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WC CWF Health District Board Minutes - 08/28/2009WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES August 28, 2009 Wichita Falls - Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas MEMBERS PRESENT: Board Members Richard Sutton, M.D., Chair Kathy Sultemeier, D.V.M., Secretary Lauren Jansen, R.N.C. David Carlston, Ph.D. MEMBERS ABSENCE EXCUSED: Robin Moreno, M.T. Tracy Hill, D.D.S. MEMBERS ABSENCE UNEXCUSED: Bryan Press, Vice -Chair Lou Franklin Amy Cone Ahmed Mattar, M.D. Not Present Not Present Not Present I Uj uj u:. :r ca w_ ii ,I E 011 i o Director of Health Assistant Director of Health Health Authority Assistant City Manager Council Liaison County Commissioner I. CALL TO ORDER & INTRODUCTIONS Chair Dr. Sutton called the Board of Health meeting to order at 12:15 pm after a quorum of members was obtained. II. APPROVAL OF APRIL 2009 MEETING MINUTES AND ABSENCES Dr. Sutton called for the review and approval of minutes from the last meeting held on April 24, 2009. Dr. Sultemeier introduced a motion to approve the minutes as presented and Dr. Carlston seconded the motion. Motion passed unanimously. At this time it was noted the excused absence of Dr. Tracy Hill and Robin Moreno and the unexcused absence of Bryan Press. III. HEALTH AUTHORITY APPOINTMENT Ms. Franklin asked the Board for the re- appointment of Dr. Mattar as the Local Health Authority and Dr. Minter as the Associate Health Authority, stating the Family Health Center being in contract with the Health District and has provided the Medical Director and Health Authority since the late 1970's. She commented that during the Spring H1N1 outbreak Dr. Mattar was an invaluable asset and did a wonderful job. He was responsive and willing to do whatever was needed no matter the time of day or night. Dr. Sutton asked for a motion to re- appoint Dr. Mattar as the Local Health Authority. Ms. Jansen introduced the motion to approve and Dr. Sultemeier seconded the motion. Dr. Sutton then asked for a motion to re- appoint Dr. Minter as the Associate Health Authority. Dr. Carlston introduced the motion to approve and Dr. Sultemeier seconded the motion. Both motions passed unanimously. IV. WIC FOOD PACKAGE UPDATE Ms. Franklin introduced the Women, Infants and Children (WIC) Director, Janna Kaelin, and Nutritionists, Polly Tonemah and Rosalyn Berry. Ms. Kaelin stated Ms.Tonemah, a Registered Dietician, and Ms. Berry, a degreed Nutritionist, provide nutrition education classes and individual nutrition counseling. Ms. Kaelin explained WIC is a federally funded Nutrition Program designed to meet the special nutritional needs of low income women who are pregnant, breastfeeding, non- breastfeeding, post partum, infants, and children up to age 5. Households at or below 185% of the federal poverty income level that meet the income guidelines based on household size are eligible for the free services. WIC counts all members of the household related or unrelated, as well as an unborn baby. Applicants with Medicaid who receive Food Stamps automatically qualify. The Texas WIC Nutrition Program food packages will undergo major changes in October 2009. There will be the addition of new allowable foods as well as changes in some of the current food items. The modifications align the WIC food packages with the Dietary Guidelines for Americans and current infant feeding practice guidelines of the American Academy of Pediatrics. WIC eligible foods do vary from state to state. Federal regulations specify the minimum nutritional requirements for the WIC foods but the WIC state agencies are responsible and decide which brands and types of allowable products they wish to include on their state WIC food lists. WIC serves over one million clients monthly; the local WIC staff serves approximately 5,000 clients monthly within Wichita and Clay counties. The participants will attend a class to explain the changes in food packages, how to use the additional foods, and be given a DVD for review. A food package with specific items they qualify for will be loaded onto an electronic card to be used at participating vendors to purchase only nutritious foods. Different food packages are issued to different clients based upon their nutritional needs. Ms. Tonemah summarized the food changes; To increase fiber intake the addition of fresh and frozen fruits and vegetables, whole grain bread, brown rice, corn and whole wheat tortillas. Elimination of juice for infants to 12 months and reduction of the amount for children 12 months and over due to contributing factors to obesity and dental care. The amount of milk, eggs, and cheese will be decreased to reduce saturated fat and cholesterol. Once again, 2 %, 1% or skim milk for women, children age 2 and over with whole milk for children 12 to 23 months. Pregnant women with milk intolerance will have an option to receive either soy milk or tofu; with a child's milk intolerance, a doctor's prescription is required. A pregnant woman has the choice to receive tofu instead of milk and cheese. Introduction of baby cereal now begins at 6 months along with the addition of fresh fruits and vegetables. Ms. Tonemah stated a lot of education is being provided to promote and support the healthy benefits of breastfeeding. The exclusively breastfeeding women and breastfed infants will receive increased amounts of food, fruits, and vegetables, those mostly breastfeeding will not receive as much, and those 2 not breastfeeding will only receive formula since WIC has to fund the formula. WIC provides breast pumps and breastfeeding support as needed. Breast pumps are for loan along with ones they can keep if they continue to breastfeed, as well as bags and nursing bras. V. H1N1 UPDATE Kerry Kea was introduced as the new Director of Nursing by Ms. Franklin. Prior to her promotion, Ms. Kea was the Infectious Disease Supervisor and actively involved in the H1N1 outbreak in the spring. Ms. Kea stated H1 N1 never vanished, it continued through the summer which is not typical, making for an unusual flu season. They have seen continuous reports from providers that call every week to state they have had positive flu. The newest recommendation from the state does not require isolation of the particular H1N1 virus because it is not going to change treatment. The individuals they would submit specimens for are those hospitalized with severe respiratory illness for longer than 48 hours, or those who have atypical presentation in age 6 months to 24 years olds. For those with the atypical presentation who died with influenza -like illness, which is your cough, fever, and sore throat, those are the only ones that the state is wanting submission on because they are continuing to study the severity of the disease and any changes. The H1N1 vaccine is hoped to be available sometime mid - October. The initial round is to be provided to the five target population groups: pregnant women, people who provide care for children 6 months and under because of that group not going to be eligible for the vaccine, children 6 months to 24 years old, healthcare workers, then 25 to 64 year old with chronic medical conditions. A second dose is to be given 3 to 4 weeks after the first dose. After the target groups are vaccinated, it will go to the age groups of 25 to 64 years then 65 years and older. Normally during the seasonal flu, those 65 years and older are at a high risk, but with H1 N1 the median age of those affected was 14 years of age. Dr. Mattar commented that with the older population there believed to be some cross protection from all the flu shots they have received over the years. Dr. Sutton asked for specifics on vaccine composition and testing and Ms. Franklin answered that no production information has been received and the vaccine is still being tested. Dr. Sutton inquired about the length of time for confirmatory H1 N1 testing. Ms. Kea replied that it is not taking long at this time; in the beginning, it was taking longer due to having to go to the Centers of Disease Control (CDC) for testing. States are now certified to test as well as some of the different Laboratory Response Networks within the state and some private providers like Quest. Typically, the results are taking 48 hours. The state is providing the vaccine and the necessary supplies to vaccinate at no charge. Providers are able to charge an administration fee and officials are still working with Medicaid, Medicare, and Insurance companies to figure out the administration fee. Providers can place an order for the vaccine on the website www.texasflu.org. Local health departments will monitor the orders to assure they appear appropriate, not ordering an abundance to vaccinate the whole population. Any providers that provide the seasonal flu vaccine may place an order on the website and provide it. Dr. Sultemeier asked if so many have the vaccine how do you enforce that only the target population is being vaccinated. Ms. Franklin responded that the state is struggling with this question due to limited control. If the Health District is going to strictly follow those guidelines and focus on the high risk population, then there will be the routine providers in the community that may give it to anyone. The CDC's ultimate goal is to vaccinate every individual in the United States against H1N1. Ms. Franklin reiterated that answers are limited at this point and things can change rapidly. Ms. Kea said one way we may be able to track that providers are giving it to the appropriate population is every dose will be required to be put into IMMTRAC, the statewide vaccine registry. They could add a question as to what target population the person is in. 3 Ms. Franklin stated when providers place their orders for vaccine, the Health District receives an e-mail of the orders to monitor since we are the hub for the Vaccines for Children's Program. She thinks they will have us do something similar to what we currently do. The state has made a lot of decisions for local health departments without the input of local health departments. Ms. Kea said the other primary recommendation is for individuals to stay home when ill and to seek doctor's recommendations via the phone prior to going to the office or hospital to limit exposure to others. New guidelines were released for businesses to be prepared and review absenteeism plans. The proven cases in Wichita County ended up being a total of 8; SAFB reported about 19. Early estimates for the season are that millions of people in Texas alone to be infected with flu, either seasonal or H1N1. Last year, 36,000 died from the regular flu and in Texas 3,000 died with over 220,000 hospitalized. Ms. Cone added if the council approves additional funds made available from the state, the preparedness program will again run a campaign regarding pandemic influenza and measures individuals can take to be prepared. VI. NEW ANIMAL RECLAIM CENTER UPDATE Ms. Franklin presented the draft initial plans for the new Animal Reclaim Center. Within the next few weeks, the deal should be finalized to purchase 6 acres of land located at the corner of Henry Grace Freeway and Hatton Road across from ABB. Thirty years of records were reviewed to determine the average occupancy and the amount of land purchased will allow for expansion as needed. The cat display will have elevated shelves and a litter box on the bottom; it will be fully visible with windows from the outside into the cat room. A glass door will be between the receptionist and dispatcher so if one needs to be away, they will be able to see and cover. The facility will house Animal Control, including offices for the officers, supervisor and shelter manager. A training room is included in the plans, which would be utilized for training for volunteers, the public or animal control staff. There will be two get to know area rooms, a cat play room, an enclosed covered outside yard area to give the animals exercise and outside time. Dogs and cats will have separate quarantine areas; there will also be a cat isolation room. All will have different ventilation systems to prevent air exchange and disease transmission. Dogs are currently screened for microchips. With the revision to the ordinance this spring, cats are allowed to be microchipped as opposed to a wearing a rabies tag; this will probably be looked into for dogs as well once moved into the new facility. The goal is to have scanners on each of the units because our goal is to give these animals a home first without have to put them on a truck and bring them to the facility. If the animal is a repeat offender, then it will be brought in. The animal control officers work with home owners to understand and comply with the law. Dr. Sutton asked if the animals picked up for identification are strays or adoptable. Ms. Franklin replied there will be some of both, but it is planned not to do a large number of adoptions. The plan is to leave options open and to do some limited adoptions, work with rescue groups and the Humane Society. The way the kennels are set up, there will be a window to the outside so that all the service area is done from the back and the public will have no actual contact with any of the animals, part of that being to control the prevention of disease from one animal to the other. The public will be able to see through the windows and any notices posted on the front that would indicate where the animal was located and whether it is adoptable. It was asked by Dr. Sutton if the Humane Society plans to remain at their present location and Ms. Franklin replied she does not know their future plans, but believes they will remain at their present location. They have asked about having a building on site to be able to do adoptions, so we are looking 4 at leasing them one acre of land of our six strictly for an adoption facility. A memorandum of agreement would have to be initiated allowing them to view and choose animals to take for adoption. Ms. Franklin clarified that the Humane Society takes in stray animals brought to them, whereas Animal Control picks up animals and that a lot of public education will be needed to define these two roles. Dr. Sultemeier asked about the surgery/euthanasia room on the plans. Ms. Franklin replied they had enough forethought to set up space to eventually spay and neuter and euthanize. If adoptions are done then there will be space to have animals spayed and neutered. Once we have the facility a Drug Enforcement Agency license can be obtained. Dr. Sultemeier commented that we need humane slaughter and humane euthanasia, but having a 'no kill' shelter is difficult since our population has over bred our animals. VII. NEXT MEETING DATE October 23, 2009 VI11. ADJOURN Dr. Sutton requested a motion to adjourn. The motion was made by Dr. Sultemeier and seconded by Dr. Carlston. The motion carried and the meeting was adjourned at 1:15 p.m. Richard Sutton, M.D., Chair, Bryan Press, Vice Chair, or Kathy Sultemeier, D.V.M., Secretary Public Health Board 5