-
Private SchOOl Lunchrooms 05 4 . = 0 I 3 .. o.~
Educational Food Service 06 . - 0 I 2
4 = = 0.00
Commissaries Preparing Food 07 4 . = 0 I 4 .. 0,00
Elderlv Nutr. Sites (Catered) 09 1 I . - , 0 I 5 .. 0.00
Publie School Lunchrooms 11 4 . .. 0 I 3 .. 0.00
Elderly Nutrition Site (Food
prepared on premises) ; 12 4 . .. 0 I 4 .. 0.00
Umitecl Food Service 14 4 . I 15 .. 60 I 5 .. 12.00
_l.
Commissary/Pushcarts & Mobiles 15 4 . = 0 I 6 .. 0.00
Lodging 20 1 . 94 .. 94 I 3 .. 31.33
-
Bed & Breakfast Home 21 1 . 11 .. 11 I 4 .. 2.75
Summer Camps 22 1 . .. 0 I 2. = 0.00
Primitive Camps 1 . c 0 I 2 .. 0.00
Bed & 8reakfast Inn 23 2 . 11 =i 22 I 4 = 5.50
;
Meat Markets 30 4 . 34' = 136 I 4 = 34.00
- ,
Rest./Nursing Homes 40 2 . 19 = 38 / 3 c 12.67
Hospitals 41 2 . 5 = 10 I 2 = 5.00
-
Child Day Care 42 2 . 76 = 152 I 3 .. SO.67
Adult Day Service 1 . .. 0 I 3 .. 0.00
I
~sidential CareIFoster Homes I 43 1 . = 0 I 6 .. 0.00
School BldglPrivate & Public 44 1 . 66 .. 66 I 3 .. 22.00
Local Confinement 45 1 . 4 .. 4 / 2 .. 2.00
Institutional Food Service - .
1 23 .. 23 I 2 .. 11.50
Orph1Child Home/Similar Institution 47 2 . = 0 / 2 .. 0.00
Seasonal Swimmlna Pools 50 1 . 317 .. 317 I 5 .. 63.40
Seasonal Wading Pools 51 1 . = 0 I 5 = 0.00
Seasonal Spas 52 1 . ;;::1 0 I 5 .. 0.00
Vear-Round Swimming Pools 53 2 . 48 = 96 I 5 .. 19.20
Tattoo Parlors 61 1 . 54 .. 54 I 5 .. 10.80
Temporary Food' Service Est. 01 -- .
I ; 1 189 .. 189 / 5 .. 37.80
Consultative Visits , . 1672 .. 1672 I 5 .. 334.40
Permit Issued Visits 1. . ' 856 = 856 I " c 214.00
Pre<lpenlng Visits 1 . 340 .. 340 I " .. 85.00
Other local Program 1 . 82 .. 82 I 5 c 16.40
Plans Reviewed 1 . 151 .. 151 I 2 .. 75.50
TOTALS 7061 146 i 1691.18
I
Allow 10% for Conducting Food Servlee Workers Education 16912 ; Estimated Staff.oaYllI 860,30
'e
e
A?R-20-04 TUB B:46 AM
p, 3
21
Ap~ 20 04 09:48a
p.4,
I i I I : I I !
I ! I I I
II. Other Environmental Health Activities ----
, i ; I Est. Staff
Total # No.
InsplYr. No. in , Insp. In Inspee. Days
Type of Establishment Type Each Est. County Year Perdav Reoulred
Family Foster Care Facility (W/S) 1 . I i 6 ..
---- -=..
Migrant Housing (Waler & Sewer) 1 . I I 6 c
Comm. Disease Investigations . .. 2 I i 1 = 2.00
- .
Consultative/Complaint Visit i 1 . 275 = 275 II 6 = 45.83
other Programs/Activities I I . - II =
----- 47JL:
I i Total Estimated Staff Davs
i -.. I I I
i
III. Administrative Acitivilies (This does not Include supervision)
Type of ActivitY ,Suggested % of Time for Acilivities Est. Staff-Devs Required
Reports and Office Worit 15% 286.22
Education. Self Improvement 5 (min. 15/hrs. Est. FTE) -- 95.41
Program Planning 5 95.41
Plan Review 5 95.41
.-". Total Estimal8d Staff Davs 572.44 -
I I I I I I I I
-
IV. SummarY
Estimated Staff Davs for Food, Lodging and Institutional State Law Enforcement (I)... .... ............... 1860.30
Estimated Staff Days for other Environmental Health Activities (II).................................................... 47.83
Estimated Staff Days for Administrative Activities (11I\.................................... ............................ mM
Estimated Total Staff Days........................... ..................... ................ ..... .................... 2480 58
----"'!i."imum No. of (Non-supervisory) Environmental Health Specialists Needed-Staff Days +220..........0..... 11.2l!
-- Present No. of (Non supervisory) Environmentel Health Specialists.................. ................................ ~
Additional No. of (Non-supervisory) Environmental Health Soecialists needed...................................... 5.28
I I I I I I ! I I
Gener.al Remarks: .
This report is based on information provided bv the New Hanover Count Health Department.
I I /" ~ I I I I.... -,
... Signature: I' .--f" -' v "J
----. Cliristophet"J. Smith, RS, MPA
Tille: Reaional Environmental Health Soeciallot
RECEIVED
Ntw Hanover Co. Health Depl.
APR 2 0 2004
fllVironmental Health
A?R-20-04 rUE 8.47 AM
, 4 22
e
e
e
'"
.\
"
.
e
e
e
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 05/17/04
A enda: IZI
De artment: Health Presenter: Cind Hewett, Business M
Contact: Cind Hewett, Business Manager, ext 6680
Subject: Budget Amendment ($13,500) for transferring additional funds needed for
Animal Control Services (ACS) Spay /Neuter Facility from the ACS Trust Fund into the
current FY 0 eratin bud et.
Brief Summary: The Animal Control Services Spay/Neuter facility is well underway and
near completion. Additional funds are needed to cover the costs for the architect and for
com letin construction actual costs have exceeded roo ected need.
Recommended Motion and Requested Actions: To approve associated budget
amendment in the amount of$13,500.
I Funding Source: ACS Trust Fund
Will above action result in:
[]New Position Number ofPosition(s)
Dposition(s) Modification or change
1ZIN0 Chan e in Position s
Explanation: Transfer of funds from the Animal Control Trust Fund are needed to cover
actual costs of the architect and completion of construction of the Animal Control
Services Spay/Neuter Facility. Original amount transferred from the ACS Trust Fund
was based on ro' ected need. Actual costs have sassed that ro' ection.
I Attachments: Budget Amendment
23
.
.
e
I-
Z
w
:liE
c
z
w
:liE
<(
I-
W
C)
C
::J
a:l
-
W
~
a::
e
.,
:li
11
in
~
.,
!
::l
ii:
...
o
z
o
Q
0
0
I-w_ It)
Z-"'" C"i
5~~ ..-
;:2zg
<(<:>
+ .. . +
0
0........
LULUZ
(l)C)::l
~OO
::l:;
a:: 10 <
............
ZLUZ
LUC)::l
0::00
a::::l:;
1310<
Ww
::>0
Zit
~5
It'"
"".
5
f>;o
...
'"
:l
....
!-l
'"
~
co
....
....
....
~
~
~ 0
0
0
N
-'z
Zo
I~ '<T
~
~
It)
z a.
0 ...J
~ LU
J:
Ul
.,
0
'~
.,
(I)
e
W -
~ I:
0
l..l
~ iii
E
~ '2
W <
~
z
w
~ 0
~
It)
0
z
::> 0
...
~
~
~
Iii
8~
::>
III
~
:li
e
z
~8
::>-
8~
~
'Zit
Ww
:lilll
::>2
0::>
oz
0
~
Z
W
~
III
It
Z
0
[3w
0<:0
"'8
~
....
-.:t
'"
~
SQ)Q)
co--
_coca
~oo
01-
UjW
cnC)
-0
cu=>
a;lD
~
~
.9!.,.,
---
i=i=~
QJ CD Q) ..
EEE.sl
co co CUCU
ZZzO
co'..:..:m
~~~e
~ '0 0
8:Q)a.Q.
< ij) 0.<
-lIo:<1:
ca ' 0
c: C'(jj
., , '"
E 10 ,-
1:: E
ca E
0. 0
., l..l
~
~
.,
Z
,.,
[
(I)
.,
.c:
-
....
0
I:
0
ii
c.
E
8
~
.2
'0
l!!
~
::l
0
,5
Ul
.,
Ul
I:
8-
x
.,
iii
I:
0
:e
'0
'0
ca
.,
=
~
.,
8
.s
'0
I:
::l
U.
1ii
2
....
g
I:
0
l..l
iii
E
'2
<
.,
.c:
-
E
,g
III
'0
I:
.a
Cl Z
I:
'I: 0
~
oS! f.i
Ul
I:
l!! :E
.... 0::
0
u.
Z 3E
0 :cl
f.i Z
~~ 0
j::
is
Ir.i ~ IS
24
.
!
e
'"
2l
O~
.,
(I)
I- w g
I:
Z i 8
w
:liE ~ 0;
C E
Z 02
W w <
:liE ~
<(
I- w 0
W ~ ~
C) It)
C
::J 0
~ Z
::> 0
... ~
~
Z ~
W
D.. Iii
><
w 8~
~
~
:Ii
e
Zo
~O
::>-
8~
<
'Zit
Ww
:Ii III
::>2
0::>
8z
~
w
~ ~
11 III
in w
! Z
0
e ! [3w
~ ;:;8
~
ii:
15 r
z
Q
Q
I-w_ 0
0
z-"~ ~
:>0 (0)
~!8 ..-
<-
+ .. , +
0
r-
Otu....
LU Z
(l)C)::l
-00
[jj::l~
0::10
....tu....
Z Z
LUC)::l
0::00
O::::l~
::l1D
U
~ 1
(I)
....
ii! z
LU
0 :;
~
0::
a.
:!!
0::
W
J:
....
0
0
0
M
CO
~
[3 0
0
< 0
N
"'OZ
OltQ
!:::D.;;;
ZD.1t
::><D.
0
-Z
U '<T
~
~
It)
Z a.
0 ...J
~ LU
J:
Ol;j
~C)
-0
>"
l:!lD
-"
~
"-
~
'"
~
.!Q)Q)
..--
-....
~OO
.,.,.,
3=;:;
....i=i=
-c
I:
::l
U.
1ii
2
....
~
o~
.,
(I)
~
I:
o
U
0;
E
02
<
E
~
....
."
~
oS!
Ul
I:
~
Cl
I:
Jl
l!!
..
Ul
."
I:
::l
U.
~
Ou
J!!
~
~
.,
z
....
[
(I)
~
.2
~
8
oS
Ul
III
I:
8-
~
0;
I:
o
:e
." ..
CD Q) CD .. "C z
~EE* ~o
z" .. 0 !l! j::
..ZZ"'"' 8 <
0; 00 00 .. :E
> '"'0; > 00::
olD>e....o
5,."C2 u.
c.Q)c.c...z
<ij)o.<z_
-lIo:<I:O.....
.l!! 00 - <
I: OOiij '::: z
., 0"'''0
E 10 0- Z
1:: E :5 E
[ gILc
., u><c
25
.
,
<
.
\
.
-
e
-
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Meeting Date: 05/17/04
Sub'ect: Bud etin for excess revenue earned in E idemiolo 5151 forFY03-04
Brief Summary: We are requesting approval to budget additional revenues generated in
the Epidemiology Program (Communicable Disease Program- Organization Code 5151)
for this current fiscal year. The additional amount of revenues generated is $13,600. We
would like to bud et this amount in de artmental su lies.
Recommended Motion and Requested Actions: To approve associated budget
amendment in the amount of $13,600.
I Funding Source: Health Fees- Epidemiology Program
Will above action result in:
DNew Position Number ofPosition(s)
DPosition(s) Modification or change
~o Chan e in Position s
Explanation: Additional revenues have been earned in the Epidemiology Program
(Communicable Disease Program) for FY 03-04. These revenues were not included in the
Adopted FY 03-04 Budget. We are requesting approval to budget these revenues in
de artmental su lies to su rt current ro needs.
Attachments: Budget Amendment in the amount of $13,600 and Local Government Financial
S stem LGFS Printouts.
26
... ~
.
.
-
I-
Z
w
:IE
Q
Z
w
:IE
c(
I-
W
Cl
Q
.
W
~
~
e
Ol:i:i
~(!)
-0
~::l ~
0::'"
...J
i5 0
0 ~
to-
~
.e
~CIlCll
---
i=i=i=
0
'0
'E
CIl
't:I
'a
w
CIl
~
-
.5
~
E ..;
III CIl
'" ~
CIl U
'" ~
C
~ ..
-
'"
.9
10 C
C 'C
0 c.
:e Ul
't:I U.
't:I S
..
~
CD Q) CD" .e Z
EEES -
cocamco CIl 0
zzzC 't:I ~
'"
.. ,. .c
10>..:..:10 0 ::E
~CD~~ I- 0::
~~E!~ 0
c. c. u.
~ ~ ~c( z ~
-x: c 0 :ii!
.l!l '0 ~
c C"iij Z
CIl ,'"
E llJ.- z 0
t: E :3 E
.. E
c. 0 II. Q
CIl t) Q
27
..
0\
~
Q
W
~
..
;!;
::l
"
~
Q
Z
Q
Q
0
0
I-w_ co
Z-'::! C")
::) 0 :s ......
O~-'
:E zO
c( ",0
+ ... , + + +
0
CI-I-
wwz
UlC):::>
-cO
Gj:::>~
o::llJc(
1-1-1-
zwz
wC):::>
0:: cO
o:::::>~
13llJC(
Ww
::lo
Zo::
~5
0::'"
Ul
w
W
u.
:x:
~
i1i
:x:
<Xl
-
-
...,.
I 0
0
0
N
-'z
~o
5~ -
It)
~
It)
z II.
0 ...J
~ W
<( :x:
>-
w Cl
~ 0
'0
"E
~ III
't:I
z '0.
w w
t
z
w
~ 0
~
It)
0
Z
::l 0
u.
~
~
~
lu
8rL
::l
III
~
::t
C)
;;!;o
~Q
::l0::
Ow
0"-
~
...
zo::
UJUJ
::!illl
"'::!i
O::l
OZ
0
t
z
UJ
~
III
0::
z
0
~UJ
<(0
~8
~
...
:>-
~
~
~
BSB
......
CCC
r--
~
e
>-
I- w Ol
~ 0
Z (5
w 'e
:IE ~ CIl
Q ~ "t:I
Z '0.
W w w
:& t
c( Z
I- w 0
W ~ ~
Cl It)
Q
. c
Z
=> 0
... ~
~
Z ~
w
a.. lu
><
w 1St
::>
III
~
::t
C)
zQ
~o
=><<
Ow
0"-
~
~o::
Ww
::till
::>::t
8~
t
Z
w
~ ~
~ III
fil w
~ Z
- 0
'" ~w
;!;
~ ~8
~
"
~ ZO
Q g
Z
Q
Q
e
I- w- e
Z -'&1 co.
=:) ~:s C")
0 3:-, ......
:E ~8
<(
+ ... I +
0
-
@!ii!z
UlC):::>
-cO
Gj::l~
a:llJ<( "0
1-1-1- w
Ul
ZWZ ~
WC):::>
a:cO 0::
a::::>~ ...J
:::>llJ<( g
t)
to-
'-
Ul
~ W
::;
II.
ii3 II.
::l
0 Ul
~
Z
w
::E
~
~
w
c
0
~
~
~
i: 0
~ 8
N
"'oz
oo::~
t::,,-:!;
z!io::
::> "-
-'z
U ~
It)
~
It)
Z II.
0 ...J
~ W
<( :x:
~
~
~
.!!CD,!!
co 10 '"
ccc
to-
W
(!)
o
::l
'"
~
o
>
u.
~
.e
(5
'e
CIl
"t:I
'0.
W
CIl
:;
.5
"t:I
CIl
E .
lU"t:I
CIl CIl
"'~
CIl u
::>~
~ lU
i;'S
~ 0
~~
o
;::;C/)
:eu..
"t:IC)
~...J
o ..
CD CD G) .. "'"" z
~ ~ ~ ~ ~Q
Z.ZZc -g~
10 ...:..:10 ~:Iii
~~~~I-15
5.-oe.... u.
c. CD C. Q. .. z
<( ~ Q.<( Z _
-X:<(cO...l
lU '0-<(
c C'iij I:; Z
CIl " '" .. 0
E llJ.- Z
t: E:3E
lU E II. Q
5l" 8 )( Q
28
,
ACTION: R SCREEN: RSUM USERID: PUBL
~
e BFY= 04
04/19/04 02:56:10 PM
REV E N U E BUD GET SUM MAR Y I N QUI R Y
FUND= 110 AGENCY= 510 ORGANIZATION= 5151 ACTIVITY= 2000
TOTALS IND:
TOTALS: 216,444.00 199,836.94 16,607.06
DESCRIPTION CURRENT AMT RECOGNIZED AMT AVAILABLE AMT
------------ -------------- -------------- --------------
FED/CTS FUND 28,000.00 28,000.00 0.00
FLU/PNEU VAC 24,000.00 33,787.24 -9,787.24
STATE GRANT 8,100.00 8,100.00 0.00
lAP-STATE 39,494.00 21,721.00 17,773.00
TITLE XIX 35,000.00 16,777.80 18,222.20
TITLEXIX MAX 0.00 0.00 0.00
NC CTR PHP 0.00 0.00 0.00
HLTH FEES 69,350.00 91,450.90 -22,100.90
GOODSHEPHERD 12,500.00 0.00 12,500.00
REV SRCE
--------
--------
01- 3142
02- 3153
03- 3224
04- 3279
05- 3327
06- 3339
07- 3528
08- 4118
09- 6063
lO-
ll-
10-*L009 HEADER CHANGE
e
Revenue Budgeted Revenue Earned Difference
$24,000 $33,787 +$9,787
$35,000 $16,778 (H8,222)
$69,350 $91,451 +$22,101
:otals: $128,350 $142,016 +$13,666
45
29
\-.
"
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2~9S0UTHI7rnSTREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
First Quarter Report
Good Shepherd Ministries Clinic
January 1, 2004 - March 31 , 2004
e
The Good Shepherd Clinic originated as a result of grant monies received by the
Good Shepherd Ministries to establish medical services for its guests. After a period of
about one month of planning, assuring that contracts were in place, and ordering and
furnishing the clinic room, the clinic opened for patients on Monday, February 9, 2004.
The clinic was staffed by nurses from the Community Services Team of New
Hanover County Health Department. A schedule was established with LPN/RN
screenings on Monday and Wednesday mornings from 7:30 to 9:30 am, and a nurse
practitioner clinic from 8:00-10:00 on Thursday morning. Additional time was required
for stocking, record keeping, follow-up and planning. The opening of the clinic was
advertised through word of mouth atthe Good Shepherd House, through staff meetings
at the health department and through various agencies in the community.
The first two months of operation saw one hundred eleven patients screened
through the nurses, and 38 of those seen by the nurse practitioner. An increase of
about 20% in patient visits during the second month pointed the need for constant
evaluation of the amount of time needed in the clinic and a potential future need for
more.
The needs of the patients have been many and varied, from previously
diagnosed but currently untreated problems, to those newly diagnosed. Many of the
problems have been untended for so long that they have advanced to a complicated
stage and have needed further evaluation and care at more sophisticated facilities. If
unable to treat at the Good Shepherd Clinic we have been able to navigate the patients
through to referral sources where they can receive help. The kinds of problems seen
most frequently have been hypertension, diabetes, minor injuries and wounds,
musculoskeletal problems of varying degrees of severity, upper and lower respiratory
infections. Of note has been the pervasive need for mental health counseling and
treatment among the majority of the patients seen. Drug and alcohol abuse, as well as
their underlying issues, may be largely responsible for bringing these folk to their current
place.
e
"Healthy People, Healthy Environment, Healthy Community"
\-..
e
We have been witness to several gratifying outcomes of note. One very young
lady, victim to breast cancer in her early thirties, but having no follow-up in over two
years, was enrolled in a program funded by the state which provided screening and
referral to a breast cancer specialist where additional tests are underway to follow her
diagnosis. A young man who had a known history of insulin dependant diabetes but no
follow-up was screened in the clinic, found to have a critically high blood sugar and
referred to the emergency room for immediate care.
An elderly gentleman, mentally challenged and challenged in his ability to talk,
was noted by the kitchen staff to have great difficulty in walking. When examined it was
discovered that his toenails had not been cut in such a long time that they had grown to
the point of curling under and pressing into the soles of his feet. In addition, there were
severe bunions, corns and callouses that impaired his mobility. The nurses began a
long steady process of soaking his feet, cutting his nails, paring his callouses, and
working with another nurse in our division to facilitate getting the patient to various
specialty care physicians needed.
Numerous patients with a history of hypertension but no medication for many
months have been written prescriptions, and the filling of them has been facilitated.
Patients with the need for eye exams and glasses have been referred to agencies that
can help in the acquisition of those.
e
Goals for the upcoming months include:
1) Evaluation of need for increased time in the clinic
2) Collaboration with Good Shepherd Ministries1to obtain laboratory
testing that we are unable to perform at the local health department
3) Collaboration with Good Shepherd Ministries to establish an on-
going process for providing medications to those with no other
resources.
4) Surveying the needs/desires of the guests regarding topics for
health education
5) Providing health education to the guests on pertinent topics.
6) Finding resources for daily needs of the homeless, e.g. insect
repellant, sunscreen, first aid supplies.
7) Collaborating with Good Shepherd Ministries to evaluate and
continue the health services
Our short time at the Good Shepherd has been rewarding on many accounts,
and we look forward to continuing this association.
e April 2004
"Healthy People, Healthy Environment, Healthy Community"
.
e
.
BUDGET CALENDAR FOR FISCAL YEAR 2004-2005
2004
May 17
June 7
June 21
County Manager Presents Recommended Budget at Board of
County Commissioners Meeting
Commissioners Establish Budget Work Sessions
Recommended Budget Information to Departments and Non-
County Agencies
Public Hearing on Budget
Adopt FY 04-05 Budget
.
TO:
Local Health Directors in Accreditation Pilot Agencies
FROM:
Joy F. Reed, EdD, RN
Co-Chair, Accreditation Committee
DATE:
April 19, 2004
SUBJECT:
Next Steps
This memo is sent to clarifY the remaining steps in our pilot process and the timeframe in which
they will occur. As most of you know, we encountered unanticipated problems, including
weather-related delays, related to site visits which impacted the original timeframe.
.
I) By May 14, the lead site visitor from the North Carolina Institute for Public Health and at
least one other person will visit each agency to review the fmal report on that agency by the
site visit team. We are asking that the lead DPH consultant who worked with the agency in
preparation of the self-assessment be present for this meeting. You, as health director, may
include key members of your staff and the other DPH consultants in that meeting as desired.
The purpose of the meeting is only to review the findings of the site visit team. Since the
entire team will not be present, this will not be the time to ''negotiate" their findings or
produce additional documentation that a standard or activity is met.
2) Following that meeting, the agency and DPH consultant(s) should meet to discuss whether
you feel any of the findings are invalid and to develop either a plan for pulling together
additional materials already on hand or a corrective action plan. Additional evidence and/or
results of any corrective action plan may be submitted for review by the Accreditation Board
when it meets to act on the Accreditation status of each pilot agency. (This may allow us to
do a compressed pilot of the corrective action plan which is identified as a part of the
accreditation process. As with all other parts of the system, this would be in a very
compressed timeframe.)
3) During the last week in May, if possible, we will convene a pilot Accreditation Board to
review all materials submitted (including the self-assessment, site visit report and additional
materials or corrective action plan and progress toward that) and make a determination on
accreditation status for the 6 agencies.
4) Following that, probably in early June, we will convene representatives of the pilot agencies,
the DPH consultants who helped out, the site visitors, and others with a vested interest in the
process to:
. discuss the fmdings of our extensive evaluation process and "lessons learned";
. determine from the group if we have missed anything;
. share a timeline for revising the tools, process, and materials and training local health
department staff, DPH staff, site visitors and Board members on the final materials prior
to full implementation in 2005
If you have questions, please feel free to give me a call. Otherwise, anticipate a call from the lead
for your site visit team within the next week to schedule your agency's review of the report.
e
.
THE NORTH CAROLINA
PUBLIC HEALTH TASK FORCE 2004
PUBLIC HEALTH IMPROVEMENT PLAN
INTERIM REPORT
4/20/04
e
Strengthening public health infrastructure is important.
Either we are all protected or we are all at risk.
The Public Health Foundation
,---.
.
North Cllrollna Put)lIc Heahll
EvctyWl"I'$,Elo'IIIYb;oy.E~,
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
.
CHARGE TO THE TASK FORCE
e
jjg Improve the quality and accountability of the
state and local public health system.
" Improve health outcomes.
/I Eliminate health disparities.
e
2
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
e
INTRODUCTION
North Carolina's public health system must respond to new and serious public health emergencies,
significant changes in population, unacceptable health disparities, decreasing funding and significant
variations in public health protection between counties and regions. A reinvestment in the state's
public health infrastructure is critical to providing the essential public health services that will assure
public health protection for all North Carolinians.
The recent terrorist events, along with outbreaks of new and often fatal infectious diseases, are a
wakeup call to North Carolina. The public health system must be strengthened in order to promote
and protect the public's health. New federal resources for bioterrorism preparedness have helped
build some additional capacity to detect and respond to certain public health emergencies. Now the
state must support these national preparedness efforts by reinvesting in core infrastructure that will
enable the system to respond to all public health emergencies and threats to the health and prosperity e
of North Carolinians everywhere.
A reinvestment of resources in the state and local public health system by the North Carolina General
Assembly will coincide with an increase in public health accountability. This will be achieved
through an improved system for identifying the public health needs in each community, prioritizing
problems and solutions, and funding public health programs and services on the basis of performance
and achievement of desired outcomes. These new systems of accountability, accreditation, and data
collection will provide the tools necessary to measure success and allow the state to invest with
confidence.
The recommendations of this report are divided into two parts:
I Core Infrastructure
2. Core Service Gaps
.
3
.
e
e
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
THE MISSION OF NORTH CAROLINA PUBLIC HEALTH
To promote and contribute
to the highest possible level of health
for the people of North Carolina.
3 PUBLIC HEALTH CORE FUNCTIONS AND 10 ESSENTIAL SERVICES
I. Assessment
I. Monitor health status to identify and solve community health problems (e.g., community
health profiles, vital statistics and health status).
2. Diagnose and investigate health problems and health hazards in the community (e.g.,
epidemiologic surveillance systems, laboratory support).
II. Policy Development
3. Inform, educate, and empower people about health issues (e.g., health promotion and
social marketing).
4 Mobilize community partnerships and action to identify and solve health problems (e.g.,
convening and facilitating community groups to promote health).
5. Develop policies and plans that support individual and community health efforts (e.g.,
leadership development and health system planning).
III. Assurance
6. Enforce laws and regulations that protect health and ensure safety (e.g., enforcement of
sanitary codes to ensure the safety of the environment).
7 Link people to needed personal health services and ensure the provision of health care
when otherwise unavailable (e.g., services that increase access to health care).
8. Assure competent public and personal health care workforce (e.g., education and training
for health care providers).
9 Evaluate effectiveness, accessibility, and quality of personal and population-based health
services (e.g., continuous evaluation of public health programs).
10. Research for new insights and innovative solutions to health problems (e.g., links with
academic institutions and capacity for epidemiologic and economic analyses).
4
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
EXECUTIVE SUMMARY
PART I: CORE INFRASTRUCTURE
Accreditation Committee
I. Establish a mandatory system of accreditation for local/district health departments.
$ 989,0001Page 12
2. Fund local health departments on an ongoing basis for accreditation and related continuous
quality improvement activities. Page 12
$ 4,400,000 annually beginning in year four (4) of program (See four-year rollout budget
with individual year costs on page 14).
Accountability Committee
3. Establish an Office of Accountability in the Division of Public Health. $ 300,0001Page 16
4 Fund local health departments to improve their delivery of the Ten Essential Public Health
Services that form the foundation of the Accountability System. $15,000,000IPage 18
Workforce Development Committee
5. Assess the needs of the public health workforce by:
=> Conducting a short-term workforce assessment study; and $ 150,0001Page 20
=> Identifying and disseminating core public health competencies. $ 1O,0001Page 20
6. Assure an adequately trained public health workforce by. (Page 21)
=> Developing and implementing an outreach and recruitment plan to ensure an
adequate, capable, culturally competent and diverse public health workforce.
$10,000
=> Fully funding necessary maintenance and operational needs of the Public Health
Training & Information Network (PHTIN); $ 600,000
=> Creating public health internships at the state and local level, $ 150,000
=> Creating public health scholarships; and $ 200,000
=> Requiring training for Board of Health members. $ 100,000
.
.
.
5
.
e
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Structure & Organization Committee
GuidinQ Principle
Collaboration, partnership and voluntary organizational change rather than
mandated consolidation of local health departments are inherent in all task force
recommendations.
7. Create and fund four (4) public health "incubators" to support voluntary and locally
driven regional collaboration and economies of scale. $2,000,000 one-time funding for
local grants. Page 24
8. Reunite the Division of Environmental Health with the Division of Public Health under
the leadership of the State Health Director. Page 25
The position of State Health Director shall report directly to the Secretary. Page 26
Promote collaboration oflocal health departments and any related voluntary structural
changes at the local and state level through the accreditation process. Page 27
Perform and distribute a Self-Assessment of the Division of Public Health using National
Performance Standards. Page 28
9.
10.
II.
Planning & Outcomes Committee
12. Improve the data and epidemiology to drive state and local decision-making and allocation
of resources. Page 30
=> Establish a common set of core health indicators.
=> Build capacity to conduct the Behavioral Risk Factor Surveillance Survey (BRFSS) to
provide county-specific or multi-county data. $300,000
=> Enhance the opportunities to collect and report county-specific or multi-county
behavioral and physical health information on children. Specific examples include
greater local school system participation in the Youth Risk Behavior Survey and
physical health indicator data surrounding the childhood obesity problem in North
Carolina.
=> Identification and analysis of existing state and local public health problems, health
disparities, and potential threats. $100,000
=> Identify the best scientific and evidence-based strategies to address identified public
health problems at the local level. $200,000
=> Provide epidemiology training for local partners. $200,000
6
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Planning & Outcomes Committee
13. Fund local health departments to assess and document community health needs through
community partnerships. Page 31
=> Establish a uniform statewide process for community health assessment to be conducted on a
four-year cycle (Comprehensive Community Health Assessment) and updated annually
(State of the County Report). $ 1,623,000
=> Establish a core set of questions to be used for primary data collection statewide. Local
partnerships (Healthy Carolinians, Community-based Organizations, and other health
agencies) may develop additional questions according to their needs.
=> Build the capacity of the state Office of Healthy Carolinians to support local
community assessment through local training, technical assistance, and report
generation. $ 441,000
.
14. Establish a process for comprehensive collaborative planning that integrates state and local
needs assessment, priorities, and strategic program objectives. Page 32
=> Develop and implement a collaborative State Public Health Plan to cover four years and be
updated annually.
=> The State Center for Health Statistics will provide county specific health data to local health
agencies for the purpose of local planning and priority setting. .
=> The Office of Healthy Carolinians will compile and report information on local needs,
community priorities, and action plans to state level programs.
=> Establish an annual integrated planning cycle to inform state and local decision makers
regarding program priorities and funding allocations.
15. Fund increased information technology capacity at the local level to collect, compile,
analyze, and report essential public health data. Page 33
=> Build local capacity to collect, analyze, and report critical public health information
electronically $5,160,000
=> Assure compliance with HIP AA guidelines.
=> Build the local interface with the Public Health Information Network to enhance the
ability ofIocal health departments, hospitals, healthcare providers, and community
partners to communicate electronically in a secure environment. $ 860,000 (one time
equipment purchase)
.
7
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
. Finance Committee
Finance Committee Guidinlt Principles
=> Recommendations of the Public Health Task Force should be fully funded on an
ongoing basis as needed. No "unfunded mandates" shall occur as a result of
any recommendation in this plan.
=> Task Force recommendations for the Public Health Improvement Plan should be
funded to the fullest extent possible in the short session 2004; however, given
the current financial condition of the state, the remaining recommendations
should be phased in over the next biennium of the North Carolina General
Assembly.
=> A data committee of DPH staff, County Commissioners, Board of Health
Members, Health Directors, and NC Association of County Commissioners staff
should be appointed to refine financial data currently being collected and define
unmet financial data needs related to LHDs and health care expenditures.
=> DHHS and DENR should develop an action plan and work with the NC
County Commissioners Association and the North Carolina General
Assembly to bring appropriate state funding to local health departments for
these essential Environmental Health Services and not rely solely on local
fees or increased state fees.
.
.
16. Consider the following as possible sources of support for the core infrastructure needs of
the public health system: Page 35
=> Empower local health departments statutorily to charge fees commensurate with the
local costs of conducting the food and lodging program activity.
=> Develop a Low Wealth Funding Formula to be used to distribute public health
program and administrative funds to local health departments.
=> Seek private funding (philanthropic foundations, trusts and business partners) for the
enhancement of public health through creative partnerships.
=> Secure state appropriations to implement the equipment replacement schedule for the
State Laboratory of Public Health.
=> Assure that a significant percentage of any new health-related revenues as set by the
General Assembly is directed to support public health infrastructure and services in
keeping with a statewide Public Health Plan.
=> Provide dedicated, ongoing funding for replacement and ongoing maintenance of the
Health Information System, including local and state interface. *
* The existing Health Service Information System is totally inadequate to meet state and local needs
for service data essential to monitor required program activity and meet federal requirements.
Current management information at both the state and local level does not allow efficient and
effective administration of the essential public health services. (NOTE. See packet insert detailing
activity to-date to upgrade the existing but antiquated information system.)
8
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
17. The state should fund the local Medicaid share on a phased basis, and direct that a .
significant percentage of freed up local revenue be appropriated for local public health core
infrastructure and service needs. The transition could begin by picking up any increase, and
then phase down county share percentage on an annual basis until the state assumes the total
amount. Page 42
PART 2: CORE SERVICE GAPS
Planning & Outcomes Committee
18. Eliminate funding gaps in critical public health services:
=> School Nurse Services* $ 13, 144,2 I 4/Page 45
=> AIDS Prevention/Control $ 3,341 ,656/Page 46
=> HIV/AIDS Drug Assistance Program (ADAP) $ 12,100,000/Page 47
=> Title VI Compliance $ 1,1 56, 849/Page 48
=> Chronic Disease Prevention $ 18,356,773/Page 49
=> Injury Prevention $1,075,000/Page 50
=> Immunizations (Prevnar) $ 13,1 13,249/Page 51
=> Environmental Health $5,428,III/Page 52
* Funding earmarked for local health departments and local educational agencies; provides for school
nurses to be placed in counties at a rate of 263/year over four years to achieve a statewide nurse-
student ratio of I :750. Request is for a four year (2005-2008) implementation schedule:
=> Year 1: $ 13,144,214
=> Year 2: $ 26,288,428
=> Year 3: $ 39,432,642
=> Year 4: $ 52,576,856/year ongoing
.
.
9
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
e
Part I:
Core Infrastructure
Recommendations
e
.
Ii
North Caronn. Public Health
~~(~)'.EWl'YBoct,.
10
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Committee on
Accreditation
North Carolln. PubUc Heefth
t:vMYWhll...~)'.E~.
e
e
e
II
.
e
e
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
1) Establish a mandatory system of accreditation for
localldistrict health departments (provided the funding in
Recommendation #2 below is authorized).
~ Local health departments seeking accreditation shall explore options for meeting the
standards including inter-local agreements, partnerships and districting as changes
needed to meet the standards, but that all such decisions be entirely at the discretion of
the local agencies involved.
~ Accreditation shall be for a maximum of four years or until the year following its next
comprehensive community assessment.
~ An organization outside of the state and local/district health departments shall be
selected to serve as Accreditation Administrator (recommended to be the North
Carolina Institute for Public Health) to provide staff support to the process and the
Accreditation Board.
~ The Accreditation process shall consist of three components: a self-study by the
local/district health department seeking accreditation; a site visit by a team of experts
and peers to clarify, verify and amplify the information in the self-study; and final action
on accreditation status by an independent Accreditation Board.
~ Accreditation standards shall address four key areas: agency capacity to carry out core
functions and provide essential services*, facilities and administration, staff
competencies and training for staff, and governance by the Board of Health or other
appropriate oversight body.
~ The Accreditation Board shall be appointed by the Secretary of DHHS (composition to
be determined based on results of pilot process now underway)
~ A process for conditional accreditation, with significant progress in meeting conditions,
shall be provided for a period up to two years. (NOTE that during the conditional
accreditation period every effort will be made to work with the agency to assure that it
can meet accreditation standards.)
~ Once the two-year conditional accreditation option is exhausted, loss of any further
state and federal funds shall be the penalty for not meeting established accreditation
standards. (NOTE that those state and federal funds will still be utilized to provide
essential public health services to the residents of the county(ies) previously served by
that agency. The Division of Public Health will find an accredited health department or
other qualified organization(s) to provide essential services and assure the same level
of quality available to all other NC citizens.)
~ The Division of Public Health and the North Carolina Association of Local Health
Directors shall advocate for and assist in developing a system to accredit State Health
Departments with ASTHO, NACHHO, CDC and other appropriate federal organizations.
2) Fund local health departments on an ongoing basis
for accreditation and related continuous quality
improvement activities.
~ The accreditation system shall be "rolled out" over a period of four years, beginning in
January 2005, with each agency (except pilot counties) seeking initial accreditation in
the year following the completion of their comprehensive community assessment.
(NOTE that this represents an average of 22 health departments per year)
12
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
2) Cont'd.
~ Funding sufficient to ensure successful implementation of this accreditation system shall
be provided. This provision includes funds for an Accreditation Administrator, support of
site visitors and the Accreditation Board, technical assistance and financial support for
agencies seeking accreditation and working to achieve conditional status.
.
*For purposes of Accreditation, core functions and essential services refer to the following:
Core Public Health Functions
~ Assessment
~ Policy Development
~ Assurance
Essential Public Health Services
I) Monitor health status to identify and solve community health problems (e.g., community
health profiles, vital statistics and health status).
2) Diagnose and investigate health problems and health hazards in the community (e.g., epidemiologic
surveillance systems, laboratory support).
3) Inform, educate and empower people about health issues.
4) Mobilize community partnerships to identify and solve health problems.
5) Develop policies and plans that support individual and community health efforts.
6) Enforce laws and regulations that protect health and ensure safety
7) Link people to needed personal health services and assure the provision of health care when
otherwise unavailable. * *
8) Assure a competent public health and personal health care workforce.
9) Evaluate the effectiveness, accessibility and quality of personal and population-based health
services.
10) Research for new insights and innovative solutions to health problems.
.
** It is not the intent of Accreditation to designate a list of "essential services" that reflects specific
programs that must be offered by each local health department. Such decisions are made locally, based
on a comprehensive community assessment of health care needs and resources.
Need Addressed/Rationale
Accreditation:
~ Demonstrates core capacity to respond to public health challenges in their communities;
~ Assures all citizens of North Carolina, regardless of county of residence, access to a standard of
quality in core functions and essential services of public health;
~ Improves efficiency and effectiveness of public health services as well as health outcomes
across the state;
~ Increases accountability for newly emerging communicable diseases; and
~ Recognizes that access to an agreed upon minimum standard of quality in delivery of core is
essential to public health services.
.
13
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
2) Cont'd.
Infrastructure/Capacity Improvement
The accreditation schedule in each county is linked to the timing of comprehensive community health
assessment. The system model being piloted is based on nationally recognized core functions and
essential services. There is a process provided for agencies to receive conditional accreditation and
receive up to two additional years to utilize corrective action plans in order to meet the standards and
become fully accredited. A deadline will be established by which all local public health agencies must
be accredited in order to continue to receive state and federal funds.
Budget
=> $ 389,000/yr. ongoing for staff to provide technical assistance to
local public health agencies during accreditation and periods of
conditional accreditation; and
=> $ 600,000 ongoing to support the Accreditation Board staff and
operating expenses (e.g., site visits)
=> Local Funding*
. $1,100,000 - Year I (FY '05)
. $2,200,000 - Year 2 (FY '06)
. $3,300,000 - Year 3 (FY '07)
. $4,400,000 - Year 4. (FY '08 and all subseauent vears)
* Funding for local health departments/districts. Provides $50,000 in support to each agency
(average of 22/year) beginning in FY '05 This would be ongoing money for each health
department to support accreditation (during the year of accreditation) and continuous quality
improvement (during remaining three years of accreditation/community assessment cycle).
FTEs
(I 1) State
( 0 ) Local
14
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Committee on
Accountability
Ncmh C.,l)llno Public Health
Ev~E~1.EW?'f&octy.
.
.
.
15
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
3) Establish an Office of Accountability in the Division of
Public Health that will implement a formal reporting
and accountability process for state and local public
health agencies.
=> Create a Community Wellness Index that will assess state and county-specific health
status-a state and county health report card.
=> Create a set of Best Practice Indicators that will provide county-specific data about
the effectiveness of efforts to promote population health.
=> Compile a set of the State Public Health Performance Measures that funders and
other stakeholders use to hold DPH accountable.
=> Implement an accountability process that will use accountability data to support and
evaluate the effectiveness of statellocal efforts to improve the health of the residents of
NC.
=> Work with the Division of Environmental Health to identify and incorporate appropriate
measures of environmental health into the accountability system proposed by the
Accountability Committee.
Need Addressed/Rationale
North Carolina's public health system is complex, with organizational units at the state, regional and
local levels. Ensuring accountability in the areas of performance and fiscal management requires
capacity not only at the program and local agency level, but also at the state, where ultimate
responsibility for system accountability resides. There is currently no formal organizational structure
to manage a public health accountability plan or comprehensive quality improvement process. There is
a clear need to centralize accountability functions within the Division of Public Health.
Infrastructure/Capacity Improvement
Resources requested for this recommendation would support an organizational home for public health
accountability in the Division of Public Health in Raleigh. Professional staff employed in this office
will be responsible for managing the state's accountability plan, monitoring quality improvement
processes both locally and at the state level, analyzing accountability data and disseminating reports.
The public health accountability system recommended by the Accountability Committee aims to hold
state and local public health agencies accountable for the funding they have been given at the state and
federal level and the responsibilities with which they have been charged by state and federal
lawmakers.
For many health outcomes, the determinants of health status are deeply embedded in social factors that
the public health agency can only ameliorate, perhaps only marginally. In other instances, the
resources available to a local public health entity to address an important health outcome may be
relatively trivial. Recognizing these limitations with respect to measures oflocal accountability, a
public health accountability system should include only those measures which agencies either control
or can exert significant influence over.
The committee has proposed the creation of a Community Wellness Index (CWI) that will provide state
and county-specific "report cards" on health status. These will be broad measures, such as Maternal
and Infant health status, Heart Disease and Stroke morbidity and mortality, and Disparities in
Premature Death among different racial and ethnic groups. They will give a good sense of the overall
"wellness" of the residents of each county and the state as a whole.
16
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
3) Cont'd. Establish an Office of Accountability in the
Division of Public Health that will implement a formal
reporting and accountability process for the state and
local public health agencies.
The committee has also worked to identify a set of "Best Practice" indicators. These will be less
global than the CWI measures and more specifically related to the charge oflocal health departments.
Examples may include: percent of children receiving appropriate immunizations by 24 months of age;
percent of women receiving adequate prenatal care; percent of restaurants appropriately inspected, etc.
The committee also proposed a system for state public health accountability based on the key measures
current stakeholders use to hold DPH accountable. Examples include: percent of infants receiving
mandated newborn metabolic screenings; percent of very low birthweight infants born at tertiary care
centers, birth rate for teens ages 15-17, etc.
Budget
$300,000 for Accountability Office staff, operating costs,
re ortin and dissemination
FTEs
(3) State
o Local
.
.
.
17
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
. 4) Fund local health departments to improve their delivery of
the ten essential public health services that form the
foundation of the accountability system.
Need Addressed/Rationale
The accountability system will help local public health agencies identify the health needs of their
communities. At the present time, however, resources are insufficient to allow local health
departments (LHD) to adequately protect the public's health. Funding, particularly non-categorical
funding, is needed at the local level to improve LHD delivery of the ten essential public health services.
In providing these services, LHDs will focus on the core goals of the Task Force: improving locally
identified health outcomes and eliminating health disparities.
Infrastructure/Capacity Improvement
Each health department will use these resources to address different aspects of the ten essential services
as determined by local priorities and needs. The Task Force goals of improving outcomes and
eliminating disparities will be critical factors in allocating these resources.
.
The Ten Essential Public Health Services
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
3 Enforce laws and regulations that protect health and ensure safety
4. Inform, educate and empower people about health issues
5. Mobilize community partnerships to identify and solve health problems
6. Link people to needed personal health services and assure the provision of health care when
otherwise unavailable
7. Evaluate effectiveness, accessibility, and quality of personal and population-based health
services
8. Assure a competent public health and personal health care workforce
9. Develop policies and plans that support individual and community health efforts
10. Research for new insights and innovative solutions to health problems
Budget
$15,000,000 to local health departments to provide
elements of the ten essential public health services most
needed in their communities.
FTEs
(0) State
Local staffing FTEs will vary, based on
local need.
.
18
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Committee on
Workforce Development
Nonh C.roRI14 Public Hcahh
~~J'.~.
.
e
e
19
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
5) Assess the needs of the public health workforce by:
~ Conducting a short-term workforce
assessment study; and
~ Identifying and disseminating core public
health competencies.
Need Addressed/Rationale
There has been no comprehensive analysis of the NCIPH workforce for sometime and specific
information is needed including an up-to-date count of public health work by;
~ Classification;
~ County and/or state; and
~ Diversity data.
Infrastructure/Capacity Improvement
The North Carolina Public Health Workforce Assessment Study would provide current data to inform
preparedness planning in the following areas:
~ Educational preparation by classification and county
~ Age range and average
~ Turnover
~ Productivity standard(s)
~ Programmatic training requirements
~ Resource directories of training resources
Budget
$ 160,000 to conduct workforce assessment
study; develop and disseminate core
competencies.
FTEs
(0) State
(0) Local
20
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
6) Assure an adequately trained public health workforce
by:
~ Developing and implementing an outreach and
recruitment plan to ensure an adequate,
capable, culturally competent and diverse public
health workforce.*
~ Fully funding necessary maintenance and
operational needs of the Public Health Training
& Information Network (PHTIN);
~ Creating public health internships at the state
and locallevel;**
~ Creating public health scholarships***; and
~ Requiring training for Board of Health members.
.
Need Addressed/Rationale
The public health workforce is aging, and many are approaching retirement. The average age of the
workforce is :t 45 years of age. Recruitment is more difficult in public health because of a lack of
clarity about what public health does. Turnover in the public health workplace also is a major issue
that complicates workforce preparedness planning.
Currently there are 188 public health job titles in the state public health personnel system (DHHS) and
173 in local public health personnel systems. There are also public health classes within DENR for
which numbers are not available at this time. These numerous job titles in the public health personnel .
system have created many difficulties in the preparation of the workforce. Often titles differ only in
level, not in function, and are simply designed to create a career ladder for public health workers.
Recent studies have shown that the current public health workforce is unevenly prepared to meet the
challenges in the practice of public health today An estimated 80% of the workforce lacks formal
training in public health (CDC-ATSDR, 2001). Moreover, ongoing changes in technology, biomedical
science, informatics, and community expectations will continue to redefine the practice of public
health, requiring that current public health practitioners receive ongoing training and support to update
their existing, skills (Pew Health Professions Commission, 1998).
Infrastructure/Capacity Improvement
This will ensure that all public health practitioners have a basic set of competencies involving general
knowledge and skills, and abilities that allow them to effectively and efficiently function as part of their
public health organization or system (CDC-ATSDR, 2000; DHHS, 2000; CDC, 2001d).
Budget
~ $ 10,000 Recruitment Plan
~ $600,000 PHTIN
~ $ 150,000 Internships
~ $ 200,000 Scholarships
~ $ 100,000 Board of Health Training
FTEs
(0) State
(0) Local
.
21
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
* NOTE. $10,000 funding is to develop a plan, not directly diversify the workforce. The committee
recognized the immediate need for a more diverse public health workforce, but while collaborating
with the Office of Minority the need for more data became apparent. There is a lack of specific public
health information by classification.
The limited diversity in the public health workforce is a concern that must be addressed. However, the
committee did not have sufficient data to draft a specific plan, thus the modest request for funds to
complete data collection. For example, the overall data about racial/cultural diversity in the health care
workforce is available, but not for specific public health work classifications (public health nurse,
health educators, environmental health specialist, etc.). The committee was not sure of the number of
bilingual staff or the applicant pool, but the need is so apparent (e.g., requirements of Title VI) that a
request is included in the service gap section of these recommendations.
Also more information is needed about why minorities do not choose public health. The committee
believes that there are several reasons: (1) public health salaries are lower than other sectors in health
care, (2) there are no recruitment incentives, (3) the applicant pool is small, (4) there is a lack of
familiarity with public health as a career and (5) hiring practices differ from county to county In other
words, there is no statewide recruitment and job placement strategy in place.
The request of $1 0,000 is not intended to solve these problems, but to develop a plan based on data
with specific recommendations. This is to be done cooperatively with the Office of Minority Health.
** NOTE. Funds to be used as a recruitment tool for professionals in other fields, not for students
enrolled in a degree program. Thus, there would be 3-5 persons per year selected for a limited time
exposure to public health professionals in local and/or state agencies. Details for program need to be
developed, probably administered by state health department's office.
*** NOTE. Scholarships do not cover need, but should be considered a starting point. Service to
state/local agencies is required in return.
22
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Committee on
Structure & Organization
Nonh C.'ollna P\.lt)lIc Heahh
~E....,yOe~.IE"'*YB9ttt.
e
.
.
23
e
e
e
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
GuidinQ Principle
Collaboration, partnership and voluntary organizational change rather than mandated
consolidation of local health departments are inherent in all task force
recommendations.
7) Fund and create four public health "incubators" to
support voluntary and locally driven regional
collaboration and economies of scale. $2,000,000 one
time funding for local grants.
Need Addressed/Rationale
The Northeast Regional Partnership was formed in 1999 and is composed of 10 local health
departments covering an 18 county region. This Partnership, which is governed by a board composed
of the local health directors and state level representatives, is supported administratively by one of the
departments. The Northeast Partnership has secured federal grant funds to support the regional work of
an epidemiologist and a health disparities coordinator This recommendation seeks to support similar
regional collaborations on a one-time basis with ongoing support to come from the participating
counties.
Infrastructure/Capacity Improvement
Implementation of this recommendation would result in the establishment of four regional resources to
assist county-level public health agencies develop cooperative approaches to service delivery,
organization and preparedness. It is expected that, once established, these regional incubators would
become self sustaining.
Budget
$2,000,000 one-time funding to establish four (4)
re ional incubator ilots at $500,000 .
FTEs
(0) State
o Local
24
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
8) Reunite the Division of Environmental Health with the
Division of Public Health under the leadership of the
State Health Director.
Need Addressed/Rationale
In 1997, the public health functions at the state level were divided when much of public health returned
to DHHS. The environmental health services (onsite water and wastewater, pest management,
radiation protection and other services) remained behind in DENR. The result has been that the
delivery of public health services at the local level has required coordination of two state agencies. At
the state level, public health policy development and rule making have also become further
complicated by this separation of responsibilities which, again, has implications on the local level. It
was the clear consensus of the committee that local service delivery would be greatly enhanced by
reuniting the two divisions under one Department under the State Health Director.
Infrastructure/Capacity Improvement
Consolidation of environmental and public health services would greatly improve coordination of
service delivery, particularly at the local level.
Budget
No new funding required.
FTEs
(0) State
. (0) Local
.
.
.
25
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
9) The position of State Health Director shall report
directly to the Secretary.
Need Addressed/Rationale
The position of State Health Director has traditionally reported to the Secretary of the Department(s)
until recent years. Given the critical impact of many public health issues on potentially all residents of
North Carolina, this direct reporting relationship is significant.
Infrastructure/Capacity Improvement
Implementation of this recommendation would result in enhanced management of public health
services, resources and programs and improved integration of public health and related human services.
Budget
No new funding required.
FTEs
(0) State
(0) Local
26
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
.
10) Promote collaboration of local health departments
and any related voluntary structural changes at the
local and state level through the accreditation
process.
Need Addressed/Rationale
For the past 30 years various efforts have been made to consolidate local health departments into a
fewer number. North Carolina's strong tradition of local control has constantly resulted in the decision
to maintain county health departments with the exception of a few, well established district health
departments. After thorough discussion it was the unanimous decision of the Committee that the drive
for efficiency, effectiveness and possible structural change should rest on the shoulders of
accreditation. Committee members voiced strongly the need for maintaining autonomous, individual
departments in counties so desiring, unless a structured accreditation and competent follow-up proves
that the individual agency cannot provide quality essential services for the county's residents.
Infrastructure/Capacity Improvement
This recommendation is a new approach which, through increased accountability and the
implementation of an accreditation system, would allow locally determined collaborations to evolve to
include the creation of new district health departments.
.
Budget
No new funding required.
FfEs
(0) State
(0) Local
e
27
e
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
11) Perform and distribute a Self Assessment of the
Division of Public Health using National
Performance Standards.
Need Addressed/Rationale
No national accrediting body exists for state level public health agencies. However, CDC has
developed a set of National Performance Standards that the state can use as a benchmark for evaluating
the Division of Public Health's ability to fulfill its role in providing effective public health services.
Infrastructure/Capacity Improvement
Implementation of this recommendation would link quality improvement efforts at the state level with
national standards, and align the state's quality improvement process with local efforts.
Budget
No new funding required.
FTEs
(0) State
CO) Local
28
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Committee on
Planning & Outcomes
Nor1h Carollno Public Hcohh
ev.,wboN.E~1.E~.
.
.
.
29
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
12) Improve the data and epidemiology to drive state
and local decision-making and allocation of
resources.
Need Addressed
Public health covers many fronts and is challenged in many ways. This breadth of responsibilities
often makes public health difficult to define to the public and state/local leaders. Additionally,
without a common set of indicators, it is difficult to monitor the State's health, identify gaps and
priorities, develop and implement statewide plans, and adequately correlate resources to high priority
issues. Establishing a common set of indicators will provide a clear statement for public health
business and can be used to monitor the health of the state and manage state/local resources.
Infrastructure/Capacity Improvement
Implementation of this recommendation would:
=> Establish a common set of core health indicators.
=> Build capacity to conduct the Behavioral Risk Factor Surveillance Survey (BRFSS) to
provide county-specific or multi-county data.
=> Enhance the opportunities to collect and report county-specific or multi-county behavioral
and physical health information on children. Specific examples include greater local
school system participation in the Youth Risk Behavior Survey and physical health
indicator data surrounding the childhood obesity problem in North Carolina.
=> Identify and analyze existing state and local public health problems, health disparities, and
potential threats.
=> Identify the best scientific and evidence-based strategies to address identified public
health problems at the local level.
=> Provide Epidemiology training for local partners.
Budget
=> $300,000 BRFSS
=> $100,000 PH problem and threat assessment
=> $200,000 Best Practices
=> $200,000 E idemiolo y trainin
FTEs
(5.5) State
(0) Local
30
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
13)
Fund local health departments
document community health
community partnerships.
to assess and
needs through
.
Need Addressed/Rationale
Integral to public health is community health assessment (CHA)-a public health core function. CHA is
also a critical part of Accreditation of health agencies. Local health agencies are mandated to conduct a
collaborative, comprehensive CHA every four years that must include a review and analysis of
secondary and primary data and development of community action plans. Primary data collection is
key in engaging community members in the discussion and planning for community health
improvement.
However, there are NO state funds to support this critical function at either the state or local level.
Public Health in NC needs to support the CHA process at the local level. This critical system will
inform each county of its health status, provide information for planning both at the local and state
levels, support accountability and continuous quality improvement in public health, and enable the
local health agency to be accredited. Providing a uniform set of core questions for primary data
collection enables data to be compared across the state.
Infrastructure/Capacity Improvement
Implementation of this recommendation would:
=> Establish a uniform statewide process for community health assessment to be conducted on
a four-year cycle (Comprehensive Community Health Assessment) and updated annually
(State of the County Report).
=> Establish a core set of questions to be used for primary data collection statewide. Local
partnerships (Healthy Carolinians, Community-based Organizations and other health
agencies) may develop additional questions according to their needs.
=> Build the capacity of the state Office of Healthy Carolinians to support local community
assessment through local training, technical assistance, and report generation.
.
Budget
=> $ 1,623,000 Community Health Assessment
. $ 75,000 state
. $ 1,548,000 local
=> $ 441,000 Healthy Carolinians
. $ 225,000 state
. $ 216,000 local
FTEs
(3) State
() Local
.
31
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
14) Establish a process for comprehensive collaborative
planning that integrates state and local needs
assessment, priorities and strategic program
objectives.
Need Addressed/Rationale
The NC Public Health System needs a comprehensive, collaborative process for planning that includes
valuable input from local public health agencies and Healthy Carolinians Partnerships as well as a
wide variety of state agencies and public health programs. This collaborative process will foster good
communication among the public health community, coordination of programs and services, and
cooperation toward health improvement outcomes. A collective process will support good fiscal
management and avoid duplication of services and careful articulation of gaps and emerging issues.
Infrastructure/Capacity Improvement
The recommendation, if implemented, would provide for the following improvements:
=> Develop and implement a collaborative State Public Health Plan to cover four years and be
updated annually.
=> The State Center for Health Statistics will provide county specific health data to local
health agencies for the purpose of local planning and priority setting.
=> The Office of Healthy Carolinians will compile and report information on local needs,
community priorities, and action plans to state level programs.
=> Establish an annual integrated planning cycle to inform state and local decision makers
regarding program priorities and funding allocations.
Budget
No new funding required.
FTEs
( ) State
( ) Local
32
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
15) Fund increased information technology capacity at
the local level to collect, compile, analyze, and
report essential public health data.
.
Need Addressed/Rationale
Technology capacity is critical for all phases of public health practice, especially community health
assessment. The need to collect, compile, analyze, report data is key to fully providing the essential
services required by public health. Because technology capacity has been left to community
resources, it is not uniform across the state. With accreditation, required community assessment, and
other reporting requirements, it is critical to assure that all local public health agencies have a
minimum standard of technology capacity.
Infrastructure/Capacity Improvement
=> Build local capacity to collect, analyze, and report critical public health information
electronically.
=> Assure compliance with HIP AA guidelines
=> Build the local interface with the Public Health Information Network to enhance the
ability of local health departments, hospitals, healthcare providers, and community
partners to communicate electronically in a secure environment.
Budget
=> $ 5,160,000 local information management
=> $ 860,000 local IT technology, one time funding
FTEs
(0) State
(0) Local
.
.
33
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
.
Committee on
Finance
.
.
North Clll,C)11M Public Heafth
~1",,.,E'o'IIl'Yl>>y.EW'Ykdy.
34
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Finance Committee GuidinQ Principles .
~ Recommendations of the Public Health Task Force should be fully funded on an
ongoing basis as needed. No "unfunded mandates" shall occur as a result of
any recommendation in this plan.
~ Task Force recommendations for the Public Health Improvement Plan should be
funded to the fullest extent possible in the short session 2004; however, given
the current financial condition of the state, the remaining recommendations
should be phased in over the next biennium of the North Carolina General
Assembly.
~ A data committee of DPH staff, County Commissioners, Board of Health
Members, Health Directors, and NC Association of County Commissioners staff
should be appointed to refine financial data currently being collected and define
unmet financial data needs related to LHDs and health care expenditures in
general.
~ DHHS and DENR should develop an action plan and work with the NC County
Commissioners Association and the North Carolina General Assembly to bring
appropriate state funding to local health departments for these essential
Environmental Health Services and not rely solely on local fees or increased
state fees.
16) Consider the following as possible sources of
support for the core infrastructure needs of the
public health system. (Note: Individual summaries .
follow.)
~ Empower local health departments statutorily to charge fees commensurate
with the local costs of conducting the food and lodging program activity
~ Develop a Low Wealth Funding Formula to be used to distribute public health
program and administrative funds to local health departments.
~ Seek private funding (philanthropic foundations, trusts and business partners)
for the enhancement of public health through creative partnerships.
~ Secure state appropriations to implement the equipment replacement
schedule for the State Laboratory of Public Health.
~ Assure that a significant percentage of any new health-related revenues as
set by the General Assembly be directed to support public health
infrastructure and services in keeping with a statewide Public Health Plan.
~ Dedicated, ongoing funding for equipment replacement and maintenance of
the Health Services Information System including local and state interface. .
* The existing Health Service Information System is totally inadequate to meet state and
local needs for service data essential to monitor required program activity and meet
federal requirements. Current management information at both the state and local level
does not allow efficient and effective administration of the essential public health
services. (NOTE. See packet insert detailing activity to-date to upgrade the existing but
antiquated information system.)
.
35
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
16a) Empower local health departments to charge fees
for food and lodging program activities at local
level to cover operational costs.
Need AddressedlRationale
Local health directors and county commissioners on the finance committee highlighted the tremendous
local burden that environmental health services/ programs in general put on county governments.
Additionally, it was evident from several of the documents that we have reviewed, as well as the
review of DPH funding, that the amount of funding that the state provides to local health departments
to support environmental health is extremely small.
Currently, local health departments are allowed to charge a fee to support the on-site sewage program
(septic tank permitting) in their counties. This fee is set by the Board of Health and varies by health
department. However, it is the local option to determine how much fee base they choose to have and
how much local appropriations they use to support this activity.
In contrast, local public health agencies are currently prohibited by state statute to charge a fee to
support the Food and Lodging Program. Currently, a fee of $50.00 is charged each food establishment
once per year at the state level. The funds generated come to the state and are redistributed to locals
according to a base of$5,500 with an additional amount provided if 100% of the county's restaurants
are inspected the appropriate number of times. The total amount that any health department receives is
significantly below the cost of the program (ranging from .07 to .66 per capita).
Infrastructure/Capacity Improvement
Will require legislative action to remove the prohibition from the current statute. Could eliminate the
state fee based on the new local fee option.
Budget
No new funding required.
FTEs
(0) State
(0) Local
36
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
16b) Develop a methodology for distribution of funds to
local health departments that takes into account
Low Wealth areas of the state and obtain additional
funding to address these needs
.
Need Addressed/Rationale
North Carolina counties vary greatly in their ability to pay for essential public services. This concept
has been recognized in the public school funding to enable students across the state to have a more equal
educational opportunity
All residents from Murphy to Manteo deserve consistent high quality public health services. In some
areas, it clearly costs more to provide the same services well. It is also true that some counties have
more funding available for essential and optional services.
To provide for consistent public health services, additional targeted funding must be obtained and a
distribution methodology must be identified and implemented to account for these low wealth
differences.
Infrastructure/Capacity Improvement
Models exist, as mentioned above, for public schools that could be used as a basis for developing
appropriate public health funding models for disadvantaged areas where health disparities are often the
greatest. This study should to be done in concert with local public health, county commissioners and _
state officials. ,.,
Budget
Yet to be determined
FTEs
(0) State
(0) Local
e
37
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
. 16c) Seek private funding for the enhancement of public
health services from private foundations, trusts,
and business partners.
Need Addressed/Rationale
Public health at the local and state level cannot exist and accomplish its goals in a vacuum. The future
success of improving the health and well being of our citizens will only be accomplished through
partnerships built between local and state government, private non-profit organizations, hospitals,
community based organizations, the faith based community and the public. The local and state public
health community must reach out and partner in new and creative ways with our traditional health care
providers as well as other organizations. Resources exist in these segments of the private sector that
could be tapped if the need and the benefit are clearly articulated and ownership of the solution for the
future public health condition is appropriately shared (public and private).
Infrastructure/Capacity Improvement
Appropriate non-governmental trusts and foundations must be developed to enable private industry and
community partners to contribute to benefit public health while retaining appropriate fiscal and policy
control of the uses and expected outcomes of these contributions.
Budget
Minimal expense involved if any.
FTEs
(0) State
(0) Local
.
.
38
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
16d) Secure State Appropriations to implement the
equipinent replacement schedule for the State
Public Health Laboratory of Public Health.
.
Need Addressed/Rationale
The State Public Health Lab has developed a S-year equipment replacement schedule. Funding has
never been provided for this purpose and the lab does not currently have the necessary resources to
provide for needed equipment replacement. Due to the state's severe financial crisis, there has been
inadequate continuation funding and no expansion funds to equip the State Lab.
As the state's only public health laboratory, the State Lab must serve in time of emergencies such as
BT threats, SARS, West Nile Virus, Avian Flu, as well as provide ongoing testing support for public
health services, hospitals and physicians across North Carolina. Due to the fast pace of improvements
in lab diagnostics and their integration with automation, the lab must upgrade its lab diagnostic
equipment, computer hardware and related software to take advantage of the new technologies. In
addition, it must have resources available to purchase upgrades as they occur. Since many mandated
services, especially services required during natural disasters, terrorist attacks or communicable disease
outbreaks, are required regardless of the costs, the State Lab must have a dependable source of state
funding to maintain required levels of expertise and laboratory equipment. While some activities, such
as services during a natural disaster, may later earn federal revenues to reimburse the state, the lab must
first be equipped to answer emergencies to protect the public safety. This requires ongoing and upfront
state funding.
.
Infrastructure/Capacity Improvement
Will require legislative action to provide additional funds.
Budget
Funding in attached schedule by year.
FTEs
(0) State
CO) Local
.
39
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
16e) Assure that a significant percentage of any new
health related revenues as generated by the
General Assembly be directed to support public
health infrastructure and services in keeping with
the Task Force 2004 Public Health Improvement
Plan and subsequent statewide health plans.
Need Addressed/Rationale
Almost unanimous support was achieved from the Finance Committee that products whose consumption
negatively impacts health should be taxed significantly to generate revenue, which could be directed to
counteract the economic impact and improve the health of North Carolina's people. If such user fees
are passed by the General Assembly, a significant percentage of the revenue should be designated for
the support of essential public health services and critical service gaps.
An essential core infrastructure need not specifically addressed in other committee recommendations is
the need for dedicated, ongoing funding for replacement and ongoing maintenance of the Health
Services Information System (HSIS), including local and state interface. The state's current Health
Services Information System is totally outdated, it does not meet state needs, and certainly it does not
meet the local health department needs.
Approximately 65 county departments are "on line counties with HSIS", and are totally dependent on
HSIS today for all of their reporting and billing activities. These departments provide one third (1/3) of
the total services reported! billed to the state from local public health. The remaining 20 departments
(larger and better funded) have purchased propriety software applications that provide them a much
more robust management information system; however, they still must send their statistics to the state
DPH through an interface with HSIS, the only system that DPH has for this activity
The 7 individual vendor applications of these health departments must interface with HSIS and are
essential for the state and local health departments. However, it is becoming more and more difficult to
get the HSIS state system to appropriately interface with these newer systems. If failed transmissions of
data occur for whatever reason it impacts county cash flow with Medicaid and requires a tremendous
amount staff time to resolve and resend information.
""
40
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
16e Cont'd.) Assure that a significant percentage of any
new health related revenues as generated by the
General Assembly be directed to support public
health infrastructure and services in keeping with
the Task Force 2004 Public Health Improvement Plan
and subsequent statewide health plans.
Infrastructure/Capacity Improvement
Revenues would be directed to priorities of the State Health Plan and this Task Force. Providing
ongoing funding for information technology requirements will ensure that both state and county
governments can document performance and accountability for public funds. Equitable state/county
funding for environmental health services will ensure consistent, reliable funding to protect the state's
environment for all citizens. Note: Legislative action required.
Budget
No new funding required.
FTEs
(0) State
(0) Local
.
.
.
41
.
.
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
17) The state should fund the local Medicaid share on a
phased basis, and direct that a significant
percentage of freed up local revenue be
appropriated for local public health core
infrastructure and service needs. Transition could
begin picking up any increase, and then phase down
county share percentage on an annual basis until
state assumes total amount
Need Addressed/Rationale
County Commissioners and Local Health Directors on the Finance Committee repeatedly stressed the
burden that the local Medicaid match inflicts on county government in NC, preventing them from
having adequate funding to support many of the other critical services needed by local residents.
The majority of committee members agreed that this burden needed to be relieved by the state. There
was no consensus on whether a percentage of the resulting county funds should be designated by the
state for public health purposes. Or, if a percentage were to be designated, there was no consensus on
what percentage should be designated.
final consensus was that all agencies of county government would benefit from a more economically
sound condition created by this relief including public health, and that this Task force must recommend
that a significant percentage of the local revenue freed up be directed to local public health for
infrastructure and core service gaps.
Infrastructure/Capacity Improvement
This issue is not new with multiple approaches being discussed in the General Assembly. State
assumption of the local Medicaid match is the #1 goal of the NC Association of County Commissioners.
Public Health would benefit greatly from local government's improved fiscal conditions.
Note: Legislative action required.
Budget
Not placed in funding scheme of this
committee's budget given the broad
benefits described.
FTEs
(0) State
(0) Local
42
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
Part II:
Core Service Gap
Recommendations
e
e
e
43
.
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
PLANNING & OUTCOMES COMMITTEE
18) Eliminate funding gaps in critical public health services:
~ School Nurse Services
~ HIV Prevention/Control
~ AIDS/ADAP
~ Title VI Compliance
~ Chronic Disease Prevention
~ Injury Prevention
~ Immunizations (Prevnar)
~ Environmental Health
Need Addressed/Rationale
See individual service gap need statements that follow.
Infrastructure/Capacity Improvement
See individual service gap improvements in proposals that follow.
e
Public Health Service Gaps
~ School Nurse Services
~ HIV Prevention/Control
~ AIDS/ADAP
~ Title VI Compliance
~ Chronic Disease Prevention
~ Injury Prevention
~ Immunizations (prevnar)
~ Environmental Health
Budget
$ 13,144,214*
$ 3,341,656
$ 12, I 00,000 at 200% Federal Poverty Level
$ 1,156,849
$ 18,356,773
$ 1,075,000
$ 13,113,249
$ 5,428,000
e
*Year 1: Request is for a four year (2005-2008) implementation schedule:
~ Year 1: $ 13,144,214
~ Year 2. $ 26,288,428
~ Year 3: $ 39,432,642
~ Year 4: $ 52,576,856/year ongoing
44
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
SCHOOL NURSE SERVICES
.
Need Addressed/Rationale
The health needs of students have changed dramatically in the past ten years creating increased
demands for appropriate care from school nurses. Yet the ratio of school nurses to students in North
Carolina remains far below national recommendations.
The North Carolina Annual Survey for Public Schools for 2003 reported 10 percent of students present
with chronic illnesses or special health care needs. More than 12,000 students needed one or more
invasive procedure performed during the school day and six percent of students receive medication
while at school. School nurses are often responsible for supervising the care of children whose illnesses
(e.g. acute asthma and diabetes) were managed in a hospital setting prior to the restructuring of the
health care system that reduced hospitalizations and/or length of stay
In addition to the growing numbers of children with complex health problems, the prevalence of high-
risk behaviors in schools continues to be elevated. The new "social morbidities" include substance
abuse, homicide, suicide, child abuse and neglect, and developmental problems. Preventive health
programs have become a greater focus in schools as the obesity epidemic is affecting children and
youth at earlier and earlier ages. One in four North Carolina teens and one in five children,S to 11
years, are now overweight.
School nurses play important roles in meeting all these needs. Yet the North Carolina statewide school .
nurse to student ratio averages I 1918. Ratios range from 1:473 in one county, to 1:7082 in another,
based on full-time equivalencies. Four local school systems do not have any school nursing services.
Infrastructure/Capacity Improvement
Set a state-funding ratio for school nurse positions to meet the national recommendation of I 750. In
FY 2002-03 there were 667 school nurses in North Carolina, 323 of which were from State
expenditures. It is estimated that additional I ,052 nurses Will be needed to meet the 1.750 ratio. This
program proposes that State funding be provided through the Division of Public Health.
Bud et
Funding earmarked for local health departments and local educational $13,144,214*
agencies; provides for schools nurses to be placed in counties at a rate of
263/year over four years to achieve a statewide nurse-student ratio of
1750.
*Year I -- Request is for a four year (2005-2008) implementation schedule:
~ Year I: $ 13,144,214
~ Year 2: $ 26,288,428
~ Year 3: $ 39,432,642
~ Year 4: $ 52,576,856/ ear on oin
.
45
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
. HIV/AIDS PREVENTION AND CONTROL
Need Addressed/Rationale
The number of new HIV and AIDS cases reported in North Carolina has increased annually since 2000
and although great strides have been made towards eliminating syphilis, much remains to be done.
HIV /STDs disproportionately affect minority populations and local health departments, community-
based organizations, Historically Black Colleges and Universities and HIV Care Consortia provide the
most direct, appropriate and effective links to the communities and populations at highest risk. These
organizations and agencies are not adequately funded, equipped or staffed to provide the variety and
magnitude of services required to effectively slow the spread of the disease in the affected communities
and populations. African Americans currently comprise 72% of the persons living with HIV/AIDS in
NC; the rate of HIV infection among Hispanics has increased from 4.1 per 100,000 in 1998 to 15.0 per
100,000 in 2002.
.
Infrastructure/Capacity Improvement
This multi-faceted initiative will increase the capacity of Local Health Departments, Community Based
Organizations, including HIV Care Consortia and Historically Black Colleges & Universities, and the
state agency charged with HIV and STD prevention and care. Existing Community Based
Organizations will receive funding to increase their outreach, case management, counseling, staffing
and infrastructure. Additional Community Based Organizations and NTSs in underserved high-
incidence areas and serving high-risk population will receive financial support for the first time. Local
Health Departments in high-impact areas will receive funding to provide enhanced outreach,
counseling and case management services and to support the hiring of eight additional Disease
Intervention Specialists. These Specialists will work at the local level in local health departments
providing direct field follow-up to persons with HIV/STD, and their partners, as well as to support
additional clinical, educational and management staff to provide training, consultation and
monitoring/quality assurance for the new and existing prevention-focused agencies and programs. The
HIV /STD Prevention and Care Branch will hire a Behavioral Epidemiologist to track, analyze and
disseminate relevant data and a Public Health Program Consultant II to perform evaluation activities
for the prevention program.
Bud et
Total funds required for SFY 2005 to meet HIV Prevelltion requirements that are $3,341,656. Of that
total, $2,000,000 is designated for community-based organizations, especially those targeting and
serving minority populations and Historically Black Colleges & Universities. An additional
$1,232,064 is designated to go to local health departments. The remaining $109,592 would go to the
HIV /STD Prevention and Care Branch to support two (2) Full Time Equivalents - a Behavioral
Epidemiologist and a Program Consultant/Evaluation Specialist - including travel and other operating
ex enses re uired to su ort the new revention initiative.
.
46
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
HIV/AIDS DRUG ASSISTANCE PROGRAM (ADAP)
e
Need Addressed/Rationale
The NC AIDS Drug Assistance Program (ADAP) had been closed to new enrollees for the majority of
time from December 15,2001 through March 1,2003, due to a shortage of funds. The Program opened
to new applicants briefly, and then was forced to re-implement a Waiting List as of September 15,
2003 About 120 individuals were moved from the Waiting List to the Program on November 30, 2003,
and the Waiting List was re-established - and remains in effect - as of December 1,2003. As of
January 22, 2004, there are 163 individuals on the ADAP Waiting List. With an average of about 65
new individuals applying to and qualifying for the Program each month, more than 300 individuals will
likely be placed on the Waiting List by June 30, 2004. An estimated 750 additional individuals will
apply and qualify for the ADAP Program next year. Serving these individuals will not be possible
without significant additional funds.
North Carolina's ADAP financial eligibility criterion, atlbelow 125% of the federal poverty level, is the
lowest in the nation. It is essential that this eligibility level be raised to 200% of the federal poverty
level in order to provide essential, life sustaining medications to individuals that are still very low
income and do not have any other means of accessing these medication. It is also worth noting that, in
FY 2003, almost 64% of North Carolinians served by ADAP were persons of color, who as a group are
disproportionately affected by HIV disease. Without additional funds to enable the ADAP Program to
remain open and serve all HIV+ North Carolinians at or below 200% of the federal poverty level, the
results may well include (I) an increase in the need for more costly health care services by these
individuals in the future, and (2) an increase in the likelihood of further transmission of HIV disease. e
Individuals that do not receive coverage through ADAP may wind up being served, both for
medications and more costly medical care, by Medicaid and/or other public state and/or local
institutions and programs, as well as by private institutions. Additional social services targeted to
families where HIV disease is present, as well as mental health/substance abuse services, may also be
required and need to be provided by public sources/programs. HIV prevention efforts are also hindered
by a lack of access to appropriate and required treatments (i.e., medications), contributing to the
continuing and further spread of HIV disease within the State. Those without access to these
medications are often unable to maintain a reasonable health status and thus unable to remain at and/or
return to work. This may increase their dependence on unemployment insurance and/or other public
agency/program support.
Infrastructure/Capacity Improvement
Increased funding is required in order for the state to serve all low-income (below 200% of the Federal
Poverty Level) HIV+ individuals, and to assure ongoing and permanent access to medications to those
individuals that are most seriously affected and most in need.
Bud et
$12.1 million in State appropriations is required; no local funding is requested and no Full Time
E uivalents are re uired
e
47
PUBLIC HEALTH TASK FORCE 2004: INTERIM REpORT
PUBLIC HEALTH IMPROVEMENT PLAN
. TITLE VI COMPLIANCE - LANGUAGE SERVICES
Need Addressed/Rationale
On August 11, 2000, the President signed Executive Order 13166, "Improving Access to Services for
Persons with Limited English Proficiency." The Executive Order requires Federal agencies to examine
the services they provide, identify any need for services to those with Limited English Proficiency
(LEP), and develop and implement a system to provide those services so LEP Persons can have
meaningful access to them. The Executive Order also requires that the Federal agencies work to ensure
that recipients of Federal financial assistance provide meaningful access to their LEP applicants and
beneficiaries. Title VI and its implementing regulations provide that no person shall be subjected to
discrimination on the basis of race, color or national origin under any program or activity that receives
Federal financial assistance. The courts have held that Title VI prohibits recipients of Federal financial
assistance from denying LEP persons access to programs, on the basis of their national origin.
e
North Carolina has a diverse population consisting of 21 4% African Americans, 14% Asian 1.2%
American Indians and 47% Hispanic/Latinos. According to 2000 U.S. Census figures, the Latino
population in North Carolina is estimated to be 387,963 residents. North Carolina's Latino population
grew by 394% between 1990 and 2000, the largest increase of any state in the country. The demand for
providers in the health and human service fields who are culturally and linguistically qualified has
increased accordingly. The growing numbers of Latino residents in North Carolina has presented new
challenges to the State's health and human service providers. They have overwhelmingly reported that
language is the most significant barrier to providing adequate care for Latino clients. In a December
2003 assessment of local health departments and community based organizations, the need for cultural
diversity training and interpreters were identified as resources needed to support their efforts to provide
effective services to clients.
Infrastructure/Capacity Improvement
Since 1998, the Office of Minority Health and Health Disparities in the NC Department of Health and
Human Services has collaborated with NC Area Health Education Centers Program, the University of
North Carolina at Chapel Hill School of Public Health, and the AHEC Office at Duke University to
implement the Spanish Language and Cultural Training Initiative (SLCTl). The initiative's ultimate
goal is to increase the availability of culturally based and linguistically appropriate programs and
services for North Carolina's increasingly diverse population. Training and resources have been
offered across the state of North Carolina to front-line health practitioners and interpreters. The SLCTl
will help local health departments and human service agencies reduce the potential for liability and
assure compliance to Title VI.
Budaet
=> Interpreter Training
=> Spanish Language Training for Health Professionals
=> Cultural Competency Training
=> Spanish Language and Cultural Training Website
=> Mental Health and Substance Abuse Training
=> Staffing and Logistical Fees
$ 273,551
$ 292,000
$ 181,298
$ 20,000
$ 18,000
$ 372,000
e
48
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
CHRONIC DISEASE - PREVENTION & CONTROL
.
Need Addressed/Rationale
Tobacco use, physical inactivity and unhealthy eating habits are the big three leading preventable
causes of death in both North Carolina and the United States. Together, they are responsible for the
deaths of] 5,000 North Carolinians each year. This represents 35% of the all deaths in the state.
Tobacco use continues to be the leading preventable cause of mortality in NC resulting in more than
]4,000 deaths annually (NC SCHS, 2002). Tobacco use is highly addictive, and most tobacco users
start at age ]2-]4 North Carolina has the]]th highest smoking rate in the nation (MMWR, 2004).
Regular physical activity reduces the risk of developing coronary heart disease, colon cancer, diabetes
and helps to control weight and strengthen bones, muscles and joints. On]y] 8% of adults in North
Carolina reported engaging in regular and sustained physical activity in 2000, and only 5 states in the
nation have a lower prevalence of regular and sustained physical activity Unhealthy food choices are
recognized as a major risk factor for cardiovascular disease. An estimated 35% of cancer deaths can be
attributed to poor diet alone. Low fruit and vegetable intake is associated with various cancers; yet in
2000, only 22% of North Carolina's adults reported eating at least 5 servings of fruit and vegetables;
the ] 7th lowest prevalence in the nation.
The combined annual cost of these preventable risk factors to the state of North Carolina exceeds $]4
billion each year in direct medical care costs, and lost productivity When combined, direct medical
and productivity losses cost NC $4.8 billion annually (Centers for Disease Control and Prevention State
Highlights 2002). The costs of poor nutrition, overweight, and obesity in North Carolina are of$4.9 .
billion each year. In terms of health disparities, the death rate for stroke among African Americans is
30% - 40% higher than for whites. In addition, African Americans and American Indians are two times
more likely to die from diabetes than whites in North Carolina.
Infrastructure/Capacity Improvement
The state currently provides very limited funding to address the leading causes of preventable deaths:
tobacco use, physical inactivity, poor nutrition and obesity This new approach for 2004-20]0 will
address the leading preventable causes of deaths and containing health care costs by implementing new
sound science and best practices interventions in NC communities. Local health promotion
coordinators and their community partners will plan and implement evidence-based programs
promoting policy and environmental change interventions that reduce the risk of cardiovascular
disease, diabetes, cancer and other chronic diseases attributable to tobacco use, physical inactivity and
unhealthy eating.
Bud et
=> Community cooperative agreements
=> Paid media interventions
=> 12.5 Full Time Equivalents
=> Program Planning and Evaluation
=> 0 eratin and E ui ment Costs
State
Local
$6,000,000
$9,300,000
$ 593,291
$2,363,226
$ 100,256
.
49
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
. INJURY PREVENTION
Need Addressed/Rationale
Injury is the leading cause of death in NC for persons aged 1-44 and the fourth leading cause of death
for all ages. In 2001, there were 5,071 deaths in NC from injuries with half of these deaths occurring in
people 1-44 years of age. Between the ages of 10-24, there was an average of 127 suicide deaths per
year (1997-2001). Injuries result in more years of productive life lost than any other cause of death. A
team from the State and Territorial Injury Prevention Directors' Association conducted an assessment
ofNC's injury and prevention program in 2003 and concluded that there is a clear need for the
development of injury prevention infrastructure at the state and local level.
In 1999, an Institute of Medicine report called for significantly increased funding to strengthen the
public health infrastructure in injury prevention by developing core injury prevention programs in each
state (i.e. ability to perform the core functions/essential services of public health). Little funding is
available to strengthen NC's capacity for unintentional injuries. The ability to perform the core
functions of assurance and policy development is greatly compromised. Local public health
infrastructure is non-existent and there is no state support to local health departments for core injury
and violence prevention programs. Suicide and homicide rates underscore health disparities in this area.
Homicide rates are especially high among minority populations, with African Americans and American
Indians being four times more likely to die of homicide than whites.
.
Infrastructure/Capacity Improvement
:::::> Develop and apply health communication strategies (including social marketing) for informing and
influencing individual/community decision-making to prevent injuries and violence.
:::::> Build state capacity to supply the leadership, financial and technical assistance needed at the local
level to conduct core elements of injury programs: needs assessment, program development/
evaluation, staff training, local data surveillance, and other technical assistance as recommended by
the Institute of Medicine (1999).
:::::> Build infrastructure/capacity at the local level to perform core functions by establishing and
supporting a lead Local Health Department within 6 regions in NC (similar to Cardiovascular
Health), and two Local Health Departments to provide leadership and capacity building for
minority/special populations.
Budoet State Local
Funding for salarieslbenefits ($182,946) for 4 Full Time $ 275,000
Equivalents (Health Communication Specialist, Program
Coordinator, Program Evaluator, and Office Assistant). Funding
($92,054) for program development/evaluation support,
equipment, and operational cost.
Funding of $1 00,000 for each lead LHD within 6 regions in NC, $ 800,000
and $100,000 for each of the two minority/special population
focused Local Health Departments
.
50
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
CHILDHOOD IMMUNIZATIONS: PNEUMOCOCCAL CONJUGATE VACCINE (PREVNAR)
Need Addressed/Rationale
Streptococcus pneumoniae bacteria harm more people in the United States each year than all the other
vaccine-preventable disease combined. The pneumococcal bacteria causes invasive disease (mostly
blood infection or bacteremia) and meningitis (inflammation of the brain and the spinal cord coverings).
It is the leading cause of bacterial meningitis in the U.S.; hitting children < 1 year of age hardest. The
burden of pneumococcal-related diseases is about 5,013,900 reported cases per year nationwide. These
diseases cause 25%-40% of middle ear infections in children. About 200 U.S. children die each year
from pneumococcal disease. Demand for the universal distribution ofPrevnar is high among parents and
physicians.
Infrastructure/Capacity Improvement
Purchase and distribute pneumococcal conjugate vaccine (Prevnar) for children. CDC's National
Immunization Program will cover the cost for vaccinating 68.2% of the eligible population. An
estimated 31.8% of the children are not covered by federal funding sources and will receive this vaccine
through this request.
Bud et
$13,113,249 in State appropriations for the purchase of pneumococcal conjugate vaccine. No local
fundin is re uested and no. additional Full Time E uivalents are re uired.
.
.
.
51
.
.
e
~
PUBLIC HEALTH TASK FORCE 2004: INTERIM REPORT
PUBLIC HEALTH IMPROVEMENT PLAN
ENVIRONMENTAL HEALTH
Secure state appropriations to increase support for environmental health services in local health
departments and to establish a state Environmental Health Office of Accreditation Support and
Accountability.
Need Addressed/Rationale
The Division of Environmental Health and local health departments work in cooperation to administer
and enforce the NC General Statutes and the sanitation rules of the Commission of Health Services.
These mandated programs serve to protect the public health in the areas of: (a) Child-Care Centers, (b)
Childhood Lead Poisoning Prevention, (c) Food Lodging and Institutions, (d) Migrant Housing (MH),
(e) On-Site Wastewater (OSWW), (f) Public Swimming Pools, and (g) Tattoos. As the NC population
increases, there is a direct relationship in the increased workload in local health departments. The
burden of funding this increased workload and enforcement has impacted county finances. Additional
state support is needed at the local level. Funding is requested at a level that would support an
additional environmental health specialist in each county This proposal to address a critical service gap
is consistent with the National Strategy to Revitalize Environmental Public Health Services, Centers for
Disease Control, January 8, 2004.
Infrastructure/Capacity Improvement
An Environmental Health Division office would be created with the purpose of: (a) conducting
evaluations of state and local environmental health programs, (b) assisting local health departments
with corrective actions in order to meet accreditation standards, (c) developing corrective action plans
to meet environmental health enforcement criteria and reduce state liability and (d) using technology to
increase communication and provide training materials to local and state agencies. This will require
legislative action to provide additional funds. The proposed increase in local capacity was determined
on a $50,000/county basis.
Budget
Environmental Health
. $ 428,111 - Office of Accreditation Support &
Accountability
. $ 5,000,000 - Local Environmental Health Core
Services
FTEs
(7) State
(Local Option) Local
52
c:
.0
.;:
.~
g~
l:l:ClI
--
ClIO
E III
Q)Q)
~~
'6 J!Jo
(/J a; 5i "C CD
&_ 00 E 2 I!? -=
asO t: m(l) 0_
-It) >,0 >2 "0<<1
.cc_:t:<<l~o
Eo -c CD.... c.."C CD
CD;: ~....c: -Q) tOo..
(/In:l UOQ)U>..c 00
~3 mujE!.~ 'EQ)~
... E aI ~ to 2 E Q) 2-'c
O:J :J.>~gg ..1::0'0
:g8 ~Q)c~..; ~I!?'>
....a:I c"COtl)a; mo
:J"C :J.... o'O..c ~'>~
g ~ uig (; c 2 :J ~ ~
.... c~ CD 0 m Cm'-
1iJ 'E .2 co CJ)~:C _:.0 0
- Q) +- f/J a:I .... _"0 0-
ttle ~E~.Q.!aQ)0)~5
~ .Q.~ ~ 2 ~ 8'0 e 5 ~ ~
c6-<tlo~as.~rJJo~cu
::::> CD 3:u. VJ 00 (; <.;dn:).2
.
. .
c.~-o -g
>.(lJ(l)Q> c E lii
cQ).5-B ~1ii is "C >
ca > E E E 0 U 0)2 8
.9~.e(l) oE'O g2'c CIJ
m I!?a;~-o ~~~ ~~::::> ~~
c .e :5 a. CD U) .... 0 ._ ~~ CD CD
<DU)Et:o oEo-E ow- Cii~
E ....0)<<1 U) --c ~(/J
>02..cc m(ijO co=.-".o
= _rn 0 CS-U')"l:t(l)aI
~ ~"CQ)CD~=~"C~.o(ij~M.o-
~ -_~.oQ)(/J_CD'-a:l-CD>.a:lO
~~ wO 'ca-~.~~-O~--o
~ CC0m~~mm0~m~_6m~
.r:. O~XI~o'c.~.~~-o.~bc .~>-
c..- 0'000 ai';: E E c fij E 0) ~.....~ E ~
E -= ~ ~ ~ -5 ~!!:!!!:! ~u!!:! 5 ! 8 !!:! m
'v._ ._ ~mm0 m... ~Q)C'
... EE'OEc=~~~a.i~-5.~ ~ ~i
", COl-cococoo.o.coo.m0.E0.C?1-
.r:. ~~~~3~EEofijEI-Q) .E8m
~ O~.c~Ec~COE_~o~~~N~
G).... o.E A.;,;:; Q)_;!::: E.2- E N(ii- c 0
::E ~EQ)E0~~.S:2o::l~I-'Q)_Q)-en
e-<E<O<O."l::O;:U"'E.e"''''E''
N.C. Department 01 Health and Human Services
Division 01 Public Health
Occupational & Environmental EpidemioloQY Branch
Hazardous Substances Emergency Events Surveillance
1912 Mall Service Center
Raleigh, NC 27699-1912
e
~~
e
e Q)
.... .S
~ e
.g .sill
o~11.~
c::;: Q" 0
Ollle-
e~ ClI e
ec::SO
01llQ)~
uC3~~
"
""
",,,
0",0
000; C
"0 '::I CO
o.s"O fD
_ 0IL co
Q)!! 0 CD
~m-g-5"E
U)Q)_ Q)tC1
.~ ~.~ >"E
'(0 co g--5 =
E~oQ)co
o.c~'O XI
<i=0 Q)Z
..'_ CO 0 .
CUC"O::IO
~COQ)C:O::
= 0.00 0 Q)
l. E 'C E f;
1l8~E~
jjjg~8~
c ~~-g
o .- 0 CO
Ec~oO Q)
E.-OlO~
o ~.~ S w
o _ C CO ci.
E~mco
e m_ co~
_cocen
o~-g:c ~
"8= <<!.S:2
iD'~ ~.E'~
Q) a.> c:o::
3: c'(i,i m m
00'- Q)= I-
.."0=60.2
jmcoo'E"E
= ::I w"O ::I!!
~$I-~::'E
Cc~oo'-
~">EoQ)o.(ij
-_ 0.0 rJ)
~ g ! ~-5i ~
olE
~ '(0 ell
:gc>-
u"W
~g.,
...,<0'8
"Eo
~..:-
,,<O-c
::I Ol.!?
0."""
(ij.~.~
u>
'Q..E is
~"Or/)
~"Ol
"::IC
'=.E '(i,i
=I-r/)
l. 0 e
CU"C"O '
mO"C E
CI)~J2J9
50 co'!::
5> en en.=
-
.g~e
0<0"
o'5,~
'si'€
!!!.~
:~ t'G is
-" J!l
e-_ 0
~~"T'E
'" -c..
__ E :R'E
.....0_1-
Qi'::~=
:!!1iiiil31
"'~t.:ICU
ca '0 ~ c
'c_ ~"C
Os = Q) 5
'" " '"
=cuQ)
~.~~~
-_cU-i c ~ g-
en>- - '0 Q) to 0 13
~ C -....:' CD _ 0 i,S ~ '
Q) ~ (;,." t'G ~ Q)'= rJ) .!!J Q) ~ La C '(0 .- ~ rJ)
.5:1!!:~~a)Q)Q):: !3Q)~::13 -0...: co o~0~~E
E t'G~":o g.a.", W .::::; 0 = 0~_ '" ""> Uo. .Q e,S G) E g
~(f)en.-'u 0. ....... .c; 0 _::1'00_
!!:!o.;::t'G ~~ -::I O'"E--e::l0 ::10::1 Q).,.o'-
! wo_~ 6 ,.:,5., Q) t'G co~ 0 co "Cot:: C: .0 C I- ~~Q)
..... a.... I-"C~_(f)m eQ)CO C<<SC'_"CO
a.~ ~ c: 0 -g ~ ~ ~ S ~ ~ -g .~ a. a; ~ ~ -e ~ -8 g E
5::1coo.=::Ir/)3: '-E'-E<Ou::O<o" Ol-U ",::Ica::s1":_
.,. co I- C)~ 0 - _ 2 <0 ., E t: -c: w
J:Q)O ~ ~I-Nui' co=.- 'Em Q):!::.g ouoc
iDoO ~U)(f)cot::~ -"CE~Q)J: "C-0 ...0 a.c.cca
E ts:; ~ ~ ~ ~ ~ Q) C Q)'- - - '0 ~ ~ a;.:: (f) .;;-&!!
I-coEom_O'"a. -a.(tJ"fi~:gs -03:.- .E l!'i 5 'Q) 'c
.gO~uiJ:..;w~ EC)"OQ)3:oO coEd EQ)~;:C:J;
o ~ 0 ~ -""": = (f) co.5 c e- Q) u) ::I'x CO 0 CO J: 0 m W Q)
Q).2 e ~"iii~'Q.e- -S.E as Q).!: Q) 00.'s"Q)C!. a; ~ - g Q) 9J
Ecoo.!::thma..... Q)co-c-ii J:oJ:>'(f)-E~
caoo ~"CccoQ)w E.::~.;..5Ci5c:: ~oa.lt) Q.~coc:oo
cm.!!J ~.5!!'E'o.Q) Ol"'iijEQ)"o .Q CD 0 E..... E_!OJ:0
iD"Co~'c;;o ~_ cEa.>Q)"C'(O >"CcaEA- CO (f)COE 1--
Q).2~:x 3:~= r/)2 . :2'2'5:;a;~ ~ ~ S.s,S f; o'ij EB's
.:: 0 0 Q) co co Q) a. CO._ 0'"- 0 c.- 0 0 Q) a. Q) E ... 0 0 c
W.Eo"C~~E-5~~EQ)!~~E~o.~::I~"iii20E~
>.:
.E~ ~
Oc ~ e
.- c: Q)
C 0 ~ e
Q) Cl.1Il Q) l)
> ........
l!!~~.ij
o......;c:
~.~ .~ ~
~Ll:U:.....
.-
c
-
~
~
>
c UJ
<0 ~
E c
" ,,-
~ ~ffi
= eW
(ij J:W~
Q) _0_
::I: (ijQ)e
Q)gas
15 :I:co...
1= uUi C7)
CD =.02
E .g::Ja..
1::: a..cnQ)
as _UlU
a.Uloaa
~B5"E=
.-'- as CD
q~:~~5
zcnC:I:cn
on
...
~
;i;on
"'on
"'on
~~ I
gchS
.s::. 0;"0
g-xi
j!~3:
c:
~ '~[t
ml20
_~CIl
~.E!;(
.,~-
.i!: c ~
e &:i
:!.< go
~~a:
c3-iIl
'" E..
c2~
l!!-.-
CJgc
>0'" ..
.0"'",
i~B
t:~C
&.Z~
c.E.c
~,,~
en zen
~~, ~1
,"{
!
F.....
"'. ". ' ,~.
,~'~ '
.. 0 C
.c ~ -::e1ij~ "glS
.!! Q)..... Ul coq.
CD -= Q)~l!!- _0
_= E ~:g~~ .58
c.E .c .!!!Ec6) "d,e,
<Gill .!'S! ~Q)&.i O-CD
~E c 'E'~ 0_ ao.l:l
!!+= III Cl,)i e.!! 8
.!:!IS g. "5oE~ CC\l
i ~ 0 Q) a.;;::: III ~ ~
E~ ="O~C? .Q~
.s.s Qi _I:: CD -E>o
.....:: E SaJ~.5 o"i'
...... Ul .c'O~E
.!!!c .c-eall!:!Sf! ~.g
CD cG u c.$." CD_"O...:
=~ ::::lClloc1J.c<<lut'l:l
CD 'iij 0 E ~::::l o."}' E
~~ ::.~~8~~5 ~
;:::;::; .gcrt:cu.c:o ~
cc~ Q)OCD--- 0:::
.a>O~O..._Q)n:lCI:IQ.li'ii-i
;>utllClo..:.o:E.cgg-
.. .c..r::.
'"
1
e
.2..
'Ui!
~o
U.
....
.s,g
~o.
H
c."
We
,..
J!:E
.=Illl
, u
H
o'\:
"'''
..",
z'"
.a
~
Q)
c
E
III
-
Q)
~
Q.E l/)
'C
ClI ...
.sill
Q)lll
:=:1:
o~
c>>CD-aUJ
(ij.s'O.c
-E-CD
Qj~E~
~Q)ee
"OJ::::-1'I:l
c ClC\l=
t'llEoQl
.r.ctlo3:
;ij ~ C\l.'O
Q)..... <0 C
:r:<(\JCU
oCij~E
c~~:E.
~"'!lJ:
Eai->o
t:0)Q)_
~(T.I';:: C
UlQl-Ci3~ c
QlCl1iia::t:~\l
f: o::::l . ctl:::::
::J.t=. C)~ a.' -S
~~~~~:gs
~
~
,,~
~~
>-
.."
E.~
C\i~.E.
8c::e
N.Q.C'
m1iju
5Ets
3-20
. cl<
..-
'5 Q) E.
.~.S e
~ E~ ~
-!9o~
Q)~o 3;
.5 Cl.."'..
~E'"
'-'..N
-5:S~Q)
~~.s'~
'<I
,;
~ ..
"m ~_
e "e ~ UJ
11l 8 ~ Eo."O ~
.c . ~'\ C -c
~~ :;::'51'1I 0
Eti oi~ u
_al ~.o.Q Ecn
~ e m.!!ai :t B
;~ ~~~~~ts
"iij:9 O;:Q)c'-co
0- "OalCJla:diia.
.'E~ (ijQ.coEQ.O)
'E!~ ~5g~!5,E
G100 :I:g:~g-g
~'O..e t-:a-t::.-t'G
:J:.~Q) OQ):g<<l~.c
_;:0 C.~<<ItO~ffi
caCl'Clu=>c..u._c..
uQ)E'x~eE'ESe
'E3:1:e's:>-c..811)cc..
!5~o~.E.E-58.E
o. . .. ..
~
:c
'il?
~
..ijj
.. 5.5
5 c~;€ c
~ gE~g
ltJiS.. ~ ::d3 ~
1~<Il'E~~'E
1iI05SQ)~~
:t ~ 'ii.j 51D"C 8
_;:<Ilua:lc
.!! ~'E ~ ~.."
c:.E!Q)S~<Ili
CD-... I'CI 0 e
E]!'iij~"E:::I ~
CCuollC'll'OC'll
eS'x:s~2e
>~F!CI)J:Ci5~
e
w. . . . .
"'
S ti
iii g .0
5,C1lfl)~
~ C <D
<(.E: ::3 I
-:-~ ~o.
.ct:-:;:
i';; a e
Q).o:.t:: 0
~~~.::
00l(b~
-2Eo
~aCllC\l
ECIl'I:ui"
t:.s"giD
~fI)<<I:::I
~~cg'3:
t: ~<( ~
~G~-g~1
$.-:..-:6 6'i~ .
t: N(ij.;::., ~
.!:g Q)"Q),!-o
~N:r:a:'ii.j.5
.,;
N
n
'0"
<DJ!!
6'i'ijj
'C~
,ai ~
N"a:::Io
glli~
N.o.y
>-~~
ro (b 0'
e.E:t:
uiEro
eDJgE
.y CD en
0"" E
is ~e
",,-
<<1-:6 C\I ~
E Q)O ~
(f.)::e~~
i~
Ji
t
!
.
I
~
.;
" ~
.! ~ ffi
i g i~
.9 0 OQ)
<Il :0 E-'=
2 1ii g.!
o!fm uOG)
C.c;: ... '-oxs-a.
.Qg.G)~~ ca<ll
'Oo~...,- ;Q)o
~-a.B~~ i'~~
ai i;'05 ~~E
:gO:: E:g g 'ii.j S,,$!
00<llO'ti<ll2 _,Y
Q) g 23:1:.- 2o.!!Qi
~.@~ g e~ ~~~
0.. Q) 0..- eD 0.- E Q)
<Il><Ilo-5<1l.$!Eo
~5~~e,gaJ!2S<'
Q.O c.:::)w c.c:(u.O
t <Ilr.631 '
-._ ~ C >-u ~E .5-al~~~
E ~o ~ 11) C'll~ oS ~-eUCD
G) E .E .0 ~ E lB g ~ ~ :,~ ~ i;':ai
2 G) ... o~..g ~ ~ o';s:. E~>--5~Q)EE
~ t::::I 0'" 8 <IluwGicCD Q)-5_E<IlCD
._ en~'~u~og -a;'EE:::I:c1ii~:;'i~<IlE~
III E 0 >..g;!.f::~o'-"" ! ~Q).s~c-E,=~'!":"o.Sg!<Il
.. ....- - :::I -.cc.<<I:::I._a.<IlUEu-<Il
.."- _ "",,-;:umJ!2Jl!..-<Il ffiUF-O<ll<llEScu:::Jcno~
~ 'v ~""D ... 0 ~.c~"C-.cCD:::Ic-'=E 0
CD.. ><-~a:I.cr.6'=~e- oJ!2<1li~J!2;o.c8Q) -tiC:
:= Q)W~a;'O~~cQ) -CDO ~UCD.cCcEC<<la>
W.s::. -C<IlC<llr.6.! .s,~,~~i.5;~'-c=i.:::c
"",,-e'E<Il'~~CD:::I Q)E::IoQ)-Ec Q)'- i::'tO
~ ca :::I <<I Q).- >-u ~ cug.sEs a:I ~ E-g~ 0':::
Q) E () <IlQ).e"ccQ)c:(.s~Q)0~~Q)<Il:::l8:::1-1iil:5
en ._ &..coc.Qc.t:cuc.-'=-'- -,=CDCU...Oa>...U
... ca x o..c'iij 1ii ~ S eD x o..!"~ ~ 0. i u 0 -; 1ii '0.. CD
Q) ... E Q)E..<Ilc.C<IlO"CCDE-<<I.-E...c"C-:'!:::<Ilf
>.... Q) Q) m1D:CCDE~CD~mm~~~~.!!~.!:!Q)
~ s~:::IQ)o=":::Iam:::l~5mQ)"C~~~-g~
~:! c3 ~ ~ ~-5 8'0 i B~ E 3 c~ E E ~,5~ U <<I <<I
c;; ~Q)
EQ) 5 ~.5
,... <IlQ)E
a.... .- ~ m
:::IJ!2 C"C1D
0" Q)" ,!2 Cs=
Q) ,5 '0 a:I a.
s::: g'~E~J!!EE
O'~~~iK~~
;; ~o-a.~m ~ ~
S:::-a;o..EE"'Q)m'O
Q) Ea;~~~:3c
> 0 g Q) c ~ ... ,0
Q) ~~E~-ri.2~
... ~&tU.o!!i.s
Q,."C ffi<ll~"E
~-!E~'E 5i~
:::""ffi'C" ~ J!I Ei
L-.b8-:g~CE
::I ~a.S:88_'
.-Oc a..c.c Q) CD
s:: tU <Il -" ...
- .
. .
. .
. . .
", ..
s:. C tU "C ~ E
E=.!!~ E Cti~.~
.2 ~ 6: 0 ~ N a.L:
'86:EE.x ~~~ ~
fJ);E5e >-EO ..c
en ;.~caJ:;~ ~1UE Co ~
~ o"'C~Cii..cc~.~:g ~ ~
_ .a!oGiEo-Co E a.
C)ca "'E:::I~EO<ll 1ii<ll<ll
C -'''e~ '6J!!tUE.c -0
ca t "CEE O'~:,!::: E: ~.B E
-"c:::l<ll.=l:::tU~ ..<D_
C = Q) ca '6 <p 0:;:;."C... .- E -=
z..c"O"Cc:.!!.!! %Q)~
.Q::: a.~<Ilx.2asasas ~.~'ii.j
ca :;w ca ~ e o.?:E ~ .._ u.. g
...I ca..!..ii:S'i..s= ~o - m 8
.....aQ;-.c.:ll:'O C C .0 ~
!: -Ej E ~E: E 8,Q~ E~~
crOt Eu,g~EE~SE5S
._ Eii:::lJ!20C'llJ!20(l)eD.!!!uu
C Eii:EW fI) uLL..:a: ELL.c:(c:(
:) C:C:E= . ... . .
.e
~1l
.=I"
i..1
i'~
a:~
, ~
:D'.=I
.=II..
..'"
i!"
0"
",.=I
0.,
..~
0..
""'"
0."
i~
a:.
'"
m 8
:; .:;
.@ -8
S ?
5 ~
" ..$
~ l'l"
ca a '~.g
<Il 2 <Il" '0
i"" <DotOJ!2
_ E,- u Q) <Il
II) ,- Q) >'C0i5 E
'E~~1D~'O-(I)
e <Il:;: ~Q)J!2 ~1D
a~OQ).2::'E~<Il
% e ~.~ ~1a~ J:Cii
iiQ)C~iS..<Ilu:a.~
uOQ)Q))(CQ)_c
'iiffi~1iiW:)~c:(c:(
~o.5C. . . . .
0.. .
e
..
Q)Q):2
Q) E 1ii e "
"C ~E12.. Q) '0
Q) ~ Q)Q) tU.2E"C ~ ~~
'i."C >- "C C E E E ~ ..2 E ... Q) tU .t:
.c-.c ~CDEtU:::I~:::IQ) L:~Q)Q)" u..2
Q)~~eD~~:::I~~~~:2~~S~5~ Q):CS=
~uu~s:.CDCOOOOtUQ)>-O"Q)tU COgCD
s~~.s~~~EEEENNNOQ)~J:g~~...c
B~5B~~2EEEE~~~~~=5~CD~~'6
CClJlCCOWWLLLL.J:J:J:..Q
..
"
'C
-g. Q) Q) ~
s= Q)Cc'-
E Q) Q)~ ~ o"E .! Q)
" .sE Q) c-~" <Il a:leD~CD
~ ~ Ea:I.c !~0~Q) 2 c~)("
CD- 0 a:le ~ OUCtUC_O o~e~
o1ii5Ei: .~~oQ)~ a.~~,yg~a. -eca-g..S!
C__:::IU E-_c"OE' o.....Q)u<ll tU>-.c
a:I~tU.-o~ CD~CU:::l C\IU~O-'=-o oU-'=u
8-tUE~~i~E5i~:g~~~-a.~~a.~555~~
~,,~~u.c-,=gQ)o~tUccc<Il~Q) ----oeD
oa:l=C'llQ~~O~~o~~~~~Qi~~~~~~~
<Il~~~~~~~zzz~~~~~~a:a:enoom(f.)~~
r::
o
.-
-
e~
~~
Q:ca
.....
'iiio
Ell)
CI)CI)
;B~
'6 ~ (;
tn <<i ~ -g CD
lD_ CI) E.... U)J:
00 t:: Q) U) '-....
ftS", >.0 >2 .g7U
~ 5 :c ~.... ~-c 0 CD
(I); ::J... C - OJ (ij Q.
0<<1 OOQ)0.i: 00
gJS m ViE ~.!B "E 8.~
... E (U ~"iU.a E 0)_'2
0:;) ::J"55g2! .co'o
f,/) g (fJ Q) c::'" - ~ ~'>
!d:l 2"00'0'2 (tic
::J"D ::J....Oo.c :J._CD
oc: 0.... 0 ~~=
2m ui":COC(1J c:.J::C
_~ c:: c: Cl.Q CD :J 0)':::
(/J c: ,2 <<l C>>tti J5 -.... D 0
(ij Q) a; (I):m .... --g 0 cu c:
::JE .S::!E::J.2Ja-cCJ>::Jo
en Q.~ ~ Q) 0 0 '0 0 C (/):;::::l
:J'3C1lt::t)E~tI)t:e::J<<I
C o-CtI 0 >.ctI.-.... 0"" Co
:J Q):;u. (/J 00 0 ocn:J..Q
e
e CI)
~ .~
.g ,sll)
o (1)r:: 9!.9!
. -...
r::';:: Q. 0
Oll)e-
e~IVe
er::SO
0.!!1~-g
00c:-.I
"
alC
'5~g
....OeDe:
o ,,"
-g g"'C II)
1>> ~ \... ~
Q)- 0 CD
::a;"8S-E
~~(ij.!S
.g (/J ~~:~
caCOcn'Q)_
~~$o ~
<c'icnCDZ
..'_ a:l U) .
cuC:'C:::IO
~ ~~ g ~
~ e';:: e=
!8~E:g
w~~8&i
.
. .
<n _ "
c:.-"O C E Q)
>>ctllDQ) 0 W
cQ).5tj EUi ::J"C >
<<I > E E E 0 8 oS 0
.E~!9(/) oE'C ~2'2 ~
~ U)<<i~u ~Q)~ "'~~ ~!
C 2 -= Co C]) :g == e .~ ~~ ~ CD
Q)(/)Et::o EO-c OQ)- Q)::
E ....om '" --c::
>-2J:: c <Dca 0 e=.- ~
= _0 .c (,) O-(/)V0<<1
_~ ~"'CQ)Q)~_~"'C~D(ij~~~-
CI) ~O~DS~~~;~OQ)~~g
C!"'m~g!~.~~Q)~~gQ)~
J: 0 CD gJ <<I o.c._.5~"C.5b c _.5~
c...- 00.0 1U'~ E E c ~ E m B T"" E as
E~Q) G>.coftS<<I>.-COCQ)OCtlQ)
ca.5ftS.5- -"Q)m(l)()mm....Owc.
EE-E-~~ '~~c~~ ~
ca mO ~~o.-a~~a.-.-ca.C'iQ)
~ ~m~~3oEE5~E~~~Egi
... o~.o~ E ci! m Etil! 0:; ~l!~ ~
G).... a.E a.-;:::: al_;O;:= E.o- E N1;i;- c 0
~ c:EalE(I)~Q)go~alo.Q)~Q)-.~
._<E",,,,_::;=Uu>E_<ncnE "
N.C. Department of Health and Human Services
Division of Public Health
Occupational & Environmental Epidemiology Branch
Hazardous Substances Emergency Events Surveillance
1912 Mall Service Center
Raleigh, NC 27699-1912
,
~&l
!
c .gj~;g
o .- 0 as
EE~.oll>
E.-O)o~
otUc-W
o a.._ ~
~ c ctI ci.
E~mco
o Q)_ m~
,;COc(l)
.....5~.- 0)
O~C~C
~- aJ C.-
~:f; <ti6~
al m lI>_ C
Q) o..~ C ~
~c(I)Q)Q)
(/).- Q)=....
a;~:6 ~.~....:
~(I)moEc
= ~ ~~ ~ CO
.t.(I)~o-:e
C'E~oO'~
~~OEalC.o'"
0- a. (I)
en g ~~"5i ~
om
~.~ !e.
(jaW
"'>--
-'''''8
~EJ2
"'...
""'i
" "'-
c.al'"
_"u
~';;'i'i
.- c'"
a..- 0
~~C1.I
~"'"
":::IC
jJ2-(i)
=....(1)
~oe
~"8~'E
Q)5~S
:: 0 CO'C
:> (I) (I).~
s~ -0 C CD '0
(I) ~ _ Iii 0
~ C <ti-o l!! (I) ti L() ~
Q) ~ol'd "'C1)'~ (l)E ~al"E m
.5:i:!!: ~~aiC1)Q) e:::l~as~co -0"':0
ECO~":oa.a.<ti 0- ~~ mQ)a.
sfi~~~m~"a. '3EtU!5~ g~:::I
!!!00_-05-:'~C1) iaslO.!9o~ ~=c:
...... .....w.... ....~~_(I)C1) OQ)cO
a.~~ ~o-g~~ ~.!!:; ~-g.~ c.;~
E:::ItUo'~:::IC1.I~ '-E'-E"'u~tU~ 0)...0
tU CO .... O)~ 0 _ ~ ~ as Q)
5~fJ~00(ij~e aJ::='- 'ElI> "'Q):!::
alE..lIt:5(1)t:Ecoll> m-g~.~~5 ~1ii(l)
OQ)mas :::10. ~as~c<n<n-" attlCD
....mEQCD.acrg. ... 0 Q) ~==.5
.e'o... ui"~_<...t ~ E O)~ CD;::.o C fJ Eci
C1.I ~u~.!:: .~(I) aJ.5ce-wu) 6')(.50
Q).a!tlQ)>as~'a.a." -=.5mCD~Q) o.s!!!q,
eas- (I) Q)CO_C-lO _0
as.o~:gC~~0 El:;~';'.5Ci5c ~oa.U")
=~a 0:~'~':$ ~(ij E~~~~ ~~ ~M
Q) :::1:= .~ ~ (I) ~ (I) .-.S: .9--;:::: - !! e Q> C ~ 0
Q)_ a.x ~~-:::l ...lIt: C:::l C'tI C'tI._ 0).... :::l~-
~ u 8 al tU as Q) .... a. CO._ 0"- 0 C.- 0 0 '" a.
(/) .5 ~ I ..lit: E -='N ~ E CD e .Q::> E u. a.::t :::l
..
... ....
.e ~ r::
5 ~ ~
.- s:::: .,
C 0 ~ ~
~~.s.E
e~'&Lfi
n......'i::
~~e3t
::l l';- it IV
._.... -J
.5
"
E
~
c W
'" ~
E c
" ,,-
;; ~ffi
= EW
10 J::W~
Q) _w_
J: <ii1lE
'0 lfije!
1: .20 g>
Q) 15.a....
E :J:lQ..
1: ll."'1l
<U - W c
D.w05m
~~5"E=
.'=::'1i)C'llQ)
t:.:! ~:~ ~ 5
ZU)O:LCJ)
0(1) .
"<nf!
os l!3
~"!=
:=~t:
"'alal
Eo.':
._ ctI 0
-'6 l!l
E!-- 0
mCD-....:
~~,:,a
<Em:c:
o_~
Q;'; Q>=
.x-Em
:;:~5~
.!! 0 ~ C
c_ ~~
O....(1)C
easccu
EE m ~
c:('iiS'OW
<Ii
al
~ 0 13
Q)_ :c:
as (I) . Q) u) E'"
::;m~>Q)o
..Q~':::Q)Eo
Q) ttI:::IB 0....
.oc::eU)~CD
C C'tI c.5"5i!:o
~-e~-8oE
(/):::l<<l:::J€~
.oE'5ooc
.$! e a..5 ~ aJ
CD - (I) (I) O),!
.5!"as'iin:
ECDl:;:=C:::l
g~o~<lii!l.
!~-;;,g~e
~~ ~ 5E,g~
tU(I)C'tI ...-
"i~e5~~
::tca2uEe
'"
;!
;i;",
~'"
$~ I
I~~
Q...,a
~~Q)
~u..~
E
~.~~
CD~C
l!!~",
cno!;;:
-;~-
.~ c ~
e&~
CD< g'
0. "a:
8= "
'-' E"
~ e m
..-"
c'5giS
>-l<l"
~~gj
~~~
8..2: "
o.E~
~~"
"'z'"
j
j
"
~.__cc_
\::/,\, '
.0
.!l
..
'"
-g~
....
-"'E
...-
a;::
.- ~
"0
">-
E",
.5.5
.0:;;
.!!!c
....
=-'"
..OJ
-~
~.E
c:'E
~8
=
'j
C
0..
ti"
"l;
'U
....
.E~
~o.
H
0."
We:
,..
Z':2
jl;l
, u
'iii:i
co
:8:&
..",
z'"
J:l
lU
..J
Q)
c
E
III
t)
.c
Q.II)
E'C
lU ...
.clU
t)N
:d~
..
]i
lii
OJ
E
.0
.!!!
C
..
0.
o
l;
;.eiij~ -g'8.
(i):IwUl ~ci
~:aC6~ .58
$~-g~ ~~
fj CD &.'0 Co Gl
'E~ 0! C::o
CD ~ e._ gg
-5e~ ~ ~~
CD 0.- ~ ~PD
"'''.0>-, ~"3
Q) ::c CD '::0
E ::::JtOC.5 >0)
(Il .8'2~E O..l
~ . aI ~ to co ~o
-'=1: (1)-- u'C
g<Da'EQ)~lO"8Tli
o E;:; ::J.o 0.'0 . E
::.~Cll 8 ~'~ 31 N
.gcrEcu'co ~
~ "0"--- s
2;!O...._Q)CtlC>>Q)";-,"';-i
ctlCloE.o:E..og-g.
.. J:J:
o~
eCl;)-a1J)
co.5;: 'C..o
- E- CD
Q)Cl:IE3:
::'Q)ee
'O.c:_a:s
c Q..N~
coEo~
.cCl:lO;>
~-SC\l'C
CllQ)U:>l:
Cb~C\l (0
l:-CD..c:
'0 &c:=
'E~~lB.
Q):::::'O::I:
E$~O cq
t:(7)CI)_
a10'l'C: C
g.....QjCD 3:
r:C1Uia:~~
~O::Jvi<<l....
:s.r:: Ol.()c."
OCO~tT:l(ll:::
cnJ2_-,o.c
.0
"
"O~
""
~:a
~ -
-V>
cj-~.E'
gc:~
C\l.Q'E:"
CD'CijU
5Sii
::2.,2 0
GiS::::':::
-..E
~.5 e <..l
~ E~ 3:
-!Clo;J:
CD (bo 3:
.s -a ~ ~
o~~:::
-5:SCD7:
OQ)CCD
:::.:::~~.~
l!l
Iii Sl .0
aQ)vi~
:::JC:Q):>
<(.5 :::II
-::E ~o.
€.5~~
t\1<lloE
Q)J::l'';::; 0
~~~.:::
o bllbgj
c2Eo
lDCOJC\I
EQ:lctlli
t::c:1:l_
ca:O::C:(/)
Q.tIlC'll:::J3:
~~cg'3:
C:J!:l<C 3:
~t5~~~1
:g.-:..:sa;.E..c;
2~(ijE iJ.i l<
~~~~'1ij]
<D
'"
n
-g.s
ii)'(ij
.c.o
.QiCD
Na:3:
8eti:g
N..Q.S2
>-~~
C'll Cl'lU'
~.S:t::
. E..
lG.se
.!:! G:I en
~-aE
ue2111
~~~ 3:
E Q)O ~
Cf.I~~~
'@
r;
~
!~
)1
l
l
.
I
~
o
.
u
~E 4i~
E:::l >.-
c..c .~ ~ ~
:::l.!!2 3'C CP
g~'Dn !ij-a
c: ~~(efij.s'EE
O.c.-as"ocpas
asYQi CP i5.E=
CP_.c;jmV>"
... 3: 2 c.~ _ :g E
C:m~~~~m'5
Q)> 2~-6>~asc
Oocpc .....2
Q) ~~E~-ci.E;j
... ~CP as.c!!i-=
'" c.....enas'D~
.... 'i!!!! as.= c
cas c'c E CP
::>".<ij.c.... J!l E R
... - .::. g-:2 e c E i1)
j~i5.5aso8_
.-oc: c..c~ &:J m
.5 . as en_'C ~
CP ~ ~
~ '5 ~
i ~!
o c Ocp
- 0 E~
en ~;j ~e
c~.~~e .2~~
~~';~~ B;jft
uoen....- "410
~-a~i! fij.~~
c.~ ~~~ ~%E
lQ'5E~~ .~~.~
oCen'O'5~t:cD;:
Q)o2.-.-...0-CP
~~,g~E,g~~~
~~ g.o~ g.~ E &
ocoCPOO:::l~~
if8-a:Sd1-a.:fu:O
oi encnQ) .
en ,C enE c.cQ)~en
c c ~~ :::lQ) ~.!!2fij~Y
E Q) i f ~ ~ ~ i ~ i * :.~ ~ i:;i
o Q)... cn 0) 'C "0 '5 J!l,C E en ~-6 E Q) E E
... j Oa;:::l fij '3 en~0a)cCD~CD.c.1!!EenG)
~ c: ~E8-0~ 8 m-EE:::l-;jS-6~G)enE.
(1).- en CP E. 0 G) > 0 0"'0 - e - ~ -a:::l G) ~
E 0 >cp,C.:M!.._ ... Q)cp_<;COI:._-_ o>en
"t':: ~'c~U;;:::l -'cc.as:::l.!:::a.en~Euoen
... _ ~,CUcp..!P:'"" ~~ ~uE-oenenE_as:::l(l):::l
Q) "" ..... o.c.... ~ E CD a. :t.c >- -g ';;.c e :::l c.c E 0
.. w>< .c..!P ~ ~ Om g 111 .2'; ~ ~ ~.; ~ ~ ~ ~ .~~ ~
=~ g~eno=~ ~Ul g.=.Een(ij.=-.:M!.'~c:.:M!..5c
W "" _ G)'-EenNenens CDE~:g_E'Dencpo_en~"ii
..... G)N<;Q):i.... Ol:en CQ)E'CG)~.",
Q) ca :::lasc:'6 -i:' .:::l.1!!=o_.c.1!!asenoc:.co'E
E .., en1D1:: c- ,CencpON:::lQ)cn:::lo~--....
en ... 0 ~o ~ '-o~-.~en.cG)as OG)....
... _.- ~-a,g.~:;~:g:g ~Q.~'C_Q) a.fij (,) o';;;;a.~
Q) "" E Q)Eena.l:eno"Q)E_as.~E....C:,,-;t::enen
> = Q) !!~31.'EQ)E31.!~31$e~~~~m.~e~
" Q).c:~~~~8~~5~~~~8~~~~~~i~
<e:iEO.
. .
. .
. . .
V>
.. 1l
-5 'S;
~ ~
-g ~
~ ;:
o B
'C en$
.. ..-
E 0"
as en o~.g
en ~ en"OO
t; en cp-cD
Q);: EoU ~m en
III C.Ou Q) S;OCo!:! E
'E ~~~:gYa;.!
a:oen~4i.2~
:J::::l G) ~oiii.! fij en~
egoiii.Qas~EE
B&Q)C:~~~.!!2'c:
'iilij~'iw:)::!:<(<(
~Oo5.c.... .
... .
~ V>
.(;) B_
2 'e 16 s
l; C
jgU. ~~" .m
>-Q) ~'5 a 8~
as.<!: 0 cr en
~~ m~5 ;ern
J!!e m.!!:; ~5
;~ .!!~~s~u
a;,Q 0.- G) c.- as
E. 'C a; 0lQ)a; is.
.E:::l ~Ee~E~
'E~E as 82 00=
caUo Ic~ag-g
N'CU ~-=:::~l::'-as
ca CD"Q) O'D,,~ as~.c
:J:~:n O(ll(ll:-CD'"
'iiE(ll:u=-s;c.B5.~
uCPE.x.!!!eE'ES2
E:2Eg~c.OQ)ca.
~5~o.i.s.Et58.s
o. . .. ..
.
"
:c
.j!!
..
V>~
en 5.~
5 cj;i c:
.~ ~ E ~~
.15. ~:::lCD~
8li1(1l'E~~'E
iio3.1!!.!~~
:J:!OUi3~'D8
_iO=enu~c
.!l~.E~~""
c:.E<Il!!~ena
!I!-... as 0 e
c~o(ij :J'E.a &
15lfio2~ JS g E
.;;f~~~~{g
c
w. . . . .
.
>- V>
.J::. l:: <<I "C e E
E~s~ E Ci;~.2
.2 ~ c 0 CD N c..c
}le:o~EE~ J!!:g~ fD
c7)-E e >-EO Iii
:: 1:; ca"g"O 13 1;5 E -a. ~
f ....::J Cl) ~ 0- :::l (Il CD
G) ;1 g~E gBo~=g ~ -a
c:n~CD-cE.2~'EEen aienen
i ~ -E~E"8'E~E;i ~s~
C i:i"'O c.2 en.: t:: as ~ -iii E"Oj
ca It) ca" CD 0:0 "... .2 Q)
Z.J::._O"C:c.!.! a.Q)>
.c:; D.i:enx2asasa:l X>'-
ca :;wca~eoZ.E:J ~:ae
..I I -'-'C .- CPO G) as...
~-J!~~~:auc: :neB
CD caiCUc. ena:l50 as~~
~ c...EEEmEu<;.!!E4ia;
CTO: Eu~~EE~SES'S
.- E'ii:::l..!!:!oasJ20CPCD.!!uu
c: E1i:2w III uu..l::1I: Eu.<c<c
::>> C:::E= . ... . .
. C
.oil
j..
, ..
...:IE
'D'
..~
a:~
, .0
:OJ
j!..
..:I:
2'.
0.0
",j
0..
..-~
0..
"'..
0."
i~
.
..
.!!!~
CD SEE ~
:g 8....-g.G) -8 ,,<<1
~ "CDID asS~" ~ ~u
~"~,,C: EEE~ OE....CP as'l:
~_,C ~CPEas:::l:::l:::li ~....CDCD~ u.2
CP~aCDB~:::l~~~~"~~S~€E Q)~.J::.
~QuC:'ccpCOOOO~CD~O"CQ)as cogQ)
S;;g~Q~EEEENNNOCD~E5ro~...c:
5555~~~EEEEm~lfi~~=""e~~~~
~~<~<~<<<<<~~mUWW&LL.IIIO
..
"
.C
-g, CD Q) ~
,C Q) C c: --
E G) ~~. ~ o,,~ .! G)
~ ~ Oe ~ ~ ~.~g:g ~ 2 g~~~
".E- 0 Q)ro~ a. ou aso-O ~c:....~
O;;:::lE~ .5~~CD~ ai~_2l::~a. >:;;as-g..2
aQi~.2ooE1D~fij~E~uEo~R~ B~,Cti
~~~~~~~~€im~~~t-at~..-a~~~~~~
,,~ U~~ -onasCc:cenc. -'-'--0-
g-a:l~~~~~~~...~=CDQ)mooc:'D'C~~~_~
(Il35~~~~~z~~~~f~f~~~~Cf.lWW~~
.
fIj
~
fIj
=
o
Q.
fIj
~
,.Q
=
~
I.e
......
fIj
~
"'0
=
=
-
u
f'f')
Q
Q
M
t"'-
t"'-
~
..
-
.e
o
~
"""'
...
~
1ft It) C8 en Cft
.a.Q:,g.Q:.C1
cu as ca co cv
..J ..J ...I ..J ..J
CDU)""ltMN
.0
co
..J
-
O.ODDI
c
=
.-
......
=
t)Il
.-
=......
c ~
:= ~
= c
-~
=c....
U =
I,.C =
1:: =
= ~
z ;
=
~
......
=
......
00
..
.. .0
co ..
.0 ..J .0 .. ..
co co .0 .0
..J CIl ..J co II
+ N ..J ..J
C> , C> GO
- - ..
'" -
. . . D..
~
.
~
...:
...
..
i
~
~
..
.,
:!