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06/05/2002 e e e Revenues Expenditures New Hanover County Health Department Revenue and Expenditure Summaries for April 2002 Cumulative: 83.33% Month 10 of 12 Budgeted Amount '11 \;P 1 -r OIIJ-a<f Current Year avenue Balance arnad Remalnin % Prior Year Revenue Balance Earned Remalnl" $ 1,580,784 $ .~3 $ $ 533,044 $ 483,271 $ $ 1,012,934 $ 789,811 $ $ 165,773 $ 165,775 $ 312,900 $ 241,583 $ 125,850 $ 134,405 $ 1,531,335 $ 1.253,480 745,871 49,773 223,123 811,404 $ 522,179 425,562 $ 97,482 384,687 $ 557,213 153,479 254.254 60.84% 81.36% 40.84'1. 100.00% 81.26% 106.370;' 77.23% Budgeted Amount Expended Amount % Budgeted Amount Expended Amount Balance Remelnln % Balance Remalnl" Summary Budgeted Actual % FY 01-02 FY 01-02 Expenditures: Salaries & Fringe $8,968,832 $6,995,413 Operating Expenses $2,086,235 $1,256,574 Capital Outlay $207,583 $109,877 Total Expenditures $11,262,650 $8,361.864 74.24% Revenue: $5,262.620 $3.903,238 74.17% Net County $$ $6,000,030 $4.458,626 7 . % 1;)' (p)- % Revenue and Expenditure Summary For the Month of April 2002 9 j e e e ~ NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS JJo 101//1 ~ Date (BOH) Grant ReQuested Pending Received Denied 5/1/02 No activity to report for May 2002. 4/3/02 No activity to report for AprIl 2002. 3/6/02 No activity to report for March 2002. 2/6/02 No activity to report for February 2002. 1/2/02 No activity to report for January 2002. Diabetes Education, Management and 12/5/01 Prevention - CFMF $60,000 $30,000 $30,000 Youth Tobacco Prevention Project- Robert 11nt01 Woods Johnson Youth Center $11,800 $11,800 Teens Against Tobacco Use (TATU)-Health Action Council of NC $350 $350 Healthy Carollnlans- NC DHHS $10,000 $10,000 Family Assessment Coordinatlon- March 9/5/01 of Dimes $16,500 $16,500 Folic Acid Prolect- March of Dimes $16,618 $3,000 $13,318 Safe Kids Coalltlon- State Farm"Good Neighbor" $500 $500 TB Elimination and Prevention - CDC, 8/1/01 NCDHHD, DPH, TB Control Prooram $10,000 $ 9,200 $800 Teen Aids Prevention ITAP)- CFMF $45,500 $25,000 $20,500 Diabetes Today - Diabetes Prevention & Control 7/11/01 UnR, NCDHHS $10,000 $10,000 Lose Weight Wilmington - Cape Fear Memorial Foundation $75,000 $75,000 Diabetic Care for Prenatal Patlents-NC Medical 6/6/01 SocietvFoundation $25,050 $25,050 Healthy Homes- Asthma Program - Partnership for Children (Smart Stert) $28,060 $26,000 $2,060 No actlvltv to reDort for Mav 2001 Matemlty Care Coordination Expansion Grant 4/4/01 NC DHHS $15,000 $15,000 Wilmington Housing Authorlty- Ross Grant - TAP & Alternative HIV Test Sites for 3 year funding $192,221 $192,221 Safe Kids Traller-8ale Kids Safe Communlties- NC Govemo~s Highway Safety $8,740 $8,480 $260 No actlvltv to reDort for Jan,Feb and Mar 2001 Intensive Home Vlsltstlon Program Expansion 12/6/00 Grant - Smart Start $100,000 $96,000 $4,000 Childhood Asthma Management & Control Interventions- NC Depertment of Heanh & Human Services, Division of Public Health, WCH 11/1/00 Section $23,000 $10,285 $12,715 Cape Fear Memorial Foundatlon-Llce 10/4/00 Eradication Program $5.000 $5,000 10 As of 5/13102 . NOTE: Notification received since last report. Date/BOH) Grant Requested Pendlnll Received Denied Healthy Carollnlans- Office of Heanhy Carolinians, Division of Public Heanh, North 10/4/00 Carolina Dept of Helinh & Human Services $10,000 $10,000 March of Dlmes- March of Dimes Birth Defects Foundation Eastern Carolina Chapter $10,000 $8,250 $1,750 Enhanced Counseling Program for HIV / AIDS 9/6/00 Enon John Aids Foundation $48,000 $48,000 Smart Stert applying for Cape Fear Memorial 8/2/00 Foundation Grant (MOW) $52,000 $50,000 $2,000 Enhanced Counseling Program- Z. Smnh Reynolds Foundation $48,000 $48,000 Teen Aids Prevention- Z. Smnh Reynolds Foundation $59,000 $59,000 7/12/00 March Toward TB Elimination- NC DHHS $10,000 $7,200 $2,800 Cape Fear Memorial Foundation (TAP Proaraml2 vear request $55,000 per vear $55,000 $35,000 $20,000 Diabetes Todav - DHHS DDPH $10,000 $10,000 Totals $955,339 $0 $391,115 $583,924 ,) , e NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS 0.00% e Pending Grants 0 0% Funded Total Request 9 32% Partially Funded 12 43% Denied Total Request 7 25% Number of Grants Applied For 28 100% e As of 5113/02 . NnTF' Notifir:ltion re('pivpn since last report. 40.94% 59.03% 11 . I , e e e Letter of Intent for 2003 Application March of Dimes Community Grants Program We are requesting Board of Health approval to submit a letter of intent to apply for the March of Dimes Community Grants Program. (We are also requesting approval to submit the application if we are invited to apply) Goals and objectives and a draft budget page are included in the following pages.) A new mandatory process includes the following: . Letter of Intent (due May 31,2002) briefly describing the proposal . Applications for full proposal will be by invitation only COVER LEITER will include the following identifYing information and funding priority being addressed: Funding Priority: n. Increasing Availability of Prevention Services . Increasing prenatal health education and information/referral services available to pregnant women who use tobacco, alcohol or other drugs Contact Person: Betty Jo McCorkle, BSN, RN Director, Women's Health Care Division New Hanover County Health Department 2029 S. 17'" St. WWnington, NC 28401 910-343-6660 (phone) 910-341-4146 (fax) Email: bmccorkle@nhcgov.com 12 I MOD Grant - Letter of Intent i - PRIORITY AREA. Category #ll. Increasing Availability of Prevention Services Increasing prenatal health education and information/referral services available to pregnant women who use tobacco GOAL. IdentifY smokers among pregnant women who receive prenatal and MCC services in New Hanover County OBJECTIVE. Offer smoking cessation education and track the progress of the identified women toward reduction or quitting. - Strategies: 1) Obtain training from experts (Trish Payne (Sheps Center), Lisa Moore (Catawba Co. Health Department), Nancy Simpson (WHISC - Winston Salem), JoAnne Carl (pOET - Region including Wilmington), Renee Douglas (DHHS) 2) Train MCC staff, Private Ob/Gyn office staff, Hospital prenatal clinic (out-patient) staff 3) Provide group education sessions (?twice weekly) 4) Contract with a local substance abuse prevention agency (?Coastal Horizons) to provide intense counseling for those who are identified as excessive smokers (ex: 2~ _ 5) IdentifY and track prenatal smokers through the use of a tracking system/evaluation ., tool (identifY who smokes, who quits, when they quit, and if they relapse) and possible use of the sticker system (identifYing smokers through the use of stickers on the medical record) in order to alert the entire staff of the individuals efforts to quit smoking. 6) Expand efforts to women of childbearing age through involvement with the health department's preconceptional counseling as timelstaffalIow (with the hopes of gaining buy-in from private offices for gyn interventions in the future). LOCAL NEED' A survey was conducted by the Family Assessment Coordinator with the New Hanover County Health Department from June, 2001 through April, 2002. Information was obtained on the number of prenatal women who requested information on smoking cessation. Based on 206 clients who responded to the survey, 10"10 of the population voiced a concern about smoking cessation. The undocumented data collected by MCC staff is that there are numerous women who smoke and express a desire to be involved in group education in order to benefit from the group exchange and gain support from other pregnant women who express a desire to decrease their smoking, but recognize their attempts in the past and their need for "buddies" in order to be successful. North Carolina SCHS data reflects that 15% of pregnant women smoked in New Hanover County in ] 998 and ]4% in ] 999 New Hanover County's percentage of smokers is equal to that of the _ NC percentage for the same penod. 13 .1 , e e a Smoking cessation classes are not available in New Hanover County. TARGET AUDIENCE. Number of participants Current MCC Caseload is 497 EVALUATION. A tracking system will be designed to follow-up with each client who is identified as a smoker and agrees to participate in smoking cessation education. We plan to obtain assistance from UNC- Wilmington for assistance with a too] for measurement. UNC-W has assisted us in the past through the development of a tool for evaluating the effectiveness of New Hanover County's Folic Acid Awareness Program. We will also utilize any tracking tools which may already be developed in successful programs (ex: Catawba County Health Department). PROVEN STRATEGY According to a 2001 Surgeon General's report, "eliminating maternal smoking may lead to a 10"10 reduction in all infant deaths and a 12% reduction in deaths from perinatal conditions" and "women are more likely to stop smoking during pregnancy, both spontaneously and with assistance, than at other times in their lives. Using pregnancy-specific programs can increase smoking cessation rates, which benefits infant health and is cost effective" The following models will be utilized as New Hanover County designs a program for training, educating and tracking: Cecil G. Sheps Center for Health Services Research @ UNC-Chapel Hill, DHHS model "Counseling Women Who Smoke", Catawba Co. Health Department "Kick Butts" program, and the Forsyth County WHISC (Women's Intervention for Smoking Cessation) model. In addition to these best practice models, we will also seek consultation from the following: NC Summit: Women & Tobacco, WATCH (Women a & Tobacco Coalition for Health). 14 . BUDGET Salaries Public Health Nurse ( 75 FTE) $39,082 Other Expenses/Fees Training consultation/travel fees 600 (5 visits @ $200 each) Training materials ...... . ., .... ., 250 postage/copying . . . . . . . . . . . . . . ., ....... 500 Incentives for training participants .......... 1,000 March of Dimes supplies .................. 500 Materials for educational sessions and workshops ..................... 3,000 Creation of printed material (graphic artist) ., . 500 Overhead costs . ...................... 4,543 TOTAL............................. $49,975 -4- i e - ~ 15 ~ .~ .~ ~ ~ ~ ~ '~ ~ -~~ - -,~ ~ ~ o--.S!!J ~ """'" ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ -::~ ~~ ~ ~ 5 G c~ r-<$ ~ ~ ~ fJ ~ [- ~ ;:::') ~ ...... o Sterilization Protects Animals & You The development of an on-site spay/neuter facility at the New Hanover County Animal Control Services shelter. Jean P. McNeil, DVM Daisy Brown David Howard, MPH Barbara McClure, MBA, CPA G. Robert Weedon, DVM NeMJ tlcvnovu CO'U+'\ty, N~COLf"'~ - ~ =---...~ -.3 d ~ 11 -:') ~ ~ :-j) ~ ==' ~ -::} ~ -4\ ~_...y ~ d ~ ~ :::} ~ ::::) :-:::) -::) :-:::) I~ " - 1.-<'\ 1''''J,f I~ '-=' ~ I~ .:::) 1;-::) I' _: ~ ~ ~ ~ ~ ~ ;j) ~ Sterilization Protects Animals & You New Hanover County Animal Control Services ~-~ Table of Contents Executive Summary 3 Company Description 5 Industry Analysis & Trends 7 Target Market 9 Competition 11 Strategic Position 15 Risk Assessment & Regulatory Issues 17 Marketing Plan & Sales Strategy 19 Operations 21 Technology Plan 23 Management & Organization 24 Community Involvement & Social Responsibility 26 Development Plan 28 Financial Information 30 Appendices 34 NC-2 Business Plan Management Academy for Public Health Page 2 of 51 - .-:9 ~ :::;) ~ ~1) ~ -d -;) -:j) ::::) :::;) ~ ~ -::J ::) :::;) ~ -:,) -::') ~ :::::) -:::} -::) .-::) ~ ~ ~, ~ .-::) -::) ~ .~ -:.:) -:;) ~ ~ ~ Sterfllzatlon Protects Animals & You New Hanover County Animal Control Services EXECUTIVE SUMMARY The Concept Pet overpopulation, irresponsible breeding, and the resultant rabies exposure risk are public health concerns in every area of the United States. According to Dr Alan Beck in his book Between Pets and People, "Recent estimates indicate that between 4 and 6 million animals were given up to shelters annually in the United States." We have tended to "solve" the problem by euthanasia of unwanted, sick, and stray animals. Our plan is to offer a proactive solution to address these problems by constructing and operating an on-site spay/neuter facility with an adoption play area. Reduction in pet overpopulation is the ultimate goaL The additions afford a means of effectively targeting this problem by increasing ease of adoptions, maintaining the 100% sterilization compliance rate, and better utilizing staff in the field and office. Community benefits, positive partnering with county residents, and increased public education and awareness are a bonus to the plan. Background In recent years, New Hanover County Animal Control Services (NHCACS) faced the challenge of achieving 100% compliance (from 50%) for sterilization of adopted animals. This was accomplished by transporting adopted animals to area veterinary hospitals by NHCACS staff for surgery after the adoption transaction. Current county budget constraints and staffing cuts have depleted NHCACS resources, making continued transport a burden to maintaining essential operations. The only viable alternative, which is more cost effective, is to perform surgeries on adoptable animals prior to adoption. The spay/neuter facility addition will provide the means to accomplish this goaL The Company The primary mandate ofNHCACS is to protect the community from the threat of rabies virus exposure. In 1989, the state of North Carolina was free of diagnosed rabies cases. One decade later, the state has few rabies-free counties (see Appendix 1-3). There have been a total of 61 positive animals verified in New Hanover County since March 26, 1996 , I Pet overpopulation, stray animals, and unethical breeding practices lead to increased rabies exposure risk. Reducing the number of unwanted pets decreases the number of strays, thereby reducing potential rabies exposure. NHCACS has the means to provide the county with a cost-effective and customer-friendly solution to pet overpopulation in our community NC-2 Business Plan Management Academy for Public Health Page 3 of 51 _C.=,-.,,--"'-- ~ ~ :::=t .:-} ~ '~'1 :::l ::j) :::t ::.l ~ :1). ~ ~ ::;) ~ ~ ~ ~ ~ ::;l ~ """"" .... ~ :=) -::) ,:::) .::::l ~ [~ ~ ~ ~ :-:?) Sterilization Protects Animals & You New Hanover Count, Animal Control Services The Market Adopters and potential adopters at NHCACS are the primary end-user target market for Phase I of our project. Phase II involves targeting community pet owners, who for many reasons do not have their pets surgically altered. Competitive Position NHCACS operates the largest (of approximately a dozen) animal adoption agencies in the surrounding region. This allows us to offer the widest range of pets suitable for adoption. Additionally, our modern technology, and physical facility offer the best possible care for shelter animals. Operations Current staff at the shelter, supplemented by local volunteers, will perform the necessary functions to operate the facility Veterinary supervision and scheduling of surgical procedures and staff will be necessary We anticipate that this can be accomplished on a volunteer basis. The Future Phase I of the project includes neutering of all adoptable animals at the shelter Phase II expansion includes low cost spay/neuter of pets owned by county residents. Other services, such as educational opportunities, classes, and training may be expanded by releasing staff to perform these functions. Financials The NHCACS trust fund (approximately $38,000) provides start-up funding for the project. Total startup cost is estimated at $92,400, including a $37,500 match from County Property Management's construction labor contribution. Funds Sought NHCACS antICipates only one round of financing to build and equip the additions. Initial funding will be taken from the existing trust fund. The remainder of the funds will come from a capital campaign conducted in the community. Once operational, the facility will be self-supporting through revenue received from adoption fees. ~~ ~ , I::;) .:::') :::!) c::) NC-2 Business Plan Management Academy for Public Health Page 4 of 51 o :-:0 ~ :.:1b ~ ::JlOIJ ~ ~ ~ ~ ~ ~ ~ ~ -~ ~ ~ ~ ~ ~ ~ ~ ~ .~ ~ ~ ~l" ~ ~ l-:'j) ~ ~ ~ b; ! ~ L:fD I-fl) ~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services Company Description New Hanover County Animal Control Services (NHCACS) is a county organization, which operates under the covering of the Health Department. NHCACS is responsible for surveillance of rabies exposure situations and protection of the companion animals in the community The shelter is located at 180 Division Drive in Wilmington, North Carolina. Our Mission The mission of NHCACS is to protect the community from the threat of rabies virus exposure, and to ensure proper animal care, through prevention, public perception, and education. One major goal of the organization is to increase successful adoption rates and decrease euthanasia rates of surrendered pets. Services NHCACS bridges the gap between public health and law enforcement. We enforce Section Five: Animals & Fowl of the New Hanover County Ordinance. This section includes all laws pertaining to domestic animal care, rabies exposure procedures, and licensing requirements. The current shelter (see Figure 1 on page 6) houses animals that are brought in or picked up running-at-large in the community Those pets that are not recovered by their owners may be placed in the adoption area after a physical exam is conducted. Pets may be boarded at the facility for rabies quarantine. Officers patrol the area for strays, canvass communities to determine licensing status, and respond to rabies exposure situations and citizen complaints. Protection is available 365 days a year, day or night. The on-site spay/neuter and adoption play area additions will assist NHCACS staff in successful placement of pets in new homes. Surgery performed prior to adoption will ensure a healthier animal going home with their new parent at the point of adoption. Development to Date The initial adoption policy allowed pet owners to take their new family member home at the point of adoption. Surgery appointments were made as their pet was adopted; however, 50% never made the trip to the veterinary hospital. NHCACS realized they were as much a part of the problem as they hoped to be a part of the solution. In October 1999, a new program was implemented that established the division at 100% compliance on neutering of adoptive pets. Animals are currently adopted at the NC-2 Business Plan Management Academy for Public Health Page 5 of 51 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ -~ ~ ~ ~ ~ ~ ~ :&~ "-.- ... ~ ~ ~ ~ ~ ~ ~ ::;1l ~ ~ ~ -::ll ~ :::;) ::;) ~ ~ ~ :::~ ~ Sterilization Protects Animals & You New Hanover County Anima. Control Services shelter, but pet owners must wait until the surgical alteration is completed before they are able to carry their pet home. Officers are required to transport the pets to the veterinary hospitals daily, thus reducing valuable time for other important duties. Legal Status and Ownership NHCACS is a county owned and operated facility The on-site spay/neuter facility may operate without state licensing for surgery performed on animals that are county property Expansion to Phase II of the plan would require state licensure to perform surgery under the covering of a licensed veterinarian. Funding for the shelter and the additions has come from the general county budget. However, the initial start-up money to build the spay/neuter facility will be accomplished by a capital campaign. Some money has already been collected in an established trust fund specifically dedicated for the county's animal needs. Once operational, the facility will be self-sufficient based on market analysis projections. Figure 1. New Hanover County Anima. Control (NHCACS) Facilities I' W" . ' ".,-\.. " 1;.' .( ~ . '. -, w "'~ -";i ~ ... ...~. . 'l." ~ ~.... 'f< ~ " ~_ ~ ~,~. "'" to . .:" .-~ , " 0'. NC-2 Business Plan Management Academy for Public Health Page 6 of 51 :::l -- ~ ::::') ~ ~ :-.:} -:J -::} ::::) :::} :::) ::;} -.:l ~ :::) ~ :::1 ::J --3 :::;) -"'!!!!l. -=- ... " ~ ~ ~ ~ ~ ~ ~ r Sterilization Protects Animals & You New Hanover County Animal Control Services Industry Analysis and Trends NHCACS is well positioned to take on the added responsibility of the spay/neuter facility and adoption play area. This marks a significant opportunity to meet customer needs in our growing community Pet overpopulation is a national problem, and any work that can diminish the numbers of animal casualties should be implemented. Size & Growth NHCACS has seen considerable development in the last decade. Advances in technology have improved licensing procedures, which have markedly increased revenue. The division moved into our new facility in April 1995, which improved public image and made adoptive pets more readily accessible. We are strategically positioned to build the addition to the shelter as part of expanding our scope of service. Seasonality The numbers of unwanted, sick, and stray animals increase in the summer months, when more animals are reproducing. The number of pets surrendered increases, also (see Figure 2). The addition of a spay/neuter facility would have a corresponding increased demand for volunteers to operate during this time of the year The Christmas holiday season also brings a wide variety of customers to the shelter seeking a new pet for a gift idea. Figure 2. Impounds and Adoptions Calendar Vear 2001 New Hanover County Animal Control Services 600 - 5001 4001 3001 ~ 200 ~ ~ :tl 100 [i.; ~ 0 Jan, 01 ." ,- , '~ " ~. :f r~ ',," .,< ~ ~ , :~ >fl' ~ ! c~ ~ ~. v " , ~ " ~ ,i ~ f\ Ii ~ l'cf: . .'~. . t 11 .. " ~ - d' - ~ '.~ ,~, j" -1- '" -r" Apr- May- 01 01 ~. ~ ::1', ....- ~, " '. "\- ". ~. -,- -,- Feb- 01 Mar, 01 Jun, Jul-01 Aug- Sep- Oct, 01 01 01 01 Nov, Dee, 01 01 I D Impounded Pet Animals IiIAdopted Pet Animals I NC-2 Business Plan Management Academy for Public Health Page 7 of 51 ~ .-::? .:j ~ .."". ~ "1 :::} ~ ~ :::;9 ~ ~ ~ -::') ~ -::} .~ ~ ~ :::) ~ ~ , ~ [-:~ c- I~} ~ ~ ~ ~ ~ g: ~ ~ ~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services Open Competitive Environment The area veterinary community may see the spay/neuter facility in Phase II as a threat to their practices. Clients that would normally seek care at their hospitals may come to the animal shelter instead. Other animal care shelters in the community may seek special privileges and discounted payment for services rendered. Failure to cooperate could result in antagonistic attitudes between organizations. Barriers to Entry Cost to build the additions is a major obstacle to implementation. An established trust fund is the initial source of start up capital, but a campaign would be necessary to fund the remainder of the project. Staffing is also a barrier in operation of the facility. Veterinarians from the area will be paid an hourly rate, but they must sacrifice time away from their busy practices. Volunteers will be needed to assist them in their duties. Long Term Opportunities Phase I will service the animals adopted from the shelter Animals will be selected based on pre-determined criteria of adoptability Surgery will be performed prior to placement in the adoption area, so the pet can go home with the new owner at the point of adoption. Since the recovery process is minimal, these animals will be adoptable within a day or two. Phase II will expand the surgical procedures to include animals in the community A veterinary overseer will be needed to operate the facility and to obtain licensure for hospital activities. This service will establish NHCACS as a provider of low cost spay/neuters for the county residents to decrease pet overpopulation. NC-2 Business Plan Page 8 of 51 Management Academy for Public Health .-""'- :::"'i --:::) d ~- -:~ ~- ~ AI =} :.::) :::j :-:-, ~ ~ -:-, ::::~ ~ --'" .~;; ~ -;0 -. -:::1> -::~ ~ ~ ~ ~ -::} --~ -"" ._4 ~ ~ --~ ~ ~ ~ -::0 :::? ~ -::\l :::0 ~ ij ?) ~ :::Q c:::) I Sterilization Protects Animals & You New Hanover CounlJ Animal Control Servlces Target Market Our target market includes internal and external customers, intermediary and end- user customers, and the two phases of our plan. Each of these is examined below Internal customers Internal customers include the Health Director, Board of Health, County Commissioners, County Property Management, and the staffofNHCACS. The Health Director, Board of Health and County Commissioners will be customers early in the process as we seek approval of this project. These stakeholders not only hold purse strings, but also control all major capital and programmatic campaigns by Health Department divisions. County Property Management will construct the facility, and therefore is a customer The staff at NHCACS will playa key role in the success of the project from the beginning, and must be considered part of the process. Their normal operations must also be respected and disruption kept to a minimum. External customers External customers include adopters/potential adopters/general public, area veterinarians, area animal groups (Humane Society, Cat Adoption Team, Friends of Felines, Rescue Organizations), pet retailers/wholesalers, pet owners of low-income status and/or those without a veterinarian relationship. Adopters and potential adopters at NHCACS are the primary end-user target market for Phase I of our project. They will be targeted to adopt from NHCACS and given reasons such as convenience, reasonable cost, reduction of euthanasia and pet overpopulation. This market will drive Phase I to ensure our efforts are market driven and not product driven. The general public will be the target of our social marketing and public relation efforts. NHCACS has a negative image among much of the public, as do most animal control operations. A partnership with other animal groups will be forged. Pet retailers and wholesalers are possible strategic liaisons for donated materials, marketing assistance, public perception improvement, and entrepreneurial opportunities. Phase II will involve targeted marketing to pet owners who for many reasons do not have their pets altered. Some low-income pet owners perceive spay/neuter as cost prohibitive and an unnecessary expense. We will target this group with a message of low-cost, beneficial, and convenient spay/neuter services at NHCACS. We also hope the broader social marketing message of pet care, responsibility, and respect will drive some pet owners to veterinary offices for animal health care services. NC-2 Business Plan Management Academy for Public Health Page 9 of 51 I" L ~=-..:;::"",,~- --"~ ~. -=-~ ==:~ -:;) -- ~ "j ~ ::] ~ ~ -~ =-~ ~ ~ :::~ -~ =-~ ~ ~ ~ ~ "'a.. . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ..... Sterilization Protects Animals & You New Hanover County Animal Control 8ervlc. Intermediary and End-users Intermediary customers in this spay/neuter project will be area veterinarians due to our plan to utilize their services at NHCACS to perform the spay/neuter procedures both in Phase I and Phase 1\ of the project. The results of our area veterinarian survey indicate 92% of the respondents were in favor of mandatory spay/neuter and only 22% disagreed with the concept of an on-site spay/neuter facility (see Appendix 8). We will target further marketing to those veterinarians supportive of the project. We hope to draw in more of the veterinary community with positive feedback from those involved from the beginning. The primary end-user customers will be pet adopters at NHCACS in Phase I and the low-income pet owner population in Phase II. In Phase I, we will market the enhanced convenience, affordability, and good deed aspect of adopting from NHCACS. In Phase 1\, we will develop marketing vehicles that reach low-income pet owners and those resistant to spay/neuter. Two Phases of Project Phase I will target those persons adopting animals from NHCACS. The improved services associated with adopting will enhance the experience for adopters and we will encourage referrals and positive word of mouth. We will also target those considering adoption. This will involve partners such as veterinary offices, pet product retailers, area animal groups, area publications, and other settings where potential adopters can be reached. In Phase 1\ we will add a marketing effort toward low-income pet owners and those who have not spayed or neutered their animals. The primary assumption with this target population for low-cost spay/neuter services is that low-income pet owners see the procedure as too costly and not really necessary Demographics The end-user demographics in Phase I include the entire county population. Those households with adequate space and living conditions for pet animals, economic resources and commitment to good physical and emotional health for the adopted animals are preferred. In Phase 1\, the end-user demographics include clients whose socioeconomic status and income level might preclude them from having their pet surgically altered. These individuals recognize the benefits of pet ownership and can afford to have a pet, but they may not feel that they can afford the 'luxury' of having the pet spayed or neutered. NC-2 Business Plan Management Academy for Public Health Page 10 of 51 ~- -- .....~ - ~ -:3 ;:--' -"">>. ~ ~ -j1 ~ -~ -J} ~ -~ ~ -~ -1) -::7) ::i} -::D -i} ~!) ::::7} .~ ~ -D ::::~ ::::, ~ -:~ -:7,t -:~ ~ ~7} --.~ ::::~ -:.~ -:~ -::~ ~ r":~ i-'"~ ~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services Competition There are two distinct types of competition that we will consider as we build our business plan. These are: . Competition for Surgical Services . Competition for Adoptive Owners Competition for surgical services refers to the demand for surgical sterilization by existing pet owners. Competition for adoptive owners refers to the availability of pets for adoption by various factions in the community It is important to consider both types of competition for the two phases of our plan. Competition for adoptive owners will directly impact the ability of NHCACS to deliver surgical spay/neuter services in a timely fashion for potential adopters. Competition for surgical services will be a major factor as we expand into Phase II providing low cost spays and neuters for that segment of the community who cannot afford to have these services provided by the private sector but did not adopt their pet from NHCACS. Introduction to Competition in the Veterinary Industry The delivery of veterinary medical services is a complex industry Traditionally, most veterinary practices use frequently-utilized, high mark-up services such as routine vaccinations to offset the other aspects of practice that do not have as high a profit margin. This is the case for several reasons. First, third party payers are just now coming into play in the veterinary industry and as a result, owners of pets facing expensive treatments or surgeries, who do not have insurance, have been reluctant to commit to such major expenses. Second, the cost of providing sophisticated services (such as chemotherapy or orthopedic surgery) is prohibitive to most owners. Consequently, most veterinarians use high mark-up routine services to offset the cost (and thereby reduce the price of) the more sophisticated procedures. A second philosophy, and one that is becoming more mainstream, is that every aspect of a veterinary operation needs to be self-supportive. In either .philosophy, the cost of surgical sterilization (spaying or neutering) is going to be more expensive for the pet owner In the first scenario, since surgical sterilization is a routine procedure with a significant mark -up, the income from these procedures will be used to offset more sophisticated services. In the second scenario, the cost of surgical sterilization will have to be self-supportive, so it must generate a profit for the practice. Competition for Surgical Services Enter the era of the low-cost spay/neuter clinic. During the past decade, the social awareness of the veterinary industry has increased and as a result, many communities now have low-cost spay/neuter facilities to encourage the public to have their pets altered NC-2 Business Plan Management Academy for Public Health Page 11 of 51 .~ ;;::} ~ ~ ~ - -=--..1 -~ =~ ~ ~ ~ :::} ~ -. ~ -. -"'" ~~ =' ~ ~ ~ ~ ~ ~ ::? ~ ~ ;j ~ ~ ~ ~ ~ ~ ~ -.;;) ~ :::t) ~ ~ ~ ~ l:-:t I~ ~ ~ ~ .~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services as a means of reducing the overpopulation of pet animals. This is the case in New Hanover County For almost a decade, the New Hanover County Humane Society (NHCHS) has operated a low cost spay/neuter facility at its shelter Operating as a private, not-for-profit organization, NHCHS can offer reduced rate surgical sterilization in direct competition with the local private veterinary community Additionally, several veterinary practices in New Hanover County have maintained their surgical sterilization fees at as low as possible in order to compete with NHCHS and to encourage their clients to have their pets altered. Still others offer low-cost surgical sterilization similar to 'loss- leaders' in grocery stores (reduced cost cola, for instance, in hopes that shoppers will buy higher-markup items such as chips and dip) with the thought that clients who decide to have their animals altered may, at the same time, choose to have other full-fee services, such as vaccinations, performed. There are other 'gimmicks' used by the private sector to encourage clients to have their pets spayed or neutered. One practice has a reduced rate spay day each week and another advertises reduced rate spays certain times of the month. All of these programs would be in direct competition with Phase II of our project-providing low-cost surgical sterilization to the general public. Competition for Adoptive Owners Another form of competition to be considered with Phase I of our project would be groups that provide adoptions (and arrange their own spay/neuter services). One such group, Cat Adoption Team (CAT) adopts cats to the general public and has an arrangement with several veterinarians to provide low-cost surgical sterilization for their adoptees. There are several other shelters in the general area that adopt both dogs and cats, including NHCHS, Southport-Oak Island Animal Rescue (SOAR) and Pender Animal Lovers (PAL). All of these facilities compete directly with NHCACS for the adoption of available animals, and indirectly compete in the demand for surgical services for those adopted pets. All of these facilities operate as not-for-profit shelters that advertise a 'no-kill' policy, that is, they do not euthanize animals. This puts NHCACS at a distinct disadvantage. NHCACS is thought of as the 'dog catcher' Even the name 'Animal Control' substantiates the misconception that the employees are more concerned with enforcing the laws than the adoption of homeless animals. Being a governmental agency, they are bound by the statutory regulations to not refuse any animal, no matter how unsuitable for adoption it may be. This results in higher euthanasia rates, which when publicized, reflects negatively on the organization. All of these perception issues result in competition for available homes for homeless animals. However, there are some positive aspects to the organization. Owing to the fact that NHCACS is the largest adoptive organization in the region, our strong suit is the sheer number, and hence variety, of animals available for adoption. This volume should allow potential adopters to find exactly what they are looking for in a potential pet. (See Appendix 7 for a graphic comparison between NHCACS and NHCHS impounds and adoptions.) NC-2 Business Plan Management Academy for Public Health Page 12 01 51 ~ :-:i' ~ ~ :~ ~ ~ ~ -j) ~ ~ ~ ~ ~ -:f; ~ ~ ~ ~ ~ ~ :::?} ~ .3 \~ -AI _ -'-J ,-::3 ~ Xl .~ --'.I ~\) :~ Sterilization Protects Animals & You New Hanover Counlf Animal Control Services Market Share Distribution A review of estimated data for the last fiscal year shows some interesting trends (see Figure 3). The majority of animals altered in New Hanover County, North Carolina are done in private practice settings. This corresponds with the number of private practices which exceed both adoptive organizations and low-cost spay neuter services in absolute numbers, and therefore availability of services. The small market share of both the adoptive organizations and low-cost spay/neuter facilities may reflect a saturation of their available services. Potential clients get fiustrated by a lack of available adoptive animals and the long wait for an appointment to have their pets surgically altered. This data is important for two reasons. First, they show the distribution and market share of the various competing organizations at the current time. Second, they show the tremendous potential for market penetration in both the area of adoptive organizations and low-cost spay/neuter services, corresponding, respectively, to Phase I and Phase II of our project. Figure 3 graphically displays the relative percentages of distribution of surgical services (estimated) currently in New Hanover County, North Carolina. Figure 3. Distribution of Surgical Sterilization Services in New Hanover County, North Carolina (Percent of Market) 5% El Private Veterinary Practice II Low Cost Spay Neuter DAdoptlve Organizations Our goal with this project is twofold. First, we would like to increase our market share of both adoptive organizations (currently estimated to be 5%) and secondly, low cost sterilization (currently estimated to be 10%). By doing so, it is believed that we can not only increase our pieces of the pie, but also the size of the whole pie, as well. It is important to note two significant concerns that we have as a result of increasing our piece of the pie. First, by increasing our percentage of the pie, absolute numbers of procedures performed will increase, thereby increasing our workload. Second, it is important to NC-2 Business Plan Management Academy for Public Health Page 13 of 51 ~ ::.:; i!'J :.::) ~ .~ d - .-A -::J -:5 ~ ::!) ::?) ~ ~ ~ :::J -~ :::) -~ -:) -A. --~ -~ ~ -:Bl -"'" .-.$J ~ ~ -:l -.(t . I Sterilization Protects Animals & You New Hanover CountJ Animal Control Services remember that increasing our piece of the pie comes with the risk of alienating the local veterinary community. We feel that this is not a significant problem since the majority of veterinarians who responded to our survey (92%) viewed mandatory spay/neuter in a positive light and only a small percentage (22%) disagreed with an on-site spay/neuter facility (see Appendix 6). Increasing the size of the whole pie means more people having their animals altered which, as a result of better education of the pet-owning public, will ultimately lead to a decrease in pet overpopulation. j' I Competitive Position I: I , I I I I As previously mentioned, NHCACS is at a distinct disadvantage when it comes to public perception due to their statutory requirement to enforce the laws regarding animal welfare and rabies prevention. This requirement results in NHCACS being viewed by the public as the 'dog catcher' With regards to Phase I of our project, this negative image has the potential to reduce adoptions. With respect to Phase II, the negative image might carry over and prevent pet owners for using NHCACS services for surgical sterilization. To combat this negative public perception, NHCACS will have to make substantial efforts to enhance their public image with regards to adoptions and pet availability Additionally, in order to attract potential clients for Phase II, NHCACS will have to be flexible and responsive to the needs of pet owners, specifically with regards to the availability of surgical appointments. NC-2 Business Plan Management Academy for Public Health Page 14 of 51 ~ ;::} :f!J ;:::, ~ Sterilization Protects Animals & You New HaRover County Animal Control Servlcas Strategic Position :::) :::;, ::5 :::J ::5 ~ :::) :.:) -:) :i) ::J ~ ::5 :::) ::l ~ ~ ~:) ::) ::) ~ -:() ~ ~ ~ ~ ~ ~ ~ -IlI.. _ .~ ~ :::0 ~ '~,J -:Q ::() :0 ::() Due to the large number of animals that annually are surrendered or impounded at the shelter, NHCACS has a tremendous capacity to adopt animals to the public from not only New Hanover County, but surrounding areas as well. No other shelter or adoptive organization has the quantity of animals for prospective adopters to choose from. Over the past five years, the other main adoptive organization in the area, NHCHS has become more selective in their acceptance and adoption criteria (see Appendix 78) which has led to additional animals being presented to NHCACS for surrender However, during that same time period, the figures cited for animals impounded and adoption rates have remained relatively flat at NHCACS, demonstrating the community's absorption (Friends of Felines, Cat Adoption Team and other private adoptive organizations) of the excess strays. The relatively low adoption rate at NHCACS demonstrates the tremendous potential to improve adoption percentages (see Appendix 7b). In order to improve in the area of number of pet animals adopted (and adoption percentages), NHCACS must work to shed the image of 'the dog catcher' and gain public perception as a more 'user- friendly' organization. Owing to the fact that it is a governmental organization, NHCACS will always have some of the mandated regulatory functions and paperwork associated with the adoption process. However, with the advent and growth of their volunteer organization, NHCACS will work to streamline the adoption process. Additionally, prospective adopters should have a wider range of 'adoption-ready' pets to choose from since the surgical sterilization will be done on-site and can be accomplished prior to the pets being put on display for adoption. Animals altered, but not adopted, would be placed in foster homes in hopes of successful adoption, in time. Pet Ownership Trends As the benefits of the human-animal bond become more widely recognized, the trend towards pet ownership in our society will increase, this, according to the U.S. Pet Ownership and Demographic Sourcebook, published by the American Veterinary Medical Association. Additionally, with more families being 'dual income-no kids,' pets will serve as surrogate family members. The trend in pet adoption is more towards shelter or rescue adoption. This is thought to be a result of a more ecologically enlightened society that will look first to help relieve the pet overpopulation problem rather than vicariously contribute to it by supporting the breeding of pet-quality animals. Another interesting trend is that more pet owners are choosing to have their pets spayed or neutered so as not to contribute to the pet overpopulation problem. Again, this can be directly attributed to the more ecologically friendly attitude that society in general takes. While all of this will have an impact on Phase I of our project, it will directly impact Phase II which will be to provide surgical sterilization services to the general public, not just adopted animals. NC-2 Business Plan Management Academy for Public Health Page 15 of 51 -~- --- ~ C) E) ::) ~ ~ :j ~ ~ ~ ~ ~ ~ ~ ~ ::] :3l ::3l ::3) ::1:l ~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services Target Market For Phase I, our target market is the individual seeking to adopt a pet animal. As previously mentioned, this market is strong and growing. By providing healthy, surgically altered animals for adoption, we hope to give pet owners years of healthy companionship and not contribute to the pet overpopulation problem. The target market for Phase 11 will primarily be the pet-owning public who may be unable to afford surgical sterilization by the private sector However, as is the case with the private veterinary practice, by keeping the fees for spaying and neutering as low as possible, we are hoping to encourage all pet owners to have their animals altered in order to prevent pet overpopulation. In the section on Competition, the graphic illustration showed only 10% of the surgical sterilization in New Hanover County is provided by low-cost spay/neuter facilities. This represents a tremendous market to be developed (See Figure 3, page 13 ). ~]) ~ ::D :::] :--Jl :--J) ~ ~ ::'J) ::1} :-!J) -j) c.-1) _....~ .~ 9 & ~ :0 :f.) .~ - ... NC-2 Business Plan Management Academy for Public Health Page 16 of 51 ;::j --;} ~ :::3 ~ -:') :::) -;j -:) ::l -::) ::j -::} -::) :ft :;l :::} -:l d :::) ~ ~ ::) t;) ~ ~ L.-~ L:~ e Sterilization Protects Animals & You New Hanover Count, Animal Control Services Risk Assessment As previously mentioned, one risk is the growth of competing adoptive agencies and low-cost spay/neuter facilities. Due to the public's increased awareness of the plight of homeless animals, there is a move to establish 'no-kill' shelters and to promote low- cost surgical sterilization. While this risk will have minimal impact on Phase I, the impact on Phase II could be considerable, and will need to be studied and considered. A second risk is the unforeseen anesthetic complication which may result in the death of an animal. While impact of this risk is minimal in Phase I (the animals would be altered prior to adoption when they are still considered the property of New Hanover County), it is substantial in Phase II, where the loss of a pet-even in the absence of negligence-might lead to negative publicity for the shelter However, this risk is present for any organization providing surgical sterilization (nationwide statistics show unexpected anesthetic death to occur approximately once in every 300,000 procedures) and is considered minimal. A third risk is the health of the economy Economic downtums may lead to fewer pets being adopted. This risk is considered minimal since studies have shown that even in the face of economic adversity, people will still adopt pets and provide the necessary care for them. A fourth risk is the potential alienation of the local veterinary community due to the loss of revenue from providing surgical services for the county (Phase I) and the direct competition offered by Phase II. This risk is viewed as minimal. Results of our veterinary community survey prior to the inception of this project indicate that the majority view an on-site spay/neuter facility in a positive light (see Appendix 6). Additionally, we plan to involve the veterinary community in the implementation and staffing of our faci lity A final risk includes the saturation of services (Phase II) by individuals seeking to have their pets spayed or neutered. Such excessive demand has forced NHCHS to suspend their waiting list and appointment scheduling on occasion. This risk is of concern because individuals may decide to have their pet altered due to an unforeseen circumstance such as the dog coming in heat or being accidentally bred. If we cannot meet the demand, some individuals may decide not to have their pet altered when the exigency of surgery has passed. Such a situation might inevitably contribute to the pet overpopulation problem. We view this scenario as not only a risk but also a justification of need. By being able to offer low cost spays and neuters in a timely fashion, we significantly mitigate the impact of this risk. NC-2 Business Plan Management Academy for Public Health Page 17 of 51 -it ~ ~ <11 1 ~ ~ ~ --:J) ~ ~ ~ .~ ~ ~ ~ .~ .~ --:0 -j) ~ ~ ~ :j ~ ~ ~ ~ ~ ~ ~ ~ ~ r-; ~ R; [-; ~ ij ~ ~ a::... Sterilization Protects Animals & You New Hanover Count, Animal Control Services Regulatory Issues The biggest regulatory issue is the licensing of an on-site spay/neuter facility by the state of North Carolina. The North Carolina Board of Veterinary Medical Examiners ('The Board') regulates the practice of veterinary medicine in the state of North Carolina. The Board has established a series of standards for the licensing of a surgical facility This will be an issue only during Phase II. The facility and the veterinarians performing surgery there will all have to be licensed. This issue is minor since we plan to consult the practice act prior to the design and construction phase of our project. The North Carolina Practice Act requires that the Board inspect our facility prior to occupancy Additionally, the credentials of all surgeons working for the facility will be scrutinized. This is not an issue for Phase I, since the facility is operated by the county-and will only surgically sterilize county animals. This is not considered the practice of veterinary medicine and is not subject to the scrutiny of The Board. Additional regulatory issues include the licensing and usage restnctlOns on controlled substances. There are accepted procedures with regards to the use and documentation of controlled substances that will have to be implemented and adhered to during the operation of a spay/neuter facility in either Phase I or Phase II. NC-2 Business Plan Management Academy for Public Health Page 18 of 51 ~ ~ ~' ~ ~-.. ~ , -=1> ::j) ~ ~ ~ ~ ~ ~ ~ -~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ---3) _.-~ -~ ~~ -:5) ~ ~ .~ ~ k~ ~ ~ ~ S; Sterilization Protects Animals & You New Hanover Count, Animal Control Services Marketing Plan and Sales Strategy NHCACS capitalizes on the strong emotional and social attraction to pet adoption. We will also increase the convenience of the adoption process with on-site spay/neuter services, play area for adopter and instructional use, and special attention to making the facility more conducive to adopters/customers. Pricing of adoption and spay/neuter services will be held to a minimum to attract the widest segment of the population as possible. Our business will meet important customer needs: affordable and convenient adoption, low cost spay/neuter, good referrals for veterinary services after adoption, educational materials, future opportunities for obedience classes, and a feeling of satisfaction for adopting a homeless animal. Our message will combine traditional features such as convenience, low-cost, unparalleled selection, extensive information, healthy animals, and good customer service along with our social message of doing a community service by adopting a homeless animal. Future relations between NHCACS and adopters will exist via rabies licensing, instructional classes offered, possible adopter e-newsletter or mailed newsletter Pointed effort will be made by NHCACS to connect adopters to area veterinarians for on-going relationships. One key vehicle for this is the information packet each adopter will receive (see Appendix 4). The emotional attraction to pet adoption (human/animal bond, benefits of pet relationship, helping community) will be marketed heavily, and the reasonable cost with increased convenience will be used as the 'closer' to convince our target market to adopt rather than buy from retail outlets or breeders. Due to our strong desire to team with area private animal adoption organizations, we will focus less energy on competing with them for adoptions and more on raising the community level of adoptions and lowering the level of homeless animals. We will focus more of our message in Phase II on convincing the public to have their animal(s) altered. This will reduce the amount of unwanted animals being euthanized. Marketing Vehicles Our initial target for Phase I will be area veterinarians. Their support and participation to perform the spay/neuter procedures are key to Phase I success. The actual vehicles will be personal communication, printed material explaining the plan and mutual benefits, and group presentations with question and answer sessions. The same vehicles will be used for internal customer marketing to our Health Director, Board of Health, County Commissioners, and other important gatekeepers for project approval. Vehicles for increasing the adoption rates at NHCACS in Phase I will include printed materials in veterinarian offices, pet retailers, public events, and other venues, which we hope to make permanent at these places. We will also solicit media coverage at the launch of the project and do media stories when the facility actually opens. An information kit will go with each adoption (see Appendix 4). NC-2 Business Plan Management Academy for Public Health Page 19 of 51 ,~~ ,if- "'~ ~ ~ :& ~ ~ ~ ~ ~ ~ ~ ~ ~ :jJ ~ ~ ~ ~ ~ ~ -j) ~ ~ -<9 --2' ~ ~ ~ --3) .~ ~ ~ ~ ~ ~ [~ ~ ~ ~ ~ ~ I~ [~ 1 Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services In Phase II, we will continue Phase I operations with associated marketing activities, but will add marketing to the low-income pet owner population and also those pet owners skeptical of the need and benefits of spay/neuter. In Phase II we will enhance the social messages about responsibility toward community, public health risk, health benefits for animals after spay/neuter, affordability of procedure at NHCACS, relative convenience, and low complication risk due to experienced area veterinarians doing procedures. Marketing vehicles in Phase II will include free or low cost media coverage of our services and message, new print materials placed at point of purchase in pet retailers, veterinary offices, other area animal organizations offices, and places of business our target market may frequent. These might include convenience stores, grocery stores, hunt clubs, employers, etc. NC-2 Business Plan Management Academy for Public Health Page 20 of 51 -----.,.- - --------=-- .- ~ --:$ ~ :::t ~ -:t ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ --:b ~ ":l ~ ~ -'" ~ ~ ~ -:t -~ ....:t ~ -::.t ~ ~ -:J ~ ~ -.>> ~ ij ~ I~ ~ r- :- t ~ Sterilization Protects Animals & You New Hanover County Animal Control Services Operations NHCACS is a division of the New Hanover County Health Department. We provide services to all New Hanover County residents, by enforcing rabies surveillance regulations; licensing cats, dogs and ferrets; and sheltering unwanted, sick, and injured animals. We also adopt animals and control pet overpopulation by spaying, neutering, and vaccinating the animals adopted from our facility. We are a customer-responsive operation, especially in light of recent budgetary and staffing cuts. We strive to provide the best possible service to the citizens of New Hanover County Our goal at NHCACS is to build a spay/neuter clinic attached to our existing facility, with a separate entrance from our main building. The clinic will operate once or twice a week depending on the number of adoption candidates on hand. The clinic will be built and operational in two years (see Appendix 8). The clinic will be staffed with contract veterinarians and volunteers, both of which will be essential for successful operations. Our intent is to provide the best service possible. With the clinic performing procedures on-site, adoption candidates are ready for their new home, no waiting periods necessary, as we have had in the past. Cost and Time Effective Program With implementation of our program, costs will decrease and time effectiveness will increase. Our procedure of transporting adopted animals to the veterinarians throughout the area will cease, therefore freeing NHCACS officers to perform rabies surveillance and license canvassing in the community Competitive Advantage On average, NHCACS officers spend 520 hours annually transporting adopted animals to local veterinarians. That translates to $9,204.00 in salary dollars. While having the clinic on site wouldn't eliminate this cost, it would allow increased enforcement of licenses and citations by the number of man-hours listed. The time will be spent generating revenue in the form of writing civil citations for violators. It is estimated that the 520 man-hours of increased citation and license canvassing would generate a 5% increase in license and citation fees, or approximately $22,000 annually NC-2 Business Plan Management Academy for Public Health Page 21 of 51 --' ~ :::} :::) ~ ~ ~ ~) ~ ~ ::::'"D ~ :::1> ~ ~ ~ ~ ~ ::j) ~ -:1) :::.1) ~ .-'1'\. ~-y ~ -:~ ~ ~ -1) ~ ~ ~ ~ l~ r~ ~ ~ ~ ~ fA' ~ ~-~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services Problems Addressed Spaying and neutering all adoption candidates prior to placement will increase cost with the initial start-up of the clinic. This is included in our cost estimates for the first quarter of operation. Other issues of concern are making sure we have local veterinarians on board, and backup available in case of an emergency Location of the site Touring our facility for the right spot was key We needed a separate entrance, but it needed to be next to the holding area of the shelter for convenience of moving the animals in and out. We decided to place the clinic on the left side of our existing facility (see Figure 6), allowing room for a separate entrance and play area. Figure 8. Location of Spay/Neuter Facility Addition , "j 'it.< .1\<, NC-2 Business Plan Management Academy for Public Health Page 22 of 51 ., -:l) ~\ ~ ~ .~. _. -~ , Sterilization Protects Animals & You New Hanover Count, Animal Control Services Technology Plan l~ -:D ~ ~ ~ ~ ~ ~ -j) ~ ~ -:1) ~ -1) ~ ~ ~ ~ ~ ~ -:~ -i) ~ ~ ~ ~~ --1} ~ ~ --l) :::::~ ~ ~J ~ ~ Ci) ~ NHCACS is on the cutting edge of technology We have a computer system in place that allows us to track our accounting functions, inventories, and clients, just to name a few Our system has functions that we have not explored yet. When we selected the software, we considered ease of use; cost; security; and ability to upgrade, expand, and integrate with our existing data technology system. At this stage our system is providing us with everything we need. Our computer system is updated annually to provide us with the most up-to-date features. At this stage we anticipate needing computer access and telephone service to meet our needs. Other technology concerns would be tracking animal medical history documentation and equipping the clinic with state of the art equipment. For external technology we would like to be able to communicate with the veterinary community via email and telephone. All of the local veterinarians do not have access to the web to communicate with us. Communicating via email would save time and money to the veterinarian community and NHCACS. Via the web the veterinarians could provide us with the latest information regarding proper animal care, medication, and vaccination information to distribute to the public at the time of adoption. This could potentially create new business for the veterinarians. With information constantly changing, having the latest information is essential. NHCACS is on the web. Check out our web site at www.nhcgov.com click on the Health Department and find the link for Animal Control Services to find out about our operations, county ordinances and fees. NC-2 Business Plan Management Academy for Public Health Page 23 of 51 ~ ~ ~ ~ ~ ~ 'D s::o :::0 -::0 ~ ~ ~ ~ ::tl ~ -::0 ~ ~ ~ ~ ~ ~ -:3) ~ -:'? ,~ c-"'It. , -'.tt/ ~ .~ ~ ~ ..~ I~ r~ ~[: ~ ~ t~ f-: ~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services Management and Organization Key Employees The success of the facility expansion is dependent on all NHCACS staff. Specific duties are divided into three main areas, including field work, clerical functions, and shelter operations. A section supervisor, who is directed by the NHCACS public health division manager, oversees each area (see Appendix 9). Managers: Jean P. McNeil. Public Health Division Manal!er Jean McNeil has worked in the division for nearly thirteen years. She moved up from an officer position to overseeing the entire division in the span of time she has been with the shelter She holds a degree in veterinary medicine and has worked in the community at local hospitals. During her term as the division's director, she has implemented the 100% compliance rate on surgical procedures for adoptive pets, installed the new software system that has added animals to be viewed on the internet site, and rescued three sets of animals from abusive situations. McNeil's major goals include increasing adoption rates and decreasing euthanasia rates of impounded animals. Customer service to the community is also a priority The additions would enhance the shelter's effectiveness and provide a boost to meeting these objectives. - Judv P. Evonko. Animal Control Supervisor Judy Evonko began her service with NHCACS as an officer She has been promoted twice since her start with the organization. The first promotion was to the position of shelter supervisor before moving into her current slot. She is a certified veterinary technician, and she worked in the private sector in this capacity prior to becoming a county employee. Daisv S. Brown. Administrative SUPDort SUDervisor Daisy Brown holds a degree in business administration. She served as the Health Department's human resource representative prior to her promotion to her current clerical supervisory position. She is the shelter contact for clerical and outreach volunteers. Nancv A. Rvan. Shelter Supervisor Nancy Ryan bred and showed dogs for the majority of her adult life. Her schooling background is in business marketing and management. She started with the division as a shelter attendant and has since been promoted to the supervisory position. She is a member of Dovia, a volunteer recruitment organization. She is the shelter contact for animal volunteers, and she will be the primary overseer of the additions. NC-2 Business Plan Management Academy for Public Health Page 24 of 51 ::) ::0 ::0 :i) ~ ::) :::0 :.::> ;::() r:J ;::!) ~ :::) ;::) ~ r;) ;::t) ~ ~~ ::::) ~ ~ ::::e; l2t [;) L~ ,. Sterilization Protects Animals & You New Hanover Count, Animal Control Services Board of Health The Board of Health consists of nine community professionals, who are appointed for service by the NHC County Commissioners. They are the direct governing body that oversees the activities of the Health Department. NHCACS is a division of the Health Department. Advisory Committee The NHCACS Advisory Committee is comprised often community citizens, who are appointed by the Board of Health. The veterinarian who serves on the Board of Health is the link between the two committees. The committee meets bimonthly from fall until spring. It serves as a valuable resource to NHCACS on a continuing basis. Specialists An area architect will design the building additions, including the surgical suite. Area veterinarians will be used to perform the surgical procedures. Their work will be monetarily compensated at an hourly contracted rate; however, voluntary assistance will also be solicited. Technicians will be gathered from local volunteers for surgery days. ~ ~ ,.-(} ~ .~ .~ --~ ,-~ ,~ ~ NC-2 Business Plan Management Academy for Public Health Page 25 of 51 r:"'l"'l ... -:0 -:i) --::J ::0 ~~ ~" ".4!I .~ :) -!) ~ -3 .-iJ -:i) -"..:) ~ .....3 ~ ~ ~ -:.(} ~ '".0)1 ::::} ~ '1) .,:j -:l '""":t ~:t ~ --:) ~ ~ ~ ~ -{t ~ HI t-1J ~ I~ C: ~ Sterilization Protects Animals & You New Hanover Count, Animal Cont...1 Sorvlces Community Involvement & Social Responsibility Due to our being part of county government, we are strictly bound by law, ordinance, county policy, and high ethical standards. We are committed to serving the entire public at the highest level possible. Being part of county government requires all of our legal, human resources, marketing, contracting, and other business dealings to be beyond reproach and absolutely fair-handed. We are guardians of the public trust, and our good citizenship plays a large role in all decisions. Our responsibility for this venture is divided into three audiences: veterinarians who will work with us and do the spay/neuter procedures, area animal groups with common goals to decrease pet overpopulation, and the public at large. Area veterinarians must know that we have their best interests in mind as we formulate strategies to reach our goals ofreduced rabies risk, reduced pet population, and improved animal welfare. We will show them we intend to get pet owners into relationships with veterinarians for regular care, and include them as our primary referral to adopters/customers. We will accomplish this in a number of ways. First, we will require that rabies vaccinations be given by a local veterinarian of the adopter's choice. Rabies vaccination is required by law in North Carolina, and the vaccine must be administered by a licensed veterinarian. We expect citations to increase as officer field time increases after they no longer have to transport animals to veterinarian offices for spay/neuter surgery Second, we will include an 'adoption packet' (see Appendix 4) which will have education materials, a list of area veterinarians, and will encourage adopters to establish a relationship with a veterinarian of their choice. We will also be sure to publicize the positive contributions area veterinarians are making. This will position us as good citizens in that we do not desire to intrude on their livelihoods. Several animal interest groups exist in our area. We are reaching out to all of them to form a coalition to work on our common goals together This coalition will be integral to this project's success and on-going success of animal welfare / control issues. Our reaching out to these groups will show we are good citizens and hopefully inspire a good cooperative relationship among all the groups. Our relations with the public are two-fold. We have direct contact with those adopting from us, those coming in to pay rabies license fees, claim their animals, and do other personal transactions. Another relationship is one of image. Animal Control here, as in many places, is perceived by many to be the place where'unwanted animals go to be euthanized. From a public perception standpoint, we have the burden that we must of enforcing laws and ordinances, and killing animals that are unclaimed, sick, or potentially dangerous. We do many on-going activities that relate our mission of animal welfare. Some examples are spay-a-thons, adopt-a-thons, low cost rabies vaccination events, fundraisers, radio shows, newspaper articles, public service announcements, and more. This project will further our goals in showing our public that we want to dramatically reduce the number of euthanasias we are forced to do, improve animal and human welfare, and find good homes for all the animals we have for adoption. As mentioned in NC-2 Business Plan Management Academy for Public Health Page 26 of 51 .--!J -3 -.3 ~ ~ ;;~" ,..... "",' :) .-3 -3 "';.J --:) -3 -" ..) --::) -.) ....3 --:J --::) -:.(} ""'.l ::::} i] -Jj -j 4 """) ~:) --") ~ ~ ~ ~ ---tt ~ ~ l{j r~ ~ ~ ,~ ,~ r~ Sterilization Protects Animals & You New Hanover CounlJ Animal Control Services our marketing plan, we will adopt social marketing strategies to effect changes in the public attitudes toward their pet's welfare and NHCACS. The message will be that stray and unwanted animals increase risk of rabies exposure and injuries for everyone, and all citizens should playa role in decreasing this risk. We will suggest that pets not be obtained unless adequate attention, housing, finances, and healthcare are planned for. We will also suggest that to do otherwise is irresponsible citizenship, and harmful to the overall health of the entire community We will make sure every citizen knows they can bring any animal into animal control and every effort will be made to adopt the animal out to a loving home. NC-2 Business Plan Management Academy for Public Health Page 27 of 51 -f) -? ..,-;J ::0 ~ ~ ) -fj -3 " .... ---1 <) -3 -3 -3 't'.J -...) -:'J -:Il ~ -.:) :::-J !J '\l -;l ~ -.) .~ -3 -:) --j) ~ ~ ~ , Sterilization Protects Animals & You New Hanover Count, animal Control "me. Development Plan Long-term Goals Our primary goal is to establish an on-site spay/neuter clinic for shelter dogs and cats that are targeted for adoption, The clinic should begin operation in Fall 2003 (see Appendix 8). An exercise/play area will also be provided adjacent to the clinic. Our second major goal is expansion of spay/neuter services to the public at low cost. We anticipate this expansion to be available in the second year of operation, or 2004 The physical facility will be added on to the existing NHCACS building and will include an exercise/play area for shelter animals. Strategies for Achieving Goals A physical facility in which to perform the services is required. It is planned as an addition to the existing NHCACS building. Concurrent with design and construction of the facility, fundraising activities will be taking place and the final arrangements made for volunteer and paid staff (assistant and veterinarians) to man the clinic. We must also equip the spay/neuter facility We expect to do this through donations, possibly of used human equipment, and purchases where necessary We will approach suppliers and manufacturers of veterinary pharmaceuticals to secure potential donations. Operations will begin with surgery on shelter dogs and cats only, and only those that are available for adoption. The expected annual number of surgical procedures is six hundred and fifty to seven hundred (650-700) for the first year, making hours of operation about six to eight (6-8) hours per week. Major Risks We prefer to think of our risks as opportunities. Thus, one of our major opportunities is to obtain acceptance of the program from both the local veterinarians and the general public. Public acceptance is crucial to the success of Phase II-expanding to include low cost spay/neuter services to the public. ~ ~ ~ ,11 Another opportunity we have is to assure adequate funding for both Phases I and II of the project. Construction cost of the facility will be met by donations already received and currently held in trust, and donations to be solicited. Ongoing operations will be covered in Phase I by the elimination of contract fees now paid to local veterinarians to perform spay/neuters on adopted pet animals. Fees for services charged to pet owners will cover the additional costs under Phase II. We anticipate limited risk here, as no full time staff will be hired, with veterinarians and assistants either working in a volunteer capacity or on a part-time, per hour basis. ~ .~ ~ -1t NC-2 Business Plan Management Academy for Public Health Page 28 of 51 ,i',''';;: 1) A ,~ , ~) :0 f21 ) Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services Phase II operations do require additional licensing and possible accreditation. An inability to acquire these could force abandonment of Phase II plans or closure of Phase II operations if already begun. Every effort is now, and will continue to be, made to ensure that all regulatory issues are addressed in advance of Phase II implementation. -~;f .~J ~J -J -.) -:) -:) -.J -3 Exit Plan Exiting Phase II of our in-house spay/neuter program, due to poor acceptance or excessive operational costs, would be through closure of the program. Should economic conditions make it necessary to also exit Phase I, we would also do so through program closure and re-initiate the current mandatory spay/neuter program. The pet exercise/play area would remain in use and the facility space could be easily converted into additional space for NHCACS. -3 ~ -i) -,) ::J ~ -...;,} .~ ~ -j ~ --:l ~ --it ~ J) -it ~ ~ ~ --{j . .... ~ ~ NC-2 Business Plan Management Academy for Public Health Page 29 of 51 ~-'; -.3 -3 .d ~:J ~ ~ ) '"'"J ._) -) -) -,) -j "") -) .,-) ';) """':) -3 -) ~ ~ ~ ~ ~ ~3 ~ :'l --') -1) ~ ~ -1t '<t -<t --(.t -it "\J ~ ~ ~ ~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services Financial Information Assumptions Personnel . Shelter Attendant Part -time o Will be required to assist veterinarians with surgery procedures and maintain the surgery area. o No other staff will be added to NHCACS at this time. Veterinarians and veterinary technicians will be working on an as needed basis, some as unpaid volunteers. Kev Exoenses . Facility Expansion . Surgery Equipment Financing . Start-up Funding o Trust funds will provide initial funding (approximately $38,000 as of December 31, 200 I ) o Community fundraising and donations expected - Approximately $16,900. o In-kind donations anticipated for all equipment and furnishings. o In-kind donation anticipated for labor to complete the interior of the building addition. . Operational Funding o Adoption fees will fully cover operation costs and provide "excess" revenues to help offset other NHCACS operations. Other Assumotions . This is a cash basis operation. o Revenues and expenditures are accounted for on a cash basis. - o Adoption fees are collected in cash. No credit is extended. Therefore there are no accounts receivable, . Co-operation and volunteer time from the veterinary community is expected. o However, full estimate of costs for veterinarian time is calculated In procedure costs to be conservative in net revenue projections. . Savings in Animal Control Officers time and travel are not an offset to the SPAY project costs. All Officer positions will remain and efforts will be redirected. . Any revenue impact from Officer redirection is not included in this projection, as it is expected to be negligible. . 5% salary increases per year (including both market adjustments and merit increases). . 3% inflation increases per year for non-salary items. . Benefits = 30% of salaries NC-2 Business Plan Page 30 of 51 Management Academy for Public Health ="~,.~ --:") -::3 ~.3 ~ ;J-nr .". -, ') Sterilization Protects Animals & You New Hanover Counif Animal Control Sorvlces Start-up Capital and Expenditures A summary of revenue sources and expenditures for the start-up phase of SPAY follows: ~ Revenue Sources -..:} -:} -.:} ~ -~ "-3 ~ ,..~ -~ -;} -:) --:) ~ 1j ::3 ~ ~ <t <J 1 -:() ~ ~ ~ ~ <t ~ I~ ~ ~ 1:(1 I '...... r~ :~ :f:(t NHCACS Trust Fund Monetary Donations In-Kind Donations Total Sources of Capital $ 38,000 16,900 37.500 $ 92,400 Start-up Expenditures Buildings Construction Fence Expansion Total Buildings $ 65,000 1.500 66.500 Capital Equipment Furniture Equipment Total Capital Equipment Reserve for Contingencies (10%) 2,500 15.000 17 .500 8.400 $ 92,400 Total Start-up Expenditures NC-2 Business Plan Management Academy for Public Health Page 31 of 51 .~ ."~ ."e,.i~'''' ..- -:) ~ ~ ::) ~ 1t -r} -:) -;') ~ ~ ~ ~ ~ ;"} -r) ~ .~ ~ :::) ~ ::1 ~ 1 -:'} ~ ~ I~ l""(t P ~ I'"() I~ 1<) t-<t ~ ! ~ r; .:!) i 'or Sterilization Protects Animals & You New Hanover Count, Animal Control Services Cash Flow -Initial twelve (12) months of operation The chart below summarizes, by quarter, the revenues and expenditures projected for the first twelve months of SPAY operation, expected to begin on October 1, 2003 This includes the second through fourth quarters of our fiscal year ending June 30, 2004, and the first quarter of our next fiscal year. Our seasonally adjusted adoption and procedure expectations are based on our actual recent adoption statistics. SPAY: Sterilization Protects Animals and You Initial 12 Months Operation by Quarter RevElll.JG lnl Expenditure Projections Projected Revenues Adoption Fees - $60 per pel 10-1- 12-31-2003 7-1 - 9-30-2004 1-1- 3-31-2004 4-1- 6-30-2004 Total 1st 12 Months $ 6,075 $ 8,100 $ 14,175 $ $ 12,150 40,500 Projected Expenditures Salaries: Shelter Attendant -15 hours per week 2,149 2,149 2,149 2,256 8,703 Benefits (estimated at 30% of salaries) 645 645 645 677 2,611 Subtotal - Salaries & Benefits 2,794 2,794 2,794 2,933 11,314 ProcedJre Costs 2,683 3,577 6,260 5,366 17,685 Maintenance Fumit....e & E",pment Insurance 150 150 Utilities Telephone Office Suppies Postage & Shppng Marketing & Advertisng Trav.. & Training 125 125 125 125 500 Subtotal - Expenditures 5,751 6,496 9,178 8,424 29,649 Net Revenue Over (Under) Expdentit....es $ 324 $ 1,604 $ 4,997 $ 3,726 $ 10,651 ~ions: Number c:J Adoptions 101 135 236 203 675 Number of SpaylNeuter Procedures 105 140 245 210 700 NC-2 Business Plan Management Academy for Public Health Page 32 of 51 ~ ~ ~ ::.:} ~ ~ 1} 1 ~ '":'} ~ -:;) ~ ~ ~~ ~ ~ -~ <l -.:) ~ ;j :-.:1 ::() ::) -:} ~ ~ ~ -!..'l -:(l '~ ~[= ~ [~ l~ ~ ~ E? ~ ~ Sterilization Protects Animals & You New Hanover County Animal Control Services Revenue and Expenditure Projections The following chart provides a projection of revenues and expenditures for the operation for the nine-month partial first year, and the following five years, Growth in adoptions is expected at a reasonable rate over the years as projected below, SPAY: Sterilization Protects Animals and You Six Year Projection Revenue am ExperdtLl'e Projections 11).1-03- FYEnding FYEnding FYEnding FYEnding FYEndng 6-30-2004 6-30-2005 6-30-2006 6-30-2007 6-30-2006 6-30-2OOl ProjoctedRevenues AOOiXion Fees - $80 per pet $ 30,375 $ 40,500 $ 42,000 $ 43,500 $ 45,000 $ 46,500 Projocted Experdtures Salaries Shelter Attenda1t - 15 hoJs per """'" 8,596 9,026 9,477 9,951 10,446 10,971 8EI1efits (estimated at 30% 01 salaries) 2,579 2,706 2,843 2,985 3,134 3,291 &bIOOII - Salaries & 8EI1efits 11,174 11,733 12,320 12,936 13,583 14,262 Proorl.re QSs (see Awendix_) 12,938 18,422 19,<a> 19,738 20,395 21.053 Mainlerenoe Fumiture & E",prnent Insurarne 150 155 159 164 169 174 Uilities T e1ll!t1<re OOioe Suppies Postage & Shif.lling Mov1<eting & Adver1ising Travel & Trairing 500 515 530 546 563 500 &bIotaI- Experdtures 24,762 30,824 32,069 33,384 34,706 36,069 Net Revenue 019: (ll1der) Expdentillres $ 5,613 $ 9,676 $ 9,911 $ 10,116 $ 10,291 $ 10,431 Assunplions: tunber of AdqJtions 506 675 700 725 750 775 tunber of Spay/Neuer ProcedJres 525 700 725 750 775 800 NC-2 Business Plan Management Academy for Public Health Page 33 of 51 l /,_:I",r;"~~- -":'\ ,-.> ::3 ,7) ::) ~ s .~ ~ r() :.} e:5 ::5 ;:;} ::5 i-' ~ ~ ~ '"'3 ~~ ~ g ::1t ~:) ~ ~ ~ ~ ~ .~ .~ ~ -.f-' ~ ~ -'3 -1t ._~ 'l. .i ~ -~ .1;' --:(t ..- r Sterilization Protects Animals & You New Hanover Count, Animal Control Services Appendices ~-- , . Appendix Contents 1. Age of Terrestrial Rabies Epizootic 35 2. Geographical Diffusion of Rabies in North Carolina 36 3. Positive Rabies Cases by Year - New Hanover County 37 4. Adoption Packet Contents 38 5. Off-Site Spay/Neuter Concerns 39 6. Survey Results 40 7a. Adoption Statistics - New Hanover Humane Society 47 7b. Adoption Statistics - NHCACS 47 8. GANTT Chart 48 9. Management Structure 49 10. Internet Resources 50 11. Editorial - Saving Pets and Taxpayers 51 NC-2 Business Plan Management Academy for Public Health Page 34 of 51 ~ 'c.'-' ,.;< i(:". ..'.;. ...... .... -~ :~ ~ ~ ~ :~ ~ ~ ~ ~ '~ '~ -::) ~ ~ ~ ~ ~ ~ -~ ~ ~ ~ _',)0 c"-:"'~ ~ ~ .~ ~ '~ ~' ~ ~ -:) ~ ~ ~ :::i} ~~ ~ ~ ~ :::() ::J3 Il Sterilization Proteets Animals & You Appendix 1 New Hanover County Animal Control Servlen Age of Terrestrial Rabies Epizootic North Carolina Counties 1990-1999 Year Rabies Was First Reported No Cases 1990 1991 1992 1993 , 1994 1995 1996 1997 1998 D1999 (Nov.) NC-2 Business Plan ~ St.. C.ntllr for Health St:;rtistics Geogl'3phical ~ii1lysis BI'3nc:h Ind I:pidemiology and Communioable Disease Control Occuplltlon2l1 Zlnd 8wironment.1 Epidemiology Branoh \Artilllrinary Publio He.lllth Program November 1999 Data Sources: \Merinlry Publio Health Program and ESRI (ko\llew 3.1) Management Academy for Public Health Page 35 of 51 t; ~ ~ ~l'-"~.. ~ I} ~ ~ ~ Sterilization Protects Animals & You Appendix 2 1990 ., . .,-. 'r ..., ,. '~. ,. ....~l~-:...::;I~........:~:.~ l",_S~' "',iO' J-{ r ~ ,LL, \.:. ,"~ Q -'-~ \\)._.~?i~-1"':'-:-:"'-~",-;-, \.-l .~~ ' i ';.f :.. ___.l..~ "'''';''.\ .\-....- -.' I..f.~_./ ---- -. i.\ :/ ).-J.-~H:~-~; I'~t,.. .T 1 "7-> ~. '''J'I ",I;:,:,. 1995 -&"':":,~. 'c~ '7:;:i:;"~~~",.:~.',,};;f?t, ;_c-._,___~- -: '. :'Y~t~>- l' " ,. ~I' I '~. I r '.".:', :.J ~ :',: ". - f ~ Q; ~ ~ ~ d ~ '~ ~ '~ L:t r ~ ~ ~ ~, ,- ~ ~ v'} ~ ~ r ~ ;:.i) ~ -fA ~-~ .. I'~.- .. 1-:,' JI'J I 40lt . ~J.,i.~ l' '" " 'it' I<~.,l' i,;I:. , ., ,to , t (' -I" 1 ~ ~ j .r: l t.~, -."I'-,:.t" ",:.;,,' _",III., ,.'t."'r r"r." Iq.;t I':,.],;,. l~":~",,'I'''J',, ...,.] , '''''''''''.~t ~ I ,,~, O. .......,\ '"., ~., l """."',, l ,,~, h,.." ""I' "''' ,I ,;....'''1 r."" '..'~ r ,I I, '1, "t>" ;;,~- , ,,'~ F ] , ,:., ' ,_" NC.2 Business Plan 1991 ,r.....:... -1.'1;:[>:::' '.o,,~~ '\':rf"---r-i";._ _J........, .-.l.,';""t, ,cO' .---i.,:+-. ..o..,-L--' 'e: ~~~'> I ~':JJ.J---'::'-'-~;~--""i:'-:""~J:~<1q_"" - _J J,','_' ',LY u~,/ rh",.' ' \J L':;:r,--:: j ;-~-~-rl' ~':, '1,1 1 11',-'.. I -~ 1994 ~._.....__~_. ^-......' "'L; ..: .,.y '-'~-'I 'b' . , ,.,~...8S .... ..",,\ ,- . ...~-jf'- ---,::.,.~......y~. 'Jif"'J _'.':,.>i"-..~ ~\~~_' ~".',": > ~- -' ~.~ Ik...1 '''[111'-' Oil' /' , - . <:> r .1(-'_ ' 'J" '," 1997 coR.-' ~~~~:~::;1l' . ' New Hanover Count, Animal Control Services 1992 ...':' "..".= ~ r- '-~-71t ~'",.,~ ~'-~~~'1' ...,-,.:.:t"h"'~J"":,\_;~,_ ,~" .<i-. ";~-\~r~.~~-",;'.~'(<:..,~') ",...: __,-_IJ. '~f"l..;;.~ lo.:.-J ..;'" -..., ~ i"'i'~ ~-1 ,-..:_ ;,j,.,. I ,'Uill"- 'II /'-~/' 1 ~~ ',' 1'-',,' "'1'1:1;" . ~ 1993 ....._. "':&_"~_ '."'. 9:( ..r:~:!~,' !.' . c"'~~:-\ ~t.:' '~:J~' ,\,:.'''' '; ; I _.... '. ,',~.. <S. . 'J.li:i::. ~ L.... V"';-'-....:...J.._ --'\....., 1'-" _ ~.../ '.J ',-\_. ! ,.,_ .... f ,~l,.-'- .k,' "'u"ill:~ ~ '~"i!5,r ': \', lu ~ _ ,_ ,'~ "~lfI ':. I ~ 1998 '''''11' f fl, I "L:r'!I" f : I L " I. L] ~ .. ," ".;, "~ .~ .. II~.- ,.""., . . . I': "II.'''', '.I"~'>." rc- -9 The Geographical Diffusion of Terrestrial Animal Rabies North Carolina 1990-2000 Management Academy for Public Health County ClassificatIOns LI:,.. ,)",,1'" "1",,11,1,'" c:I i: ": ,"'j'. I:.:. '1'" I: h.:,.;, ",'I"" Page 36 of 51 ~ -:3 -:3 ~ ~ ~'::/ '). ~ ~ ~ -.?} --:!j ~ --:J ~ ::::t 3J ~ :::!j ~ :::?) ~ '-. ~ :3 ~) :::::t :::) ~~ -:J :::J :::?t :::) ::::J -.:t -::t -::t -'} 1::3 ~ e;..:; ~ ~ i. Sterilization Protects Animals & You New Hanover Count, Animal Control Services Appendix 3 POSITIVE RABIES CASES BY YEAR NEW HANOVER COUNTY Calendar Year Fiscal Year 1996 19 cases 95-96 8 cases 1997 26 cases 96-97 29 cases 1998 8 cases 97-98 13 cases 1999* 3 cases 98-99 5 cases 2000* 3 cases 99-00 2 cases 2001* 2 cases 00-01 3 cases 2002* o cases 01-02 1 case The first positive rabies case was discovered on March 26, ]996. The anima] was a bobcat found in a dog pen on Marathon Road in Castle Hayne, NC. *The decrease in the number of diagnosed rabies cases can possibly be attributed to better public education, implementation of the mandatory spay/neuter program, and fiscal responsibility This list is current through March ]4,2002. NC-2 Business Plan Management Academy for Public Health Page 37 of 51 ,- ~ --~ --::J ~ ~ ~~ -, \", ~- o ~ --::.J -..j -=' ~ ~ ~ ~ :.:J ~ ~ ~ -i'b --~ ~., ~.. - , ~.-~ :::jl 1-) ~ r 5 ~ ::-...-) r:) ::':} :--,l .-::) ~ --""iIo ;-_..Jf ~ ~ - ~. '-""'3 ~ ~ ....J l::l r 'W' ra'.,,- ,', .. 'it,;. Sterilization Protects Animals & You Appendix 4 ADOPTION PACKET CONTENTS NEW HANOVER COUNTY ANIMAL CONTROL SERVICES . Short version of County ordinance . Veterinarian list . Rabies brochure . Vaccination schedule . Post-operative care (if needed) . Behavior issues and resources . Free samples . Collar & leash (Or cat-box) . Recommended care: o Grooming issues, e.g. flea control o Heartworm disease o Feline leukemia concerns o Denta] upkeep NC-2 Business Plan Management Academy for Public Health . .-'i.{""-,,,~~,~W"'~n_-- .~...-.>,,~ .,;./tF" ill -- New Hanover Count, Animal Control Services Page 38 of 51 -::') --:} .-:} ::::3 ~ ) :) ~. -i' ~ ~ -::) ~ -:) -:) ::::) ~ :-:) -rJ ~ ~ :::t :..J ~ :;) -(t -:J ~ :::t ::) ~ -!t -:I -:J ....f.t l::it I ~ pi r ~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services Appendix 5 OFF-SITE SPAY/NEUTER CONCERNS NEW HANOVER COUNTY ANIMAL CONTROL SERVICES Veterinarian concerns: . Surgical complications discovered @point of surgery (e.g. cryptorchid, pyometra or pregnant) . No desire to perform pediatric surgeries . Transported animals contaminating their front office . Additional surgical care required (pain medication) . Time constraints of transport Officer concerns: . Long wait for service at veterinary hospital . Multiple questions asked regarding animal transported . Multiple deliveries---decreased time for other duties . Verification of correct pet for transport Clerical concerns: . Prolonged time to secure surgery appointment . Unable to schedule appointment on Saturday afternoons . Drawn out adoption process---complete all requirements . Customers desire to take pet at point of adoption . Need for explanation--necessity of performing surgery . Unable to adopt to a broader range of customers Customer concerns: . Unable to take pet at point of adoption . Pet dies under anesthesia (this is also extremely difficult for ACS staff and veterinary personnel to deal with) . More pets available for adoption . Better process to adopt NC-2 Business Plan Management Academy for Public Health Page 39 of 51 -::') -:3l ,-:3 ::3 p\ ~~ J ) -:1) -9 -3 ~ -:3 ~ -:3 -:3 -:l -::3) ..jJ -:3 ::) ~ ~ :4 ~ ~ ~ -~ -.I -:J ~ -J '":J --' -'f I";. ~ . ~ [ [-.. f~ , Sterilization Protects Animals & You New Hanover County Animal Control Services Appendix 8 Results of Surve, Sent to Local Veterinarians A brief summary, in table form, follows of the average answers to the rated questions, with I = Strongly Disagree, 2 = Somewhat Disagree, 3 = Neither Agree Nor Disagree, 4 = Somewhat Agree, and 5 = Strongly Agree: NHCACS Mission I feel that the mission of NHCACS is to prevent rabies. I feel that the mission NHCACS is to prevent pet overpopulation. I feel that the mission of NHCACS is to enforce the laws regarding animals. More can be done to enhance/increase adoptions at our shelter More can be done to further enhance the relationship between NHCACS and the local veterinary community Adoptions and Mandatory Spay/Neuter I would be willing to foster shelter animals for adoption in our hospital. I support NHCACS adoption services, including mandatory spay/neuter program. I think NHCACS should provide an on-site spay/neuter program. I would be willing to participate (either as a volunteer or for compensation) in a NHCACS on-site spay/neuter program. I support the concept of pediatric spay/neuter on puppies and kittens. I think more can be done to encourage adopters to establish a relationship with local veterinarians. Rabies Surveillance and Licensing NHCACS is doing a good job in rabies surveillance/prevention and county licensing program. I support the concept of low-cost or free rabies clinics sponsored by the county I would be willing to participate in such clinics. More can be done to increase compliance with rabies vaccination and county licensing. Volunteering I support the efforts of groups such as The Cat Adoption Team and Friends of Felines in their efforts to reduce the overpopulation of animals in our community I am aware that NHCACS has a volunteer program. I encourage our employees and/or clients to become involved in our volunteer program. I, as a veterinarian, am interested in volunteering at the NHCACS shelter. NC-2 Business Plan Management Academy for Public Health Average Score 4.5556 4.3846 4.8889 3.6667 3.5556 2.2174 4.6923 3.3 704 3.5556 3.8148 3.6296 4.0800 41481 4.2222 3.2963 4.423 I 3.4444 3.0370 2.8519 Page 40 of 51 ... -::) --::1 -.j :::l ~ ) ') -::t -.it .~ - -~ -=' ~ -.;) -=" --:t ~ -::::') -::t -., -'6 .-:,. ~ :}.'!11 ::t --. ~. _iA -=-..;....9 ~t ::. '-I r;' r-! [Y c:;1 re' L:..t L7' L,- ,~. I c..,J ~ E: Sterilization Protects Animals & You New Hanover County Animal Control Services Rabies Surveillance and Licensing NHCACS is doing a good job in rabies swveillance/prevention and county licensing program. 0 2 4 9 to 25 4.0800 I support the concept of low-cost or free rabies clinics sponsored by the county 2 3 6 15 27 4.1481 I would be willing to participate in such clinics. 2 0 3 7 15 27 4.2222 More can be done to increase compliance with rabies vaccination and county licensing. 2 2 12 8 3 27 3.2963 Volunteering I support the efforts of groups such as The Cat Adoption Team and Friends of Felines in their efforts to reduce the overpopulation of animals in our community 0 2 8 15 26 4.4231 I am aware that NHCACS has a volunteer program. 3 4 5 8 7 27 3 4444 I encourage our employees and/or clients to become involved in our volunteer program. 3 2 14 7 27 3.0370 I, as a veterinarian, am interested in volunteering at the NHCACS she Iter 6 2 II 6 2 27 2.8519 Comments from each section are summarized below by topic: NHCACS Mission What do you view as the mission of New Hanover County Animal Control Services? . Enforce laws pertaining to animal and human health and safety . Protect the public from diseases or injuries incurred from animals. . What most pet owners see is you simply give out citations and require fees for pets. They are not aware of what these services help to support. . Saving animal lives, avoiding euthanasia whenever possible, placing adoptees, preventing pain, disease and suffering for shelter pets. . Control the animals (dogs and cats) in NHC · Public education. Control of overpopulation, dangerous & stray animals, enforcing rabies vaccinations. . Control stray animals & prevent rabies . Control animal population & enforce rabies laws . Prevent pet overpopulation,- inform public of rabies awareness . The top three mission statements {referring to rated questions} above sum it up. . Public health/rabies prevention, population control; animal welfare protection NC-2 Business Plan Management Academy for Public Health Page 42 of 51 ~..............~~- --.@- -i.~ ~*~~~ -:::) :;:i} ~ :::i l'co -_l ~ \ :) '3 --3 -.:) -:i ~ ~ -:t -::t -.:$ ::'t ~ .,-:...~ ~ -:t ~ 1'" - ,.. ~ -At -;.1t ~ :Dt :::" ~. :'Jt ?t ::e -.. -:. .". ~. :::.. t ~ -:. -::e -:e - .....,~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services . Prevent pet overpopulation . Rabies prevention and awareness. Prevention of overpopulation. . Consensus of the above {related to the rated questions} What could we do to enhance and/or increase adoptions at our shelter? . Posters or flyers to be distributed to vet clinics, groomers, boarding kennels . Nothing . Speak to more young peoples which I know takes money & personnel. . Pet of the week, adoption fairs, etc. . Increase volunteer participation . News media - special interest stories . Public adoptions, tours. Media exposure. . More positive PR! More Sat. "adopt-a-thons"! Get on WRAL TV am show! Have flyers made for vet offices explaining who NHCACS is & what's required by the county, etc, . More public awareness . More publicity - TV and radio; the Humane Society has a pet of the week; make a website with pictures of found/adoptable animals. . More local community involvement . Public awareness/education - work with local media, open house, adopt-a-thons, fund raisers . Improve shelter conditions, offer basic training classes, adoption fairs, advertising . More advertising with pictures of animals on tv/paper/at clinics What steps can be taken to further enhance the relationship between NHCACS and the local veterinary community? . Monthly or bi-monthly newsletter . Nothing . Decrease the need for veterinarians to require pet owners pay county fee at hospitals or decrease # of notices stating fee not paid when it has been paid for 3 years. Try to increa~e computer program to include greater than I year in fee payment. Clients tend to blame our receptionist for the mistake! . Not from New Hanover County, don't know . This is a great idea. Perhaps see iflocal association interested in having a question & answer at first part of a meeting or even having a meeting at AC- . Doing a fine job . Foster animals at local hospitals for adoption. . Encourage local veterinarians to keep community service at dangerous dog meetings and special events . I feel the relationship is good currently . I think it is good as far as my hospital is concerned . Stop making us feel like tax collectors . More meetings between the two groups to make communication easier NC-2 Business Plan Management Academy for Public Health Page 43 of 51 ~. -..;. -.:t --:j ::;t .~.:. - \, t ,) -"t .... ~ ~ ~ ~ ~ -. :'t :'i ~ ~ ~ i =- . :e ~ ::tt -:e ... -:e :e ~ ~ r. ~ ~ :. t ~ ~e ~ ~ t~ Sterilization Protects Animals & You New Hanoyer Count, Animal Control Services . Meetings, newsletters . More interaction between veterinarians/animal control employees . Keep communications and more of them Adoptions and Mandatory Spay/Neuter How do you view our adoption services, including our mandatory spay/neuter program? . Excellent . Good policies · The spay/neuter program seems to work well- however, I do feel that several recent adopted animals are placed in homes without means for sufficient care. IE unaware of financial needs to care for pet HWP/vaccines, etc. . Very positive . Excellent step with mandatory spay/neuter before adoption. . I feel it has greatly increased adoptees contact with DVM & benefits animal and client. Great follow-up from the majority of animals we see. . Animals I've seen from shelter seem to find good homes . I believe it works well, yet most adopters never come back - so it may be better to interview them . As a citizen, I haven't heard much about it. I only hear about it as a vet. . Good . Seems to be working . Great program - seems to be working . Spay/neuter program is great - but an onsite facility would be much better! . Fairly successful . Necessary . Services are lacking - people are confused about policies . Beneficial . Questionable the very young ---> future What additional steps can be taken to encourage adopters to establish a relationship with local veterinarians? . 15 minute counseling/written handout given by shelter officers to adoptees explaining necessary vaccines/products (HW Prevention - flea control) needed to maintain healthy pet. . Increased awareness/information given or discussed with new pet owners about the need for continued care for their new pet. . Require heartworm testing for dogs, FCL V /FIV testing for cats - these services should not be offered at the animal shelter. . That's up to us as veterinarians. . If an adoption counselor volunteer were ever found that would be a wonderful addition. . Provide a list of area vet clinics, hrs, location NC-2 Business Plan Management Academy for Public Health Page 44 of 51 . . it I t I I [t tt tJ (I :a =- ;D ~ ~ :'9 :rt :9 :9 I =- :<0 :e =- :.18 :e :e :e ::e ::.e ... ~ .... ... =-- t -. -e ::-.. :e ~ Sterilization Protects Animals & You New Hanover Count, Animal Control Services . Establish a program to ensure every animal sees a vet - free exams, rabies vacs, etc. . I find that all they want is the spay/neuter and do not understand the responsibility of pet ownership lifelong. . If shelter workers would "mention" to potential adopters about what vacs are needed, heart worms, etc .. . Educate adopters in proper care for animals before adopted . I am not sure what is being done now - new adopters should be counseled about vaccines, heartworm preventative and flea preventative . Educate adopters better on basic and preventive health care for animals . Client education on proper animal care . Allow them to chose a vet & pick up animal there. . Tell them at adoption time what services are still needed and approximately what time they are due . More communication Rabies Surveillance and Licensing What can we do to increase compliance with rabies vaccination and county licensing? . Poster re: County regulations/fines to be imposed - post in public places . Increase exposure of county laws IE - advertisements other than newspaper- radio/TV . Offer rewards to people who report unlicensed or unvaccinated animals - much as rewards are offered with "no questions asked" for turning in drug dealers. . More can be done but it takes more money & more manpower neither of which the county is going to provide. . Persons who cannot/will not pay for license will forego rabies vaccination for the pet as it will be reported - this is counterproductive to rabies control efforts. . Awareness by advertising . Revise the licensing system. Too confusing. Consider annual rabies vaccinations. . As far as low-cost clinic, I feel that if a person can't afford a rabies vaccination they can't afford a dog. We have clients that get the low cost vaccination who have more income than you or I. . Increase fines . Make more people aware of consequences of not vaccinating. Education is the key . Issue more warnings and fines . Educating the public . Public education - radio/TV/paper announcements NC-2 Business Plan Management Academy for Public Health Page 45 of 51 - -- -- ---1 -~ :-:.0 ~'O :----0 ~ 1) 'D --"~ ..{J> -:0 -:D -:D ~ -".0 ~ -(C -'t) -1) ~ ::to * ::f) '-~ ~ :::!) ::10 :~ ~ ~ ::JQ ~ -(J ~ .-c ~ :e ~ ~ e ~. rS rO Sterilization Protects Animals & You New Hanover Count, Animal Control Services Additional Comments . I feel NHAC does a spectacular job for our community - keep up the good work! . Related to volunteering: Shame on me for not thinking to do so before now Related to supporting CAT & Friends of Felines, etc.. Strongly agree and disagree - the last 2 kittens with ring worm I had in here were CAT adoptees and I have mixed feelings about releasing domestic cats to live a feral life, but every cat spayed is a good thing. . I don't wish to work for the NHCACS as I am not in agreement with many of the NHCACS policies and the regulations and the implementation ofthe regulations and the very poor bookkeeping-computer records of the NHCACS. . Overall the relationship between NHCAC and myself has been positive. I have respect for your positions, and support the program as a whole. . My experience with CAT cats has been less than positive - the majority are being adopted out with visible clinical signs of ringworm and the owners aren't being told about it. Related to support of pediatric spay/neuter Young males whose testicles have not dropped yet should not be subjected to longer, more complicated surgical procedures. Neutering can wait until both testicles have dropped. . If owners cannot afford a rabies vaccination they do not need an animal to care for The ones I've seen at rabies clinics are the ones that can afford a rabies easily, anyway . I was not aware that there was a volunteer program at the animal shelter get the word out! I get asked every day by clients - where can they volunteer! . Also - encourage potential adopters to acquire a pet that fits their life style - this is a huge problem - college students in an apartment adopting a puppy that's going to be 80+ Ibs, etc . You all do a wonderful job!! Keep it up! . Related to willingness to be a foster shelter' Inadequate kennel space. Related to pediatric spay/neuter' Unnecessary anesthetic risk compared to 6-month old. Also, masking of isoflurane exposes operating room personnel (Staff) daily- potential LIABILITY for NHCACS!!! Ifthey sue, they will win. . Keep up the good work! NC-2 Business Plan Management Academy for Public Health Page 46 of 51 ------. ------- Sterilization Protects Animals & You Appendix 7a NHCHS Statistics New Hanover Count, Animal Control Services Note: Euthanasia statistics are not available for the Humane Soclet,. New Hanover Humane Society Adoption Statistics 5000 1 4500 1 4000 1 3500 1 3000 1 2500 1 2000 1 1500 1 1000 - 500 4 n--l 111 o~_;_CD 1995 1996 1997 '...1 o--l D=L,--..Ctl, 2000 2001 1998 1999 [ EI Animals Accepted 0 Animals Adopted [ Appendix 7b NHCACS Statistics NHCACS Adoption Statistics 5,000 1 4,500 1 4,000 1 3,500 1 3,000 1 2,500 1 2,000 1 1,500 1 1,000 1 500 1 , -,- 1995 1996 1997 1998 1999 2000 2001 I D Animals Accepted 0 Animals Adopted El Animals Euthanized [ NC~2 Business Plan Management Academy for Public Health Page 47 of 51 ------- ----'--"--- --- -- Sterilization Protects Animals & You Appendix 8 GANTT Chart New Hanover County Animal Control Services Sterilization Protects Animals and You (S.P.A.Y.) Project GANTT Chart Presentation to Health Director, Board of Health, and County Commissioners and project Approval Construction. Inspectioll\. Equipping. Staffing of farilih Rl'lTUifllll'1l1 01'\ {'It'l"lll;lt'l;;l1' It+! Spayl'\l'lIltT "-ur:":tT\ Recruitment of .\n.'a .\nilllal (,rHups into Coalition Den'h.p ~tIld Phli..'i..' Pha\t.' I \larkt'lillg Mattrials Open Phase I Meet All Regulatory Requirements for Phase II Operations Recruit .\dditional \ l'lninariall\ for Spay/Neuh'r "uq!t'n Dl'\Tlop :I lid : nrti:dl/i.. f I:;t,,( It \1;: "I,::ljli:'" Opn 1'11;.:\,\ , " ,- NC-2 Business Plan Year 1 3 Months (6/02 - 9/02) = 12 Months (8/02 - 8-03) 4 Months (2/03 - 6/03) 6 Months (6/02 - 12/02) 7 Months (3/03 - 8/03) (10/03) 8 Months (10/03 - 8/04) - 6 Months (12/3 - 5/04) 4 Months (6/04 - 10/04) (10/04) Management Academy for Public Health Year 3 o Page 48 of 51 Year 4 " ~ -' , J < " , ;!t t .- .i~ <c ~ ~, '~- ;~ ,;- " ~ ;;,~ ~ 1- , " 'i '" ,;;. l- 'i iji:--- "'~ t ~ J.~ ;f.. .t ~~ ->c- r '" ~- ~~ L .x- :~ c .f Sterilization Protects Animals & You New Hanover County Animal Control Services Appendix 9. ..lIlIle_nt Btructuru New Hanover County Health Department - Animal Control Services Public Health Division Manager (Animal Control Services Director) Animal Control Administrative Shelter Supervisor Spay/Neuter Supervisor Support Supervisor Operations Director I Animal Control - Administrative Shelter Attendants f- Veterinarians Officers Support Technicians - Fiscal Support ~ Shelter Volunteers Technicians Represents Proposed Operations NC.2 Business Plan Management Academy for Public Health Page 49 of 51 Sterilization Protects Animals & You Appendix 10 Internet Resources Resource Azalea Dog Training Club Brunswick County Animal Services Carolina Canines for Service Cumberland County Animal Control New Hanover Humane Society PAWS Place San-Lee Humane Society SOAR Fiends of Felines Pet Finder National Breed Club Rescue Network NC Equine Rescue League North Shore Animal Rescue League American Veterinary Medical Association -,0 o t) o o @ C' o . e ,e NC-2 Business Plan Management Academy for Public Health Page 50 of 51 New Hanoyer County Animal Control Services Internet Address htto .Iladtc, wi Imington,org htto .Ilbrunswickanimal.org htto.llwww,carolinacanines.colm htto .Ilwww.co.cumberland.nc.us/ccac/index.html htto .Ilhumanesocietv. wi Imin gton .org htto .Ilwww, oa wsolace.org htto .Ilwww.sanleehumanesocietv.org htto.llsoarso. wilmington.org h tto .Ilhome. ec. IT. coml fri endsoffe lines htto :llwww. oetfinder.org htto :llwww.akc.org/breeds/rescue.cfm htto:llwww.ncerl.com htto.llwww.nsal.org htto .Ilwww.avma.org/care4oets/default.htm ."",- ''ii''$!-- Sterilization Protects Animals & You New Hanover County Animal Control Services Appendix 11 Editorial from the WilmIngton Mom/nll Sta, January 7, 2002. Saving pets and taXpayers Most dog~ and cats that end up at New Hanover County Animal Control never come out alive. They're killed within a few days. Finding people to adopt these innocent domestic ani- mals is difficult in any case. But it's made even more dif- ficult by the county's policy requiring animals to be spayed or neutered by a veterinarian before they can be taken home. That approach is sensible l!Dd humane. It's aimed at preventing the births of even more unwanted animals who will live hungry, lonely, miserable lives until they die or are picked up and, in most cases, killed And be- fore that happens, they may reproduce. The trouble is that the requirement prevents people from taking animals home as soon as the adoption is ap- proved. They must wait several days and pick them up at a veterinarian's office. And when they get to the vet, they sometimes might be surprised by additional charges. Nor is the current routine ideal from the standpoint of Animal Control. It has to take animals to the vets, which takes time and money, And it has to kill animals who might have been saved if the procedure had been a bit easier: The director of Animal Control, Jean McNeil, thinks she has a better idea: Hire vets by the hour to perform these operations at the shelter. That way, adoptable ani- mals would be healthy and ready to go. She says it also would save money for the county. If that approach worked as Ms. McNeil thinks it would, more animals would be saved, more people would be happy with them, and the taxpayers would come out ahead. Ms. McNeil says she'll make a formal proposal to the Board of Health in June. The only question at this point would seem to be, is it possible to move faster than that? * Note that this editorial appeared as a result of Jean McNeil's presentation to the Board of Health regarding our upcoming proposal. A Wilmington Morning Star reporter did a small story on the idea and the editorial, unsolicited as it was, appeared in the paper as a result of that story. We view this as strong support for our project, as a win-win situation for our community and its animal population. NC-2 Business Plan Management Academy for Public Health Page 51 of 51 "..~ .,,<,~ ""!F-- ,"..e;}A! ..,':'!1';l!;~- ". e e e ~'r. v _ - , _' I'; r;'T:j; ,I,'. fl~. .....~; :J!r.i :", I.J.. J. ,."", 'I_ 1\:' . ~ _'i :. )* .. ,. ~1' .:r~'::f"1YJj !'.o'1ioii1!~" W^,~DA M. con.n C.ounlyAl"Xltc)' I(~'II P IIlillPiAU fJc~t). Count)' Anurncy E. hOLT MOOR2. In A.~iJ\lmt C""ftty ....:ItI~i:) TO: FAX NO.: FROM: NEW HANOVER COUNTY OFFICE Of THE COUNTY ATI'ORNEY 320 CHESTNUT STREET, ROOM 309 WILMINGTON, NORTH CAROLINA 28401-4095 TELEPHONE (9to) U!-7/H FAXf910j 3n.4170 FNURANSMISS!ON COVER SHEET ~ 4; "tJ , _.__1/31L ~./J ;j{(4n',,'~ r , FAX NO.: 19101341-4170 PHONE NO.: 1910\ 341.7153 DA TE;__-d'bJt:f!..,;J~C).:L- NUMBER OF PAGES INCLUDING THIS COVER SHEET: .cJi.. COMMENTS1MI:SSAGE: THiS FACSIMILE TRANSMISSION CONTAiNS CONFIDENlIAL ANDIOR LEGALLY PRIVILEGED iNFORM."TION iNTENDED ONLY FOR THE USE OF THE INDIVIDUAL(S) NAMED ON THE: TRANSMISSION COVER SHEET IF YOU ARE NOT THE INTENDED RECIPIENT. YOll ARE HEREBY NOTIFiED THAT MY DISCLOSlJR". COPYll~G. DISTRIBUTION OR THE TAKING OF 1M( ACTION iN RELIANCE ON THE CONTENTS OF THiS FACSIMILE TRANSMISSiON is STRICTLY PrtOHIBITED. IF YOU HAVE RECEIVED THIS TRANSMISSiON IN E~ROP PLEASE NOTIFY US 6Y TELEPHONE IMMEDIATELY SO THAT WE CAN ARRANG;:' FOR RETUP.N OF 1 HE DOC UMENTS TO US AT NQ COST TO YOU. 16 ,. ~ fI . e - .ii.:.~'-:1 -~:i: :.:~E 1 j ~': /.l~ P. ....~i' AN ORDINANCE OF THE NEW HANOVER COUNTY BOARD OF CQ//.MISSIONERS The Boa,..,:; c-f CC1Vl1!SSIOncrs of New Hanover County, North Ccrclina, does herety ord'3;r. lhaI Chapter 5 ,~,n;m;;!s, Articie I, of th'1 New Hanover Count'/ Code be amended as foilows (1) Add a new ~ectjon to be designated: Section 5.25. 900s Prc})iblt~(LI.,-nJv'asqn Inlet Beacl; and Public RiQE,rian Property: "I Certain Times, Places. No pe,5o" ,,-.a!' alia-,\' a dog on the publi<:: beach cf lr,e At!antic Ocean cr ether public f!pGri3n p'~per;y '"ithin ailY ;JoGion of the unircorpora'ed Cc~mty situated o~ Wrigr.ts'."i!o 882::n lsiand nor'th of the Towr cound",y !;;1e~. ""ether on a lecsh or net. at anj tirr-,e between the dates or Aoril1 anc Septemte3C cf e"Cr1 year (2) Add a new section to be designated' Section 5-26 Qog,~LRunninQ_At.Larae Prohibited at Mason h,let Beach arlo Public R,oarian ProQerty, it 5n~!i ba I.!r,id...~i'..i~ fo~ the O\;'incr c~ a dog tc alIa...." the an:Ij,81 to be off the premises cf .,is OWi,er and n.-:t en a leasfi '.'.idl!ri =3Ciy porte, cf trle lJni(~corp:)iated Cour:ly situated c"n VVrlgr~t5\i!!e B~:;ch lSian,j north of lre Town tx::....ncary lines Ex~epl 25 ~;,:ecJied refetencec r!~:~ein. ~he exist'ng prevision.:; c": Chdpter 5 shall . f" f :J if rem21l1 In ...HI arcs ;7!r:~ e .ec.~. This the 4'. .:::ay cf Februa:~f 20C2 NEW HM'Ji)\/E": 80UNTY ,~ ') / Ii I } . I J/LLlMtt)\ " Ted Dav:;;, Jr CMairrnan Baed ci CommiSSioners -!~7~ Ci rk to the Boara II - -. 17 ,. e e e Wrightsville Beach Animal Control Services Fee Schedule Revision The Board of Health accepted and approved the proposed fee revision to be incorporated with the New Hanover County Health Department Animal Control Services Fee Policy. It includes the differential fees for conformity to the Wrightsville Beach ACS fees for dogs running loose on the area North of Wrightsville Beach. Following the Board of Health meeting, the Health Department was advised by a Wrightsville Beach Animal Control Officer that the Mason Inlet proposed fees adopted by the Board of Health are not the current citation fees charged by the Town of Wrightsville Beach, The current fees are listed below with differential fees: NHC Animal Control Mason Inlet - Wrlghtsvllle Beach Fees Fees Proposed Revised 03/28/02 Violations $ $ $ First 25 20 25 Second 75 20 50 Third 200 50 75 Fourth 500 50 75 Fifth 500 50 75 ~ The Board of Health approved the proposed fees and the fees presented to the County Commissioners for their consideration were the current fees charged by Wrightsville Beach revised on March 28, 2002. 18 FAX tIJ. 910 2567918 May. 02 2I!Ii!l2 02: 46PM P2 , ~ : WRIGfTSVILLE IlEACH POL ICE . ,., t' e' ..... f e \...... e "-- ORDXNANCB NO. (2002) 1413 Board of ~lde:rmen Town of Wrightsville Beach, North Carolina ~ate: March 28, 2002 AN ORDINANCE OF THE BOARD OF ALDERMEN OF THE TOWN OF WlUGHTSVILLB BEACH, NOR.'l'H CAROI.INA !\MENDING CltAPTER 91 OF THE CODE OF THE TOWN 0" WRIGHTSVILLt BEACH, NORTH CAROLINA The Boaro of Aldermen of the Town of Wrightsv1l1e Beach. North CarOlina, doth ordain: 1. That S 91.21 of the Code of Ordinances, Town of Wr1ghtsville Beach, is hereby amended to read as followS: !I 91.:21 :D.NNtJ1\.L ANIMl.L LIC'RNSE TAX. (AI All dog and cat owners residing in the town for over 15 days shall register tneir dogs and cats with the police Department annually, and p:rovide pertinent inforlll&tion as may be requested including the size, age, breed, color, sex, legal residence of the animal, and the name and address of the owner. (B) A license tax, to be established by the Board of Aldenlen, shall be paid to the police DepartlllSnt who, in retUrl)., will provide the owner with a suitable dog or cat license tax tag. The animal license tax levied by thili section shall be for the privilege of keeping, harboring, and maintaining a dog or cat within the t.own, and the animal license shall expire at the end of the ensuing tax listing period. (D) It sha.ll be unlawful for any dog owner to per\llit any dog over four months old to appear or be on any street, park, or public way of the town or in any public place therein urile8S the dog is wearing a. collar or harneSS to which is attlilched a current rabies vaccination tag and a .c:urrent town animal lic:en8e tax tag (when the license tax tag is required under this chapter) which have been issued for that Qog. (I) hereunder and cats. The mmual animal license tax required shall be $5 for altered and unaltered dogs 2.. That ~ Ordinances, Town of as follows I 9)..99. subsection Ie). of the Code of Wrightsville Beach, is hereby amended to read 19 J FRI;I'I : WRIGfTSVIUJ: ~ POL ICE May. 02 2Illl2 02: 46F'M P3 ...... \...... (.. FAX tIJ. 910 2567918 I J S 91.99 PENALTY. (C) The violations of any provision of this chapter shall subject the offender to a civil penalty of $25 for the first violation and $50 for the second violation. However, the third and any subsequent violation of this chapter shall subject the offender to a civil penalty of $75. Failure to pay the penalty within 14 days after being cited for any violation shall subject the offender to a civil action in the nature of a debt il;l accordance with the provisions of G.B. S160A-175 (C) or enforcement under other provisions of this section; or 3 . If this ordinance or the application thereof to any person or circu1lIStance is held invalid, such invalidity shall not affect other provisions or applications of the ordinance which can be given separate effect and to that end the provisions of this ordinance are declared to'be severable. 4. Any ordinance or any part of the ordinance in conflict with this Ordinance, to the extent of auch conflict, is hereby repealed. 5 . This Ordinance is adopted in the interest of public: health, safety anQ general welfare of the inhabitants of the Town of Wrightsville Beach, North carolina, and shall be in full force and effect from and after its adoption. This Ordinance adopted this 28th day of March, 2002. 12,~..:Il }.. yor v ATTEST: ~_ rJ.h'lb~ T C e APl'V-OVED AS TO FORM: ~c.~~.r Town ttorney 2 .. e e e 20 . e. e e Kemp Burpeau 03/07/200201 :22 PM 10: Jean McNeiIlNHC@NHC ee: (bee: archive) Subject: fee schedule Jean, Please ask the board of health to consider adding to the fee schedule the following for the Feb. 4, 2002 ordinance regulating dogs at Mason Inlet: For the first and second offense: $20.00 For the third and subsequent offense: $50.00 Thank you for all your help. ~v.... ry-r ~ ~. c:~ s \ ~\o~ Civil Citation SeetionlDescription 3-9 First Violation Second Violation Third Violation Fourth Violation Fifth Violation Proposed Differential Fee Change Below Animal Control Services Fees Different Fee Proposal for Mason Inlet (same as Wrightsville Beach Citation amounts for running loose) $ . 20.00 20.00 50.00 50.00 50.00 $ 25.00 75.00 200.00 500.00 500.00 Corrected Different Fee proposal for Mason Inlet (same as Wrightsville Beb Citation amounts fOf fnnning loose) $25.00 $50.00 $75.00 $75.00 $75.00 21 . I '. Ie e e Kemp Burpeau OS/29/200205:02 PM To: David E RicelNHC@NHC ee: (bee: archive) Subject: Re: Draft Resolution Ii:} The proposed ordinance is appropriate as to form and contents. The approach you use evaluating the specific behavior of a particular dog is more legally defensible than a breed orientation. Should you at any time wish to consider breed specific regulations, you would be advised to first find studies to support that a given breed is more likely to attack or that the breed's attacks are more harmful that those associated with the general dog population. David E Rice IM.- David E Rice q n- OS/29/02 09:01 AM To: Kemp BurpeauINHC@NHC ee: gelajim@hotmail.com, Lynda Sm~h/NHC@NHC. Jean McNeiVNHC@NHC, (bee: archive) Subject: Draft Resolution Kemp, Last evening, the New Hanover County Board of Health Executive Committee recommended the preparation of a resolution regarding opposition to breed specific regulation. Attached, please find a rough draft of a resolution. Please review and edit I will need to place the final draft in the NHCBH agenda packet by Thursday, May 30 at 12:00 p.m. iii Resolution - Breed Specific Regulatior Thanks, David E. Rice, Health Director New Hanover County Health Department 2029 South 17th Street Wilmington. NC 28401 Phone (910)343-6591 Fax (910)341-4146 drice@nhcgov.com http://www.nhcgov.comlHLTHlHLTHmain.htm 22 , , , ,~ e e e DRAFT NEW HANOVER COUNTY BOARD OF HEALTH RESOLUTION IN OPPOSITION TO BREED SPECIFIC REGULATION WHEREAS, New Hanover County has long had an ordinance regulating dogs with a history of excessive aggression or viciousness, and I. WHEREAS, Breed specific legislation is not a practicaete approach to regulation of dogs. Proving that a particular dog falls within the ordinance usually requires expert testimony, and WHEREAS, Application of breed specific ordinances to mixed breed dogs presents both legal and practical difficulties. Whether an expert can adequately identify a mixed breed dog is itself subject to controversy, and WHEREAS, Prediction of a dog's temperament based upon its breed is a hotly debated issue, and WHEREAS, Viciousness can, and does, occur in any breed of dog, and WHEREAS, Regulation defining prohibited dog behavior is a more practica'*' approach than breed specific regulation. Regulation has the advantage of wider acceptance and clearer standards resulting in easier administration. Regulation focusing on inappropriate and prohibited dog behavior is readily supportable legally, and creates fewer evidentiary problems, and THEREFORE BE IT RESOLVED, The New Hanover County Board of Health opposes breed specific regulation and supports regulation defining prohibited dog behavior. Adopted the _ day of ,2002. (Seal) Gela N. Hunter, Chairman New Hanover County Board of Health Attest: Secretary to the Board of Health 23 c r' ~ .. e t., ,. L New Hanover County Health Department , 1 ;..,:'.r'.", ~":'~""'I.:. " ~~~1 ;~ Recommended - vs- Requested FY 03 Budget Summary June 5, 2002 e J~apilal Outlav: IT Requests for FY 03. . . Software for Environmental Health $ 2,~99 $24,106 $6,000 $2,320 $0 $2,700 HUBS, Cahles & Other Peripherals Ag400 t29,175 $ 6,000 $ 2,09g $ 59,Ogg Computers for Dept (14) Printers Note: Remaining funds in 5131-6399 from FY02 will be rolled forward to suppon AS400IJT needs. [:]'= , };/ IllY."'.....;;...... .... '; '.."":"~""}f). "~~_#!~;/ TOTAL IT Requests: $89,776 Recommended: $ 35,126 e Difference: ($54,649) 24 . .J e e e -"'CapitaIOuUav: ExclUding IT RequestS Organization D'Y Description TotllCosl Vector Control J Operations Building $1)6,200 $0 Total Combined Capital Requests: $89,775 I $96,2ee $185,975 $35,126 + $0 = $35,126 Difference: ($150,849 I " i! ~- Requested " I ........ ,..--....-.. 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I I~:. 1ll5Z,1I' ,; .; r.::~~:::~~:==--===l:~.~:~,-. -=~~~f ":=--{8S~=--=~~~::1 r'-51ll5IIJCCCP-'-"-"1I-1'l2;74l1l,.--(tt;~ ....--:-r------o;mi r...-.-.;,gtf=iitMliliiPlil::l'ililiiii.rs--------:j1.-.-....---:- ."---:r---'-1l;'CO%"1 f871t2i1ifRiilli1l:NI;OOf )' Zll.4Dil- ;u1,r' lUa&! I.M] t:"51lJ1iDiifil-----I.'--..-u;m:r-"..u;V!5IJ" 'r1:221'--"-'-"1:7t'l", R:~=.=rr-~.;~~}-'--""'~1,::=:.-tsiJt -~~.1 1--"'Sf7(;JiiI'HiiiiIfl-~-''''- -..h-......tr.Z8"tl.---e;q;--t:\1S;V2lIlr--:;z:IO%'i \~\Ei5i~;::i~::~~~li:==:~~~~l---=~i <lo\al~ ~ 5:839.698 $ 5.569,037 ! S Pin:.6.f11. ~U::',~ ChaD.elD Call1\lJ$$ InlIII AdGDlld ml II .ecammeaded nl3 l$m.&11J -4.li1l% 26 '" .Uti~ THE NORTH CAROLINA INSTITUTE fOR PUBLIC HEALTH May 7,2002 MI. David E. Rice Heldth Direculr, New Hanover County 2029 South 11" Stteet WllmIngtol\, NC 28401 DearDavicl: e On behalf of the North Carolllla Institute for Public Health, I would lilce to offer our asai&ta11CC in assessing the organization and manaacmcnt of the New Hanover County Health ~ including a review of the Departmcut's CIll:'mIt programs and services. The product of this assessment will be a report coutalnins our findings and recommendali.ons. The assessment will be followed by a strategic planning process that will produce a ~1"""l.t that will include SlIlltegic planning priorities and issues for the Depamncnt. Auached please fllKl the frameworlt we pEOpOSe to use in the process. The project team IIlCtIIbeR who will contribute time to this effort will includo a project director (myself), faculty consultants, graduate assistant and an administrative support staff pe18OIl. Expenses for this project will not exceed S42,SOO. We look forward to the possibility of collaborating with you. Sincerely, +W~~Ib-') R Pennington Whiteside,Ir., MSPH Depllly Director HPW:gh A......~t e The Univenily 01 No:th CaIOlIna at Cllape! HiI1 Campus llax8165 Cllapel HiU, NC 27599-&65 Phone: 919.966.2248 . Fax: 919.966.9138 Web: www.splu=.edu/rlCiph 27 -0 . - The North Carolina Institute for Public Health (NCIPH) Organizational Assessment and Strategic Planning Process for the New Hanover County Health Department (NHCHD) A Proposal .:. Basic Elements of Organizational Assessment: The following topics, considered along with existing NHCHD priorities and issues, comprise a list of factors that could be considered in an organizational assessment. This assessment will be an integral part of a subsequent strategic planning process. The strategic planning process will be conducted according to a successful model used previously in the NHCHD by the NCIPH. e ~ Organizational Mission/GoalslValues ~ TasksrrechnologylWorkload ~ Structure/Communication/Coordination ~ Management Systems and Procedures ~ Human Resources ~ FinanceslFacilitieslEquipment ~ Marketing and Related Outreach Activities ~ Inter-organizational Collaboration and Coordination ~ e .:. General Steps: ~ Agree upon scope, priorities, and general work plan ~ Recruit staff and refme work plan ~ Develop instrumentation, structured interviews, identify "exemplar organizations," relevant "best practice" information, onsite observation and review plans, etc. ~ Conduct onsite surveys, interviews, observations, document review and prepare summary reports ~ Review and analyze data, prepare and present summary recommendations (based on organizational standards, comparison with exemplar organizations, and best practice information). 28 ., ... .:. Unique Characteristics oflnstitute of Public Health and New Hanover County Health Department organizational assessment effort: This effort has an important two-fold potential: one, to provide the NHCHD with the benefit of outside review and recommendations for improving its organizational effectiveness and efficiency; and, two, it provides the NCIPH with a model that can have value to other local organizations. .:. Responsibilities of North Carolina Institute for Public Health: ~ Build a project team for design and conduct of the assessment effort . Project Director - overall project coordination · Consultants (Health Administration, Public Health Nursing, Environmental Health) - assessment design, onsite interviews and observation, data analysis, develop and present recommendations . Graduate Student Fellowship - design, collect and analyze data, survey exemplar organization, collect standards and "best practice" data, day to day coordination with NHCHD staff, assist in report preparation . Support Staff- logistics, data tabulation and analysis, general support services ~ Develop and refine instrumentation for assessment (with active review and collaboration ofNHCHD leadership) . Itemized assessment profile . Individual and team interviews of key staff and organizational leadership . Unit and individual survey questionnaires (if needed) ~ Collect and analyze assessment data . Onsite interviews and operational observation . Tabulate and analyze interview and survey data . Review relevant organizational data: structure, systems, policies, processes, service statistics · Gather and analyze comparison data from similar and/or exemplar organizations, as well as relevant public health performance standard data ~ Develop and present indicated recommendations . Written report · Executive briefing to key organizational leadership . e e e 29 . - .:. NHCHD Responsibilities: ~ Provide timely review and comment of the Institute work plan, draft instruments, and structured interview schedules ~ As possible, participate as an active partner in Institute team planning and design efforts ~ Assist in arranging local onsite interviews, procedure reviews, operations reviews, and staff surveys ~ Convene a core team of staff to review the overall assessment effort and develop recommendations for improving the methodology, instrumentation, and onsite efforts. .:. Required Resources: The resources required for this project will not exceed $42,500. e e 30 . .if ~ , e {........r. (ri(0~Sr;:~~I-c. r,,\; '-II'! ' r" ,'. .. . I ' I~I? '((ff~ 1:/ /1" I z'~!J 0, , I ,. j" "(..' (, , I ......... ' ,;;:. ,,"" \ !). I I \ - --, / lie:' \"" ;"';; f!J' ) 0' (J' 1/ .rJ (...'~\ -~ - Ii '1' .;u'i,,'~ c" " ('J I~ ~ Sterilization Protects Animals & You e The development of an on-site spay/neuter facility at the New Hanover County Animal Control Services shelter. Jean P. McNeil, DVM Daisy Brown David Howard, MPH Barbara McClure, MBA, CPA G. Robert Weedon, DVM e New tlCM'\.O"\let'" County, N~ClM"'~ e e e Sterilization Protects Animals & You Slide I Slide 2 Slide 3 - J..n_llDYll(TOPDOG~ '""o.lor_nflllclllloDouI 1Ia.....IkC......fIlBA.CP...ll'DouI __.....fIlPHlEd~1 G_R___.DVfIlIJ..IADouI New Hanover County' animal Control Services NC-2 Business Plan Management Academy for Public Health Page 2 of 12 e e e Sterilization Protects Animals & You Slide 4 Slide 5 Slide 6 New Hanover Count, animal Control Service. NC-2 Business Plan Management Academy for Public Health Page 3 of 12 e e e Sterilization Protects Animals & You Slide 7 Slide 8 Slide 9 NC-2 Business Plan New Hanover County Animal Control Services Management Academy for Public Health Page 4 of 12 Ie e e Sterilization Protects Animals & You Slide 10 Slide II Slide 12 NC-2 Business Plan New Hanover Count, Animal Control Services Management Academy for Public Health Page 5 of 12 e e e Sterilization Protects Animals & You Slide 13 Slide 14 Slide 15 NC-2 Business Plan Strategic Position ~~ '"WuilihIUL' =u ~:: :: ~ ~~~~: .. ': ..,...,-"-"-- - - - - - - - .. - .. - - - - = ~ " , ."0'. '^u.,<.. ) New Hanover County Animal Control Services Management Academy for Public Health Page 6 of 12 e e e Sterilization Protects Animals & You Slide 16 Slide 17 Slide 18 NC-2 Business Plan New Hanoyer County Animal Control Services Management Academy for Public Health Page 7 of 12 e e e Sterilization Protects Animals & You Slide 19 Slide 20 Slide 21 NC-2 Business Plan ~;;Ji~~t~[., rIiI Hurdles on the W:lY to Success 1'11d~': 1 Vl:t(~lill;llidll ^CCl~pt,lIl(,~:-<' :;lIl)IX)11 Applo\!<ll hv 1'()lilicdll;():\Id~ ~; I <Ill -liP F 1111(1 i 11\ 1 C\ I~:t ,lIlll'l ~~IIPIXlll "[ )()~ 1- ( : oil cl h' r .. 1,1<' IlL 1 ht y III New Hanover CountJ Animal Control Services Management Academy for Public Health Page 8 of 12 -- e e Sterilization Protects Animals & You Slide 22 Slide 23 Slide 24 NC-2 Business Plan Hurdles on the Way...!.? Success Pll<1';': II 1~\.'~llllilt iOllS 1\:ICdv!:l! (Ollllldilillll witll V('\(~lillilli(1I1<' (11';IIlIll,:1 SlIppilll ~ Cost Benefit Analysis :' '_~d~_1 S;;~~~J ~:~II' ~"..I ~~~I~___I~-::~.~_ I :. " r, " II I s: III or i I ":,: II \, I H I !I ~.;:, r i, IJ! I i ~.;:',f) (J Ii l:",,1 I '",j'.'d',,1 I :~~I_(iii-ITI(; uill' :<11 Ti'lilS!~-j~ (:,,",1 ,"",'/i'l'l" 1-S7.-ij(;-I~iTO(I--I~.; ~{I;.I--is~~ New Hanoyer Count, Animal Control Services Management Academy for Public Health Page 9 of 12 e e e Sterilization Protects Animals & You Slide 25 Slide 26 Slide 27 NC-2 Business Plan r.II Startup Costs & Funding I III I! :I\I:~ 1101,;1 I~""d I -------- ---- 1"--- -------- r,..l"",:.!;orv 111\11;01;,,,1-' :.;'I(;,'lIlfI I;-;_K~~rll-),;~'-"~r~;- ---i---S~iJ-:;;Ii!I----- l~;t;I:<;;:;lllc(~;-(;f--- --I.----~17:;-lill-- -~- Capital SOllle,-,,, oj Capital ':<II1,lIill) New Hanover Count, Animal Control Services Management Academy for Public Health Page 10 of 12 .. e e Sterilization Protects Animals & You Slide 28 Slide 29 Slide 30 NC-2 Business Plan New Hanover Count, Animal Control Services Management Academy for Public Health Page 11 of12 . e e Sterilization Protects Animals & You Slide 31 Slide 32 Slide 33 NC.2 Business Plan NC-2 Team Members Jr}~lll f'v1rN,il, !Jvrvl CIUI'LJUC~) [):lisy Ih\\NII (rVliliilll~ 1)l!~J) 1\;111)~1I:1 ['lilr;l:lllI-u, r\'lLl/\, C1-'/\ UJ r.hl~l) 1J~1Vid I-I< )\1\1:11<1, r>lill'll (l::tlll-1l11~!) (; I-~()!I')rl V\/(~.,tllI11, Llvr\;i (JII"1 ^ U')~I) -{@ ...,~, New Hanover Count, Animal Control Services Management Academy lor Public Health Page 12 01 12 . ,,0-,0<r: ~ e4 cf\ e ill ~- -<tli) ocx Oi{) I-j{) d)_ 00 OOm ~ ~ oc I--<t IL o~ Q-1 -<tIL ILi{) ill X oc- IL~ \: -1 ill Z Z ill U. ~~ ZZ QI- -1d) OX II!! --1 o OC !z o o --1 t o~ t->- Zt- OZ -::J t-O ao aoc '<[w a> wo Q)z 0'<[ D-I o 3 ~tl5 OCwJ)~ D- Z ~~ >- III ~ > Z O(j;)j:: uxd) ill- X OC~I!! d) Z ~~ I-Z ILI- ad) QX -<tl!! . PRESENTATION FOR COUNTY COMMISSIONERS "Your health - our priority" is the motto ofthe Health Dept. Mr. Chairman, Commissioners, Mr. O'Neal and staff, I 'm Gela Hunter the RN representative on the board and present Chairman of the Bd. of Health. My experience in Public Health did not begin with my service on this board, but as an employee in 1973 for a period of 9 years. Having worked for the county and now working in the private sector allows me a somewhat different perspective into the needs of the department. I'd like to recognize the other members of the board here this evening: Dr Wilson Jewell, budget chairman, and Ed Link, vice chair of the board. The New Hanover County Board of Health continues to be impressed by the management team within the health dept. Those in attendance tonight are David Rice, Health Director and Cindy Hewett, business officer. I acknowledge them and their staff because of their remarkable ability to acclimate to changes imposed in this time of economic downturn for state and local governmental agencies. . I must also take this opportunity to thank you for your recent approval of the organizational review and strategic planning process to be done within the department. I come before you this evening not to argue the requested budget items that the county management team has seen fit to remove from our budget. We have been well informed of the inevitable by Mr. O'Neal, himself. We are all aware that there are many constraints of funding facing us not only this next year but in the future as well. I do not envy your job of having to make the decisions regarding this next budget year and I commend you in advance for doing what you feel is in the best interest of the citizens that you represent. Because of this time of reductions and loss, I am here to make you aware of some of the changes being made to accomodate the cuts that we are experiencing. I want you as commissioners to know exactly what all these changes mean for the Health Dept. and you in terms of your own needs for health protection and disease prevention. e The Women and children who choose to obtain services at the dept. will certainly be affected. Nutrition counseling has been reduced and education programs have been decreased that are normally given at clinics, schools and other organizations.There has also been an elimination of evening clinics for family planning. Case loads for child services coordinators have increased thereby allowing for a decreased quality of care. Even the dental health program is being affected by the loss of staff and funding, The Communicable Disease Division projects nearly $120,000 in lost revenues next fiscal year because of reduction in services.These reductions have been made to accomodate the loss of staffing for the evening clinics offering immunizations, TB Screening, and HIV counseling and testing. STD clinic time has been reduced as well. An effort has already been made to transfer some services to other staff members and utilize persons as necessary to meet clerical needs. The outreach program to 'at risk' populations to identify tuberculosis early has been eliminated. .1 , I Environmental Health is finding it increasingly difficult to keep up inspections with their limited staff. The frequency with which they normally inspect restaurants and other eating establishments is being reduced. The inspections involving child care facilities, schools, nursing homes etc. has also been reduced. To continue to respond to complaints in regard to water quality and vector control in a timely manner seems to have reached an impasse. With the present resources, residents can expect less control measures, for example, decreased mosquito spraying throughout the county. I know you are aware of recent events concerning animals in our area. As of last Sat., Animal Control Services is no longer open on weekends. Hours of operation have been reduced, as well as field coverage.for evenings and weekends. We expect a reduction in revenue secondary to gains received in the past through many prevention measures. You can be assured that these changes have not been made with callous abandon but with much trepidation in trying to prioritize needs. It is a grim picture! You need to be aware of what is presently .going on within the department. There are federal mandates that must be met. It will be increasingly difficult should we have to endure even more losses in staffing as we have already suffered a 12% decrease this year. We understand that cuts must come from somewhere if there is to be no tax increase. A large part of the staff at the dept., particularly the nurses, are in a very competitive market. When jobs are frozen, it is precarious at best for those divisions where turnover is inevitable. . In spite of the changes that we are experiencing, however, I feel strongly that the staff at the health dept will rally to continue to provide the highest quality of service possible. They will confront and address the issues relating to your health as it truly is their priority. Thank you for your time and for listening. e ..:" e e e .. STRATEGIC PLANNING PRIORITIES May 28, 2002 Update Access to health care Issues #7, 11 & 5 -+ Child Safety Seats: Effective immediately. please do not refer any clients for convertible car seats...we are out and don't know when we will be getting anymore. -+ Carolina Access 11/111- Janet McCumbee and David Rice attended a meeting 5/17 regarding bringing Carolina Access 11/111 to New Hanover and surrounding counties. CA II/III is the Medicaid case management program already in 10 counties. A network consisting of Health Dept., hospital, DSS, and private physicians will meet regularly to set up a case management system and monitor outcomes, to ultimately save Medicaid money and provide better quality care for patients. Dr D. Gottovi and Rep. T Wright are leading this effort. The state level staff present Friday feel confident that the money will be available to proceed and that the legislature is interested in moving this system into all counties quickly. -+ Hours of services reduced for Immunizations, STD appointments, HIV Counseling and Testing, discontinuing Hepatitis B vaccines to sixth graders in schools, eliminating TAP, and other prevention education outreach activitiesfor communicable diseases. -+ II. I. Preventive services & lifestyle-related risks Issues #12 & 15 -+ TB Suspects: Three new TB suspects in hospital, bringing the FY total for TB suspects to 49. TB staff have 209 individuals being followed that are on medicines for disease or preventive therapy, which may be an all-time record high. -+ The Child Care Nurses have begun to use a new developmental screening tool, in place of the traditional Denver The new tool is "Ages and Stages", and will be the screening tool of choice for young children seen through Health Departments, beginning July 2003. Once they feel comfortable with the tool, they will assist other Health Department staff in the transition. -+ Carol Bottoms presented nutrition topics at Winter Park Pre K, Lower Cape Fear Child Care Association, and Gresham Place Retirement Center -+ Susan Diamond, WIC Nutritionist, presented a program AChild and Adult Nutrition@ for the Hermanas Latinas Program at Tileston Outreach Health Clinic. -+ In cooperation with Cooperative Extension, Carol Bottoms presented AColor Me Healthy@ training for day care providers. -+ The New Hanover County Dental Staff celebrated Public Health Month with various dental activities conducted throughout the community. The Dental Staff produced an interesting display located in the Health Department clinic reception area entitled "Seal Your Smile" In addition to the display, the Dental Staff answered patients' questions and distributed sealant literature. On various dates throughout April, the Dental Staff conducted educational sessions at schools and after school enrichment programs on various topics such as dental careers, nutrition, brushing, flossing, and the benefits of sealants. -+ III. Communication, education & marketing (promotion) Issue #1 & 4 in art -+ Beth Jones made a presentation on Bioterrorism to local Hotel Association on 4-25-02. They are very interested in the role hotels may play and want resource list to call to report appropiate incidents to public health department. -+ Latino Festival: NHCHD will be participating this weekend. -+ Smart Start: On Thursday 4/25, Janet McCumbee spoke to a group of Smart Start su orters and a few oliticians about the health of oun children in New Hanover Count and 1 the beneficial services being provided by Smart Start. The legislators spoke on the grave state of the NC budget and how everyone would take cuts. -+ Pet Adopt-A-Thon: ACS held their annual Pet Adopt-A-Thon Saturday, May 4-5 at the shelter on Division Drive. A total of 17 animals were adopted (16 dogs and 1 cat). -+ Animal Commercial: FilmDogz, a local commercial production company, will be at ACS this Thursday to film a national psa commercial for the Humane Society of the United States. They should complete the project for viewing by mid-June. -+ World Asthma Day' Today is World Asthma Day. The Asthma Task Force was not able to plan a community wide event this year; however, they will be raising funds to send children to Asthma camp again this summer Lorna Blackler will be sending out a LotusNotes regarding Asthma greeting cards for sale. These lovely cards will be available year round. -+ National Pregnancy Prevention Day' May 8 is National Pregnancy Prevention Day Health Department staff will be providing information to teens on how to access the on-line quiz that has been produced by the National Coalition. The quiz is interactive, fun, and designed to create opportunities to think about risky behaviors and make improved choices. There will be opportunities for prizes and sweepstakes entries on this day. -+ Hurricane Expo: To be held on June 8 at the CFCC Schwartz Center NHCHD and ACS booths will be side-by-side. -+ Special project with NC Jr Sorosis to promote childhood vaccines among Hispanics. -+ Brett Schoen presented the Prenatal Universal Screening Survey to an OB office that does not see Medicaid patients. He also showed data from the past year to prove that Medicaid and private pay patients have similar concerns about parenting. Most new parents indicated a need for information about topics such as child nutrition and development. -+ IV. Facility utilization & Information technology (Issues #6 & 4 in Dart) -+ Office Furniture: Office Showcase was awarded the informal bid for office furniture for Public Health Bioterrorism Team offices. The furniture should be delivered in 2-3 weeks. -+ Help Desk Update: Health IT is working with the County IT office to provide division directors and supervisors with access to view the requests that have been submitted for their respective divisions. This is a work in progress and will require "re-opening" several help desk tickets that have already been c1osed- should you recieve notification that a ticket which was previously taken care of has been re-opened and closed- please disregard and delete the message. We apologize for any inconvenience but appreciate you working with us through this process. The end result will allow divisions to better track those requests that are being submitted from their staff. -+ Space upstairs for Public Health Bioterrorism Team, has been painted and furniture ordered. Furniture is scheduled to arrive in 2-3 weeks. -+ Fire Safety Deficiencies: On March 25, 2002 Captain Powers from the Wilmington Fire Prevention Bureau conducted an inspection of our facility. We were given a list of deficiencies to correct by April 25, 2002. All deficiencies were corrected and on his return visit on April 30, 2002, we passed with flying colors. Thank each of you who assisted Lynda Smith in getting these deficiencies corrected. -+ AS400 Printer' Plans are progressing to replace the AS400 printer We will be moving from impact printing to laserprinting. Staff need to be aware that as of July 1, 2002 reports/output (from PCMS and the State) will be on laser paper As of that date we will no longer be printing on greenbar (or continuous feed paper) from the AS400. We will complete this fiscal year with our current printer -+ PC Rollouts: Health IT has begun the PC rollout! This project will be intensely time- consuming and will consist of 30 new Windows 2000 units (26 desktop and 4 laptops). 44 Windows ME systems are also scheduled to be upgraded to Windows 2000. The final phase of this project will be the "trickle-down" systems. The new units were purchased with Medicaid Cost Settlement funds, NC Public Health Preparedness funds, and Public Health Bio-terrorism ... '" e e e 2 . e e e . funds. Donna Malpass will work with staff to back up files, lotus notes address books, etc. Debbie Toth and Robbie Shaffar (from E+ Technologies) will be imaging and configuring each system. Donna, Debbie and Robbie will each be working to place the units in their desinated locations. Staff will be contacted for backing up files and also for installation of systems. Staff cooperation (and flexibility) with this project (as always) will be greatly appreciated. -+ Barcoding Project: Health IT will be working with Smead Link and the County IT folks to install the Barcoding Prototype tomorrow (5/8102). Testing of the application will be underway after the prototype is installed. Final installation is scheduled for mid-June. -+ Carpeting for Downstairs Nursing Office/Child Health: After many efforts at cleaning and salvaging the existing carpet, the downstairs nursing area and health promotion/child health area will have carpet installed in the next couple weeks (funded through budgeted, unspent Medicaid Cost Settlement funds.) Please bear with us in the dismantling of partitions and temporary displacement of furniture and staff while this takes place. Once begun, this should take approximately a week to complete. Dismantled partitions, etc. will be temporarily put in the auditorium. -+ Security Team: Has been established to address security issues of Health Department Facilities. Property Management will be asked to participate. Members of the Security Team are: Nancy Nail, Elisabeth Constandy, Sharon Neuschafer or Dianne Harvell, Frances DeVane, and Lynda Smith or Dave Rice. -+ Operable Movable Partitions: Confirmed for installation to begin June 17, 2002 with estimated installation completion of 3 weeks. -+ Animal Control Services: The ACS Shelter will be closed on Saturdays, effective June 1, 2002. -+ V. Water quality, storm water management & drainage; & Air ualit Issues #3 & 8 -+ Realtor Education Forum: Twice during the past year, staff from our Water Quality / Wastewater Program have provided training to local realtor groups with assistance from the Cooperative Extension Service. Water supply and wastewater systems are critical components of residential properties that are not served by municipal or county facilities. Questions concerning the performance of these systems are imminent during the resale of properties. The goal of training is to assure basic knowledge of these features and available local resources. -+ VI. Emerging health risks Issue #13 -+ Betty Creech and Beth Jones will represent NHCHD on a task force to address the National Pharmaceutical Stockpile process. Jeff Babb from NHC Emergency Management will facilitate the task force. -+ Suspicious letter submitted 5-3-02 to NC State Public Health Lab for testing after MD concerned about potential threat of anthrax. Report due today (Tuesday, 5-7-02). -+ Genetics Research: State TB Program will be participating in genetics research with Duke University Medical Center and will contact individuals in NC ( including from New Hanover County) to request participation in the study. Patients currently and previously treated for TB since 1993 and their parents are eligible to enroll. The study will examine whether there are genes that contribute to TB susceptibility -+ Sentinel Chicken Flocks:_ Chickens will not be used this year to identify the presence of arboviruses transmitted by mosquitoes due to the absence of financial resources to support this project. The Public Pest Management Section of the DENR Division Of Environmental historically has established and sampled blood from small chicken flocks in various counties across the state through summer into early fall. For enhanced protective measures, Vector Control Program staff established and sampled two additional flocks during the past two years. However, without the anal icallaborato su ort of the state, we will even be unable to 3 conduct our portion of this project. The encephalitis and West Nile viruses presence can be determined through this environmental sampling methodology. Their presence of course indicates greater risk of disease to the equine and human populations, and signals the implementation of more intense control practices. .. VII. Population growth & diversity (Issue #2) .. VIII. Discontinued services picked up by Health Department (Issue #9) .. IX. Staff Development & continuing education (Issue # 14) .. IT Policies and Procedures: Due to the recent occurrence of a system being infected by a trojan (virus), staff are request to review the County IT Procedures and Policies. To lessen the possibility of these types of future occurrences, it is advised that staff not access personal e-mail accounts via the use of county systems (Le. hotmail, aol, yahoo, etc). .. Pediatric Grand Rounds: On Tuesday, 4/23, Janet McCumbee along with Developmental Evaluation Center staff, attended the Pediatric Grand Rounds at NHRMC. The Pediatricians were presented bags of information on early intervention services, provided by the state. Ron Manson, from DEC, led a discussion about referring children to CSC, DEC, and Consortium. .. Volunteer Appreciation: Thanks to all staff who participated in Volunteer Appreciation Brunch, and to Kim Roane and Marcy Smith for their leadership. It was a huge success, and we need volunteers more than ever! Since last year's Volunteer Brunch, a total of 3,730 hours have been volunteered in the New Hanover County Health Department, valued at $37,515 !!!! Cause for celebration!!!!! .. WIC Vendors: Annual WIC Vendor training is scheduled for May 9 and 15. All vendors are required to attend one session. Many changes are occurring effective July 1, 2002 due to new Federal regulations. Vendors will be signing a statement stating that they attended training AND understood the changes. .. Reference Checks: All NHCHD supervisors are to use the new reference check form available on LotusNotes. .. The three new Public Health Bioterrorism Program staff are attending State training for Bioterrorism Teams, May 13-15 in Raleigh. .. HIV/STD Uddate: Videoconference scheduled for May 23 from 1Oam-4:30pm on PHTIN. Coastal AHEC added as site. Presenters: Dr Peter Leone and Dr Christopher David Pilcher Pre-register through Kristi Barnes by May 16. No fee. .. Open enrollment meetings started yesterday. Attendance at these meeting is mandatory for all county employees. A sign-up sheet is provided for attendance. .. Carol Bottoms attended the Public Health Update on obesity .. City of Wilmington to conduct their annual emergency simulation exercise on June 26-27 Health Department will participate. .. GIS Software: To be installed at CDD workstation on Tuesday, May 28. NHCHD Staff attended GIS training last week. .. Volunteers: Are providing valuable assistance at a time when we would have to reduce services further were it not for their help. Two new volunteers on board this week to assist with provision of direct patient services. Great timing!! Thanks to staff who welcome them, orient them to their assignments, and keep them happy so they'll want to continue. .. X. Evaluation of services (Issue #16) 4 < . e e e ~ e e e . + Budget: Allen O'Neal, County Manager, distributed his memo to the New Hanover County Board of Commissioners entitled "Budget Crisis is Inevitable" all employees. Allen and Pat Melvin plan to attend the next Board of Health meeting to discuss the County's financial condition. + Due to the current and projected budget crisis, several of our program budgets have been adjusted so that expenditures and revenues will balance without the assistance of county appropriations. These include: Public Health Bioterrorism, Child Health Services Coordination, WIC, Navigator, Child Care Health Consuitant, Maternal Outreach Workers, Temporary Aid to Needy Families, Maternity Care Coordination, Project Assist, Navigator- Partnership, Health Check, Partnership for Children, and Smart Start for Asthma. Revenues for these programs are either 100% grant funded, Medicaid earning or a combination of both. County appropriations will not be used to support these programs. + Goals, Objectives and Performance Measures: Dave Rice and Lynda Smith will be reviewing these today for submission to the NHC Budget Office. + Restaurant Scoring Project: The NC Commission for Health Services will meet on May 15, 2002 in Raleigh. NCDENR staff will update them on the Numeric Scores Pilot Project. This week, Dianne Harvell will be distributing information to local restaurants regarding this meeting. + ACS Fees: Changes have been submitted to the NEW HANOVER COUNTY BOARD OF COMMISSIONERS to charge Differential Running Loose Animal Control Fees for Mason Inlet. + Service Reductions: Management team received listing of CDD services cut, which includes reduced hours for immunizations, reduced appointments for STD and HIV counseling and testing, discontinued weekly Thursday evening hours and discontinued outreach in community for preventive education, participation in health fairs, and hepatitis B to sixth graders. These cuts are necessary because of the loss of 80 hours of public health nursing per week ( 2 full-time nurse positions).Changes effective 5-06-02. News release distributed to inform public. + TB Program review: TB Program review done by state TB Consultant indicated TB team doing an outstanding job! + Two WIC vendors have received enough sanction points to be disqualified for accepting WIC checks. After the 90-135 days disqualification period, they will need to re-apply to become a WIC vendor + HIPAA Update: Our In-House HIPAA Committee met on April 24th. Committee members are reminded that if you have not yet reviewed you IFA, please do so and notify Cindy Hewett of any changes (deadline was May 3rd). May17th is the deadline for submitting the list of policies and procedures used for daily operations within each division. May 24th is the deadline for submitting the list of providers that each division exchanges patient information. + Medicaid: We have received $42,401.05 in Medicaid Maximization revenue for the period October 2000 - September 2001 We have a request on the County Commissioners' agenda for May 20, to budget this money to assess the organization and management of the health department, including a review of our current programs and services. The UNC-SPH North Carolina Institute for Public Health has submitted a proposal to provide this service. + Recommended Budget FY 2002-2003: Received and will be presented to the Board of Health Executive Committee on May 28, 2002. Cindy will copy information and distribute to Division Directors. + Organization Assessment: With the approval of the budget amendment for the Medicaid Cost Settlement funds, plans are in process for an Organization Assessment and Strategic Planning Process for the New Hanover County Health Department. Discussion have taken place with the North Carolina Institute for Public Health (NCIPH) and NCIPH has submitted a proposal for the project. This was copied to the Management Team and discussed briefly. More information will follow as specifics and timelines are established. + 211 - A new Resource/Referral System: A universal call in number -211- is being looked at by a group in New Hanover County This system is spreading across NC and is being initiated by United Way. It would replace the First Call For Help system at Coastal Horizons. NC Spin throuoh UNCW is also involved with this effort. Brett Schoen is attendina the olannina meetinas 5 from the Health Dept. and will kept us informed about progress and usefulness for our staff and clients. -+ Mail - Business or Personal Mail must contain return address -+ Organization Assessment: NHCBH will consider the budget amendment for the Medicaid Cost Settlement funds on Junc 5. Plans are in process for an Organization Assessment and Strategic Planning Process for the New Hanover County Health Department. Discussions have taken place with the NHCBH Personal Health Committee and the North Caroiina Institute for Public Health (NCIPH). NCIPH has submitted a proposal for the project. The draft of this proposal is attached for your information. -+ Information on Service Reductions: Information on necessary service reduction due to lost positions and funding has been compiled from each Health Department Division and sent to the Budget Director per request. A copy of this information is attached -+ TAP Program: Mayor Harper Peterson requested meeting to discuss TAP Jessica Nakell and Beth Jones will meet with him on Wednesday, May 29. Perhaps City of Wilmington will find a department that can continue the program, which would work well since most of the sessions have been inside city limits. -+ 6 ,. . . e e 3/t1ROJ-- .Pr 60 I/o'! I J~!r J ()/2.. - AGENDA Southeastern North Carolina Medicaid Access Three Planning Meeting May 17,2002 New Hanover County Health Department Board Room Lunch will be available beginning at 11 :30. Please come a little early if you can so we can begin the meeting promptly at noon and end it by 1 pm. 12-12:10 Introductions and brief review of progress thus far by Dan Gottovi e 12:10-12:20 Review of political realities regarding Medicaid and the State budget by Rep. Thomas Wright 12:20-12:40 Review of Access Three progress in other parts of the State by Jim Bernstein, Assistant Secretary for Health and Torland Wade, Director, Office of Rural Health 12:40-12:55 Discussion of next steps moderated by Dan Gottovi 12:55-1:00 Wrap up by Dan Gottovi Almost all of the participants have let me know that they are coming. If you are coming and have not let me know, please leave word on my voice mail 341-3481 so I can be sure to have enough lunch from 1tt' Street Deli. J ff~ ~ J () Thanks, ,. Dan Gottovi O~- ~r~ e North Carolina's Community Care ProlZflll1l Quality Care is Cost Effective Care - North Carolina's community-based approach to improving the management and delivery ofcare for Medicaid and other low-income residents has become a national model. By building a care management system that is organized and operated by community providers, North Carolina is creating community networks that can achieve access, quality, utilization, and cost objectives. Through the use of such health management tools as risk assessments, disease management, and case management, these networks have put in place the processes and supports by which high risk patients can be identified and their care managed before costly interventions become necessary Eleven Networks with over 1400 physicians across North Carolina are working with their local health departments, hospitals, and social service agencies to better manage the care of their Medicaid enrollees. . AccessCare (50 provider sites including UNC) . Access II Care of Western NC (Buncombe Co.) . Cabarrus Community Care Plan (Cabarrus Co.) . CMC Access II (Mecklenburg Co.) . Central Piedmont Access II (Forsyth Co.) . CLECO (Cleveland Co.) . Community Health Partners (Gaston Co.) . Durham Community Health Network . Guilford Access II Partnership (Guilford Co.) . Community Care Plan of Pitt County (pitt Co.) . Surry County Health Systems (Surry Co.) e Kev Elements. Community networks are putting into place the population health management programs that are needed to achieve improved performance: Clinical Improvement Initiative. Physician leaders from participating networks come together to design and develop clinical improvement initiatives: . Initial Health Status Screening . Case management of High Risk . Disease management . Population Health Management . Community providers sharing resources and responsibility for healthcare performance. . Evidence-based Medicine . Best Practices . Improvement Goals . Guidelines and processes for lasting improvement . Asthma Disease Management . Diabetes Disease Management . Pilots Cost Effectiveness. Reducing unnecessary hospital admissions and emergency room visits were the areas targeted during the program's development phase. The program has achieved substantially lower hospital admission rates and emergency room visit rates that the control group. e NOR THe A R 0 L I N A' S Community Care Program (Access II and III) ~;,.<. .1'. ..... - Frequently Asked Questions May. 20lH Q What is North Carolina's Community Care Program? The Community Care Program is a community-based health care delivery system for Medicaid recipients that is organized and operated by community providers. It is a program built on the success of North Carolina's Primary Care Case Management Program (Carolina ACCESS). The Program is presently comprised of nine provider-led community networks that have assumed responsibility for managing the care of 190,000 Medicaid enrollees. Each network is putting in place the care management programs and processes needed to maximize access to health care and to improve its quality and cost-effectiveness. Q Why has it been established? To achieve real improvement in the access, quality, and cost-effectiveness of care for Medicaid recipients, new approaches have been needed. After considerable study by North Carolina providers and policy-makers, it was determined that the key to improvement was a community-based system that looked at all Medicaid recipients, not just those who presented for care, and to pro-actively manage their overall health care before costly interventions became necessary The Community Care Program has incorporated the key elements that are needed to achieve improved performance _ population health management and shared accountability By taking responsibility for a defined Medicaid population, putting in place the population health management tools, and assuming responsibility for performance, the participating local provider networks are putting in place the systems and supports that can deliver improved performance. Q_What is_the-1JlltiE'rlyiT1g philosophy of thE' Progr..rn? The Program is built on four key concepts: . Partnership The program is a partnership of essential local providers (physicians, hospitals, health departments, and social service agencies) who are working together (and with the State) to develop programs and processes for meeting the health needs of their Medicaid enrollees. Q Q Q Frequently Asked Questions -- .~ -,. '- " . Populatioll Health Management Rather than look only at those who present for care, the participating networks look at all recipients and put in place the processes to identify at-risk enrollees and to manage their care before costly interventions become necessarY . UlIality Improvement The heart of the program is quality improvement. \Vith the conviction that "quality care is cost-effective care," program participants are concentrating their efforts on putting in place the programs and processes that can lead to improved quality of care. . Cost ~lanagement and Accountability The participating networks are putting in place the programs needed to achieve cost management objectives. The networks are also working with the State in defining and tracking performance. (The program has contracted with the Codman Group for risk-adjusted profiling software to enable participants to better gauge their performance.) What is the goal of the Program? The goal is to create a North Caroiina system of care that can consistently deliver improved access, qUalie and cost-effective care for Medicaid recipients. This system is community based and led by local physicians and key community leaders, encouraging local ownership, coordination of resources, and long-term sustainability of the program. Does the Program have support? In addition to its sponsorship by the Department of Health and Human Services, the Program has been endorsed and supported by the N.C. Medical Society, N.C. Hospital Association, N.C. Pediatric Society, and the N.C. Academy of Family Physicians. The Program operates under a 1915(b) waiver provided by the Health Care Financing Administration. Who participates in the Program? The participating networks include: . AccessCare (102,390 enrollees) . Access II Care of West em North Carolina (13,429 enrollees) . Cabarrus Community Care Plan (9,652 enrollees) . CLECO (Cleveland County - 4,354 enrollees) . Community Health Partners (Gaston County - 11,222 enrollees) . Durham Community Health Network (11,486 enrollees) . Guilford Access II Partnership (13,507 enrollees) . Community Care Plan of Pitt County (21,126 enrollees) 'Surrv Countv Health System (3,704 enrollees) e (March 2001 enrollment numbers) Q Q Q Q What are the network responsibilities? Using a population health management approach, each network assumes responsibility for managing the care of a specific Medicaid population and addressing their health status by pro.actively managing their care. By employing such tools as risk assessments, disease management, coordination of local resources, and case management, the networks are putting in place the processes to identify at-risk enrollees and to manage their care before costly interventions are necessary What are the key tools networks employ? The networks rely on two primary tools to improve the management of care of Medicaid enrollees: case management and disease management. Using their case management staffs, as well as support from participating provider organizations, the networks manage the care of those enrollees with complex medi<;:al and social needs. For enrollees with specific health conditions, such as asthma and diabetes, the participating physicians employ a quality improvement process developed by the Institute for Healthcare Improvement. Under this process, the physicians identify best practices, develop practice guidelines, establish improvement goals, define performance measures, and begin the arduous task of developing the processes and supports within the practice that are so essential to achieving lasting improvement. What are the benefits to the State? The State creates a care management system where private and public providers work together to improve the access, quality, and cost-effectiveness of services for Medicaid recipients. By taking responsibility for a defined Medicaid population, by putting in place the population health management programs and by assuming responsibility for perfonnance, the Access II and III provider networks are putting in place the systems and supports that can deliver improved performance for Medicaid and other community residents. What is the cost to the State? The annual costs to the State in supporting the development of Access II and III plans and initiatives is approximately $1.5 million a year. Each Access II and III project receives $2.50 per member per month for each Medicaid recipient enrolled in their network. These funds can only be used by the networks to develop the staffs and programs needed to improve the management of enrollee care. Note: The initial costs to the State have been more than offset by the cost savings generated by the program (see next two pages). . Frequently Asked Questions e Q Is the Access II and III Program cost-effective? While the program is still in its early development, preliminarY results are positive. In .the two areas of health care utilization, inpatient hospital and emergency room, which were targeted during the first two years of operation, the program has achieved impressive results. o o o "'"'", ~~ ~~ Q..,Q ~= ...~ ~= 80 70 60 50 40 30 20 10 o Hospital Admission Rate for Under 21 FY 1998 FY 1999 51.5 53.4 53.5 68.5 Percent Change FY 1998 - FY 2000 Access II and III -2% Access I 18% . Access II and III . Access I FY 2000 50.4 63.2 ~ Q.l "S ~ =-5 ~c: Q.lo ~= "'~ oQ.l Oc. S20.00 S18.00 S16.00 S14.00 SI2.00 SIO.OO S 8.00 S 6.00 S 4.00 S 2.00 S 0.00 Hospital Admission Costs for Under 21 ;t= -1 ~ FY 1998 FY 1999 FY 2000 SI5.l7 SI7.28 SI5.64 SI4.69 S16.81 SI6.67 Percent Change FY 1998 - FY 2000 Access II and III 3% Access I 13% . Access II and III o Access I ~ ~ .D. = ~ =-5 ~c: ~o ~= "'~ o~ Oc. . Access II and III . Access I Emergency Room Visit Costs for Under 21 $5.00 M.50 M.OO $3.50 $3.00 $2.50 $2.00 $1.50 $1.00 $0.50 $0.00 9 ill CD . . - ---------~----------- -- FY 1998 FY 1999 FY 2000 $3.02 $3.06 $3.41 $3.60 $3.86 M.36 Percent Change FY 1998 - FY 2000 Access II and III 13% Access I 21 % When the two year experience of Access II and III enrollees is compared with Access I enrollees, the percentage increase in both hospital and emergency room for Access II and III enrollees is 50% lower. According to the Center for Health Informatics and Statistics, the net-savings from reducing just hospital admissions for enrollees under 21 was approximately $2.5 million a year. When looking at percent increase in total costs for Medicaid across the three systems of care, the Access II and III Program had the lowest percentage increase over a one-year period of time. Percentage Increase in Cost per Member Month From FY 1999 to FY 2000 16% 14% 12% 10% 8% 6% 4% 2% 0% . % Increase Access II and III 8% Access I 11% Q Frequently Asked Questions . '< e ',. What has been the impact of the quality improvement effort? The emphasis on quality improvement is changing how care is being organized and delivered to Medicaid recipients. Participating physicians have come together to carry out a quality improvement process at the practice site and community level. The physician-led quality improvement team chose asthma as the first disease management initiative. A few of the guiding principles used in choosing asthma were: . There are enough Medicaid enrollees with the disease to obtain a "return on investment;" . Evidence exists that best practices lead to predictable and improved outcomes; and . A gap exists between best practice and everyday practice and we have the ability to measure our improvement. When analyzing the average asthma episode cost for children in 2000, the children enrolled in Access II and III cost 24% less as demonstrated below: $900 $800 $700 $600 $500 $400 8300 $200 $100 $- Average Asthma Episode Cost for Children Under 18 in 2000 was Lower for Access II and III Patients than for Children not Enrolled e Quarterly chart audits, carried out under the direction of the Program office, confirm that there has been substantial improvement in how care is being delivered in the targeted areas. When looking at the improvement in our program from the baseline chart reviews from July - September 1999 to the most recent results obtained for April - June 2000, the following improvements were made: ~. The number of patients with asthma who had documentation of staging increased from 43% to 57%; and . The number of patients staged II-IV who have an Asthma Action Plan (AAP) increased from 66% to 80%. e 100% 80% 60% 40% 20% 0% Legend . Round I III Round II Access II and III Asthma Disease Management Quality Initiative ..---~.~ rn f'''",'' " > '.:1",'.~1 ~ ~~ <~,~.,: '~:: ~1 .. _ -~ ~,;;!@ t\;;~. # with asthma who had documentation of staging # staged II-IV who have AAP . Round III II Round N Jan. - March 2000 A til - June 2000 The NC Center for Health Informatics and Statistics found that the Access II and III enrollees had the highest overall appropriate asthma medication use rate when compared to other systems of care for the Medicaid population. 80% 70% 60% 50% 40% 30% 20% 10% 0% . % Increase 1998 NC Medicaid Asthmatics Ages 5-20: Percent Receiving Appropriate Long-term Control Asthma Medications in 1999 Access II and III 67% Access I 58% Fee for Service 53% HMO 53% System of Care . 'Ie:. . , . , ,,~ e z o 101 ~ (j ~ 101 o ~ ~ - 00> (j~ o ~ 8 ~ I~ ~ ~ ';1 a.~ 40- (j= ~ ~ ~ 101 e.9. (C ~ ~ rJJ ~. (t 00 e ( .' . ') e. NEW HANOVER COUNTY ALLEN O'NEAL County Manager OFFICE OF THE COUNTY MANAGER 320 CHESTNUT STREET, ROOM 502 WILMINGTON, NORTH CAROLINA 28401-4058 TELEPHONE (910) 341-7184 FAX (910) 341-4027 ANDREW J. ATKINSON CPA Deputy County Manager PATRICIA A. MELVIN Assistant County Manager DAVID F. WEAVER Assistant County Manager 414 Chestnut Street, Room 101 Telephone (910) 341-7139 Fax (910) 341-4035 May 17, 2002 To the New Hanover County Board of Commissioners and Citizens: I present to you the recommended budget for fiscal year 2002-2003. After completing a very thorough budget review process, I propose a tax rate of 69 cents, no increase from the current tax rate. Substantial cuts in positions and services were necessary to prepare the budget without a tax increase. This follows the Commissioners' directive to decrease the size of County government. The increase in voter-approved debt has been absorbed in the proposed budget with no tax increase. e As we know, the State's continued budget crisis greatly impacts all local governments. In each of the last two years, because of the economic downturn, Governor Easley decided to withhold monies due counties and cities in order to balance the State budget. At the same time, the cost of mandated programs (especially Medicaid) is dramatically increasing. The current economic conditions have impacted County revenue considerably. The two primary decreases are: 1 cent sales tax, $1.6 million, and interest income, $1.1 million. There are a number of significant increases in County expenditures as listed below. Expenditure Increases - FY 02-03 Bonded Debt Service/General Fund $ 612,488 Increase in Debt Service For Schools 2,007,663 Department of Social Services - Medicaid 1,023,750 Increase in Medical and Dental Insurance 687,061 Economic Incentive For Corning 450,000 Additional Cost of New Jail and Court Security 1,000,000 Increased Funding For Cape Fear Community College 600,000 $6,380,962 e 1 . . 1 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 The FY 01-02 budget was adopted with Board directive to reduce the size of County government. During the current year, the equivalent of 100 positions have been eliminated; 87 of these were full-time regular positions, with the remainder being temporary positions. At the beginning of the FY 02-03 budget process, department heads were instructed to request no new positions, hold operating budgets at the current level or less, and request only essential capital outlay. On numerous occasions throughout the year, department heads were directed to critically review departmental operations to reduce expenditures. While some reductions improved efficiency, other reductions were inefficient, as resources are stretched thin. Most departments have held their budgets constant for a number of years. Inflationary increases and serving an increasing number of citizens have been absorbed in static or declining budgets. GENERAL FUND Public Schools: A transfer of $65,406,709 is recommended for the Schools from the General Fund. Of this amount, $5,451,346 is funded by the portion of the sales tax designated for the Schools. The Schools' administrative staff agreed to no increase in operational funding for FY 02- 03. Even if the County funds the Schools at the FY 01-02 level, they may actually be dealing with less revenue due to State reductions. Due to the significant nature of the State budget crisis, the Board of Education was unable to meet the May 15th deadline for submitting its local budget request. As soon as State information is available, the Board of Education will finalize and submit its budget request. The new debt service for schools, approved by the voters in two bond referendums, will be an additional $2 million. The only other increase for the Schools is a $250,000 increased contribution to the New Hanover County Board of Education Pension Trust. As adopted in the current year budget, $1 million of the Schools Fund/fund balance is budgeted in the FY 02-03 budget. Cape Fear Community College (CFCC): Funding of $3,772,409 is recommended for Cape Fear Community College, an increase of $600,000 An increase of $1 ,004,890 was requested due to operational expenses of new facilities. 2 l e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 Personnel Issues: County departments were instructed not to request new positions. No new positions are recommended. An amount of $687,061 is recommended to absorb the increased cost of employee dental and health insurance. While it is not recommended that employees pay the additional insurance cost, their out-of-pocket cost for services and prescription drugs will increase. For the second year, no funds are included for the merit program or to provide a pay plan adjustment for employees. County-wide, funding for overtime and temporary positions has been substantially reduced. Departmental professional development budgets continue at one-half of the FY 00-01 adopted amount or less. Programs implemented in the past to promote employee morale and show appreciation were eliminated in the current year and are not recommended for FY 02-03. Position reductions have caused County staff to closely examine what they do, focusing on essential functions. In some cases, most notably the library system, hours of operations have been reduced, which includes closing the main library and all branches on Fridays. In certain areas, we are beginning to lose experienced and highly-trained staff. Some of the employees have left for higher paying jobs or jobs with more security or growth potential. There is a great deal of concern and anxiety among County employees. While our employees are genuinely appreciative of their jobs and benefits, the budgetary uncertainty is creating a cloudy future. The Management Team and I are doing all that we can to maintain the morale of employees, but I must admit that morale is falling. Employees are trying to provide quality services with reduced staffing levels. They see programs they have worked to build and maintain become a potential budget cut. Our employees are, without a doubt, our most valuable asset. Library: The Library's hours of operation have been reduced due to a reduction in regular staff and elimination of temporary and part-time staff. The Main Library renovations should be completed during the early months of FY 02-03 3 . e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 Department of Social Services (DSS): County dollars in the DSS budget will increase $1,806,778, primarily due to an increase in Medicaid costs of $1,023,750, and Foster Care and Adoption Assistance costs of $645,979. North Carolina is one of seven states with counties contributing to the cost of Medicaid. Counties have no involvement in setting the Medicaid policy, eligibility, or service options that influence Medicaid costs. Eligibility is based on State and Federal policy. New Hanover County's FY 02-03 Medicaid budget is $8.5 million. According to the North Carolina Association of County Commissioners, Medicaid costs are projected to increase roughly 20 percent annually for the next several years. County funding for Medicaid reduces the resources available to support local schools, public health services, criminal justice systems, and other essential County programs. Sheriff's Department: The new jail is scheduled to open during FY 02-03. A $1 million administrative reserve is included to provide partial year funding for increased jail staff and operating expenses and increased security for the courthouse expansion. Both facilities will be completed in the upcoming year. The new jail will be partially staffed with detention officers, which will be more cost-effective than staffing the facility with deputies. Additional positions will be recommended during the year for court security and the jail. A new firing range will become operational during FY 02-03. This range replaces a 30- year-old range that had to be relocated due to road construction. Public safety organizations in the County, except the Wilmington Police Department, use the range for State mandated qualification as well as practice. The range site will be used for bomb disposal. Southeastern Center: Funding of $1,643,584, an increase of $114,930, is recommended for Southeastern Center for Mental Health, Developmental Disabilities, and Substance Abuse Services. The 2001 session of the General Assembly passed legislation to phase in implementation of mental health system reform at the State and local level. This act is designed to restructure the State's mental health system. It expands the role of counties in choosing how these services will be offered and encourages regionalization and a reduced number of multi-County delivery areas. Counties are required to develop business plans describing how administrative functions will be carried out and services delivered. State-wide, counties are concerned the local cost of providing mental health may increase as the responsibility for providing services to patients currently served by the State is shifted to the counties. 4 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 Non-County Agencies: Funding has been eliminated for the non-County agencies that do not have a multi-year contract. The elimination of funds to these agencies will have a negative impact on the community, but financial support is not available without increasing taxes or cutting additional County programs. Agencies have been warned that with the current budget situation elimination of funding was possible. REVENUES The tax base growth between FY 01-02 and FY 02-03 is expected to be 3 percent. The current ad valorem tax base is estimated to be $17 billion. Based on this estimate, a penny will be worth $1,666,000. There is an estimated decrease of $1,590,476 in the 1 cent sales tax revenue, from the FY 01-02 adopted amount, due to current economic conditions and the last phase of the City of Wilmington's annexation. Estimates are based on actual receipts for the last four quarters, adjusted for the City's increasing share due to annexation. Local sales taxes are distributed by the ad valorem method and are the third largest revenue source for the county. Approximately $3.7 million of the undesignated portion of the two one-half cent sales taxes is budgeted for General Fund operations. One million is maintained for an administrative reserve for Environmental Management, and $1 .9 million is budgeted as a transfer to the Water and Sewer District. This is the same amount that was transferred in FY 01-02. Revenue estimates for the two one half cent sale taxes are based on the last four quarters, adjusted for annexation, and a 1.5 percent increase based on the most recent growth estimates of the Association of County Commissioners. An amount of $4.5 million is budgeted for State-collected local government reimbursements. These reimbursements were promised as continuing sources of replacement funds for locally levied taxes that were repealed by the General Assembly. In each of the last two years, because of the State's dire economic situation, the Governor decided to withhold monies that were due counties and cities to balance the State's budget. If the reimbursements are not made to the County, changes to the budget will be required. 5 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 FUND BALANCE I cannot recommend appropriating the County fund balance, since this would jeopardize our bond rating and reduce the amount below the current 11 percent. During these difficult economic times, fund balance is needed as a safety net. Much as a household tries to maintain some funds in a rainy day account, the County needs a fund balance. Remember it can be spent only once. We will soon enter what is predicted to be an above average hurricane season, and it may be needed more than ever. A strong fund balance is important to the continued financial strength and preservation of our excellent bond rating. The maintenance of a healthy fund balance is among my top priorities for FY 02-03 and beyond. ENVIRONMENTAL MANAGEMENT FUND The Environmental Management Fund is balanced with a $48 tipping fee. No transfer from the General Fund is budgeted, but an administrative reserve of $1 million is budgeted. Hopefully, the reserve will not be needed and can be used to increase the County fund balance or provide other services. New Hanover County is currently in the process of asking the local Federal Court to allow us to enforce our "flow control" ordinance, which requires waste haulers to deposit the solid waste they collect at County approved facilities and pay the associated tipping fee. We were enjoined from the enforcing ordinance in 1993, and then entered into a consent order with the waste haulers that brought the lawsuit, agreeing not to enforce it, based upon the appearance that the controlling law prohibited such ordinances. The interpretation of the law appears to have changed, or at least to have been clarified, such that we think we can convince the courts to allow us to enforce the ordinance. It is not a guarantee, and that is why a reserve for Environmental Management is appropriate. We are working to create a franchise system which would have the same result, but that is not totally immune from attack as well. Therefore, it seems that a reserve is very appropriate in the event these matters are delayed through litigation. FIRE SERVICE DISTRICT The current tax rate of 5 cents is recommended for the Fire Service District tax. The impact of the City's annexation plan on the Fire Service District will continue to be reviewed by the Fire Commission and reported to the Board of County Commissioners. 6 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 WATER AND SEWER DISTRICT The Water and Sewer District currently provides service to approximately 26,000 water and sewer customers (residential, industrial, and commercial). This is more customers than are served by most municipalities in North Carolina. The District's current operation and future expansion are funded by user fees and a $1.9 million transfer from the General Fund. CAPITAL IMPROVEMENT PROGRAM No funds are included in the recommended budget for new capital projects. It is unreasonable for the Commissioners or the public to expect that, in the future, capital projects will not be considered for funding. The County continues to grow and the demographics are changing. The current infrastructure of schools, parks, libraries, court space, and other public buildings must meet the community's needs. The elimination of capital projects will not be a trend the County can sustain, if it wishes to remain competitive in recruiting new industry and business investment in the community, while maintaining the quality of life for which we have become known. ACCOMPLISHMENTS Summarized below are a few of the many items that the County and its staff have accomplished during the current fiscal year. . The County Commissioners continued to expand the use of television and the web to provide information to the public. . County staff designed and built 1,800 square feet of new office space for the Transportation Program. . The bond rating of Aa2 with Moody's and AA- with Standard & Poor's was maintained. . The color orthophotographic mapping system was initiated for the entire County. . A $3.2 million Hazard Mitigation Grant (HMGP) was received to purchase and demolish 16 houses that were impacted by Hurricane Floyd. . A $400,000 Community Development Block Grant (CDBG) was implemented to rehabilitate 14 houses occupied by very low-income homeowners. . A $1.8 million grant from the HUD Disaster Recovery Initiative (DRI) Program was implemented for the beach communities and sewer and plumbing assistance for 235 homes in Castle Hayne. . New subdivision standards for the City and County were completed. . The Finance Department was awarded the Certificate for Excellence in Financial Reporting from the Government Finance Officers Association (GFOA) for the twenty-first consecutive year 7 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 . The Budget Department was awarded the Distinguished Budget Presentation Award from the Government Finance Officers Association (GFOA) for the eleventh consecutive year. . Employees in Emergency Management, Health, Library, and Social Services received recognition for outstanding performance from state and national organizations. Future Concerns As pointed out in the budget work sessions, the challenges faced in developing this budget will continue into the implementation of this proposed budget. . The level of trust between the State and local governments needs to be restored. Three times in the past 12 years, during a budget crisis, the State has seized monies that were due to local governments. Counties cannot prepare budgets if a significant portion of their revenues is jeopardized. . The one-half cent State-wide sales tax that went into effect last fall is scheduled to sunset June 30, 2003. At that time, the Boards of County Commissioners have the option to continue the tax with the County receiving all the proceeds to be divided with the municipalities. The State will cease all reimbursements due to local government after fiscal year 2003. Counties are worried they may change the arrangement to the financial disadvantage of the counties. . The State has not adopted its FY 02-03 budget. We continue to receive information that funding for programs has been reduced. In each case, the County must pick up an increased cost of the program or serve fewer clients. . The State Department of Health and Human Services continues to move forward with implementation of a reformed system to provide mental health, developmental disabilities, and substance abuse services. If changes to the current system shift responsibilities to the counties without the commensurate funding, local costs will rise and taxes may have to be increased to provide services. . I reiterate the need to maintain a healthy fund balance. This becomes more critical as the State's financial position weakens. Protecting the County's financial integrity as we strive to meet the future needs of the community is paramount when we seek financing for capital construction and infrastructure development. . No funds are included in the recommended budget for new capital improvements. In future budgets, funding for capital projects will be needed. The most urgent need is to renovate or replace the County Administration Annex Building. 8 e e e New Hanover County Board of Commissioners and Citizens May 17, 2002 Future Plans The General Assembly must be kept aware of local governments' needs for alternate revenue sources. Additionally, the financial hardship that program mandates, shifting of program responsibility, and freezing local reimbursements has on local governments must be made clear. Counties need a stable and growing source of revenue instead of the static reimbursements that are subject to State government budget problems and fluctuation in the economy I am personally and professionally grateful to the employees of New Hanover County. As the County faces many challenges, I know the citizens can continue to rely upon high employee dedication. But static or reduced staffing can be stretched only so far. The staff and I look forward to working with you as the FY 02-03 budget process is completed. ely, --- All O'Neal County Manager 9 ; 'W.~ ~ e NORTH CAROLINA ASSOCIA TION of LOCAL HEALTH DIRECTORS An Affiliate of the North Carolina Association of County Commissioners May 29, 2002 Honorable Members of the Appropriations Subcommittee on Health & Human Services North Carolina General Assembly Raleigh, NC Dear Senator/Representative: As President of the NC Association of Local Health Directors, I urge you to consider the following issues when debating the cuts to local health departments as proposed by the Fiscal Research Division: Medicaid Reimbursement Rate Reduction $7.4 Million Total ($2 million State + $5.4 million Federal loss) - A $2 million reduction in State funds will result in an additional $5.4 million reduction in Federal matching funds for a total of $7 4 million reduction to local health departments -Though local health departments are cost based providers for Medicaid, the settlement is delayed often by 18 months beyond the service date where the expenses are incurred and those settlement dollars are not the full cost, only the federal cost. This fiscal year, health departments only received 62 cents for every $1.00 of costs. "Local Health Departments cannot afford to upfront the funding of services until Cost Settlement Funds are -'eceived. Clinical services will be reduced or eliminated and trained public health staff will be terminated. -Many Health Department patients have multiple socioeconomic and complex health issues that require(s) additional staff time in counseling and follow-up that are not reimbursable services. -Local health departments may be the only provider for many of the state's population. Health departments accept all patients regardless of their ability to pay Aid-To-County Funding $1 million (State) -Counties are mandated through State Administrative Rules to provide or ensure provision of many programs yet receives very little financial support from the State (in some cases less than 10%) for provision of these mandated services. -Past reversions were due, in part, to eligibility restrictions, no local flexibility in utilizing these funds, and inordinate delays that often prevents availability of funds until the 4th quarter of the fiscal year which prevents full utilization of funding source -Reversion is less likely this fiscal year due to decreased State aid and loss of local funding because of the State's Withholding of Local Inventory Tax, and the expected increased demand on services due to the economy TANF - Out of Wedlock Births $1.9 Million Total ($1.4 million State + $500,000 Title X loss) -$1 4 Million in State funds will result in an additional loss of $500,000 in Title X funds -These funds avert an estimated 788 out of wedlock births each year and over $9.5 million in Medicaid expenses that will be paid as a result of theses pregnancies and births _out of the 46 states and DC, North Carolina has the 61h highest pregnancy rate, with the teen pregnancy rate among the Hispanic population being the highest in the nation -85% of teens who give birth are poor or near-poor, making them less able to support the child and increasing public assistance costs. I . .' e Health Promotion $700,000 (State) -25,000 people in North Carolina lose their life due to cardiovascular disease in a given year This equates to one death every 21 minutes -Cardiovascular disease is the leading cause of hospitalization, totaling $2.1 billion in hospital charges in 1996 -These funds are the only dollars many local health departments have to dedicate to prevention activities, and prevention costs are only a fraction of treatment dollars. _$ I million in Health Promotion funds were cut in FY 2001 -02 The NC Association of Local Health Directors urge you to consider additional reasonable enhanced revenues in lieu of these severe cuts to local health departments. The local health departments have been entrusted to protect the public's health and to promote healthy lifestyles. Local Health Departments are the providers of last resort and the safety net for citizens that will not be seen elsewhere. We serve all who come through our doors regardless of whether they have a payment source. These proposed cuts will undermine the ability of local health departments to continue to serve the community as it has in the past. Trained public health staff will be terminated and many clinical services will be reduced or eliminated entirely. We appreciate the task that you have before you and implore that you use your courage to enhance revenues in an effort to save programs that serves many of the state's most vulnerable population. Your personal health director is available to you to answer any question you may have as to how these cuts will affect your constituents and communities. Thank you. einCerelY, Wayne Raynor, President NC Association of Local Health Directors A WRldtr e e New Hanover County Health Department Additions to Reportable Diseases A s a result of recent rule changes, several diseases have been added to the list of re- portable communicable diseases required by law. See table for additions, code numbers, and re- quired reporting time. e Please retain this code list until a supply of revised reportable dis- ease cards is issued from the state. Report code numbers in the upper left box of the current card. Please note that Ms. Ruth Foy, RN, has assumed duties as our reportable disease nurse. She may be reached at 343-6533. Fatal Yellow Fever in a Traveler e A previously healthy 47 year old male traveled to Brazil for a fishing trip in March 2002. There he contracted yellow fever, returned to his home state of Texas, became severely ill and died. This is the third death from yellow fever in a U.S. citizen reo ported since 1996. The report was published in the Morbidity and Mortality Weekly Report (MMWR, CONTENTS Fish cant. ............. 2 Stats ..................... 2 Betsy Summey, FNP, 343-6531 vol. 5 I, no. IS) by the Centers for Disease Control. Because yellow fever is found pri- marily in pam of Africa and South America, most U.S. citizens are not aware of the severity of the disease. A viral ~ disease trans- 15) iii mitted by the / bite of a mos- quito, its fatality rate is approxi- mately 20 percent. A simple one dose vaccination at least 10 days before his departure could have saved this man's life. Travelers generally rely on travel agents to inform them of vaccina. tion certification needed for the countries they visit; however, the requirements may not reflect the risk. This traveler was given in- correct information by his travel agent. Consultation with a travel medicine clinic may of. fer recommendations more representative of the risks in an area and provide more protection to the traveler. Mercury in Fish Summertime brings renewed concern about the mercury content of some fish and the ne- cessity for cau- 4J tion by consum- _.. ers. The North -- Carolina Division ~\i:::! of Public Health has just announced a new, simpli- fied health advisory. This re- places previous advisories for specific water bodies. Information about the new advice is on the Division of Public Health's revised web- site at: www.epi.state.nc.usl epi/fish or call (919) 733- 3410. The crunch in state funds may limit the publication of brochures for distribution to health care providers and other outlets. We are relying on you to share this information with your patients. (Continued) 2 ~-------------------------------------------------. 4It ADVICE ON EATING FISH Fish is an excellent source of protein and other nutri- ents. However, several varie- ties of saltwater and North Carolina ~_~ freshwater ~;'\i.-,~ fish may "'" contain high levels of mercury, which may pose a risk to hu- man health. This advice will help you make healthy food choices. Women of Childbearing Age (15-44 years), Preg- nant Women, Nursing Women, and Children under 15 . Do not eat shark, sword- fish, tilefish, or king mack- erel; or blackfish (bowfin), largemouth bass, or jack fish (chain pickerel) caught in North Carolina waters south and east of Inter- state 85. These fish are high in mercury. . Eat up to two meals* per week of other fish. Other Women, Men, and Children 15 years and older . Eat no more than one meal* per week of shark, swordfish, tilefish, or king mackerel; or blackfish (bowfin), largemouth bass, or jack fish (chain pickerel) caught in North Carolina waters south and east of Interstate 85. These fish are high in mercury. . Eat up to four meals* per week of other fish. *A meal is 6 ounces of cooked fish for adults, or 2 ounces of cooked fish for children under IS. Fish high in mercury Saltwater: shark, swordfish, tilefish and king mackerel. Freshwater: blackfish, large- mouth bass and jack fish caught south and east of 1-85. Fish with lower mercury levels Saltwater: cod, whitefish, pollock, mahi-mahi, ocean perch, halibut, haddock, floun- der, croaker, herring, canned tuna and other canned fish. Also shrimp, crab, lobster, clams, oysters, scallops. Freshwater: farm-raised fish, trout, crappie, sunfish, white perch, yellow perch, bream, and salmon. e Communicable Disease Statistics , New Hanover County July 1, 2001 - April 30, 2002 , AIDS ...........................34 Campylobacter ..........11 Chlamydia ...............404 E. coli 0157:H7 ............0 Gonorrhea ...............236 Hepatitis A ...................4 Hepatitis B (acute) ......6 Hepatitis B (carrier) ..17 Hepatitis C (acute) ......2 HIV Infection ....................42 Lyme Disease.................... 1 Pertussis............................ 1 Rky. Mt. Spotted Fever... 11 Salmonellosis .................. 75 Shigellosis ......................... 3 Strep, Group A Invasive ...1 Syphilis ............................26 Tuberculosis......................9 e The Foundation of Local Public Health: Boards of Health, Health Departments and Health Officers L o U I S I A N A New Orleans July 10-13, 2002 The Astor Crowne Plaza Hotel New Orleans, Louisiana Co-located with the National Association of County & City Health Officials (NACCHO) . Awards and Officer Nominations: Jnne 1,2002 . Special Conference Room Rates: Jnne 19,2002 . Early Bird Registration Special: June 19, 2002 BRAND NEW HOTEL Astor Crownc Plaza Hotel $109/Single l\'l-\'WaSlorcrol\'nepiaza.cnm (X88) 487.9644 ,'- --- Iie;'dllneDiiieS - - - - . - --- Special Opportunities ? 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C :l /D I-' ~ N o o N ? ::: . ....................................................................................... ~-;::: " " '" ~ '" ~ '" - v-,=> ~~ c ., " " t::l o.s. ~ ~ " i:l " - :::. 0' '. " ~.~ ~ " :::-....:; ~ w " c ~ ~ " :! " c :::. ~ ,"-", t::l' g ~a t-:! b:l" o:! ~g- ;<:~ ::... ~ Qo ~ ~ O;it:>.. " " -.!~ I I >< >< ~ 8 ... ... <:::> ~. " " - t>, .. ~ i:;' '" " "" .. ~ ,.,. ... c .. ~ 3' /D ." ::r o " ~ c - - w C ~ ~ A golf scramble is being offered to attendees of the NALBOH and NACCHO () conferences. The outing will be held Saturday, July 13, 1001, 1 :00 p.m. tee time at Bayou Oaks Golf Facility (meet in the hotel lobby at 12 noon) located in beautiful historic City Park. Check out < www.neworleanscitypark.com/golfhtmt> The "West Course" site of this event is punctuated by bayou water and century old oak trees. The bayou shoreline is residence for white cranes, great blue herons and an occasional alligator. Price: $40 (includes the Green Fees, Cart & Prizes); Rental Clubs are available for an additional $20 Non Golfers: Enjoy City Park - a 1500 acre tract ofland which has evolved into the fifth largest urban park in the nation. Approximately 14 million visitors come through the park each year to enjoy its magnificent oak trees, picturesque statues and fountain~::) sport and recreational facilities, and historic buildings. Home of the New Orleans Museum of Art and the largest collection of mature live oaks in the world. Check out <www.neworleanscitypark.com> National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 NONPROFIT ORG. U S Postage PAID Bowling Green, OH Permit No. 47 -~ \ J ,- I, i ; MAKING A DIFFERENCE IN DIABETES WITH TIMELY INFORMATION FOR THE CITIZENS OF NEW HANOVER COUNTY I . - .. . .... I ~,-,._,---"""-~------_._--"-------,-------"--_'_----"--~--~,-~~~--,----~--~~,-~~-~"~-~-~----------------'--- ~ ".-._---_._._,~.._.._.---_.,---_.._--_.~----------- " La epidemia de Diabetes Esta Usted en riesgo? EI terminG "epidemia de diabetes" se retiece a un incremento alarmante en el o(unceo de per- sonas que estan adquiriendo diabetes en USA yen el resto del mundo_ Como un ejemplo de esto, los datos coleccionados por el Centro de Control de Efermadades (CDC) muestarn que el numero de personas con diabetes en las edades de 30 a 39 ailos aumento en un 70% entre los ailos 1990 y 1998. Durante este mismo periodo la prevalencia de diabetes subio en un 40% en las personas de 40 a 49 ailos y en un 31 % en las de SO a 59 ailos. Los grupos mas j6venes no fueron estudiados pero la gente que Ira- baja en diabetes cree que el mayor aumento es en los ninos y gente joven. Estos aumentos son en Diabetes tipo 2. Esta enfer- medad era Hamada antes "Diabetes del Adulto" Esta enfermedad se produce porresitencia de los tejidos a la accion de la honnona insl1lina Esta resistencia esta relacionada directamente con el grado de obesidad. En general se puede decir que mientras mas peso gane, peor sera su resistencia a la insulina. . - Ha estado engordando los Estados Unidos ulima- mente? Mire alrededor. Los estudios muestran que el nUmero de gente obesa se fue de un 12% en 1991 a un 17.9% en 1998. Este aumento de peso se ve en todas las edades, todos los grupos raciales y en todos los niveles educacionales. EI mayor aumento de peso se vio en el grupo de 18 a 29 ailos, en los Hispanicos, y en las personas viviendo en Is regi6n Atlantica Sur ( el peor estado fue Georgia). Arigual, en 1970 el porcentaje de ninos obesos eran 5%, habiendo subido a 11 % en 1998. A medida que nuestros ninos continuen comiendo comida de alta graza y dulces cuando estan sen- tados al frente de la television 0 el juego electronico, se espera que el nUmero de gente j6ven con diabetes continuara a creeee. Sabemos que hay otros factores que aumentan su riesgo: historia de diabetes en la familia y pertenecer al grupo Africano Ameri~ano, Americano Nativo 0 Hispanico. Pue4e Usted hacer algo para prevenir la diabetes, especialmente si esta en un grupo de alto riesgo? Los estudios muestran sin ninguna duda que la incidencia de la diabetes puede ser reducida con perdida de peso y ejercicio. Facilito, no es cierto? Tenemos alguna esperanza como una naci6n? Estamos destinados a ponernos progresivamente mas gordos y con mas diabetes? Bueno, no tenemas ninguna esperanza si seguimos aumentan~ do el tamailo de las porciones de las comidas , si seguimos comiendo 10 que comemos (se ha dado cuenta Usted que una hamburgesa doble con papas fritas y un "milkshake" llega a las 1000 calorias?) y si seguimos disminuyendo nuestras actividad fIsica. Esto es especialmente impor- ionte para los nino.. . En este pais, diabetes continua siendo la causa principal de ceguera, falla renal, perdida de miembros y una causa importante de enfermedades del coraz6n. Cuanto mas joven uilo sea cuando adquiere diabetes, mas tiempo tendra para desarollar las complicaciones de la enfer- medad. Asi p-uo., levantese, cambie su dieta y saque a 8US ninos a jugar afuera! Jorge J. Gonzalez MD FA. C.E Profesor de Medicina UNC The Diabetes EJ?idemic Are you at nsk ? The term "diabetes epidemic" refers to an alarming increase in the number or people acquiring diabetes in the USA and around the world. As an example of this, the data collected by the Center for Disease Control (CDC) showed that the number of people with diabetes in the 30 to 39 year old group increased by 70% between 1990 and 1998. Over this period of time the rate of diabetes increased by 40% in those aged 40 to 49 and by 31 % in the SO to 59 group. The younger groups were not studied but people working in the field feel that the fastest increase is happening in the younger ages. These increases are in type 2 Diabetes. This illness was for- merly known as Adult Onset Diabetes. It is related to resist- ance of the tissues to the action of insulin. This insulin resist- ance, is directly related to obesity. In general, the more weight one puts on the higher the insulin resistance. Has the United States gained weight lately? Just look around. Studies show that between 1991 and 1998' the num- ber of obese people in our countrY went from 12% in 91 to 17.9% in 1998! A steady increase was seen in both sexes across age groups, race and educational levels. The greatest weight gain was seen in the 18 to 29.years old group, the Hispanic population and the people living in the South Atlantic region. (The.worse state being Georgia). Likewise in 1970, the percentage of overweight children was 5%, by 1998 it had gone up to II %. As young people continue to eat fast, fatty foods and sweets while they sit in front of television sets and electronic, game boxes, researchers expect that the number of yoimg people with diabetes will continue to increase. There are a series of other factors that can put you at a greater risk: family history of diabetes or. belonging to the African American, Native American or Hispanic group. Can we do anything to prevent getting diabetes, especially if one belongs to a high-risk group? Studies clearly show that the incidence of diabetes can be reduced with weight loss and exer- cise. Real easy, is it not? Do we have any hope as a nation? Are we destined to become pro- gressively more overweight and diabetic? Well we do not have much hope as long as we con- tinue to increase the portions we eat, eat what we eat (Do you realize that a double hamburger, big fries and a milkshake top 1000 calories?) and continue to decrease and undervalue physical activities. This applies especially to children. Diabetes continues to be the leading cause of blindness, kidney failure, limb loss and a major cause of heart disease. The younger you become a diabetic, the more time you will have to develop the complications of the disease. So get off your duff, change your diet and take your kids to play ball!, Jorge J. Gonzalez MD FA.C.E Professor of Medicine UNC ~ ' ~ If you do not have a doctor, you can call.the New Hanover Community Health Center -' (910) 343-0270. 81 no tiene un medico, puede llamar a New Hanover Community Health Center - (910) 343-0270. ~ ~ Diabetes Today is a special publication of the New Hanover County Diabetes Today Coalition which provides the editorial content. The Diabetes Today Coalition was formed in 1999 to advocate for dia- betes care and prevention in New Hanover County. The Coalition is supported by the North Carolina Diabetes Prevention and Control Unit, on the web at wwwnediabetesol'l! .' . ( , ~_'------~-...o___ \ "- /' ./ I ., .~ f , j ( ( I --l I I J I I 1 1 l .I \ I, I ,,.-..,, Diabetes Tk",y, May 2002 \ Regardless ofthe type , MoIiito~ of medication or IBloodGIl1.<<Ii~ ~n:~~:r ~~~y u::~i~:~ _ will be testing your blood glucose levels. Traditional testing involves using a smali, sharp needle called a lancet to prick your finger. A small drop of blood is placed on ~trip and inserted into a meter that will read and display your sugar level. Depending on the severity of your condition. your doctor will have you test your blood glucose from one to six times a day. Blood glucose testing is usually done before meals and at bedtime. If you are testing once daily, you should vary your times of testing. Instead of just testing in the morning before breakfast, randomly test before other meals to give an idea of how your sugar levels are throughout the day Your blood sugar range will vary throughout the day. The chart below will give you an idea of where blood glucose levels should be. Time of Test Ideal 80 - 120 mg/ dI Acceptable 80 -140 mgldl .100 - 160 mgldl Before Meals . Before Bedliroe Snack 100 - 140 mg/dI .Source: American Diabetes Association. 1997 Fasting blood sugar more than 180 mg/dl is too high and blood sugar less than 70 mg/dl is too low. You should notifY your doctor if you experience these extremes on a regular basis, and he/she can suggest some changes in your diabetes care plan to get you back to acceptable ranges, such as adjust- ing your insulin injections or medications. Blood glucose meters are available at your .local pharmacy. They vary in their features, readability, ease of use, portabil- ity, and price. Your pharmacist can help you decide which meter will work best for you. Most have a memory feature that allows you to keep a record of your testing easily. This should also be taken with you when you see your doctor so he/she can see how your levels have been. Keeping good records helps your doctor make 'adjustrftents in your daily routine. Generally, Medicare and most insurc:mce companies cover meters and strips. It is wise to find a local pharmacy or med- ical supply company that will file the claims for you. They can help you with your testing and any changes you may need. Get into a routine, keep good records, and work with your local health professionals to make sure you stay on top of your condition, and you will be able to enjoy life to the fullest! by Edwin Link, pharmacist llJ1 Wilmington Health Associates 1202 Medical Center Drive Wilmington, NC 28401 Our Board Certified Endocrinologists Are Here To Help S. Bryson Ley, M.D. OeOe Waring, M.D. 341-3375 - ( ~..... "--' :) Page2 When Y oq've Been Diagnosed With Diabetes. The first step to successful blood glucose control begins with diet and exercise. If your blood glUCOSe is not controlled with diet and exercise, your doctor will likely suggest a medication. Depending on the type of diabetes you have, the medicine will be Insulin, oral medication or a combination of these. There are several types of oral medications available. Some are taken once or twice a day, others before meals and some are taken with one specific meal. Some have specific side effects which your doc- tor will go over with you. Pay attention; if any ofthese side effects should occur, let your doctor know immediately so the prop- er adjustment in your medical therapy can be made. If you are started on Insulin, you will be taught how to prepare an insulin syringe and give yourselfinjections. You will be asked to monitor your blood sugar. You do this with a simple home test machine called a glucometer. This involves pricking your finger and placing a drop ofbloodihto the machine. A number will appear on the screen; this is a reading of your blood sugar level. Your doctor will explain how to interpret this number and what is an ideal blood sugar reading for you. You will be told when and how often to check your blood sugar, and you will be asked to keep a record of these numbers.to bring to your next doctor's visit. (See Monitoring I,llood Glucose). You will be asked to modifY your lifestyle. If you smoke or drink alcohol excessively you will be asked to stop. You will need to exercise. The best way to start is a simple walk for five to ten minutes until you can walk 30 - 45 minutes without slrain, pain or shortness of breath. Your diet will need to change to reduce your fat and sugar intake. Dietary counseling with a dieti- tian will be recommended to assist you. Your diet will most likely need to stress whole grains; protein; vegetables, fruits, and fibers. To watch for complications, it will be required that you have an ai1nual eye exam by an ophthalmologist, a foot exam by a podi- atrist and visits with your primary provider two to four times a year to monitor and provide further education for your needs about diabetes. You may be asked to see other specialists. depending on your progress. Blood work will be checked routinely to mon- itor how well you are doing with diabetes and to watch for other associated problems such as high cholesterol or kidney disease. This combination of diet, exercise and risk reduction will optimize your health, improve your overall well-being, and minimize future complications of diabetes. There are many life changes you will have to make, but you ~ take control of your diabetes. William L. Joyner, M D. Medical Director New Hanover Community Health Center Wilmington Health Access for Teens . "While most people ask what should they eat, the real question should be how much they should eat. Whether trying to control blood sugars or lose weight, focusing on portions can be a simple aJid inexpensive way to reach your goals. In these days of All You Can Eat buffets and Super Size meals, we have lost the knowledge of how much is too much." - Pam DiBiase, RD,LDN,CDE Pam DiBiase is a registered dietitian and a certified dia- betes educator Know your HbAle Taken from Making a Difference in Diabetes The hemoglobin Ale test measures the average amount of sugar in your blood over the last 3 months. It's a simple lab test done by your health care provider - and it's the best test to find out if your blood sugar is under control. People with diabetes should have the HbA1c test at least twice a year. If your blood sugar stays too high or if your treatment changes, you should be tested every 3 months until your blood sugar level improves. The hemoglobin A I c goal for people with diabetes is less than 7 percent. The findings of a major diabetes study, the Diabetes Control and Complications Trial (DCCT) showed that people with diabetes who keep their hemoglobin A I C levels close to 7 percent have a much better chance of delaying or preventing diabetes problems that effect the eyes, kidneys and nerves than people with hemoglobin A I C levels 8 percent or higher. You can do a lot to bring down high blood sugar and get it under control. Start by asking your health care provider for a hemoglobin Ale test. If your test result is too high, talk to your health care provider about how to lower it. To get your blood sugar under control, follow the meal plan recommended by your health are provider, stick to a physical activity pro- gram, take prescribed medications, and consult your health care provider often. SUMMIT PODIATRY Glaser root & Ankle Clinic 1717 Shipyard Blvd. 791-1300 Committed to a Healthy Community For advertising information on upcom- ing issues of our Health & Medicine Guides, Diabetes Today tabs and other health publications... Call Medical Marketing CoordiTUltor, I Cae Emerson, 343-2289 If you're "Iabetle, your feet need specl!!1 attentlon.j . INFECTION. Foar ULCERS' NEUROPATHY . VASCULAR DISEASE' BONE PROBLEMS Call for a consultation today! .J """ , ...-'-..- (' Diabetes Today, May 2002 o Your Child Has Diabetes You knew something was wrong. Your 7- year-old son had been losing weight, acting cranky, drinking gal- lons of water and tak- ing bathroom breaks every 45 minutes. A trip to the pediatrician determined thaI' your child has Type I Diabetes. How could this be? No one in your family has ever had it. Your son is not overweight. He doesn'i eat a lot of sweets. And children don't get diabetes, do they? Children are diag- nosed with diabetes every day. As.a parent ofa child with dia- betes, you may feel isolated and confused about where to go for help. Please know that you are not alone. There are more than I million families in the US coping with a child with Type I diabetes, also known as juvenile or insulin dependent dia- betes. Many of these families live in our community, and are more than willing to help you with this adjustment. There is no need to "reinvent the wheel" with situations such as birth- day parties, Halloween, babysitters and daily roul'ines. These experienced families can make these modifications to your child's lifesty[e easier. You can find mentor families, some of whom may have a child ~e same age as yours - someone your child can talk to. WHAT CAN YOU DO? JOIN A SUPPORT GROUP The Wilmington affiliate of the Juvenile Diabetes Research Foundation meets monthly al' the offices of Wilmington Health Associates. The meetings often feature speakers and are open to people with diabetes and their family members. Meeting dates vary, but are always advertised in the newspaper and on television. EDUCATE YOURSELF The Juvenile Diabetes Research Foundation has a comprehensive collection of educational and supportive materials called the "Bag of Hope" Parents of chil- dren with diabetes have put this kit together for parents of children with diabetes. An excellent website for diabetes infor- mation is wwwchildrenwithdiabetes com. FIND A DOCTOR THAT MAKES YOU COMFORT- ABLE. You will likely want a pediatrician or family practi- tioner with experience caring for people with Type I diabetes. You will probably want 1'0 consult an endocrinologist. REMEMBER THAT YOUR CHILD IS A CHILD FIRST. Children with diabetes can participate in the sam~ activities as their peers. However, they must always be pre- pared.l'o treal' their fluctuating blood sugars with insulin or food. ,Never punish your child for high blood sugar numbers, and don't refer to blood sugar readings as good or bad. Refer to them as high or low. TAKE TIME FOR YOURSELF AND OTHER MEM- BERS OF YOUR FAMILY It's nol' unusual for siblings of I'he newly diagnosed family member to feel resentment because the child with diabetes is receiving a lot more atten- tion. Jean Denne, Diabetes Clinical Nurse Specialist ~ J Page3' FOR MORE INFORMATION American Diabetes Association Web site: www.diabetes.orl! 1-800-DIABETES American Association of Diabetes Educators Web site: www.aadenet.orl! 1-800-TEAM-UP-4 Juvenile Diabetes Research Foundation International Web site: www.idrf.org 1-800-533-CURE National Diabetes Education Program'" Web site: www.ndep.nih.l!ov National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Information Clearinghouse web site: www.niddk.nih.l!ov 1-800-860-8747 For questions about your diabetes, call VitaLine at 815-5188, or toll free 1-888-lrI5-5188 Facts about Diabetes About 16 million people in the United States have diabetes. Type 2 diabetes accounts for 95% of all diabetes cases. ---. Type 2 affects 8 percent of the US population age 20 and older. The prevalence of type 2 diabetes has tripled in the-last 30 years. Joseph C. Konen, MD, MSPH Chair, North Carolina Diabetes Advisory Council ,OV"u""""" Take Care of Your Feet Takenfrom the National Diabetes Education Program "V"u""""" l I I To avoid serious foot problems that can lead to a toe, foot or [~ amputation, you need to take care of your feet. Foot care is very important for each person with diabetes. Nerve damage can cause you to lose feeling in your feet. You may not feel a plobble inside your sock that is causing a sore. You may not feel a blister that is caused by poorly fitting shoes. Foot injuries such as these can cause ulcers which may lead to amputation. Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems. Follow these guidelines: Keep the b~ tlowing to your feet. Puty,. feet;tJ! ~ ~:!iitting, ~1Ule~' toes1i\r 5 m_s 2 or3 timesa day. Move your ankles 'IlP llI\d down and in and out to improve flood flllW~ your fe!It and~. Don:tc!'llSS ~Qur leIiSlor long periods of time. DOn't wear tight socks, elastic or rs.around; our I . Check your feet every day. . Wash your feet every day - and dry them well. . Keep the skin soft and smooth. . Smooth corns and caI[uses gently. . Trim your toenails each week or when' needed. . Weai shoes and socks at all times. . Protect your feet from hot and cold. 1. For more information, talk with your podiatrist or contact American Podiatric Medical Association www.aoma.org 1-800-FOOTCARE ,. Obesi tYis a major influence of Dia be t e s We'll file your insurance and work with your physician to put you in comfortable shoes to protect your feet! Vascular Disease from Diabetes may cause premature hardening of the arteries. IT you experience: . poor circulation . pain in calves while walking . wounds that will not heal We now offer weight reduction through surgery for severely obese patients . diabetic guidance. behavioral counseling Insulin Pumps & Supplies 392-5553/800-593-5556 Ask for Sam MEDMAlLONLlNE.COM .~~v~~~~~.~~~~ 763-6332 PlluJ. c. Whitesides. Michael S. McGarrity, M.D. M.D. M.D. j . Certified Diabetic Education/Diet Counseling . Insulin &. Non Insulin Dependent Diabetes' Insulin l\nnps . Thyroid Disease including Thyroid Nodule Biopsy . Osteoporosis Evaluations including Bone Density Testing - ,-~ ( . ') 0. ~ /"') ~ 1 ( \ I 1 -- -~ t ) \ i I \ ! I , . \ I I ! , , I I -\ I r I \ I I 1 ( I ) I i i I I I I :> .. 330/0 of those with Diabetes don't know it. -~ c_ c , 0 . , Who's at risk for Diabetes? Your risk for biabetesgoes up as you 8~t older, if you are overweight, or if you are not active. Risk factors for diabetes include: ~ Having high blood pressure (at or above 130/85) ~ Having a family history of Diabetes ~ Having Diabetes during pregnancy _," or having a baby weighing more than nine pounds at birth. , , " Don't wait for signs. Most people ~ith diabetes do not notice any symptoms. However, if you have any of these symptoms, contact your health care provider right away. ~ Being very thirsty ~Urinating often I ~ Losing weight without trying I I I I i' I) "-" I' What can you do? You can do things now ~o lower your risk for diabetes: ~ Keep your weight in control ~Stay active most days of the week ~ Eat low fat meals that are high in fruits, vegetables and whole grain foods. If you have Diabetes... be sure that: ~ Your doctor checks your feet and eyes every visit. ~ You have your 3-month blood test (HbAlc) ? ? ~ Your eyes are checked by .. a specialist once a year ~ Your doctor checks your cholesterol and kidney functions ~ You keep your blood glucose levels.asclose to normal as you can. Are ou one oftheni Diabetic Foot CaRe , Trust rour foot care to someone who cares. - Problems associated with diabetes are serious, and life threatening. Please call today for an assessment of rour condition. , ~~ll~y I ,D./oM. 251-9880 5 Medkalc:em..llr. 1011....'-877-84s.7558 Diabetic - --'- ~etinopathy BoenI c.tiffed In Q,il1fI.Jl...Juv) Igor W-. 'liD . ErIk van R_, MD 1801 Nftt HanoYw,Medleal PmX Or. . WlImlngI:on, Ne 1703 Ccu1lry autI Ad. SuI'le 104 . JacksorIIIIlIe. He 4OQOHlghwayfE:' SuIte 240 . L..ftlIeRlver, NC j www.retfcarollna.com ~. :;: .. ~~I I, \ Insulin PumP Therapy For f 'I Better Diabetes Control For Information Call 1.800.999.9859 When Wounds Won't I k;ll THE ~d L___~ WOUND CARE -.>0 , (' r \ \) -I I \ 'I I 11 J :(, I' -... :1 I I I I ')