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GENESEE COUNTY HEALTH
DEPARTMENT
2012
ANNUAL REPORT
2
TABLE OF CONTENTS
ADMINISTRATIVE STAFF/ MEDICAL CONSULTANT/ BOARD OF HEALTH...………………………………………………...............3
DEPARTMENTAL VISION, MISSION, VALUES…………………..4 GENESEE COUNTY HEALTH DEPARTMENT
ORGANIZATIONAL CHART ………………………………………...5
REPORTS
PUBLIC HEALTH DIRECTOR .............................. ......................6 CHILDREN WITH SPECIAL HEALTH CARE NEEDS .................8
ENVIRONMENTAL HEALTH .....................................................14
NURSING DIVISION ..................................................................24 PUBLIC HEALTH EDUCATION..................................................28
PUBLIC HEALTH EMERGENCY PREPAREDNESS..................32
FINANCE….………………………….………………………………35
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ADMINISTRATIVE STAFF / BOARD OF HEALTH PUBLIC HEALTH DIRECTOR
Paul A. Pettit, MSL
DEPUTY PUBLIC HEALTH / ENVIRONMENTAL HEALTH DIRECTOR
David Whitcroft
ADMINISTRATIVE / BUDGET OFFICER Tammi Ferringer
DIRECTOR OF PATIENT SERVICES
Mary Janet Sahukar, RN, BSN CHILDREN WITH SPECIAL NEEDS DIVISION, Sr. Case Manager
Debbie Johnson
EMERGENCY PREPAREDNESS COORDINATOR
Douglas VanSlyke
PUBLIC HEALTH EDUCATOR
Kristine Brice, CHES
MEDICAL CONSULTANT Bruce Baker, MD
BOARD OF HEALTH
Dr. Irene Burns Dr. Mary Obear
Dr. Alan Barcomb
Ken Oakley Ed DeJaneiro – Legislative Representative
Mary McJury Deanna Page
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GENESEE COUNTY HEALTH DEPARTMENT
Vision
The optimal health, safety, and wellness, are attained and maintained for the citizens of Genesee County
Mission Statement
To build community collaboration in promoting health, preventing disease, protecting the environment, education, surveillance, intervention, and commitment to the principles of public health
practices to achieve optimal health status for the citizens of Genesee County.
Values
Caring
Service
Respect
Integrity
Education
Fellowship
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GENESEE COUNTY LEGISLATURE
LEGAL
COUNSEL
BOARD OF
HEALTH
PUBLIC HEALTH
DIRECTOR
NURSING DIVISION
SUPPORT STAFF DIVISION
ENVIRONMENTAL HEALTH DIVISION
HEALTH EDUCATION
CHILD WITH SPECIAL HEALTH
CARE NEEDS
MEDICAL CONSULTANT
PH EMERGENCY PREPAREDNESS
COORD
CORONERS OFFICE
MEDICAL EXAMINERS
CONTRACTURAL
HUMAN SERVICE COMMITTEE
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PUBLIC HEALTH DIRECTOR The Genesee County Health Department (GCHD) operates a “full service” health department that provides services to the residents of Genesee County in the five core public health areas: prevent epidemics and the spread of disease, protect against environmental hazards and prevent injuries, promote and encourage healthy behaviors, assure the quality and accessibility of health services and to respond to disasters and assist communities in recovery. The mission of the GCHD is to build community collaboration in promoting health, preventing disease, protecting the environment, education, surveillance, intervention, and commitment to the principles of public health practices to achieve optimal health status for the citizens of Genesee County. This mission is carried out through the five core divisions of the department which include: Environmental Health, Public Health Nursing, Children’s with Special Health Care Needs, Emergency Preparedness and Health Education. In carrying out this mission from a fiscally conservative perspective, all divisions are being challenged to think critically on their roles and services and focusing on quality improvement. Looking ahead, 2013 is expected to be filled with both fiscal and programmatic improvements created by efficiencies and streamlined service delivery due to a favorable proposed state budget and the shared service project with Orleans County that began in October of 2012 with the sharing of a Public Health Director and Deputy Public Health Director.
The Shared service project with Orleans County will be the primary driver behind changes during the upcoming year, helping to identify approaches to become more efficient both fiscally and in services delivery. Although fiscal savings will occur, major impacts, especially early on in the project, will result from efficiencies gained from working together and leveraging each other’s strengths to improve services in both counties. Both departments will be participating in a national Robert Wood Johnson shared service learning environment study which will allow for a thorough examination of health department services and help to identify best practices and other areas to work collaboratively with other Counties. This project is the first being conducted in New York State, putting Genesee County in the forefront of shared services and potentially becoming a model for other municipalities seeking to do something similar. This upcoming year will require the completion of an updated Community Health Assessment (CHA). This document is required by public health law to be completed every four years and is the guidance document for public health programming and priority areas to focus on in our community. As detailed in the budget season, this document will be completed in house by the recently added Public Health Educator. This document, which is due November 15th, will be developed collaboratively with the Orleans County Health Department and community partners, including the United Memorial Medical Center. Environmental Health and Public Health Nursing will be focus areas during the shared service project. These divisions, under the direction of currently shared supervisors, will be examining their programs and services with an intimate view of both departments, ultimately moving towards the most efficient service for both Counties. The use of technology will continue to be leveraged in streamlining these services and delivering information to County residents. The Public Health Emergency Preparedness program continues to be flat funded from last year and underfunded considering the mandates and requirements of the grant. Recent
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natural disasters, including several close to home in New York (Irene, Lee, Sandy), continue to keep these preparedness activities in the forefront. In an effort to emphasize the importance of emergency preparedness, the 2013 executive budget proposes to categorize it as a standalone core service for article six reimbursement purposes. Continued changes to the Early Intervention Program are included in the State budget proposals for this year. The restructuring have been in development for almost a full year and are expected to bring relief to municipalities, in the administration and financial cost of the Early Intervention program. The proposed changes would ensure that crucial services are provided to children who need them while bringing Early Intervention into the mainstream of the health care system. The proposals bring insurers to the table, require providers to work with health coverage plans, and reduce unnecessary evaluations that are a burden on children, parents, providers, and local health officials. Although predicted savings may occur, there remain concerns that services may be negatively impacted locally, especially in rural counties as providers may discontinue services as requirements increase and reimbursement stays flat. The department continues to utilize contracts to supplement staff provided on-going service coordination. The individuals are paid only for the time spent performing, New York State defined, “billable services.” The ability to contract for this service eliminates a number of costs associated with a traditional employee. Proposed 2013-2014 reforms to the Preschool Supportive Health Services Program (Pre-K) continue to fall short in providing significant mandate relief in Genesee County. Minor proposed changes will have little impact in Genesee County. NYSAC and NYSACHO continue to support a shift in the fiscal responsibility of the program to the schools as detailed by the 2007 Gubernatorial Task Force. They recommended that fiscal, administrative and programmatic responsibility for the Preschool Supportive Health Services Program be transferred to school districts to ensure fiscal responsibility and greater accountability. I expect 2013 to be an exciting and challenging year full of new opportunities. With the shared service project in full swing, I am looking forward to leading the process of identifying new ways we can become more efficient and successful in the services we provide to our residents. The financial climate will continue to require us to be innovative and streamlined in the ways we deliver services to the residents of the County. Budget reductions, cultural changes and rapidly evolving technology are all issues that will impact the way we can, and will, provide public health services throughout this upcoming year. Working collaboratively with department staff, county management, community and regional partners, I’m confident that we can leverage our strengths and add value to this department and the residents of this County.
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CHILDREN WITH SPECIAL HEALTH CARE NEEDS DIVISION
The Early Intervention Program (EIP) is part of the national Early Intervention Program for infants and toddlers with disabilities and their families. First created by Congress under the Individuals with Disabilities Education Act (IDEA), the EIP is administered by the New York State Department of Health through the Bureau of Early Intervention. To be eligible for services, children must be less than three years of age and have a confirmed disability or established developmental delay, as defined by the State, in one or more of the following areas of development: physical, cognitive, communication, social emotional, and/or adaptive.
The mission of the program is to identify and evaluate as early as possible those infants, and toddlers, whose healthy development is compromised and provide for appropriate intervention to improve both child and family development. This is achieved by a variety of services, including: family education and counseling, home visits, and parent support groups, special instruction, speech therapy, audiology services, occupational therapy, physical therapy, psychological services, service coordination, nutrition services, social work services, vision services, and assistive technology devices.
In 2012, there were 170 referrals to the Early Intervention Program. This number is an increase from previous years. This increase may be due to an increase in referrals from doctors and hospitals (24% of all referrals) and also increase knowledge about the program. Of the 170 children referred to the program in 2012, 64 were not eligible to receive services based on their evaluation or they never had an evaluation completed. This is also an increase over the last few years.
126
150
170
29 36
64
0
20
40
60
80
100
120
140
160
180
Actual 2010 Actual2011 Actual 2012
Early intervention
New Referrals
Ineligible at Evaluation
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In 2012, Genesee County began contracting with independent contractors for ongoing service coordination. Program coordinators have been instructed to continue this effort into 2013. The goal will be to have most; if not all ongoing service coordination performed by contracted staff, as reimbursement for these services is very limited. Following the best practice model provided by New York State, Health Department staff will perform all initial service coordination.
The computerized New York Early Intervention System (NYSEIS) program was phased into each county in New York State throughout 2011. Genesee County adopted the usage of the mandated system on April 1, 2011. The program is utilized to track children enrolled in the program as well as for billing and claiming purposes. However, there continue to be many unresolved issues with the NYEIS program. State Officials are refining the process through the NYEIS program for the counties to claim for State Aid reimbursement. Providers, counties, and New York State Association of County Health Officials (NYSACHO) have continued to address the concerns with the Bureau of Early Intervention.
Genesee County has two Local Early Intervention Coordinating Council (LEICC) meetings per year. This committee includes county officials, Early Intervention providers, Department of Health staff, community agencies, child care providers and parents of children enrolled in the program, both past and present. The continued goal of the LEICC is to have a more active LEICC and to meet quarterly. The mission of the LEICC is to enable Genesee County families with infants and toddlers who have developmental delay(s) and/or disabilities to build and maintain relationships based on trust and respect with service providers to:
A. Identify and access family centered services and supports in the most natural setting
recognizing each family’s resources, priorities, and concerns.
B. Empower each family to advocate for their child(ren) to enhance the quality of their
lives.
Early Intervention’s main focus is on helping families who have a child with a disability or developmental delay. The program is voluntary and parents are involved 100% of the time in the program. When parents were asked how their child and family have benefitted from Early Intervention, here are some of the responses:
“Early Intervention has given us the tools to help my child learn and grow. It has also helped my child express himself and let his knowledge shine. My son went from not talking to knowing shapes, colors and saying complete sentences. Early Intervention has been amazing.”
“Early Intervention is such a blessing. My twins were born at 25 weeks and started early Intervention within a month of coming home from the NICU. Now they only have a mild delay and are making huge gains.”
“We are very grateful for the existence of the Early Intervention program. It is wonderful to have such great resources and people willing to work with our son.”
The story below demonstrates the importance of the Genesee County’s Early Intervention Program. This is a factual story about a child currently enrolled in Genesee County’s Early Intervention program.
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Ava, was born at 24 weeks gestation, weighing 1 lb. 2 oz. Ava remained in the hospital for almost 15 months due to many medical complications. Upon coming home, Early Intervention was called to begin services to help the family with Ava’s delays. Through Early Intervention, Ava has received physical therapy, occupational therapy, speech therapy and special instruction services. The doctors had told the family that they didn’t know when Ava would walk, how long she would have a tracheal tube or when she would eat solid foods (she also has a g-tube for feeding).
Today, Ava, who just turned three, is walking, her tracheal tube has been taken out and she is talking in sentences. Ava’s cognitive and social-emotional skills are age-appropriate. She is eating solid foods.
The family states, “Early intervention has been an integral part of the care for our daughter. Our daughter who was basically laying around for over a year of her life needed help learning what came naturally to most children. As parents, helping Ava to learn those skills is a significant task, especially when you (the parents) don’t have the skills and experiences to teach a special needs child. With the advice and assistance of her therapists, Ava has grown leaps and bounds into a typical 3 year old.”
Ava will continue in the Early Intervention program until the end of August 2013. She will then transition into the Preschool Supportive Health Services Program. It is the family’s hope that Ava will no longer need services by the time she is old enough to enter kindergarten.
PRESCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM
In 1975, Congress passed Public Health Law 94-142 (Education of All Handicapped Children Act), which was the first major law to ensure a public education for children with disabilities, ages five to twenty-one. The intent was to provide each student with a disability a free appropriate public education (FAPE). The Act reauthorized several times since, includes children ages three to five years, and is now codified as the Individuals with Disabilities Education Act (IDEA) (PL 108-446). States are required to establish and implement policies that assure a FAPE to all children with disabilities.
The Preschool Supportive Health Services Program is a mandated partnership between the Genesee County and local school districts to provide services for children ages three to five years of age who have a disability or exhibit delays in development, which affect their learning. The purpose of this program is to maximize a child’s developmental and educational potential prior to the start of kindergarten. Services include, but are not limited to educational and physical evaluations, transportation, special education teacher services, physical therapy, speech therapy and occupational therapy. Local School Districts guide families through the program while Genesee County and the New York State Education Department share the cost of the educational services.
Section 1903 (C) of the Social Security Act permits payment of certain Medicaid-covered services furnished to children with disabilities if those services are included in an Individualized Education Plan (IEP). Currently, in New York State, Medicaid-covered services for students with an IEP include:
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Physical Therapy Occupational Therapy Speech Therapy Psychological Evaluations Psychological Counseling Skilled Nursing Medical Evaluations Medical Specialist Evaluations Audiological Evaluations Special Transportation
Genesee County is responsible for contracting with service providers and transporters. Tuition rates, multidisciplinary evaluation rates and Itinerant Teacher rates are determined by New York State, while County Officials determine related services’ rates. The cost of transportation is approved through a bidding process in accordance with the provisions of the general municipal law. The County is reimbursed by the state 59.5% minus any Medicaid payment on eligible children for services and transportation expenditures. The county also receives seventy-five dollars per child for administrative costs. School districts are reimbursed for each child referred to the Committees on Preschool Special Education (CPSE) in their school district. If an individual school district’s costs exceed the federal allocation, and is approved by the New York State Commissioner of Education, the County is then responsible for the additional cost incurred by the district. The County would then receive 59.5% reimbursement from New York State for CPSE administrative costs.
206 224
189
41 42 32
131
193 178
60 60 45
20 20 9
0
50
100
150
200
250
Actual 2010-2011 Actual 2011-2012 Currently 2012-2013
Preschool Supportive Health Services Program
Program Census Special Education Classroom
Related Services Special Ed. Itinerant Teacher
1:1 Aides
12
Genesee County contracts with three Municipal Representatives, who attend all Committee on Preschool Special Education (CPSE) meetings held for children in the Genesee County Preschool Supportive Health Services. The Municipal Representatives have continued to be assertive in making sure the school district’s CPSE and providers of services adhere to State Education regulations. One year ago, there were 19 1:1 aides for children in the Preschool Supportive Health Services Program. Today, there are only 9 1:1 aides, with two aides being only part-time aides. All of the efforts put forth by the county and CPSEs have resulted in reduced spending in the Preschool Supportive Health Services program. Below are some specific statistics showing reduced spending:
Program Year Amount paid for services, evals. and transportation
January 2011- December 2011 $2,851,580.91
January 2012 -December 2012 $2,415,897.90
Difference of $ 435,683.01
Month Average Amount spent per child
December 2011 $ 1102.37
December 2012 $873.65
Difference of $228/child
Following an Administrative review of regional service rates, Genesee County has reduced its related service rates to providers by approximately two percent. An initial fear of losing program providers was eliminated after all providers agreed to renew their contracts thru the
39%
14% 12%
9%
8.50%
5.50%
4.60% 4%
4%
Percent of Children in Preschool Supportive Health Services Program by
School District for School Year 2011-2012
Batavia
LeRoy
Byron Bergen
Alexander
Pembroke
Elba
Pavilion
Oakfield Alabama
Akron, Alden, Attica
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2012-13 school year. Program Administrators initially observed a hesitation to renew by a small hand full of providers. Sue Chatley, Sr. Financial Clerk, has been working diligently on claiming Medicaid services and making sure Genesee County has all the necessary paperwork on file for Medicaid. Genesee County is looking at all Medicaid requirements to make sure we are maximizing our Medicaid reimbursement. Families of children enrolled in the Preschool Supportive Health Services Program were asked what the program has meant to them and how their child has benefitted from the program. Some of the responses were as follows: “Without the program we wouldn’t have the wonderful little girl we do. They (the preschool) have helped her more than I can say.” “The program has done countless wonderful things for our daughter, we couldn’t be happier.” “My daughter has benefitted from the preschool program in many ways. Her speech is the best improvement. She also has improved with her social skills and loves playing with friends in her age group. My daughter is truly in a better place in her life due to preschool.” CHILDREN WITH SPEICAL HEALTH CARE NEEDS
This program is an informational, referral and advocacy program for children from birth to 21 years of age who may require health or related services of a type or amount beyond that typically required by children. Program assistance does not require eligibility or fees in order to obtain services. Case Management is a free service under CSHCN, offering outreach and referral to connect families with appropriate services. In 2012, this grant funded program was contracted out to Lake Plains Community Care Network. Supervision of the program was done by Genesee County Department of Health. Below is the number of referrals from the last three years. There was a decrease in referrals for 2012. One reason for the decrease may be due to not enough families knowing about the program. As of January 1, 2013, Genesee County Health Department will supervise and run the program. The new Health Educator will be responsible for the services provided in the grant.
27
50
15
0
10
20
30
40
50
60
Referrals
CSHCN
2010
2011
2012
14
ENVIRONMENTAL HEALTH
The Environmental Health Division is a small highly efficient group of field agents whom operate within the County to provide direct service to the citizens of Genesee County and the State of New York. Their responsibilities are diverse and broad covering those areas listed below: Permitted Facilities (plan review, enforcement, inspection)
Food Service Establishments (Restaurants, caterers, mobile food vendors) Temporary Food Service Establishments Temporary Residence (Motels/Hotels) Children’s Camps Campgrounds Migrant Labor Camps Manufactured Home Parks Swimming Pools Bathing Beaches Agricultural Fairgrounds Mass Gatherings Realty Subdivisions Recreational Aquatic Spray Grounds Community Health and Safety Programs
Clean Indoor Air Act (investigation and enforcement) ATUPA (Adolescence Tobacco Use Prevention Act) (compliance and enforcement) Public Water Supplies (compliance monitoring, plan review and enforcement) Individual Water Supplies (testing by request, consultation re: siting and treatment) Individual Sewage Disposal (permitting, complaint investigation and enforcements) Rabies (animal bite investigation, post-exposure rabies prophylaxis, anti-rabies free immunization clinics) West Nile Virus Other Vector Borne Disease (Monkey pox, EEE, etc.) Residential Lead (Environmental Investigation of Children with Elevated Blood Lead Levels >15) Public Health Nuisances (Rodents, Bedbugs, Garbage) Health Communities Capacity Building 2012 proved to be especially challenging with the impact of the fiscal cuts that necessitated new efficiencies due to the loss of three full time field staff and the division’s full time clerical support. The addition of a brilliant part-time team member as clerical support, the inclusion of another gifted individual as summer field support and the use of technology has allowed the division to meet all its obligations to the State of New York and Genesee County. In addition to the activities reported in the following charts and graphs, members of the division also delivered enhanced service to the community in a number of program areas. Environmental personnel developed and researched data on individual water supply and on-site waste water systems that has been used in a Small Cities Block Grant Application. If successful, this grant will provide a significant source of funding for those home owners in
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Genesee County that need to improve those basic public health necessities. (Grants to be announced early 2013) Team members attended numerous community events to outreach and educate the public on issues of Public Health concern that went beyond Environmental Health’s programmatic core. Team members worked in cooperation with New York State DOH, New York State DEC and the E.P.A. to perform enhanced environmental sample collection in and around the Lehigh Valley Derailment Super Fund Site in LeRoy in conjunction with the Conversion Disorder Incident at LeRoy Central School in early 2012. Environmental staff did enhanced investigation of the sale of “Bath Salts” and synthetic Cannabinoids in the community; to aid the Board of Health in its look at the issue as a Public Health Nuisance. The findings have been shared with law enforcement in the prosecution of the owners of the 420 Head Shop.
Genesee County Environmental Health Department
Abby Diegelman Thomas Sacco
Sarah Balduf Jessica Zaremski
Alabama Oakfield Elba Byron Bergen
14013 14125 14058 14422 14416
Pembroke Batavia Stafford Leroy
14143
14036 14020 14482
E 14056
Darien Alexander Bethany Pavilion
14040 14525
Director Environmental Health : David G. Whitcroft
Health Director: Paul Petitt
14005 14054
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GENESEE COUNTY PERMITTED FACILITIES
Genesee County Onsite Wastewater Treatment System Permits
Permit by Town New
New Engineered Replace
Replace Engineered 2012 Total 2011 Total
Alabama
2 2 1 Alexander
1
1 2 6
Batavia 4 4 6 3 17 7 Bergen 1
1 1 3 3
Bethany
1
1 2
Byron
2 2 1 Darien
3
2 5 3
Elba
1
1 3 Leroy 3
1 1 5 11
Oakfield 1
1 2 0 Pavilion
1 1 1 3 3
Pembroke
3 2 2 7 11 Stafford 1
1 4 6 5
Totals 10 12 14 20 56 56
2012 Electronic Health Information Portal System Statistics (eHIPS)* OPERATION TYPE
NON-FOOD Permits Inspects PHH** cited
Uncorrected PHH Complaints
Unresolved Complaints
Agricultural Fairgrounds 1 1 0 0 0 0
Bathing Beaches 3 4 0 0 1 0
Campgrounds 8 8 1 0 0 0
Children's Camps 3 6 0 0 0 0
Migrant Farmworker Housing 10 19 0 0 0 0
Mobile Home Parks 21 22 2 0 6 0
Swimming Pools 32 39 8 0 3 0
Recreational Aquatic Spray Ground 1 1 1 0 0 0
Temporary Residences 16 19 2 0 3 0
Total Non-Food 95 119 14 0 13 0
FOOD
High Risk 90 176 88 0 13 0
Medium Risk 235 202 82 0 18 0
Low Risk 28 26 2 0 0 0
Mobile 55 51 5 0 1 0
Temporary 175 174 0 0 0 0
Total Food 583 629 177 0 32 0
Grand Total 678 748 191 0 45 0
17
0
2
4
6
8
10
12
14
16
18
New
New Engineered
Replace
Replace Engineered
2012 Total
324
210
74
77
17 22
Total Water Samples 2012
Public Samples
Private Samples
Special Survey Samples
New Districts
DWE/Special Samples
Beach Samples
18
147
45
77
5
40 2
Public Water Samples By Type 2012
Community PWSMonitoring
Community PWSSurveillance
Non-Community PWS
Non-Public
Nitrates
161
26
10 13
Private Water Samples By Type 2012
Coliform/E-coli
Nitrates
Nitrites
Metals
1391 DOGS
940 Cats
9 Ferrets
Anti-Rabies Immunization Clinics 2012
1391 DOGS
940 Cats
9 Ferrets
Anti-Rabies Immunization Clinics 2012
19
0
5
10
15
20
25
Total PostExposure
Treatment
Bat Exposure RaccoonExposure
SkunkExposure
Cat Exposure OpossumExposure
2012 Post Exposure Treatments
0
50
100
150
200
Incident Reports 2012
20
0
5
10
15
20
25
30
Raccoons Skunks Cats Dogs Bats Bovines
Specimens Submitted 2012
Negative Positive Untestable
0
2
4
6
8
10
12
14
CIAA Waivers Complaint Investigations
Clean Indoor Air Act (CIAA) 2012
Total Number
Number Inspected
Notice of Violation Issued
21
52
54
56
58
60
62
64
66
68
Partial Compliance Checks Compliance Checks with aMinor
Adolescent Tobacco Use Prevention Act (ATUPA) Compliance Checks 2012
Sales/Violations
Total Facilities
0
0.5
1
1.5
2
2.5
>= 20 15-19 10-14
Number of Children Aged Birth to Less
Than Eighteen Years
Confirmed Blood Lead Levels in ug/dl
Lead Investigation Referrals 2012
22
Lead Investigations of Dwelling Units 2012
Dwellings
Assessed
Dwellings with Lead
Hazard Found
Notice and Demand
Sent1
Investigations
Closed2
Primary 3 3 3 8
Primary Relocation 2 0 0 2
Secondary 0 0 0 0
Total 5 3 3 10
1-Whenever a condition conducive to lead poisoning exists in a dwelling, a written Notice and Demand is issued. 2- Includes Lead Investigation Referrals from previous years.
SUMMARY OF ENFORCEMENTS
$1,700
$3,650
$0 $200
$580 $600
$0 $0 $0 $200
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
Total Fines 2012
Total Fine Amount
23
ATUPA, 5
FSE, 28
MHP, 1
Swimming Pools, 2
Campgrounds, 1
Sanitary Code, 2
MFH, 0 CIAA, 2
Lead, 0
PWS, 3
Total Notice of Violations Issued 2012
24
PUBLIC HEALTH NURSING
The Licensed Home Care Services Agency (LHCSA) continues to provide Public Health Nursing Services in the client’s home when deemed necessary. Services provided to Genesee County residents in 2012 included visits related to Maternal Child Health, Elevated Blood Lead Levels, and Mantoux (PPD) Testing.
Representatives from the New York State Department of Health performed an evaluation of the Licensed Home Care Services Agency in Genesee County in February, 2012. Minor adjustments to the program were recommended, and a plan of corrections was submitted and accepted. Investigations/ Reportable Diseases
In 2012, the Community Health Nurses investigated and dismissed 82 cases of communicable disease and reviewed and dismissed 75 laboratory reports. A total of 157 cases were reviewed or investigated. Services
The following lists the numbers of various services provided by the nurses, either at the Health Department or in the home:
Perinatal Hepatitis B Cases 15
Maternal Child Health Visits 33
Elevated Blood Lead Levels (5 and above)
6
HIV testing, pre/post test counseling 108
Pre- and Post Exposure Rabies Vaccines 76
STD testing/treatment 151
TB Skin Tests 76
Lead Poisoning Prevention Program
The Community Health Nurses of the Genesee County Health Department provide Lead Prevention Services for children under seven years of age, with Blood Lead Levels (BLL) of 5 ug/dl per Federal and New York State follow-up requirements. Letters are sent on a monthly basis to parents, as their children attain the ages of one and two, to remind them to obtain lead tests for their children. There was one child in 2012 with a BLL greater than 45, who required chelation therapy.
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Sexually Transmitted Disease/HIV Testing
The Genesee County Health Department provides clinical services weekly for gonorrhea, chlamydia, and syphilis testing and treatment. The contracted Nurse Practitioner provides assessment, diagnosis, and treatment with the assistance of the Community Health Nurses. The New York State Department of Health has approved the Department’s application to provide rapid HIV testing. That process is currently being developed. PPD Skin Testing Mantoux clinics are offered twice per month, with special accommodations made outside of scheduled times based upon client needs. Individuals with positive results are followed at the monthly “chest clinic”, and treated prophylactically as deemed necessary by the contracted Pulmonologist.
Immunizations
Immunization clinics are offered twice per month, with a time slot available on a weekly basis to accommodate those individuals who are unable to attend the bi-monthly clinic. In addition, special appointments are provided to fulfill the needs of the client. Children’s Immunizations
The Health Department receives free vaccine from the Federal Government and New York State, through the Vaccine for Children (VFC) Program to immunize children under 19 years of age who meet certain criteria. Effective October 1, 2012, the eligibility requirements for providing vaccine through the NYS Vaccine program became more stringent. The Health Department is no longer able to provide vaccines through this program to children who are covered by insurance, even if their physician does not have the vaccine or if they do not meet school attendance requirements. The Vaccine for Children’s Program provided vaccines to 148 children in 2012. Listed below is the number of immunizations given free to children at the Health Department:
Children’s Immunizations
DTap 9
Hepatitis A 20
Hepatitis B 5
Hep B/IP/DTap 10
HIB (Haemophilus Influenza Disease 12
Humanpapillomavirus (HPV) 9
Influenza 32
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MMR (Measles, Mumps, Rubella) 50
Menactra (Meningitis) 13
Pneumonia 5
Polio 10
Prevnar 14
Td 18
Tdap 27
Varivax (Chickenpox) 19
Adult Immunization
Vaccines for adults involve a charge that includes the cost of the vaccine plus a small administration fee. The Genesee County Health Department is currently engaged in contracts with Excellus, Univera and MVP for specified vaccinations and is in the process of developing a contract with Independent Health. Medicare Part D (pharmacy) can also be billed for the Zostavax (shingles) vaccine for individuals 65 years of age or older.
The Health Department had been able to provide free Tdap (Tetanus, Diphtheria and Pertussis) vaccine to adults, through the AmeriCares Program. Vaccination with Tdap is especially important for families and caregivers of infants who are too young to be vaccinated.
The Health Department provided the following vaccines to 290 adults in 2012.
Hepatitis A 13
Hepatitis B 46
Humanpapillomavirus (HPV) 8
Influenza 10
MMR (Measles, Mumps, Rubella) 14
Menactra (Meningitis) 2
Post-exposure Rabies 76
Pre-exposure Rabies 54
Tdap 46
Twinrix (Hepatitis A & B) 6
Varivax (Chickenpox) 3
Zoster (Shingles 67
27
The Genesee County Health Department did not offer public influenza clinics in 2012 due to the number of public and private sites, including pharmacies, available to the community for individuals with insurance. However, a limited supply of vaccine was available to those individuals who did not have insurance or the ability to pay.
LeRoy Tics
In 2012, the surveillance of the LeRoy Tic situation continued involving national media and public and private communication. This effort required an appreciable amount of time from the entire department in conjunction with the New York State Department of Health and the involved school officials. A determination of Mass Hysteria was made in April, 2012.
Smilemobile
The Smilemobile returned to Genesee County in 2012 with 310 visits related to diagnosis, prevention, and treatment. The Health Department collaborates with Eastman Dental Center and various county agencies to provide services to children of Genesee County who might otherwise be deprived of dental care. The Health Department distributes flyers to school districts, Medicaid recipients, and various organizations and schedules initial appointments prior to their arrival. The Smilemobile accepts all insurances, including Medicaid, and provides complete dental care for children ages 1-18 who are not currently receiving care form another dentist. The aim is to reach every qualified child in Genesee County who can benefit from this service. Outreach and Education
The Health Department has not had a Public Health Educator for many years. However, outreach and education to the community is of vital importance. In lieu of a dedicated employee to perform this function, the Public Health Division, in conjunction with the other divisions, has attempted to fill this void through news releases and presentations as well as distribution of information at health fairs and other community events. For the past ten years, each of the department’s major program units has taken part in educating the community. Staff attends outreach events, provides in-services, distributes educational materials, addresses health-related complaints, and promotes health and wellness topics through various media outlets.
Health Education Programming
In 2012, Health Department staff attended several outreach events including the Genesee County Fair, Genesee County Youth Bureau’s Family Fun Night, Genesee County Expo, Safe Summer Children’s Carnival, and various health fairs. The Community Health Nurses (CHNs), Emergency Preparedness Coordinator, and a Seasonal Public Health Technician provided in-services to community members, county employees, and United Memorial Center (UMMC) staff. Training topics included blood borne pathogens, functional needs sheltering, communicable disease prevention, lead poisoning prevention, and proper rabies post- exposure protocols. Material distribution has been highly utilized to educate the public over the years.
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PUBLIC HEALTH EDUCATION
The CHNs routinely distribute information pertaining to Maternal and Child Health, Lead Poisoning Prevention, and Immunization. Materials are most often distributed to the public during outreach events, monthly mailings, or in-service trainings.
General Health Education
In absence of a position dedicated primarily to public health education, time has been allowed for required duties only. For many years, the department has maintained a number of connections with physicians, community organizations, and not-for-profit agencies to promote wellness and public clinics. Currently, the department is involved with the Genesee County Interagency Council, WNY Healthy Lifestyles Coalition, Healthy Families & Children Coalition, and Office for the Aging: Falls Prevention Coalition.
The Health Department promotes its services, as well as wellness related topics via the department’s website, Batavia Daily newspaper, Time Warner Cable’s community calendar, Facebook, and Craigslist. A public health column is also published twice per month. Due to the onset of the pilot project with Orleans County, which began in late 2012, the column is now entitled the “Genesee and Orleans County Health Departments Public Health Column.” The department joined the social media outlet, Facebook in mid-2012, the department’s page is entitled “Genesee County Health Department”. Since social media is becoming a significant source to receive information, it is a perfect venue to promote our public clinics, and other topical health information.
The division is expected to prosper over the next several years with the reestablishment of the Public Health Educator (PHE) position in January 2013. The PHE applied for, and was granted, a Certified Health Education Specialist (CHES) certification through the National Commission for Health education Credentialing (NCHEC). Having a CHES certification is indicative of professional competency. The PHE will continually work to obtain a Master Certified Health Education Specialist (MCHES) certification during the next five years, after which time the PHE will be eligible to take the MCHES exam.
The educator will maintain, develop, consult, and encourage links with various community organizations, businesses, and not-for-profit agencies to promote wellness and services provided by the Genesee County Health Department. The PHE will also expand on outreach activities and in-services, develop of wellness programs, write grants, mentor interns, and fulfill state mandates. Collaboration with Orleans County’s PHE will also be utilized when appropriate.
Social media outlets will continue to be utilized and explored in order to promote the services our department offers, as well as health related information. The PHE will also work diligently to increase educational opportunities that focus on the categories lacking in the below graphs.
The following pie-graphs on the next few pages breakdown educational materials distributed, in-services conducted, and a combination of both. The pie-graphs are composed of various health-related categories. The uneven distribution among the categories is due largely to funding sources and time constraints. The categories are listed from least to most abundant.
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Materials Distributed
Mental Health
Nutrition
Communicable Disease
Maternal/Perinatal
Child Health
Healthy Communities
Family Planning
Chronic Disease
Rabies/EnvironmentalIssues
Dental
STD/HIV
InjuryPrevention/EmergencyPreparednessImmunization
Lead
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Education and Outreach
Dental
Family Planning
Nutrition
Mental Health
Chronic Disease
Healthy Communities
Communicable Disease
Injury Prevention/EmergencyPreparedness
STD/HIV
Child Health
Maternal/Perinatal
Lead
Immunization
Rabies/Environmental Issues
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Health Education Total Hours
Mental Health
Nutrition
Family Planning
Chronic Disease
Child Health
Dental
Communicable Disease
Healthy Communities
STD/HIV
Maternal/Perinatal
Injury Prevention/EmergencyPreparedness
Rabies/Environmental Issues
Lead
Immunization
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PUBLIC HEALTH EMERGENCY PREPAREDNESS
The Genesee County Public Health Emergency Preparedness Program is a grant-funded program, which is responsible for coordinating efforts to fulfill NYS DOH Deliverable requirements. Deliverables are a list of tasks to be completed on a quarterly basis, originating from the Center for Disease Control and Prevention (CDC), which developed 15 capabilities to serve as national public health preparedness standards (see http://www.cdc.gov/phpr/capabilities/). 2012 program highlights include:
PLANNING
o The overall score for the Strategic National Stockpile (SNS) plan was a 94.
(Initially this was to have been developed through a consultant working
conjunctly with Emergency Management. However the “cookie cutter” material
that was delivered, that did not fit uniqueness’s relative to “Our” county.) The
weighted score was derived by a Technical Assistance Review (TAR) tool
completed by the LHD and graded by NYSDOH based on CDC criteria. The
TAR is a matrix of sections of targeted checklists requiring verification and
documentation in order to achieve the established credit. The plan requires
yearly updates in as well as incorporation of reviewer improvement comments.
Collaboration and cooperation from multiple county departments and agencies
are pursued in its ongoing development. Additionally, updates to other plans
such as the Chempack and Medical Countermeasures (MCM) were completed.
EXERCISES
o On December 5, 2012 the entire Health Department conducted a Medical
Countermeasure Point of Dispensing Exercise (POD) at Genesee Community
College. Assistance from of agencies such as Office of Emergency
Management, Information Technology, Orleans County Health, GCC Nursing
Program, its faculty and students, and volunteers, allowed the PHEP Program to
test its operational plan (a deliverable requirement). The Full Scale Exercise was
based on a CDC scenario of a medical countermeasure of an Anthrax dispersal.
A formal document was drafted, called an After Action Report, detailing the
operation along with the strengths and areas for improvement, so enhancements
can be made of future events. The Health staff with limited resources did a
remarkable job in obtaining a patient throughput of nearly 250 patients per hour.
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COMMUNITY OUTREACH
o In addition to the ReadyGenesee website, a FaceBook page has been
created to promote Preparedness and notifications. During periods of
heighten concern, information can be and has been, published in order to
facilitate delivery of pertinent, factual messages to the community.
o As I serve as the Health Departments representative to the Youth Bureau’s
Board of Directors, I was able to lend assistance in the bureaus’ Youth
Leadership Program. This program was recently accepted by Genesee
Community College for college credit, for junior and senior high school
students.
o I also regularly attend the Fire Advisory Board and Emergency Medical
Services Councils as a coordinator member and provide updates from public
health and assist with training needs.
VOLUNTEER’s
o A cooperative arrangement between the Health Department and the Office
For the Aging provides utilization of the RSVP volunteers to assist at many
functions such as Points of Dispensing (POD’s) exercises.
o ServNY is a New York State Volunteer database that is comprised of local
volunteers (mostly with a health orientated background) that are willing to
assist in times of need. Individuals are screened and credentialed through
NYS and when deployed as a State request, they fall under the State’s
workman’s compensation insurance. The current rooster is roughly 42 (with a
number of them belonging to multiple counties).
REGIONAL PARTNERSHIPS
o I represent Genesee County Public Health Emergency Preparedness through
a workgroup comprised of my peers within the western eight counties,
through the Western New York Public Health Alliance Workgroup.
Additionally I helped to organize a sub-workgroup, made up of rural counties
to address deliverables and concerns unique to our communities.
o Together with Tim Yaeger (Director of Emergency Management), we
participate as members of the WNY Incident Management Team (WNYIMT).
This group regularly trains and deploys to numerous events throughout the
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state. Including the most recent, deployment to assist in the management of
localities hit by Hurricane Sandy. Membership to this organization has
brought a tremendous amount of education and experience to assist in our
county’s planning and response efforts.
FUTURE GOALS
o Continued collaboration with county resources. Over the course of the past
year there has been a change in some of the leadership. One of my goals is
to address these new members and assist in bringing them up to speed.
o Expanding the roll out of the Special Needs Shelter training that was initiated
last year to remainder of the county, utilizing lessons learned (where
applicable) from hurricanes Irene, Lee and Sandy. Paving the way towards a
functional exercise to test our capabilities and reveal areas for improvement.
o Implementing an inventory tracking system for the emergency response
cache of equipment. This will be needed not only to track the material but to
ensure required maintenance and inspections are up to date when items are
needed.
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2012 FINCIAL REPORT
SUMMARY OF HEALTH FINANCE
Appropriation By Object Actual 2011 Actual 2012 Adopted 2013
Salary 934,503 721,856 770,494
Equipment 1,497 - 10,000
Contractual 4,440,291 4,017,660 4,289,147
Fringe 377,735 308,129 365,882
Total Appropriation 5,754,026 5,047,70 5,426,523
Revenue 3,904,718 3,574,343 3,758,696
Net County Support $ 1,849,308 $ 1,473,301 $ 1,667,827
ANNUAL FULL TIME EQUIVALENT
DEPARTMENT INCOME
DEPARTMENT INCOME
Note: The data utilized in this chart excludes all contracted services or FTE of County Coroners.
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Department Income
Adopted Budget Actual
PRESCHOOL SUPPORTIVE HEALTH SERVICES FY 2012 FY 2012
Medicaid $ (29,000) $ 313,886
ADMINISTRATION
Misc Fees $ - $ 342
NURSING
Disease Control $ 75,000 $ 53,290
Moms $ - $ -
$ 75,000 $ 53,290
ENVIRONMENTAL HEALTH
Anti Rabies Clinics $ 5,000 $ 5,060
Comm Sanitation & Food $ 80,000 $ 71,665
Private Water $ 8,000 $ 9,497
Sewage $ 35,000 $ 32,925
Fines $ 3,200 $ 4,955
Realty Subdivisions $ 160 $ 50
Public Water Sample $ 7,000 $ 11,721
ATUPA Fines $ 1,500 $ 1,700
CIAA Fees $ - $ -
$ 139,860 $ 137,572
EARLY INTERVENTION
Insurance $ 30,000 $ 34,670
Medicaid $ 626,400 $ 363,099
Medicaid Admin $ 83,217 $ 39,404
$ 739,617 $ 437,173
HOME CARE
Medicare $ - $ (2,112.44)
Medicaid $ - $ (3,925.47)
$ - $ (6,037.91)
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STATE & FEDERAL AID
Adopted Actual
FY 2012 FY 2012
STATE AID
Preschool $ 1,611,140 $ 1,637,634
GPHW – Article 6 $ 602,956 $ 549,718
NYS COLA Awards $ 7,500 $ 10,484
Tobacco Enforcement $ 35,000 $ 30,353
Water Enhancement $ 87,400 $ 85,050
Rabies Reimbursement $ 23,000 $ 4,761
Early Intervention Services $ 276,164 $ 132,039
$ 2,645,160 $ 2,450,070
FEDERAL AID
PH Emergency Preparedness $ 65,000 $ 60,067
Lead Poisoning Prevention $ 38,360 $ 39,009
Immunization $ 30,000 $ 29,507
EI Admin $ 41,923 $ 41,168
CSHCN $ 18,242 $ 18,249
$ 193,525 $ 187,999
2012 FUNDING DISTRIBUTION
Sales, Departmental
Income, $925,477 , 26%
Sales, State Aid,
$2,450,070 , 69%
Sales, Federal ,
$187,999 , 5%
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EXPENDITURES
Adopted Actual
FY 2012 FY 2012
MEDICAL EXAMINER & CORONER
Salary $ 17,475 $ 12,750
Equipment $ - $ -
Contractual $ 74,920 $ 80,827
Fringe $ 2,406 $ 2,961
TOTAL ME & CORONER $ 94,801 $ 96,538
PRESCHOOL SUPPORTIVE HEALTH SERVICES
Salary $ - $ -
Equipment $ - $ -
Contractual $ 2,714,363 $ 2,898,651
Fringe $ - $ -
TOTAL PRESCHOOL SUPPORTIVE HEALTH $ 2,714,363 $ 2,898,651
PUBLIC HEALTH
Salary $ 665,137 $ 630,099
Equipment $ - $ -
Contractual $ 291,301 $ 206,741
Fringe $ 290,855 $ 265,445
TOTAL PUBLIC HEALTH $ 1,247,293 $ 1,102,285
EARLY INTERVENTION
Salary $ 78,918 $ 79,007
Equipment $ - $ -
Contractual $ 1,249,853 $ 831,441
Fringe $ 40,642 $ 39,722
TOTAL EARLY INTERVENTION $ 1,369,413 $ 950,171
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SUMMARY OF COUNTY CORONER
Indicators Actual 2011
Actual 2012
Estimated 2013
Active Days Reported 226 170 233
Average Cost to Transport ($) 256 249 256
Disaster Pouches 27 30 30
Medical Examiner Autopsies 34 54 50
Annual cost of additional testing ($) 299 433 1160
MEDICAL EXAMINER RESULTS
Sales, Undetermine,
1, 2% Sales,
Suicide, 7, 13%
Sales, Pending Further
Investigation, 6, 11%
Sales, Natural, 26, 48%
Sales, Accident, 14, 26%
