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WC CWF Health District Board Minutes - 02/28/2003WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD PLACE: Wichita Falls- Wichita County Public Health District TIME: 12:15 p.m. DATE: February 28, 2003 BOARD MEMBERS PRESENT: Susan Strate, M.D., Chairman Kathy Sultemeier, D.V.NI. Larry Rains, D.D.S. Tom Delizio, M.D. BOARD MEMBERS ABSENT: Diane Stewart, R.N. Beverly Stiles, Ph.D. Gregory Stockton HEALTH DISTRICT Barbara J. Clements. Director of Health REPRESENTATIVES: Reuben A. Warren, Jr., Assistant Director of Health WICHITA CO. REPRESENTATIVE: Joe Miller, County Commissioner WICHITA FALLS CITY COUNCIL: Mike Nome, Councilor WICHITA FALLS CITY MANAGER'S OFFICE: Matt Benoit, Assistant City Manager MINUTES: I. Call to order Dr. Strate, Chairman, called the meeting to order at 12:15 p.m. II. Approval of Minutes Moved by Dr. Sultemeier, seconded by Dr. Rains and carried that the January 3, 2003 minutes be approved. The Board was asked to consider an amendment to the minutes of the December 21, 2001 meeting. It was stated that the amendment was required to more clearly record the vote of a motion. A tape recording of the December 2001 meeting was offered to the Board prior to voting on the amendment. After discussion it was moved by Dr. Sultemeier, seconded by Dr. Delizio and carried by unanimous vote that the amendment to the aforementioned minutes be approved. III. Swearing In of Appointed Members Joe Miller, Wichita County Commissioner, administered the Oath of Office to Tom Delizio, M.D. RECEIVED IN CITY CLERK'S OFFICE Date 05— 0 LP — By Time ksGam- Page 1 of 5 . , IV. Introduction of Dr. Dale Moquist, Director of Family Practice Residency Program Dr. Strate introduced Dr. Dale Moquist, the Program Director of the Family Practice Residency Program since January. Dr. Moquist distributed a handout to the Board members outlining the Vision and Mission Statement of the Residency Program. He discussed the historical relationship of the Health District and the Residency Program and the different clinics staffed by the residents. He stated that at present, nationwide, 60% of uninsured patients are taken care of in academic health centers and residency programs. Dr. Moquist commented that it is not much different in our community. He also discussed the current concern over impending Medicaid benefit and funding cuts and the resulting emergency room visits for routine care. He offered that the residents take care of approximately 90- 95% of staff admits through United Regional Health Care Systems and that they provide for hospital admissions for the Community Health Care Center and Health District. They also see emergency room patients from the North Texas State Hospital as well as Red River Hospital. Dr. Moquist stated that the Residency Program now has an open appointment policy in that if a client calls for an appointment, they try to schedule that client an appointment for the same day. The Board discussed impending state budget cuts and the possible impact on the Residency and Health District. Commissioner Miller asked how many residents are currently in the program and if there are any plans to reduce the number of residents. Dr. Moquist stated there are now eight residents at each level, 1", 2 "d and 3`d year for a total of 24 residents. Dr. Strate commented that the past issues that prompted a recommendation to reduce the number of residents have all been resolved. Residents have more sites available for their experience. Dr. Moquist and Dr. Strate commented on the new requirements to limit the maximum number of hours a resident can work. Page 7 of Dr. Moquist's handout referenced the current contract funding paid by the City of Wichita Falls to the Residency for Health Authority and medical supervision of direct clinical care. Ms. Clements commented that in addition to the funding shown, the City of Wichita Falls reimburses the Residency for all Medicaid eligible patients seen by residents at the Health District. This is approximately $25,000- $30,000 per year. There is also a TB reimbursement based on $100 /clinic. Remuneration for the Early Intervention (HIV /AIDS) clinics is under separate fee for service agreements; the Residency receives $250 for each clinic. Councilor Norrie commented in regard to a particular comment in the handout that the City, at the present time, is open for contract negotiation with the Residency administration. Page 2 of 5 T L The Board continued a discussion of the contract between the City of Wichita Falls and the Residency. Mr. Benoit asked what the County's current contribution is to the Residency contract. Ms. Clements replied that the amount shown is entirely City funding. Commissioner Miller stated that the County directs County Indigent Health Care (CIHC) patients directly to the Residency Program and the Community Health Care Center. The County pays approximately $65,000 per year to the Residency for this service. The County is mandated by the State to set aside 8% of the gross tax levy for indigent health care. If the actual cost is more than this amount the state will return 90 %. Dr. Miller commented that in the current situation it is doubtful the County will receive reimbursement this year. Mr. Benoit asked what the bulk of the services received by the City from the Residency consists of. Mrs. Clements stated that individual patient care in the various clinics requires most of the residents' attention. V. Report on Proposed Amendment of the Animal Control Ordinance — Roy Ressel, R.S. Mr. Ressel stated that the Board first discussed a possible change or waiver of the Animal Control Ordinance in January of 2001. He asked the Board to again consider two issues of the current ordinance for review in response to a request from the City Council. The first involves the setback requirements contained in Section 14- 420(a), and the second concerns the removal of manure from the premises, as required in Section 14- 420(c). Mr. Ressel distributed a memo from the City Attorney outlining the current ordinance and proposed language changes for the two sections under review. The memo also provided excerpts from ordinances of 19 other Texas municipalities concerning these issues. The Board discussed the proposed options. Mr. Ressel commented that he would recommend some of the proposed options, but staff recommendation would be to have more specific language and avoid "gray areas." Counselor Norrie commented that the Council subcommittee did not suggest a change in the requirements of the ordinance, but asked the City Attorney to offer some suggestions for alternative language to more clearly define the ordinance. The Board continued a discussion on the options as presented. Commissioner Miller stated that if the variances discussed were allowed the Board is allowing a public health nuisance within the city limits. Dr. Sultemeier expressed concern about changing an ordinance after neighborhoods were established. Ms. Clements commented that some of the recommended language in the ordinance would not necessarily change what was allowed under the ordinance; rather it would provide further definition. However, in the matter of daily pick up of manure, there could be a definite change in the requirement if certain options were adopted. After further discussion it was moved by Dr. Sultemeier to enforce the ordinance as it stands with current requirements and language, seconded by Dr. Rains and carried unanimously by voice vote. Page 3 of 5 VI. Administrative Report — Barbara J. Clements, Director of Health Mrs. Clements reported on the status of the Shigellosis cases and distributed handouts showing the number of cases and distribution by age, race, zip code, and gender. To date all laboratory results identify Shigella sonnei as the single group. She commented that in addition to routine lab testing, specimens have been forwarded to the Texas Department of Health laboratory for further more sophisticated subtyping using Pulse Field Gel Electrophoresis (PFGE). This DNA "fingerprinting" may help to identify the source of the outbreak. Commissioner Miller asked if the outbreak is still ongoing. Ms. Clements responded that although 25 new cases have been reported since January I", the rate of reporting appears to be slowing. The County usually sees about 4 to 12 cases reported annually. The Board discussed other aspects of the outbreak, including the results of a review of the City's Water Quality Management Committee. This committee is made up of persons from Public Works, Public Information, Legal, and Health District personnel. The Committee reviewed the Epidemiology reports and the water testing results. They did not find any evidence in the existing data to suggest the City water supply was the source of the outbreak. Ms. Clements commented that the Health District had received phone calls from parents stating that their pediatrician advised them that tap water was the source of the Shigella outbreak. It was reported that the water fountain in the physician's office had been covered with cellophane with the word "contaminated" written on it. The Public Works Department reported that the physician had requested testing of the tap water in his office due to a cloudy appearance. The tests did not show any bacterial contamination. Scott Taylor, Director of Public Works, forwarded a letter to the physicians assuring them that proper water testing had shown that there was not a problem with water quality. Mr. Taylor invited the physicians to meet with him to review the water testing documentation. As of this date, he has had not response to his letter. Dr. Strate asked that Ms. Clements follow -up to see if there is still a problem and if so, either she or Dr. Szczerba would call the physician to discuss the issue. Mrs. Clements stated that she would follow -up with Scott Taylor for resolution. Page 4 of 5 Y Dr. Sultemeier asked about the progress in public health emergency response and bioterrorism planning. She suggested that this would be a good topic for a full report to the Board. Ms. Clements reported that committee work is continuing with good cooperation from the community. The Memorandums of Understanding and Interlocal Agreements needed for use of certain facilities and other resources are still not signed. However, the City Attorney is working with the Health District to prepare the documents and bring a resolution to the Council for approval as soon as possible. The smallpox vaccinations for public health and hospital workers began last Monday with 4 Health District nurses receiving their vaccination in Abilene. They, in turn, will inoculate other Health District and hospital employees. VII. Other Business The next Board meeting is scheduled for April 25`'. Judge Gossom is in Austin today. Greg Stockton and Diane Stewart are both out of town. Beverly Stiles had a class to teach today. Mrs. Clements stated that since several members were to be absent, the Board picture has been postponed until the April meeting. VIII. Adjourn It was moved by Dr. Sultemeier and seconded by Dr. Delizio that he meeting be adjourned. The motion carried and the meeting was adjourned at 1:45pm. athy Sr temeier, Secretary lief ealth Board Page 5 of 5