On September 11, 2006, Dr. Guidry gave a presentation to a group of physician MPH students in the UTMB  Department of Preventive Medicine.  Dr. Guidry gave an overview of public health responsibilities and a summary of the Board’s 2005 Annual Progress Report on priority activities in the Health District.   As a result three of the students have engaged in public health projects with the Chief Epidemiologist, Dr. Dana Beckham.  Additionally, Dr. Guidry, an adjunct faculty of the UTMB Department of Family Medicine, has initiated a public health rotation for third-year family medicine residents.  One resident will rotate every four weeks continually and will be exposed to community and environmental health programs to include TB, HIV/STD, public health preparedness, epidemiology, etc.   The current resident, Dr. Hernandez, was impressed with the scope of public health responsibilities to prevent and control tuberculosis.  Finally, Dr. Guidry and Brian Rutherford met with a CDC Senior Management Official, Mark Russell, who works in the office of the State Commissioner of Health.   Discussions centered on a recent CDC assessment of the public health system in Texas and the unique organization and services of the Health District.   The CDC official was impressed with the District’s unique organization, level of community collaboration, two board structure, Strategic Health Plans & annual progress reports, and quality of information available on the website.   Parties agreed to share best practice information in the future that many be beneficial to other local health departments in the state.   Dr. Guidry is working on committees with other public health officials on the statewide Texas Public Health Association Conference to be held at Hotel Galvez in Galveston on February 25-27, 2006.   A comprehensive agenda will include panel discussions on the accreditation of local health departments and on state legislative and policy issues impacting public health. 

On September 11^th the office of State Senator Mike Jackson received an envelope containing a powder with a note indicating the powder was anthrax.  The Health District was contacted by the League City Police and immediately activated the District’s Bioterrorism Response plan. This set into motion a number of well rehearsed activities directed by Dr. Guidry. Epidemiology staff notified state Epidemiology officials and prepared guidance for health care providers regarding the disease. The Public Information Officer prepared information for possible news releases. Public Health Preparedness staff notified the FBI Weapons of Mass Destruction Coordinator of the incident and informed county emergency management staff about the incident. A conference call was established with Health District and state health officials to assess the incident and plan a course of action based on the circumstances. A local lab was also notified and asked to prepare to receive the substance to conduct confirmatory tests on it for anthrax spores. After initial testing showed the substance not to be anthrax, the FBI deemed the substance not to be a threat. Resources at the scene were demobilized and Health District operations returned to normal.

The advisory council meeting was well attended on August 26, 2006.    Representation at the meeting included UTMB, College of the Mainland, Mainland Medical Center, Hitchcock ISD, and Guidry News.  Discussions during the meeting included outcome of outreach activities, additional funding from DSHS, emergency vaccine storage plans and plans for the flu season.  Council members offered to assist in recruiting volunteers for the Vote to Vaccinate campaign, to assist in advertising locations of our flu clinics and to find nurses and clerical assistance.  One Program manager from UTMB has suggested that this would be a good opportunity to rotate students through as a public health project

Since the loss of Russell Miller, MD, on August 8, 2006, Dr. Guidry is serving as Interim EMS Medical Director until a new Director is selected.   The position was posted and 11 highly qualified candidates submitted letters of interest and resumes.   The EMS Advisory committee comprised of representatives of GCHD, Texas City, La Marque, and Dickinson, selected five candidates for a first interview and one candidate for a second interview.  More information will be provided when the process is finalized.

Plans to renovate the Texas City Clinic were presented to the United Board of Health on August 30, 2006.  Board members provided valuable feedback and approved action to proceed with finding funds to complete the project.   Executive staff have met with architects to design additional space needed for community health programs including immunizations and tuberculosis services.   The additional plans are now finalized and a total cost for the dual project (Clinic renovations and public health relocations) is estimated at over 2.2 million dollars excluding the cost of any furniture and equipment. The next step is to brief the County Judge and plan for securing needed financial support from community/industry donors.   

• Dates for upcoming mammogram screenings can be found on the District’s web site at http://www.gchd.org/pages/chn/dfeet.htm.
• A press release was issued September 7^th recognizing National Food Safety Education Month.  Included in the article were tips on how to be safe when preparing food at home and also when taking food to outdoor events.  All of the food safety tips can be found in the release at http://www.gchd.org/press/2006/09foodsafety.htm. The Galveston Daily News carried the story on September 20^th. http://www.gchd.org/press/2006/09foodsafetyDNews.pdf.
• A La Marque kennel was closed in August when Consumer Health inspectors were dispatched to investigate an odor complaint.  Instead of finding an inoperable septic system as first suspected they found many animals being kept in poor conditions.  The Galveston Daily News contacted the District on September 12^th covering the story.  Public Information Officer, Kurt Koopmann was interviewed for the story that can be found at http://www.gchd.org/press/2006/09Animals.htm.
• September 13^th was a surprisingly busy media day after the Galveston Daily News published two animal interest stories.  In addition to the previously mentioned story about a kennel closing there was also a story covering a dog bite in Texas City.  The Houston television station picked up on both stories.  ABC13 had reporters assigned to both stories.  On-camera interviews were provided by Kurt Koopmann, PIO and Kim Schoolcraft, Animal Services Manager.  While ABC was filming at the animal shelter, unannounced CBS11 arrived on scene and also did on camera interviews.  ABC13 did a live feed from the shelter on their 5 p.m. broadcast. 
• A reporter from the Sarasota Herald Tribune contacted the Public Information Office on September 19^th.  There is currently controversy in Florida on the opening of additional offshore drilling fields.  The reporter who recently visited Texas City to see what life in an industrial center was like requested information on the types of illnesses people present with in our 4C’s clinics.  A recently compiled report on numbers from the 2005 UDS report was shared with the reporter. 

• Increase in Immunization Funding - Immunization Services has been awarded an increase of $25,020 to implement activities related to DSHS’s Call-to-Action plan.  The activities will be used for public education, partnerships and to promote the use of reminder/recall systems.  In addition, $72,000 will be added to the immunization base budget to support two new ImmTrac/PICS Outreach Specialist positions.  
• DOW Community Grant- Immunization Services received verbal notification that we will be awarded $5,000 to provide flu shots for Jesse Tree clients through the 2006 Dow Community Grants program.  These clinics will begin providing free flu vaccine to homeless and low income clients toward the end of October.
• Interfaith Caring Ministries Immunization Collaborative - The Space Center Rotary Club donated funding to provide free immunizations for children at the Interfaith Caring Ministries.  The Immunization Services staff held three clinics at that site during August and September and provided a total of 318 immunizations.
•  WIC - The WIC Peer Breastfeeding Counselor program is fully staffed with five Peer Counselors.  Since hiring these Peer Counselors, the rate of breastfeeding among WIC mothers has increased from 54% to 64%.
• Senior Health - The Senior Health Advisory Council met on September 12.  The council reviewed their accomplishments thus far in 2006 (expanded programs in senior centers, Medicare Part D trainings, support of the Senior Health Summit, Walk Across Texas physical activity event, and cooking schools for seniors, and the distribution of Senior Health Resource Guides and Critical Numbers for Seniors card).  The programs are being evaluated by the council and a plan will be developed for 2007 at the next scheduled meeting.
• Breast Cancer Screening Programs (Breast and Cervical Cancer Control Services and D’Feet Breast Cancer) - So far in 2006, 772 women have received breast cancer screening services; of these women, approximately 21% had abnormal screening exams and have received follow-up.   Three breast cancers have been discovered this year.  To celebrate National Breast Cancer Awareness Month, staff from both programs will be providing clinical breast exams and referrals for mammography during October evening clinic hours.
• Robert Wood Johnson Building Community Support for Diabetes Self-Management grant officially ends on October 31.  However, GCHD has asked for an extension to continue the program until the end of the year.  In the past 2 ½ years, training and support has been provided to over 700 individuals, 52 Health Coaches have been trained, and partnerships have been formed with 19 Area Health Education Centers in East and Southeastern Texas.  The curriculum is currently being adapted for the Texas Department of Criminal Justice and the revised curriculum is being translated into Spanish.  The RWJ staff is currently working on the sustainability of program activities.
• STD/HIV- The 1^st Semi-annual STD Report for 2006 shows that GCHD STD/HIV Services has been meeting 82% of the program objectives (compared to 65% in Region 6/5S and 77% at the state level).  GCHD Services staff has developed a “Healthy Relationships” support group that meets twice weekly at the AIDS Coalition for Coastal Texas (ACCT).  The support group now has about 10- 12 persons at each meeting.  In the past month, the staff participated in the Recovery Street Festival and a health fair at Wright Cuney Park.  STD/HIV Services is currently recruiting for the Lead Disease Intervention Specialist position.
• Community Outreach - Community Health Services staff participated in 10 health fairs and community activities in the past month.  Over 600 Galveston County citizens were reached through these community efforts.  Activities included Public Health Preparedness and Fall Prevention for seniors, Immunizations, and an award ceremony for those who took part in the Walk-Across-Texas.  

• Early Childhood Learning Center –The office of Environmental Health Programs met with a group of citizens that had concerns about the La Marque Independent School District’s Early Childhood Learning Center.  The Center is a pre-kindergarten and kindergarten facility.  There were concerns about possible mold, air conditioning problems and other maintenance issues.  In a walk-thru inspection no obvious problems that would impact students’ health were detected and the air conditioning system was in the process of being repaired at the time of the visit.   
• Animal Shelter Update – The staff at the animal shelter continue to receive and house hundreds of animals taken into the shelter each month.  Currently, the shelter is experiencing a staff shortage that has been resolved for the time being by hiring temporary staff while job candidates are interviewed and hired.  In addition to the normal flow of animals, the shelter has also been the recipient of many animals from seizures, owner turn-ins and animals displaced by the Texas City apartment explosion. While the shelter continues to receive a high number of animals, shelter management and Health District executives are currently prioritizing shelter upgrade projects and working on the implementation of these upgrades.  These upgrades, funded by budget savings and the additional funds provided by the Commissioner’s Court in fiscal year 2007, include replacement of the freezer, repairs to the kennel gates, painting of the interior of the shelter, construction of a drop ceiling in the kennel, camera surveillance system, portable radios for the animal control officers, washer and dryer, dishwasher, and lobby furniture.  These upgrades will occur over the next several months.  In addition, the Health District has posted a position to hire an additional animal control officer to assist with the rising citizen calls that we receive on a daily basis within the county. 

• Headstart Program – Clinic outreach to several Galveston County Headstart programs will begin on October 10, 2006. Dr. Harlan “Mark” Guidry will head up this program along with other 4C’s Clinic providers to offer well child check ups, medical and dental referrals and immunization information.  This program offers the 4C’s clinic another great opportunity to serve our Galveston County Children. 
• Galveston Clinic Parking – Within the next month, construction on the parking lot of the Galveston Clinic will begin. During the construction phase, the front entrance will be closed. All patients can enter the building using either the West or East entrances. Notifications will be posted to inform the 4C’s patients and a curator will be provided by the Housing Authority to guide patients.
• Clinic Leadership Team (CLT) - CLT is working on several initiatives, including (1) researching how other FQHC’s evaluate and streamline the registration process, (2) tracking all walk-ins that are coming to the clinic to better identify their needs and to identify potential barriers, (3) developing a process to receive Patient Assistance Program (PAP) medication in La Marque to better track distribution and accountability, and (4) implementing a new software database to track Diabetic patients.
• HRSA Mid Year Project Review – Annually the 4C’s management staff responds to questions from our federal project officer that is used as a “Mid-Year Project Review”.  Once staff has responded to the questions, returned them to the project officer, a conference call is held to review the answers with the project officer to answer any outstanding questions.  The project officer then prepares a written review of our responses, which are to be used in the preparation of our upcoming “non-competing budget period renewal” (FY 07 grant request).  Staff have responded to the questions and a conference call is scheduled for October 3.  The questions are basically the same each year and are to designed to determine if there are any new problems/deficiencies, Notice of Grant Award issues, Audit problems, etc.  This year one question asked us to list the accomplishments/improvement made during the year.  Those cited by staff were:
  
  1. As a result of re-engineering

  1. Average patient per provider is still increasing – 2.2 – 2.6/hr which translates into approximately 150 additional patients per month.

  2. The number of walk-ins seen each day is up over the previous year.

  3. Increased patient satisfaction through the delivery of normal lab results to patients via the Nurse Line.

  • Providers are increasing the usage of PAP and Share the Care thus expanding the availability of patient medications.
  • Increased number of pediatric patients being seen by providers and increased use of RN to see Well Child Visits as authorized under Texas Health Steps.
  • Expanded outreach to Head Start Children through initial physicals and medical/dental referrals for follow up.
  • Increased access for walk-ins in the evening clinics by increasing the number of providers available to see patients.
  • Partnership with Mainland Children’s Partnership whereby they provide pregnancy testing and referral of clients to the Clinic – as a result of the loss of Title XX dollars.
  • Increased Medicaid revenue as a result of increased FQHC rate, increased access and additional Medicaid HMO contracts.
  • Significant increase in Self Pay revenue as a result of changes in the billing process.
  • Market place analysis of provider (MD & Midlevel) done and salaries were adjusted thus improving recruitment and retention of competent staff.
  • Implemented a career ladder and compensation packet for MA’s, LVN’s and RN’s thus improving staff’s ability to support the provider and improved recruitment and retention of competent staff.
  • Staff participated in review of disaster activities/lessons learned from their activities related to Hurricanes Katrina and Rita.  Staff, at the start of hurricane season, participated in planning and staff relocation/emergency contact updates.
  • >Completed an architectural redesign of the Texas City Clinic site.  This redesign is to make the facility more user friendly in the flow of patients, increase access and is a necessary step in the preparation for EMR.  The funding for this project will come from local funding, both governmental and private sources 

• GAAA Operations – Staff schedules have been adjusted to make an additional ambulance available during peak hours to meet surge capacity.
• Staffing Update –There are currently 28 vacant full time positions in the Emergency Medical Services area; however, we currently have one applicant who has drug test results pending, two applicants who have physicals and drug tests scheduled, and three who we are contacting to schedule testing.  We have one part-time EMS employee who wishes to transfer to a full-time position in October.  In addition, there are four applicants who want part time employment and we will be making offers to them this week to work part time providing transfer services. 
• Staff Training - EMS Supervisory staff continue to work with administrative staff to develop resource materials for staff members.   Staff have recently been trained on supervisory expectations while performing their duties.  In addition, supervisory and administrative staff are developing a set of Standard Operating Guidelines to serve as a ready reference for daily operations.

• Health Alert Network (HAN) - Two HAN advisories were distributed to medical professionals on the multi-state outbreak of E. coli 157 H:7 infections in the month of September.  The advisories consisted of the number of cases of illness due to the E. coli 157 H:7 reported to the Centers for Disease Control and Prevention,  multiple states affected, laboratory findings and recall on products that may contain spinach.  As of September 26, 2006, there have been 183 cases, 1 death and 26 states affected.   The number of cases continues to grow but at this time none have been reported in Texas. 
• Trainings - The Health District staff attended a train the trainer course on fit testing for Personal Protective Equipment (PPE) on September 12, 2006 at Department of State Health Services (DSHS) Region 6/5S.  This training will be used to fit test medical professionals in the event of a public health emergency.  All persons that will be fit tested must be medically cleared to wear a respirator.  Epidemiology staff also presented at the core immunization class offered by the Health District’s Immunization Services on September 15, 2006.  Medical community participants received training on vaccine preventable diseases and how to report them to the Health District and DSHS.  
• Health Fair - The Health District participated in the 1^st Annual Celebration Recovery Addiction Festival on September 23, 2006 sponsored by UTMB Centers for Addiction Research.  Galveston County Health District  HIV/STD staff distributed outreach materials and information on sexually transmitted infections, Epidemiology Services educated the public on hepatitis in Galveston County and EMS provided safety information and free blood pressure readings.

• Volunteers - In the month of September, nine volunteers were recruited and placed in various departments throughout the Health District. Of the nine volunteers recruited, three were seniors.  A presentation on Stress Reduction was given on September 7^th to 45 seniors at McKinney Memorial Methodist Church in La Marque. Health District brochures were given to each participant.  On September 13^th, at the Dickinson Senior Center, the Volunteer Coordinator was interviewed by peer reviewers from the National Senior Center Accreditation Office. This was the second phase of the accreditation process that started in October of 2005. During this phase the interviewers are doing site visits and interviewing committee members. The peer reviewers will be making a recommendation for the Dickinson senior center to be accredited by the National Senior Center Accreditation Office in Mesa Arizona.
• Galveston County Emergency Response Collaborative - The Galveston County Emergency Response Collaborative (GCERC) met on September 14^th.  Participants discussed roles and responsibilities in response to bioterrorism in Galveston County.  Participants were able to identify areas where plans could be updated and reviewed the current plan which outlines the public health role in response to such an event.  As a result of this discussion the group decided to further examine the role of healthcare in bioterrorism  preparedness and response activities.
• Health and Medical Focus Group – The Public Health Planner participated in a focus group discussion sponsored by DSHS on September 18^th.  The purpose of the meeting was to assess where we are in planning for public health emergencies and where we need to be.  Other participants in the discussion included staff from UTMB, Harris County Public Health and Environmental Services, Montgomery County United Way, the Gulf Coast Center and the Gulf Coast East Texas Trauma Service Regional Advisory Committee.  Additional focus groups will be held across the state.  The information gleaned from these discussions will be used by the state to target planning efforts.  While it was agreed that progress had been made in many areas, participants identified additional help needed in recruiting medically licensed personnel for medical surge, mass prophylaxis, and mass care and in providing resources and support in the event isolation or quarantine measures are needed.
• Collaboration in Planning – On September 11^th, Public Health Preparedness staff met with planners from other area local health departments to collaborate in planning in event of a large scale disease outbreak in which antibiotics must be dispensed to our populations.  The planners are working to develop a fairly consistent approach to mass dispensing operations and public information resulting in efficient operations and less confusion for the general public.
• SNS Operations Training – Training was held on Strategic National Stockpile (SNS) clinic operations on September 13^th and 16^th.  The class on the 13^th consisted of Health District personnel while the class on the 16^th consisted of Medical Reserve Corps members, Red Cross and students from UT School of Public Health in Houston.  The training focused on how to effectively operate a mass antibiotic dispensing clinic and the roles and responsibilities of staff and volunteers.

• DSHS Triple Zero grant was signed on August 31, 2006 for $314,856.  This grant provides essential public health functions and the funding is the same as the previous year.
• Public Health Preparedness Extension contract budget was signed on August 31, 2006.  The extension included an increase of $183,515 for the Community Preparedness Section.   The additional funding will be used to develop and improve emergency plans, expand epidemiology capacity, improve communications and provide training to staff and volunteers.  New budget is now $592,500 with the contract expiring August 31, 2007.
• DSHS HIV/STD EPI & Surveillance grant was signed on August 31, 2006.  There is no change in funding ($36,063) from the previous year.
• DSHS Immunization grant was signed on August 31, 2006 in the amount of $142,825.  There is no change in funding from the previous year.
• Texas City ISD Cooperative Head Start MOU was signed on August 22, 2006 to allow GCHD to perform onsite physicals for enrolled children.
• Mainland Children’s Partnership Lease Agreement for 2000 Texas Avenue location was signed on August 31, 2006.    The lease commenced on September 1, 2006 and shall end on August 31, 2016.  The rate increased from $1.15 to $1.20 per square foot per month.  However, there was a 700 square foot decrease in the premises.
• SBC Global Services Inc. contract for the call center was signed on August 31, 2006 for the upgrading and integrating GCHD telephone systems for routine and disaster-related purposes.
• College of the Mainland MOU for the Health District to provide required drug screens and blood tests for new nursing students was signed on September 20, 2006.
• Lactation Consultant contract was signed on September 25, 2006 for a year.  The consultant will assist WIC mothers with any difficulties in breastfeeding.
• DSHS Nutritional Service grant for WIC card participation was signed on September 15, 2006.  Administrative funding earned for providing supplemental food instruments, nutritional education and counseling to low-income WIC identified to be at nutritional risk.
• Agreement for a Registered Dietician (RD) was signed on September 25, 2006.  The RD will conduct high risk individual counseling, consultation and nutrition education classes.  Compensation will be paid at the hourly rate of $45.00 and will be limited to no more than 32-hours per month.