12/03/2003 Exhibits
New Hanover County Health Department Revenue and Expenditure Summaries for October 2003 Cumulative 33 00 Month 4 of 12 Revenues Cunt Year Prior Year Type of Budgeted Revenue Balance
Budgeted Revenue Balance Revenue Amount Earned Remalnln Amount Earned Remalnln Federal State 1 688 857 840 486 848 371 278 654 1 426 554 16 34 nimal CJntrol 570 161 218 840 351 321 186
394 401 550 31 70 Medicaid 1 044 080 48225 961 655 179 573 855 813 17 34 Medicaid Max 268 833 0 00 EHFees 300 212 228 986 27 46 Health Fees 113 850 52 87 Other 2 307 095 32 57 Expenditures
e ype of Ex ndlture Budgeted Amount Cunt Year Expended Balance Amount Remalnln Budgeted Amount Prior Year Expended Balance Amount Remalnln 2 570 912 6 560 616 26 15 532 462 1 393 384
27 65 2 606 161 140 1 42 Summary Budgeted Actual F0Y403 F0Y403 Expenditures Salaries Fringe 9 938 494 2 620 963 Operating Expenses 1 498 835 442 229 Capital Outlay 340 363 21 758 Total
Expenditures 11 777 692 3 084 950 26 19 Revenue 6 293 088 2 140 934 34 02 Net County 5 484 604 944 944 016 17 00 Revenue and Expenditure Summary For the Month of October 2003 10
e NHCHD BOARD OF HEALTH APPROVED GRANT APPUCATlON STATUS FY OU4 Date SOHl Grant Reouested Pendlna Received Denied Cape Fear Memorial Foundation Funds needed to cover deentalsll8lYk for
needy children as Identified by 11 512003 School Heallh lN8uSI 3 000 3 000 NC Medlcal Foundation Through tile Good Shephard Ministries for nursing eervlces to tile population frequenting
the sheller 25 000 25 000 Duke Unlveralty To provlde 10 hours of nursing eervlces for TB Outreach 10 388 10 388 NC Tobacco and Control Branch DHH8 Continuation of Tobacco Prevention
Program 100 000 100 000 101112003 No acIIvIty to report for October 2003 New Hanover County Safe Schools Uniting for Youth U4Youth fundlng will be received over a 91312003 3 War grant
period 49 000 49 000 Safe Kids Coalition Fire Prevention please nota this grant was pullad coalition not able to meet daadllna for requast 2 500 2 500 81612003 NC DHHS OPH Precaredneas
and ResPOnse 82 350 31 950 50 400 Smart Start Partnel8hlp for Children GI8nl 71312003 Ilnc8real for for Part TIme Nurse Position 5 523 5523 Cape Fear Memorial Foundation Diabetes Today
twoyear 18quest 42 740 annually Reoalved 25 00 year 1 and 20 000 year 2 85 480 45 000 40 480 Duke Unlvel8lty Nicholas School of the EGnevolrgornamphelnct Information Systems Grant Env
Health 10 000 10 000 Safe Kids Coalltlon Safe Kids Mobile Car Seat Check up Van 50 000 50 000 Safe Kids Coalition RIsk Watch Champion 642003 Team 10 000 12 500 Smart Start Partnel8hlp
for Children Child 51712003 Cere Nursing Program Preliminary Approval 171 977 172 500 Smart Start Partnel8hlp for Chlldl8n Health Check preliminary Approval 41 035 41 747 UCNHC Child
Care Health Consultant 62 649 84 495 Cape Fear Memorial Foundation through PartnershIp for Chlldrenl Navloator Pnoal8m 176 707 160 000 4312003 No activity to report for April 2003 3512003
No activity to report for Msrch 2003 2512003 No sctlvlty to report for February 2003 11812003 NC DHHS OPH Precaredness and Resconse 115 95O 33 600 82 350 12412002 No activity to repori
for Dacember 2002 NC Health and WellnessTrust Fund Teen TobaCCXl Use Prevention Cessation Progl8m 111612002 100 000 per year for 3 vears 100 000 100 000 Safe Kids Buckle Up PNroogrrathm
Carolina 101212002 Safe KIds 5 000 5 000 f As of 11 1712003 NOTE NotIIIcation received 81noa last report 11
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 034 Developing Geographic Infonnatlon Systems GIS Capacity In Local Health Department In Eastem North CDaurokllnea University
Nicholas School of the Environment and Earth ScIences NSEES 18 000 oa ty repo or ep oa tytorepo r g oa ty report r u Totals 1 126 759 187 388 18 63 Pandlng Granta 5 25 Funded Total Reouest
8 40 Partlsllv Funded 3 15 Denied Totel ReQuest 4 20 Numbers of Grants ADolled For 20 100 As of 11 1712003 NOTE NotIIIcation racalvad since last report 18 000 614 792 54 56 331 2Q 29
40 8e 12
lJ J t fA l 93 ilr rl November 25 2003 NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 soum 17TH STREET WILMINGTON NC 248944061 TELEPHONE 910 343 6500 FAX 910 341 4146 To New Hanover County
Board of Health From Cynthia W Hewett Business Manager Subject Changes in CPT Codes and Fees We are requesting approval for the following changes related to the New Hanover County Health
Department Fee Policy CPT Codes and Fees Change CPT Code Fee Justification Needed Addition 99172 30 00 Establishing fee for Vision Screening color procedure provided in Child Health
Services Addition No code 27 00 Establishing fee for Ortho Evre birth control patches ee Change 11977 193 14 Medicaid Reimbursement increased from 190 30 to 193 14 for Removal Reinsertion
ofNorplant Fee Change 46900 179 37 Medicaid Reimbursement increased from 179 07 to 179 37 for Destruction of Anal Lesion s Fee Change 96152 1229 Medicaid Reimbursement increased from
13 25 to 22 19 Intensive Psychosocial Counseling Fee Change 90676 160 00 Medicaid Reimbursement increased from 120 00 to 160 00 for Rabies Vaccination Fee Change 99001 18 00 Increase
in Handling Fee from 15 00 to 18 00 Deletion 84479 26 No fee Lab Service sent to State Lab T3 or T4 State no longer providing this service Deletion 84443 26 No fee Lab Service sent to
State Lab Assay Thyroid Slim Hormone State no longer providing this service The following needs to be included in the Medications Available for NBC Employees Section Addition No CPT
12 00 Ortho Evre Code e 13 Healthy People Healthy Environment Healthy Community
e NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda Meeting Date 12103 03 Subject Request for approval to accept additional Bioterrorism funding for use in the
Public Health Bioterrorism PHRST 2 bud et in the amount of 71 880 Brief Summary New Hanover County Health Department will receive an additional 71 880 funding from NC Department of Health
and Human Services Division of Public Health Public Health Preparedness and Response Branch to be used to support the Re ional Bioterrorism Pro am Recommended Motion and Requested Actions
To approve receipt of additional state funding to be used to support the Regional Bioterrorism Program in the amount of 71 880 and associated budllet amendment Funding Source NC DHHS
Division of Public Health Public Health Preparedness and Response Branch Will above action result in New Position Number ofPosition s DPosition s Modification or change o Chan e in Position
s Explanation These funds will be used to support the daily operations of the PHRST 2 Team hosted by the New Hanover County Health Department Due to this Team traveling extensively to
other areas within the region and state the majority of these funds will be bud eted in trainin and travel for PHRST 2 Staff I Attachments Copy of Contract Addenda 14
teIZ wiczw icIWCCWDW iIil rj15 zoo I l 0 0 0 0 0 0 0 0 CXl 0 0 0 0 0 0 0 0 CXl O 0 q 0 0 q 0 0 It N M N 0 oL It Ez8 c C I 0 01 1 WWZ OO l 500 Wl O CD 1 1 1 zwz w l 0O 00 lCD l U I 00
UW W z ii3 00 u 00 I 0 Z I l 00 ii J 0 W W Z W W Z 0 W a W I E ii E 0 a ol a a u Q 0 J l 5 00 I W l I U 00 0 CD ol Z 0 l 0 l 0 W 00 J 00 W Z Z z a 0 i ol Z W 0 0 J 00 J 15 ol ol Z W
LL W W ii l j l I E a LL 0 I 0 00 0 0 0 0 0 0 0 N 0 ltl 0 0 00 00 m m N N v v V ltl 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N oz o 0 gzia II zUl l N N l l
l l l l ltl ltl ltl ltl ltl ltl ltl ltl ltl Z a 0 JWJ EIn iii w 1ii QJ Q isI W a zw 0ltl CZ 0 lu8CD Cl Zco0 8 a WwCD zwCD WZ0I w8r 01 WW CIlCl 0 j l a lD Je SS 0001Il1ll QEIn g is 1ii
lo Q Q t I 1 i 1 15
eIZwiczwicIWCCW li 0CXl I l CXl ZO g 8 I 0 WoliiZl oolt 00 ilii E O CD I z liiZl Wt l 0 00 O lCD l UWw0ig IztWI00 VN I 000N J ZUNNltl Z i 0 WJ EIn iii w 0Gl JQ isI W a zw 0ltl CZ 0 lu8CD
i 8 t12 8 a Ww liCD li 0 8z zwCD az0fjw8 r r15 zoc 9 tDG maim 000 Gl EIn lg 01 is WW 0 CIlCl 0 l j l 0 a lD l 1 e 8cI In GlGlGl 9 e e E I i i jaElgJ0 iii gfi E l g g al QE8 C C l le
0 Ii l0e C 00 GlGl g Z EEEJ0 III III 01 III l ZzzO Gl i 0 0 C e e ICD 0 cal u c c Z l 0 l 0 l Ojjj Gl E CD S 0 1 E E III E c 0 Ql U l 16
I NORTH CAROUNA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH FUNDING AUlHORIZAliON ISSUED TO NEW HANOVER COUNTY STATE FISCAL YEAR PubliC Healtb DepartmentJDistrlet
FROM July 1 1003 througb June 30 1004 FUNDING SOURCE 536961 4513 NAME F PROGRAM PH Regional Response Team EFFECTIVE DATE 07 01103 AUTII 1 INITIAL ALLOCATION 5109 811 50 PRIOR ADJUSTMENTS
YEAR TO DATE INCREASE DECREASE INCREASE DECREASE THIS AUTHORIZATION 000 SJ3I381 oo NET ANNUAL ALLOCATION 5441 7s380 GRANT INFORMATION nd Service Months Payment Months Codes ederal JuneMay
JJuunlye 1451 5685 EN Federal SeptMay JOancet 15612688 ET Federal Sept May JOuncet 1561 1681 ET Total Amount CFDAtI 19833 19833 19833 58110z9 so 11 170 00 5310 64800 5441 7s380 44 130
57 3Q 5 D 71 iiSD 13 IJar l 5l JTfJe AUTHORIZED SIGNATURE Jui dn DATE 10Jn103 DCHOHS 741 17
I Ie NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda Consent Meeting Date 1203 03 A enda 8J D artment Health Presenter Cind Hewett Contact Cind Hewett Business
Manager ext 6680 Subject Request for approval to accept additional Bioterrorism funding which have been made available to local health departments to further assist counties in continuing
to strengthen local public health infrastructure and capacity and to effectively respond to a possible bioterrorism event Brief Summary New Hanover County Health Department will receive
137 863 of funding from NC Department of Health and Human Services Division of Public Health Public Health Preparedness and Response Branch to be used to support the local public health
department in its efforts to build strength and capacity allowing it to effectively respond to a possible bioterrorism event These funds will be used to fund a new Planner position for
coordinating local bioterrorism efforts temporary IT staff to assist with added technology requirements computer equipment printing charges operational supplies and trainim and travel
for staff Recommended Motion aild Requested Actions To approve receipt of state funding to be used to support the local public health department in its efforts to build strength and
capacity allowing it to effectively respond to a possible bioterrorism event in the amount of 137 863 and associated budget amendment Funding Source NC DHHS Division of Public Health
Public Health Preparedness and Response Branch Will above action result in 8JNew Position I Number ofPosition s DPosition s Modification or change DNo Chan e in Position s Explanation
These funds will be used to fund a new Planner position for coordinating local bioterrorism efforts for New Hanover County temporary IT staff to assist with added technology requirements
within the health department additional computer e ui ment rintin char es 0 erational su lies and trainin and travel for staff I Attachments Copy of Contract Addenda 18
zwEQ ZwEcwCQ eiwll W gcw li lubz 8 I 0 C r 0 C 0 0 0 0 0 0 0 co r 0 0 co 0 0 0 0 ZO co q C It 0 0 CC 0 0 It 0 6 a N N cD 0 Ci 0 N a N N N N g c 0 owwz l C00 O lXl zwz wC 0O 00lXl i u
wW9Q WI z w z w w w I I Q W Q U W U w I C z W Q I 5W W I Q W @lXl C 0 J U Z I J I 0 z w w I z I w ca 0 Q J Q 0 it J z I z u z w U all 0 z w I w w w 0 I J iii 0 C C w ca J Z J it J W0Q
i 0 Z Q u is is wJ ca W 0 w i w 0 W 0 I 0 Q 0 u 0 lil 0 0 0 0 0 0 0 0 Ol 0 0 0 0 0 0 en 0 0 N ex N N N N N CD I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 lil
0 N N N N N N N N N N N LLOZ o 0 t g z aII zUIt It It It It It It It It It It It Z Q 0 JWJ c w 0U2E ww 0It 0Z LL 0 Iii 8III ZoO 8ffiall 82 wIII WZ0 w8 r cjt g a lXl SCDJj maili 000 CDQl
EEE zzz 0 19
zwEQ ZwEcwCQ mwa fil lli jbzoc 0 CO 0 C It 0 0 r 0 0 0 0 ZO 0 t 0 as 6 It r g I 0 wotii z I C00a lXl i z tii z wC a OO a lXl i U cCD EU I UCD ffi z0 all W c Za a 0 U lrl w 2 aQ EE I
0 it u 0 E a UC a w g 15 iii iii N Ii It It I 0 0 0 0 0 0 0 0 0 0 0 0 N N N N z U It It It It Z Q 0 J 1 wJ c w 0l 2E wZW 0It 0Z lL 0 Iii 8III OO Ea Ww1Il ZwIII aZ0 II nSS EUC 000 gccCD
CD ECD Clii s 0jlj a lXl CDCD j EE QEUCg iii SCD U E c g 2 al 2 CD U g cc 1 CD CD u EE z CDO z o joe J 1 1 E e e a0 Qal CI 2 2 zuz c lI 0 c 0ai j 8 Q CD u 20
NORTH CAROUNA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH FUNDING AUTHORIZATION ISSUED TO NEW HANOVER COUNTY STATE FISCAL YEAR Public Health DepartmentIDistrIct
FROM Jnly 1 2003 through Jnne 30 2004 FUNDING SOURCE 536961 4519 EFFECTIVE DATE 07101 03 NAME OF PROGRAM Bioterrorism Smallpox INITIAL ALLOCATION 78 073 00 PRIOR ADJUSTMENTS YEAR TO
DATE INCREASE DECREASE INCREASE DECREASE THIS AUTHORIZATION 0 00 0 00 NET ANNUAL ALLOCATION 78 073 00 GRANT INFORMATION TvDeofFnnd Service Months Payment Months Codes ederal Sept May
JOuncet 1563 2680 ET Federal Sept May JOuncet 1563 2681 ET Federal Sept May JOuncet 1563 2686 ET Federal Sept May JOuncet 1563 2687 ET Federal Sept May JOuncet 1563 2688 ET Total Amount
1 181 00 26985 00 893 00 869 00 683500 78 073 00 S 130 Lo AUTHORIZED SIGNATURE Jdn DATE 10123103 Daasco 701 AUTII 1 CFDA 29833 29833 93 283 93 283 29833 21
NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH FUNDING AUTHORIZATION ISSUED TO NEW HANOVER COUNTY STATE FISCAL YEAR Public Health DepartmentIDlstrlet
FROM July 1 2003 through June 30 2004 FUNDING SOURCE 536961 4514 EFFECTIVE DATE 07 01 03 AUTH 2 NAME OF PROGRAM BT Preparedness and Response INITIAL ALLOCATION 5750 00 PRIOR ADJUSTMENTS
YEAR TO DATE INCREASE DECREASE INCREASE DECREASE THIS AUTHORIZATION SO OO 49 306 00 NET ANNUAL ALLOCATION 50 056 00 GRANT INFORMATION ofFnnd Service Months Payment Months 91 Federal
JuneMay JJuunlye 1451 5685 EN Federal Sept May JOuenet 1561 2680 ET Federal Sept may JOuenet 1561 2681 ET Federal Sept may JOineet 1561 2687 ET Total Amonnt CFDA 5750 00 8 190 00 36
473 00 4 643 00 50 05600 93 283 93 283 93 283 93 283 JT 123 AUTHORIZED SIGNATURE tdn DATE 10123103 DCHOH8 701 22
NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH FUNDING AUTHORIZATION ISSUED TO NEW HANOVER COUNTY STATE FISCAL YEAR Public Health DepartmentlDistrid
FROM July 1 2003 through June 30 2004 NAME OF PROGRAM Bloterrorism Communications and Risk Assessment EFFECTIVE DATE 07 01103 AUTH 2 FUNDING SOURCE 536961 4515 INITIAL ALLOCATION 0 00
PRIOR ADJUSTMENTS YEAR TO DATE INCREASE DECREASE INCREASE DECREASE THIS AUTHORIZATION 0 00 5406800 NET ANNUAL ALLOCATION 4 06800 GRANT INFORMATION e or Fund Service Months Payment Months
Codes Amount CFDA ederal Federal Total June May JJuunlye 1451 5688 EN Sept May JOunde 1561 2686 ET 0 00 4 068 00 4 068 00 93 283 93 283 Reeewed eed h Director I Local Finance Officer
AUTHORIZED SIGNATURE Joitdn DATE 10123 03 DCJIOHS 701 23
NORTH CAROUNA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH ISSUED TO NEW HANOVER COUNTY Public Health DepartmentJDistrict FUNDING SOURCE 536961 4518 NAME OF PROGRAM
Bloterrorism SNS INITIAL ALLOCATION FUNDING AUlHORIZAliON STATE FISCAL YEAR FROM July 1 2003 throngh Jnne 30 2004 EFFECTIVE DATE 07101 03 5 666 00 0 00 PRIOR ADJUSTMENTS YEAR TO DATE
INCREASE DECREASE INCREASE DECREASE THIS AUTHORIZATION NET ANNUAL ALLOCATION GRANT INFORMATION of Fund Service Months Payment Months Sept May JOuncet to by J7f Ith Director Local nce
Officer oJcitdn AUTHORIZED SIGNATURE DCHOllS 7 1 0 00 5 66600 Codes Amonnt 1562 2688 ET 5 666 00 DATE 10123 03 AUTH 1 CFDAII 93 28324
tee NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda Meeting Date 12 03 03 Subject Request for approval to accept additional Family Planning funding for use
in the Tern 0 Assistancefor Need Families ANF bud et in the amount of 2 1 408 BriefSunrmary New Hanover County Health Department will receive 21 408 funding from NC Department of Health
and Human Services Division of Public Health Women s and Children s Health Section to be used for family planning approved ex es Recommended Motion and Requested Actions To approve receipt
of additional state funding to be used to support Family Planning in the amount of 21 408 and associated budget amendment Funding Source NC DHHS Division of Public Health Women s and
Children s Health Section Will above action result in DNew Position Number ofPosition s Dposition s Modification or change o Chan e in Position s Explanation These funds will be used
to support salary and fringe of public health nursin staff rovidin above listed services I Attachments Copy of Contract Addenda 25
I IZwE QZwECIWCQ eiw e IIII 0lu Ii zoo ClO 0 I Zol 5 N 8 I 0 Cl I WWZ CIlCcO jj It 1ll IZ liiZl WC It co It BIll Ww0 Za5 a 0l IZCWNCl00 0N zUClO Z 11 0 J i wX II E1II ual CIl zgCIl 0ciij
Ol Wi e8E CIl w l tZw 0 0Z u 0 Iii 8III iIZo 80ia82 tZwIII aZ03w CliO i8 fCIl I 1 0 1II111111 Ccc IgEc 1II aE1II U1 I II otii s C E 0 IJ a al 11 i 0 Sl l XCIl CIlCllCll leE c I i i CIl
11 II cCIl Ei ai CIl i CIl 6E c g 0 al CIl E II 8 tl i c2cE iii i c0etl CIl CIlCll al Z EEE 11 0 z1IIz111z111c tl tll c0I 0 cal c u Z Eli c 0 0 c cai j 0E II g I c CIl C 26
IZwEQ ZwECIW CQwaw e III 0Ii z8 I ClO 0 ZO t 5 N 8 I 0 cw liiZl ClC co jj It llJ 1 1 1 zwz wC It It co llJ tWCl a3 wC 0 czClw1i 500 0000 N U oz oa o t 1I z1 aII zUClO z 11 0 JW t oe
1II U1zg8c1II 1ii iii wi e8E CIl w l tzw 0 0z 0 Iii 8III iIz 8 @0iaWwIll 82 tzw III WZ03w CliO i8 01 WW wC0al JoI CIl oJo G S co as co Ccc Oe 1II U180J Ul scimtc 11 Ul Oc CIl Esi7l CIl
0 6 ll E 1II gj al c o CIl Ol g c1II coEJCl 1II 0 z CIlO g0Olt E I 0 0 co Ii q l o z oCt CIl 00 Z c Ol l 0 C c COinZ Q 1 E llJo Q 1 E J I II g II C CD CIlCllCll e1 1 1 27
Distribution of FP Bonus and Outreach Funds e by LHD or District October 2003 e COUNTY DISTRICT FP COUNTY DISTRICT FP COUNTY DISTRICT FP 01 ALAMANCE 35 777 35 FRANKLIN 4 213 67 ONSLOW
1 875 214 ALBEMARLE 15 195 36 GASTON 12 299 68 ORANGE 5 480 02 ALEXANDER 4 359 38 GRAHAM 1 875 69 PAMLlCO 3 288 04 ANSON 6 649 221 GRAN VANCE 5 650 71 PENDER 4 311 204 APPALACHIAN 20
482 40 GREENE 4457 73 PERSON 1 875 07 BEAUFORT 15 124 41 GUILFORD 1 875 74 PITT 16 391 09 BLADEN 1 875 42 HALIFAX 1 875 76 RANDOLPH 2 216 10 BRUNSWICK 1 875 43 HARNETT 7 964 77 RICHMOND
2 947 11 BUNCOMBE 52 631 44 HAYWOOD 18 972 78 ROBESON 41408 12 BURKE 1 875 45 HENDERSON 4 798 79 ROCKINGHAM 1 875 13 CABARRUS 8 207 209 HERT GATES 4 627 80 ROWAN 1 875 14 CALDWELL 32
757 47 HOKE 4 213 216 R PM 5 625 16 CARTERET 3434 48 HYDE 2 313 82 SAMPSON 9 328 17 CASWELL 4 603 49 IREDELL 1 875 83 SCOTLAND 5 528 18 CATAWBA 17 852 50 JACKSON 1 875 84 STANLY 6 990
19 CHATHAM 2 995 51 JOHNSTON 2 021 85 STOKES 11 520 20 CHEROKEE 1 875 52 JONES 2 411 86 SURRY 10 740 22 CLAY 2 460 53 LEE 2 216 87 SWAIN 1 875 23 CLEVELAND 48 052 54 LENOIR 1 875 205
TOE RIVER 8 548 24 COLUMBUS 18 680 55 LINCOLN 4 798 88 TRANSYLVANIA 13 127 25 CRAVEN 1 875 56 MACON 9425 90 UNION 13 127 26 CUMBERLAND 69 484 57 MADISON 8 841 92 WAKE 72 651 28 DARE
1 875 218 MAR TYR WASH 10 447 93 WARREN 2 460 29 DAVIDSON 1 875 60 MECKLENBURG 47 127 96 WAYNE 3 921 30 DAVIE 2 216 62 MONTGOMERY 7 964 97 WILKES 2 703 31 DUPLIN 1 875 63 MOORE 1 875
98 WILSON 1 875 32 DURHAM 23 210 64 NASH 6 064 99 YADKIN 1 875 33 EDGECOMBE 1 875 65 NEWHANOvER 420f8 875 000 34 FORSYTH 42 256 66 NORTHAMPTON 1 875 e 5151 wksht RNC bonusOR rev10 23
2003 28 Page 1 of 1
ee Animal Control Services Advisory Committee Members The ACS Advisory Committee make up is as follows Group One end 151 term 2002 Member @large Joyce Bradley Friends of Felines JoE
Needham replacement Kennel Operator Sylvia Hall Group Two end 11 term 2003 Hanover Kennel Club John Boozer Azalea Dog Club Patrice Kaizer replacement Cat Interest Jeannie Leonard Group
Three end first term 2004 Member @large Jewell Ann Diehn Member @large Gretchen Colby Humane Society Martha Raynor Note The veterinarian position is currently filled by Dr Melody Speck
from the Board of Health Those in service as Group Two are seeking reappointment to serve for three more years on the committee Thank you Jean McNeil ACS Director 29
j t s l i l L f l NEW HANOVER COUNTY BOARD OF HEALTH 2029 SOUTH 17TH STREET WILMINGTON NC 248944061 TELEPHONE 910 6354030 FAX 910 4314416 W EdwIn IJDk Jr RPh ChaIrman Melody C Speck
DVM cVhalr1mo DcmaldP Blake Henry V Estep RBU MarvID E Freemllll Sr Commissiooer Robert G Greer GeIa N Hunter RN FNP SaIIdra L MIles DDS PbWp P SmIth Sr MD Jobn S T1mstaII PE Edward
Weaver Jr OD DavId Eo RIce MPB MA Health Director 2004 Meeting Dates etW e January 7 2004 February 4 2004 March 3 2004 April 7 2004 April 8 2004 Staff Appreciation Luncheon May 5 2004
June 2 2004 July 7 2004 August 4 2004 September 1 2004 October 6 2004 November 3 2004 December 1 2004 December 9 2004 Holiday Celebration e 30 Healthy People Healthy Environment Healthy
Community
yeee David E Rice 121 2003 08 36 AM To donblake@aol com eweaver@ec rr com IInkrx@aol com gelajim@hotmail com hankestep@ec rr com jstunstall@andrewandkuske com freemanm@wrightCOlJl com
MCSpeck@bizec rr com ppsmithsr@aol com bg @nhogov com iamsmiles@bizec rr com Health 00 Allen O NeaIlNHC@NHC Pat MelvlnINHC@NHC leah devlin@ncmail net Subject Pilot for Accreditation
NHCBH Members and NHCHD Staff I am pleased to announce that NHCHD has been selected as one of six health departments in NC to pilot the accreditation process As you can read in the attached
amail we have the opportunity to be one of the first to demonstrate our excellence in assuring the safety and health of our community Thanks in advance for your help with the accreditation
process DaveForwarded by David E RiceINHC on 121 2003 08 15AM a Joy Reed Joy Reed@ncmall net To drice@co new hanover nc us cc Sheila Pfaender spfaende@ernallunc edu bee archive Subject
Pilot for Accreditation 12012003 07 27 AM This is to notify you that your agency is one of the six selected to participate in the pilot for the Accreditation process We greatly apprecate
your agency s willingness to participate in helping us refine this system Dr Devlin has committed to providing 3 DPH consultation staff to work with each of the 6 local health departments
to assist them with pulling together or preparing evidence that standards are met developing drafts if needed of policies and procedures conducting surveys assessments and compiling
data preparing the initial draft of the self study and coordinating with the consultants assigned to other pilot agencies to assure consistent interpretation of the standards You of
course can feel free to tell us that you do not need this resource but we want to make it available In the next few days you will receive the following additional information 1 the names
of the 3 DPH staff assigned to your agency designating one as your primary contact for coordination 2 PRELIMINARY timeline for the process and drafts from the subgroups of the standards
and and documentation NOTE that these have not been seen and reviewed by the full Accreditation Committee so they are not the final standards but we want you to have as much advance
information as possible We will be establishing training dates on the your staff as well as the consultation staff place in December and you will be notified of are finalized standards
and process for That training will take the dates as soon as they Again thank you for volunteering We look forward to working with your agency to successfully pilot an accreditation
process which will dochment and improve the overall quality of public health services in North Carolina I J
The University of North Carolina at Chapel Hill HEALTH LAW Number 81 November 2003 THERULEMA GAUTHORITYOFNORTH CAROLINA LOCAL BOARDS OF HEALTH Aimee N Wall State Jaw authorizes local
boards of health in North Carolina to adopt mles neocssary to protect the public s health Ibis statutory grant ofauthority is further defined by two relative1y recent court decisions
Ibis bulletin summarizes the statutory rolemaking authority oflocal boards of health as well as the judicially imposed limitations placed on that authority Statutory Authority State
law requires counties to provide public health services I Each county may provide these services in one of five ways2 The county may opeIlIte a county health department participate in
a district health departmeoI3 establish a consolidated htnnan services agency 4 establish a public health authority or contract with the state for the provision ofpublic health services6
The author is an Inslitule of Government facully member who specializes in public health law 1 N C Gal Stat 13OA 34a hereinafterG s 2 G B 130A 3b4 stating four oflbe methods for providiDg
public health se1rv3ic0eAs4S stating that lbeJlUlllOSC ofCbapter 130AIlIrt IB is to povide ana1temative method for COlDlties to provide public health services through the aeation of
a public hea1th authority 3 A distric1 health departmeo1 is one that provides public health services to two or more counties G B 130A 36 4 A county with a population over 42S OOO may
elect to establish a consolida1ed h1lDlllll services agency and boaJd to oversee public health social services menta1 hea1th and other human services or have the boaJd ofCyOUIl COmmissiOllClS
8SS1DDC all oflbe statutorY powers and timclions oflbe boaJd of health G B IS3A 77 130A43 S A public health authority is a 1egal entity that is CIC8Ied for the specific pwpose of providing
public hea1th services in a defined geographiealllllllL G S 13W0AI4SFor a discussion ofthe powers ofpublic health authorities seeA Fleming Bell n and Warren JakeWicker eels CyOIIIl Govemment
In North Carol 1ID ed 6379 ChapelHill N CInslitule ofGovenunent The Univer1lity ofNorth Carolina al Chapel Hill 1998 6 G s 130A 34
Health Law Bulletin No 81 Each county agency district or authority has a boaId of hea1th that is the policy making ru1emaking and adjudicatory body for the department agency or authority
These boards of health have the responsibility to prolect and promote the public health and are specifically authorized by statute to adopt roles neocssary for that purpose s There are
three statutory limitations on this genetal rul 1cillg aUlhority First if the Commission for Health Services or the Environmenta1 MmlIIUlgrnl Commission EMC adopts a role that state
rule will prevai1 over any more lenient role adopted by a boaId ofhealth However a boaId ofhealth may adopt a role that is more stringent than a CO juedsinjXg state role when in the
boaId s opinion a more stringent role is necessary to protect the public health Second a boaId ofhealth is not authorized to adopt any roles reIaIing to the grading opeIlIting or permitting
offood and lodging 1itciIiIies 10 Fina1ly a boaId ofhea1th may adopt roles governing wastewater collection treatment and disposal systems that are not igTIed to discharge eftIuent to
the land surlilce or surliIce waters Such roles may be adopted however only when the state has reviewed the local rules and determined that the local roles are at least as stringent
as the roles adopted by the EMC and are sufficient and D8llCreySl to safeguani the public health 11 In addition to the geuera1 rol lrillg authority to prolect and promote the public
health boards ofhealth are in a few instances specifically authorized or rdequiJl to enact roles in a few in nces For example although state SlaIutes and EMC reguIaIioDs govern the CODSII11Ction
ofwe1ls local boards ofhealth are specifically authorized to adopt by reference the EMC rules and then adopt more stringent rules wbcn Del mnto prolect the public health 12 Also local
boards ofhealth are rdequiJl to adopt roles governing adminislJaIive peua1ties for violations ofany local roles governing wastewater collection treatment and disposal 13 7 G s 13OA 35
a COIDlty COIDlty boards of he1a3lt0hA 37 a distriet boards of health 14305A 1 a public hea1th authority boaJd 8 G 8 130A 39a local boards ofh1e3a01Ath39a district boards of health 143O5A
3 aXl public health authority 9 G S 130A 3b9 10 Id I Id G 8 13OA 33Sc 12 G 8 8967c See saol G S 837 t eq We1l Construction Ac1t5ANCAC 02C 0101 tWI EMC regulations governing wellconstruetion
13 G s 13OA 2h2 November 2003 Court Decisions Two coort decisions within the last decade have defiued and nanowed the ldegauthority oflocal boards ofhealth to adopt mles Jdated to public
health City of Roanoke Rapids v Peedin In City afRoanoke Rapids v Peedin the North Carolina court of appeaJs invalidated Halifax County s boaId of health rules relating to omnlrillg
in public places restauIl1nIs and p1aces of employmentl4 The roles generally prohibited smoking in public p1aces but provided for several exceptions For example restaurants with a seating
capacity of thirty or more patrons were required to designate a noncmo1cing area comprising a certain percentage ofthe dining area while bars and restaurants with a seating capacity
of fewer than thirty patrons were permitted to choose whether to offer a nonomn1cillg areaU The conrt invalidated the rules as eyrwlillg the genera1 limilations imposed upon rule making
powers of boards of health 16 For the first time the court identified a five part test for determining wheu a board of health has acted within its rul 1ci1lg authority The court stated
that a boaId of hea1th acts within its aUlhority wheu it enscts a role that is re1ated to the promotion or protection of health is reasonable in light of the health risk addressed does
not violate any law or constitutional provision is not discriminatory and does not make distinctions based upon policy concerns uaditiona11y reserved for legislalive bodeis17 The court
explained that this fivepart test was based upon previous holdings in re1ated areas as well as the holdings ofcourts in otherjurisdictions IS 14 124 N CApp 578 478 8 E2d 528 1996 IS
Id at 583 478 SE2d at 53 16 Id at 587 478 S E2dat 533 17 Id 18 Peedin 124N C App at 587 478 8 E 2d atS33 The court cited sevem1 eases as support for its fivepart test StJJte v CUrliI
230 N C 169 171 52 SE2d 364 365 1949 cited as support for the conclusion that boards of health do not have authority to make distinctions based on policy 0 2
November 2003 The court did not provide any additional guidance reganling the inlerpnUtion and application ofthe first four parts ofthis test ins1ead choosing to iDvaIidate the board
of health roles based on the fifth part ofthe test The court reasoned tb8I in order to achieve the roles stated purpose of miniminllg the public s exposure to environmental tobacco smoke
the boaId was required to establish aanss the boaId requirements tbat tre8I similarly situated patrons and employees of all restaurants eqnally I The court noted tbat the distinctions
drawn by the boaId in the ro1es such as the distinction between 1arge and small restaumnIs involve the holoncillg tooffrisll other than healthH2O The court conc1uded that absent express
statutmy authority a boaId ofhea1th may consider notbing but health when adopting roles it may not consider issues such as economic bmdship or difficulty of eemnfeonnt21 The court emphoOi7M
tb8I 0Dly legislative bodies such as the General Assembly or a board ofcounty commissioners are authorized to make such bpaosliecdy distinctions22 Cnig v County of Chatham In CraIg v
County afChatham the North Carolina supreme court iDvaIidated board of hea1th roles regulating swine farms23 The roles adopted by the boaId of health required swine farms to comply with
certain specifications regan1ing permitting setbacks buffers and other re1ated issues ceomnsc lnIdilionally rescned for lesisJative bodies C CharlDIt 11ftv Hrmter 261 NC 222 229 134
S12d364 369 1964 cited as support for the conclusions th8t rules musl benasonahle IIIICI must not be disCcoriomIriinatmDyiMr 1m Col 1nu BoanJ qf Health 65 Ohio Misc 2d 65 74 640N E2d
1231 1236 1994 cited as support for the concllllions th8t rules must be W must not be discriminalllly must not violate ofany law or constituIional provision and must not maIce tdiiostnilsu
based on policyceomnsc lnIdilionaDy rescned for 1egisIative boWdieebser v BIllInCty Bd qfHealdr 148 Ohio St 389 396 74 NE2d331 336 1947 BoreaItv A2wIrod 523 N Y28d 464 468 5E17N2d 1350
1353 cited as support for the conclusion th8t boards of health do not have authority to maIce distinctions based on policy concerns lnIdilionally rescned for lesisJative bodies 19 Peedin
124 N C at 588 478 S E2d at 534 20 1d 21 ld at 589 478SE2d at 534 22 Id at 58898 478ES2d at 534 23 356 N e 40 565 SE2d 172 Hea1th Law BulletIn No 81 The court of appeals determined tb8I
C the state had enacted the Swine Farms Siting2A4cand Animal Waste MOl1llV t Systems taws2 which like the local roles imposed comprehensive requirements on swine farms relative to permitting
setbacks buffers and other related issues local regulation of swine farms with the exception of zoning regulation in limited circumstances was not allowed26 The court held tbat the boaId
ofhealth roles were preempted by state law because the state bas already provided a complete and iDtegJated regulatoty scheme of swine tlum regulationswJ7 In afIlrming the Io court s
pI 1on decision the supreme court inod stale Sl8Iutes and regulations govemiDg the siting ofswine farms and animal waste as well as the exprlnl JlUIPOSC intent breadth and scope ofthe
staIutes The court articulated three jI stifications for concluding tb8I the local roles wereoper 1eFirst ftom the ofpmpose 1iDgthe Swine Fann Siting Act the court concluded tb8I the
GenetaI Assembly in ill to Slrike a balance between JlIlllectiD3 thebrtisof landowners and suppmting the swine tlum indusby because it is iwpudlwl to the pWnOnric stability ofthe staten2sThe
court stated that regulation by both the stale and the county was conttary to this intent because it wou1d pIeseal an excessive bunIen on swine flmners and the potk production iDdusby
as a wholen29 Second the court recognized tbat one pmpose of the animal waste law was to promote a cooperative and COOJdin8Ied approach to animal waste 1IllInlli llIIIOII8the es ofthe
Slate30 The court explained that dual regulaticm was conttary to this pmpose because if each county allowed to enact its own waste 1IllI 1m 1i there could be DO statewide COOJdin8Ied
a8oJaclbI m31 The thirdjustification for cIeterminin that the local roles were I tod was based on the breadth and scope ofthe state s regulation The court concluded tb8I the staIuleS
are so comprebensive in scope tb8I the General Assembly must have inle 24 G s 18006 805 25 G S 14321S 10A 12O1M5 26 Ovig v Cootnty ofClralhom 143 N CApp 30 40 S45 SE2d455 461 Ibeno is
a specific tmyprovision th8t pamitscounties to adopt zoning lJIfinon governing swine farms in 1imited ucnlIIiImnlles Id citing G S 15lA b3X40327 1d 8140 S45 S E2d at 462 28 Cnzlg 356
Ne 8147 565 S E2dat 177 29 ld at 48 56 S12dat 178 3O ld 3Ud 3
Bea1th Law BulletIn No 81 that they comprise a complete aud integmted regu1atmy scheme on a SlaIewide basis 32 Based on this review the court concluded that the board of health ndes
were invalid because the state had in place a complete and integmted regulatmy scheme for swine farms and intended to preempt or OYeJricle any local regulation of swine farms 33 The
court did recognize that dual regulation may exist in some situations se in addition to their genera1 ruI 1ci1lg authority locaI boanIs ofhealth are authorized to adopt more stringeot
regulations than those ofeither the i lII for Hcalth Services or the EMC when more stringeot roles are required to protect the public bealth 34 Tbc court reviewed the applicableEMC regulations
aud coocIuded that the board ofhealth roles were more stringent in some reprds Thecourt however fOlllld that the roles were still IJPlleIdbecause the board ofhealth simply included a
etmasserting that more sIIingaII rules were I to protect the public health aud did not iandnndye I8liona1e or basis formaking the restrictions infhothom County more rigorous than those
applicable to aud foI1owed by the rest ofthe state03 Summary The statuIOIy gmnt ofgenera1 rul 1ci118 authority to boards ofhealth is rather broad the boanIs are authorized to adopt ndes
nee I i to protect aud promote the public s hea1th They are also specifically authorized to adopt more slringatt ndes in aress by the Coomomfoi r Hcalth Services or the EMC ifmore slringatt
ru1es are ry to protect the public health Two receot court clecisions however have limited local boards authority in tIuee basic ways First a board of bealth is acting within its ruJemalcil1g
authority only if the role is re1ated to the promotion or protection of health is reasonable in light ofthe health risk addmud 32 Craig 356 N C at SO 565 SE2d at 179 33 ld at 52 56 8
2Ed at IllllOl The pnurindPr of the llIIJlIe1IIe court decision11tl 7M one limited statutory exception to this preemption The slate law permits counties to adopt zonins ozd governing
swiDe farms in limited uccmaiatnanc ld at 54 56 ES2d at 181 citiDg 0 8 153A b3X40334 ld at 51 56 8l2datl79 cilina O S 13OA 39 35 ld at 52 56 S E2d at 180 November 2003 1 does not violate
any law or constitutional provision isnotdiscriminatory aud does not make distinctions based upon policy concerns traditionally reserved for legislative bodies 1Woo1f1the last requirement
described above a board ofhealth may not adopt roles based on the consideration tooffrisll other than health Second the local board ofbealth ndes may be OpOlIlpIlcd if the state has
already provided a complete and integmted regulatmy scheme of regulation such as in the field ofswine farms 1bird if the board of health adopts ndes that are more stringent than roles
adopted by the Commission for Health Services or the EMC the board must express1y demonstJate that more stringeo1 ndes are ry to protect the public s hea1th 11da Is pabIlshed by the
SdlocI ol Govemmenl lo ddJo ol 1o govemmeI1l oifIdal PabIlc offIdela IlIlIY prtnI ou or phoIooopy the baIIetIn U11der the foIIowtna coouIWono 1 It IscopIed In lis entIJety 2 It Is copIed
ooIeIy for tton 10 other pabIk olfIdaI8 empIoyeee or lol1tebffell1nl 0I1d 3 oopIee not ooId or used for amunelde poupcoeo AdcIItlonaI prI11IecI oopIee of this bulleltn may be pwdwedomthe
School ol Covemmenl To pIaal an order or a catalog olSchool ol Government aptukbmlko pleue vfslt theSchool Web site athttD I8wDwwf n or contact the aPtukbm1ok SeIeaOffIce SdlocI ofGovenmumt
CBl3330 Knapp Bullclls UNC Clape1 HlII Clapol HlII NC n oeaIeoOIdogmaIUuogUDC te1ephone 919 4916169 or fax 919 962Z1U7 Por genend l11qulIlea caIl the School 01eo t malnnumber 919 Tho
SdIooI ofOovemmenl ofTho Uaiwnity ofN CaroIius 01 CIIspeI Hill bu primed lclts1 of410 copies oftbis public entol ofS 74 9 or liS Thoso iDdude cm1y the ofreproduClioo They do DOl iaoh1do
pnpsntiOll bsndIia or dilllcriobluisti C2OO3 School ol Government The UnlYeIllIty ol North CaroUna at Clapol HlII PrIn1ed In the UnIted Staof Amerlca 11da pauttbo1nk Is prI11IecI on
pennanent lelCeid paper In maplesnwith the North CaroUna Genersl Statu 4
II I1 ee g North Carolina Department of Health and Human Services Division of Public Health Women s Children s Health Section 1917 Mail Service Center Raleigh North Carolina 27699 1917
Tel 919 733 7752 Fax 919 715 6781 Michael F Easley Governor Cannen Hooker Odom Secretai November 26 2003 To Local Health Directors Loca Health Department Nursing Supervisors Universal
Childhood Vaccine Distribution Program UCVDP Participants Beth Rowe West RN BSN Head Immunization Branch From Re Influenza Alert The purpose of this memo is to provide you with two essential
documents I press release entitled State Health Director Strongly Advises Children and Pregnant Women to Get Flu Vaccine and 2 Request for Information Acute Encephalopathy Associated
with Influenza Virus Infection in U S Children This is in response to a recent Centers for Disease Control and Prevention CDC announcement that the 2003 04 flu season is expected to
be severe numerous cases have already been reported across North Carolina and the nation Reminder Reminder The North Carolina Immunization Branch provides flu vaccine to UCVDP participants
for children 6 to 23 months of age 6 months through I 8 years of age with chronic health conditions children under 9 years old who have not had their first influenza vaccination and
pediatric contacts of high risk individuals The Branch also provides state supplied influenza vaccine to local health departments to be administered to any non Medicaid recipient during
her second and third trimester of pregnancy regardless of age during the second and third trimester of pregnancy as long as influenza vaccine is available Medicaid enrolled prenatal
patients 18 years of age should receive privately purchased influenza vaccine Please urge all staff in your agency to be vaccinated against influenza The CDC estimates that only 37 percent
of health care professionals have received flu vaccine It is strongly recommended that every health care professional who interacts with patients receive an annual flu vaccination as
soon as possible If you have questions please contact your regional immunization consultant or call the Branch s central office at 919 733 7752 Cc Dr Jeffrey Engel Sheila Cromer Immunization
RIes Carol Schriber Office ofPublic Affairs Immunization Central Office Staff SMT LocatiOll 1330 St Muys Street Raleigh N C 27605 An Equal Opportunity Employer
Michael F Easley Governor Carmen Hooker Odom Secretary State of North Carolina Department of Health and Human Services For Release Contact Immediate Laura Leonard 79159 6762 Carol Schriber
791339 9190 State Health Director StronlIv Advises Children and Prelnant Women to Get Flu Vaccine Date November 25 2003 RALEIGH With the eenters for Disease Control and Prevention CDC
warning of an early and potentially severe influenza season pregnant women in their second or third trimester of pregnancy should receive a flu shot as soon as possible say North Carolina
State Health Director Dr Leah Devlin and North Carolina O stetrical and Gynecological Society President Dr Robert Littleton Children under 9 years old who are not already imriiunized
against flu and especially those ages 6 through 23 months should also get their flu shots now The beginning of this years flu season is earlier than usual and North Carolina like the
rest of the nation has identified multiple cases of the disease It takes two weeks to develop immunity to the flu virus after getting a flu shot so it s a good idea to get vaccinated
now Dr Devlin said The flu season can last through March Numerous cases have already heen reported of influenza related hospitalizations among pregnant women in the United States Because
pregnant women are at a higher risk of flu related complications it is important for them to get flu shots immediately she said Flu can be a serious illness Each year 114 000 people
are hospitalized and 36 000 people die in the United States as a result of the flu Dr Littleton supports vaccination of pregnant women For every 1 000 pregnant women vaccinated an estimated
one to two hospitalizations could be presvaeidntDedr Littleton Studies have shown that there is an increased rate of illness and death in pregnant women who contract the flu It is much
better to be vaccinated than to risk getting the disease Children also face many complications from flu disDearseDevlin said A primary flu related complication in children is brain damage
known as encephalopathy which has been reported this year in the United States and in Europe I strongly encourage those at risk including women during their second or third trimester
of pregnancy and children to get the flu vaccine at their physician s office or local health desphaertmadednetd The flu vaccine is safe and is the most effective way to prevent the disease
and its complications Get a flu shot it s that simDprleDevlin said With the holidays approaching college students will be coming home children will be out of school and families will
gather together creating an environment which allows the flu virus to spread rapidly Although many of the influenza cases diagnosed this year have been found to be a strain somewhat
different from those contained in this year s version of the flu shot the vaccine is believed to be cross protective It is still necessary to be vaccinated against the disease Dr Devlin
said since this year s vaccine protects against many varieties of the flu a VIrUS More Public Information Office 200 I Mail Service Center Raleigh NC 27699 200 I 919 733 9190 FAX 791339
7447 Debbie K Crane Director @
t Flu Shots 1214 03 page 2 6The Advisory Committee on Immunization Practices ACIP also recommends that the following people get flu shots Adults aged 50 or older Infants and children
aged 6 months through 23 months Anyone aged 249 years who is at increased risk for influenza related complications Children under 9 years old who have not had their first influenza vaccination
Pregnant women who will be in their second or third trimester during flu season Healthcare workers and All household contacts of persons at high risk for influenza Dr Chuck Willson president
of the North Carolina Pediatric Society reaffums the CDC s decision to encourage flu vaccination for children Children are more likely to spread this virus because of their close proximity
to one another and their active nature It is important to remember that ch11dren are more susceptible to iJItluenza re1ated complications because oftheir developing immune systems The
best thing a parent can do to protect their child this flu season is to vaccinate as soon as possible against the flu disease Dr Willson said As in any flu season Dr Devlin urges everyone
to take basic precautions to help prevent influenza Avoiding contact with ill persons and frequently washing your hands can reduce the risk of infection People who cough or sneeze should
cover their nose and mouth with disposable tissues or a handkerchiefto limit spread of the virus Flu symptoms begin suddenly and may include fever severe headache body aches sore throat
and cough Flu can make a person more susceptible to pneumonia an illness that puts a severe strain on the heart and lungs which can be especially dangerous to people who already suffer
from heart and lung disease Those who develop flu like symptoms should drink fluids rest and stay home to avoid spreading the infection Flu sufferers may also take over ctohuneter drugs
such as acetaminophen and ibuprofen but aspirin should be avoided because taking it for some forms of flu has been associated with Reye s Syndrome a seriClus disease in children that
can occur following a viral illness and that causes swelling of the brain Prescription drugs are also available to treat flu they are most effective if taken within two days of developing
symptoms Antibiotics are not effective against viral diseases like flu For information regarding local area flu vaccinations contact your local health department or the state Immunization
Branch at 919 733 7752 or North Carolina flu clinic locations can be found on line at http www mrnc orglfcfl 1 e
Request for Information Acute Encephalopathy Associated with Influenza Virus Infection in U S Children Since the mid I 990s several hundred cases of acute encephalopathy have been reported
in Japanese children with influenza These illnesses have been characterized by fever and rapid onset of encephalopathy resulting in a high frequency of neurologic sequelae and mortality
Most of the children have had laboratory confirmed evidence of influenza virus infection Reports of influenza associated encephalopathy have been uncommon in the United States To determine
if a similar pattern of influenza associated encephalopathy is occurring in the United States the Centers for Disease Control and Prevention CDC is requesting information from health
care providers on any patient with acute encephalopathy meeting the following criteria 18 years old Altered mental status or personality change in patient lasting 24 hours and occurring
within 5 days of the onset of an acute febrile respiratory illness Laboratory or rapid diagnostic test evidence of acute influenza virus infection Diagnosed in the United States Please
report any suspected cases to either Dr Tim Uyeki 404 639 0277 trnuO@cdc gov or Dr Niranjan Bhat 404 639 2893 naib9cdc gov at CDC t I Request for Information Influenza associated Deaths
in U S Children CDC would like to receive reports about any deaths in patients 18 years old with evidence of influenza virus infection We would like the following informatiaGon fatal
cases in the U S Clinical summary with history of illness Laboratory results including documentation of influenza virus infection Autopsy report if available Please report any fatal
influenza associated pediatric cases to either Dr Tim Uyeki 404 639 0277 tarnuOcdc gov or Dr Niranjan Bhat 404 639 2893 naib9cdc gov at CDC I J ee
November 2003 New Hanover County Health Department Betsy Summey FNP 343 6531 Influenza children with encephalopathy given before repeating it If Are We Protected Please notify the Health
you prefer you can perform Department if you see serologic testing to check for Along with other regions suspected flu activity or immunity in the U S North Caro cases of flu associated
Iina is experiencing early flu pneumonia in pregnant Think TB activity this season Sentinel women or encephalopa sites at college and university thy in children New Hanover County student
health exceeded the na centers have Vaccine Questions tiona and state rates of noted clusters tubercu of fl u cases F or medical care pro losis last NCSU in Ra viders who give im year
The leigh has re munizations these ques current Sta ported an outbreak since No tions occasionally arise tistics indi vember II Soon these stu cate the e dents will be dispersing for
Q Is it required to use a vac same may occur this year the holidays carrying the vi cine information statement and by a greater number To ruses to many other areas VIS in an emergency
room date New Hanover when Td is given to a patient County has had 15 cases All isolates statewide are A Yes The National Child of tuberculosis disease this type A1H3N2 and samples hood
Vaccine Injury Act re calendar year with a sus have been sent to the quires that a VIS be given to pect currently hospital CDC for strain identifica persons of any ized Of note two of
the tion Panama vs Fujian re JD cases did not survive their iII Type AlH3N2IPanama is in receive a d se 0 ness having received medical the current vaccine but it is of any vaccme attention
too late in the not known whether it will included in the course of the disease One protect against the Fujian Act Tetanus case is INH resistant strain Vaccination is still en and diphtheria
toxoids are in couraged because there may c1uded in the Act If the pa A change in the Administra be cross protection The vac tient is unaccompanied and tive Code is currently being cine
will protect against the unable to clearly read and un proposed which will require other two viruses AlH I N II derstand the information in laboratories who cultivate M New Caledonia
and type BI the VIS this should be noted tuberculosis to submit the iso Hong Kong Immunity oc in the patient s chart late to the State Laboratory of curs in two weeks after Q What should
be done if a Public Health for genotyping vaccination so it is impor dose of expired vaccine is We have been able to access tant to vaccinate now given to a patient this capability by
special re A The dose should be re quest and found that several e Texas has reported increased peated If the dose is a live of our cases have the same morbidity in type AlH3N2 virus
vaccine you must wait genotyping This came as no cases in pregnant women with at least four weeks after the big surprise when we found pneumonia and in school aged previous expired dose
was continued
the contacts of the cases over lapping time and time again We do appreciate your contin ued awareness of the problem of tuberculosis in our commu nity and hope that you will con tinue
to think TB CDC Health Advisory Pursuant to a CDC Health Advisory regarding the pos sibility of anthrax being identi fied in the Ana costia Naval Postal Sorting 0 Facility clinicians
are urged to re view the signs and symptoms of anthrax and consider the diag nosis with their patients Inhalation anthrax starts with a nonspecific pro drome i e fever dyspnea cough
and chest pain fol lowing inhalation of infec tious spores Approximately 2 4 days after initial symptoms and sometimes after a brief pe riod of improvement respira tory failure and hemodynamic
collapse ensue Inhalation an thrax also might include tho racic edema and a widened me diastinum on chest x ray Cutaneous anthrax follows deposition of the organism onto the exposed
skin An area of local edema becomes a pruritic macule or papule which enlarges and ulcerates after after 1 2 days Small 1 3 mm vesicles may surround the ulcer A painless depressed black
es char usually with surrounding local edema subsequently devel ops The syndrome may in clude lymphangitis and painful lymphadenopathy Any suspected case of an thrax should be immedi
ately reported to the appropriate local or state health department Final Issue This will be the final issue of e the EPllnformation news letter Takingits place will be a news letter
with a more comprehensive view of health department activity and written by i i our Health Promo tion Division staff In the search for topics of interest for EPllnfonnotion I have learned
much and I hope there s been a pearl or two for you as well e Communicable Disease Statistics New Hanover County July 1 2003 October 31 2003 AIDS 19 Campylobacter 5 Chlamydia 172 Ehrlichiosis
Monocytic 1 Gonorrhea 88 Haemophilus Influenza Invasive 0 Hepatitis A 1 Hepatitis B acute 1 Hepatitis B chronic carrier 8 Hepatitis C acute 0 HIV Infection 19 Legionellosis 0 Listeriosis
0 Lyme Disease 3 Meningitis PneumoO coccal Meningococcal Disease 0 Pertussis 3 Rky Mtn Spotted Fever 2 Salmonellosis 46 Shiga Toxin Producing Infection formerly E coli 0157 H7 2 Shigellosis
1 Strep Group A Invasive 1 Syphilis 6 Toxic Shock Syndrome 0 Tuberculosis 5 Typhoid acute O Vancomycin Resistant Enterococcus 4 e
jI MAKtl Ci A Dt FERfNCEIN DIABETES WITH T1MELY INfOIlMAtlQNfORTHECITIZENS OF NEW HANOVER COUNTY L Where to Go for Help in If You Have Diabetes New Hanover County a Flu Shot Could Save
Your Life For people with diabetes the flu can be more than aches and pains Diabetes can make the immune system more vulnerable to severe cases of the flu which can mean longer ill ness
hospitalization even death Consider the odds During flu epidemics deaths among people with diabetes increase 5 15 People with diabetes are 6 times more likely to be hospitalized with
flu complica tions and 3 times more likely to die with the flu or pneumonia Each year up to 30 000 deaths among people with diabetes are associated with influenza and pneumonia Flu vaccines
are available at the New Hanover County Health Department doctor s offices clinics and pharmacies and Medicare Part B covers them Diabetes is a complicated disease and adequate management
requires access to many resources Most patients rely on their primary care doctor to both monitor and educate them about the disease Additionally those with diabetes are encouraged to
see their ophthalmologist and podiatrist on a yearly basis to monitor potential long term complications Optimally all diabetics should see a diabetes educator and nutritionist Diabetes
educators teach patients about their disease and cover issues such as blood glucose tesling insulin pump education and dietary counseling The diabetes educators at Wilmington Health
Associates and Hanover Medical Specialists work with patients who are referred to their endocrinology department Liberty Home Care offers outpatient diabetes education Nutritionists
such as Heidi Kaufman counsel diabetics about special dietary neecls Medicare and some private insurance companies pay for diabetes education Patients may be required to first meet an
annual deductible andor pay in advance for services The New Hanover Diabetes Today Coalition offers self management classes for those who do not have insurance to cover diabetes education
For those who do not have a doctor the New Hanover Community Health Center accepts new patients Indigent patients with no insurance are eligible for the free walk in diabetes clinic
at Tileston The outpatient department at New Hanover Regional Medical Center offers a diabetes clinic with physician referral Nis the j I lower lege Heart dfs s aill Stroke People with
diabetes aw 24 nIeis more IikelY to liilvj lieaif disease and 24 funes 1iketY to SUffer a stroke v l xOU Kfep Bray aC Eat loWjat vegetables lU For more information please call New Hanover
Community Health Center 0324730 Wilmington Health Associates 251 2093 Hanover Medical Specialists 763 5182 Wilmingion Endocrinology 2549464 Heidi Kaufman 343 7087 Liberty Home Care 815
4353 extension 274 New Hanover Regional Medical Center 343 7001 Tileston Outreach Clinic 343 1736 wer your risk trot f the week are high in fruits giafu foods c For additional information
on resources in southeastern North Carolina www dmpartnership org For information about the New Hanover Hanover Diabetes Support Group email DiabetesToday1@aoLcom MARK YOUR CALENDAR
Diabetes Self Management Classes Tuesdays November 3 10 17 and 24 3 to 5 PM at Cape Fear Community College Phone 343 675185 registration fee Diabetes Self Management Qass Saturday November
15 9 am 1 PM at New Hanover
CoHmemaluthniCittr Phone Nella at 343 0270 x 119 to register Spanish Translationavailable Free for Health Center patients Diabetes Support Group November 20 EndocrinologistJohn Parker
MD How to Successfully Manage Your DIabetes 1 30 3 00 PM at the New Hanover Senior Center Phone 343 6758 for information Free Foot Screenings November 8 at Brunswick County Airport phone
457 4789 November 15 at Second Wind Fitness Center in Hampslead phone 259 5451 November 22 in Wilmington phone 343 2470 for details Diabetes Today is a special publication of the New
Hanover County Diabetes Today Coalition which provides the editorial content The Diabetes raday Coalition was formed in 1999 to advocate for diabetes care and prevention in New Hanover
County The Coalition is supported by a grant from Cape Fear Memorial Foundation
f Diabetes Tc j November 2003 Diabetes iI tes es una le1medeaJd silenci i tenerla jnuchos alios X i Ia padece usted no jselmiI J I J e la enferm ta misma Ie eslli do sus ojos SUB nimoios
y SUB riiiones I conslantemente Ceguera Diabetes es Ia principal causa de I nuews casos de ceguera en personas entre r lal de227 ad de los biabetes es lae causa de terminal dee f P ii
edad de los NerviOs y Amputaciones Diabetes es la causa principal de EX edd sdeC dioe es y Paros dClacaos Las personas con diabetes son 2 0 4 veces mas pro a sufrir dades car es 0 dehioraz6n
asi CDOt bien ataques del coraz6n EI rie sgo de contraer Diabetes au ta con la ed Bted pelll mas de lo normal 0 Bles sedentario 0 se a La deillbet lelllsis comnn entre los Africanos
Americanos Latinos Indigenas AmericanOB y si3ticos Americanos Algunos de los factores que aumentlln as posibilidades de contraer la enfermedad son 1 Pr 6n Uta de mas 5 2 Teller historia
de Ia tamilla j llmer diabetes l embarazo oe dado a luz II un itlilo de mas de 9 libl1lS iiIII ii1IiiI iI II II I lsputeede hllCer ci Xlsas pam reducit I supeso j i ngase activo dillriaOumte
COOsurila alimentos altoll en fibra como I v y blljOB en grasay ca1orias 0 CQue puede Hacer G cD6nde pueclo obtener ayuda en el condado de New Hanover La diabetes es una enfermedad complicada
que requiere de un tratamiento adecuado asi como de acceso a diferentes recursos para lograr un buen control La mayoria de pacientes COMan en su medico para que les administre y eduque
acerca de su enfermedad Es muy importante que los diabeticos visiten el oftalm61ogo doctor de la vista y el podiatra doctor de los pies por 10 menos una vez al aiio para asegurarse que
se encuentren bien Idealmente todo diabetico debe reunirse con un educador de la diabetes y nutricionista para obtener consejeria sobre aspectos c1aves en el manejo de su enfermedad
tales como medir el nivel de azUcar diariamente c6mo usar la bomba de insulina asi como aspectos relacionados con la nutricion Lugares como Wilmington Health Associates y Hanover Medical
Specialists trabajan con los pacientes que son remitidos por los departamentos de endocrinologia AIgunas compaiiias de seguro privadas pagan por estas sesiones Nutricionistas como Heidi
Kaufman aconseja a los diabeticos con respecto a sus necesidades dieteticas individuales Medicare y algunas compaiiias de seguro medico privadas cubren estas c1ases de educacion de la
diabetes Puede ser que los pacientes tengan que pagar un deducible anual 0 pagar por adelantado por estos servicios La Coalicion de Diabetes Today ofrece c1ases para el control propio
para aquellas personas que no tienen seguro medico Una muy buena opcion para aquellas personas que no tienen seguro medico es el New Hanover Community Health Center que cuenta con un
programa de descuento familiar y que ofrece c1ases de diabetes totalmente gratis Tambien Tileston ofrece una clinica para diabeticos sin seguro medico y acepta pacientes sin cita Finalmente
el Hospital de New Hanover ofrece una c1inica para diabeticos con recomendacion del doctor Para mas informacion por favor llame a New Hanover Community Health Cntr 910 343 0270 ControYing
Diabetes isn t a Piece of Cake HANOVER MEDICAL IF YOU ARE 18 YEARS OR OLDER H SPECIAUSTS PA AND HAVE BEEN DIAGNOSED WITH TYPE 2 Diabetes Mellitus then you may and the Division of Endocrinology
be eligible to participate in a medical Paul C Whitesides Jr MD research study of an investigational drug Michael S McGarrity MD for diabetes John C Parker MD For more information call
New Hanover Medical Research 1515 Doctors Circle Wilmington NC 28401 910 763 6332 910 799 5500 Office Hours By Appointment r o Page2 Wilmington Health Associates 910 251 2093 Hanover
Medical Slpiecliats 910 763 5182 Wilmington Endocrinology 910 254 9464 Heidi Kaufman MS LDN CDE 910 343 7087 Liberty Home Care 91O 815e4353 extension 274 Tileston Outreach Clinic 910
343 8736 Para mas informacionpvisitor la pligina web www dmpartnership org Para mas informacion con respecto li gropo de apoyo Puede enviar un correo electronico a DiabetesToday l@aolcom
Si usted tiene Diabetes la inyecciOn contra Ia gripe Ie puecle salvar la vida Si usted tiene Diabetes la inyeccion contra la gripe Ie puede salvar la vida Para las personas que padecen
de la diabetes la gripe puede significar mas que dolores de cabeza y cuerpo La diabetes Qace que el sistema inmunologico sea mas vulnerable a casos severos de la gripe 10 que puede significar
enfermedades por largos periodos de tiempo hospitaIizaciones y hasta la muerte Considere las condiciones Durante epidemias de gripe el porcentaje de muertes entre diabeticos aumenta
entre un 5 15 Las personas con diabetes son seis veces mas vulnerables a Ber hospitalizadas con complicaciones relacionadas con la gripe 0 neumonia Cada aDo entre 10 000 a 30 000 muertes
estan asociadas con la infiuenza 0 neumonia Usted puede vacunarse contra la gripe a un costo reducido en lugares es como EI New Hanover Community Health Center el Centro de Salud oficinas
de doctores privadas farmacias La mayoria de los seguros medicos cubre la acuna contra la gripe asi como Medicare y Part B Dial itter Ma1ll1j W rompklld advanad training in TIIlnuk lVJ
on wourul care live manogement ofdUlhetes Let her exptrtisepuI you in 1M rigid sIwe Medical Center 7 7 AW Hours M F 8 5 30 Home Care mwedicalcwenterhowmecare com FooT ANKlE SURGERY DIABETIC
FooT CARE SPRAINS FRAOURES AMBULAlORY SURGERY INGROWN NAIlS ENDOSCO C SURGERY SECOND O NION CoNSULTATIONS XRAY FAOUT1ES o 2 sl Q 1 Ys l 9lC2 Insurance accepted and liIed Ilk I I IIII
III j II IIiI II
Diabetes TOd ovember 2003 Mexican American Cooking By Marisa Warrix The Mexican diet oftoday is rich in a variety offoods and dishes that represent a blend of pre Columbian Spanish French
and more recently American culture The typical Mexican diet is rich in complex carbohydrates which are provided mainly by corn and corn products beans rice and breads The typical Mexican
diet contains an adequate amount of protein in the forms of beans eggs fish and shellfish and a variety of meats including beef pork poultry and goat Because of the extensive use of
frying as a cooking method the Mexican diet is also high in fat Try cooking in canola or vegetable il to avoid saturated fat The nutrients most likely to be inadequately provided are
calcium iron vitamin A folacin and vitamin C Marisa Warrix Family and Consumer Sciences Ohio State University Spanish Style Rice with Chicken Ingredients 1 tablespoon canoIa oil 2 medium
onions chopped 4 garlic gloves minced 2 stalks celery diced 2 medium red or green peppers chopped 1 cup chopped mushrooms 1 3 1b chicken cut in 8 pieces skin removed pinch of salt 3
h cups chicken broth fat removed 4 cups water pinch of saffron for color 3 medium tomatoes ch6pped 1 cup frozen peaS 1 cup frozen green beans Olives for garnish optional This dish is
low in fat and chock full of healthy vegetables The substitution of brown rice for white rice also makes this recipe high in fiber Preparation Heat oil over medium heat in nonstick pot
Add onion garlic celery green pepper and mushrooms Cook over medium heat stirring for about 3 minutes or until tender Add the rice saute for 2 3 minutes stirring constantly until it
begins to brown Add the chicken salt broth water saffron and tomatoes Bring the water to a boil then reduce beat to medium low and let simmer Cover the pot and let simmer until the water
is absorbed and the rice is tender about 25 30 minutes Stir in the peas corn and beans and cook for 8 10 minutes Garnish if desired Serves 8 IIIIIIIIII Get Real You don t have to eat
like this to prevent diabetes Over 45 and overweight Talk to your health care provider about the small steps you can take to prevent diabetes For free information about preventing diabetes
call 1 800 438 5383slate of North Carolina Deparbnent of Health and Human Services Division of Public Health Diabetes Prevention and Control Branch www ncdiabetes orgll l A North Carolina
DllIbeta AYdCouncll I Page3 Arroz con PolIo Ingredientes 1 cucharadas de aceite de canola 2 cebollas medianas 4 dientes de ajo picaditos 2 tallos de apio en cubitos 2 pimientos verdes
rojos cortados en tiras I taza de bongos 2 tazas de arroz I polio de 3 libras cortado en 8 piezas sin la piel I cucharadita de sal 3 112 tazas de caldo de pollo quitele la grasa 4 tazas
de aqua Azafran si 10 desea 3 tomates medianos cortados I taza de guisantes petit pois congelados I taza de maiz congelado I taza de guisantes verdes habicbuelas tiernas Aceitunas para
adornar si 10 desea Preparacion Caliente el aceite en una cacerola gue no se pegue Anada la cebolla el ajo el apio el pimiento verde y los hongos Cocine a fuego mediano removiendo a
menudo por cerca de 3 minutos or hasta que esten tiernos Anada el arroz y sofria por 2 3 minutos moviendo constantemente hasta que coimienze a dorar Anlida el polio la sal el caldo de
polio el agua el azafran y los tomates Espere hasta que el agua hierva entonces baje a fuego mediano y deje que continue hirviendo Cubra la cacerola y deje que hierva hasta que toda
la agua se absorba y el arroz este tiemo 25 30 minutos Agregue los guisantes el maiz y los guisantes verdes y cocin de 8 10 minutos Adorne si 10 desea 8 porciones 1 LA COMIDA AMERICANA
MEXICANA Por Marisa Warrix La dieta mexicana es muy rica en una variedad de platos que representan una mezcla de tradiciones pre colombinas espaiiolas francesas y mas recientemente de
la cultura Americana La tipica dieta mexicana es rica en carbohidratos de los cuales la mayoria proviene del maiz y productos del misnlO asi como de los frijoles el arroz y el pan La
tipica dieta mexicana contiene contiene una cantidad adecuada de proteina en la forma de frijoles huevos pescado y unavariedad de mariscos carnes cerdo pollo etc La dieta mexicana es
alta en grasas debido a que la forma mas popular de cocinar los alimentos es friendolos Para reducir el contenido de grasas en las comidas pruebe el aceite de canola para evitar el consumo
de grasas saturadas Los nutrientes que esta dieta no proporciona adecuadamente son el calcio hierro vitamina A encontrados en 10s alimentos son el calcio el hierro la vitamina A acido
folico y vitamina C Marisa Warix Ohio State University I Family and Consumer Scienc i 1787 Neil Avenue Columbia OH 43210 I SUMMIT PODIATRY Glaser Foot Ankle Clinic 1717 Shipyard Blvd
791 1300 llJ1 ington Health Associates NEW LOCATION 1501 Medical Center Drive W mington NC 28401 F Our Board Certified Endocrinolo ists Are Here TdJUlp 1tlm ugh M D J lllil jil 1tIl
DeDe Warmg M D 375 I If youre diabetic for yourneed lpeclal attention INFECTION FOOT ULCERS NEUROPATHY VASCULAR DISEASE BONE PROBLEMS
PROBLEMSJ l r DiabetesCJ Nov 2003 page4 How to Enjoy Your Holiday Season and Still Eat Healthily by MindySaenz RD LDN CDE Food is one of the pleasures of parties holiday festivities
1 2 pound 1 stick unsalted butter left at room thigh piece 12 hen on each plate and other social gatherings Any food even traditional temperature until just soft about 15 minutes Remove
the Herb Butter from the freezer Unroll the holiday treats can fit into a healthful eating plan The Corirlsh Hens wax paper slice 8 coin sized slices equal to about I secret is moderation
and balance Here are some tips to 4 Cornish game hens fresh or frozen if frozen teaspoon each If you want to remove t1ie skin from the help you make it through the holiday season allow
to defrost fully in the refrigerator before hens do so now Before serving place a coin of Herb WIlen you go to a party focus on visiting with friends be2inning the recipe Butter on top
of each portion It Will melt and enhance and faffiily and set ourself as far away from the food 3 4tap salt the flavor ofthe dish table as possible Otily go through a buffet line once
and 12 tap white pepper Rewrap the remaining stick of herb butter and return it to only take small amounts of fOOdS you really want You 1 ounce 5 tsp olive oU the fi r f ter l I don
t have to taste everything to enjoy yourself If you 8 tap Herb butter one tap per portion WIilJlpeiJ SweefPOtitoes iWiijieuiztelcilC5liimiioi are asked to bring something make sure you
take a low To prepare Herb Butter In a medium size bowl combine MaJes S seiVings fat item That way you ll know there is at least one thing the thyme sage and r semary with the unsalted
butter This recipe takes about 60 minutes to prepare and cook i alowed on your meal plan You can work the Spices into the butter with the back of a 3113 ounces raw shallots including
sliin r Je realistic Trying tolose weight during the holidays is spoon Set the Herb Butter 1 lgtliwise on a 1 foot length 1 tsp olive oU 1 probably an impossible goal ft may be better
to decide of waxed paper I inch form the edge of the paper Roll 1 pound fresh sweet potatoes peeled to just not gain any weight the Herb Butter in the waxed paJer to make a cylinder
2 quarts water I Try to stiel with your normal eating schedule as much Crimp both ends of the papei anil tape it shut so it does 1 tap salt most wUlbe thrown out with the water I as
possible Studies have found that Jeople who skip not unroll Place the cylinder of Herb Butter in the 3 ounces Ja bit less than 1 4 cup evaporated not meals end up snacking or eating
more later on It can freezer Allow it to chill there for at least 2 hours It can condense skim milk I even lower your metabolism so you don t burn as much be stored for up to 3 months
2 tbsp margarine energy To Jrepare hens Discard the giblets and rinse out the lf4 tsp white pepper or to taste Eat slowly Really enjoy the taste of the food It takes insiile of the hens
Preheat the oven to 350 degrees F 14 tap cinnamon or nutmeg or to taste about 20 minutes for your stomach to signal your brain Season each hen by robbing it with the salt and white To
caramelize the shallots Peel the shallots slice them that you are full If you pup everything down you can pepper inside and out Now rob the olive oil onto the into 14 inch pieces Take
a medium size saute pan or eat more than you need oefore your brain has a chance entire outer surface of each hen Place a saute pan or nonstick skillet and heat it on medium high heat
Then to figure that out nonstick skillet over medium high heat When the pan is add the olive oil It is usually better to eat a small serving or just a bite of fairly hot place two of
the hens in the pan and sear them Now add the shallot pieces and saute until the shallots some of your high calOrie food than to avoid it for so long to a golden brown Then turn them
over and repeat on turn golden about 3 to 5 minutes Take the shallots out that you end up pigging out on it Eat a small bite and go the other side This will take about 30 seconds on
each of the pan and reserve them for later use use on with life side To prepare the sweet potatoes Dice the peeled sweet Balance your holiday meals with other meals during the Note Searing
each hen not only turns the skin a potatoes into I inch pieces In a medium size sauce pan day Eat lower calorie meals during the day so you can golden color but also begins the cooking
process It s a bring 2 quarts of water to a boil Add the salt and diced enJoy your celebration foods without feeling guilty It s necessary steJ for the recipe even if the high fat skin
is sweet potato to the water Allow the water to continue your total calories for the whole day that maller not the later discardeil Roasting the hen in the oven then makes boiling gently
until the sweet potatoes are fork tender calories in one meal Drink sparkling water with a twist it tender and helps keep the meat moist about 10 to 15 minutes Drain the sweet potatoes
and of lime or a diet soda instead of alcoholic beverages If If possible also stand the narrow sides of each hen in place them in a medium medium sized bowl Using an electric you do
drink alcohol only have one or two drinks and the pan and let each side sear for 30 seconds This will hand mixer combine the sweet potatoes half of the IYlLdrink and drive Remember that
alcohol has ensure that the cooking process begins evenly on all four caramelized shallots and the rest of the ingredients almost as many calories as fat so be careful sides helJing
the hens to continue cooking evenly after until they are thoroughly mixed Place this mixture in Stop eating when you leave the table Avoid the urge to they are plaincseide the oven a
serving dish Garnish by Jlacing the other half of the nibble as you are cleaning uJ the leftovers Set the two seared hens aside and repeat the searing carame d shallots on top Servebot
Remember to HAVE FUN Sharing food is part of many process with the remaining two hens JTeBh ePeiii Qmtn I celebrations but njoying a traditional holiday meal or a Place the 4 seared
hens on the rack of a roasting pan Makes 8 servings p food doesn t need to rum the healthful food hab ts Place the uncovered roasting pan m the preheated 350 This recipe takes about
30 minutes to prepare you ve worked on all year long degree F oven until hens are fully cooked The hens are 1 medium Red Delicious apple unpeeled To help you plan a healthful holiday
meal he e are cooked when an instant read thermometer inserted in the 1 Granny Smith apple unpeeled reciJes created by Chef Chris Smith The Diabetic breast reads 170 degrees F inserted
into the thigh reads 1 medium Bartlett pear a1i g d c nf r ir n rangejwce wiili Cliidren or tUrkey tooT minutes 14 tsp cinnamon This recipe using fresh or defrosted hens takes about
an To carve the hens Split each hen in half len wise by 5 fresh mint leaves finely chopped hour anda half to prepare d cook pl mg the hen n a solId urface such as a cutting bo d Core
the apples and the pear Wash the fruit well and The Herb Butter takes 15 mmutes to make and 2 hours WIth the breast de up usmg a sharp knife carefully slice leave the skin on It wilf
add color and fiber Dice the to chill from the breast bone fength se down thebreast keep g apples and the pear into 12 inch cubes and place them Herb Butter the knife next to the bone
WIth the tip of the kirife in a medium size bowl 12 tsp fresh thyme finely chopped or 14 tap f llow throu around the underside of the hen Now Add the rest of the ingredients raisin grated
orange rind dried still usmg the tip of the knife cut the breast away from the orange juice vanilla extract cinnamon ahd mint leaves 12 tap fresh sage finely chopped or 14 tsp dried
rest of t1ie hen Finally cut the leg and thigh piece away Mix well 12 tsp fresh rosemary finely chopped or 14 tap This will complete one portion Cover the mixture and place it in the
refrigerator for I dried After carving all 4 hens arrange I breastand I leg and about 3 hours Serve chilled r it1I I Diabetic Retinopathy BoardCtirtified In OphthaJmology Igor W MD Erik
van Rens MD 1801 NowHarKMlItlledical Park Dr Wdmioglon NC f703 Qi4 Rd Suite 104 JacksorlVine NC 4QOllJtrg E Suite 240 Utile River NC OfcoastaJcarolina com f II WOUND CARE Ghobad Azizi
MD LMINGTON Endocrinology PA SpeclaBzed MediclneF9rson8Ilzed Care Board Certified in Internal Medicine Endocrinology Diabetes and Metabolism Welcoming ExIsting PaUents New PaUents and
Physlclsn Referrals For Appointments 910 2549464 1776 Wellington Avenue Suite 2 Wilmington NC 28403 Ji a CC c W Qt o lilc 00 Meter Conversion Day Call 910 6862988 to find out how afreemeter
Ie Nov 5th Retirement Uvinp Showcase World Smallest SSamipzle CoastlJ Convention Center Approved for Alternate Site Wilmington NC Testi Nov 6th Johnson Home Medical PoNrteecrk Shopping
Coo 8e20t7SMarll Wilmington NC 910 6862988 111 11 1I11 b l ll ll k li CINft f 1mWlU NCIOti AlNUl WU MOtNNGl 910 81S000s II i