Grand Forks Public Health Department

Board of Health Minutes
October 6, 2011
Page 6


Thursday, October 6, 2011

I. Call Meeting to Order

The Grand Forks Board of Health meeting was called to order at 4:20 p.m. on Thursday,
October 6, 2011, at the Public Health Department Conference Room. Members that were present:
Cynthia Pic, Dana Sande, Judy DeMers, and Dr. James Hargreaves. Others present: Timothy
Haak, Debbie Swanson, Todd Hanson, Theresa Knox, Kailee Dvorak, Aly Barclay, and Keith Westerfield, all from Grand Forks Public Health Department (GFPHD). Also in attendance were: Dr. Sally Pyle, Director of University of North Dakota (UND) Honors Program; and Heather Lepp and Sarah Bell, both UND Nursing students.

II. Approval of Minutes of Regular Meeting, July 14, 2011

A motion was made and seconded to approve the July 2011 minutes as submitted. All approved and the motion passed.

III. Old Business

A. Minot Flood Support Update: Timothy H. gave a final update on support given during the
Minot Flood (see Issue Listings attachment).

· Jim Schothorst retired from the department in December 2010, but has been working part- time for GFPHD Environmental Health. He has spent a fair amount of time helping out in Minot. Since he had a lot of experience with the Grand Forks Flood of 1997, Minot’s Public Health Department (MPHD) considered him an excellent help to them. He was especially helpful when residents were first able to get into the houses after the floodwaters receded. Jim spent 130 hours in Minot doing flood evaluations.

· Allen Anderson, GFPHD Nutritionist, also spent a week in Minot. Allen used to work for the State Health Department as a restaurant inspector. He helped Minot’s Environmental Health branch catch-up on their backlog of food service inspections.

· The Emergency Preparedness Coordinator at GFPHD, Delbert Streitz, helped find materials and information that was needed. He obtained Center for Disease Control (CDC) forms for flooded home assessments and mitigation of those homes.

· Cynthia P. thanked all the Public Health staff that helped out with Minot’s flooding. She asked about Minot’s housing situation since many of Minot’s homes were destroyed or damaged. FEMA brought in a large number of trailers to hopefully meet the housing needs. FEMA is developing sites as fast as they can, but they are fighting the clock with the weather.

· Debbie S. noted that the Nursing division had limited time in Minot, but provided some resources to Minot’s health unit. The MPHD had 17 staff members impacted by the flood, with 11 members still without permanent housing. The GFPHD provided some supplies and cash assistance to the staff at MPHD. Also, public health departments from around the state contributed gift cards to help those in need.

· On September 24, 2011, Debbie S. and Theresa K., along with two other public health nurses; Linda Opstad and Nancy Compton, went to Minot to cover a large community flu clinic for the MPHD. Their staff was able to stay home and work on their flooded houses. About 250 flu shots were given. The flu clinic also gave an opportunity for the GFPHD Nursing staff to hear
stories about the flooding from residents that were reminiscent of experiences from the Grand Forks flood. The residents of Minot were greatly appreciative of the GFPHD assistance.

B. Grand Forks Alliance for Healthcare Access Update: Debbie S. had some exciting news to
share on healthcare access (see Issue Listings attachment).

· The Alliance for Healthcare Access requested that the City of Grand Forks apply for a Community Health Center Planning Grant, which they did. An $80,000 grant was recently received for a one-year grant that will allow the city to hire a project coordinator to begin planning a community health center. This is the first direct federal grant that GFPHD has ever had. Debbie S. thanked the City for the support to apply for the grant.

· One of the things the Alliance accomplished recently was evaluating agencies in the community to find out their interest in operating a community health center. The Alliance will be doing a lot of work in the next year; community engagement, looking at space and locations, plus much more.

· Community health centers are required by law to offer primary care, behavioral health, and dental care. They can operate by contracting private providers or offering it themselves. Valley Community Health Centers in Larimore and Northwood, ND, operate their dental component in Grand Forks, ND, and contract their behavioral health.

C. Environmental Health Data Management System: Timothy H. briefed on their new data
system (see Issue Listing attachment).

· The data is still being collected to input into the Data Management System. It was realized that the data needed was not all in one location. The information had to be retrieved from different sources, and it has taken longer to coordinate that. The data should be sent in a couple of weeks to the managing company to input the information into the new system, and get it up and running.

· The GFPHD Environmental Health branch only does inspections of city food facilities, with the exception of Grand Forks County Schools. The ND State Health Department covers inspections of food facilities in rural areas.

D. Grand Forks City Food Code Update: Timothy H. talked about the updated City Food Code
(see Issue Listing attachment).

· Timothy thanked the City Council for approving the new City Food Code, based on the 2008 State Code. It was approved by the City Council on September 19, 2011.

· Timothy also wanted to thank the Board of Health members for their support of the code change. Now the work actually begins, by getting at least one manager from each restaurant in the city to attend a certification course.

· Hopefully, the updated food code will also improve the quality of food in Grand Forks.

· Environmental Health has been monitoring the situation of contaminated cantaloupes that has been in the news recently. The only store that thought to have received these cantaloupes was Wal-Mart, but the Grand Forks Wal-Mart produce manager said they did not receive any of cantaloupes from the infected area.

E. CHAMP Software Update: Debbie S. briefed on the update (see Issue Listing attachment).

· The GFPHD has signed a contract with a vendor, who will provide electronic health records for many of the programs, account billing, and patient registration.

· Since the vendor has a number of contracts with other public health departments in the state, implementation of the program will not start until after January 1, 2012. Public Health has an implementation team set up, and will be meeting with the project director assigned to our department.

F. Immunization System Changes: Debbie S. informed the board about the changes regarding
immunizations (see Issue Listing attachment).

· During the 2011 Legislative Session, there was an immunization bill that was originally intended to bring Universal vaccinations to all children in ND through age 18. The state would provide funding for all children to receive those vaccines at no cost, other than an administrative fee, regardless of their insurance status.

· The bill changed significantly during the session. It was changed so that universal vaccines would only be given at local health departments, and federal funding would be used to provide this.

· After visiting other health departments and our health officers, it was decided to not go with the Universal Vaccination Program. It has not changed anything the GFPHD is currently doing. There is still the Vaccines For Children program (VFC), for children who are uninsured, on ND Medicaid, or American Indian. Any children with Blue Cross/Blue Shield insurance, private vaccine is available for them. Children with other insurance plans that consider GFPHD as ‘Out of Network’ will be referred to wherever their network covers immunizations.

· One of the main concerns with the bill change was that this would cause patients to leave their medical homes to come to public health to get vaccinated. Federal funds that were designed for vaccines for children without insurance, will be taken and used for kids with insurance. It is not known if the Center for Disease Control (CDC) will allow this to continue, so there is a possibility that this will be reversed in a year or two.

· Funding that was available to public health for programs for adults that do not have insurance was eliminated. For example, the program for adults who are uninsured to receive free pneumococcal vaccines was completely wiped out, so that vaccine for children with insurance could be provided, but only at local health departments.

· Three large health departments opted out: Fargo, Grand Forks, and Williston; and also three smaller county local health units: Dickey, Cavalier, and Nelson-Griggs. There are other places people can get vaccines, and there are programs in place to help people without insurance. So far it has been working well. Debbie S. developed talking points on their decision not to participate in the Universal Vaccination Program (see attachment).

IV. New Business

A. Thank You to Judy DeMers (see Issue Listing attachment): Cynthia P. presented Judy D.
with a plaque, in appreciation of her 11 years of service on the Grand Forks Board of Health. Judy started on Thursday, April 13, 2000, as a new board member. The board appreciates all that she has done for the community, and the state of ND.

· Judy thanked the board and staff at Public Health for all they do for the community. She felt that the department is one of the most underappreciated services that is provided to all the citizens of the community. Judy said, “Look at all that Public Health does to ensure their safety and health.” Judy was glad she was part of that effort and could contribute to it.

· Dr. Hargreaves commented that Judy’s knowledge of politics and how government works will be hard to replicate.

B. Welcome New Public Health Nurses: Debbie S. reviewed the Nursing changes (see Issue
Listing Attachment).

· Korrine Olson started this summer as a nurse at the Correctional Facility, and also works at GFPHD. Nancy Compton started with the Home Visit program. Sarah Chelliah is a seasonal staff member. Terry Drees was a new LPN at the Correctional Facility, but has since resigned. This week, Public Health hired Grace Hornbaker, an LPN that will fill a newly created position at the Correctional Facility.

C. Board of Health Appointments: Don S. was not able to brief on these appointments, but it
was noted that Dr. Eric Lunn and Dr. Brousseau were not Board of Health members, but were reappointed as Grand Forks Deputy Public Health Officers by the mayor.

· Dr. James Hargreaves was reappointed as the Grand Forks Public Health Officer, along with the reappointment of Dana Sande to the Board of Health (see Issue Listings attachment, and Mayor’s Appointment Letter attachments) .

D. Tobacco Use and Secondhand Smoke Exposure Assessment/Ask, Advise, Refer (AAR)
Implementation in Public Health Programs: Kailee D., Public Health Nurse and Tobacco Prevention Coordinator at GFPHD, talked about the assessment, and the AAR implementation in Public Health (see Issue Listings attachment), and handed out a new metric chart (see attachment).

· The AAR policy was adopted in 2009, and fully implemented in client-based programs in 2011. GFPHD nurses asked their clients about tobacco use and secondhand smoke exposure, advised them to quit, and referred them to the ND Tobacco QuitLine or QuitNet. Implementation of such policies is cost effective, promotes quitting, and helps prevent youth initiation of tobacco use.

· The first chart audit was conducted on client-based programs implemented prior to January 1, 2011. The audit showed that 84.17% of clients were asked about tobacco use, and 64.29% were asked about secondhand smoke exposure. The chart audit will be used as a quality improvement measure, and data collected will be used as a baseline for future reporting periods.

· Since the passing of the Smoke-Free ordinance last August, no bars have closed due to the new ordinance.

E. Refugee Preventive Health Services Grant: Debbie S. briefed the board on the grant received
to provide preventive health services for refugees (see Issue Listings attachment):

· Lutheran Social Services (LSS) is the official agency in ND that resettles refugees. Public Health works with LSS and other health care organizations in the community to provide health services to new refugees.

· In the past, GFPHD received $18-20,000 yearly in funding for refugee services. Unfortunately, this funding has now been reduced because the state received a reduction. This year, Public Health is able to receive $14,000 from this grant, and $20,000 in new funding for a total of $34,000. The new funding will help with the initial screening of refugees; TB testing, TB medication, immunizations, and referring them to health care providers.

· Grand Forks resettles between 90-100 refugees yearly, primarily from Bhutan, Iraq, and African countries. Fargo resettles about 400, and Bismarck does about 20 refugees every year.

· This is a great opportunity to get new funding to support the work that Public Health has been doing for a number of years, but has only been funded in the last three years.

· Refugees are eligible for ND Medicaid for eight months, but the children normally are eligible longer due to family income, or insurance not available.

F. Flu Shot Update: Debbie S. gave an update on flu shots this year (see Issue Listings

· The GFPHD did a flu clinic for Grand Forks City and County employees, with about 250 shots given. The county flu clinics were just finished, with about 120 people throughout Grand Forks County attending five county clinics to get immunized.

· GFPHD will begin doing flu shots in the office beginning Monday, October 10, 2011, on a walk-in basis. There has not been a tremendous rush. Many places in the community are advertising for flu shots. Since the vaccine is readily available, Public Health is able to focus its efforts more on those at risk, those not likely to get vaccinated, and people who have difficulty getting to places to get vaccinated.

G. Mosquito Control 2011Season Update: Todd H. briefed on this year’s program (see Issue
Listings attachment), and provided handouts (see attachments):

· The season started pretty wet, but Grand Forks was fortunate with the cold June temperatures that we had. The number of mosquitos did not get out of control all year long.

· There were no West Nile Virus (WNV) cases in Grand Forks County, with only four WNV cases in ND, and 402 human cases of WNV nationwide.

· The United States Air Force Aerial Spray Squadron from Youngstown, Ohio was in the Grand Forks area twice this year. Mosquito Control declined aerial spraying though because the risk of WNV was not elevated.

· There were only nine city-wide sprayings in 2011, compared to 18 last year.

· Mosquito Control revised their spray policy, lowering the nuisance trigger number from 100 to 75 mosquitos.

· The budget for Mosquito Control will end in the black this year.

· Spring flooding seemed to help with controlling mosquitos. Newly hatched larva drowned in the cold, flowing water. The three years that had heavy flooding; 1997, 2009, and 2011, Mosquito Control did not have to do the first city-wide spraying until July.

V. Next Regular Scheduled Meetings – 4:15 p.m., Thursdays, January 12, April 12, July 12, and October 11, 2012, at the Public Health Conference Room.

VI. Other:

· Judy D. – Introduced Dr. Sally Pyle, Director of the UND Honors Program. Dr. Pyle has a Ph.D. in Experimental Pathology and Toxicology. She has expressed interest in becoming a citizen on the Board of Health.

- Dr. Pyle announced that the Honors Program is celebrating its 50th Anniversary this year by hosting a Great Conversations event on Wednesday, October 26, 2011, at 7:00 p.m. at the Chester Fritz Auditorium with Dr. James Orbinski. Dr. Orbinski accepted the Nobel Peace Prize in 1999, on behalf of Doctors Without Borders.

· Debbie S. – Introduced two UND Public Health nursing students attending the meeting; Heather Lepp and Sarah Bell.

VII. Adjournment – The meeting was adjourned at 5:10 p.m.

1. Issue Listings
2. Mayor’s Appointment Letters, dated August 8, 2011
3. Tobacco Prevention and Control Metric Chart
4. Signed Resolution In Support of Comprehensive Tobacco-Free School Policies, dated July 14, 2011
5. Mosquito Control Activity Report and West Nile Virus handout
6. Talking Points on Universal Vaccines
7. Great Conversations – UND Honor’s Program 50th Anniversary Event flyer

Respectfully submitted,

James Hargreaves, MD, Secretary
by: Keith Westerfield
Office Specialist, Senior
Public Health Department