Grand Forks Public Health Department


Thursday, January 17, 2013

I. Call Meeting to Order

The meeting was called to order at 12:11 p.m. by Javin Bedard.

Members present at the meeting: Dave Molmen, Dr. James Hargreaves, Donna Bernhardt, Gretchen Graf, Jon Green, Mary Amundson, Terry Hanson, Lee Lipp, Tara Dupper, Col. Jane Denton, and Ed Christ. Other individuals attending the meeting were: Javin Bedard, Keith Westerfield and presenter Mara Jiran, all from Grand Forks Public Health Department (GFPHD); Molly Soeley and Katie Johnke, both from NDSU Extension Service; Lacey Bartosh, Altru Intern; and Lt. Col. Marie Colasanti, Grand Forks AFB.

II. Old Business

A. Review and Approval of Minutes of meeting on October 18, 2012: The October meeting minutes were motioned and approved with no changes.

B. Grand Forks “Detox” Community Facility Initiative Update: Kate Kenna was unavailable to give an update, but it was commented that a detox center was still needed.

III. New Business

A. Presentation – “Alliance for Healthcare Access (AHA) Update”: Mara Jiran gave an update on the AHA.

· There have been a number of advances with the Community Health Center (CHC) since the last time Mara was here. The AHA consists of over 20 agencies throughout Grand Forks County and Polk County, and they are trying to establish a CHC in the city. The AHA was expecting to receive guidance since August 2012 on applying for new funding for a CHC in order to make it sustainable. The guidance was finally announced last night.

· As of today, there will be 25 new CHC sites that funding will be available for, through Health Resources Services Association (HRSA). It will be a very competitive process. There are a lot of ifs, with the biggest one being if Grand Forks gets funded. If Grand Forks does not make this round of funding, a CHC would not be able to financially operate. There will be hundreds of applicants from cities that are really big and have a high number of individuals in poverty. The alliance will do their best and are optimistic that they will be in the competitive round. The applications are due April 3, 2013, and then there will be a review process with the awards coming out in August 2013. If Grand Forks is awarded funding, the money would come the first of September 2013, and the AHA would have 120 days for the CHC to see its first patient. HRSA does the process this way so that the money awarded is not just sat on.

· An architect from Altru has been working with the Alliance, looking at the third floor of the old Deaconess Hospital building downtown, the same building that the Valley Community Health Center (VCHC) Dental Clinic is located in. The space for the CHC would be close to GFPHD, and also Valley Health Clinic and WIC that recently just moved into the same area downtown. The AHA has been working with the building manager who is willing to renovate the space if needed. Mara showed a current blueprint of the proposed CHC layout. The space would consist of ten exam rooms for five providers, made up of two physicians and three nurse practitioners. The CHC would utilize VCHC’s dental clinic reception area to establish ease of patient check-in along with the idea that your teeth are as important as your health. There will be a room for education and financial assistance, a basic laboratory, a procedure room, and possibly a section for pediatrics.

· The AHA has been working on a partnership with Altru for when a person has gone past the level of care the center can give. The Alliance was in Fargo, ND a few days ago with Altru’s financial team, to see how Altru’s relationship with Fargo’s CHC has built up over the 20 years it has been in operation. The Alliance was there looking at ‘lessons learned,’ and options for providing care for those that do not have insurance.

· Mara’s position as project coordinator was funded with a HRSA planning grant that ended in August 2012. The United Way funded the position for a time, with GFPHD extending it. Altru is currently funding the position until the end of February 2013.

· It has been an exciting day for the AHA, and they are excited to embark on applying for CHC funding, but remind everyone again that this will be very competitive.

· This grant from HRSA is on a scoring system. One section that HRSA concentrates on is the applicant’s need for assistance. For that need an applicant would get extra points for being really rural, or if the applicant is from a large metropolitan area, they would have a higher level of poverty. Grand Forks is at a bit of a disadvantage for being a mid-size city. Looking at the uninsured percentage rates, Grand Forks has a number of people who have insurance, but a high deductible plan that a CHC could help alleviate with its sliding-fee scale, so it becomes more income-appropriate. Those numbers however, do not come into consideration with HRSA’s process, so it will be a challenge to get past that point.

· One of the concerns with the new guidelines is that some of the guideline language has changed. The process used to just look at target population of people with low income, but now it is looking at more of the service area. We are not sure yet what how this will affect Grand Forks in the scoring system, as the guidance was released last night and the Alliance has not had the opportunity to fully review the guidance. The grant writer that the AHA had hired is currently working to get that information, and will get back to the alliance soon to give them a better picture.

· One of the Alliance's greatest attributes is the high level of community collaboration, which is necessary to have if a health center is to be successful. If there is not a really strong collaborative relationship in the community the health center will struggle. The AHA has wonderful partnerships and agreements that are already in place (Altru, NEHSC, etc.).

· Grand Forks also has different minority populations whose health indicators show they are struggling, especially the large American Indian population. The Alliance hopes to incorporate this rich culture into the health center model of care.

B. Grand Forks “Tuberculosis (TB) Outbreak” Update”: Javin B. gave an update.

· The North Dakota Department of Health (NDDoH), GFPHD, and Altru have been investigating an outbreak of tuberculosis in Grand Forks County. There have been a total of 15 confirmed cases reported in Grand Forks County since October 2012. Nine individuals have been hospitalized at various intervals for treatment and isolation. The contact investigation activity to determine the number of people who may have been exposed to TB has been extensive.

· Approximately 450 people have been tested, and those testing positive on a TB skin test were referred to a health care provider for evaluation and follow-up care.

· GFPHD have conducted TB testing in a couple of Grand Forks schools on students, and follow-up testing at the schools eight weeks later to make sure. There were not any transmissions of TB in the schools. What public health found was that the TB outbreak seemed to be linked to home-based transmission. It is not transmitted out in the public by touching common objects, sharing a toothbrush, kissing, etc. It takes prolonged exposure and close contact activities.

· In the course of testing, GFPHD came across more than 30 new cases of latent TB among the contacts of the individuals that have active TB. Persons with latent TB were treated with antibiotics to prevent the TB disease in the future. This is an important aspect of control for the disease. Persons with active TB receive a daily four-drug therapy that is observed by health nurses to treat the TB disease. In some cases, individuals must remain in isolation until they are no longer infectious.

· Personnel from the NDDoH, Division of Disease Control have provided resources to conduct epidemiological activities and numerous other support activities. The Center for Disease Control (CDC), Epi A-Team were here for three weeks helping out. The team reviewed the data and gave some pointers to move forward with the investigations. There were a lot of follow-up on named individuals who are contacts to people with the active TB disease, to ensure they were getting tested. Through continued investigation there will probably be more number of active TB cases. All active cases of TB have been genetically linked back to two cases that were successfully treated in 2010.

C. Member Update:

· Ed C. – Grand Forks County Social Services (GFCSS) are watching the state legislature. Governor Dalrymple included Medicaid expansion as part of his budget, as it relates to the Affordable Healthcare Act. This is being watched carefully because it could impact their social services work. Initial figures indicate GFCSS caseload would increase from 3,000 to 3,500, which is huge. According to how the state would decide to manage the increase, GFCSS could end up adding a lot more workers.

GFCSS is in the midst of a classification salary survey and study.

· Col. Jane D. – The 319th Medical Group is still ramping up for the Readiness Inspection in May 2013, with exercises regularly. They are also preparing for the Accreditation Association for Ambulatory Healthcare (AAAHC) in August 2013, which is basically the Joint Commission for outpatient facilities.

· Tara D. – New American Services (NAS) had a busy last quarter in 2012, with a 50 percent more new arrivals than anticipated in the last quarter. No new arrives for past six weeks though, so they are getting paperwork caught up. This year NAS will be matching up UND nursing students with families to interact and help mentor.

NAS will hold a two-day conference in Fargo, ND, on April 16 and 17, 2013. There will be national speakers presenting on immigration issues.

· Lee L. – As far as the mental health of the community; there is too much drugs, too much alcohol, and too much breakdown of family. We all need to work together to improve family structure.

· Terry H. – The Mayor appointed a Blue Ribbon Commission for Housing in August 2012, to come up with ideas the city could pursue to reduce overall cost of housing in Grand Forks. Their report came out January 9, 2013, and can be accessed at, under ‘Blue Ribbon Commission.’ One way the commission suggests to reduce housing costs is looking at reducing the amount of land dedicated to parkland in Grand Forks. Since the 1970s it has been eight percent, and the commission suggests reducing the amount to five or six percent.

· Mary A. – At UND’s Department of Family and Community Medicine conducts Healthcare Vacancy Studies quarterly. Mary is finalizing the current report, and it has the largest number of healthcare provider vacancies she has ever recorded since 1991. The vacancies are for all kinds of health care providers; specialists, primary care, RNs and CNAs, and it is frightening to see all these vacancies across our state.

The National Health Service Corps federal program came out with a new nurse corps program that is available for facilities that qualify. The facility has to be in a professional shortage area for the specialty that the nurse is practicing in, such as mental health or primary care.

· Jon G. – The Altru Foundation is pleased to have a good year with fundraising last year, that help out with family and patient needs.

· Molly S. – There is a group called ‘Take Action’ that works with different initiatives in the city; from tobacco-free parks to healthy restaurant choices, community gardens and ATMs at the Farmers Market. The group has recently been working with concession stands at Central and Red River High Schools, and the park district’s Purpur Arena. These concessions have made unbelievable changes. They have stopped using transfat to pop their popcorn, with no decrease in sales. Water is their best seller, and the concessions downsized the selection of candy bars from fifteen to five lower-calorie choices. The fat content in the tacos-in-a-bag is now lower since they switched to ground turkey meat, added beans, and use fewer chips. Red River High School added salads to their concession.

· Dave M. – Altru is in the process of being the sponsor agency for a community health assessment. What they hope to get from the assessment is very broad information on the health of the community. A steering committee has started the assessment; looking at what the level of safety, violence, nutrition, exercise, fire safety, etc., is in the community. Once the assessment report is completed later this year, it will not be the end to just know what the health of the community is. It will be a starting point and guide to zero-in on the community’s most important problems.

Another significant initiative for Altru is the encouragement of healthier life styles if we are going to have a healthier community. Grand Forks enjoy relatively good health as a community, but clouds are on the horizon. Things are changing about the health of the community as we grow and age. Obesity is a huge issue, along with heart disease, smoking, drinking, even seatbelt usage.

IV. Other: Dr. Hargreaves suggested a letter of recognition from the mayor should be accomplished to thank the people at Altru Health System, GFPHD, and the state health officer who helped out dealing with the TB outbreak. The Grand Forks community is so fortunate to have the right people doing such an incredible job dealing with a difficult and almost impossible task. Some patients have been very challenging. The CDC did not discover anything new when they arrived; only affirming what was already accomplished. There is a lot to be proud of, with professionalism at every step.

V. Adjournment – The meeting was adjourned at 1:12 p.m.

VI. Next Meeting: Thursday, April 18, 2013, at 12:00 noon,
Altru Hospital (Lower level, Multi-media room) Conference Room
(Lunch will be provided by Altru Health System).