WC CWF Health District Board Minutes - 01/13/2017WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES
January 13, 2017
Wichita Falls -Wichita County Public Health District
1700 Third Street - Parker Conference Room
Wichita Falls, Texas
BOARD MEMBERS PRESENT:
Julie Gibson, D.V.M., Chair
Robin Moreno, MHA-HSA, ACHE, Secretary
Keith Williamson, M.D.
Scott Plowman
Kaye Knauff, DNP, RN, FNP-BC
Larry Rains, D.D.S
BOARD MEMBER EXCUSED ABSENCE:
David Carlston, Ph.D., Vice -Chair
OTHERS PRESENT:
Lou Kreidler, R.N., B.S.N.
Amy Fagan, M.P.A.
Arthur J. Szczerba, M.D.
Woodrow W. Gossom, Jr.
Eric West
Veterinarian -City
Citizen At -Large -City
Physician -City
Restaurant Association -City
Registered Nurse -City
Dentist -County
Citizen At -Large -County
Director of Health
Assistant Director of Health
Associate Health Authority
Wichita County Judge
City Council Liaison
I. CALL TO ORDER
Scott Plowman called the Health Board meeting to order at 12:00 pm after a quorum of members
was attained.
II. NEW MEMBER INDUCTION AND RE -APPOINTMENTS
Appointment of new Health Board member Julia (Kaye) Knauff, RN into the City appointed
Registered Nurse vacancy left by Diane Stewart was conducted by Janice Flores, Notary.
Keith Williamson, MD re -appointment in the City appointed Practicing Physician was conducted by
Janice Flores, Notary.
III. ELECTION OF OFFICERS
Dr. Keith Williamson introduced a motion to nominate Dr. Julie Gibson as Chair and Robin Moreno
seconded the motion. The motion passed unanimously.
Scott Plowman introduced a motion to nominate Dr. David Carlston as Vice -Chair and Dr. Keith
Williamson seconded the motion. The motion passed unanimously.
Dr. Keith Williamson introduced a motion to nominate Robin Moreno as Secretary and Scott
Plowman seconded the motion. The motion passed unanimously.
IV. APPROVAL OF MINUTES AND ABSENCES
Scott Plowman called for the review and approval of minutes from the meeting held on Friday
October 28, 2016. Dr. Williamson introduced a motion to approve the minutes as presented and Dr.
Gibson seconded the motion. The motion passed unanimously.
At this time it was noted the excused absence of Dr. Carlston.
Lou Kreidler stated the Board of Health meetings are set by City ordinance to meet on the fourth
Friday of every other month starting in February. Historically it had been an issue for the Board to
make quorum in August with the Hotter-n-Hell and the December holidays. Since the City updated
some of the Boards and Commissions the Board of Health was changed to meet on the second
Friday of every other month starting in January. The change was made by ordinance that passed at
the last Council meeting.
V. HEALTH DEPARTMENT OVERVIEW
Amy Fagan, Assistant Director of Health annotated that the vision of Public Health is to obtain
Healthy People, Healthy Community.
The Health District budget is $5.6 million with $2.2 million (39%) from grants. A full time staff of 86
with 49.9 (58%) supported by general revenue tax dollars the rest 36.1 (42%) supported by grants.
Total employees can be up to 101 to include part time staff and seasonal workers.
The Public Health District (PHD) Organizational Diagram presented shows Director Lou Kreidler
reports to the City Manager Darron Leiker. Assistant Director Amy Fagan, Environmental Health
Administrator Susan Morris, Animal Services Administrator Katrena Mitchell, WIC Administrator
Janna Kaelin and Nursing Administrator Lynette Williams report to Director Lou Kreidler. Dr. Mattar
is the PHD Medical Director and Local Health Authority. Dr. Szczerba is the Associate PHD Medical
Director and Associate Local Health Authority.
The Board of Health is an Advisory body with provisions set by local ordinance with requirements for
the number and type of professionals on the Board. One of the main purposes is to be conducive in
the review of ordinances (proposed, modifications, revised) and provide feedback with expertise and
knowledge before presented to City Council. Periodic briefings include disease outbreaks,
concerns, challenges and programs. Aspirations are that the Board advocates for Public Health in
the community. For a small community it is proactive and the ordinances are progressive being the
first in the State to have a Hotel/Motel ordinance and the only one in the State with a smoking
ordinance that contains restrictions such as 100% no smoking in hotels/motels.
For a better understanding of the Health Department services each Division was reviewed.
ADMINISTRATION - Supervised by Assistant Director Amy Fagan
General Administration
o About $800 thousand generated in fees and other revenue
o Front desk collects about $500 thousand a year in cash and credit cards
Central Billing
o Generates revenue from certain services billed to Medicare, Medicaid, Blue Cross Blue Shield
Vital Statistics
o Birth and Death certificates within the City
o Paternity filing assistance to amend a birth record
o Genealogy research assistance
Public Health Preparedness
o Program since 2002 in planning, response, mitigation, recovery
o Works with Local/State partners to include City/County Emergency Management Coordinators,
Sheppard AFB, and Hospitals to coordinate efforts
o Education/training for individuals in the community for preparedness of a catastrophic disaster
o Surveillance and Epidemiology on disease outbreaks, trends such as Ebola, Zika
Accreditation
o New for Public Health within the last 4 years
o Measurement of Health Department performance against a set of nationally recognized practices
focused and evidence based standards
o Recognition of achievement issued by the Public Health Accreditation Board (PHAB)
o Continual development, revision and distribution of Public Health standards
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o Important component of the Accreditation Specialist position is quality improvement
➢ Quality Improvement
• Internal Quality Improvement team
• Follows QI plan
• Identifies and addresses QI projects
• Implemented a new employee orientation
Laboratory
o CLIA (Clinical Laboratory Improvement Amendments) licensed for tests in support of Nursing
clinical services
o TCEQ (Texas Commission on Environmental Quality) certified for water testing
o Testing for Environmental Health
o Generates $33 thousand in revenue
ENVIRONMENTAL HEALTH —Administrator Susan Morris
Director Lou Kreidler asserted Environmental Health encompasses various programs under
authority to permit, inspect and enforce in different jurisdictions as presented below.
PROGRAM
AUTHORITY
PERMITED
INSPECTED
ENFORCEMENT
JURISDICTIONS
REVENUE
Food
City Ordinance
✓
�/
�/
Burkburnett, Wichita nElect a,
$ 205,000
County Order
Iowa Park
Grease Traps
City Ordinance
✓
✓
✓
WF
$ 34,000
Hotel/Motel
City Ordinance
✓
✓
V/
WF, Burkburnett,
$ 71450
Electra, Iowa Park
Public
City Ordinance
✓
✓
✓
Wichita County, WF,
Swimming Pools
Burkburnett, Electra,
$ 33,200
Iowa Park
Body Art
City Ordinance
✓
✓
✓
WF
$ 13,500
Smoking Ordinance
City Ordinance
X
X
✓
WF, Burkburnett
$ -
Wichita County, WF,
Septic Systems
City Ordinance
✓
✓
✓
Burkburnett, Iowa Park
Electra, Pleasant Valle
$ 30,000
County Order
City leased lots at Lake
Kickapoo, Arrowhead
Vacuum Trucks
City Ordinance
✓
✓
✓
WF
$ 2,500
Ambulance
Franchise
City Ordinance
✓
X
✓
WF
$ 1,000
Wichita County, WF,
Site Plan Review
City Ordinance
NA
NA
✓
Burkburnett, Electra,
$ 1,000
Iowa Park
Daycare Facilities
Regulated by Day
Care Licensing
Wichita County, WF,
Foster Homes
Health & Safety
X
✓
X
Burkburnett, Electra,
$ 5,500
Inspections Required
Iowa Park
Mosquito Control
Health & Safety
X
X
Un-incorporated Areas
$
of Wichita County, WF
Total Permit & License Revenue $ 333,150
Food inspections are done at any facility with a kitchen that food is sold to the public in any manner
that includes a church and non-profit.
Annual grease trap inspections are done at restaurants, any place that produces grease even a
mobile food vendor and snow cone stand with any type of milk products. The City grease trap
ordinance was established out of sewer overflows when the grease would go directly into the
sanitary sewer system that caused clogs. The City was near to be put under sanctions with TCEQ
for the number of overflows the ordinance reduced the numbers and a lot of the problem.
The first in Texas to have a Hotel/Motel Lodging Ordinance in the preparation worked closely with
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the Hotel Association. The whole premise of the ordinance is whether you pay $20 or $120 for a+
room there should be a basic level of cleanliness. Inspections are done twice a year on random
vacant rooms. Sheets are pulled off the mattress to check the mattress for bed bugs, undo electric
sockets around the bed where bed bugs like to hide, swab the drinking glasses, tub and bathroom
counter. The hotels are usually responsive most often the travelers are whom bring in the bed bugs.
Inspect swimming pools that are semi-public, any pool open to the public, apartment complexes,
hotels/motels, gyms, etc. but not a private home. Test water samples, appropriate equipment in
place, an emergency telephone on site for public health and safety. Each operation is required to
have a pool operator trained annually by Environmental Health.
The local Body Art Ordinance caused several tattoo parlors to move out but had more open. The
ordinance not only permits the facility but each artist with monthly inspections. To be a local tattoo
artist the requirements are to apprentice under a sponsor for a 2 year minimum, possess knowledge,
good technique and take a tattoo artist test at the Health Department to identify a basic level of
knowledge and blood borne pathogens. Anyone that does cosmetic tattoos such as eyebrows, lips
must also take the test.
The Smoking Ordinance was passed 2 years ago the grandfather clause ended in July so now all
Wichita Falls establishments are smoke free. Most current with it colder some establishments have
closed in patios with plastic and tarp which converts the patios into an enclosed space nonsmoking
area.
Scott Plowman asked had there been a decline in the people trying to fight the smoking ordinance at
Council.
Lou Kreidler responded it dwindled down to one gentleman. The number of bars to close has been
4-5 but 4-5 open it is just a flux.
Dr. Rains commented that happens all the time.
Lou Kreidler continued Wichita Falls was actually the first new ordinance to include e-cigarettes.
Some cities that passed their ordinances before e-cigarettes have had issues going back to include
e-cigarettes. The only local feedback was two questions from a physician at a Health Board meeting
and Councilor at a City Council meeting. In the ordinance draft all Wichita Falls hotels/motels are to
be nonsmoking at a meeting with all the lodging individuals no one said anything so it remained in
the ordinance.
Eric West asked how and who does the enforcement.
Lou Kreidler replied the Environmental Health (EH) staff answers the complaints and handles the
enforcement. In the next couple of months the EH staff plan afterhours when not expected to visit
the bars to check for compliance of the ordinance. Signage and signs of ashtrays are checked on
routine inspections. When an individual is smoking and informed it is a nonsmoking bar if the
cigarette is not put out then the individual is written a ticket. An owner of the establishment can be
ticketed as well when an individual is allowed to smoke, not informed it is nonsmoking to put the
cigarette out there is a place outside to smoke but not inside. A downtown bar decided to be called
a Tobacco Shop the EH staff with police went in afterhours no one was smoking but the
establishment had ashtrays out and the nonsmoking signage was covered it was one of the first
tickets issued.
On -Site Septic system coverage includes all of Wichita County and the Lakes Arrowhead and
Kickapoo. Coverage of the lakes is to ensure the systems around the lakes have not caused any
problems to the City water sources.
Under the Ambulance Ordinance when a new ambulance franchise wants to operate in the City a
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need for additional services in the community must be shown.
Susan Morris does the Site Plan Reviews that consumes a lot of her time
Mosquito Control is probably one of the biggest complaints heard by City Counselors and County
Commissioners with the mosquito complaints and spraying in the early fall. This year being a wet
October brought about 1,000 complaints normally it ranges from 125-200 complaints. Spray is the
most expensive and least effective method of mosquito control. Seasonal vector control workers are
hired to spray, treat water, set and monitor traps. A Press release is broadcast on a positive pool of
West Nile mosquito or any mosquito borne diseases with a positive pool to alert area physicians.
ANIMAL SERVICES — Administrator Katrena Mitchell
The Animal Services Center (ASC) is located at 1207 Hatton Road that consists of 36 large dog
kennels, 12 small dog cages, 18 cat cages, 12 cat isolation cages, 9 cat quarantine and 10 dog
quarantine areas. In 2016 the Center took in 3,701 dogs and cats brought in by Animal Control
Officers (ACOs), owners and citizens, with 468 adoptions. The Euthanasia rate is 55.79% better
than when the shelter was first open and took over the services from the Humane Society that had a
rate of about 75%.
A ceremony will be held once the Adoption addition opens it is at 179 days behind schedule.
Adoptions started 2 years ago at almost 1,000 adoptions the additional 18 kennels enables an
increase in the number of animals held at any one time for adoption. Adoptions began April 18,
2014 currently at 950 adoptions the adopters pay for spay/neuter surgery. It is important to micro-
chip there was a micro -chipped dog that showed up in the shelter they called the number on the
micro -chip their dog had been gone for about 6 years and they lived in another state do not know
how it ended up here but they drove and picked up their dog.
Katrena Mitchell is great at working with rescue groups and to get animals returned to their homes.
One group sends rescues up into New York they have people lined up to wait for the animals to get
to the shelter where they could sit here in a shelter for months. Every dog in the City should have a
license it allows Animal Control to find the owner to get the dog back home.
Rabies is prevalent in the area in 2016 with 5 positive cases (3 skunks, 2 cats) it is important to have
your animals vaccinated against rabies. The Animal Services Supervisor is appointed as the Local
Rabies Control Authority (LRCA) and the Health District serves as the Local Rabies Depot. Health
District Nursing Division -Immunization handles dispense of HRIG and PEP with the required
paperwork and prescription.
In addition Dr. Gibson remarked she and other Veterinarians have seen a decline in cats vaccinated
her opinion is that people have become lax to vaccinate their cats.
Animal Services have trap rentals, does micro -chipping, euthanasia, and offers tours. Any wild life,
feral cats around your residence can be trapped but not in inclement weather because it is cruel to
the animal. Girl Scouts, Boy Scouts, school groups, and day cares have toured the facility.
Education and Community Resources are conducted on the chaining ordinance and breeder
permits, spay and neuter, animal permitting. ASC had an abundance of feral cats not suitable for
adoption but great for barns. The Barn Cat program offers a warehouse and barn the feral cats and
kittens with no fee but do require them to spay/neuter the animal and a rabies vaccination.
Dr. Rains asked to expand on the Chaining ordinance.
Lou Kreidler explained in the City of Wichita Falls it is illegal to have an animal on a chain unless
outside within 5 feet of the animal. There had been a lot of issues with people that left animals
chained without the appropriate shelter the ordinance was brought before a previous Health Board.
A big enforcement push was done it is not as much an issue now but still get some complaints. The
Chain Off program was organized through P.E.T.S. Low Cost Spay and Neuter from raised funds.
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When an animal was on a chain because of a fence issue or inadequate enclosure the individual'
could apply to be a part of the program with the requirement to spay/neuter their animal and several
were not helped because of refusal to spay/neuter. Upon approval the Chain Off program would go
out to build the fence due to a back log to build fences the ASC put out signs for the individuals that
said "Yes my dog is chained but I am waiting on the Chain Off program".
WOMEN, INFANTS AND CHILDREN (WIC) — Administrator Janna Kaelin
Amy Fagan explained the WIC program is a 100% federally funded nutrition program for growing
families that help pregnant, post-partum, breastfeeding women, infants, and children less than 5
years of age. The program also can provide assistance to Dads, Grandparents, Aunts, Uncles and
Guardians. Requirements are specific a nutritional need and income screening criteria must be met.
Focus is on breastfeeding education locally about 70% of women electively breastfeed the intent is
to increase participation due to the importance of breastfeeding. The program is a Milk Depot that
collects donated breast milk for the North Texas Area Mother's Milk Bank. Donor milk is uniquely
superior and can be lifesaving for fragile infants. The North Texas Area Milk Bank picks up,
sterilizes, and distributes the milk to critically ill and premature infants in the metroplex. WIC
endeavors to do more education and outreach because on the national and local levels the number
of participants have declined substantially and the food stamp participation is on the rise. The WIC
program has so many requirements the food bought at local stores must meet certain nutritional
criteria such as the % of fat in milk much education goes into the process.
Local WIC Statistics
• 45,500 Participants
• Average of 4,136 Participants per month
• Serves 5 Area sites (Wichita Falls, Sheppard AFB, Burkburnett, Electra, Henrietta)
• 19 Employees
NURSING DIVISION — Administrator Lynette Williams
The Nursing Division is split into 3 different facets; Epidemiology, Clinical Services, Preventative
Health Services.
EPIDEMIOLOGY is grant funded with an Epidemiologist on staff for about a year investigates all
reportable conditions based on responsibility outlined in the Texas State law. The job entails to work
with the medical community to educate and provide resources in regards to reportable conditions. In
Texas under State law the hospitals and healthcare providers have the responsibility to report
certain diseases. Syndromic surveillance data is reviewed from both to identify any possible
outbreaks or clusters.
CLINICAL SERVICES: Tuberculosis, Sexually Transmitted Infections and Immunizations
Clinical services mission is to reduce the overall communicability of certain diseases.
Tuberculosis (TB) is not common the number one objective for TB is to contain the spread for the
safety of the community.
• Treat all active TB cases in Wichita County
• Investigate all contacts to active TB cases
• Treat all persons with the TB infection
• Testing done in targeted areas
• Educate the public and other health care providers about TB testing and treatment.
Sexually Transmitted Infections (STIs)
• Test any person age 14 and older that desires testing
• Treat any person that tests positive for an STI except HIV
• Educate the public about STIs and prevention
STI clinic see patients every day of the week, also goes to the jail and jail annex to conduct
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examinations once a week as part of the WFWCPHD agreement with the County. Now syphilis is a
local issue but the number for gonorrhea and chlamydia are high compared to the rest of the State
and the National STI averages it is a real big problem in the area. In all the different factors
education was the consensus. The STI clinic is not just about doing the clinical diagnosis and
treatment but doing a prevention component. STI collaborates with epidemiology on disease
outbreaks the last six months have seen a rise in the number of shigella, campo, crypto, GI type
illnesses very concerning.
Immunizations
• Provides all recommended vaccines for both children and adults, offers both private pay and state
funded vaccines
• Currently only accept Medicaid and CHIP, some Medicare and Blue Cross Blue Shield
• No child will be turned away due to the inability to pay
• Travel vaccines like Yellow Fever and oral and injectable Typhoid
• Take part in the Perinatal Hepatitis B Prevention Program
• Provides pregnancy counseling for positive and negative testing
• Offer Lab services on a walk-in basis
• Provide immunizations to the public and area medical practices
• Attend events such as Kids Fest, Health Fairs and Project Back to School
PREVENTATIVE HEALTH SERVICES
• HIV Prevention
• Tobacco Prevention & Control Coalition (TPCC)
• Community Partnership Program
• Texas Healthy Communities Program
• Community Diabetes Education Program (CDEP)
• ASTHO Hypertension Grant
HIV Prevention provides free HIV testing and education for Archer, Baylor, Clay, Cottle, Foard,
Hardeman, Jack, Montague, Wichita, Wilbarger and Young counties along with the package free
Syphilis testing. Jails, drug rehabs, colleges, shelters, streets, bars, health fairs, and industries are
some of the testing locations.
TPCC is a DSHS funded grant from tobacco settlement funds received on January 15, 2014 to:
• Prevent youth tobacco use
• Increase cessation among young people and adults
• Eliminate exposure to secondhand smoke.
Texas Healthy Communities was a one year grant awarded in October 2014 that now is three years,
a recipient of the Community Assessment "Silver Award". The program goals are:
• Active Living Plan
• Mother -Friendly Workplace
• 5-2-1-0=8
• Health Vending/Worksite Wellness
• Tobacco -Free Communities
Community Diabetes Education Program (CDEP) was awarded in September 2015 as a four year
grant, all program staff are Certified Community Health Workers.
• DEEP (Diabetes Empowerment Education Program) - Free education classes for individuals
diagnosed with type 2 diabetes by trained Health Educators that use the licensed Diabetes Self -
Management Education (DSME).curriculum
• DPP (Diabetes Prevention Program) — Free classes for individuals diagnosed with pre -diabetes or
at risk to develop type 2 diabetes
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Association of State & Territorial Health Officials (ASTHO) Hypertension Program
• Awarded November 15, 2015 a six month grant extended to June 2017
• Goal to reduce disparities in hypertension identification and control
• Projects include:
-Home blood pressure monitoring
-Improving clinical linkages
HEALTH DISTRICT SOCIAL MEDIA
Twitter: WF HEALTH DISTRICT
Instagram: WFHEALTHDISTRICT
Facebook: WICHITAFALLSHEALTHDISTRICT & CITY OF WICHITA FALLS ANIMAL SERVICES
LOOKING TO THE FUTURE
Public health it is so different than clinical services how does public health integrate community and
clinical linkages such as Indigent Care, Community Healthcare Center, Family Health Center and
Public Health to move forward to the future together toward the common goal. Public Health often
sees people whom are not in the system that feel they cannot get the needed care so the bi-
directional referral piece is very important. What is known even if seen by a physician often times on
their return home they either do not know what to do, what the physician had told them to do or not
feel they have the capability or capacity to do that, no focus has been on the behavioral health
change. The behavioral health is where to kind of bridge the gaps to see how to help people
manage their own behavioral health change.
A lot of Strategic planning was done in the last 6 months out of that was to bring all the staff
together. There was a need to affirm to all the staff that even with the many different variables all
the staff work toward the same vision and to understand achievements have been made.
VI. NEXT MEETING DATE
Friday March 10, 2017 was noted as the next meeting date.
VII. ADJOURN
Scott Plowman adjourned the meeting at 1:05 pm.
Julie Gibson D. V.M. Chair David Carlston Ph.D.. Vice -Chair. or Robin Moreno, MHA-HSA, ACHE, Secretary
Wichita Falls -Wichita County Public Health Board
City -County Board
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