On October 23rd the Health District hosted a focus group with local stakeholders to discuss issues to consider in pandemic flu planning. The focus group participants included representatives from the Health District, County Emergency Management, Moody Gardens, UTMB, Mainland Medical Center, League City Police and EMS, and the Gulf Coast Center.  Scott Bentley, Steven Leach, and Dr. Ben Raimer from the United Board of Health also participated in the discussion. The group discussed many aspects of pandemic flu planning including communication capabilities, coordination of response activities, disease reporting, priority groups for treatment and vaccination, measures to limit the spread of disease such as quarantine and cancellation of school classes, and developing plans for participating agencies to continue critical functions during a disease outbreak. The information gleaned from this discussion will be used to further develop plans to prepare for and respond to a flu pandemic.  The discussion was facilitated by a representative from the O'Brien's Group, a contractor hired by a collaborative of local health departments to provide training and exercise for pandemic flu preparedness.

This month, Dr. Guidry and Dr. Arceneaux, UTMB Preventive Medicine Resident, met with State Health Department officials, Dr. Janet Lawson & Dr. Beth Ferrell, to discuss the role and relationship between state and local health departments.  Dr. Guidry shared previous lessons-learned as a state official and agreed to provide them with historical information to assist them in their new roles.  Dr. Lawson has assumed the position of Associate Commissioner of Regional and Local Health Services and Dr. Beth Ferrell is the new Regional Director, a state position previously held by Dr. Guidry from 1996-2002.

Dr. Guidry and Susan Studebaker attended a meeting with National Cancer Institute officials, hosted by Dr. James Goodwin (UTMB) to provide support to a UTMB grant, “Stopping the Spread of Hepatitis C.”   The Health District provided a letter of support  to the project goal stating we would provide screening for hepatitis C in the Hispanic population.  This is based on a preliminary finding of a high prevalence rate among a sample of such male residents in the Texas City area.

Dr. Dana Beckham represented the Health District at the UTMB MPH Advisory Board Meeting held on October 18, 2006. The meeting discussed the preparation of students for careers in which they will actively contribute to the protection and promotion of health in human populations. In addition, the committee identified additional sites for public health practice experience and the capstone topics for MPH students.

Water Quality Issues in Galveston County was the focus of the third annual Environmental Summit held at the offices of the Texas City/La Marque Chamber of Commerce.  Participants at the October 19^th Summit were welcomed by Dr. Mark Guidry and provided a short presentation highlighting the major waterways of concern to the Health District.  The Houston – Galveston Area Council, Texas Parks and Wildlife, Galveston Bay Foundation, Galveston Bay Estuary Program, City of Clear Lake Shores, Water Control and Improvement District #1, Texas A & M University and many more were in attendance and provided valuable insight into water quality and control issues in Galveston County.  The summit focused on issues such as public education, sampling efforts, waterways of concern, collaborations and much more.  At the suggestion of Dr. Guidry, an environmental quality advisory committee was created and many of the attendees volunteered to serve on this committee.  Proceedings of this committee will be provided to the Board. 

Dr. Kevin Rittger assumed the position of EMS Medical Director for the Medic One System on October 1, 2006.  Dr. Rittger completed his emergency medicine residency in 1996.  He is currently an associate professor at UTMB and also works in the emergency rooms at UTMB, Mainland Regional Medical Center in Texas City and Brazosport Regional Health System in Lake Jackson.  Since 1998 Dr. Rittger has had extensive experience as a Medical Director for urban and remote medical services around the globe.  He and his family currently reside in League City.  In accepting the position, Dr. Rittger said, "It is an honor and a privilege to serve as Medical Director for the Galveston County Health District’s Medic One System and associated entities.  I am very excited about the future prospects of working with all members of the system to build a model pre-hospital provider program that others either want to emulate or work for!"

• Dates for upcoming mammogram screenings were submitted to the Galveston Daily News and can be found on the District’s web site at http://www.gchd.org/chn/dfeet.htm.
  
• The 2006 Flu Shot Campaign press release was issued on September 29^th.  High risk populations were outlined and dates and locations for upcoming vaccination sites were included in the release found at www.gchd.org/press/2006/09flu.htm. The Galveston Daily News used information in an article about early signs of flu found at www.gchd.org/press/2006/09fluDNews.htm.
  
• The selection of Dr. Kevin Rittger as EMS Medical Director was announced in a press release located at www.gchd.org/press/2006/10MedicOne.htm.
  
• The appointment of new members and the election of officers for the United Board of Health and the 4C’s Governing Board were highlighted in a press release issued on October 6^th.  The information was carried by Guidry E-News and submitted to all other media outlets: www.gchd.org/press/2006/10HealthBoard.htm.
  
• The District’s Office of Public Information contributed to an article published in the Galveston Daily News on October 7^th concerning a rabid bat found in a Friendswood church: www.gchd.org/press/2006/10RabidBatDNews.htm. Epidemiology confirmed there have been two previous bats that tested positive for rabies in Galveston County for the year.
  
• The 3^rd annual Environmental Summit was announced in a press release issued on October 13^th, with the complete announcement at www.gchd.org/press/2006/10EnvirSummit.htm.
  
• An article in the Galveston Daily News on October 10^th concerning a child attacked by a family dog included actions taken by District Animal Control Officers to capture the dog and bring it in for rabies testing.  The story can be found at www.gchd.org/press/2006/10DogAttackDNews.htm. 
  
• The incident involving the dog attack on a child prompted the Galveston Daily News to run a story on the proper way to restrain dogs.  Animal Services ManagerKim Schoolcraft contributed to the article located at www.gchd.org/press/2006/10ChainDogsDNews.htm.

• Community Health Services outreach activities – CHS outreach activities reached over 700 people in October.  Activities included participation at health fairs, presentations at senior citizen centers, and informational sessions at the Jesse Tree Food Fairs.
  
• Immunization Services - To date, 865 immunizations against flu have been given to high-risk individuals.  GCHD has received only a small portion of vaccine ordered but expects to begin seeing larger shipments this week.  The staff is actively preparing for three immunization sites for the VOTE AND VAC campaign on November 7, 2006.  On October 25, Immunization Services received a $5,000 grant from Dow to provide 250 flu shots to Jesse Tree clients who could not otherwise afford to obtain this vaccine.  A voucher system and specific clinics are being established to distribute these flu shots.
  
• Robert Wood Johnson (RWJ) Building Community Supports for Diabetes Self-Management - Staff attended the RWJ Capstone Meeting in Tucson October 18- 20 where they presented outcomes and lessons learned from this 30-month project.  Highlights of the projects include the training of more than 75 Health Coaches (23 from outside of Galveston County), classes and support groups offered in 17 locations, and 704 program participants.  In addition, the Health District received notice that our request for a budget extension was approved and will end on December 31, 2006.
  
• STD/HIV Services has reported an increase in the number of reported cases of early syphilis in Galveston County since July 1, 2006.  Investigation of these cases by STD/HIV and Epidemiology staff is on-going.  In addition, GCHD has 1) enlisted the support of the DSHS Regional office with a request of a one-week re-assignment of a Disease Intervention Specialist to assist in the investigation, 2) issued advisories to appropriate local health providers regarding the proper identification, treatment, and reporting of STDs, 3) re-assigned non-STD personnel to aid in data entry, and 4) is aggressively recruiting qualified persons to fill open positions in STD/HIV Services.

• Health Concerns at Local Hotel - The Health District received an inquiry concerning many health and safety concerns at Galveston’s Flagship Hotel.  The complainant was primarily concerned with general cleanliness and a possible roach infestation.  Consumer Health Services Division along with a building inspector for the City of Galveston made an unannounced inspection on October 16^th in the presence of the hotel’s General Manager. The inspection did not support the complaint.  Concerns that were identified were primarily within the purview of the city which is scheduled to complete a comprehensive annual inspection of the hotel next month.
  
• National Beaches Conference – Audra Ament and Ronnie Schultz attended the National Beaches Conference in Niagra Falls, New York.  This conference is associated with the Texas Beach Watch Program who funded the travel.  Experts from around the United States and beyond provided information pertaining to the health and safety of our nation’s beaches and the people who frequent them.  Main topics of interest focused on the new sampling technologies that will allow for instantaneous sampling results.  In addition, innovative technologies being developed at this time allows for the species-specific identification of bacteriological contamination. 

• Headstart Program- Outreach physical examinations were completed in two local Head Start programs, Texas City and Hitchcock, in October.  77 children received services, including Texas Health Steps exams and lab work for anemia and lead screening.  The services will be billed to Medicaid for the eligible children and to the respective Head Start programs for the others.  Dr. Arceneaux, a resident physician from UTMB, headed the team effort, along with RNs, an MA and other staff from the 4C’s Clinic.  Letters and educational materials will be sent to the children’s parents and guardians.  This effort provides a needed community service and is also a way to showcase 4 C’s pediatric services and invite patients to establish a medical home.   More Head Start physicals will be provided to the Galveston and La Marque Head Start Programs at the clinic sites on November 7^th and 9^th
  
• Galveston Clinic Parking- Major construction has begun in the landscaping phase. They will shut down access to the front of the building in the second or third week of November. 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) 1) Selected employees visited a FQHC clinic in Harris County to gain ideas in efficient clinic operations.  One such idea was how eligibility clerks double check all data information two weeks prior to a patient’s appointment to ensure all required information is complete. 2) A tracking form has been approved to track walk-ins on a daily basis. 3) Medical Records has developed a form for tracking daily activity for every employee and what they are accomplishing. 
  
• TACHC Conference- On October 14th through 18^th several employees attended the 23^rd Annual Texas Association of Community Health Centers conference in Houston.  They were able to attend some of the following sessions: Electronic Health Records- Organizational Needs and Readiness Assessment and Vendor Contracts, State and Federal Health Policy Update, Diabetes Clinical Update, Optimizing Reimbursement and Revenue Streams, Outreach to Special Populations for Family Planning and Women’s Health Services, Behavior/Mental Health Update for Primary Care Providers, Reigniting the Spirit of Teamwork and the Future of Health Care, and Implementing a Successful Capital Campaign. It was a great experience for everyone and opportunity to learn fresh ideas to carry on within our clinics.
  
•  4C’s Counselor - Clinic patients who are currently in counseling or have been referred to the 4 C’s counselor will be temporarily referred to other community resources due to the recent incapacity of the counselor.  The NurseLine staff has been contacting patients to explain the temporary loss of this valuable service and to help patients access the resources they need.  Several outside agencies provide discounted counseling services in the County.

• Response Record Software – GAAA is the final stages of rolling the new automated response record software.  The system, called Sweet Field Data System, is a product of Ortivus, USA.  The software has been configured, staff have been trained, and the software has been deployed to the stations.  The software will be used to document EMS responses.  Management will continue to monitor the installation for functionality.  The installation is expected to streamline data entry and collection and to assist in Quality Assurance activities, and management reporting functions.
  
•  Medical Director Meets Staff- Kevin Rittger, MD, the recently appointed Medical Director for GAAA and Medic One has been busy acquainting himself with the operations of the EMS systems under his direction.  The process started with a “meet the Medical Director” reception on Wednesday, October 4, 2006.  Dr. Rittger met with Medics from GAAA, explaining his philosophy in medicine and his vision for the staff of GAAA and the rest of the Medic One staff.  He continued his day by meeting with other Medic One medics in Texas City.  Dr. Rittger will meet with all of the supervisors in the Medic One system on Tuesday, November 14, 2006 to further discuss his expectations and ideas.
  
•  High School Football Game Stand By – GAAA has been busy on Thursday and Friday evenings this fall providing EMS stand by for sub-varsity and varsity football games for Galveston ISD and Hitchcock ISD.  University Interscholastic League rules require EMS standby for all varsity games.  GAAA crews have been tasked with medical treatment and transport of several student athletes from these contests.
  
•  Staffing Update –There are currently 26 vacant positions in the Emergency Medical Services area.  We currently have an applicant (potentially part-time) who has drug test results pending and two (potentially full-time) applicants who we have scheduled for testing.  In addition to standard recruiting efforts, EMS representatives will recruit heavily at the annual Texas EMS conference to be held in November.
  
• Medic One Committee – The Committee had an open discussion about the need to continue collaboration even if a decision is made to discontinue a part of the agreement that calls for GAAA providing non-emergent transfers on the Mainland.   The group also discussed how to eliminate barriers to full collaboration and the importance of leadership to assure collaboration, necessary for system-wide quality of care, occurs at the ground level.  The group also discussed a recent customer service survey and the importance of working as a committee to develop quality and comprehensive surveys.

• Health Alert Network (HAN) - On October 19, 2006, a HAN advisory was distributed to emergency departments and medical professionals after three human cases of West Nile virus infections were confirmed in Galveston County residents.  The advisory requested medical professionals to consider WNV and other arboviral infections in the differential diagnosis of patients presenting with sudden febrile illness accompanied by neurologic symptoms.  The advisory also recommended specific diagnostic testing of arboviral infections, such as WNV and St. Louis Encephalitis to differentiate between the flaviviruses.
  
•  Pertussis Investigations - For the months of September and October, there have been 2 pertussis cases reported in Galveston County, a 4 month old male infant and a 4 month old female infant.  Both cases were unrelated, investigated and followed up.  All contacts to index case were identified and given prophylaxis by their health care provider.  Pertussis or Whooping cough is a highly communicable vaccine preventable disease that is transmitted from person to person through coughing or sneezing of a person infected with the bacterium.    Since January 2006, there have been 5 cases of pertussis in Galveston County.
  
• Texas City High School - On September 30, 2006, the Health District received a report regarding an incident that involved a student puncturing several others with a sharp object.  The school and Health District investigated the incident and referred the 2 victims that came forward to seek medical attention immediately. 
  
•  Influenza Reporting - The Health District is conducting influenza surveillance in Galveston County during October 2006 through May 2007.  Influenza is not a reportable condition, however, flu surveillance remains the only way to collect data that enables health agencies to prepare for new vaccines, assess the severity of the annual epidemic, and detect new strains of the virus before a pandemic influenza strain can emerge.  Mainland Medical Center, UTMB, Galveston County Coordinated Community Clinics (4C’s), and Galveston County ISD schools are the public health partners participating in the flu surveillance.

• UTMB-Galveston contract with GAAA for Emergency Medical Transportation Services was signed on October 6, 2006 by the COO.   GAAA will provide transfers to inmates of the Texas Department of Criminal Justice (TDCJ), wards of the Texas Youth Commission (TYC), and inmates of the Federal Bureau of Prisons (FBOP).   The compensation is $300 per transfer plus mileage, $7 per mile.
  
• Water Pollution Control and Abatement Services Contract with the City of Santa Fe was signed on October 10, 2006.  The total contract price was $6,826.95.  There was an increase of $620.75 from last year which was based on an increase in the population estimate for the City of Santa Fe.
  
• Contract Renewal with the Managing Pharmacist for the 4C’s clinics, Don DePasqual, R.Ph., dba DePasqual Enterprises was signed on 9/21/06.  The duration of this contract shall be from October 1, 2006 through December 31, 2006. 
  
• Galveston County Community Action Council Head Start Program (which has 5 sites: Crystal Beach, 2 in Galveston, N. Texas City and Dickinson) contract was signed on October 18, 2006.  GCHD will perform developmental assessments, physical examinations, and organize treatment programs for those children enrolled in the Head Start program.
  
•  Landscape Professionals of Texas was awarded a one year contract to perform landscape maintenance at six different GCHD sites.  The cost is $1,145 per month totaling $13,740 for the year.  The cost of services increased $3,830 from last year’s bidder.