Van Buren/Cass County
District Board of Health
Minutes
6/11/08
Board Members Present: Chairperson Carl Higley Sr., Robert Morris, Don Hanson, and Richard Freestone.
Board Members Absent: Judith Schincariol, Dwight Dyes & Cathy Goodenough.
Health Department Employees Present: Jeff Elliott, Chantal Wojcik, Dr. Rick Johansen, George Kilts, Emily Diederich, Jennifer Zordan, Mike Laufer and Tina Cox.
Others: John Tapper Sr., and Ardith Higley.
Corrections to May minutes. Estimated expenditures for Van Buren & Cass were $761,611.08. Actual expenditures were $772,956.27. Difference of $11,345.19. Difference due to: Pager Rental, BCBS Premium adjustments, contractuals, elevator maintenance, professional liability insurance, telephone charges and payroll. Motion by Hanson, 2nd by Freestone to accept the minutes as corrected. All voting yes, motion carried.
Cash flow analysis for both Van Buren and Cass County were discussed. Items reviewed were: AGENCY SUPPORT: Jeff reminded the board that state funds for the Bangor Health Clinic is received quarterly. ENVIRONMENTAL HEALTH: Food license fees are usually received in April and May, however a few are still coming in. PERSONAL HEALTH: The jail contract with Cass County Sheriff is for two months. DENTAL: State Plan Amendment for the first 6 months has been received. SUBSTANCE ABUSE: Jeff explained that the money received from Medicaid depends on billing. He also explained how the PA2 funds are handled between the county and the coordinating agency.
Expenditure report for both Van Buren and Cass County were reviewed. Items discussed were: Environmental Health individual’s travel is higher due to less staff and data management’s travel is higher due to travel between agencies to get dental ready; PA2 funds to the Coordinating Agency and the last payment to MCDC. Motion by Morris, 2nd by Hanson to accept vouchers 19 and 20 in the estimated amount of $648,361.77 for Van Buren and Cass for payment. All voting yes, motion carried.
Administrative Report: Jeff took a moment to thank the staff for helping with dental and for stepping in to cover where needed due to staff shortages in other programs. He also thanked the board for all the progress that has been made in the past few months.
Jeff informed the board of recent conversation with MCDC regarding final payment and termination of contract. A spreadsheet showing total outstanding invoices was distributed to the board for their review. It was decided that the final settlement needed to be in writing. A Termination of Contract for Dental & Dental-Related Services was distributed to the board to review. Jeff recommended that the board accept this settlement as written and a signature from the chairperson was needed. This was discussed and reviewed. Motion by Morris, 2nd by Hanson to accept the termination contract as written and have Chairperson Higley sign. Roll call vote taken, all voting yes, motion carried.
The 2009 proposed budget was distributed to the board. Jeff highlighted several areas: No changes with state revenues expected but is still unknown; pandemic flu will not be funded this year; and we will not be the fiduciary for the adolescent health care program in Bangor schools; discussed the possibility of either Intercare or South Haven Hospital taking over as fiduciary for the Bangor Health Center. Believes they are better capable of billing for services received. Meeting with those necessary to make sure there is a smooth transition. The state still needs to review; departmental fees will not be increased; expect Dental Medicaid State Plan Amendment to increase; asking to go back to 1983 level of funding for county appropriations, which is $3.67 per capita; plan on health insurance increase of 8%. Jeff stated that if the board accepts he will put together an organizational plan with the proposed budget and submit to each county administrator. This was discussed and reviewed. The board agreed that Jeff should go ahead and put the organizational plan and budget together and present to each respective county administrator as requested.
Jeff recommended to the board that they allow staff to take a one time payout of accrued sick and/or annual leave in accordance with our current policy. He explained that due to staff changes and state revenues received; this will help decrease the department’s accrued liabilities. This was discussed and reviewed. Motion by Morris, 2nd by Freestone to allow staff a one time payout of any accrued leave they have accumulated, in any amount desired, as long as requested before June 30th. All voting yes, motion carried.
Nursing Activities Report for May for Van Buren. COMMUNICABLE DISEASE: There were 30 animal bites, 1 Camphylobacter, 1 Chickenpox, 8 Chronic Hepatitis C, 1 Kawasaki, 1 Aseptic Meningitis and 1 Invasive Group A Streptococcal Disease. IMMUNIZATION CLINIC: Hartford: There were 14 new clinic clients and 19 revisits. Paw Paw: There were 5 new clinic clients and 4 revisits. CSHCS: 8 Care plans were done in person. 10 nursing assessments were done in the home. 2 diagnostics were issued. There are 351 active cases with 71 pending. STD/HIV: There were 48 total STD clinic visits and 48 received STD testing and/or treatment. 34 STD/HIV partner notification interviews were conducted. There were 3 Chlamydia reported by the health department. There were 9 Gonorrhea, 13 Chlamydia and 1 HIV/AIDS reported by private clinics. There were 25 for HIV/AIDS counseling and/or testing. There were 21 for HIV/AIDS post test counseling. 82 received education on an individual basis. HIV CASE MANAGEMENT: There are currently 90 individuals with HIV/AIDS.
Nursing Activities for May for Cass. COMMUNICABLE DISEASES: There were 3 animal bites, 1 Giardiasis, 1 Chronic Hepatitis C, 40 Flu, 1 Salmonellosis and 4 Group A Invasive Streptococcal Disease. IMMUNIZATION CLINIC: Dowagiac: There were 5 new clients and 4 revisits. Cassopolis: There were 6 new clients and 12 revisits. CSHCS: 7 care plans were completed in person. There are 271 active cases with 2 pending. STD/HIV: There were 33 total STD clinic visits and 25 received testing and/or treatment. 18 STD/HIV partner notification interviews were conducted. There were 2 Chlamydia reported by the health department. There were 6 Chlamydia reported by private clinics. There were 18 for HIV/AIDS counseling and/or testing. There were 16 for HIV/AIDS post test counseling. 62 received HIV/AIDS education individually. HIV CASE MANAGEMENT: There are currently 24 individuals with HIV/AIDS.
These statistics were discussed and reviewed with Dr. Johansen reporting that the increase in animal bites is due to an increase in reporting from one area hospital. He also stated that the increase in STI is due primarily to an encouragement at the national level to test more women. Also STI testing can now be done with a urine sample versus a pap. Southwest Michigan has reported the largest increase in STIs in the State of Michigan. There is also an increase nationally.
Medical Director’s Report: Dr. Johansen reported on the recent Salmonella outbreak. There have been 175 cases nationally with 2 cases in Michigan (Kent & Washtenaw Counties). No deaths have been reported. A handout was distributed listing the types of tomatoes to avoid and what tomatoes are considered safe. This information will also be placed on our web site.
Dr. Johansen updated the board on West Niles Virus. Stating that birds are no longer sent in for testing, if a resident insists, they can send the bird to the state at a cost of approximately $40, at their own expense. Information on how to make a report of a dead bird is available on our web site.
Dr. Johansen reported that HIV Awareness Week is coming up. As a result, free counseling and testing will be offered at our health department facilities. A handout was distributed to the board. He explained that instead of using a needle to withdraw blood, the oral swab technique will be used and results will become available within 1 week.
Reproductive Health Statistical Report for May. FAMILY PLANNING: Hartford: 52 clients were seen; 12 for refills, 21 for medical revisits, 10 for annuals and 9 for initials. 52 clients received education. Paw Paw: 26 clients were seen; 6 for refills, 8 for medical revisits, 6 for annuals and 6 for initials. 80 clients received education. Cassopolis: 47 clients were seen, 18 for refills, 13 for medical revisits, 11 for annuals and 5 for initials. 47 clients received education. Dowagiac: 45 clients were seen, 12 for refills, 14 for medical revisits, 12 for annuals and 7 for initials. 45 clients received education. 52% of all new clients seen were teens, ages 14 through 18. Others seen were between 21-46 years of age. TEEN PREGNANCY: Van Buren: 15 clients received a UCG (pregnancy) test and 1 tested positive, the positive result was not a teen. There is a 0% positive teen pregnancy rate. Cass: 15 clients received a UCG test and 3 tested positive, one of those tested positive was a teen, age 17. There is a 33% positive teen pregnancy rate. All other positives were between 26-36 years of age. SEXUALLY TRANSMITTED DISEASES: Van Buren: 9 Chlamydia tests were given. Zero tested positive for Chlamydia. There is a 0% positive Chlamydia rate. Cass: 22 Chlamydia tests and 1 Gonorrhea test was given. Zero tested positive for Gonorrhea and one tested positive for Chlamydia, age 19. There is a 0% positive Gonorrhea rate and 5% positive Chlamydia rate. CLINICS SCHEDULED: 19 clinics were scheduled, 14 medical and 5 non-medical. There were 290 possible appointments, 183 appointments were scheduled and 170 appointments were kept. There was a 63% scheduling rate and 93% show rate. CONTRACT COMPLIANCE: Total projected users are 1100 and 1201 have been seen to date, at 109% compliance. Projected Title X is 800 and 992 have been seen to date, at 124% compliance. Projected Plan First is 300 and 209 have been seen to date, at 70% in compliance. REFERRALS PROGRAM: 1 client was referred to the STD-HIV Program and 1 referred to mental health. REFERRALS SERVICES: 1 were referred to PNC, 1 to MSSP, 1 to WIC, 1 to DHS (FIA), 2 for medical, 6 BCCP-RFC, 7 for Mammograms and 2 for breast follow-up.
These statistics were discussed and reviewed with Dr. Johansen reporting that we are now at 124% in compliance with Title X funding. Will continue to serve the public regardless of available funding. Plan First is now at 70% in compliance, believe the increase was due to limiting the qualifications that were once needed. The state at one time insisted clients needed a birth certificate, driver’s license and/or passport to be approved for this funding. The state has since changed these requirements.
Each board member was given a copy of the Bi-Annual Client Satisfaction Survey for 2 weeks in May 2008 that was conducted at all sites. Of the 170 clients served, from 5/5/08 thru 5/19/08, 54 individual clients completed anonymous evaluations with an age range of 16-51 years. The results represent a 32% survey sample (21 teens and 33 adults) with an average 97% satisfaction ratio. Respondents were asked to evaluate not only the services provided, but also to assign numerical ratings for the individuals providing those services. Satisfaction survey results were: 93% satisfaction rate for scheduling, 100% satisfaction rate for the nurse, 98% satisfaction rate for the nurse practitioner, 97% satisfaction rate for education and 98% satisfaction rate of the supplies/exiter. The adult and teen utilization rates were kept separate along with their comments and suggestions.
Adult survey results were: Of the 54 surveys completed, 33 were completed by an adult. Age range was 20-51. 51% were between 20 and 25 years of age, 19% were between 26 and 30 years, 12% were between 31 and 35 years of age, 5% were between 36 and 39 years and 14% were between 40 and 51 years of age. Clinic Utilization rate: Of the 33 adults completing the survey, 12% reported it was their first visit, 9% for less than 1 year, 21% for 1-2 years, 30% for 3-5 years, 18% for 6-10 years, 3% for greater than 10 years and 6% for greater than 15 years.
Teen survey results were: Of the 54 surveys completed, 21 were completed by teens or 39% of the survey sample. Age range was 15-19 with 48% being between ages of 15-17. Of the 21 teens surveyed, 16 reported still being in school, in grades 9th thru 12th, there were no drop outs, 5 were HS graduates and 4 are currently enrolled in college. 5 teens or 24% surveyed reported it was their 1st clinic visit while 8 (38%) reported attending the clinic 1-2 years, with 3(14%) receiving services for 3-5 years. All 21 of those surveyed stated that the #1 reason for obtaining care was to secure a contraceptive method. Teens were asked to evaluate other areas of concern. Such as: Do you feel safe receiving your care here? All 21 reported yes, 100%. Are the hours of the clinic convenient? 18 reported yes, 86%. Did the staff answer your questions and treat you with respect? 21 reported yes, 100%. Are you satisfied with the care you receive? 21 reported yes, 100% and would you recommend this clinic to a friend? 21 reported yes, 100%. The teen-age breakdown was as follow: 14% were 16, 33% were 17, 24% were 18 and 29% were 19 years of age. Copies of these surveys and comments were available for board’s review.
Dental Report: An YTD (year to date) Practice Analysis report was distributed to the board for their review. Number of active clients to date is 7,791. Over $595,000 has been billed year to date. Jeff stated that dental continues to be very busy. Another chair is needed to keep up with the demand. Will be offering a dental incentive to first time clients meeting the 200% poverty guidelines. This will be adjusted along with the fee schedule every 6 months. Will not compete with private providers, as was done in the past with MCDC.