Loading...
WC CWF Health District Board Minutes - 01/10/2020WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES January 10, 2020 Wichita Falls -Wichita County Public Health District 1700 Third Street — Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: David Carlston, Ph.D., Chair Keith Williamson, M.D., Vice -Chair Julie Gibson, D.V.M., Secretary Tonya Egloff, D.D.S. Lauren Jansen, Ph.D., R.N. Melissa Plowman Citizen At -Large -County Physician -City Veterinarian -City Dentist -County Registered Nurse -City Restaurant Association -City Paris Ward, M.A., B.S. Citizen At -Large -City BOARD MEMBERS EXCUSEDIUNEXCUSED ABSENCE: None OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Arthur J. Szczerba. M.D. Michael Smith Woodrow W. Gossom, Jr. Mark Beauchamp Director of Health Assistant Director of Health Health Authority City Council Liaison County Judge County Commissioner I. CALL TO ORDER David Carlston called the meeting to order at 12:01 pm after a quorum of members was attained. II. MEMBER RE -APPOINTMENTS Re -appointments of Tonya Egloff, DDS to the County appointed practicing Dentist and Melissa Plowman to the City appointed Restaurant Association was commenced by Janice Flores, State of Texas Notary Public. III. ELECTION OF OFFICERS Lauren Jansen introduced a motion for David Carlston to continue as Chair and Keith Williamson seconded the motion. The motion passed unanimously. Lauren Jansen introduced a motion to appoint Keith Williamson as Vice -Chair and Melissa Plowman seconded the motion. The motion passed unanimously. Tonya Egloff introduced a motion to appoint Julie Gibson as Secretary and Lauren Jansen seconded the motion The motion passed unanimously. IV. APPROVAL OF MINUTES AND ABSENCES David Carlston called for the review and approval of minutes from the November 8, 2019 meeting. Keith Williamson introduced a motion to approve the minutes as presented and Lauren Jansen seconded the motion. The motion passed unanimously. It was noted all Board members present. V. NACCHO AWARD Amy Fagan announced that the National Association of County and City Health Officials (NACCHO) the Public Health organizational umbrella for the Nation occasionally release grants for application. The Health District was 1 of 2 in the Nation to receive the Disability Inclusion for the Mobilizing for Action through Planning and Partnership (MAPP) process. Along with the University of Illinois in Urbana -Champagne for the next 3 months receive $10,000 to hire a contractor who is a Subject Matter Expert in Disability and Disability Inclusion for physical or intellectual disabilities. The Health Department goal beyond the MAPP process is to ensure populations across all boards are reached and served, especially those with mental or physical disabilities. As example, a staff member does Community Strengths Assessment Surveys at various events and talks to about 1,000 people in a year. The survey asks how healthy do you think you are and the community. Survey analysis aids in the development of the departments type of work. So in question, had the communities with disabilities been reached to get their input. Nationwide 1 in 4 people in any given community suffer from some type of disability. Local agencies as the Arc, Beacon Lighthouse for the Blind and others had been contacted by the Health Department to host two community forums to ask for input to incorporate that information into the Strategic Plan process. In the plans is another Local Public Health Performance Assessment Initiative to bring together about 50 leaders from different aspects in the community to move health forward as a community. The planning process will include the Subject Matter Expert to assure agencies that serve those with disabilities are included. The leaders vote on how well as a community the 10 Essential Public Health Services have been accomplished, as to doing well or does not meet the measure, then talk about improvement in those areas. It is a National process adapted locally to use the next 5 or 10 years based on the Strategic Plan. If the report is done well when submitted to NACCHO it will be used as a best practice for other Health Departments across the Nation. The last 10 years the Health Department has been on the path of strategic planning framework. The recognition from NACCHO on the Health Departments process helped inform or influence other Health Departments across the Nation. Councilor Smith asked had there been any contact with the private and public school system on this. Amy Fagan responded it is on the list to engage with the School Districts. The Healthy Eating Active Living sub- committee of the Health Coalition did bring in those agencies. Midwestern State University (MSU) has a Disability Inclusion Specialist that serves many students with required and needed services. What the Special Coordinators of the School Districts do to help those students coordinate and get what they need out of education whether at the University or Elementary level is amazing. A Health Board member will be asked to attend the Local Public Health Assessment Initiative to relay feedback to the other Board members. Councilor Smith stated he looks forward to serve on the Health Board committee, that it is certainly needed and looked up to as support for the citizens. The Animal Ordinance Revision was a lot of work he thanked all for the work that had to be done over and over again. VI. EVALI UPDATE Jisue Lee the Health District Epidemiologist stated the E-cigarette or Vaping product use -Associated Lung Injury (EVALI) case definition that the Centers for Disease Control (CDC) established September 18, 2019 has not changed. The case definition is a history of vaping or dabbing within the 90 days of hospitalization, have some type of pulmonary infiltrates, and rule out other infectious diseases that could cause the pulmonary illness. Recently CDC has announced that Vitamin E acetate is closely associated with EVALI but this is not conclusive there may be more than one cause. As of December 3, 2019 the CDC no longer accepts non -hospitalized EVALI reports. CDC removed previously reported non -hospitalized cases from their case count that could reflect a slight decrease of cases. Texas still accepts reports of non -hospitalized cases. Another update is the ICD-10 coding guidelines listed on the CDC website. CDC has identified EVALI patients with chronic medical conditions at risk for re -hospitalization and death, so to prevent re -hospitalization provide discharge guidelines. As of January 7, 2020 in the United States there have been 2,602 hospitalized EVALI cases reported from all 50 states, D.C., Puerto Rico and Virgin Islands. Out of the reported cases there have been 57 deaths from 27 states and D.C.; median age 51 (range 15-75). Demographics of the reported cases; 67% male, 78% under 35 years, median age 24 (range 13-77). A discrepancy in the median age of the deaths and demographics could be explained by the date analyzed due to the December 3, 2019 removal of all non -hospitalized cases. An 80% of patients reported the use of THC products. Overall in the United States and Texas the most commonly used brand is Dank Vapes. Number of EVALI patients hospitalized as of March 31, 2019 to January 4, 2020 shows the outbreak began summer of 2019. peaked in September 2019 then declined. Texas and Illinois have the highest number of EVALI cases reported to CDC with no explanation of reason. In Texas as of January 6„ 2020 reported 298 cases; 120 confirmed, 116 probable, 4 deaths (61 not a case, 1 under investigation). Demographics of confirmed and probably cases; 69.29% male, median age of reported cases 22 years (range 13-75). A 90% of reported cases used THC products. Wichita County is in Region 213 that accounts for almost 50% of the reported EVALI cases with 58 confirmed, 69 probable, and 3 deaths. Councilor Smith asked what are the large cities in Region 2/3. Lou Kreidler said Region 2/3 goes as far South as the Dallas/Fort Worth Metroplex area, West as Abilene, and East as Grayson County, a large area with the majority of cases seen in the Metroplex area. Wichita County reported 6 cases; 4 probable, 2 not cases. Demographics of all are male aged 18, 34, 49. Recently had a 41h 2 EVALI related death in Wichita Falls with previous deaths in Dallas, Galveston, and North Texas. CDC sent notification on the local death, a press release is to go out Monday to inform the community and present prevention factors. Lauren Jansen asked is any ethnicity related, has it become a trend to vape instead of smoke. Lou Kreidler replied higher in white than any other ethnicity. It has become a trend to go from traditional cigarettes to vaping devices. A noticeable number of school age children that vape is on the increase while cigarette use declined, vaping is seen as safer. Dr. Sczcerba stated vaping is actually worse than tobacco use because of the different substances, oil based, filler, any substance using solvent to be hydrophobic causes more pronounced lung injury. The selling point of E- cigarettes are shown to be healthier. THC generates questions with the States different laws, source of origin, how manufactured, etc. Dr. Gibson questioned if there is a common brand, what about the lot number or specific matter. Lou Kreidler said on a State conference call she asked the Director of Dallas County due to their large number of cases if a commonality was found, or had the Regional, State Health Department discovered a commonality, a distribution point. No one had anything but continues to investigate. Jisue Lee stated an interesting point is other countries vape and use electronic cigarettes. None of the other countries have reported as many cases of EVALI than the United States. United States is the only country to see an outbreak and highly unregulated. Dr Sczcerba it is a new thing with people experimenting, adding substances, no one knows unless the people reveal what happened. Everyone saw patients that had smoked over the years with effects. Europe went through the designer narcotics, as the United States, when dealers looked to manufacture new substances under the radar on the black market. Physicians had no antidote to treat the overload of patients since there was no clue what the patients had in their system. It is a big puzzle, to see the toxicity in patients but do not know to what, no one wants to tell that missing part. Councilor Smith hates to think a lesson was not learned from dealing with the tobacco companies for years and years, which was a conspiracy. History of what the tobacco companies did to sell and distribute was insane. Dr. Williamson stated they stood up and lied one by one to Congress in 1996 and said it is not additive. What is crazy is the implication that vaping is healthier than smoking, to imply that it is healthy but it is not healthy at all. Jisue Lee distributed print outs on the Discharge Guideline that Doctors should use to insure the outpatient follow- up with the right Specialist optimally within 48 hours. The other was an Algorithm made to help Doctors navigate patient care. Amy Fagan said all the most recent available information is accessible on the Health District website with links to the CDC and DSHS. Counselor Smith asked what is the first symptom in the EVALI situation. Jisue Lee answered she did not know if it had been narrowed down to one symptom. Dr. Sczcerba replied usually the chest X-ray that shows an acute lung injury that looks like diffuse pneumonia which happens with smoke inhalation. Dr. Williamson stated part of the confusion about the initial presentation of EVALI is the symptoms are fever, cough, nausea, vomiting, and diarrhea, that makes it look like so many things. A fever is not expected with a chemical toxicity it is an intensive inflammatory reaction. Councilor Smith asked what do we do about it. Lou Kreidler said it is an issue everyone wants to see what happens at the National level but expectation is it will be a push on the Local level during the next Legislative session for stricter legislation on e-cigarettes. It was forward thinking for the community to include vaping devices and e-cigarettes in the Smoking Ordinance. The Health District has an active education campaign working with the WFISD for a commercial contest. The 3 Communities in School program teens are to put together different videos, developed by local teens focused toward teens, the winning commercial is to broadcast on television. Amy Fagan suggested anyone that uses tobacco can come to the Health Department Tobacco Cessation classes that includes vaping and all the different types. A curriculum is taught in the schools to help kids stop and never start the use of tobacco. VII. ANIMAL ORDINANCE UPDATE Lou Kreidler stated as the Animal Ordinance was presented to the Board and Council, the requirement for all animals reclaimed would have to be microchipped it was discovered through the implementation process it had not been put into the reclaim section, so it could not be required. In speaking with City Manager Darron Leiker it was agreed to offer a free microchip but if not chosen there would be no reduction in impound fees. Fort Worth passed an ordinance that a microchip is a lifetime City License but must update any changes. Maybe an option in the future but only after assessment of the Fort Worth implementation and community response. On a positive note 5 citizens scheduled appointments to owner surrender their animal, 3 chose to keep their animal based on resources Animal Services provided. That was the intent for owner surrender appointments the process was a success. Three animals did not enter the shelter, are back home due to the ability to help the owners keep their animal. Dr. Gibson sees it all the time animals are microchipped but never registered. People are just not educated on what they need to do an animal may pass 3 owners to still be under the first owner. These are problems, could educational information be posted on the Live Well website. Lou Kreidler said Animal Services register the animal before the animal ever leaves the shelter. It is a problem the shelter gets in animals with a microchip with no or outdated information due to not being kept updated. Amy Fagan can request a rescue group that meets quarterly to provide education to individuals that adopt from the group A Pet category was added on the Live Well website so more about that education can be added. Judge Gossom asked if there is a maintenance charge from the microchip company. Lou Kreidler said some charge to change information the shelter uses one that does not. Dr. Gibson's Vet Clinic uses Home Again the only charge is for an added service to locate your animal about $14 a year. Call them it is circulated 50 miles out to every Vet, Human Society, Animal Shelter the animal is lost and faxes a picture. Once the animal is in the system it is in the system from then on. Vill. NEXT MEETING DATE Friday March 13, 2020 was noted as the next meeting date. IX. ADJOURN Dr. David Carlston adjourned the meeting at 12:50 pm. Signature Print Name David Carlson, PhD, Chair Keith Williamson, MD, Vice -Chair, Julie Gibson, OVM, Secretary Wichita Falls -Wichita County Public Health Board City -County Board 4