GRAND FORKS BOARD OF HEALTH MINUTES Thursday, October 11, 2007 I. Call Meeting to Order The Grand Forks Board of Health meeting was called to order at 4:05 p.m. on Thursday, October 11, 2007, in the Health Department conference room. Judy DeMers called the meeting to order. Members present: Judy DeMers (Chairperson), Arvin Kvasager, Don Shields, and Dr. O’Connell. Mike McNamara was present by conference call. Others present: Debbie Swanson, with two nursing students (Rhianna Ghents and Katie Hatt), Wally Helland, and Keith Westerfield. Also present was Mr. Tu-Uyen Tran with the Grand Forks Herald, and citizen Ray Dohman. II. Approval of Minutes of Regular Meeting July 12, 2007 A motion was made by Arvin K. and seconded by Don S. to approve the minutes as submitted. All approved and the motion passed. III. Old Business A. Northern Valley Dental Health Coalition update – Debbie S. gave an update the progress of the public dental clinic, and showed photos of the renovation process. The dental clinic should be open in early November. A question was asked about unmet needs. Debbie said that she would have to refer that question to Sharon Ericson, but she believes they still need window treatments, office furniture, and money. The clinic has received donated furniture for the waiting room, and artwork for the walls, but some things won’t be completed until after the opening. Most of the funding is going towards the actual supplies, and salaries of the staff. The dentist, Dr. Grant Korsmo, originally from Northwood, is currently working at the Fargo Family Health Care Center until the clinic is complete. Other staff has been hired, including a hygienist, dental assistant and receptionist. Judy Demers thanked Debbie on behalf of the Board of Health, for all the work she has put into the dental project, playing a huge part in getting it off the ground, and the community is going to be very appreciative, particularly the underserved people. IV. New Business A. Reappointment of City Council Member and Health Officers (see attached letters) – Letters were received, reappointing the following individuals by Mayor Brown: Mike McNamara as City Council representative on the Board of Health; Dr. James Brousseau, and Dr. Eric Lunn as Grand Forks Deputy Public Health Officers, and Dr. James Hargreaves as the Grand Forks Public Health Officer. (no vote required—information purposes only). B. Northwood Tornado Public Health Update – Don S. gave an overview of Public Health’s response to Northwood (see attached Issue Listing). At approximately 8:50 p.m. on August 26, 2007, a category F-4 tornado tore apart the community of Northwood, North Dakota. This tornado caused great damage, injuring 18 people, and killing one person. Many streets were impassable because of debris and power lines brought down by the storm. Grand Forks Public Health nursing, environmental health, administrative, and emergency preparedness staff were involved with coordination and providing resources for emergency rescue, evacuation, and shelter. We then assisted with tetanus immunizations, restoration of services, food and water contamination, personal safety, injury surveillance, mosquito control, clean up, debris removal, assessing of safe structures, and more recently, the rebuilding process. The Grand Forks Public Health Department spent approximately $10,000 supporting Northwood during the first month after the storm. The North Dakota Regional State Epidemiologist increased disease surveillance at the Northwood Community Health Center (hospital, clinic, and nursing home). The surveillance report for the period August 27, 2007 – September 7, 2007 revealed no increase in use of the Northwood Emergency Department, no significant increase of gastrointestinal or respiratory illness, and no symptoms indicative of carbon monoxide poisoning during this period. There were however anecdotal reports from residents that included increases in minor cuts and debris in the eye (i.e. sawdust, plaster, sheetrock) from the ongoing community cleanup efforts. An informal discussion with community residents found many of them stating they had minor health issues. However, they were too busy cleaning to go to the local community health center, and chose to treat many of these conditions themselves. The citizens of Northwood were overwhelmed with the generosity, caring, and commitment of the many volunteers, agencies, and people that helped them in this time of great need. Mr. Kvasager asked if there were items that could be done differently. Don and Debbie discussed the need to temporarily reassign staff that are paid with state and federal grants to respond to an emergency. Currently the North Dakota Department of Health prohibits using staff in an emergency response situation paid by the categorical programs. Grand Forks, like many public health departments, have about one half of the staff members that are funded by state and federal grants programs. A good example involves the emergency readiness preparedness grant. Currently this grant pays for an emergency response planner, an environmental health specialist, and a public information officer. All of these individuals responded and were paid by the grant for their efforts. A key component of this grant is the County Supplement portion that funds staff training and exercises to increase proficiency. What better staff training than an actual emergency event? Does it not make intuitive sense to use these funds to pay the salary of other department staff to respond during an emergency? Debbie further commented that this is an important issue that greatly impacts our ability to respond to infectious disease such as how would we handle a influenza pandemic if we can’t respond to emergencies outside of local funding? The State Health Department positions are 70% federally funded, so in the event (for example) that you’d have a 40% reduction of your workforce, you might not have people in the right programs and the right funding to respond. Don mentioned that North Dakota Public Health has a representative (Lisa Clute from Minot) on an interim legislative committee group and she will be raising this issue at the next meeting. In short, it is our belief that funding silos should not be a deterrent to a seamless and effective response during an emergency. C. ND Department of Health Immunization “Provider Choice” System – Debbie provided an overview with slides of the immunization program and changes that will take place on January 1, 2008. (See Immunization Funding attachment). The Vaccines for Children (VFC) program will remain in place. Grand Forks Public Health Department was recently deputized by Valley Community Centers to give vaccines to under-insured children, who are VFC eligible, on their behalf. The federal section 317 funding was not intended to be used to purchase vaccines for privately insured children, so in the future this will be used for special projects only. The rising cost to vaccinate a child ($45 in 1985 compared to $1137 in 2006) also contributes to the problem. Now children who have health insurance will be billed for the cost of vaccines. Families with high deductibles may have the greatest financial impact. This new system creates many complex reimbursement issues that Grand Forks Public Health is not accustomed to dealing with such as billing health plans, checking insurance coverage, and billing patient deductibles. We currently do not have a contract with Blue Cross/Blue Shield yet, implementation is scheduled for January 1, 2008. Mr. Dohman asked if there any mercury in the vaccines. Debbie responded that most mercury that was present in vaccines as a preservative has been removed. Mr. Dohman also asked if the increase in children with autism is attributed to vaccines. Debbie explained that the increase may due to better diagnosing of autism than 10 years ago. She also pointed out that there is a significant decrease in childhood disease due to vaccinations. D. Smoke-Free Ordinance Update – Debbie provided information to the Board of Health on the status of the Minnesota smoke-free law, that just went into effect recently, that is stronger than our ND law. It doesn’t exempt bars, hospitals, or truck stops, like the ND law does. (See attached Issue Listing.) The Grand Forks Tobacco Free Coalition is working to establish smoke-free laws that protect all workers. They are requesting discussion and support from the Board of Health for strengthening the existing City smoke-free ordinance. Knowing that eyes are on Fargo as they debate this issue, and with the implementation of a smoke-free law across the river, the Tobacco Coalition felt it was important for some discussion begin with our city council members about whether or not they would support it. Debbie provided handouts from NACHO and NALBOH on Joint Policy Action Steps (see attachment) that outlines what a local Board of Health responsibility is, respective to tobacco use prevention and control. Mr. Dohman gave comments and suggestions regarding tobacco and drug use and stated he was opposed to strengthening the tobacco law. Mr. McNamara asked if the Health Department or Tobacco Coalition has received any complaints from employees of any bars or truck stops about second-hand smoke. Don Shields stated he was not aware of any complaints on file. Debbie Swanson stated the coalition has received requests to strengthen the city ordinance, especially since the Minnesota law was implemented. Judy Demers stated that it would be helpful for the coalition to provide more information on the specifics of strengthening the city ordinance and that the topic could be brought to another meeting. Discussion followed by board of health members. No action was taken on this item. V. Next Regularly Scheduled Meeting – 4:15 p.m., Thursday, January 10, 2008 VI. Other 1. Mosquito Control Facility – Wally H. gave an update that the Mosquito Control Facility (along with the Fire and Police departments) construction is progressing nicely. They hope to have it enclosed before winter, and have it completed by May-June timeframe. The facility will have the ability to test mosquitoes for West Nile Virus (WNV), as opposed to sending the tests out to the state and waiting couple of weeks for results to see if there is a pool of WNV-carrying mosquitoes in the area. We will be able to test and have results in a 24-hour turnaround. North Dakota had 343 cases of West Nile Virus (WNV) this year, but only 3 in Grand Forks county. The ND average is 1 case per 1,800 people, but Grand Forks county had only 1 case per 21,000 people (even Fargo’s average was 1 in 3,000)! That says a lot for the mosquito control program that Todd Hanson is running, that has reduced the risk from WNV in Grand Forks this summer. We now have the equipment to currently test for WNV on a trial basis. The state is no longer doing the testing for it, so Grand Forks will be the only place in the state that will be doing that. This is important, because if first detected in a mosquito, you can be proactive before it shows up in a human case. That is valuable because our Mosquito Control can start the larvaciting and adultciding in areas where we know there are mosquitoes that can carry the WNV. Judy D. asked if we will be able to test then for other regions of the state? Wally didn’t think so, but it could possibly happen in a serious situation. VII. Adjournment – A motion was made by Arvin K. and seconded by Don S. to adjourn the meeting. The meeting adjourned at 5:20 p.m. Respectfully submitted, James Hargreaves, MD, Secretary by: Keith Westerfield Office Specialist, Senior Public Health Department Attachments: - Mayor’s Letters of Reappointment - Issue Listing, October 11, 2007 - Immunization Funding Handout - Joint Policy Action Steps