Van Buren/Cass County

District Board of Health

Minutes

2/13/08

Board Members Present: Robert Morris, Carl Higley Sr., Dwight Dyes, Don Hanson, Cathy Goodenough and Judith Schincariol.

Board Members Absent: Richard Freestone

Health Department Employees Present: Jeff Elliott, Chantal Wojcik, Dr. Rick Johansen, Mona Hale, Mike Laufer and Tina Cox.

Others Present: John Tapper Sr.

Corrections to January minutes. Estimated expenditures for Van Buren & Cass were $490,332.67. Actual expenditures were $512,351.65. Difference of $22,018.98. Difference due to: T-shirts for Girls on Track, CPR/First Aid Training for Health Promotions, Premium adjustment for February to BCBS, Bank interest & fees, Utilities, CLIA Certification for Bangor Health Center, Refund to Delta Dental, Flooring for Dowagiac office, Medical supplies, Telephone Charges, Laboratory Services for Family Planning, Registration fees, Informational material for Substance Abuse and payroll. Motion by Goodenough, 2nd by Hanson 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: PA2 Liquor tax has been received from Van Buren. Jeff explained that state contracts are received either quarterly or semi-annually depending on the program. DENTAL: Formula on the State Plan Amendment reviewed, should receive at the end of the month. SUBSTANCE ABUSE: The $32,485.11 projected for State Prevention is for 2 months.

Expenditure report for both Van Buren and Cass County were reviewed. Items discussed were: 2007 audit expenses to Abraham & Gaffney, have a 3 year contract with them; dental reimbursement and expenses to Patterson. Motion by Morris, 2nd by Hanson to accept vouchers 9 and 10 in the estimated amount of $528,506.97 for Van Buren and Cass for payment. All voting yes, motion carried.

Administrative Report: A letter from MDCH stating that Van Buren/Cass District Health Department has been awarded the Cycle Three Certificate of Accreditation was presented to the board.

Jeff gave an update on union issues, stating that negotiations have not started yet. Teamsters have not contacted Administration as of this date. However this does not prevent the health department from looking at our health insurance options. Recently met with representatives from National City Insurance Group to review a couple of plans to present to the union. Each board member received a copy of the health department’s current health insurance plan (BSBS Community Blue PPO Plan 4) and a copy of the proposed plan (BCBS Community Blue PPO Plan 15) for their review and comparison purposes. Jeff stated that National City Insurance Group will be conducting three upcoming educational meetings to the employees on February 27th and 29th at the Hartford facility and on February 28th at the Cassopolis site. All employees are encouraged to attend one of these meetings.

Nursing Activities Report for January for Van Buren. COMMUNICABLE DISEASE: There were 8 animal bites, 3 Camphylobacter, 2 Chicken Pox, 1 Coccidioidomycosis, 4 Hepatitis B, 4 Chronic Hepatitis C, 139 Flu, 2 Bacterial Meningitis and 1 Salmonellosis. IMMUNIZATION CLINIC: Hartford: There were 21 new clinic clients and 34 revisits. Paw Paw: There was 1 new clinic client and 1 revisit. CSHCS: One (1) care plan was done in person, 9 nursing assessment were done in the home. Six (6) diagnostics were issued. There are 361 active cases with 85 pending. STD/HIV: There were 65 total STD clinic visits and 37 received STD testing and/or treatment. 38 STD/HIV partner notification interviews were conducted. There was 1 Gonorrhea and 3 Chlamydia reported by the health department. There were 6 Gonorrhea, 20 Chlamydia and 1 HIV/AIDS reported by private clinics. There were 23 for HIV/AIDS counseling and/or testing. There were 22 for HIV/AIDS post test counseling. 125 received education through a group setting, 150 received education on an individual basis. HIV CASE MANAGEMENT: There are currently 89 individuals with HIV/AIDS.

Nursing Activities for January for Cass. COMMUNICABLE DISEASES: There were 5 Animal bites, 1 Camphylobacter, 1 Chicken Pox, 2 Chronic Hepatitis C and 67 Flu. IMMUNIZATION CLINIC: Dowagiac: There were 5 new clients and 6 revisits. Cassopolis: There were 9 new clients and 14 revisits. CSHCS: Six (6) care plans were completed in person and two over the phone. One (1) diagnostic was issued. There are 270 active cases with 2 pending. STD/HIV: There were 55 total STD clinic visits and 41 received testing and/or treatment. 23 STD/HIV partner notification interviews were conducted. There was 1 Gonorrhea and 3 Chlamydia reported by the health department. There were 2 Gonorrhea and 9 Chlamydia reported by private clinics. There were 29 for HIV/AIDS counseling and/or testing. There were 27 for HIV/AIDS post test counseling. 37 received HIV/AIDS education on a group basis and 81 received education individually. HIV CASE MANAGEMENT: There are currently 23 individuals with HIV/AIDS.

Medical Director Report: Dr. Johansen updated the board on flu, stating that the strain of flu is not a great match to the vaccine that was given this year. However the flu vaccine will protect some. Expects flu to peak next week.

Each board member was given a policy for review and possible implementation regarding making Van Buren/Cass District Health Department facilities smoke free campuses. Dr. Johansen stated that this is similar to what other agencies are doing. This was discussed and reviewed. Motion by Morris, 2nd by Hanson to implement this policy with an effective date of April 1, 2008 as presented. All voting yes, motion carried.

Reproductive Health Statistical Report for January. FAMILY PLANNING: Hartford: 71 clients were seen; 16 for refills, 29 for medical revisits, 16 for annuals and 10 for initials. 124 clients received education. Paw Paw: 50 clients were seen; 12 for refills, 16 for medical revisits, 15 for annuals and 7 for initials. 51 clients received education. Cassopolis: 77 clients were seen, 26 for refills, 26 for medical revisits, 19 for annuals and 6 for initials. 77 clients received education. Dowagiac: 54 clients were seen, 11 for refills, 18 for medical revisits, 16 for annuals and 9 for initials. 54 clients received education. 72% of all new clients were teens, ages 15 through 19. Others seen were between 20-48 years of age. TEEN PREGNANCY: Van Buren: 37 clients received a UCG (pregnancy) test and 3 tested positive, with 1 of those being a teen. There is a 33% positive teen pregnancy rate. Cass: 22 clients received a UCG test and 5 tested positive, 3 of those testing positive were teens. There is a 60% positive teen pregnancy rate. Teens were ages 16, 18(2) and 19, all other positive pregnancies were 20-29 years of age. SEXUALLY TRANSMITTED DISEASES: Van Buren: 22 Chlamydia tests and 3 Gonorrhea tests were given. Zero tested positive for Gonorrhea and one (1) tested positive for Chlamydia. There is a 0% positive Gonorrhea rate and 5% positive Chlamydia rate. Cass: 26 Chlamydia tests were given. One (1) tested positive for Chlamydia. There is a 4% positive Chlamydia rate. CLINICS SCHEDULED: 26 clinics were scheduled, 20 medical and 6 non-medical. There were 405 possible appointments, 289 appointments were scheduled and 253 appointments were kept. There was an 71% scheduling rate and 88% show rate. CONTRACT COMPLIANCE: Total projected users for 08 are 1100 and 776 have been seen to date, at 71% compliance. Projected Title X for 08 is 808 and 671 have been seen to date, at 83% compliance. Projected Plan First for 08 is 300 and 105 have been seen to date, at 35% compliance. REFERRALS PROGRAM: 4 clients were referred to the health department’s STD/HIV program, 1 to Substance Abuse, 1 to Dental and 1 to Community Mental Health. REFERRALS SERVICES: 5 were referred to PNC, 5 to MSSP, 5 to WIC, 5 to DHS (FIA), 4 for medical, 8 BCCP-RFC, 7 for Mammograms, 1 for pap follow-up and 3 for breast follow-up.

These statistics were discussed and reviewed with Mona reporting on year to date and fiscal year numbers for Title X projected users. Already at 83%, only need 137 before reaching 100% in compliance. Plan to do abbreviated services. Have received permission to write prescriptions and working on alternative methods of providing services to Title X clients after 100% mark reached.

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 6,475. Over $160,000 has been billed. Jeff expressed his concerns with MCDC and hopes to have them settled soon. Problems are not with any specific site, but basically have to do with administrative rates and management at MCDC. Jeff reported that dental continues to be busy. This was discussed and reviewed.

Environmental Health Report: Statistics were discussed and reviewed with Mike reporting that permits continue to be slow, basically due to the weather.

Mike reported that he is still waiting to hear from the engineers on the installation of the Advantex System for property in Almena Township that was discussed at January’s meeting.

Higley stated that the Board of Health and Environmental Health need to seriously look at these alternative septic systems that are being used in/or near swamp land before approving. He asked Mike to notify him if the Environmental Health Department is ever requested to install an alternative septic system for any property involving lakes and/or swamp land in Cass County. Mike stated that the biggest problem usually involves septic systems around lakes due to all of the specifications that need to be followed; topography, so many people to area, etc. Also discussed situation at Baldwin Lake, will keep board informed.

Substance Abuse Report for January. REFERRALS: 62 referrals were received;31 from court, 1 from New Directions, 7 from SARF, 6 from DHS, 9 from Community Mental Health, 2 self referred, 1 referred by family and 5 from other sources. OUTPATIENT INDIVIDUAL APPOINTMENTS: 244 total individual sessions were scheduled; 109 in Paw Paw and 135 in Hartford. There were 135 individual sessions held; 65 in Paw Paw and 70 in Hartford. 17 sessions cancelled by staff; 8 in Paw Paw and 9 in Hartford. 56 sessions cancelled by the client; 18 in Paw Paw and 38 in Hartford. There were 36 no shows; 18 in Paw Paw and 18 in Hartford. GROUP SESSIONS: 12 therapy groups were held with 45 units of services. IOP: There are a total of 10 clients, 4 women and 6 men. There were 28 units of service. UTILIZATION REVIEW: Direct Service rate for January is at 52% and show rate is at 55%. SARF: Screenings: 12 sessions were scheduled, 10 attended sessions and 2 sessions were cancelled. DLAD: Five (5) sessions were scheduled, 3 sessions were attended, 1 session was cancelled and there was 1 no show. Show rate is 76%.

Other Business: Jeff informed the board that both he and Dr. Johansen have recently met with South Haven Community Hospital to discuss the possibility of the hospital taking over the school based clinic in Bangor. He explained why he felt this would be a good move. Dr. Johansen informed the board that currently there are only 12 clinics out of 57 in the state of Michigan that are affiliated with health departments, and he also believes this to be a good move.

Jeff asked the board to change the meeting date in April from the 2nd Wednesday to the third. The board agreed. A memo will be sent out to remind everyone of this change.

Motion by Hanson, 2nd by Dyes to adjourn. Next regular District Board of Health meeting scheduled for Wednesday, March 12th at 4:00 p.m. at the public health department facility in Cassopolis.

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District Board of Health