02/07/2007
• New Hanover County Health Department
Revenue and Expenditure Summaries for December FY 2006 - 2007
Cumulative: 50.00% Month 6 of 12
Revenues
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & Slate $ 1,987,805 $ 1,187,110 $ 800,695 59.72% $ 1,865,591 1,236,687 $ 628,904 66.29%
AC Fees $ 611,161 $ 315,432 $ 295,729 51.61% $ 659,496 $ 309,679 $ 349,817 46.96%
Medicaid $ 1,546,994 $ 498,538 $ 1,048,456 32.23% $ 1,500,300 $ 545,476 $ 954,824 36.36%
Medicaid Max $ 310,000 $ - $ 310,000 0.00% $ - $ - $
EH Fees $ 310,000 $ 90,692 $ 219,308 29.26% $ 300,212 $ 97,618 $ 202,594 32.52%
Health Fees $ 250,200 $ 140,306 $ 109,894 56.08% $ 128,000 $ 118,085 $ 9,915 92.25%
Health Choice $ 35,125 $ 9,227 $ 25,898 26.270%o $ - $ - $ -
Other $ 2,751,461 $ 1,296,136 $ 1,455,325 47.11% $ 3,053,386 $ 1,094,362 $ 1,959,024 35.840A
Totals $ 7,802,746 $ 3,537,442 $ 4,265,304 45.34% $ 7,506,985 $ 3,401,907 $ 4,105,078 45.32°h
Expenditures
Current Year Prior Year
• Type of Budgeted Expended Balance % Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary &Fringe $ 12,163,729 $ 5,152,405 $ 7,011,324 42.36% $ 11,315,151 $ 4,898,828 $ 6,416,323 43.29%
Operating $ 2,274,248 $ 781,291 $ 1,492,957 34.35% $ 1,898,430 $ 760,655 $ 1,137,775 40.07%
Capital Outlay $ 88.585 $ 32,690 $ 55,895 36.90% $ 679,225 $ 191,655 $ 487,570 28.22%
Totals $ 14,526,562 $ 5,966,386 $ 8,560,176 41.07% $ 13,892,806 $ 5,851,138 $ 8,041,668 42.12%
Summary
Budgeted Actual %
FY 06-07 FY 06-07
Expenditures:
Salaries & Fringe $ 12,163,729 $ 5,152,405
Operating $ 2,274,248 $ 781,291
Capital Outlay $ 88,585 $ 32,690
Total Expenditures $ 14,526,562 $ 5,966,386 41.07%
Revenue: $ 7,802,746 $ 3,537,442 45.34%
Net County $ 6,723,816 $ 2,428,944 36.12%
• Revenue and Expenditure Summary
For the Month of December 2006
10
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 06-07
Date (BOH Grant Requested Pending Received Denied
• 1/312006 Smart Start - New Hanover County
Partnership for Children - Child Care
Nursing Program $178,500 $178,500
121612006 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
111112006 No Activity for November 2006
101412006
March of Dimes - Maternity Care
Coordination expenditures for Baby Love
Program Baby Boutique and Learning Center $3,000 $3,000
91612007 No Activity for September 2006
81212006 No Activi for August 2006
- rd- 7/512006 I ervlce oor Ina Ion Family
Counseling Program (Cape Fear Memorial
Foundation) - Funding for Licensed Clinical
Social Worker for 3 ears $260,000 $75,000 $165,000
Eat Smart Move More - Community Grant
(NC Dept of Public Health Physical Activity
and Nutrition Branch $16,495 $12,416 $4,079
Totals $497,996 $221,500 $87,416 $189,079
44.48% 17.55% 37.97%
Pending Grants 3 60%
Funded Total Request 0 0%
Partial/ Funded 2 40%
Denied Total Request 0 0%
• Numbers of Grants Applied For 5 100%
11
As of 114/2007
y NEW HANOVER COUNTY
HEALTH DEPARTMENT
Q4
P NEW X.NOVEN COUNTY XFNETV
N q~H
To: New Hanover County Board of Health Executive Committee
From: Kimberly Roane, Business Manager
Date: January 25, 2007
Subject: Budget Summary Packet Fiscal Year 07-08
Attached is a budget summary packet for fiscal year 2007-2008, including a list of
budget preparation considerations used during development of the requested budget
and the department's organization chart. Our total budget request for FY 2007-2008 is
$14,472,631. This is an increase of $348,083 (2.46%) over the Adopted Budget FY
2006-2007 amount of $14,124,548. We are requesting four and one-half (4.5) new
positions for this fiscal year, to include two new school nurses, one animal control
officer, an increase of 20 hours/week for one administrative support technician in Animal
• Control Services, and one administrative support technician in Support Services to
provide combined administrative support to our Deputy Health Director, Personal Health
Services Manager and Administrative Support Coordinator. Projected salary and fringe
figures for these positions are included in the information provided. However, overall
salary and fringe projections do not include any projections for salary market adjustment
or merit increase.
Revenues through federal and state grants, fees, Medicaid, and other sources show an
increase of $174,028 (+2.33%). The net increased cost to the county is $174,055
(2.62%).
Our Budget Request for FY 2007-2008 is due to the County Budget Office on February
12, 2007, for review by the County Manager, Bruce Shell, and his budget team. On
March 1, 2007, the Health Director and I will meet with the County Manager and his
team to present our budget request and respond to questions. In May we will receive
the County Manager's Recommended Budget for FY 2007-2008 for the Health
Department. Any revisions to our original Budget Request will be presented to you at a
later date. On May 21, 2007, a Public Hearing is scheduled providing you with the
opportunity to appear before the County Commissioners to discuss budget matters.
C: Board of Health Executive Committee
David E. Rice, Health Director
Health Department Management Team
12
"Healthy People, Healthy Environment, Healthy Community"
d
n n
rn w N v
~ o N E F
o o ~ o
• y N u m t ~ n
0 ] a U 2
aui C t~ w W x v ~
o L u q
w m a E E
E v
2 = = i
a
N y
O q
~S N S u o
m > F N n o N r N N S S Y S K
O O Vl N o L N t+ n N 6
N n n L n Y S u o y F Y > >
n N
m ~ n N N n N ~ ~ N ~ ~ ~ N a < < o
- v O N ~ a N ~ E c o i, o 'c ~ a Q ¢
0
2 c LL Q _ °Q ~
N j LL x
c 6t
m
E
x
C
N v v W N N O ¢ y .
u n N y uc{ 6 U N
u 76 N E -
c m N o a N $ 2 E y > W
m 2 n W n w w d w n
x x x
T.. T
- w w w w
d
0 E
o o
U Y
0
n
w
N ° R C
c ~ a a SR
~ L
'E m ~ C n v v ~ v
H c
v y Y Y ^ ~
E ~ ~ ~ Y N° m° voi a
u o O N ~ ry gym, r
_x -y =
2 l'n U c aE
IT
to U Q y < y N
o a a
}
O
o U
d Em
L v m
r y
l0 b v N N
N r N v > ~ N N y y Y
> 0 N O 9 V Ln Q L >1 v
v'i C z 2 d w x o ~ in
v o o y 5 o m o
j p U Z 3 T d = c fn w n= ? 2
c _ n
z 3 x E 5 m .u m w u E Z _o fn V z
76 c .Y 10 d o i. x `n o c .o c £ u
0 z o g x N a` a' U :g Z v x S
H ~ u N a a u ~ .Y
a
r m a' a' Z a'
c
m ~
J N
C g'
10 2 _
1 m
tYa ~ ~ = n C n 6
U 2 d y ~ v to t ~ o v uNdi ~
o = vi w Z J a Z a~i Z w
5 S £
O N N a V J J O $ E
a Q ¢ y
N x ~ E S J N ~ ~ 2 ~ y ~
o Q o o ~ ~ O B
~ a a a 4 N a' a
v 13
x
z
EA Q C v
W L
o N V H
9 0 ~ Y
~ h d E z y S
V d n
O y O O D cr p) O
u C ~ W W = = N
w L c
d > V L O
~ a i° m m a v E
.S L _d U ~ L D
N a - Q
S d y L
x x a I
N
Q v
b
m 4 Y t d J N Hri N N S "Jn O
E O S O N n N u n N Y = ~ N n a
fn n n Y C Q o y H Y JEE;
O O N u N D O D
L C N Q C Q
N LL -
L m
m
E
2
in N u in ul O n
C'i
d d U L O d
u
Y n d g N h N ~ U
m „ ~ E z„ N o ~
E Nom- N E I
t Eto °i a` y EW E' > 0 2
d w
d
x s w w = w
_ 9 ~ W W
C
D
o d E
o n o
0 d 5 •
Y rc iu
6 N
6 d
O O `f.
C_ 0 v U R
Q c `a " ~ Y Y
wl r
E ~ ~ !-t Y fA y N Q .
x'
L L
5E
y U Q v Q LL N y
O Q Q
LL L
C
O
U
70
u r E
E
O < m
5 m
d w o n .r.. m _ m Q N
n N Z a n d d ~ 5 = 6 N Y N
41O N U Z j. d d L N C S„ N Z
3 2 E c m u E Z .o m M z 6
76 0 c .1
d ° x N La a° U ° 5 o E x a
m x w a a` u Z v o
O d Q n O
O ° > > 5
N c a a 2 a
d
2
c y
m 5
-cc
d >
t a N ~ N ~ N ~ ~ w
U a' m d u d N r m v ° ~3
h a ° N 9
N O 10 VO O 10 d Q O Z N
O O S W N O N L J a L N
C N D 6 N Z J O Q
N C S Q L N E S a O tR. S 3 N A
_ V
C V N C N ° L V D 0 V a O1
O
°x 14
U
S
Z
New Hanover County
Health Department
9
Requested Budget FY 08
Summary
January 30, 20U7
Requeslt~ed PoSit~ions for FY 07-08
fraWy~ wytm ts.e. syay rxw wfmman nw.r.. wy+un rorx
1.OSY afsx nw 3)n00 9.
Svwy wan nlouc ll.an NU.. N161 faSAn fJA91 S)3f1 st1218 3106 Wz]0)
3tlno11Maln flYYk waln NVw NUZI f45An f)}W St201 s11310 si05 N2T01
Limy Cpgq /rvmy CMtdWW 1]110 SZ
3.M ftitl SI„ln fll jIB {G M]AW
/rvmy LaN YvOn.Mmn Supp}ITMfpn Ptb Ff ISIO ff f1pG f8[0 ,3,}M tlrpp)
CM1b wyn Asn0.AUppy~Tgvuea~~Pr.9W000 t%p fTIAIO ft,131 fl.)n 311310 SW N1AG~
$ 2~2t8,688
15
Ter~.p®ra.ry and UT RequesNt~s
TESPOMRY6AA6F2
XOT
la am°:~:° $ 308,258
MM 'Ut
n.eao ~uev y o
'a .;+wvm
P 5 r . 26.91
~r+Y Meitn '1 5,6, r.'f@' Jt Km 36
MrifilrJtiul S 3,010 , - 3216 T6
we i~ Amo"1"A. a ammo 4
'614
,mASU Obame W 49by "`9301
TW 316
y Goo056 " +.}}3]~~no 3a~1 1301
L54
;4H m~ r 1a.St0 u S 0 .3
4NC PaMnt Flu L 3" 'f + . " ~ "
-T6Qattla, ~~,1 a. ~aw~e(f~ „646464 0309 !m,~y~F~:~e6~5
TOTAL TBIPORMY ~35 t@.632., ;35285 e02 3 et.'2~09
7777-
Y17k ERf1YFl0
H
° ~ .3 Increase: $ 75,991
veua, sotiml ~3os5e a3DD {i1fi1~
An9nY Cmml F106 S,O 0
Y y psp~ _ s
t 5.. p OVER61YT2 L v13":.1776 S $11.]11
•
pendifur`e4Change"s ~Opeating Mcap'ital) from FY 07
YNote: H o9e °b
ORGN FY 0748 Espere., aNy Tml ~ CNOrvGE
Salary 8 EmHeW~ 5113. 50 £1.M Po 10
a,oSo
Fringe 81050 Vew,Coma 180.sw 683 7.000 51M89 064 ($1.010)
" are nOt em an'mai Oenwl 20°,677 6,900 $212.517 ` St9,25t
8l1010 LaEOtON 68,410 0 S61,a6J r 50
inelUded 61130 PwCHeath6T 9.918 0 626,9"8 F.'. $6.@5
01130 Care Cavaration 64.111 0 561.110 S(S
3
00
61150 Wm ftuth e 211 Q.467 .615 01 1 3211,615 1 3- (S300
~ D
61190 Ce=,a6] 0 503.866 7; $].568
51190 Hea1NPty Ik mngtgn 0,698 0 $5.896 11 $1.250
61010 A6M "ban 211.336 0 3211,338 (536,6531
01210 eoam 3.5W 0 53,900 50
6118) Na WbPan e h 6 0 50 y- (52,310
61290 WE 52290 0 552,290 $13.631 A
61290 NuMn 1,500 0 51,500 500
61310 EPi6mn y 336.300 0 5308300 F RSOJ62
61330 m 85.000 10,000 565,000 $X,lo1
6112(1 Lora ST 06,]18 0 315,618 t.. $16,618
61450 He Check 2.500 0 S2.6DO (51,188
61010 Matemel Health 32665 0 532.865 i' 56,000
61530 PWWWCNb 4672 0 55,772 e- ($2528
Overall 01550 CNW H6a1h 36.880 0 $36.0150 (51,500)
61570 C tal H M 5.20D 0 55,210 50
Increase: 61590 S~Meauh 55,830 0 565.816 53,382
61610 NC WiseWaman 8,853 0 50,653 15293)
$43,404 6;8100 Sak CU.A'Nnu hn 6.2 0 00 56.2:]o (35,956)
.5 61681 P 'eat Slap 0 0 SO a so
61770 lm Goof SF~, O V 19.678 0 519.678 ' $1290
e
81640 NC Pardo Flu 0 0 50 - 50
61300 Motile Oeotal Uat 200,600 0 5280.600 58,600 ,
TOTAL 32,064,316 uSM 32090,216 313,161
16
Expanded Funding Reques~t~s
•Security Guard for 17'" St. Facility $55,000
D
•Building repair/maintenance $10,000 '
•Storage Space U LM
•Health Promotion -Cape Fear Healthy C-arolinians' ~
Injury Prevention support $ 1,250
Total $75,650
•
Capital Outlay Requests FYO8
Vector Control ~
Trailer - 2 axle replacement
~ S 8,000
Animal Confro/
1 Fujitsu Scanner
S 7,900
Tuberculosis
Decrease $55,500
~ Copier replacement
510,000 ALL Funded via
increased Revenues
Total Capital Outlay: $ 25,900
17
I
Revenue Changes from FY 07
N %q Sr1R It8 e6f m 01191 ioY W I~
k
6nNM mf/C° ml°.K° p p W~.pm im ~
Vas feN aID] ° 0 IY1 {la,ep sa.Yl]
sm r<,.u ° axa~as ° ° wa.lel su,on
I..w o mo ° ° mm m Z
P~~YiiBi VpAa ° 0 ° 4p.bY WA[
fieCmW, nW ° I.a 1.Ke ° it ]A.M yx,y
m.ny Rw.w IpSj°I b.tla MqV ° ia1101 {OFYf urS .:gyn.:.:
MM ID.aa le.tlp ~ ° IDAa [pMl D
N~,Pmm, H.°a ° ° sa,Wl m
ACC le.tlp II,W {l0,1m I3~SrAY
ee.A • a a o o m m
M1s ° 0 0 o m ImC}ml
we m.wo 0 0 o isaw sm.em
x.u. o IDo amo o sr.sm sm 4
n.w w.mo uo.m o W~.In spml
t eamo aoa .mo o pa.ep snits
:nr ue s,i ° ° o sr.m va.W
wr~ati.{ a.en a nAm o 1335 my
rxua a o ]Ap na.ns nmo
1`.~.loaw.~ o o nesm sm.sm iu.m
o+. ~..m e.%s ]p° sops o tlaAp u4m~
u.ulr..n o ° o o m p
sum wM o o ]Plane nw.pi smni Overall
xcvr.s~ m.sp o ° o tm.sp p
° UI ° ° ° el,l.l mA~l Increase
>?.r ° o o m p
I,RY ° V ° o m p
Aws.~ ° ° ° ® W. arm. $ 174,028
v.sum+n o s o ° o p lim,°m
o°.e s+.p.,a o ° a°m nA°o W.ooo iA.®
rcwu~.w o ° o o m m
o T. mm +2.33%
auw sa o t]A® m
°ru a.en.A. a.au.W i w sxuam sxsa.nr nnsn
TOTAL
•
I
Increased Revenues Support all Increases in
Operating and Capital
D
I _-J
s,eo,ooo.00 i I
s+sa.oao.a0 i --1
s,a0,oao.ao I I
U$174,028+00
$i20,0o M I I o Operatvsg
Capital
$10,0.0
$80,000.00 I ¦ Reenue.
$60.000.00 $43,406.00
$40,000.W
$20,000.00 .
S
YmreaseG Re]saae Vmsaasatl Operawsp Captal,
18
Increased Revenues Support Increased Operating,
Capital, OT, On C?all & Ternp Salaries R
a
$180.000 r
$160,000
$10,000
$1220,000 ~ - - ¦Raverwe
$100,000 R'177028 $ ¦Temp Salanes
$60.000 y®y El OT80n Call
$60.000 P • ROpeatng Ca ital
Eai 404;
$0,000
$20,000
so
kweaud Revane Inc eaeed E)q ditm
•
Increased Expenditures with New Positions Added
;f '34SfxK^~R~-e' 3' a1F^'
350000
300000 I ~RE19111P
250000 iWra' 5726.669
t~ gj,; aNex Pr4itont
x.:7
200000 ._3 ¦TamD Salaries
eOT80n Call
150000 E17402600
:250.00
100000 •S " OOpentinO Capital
- $43.4
50000
0
li m ed Pa k t sd Expenflues
•
19
Total Cost to County for FY 08
FY 06-07 FY 07-08
D
Salary &Fringe $12,077,735 $12,382,414
Operating $ 1,965,413 $ 2,064,317 A
Capital $ 81,400 $ 25,900
Total $14,124,548 $94,472,631
Revenue $7,481,589 $7,655,617
2.62% Cost to County $6,642,959 $6,817,014
increase
•
I _
Your Business Office Team
at Work...."
Fa.
e v
1
}t f Ik;.a
Special Thanks to:
Rob Neilson, Business Officer
Scott Sutcliffe, Fiscal Support Supervisor
Sharon Neuschater, Fiscal Support Tech
Lindy Tatum, Fiscal Support Tech
Doris Buchanan, Fiscal Support Tech
Paula Jenkins, Billing Supervisor
Gail Jernigan, Admin Support Tech
20
h
• NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH Mtg. 02/07/07
CC Mtg. 02/19/07
Depart ment: Health Presenter: Janet McCumbee, Personal
Health Services Manager
Contact: Janet McCumbee, 798-6559
Subject: Budget Amendment - Acceptance of Grant Application Funds from UNC-
Cha el Hill for Child Care MRSA Project - $12,600
Brief Summary: UNC-CH School of Medicine has requested that New Hanover County
Health Department's Child Care Nursing Program assist with a research project related to
the prevalence of community-associated-methicllin resistant Staphylococcus aureus (CA-
MRSA). The Child Care Nursing Program would recruit child care centers to participate
and obtain parent permisison to test children. UNC-CH will fund a full time temporary
nurse position over the next few months, up to $12,000 in salary/FICA expense (with
$600 for mileage), to test the children for CA-MRSA with a nasal swab. NHC was
chosen because of the quality of our current Child Care Nursing Program and our
working relationship with local child care centers.
• Recommended Motion and Requested Actions: To approve the acceptance of UNC-CH
funds up to $12,600 in the current fiscal year to hire two (2) part-time temporary nurses
(to fill one FTE nurse position) for the CA-MRSA project; and to approve any budget
amendment associated with receipt of the funds and to submit to the New Hanover
County Commissioners for their consideration.
Funding Source: UNC-CH School of Medicine. No matching County funds are
required. Temporary positions will be eliminated at the end of the grant funding. No
offices ace is required for these two nurses.
Will above action result in:
®New Position 2 part-time temporary nurses - no benefits
Number of Position(s) 2 part-time 20-hour/week nurses to fill one FTE postion included
in grant funding Number of Position(s)
?Position(s) Modification or change
?No Change in Position(s)
Explanation: Upon approval by Board of Health and County Commissioners, we will re-
instate the 2 temporary flu clinic nurses from December to share the 40-hour position
included in the rant funding.
• Attachments: UNC-CH Summa of Project "CA-MRSA Prevalence in North Carolina Child
21
' CA-MRSA Prevalence in North Carolina Child Care Centers
Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is becoming
• an increasingly important disease entity for which the prevalence and risk factors in the pediatric
population are incompletely described. While hospital-associated MRSA (HA-MRSA) is an established
worldwide problem linked to defined risk factors, there are now numerous reports of MRSA infections that
cause skin and soft tissue infections (SSTIs) and fatal necrotizing pneumonia in children without well-
defined risk factors. The CDC estimates that at least 12% of clinical MRSA infections are community-
associated, but this number is steadily increasing. One recent study found that subjects less than two years
of age had a higher incidence of acquiring a CA-MRSA infection than those who are older (Fridkin et al.,
2005). CA-MRSA strains characteristically carry the type IV SCCmec (Staphylococcal chromosomal
cassette gene) and harbor the Panton-Valentine Leukocidin (PVL) virulence factor. This study seeks to
define the prevalence and risk factors for CA-MRSA carriage in the pediatric population that attends child
care centers (CCCs). To help understand, control, and ultimately prevent and eliminate CA-MRSA
infections, it is critical to understand the prevalence and risk factors for CA-MRSA in this population as
these strains will likely spread throughout CCCs affecting multiple children and families.
Objective(s) and Hypothesis(es):
1. To assess the prevalence of CA-MRSA carriage in infants and toddlers in multiple NC CCCs.
2. To assess the risk factors for CA-MRSA colonization among infants (>12 mos) and toddlers (1-4 yrs.).
3. To determine the antibiotic susceptibility, SCCmec type, and PVL prevalence among MRSA strains.
4. To determine the relatedness of CA-MRSA strains using pulsed-field gel electrophoresis (PFGE).
We hypothesize that the CA-MRSA strains will harbor SCCmec type IV, carry the PVL genes, and
generally be resistant only to P-lactam and macrolide antibiotics. We estimate that the prevalence of CA-
MRSA carriage will be 2-5% and that some of the risk factors for carriage will be poor hygiene and
• crowding. Further, the prevalence in classrooms will be bimodal indicating child-to-child transmission as
determined by molecular analysis.
Desi n: The prevalence of CA-MRSA carriage will be assessed using nasal swabs by means of a cross-
sectional prevalence study in selected NC CCCs. All infants or toddlers will be eligible for inclusion, and
we hope to obtain at least 2000 nasal swabs. The study will be conducted with IRB approval and over-seen
by co-investigators with over 20 years of experience in epidemiology and CCCs research in facilities and
laboratories that are approved by UNC.
After we identify the number of children in NC CCCs that are colonized with MRSA and MSSA,
we will assess the risk factors for CA-MRSA carriage by entering children from the same classroom into a
case-control study (1 case of CA-MRSA to 4 MSSA controls). Risk factors for CA-MRSA colonization
will be determined via questionnaires about the lives of the carriers. Collectively, these data will help us
define the factors that put the children at risk for harboring CA-MRSA.
The antibiotic susceptibility of MRSA strains will be assessed using CLSI criteria. PVL will be
detected using a multiplex real-time PCR assay. PCR will be used for SCCmec typing and PFGE will be
performed on the isolates to determine if there is any evidence of clonal spread.
Potential Impact: This study will be the first to determine the prevalence of CA-MRSA colonization
among large numbers of children in multiple CCCs. Risk factors for colonization will be identified and
compared to risk factors reported in the literature for children ascertained via hospitalization or physician
visits. The data obtained from this study will help physicians identify CA-MRSA infections and treat them
properly to promote rapid eradication to eliminate progression to more serious infections. This study will
• significantly contribute to the understanding of the epidemiology of CA-MRSA in the pediatric population.
Comparing clones may help identify the source of the infection and hopefully help to eliminate or control
it.
23
1
Lay Summary: CA-MRSA Prevalence in North Carolina Child Care C nters
Background: Staphylococcus aureus (SA) is the most prevalent bacterial pathogen in hospitals accounting e
for 10-20% of hospital-associated infections. In the community, it is also an important pathog n causing
many types of infections. Recently, a new type of SA has emerged: community-associated methicillin-
resistant SA (CA-MRSA). This strain has unique genes that allow it to infect people with greater
frequency and cause more damage. Studies have shown that CA-MRSA infects younger popullations and is
especially problematic in children and adolescents that participate in group activities. Since CA-MRSA is
recently described, little is known about the frequency and severity of infections especially am Ing children
attending child care centers (CM). With at least 32% of U.S. children in CCCs, specific knowledge about
CA-MRSA in this setting is critical to prevent and control infection.
Obiective(s) and Hypothesis(es): We will determine the rates for CA-MRSA colonization (presence of
bacteria without infection) in multiple CCCs in NC; we estimate that the prevalence of CA-MRSA carriage
will be 2-5%. We will identify risk factors for CA-MRSA colonization from questionnaires about the lives
of the carriers. We will use state-of-the art molecular analyses to characterize the CA-MRSA isolates and
hypothesize that CA-MRSA strains from different centers will have similar genes and infectivity.
Potential Impact: This is the first study to look at the frequency of CA-MRSA colonization risk factors in
the pediatric population of multiple CCCs. This study aims to collect both field and laboratory data that
will contribute to understanding this critical public health problem in an effort to contain or eliminate CA-
MRSA infections.
Flowchart: Phase I Phase II Phase III Phase IV
I I
Prevalence Case-Control j Incidence of infection j Intervention
MRSA 25 cases -rte
2-5% j j
(n=25) Medical questionnaire I j Observe CCCs ith
Antibiotic I Physician contacts j
SA Demographic susceptibility Bi-weekly phone calls I CA-MRSA j Swabs 25% questionnaire pVLdetection j for 6 months infected individuals
j
(n=2000) (500) SCCmec typing
MSSA PFGE I I
95% I I
(n=475) 200 controls
Following Following
jCDC guidelines Standard Practices
and enhanced
environmental
disinfection
24
2
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
• Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH - 2/7/07
(Co Comm- Consent
Agenda Only - no Board
Action Request to be
submitted for Co Comm
Mt g)
Department: Health Department Presenter: Janet McCumbee, Personal
Health Services Manager, and Kim Roane,
Business Manager
Contact: Janet McCumbee, 798-6559; Kim Roane, 798-6522
Subject: Request to Approve New Vaccines and Fees
Brief Summary: The New Hanover County Health Department (NHCHD) requests the
addition of three new vaccines to be offered in our Open Access Clinic:
Gardisil is the new vaccine for certain strains of HPV (Human Papillomavirus) which can
• lead to cervical cancer. This is also a three part vaccination series for females ages 9
years through 26 years of age. The Vaccines for Children program will cover adolescent
females from ages 9 through 18 years of age. Any female that does not qualify for the
program will be charged for the vaccine..The recommended fee is $140.00/dose. The
schedule is first dose at elected date, second dose is 2 months after first dose, and the
third dose is 6 months after first dose. The Advisory Committee on Immunization
Practices has made a provisional recommendation for routine administration of HPV
vaccine for adolescent females 11-12 years of age, with catch-up vaccination
recommended for females 13-26 years of.age who have not been previously vaccinated.
Zostavax is a one time vaccination against shingles or herpes zoster. This live, attenuated
vaccine is available and recommended by the Centers for Disease Control to be
administered to adults 60 years of age and older. The requested fee is $175.00 per dose.
Medicare Part D will cover the vaccine, but clients will pay and seek reimbursement
themselves. We have received numerous requests from patients for this vaccine.
RotaTeq is a live, oral vaccine to provide protection against rotavirus. Rotavirus is a
virus that causes severe diarrhea, mostly in babies and children. Vaccination consists of
three doses with a dose given at 2, 4, and 6 months of age. The vaccine will be state-
supplied through the Vaccines for Children program which covers medicaid-eligible
children, no insurance, Native American or Native Alaskan, and underinsured children
• that receive vaccinations at a Federally Qualified Health Center or Rural Health Center
(this does not apply to us).
25
.
Recommended Motion and Requested Actions: To approve the, addition of three new
vaccines and the associated fees to the NHCHD Fee 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
Ex lanation:
Attachments: Vaccines and associated fees
26
Vaccines and Fees Requested
To be added to NHCHD Fee Policy
• February 7, 2007
Vaccine Fee Requested
Zostavax $175.00/dose
Gardisil $140.00/dose
Gardisil $0 (for State provided)... $20.00/dose admin fee
(Vaccine code with 52 modifier to administer vaccine to bill private insurance)
Rota Teq $0 (State provided)... 20.00/dose admin fee
(Vaccine code with 52 modifier to administer vaccine to bill private insurance)
(no private pay fee for Rota Teq)
•
27
`i
r
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH - 2/7/07
(Co Comm- Consent
Agenda Only - no Board
Action Request to be
submitted for Co Comm
Mtg)
Department: Health Department Presenter: Kim Roane, Business Manager
Contact: Kim Roane, Business Manager 798-6522
Subject: Budget Amendment - Request to Increase Revenues and Expenditures for WIC
(Women, Infants and Children) Program Budget - $9,474
Brief Summary: The New Hanover County Health Department (NHCHD) requests an
increase in the revenue budget for the WIC program in the amount of $9,474 for FY06-
07. The adopted budget for FY06-07 included revenues of $457,692. Actual revenues
allocated to the NHCHD WIC program are $467,166 as of the current date. We request a
corresponding increase in the WIC operating expenditures to cover the cost of computer
• equipment and temporary salaries to support the increased caseload in the WIC program.
This will allow us to purchase equipment in the current year instead of requesting
additional expenditures for equipment in FY07-08, and will support the temporary salary
currently being paid to a temporary nutritionist to serve the increased WIC patient
caseload.
Recommended Motion and Requested Actions: To approve the requested budget
amendment to increase revenues and expenditures in the WIC budget by $9,474 for
FY06-07.
Funding Source: Federal WIC Health Grant
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Explanation:
Attachments: State Funding Authorization for WIC program
•
28
t
North Carolina Department of Health and Human Services
Division of Pubilc Health
• DPH BudgetfContrad Unit
WIC PROGRAM
Agency Name New Hanover County Health Department
Original SFY_ 06-07 Revision #
Revision Date
STATE USE ONLY
PO# Amount GG GH
FRC FRC
/21 5}S. acts(
5403 Client Services $337,726
5404 Nutrition Education ' 93,433 IL 4 ba/ 291
(Minimum Amount $93.433)
5405 General Administration 18,000 (000. A2 ooU
(Maximum Amount $46.717)
5409 Breast Feeding Promotion 18,007 (pb0a. ODS.
(Minimum Amount $18.007)
Total $467,166
Instruction:
.Using the funds listed in the column "Total of all Sources" on the Budgetary Estimates page, allocate your funds among
the four WIC activites. Note the minimum level of funds that must be budgeted for Nutrition Education and Breastfeeding
Promotion. Your total for the four activities should match the total from the Estimated Budget page. This form is to be
signed and returned to the Nutrition Services Branch Aft: Operations Manager, 1914 Mail Service Center,
Raleigh, NC 27699-1914.
Signature of Agency Director Date
1r u s 13 ~o(o
Ign re f FinanceOfficer Date
Signature of WCHS rwgram Manager Date
DHHS T1506 [)PH Budget/Conaad Unit (Review 3/02)
29
t
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:? Consent Meeting Date:
Agenda: ® BOH - 2/7/07
(Co Comm- Consent
Agenda Only - no Board
Action Request to be
submitted for Co Comm
Mt
Department: Health Department Presenter: Kim Roane, Business Manager
Contact: Kim Roane, Business Manager 798-6522
Subject: Budget Amendment - Request to Decrease Revenues and Expenditures for
Project Assist - $2,954
Brief Summary: The New Hanover County Health Department (NHCHD) requests a
decrease in the revenue budget for the Project Assist program in the amount of $2,954
for FY06-07. The adopted budget for FY06-07 included revenues of $2,954 for
American Legacy funding, which we will not be receiving per guidance from the regional
consultant for that program. We request a corresponding decrease in the Project Assist
• perating expenditures in contract services to offset the decrease in revenues.
Recommended Motion and Requested Actions: To approve the requested budget
amendment to decrease revenues and expenditures in the Project Assist budget by $2,954
for FY06-07.
Funding Source: American Legacy Funding
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Ex lanation:
Attachments: State Expenditure Allocation Summa showing no Funds for American Legacy
30
t~r x • • Hello,
Kim
e Deotof Heahh Aid Toa ,i
and Human ` Logout
Services
Home Reports County Authorization Allocations/ County Line DHHS Disclaimer
Edit Line Item
Tobacco Prevention and Control
County: NEW HANOVER
Beginning Date: 6/1/2006 Ending Date: 5/31/2007 Liquidation Period: 6/30/2007
Activity: Requested Total: Reported 101: Reported 102: Reported 103: Total Reported:
451 $48,303.00 $0.00 $0.00 $0.00 . $48,303.00
This Month's Allocations has already been certified by the County Administration, this is READONLY information.
Activity 451 Fiscal Year 06/07
Fund 1551 Amount Requested 0.00
FRC 00 Local 101 0.00
RCC 5451 Local 102 0.00
Local Budget 101 $0.00 Local 103 0.00
Local Budget 102 $0.00 Expenditure/Amended Month
Local Budget 103 $0.00 Reporting Month January
Remaining Allocation $0.00
NC DHHS DPH Aid To Counties v1.0.5 - Last Modified 1/18/2007
31
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: E] BOH Mtg. 02/07/07
CC Mtg. 02/19/07
Department: Health Presenter: Jean P. McNeil,
Animal Control Services Manager
Contact: Jean P. McNeil 798-7505
Subject: Revisions to New Hanover County Code, Section Five: Animals & Fowl
Brief Summary:
Suggested changes to the New Hanover County Code regarding control of dogs as
enforced by Animal Control Services (ACS). Issues have been reviewed and supported
by County Legal, ACS staff, and the ACS Advisory Committee.
CURRENT: Sec. 5-4. Definitions.
Restraint means the state of a dog if it is controlled by means of a leash, or is on or within
a vehicle being driven or parked, or is within a secure enclosure. Exceptions to restraint
are as follows: Organized and lawful dog functions; e.g., hunting, obedience training,
field and water training, law enforcement training and/or in the pursuit of working or
• competing in those legal endeavors. A dog shall be maintained securely on the property
of its owner. Ropes, chains, and the like shall not constitute adequate security under this
chapter.
PROPOSED: Sec. 5-4. Definitions.
Restraint means the state of a dog if it is controlled by means of an attended leash,
or is on or within a vehicle being driven or parked, or is within a secure enclosure.
Exceptions to restraint are as follows: Organized and lawful dog functions; e.g., hunting,
obedience training, field and water training, law enforcement training and/or in the
pursuit of working or competing in those legal endeavors. A dog shall be maintained
securely on the property of its owner. Ropes, chains and the like are prohibited for any
purpose under this Chapter.
Recommended Motion and Requested Actions: Recommend for the Board of Health to
approve the Revisions to the New Hanover County Code, Section 5-4 Definitions:
Animals and Fowl and to submit to the New Hanover County Commissioners for
consideration.
Fundin Source: N/A
32
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Explanation: Received customer complaint regarding wording of tethering ordinance.
Met with ACS Advisory Committee and individual to review potential changes to the
law. Committee suggested proposed change based on recommendation of Kemp
Burpeau, Deputy County Attorney. The change reflected should eliminate any
uncertainty in understanding the intent of the law.
The committee felt that the ordinance should be maintained and revised for better clari y.
They believe that New Hanover County should keep this law in place for the continue
protection of the dogs in our jurisdiction. The proposed method of tie out was not
deemed acceptable by the group. It also would lend itself to citizen misunderstanding
and abuse of the intended protection measures against tethering.
Attachments: N/A
33
David E Rice/NHC To spradleyins@bellsouth.net, donblake@aol.com,
02/06/2007 01:38 PM eweaver@ec.rr.com, rweedon@bellsouth.net,
hickmonj@bellsouth.net, jtunstall@nkteng.com,
cc kroane@nhcgov.com, Marilyn Roberts/NHC@NHC
• bcc
Subject Board of Health Compensation -Proposed Increase
NHCBH Members,
The following item will be discussed during the FY 2007-08 Budget Recommendation
under new business.
BOH meeting compensation.doc
New Hanover County Board of Health
FY 08 Budget
Meeting Compensation Proposal
Executive Committee Meetings:
12 meetings
Chair - $25 x 12 = $300
Other members (4) - $20 x 12 x 4 = $960
• Personal Health Committee:
5 Members 5 x $20 x 2 meetings = $200
Environmental Health Committee:
4 Members 4 x $20 x 2 meetings = $160
Animal Control Advisory Board:
1 Member 1 x $20 x 4 meetings = $80
Total committee meeting compensation proposed for FY08 = $1,700
Current meeting compensation approved for FY07 budget = $2,700
Board of Health Meetings:
12 meetings
Chair - $25 x 12 =$300
Other members (10) - $20 x 12 x 10 = $2,400
Increase in FY08 budget needed for compensation for committee
meetings: $1,700
Board of Health Compensation '
North Carolina Comparison by County
January 2007
County Health Department $ Amount Paid to Each Donation to cholarship
Member
Cabarrus $0 N/A
RPM - District $0 N/A
Gaston $25 NO
$50 Chair
Once a year donate stipend
for staff luncheon -Pay to
send chair to one state &
one national conference
Onslow $10 NO
Brunswick $50 (comm. mtg. also) NO
Nash $50 (plus mileage) NO
Guilford $18 NO
Caldwell $35 NO
Cherokee $100 NO
(not paid for comm. mtg.)
Buncombe $0 (provide a meal) NO
Alamance $15
Madison $200/quarter
Provide a meal & donate
towards employee of the
quarter
Wilson $20
$25 chair
(meet every other month)
Richmond $50
$55 chair
Haywood $25 & a meal
Pitt $0
Chatham meal & mileage
Scotland $35 chair & vice chair NO
$25 everybody else
Cherokee $100 NO
Columbus $35 NO
Transylvania $0 NO
Montgomery $25 NO
Swain $25 YES
Stipends put toward
scholarship fund
Yadkin $25 member
$30 chair
Orange 25 & light snacks NO
Davie $30 chair NO
$20 everybody else
Lincoln $20 (dessert & coffee)
• County Health Department $ Amount Paid to Each Donation to Scholarship
Member
Henderson $20 NO
Durham $o NO
Beaufort $25 & a snack NO
Greene $20 member NO
$25 chair
Davidson $25 chair NO
$20 members & meal
Wilkes $25 NO
(meet every other month)
MTW District $0 NO
Duplin Meal NO
Rowan $50 chair NO
$40 member
Meet every other month -
A noon meal provided
Union $30 NO
Caswell $40 (not co. comm..) NO
• Lee $20/month NO
Craven $55 (plus lunch)
Surry $0 (mileage)
Franklin $15
Jones $35 chair
$20 member
Graham $50/quarter per member
Robeson $150/mtg chair NO.
$100/mtg members
Sampson $15/mtg NO
(plus mileage & meal)
Catawba $50/mtg chair Some donate to KIN fund for
$35/mtg members indigent children medical care
or dental care
Hoke $50/mtg
Bladen $20 chair
$15 members
(plus mileage)
Macon $35BOH mtg
(no committee mtg
payment)
Rockingham S25/130H NO
$30 chair
Person $20/mtg
(includes committee mtgs)
Stokes $30/mtg
(regular & special) a
Alexander $50 (plus mileage)
Thanks,
David E. Rice, Health Director
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
Phone: 910-798-6591 Fax: 910-341-4146
drice@nhcgov.com
http://www.nhchd.org
David E Rice/NHC To Kim Roane/NHC@NHC
01/16/2007 11:46 AM cc sharrelson@nhcgov.com, jmccumbee@nhogov.com
bcc
Subject Re: F.A.C.T. Recommendations[]
•
Approved.
Kim Roane/NHC
Kim Roane/WC
01 /13/2007 08:38 AM To David E Rice/NHC@NHC
cc
Subject F.A.C.T. Recommendations
The F.A.C.T. meeting held on January 10, 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):
• Deletion of dental codes D1201 (topical application of fluoride- child) and D1205
(topical application of fluoride - adult) per guidance from Medicaid
• Addition of dental codes D0273 (Bitewings - 3 films) - with a fee of $26.91 (Medicaid
reimbursement is $24.46) and D2970 (Temporary crown, fractured tooth) -with a fee
of $139.60 (Medicaid reimbursement is $126.91) per guidance from Medicaid.
• Review of Medicaid reimbursement rates for 2007 results in no need to change any of
our existing rates for established dental procedures.
• New subprograms are required for Travel Clinic reporting: TC (for the visit) and TCI
• (for the immunizations given).
Elisabeth has agreed to make no changes to the current car seat fees while she conducts
further research into other options available. She will also work with Scott Harrelson to
seek Cape Fear Memorial Foundation funding for car seats. She will work with billing
and maternal health staff to investigate Medicaid eligibility guidelines and consider the
impact of those on the overall car seat program requirements.
Kim Roane
Business Manager
New Hanover County Health Department
(910) 798-6522
fax (910) 341-4146
to
V ~
•
Required To Report: • Viral Hemorrhagic Fevers • Measles • Chlamvdia, NGU (Nan-gonococcal
• Phasicians (Nurse Practitioners and • Novel Influenza Virus Infection _ • Meningococcal Disease urethrilis) not lab confirmed
Physician Assistants report under . Within 24 Hours (By Telephone And • Monkeypox • Dengue
physician supervision) Dis Report Card): • Pertussis (Whooping Cough) • • Eiosis (Granular, Monocytic)
• Laboratories (10A NCAC4 11- • yeirn lerlnfectlon • Polio, Paralytic • I alitis, Arboviral(WNV, LaCrosse,
.0102) • aneroid • Rabies, Human etc.)
• Restaurants and other food and drink • Cholera • Rubella • Hantavirus
establishments (Suspected or confirmed • Cryptospnridiosis • Salmonellosis • Hepatitis B Carrier
Foodborne illness) • Cyclosporiasis • SAPS (Coronavirus Infection) • Hepatitis C, Acute
• School principals • Diphtheria • Shigellosis • HIV Infection
• Day care operators • E. coli Shiga Toxin-producing Infection • Staphylococcus nureus Infection resistant • Legionellosis
May Report: (Includes O 157:H7) lu Vancomycin • Leplospirosis
• Medical facilities including hospitals • Foodborne Disease: C. perfringens, • Syphilis • Lyme Disease
Staphylococcal, Other or Unknown • Tuberculosis • Lymphogranulonm venereurn
• Gonorrhea (Genitourinary, Ophthalmia • Typhoid, Acute • Malaria
Of These Diseases To Patient's Local I Neonalormn) • Vaccinia • Meningitis,
Pncumococcal
Department: • Granuloma Inguinale • Vibrio Infection, Other • Mumps
-Health Immediately (By Telephone And Disease • Henrolvtic Uremic Syndrome (HUS) • Vibrio vulnificus • Pelvic Inflammatory Disease
Report Card): • HeniopMlus in(luenzae, Invasive Disease Within 7 Days (By Disease Report Card): • Psittacosis
• Anthrax • HepatitisA • AIDS • QFever
• Botulism • Hepatitis B, Acute • Brucellosis • Rocky Mountain Spotted Fever
• Plague • Hepatitis B, Perinatal • Transmissible Spongiform • Rubella Congenital Syndrome
• Smallpox • Influenza Death < 18 years old F.ncephalopathies (CID, vCJD) • Streptococcal Group A Infection, Invasive
• Tularemia • Listeriosis • Chlamvdia (lab confirmed) Disease
• 't'etanus To http:l/vaers.hhs.gov
• Toxic Shock Syndrome • Any vaccine adversecvent JxipGPfahf TTe&Repifione Ceiftidaft
• Toxic Shock, Streptococcal • • NNM1Vg~s •Cg¢E ~j'Nid ¢
• Trichinosis
• Typhoid Carrier • Local Health Department:
• Typhus, Epidemic Imm ely Nor rolina Health Care Provider
• fellow Fever • Acute pesticide-related deaths" Disease And Injury
Report These Injuries As Soon As Within 48 Hours Local Division of Social Services (DSS): Reporting Requirements
• Acute pesticide-related illness or injury"
Practicable: Within 15 Days: Timely Reporting Protects The Public
To Local Health Department: • Adult (2 16 y.o.) blood lead level 2 40 Local Sheriff or Police: And...
• Any mammal bite pg/dL III; The Law
To Law Enforcement: "May report 24/7 to Carolinas Poison Center, NC General Communicable Disease
• Any firearm discharge wound 1.800-222-1222, Option 5
• Any poisoning Control Branch (GCDC)(2417/365):
• Wound from sharp-pointed instrument (919) 733-3419
(If suspected criminal link/cause) • • NC Office Of Occupational And
• Injury with grave bodily harm/ illness ¦ ~t Environmental Epidemiology (OEE):
of any kind (If suspected criminal link/ nn (919) 707-5940 or 1-800-200-7090
cause) December 2006
To Local Division Of Social Services (DSS): State Laboratory For Public Health: NC State Law
• Child abuse or neglect Acknowledgement: New Jersey Department Of Health (919) 733-7834 NCGS I30A-134 thru 143;
• Abuse or neglect of disabled adults and printed By Public Health Regional Surveillance Team 6 in Carolinas Poison Center: IOA NCAC 41 A .0101-.0103;
elders Asheville, NC.70,000 Copies of this document were printed 1-800-2221222 1 SA NCAC 19C.0701-.0703
at a cost cA7.9 cents per copy fora total of 51593.05.
David E Rice/NHC To Kim Roane/NHC@NHC
01/17/2007 09:39 AM cc
_ bcc
Subject Re: Fee Policy Language - Good Shepherd and Solomon
• Towers[]
Approved.
Kim Roane/NHC
Kim Roane/NHC
01/16/2007 12:12 PM To David E Rice/NHC@NHC
cc
Subject Fee Policy Language - Good Shepherd and Solomon
Towers
Dave,
The F.A.C.T. had one other recommendation that staff have been working on, pertaining
to the need to charge patients at Good Shepherd Clinic and Solomon Towers for services
if we want to bill Medicaid for the services (we cannot bill Medicaid unless we charge the
patients). We recommend using the sliding fee scale, so that the patients won't actually
have to pay a fee based on having little or no income. The document with the language
we'd like to recommend or your approval is:
Fee Policy • Good Sheowddoc
•
Thank you,
Kim
Good Shepherd/Solomon Towers
Page 13, "E"
E. Patients seen for services at the Good Shepherd and Solomon Towers Clinics ill
be charged in accordance with the NHCHD Sliding Fee Scale, 101% - 350%
(Page 29), with the exception of flat rate fee services and those prohibited by
North Carolina State Law (see Pages 9 & 10). Income shall be documented on
the Socio-Economic Income Statement for determination of sliding fee scale
percentage. Medicaid and other third party insurances will be billed unless the
breach of confidentiality statement on the Authorization and Assignment of
Benefits Form (Page 37) is signed by the patient requesting third party billing t
occur. Medicaid is the payer of last resort.
Coastal
AHEC
• and
New Hanover County Health Department
WANT YOU TO KNOW ABOUT THIS PROGRAM!
Pandemic Influenza (PI) Awareness Summit
DATE/LOCATION:
February 17, 2007
Shell Island Resort, Wrightsville Beach, NC
AGENDA:
8:30 AM Registration/Breakfast
8:55 Welcome and Introductions:
Dr. Robert M. Shaker, Jr., Physician Representative
New Hanover County Board of Health
9:00 NC Pandemic Influenza Response Plan
Dr. Krissy Simeonsson, Medical Epidemiologist, Chief Planner, General
Communicable Disease Control Branch, NC Division of Public Health
9:45 Medical Community Preparedness
Dr. Janelle Rhyne, MD, FACP, Clinical Associate Professor UNC School of
Medicine, Wilmington Health Associates and New Hanover County Health
• Department
10:15 Break
10:30 Avian Influenza
Dr. Daniel Wilson, DVM, PHRST-2 Veterinary Epidemiologist, NC Department of
Agriculture and Consumer Services
11:00 Local Health Department Pandemic Influenza Response Plan
David Rice, MPH, Health Director, New Hanover County Health Department
Scott Harrelson, MPA, Deputy Director, New Hanover County Health Department
11:20 Local Hospital Preparation
Pam Moore, RN, Public Health Epidemiologist, Infection Control, New Hanover
Health Network
Cheryl Schmitter, RN, CIC, Manager Infection Control, New Hanover Health
Network
Dr. Gregory Steinkraus, MD, Department of Pathology and Laboratory Medicine,
New Hanover Health Network & Wilmington Health Associates & Next Wave
Diagnostic Laboratories
12:00 Question/Answer
12:15 Evaluation/Adjourn
PROGRAM OBJECTIVES:
Upon completion of this program, participants should be able to:
1. Describe the pandemic influenza preparation plans of the NC Division of Public Health
2. Discuss the role of animals in PI preparation
3. Relate the role of the local health department in PI preparation
4. List the issues addressed in the PI plan for New Hanover Health Network
• TARGET AUDIENCE:
Physicians, nurse practitioners, physician assistants, nurses, public health professionals, laboratory staff,
{ dentists and dental allied health staff, emergency room personnel, emergency medical services
professionals, community leaders, and other interested persons.
CREDIT:
Coastal Area Health Education Center (AHEC) is an approved provider of continuing nursing educatio by
North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Cen er's
Commission on Accreditation. Total number of approved Nursing Contact Hours: 3.0 nursing contact
hours. Attendance to the entire activity is required to receive credit. No partial credit will be given.
Coastal AHEC is accredited by the North Carolina Medical Society (NCMS) to provide continuing medi al
education for physicians. Coastal AHEC designates this continuing medical education activity for a maiimum
of 3.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the ' xtent
of their participation in the activity.
3.0 Hours AGO 3.0 Hours DANB (pending) 3.0 Hours CDE
is1t~
Statement of Disclosure
Coastal Area Health Education Center (AHEC) adheres to NCMS and ANCC Essential Areas and Policies regarding
industry support of continuing medical education and continuing nursing education. Commercial support for the program,
and faculty relationships within the industry, will be disclosed at the activity. Speakers will also state when off-labellor
experimental use of drugs or devices is incorporated into their presentations. Participation in an accredited activity does
not imply endorsement by Coastal AHEC or NCNA of any commercial products displayed in conjunction with an activity.
ADA Statement
Coastal Area Health Education Center (AHEC) is committed to equality of educational opportunity and does not
discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, agg,
disability, sexual orientation or veteran's status. If you require reasonable accommodations for a disability in order to
participate fully in this continuing education activity, please call 910 792-5560 ext.100 no later than 3 working days efore
the date of the activity.
REGISTRATION INFORMATION
New Hanover County Health Department is funding this program and has made the training ava table
to other New Hanover County organizations. There is no registration fee for individuals working with
organizations in New Hanover County. Although there is no fee, pre-registration is still required for
food and handouts.
If you have any questions, please feel free to call
Coastal AHEC, customer service, at 910-792-5560, ext 100.
Pan Flu Summit REGISTRA TION FORM Feb. 17, 2007
(LW #1-18152) No registration fee
Name: SS# (last 4 digits
Home Address:
City: State: Zipcode:
Workplace:
Title/Department:
Supervisor's signature & Dept. Cost Center/PO#:
Work Address:
City: State: Zipcode: Work County:
Work Phone: ext:
Home Phone:
Email: (Please indicate whether home or work):
All of the above is needed to update and maintain our computer records.. To register, please c mplete
this form and fax it to 910-792-5565 or return this form to Coastal AHEC, ATTN: Registratioi, 2250
Shipyard Blvd, Ste. 13, Wilmington, NC 28403.
Please indicate type of credit desired: _ Contact Hours _ CNE Hours (Nursing) CME
or Dental credits: AGD DANB CDE
• New Hanover County
Animal Control Services
Advisory Committee
Meeting Minutes 01/10/07
Members present: John Boozer (Chair), JoE Needham (Vice Chair), Bob Weedon, Martha Raynor,
Gretchen Colby, Patrice Kaizar, Cindy Miles, Dianne Connor, Whitney Doremus
Visitors: Board of Health Chair Ed Weaver, Health Director Dave Rice, Deputy County Attorney Kemp
Burpeau, Joyce Bradley
Guests = 1) Ms. Andrea Press on dog tie out ordinance.
Ms. Press presented an alternative method of tie out for dogs. She suggested
an annual permit to be regulated and offered by ACS.
The committee decided to accept the revision crafted by Kemp Burpeau,
Deputy County Attorney, and forward this to the Board of Health.
2) Ms. Karen Campbell on Ashley HS dog training project.
Ms. Campbell presented a plan for ACS to partner with students at Ashley
HS. The students would visit the shelter daily to train dogs in the adoption
area. The plan has had great success in other locations. (Whitney & Patrice)
Old Business
. 1. Advisory Committee by-laws.
These need to be re-done to match the recent changes in the Board of
Health by-laws, which were amended to meet state guidelines.
2. Advisory committee member training.
Requested a sub-committee to look into this. (no takers!)
3. Prison/pet partner program.
"New leash on life" - Whitney is working on this.
4. Adopted animal registration form.
JoE has field-tested this; final revisions were made.
5. ACS adoption play area.
Working with Parks Dept. to get it landscaped.
6. New member.
Must advertise the slot.
New Business
1. First rabies positive canine.
Almost 50 people went thru post-exposure vacs. Relayed details.
2. SEPHLI project.
Focused on education and developing partnerships. (Bob & Jean)
3. Area veterinarians - public forum.
Part of #2. Set for April = public health month.
4. Co-location shelter.
Trailer has been purchased. Noble School is ided as the location.
5. Animal euthanasia.
We need support for having the ability to have a choice in euthanasia
methods. Need a letter sent to the state (Joyce & Martha)
6. College Acres Drive.
Major problem here w/ barking dogs that has gone to county
commissioner level. We will probably take them to court.
7. QA initiatives.
Several items have been implemented to be more accountable and
productive. For example, tracking monthly rabies certificate
submission from area veterinary hospitals.
8. Committee meeting dates.
Next meeting set for Wednesday, March 21, 2007, at 7 p.m.
9. Building community partners.
See above.
10. Where do we go from here?
• New Hanover County
Community Child Protection Team Report
January - December 2006
PROBLEM STATEMENT
According to Black's Law Dictionary, Fifth Edition, child abuse is "any form of cruelty
to a child's physical, moral or mental well-being..." North Carolina General Statutes
defines child abuse and neglect as two separate categories. The New Hanover
County Department of Social Services responds to allegations of abuse and neglect
by applying the Multiple Response System (MRS), which is a two-prong approach:
The Family Assessment track, used in neglect cases, and the Forensic track, used
for all abuse and serious neglect cases.
In 1991, Community Child Protection Teams were established as one means for the state
and local communities to form a partnership to strengthen child protection. The original
purpose of the team was further formalized and expanded by G.S. 7B 1406, effective July
1, 1993. The CCPT Mission Statement reads:
Recognizing that child protection is the responsibility of everyone, and
responding to child protection needs is more effective before a child is harmed:
• the Community Child Protection Team, a team composed of agency
representatives, child advocates and citizens-at-large, will take action to identify
and address gaps or deficiencies in services and resources through the annual
report to the Board of County Commissioners, collaboration with community
partners, promoting public awareness, and advocating for action that addresses
the child protection needs of each county.
GAPS/BARRIERS
In 2006, the New Hanover Community Child Protection Team (CCPT) reviewed 17 cases
(7 abuse; 10 neglect) involving substantiated abuse or neglect, and which were identified
as having gaps/barriers in accessing community resources. These involved financial
barriers, transportation needs, failed community systems between resources, procedural
barriers, inadequate services, etc.
The following list outlines the critical gaps in services identified by the CCPT participants:
Lack of mental health services.
[Comment: The restructuring of mental health services at the State level has
increased the difficulties of providing local mental health services in the following
areas.]
? minimal therapeutic services that address concerns of children who have
been abused or exhibit inappropriate sexualized behaviors.
Page 1 of 5
? minimal services/therapists that practice 'play therapy' far childr n three
and younger.
? minimal comprehensive family intervention services.
? very limited therapeutic placements available within a reasonab e
distance for children with severe mental or physical health issu s.
? lack of services/placements for teens with severe behavioral or
delinquency issues.
[Comment: There has been an increase in calls from parents with to ns who
are exhibiting behavioral problems and the parents no longer can/want to deal
with the situation. The parents are asking to have teens placed out o the
home due to their behavior.]
? lack of Level IV and Psychiatric Residential Treatment Facility ( RTF)
group home placements for teens. Teens are currently placed i~ Level
III homes and then are discharged for exhibiting the same disruptive
behaviors that caused them to be initially placed in that same grooup
home.
? lack of a resource guide that lists currently available mental heal~h
therapists and services.
? lack of Spanish-speaking therapists treating abused children.
? insufficient and targeted emergency funding for children who ha e
insufficient insurance coverage or are undocumented.
? no available resources for long-term in-home intensive pzirentin
programs/mentoring for developmentally-delayed parents.
? insufficient number of personnel trained in Child Forensic Evaluation
procedures.
Insufficient community education about:
? effects of domestic violence on children.
[Comment: Child abuse occurs in 30% - 60% of family violence cases. In
homes where partner abuse occurs, children are 1500 times more likely to be
abused. In addition, children who have experienced domestic violence have
lower school performance, higher delinquency rates, and various health
problems.]
? effects of sexual assault on children.
(Comment: A recent University of Pennsylvania study found that "...a
disproportionate number of street youth have histories of recurrent phys cal or
sexual abuse at home and took to the streets in a desperate effort to bring their
abuse to an end....Ironically, running away from home increases their risk of
physical violence and sexual abuse... Most children in the study were white
youth who had run away from middle-class homes ...Less than 25% ca a from
impoverished families... Summary: many sexually abused children, who do not
receive treatment, run away to escape abuse and subsequently become)
victimized in commercial sex. Many of the victimizers are married white en.]
It
Page 2 of 5
• Additional law enforcement personnel to investigate and work with the
• District Attorney's office to prosecute an increasing number of reports of
substantiated abuse and serious neglect.
• Very limited out-of-home placements for children of other cultures.
• Safe Surrender Law - The current law does not allow a mother to surrender
her child under certain circumstances.
[Comment: For example, if a mother checks herself into the hospital and gives birth,
she can not surrender her child under the law because she has already given
identifying information. Her only option would be to relinquish her parental rights and
the child can be cleared for adoption.]
• Lack of mentoring services through the faith community for 'one-on-one' with
teens and families.
[Comment: Services through the faith community either work with the teens or the
parents only. There are no services available that work with the family as a whole.]
SERVICE DELIVERY NEEDS
The New Hanover County community must become proactive in its awareness and
prevention of child sexual violence. Emphasis should be on child sexual abuse, and
• sexual violence as a major factor in many domestic violence cases. The CCPT has
identified the following needs and the actions needed to address them.
• increase access for children to additional mental health and counseling
services, including comprehensive family services and 'play' therapy.
• increase amount of community-wide education and services for children and
their families regarding:
o sexual assault and domestic violence issues and prevention;
o identify age-appropriate sexuality education for children and their
caregivers;
o expand adolescent education to include how to deal with rape and
domestic violence abuse issues.
• increase funding for The Carousel Center which treated 105 New Hanover
County children in 2006, compared to 82 the previous year, a 28% increase
of new clients.
[Comment: 90% of the allegations involve sexual abuse. 85% of the children are
age 11 and under. A 4-year-old is the most likely age seen. In 46% of the cases,
charges were filed. Convictions were received in 86% of the cases filed.]
• implement a continuing education program with New Hanover Regional
Medical Center's Emergency Department personnel to increase awareness
and recognition of child abuse and neglect, as well as, the required reporting
procedures.
• • continue recruitment of'rostered' Child Medical Examiners to address the
increasing number of child sexual and physical abuse cases.
Page 3 of 5
t
ACCOMPLISHMENTS/IMPROVEMENTS
• Conducted four quarterly meetings of agency directors and 12+ meetings of
staff members who directly deliver services to abused and neglected
children.
• Conducted two (2) Child Fatality Reviews of children whose death involved
abuse or neglect.
• Facilitated two (2) successful Safe Surrenders using the 2004 adopt d Safe
Surrender program guidelines. .
• Restructured monthly CCPT group to improve the efficiency and
effectiveness of the members.
[Comment: This change has provided an expanded ability for problem soh ing and
acquiring available services for families during the review of cases. CCPT Oded
five agencies including six additional members who attend regular monthlyl
meetings. Agencies attending CCPT assisted DSS with accessing services for
children.]
• Sponsored a "Child Watch" forum attended by 100 people. The Form
discussed the mental health reform and its impact on services for children.
• Developed a partnership with a local radio talk show that gives community
agencies an opportunity to explain services and needs for children.
• Sponsored a Community Dialogue on Domestic Violence and Child
Maltreatment on April 19, 2006, as part of the NC Association of County
Directors of Social Services "Domestic Violence Child Welfare Initiati{re."
Thirty-one (31) key community stakeholders participated in developi g an
action plan to address domestic violence-related child maltreatment.
• Worked with the New Hanover County School System to incorporate a child
safety curriculum.
• New Hanover Sheriff's Office added another detective in their "Crimes
Against Children" unit.
• The Wilmington Police Department initiated mandatory in-service trai~ing for
all staff on "physical and sexual child abuse." Experts from other agencies,
in collaboration with the Police Department, teach this class on a monthly
basis.
• A Psychiatric Residential Treatment Facility is proposed to be built in New
Hanover County. This 60-bed facility will provide in-patient services for
children from southeastern North Carolina.
•
1
Page 4 of 5
• New Hanover County Community Child Protection Team
MEMBERSHIP
Position Individual(s) Appointed by
Mandated
DSS Director and staff LaVaugh Nesmith
Wanda Marino
Law Enforcement Sheriff Sid Causey Board of Commissioners
Sgt. Missy Perkins, WPD Board of Commissioners
District Attorney's Office Ben David District Attorney
Local community action agency W. Clancy Thompson
Executive Director Child Advocacy Commission
Superintendent of school district (or Al Lerch
designee) Assistant Superintendent
Member DSS Board of Directors John Craig DSS Board
• Local mental health professional Art Costantini Area MH Agency
Local Guardian ad /item Program Liz Kachris-Jones
District Administrator
Health Department Director David Rice
Janet McCumbee, designee
Local health care provider Sonja S. Brown, MD Board of Public Health
Recommended Appointments by the Board of Commissioners (maximum of five additional
members to represent various county agencies or the community-at-large)
Domestic Violence Shelter & Services, Inc. Mary Ann Lama, Executive Director
Coastal Horizons Center, Inc. Amy Feath, Rape Crisis Center Director
New Hanover Regional Medical Center Barbara Beuchler, Director-Women &
Children's Services
• The Carousel Center, Inc. Kevin Lee, Executive Director
Community Member Diana Woolley
Page 5 of 5
i
January 2, 2007
•
i
SEEK:
Increase of $25 million in "general aid, to county" for local health departments to
build necessary infrastructure and support the capacity to provide essential public
health services
Elimination of health hazards of second hand smoke by:
j Mandating smoke free state buildings and providing local governments the
option of designating their buildings and campuses smoke free
• Eliminating smoking in all work sites and public places statewide
Repealing preemption
i
Providing County Boards of Health the authority to set/collect local fees for food and
lodging inspections with approval by County Boards of Commissioners
• ' $4.3 million to strengthen the Statewide. Health Promotion program by supporting
one Health Promotion Specialist in each county
$2 million increase in recurring funds to support and expand involvement in "public
health incubators"
j
SUPPORT:
i
Mandatory meningitis vaccine for college freshman
• $2,236,500 to expand access to evidence-based screening-expand eligibility from 200% to 250% of
the FPL for participation in the Breast and Cervical Cancer Control Program (BCCCP)
• $1,575,000 to improve control of chronic disease risk factors-promotional nicotine replacement
i
therapy campaign plus funds to implement and maintain a quit line for residents
• $5 million to ensure that each health department receives one interpreter
• Additional Medicaid reimbursement rate for all services, including Child Service Coordination
$280,000 for folic acid campaign
• $15+ million for Year 2 of the Health Information System (HIS) contract
Option for three counties to pilot a needle exchange program to include $550,000 for these pilots
• $6 million for Health Disparities Initiatives
• Recommendations from the Public Health Task Force Report
For more information please contact Heather Gates, Executive Director-hkgates@ncapha.org (919) 233-7332
ra
SIC Public Health Agreement on Critical Elements for Smokefree Worksites
and Public Places laws
• NC Division of Public Health and NC Association of Local Health Directors
DRAFT January, 2007
We support model statewide legislation to ban smoking in all North Carolina worksites and public places that is
consistent with the following critical elements' necessary to protect the health of the public and all workers.
An effective law should include the following:
1. Clear definitions
2. An Implementation plan detailed through the rules process of the Commission of Health Services.
3. Adequate time before the bill becomes law to complete this process and train state and local officials.
4. Important elements include:
a) Roles defined:
Compliance and Education are public health responsibilities to educate and ensure agency
compliance. This includes public communication and education as well as communication with an
agency that has been reported as out of compliance through a complaint-driven system.
• • Enforcement is the responsibility of local law enforcement agencies, including handling violations
and penalties.
b) Signage requirements for a complaint driven system, including the signs include a toll free,
geographic locater system telephone number;
c) Violations and penalties should address both employers who fail to comply with the law as well as
individuals who smoke in an area where smoking is prohibited;
d) A plan to educate and publicize the law through earned media;
5. Non preemption language makes it clear that local government has the authority to pass stronger
regulations than the state law to protect their local citizens and workers from a public health hazard.
•
An effective law should avoid the following:
Ventilation systems and/or Smoking Rooms are ineffective and costly. Ventilation cannot remov the harmful.
constituents of secondhand smoke and smoking rooms put employees who work in them at risk.
Exemptions for Bars, Bowling Alleys, Billiard Halls and Bingo Parlors
The law must protect all workers. Prohibiting smoking in places such as bars, bowling centers, billiard halls
and bingo parlors may be contentious. But smoking should be completely eliminated in these and othet~venues
in order to protect worker health; the health hazards of secondhand smoke are dangerously high in these
establishments.
Minors Only Provisions allow smoking if minors are not allowed on the premises. These provisions do of
protect employees or patrons. Smoke-free laws are important for everyone, not just minors.
Signage or "Red Light/Green Light" Provisions allow businesses to simply post signs indicating that an rea
allows smoking do nothing to protect employees and patrons in those areas.
Hours Provisions restrict smoking only during certain hours of operation. These provisions are not only
ineffective, but create confusion and are difficult to enforce.
Preemption in any form is where local governments are bound by state action, and states are bound by federal
action. This favorite tobacco industry tactic - to pass weak laws at the state level and preempt local action -
shifts the struggle for smoke-free air from local jurisdictions, where grassroots smoke-free advocates are more
likely to be in touch with local support.
Hardship Provisions allow for exemptions if a business can demonstrate economic hardship after going
smoke-free. These exemptions are unnecessary and are based on the false premise that a negative economic
impact results from smoke-free air laws.
Grandfather Provisions exempt certain existing businesses from the smoke-free regulations, which is unfair to
both employees and patrons. There is no legitimate economic argument for-permitting older_ esta_b_lish_m_ e_n_ts to
avoid a health regulation.
.onsent Provisions allow smoking if all employees in a business consent. Employees are then pressured into
.onsenting" to work in smoke-filled areas either voluntarily or contractually (by signing a contract as a
ndition of employment). Employees should never be put in a position where they must choose between
pardizing their health or their job.
using Fees allow businesses to permit smoking on the premises upon payment of a licensing or other fee.
arrangement is completely ineffective and does not protect the public health.
tcentives that make going smokefree voluntary in order to have a tax incentive for smoke-free businesses
reward businesses for doing something that they should be required to do in any case - providing a safe
Ithy workplace for their employees and customers.
ase-in Provisions delay health protections. Laws typically become effective within 30-90 days of
t, which allows ample time to inform business owners and residents of their responsibilities. Longer
nply allow time for possible weakening or repeal of the law.
2
Exemptions for Casinos and Other Gambling Venues
Casino or other gambling venues are workplaces and should be included within the coverage of a smoke-free
law.
'Exemptions for Private Clubs
This exemption is not recommended. Restaurants and bars may try to establish themselves as private clubs in
order to avoid compliance with the law. If private clubs are exempted, the definition of a private club must be
clearly a place not open to the public, and include only not-for-profit clubs with no paid employees.
' This is based on "Fundamentals of Smokefree Workplace Laws" April 2006 - endorsed by 12 national organizations, including the
American Public Health Association, National Association of Local Boards of Health (NALBOH), American Cancer Society,
American Heart Association, American Lung Association, Americans for Nonsmokers Rights, Campaign for Tobacco Free Kids, the
Tobacco Control Legal Consortium National Latino Council on Alcohol and tobacco Prevention (LCAT), the Praxis Project,
APPEAL, and the Tobacco Technical Assistance Consortium.
3