A hospitalized Galveston county resident was recently quarantine to a state TB hospital in accordance with the Texas Health & Safety Code procedures when necessary to protect the public’s health from spread of an infectious disease.  In consultation with county attorney, Barry Willey, Dr. Guidry, County Health Authority, completed a notarized medical affidavit regarding the case which was forwarded to the Texas Commissioner of Health for review.  The Commissioner’s designee issued an official concurrence as well as designated the facilities for temporary and long-term quarantine.  Mr. Willey filed necessary documents in local courts and the case which ultimately lead to the necessary court order for quarantine to a state TB hospital.   After a few days of working through logistical issues involving arranging transport, arranging for a deputy to guard the patient, holiday staffing shortages, reluctance to accept the patient by state hospital physicians, and failed communications within state offices, the patient was finally transported 6 days after the court order was executed.   The Health District will receive a bill for the cost of a deputy guard who remained with the patient continuously from the point a temporary order was issued November 17^th  – a total of 12 days.  

The Health District’s participation in a national flu vaccination effort on Election Day was the subject of a press release issued on October 30^th.  The program being conducted in 25 communities across the country known as Vote and Vaccinate is sponsored by the Robert Wood Johnson Foundation.  Media attention was drawn to the local program when the City of Houston cancelled their efforts due to concerns about the legality of the program.  A fundamental difference in the two programs, Houston was giving free shots and the Health District was requiring payment, allowed the District to successfully complete the initiative.  The Health District vaccinated any citizen from any county location, including children.  This campaign successfully vaccinated 502 people.  See the release at http://www.gchd.org/press/2006/10VoteVax.htm.

Epidemiology reports that flu has been confirmed in Houston.  While there are no laboratory confirmed cases of influenza in Galveston County, there are 95 reports of unconfirmed “flu-like illnesses” with consistent symptoms.  As a result of confirmed flu in our proximity and an abundance of vaccine, a news release was issued on November 14^th which stressed, it is not too late for a flu shot for anyone who wants to prevent the flu.  The release is located at http://www.gchd.org/press/2006/11flushots.htm.  A large shipment of flu vaccine was received last week giving the Health District a total of 3,854 doses currently available.  To date, total flu shots given by the Health District are approximately 2,750.

Executive Officers have been working diligently on a challenging 4C’s Budget, as part of its annual FQHC report due in December.  Comparing FY 07 budget to the proposed FY 08 budget (starting in April 2007), total projected Revenue (all sources) will decrease by $119,266 - approximately $85,000 due to loss of HOGG & Morehouse grant funding.  Total revenue from county and federal sources remains unchanged.  The Governing Board will be briefed on environmental factors including the impacts of HMO Medicaid, growing population of uninsured, and access to care barriers.   Other factors include provider productivity, decreases in covered patients, collections and bad debt, operational costs, and the impact of public perceptions.  Based on the projected budget reduction, staff worked to preserve and enhance essential (mission-critical) resources while reducing non-essential operational costs, including a 6.5 FTE workforce reduction and the discontinuation of one non-essential service.  The 4C’s Governing Board will consider the proposed budget at its November meeting.

• Dates for upcoming mammogram screenings can be found on the District’s web site at http://www.gchd.org/chn/dfeet.htm
   
• The three human cases of West Nile virus infections in Galveston County prompted the release of a prevention-based advisory issued to cities in the north county on October 17th, which is posted at http://www.gchd.org/press/2006/10WNV_HlthAdvisory.htm.  The information was covered by the Galveston County Daily News and also mentioned on evening news reports in Houston. 
   
• The Galveston County Daily News published an editorial promoting the District’s overall flu prevention efforts on November 1^st.  In the editorial high risk groups were identified and encouraged to seek out flu shots.  The editorial can be found at http://www.gchd.org/press/2006/11flushotDNews.htm.
   
• Public Information Officer Kurt Koopmann attended a conference on November 13^th, “Keys to an Effective Information Response” with other Public Information Officers from the region.  Part of the regional Cities Readiness Initiative topics included a variety of subjects that will assist in disseminating an accurate and timely message during major events.
   
• Houston’s ABC Channel 13 interviewed Animal Services Manager Kim Schoolcraft on November 27^th.  The station had received a call from a San Leon family with concerns over stray dogs.  Kim stressed that residents should never approach stray animals because they may be dangerous.  She also explained that Animal Services has to prioritize response to calls based on things like aggressiveness of the animal.  The reporter was also informed that a fifth Animal Control Officer has been added to the staff in an effort to address the calls received.  Kurt Koopmann, Public Information Officer was also interviewed early on the 28^th by a reporter from the Houston Chronicle working on the same story.  The same points stressed by Schoolcraft in the earlier interview were shared with the reporter. 

• Health Alert Network (HAN) - On November 3, 2006, an advisory was distributed regarding increased reports of early syphilis in Galveston County residents.  The advisory noted 20 cases from July to October 2006 requiring investigation to identify contacts for treatment and outbreak prevention.  The majority of the cases occurred among adult residents of Texas City and Galveston.  The Health District wants all primary care providers to be on alert for testing, treating, and reporting cases to the Health District's STD/HIV program.  An epidemiology summary has been completed and will be presented to the United Board of Health this month.
   
• Training – On November 7^th and 8^th, the Epidemiology staff made community presentations in Hitchcock and Texas City on the prevention of lead poisoning.  The lead workshops included history, sources, prevention methods, and affects of lead on children. Staff provided a disease reporting in-service to Texas City ISD nurses on November 14, 2006.  The in-service consisted of the “who, what, when, and how” of reporting notifiable conditions and diseases to the Health District and disease surveillance in Galveston County.
   
• Bat Rabies in Galveston County - From January 1, to November 9, 2006, six bats have tested positive for rabies.  The rabid bats were found in Dickinson (1), Kemah (1), Friendswood (1) and League City (3).  This number has increased significantly from the past 5 years (2001 three cases; 2005 one case).  The increase may be due to enhanced media coverage of rabies in bats and specimen submission for testing.   

• Animal Services Advisory Committee – The quarterly meeting was held on November 7, 2006.  The committee heard from a citizen concerned over the current Rules on Animal Control requiring kennels to have a separate entrance into a kennel. A recommendation seeking a variance from that portion of the rule is being presented to the Board as an Action Item. A draft copy of the revised Policy/Order for the Galveston County Animal Services Local Regulations and Rabies Control was provided to the committee members for review and comment.  Update items presented for the good of the committee included:  finalization of the animal fostering procedure, shelter upgrades, staff vacancies and recent hires, and reports on rabid bats as reported in the local media.
   
• Animal Shelter Upgrades- Many upgrade activities are in progress at the shelter including the painting of the interior of the lobby, offices, cat room and dog kennel.  An outdoor run was constructed that will allow dogs to get some exercise and allow potential adopters to socialize with dogs prior to adoption in a quiet area.  Security cameras are also being installed throughout the shelter providing an additional measure of security for the controlled substances on property.  Bid packages have been reviewed and the contract executed for the replacement of the walk-in freezer.  After upgrades are completed, an open house will be planned with invitations to board members and public partners.
   
• National Environmental Laboratory Accreditation Certification - The program requires performance standards for operating environmental labs.  Standards include analytical testing processes and the laboratory accreditation.  The Texas Commission on Environmental Quality will assess our Public Health Lab for accreditation under the NELAC Certification program for drinking water and for our particulate matter-monitoring program.  NELAC compliance requires completion of its application one year prior to the deadline of July 2008 and of a Quality Assurance Manual addressing 23 specific items.
   
• Lake Madeline Update - The Environmental Institute at the University of Houston - Clear Lake recently released their a report on the Lake Madeline Bacteria Study as reported in the Galveston County Daily News. This study was funded and conducted in cooperation with the City of Galveston on the heels of an intensive investigation conducted by the District. This four month study revealed that the Lake does not appear to meet contact recreation standards established by the State of Texas which confirmed the findings of the Health District’s prior investigation.  Based on the study, there is strong evidence that storm sewer discharges are a major source of bacterial contamination.  The District's investigative findings concerning a suspicious discharge from the wastewater treatment plant during a rainfall event was cited as historical data of discharges impacting the health of the Lake.  The report highly recommends that the City complete a detailed investigation of the sanitary sewer collection system that surrounds the Lake, review current operations at the wastewater treatment plant and make the necessary upgrades. 

• Health fairs and community outreach - During the past month, over 430 people have been reached through CHS Outreach activities which have included providing information about STD/HIV, WIC, and immunizations as well as classes on Healthy Eating for the Holidays.   81 immunizations were provided at an immunization outreach school activity and 1,351 flu/ pneumonia shots were given through community outreach efforts. 
   
• The Senior Health Advisory Council met on November 14 to set their priorities and activities for 2007.  These include the expansion of the educational programs in the senior citizen centers, participation in 3 major health fairs or community events and the Walk Across Texas project, piloting a senior newsletter, investigation of funding to continue the Senior Cooking Schools, promotion of the “agency notebooks” via organization websites, and the distribution of the Critical Phone number cards with revisions to include “211” and Medicare Part D information.
   
• Building Community Support for Diabetes Self-Management - November is National Diabetes Month. Posters and educational information is posted in the 4C’s Clinics.  The Diabetes Educator has presented classes on Healthy Eating for the Holidays at four senior citizen centers.  An evaluation of the Spanish diabetes classes at 4C’s revealed that classes would be better attended with a change in date and time. Effective December 1, the classes will be held on Tuesdays from 2- 4 pm in Texas City and Wednesdays from 10 am to 12 noon in Galveston.

• Staffing Update There are currently 27 vacant positions in the Emergency Medical Services area.  We currently have one full-time applicant pending drug tests results, one full-time paramedic who we are conducting reference checks on, one full-time paramedic and one EMT Basic scheduled for testing and we have calls out to three EMT Basics.
   
• Response Record Software – GAAA is using its new automated response record software.  The system, called Sweet Field Data System, is a product of Ortivus, USA.  The software is being used by response personnel to document their EMS responses.  Management will continue to monitor the installation and adjust the configuration for best functionality.  The installation is streamlining data entry and should make collection efforts more efficient.
   
• Medical Director Meets Medic One Supervisors- 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 continued with a meeting of all Medic One Supervisors on November 14, 2006 in the GCHD Environmental Auditorium.  Dr. Rittger met with the supervisors explaining his philosophy in medicine and his vision for the Medic One system.  The group will meet again on January 9, 2007 to continue planning for the coming year.
   
• GAAA Recruits at the Texas EMS Conference – GAAA staff members traveled to Dallas on November 19-22, 2006 to recruit EMS professionals for GAAA operations.  The conference was attended by more than two thousand certified EMS providers.  GAAA made contact with approximately 20 potentially interested and qualified EMS professionals.  Follow up contact will occur during the month of December to arrange screening for those who remain interested in a career in the Galveston County area.

• UTMB Glyburide Research – The UTMB Department of Obstetrics and Gynecology has notified us of a change in the research project on Glyburide that was approved by the 4C’s Governing Board on June 1, 2006.  UTMB requested that we help them recruit patients to participate in the study by giving flyers to patients at the 4C’s Pharmacies if they were taking Glyburide for diabetes.  UTMB has now opened the study to women who are taking other diabetes medications along with Glyburide. 
   
• New Head Start Dental Referrals – Dr. Guidry was contacted and executed an MOU to provide dental services to about 100 Head Start children. The children are located throughout the county and will be seen in both the Texas City and Galveston clinics.  Andrew Carmouche will assure a smooth registration process and Dr. Foster will arrange scheduling and staff to accommodate the expected 100 dental visits between now and mid January. 
   
• Galveston Clinic Parking – For approximately two weeks in November the front entrance was closed and all patients had to enter the building using either the West or East entrances. Although construction is expected to continue through the end of the year, patients are now able to reenter through the front doors. Parking in the front of the building will continue to be limited until the construction is completed.
   
• 4C’s New Appointment Schedule- Approved by the CLT, a new appointment system will be implemented for the January schedule.  The new appointment guideline simplifies the template by entering patients in the system every 20 minutes.  Since no-show rates are high, walk-ins will continue to be accommodated and patients will continue to be seen by providers as soon as possible through the redesign procedures.  Types and Departments are simplified for data collection and reporting. Training for staff was conducted at in-service on November 8, 2006.
   
• Clinic Leadership Team (CLT) - CLT approved several new forms in the last meeting on November 7, 2006 such as: (1) 4C’s Clinic Financial Policy and (2) Acknowledgement of Receipt forms that are used by Registration to inform the patient of financial responsibility, rights and responsibilities and consent of treatment. These forms were revised and combined with other forms to benefit our patients. (3)Authorization to Release Health Care Information is a form that is used by the Medical Records department to give consent to release health information. Patients will receive copies of the forms they sign to better understand their health. (4) CLT also approved a new encounter form that will be implemented in January 2007.   

• Water Pollution Control and Abatement Services Contract with the City of Texas City was signed on October 26, 2006.  The total contract price was $28,011.75.  There was an increase of $1,023.10 from last year which was based on an increase in the city’s population estimate.
   
• Water Pollution Control and Abatement Services Contract with the City of Friendswood was signed on October 26, 2006.  The total contract price was $13,298.66.  There was an increase of $1,248.30 from last year which was based on an increase in the city’s population estimate.
   
• Water Pollution Control and Abatement Services Contract with the City of La Marque was signed on October 26, 2006.  The total contract price was $9,008.35.  There was an increase of $115.05 from last year which was based on an increase in the city’s population estimate.
   
• Water Pollution Control and Abatement Services Contract with the Galveston County Water Control & Improvement District #1 was signed on October 26, 2006.  The total contract price was $7,324.22.  There was an increase of $452.76 from last year which was based on an increase in the city’s population estimate.
   
• GAAA Ambulance Services Contract with Gulf Health Care in Texas City was signed.  The contract expires on September 30, 2008.  The rates for patients being transported into or out of the facility one-way are at Level One the base rate is $195.00 and at Level Two the base rate is $75.00.  There is a $50.00 per hour fee for wait time.  And, a mileage fee of $5.00 per mile for traveling outside of Galveston County.
   
• The Obesity Prevention Project, Overweight and Obesity Prevention Education Classes, was approved by DSHS.  GCHD-WIC will be reimbursed for up to $15,000.00 in expenses incurred between October 1, 2006, and September 30, 2007.
• Addendum to the Galveston County Regional Trunked Radio System Participating Governmental Users Agreement was signed on November 20, 2006 by the COO.  It addresses the purchase of accessories and the cost of radio repairs.
   
• Addendum to the Galveston County Community Action Council Head Start program was signed by the CEO on November 21, 2006.  The purpose of the addendum was to include dental services in the agreement.
   
• The Robert Wood Johnson Diabetes Grant received an extension of two months to December 31, 2006. 
   
• As of this month, all contracts for the new Call Center have been signed by the COO.
   
• Texas Beach Watch grant from the Texas General Land Commission was amended on November 27, 2006 to extend the grant to January 26, 2007 with additional funding of $42,961.88.  The total amount of the grant not to exceed $200,961.88.
   
• Texas Commission on Environmental Quality amended the Bio Watch monitoring grant on November 27, 2006 to include a budget breakdown as part of the contract. The contract amount ($76,000) remains the same.