04/04/2007
• New Hanover County Health Department
Revenue and Expenditure Summaries for February FY 2006 - 2007
Cumulative: 66.67% Month 8 of 12
Revenues
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal& State $ 1,948,525 $ 1,522,068 $ 426,457 78.11% $ 1,846,138 $ 1,247,363 $ 598,775 67.57%
AC Fees $ 611,161 $ 443,090 $ 168,071 72.50% $ 659,496 $ 432,170 $ 227,326 65.53%
Medicaid $ 1,580,867 $ 704,704 $ 876,163 44.58% $ 1,500,300 $ 516,120 $ 984,180 34.40%
Medicaid Max $ 310,000 $ - $ 310,000 0.00% $ - $ - $
EH Fees $ 310,000 $ 123,100 $ 186,900 39.71% $ 300,212 $ 131,298 $ 168,914 43.73%
Health Fees $ 334,200 $ 289,354 $ 44,846 86.58% $ 128,000 $ 151,971 $ (23,971) 118.73%
Health Choice $ 35,125 $ 10,913 $ 24,212 31.07% $ - $ - $
Other $ 2,625,988 $ 1,750,816 $ 875,172 66.67% $ 3,235,186 $ 1,901,078 $ 1,334,108 58.76%
Totals $ 7,755,866 $ 4,844,046 $ 2,911,820 62.46% $ 7,669,332 $ 4,379,999 $ 3,289,333 57.11%
Expenditures
Current Year Prior Year
• Type of Budgeted Expended Balance % Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary&Fringe $ 12,114,229 $ 6,909,242 $ 5,204,987 57.03% $ 11,276,483 $ 6,641,743 $ 4,634,740 58.90%
Operating $ 2,268,968 $ 986,002 $ 1,282,966 43.46% $ 2,064,395 $ 953,981 $ 1,110,414 46.21%
Capital Outlay $ 96,485 $ 53.611 $ 42,874 55.56% $ 714,275 $ 203,750 $ 510,525 28.53%
Totals $ 14,479,682 $ 7,948,855 $ 6,530,827 54.90% $ 14,055,153 $ 7,799,474 $ 6,255,679 55.49%
Summary
Budgeted Actual %
FY 06.07 FY 06.07
Expenditures:
Salaries & Fringe $ 12,114,229 $ 6,909,242
Operating $ 2,268,968 $ 986,002
Capital Outlay $ 96,485 $ 53,611
Total Expenditures $ 14,479,682 $ 7,948,855 54.90%
Revenue: $ 7,755,866 $ 4,844,046 62.46%
Net County $ 6,723,816 $ 3,104,810 46.18%
• Revenue and Expenditure Summary
For the Month of February 2007
8
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 06.07
Date(BOH) Grant Requested Pending Received Denied
317/2007 Closing The Gap- Request for $225,000
• ($75,000 per year for 3 years) from North
Carolina Office of Minority Health and Health
Disparities for a Health Educator to focus on
prevention of HIV and other sexually
transmitted disease in the Latino and Afro-
American populations. $225,000 $225,000
21712007 CA -MRSA: Funding from UNC-Chapel Hill
School of Medicine to assist with research
related to the prevalence of community
associated methicillin resistant staphylococus
aureus $12,600 $12,600
113/2007 Smart Start - New Hanover County
Partnership for Children - Child Care
Nursing Program $178,500 $178,500 a ~600
12/6/2006 Duke Endowment Funds, NHRMC - Dental
Unit - Personal Health Services. $25,000 for
indigent dental care and $15,000 for sedation
equipment $40,000 $40,000
11/1/2006 No Activity for November 2006
10/412006
March of Dimes - Maternity Care
Coordination expenditures for Baby Love
Program Baby Boutique and Learning Center $3,000 $3,000
91612006 No Activity for September 2006
8/2/2006 No Activi for Au ust 2006
• 7/512006 i ervice oor matron amf y
Counseling Program (Cape Fear Memorial
Foundation) - Funding for Licensed Clinical
Social Worker for 3 years $260,000 $75,000 $185,000
Eat Smart move more - Community Grant
(NC Dept of Public Health Physical Activi
and Nutrition Branch $16,495 $12,416 $4,079
Totals $735,595 $443,500 $103,016 $189,079
60.29% 14.00% 25.70%
Pending Grants 3 43%
Funded Total Request 2 29%
Partial) Funded 2 29%
Denied Total Request 0 0%
Numbers of Grants Applied For 7 100%
9
As of 3/2112007
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 04/04/07
CC Consent Agenda
04/16/07
Department: Health Department Presenter: Kim Roane, Business Manager
Contact: Kim Roane, Business Manager 798-6522
Subject: Budget Amendment - Family Planning Program - Personal Health Services -
$33,370
Brief Summary: The New Hanover County Health Department has received notification
from the North Carolina Department of Health and Human Services, Division of Public
Health, that an additional $33,370 has been awarded to be used for any Family Planning
(Title X) approved expense. These funds have been awarded as one-time bonus funds,
based on increased caseload of family planning patients.
• Recommended Motion and Requested Actions: To accept and approve the $33,370
additional State funds to be used to support the New Hanover County Health Department
Family Planning expenditures, and to approve the associated budget amendment for
FY07.
Funding Source: N.C. State Department of Health.and Human Services, Division of
Public Health, Women's and Children's Health Section (Federal Title X funds). No
matching County funds are required.
Will above action result in:
QNew Position Number of Position(s)
Position(s) Modification or change
®No Change in Position s)
Explanation: Funds are to be used for Family Planning Program Title X approved
expenses.
Attachments: Division of Public Health Fund Distribution
•
10
Distribution of One-Time Family Planning Title X Bonus Funds
for FY 2006-2007, March, 2007
be Expended 213 by May 31, 2007 and 113 by June 30, 2007
Spend by May Spend between
I=UI 31, 2007 June 1 and June 30,
[::C:ounty 2007
Total 213 Total 113 Total
Alamance $29,410 $19,607 $9,803
Alexander $7,039 $4,693 $2,346
Alleghany $6,514 $4,343 $2,171
Anson $7,278 $4,852 $2,426
Ashe $9,142 $6,095 $3,047
Avery $7,087 $4,725 $2,362
Beaufort $3,375 $2,250 $1,125
Bertie $8,760 $5,840 $2,920
Bladen $3,375 $2,250 $1,125
Brunswick $11,007 $7,338 $3,669
Buncombe $30,412 $20,275 $10,137
Burke $3,375 $2,250 $1,125
Cabarrus $23,242 $15,495 $7,747
Caldwell $15,642 $10,428 $5,214
Camden $7,040 $4,693 $2,347
Carteret $33,664 $22,443 $11,221
Caswell $7,805 $5,203 $2,602
atawba $50,000 $33,333 $16,667
hatham $25,730 $17,153 $8,577
Cherokee $3,375 $2,250 $1,125
Chowan $7,230 $4,820 $2,410
Clay $9,812 $6,541 $3,271
Cleveland $9,620 $6,413 $3,207
Columbus $3,375 $2,250 $1,125
Craven $11,055 $7,370 $3,685
Cumberland $18,320 $12,213 $6,107
Currituck $11,245 $7,497 $3,748
Dare $9,335 $6,223 $3,112
Davidson $3,375 $2,250 $1,125
Davie $6,800 $4,533 $2,267
Duplin $8,140 $5,427 $2,713
Durham $48,960 $32,640 $16,320
Edgecombe $9,190 $6,127 $3,063
Forsyth $19,659 $13,106 $6,553
Franklin $3,375 $2,250 $1,125
Gaston $50,000 $33,333 $16,667
Gates $3,375 $2,250 $1,125
Graham $3,375 $2,250 $1,125
Granville $3,375 $2,250 $1,125
Greene $3,375 $2,250 $1,125
Guilford $3,375 $2,250 $1,125
alifax $6,130 $4,087 $2,043
arnett $13,970 $9,313 $4,657
Haywood $18,463 $12,309 $6,154
Henderson $11,964 $7,976 $3,988
1 11
To be Expended 213 by May 31, 2007 and 113 by June 30, 2007
County Spend by May Spend between
31, 2007 June 1 and June 30,
Coun 2007
Total 213 Total 113 Total
Hertford $3,375 $2,250 $1,125
Hoke $3,375 $2,250 $1,125
Hyde $3,375 $2,250 $1,125
Iredell $3,375 $2,250 $1,125
Jackson $10,380 $6,920 $3,460
Johnston $6,323 $4,215 $2,108
Jones $3,375 $2,250 $1,125
Lee $12,100 $8,067 $4,033
Lenoir $9,765 $6,510 $3,255
Lincoln $14,015 $9,343 $4,672
Macon $9,621 $6,414 $3,207
Madison $3,375 $2,250 $1,125
Martin $3,375 $2,250 $1,125
McDowell $3,375 $2,250 $1,125
Mecklenburg $50,000 $33,333 $16,667
Mitchell $3,375 $2,250 $1,125
Montgomery $7,800 $5,200 $2,600
Moore $23,244 $15,496 $7,748
Nash $11,580 $7,720 $3,860
New Hanover $33,370 $22,247 $11,123
Northampton $3,375 $2,250 $1,125
Onslow $3,375 $2,250 $1,125
Orange $12,050 $8,033 $4,017
Pamlico $15,450 $10,300 $5,150
Pasquotank $3,375 $2,250 $1,125
Pender $10,386 $6,924 $3,462
Perquimans $8,092 $5,395 $2,697
Person $3,375 $2,250 $1,125
Pitt $3,375 $2,250 $1,125
Polk $6,130 $4,087 $2,043
Randolph $3,375 $2,250 $1,125
Richmond $3,375 $2,250 $1,125
Robeson $33,610 $22,407 $11,203
Rockingham $8,140 $5,427 $2,713
Rowan $6,084 $4,056 $2,028
Rutherford $3,375 $2,250 $1,125
Sampson $15,835 $10,557 $5,278
Scotland $3,375 $2,250 $1,125
Stanly $3,375 $2,250 $1,125
Stokes $6,750 $4,500 $2,250
Surry $3,375 $2,250 $1,125
Swain $6,419 $4,279 $2,140
Transylvania $17,843 $11,895 $5,948
Tyrrell $3,375 $2,250 $1,125
Union $32,080 $21,387 $10,693
Vance $3,375 $2,250 $1,125
Wake $40,880 $27,253 $13,627
Warren $3,375 $2,250 $1,125
2 12
To be Expended 2/3 by May 31, 2007 and 1/3 by June 30, 2007
Spend by May EE-
Total 31, 2007 0,
Count 2/3 Total 1/3 Total
twa;shington $3,375 $2,250 $1,125
Watauga $11,390 $7,593 $3,797
Wayne $12,150 $8,100 $4,050
Wilkes $7,280 $4,853 $2,427
Wilson $3,375 $2,250 $1,125
Yadkin $3,375 $2,250 $1,125
,Yancey $9,000 $6,000 $3,000
State Total $1,125,682 $750,455 $375,227
•
•
3 13
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 04/04/07
CC Consent Agenda
4/16/07
Department: Health Department Presenter: Kim Roane, Business Manager
Contact: Kim Roane, 798-6522
Subject: Budget Amendment - Reduce Revenues and Expenditures in Epidemiology
Division - Foreign Travel Clinic - Personal Health Services - $33,000
Brief Summary: The New Hanover County Health Department's Travel Shot Clinic was
delayed in opening due to operational issues with regard to physician standing orders and
other administrative details that took additional time to ensure operating procedures
satisfied all necessary requirements for compliance. As a result, the hiring of the nurse
was delayed and operating expenses were reduced for the current fiscal year. We request
approval of a budget amendment to reduced revenues and expenditures by an equal
amount ($33,000) to reflect the delayed start of clinic operations.
•
Recommended Motion and Requested Actions: To approve the budget amendment for a
$33,000 decrease in the Epidemiology Travel Shot revenue and expenditure budgets.
Funding Source: Patient health fees
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position s)
Ex lanation:
Attachments: Budget revision explanation
i
14
New Hanover County Travel Shot Clinic
Requested Budget Revision
April, 2007
•
Original budgeted revenues from patient health fees: $78,000
Revised revenue projection: 45,000
Requested amount to reduce revenues for health fees: $33,000
Salary/fringe reduction due to delayed hiring of nurse: $20,000
Operating expenditure reduction: 13.000
Requested amount to reduce expenditures: $33,000
15
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:? Consent Meeting Date:
Agenda: ® BOH: 04/04/07
CC Consent Agenda
4/16/07
Department: Health Department Presenter: Kim Roane, Business Manager
Contact: Kim Roane, 798-6522
Subject: Budget Amendment - Reduce Revenues & Expenditures for Mobile Dental Unit
for FY07 - Personal Health Services - $125,000
Brief Summary: The New Hanover County Health Department's Mobile Dental Unit
program has contracted with a new dentist to provide professional services on the unit.
The recruiting effort spanned a several month period during which temporary dentists
were used to staff the unit. As a result, revenue generation and the associated operating
expenditures have been reduced for the current fiscal year. Approval is requested for a
budget amendment to reduce the revenue budget for Medicaid revenues and the
expenditure budget by a total of $125,000. The expenditures being reduced are salaries
• ($30,000), contract services ($40,000) and supplies ($55,000).
Recommended Motion and Requested Actions: To approve the budget amendment for a
$125,000 decrease in the Mobile Dental Unit revenue and ex enditure bud ets.
Funding Source: Medicaid revenues
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s
[-Explanation:
Attachments: Budget revision explanation
•
16
New Hanover County Health Department
Mobile Dental Unit •
Budget Amendment Request
April 4, 2007
Original Medicaid revenue budget amount: $337,875
Requested revised Medicaid revenue budget: 212,875
Amount of budget amendment request: $125,000
Expenditure budget:
Original budget amount Requested revised budget Amount of budget amendment request:
Salaries $112,334 $ 82,334 $ 30,000
Contr Svc $166,755 $126,755 $ 40,000
Supplies $ 87,000 $ 32,000 $55,000
Total reduction $125,000
•
17
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
• Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 04/04/07
CC Consent Agenda
4/16/07
Department: Health Presenter: Kim Roane, Business Manager
Contact: Jean P. McNeil 798-7505
Subject: Budget Amendment - Transfer of Animal Control Services Trust Funds -
Landscape Adoption Play Area - $2,500
Brief Summary: ACS obtained approval from the County Commissioners on August 19,
2002, to build an on-site spay/neuter facility and adoption play area. Construction for the
clinic was completed in June 2004, and surgeries began in September 2004. Fencing for
the adoption play area was erected in the last year. We have recently received plans to
landscape the area. Our desire is to provide a welcome location from potential adoptive
"parents" to have assistance in selection of a new companion animal. Dogs may be better
viewed for behavioral characteristics in the enclosed fencing. Beautification of the area
is also a plus to enable citizens to envision their own home environment with the new pet.
•
Recommended Motion and Requested Actions: Recommendation for approval of a
budget amendment allowing transfer of funds from the ACS trust fund to cover costs
associated with landscape of the adoption play area. Cost of the project is estimated at
about $2,500.
Funding Source: ACS trust fund
Will above action result in:
QNew Position Number of Position(s)
QPosition(s) Modification or change
®No Change in Position(s
Ex lanation:
Attachments: Estimates received from County Parks Department.
•
18
MAR-13-2007 TUE 02.12 PM HHCO!MRKS FAX k;9104526385 P. 03/05
01/25/2007 16:26 910763377 TRUGREEN LOANDCARE PAGE 02/04 k'
. ~ 4
• it - rn I; -
! UCR EN to dCare
2005 Blue Clay Road
3
Wilmington, NC i 8405 nH
(910) 763-3774 (910) 763-3779 Fate
January 23, 2007
Suzanne Sykes, Landscape S pervisor
New Hanover County Pica
Re bivisid!n Drive Animal ntrol - Front of Building'
a I
Suzanne,
Tr'uGreen IandCare proposes to do the following work at Ana nil Control located within the
Division Drive Facilities:
41 # 1 Sparkims jot islamtd where large tree was removed)
-Install one cubic, yardf soil to build up the bed area ' ;
1 : Install one 2.5" diam` or Kwanzan Cherry tree (pink blooms).
• Instil (14) 1 quart V: 'gated Litiope to complete the roe of existing Liriope which
at= funds that bell.
• . Install (6) 3 gallon DWirf Indian Hawthorn (pink blooms)
• Install (6) 3 gallon E re Azalea 'angel' (white blooms that flower 2.3 times a season
f )
- mature size 3x3
Install 10 bales pines raw to cover the area
subtotal $924.00
rea 2 frbn ofbuii ' o o air) entrance)
•i Tm' plant the exi Crape Myrtle from front sidewalk square to just off the tight side
edge of the front sides elk.
Install 3 Dwarf Indian Hawthorn (pink blootns) neare Crape Myrtle to complete the
plant bed.
• Mechanically trench he outside bed edge and install 3.bales pine straw to cover the now
addition to the bed at near the building.
Subtotal $134.00
inside fro 't sidewalk)
MAjaZWmi
Inyt~ (2) Azalea ;pearl' (pink blooms that flower once in spring --mature size 5 x 5
feet) one Azalea.,in a center of each square.
I it
• Insta1124 Daylily `.`ste. Ia d'oro" (yellow flowers all summaer long-12 in each square 3
perotnet)
Install 2 bales pine stra}v to cover the area.'
Subtotal S2b8.00
Total cost of the above will 1~ $1,326.00
19
i r
t1AK-13-2UU1 TUE 02.13 PM NHCOIPARKS FAX NOl 79104526385 P. 04/05
'01/25/2007 16:26 910763377IKiKittkkryi~i'LaifyUI:F1Kt hWlat lost U4 Tr6dreen IbL.andCare can't arantee survival of any p!a Qty that are not irrigated or any
eadstmg plant matcrial'that is transplanted. AR plants. be watered in and fertilized with
a slow release fertilizer at tie time of installation. Suppigmental watering can be provided
upon request for an CUM c"rge of $70.00 per man hour. }br a tank truck or $30.00 per
man hour for watering wtth a garden hose within 100 feet'of a working hose bib.
The plant varieties, numbers' d sizes chosen were selected f'ot their color, size at maturity and
blooming s hedute, as well ;;fojr their safety around animalChnd their ability to survive (once
established without irngatio present in heavy traffic areas. V
If the abov is acceptable, pl Sve fill out the bottom of the prGposal and fax back to me at 763-
3779. If yogu have any questi as, please call.
1:: f
Thank you,
Neil jCegielEnhancement Manager
TruGrcen II.andCare
a
Accepted By lDate
.a
I
Print Name
iI
i
20
I i
MAR-13-2007 TUE 12,13 PM NHCOIP RKS FAH NQi 9104526385 P. 05/05
' 01/_25/2007 16:26 910763377!. :TRUGREENI ANUCARL t'AGt norroa
TRUGR~FIV L dCarem
2005 Bloc Clay Road
Imiagtori, NC 28405
(910) 763-3774 I
(910) 763-3,779 Fak N
January 231 2007
1
Suzanne S~kes, Landscape S pervisor
New Hanoi er County Parks ; 1 €
~ Ef
Re: Division Drive Animal Control - Inside Fence area i'
i
Suzanne,
TruGreen Landeare propos the following work at Animal rroritrol, at Division Drive facilities. j
no am proposed is loco.ted inside of the fenced area. ~1: `
f
Pr6p area for new bed, plant install $90.00
14tall (5) 3 gal. Ca 'ssa HolIies $110.00
• • Install (12) 3 gal. "Bltlie'b White Azalea $234.00
• all (9) 3 gal. He Blush" Azalea $176.00
• Install (9) 3 gal. "R y " Lorapetalum $223.00
• . Install (2) 3 gal. Os anthas Tea Olive $50.00
• Install (2) 3 gal Pod carpus $50.00
• Ins. (20) Bales of ''ne straw : $140.00
TOTAL FOR MATEW.LS„AND LABOk $1,072.00
TruGreen LandCare cannot ntee survival of p1nnt material; that has no irrigation. Plants
will be wa~ed and feltiliz i with installation. Supplement v attiring can be provided, upon
requesti&4 for an extra ebaa'ge f $70.00 per ~ an hour with our water truck. We can also water
with a en hose, i£thtre i `a boss bib Within 100 feet, at cost of $30.00 per man hour.
If the above is acceptable, pl _ fill out the bottom of the p opt sal and fax back to me at 763-
3779. We appreciate your ' 'sideration and if you have anyquestions, please call.
Thank you,
Neal Johnson, Area Manage
TruGreen laridCare • Accepted By Date
I
Print Name
I
j I f 21
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
• Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ? BOH: 04/04/07
CC Mtg: 04/16/07
Department: Health Presenter: Betty Jo McCorkle, Clinic
Su ervisor, Personal Health Services
Contact: Janet McCumbee 798-6559
Subject: Request to provide Colposcopy Services in Women's Preventive Health (WPH)
- Personal Health Services - ($12,000
Brief Summary: Pap smears are performed on women who receive Family Planning
services, Sexually Transmitted Disease (STD) screening, and Breast and Cervical Cancer
screening from our department. Fifteen percent of the pap results are abnormal and
require colposcopy. Over the past year, the patients with abnormal pap smears in need of
Colposcopy have been waiting for 4 to 5 months from the time of notification, until
Colposcopy could be scheduled at New Hanover Regional Medical Center (NHRMC).
Recently, we were notified that NHRMC will now only take referrals for the highest
grade paps; therefore, we have no referral source in New Hanover County. We are
currently looking for $12,000 to purchase equipment to begin doing Colposcopy in our
• Women's Health Clinic. We also hope to seek grant funding for 07/08 for additional
start-up costs and training. There is a critical need to begin these services ASAP, as these
women must receive services in a timely fashion to meet state requirements, rule out
cancer, and determine follow-up care.
We request approval from the Board of Health and County Commissioners to offer this
new essential service. Start-up equipment costs of $12,000 (Colposcopy machine,
Autoclave, and instruments) to be provided by private grant funds or WPH state funds.
Dr. Henry Temple, local GYN, has agreed to do the Colposcopy at our facility. Thank
you for consideration of this request.
Recommended Motion and Requested Actions: To approve the addition of colposcopy
services and to approve any grant requests available for start up costs; and to approve any
associated budget amendments for FY07 if grant funds are received and submit to the
New Hanover Count Commissioners for their consideration.
Funding Source: Seeking funds from several potential grant sources for start-up costs;
Operating expenditures supported by fees for services, state Cancer grant funds and
Medicaid revenues. Space is available in the clinic for the Colposcopy equipment and
procedures.
• Will above action result in:
22
®New Position (1 temporary physician) Number of Position(s) •
Position(s) Modification or change
EjNo Change in Position(s)
Explanation: Temporary physician to perform services art time as needed; no benefits
Attachments: Col osco Services Proposal
•
23
V NTY.
New Hanover County
Health Department
_
0 2029 South 17th Street .1 J
3y ,i Wilmington, NC 28401-4946 3 k; , O,~;
Phone 910/798-6500 FAX 910/341-4146 NEW NPNOVER COUNTY NEAO~
F ~
'~eeusntn`
Colposcopy Service Proposal
We are actively seeking funds ($12,000) for Colposcopy equipment.
History
The majority of Colposcopy exams performed in New Hanover County for women with Medicaid
and for those without insurance have been done in the outpatient clinics at New Hanover Regional
Medical Center. The OB/GYN residents and Coastal AHEC faculty perform an average of 70
Colposcopy procedures per month and they have stated they are at capacity for this procedure.
Need
New Hanover County Health Department served 1589 female patients who received pap smears
from January 1, 2006 to September 27, 2006. Female patients seek services for Family Planning,
Sexually Transmitted Disease (STD) screening, and Breast and Cervical Cancer screening from
our department. Of the pap smears obtained from January 1, 2006 to September 27, 2006, two
hundred forty nine (249) were abnormal, for a 15.54% rate. Over the past year, the patients with
abnormal pap smears in need of Colposcopy have been waiting for 4 to 5 months from the time of
notification, until Colposcopy could be scheduled at New Hanover Regional Medical Center. The
current recommendation for pap follow-up is: referral within two weeks of receiving the abnormal
results, with the final diagnosis and treatment plan sixty days from receipt of the abnormal pap
results. Patients are receiving notification as recommended, but are not receiving a final diagnosis
• or treatment within the recommended time frame.
This funding would allow the New Hanover County Health Department to provide Colposcopy
services to our patients, so that they receive a treatment plan and final diagnosis within the
recommended time frame. It would provide more efficient follow-up, service low-income
patients, enhance continuity of care, and provide easier patient monitoring to assure compliance
for abnormal pap smear follow-up.
Approximately 75% of our patients have no insurance or Medicaid. There has also been an
increase in Spanish speaking low-income clients who are in need of free services/reduced fees.
Both Pender and Brunswick Health Departments do their own Colposcopy and the procedure is
doable for our department, if we can obtain funds for the equipment. We have known since
September of 2006 that the NHRMC OB/GYN Clinic was back-logged and they had warned us
that we may need to make other arrangements. Since we did not anticipate this before the current
budget year, we had not budgeted to start Colposcopy in 06-07. We had hoped to seek grant
funding from CFMF in July 07. Now the need is critical. NHRMC has stated they can take no
more referrals for regular Colposcopy, indefinitely. They will continue to accept referrals from the
Health Department for the very high risk paps (a small percentage of our totals).
We request approval from the Board of Health and County Commissioners to start this new
service if we can cover start-up equipment costs of $12,000 (Colposcopy machine, Autoclave, and
• instruments). Dr. Henry Temple, local GYN, has agreed to do the Colposcopy at our facility.
Thank you for consideration of this request.
Janet McCumbee, Personal Health Services Manager 3/21/07
24
L n
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
A enda: ? BOH: 04/04/07
Depart ment: Health Presenter: Scott Harrelson, Deputy Health
Director
Contact: Scott Harrelson 798-6592
Subject: Policy Revision - Employee Contact with Board of Health
Brief Summary: Review and advise staff on proposed Employee Grievance and revised
Personnel - Appeals Process policies in regards to the New Hanover County Board of
Health delegating the hearing of grievances and appeals to the Executive Committee.
Revise current Employee Contact with Board of Health policy..
Recommended Motion and Requested Actions: Advise staff regarding the draft
Employee Grievance policy and the revised Personnel - Appeals Process policy. Approve
the revised Employee Contact with Board of Health policy.
• Funding Source: N/A
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Explanation: The NHCHD Policy Team and the Management Team recommend changes
to the Employee Contact with Board of Health policy due to the development of the new
NHCHD Employee Grievance policy. Based on a discussion at the Executive Committee
meeting on March 27, 2007, the Executive Committee recommended that grievance
issues be heard at the Executive Committee rather that the entire Board of Health level.
In addition, the Executive Committee thought the appeals process should be changed
from the Board of Health to its Executive Committee. Staff asks for Board direction
regarding the Employee Grievance and Personnel -Appeals Process policies. The only
policy for the Board's approval is the Employee Contact with Board of Health.
Attachments: 1) Draft Employee Grievance policy 2) Personnel - Appeals Process 3) Revised
Personnel - Appeals Process 4) Employee Contact w/ BOH policy 5) Revised Employee Contact
w/BOH policy
•
25
1 0%~N4Y.N0 New Hanover County Health Department
o ' s Policies and Procedures
2 ~y
4 9 i
a2
0
NEW NANO ER COUNTY HEW~
I~TgN5HF0
Subject: Employee Grievance
Date of Origin: DRAFT
Date Revised:
Policy Number: GS-ADM-068
PURPOSE AND SCOPE:
The purpose of this policy is as follows:
• To provide employees a procedure by which their complaints can be considered rapidly,
fairly, and without reprisal.
• To encourage employees to express themselves about the conditions of work which affect
them as employees.
• To promote better understanding of policies, practices, and procedures that affect
employees.
To assure that personnel actions are taken in accord with established, fair, and uniform
• policies and procedures.
The scope of this policy applies to all members of the New Hanover County Health Department
(NHCHD) workforce.
POLICY:
This policy contains the items required by the state personnel commission to address employee
grievances as well as issues that cannot be heard by the office of state personnel but are
addressed by the NHCHD. This policy describes the steps an employee may take if they believe
they have a grievance. This policy works in conjunction with the Personnel- Appeals Process
policies in offering the employee an avenue to voice concerns.
State Personnel Commission Grievance Issues:
• Denial of promotion due to failure to post
Failure to give promotional priority over outside applicants
• Failure to give RIF (reduction in force) reemployment consideration
• Failure to follow systematic procedures in reduction in force (not alleging discrimination)
• Denial of request to remove inaccurate or misleading information from personnel file
• Violation of the FLSA, Age Discrimination Act, FMLA or ADA (except for employees in
exempt policy-making positions)
• Hostile work environment
• Unlawful workplace harassment
Grievance Issues Not Covered by State Personnel but Addressed by NHCHD:
"Healthy People, Healthy Environment, Healthy Community" 26
• Unfair supervisory practices
• Unjust treatment by fellow co-workers
• Unsatisfactory physical facilities
Unsatisfactory material or equipment
Safety or health hazards
Issues that will not be covered under the grievance policy: •
• Classification of positions
Performance evaluations, performance pay increases or any other honorary or
discretionary award
PROCEDURE:
Any employee having a grievance arising out of his/her employment and who does not allege
discrimination because of age, race, sex, religion, color, national origin, visible and non-visible
handicaps, pregnancy or political opinions or affiliations shall follow the steps listed below:
1) The employee with a grievance shall present the matter to the immediate supervisor
within 30 calendar days of its occurrence in writing with the objective of resolving the
matter informally. The supervisor should consult with their supervisor or any other
county employee deemed necessary to reach a correct, impartial and equitable
determination to be given to the employee in writing within 5 working days. The
grievance and answer shall be reported to the Health Director, Division Manager, and
Deputy Health Director.
2) If the grievance is not resolved during step one, the employee within 10 working days
may file the grievance in writing with the Health Director or designee, who shall hear
the grievance within 10 working days and render a written decision within 10 working
days of hearing the grievance.
3) If the grievance is not resolved to the satisfaction of the employee or group of
employees, they may ask within 10 working days that the grievance be presented to
the Executive Committee of the Board of Health at the regularly scheduled monthly
meeting. All involved parties will be notified of the meeting and may attend to present
verbal testimony. The Executive Committee of the Board of Health will give a decision
in writing within 3 working days after the grievance is heard.
4) If the. grievance is not resolved to the satisfaction of the employee or ,group of
employees they may file a grievance to the State Personnel Commission for issues
listed as grievances by the State Personnel Commission. If the issue is not a
grievance to the State Personnel Commission then the decision of the Executive
Committee of the Board of Health is final.
5) The appeal to the State Personnel Commission must be filed within 30 calendar days
of the final decision rendered by the Executive Committee of the Board of Health.
OTHER INFORMATION:
An employee alleging illegal discrimination has the right to bypass the NHCHD grievance
procedure and appeal directly to the State Personnel Commission. In order to appeal to the
Commission, the employee must file a petition for a contested case hearing with the Office of
Administrative Hearings within 30 calendar days of the alleged discriminatory action. This is
covered in the NHCHD Personnel -Appeals Process Policy.
Exception for Unlawful Workplace Harassment- An employee alleging unlawful workplace •
harassment which results in denial of employment, promotion, transfer, or training, or in selection
"Healthy People, Healthy Environment, Healthy Community" 27
i
for demotion, RIF, or termination, shall have the right to bypass any step involving discussions
with or review by the alleged harasser.
• To prepare for participation in the internal agency grievance procedure an employee shall be
allowed up to a maximum of 8 hours of leave time off from the employee's duties. This leave is
granted without the loss of the employee's pay, vacation or other time credits. This shall only
occur if the appeal reaches the Executive Committee of the BOH level.
For participation in contested case hearings, or other administrative hearings, the employee may
request necessary paid administrative leave. This request is subject to the supervisor or
personnel officer's approval. THe supervisor, Health Director or County Human Resources
Director determines if the leave is necessary and reasonable.
Attorneys or other persons cannot represent either party to the grievance during the internal
agency grievance procedure.
REFERENCES: - - -
State Personnel Manual
NHCHD Policy: Employee Contact with Board of Health
NHCHD Policy: Personnel - Appeals Process
CHANGE HISTORY:
• Version Date ornments
A Original Document (DRAFT)
i
•
"Healthy People; Healthy Environment, Healthy Community" 28
t NEW HANOVER COUNTY HEALTH DEPARTMENT
• Policies and Procedures
i
NFN xxFOYf Y (W Fl. xf NF•
Subject: Personnel - Appeals Process
Date of Origin: 06/13/00
Date Revised: 10/31/06
Policy Number. GS-ADM-012
PURPOSE AND SCOPE:
This policy provides appeal procedures for permanent employees of the New Hanover
County Health Department who have been demoted, suspended, dismissed, reduced-
in-pay or who believe they have been discriminated against because of age, race, sex,
religion, color, national origin, visible and non-visible handicaps, pregnancy or political
opinions or affiliations. The scope of this policy applies to all New Hanover County
Health Department (NHCHD) work force.
POLICY:
No action involving demotion, suspension, or dismissal is to be taken against any
• employee for disciplinary reasons until such action has been recommended to and
approved by the Department Director, except when, in the judgment of the supervisor,
immediate suspension is necessary. In no case will an employee be dismissed without
approval of the Director and without the furnishing of a statement, in writing setting forth
in numerical order the specific acts or omissions that are the reasons for the disciplinary
action and the employee's appeal rights.
PROCEDURE:
STEP 1 - APPEAL TO DIRECTOR
In cases of demotion, suspension, dismissal or discrimination, a permanent employee
has the right to appeal to the Department Director. The appeal must be made in the
form of a written request and must be received by the Director within fifteen (15)
calendar days after demotion, suspension, dismissal, or alleged discrimination. Upon
receipt of the appeal, the Director will make arrangements for the employee to present
his case if the employee so desires. The Director will make a decision within five (5)
working days and a written copy of this decision will be furnished immediately to all
parties concerned.
STEP 2-APPEAL TO AGENCY PROGRAM BOARD
If the decision reached by the Director is not acceptable to the employee, he/she may
. request that his/her case be presented to the local Board of Health for its consideration.
This request should be made in writing and submitted through the Director not later than
fifteen (15) calendar days after receipt of the Director's decision. The case will then be
placed on the Board's agenda at its next regularly scheduled meeting. Facts
"Healthy People, Healthy Environment, Healthy Community"
29
r
surrounding the case will be presented to the Board and the employee may speak to •
them if he/she so desires. After reviewing the case the Board will consult with whatever
other sources it deems appropriate and render an advisory recommendation to the
Director within five (5) working days after having heard the appeal.
STEP 3 - APPEAL TO THE STATE PERSONNEL COMMISSION
If the employee is not satisfied with the final decision or is unable to obtain a final
decision from the agency Director within a reasonable length of time, he/she may file a
written appeal to the State Personnel Commission not later than thirty (30) calendar
days after receipt of notice of the Directors decision. The grievant shall be informed in
writing that an appeal to the State Personnel Commission may be made by filing such a
request with the Office of Administrative Hearing, P. O. Drawer 11666, Raleigh, NC
27604. The grievant must give New Hanover County notice of the appeal. Notice must
be given to the County Manager or the Chairman of the Board of County
Commissioners by certified mail within fifteen (15) calendar days of the filing of the
notice of appeal. Notice should be sent to the following address: County Manger (or
Chairman, Board of County Commissioners), New Hanover County, 320 Chestnut
Street, Wilmington, NC 28401.
Grievances involving disciplinary action or allegations of discrimination appealed to the
State Personnel Commission, either from a final decision of the agency grievance
procedure or directly because of allegations of discrimination, will be heard by a hearing
officer of the Office of Administrative Hearings. Following the hearing, the hearing •
officer will make a proposal for decision containing findings of fact and conclusions of
law and will deliver a copy of this proposal to each party. Also, the hearing officer will
give each party an opportunity to file exceptions and proposed findings of fact and to
present written arguments to the hearing officer. After considering all exceptions,
proposed findings of fact and written arguments presented to him by the parties, the
hearing officer will issue a recommended decision containing findings of fact,
conclusions of law and a recommended decision to all parties. The hearing officer will
forward a complete record of the case to the State Personnel Commission, including the
recommended decision. Each party may request an opportunity to appear before the
full Commission and make an oral argument on the recommended decision. The
Commission at its next meeting or as soon as possible thereafter, shall consider the
report and modify alter, set aside, or affirm said proposed decision and certify its
findings to the appointing authority. Decisions which may be made by the Commission
include the reinstatement of an employee to the position from which he has been
removed, the employment, promotion, transfer, or salary adjustment of any individual to
whom it has been wrongfully denied, or other suitable action to correct the abuse which
may include requirement of payment for any loss of salary which has resulted from the
improper discriminatory action of the appointing authority. The decisions of the State
Personnel Commission shall be binding in appeals of local employees subject to the
State Personnel Act if the Commission finds that the employee has been subjected to
discrimination or in any case where a binding decision is required by applicable Federal
Standards. However, in all other local employee appeals, the decision of the State
Personnel Commission shall by advisory to the local appointing authority. •
2
GS-ADM-012
30
• OTHER INFORMATION (attached)
REFERENCES:
Section .2310 from the Personnel Rules for Local Government Subject to the State
Personnel Act
CHANGE HISTORY:
Version Date Comments
A 6/13/00 ;Original document
B 02/111051 Revised document
C 1017/06 Revised document- name change
D 10/31/06 Rev. document- added the word calendar
•
•
3
GS-ADM-012
31
I I pNTY.
o New Hanover County Health Department 074
i Policies and Procedures
i o
< n
' f I"AL
i
0
J. J NEW NANOVff COUXiY XFWN'
A 3~ 2
~~~fllSllf01~
Subject: Personnel - Appeals Process
Date of Origin: 06/13/00
Date Revised: 04/04/07 - Draft
Policy Number: GS-ADM-012
PURPOSE AND SCOPE:
This policy provides appeal procedures for permanent employees of the New Hanover County
Health Department who have been demoted, suspended, dismissed, reduced-in-pay or who
believe they have been discriminated against because of age, race, sex, religion, color, national
origin, visible and non-visible handicaps, pregnancy or political opinions or affiliations. The
scope of this policy applies to all New Hanover County Health Department (NHCHD) work force.
POLICY:
No action involving demotion, suspension, or dismissal is to be taken against any employee for
• disciplinary reasons until such action has been recommended to and approved by the
Department Director, except when, in the judgment of the supervisor, immediate suspension is
necessary. In no case will an employee be dismissed without approval of the Director and
without the furnishing of a statement, in writing setting forth in numerical order the specific acts
or omissions that are the reasons for the disciplinary action and the employee's appeal rights.
PROCEDURE:
STEP 1 - APPEAL TO DIRECTOR
In cases of demotion, suspension, dismissal or discrimination, a permanent employee has the
right to appeal to the Department Director. The appeal must be made in the form of a written
request and must be received by the Director within fifteen (15) calendar days after demotion,
suspension, dismissal, or alleged discrimination. Upon receipt of the appeal, the Director will
make arrangements for the employee to present his case if the employee so desires. The
Director will make a decision within five (5) working days and a written copy of this decision will
be furnished immediately to all parties concerned.
STEP 2 - APPEAL TO AGENCY PROGRAM BOARD
If the decision reached by the Director is not acceptable to the employee, he/she may request
that his/her case be presented to the Executive Committee of the Board of Health for its
consideration. This request should be made in writing and submitted through the Director not
later than fifteen (15) calendar days after receipt of the Director's decision. The case will then
• be placed on the Executive Committee's agenda at its next regularly scheduled meeting. Facts
surrounding the case will be presented to the Executive Committee and the employee may
"Healthy People, Healthy Environment, Healthy Community" 32
speak to them if he/she so desires. After reviewing the case the Executive Committee will t
consult with whatever other sources it deems appropriate and render an advisory
recommendation to the Director within five (5) working days after having heard the appeal.
STEP 3 - APPEAL TO THE STATE PERSONNEL COMMISSION
If the employee is not satisfied with the final decision or is unable to obtain a final decision from
the agency Director within a reasonable length of time, he/she may file a written appeal to the
State Personnel Commission not later than thirty (30) calendar days after receipt of notice of the
Director's decision. The grievant shall be informed in writing that an appeal to the State
Personnel Commission may be made by filing such a request with the Office of Administrative
Hearing, P. O. Drawer 11666, Raleigh, NC 27604. The grievant must give New Hanover
County notice of the appeal. Notice must be given to the County Manager or the Chairman of
the Board of County Commissioners by certified mail within fifteen (15) calendar days of the
filing of the notice of appeal. Notice should be sent to the following address: County Manger
(or Chairman, Board of County Commissioners), New Hanover County, 320 Chestnut Street,
Wilmington, NC 28401.
Grievances involving disciplinary action or allegations of discrimination appealed to the State
Personnel Commission, either from a final decision of the agency grievance procedure or
directly because of allegations of discrimination, will be heard by a hearing officer of the Office
of Administrative Hearings. Following the hearing, the hearing officer will make a proposal for
decision containing findings of fact and conclusions of law and will deliver a copy of this
proposal to each party. Also, the hearing officer will give each party an opportunity to file
exceptions and proposed findings of fact and to present written arguments to the hearing officer.
After considering all exceptions, proposed findings of fact and written arguments presented to •
him by the parties, the hearing officer will issue a recommended decision containing findings of
fact, conclusions of law and a recommended decision to all parties. The hearing officer will
forward a complete record of the case to the State Personnel Commission, including the
recommended decision. Each party may request an opportunity to appear before the full
Commission and make an oral argument on the recommended decision. The Commission at its
next meeting or as soon as possible thereafter, shall consider the report and modify alter, set
aside, or affirm said proposed decision and certify its findings to the appointing authority.
Decisions which may be made by the Commission include the reinstatement of an employee to
the position from which he has been removed, the employment, promotion, transfer, or salary
adjustment of any individual to whom it has been wrongfully denied, or other suitable action to
correct the abuse which may include requirement of payment for any loss of salary which has
resulted from the improper discriminatory action of the appointing authority. The decisions of
the State Personnel Commission shall be binding in appeals of local employees subject to the
State Personnel Act if the Commission finds that the employee has been subjected to
discrimination or in any case where a binding decision is required by applicable Federal
Standards. However, in all other local employee appeals, the decision of the State Personnel
Commission shall by advisory to the local appointing authority.
OTHER INFORMATION: (attached)
REFERENCES:
Section .2310 from the Personnel Rules for Local Government Subject to the State Personnel
Act
"Healthy People, Healthy Environment, Healthy Community, 33
CHANGE HISTORY:
Version :Date Comments
A 6/13/00 Original document
IB 02/11/05 1 Revised document
C j1017/06 ,Revised document -name change
D 110/31/06 Rev. document- added the word calendar
E ;4/04!07 ,Changed process from Board to Executive Committee -Draft
•
"Healthy People, Healthy Environment, Healthy Community" 34
NEW HANOVER COUNTY HEALTH DEPARTMENT
Policies and Procedures _
i
F, NFW NAHOVEF COUNTY NEA
~N flTN~
Subject: Employee Contact with Board of Health
Date of Origin: 09/06/2006
Date Revised:
Policy Number: GS-ADM-058
PURPOSE AND SCOPE:
The purpose of this policy is to establish guidelines regarding communication between a New
Hanover County Health Department employee and members of the New Hanover County Board
of Health when the employee has a complaint or concern regarding personnel practices or
procedures. This policy applies to all staff and Board of Health members.
CHANGE SUMMARY:
Original Document
POLICY/PROCEDURE:
• Generally, an employee who has a grievance, complaint or concern regarding personnel
practices or procedures, which do not fall under the New Hanover County Health Department
Appeals Process Policy, and Procedures should follow the New Hanover County grievance
policy, which can be found in the County Personnel Policy. However, an employee may request
an informal meeting with Board of Health members at any point to present concerns. The Board
of Health will require at least two (2) Board members to attend such a meeting with an
employee.
Examples of alleged issues which may be addressed include but are not limited to: staff
morale, safety or health hazards, unsatisfactory physical facilities, surroundings, material or
equipment, unfair supervisory practices, unjust treatment by fellow workers, unreasonable work
quotas, or any other grievance relating to conditions of employment. Issues related to
demotion, suspension, reduction-in-pay or dismissal or to alleged discrimination based on age,
race, sex, religion, color, national origin, disability, pregnancy, or political opinions or affiliations
should be addressed through the established Appeal Policy.
OTHER INFORMATION: N/A
REFERENCES: N/A
CHANGE HISTORY:
. Version Date Comments
A 09/06/2006 Original Document
B
35
"Healthy People, Healthy Environment, Healthy Community"
~o°"; 'NO New Hanover County Health Department
Policies and Procedures
F
w2 a2 ~ oE'P
NEW HANOVER COUNTY HEW
TJT TP
AdLISN[~
Subject: Employee Contact with Board of Health
Date of Origin: 09/06/2006
Date Revised: DRAFT
Policy Number: GS-ADM-068
PURPOSE AND SCOPE:
The purpose of this policy is to establish guidelines regarding communication between a New
Hanover County Health Department (NHCHD) employee and members of the New Hanover
County Board of Health. This policy applies to all members of the NHCHD workforce and Board
of Health members.
POLICY/PROCEDURE:
An employee may request an informal meeting with Board of Health members at any point. The
Board of Health will require at least two (2) Board members to attend such a meeting with an
employee.
OTHER INFORMATION: (attached) •
N/A
REFERENCES:
N/A
CHANGE HISTORY:
version Date Comments
I A 09/06/20060riginal Document I
B 03/27/2007 Reduced procedures with the development of the Health Department!
Employee Grievance Policy
I
"Healthy People, Healthy Environment, Healthy Community" 36
1
John Graham To econstandy@nhcgov.com
<jwgraham@emaiLun cc drice@co.new-hanover.nc.us
c.edu>
03/26/2007 09:45 AM bcc
• Subject revised agenda
Elizabeth, Attached is a revised agenda and questions for
distribution
about a week before the retreat. Let me know if you have any
questions
or suggested changes. Thanks John
John Graham
Deputy Director
North Carolina Institute for Public Health
The University of North Carolina at Chapel Hill
CB#8165
(919) 966-8450
Draft New Hanover Heath Department Strategic PWnnargActivities Draft 2.doc
•
•
Draft New Hanover Health Department Strategic Planning Activities
2007 .
Planning Retreat Preparation:
Draft and Distribute SWOT questions and materials
o Strength and Weaknesses questions relate to internal capacity to: 1)
respond to mission and vision and 2) to address external public health
priorities
o Existing mission and vision distributed
o Most recent community assessment analysis and community public
health prioritization
o One to two page description of staffing, grant writing, relationship-
building and other activities undertaken since the last planning session
that address current community public health priorities
Planning Retreat:
8:00 - 8:15 Review mission & vision
8:15 - 9:00 Discussion of external public health priorities and funding:
• Emergence of infectious diseases
¦ Threat of natural disasters, especially hurricanes
¦ Rapid spread of chronic illnesses
¦ Access to clinical and dental healthcare •
¦ Availability of/competition for funding
9:00 - 10:00 Identify and prioritize relationships with key community
stakeholders (power/interest grid)
10:00 - 10:15 Break
10:15 - 11:15 Identify key opportunities and threats
11:15 - 11:30 Break for lunch preparation
11:30 - 12:30 Discuss internal strengths and weaknesses vis a vis identified
opportunities and threats
12:30 - 1:30 Identify and prioritize key strategic issues
Post Retreat Planning Activities:
At health department management team meeting following the planting retreat:
• Review/validate/modify departmental strategic issues and issues
prioritization.
;
• ¦ Select 1, 2 or 3 issues as action items
• Constitute work plan teams to develop work plans to address
these action items with mandate to develop high level
tasks/deliverables, time line for deliverables and reporting, and
assigning task responsibilities
At subsequent health department management team meetings:
Review/validate/modify workplans and constitute work teams for highest
priority issuelwork plan
SWOT Questions:
These questions are intended to stimulate your thinking in anticipation of the retreat.
Please look them over, give them some thought and jot down any notes that you'd like to
keep in mind for the retreat.
The following areas of public health concern have been identified as important to the
New Hanover community:
¦ Threat of natural disasters, especially hurricanes
¦ Rapid spread of chronic illnesses
¦ Access to clinical and dental healthcare
• • Availability of/competition for funding
¦ Emergence of infectious diseases
1) Are there other areas of concern that we should consider?
2) Which of these do you believe to be the most important and should be prioritized
with regards to assignment of health department resources?
3) For the most important areas, what is the capacity of the health department or
other community members to address them? Does the health department or
community have particular strengths to address them? What are areas of
particular concern?
4) Is our current allocation of departmental resources in line with our mission and
vision? Are there things we're currently doing that may be a departure from what
we should be doing based on our mission?
5) Are we addressing and/or managing the expectations of key stakeholders well? If
not how might we better respond to or better anticipate their expectations?
•
NEW HANOVER COUNTY
y,
• HEALTH DEPARTMENT
• 9 ? 2029 SOUTH 17 T11 STREET o
IV WILMINGTON, NC 28401-4946 NEW """°"E" `°U"T" "`pO"
TELEPHONE (910) 798-6500 FAX (910) 341-4146
NHCBH - NHCHD Strategic Planning Update
April 4, 2007
Access to Health Care
• Implemented open access scheduling for clinic services to increase capacity for additional patient
visits, improving revenues for health services and improving staff efficiency to reduce the need to
add staff to handle increased patient load. Transformed counseling rooms in to patient treatment
rooms to accommodate more patients. The amount of clients served was doubled with the same
level of staffing.
• Actively sought private grant funding for programs needed in the community, to include (but not
limited to) Diabetes education, maternity and early childhood care, dental services for children,
smoking cessation programs, and nursing services.
• Utilized competitive bidding for contract services to satisfy mandated interpreter needs, reducing the
hourly rate paid for mandated services and increasing availability of contractors to avoid lost time
waiting for interpreters busy with other clients.
• Implemented mass flu clinics to improve service to the community, increase staff efficiency and
maximize revenues for flu and pneumonia shots
• Implemented North Carolina Immunization Registry - computer entry of immunizations saves staff
time (no patient signatures required, no nurse written documentation, ordering state vaccine
• electronically) - producing more efficiency among staff.
• Good Shepherd Clinic (GS), which is funded by several grants, is a cost savings for the county.
From Jan 05 - Sept 05 - according to our survey of clients at GS 68 ER visits were saved based
on the question asked at time of service "What would you have done about this problem if the clinic
had not been here?" The 68 stated that they would have gone to the ER. This is 5% of all the
patients that were seen at the clinic during those 9 months (1302 patients seen). The majority of the
population does not have any type of insurance or income so their medical expenses fall on the
taxpayer and those paying patients at the hospital.
• Implementation of Directly Observed Therapy (DOT's and DOPT's) for homeless TB patients at the
GS clinic is more efficient use of our time/resources - TB nurses do not have to locate these patients
in the community daily. The expense of treating an outbreak of TB or other CD in this homeless
population is costly to the community as well as a health consideration. Having a part time nurse
there helps with communicable disease control.
• Expanded clinic hours to include one night per week for late appointments to improve access to
services for those unable to get to the Health Department during normal work hours. Expanded clinic
hours with lunch hour services.
• Utilized grant funding from Kate B. Reynolds Charitable Trust and Cape Fear Memorial Foundation
to purchase, staff and implement new Mobile Dental Unit to provide dental care to children in New
Hanover and Brunswick Counties.
• Implemented new services in clinic to offer limited physical examinations on a flat rate basis for
employment, sports, and foster care, camp, college, day care, scouts and Head Start programs.
• Worked with Cape Fear Healthy Carolinians to develop Access to Healthcare committee. The
priority area for this committee is affordable quality medical care for poor and uninsured. Cape Fear
Area United Way funded the Committee in the amount of $225,000 for 3 years 2006-2009
• Animal Control Services staff conducted numerous visits to partner animal control agencies to share
• ideas on procedures for our county's agency. Their desire is to bring their group up to the standards
set by our team by implementing such practices as animal licensing ad other successful methods.
State standards will more readily address animal needs as other animal control agencies learn best
practices for their area of jurisdiction.
• Biannual no cost animal rabies vaccination clinics continue to be held, including one in the inner city
community for clients unable to travel to area veterinarians.
"Healthy People, Healthy Environment, Healthy Community"
• Added new CSC and MCC positions for 06-07, to address the need for case management in •
Maternal Child population.
• Increased Revenue & Expenditures for WIC (Women, Infants & Children) Program
• Grant Application - Smart Start Child Care Nursing
Approval of Proposed Fees for Travel Shot Clinic, December 6, 2007
• Grant Application - Duke Endowment Funds - Dental Unit
• Grant Application - March of Dimes (MOD) - Maternity Care Coordination
• Substance Abuse Facilities Meetings
• Access To Care committee has hired staff to develop a community health net of safety net providers
from Brunswick and New Hanover counties. They are working to establish care for the uninsured
and a consistent eligibility and fee structures among the safety net providers. They also plan to
provide case management for the uninsured much like Access III of the Lower Cape Fear provides
case management for the Medicaid population.
• Hired a dentist to work on the mobile dental unit and reduced the number of forms for parent
signature to give consent to treat. Should be financially solvent by June 30, 2007.
• Implemented improved telephone menu options for callers to the general Health Department phone
number, offering more customer-friendly menu options to improve customer access to department
services.
• Obtained funding through Cape Fear Memorial Foundation for a Licensed Clinical Social Worker to
provide direct counseling therapy for families enrolled in Child Service Coordination
• Contracted with Children's Developmental Services Agency for the provision of Targeted Case
Management Service Coordination for children enrolled in Infant Toddler
Obesity
• Partnered with Cape Fear Healthy Carolinians to develop an Obesity Prevention committee to raise
awareness about importance of healthy weight, reduce Body Mass Index of children 2-18 and adults
• Kate B. Reynolds funded projects for Obesity Prevention Committee in the amount of $387,478.00.
• NC Fit of Health and Wellness Trust fund provided $30,000 for 2 years 2006-2008- (fiscal entity is
City of Wilmington Parks and Recreation).
• Cape Fear Memorial Foundation awarded $75,000 for 2006 and is committed to pay an additional
$75,000 for each year (2007 and 2008) contingent upon finding a funding match (fiscal entity is
New Hanover County Health Department).
• An Obesity Coordinator has been hired through UNCW to implement the action plans of the Obesity
Prevention committee for our area.
• A multi-million dollar bond referendum was passed in may 2006 to increase monies for Parks and
Recreation opportunities, including trails, bike lanes and paths, and community focused fitness
opportunities. (Fiscal entity is City of Wilmington)
• YMCA is promoting lifestyle changes in middle school-aged children, by offering more after school
activities (with transportation)), based on a management team business plan that our staff wrote.
• Our Women's Health Services Program is addressing obesity by using Body Mass index and giving
educational literature on weight control; nutrition referrals are also made, assessing and
documenting BMI values for women receiving WPH services (at each visit); providing appropriate
counseling and referrals based on values,
• Our staff serve on the School Health Advisory Council (SHAC), that is promoting the "30 minutes of
physical activity/day" in K-8. Some schools have incorporated activities into the classroom by using
instructional time that is getting the children up and moving. Also through the SHAC, NHCS have
eliminated fried foods from the elementary school cafeterias, and made other improvements in the
dietary menus.
• Child Care Nurses are participating in the "Nutrition and Physical Activity Self-Assessment for Child
Care Project". The project goal is to improve the nutrition and physical activity in childcare.
• WIC staff is trained in "Eat Smart Move More" program and are beginning to implement.
• Cape Fear Healthy Carolinians worked with community partners to develop the downtown walking
loop this past year.
• Schools continue to look at healthier choices in menus such as an increase in fruits and vegetables,
low fat dairy products and decreased frying in the Middle and High Schools. Elementary schools no
longer have the fryers. Vending machines now stock healthier snacks and beverages instead of
sodas. School nurses are working with staff to increase exercise and healthier lifestyles in
"Healthy People, Healthy Environment, Healthy Community"
• individual schools.
Emerging Health Risks
• Developed comprehensive purchasing strategy to ensure vaccine availability throughout periods of
national shortages, resulting in the Health Department's ability to protect the health of the community
and increase revenues. The Pandemic Flu Team was formed out of the health department
epidemiology team to develop a plan for a potential bioterrorism attack in this field.
• A mass dispensing exercise was planned for Fall 2006.
• EpiTeam members attended the 2005 and 2006 NC Epidemiology Teams Conference
• Conducted Smallpox Vaccination Training for the SMAT II conference April 2005
• Completed their "Introduction to Bioterrorism Preparedness" training in conjunction with Coastal
AHEC and the NC Center for PH Preparedness. May 2005
• Attended a meeting to discuss issues related to methamphetamine labs. NC DENR rules became
effective January 1, 2005. Environmental Health and Personal Health are represented on ongoing
local community Meth Lab task force.
• Participated in the Regional Homeland Security Table Top Exercise in Morehead City May 2005
• Attended Community Emergency Response Team (CERT) Training May 2005
• Attended the ATF sponsored training on Terrorist Bombings at UNCW May 2005
• Walk through the school shelters with EM, DSS, and Red Cross June 2005
• Attended the Wilmington International Airport Exercise Planning Committee June 2005
• Attended the IC3 Team Meeting on June 21, 2005 in preparation for the Hurricane Drill
• Attended the Mobile Chernobyl Regional Exercise Planning Committee meeting in Morehead City
June 2005
• Met with Hospital-Based Public Health Epidemiologist June 2005
• Attended the Military Civilian Task Force (MCTFER) meeting July 2005
• Coordinated with NC OPHP&R PIO and AHEC to organize ICCE Net training for the Wilmington
area July 2005
• Attended the SERAC Disaster Preparedness meeting July 2005
• Met with BT Coordinators and Planners form various parts of NC. Recommendation that position be
expanded to encompass All Hazard Preparedness, and title change of Preparedness
Coordinator/Planner. July 2005
• Distributed, for review and comment, draft Computer Training Schedule, North Carolina Public
Health Workforce NIMS Training Plan with requirements August 2005
• Assisted in the development of Plague "play cards" for the upcoming Homeland Security Exercise.
August 2005
• Participated in the NC Dept. of Homeland Security Force Protection Exercise 2005 (Mobile
Chernobyl), the largest preparedness exercise in eastern North Carolina's history. August 2005
• Assisted Carteret County Health Department staff in conducting a Rapid Needs Assessment. August
2005
• Hurricane Oohelia: After action discussion was held by the Management Team September 2005
• Sent out numerous emails regarding Hurricane Katrina response, evacuees, and health issues.
September 2005
ICS Training: The Management team discussed who needed to attend future Incident Command
System trainings. We decided that Health Department employees involved with the EpiTeam, NHC
EOC, and the IC3 should attend. September 2005. Staff has attended ICS training as appropriate to
their position.
• Worked with the NC Dept. of Agriculture and Consumer Services to coordinate mass vaccination flu
clinic exercises with poultry workers. October 2005
• As part of North Carolina's contribution to Hurricane Katrina relief, through Emergency Management
Assistance Compact (EMAC), members of PHRST-2 were deployed to Waveland, Mississippi, in
support of MED-ONE along with SMAT 11. October 2005
• Assisted with the facilitation of a Region 2 BT Planner's meeting aimed specifically at SNS planning
November 2005
• Developed an Avian Influenza PowerPoint presentation for the general public December 2005
• Conducted a Smallpox Vaccination Training workshop with the NHC Health Department. Gave a
Personal Protective Equipment (PPE) presentation for the NHC Health Department annual OSHA
training January 2006
"Healthy People, Healthy Environment, Healthy Community"
• Attended the New Hanover County Local Emergency Planning Committee (LEPC) meeting Jan 06 .
• Collected revised information from the Region 2 health departments for EPI-X. January 2006
• Participated in the Local Health Information Team (LHIT) meeting January 2006
• Discussed the upcoming Tall Ships Event this summer in Carteret County January 2006
• Participated in Avian Flu Seminar and Tabletop February and March 2006
• Consulted with US Coast Guard regarding incoming ships and considerations about Pandemic and
Avian Flu. February 2006
• Consulted with State HAN Administrator regarding HAN issues. February 2006
• Consulted with NC OPHP&R regarding KI issues. Consulted with a local ID physician regarding non-
tuberculosis diseases not reportable to the state or county health departments February 2006
• Participated in an After Action Review conference call on Operation 8-ball, the recent statewide Pan
Flu exercise March 2006
• Attended the New Hanover County Pandemic Flu Tabletop Exercise March 2006
• Consulted with NC Emergency Management regarding needs assessment for the upcoming "Tall
Ships" event in Carteret County March 2006
• Attended the Governor's Pan Flu Summit. NHCHD Website updated March 2006
• Assisted with "White Powder Protocol" training at the Regional Response Team - 2 March 2006
• Disseminated information about the SNS 50-ton inventory to PHRST Team Leaders, RN's, regional
pharmacists, and SMAT II Coordinator April 2006
• Participated in a deployment exercise sponsored by NC OPHP&R. The scenario involved a
"Botulism outbreak April 2006
• Met with NC GCDC, to discuss North Carolina's Quarantine Ports Response Plan draft for airports
and seaports. May 2006
• Attended Epi Info Training at the NE Library June 2006
Hurricane Exercise: The New Hanover County Department of Emergency Management hosted a
hurricane exercise on June 27, 2006. The purpose of the exercise was to evaluate the functions of
the Emergency Operations Center (EOC) and Emergency Public Information Center (EPIC) June
2006
• Met with NHCHD's SNS Site Review Committee regarding selection of mass vaccination "drive by"
sites June 2006
• Participated in the US Coast Guard Maritime Security (MARSEC) tabletop exercise which involved
multi-agency participation June 2006
• Worked at the "Tall Ships" event in Carteret County as part of PHRST-2's public health response.
Provided leadership, collaboration, and liaison between PHRST, OPHP&R, Federal, Local and State
Agencies July 2006
• Responded to an incident per the request of the Regional Response Team - 2 (RRT-2). Assisted
with evaluating possible patients and determining credibility of the agent. Assisted NC GCDC so
that a determination could be made on a sick passenger from Singapore arriving on a flight at
Wilmington International Airport July 2006
• Prepared Region 2's SNS plans to be forwarded to the state August 2006
• Attended the "Suspicious Letter" After Action meeting with the Regional Response Team (RRT-2).
August 2006
• Participated in the statewide "Field Days" exercise in Freedom Park, Charlotte, NC August 2006
• Community increase in pertussis disease is being addressed with addition of a new vaccine to boost
immunity- Tdap.
• Pandemic Flu plans and Strategic National Stockpile plans either are being continuously worked on.
• Mandated Incident Command Systems/National Incident Management System (ICS/NIMS) trainings
being provided for all staff. Deadline of 8/31 from state will be met. ICS training worked into
orientation for new employees.
• Epi Team members took training on use of a software program called Epi Info, to be used during
outbreaks. Epi Info has already been used in one outbreak.
• Updated Epi Team response protocol including improving knowledge of after hours notification
• Worked with other agencies (USCG, ILM Airport) for training and identification of weak areas.
• Incorporated using WebEOC as a medium for reporting, collaborating, communication, and
requesting materiel during incidents and planned events.
• Developed procedural protocols for petting zoos and other venues where people have close contact
with animals and potential risk for zoonotic infections. (Ex: E. coli 0157:1-17)
• Acceptance of Grant Application Funds from UNC-Chapel Hill for Child Care MRSA Project
"Healthy People, Healthy Environment, Healthy Community"
• Discussion on Secondhand Tobacco Smoke - Potential Legislation
• NHC Child Fatality Team 2005 Summary
• Budget Amendment- Phase II Pandemic Influenza Funds
• Budget Amendment - Lead Prevention Program
• Incident Command System Training - National Incident Management System
• On March 29, 2007 we conducted a receiving exercise of the national pharmaceutical stockpile in
conjunction with the state port and local law enforcement.
• On March 30, 2007 we conducted a full-scale drive through mass vaccination clinic at Veterans
Park. The exercise was evaluated by the state and included 6 neighboring health departments as
well as NHC Sheriff, City of Wilmington, County Fire, City Fire, DOT, County Schools and County
Parks and Recreation. We had approximately 300 staff members and 750 participants.
Environmental Health Risks
• Installation of laptop computers in Animal Control Services (ACS) and Environmental Health
Services (EHS) vehicles improves staff efficiency, quality of work and eliminates travel to the office.
• Received grant from Duke University for GIS hardware/software/training. Very successfully used
these & other IT resources particularly from efficiency/information viewpoint in response to citizen
concerns/inquiries.
• Encouraged NHC administrators & officials to educate legislators on the need to repeal legal
restrictions prohibiting local health department's from instituting appropriate fees for services, i.e.
restaurants.
• Added five (5) new Environmental Health Specialist positions to meet the increased demand for
evaluating and monitoring food service operations.
• Sought food science training venues so as to enhance staff competency/focus on HACCP analysis
and risk assessment.
• Equipped all Environmental Health Specialists with updated copies of FDA Food Code and new
thermocouples.
• Structured EHS staff assignments with multidimensional scale to accomplish: (1) development of
increased expertise levels in complex program areas, e.g. food service catering, identifying mosquito
species, interpretation of water quality analyses, (2) reduced cost and time lost to traffic/travel within
the county; and, (3) cross-training of staff/greater capacity to effectively use available personnel
resources at any given time including disaster/emergency response scenarios.
• Through specialized training from NCDENR entomologists, increased staff competency in mosquito
taxonomy.
• Established communication/protocol with municipal and NHC Public Information Officers to assure
prompt notification of the public when sewage spills pose imminent risk to users of recreational
waters in the county.
• Purchased signage for posting notice of sewage spills adjacent to recreational waters when
NCDENR officials identify imminent risks to users, but are not available to assume/perform this
function and task.
• Successfully acquired NHC budget funds to construct an additional building for Vector Control
Program staff to use as a workshop/equipment storage area.
• Successfully acquired NHC budget funds to purchase a large commercial scale tractor with various
peripherals for mosquito control tasks on Eagle Island.
• Provide enhanced reporting of mosquito control activities to the USACE using digital photographs
along with GPS data and ArcMap tools.
• Embargo Authority - December 1, 2006
• Resolution to Support Legislation Authorizing Counties to Set Fees for Local Environmental Health
Food and Lodging Services
• October 2006 - launched yearlong multi-disciplinary project to develop proposal for replacement of
Environmental Health software system to improve staff efficiency, data integrity and customer
• service. Project team includes staff from Environmental Health Services, Health IT, County IT,
County Finance and Human Services Agency Business Manager.
• Communicable Disease staff and Health planner are working with UNCW and the airport concerning
plans for outbreaks or infectious disease events.
• Equipped mosquito adulticide trucks and ULV sprayers with GPS units and software so as to better
manage dispersion of pesticide products and other resources.
"Healthy People, Healthy Environment, Healthy Community"
• Staff met with city and other county staff on Monday, March 5, 2007 to learn about features of the •
newly upgraded Reverse 911 software. A number of potential uses that would enable disseminating
critical information to the affected public more readily were discussed.
Enhanced customer service by equipping staff with air cards for laptops thus enabling real time
notification of permits issued/released to the NHC Inspections Dept.
• Staff attended response training for mass fatalities offered through NC Dept Of Emergency
Management March 5-7, 2007.
• With NHCHD and NHC IT staff, developed RFP for a comprehensive, high-level Environmental
Health Services software package.
NHCHD Internal Issues
• Took advantage of privately funded training opportunities, such as the UNC-CH Management
Academy for Public Health, to provide management development and staff training.
• Utilized volunteers to perform a wide variety of duties, including nursing services, computer data
entry and clerical tasks.
• Negotiated turnkey contracts as often as practical, which in just one case alone avoided $5,000 in
implementation costs that the vendor provided when met with technical installation issues.
• Centralized billing and fiscal operations to improve efficiency reduce cost of items purchased and
specialize position duties.
• Sought and successfully obtained approval for national Public Health Pricing to purchase drugs at a
significantly reduced cost, even lower than state contract pricing.
• Implemented a more restrictive travel policy for the Health Department to reduce travel expenses.
• Utilized county vehicles rather than employee mileage reimbursement for routine courier duties to
reduce cost of transportation.
• Utilized third party insurers to maximize revenues by ensuring billing comprehensive billing.
• Pursuing debt set off to reduce the bad debts and increase collections for past-due accounts. •
• Purchased automated folding/inserting equipment that is estimated to save over 400 staff hours/year
through automation.
• Centralized department courier duties to eliminate multiple trips by multiple staff for deliveries/pick-
ups of mail, bank deposits and supply items.
• Implemented PHTIN video training in our facility for live video conferencing for trainings/meetings to
reduce travel costs for mileage and hotels/meals.
• Laboratory savings/cost avoidance via changes implemented 05-06, such as changing vendors for
the pregnancy test kit, resulting in a $4000 annual savings in those supplies, which will offset the
increases in other areas of supplies. The Laboratory Information System has improved staff
efficiency and enhanced customer service.
• Staff events occurring outside normal work hours & weekends through flexing of time during normal
work hours @ hour for hour rate, i.e. during affected pay period so as to limit/prohibit time & a half
accruals.
• QI plan developed with a general 10-step process. Performance standards for the entire department
are being compiled to assure accountability.
• Began the Service Excellence customer service program for all staff and will incorporate customer
service in to the work plan of each employee. The plan will include staff trainers for all internal
customers. The effort brought attention to customer service for the entire county, as a new position
for this function has been added in Human Resources.
• Staff training and programming have led to improved reporting for clinical services and Community
Health. Our supervisors can run queries that produce reports for 1 day, 1 week or monthly.
Revised the NHCHD 2005 and 2006 New Employee Orientation Schedule
• Operational Definition of a Functional Local Public Health Agency April 2005
• Reviewed Annual Marketing Plan for NHCHD May 2005
• The lab consolidated operations into fewer rooms by contracting out some lab work, rather than
replacing an expensive broken machine, and then freed up a room that will be used by WIC.
• Initiated internal customer service training.
• Reclassified a position to create a Quality Assurance Nurse position to continue the efforts related to
medical record audits, preparing for state audits, OSHA compliance, Infection control, etc.
• Smart Start Grants - Personal Health Services
• NHCBH Operating Procedures adopted January 3, 2007
"Healthy People, Healthy Environment, Healthy Community"
• NHCBH - New Member Orientation
Holiday Celebration - December 14, 2006
• The Board of Health Rulemaking Authority: A Primer for Local Boards of Health
• Performance Appraisal - Health Director
• Performance Management Process - Annual Appraisals of Employees
• NHCHD Annual Report - FY 2005-06
• Public Health Task Force 2006
• Fee Policy Changes
• Fee Policy Change - NHC Health Department Administrative Approval
• Developed and implemented in January 2007, a quality-assurance report tracking patient wait time
during the patient's clinic visit, measuring registration time, clinic service time and total visit time.
Actual results are measured against established objectives.
• Active participation in all County Customer Service Committee meetings and activities to strengthen
consistency with other County departments from a customer's perspective.
• Joined a statewide effort to improve quality of patient information systems by participating in the
state's conversion to the new Health Information System (HIS), which will replace the existing state
system for processing patient information and billing services. New system is proposed to include
some form of electronic medical record imaging.
• Implemented imaging projects in medical records and Environmental Health Services to scan hard
copy records into digital format to reduce the need for storage space and improve access to inactive
records.
Human Sexuality
• Applied for and received additional vasectomy funds - reduces costs of unwanted pregnancies,
successfully requested permission from State to utilize unused vasectomy funds to purchase
department supplies for women's preventive health program.
• Implementation of Family Planning Waiver (Medicaid) - makes services available for individuals that
may have been self-pay on a sliding fee scale or who were unable to pay at all - increasing
revenues.
• Use of lower-priced oral contraceptives (added Ortho Tricyclen Lo to our formulary)
Animal Control and Rabies
• Installation of laptop computers in Animal Control Services (ACS) and Environmental Health
vehicles improves staff efficiency, quality of work and eliminates travel to the office.
• ACS increased individual and kennel pet licensing fees, the breeder permit, and boarding fees in FY
2001-2002.
• Completion of an on-site spay/neuter facility at ACS, which has resulted in greater efficiency of
animal adoptions and better usage of Animal Control Officers. Officers no longer must transport
pets for next day surgeries from area veterinarians, enabling them to respond to field complaints
more rapidly.
• On-site surgeries have resulted in a decreased cost of performing the procedure by utilizing
contracted employees. Area veterinarians had agreed to do next-day surgery based on the size and
type of the animal. Their fees on a per animal basis are considerably higher than on-site
procedures. The facility was built without use of county funds, but it greatly benefits every citizen.
• ACS has gone from using a private collection agency to utilizing County Legal to do general
collections and debt set-off for completion of the pet licensing process. The collection agency kept
30% of monies collected, and County Legal does not. Legal is also able to do government agency
debt set-off procedures on every offender who does not pay through the routine collection process.
• ACS currently utilizes an in-house appeals process for all citations issued. Prior to this being
implemented, violators were taken to small claims court, at considerable cost to the division.
• Purchase of two climate-controlled vans for animal transport in ACS is directly linked to reduced fuel
• cost for officers working further from the shelter. During months of inclement weather, such as
extreme summer heat, the animals may be carried for longer periods of time before unloading at
Division Drive.
• Recent (2006) revisions to the New Hanover County Code, Section Five, will enable ACS to write
citations for animals that are not walked on lead with their owners. Other changes included
neutering of dos that have been declared dangerous or potentially dangerous found in violation of
"Healthy People, Healthy Environment, Healthy Community"
the ordinance, and one aimed at reduction in the number of unwanted litters in the community. It •
stipulates that animals adopted in this county must be neutered.
• NHCBH Revision to Animal Control Services Ordinance, Tethering, February 7, 2007. From March
to April 2007, staff battled to maintain the county's anti-tethering ordinance after it was challenged by
a resident. The law is in place primarily to reduce cost of call responses and to provide one means
of protection against animal cruelty for the dogs of the community.
• Staff is working towards strengthening the mentoring partnership between ACS and students at the
local university. Students are undergoing training, so they can go into the schools to teach children
from K-5 about rabies exposure and general pet care.
• Staff developed an outreach tool notifying pet owners to rabies vaccinate and license their animals.
The bookmark-sized tool will be distributed to area veterinary hospitals and other community
agencies; so incoming residents understand ACS pet requirements.
Held a Public Health Forum for area veterinarians on April 10, 2007, featuring Board of Health
Veterinarian Bob Weedon and State Veterinarian Carl Williams as two of the speakers. The
county's first positive canine, identified on December 22, 2006, prompted an increased desire to
educate citizens about this dangerous threat. Nearly 50 people had to undergo post-exposure
vaccinations as a result of handling the puppy.
• Newly formatted customer satisfaction surveys have been distributed for field and office services at
ACS. Program Support developed these through the Quality Assurance team. The first batch was
started in March as a health department pilot for the new forms.
• Animal Control Services Request for Additional Animal Control Officer, December 6, 2006
• Began Saturday shelter hours on March 3, 2007, at Animal Control Services. Customers may visit
the facility for adoptions, redemptions, animal surrenders, and license updates from 10:00 a.m. until
1:45 p.m. each weekend.
Health Disparities
• Collaborative effort of Cape Fear Healthy Carolinians netted grant funding from the Kate B. •
Reynolds Charitable Trust, a philanthropic organization that focuses on financially needy and
disparate populations. Obesity prevention efforts will largely target communities of low socio-
economic and educational levels.
• Guidelines for Limited English Proficiency (LEP) Interpreter/Translation Services
• Biannual no cost animal rabies vaccination clinics continue to be held, including one in the inner city
community for clients unable to travel to area veterinarians.
• Latino speaker (professor form UNCW) brought in several times over last 2 years, to talk to staff
regarding cultural diversity/Latino population and health care.
• WIC has added additional appointments for Hispanics, as the caseload has continued to increase
every year.
• Evening clinic hours allow staff to reach a client population that may have had difficulty obtaining
time away from work to receive services.
• Applied for and received grant funding to add one additional interpreter to increase ability to provide
services to Hispanic population.
• Grant Application - "Closing the Gap" (NC Office of Minority Health - Eliminating Disparities)
Violence
• Worked with the Cape Fear Healthy Carolinians to develop a Violence Prevention committee with
the following priority areas: youth and gang violence, intimate partner violence and reduction of
intentional injuries. Speakers from Gang task Force presented to staff.
• Collaboration between Animal Control Services (ACS) and other law enforcement agencies to
protect the community from dangerous/potentially dangerous dogs. Wilmington Police Department
sought assistance in patrolling downtown neighborhoods in a preventative measure to identify
households with aggressive dogs.
• ACS also has partnered with members of their Advisory Committee to do school education on
proper methods to protect you against an attack by a vicious dog. This includes dog behavior
recognition and general safety measures.
• A second Management Academy of Public Health ACS team (composed of ACS and Health
Promotion staff) completed a business plan directed towards education of children in bite prevention
methods.
• ACS staff joined the Community Child Protection Team overseen b Social Services to add
"Healthy People, Healthy Environment, Healthy Community"
• information on the connection of animal abuse to future human violence and abusive tendencies.
• Staff attending training on violence and its impact on families
• Staff involved in several community committees/boards that address violence- Community Child
Protection Team and Juvenile Crime Prevention Council; these groups promoted the re-institution of
the Gang Task Force. Task Force is now receiving grant funds and staffed with 3 deputies, and
counselors/case managers; staff have also participated in trainings related to gangs.
• Many of the school nurses are involved with "bullying task forces" at their schools.
•
•
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• David E Rice/NHC To Health, spradleyins@bellsouth.net, donblake@aol.com,
03/21/2007 09:57 AM eweaver@ec.rr.com, rweedon@bellsouth.net,
hickmonj@bellsouth.net, jtunstall@nkteng.com,
cc Pat Melvin/NHC@NHC,
Veronica.Gonzalez@starnewsonline.com
bcc
Subject Fw: Periodic Influenza Report #19
Little change from last week.
INFLUENZA SURVEILLANCE, NC 2006-2007
Influenza-Like Illness-in Sentinel Site Patients (Solid
Comparative prior years, Dashed Lines
Data available as of 21 March, 2007
8.0%
M
7.0% i- - - -
• 2003-2004 1 1,
6.0% ----------------------I-------
1 00,
5.0% ---------------------------------------------------o - -
mom:
J
4.0% - - - r-----
- -
3.0 /o - 2006-2007
-
L 2004-2005
2.0% - , -
L - o -
1.0% - , O.
- - - -
*,y - -A -AOe.
0.0%
N ~~b h4 hN N DR co CO
o ^N
WEEK #
Forwarded by David E Rice/NHC on 03/21/2007 09:55 AM
Torrey McLean
~6 i'ii
t
<Torrey.McLean@ncmail.net To Ihd <Ihd@ncmail.net> •
CC "epi.mgt-staff' <epi.mgt-staff@ncmail.net>, publichealthmgt
03121/2007 09:35 AM team <Public.Health.Mgt.Team@ncmail.net>, gcdc-epi
<gcdc-epi@ncmail.net>, Newt MacCormack
<newt.maccormack@ncmail.net>, Martha Salyers
<martha.salyers@buncombecounty.org>, Janet Alexander
<jalexander@ppcc.dst.nc.us>, MaryAnne Johnson
<spcmaj@MSJ.ORG>, Emily Sickert-Bennett
<esickber@unch.unc.edu>, Jennifer MacFarquhar
<jennifer_macfarquhar@med.unc.edu>, Mark VanSciver
<Mark.VanSciver@ncmail.net>, Ruth Ethridge
<RElhridg@PCMH.COM>, Sheree Smith
<sheree.smith@ncmail.net>, Ken Ring
<kring@maconnc.org>, Gary Fink
<gofficedr@carolina.rr.com>, Jamie Staton
<jstaton@tchospital.org>, Kathleen Shapley-Quinn
-<Kathleen.Shapley@alamance-nc.com>, Kim McDonald
<kwmcdonald@co.pitt.nc.us>, James Roosen
<James.Roosen@waynegov.com>, Eric Lavonas
<Eric.Lavonas@carolinashealthcare.org>, Brad Irvin
<birvin@carilion.com>, Phyllis Rocco
<Phyllis.Rocco@buncombecounty.org>, Sharon Evans
<evans001@mc.duke.edu>, Sherry Yocum
<Sherry.Yocum@clevelandcounty.com>, Tom Barnes
<tom.barnes@ncmail.net>, MH Johnson
<MHJOHNSON@wakemed.org>, T Bischof
<tbischof@wfubmc.edu>, M Scholar
<mscholer@med.unc.edu>, Kristi Clutts
<Kristi.Clutts@carolinashealthcare.org>, Bill Cleve
<WECleve@PCMH.COM>, Pam Moore •
<Pam.Moore@nhhn.org>, engem
<engem001@mc.duke.edu>, Sharon Evans
<evanS001@mc.duke.edu>, Pat Hilliard
<pat.hilliard@mosescone.com>, Susan Hudson
<slhudson@email.uncc.edu>, Ron Sapp
<rsapp@scotlandcounty.org>, Stephen Keener
<stephenkeener@mindspring.com>, Rich Rosselli
<richross@email.unc.edu>, Lou Velazquez
<Ielazquez@uhseast.com>, Kim McDonald
<kwmcdonald@co.pitt.nc.us>, Teresa Ceballos-McArthur
<Teresa.Ceballosmcarthur@med.navy.mil>, Robert Ford
<rford@hotspringshealth-nc.org>, Christopher Klipstein
<christopher_klipstein@med.unc.edu>, Kathy Merritt
<Kmerritt@nc.rr.com>, Rex McCallum
<rex.mccallum@duke.edu>, Bob Weant
<bweant@co.guilford.nc.us>, Steve Dallas
<sddallas@novanthealth.org>, Susan Clark
<aicstc@msj.org>, Eva Dozier
<eva.dozier@scotlandhealth.org>, Judy Vernon
<judy.vernon@ncmail.net>, Mark Picton
<mpicton@caldwellcountync.org>, Nancy Skaletsky
. <nskaletsky@ph.co.durham.nc.us>, Kevin Feig
<feigkp@forsyth.cc>, Sandy Allen
<Sandy.Allen@ncmail.net>, Dianne Enright
<Dianne.Ennght@ncmail.net>, Carol Schriber
<Carol.Schriber@ncmail.net>, Dawn Puryear
<dawn.puryear@ncmail.net>, Sheree Smith
<sheree.smith@ncmail.net>, Patty Poole
<Patricia.Poole@ncmail.net>
Subject Periodic Influenza Report #19
a
Local Health Directors -
Attached for your information is the 19th of our periodic influenza surveillance reports for this
winter. Information from our sentinel sites and the State Laboratory of Public Health shows little
change from last week's figures.
Based upon all available information, the State Epidemiologist has reported to CDC that the level
of influenza activity in the state declined to REGIONAL.
I will be out of the office next week, so the next periodic report will be during the week of April
2nd.
Regards, Torrey
Torrey McLean
General Communicable Disease Control Branch, Epidemiology Section
Division of Public Health, Department of Health and Human Services
L-1
Influenza Sentinel 2006.2007 Report No.19.doc
•
•
• New Hanover County
Animal Control Services
Advisory Committee
Meeting Minutes 03/21/07
Members present: John Boozer (Chair), JoE Needham (Vice Chair), Bob Weedon, Dianne Connor,
Whitney Doremus
Members Absent: Martha Raynor (ex), Gretchen Colby (ex), Cindy Miles (ex), Patrice Kaizar
Old Business
1. Advisory Committee by-laws.
Bob said he'd be glad to ask for the revised BOH by-laws, so we'd
have some to work from to develop ones for this group.
2. Advisory Committee member training.
Suggestions for a packet included: by-laws, ordinance copy, ACS
staff list, licensing process. It could also include ACO ride-along,
shelter tour, and DD meeting.
3. Prison/pet partner program.
Whitney said the prison was not agreeable to pursue this.
4. Adopted animal registration form.
• JoE has revised this. She'll send the updated version.
5. Ashley HS w/ Karen Campbell.
Whitney will contact Karen to get this started.
6. New member.
Advertising will go out to fill the vacancy.
7. Anti-tethering ordinance.
Second county commissioner meeting reading is on April 2 at 5:30
p.m. We still need supporters to attend to get it passed.
New Business
1. Public Health Forum - April 10, 6-8:30 p.m.
We have secured continuing ed credits and Dr. Carl Williams will be
there, also. They will respond to Jean until she is gone, then to Bob.
2. Rabies clinic @ ACS - April 21, 1-3 p.m.
Bob will be at HD strategic planning, so we need a veterinarian.
Please come to volunteer time to do certificates.
The pre-veterinary students have been granted $350 in next year's
school budget to host a campus rabies clinic. They want to have it
• near the beginning of the year, as students return to school. They will
ACS AdvCom Meeting Minutes 03/21/07 page two •
also do rabies/pet education on April 12 at Parsley Elementary, grades
3,4,&5, as a pilot for our mentoring work. Campus leaders are excited
about the community involvement opportunity this provides. (They
have been seeking ways to connect with the surrounding area, and this
fits right in with their plan.)
3. NC Animal Rabies Association meeting.
We (Bob & Jean) will go to do a presentation in October.
4. Co-location shelter.
Carol Thiel has left Emergency Management (to DSS). There is no
replacement yet. Rick Hairston is heading this up.
5. ACS adoption play area.
We have estimates to do landscaping. Bob will present at the Board
of Health. The financing will come from the trust fund.
6. Letter to the editor.
A citizen sent a letter to the Star News criticizing veterinarians for not
doing free work. Bob responded by pointing out that their work was
their livelihood, and not all work could be done free of charge.
7. Additional ordinance changes/updates.
ACS staff is looking at changes to consider. We will review these in •
May and adopt them in July to be taken to the Board of Health in
August. We want to be sure to get the one passed (if possible) before
the next fair. It dealt with selling/prize awarding of animals.
8. Committee meeting dates.
Next meeting May 9, 2007. We'll also meet in July (tba).
9. Building community partners.
Let's see where we go with the students and the forum.
10. Where do we go from here?
Isn't this enough?!
David E Rice/NHC To Rob Neilson/NHC
03/1611007 10:08 AM cc Kim Roane/NHC@NHC, Paula Jenkins/NHC@NHC
bcc
Subject Re: F.A.C.T. Recommendations from the 3/14/07 Meeting.
• Approved.
Rob Neilson/NHC
Rob Neilson/NHC
03/14/2007 03:32 PM To David E Rice/NHC@NHC
cc Kim Roane/NHC@NHC, Paula Jenkins/NHC@NHC
Subject F.A.C.T. Recommendations from the 3/14/07 Meeting.
David,
The F.A.C.T. meeting held on March 14, 2007 resulted in the following recommendations
for your approval (no item will result in a change in revenues greater than the $5,000/year
threshold for your approval):
• Foreign Travel Fee for new medication, Chloroquine (250mg) recommending $2.00
per dose.
• Immune Globulin, currently we charge $20 per dose, recommend changing to $30 per
dose based on increased cost.
• Mobile Dental Unit - We would like to stop charging CPT code D9215 (local
anesthesia). Medicaid and Health Choice do not reimburse for this. Per Dr. Hunter is
• considered a required component of various procedures. Request approval to delete
service from fee policy.
• Menomune - currently we charge $95.00 for private pay, and $70.00 for employees.
Due to increased cost we recommend changing the private pay charge to $100.00,
and the employee charge to $95.00.
• Menactra - currently we charge $92.00 for private pay, and we don't have a charge for
employees. Due to increased cost we recommend changing the private pay charge
to $100.00, and set the employee charge to $95.00.
• Employee Medication List - We recommend deleting Triphasil, as it is no longer
carried by the NHCHD. We recommend adding Orto Trycyclen Lo at $8.00 per pack
(the same price as Orto Trycyclen, as it is the same cost).
• Foreign Travel Fees for Health Department Employees - We recommend setting the
fees as listed below:
•
Private Pay NHCHD Employee
Vaccine Charge Charge
Typhoid oral capsule $ 40.00 $ 35.00
T hoid Injectable $ 52.00 $ 47.00 •
Polio Adu@ $ 27.00 $ 25.00
Immune Globulin $ 30.00 $ 28.00
Japan a Encephalitis $ 107.00 $ 95.00
Yellow Fever $ 82.00 $ 75.00
Chloro uine 250 m $ 2.00 $ 1.50
Chloro uine 500 m $ 4.00 $ 2.50
Malarone (pediatric) $ 2.00 N/A
Malarone adult $ 5.00 $ 4.00
Dox c cline 50 m $ 0.10 $ 0.05
Dox cline 5 m $ 4.00 $ 2.00
Dox cline 100 m $ 0.10 $ 0.05
Thank You,
Robert Neilson
Business Officer
New Hanover County Health Department
(910) 798-6680
fax (910) 341-4146
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Post-Contract$yndro a Ctiangmgthe`Cutture rt { +
POLICY FAAsSm;a trategiesforWeathenng -
•the.PerfeH Storm
OPINION: Coping with the Perfect Storm
PROFILE: Senator Daniel K. Inouye
Really Big Planes: Part I
Attracting New Air Service
North to Alaska: Capstone Reducing Accidents
38
d' r
® "Whooping. It Up!
By Vivian Mears RN, BSN, Communicable Disease Program Coordinator. New Hanover County
Health Department, Wilmington, NC
tionately so in adolescents and adults. Chris' deficiency, pneumonia, seizures, brain dys-
physician tested him for whooping cough and function, and malnutrition. The infection is
wrote a prescription for an antibiotic to be spread through direct contact with the tiny
started right away. droplets that travel through the air when an
He also referred Chris' w fe Karen, to her infected person coughs, sneezes, or speaks.
t
obstetrician. The physician told Chris that he Whooping Cough Immunity Wanes,
would be contacting the public health depart- Leaving Adolescents and Adults
men( in Chris' county of residence. Because Unprotected
of its highly contagious nature, a physician Although most children are protected
;a must report a person suspected of having against whooping cough by vaccination,
whooping cough to the local health depart- immunity wanes over time and leaves
"9-;•,,,,`(, ment, so that an investigation can begin adolescents and adults unprotected. During
I~ and people at risk of infection can be treated. 2004, a total of 8,897 (34 percent) of the
Household members and other people 25,827 reported US cases of whooping
close to Chris should begin an antibiotic as cough occurred among adolescents aged
soon as possible, to minimize their illness 11-18 years; 7,481 (29 percent) occurred
Chris Mead* thought that once he had a few and to prevent the spread to others. If Chris .
days away f rom the sniffles and sneezes o among adults aged 19 years and olderr
of indeed had whooping cough, he could have In 2005, the Food and Drug Admin-
his high school physics students, he would been contagious to others for six days before
start feeling better and would be able to he started coughing, and would continue to product products as b (FDA) ooster licensed vaccines two to pnewrovvaccine •
i de
enjoy his holiday break. He and his wife, be contagious until he completed five days protection against tetanus, diphtheria, and
Karen, had reservations to fly to California of the prescribed antibiotic. whooping cough (pertussis) in persons 10
on the twenty-sixth of December. The whooping cough result should be to 64 years of age. Any person who is due
They were going to spend time with available the morning of Chris' departure g for their tetanus shot should speak with
her parents before she was grounded due to date for California. The physician would call their medical provider about replacing this
pregnancy. Chris' illness had begun with the Chris and let him know if he was negative, vaccine with the new vaccine known as
same sniffles and sneezes as his students, and therefore safe to fly. TDAP (Combined Tetanus, Diphtheria and
along with a mild cough and low-grade fever. Pertussis vaccines) that now additionally
However, the cough had become progressively Chris was lucky to have seen a boosts protection against whooping cough.
worse. At this point, he had been coughing physician before he boarded the
for more than two weeks, and it was so force- flight to California, because his Local Policies Vary on TDAP Vaccine
ful at times, he would vomit after a series of illness was much more serious than he Every state health department is different,
coughs finally ended. realized. Like most diseases, whooping so it is imperative that you contact your
He knew he could not fly across the cough has a number of specific symptoms local health department. In North Carolina,
country coughing like this, so he went to an and behaviors. TRAP is available free-of-charge from the
emergency care center. Among the diagnoses . The cough associated with whooping health department. The decision to buy the
considered, the physician suggested he might cough lasts for many weeks, although the vaccine and how to dispense the vaccine
have whooping cough (pertussis), a highly person is not contagious to others either is made state-by-state. If a fee is charged,
contagious respiratory tract infection. (1) after they have taken the appropriate it also can vary from county to county.
"I didn't think people got whooping cough antibiotic or (2) they have been coughing
anymore," Chris said to his physician. for more than three weeks. 'Names have been changed.
' CDC. Preventing Tetanus, Diphtheria, and Pertuss
lie. was informed that since 1990, there Major complications most often are
Among Adolescents: Use of Tetanus Toxoid, Redu
has been air increase in the number of cases common among unvaccinated infants Diphtheria Toxoid and ACellular Pertussis Vaccines.
of whooping cough in the U.S., dispropor- and young children and include oxygen MMWR (Morb Mortal Wkly Rep) 2006; 55/RRgc5.
L "in, trn kln M, t/Apt coo] I
"Communicable Disease Planning
By John D. Sideris, Air Traffic Manager, Wilmington. NC, and Director of Comirimico i io",,
FAA Managers Association
n the confined space of an aircraft, of the first responders. The aircraft crew of passengers a year are very susceptible
T the seriousness of being contaminated would notify FAA and then set a plan into to the threat of a communicable disease
1 by a passenger who is unaware they motion. Information is passed to local outbreak. And we are landing passengers
are carrying a contagious disease is truly airport officials, who initiate a plan. Fortu- every day from airports around the world.
frightening. This scenario can occur nately, they are prepared, and they are very Consider the implications: even diseases
anywhere, at anytime, and to anyone! good at doing this. once believed to be under control are, in
What would you do? How can anyone In my specific airport situation, the some cases, making a comeback. Rare and
combat this situation alone? Is the crew Airport Director of Wilmington Interna- even new diseases literally can land in your
prepared to handle the problem? How many tional Airport - like many others around the airport tomorrow, quietly and completely
more people can be infected, and yet remain country - already realizes the potential for and without warning. What follows can be
unaware of the situation? What is being this type of disaster, and has commissioned chaos without a plan in place.
done to prepare for this possible airborne a group of aviation and community officials
threat? Are we truly prepared to handle 100 to put a Communicable Disease Plan in Be Aware and Be Prepared
to 400 sick passengers and crew? place. This proactive approach will ensure Be aware of what's possible, and resolve
Center for Disease Control is Initiating a the safety of the flying public as well as the to get prepared now to deal with future
Communicable Disease Plan for Aviation wellbeing of the surrounding community situations. Now is the time to be certain
The Centers for Disease Control and Preven- your airport or facility has a Communicable
Cooperation Among a Tremendous Disease Plan firmly in place - reviewed and
tion (CDC) of the Department of Health and Number of Agencies and Law
uman Services, in association with the US endorsed by the CDC, if possible.)
Enforcement Officials is Key
epartment of Transportation, has answers An unbelievable number of agencies and
and sound. advice for passengers, air crews, law enforcement personnel are required to
airports, aviation officials, and others: respond in order for any Communicable
Develop a "Communicable Disease Disease Plan to work. Think about what New Manual Helps Airports, Airlines,
Plan" in concert with all responding and you would expect to find on the ground and Local Governments Respond to
affected agencies in order to validate the to help support the many facets of a true Passengers with Communicable Diseases
cause and isolate a suspected infectious `panic" situation: The National Aviation Resource Manual
person (or persons). By utilizing a plan, law enforcement (local, county, and State), for Quarantinable Diseases is the first
you may be able to prevent shutting down Hospitals, comprehensive guide for the aviation
your entire airport. Emergency Medical Services, community on preventing the introduc-
Implementing this Communicable Airport officials, tion of threatening diseases to the US
Disease Plan now is a major initiative at Airline representatives, by international air travel. Published by
airports and their expanded communities County Health Department the US Department of Transportation in
throughout the US. association with.the Centers for Disease
Think how simple it is for someone to, All of these people are players: this short Control and Prevention of the US Depart-
take a flight, sit down next to you, and list probably represents the proverbial "tip ment of Health and Human Services, the
unknowingly infect you with a disease. As of the iceberg" in a real communicable
disease situation. manual provides guidance for communi-
a member of the airport community and ties on developing airport-specific plans.
a manager in an air traffic control tower, Currently, in the US, many Communica-
I know that the possibility of spreading ble Disease Plans are in effect, reviewed and The manual is available on the Internet at http://
endorsed b the CDC. Some "boilerplate" isddc.dot.gov/OLPFles/OST/013334.pdf.Printed
communicable disease will affect everyone en Y P versions maybe ordered at no charge tram: DOT
in our community plans are being used at airports such as Warehouse. 334175th Avenue, Landover, MD
Anchorage, Atlanta, and Memphis airports. 20785-15". There also is a handy link to the
irTraffic Control Could be a manual atvmw.raama.org.
oirst Responder International Airports are
If infection is suspected on a [light, air Especially Susceptible
traffic control will necessarily become one International airports that receive millions
..faama.org j managing the skies Mar/Apr2007 25