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WC CWF Health District Board Minutes - 02/27/2009fj;A WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES February 27, 2009 Wichita Falls - Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas MEMBERS PRESENT: Richard Sutton, M.D, Chair Kathy Sultemeier, D.V.M., Secretary Lauren Jansen, R.N.C. Robin Moreno, M.T. David Carlston, Ph.D. Tracy Hill, D.D.S. MEMBERS ABSENCE EXCUSED: Bryan Press, Vice -Chair Lou Franklin Amy Cone Not Present Matt Benoit Ray Gonzalez Dorothy Roberts -Burns Board Members I Director of Health Assistant Director of Health Health Authority Assistant City Manager County Commissioner Council Liaison 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 JANUARY 2009 MEETING MINUTES & EXCUSED ABSENCES Dr. Sutton called for the review and approval of minutes from the last meeting held on January 23, 2009. Ms. Jansen introduced a motion to approve the minutes as presented and Dr. Sultemeier seconded the motion. Motion passed unanimously. The excused absence of Bryan Press was noted. III. NURSING SERVICES — COMMUNICABLE DISEASE Infectious Disease Kerry Kea, Infectious Disease Supervisor, presented a brief overview of the following programs she oversees: Tuberculosis (TB), Protocol Base Counseling (PBC), Early Intervention Program (EIP), and the Sexually Transmitted Diseases (STD) program. A walk -in clinic is provided for STD testing and treatment for gonorrhea, Chlamydia, syphilis, and HIV The TB program takes referrals from physician's offices and educational programs that require TB skin testing prior to admission to their program. Treatment and education are offered to the TB cases, suspects or LTI (Latent Tuberculosis Infection) persons. LTI is exposure to the TB germ but it is not present at the time as an active infection in your system; treatment is offered in a 6 to 9 month course that builds a wall around the germ, so later, if your immune system weakens, you will not become infected with an active case of TB. Protocol Base Counseling has two outreach workers that go out into the community and offer confidential HIV testing and counseling which includes risk reduction steps to prevent contracting HIV. After the counseling session, a confidential HIV test is done. Later on, they return to review the contacts success in following the risk reduction steps then they are given their HIV test results. When an HIV positive person is identified, we offer counseling and connect them to our EIP services or make referrals according to their needs. A Disease Intervention Specialist from Dallas is contacted to perform a partner investigation to identify the individual's partners so they can be notified of a potential exposure and advise them to seek HIV testing. All of these services are done confidentially. The Early Intervention Program (EIP) offers case management, referrals, housing, transportation, food, dental, and medical services to clients who are HIV positive. Dr. McBroom and Dr. Padakandla are the two Infectious Disease Doctors that conduct clinics on Monday afternoons along with a resident from the Family Health Center. Clients are scheduled at least twice a year for a routine clinic visit, but can be seen for any medical needs as a walk -in or schedule an appointment. Dr. Sultemeier inquired as to how many new cases of HIV and TB were identified in Wichita Falls within the last year. Ms. Franklin answered that currently this year there were 4 new HIV cases identified through the HIV testing and counseling program. EIP's enrollment stays around 120 to 130 clients, and currently they are at 125 clients. Ms. Kea also responded that only 4 or 5 TB cases were identified in addition to the suspect cases that came back being non - tuberculosis. Dr. Sutton asked if any of the cases had been antibiotic resistant tuberculosis and Ms. Kea replied not yet, but there was one individual that was close being very slow to respond to treatment. Ms. Franklin stated 2 to 3 years ago they actually had one that had to be sent to the San Antonio TB hospital. Clients are hospitalized there for treatment when they have difficulty, either non - compliant or the TB is too difficult to treat here. Non - compliant clients are those not taking the medicine, not staying home, not doing the things we ask. of them to protect the public, so we would get a court order and they would be hospitalized for the duration of the treatment. Dr. Sutton asked Ms. Franklin if they had done a court order and she replied they had sent out a letter and told the client they would get one, but the client decided it was better to comply instead of being sent away for the course of their treatment. Ms. Kea said usually after 60 days if it appears someone is not responding appropriately to the medicine, a call is made to our regional office to consult a TB expert on the next course of action. New Services Teressa Stephenson, Preventative Health Services Supervisor, announced that of December 2008, the Health District is the distributing Rabies Depot for our region. United Regional no longer provided the service, so it was important to the Health District to take responsibility in the distribution of the vaccine for any exposures in our area. If there is an exposure in an outlining county the physician may contact us or one of the DSHS Regional Rabies Depots in close proximity to them. The Depots are located in Abilene, Arlington, and McKinney. i-: We receive a written order by a physician on what to distribute, generally it is the vaccine and (HRIG) human rabies immune globulin, with that order we can distribute it to the patient. The patient then will take the vaccine and HRIG back to their physician to administer. The Health District does not administer the vaccine; it only distributes the vaccine and the physician treats the patient. Dr. Mattar with the Family Health Center agreed to evaluate those patients who do not have a physician and determine if the post exposure vaccine is necessary. Dr. Sultemeier asked if the Health District had any of the pre- exposure while Dr. Sutton asked if there is any exposure vaccine. Ms. Stephenson replied that a shortage was caused by decreased production in one of the Sanofi Pasteur distribution plants being remodeled so we have no pre- exposure, only exposure. Ms. Franklin added that over the last year, it has gotten better because if you had an exposure to a rabid animal, it did not mean you would get the vaccine. It was weighted on the amount of contact whether they felt it was a true exposure because the vaccine amount was so limited. It was not generally the Rabies Depot that gave out the full course of treatment needed, it would be all of their HRIG as well as their entire amount of rabies vaccine they needed to get through the series of shots and since there was a shortage, they would get 2 -3 doses to start with then the physician had to work with the state to obtain the remainder of the vaccine. There was such a shortage they did not want that much vaccine sitting out there when it might be needed somewhere else. Ms. Stephenson advised at the end of December, the Health District dealt with their first exposure in which they did not have vaccine but had a HRIG on hand. To stock the vaccine was not allowed it had to be ordered as the cases occurred. They now have provided some stock with expectations of the shortage to resolve at the end of 2009. IV. FERAL CAT ORDINANCE UPDATE The feral cat ordinance was taken to council two weeks ago by Ms. Franklin just as a discussion item to go over what was proposed in the ordinance and the Board's recommendation. It will be on the Agenda for council's vote at the next Council meeting Tuesday, April 3. V. NEXT MEETING DATE April 24, 2009. VI. ADJOURN Dr. Sutton requested a motion to adjourn. The motion was made by Dr. Sultemeier and seconded by Ms. Jansen. The motion carried and the meeting was adjourned at 1:02 p.m. RECEIVED IN CITY CLERK'S OFFICE DateWL l I s ByQj ' Time Richard Sutton, M.D., Chair, Bryan Press, Vice Chair, or Kathy Sultemeier, D.V.M., Secretary Public Health Board 3