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WC CWF Health District Board Minutes - 04/25/2003I WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD PLACE: Wichita Falls- Wichita County Public Health District TIME: 12.15 p.m. DATE: April 25, 2003 BOARD MEMBERS PRESENT: Kathy Sultemeier, D.V.M. Diane Stewart, R.N. Tom Delizio, M.D. Gregory Stockton Larry Rains, D.D.S. Beverly Stiles, Ph.D. BOARD MEMBERS ABSENT: Susan Strate, M.D. HEALTH DISTRICT Barbara J. Clements. Director of Health REPRESENTATIVES: Reuben A. Warren, Jr., Assistant Director of Health Arthur J. Szczerba, M.D., Medical Director WICHITA CO. REPRESENTATIVE: Joe Miller, County Commissioner WICHITA FALLS CITY COUNCIL: WICHITA FALLS CITY MANAGER'S OFFICE: MINUTES: I. Call to order Diane Stewart, Vice Chair, called the meeting to order at 12:15 p.m. II. Approval of Minutes: Moved by Dr. Stiles, seconded by Dr. Sultemeier and carried by voice vote that the February 28 and April 7, 2003 minutes be approved. III. Public Health Emergency Update Mrs. Clements introduced Amy Come, Public Health Emergency Response Coordinator and Michelle Wood, Public Health Specialist to present the program. We now have an agreement written for all cities within the county and sent to their Mayor for approval and signature to designate a Public Health Authority and to have an understanding for mutual aid in the event of a public health emergency. We are also formulating the agreement with the public schools to use their facilities. RECEIVED IN CITY CLERK'S OFFICE Date Time Page 1 of 5 Strategic National Stockpile (SNS) Formally known as the NPS (National Pharmaceutical Stockpile). If there is an incident that requires more medications /supplies than Wichita County can handle, CDC will deploy a 12 hour push package made up of everything from gauze to IV's. The plan is similar to the Smallpox vaccination plan. We would use the same 8 -10 distribution centers in Wichita County and logistics and security are basically the same. The differences begin with transportation. Large trucks will be required to transport the larger amounts of medical supplies. We do not have an airport large enough to offload supplies and the railway cannot be used for security reasons. Warehouses will be required with a minimum of 12,000 square feet for receiving, storage and staging. The State Board of Pharmacy has not resolved many of the legal issues concerning who has the legal right to dispense medications in an emergency. Many volunteers, mostly pharmacists and technicians, will be needed to dispense and inventory the meds. Once the inventory is turned over to the county, the local health department is responsible for tracking all supplies and returning unused supplies and/or medications to CDC. Memorandums of Understanding are agreements with private companies giving permission to use their buildings, staff, supplies, etc. in time of need. These will require being updated and renewed each year. It ranges from ice to pharmacy supplies and is important to be scheduled before an incident occurs. 2. Severe Acute Respiratory Syndrome (SARS) SARS is rapidly gaining importance in the general public. A Gallup Poll has been done showing 47% of the public wanting information on SARS. That is higher than the interest shown in Anthrax. On February 11, 2003, respiratory illness in Guangdong province, China reflected 305 cases and 5 deaths since November 16, 2002. February 26 thru March 12, 2003 the disease spreads to large number of health care workers in Hong Kong and Vietnam. On March 12, 2003 there was a global alert for SARS and the CDC offered assistance to the World Health Organization (WHO). There was a CDC presentation depicting the progression of the disease thru the Hotel M connection in Hong Kong. It was thought to be from raw sewage or fecal contamination. The reported U.S. cases of SARS will be classified as suspect or probable. To this point, there has not been a diagnosed case in the United States. For a respiratory illness to become suspect of SARS there must be: 1) respiratory illness of unknown etiology with onset since February 1, 2003, and; 2) measured temperature greater than 100.4° F (greater than 38° C) and: 3) one or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia) and: 4) travel within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS excludes areas with secondary cases limited to healthcare workers or direct household contacts) or: 5) close contact within 10 days of onset of symptoms with a person known to be a suspect SARS case. Standard precautions (e.g.,) hand hygiene) together with airborne (e.g., N -95 respiratory) and contact (e.g., gowns and gloves) precautions. The United States at the present time has 202 suspect cases and 27 probable cases. Texas has 7 suspect cases including 6 recovered and 1 recovering. Page 2 of 5 The Public Health Objectives include rapidly identifying and investigating any suspect cases and controlling potential secondary spread. It also includes providing education on disease transmission and prevention. We have had meetings with community members and receive regular messages sent via Health Alert Network. Dr. Delizio asked if we knew the method SARS is spread, if it is fecal /oral, respiratory or both? Ms. Cone answered that at the present time, it is thought to be person -to- person contact. It has also been thought to be all fecal contamination. Mrs. Clements stated that the thinking behind that resulted from Amoy Gardens where from one case there were 90 subsequent cases. The method of sewage disposal was such that it had backed up and re- entered the house. They tried to isolate coronavirus from samples there and found it. Dr. Miller stated he had no idea what person -to- person contamination meant. Dr. Delizio explained that person -to- person contact would result from fecal /oral contamination or respiratory droplets. Mrs. Clements stated that in the news broadcasts depicting healthcare workers; they are covered from top to bottom including hair, face shields, respirators, gowns and gloves. This is a new virus and people are afraid to say whether it is airborne or fecal /oral. A lot of symptoms resemble flu but travel still is the key to diagnosis. Some hospitals now have "STOP" signs outside their doors stating " If you have traveled to ........ and have flu like symptoms, put on this mask ". Dr. Gerberding from CDC said that the death rate as of now in Singapore is 8 -9% versus the lower end at 4 %. It seems in some areas the disease is more virulent than in others. Death has occurred in persons aged 25 -70 healthy, not immunocompromised. She also stated that a test for coronavirus antibodies would be done on suspected cases. 3. Smallpox Vaccination Phase I of the Smallpox vaccination program has been completed. We initially had a smaller turn out of volunteers than expected. We vaccinated 54 persons in Wichita Falls with no severe reactions reported. As of April 11, 2003 3,008 persons had been vaccinated in Texas and 32,644 in the United States with 61 reporting adverse events. More than half of those events resulted from inadvertent inoculations. At this point, we have no guidelines for who will be vaccinated in Phase II nor is there a timeline for this phase to begin. IV. Annual Program Report Ms. Clements requested permission to remove this item from the agenda. She explained that the report is completed with the exception of information from Personnel regarding one objective. The Division compares the racial /ethnic percentages of employees to the percentages in the jurisdiction. The objective is to have the workforce reflect the racial /ethnic makeup of the population served. It was suggested that the report be delayed until the June meeting. V. Family Practice Residency Proposal for Maternity Services Ms. Clements provided a summary of prenatal care services offered by the Health District. Currently, the Family Practice Residency Program contracts with the Health District for several clinical services including maternity services. The "Health Unit" was established more than 60 years ago and has provided maternity services for more than 40 of those years. Page 3 of 5 The usual patient enrollment in prenatal care at any one time is between 100 and 120 patients. The unduplicated admission count for 2002 was 251 patients. The average number of births each year in Wichita County is somewhere around 1900. The maternity patients receive nursing care by specially trained public health nurses and medical care by the residents in the Family Practice Residency. Two (2) residents staff each clinic (2 /week) with an attending physician to supervise. The District provides lab work, ultra -sound and prescription medication to the patients. Some of these services are provided in- house, and some are accomplished through contracts with Texas Department of Health (TDH), United Pharmacies and United Regional Health Care Systems (URHCS). The District also provides counseling, family planning and prenatal education. Case management is offered for those patients considered high risk with a significant percentage of patients meeting these criteria. Services are provided for all clients requesting care regardless of their inability to pay. The District seeks reimbursement through third party payer sources (Medicaid and Title V) when possible. Approximately 30% of Health District maternity patients are Medicaid eligible. Ms. Clements explained that Title V grant funding is administered to local health departments by the Texas Department of Health. In addition to prenatal and postpartum care, Title V also provides minimal funding for child health, dental and case management services. Title V funding has decreased by 53% since 1995; this loss has been offset by the District's ability to bill for Medicaid eligible clients. The City of Wichita Falls contributes significant funding for maternity care in the Personal Health Services Division budget and they also provide for medical care through the contract with the Residency Program. The County provides for the travel portion of the Case Management program. They also provide salary and benefits for one nurse position with a percentage of this employee's time being available for prenatal services. The proposal from Family Residency Program would move our maternity patients. from the Health District to the Family Practice Residency for care. There would be a physician assigned to each patient. Dr. Moquist recently proposed that case management, stress testing and most routine ultra- sounds be done at the Residency. Some more definitive ultrasounds would still be referred to URHCS. Under this proposal the Health District would have a decrease in patient load, resulting in a decrease in funding and staff. Ms. Clements stated that if the proposal includes eliminating case management, the District would possibly cut two (2) RN positions and two (2) Community Service Aides. The District eliminated one (1) RN position two years ago in response to a decrease in Title V funding. Ms. Clements expressed concern for the ability of the Residency to sustain the program financially since some patients have no method of payment or third party reimbursement. She commented that Dr. Moquist has provided assurances that the Residency would not turn away patients due to inability to pay. Ms. Clements expressed doubt that the Health District would be in a position to resume the program once it had been moved to the Residency, especially if staff is reduced due to the loss of the case management activities. Dr. Szczerba explained that the Residency would continue to provide for all patients as the Health District does now. He discussed the availability for the stress tests, ultra - sound, lab work and physician care that would be available in one place. He explained that their objective was continuity of care for the patient. This arrangement would also allow improved supervision by an attending physician and on -site consultation with an OB specialist. Page 4 of 5 He stated that patients have not been showing up at United Regional for stress tests or ultra- sounds because they were afraid they would be charged and they did not have the ability to pay. He stated the Health District staff would still be working with the clients. He stated that the resident would have a better chance for training on a broader scale. Mrs. Clements commented that URHCS would support having the majority of tests done at the Residency due to the length of time patients now stay in labor and delivery, often up to 10 -12 hours, waiting for a senior resident to review test results. This would alleviate congestion in the labor and delivery area. Dr. Miller asked Dr. Szczerba to comment on the question of financial stability for the Residency and the ability to sustain the program. Dr. Szczerba commented that with the current situation in the Legislature and the possibility of some loss of funding for medical residency programs, no one could guarantee the future financial situation. Mr. Stockton inquired if the Board needed to make a motion or recommendation to the District at this time. Ms. Clements replied that the District and the Residency would continue discussions and report back to the Board in future meetings. VI. CDBG Grant Proposals Two CDBG grants have been submitted to Community Development: a renewal for the MLK health clinic and a request for an 8,000 sq ft expansion to the Health District facility. Board members expressed interest and support for the grant requests. VII. Legislative Impact on Funding After some discussion it was recommended that due to the lateness of the hour, this item be postponed until the June meeting. VIII, Adjourn Since Dr. Strate was not able to attend today, the picture has been postponed until the June 27`h meeting. It was moved by Dr. Delizio and seconded by Greg Stockton that the meeting be adjourned. The motion carried and the meeting was adjourned at 1:30 p.m. athy Sult eier, Secretary is Iiialth Board Page 5 of 5