Health Officer’s Report of Department Activities

Meeting of the Board of Health St. Joseph County Department of Health

8th Floor, County–City Building Board Room

October 9, 2019 4:30 p.m.

I. AGENDA AND MINUTES:

It is recommended that this agenda for the October 9, 2019, meeting of the Board be adopted as presented. Motion by _________________ Seconded by ________________ Vote _________ APPROVAL OF THE MINUTES OF THE SEPTEMBER 11, 2019, REGULAR MEETING OF THE BOARD: Motion by _________________ Seconded by ________________ Vote _________

II. HEALTH OFFICER ORAL REPORT:

III. DEPUTY HEALTH OFFICER ORAL REPORT: IV. NEW BUSINESS:

19-45 Discussion and Vote on August 2019 Health Officer’s Report 19-46 Medicaid enrollment 19-47 Lead School Board presentations 19-48 Harm reduction strategies to reduce HIV Outbreak risk and relationship to opioid

epidemic. Is it time to engage without neighboring county health departments?

V. OLD BUSINESS:

VI. BOARD NOTIFICATIONS:

1. Hirings: Sarah Ladd – Health Educator – October 7, 2019 2. Resignations: None 3. Retirements: Luis N. Galup, M.D. – October 18, 2019 4. Terminations: None

VII. PUBLIC COMMENT (3 Minute Limit):

The Title VI Coordinator has made available at this meeting a Voluntary Public Involvement Survey to collect demographic data to monitor and demonstrate St. Joseph County’s compliance with its non-discrimination

obligations under Title VI and Federal Regulation 23CFR 200.9(b)(4), and more importantly, ensure that affected communities and interested persons are provided equal access to public involvement. Compliance is voluntary.

However, in order to demonstrate compliance with the federal regulation, the information requested must be documented when provided. It will not be used for any other purpose, except to show that those who are affected or have an interest in proceedings, or the proposed project have been given an opportunity to provide input throughout

the process.

VIII. TIME AND PLACE OF NEXT REGULAR MEETING:

November 13, 2019 - 5:00 p.m. St. Joseph County Department of Health Board Room – 8th Floor

CLOSE OF MEETING

MINUTES AND MEMORANDA ST. JOSEPH COUNTY BOARD OF HEALTH

September 11, 2019

Regular Meeting

Present at the Meeting: Dale Deardoff, M.D. President Heidi Beidinger-Burnett, Ph.D, MPH Vice President Jason Marker, M.D. Member Ilana Kirsch, M.D., FACOG Member Emily Dean Member

Also Present at the Meeting: Luis Galup, M.D. Health Officer Mark Fox, M.D. Deputy Health Officer Amy Ruppe Finance Manager Jennifer S. Parcell Executive Administrative Asst. Mark Espich Environmental Director Brett Davis Assistant Environmental Director Robin Vida Health Outreach, Promotion and

Education Director Carolyn Smith Food Services Director Karen Flanigan Assistant Food Services Director J. David Keckley Attorney for Department of

Health I. AGENDA AND MINUTES: Prior to the start of the Regular Meeting, Dr. Deardorff invited all St. Joseph County Department of Health staff to be present in the conference room for the announcement of Dr. Galup’s replacement as Dr. Galup is scheduled to retire October 18, 2019. Dr. Deardorff announced the appointment of Robert Einterz, M.D., as the next St. Joseph County Health Officer. Dr. Einterz will commence his duties on February 18, 2020. In the interim, Dr. Fox shall be acting St. Joseph County Health Officer.

On motion made by Dr. Beidinger-Burnett, seconded by Emily Dean, and unanimously approved, the agenda for the September 11, 2019 Regular Meeting of the Board of Health was adopted as presented. Upon motion made by Dr. Kirsch, seconded by Dr. Beidinger-Burnett, and unanimously approved, the Minutes of the August 14, 2019 Regular Meeting of the Health Board were approved with the correction on page 3, section 19-32, that the Personnel Committee consists of Dr. Deardorff, Dr. Beidinger-Burnett, Sharon Imes, Emily Dean and John Linn.

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II. HEALTH OFFICER ORAL REPORT Dr. Galup indicated that he would have comments regarding items to be covered in New Business. III. DEPUTY HEALTH OFFICER ORAL REPORT: Dr. Fox presented an update with regard to the following areas: 1. Lead Action Report.

• Final school based lead testing events are scheduled for October. • National Lead Poisoning Prevention Week is October 20 – 26, 2019. Events are being

planned. • No definite answer yet on implications of LabCorp acquisition of SBMF clinical lab. • Mona Hanna-Attisha, M.D., MPH to give Sensenich lecture at IUSM-SB on October

15, 2019 at 6:15 p.m. at the medical school auditorium.

2. Immunizations.

• 238 patients were seen in July, 2019. Year-to-date total: 1,286 patients as compared to 652 patients seen year-to-date in 2018.

• 474 immunizations administered in July, 2019, with 2,906 - 2019 year-to-date total as compared to 1,491 in 2018 year-to-date. More consistent hours for the clinic and more mobile unit events have contributed to the increase.

• ISDH Grant priorities include expanded deployment of the mobile unit, expanded focus on HPV, and expanded capacity for billing commercial insurance.

• A proposal to contract with VaxCare was reviewed. They would provide a private vaccine stock for the Department of Health, and we would become the administrator of their vaccines. Dr. Fox reviewed the advantages to this program.

• Dr. Kirsch reported that her office utilized VaxCare for one year and there were problems. Dr. Fox agreed that he should discuss this matter further with Dr. Kirsch and her partner, as well as contacting other Indiana county health departments that utilize VaxCare, and report back to the Board.

3. Health Outreach, Promotion and Education. Health Outreach Promotion and Education Director, Robin Vida, is interviewing to fill the vacant position for a health educator. The Nursing and Environmental Divisions are included in the interviewing. One interview has been done, and two more are scheduled.

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IV. NEW BUSINESS: 19-36 Discussion and Vote on July, 2019 Health Officer’s Report. Board members reviewed and approved the July, 2019 Health Officer’s Report. The motion was made by Dr. Marker, seconded by Dr. Beidinger-Burnett and unanimously adopted. 19-37 Accounts Receivable – Collection of Past Due Debts. Dr. Galup continues to work with Environmental Health Director Mark Espich and Finance Manager Amy Ruppe with regards to collecting overdue accounts regarding septic and well installers primarily owed by two companies. Attorney Keckley will continue to monitor this situation. 19-38 New Septic Position for 2019. Environmental Health Director Mark Espich explained that there is a current need to hire a septic inspector at this time. This position has been approved for the 2020 budget and there are funds available to fill this position for the balance of 2019. There is a good candidate that works in public health that is available for this position.

On motion made by Dr. Beidinger-Burnett, seconded by Dr. Marker, and unanimously approved, this position will now be filled. 19-39 Retention of Records. Dr. Galup reviewed with Board Members his research into the records retention issue. He presented the response received from County Attorney Jamie Woods. That response indicated that the County Commission of Public Records for St. Joseph County have not implemented a records retention policy for the St. Joseph County Department of Health. Further, the Oversight Committee on Public Records has not adopted a records retention schedule applicable to local health departments and therefore the Indiana Archives and Records and Administration database does not have an approved retention schedule for local government agencies. The records held by the Department of Health do not fall under the records listed in the General Records retention schedule for local governments. Mr. Woods response included recommendations which Dr. Galup has included in the proposed Records Retention Policy submitted for Board review. The policy included a description of the applicable records, the length of time to retain the records and the process to be utilized to obtain permission from the County Commission of Public Records to dispose of the records. On motion made by Dr. Kirsch, seconded by Dr. Marker, and unanimously approved, the St. Joseph County Department of Health Records Retention Policy was adopted as proposed. 19-40 Resolution Lead Testing – SJC School Boards. The Board reviewed the proposed school letter prepared by Dr. Fox together with the proposed St. Joseph County Board of Health Resolution regarding blood lead testing for school

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enrollment. Some minor revisions were recommended by Board Members and they fully endorsed this project and the documents presented.

On motion made by Dr. Kirsch, seconded by Emily Dean and unanimously adopted, the Board approved and authorized the distribution to local school boards the cover letter and Resolution. The Resolution calls on all school boards and early childhood education providers in St. Joseph County to implement policies requiring evidence of blood lead test for enrollment in educational programs 19-41 Fetal Infant Mortality Review Program. Robin Vida reported that on Friday, September 13th there will be a Fetal Infant Mortality Review Program report for public officials to be held at the WNIT Public Television Meeting Room beginning at 10:00 a.m. Invitations have been sent to community partners, legislators, city officials and county officials. The Department of Health has received the requested $37,300.00 award to be utilized with the FIMR program. A part-time employee to assist Sally Dixon may be hired if additional state funds are provided. Sally Dixon will be attending a national conference next week. 19-42 SJCDOH Fee Increases – Environmental and Immunization Divisions. Environmental Health Director Mark Espich presented the Environmental Division proposed fee schedule effective January 1, 2020, to include increases in certain septic, massage and tattoo permits. He explained that fees in these areas have not been increased since 2014 and is based on the increased activity in these areas. Dr. Fox explained that the proposed increases for vaccines was necessary to meet the purchase price charged the Department of Health. These fees will be effective October 1, 2019. On motion made by Dr. Marker, seconded by Dr. Kirsch, and unanimously adopted, the requested fee increases were approved. 19-43 Personnel Committee Report. The Personnel Committee, consisting of Dr. Deardorff, Dr. Beidinger-Burnett, Sharon Imes, Emily Dean and John Linn, will review the work completed by Dr. Galup with regards to addressing a performance appraisal policy for Department of Health employees. Dr. Galup’s report contains a list of the tasks performed by individual employees and methods which will be utilized to evaluate their performance. The committee will consider this information, review the information with the new health officer and report to the Board. Dr. Deardorff announced the appointment of Dr. Robert Einterz to replace Dr. Galup who is scheduled to retire October 18, 2019. Dr. Deardorff and Board Members thanked Dr. Galup for his service and wished him well. Dr. Fox will serve as interim health officer until Dr. Einterz commences his duties which is expected to be February 18, 2020. Dr. Fox’s Addendum to

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Employment Agreement noting his appointment as interim health officer was approved by the Board upon motion made by Dr. Kirsch, seconded by Dr. Marker, and unanimously adopted. 19-44 Finance Committee Report. Dr. Fox reported that he attended the St. Joseph County Council Meeting at which time the 2020 budget for the Department of Health was approved to contain only a 1% raise for Department of Health staff. Dr. Deardorff assured Department of Health staff that the Board would continue the efforts to seek increases in the salaries paid to Department of Health employees. V. OLD BUSINESS.

No old business was conducted at this meeting. VI. BOARD NOTIFICATIONS:

The Board noted the resignation of Samuel Schaeffer who was a part-time intern. VII. PUBLIC COMMENTS: There was no public comment at this meeting. VIII. TIME AND PLACE OF NEXT REGULAR MEETING: The next regular meeting of the St. Joseph County Board of Health is scheduled for Wednesday, October 9, 2019, at 5:00 p.m., at the St. Joseph County Department of Health, 8th Floor Board Room. ATTEST: Respectfully submitted, ___________________ _________________________________ Luis N. Galup, M.D. J. David Keckley St. Joseph County Health Officer St. Joseph County Health Board Attorney

Tests drawn August 1, 2019 – August 31, 2019

Pb Level (ug/dL) Venous Capillary Total Duplicate Tests

0-4.9 123 420 543 (-3)

5-9.9 19 18 37 (-1)

10-19.9 3 11 14 0

20-29.9 1 1 2 0

30-39.9 3 0 3 (-1)

40-49.9 2 0 2 0

≥50 1 2 3 (-2)

Total 152 452 604 0

2019 YTD = 3431

2018 YTD = 2380

Test Levels (ug/dL) Percentage of Confirmatory Tests

0-4.9 23%

5-9.9 51%

≥10 50%

All tests 25%

46601 14 elevated

46613 5 elevated

46614 5 elevated

46615 2 elevated

46616 3 elevated

46619 7 elevated

46628 12 elevated

46530 2 elevated

46554 1 elevated

46545 5 elevated

46544 3 elevated

N/A 2 elevated

St. Joseph County Department of Health

Health Officer’s Report of Department Activities

August 2019

Environmental Health AUGUST

2019

YTD 2019 YTD 2018

SEPTIC PROGRAM

Residential - New Construction

A. Inspections 31 149 181

B. Consultations 0 9 26

Residential - Replacement



Commercial



C. Cluster System Inspections 0 1 7

Abandonments without Replacements 2 13 *

Permit Applications Received 43 426 383

Permits Issued 56 336 281

Public Information Events 0 0 *

SUBDIVISION PROGRAM

A. Health Officer Reports 3 17 19

B. Subdivision Reviews 5 22 22

C. Rezoning and Replat Reviews 1 7 10

WELLHEAD PROGRAM

A. Inspections Performed 16 142 89

WELL DRILLING PROGRAM

Residential


B. Well Abandonments 22 129 117

Commercial


B. Well Abandonment Inspections 1 4 0

New Construction

A. Permit Applications Received 11 98 89

B. Permits Issued 9 78 58

Replacement Permits Issued 23 167 168

Public Information Events 0 0 *

SOURCE WATER PROGRAM

A. Phase I Inquiries 12 109 92

B. Spill Responses 0 0 0

C. Meth Lab Occurrence Response 0 1 1

D. Other Source Water Inspections 6 21 34

SURFACE WATER PROGRAM

2

A. Surface Water Sampling 0 0 0

LEAD PROGRAM

A. HUD Lead Inspections 0 2 1

B. Lead Risk Assessments 11 64 18

a. EBLL Assessments 4 19 *

b. Parent Request 7 45 *

C. Clearances 3 29 *

D. Off-site Meetings 4 21 *

E. Public Information Events 4 18 10

D. Children Tested for Lead Levels** 604 3380 2380

CAFO PROGRAM


AIR QUALITY PROGRAM

A. Indoor Air Quality Investigations 0 0 0

B. Mold Investigations 0 0 0

VECTOR PROGRAM

A. Larvicide Swimming Pools/Stagnant Water 4 10 19

B. Sites Treated 2 4 *

C. Traps Collected 0 0 *

D. ISDH Submissions 0 0 *

E. Public Information Events 2 2 *

HEALTHY HOMES PROGRAM (Inside)

A. Initial Complaints 10 90 38

a. No Water 4 23 *

b. Garbage/Food Waste 1 39 *

c. Feces 3 12 *

d. Rodents/Cockroaches 2 16 *

e.

A. Follow-up Complaints 23 128 *

a. No Water 6 35 *

b. Garbage/Food Waste 8 58 *

c. Feces 2 15 *

d. Rodents/Cockroaches 7 20 *

B. Dwellings Declared Unfit 0 19 9

MASSAGE

A. Establishment Inspections 1 62 57

TATTOO/BODY PIERCING PROGRAM


COMPLAINTS / INVESTIGATIONS

A. Garbage/Food Waste (Outside) 8 46 62

B. Sewage 17 58 70

C. Water (ditches, lakes, ponds & swells) 0 6 2

3

D. Motels/Hotels 0 0 3

E. Burning 0 8 6

F. Other 7 47 40

ABATEMENT LETTERS

A. Abatement Letters Sent 9 115 109

B. Immediate Threat to Public Health Letters

Sent

0 2 7

C. Order to Vacate/Condemn Letter Sent 0 21 *

D. Impending Legal Action Letters Sent 1 9 41

* Revised monthly report, 2018 data not available at this time.

** Due to time lag of State Database System, the Lead testing numbers are one month behind.

Epidemiology, Bioterrorism and Emergency Preparedness

A. Epidemiology / Bioterrorism

1. Compiled child and infant mortality reports

2. Facilitated case review for Overdose Fatality Review Team meeting

3. Assisted with Stop the Bleed Training in LaVille

4. Sponsored and supported ‘In Plain Sight community training as part of

Overdose Response Grant

5. Met with Northern Indiana Maternal Child Health Network about

collaboration and Board of Directors membership

6. Spoke with students interested in epidemiology

B. Emergency Preparedness

1. Performed ESF 8 and MRC call down drills

2. Attended monthly District 2 meeting Plymouth

3. Assisted in the Stop the Bleed training for South Bend schools, Penn

Schools, St Joseph grade school.

4. Continued efforts in contacting remainder of St. Joseph County schools to

schedule Stop the Bleed training

5. Participated in District 2 monthly radio drill.

6. Quarterly call down with ESF8.

7. Continued efforts in procuring Closed POD sites.

8. Continued effort in procuring Alternate Care sites.

9. Continued efforts to recruit Medical Reserve Corp volunteers.

Finances

• Items receiving final approval from the County Council:

o Appropriations:

▪ Donation received from Beacon for Roc Ur Body event

Food Services Division

YTD YTD

Month 2019 2018

Food Store Complaints 3 10 14

Food Service Complaints 21 131 138

Civil Penalties 2 3 1

Health Officer Hearings 0 1 1

4

Abatements Correspondence 6 34 23

Possible Foodborne Illness

Investigations

0 6 4

Opening Inspections 9 126 137

Inspections 234 1793 1276

Plan & Review/New

Constr./Remodel

2 28 29

Fire Investigations 0 5 12

# Establishments Requested to Close 0 3 4

Number of Temporary Events 27 187 172

Temporary Inspections 26 592 474

Mobile Inspections 2 63 92

Meetings 4 32 15

Smoking Information

Smoking Complaints 0 0 0

Smoking Appeals Hearings 0 0 0

Pool Information

Pool Inspections 48 85 126

Pool Consultations 0 13 10

Pool Complaints 0 0 4

Pool Closings 14 15 44

Our county attorney, Mr. Keckley, requested a court ordered injunction to enforce the August 1,

2019 Order of Abatement issued to food vendor operating at 515 North Olive St., South Bend.

The unpermitted food operation has continued since first observed on June 7, 2019. A hearing

was set for 9/9/2019.

Commissioners approved the request, for all members of the food division field staff, to attend the

Indiana Environmental Health Association (IEHA) 69th Annual Educational Fall Conference,

September 22-25th in South Bend. The conference, being held in South Bend, provided a rare

opportunity for all staff to attend and learn new perspectives from area and national leaders, in

food protection, to be educated on increasing food protection challenges and hear about on-going

industry updates.

Y-T-D routine inspections of 1793 are 40.5% more than the 1276 inspections reported January-

August last year.

Health Outreach, Promotion, & Education (HOPE)

PRESENTATION

TOPIC

TOTAL NUMBER

(PRESENTATIONS)

ADULT

(AGE)

HIGH

SCHOOL

(AGE)

MIDDLE

SCHOOL

(AGE)

ELEMENTARY

SCHOOL

(AGE)

PRE-

SCHOOL

(AGE)

Wellness

(Nutrition, Physical

Activity, etc.)

3

Substance Abuse

1

Communicable

Disease

1

STDS/Sexuality

5

Healthy

Relationships

0

Chronic Disease

0

EVENT TOPIC LOCATION NUMBER OF

PEOPLE

(APPROX.)

Lead in the Home Lead awareness Vida Nueva Church 100

Family Passport to

Play

Merrifield Night Out Merrifield Park 100

Back to School Lead &

Immunizations

Clay Church 75

Mishawaka

Farmers Market

Cooking Demo-

healthy snack

Central Park 25

National Health

Center Week

Lead, Safe Sleep,

Immunizations,

Healthy Living

Health Linc-

Mishawaka

60

National Night Out Lead, Safe Sleep,

Immunizations,

Healthy Living

Clay High School 200

Fitness in the

Parks

Family Fitness Central Park 10

Let’s Cook Desserts Martin’s

Supermarkets

3 families

Mishawaka

Farmers Market

Cooking Demo-

healthy snack

Central Park 30

Let’s Cook Muffins: Back to

School

Martin’s

Supermarkets

2 families

Healthy Tailgate Lead, Immunizations,

Healthy living

Mishawaka High

School

50

Boomin’ Parks

Tour

Lead/Healthy Living Harrison Elementary 50

Meetings-

Priority: Substance Abuse (includes Mental Health, Trauma-informed community efforts

(ACES))

• SJC Cares Executive Committee meeting; Monthly meeting of executive committee to

discuss scope of work, initiatives, and efforts.

• Community Mental Health Assessment Planning; as a System of Care, SJC Cares, is

responsible for completing a youth and parent mental health assessment of community

resources and needs. This will also direct the SOC scope of work through the Dept. of

Mental Health & Addictions. This was the first meeting of this group and will meet every

other week to meet end of October deadline. Director of HOPE is assisting in the

development and efforts of information collection.

• Mobile Overdose Response Team Grant meeting- meeting of partner agencies to

complete the Trauma-Informed Recovery Orientated System of Care assessment that is a

mandatory piece of the grant.

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• Overdose Response Plan Project -Follow up meeting with Becky Savage to discuss

Wise Up Campaign.

• Overdose Fatality Review Team meeting- monthly meeting to review specific OD

death cases to identify trends and make recommendations for improvement.

• Self-Healing communities meeting; hosted by Beacon Health System, an effort to

engage and support those working to address trauma in the community. Dr. Laura Porter

was in town and hosted the afternoon session. SJCDoH Director of HOPE was asked to

be on advisory council moving forward as she is one of the original ACE master trainers.

Priority: Maternal/Infant Health

• Meeting Beacon Community Impact; was invited to participate in their vision/mission

brainstorming meeting as a community partner.

• One Key Question Training Seminar – This is was attended by 10 people

representing: WIC, NIMCHN/Olive Health, Indiana Health Center, Healthlinc, E Blair

Warner and Healthy Families. The seminar was well received, and everyone is in various

stages of how they will proceed with implementing the whole approach to pregnancy

intention. Sally is assisting each entity with the next step.

Phone conversation with ISDH Breastfeeding coordinator; meeting to discuss

breastfeeding and infant mortality. Discussed that the FIMR team discusses breastfeeding

primarily in terms of safety related to breastfeeding and SUID

• FIMR Steering/Home Visiting workgroup; met to continue progress in developing a

streamlined process for providers, 211 to make referrals to home visiting. Next steps are

formalizing the process and rolling out the availability with providers/Emergency

departments and other agencies. Next meeting will develop flyer/script and plan for

marketing. It is very important to have this process in place prior to the ISDH OB

Navigator program rolling out in our area in 2nd quarter 2019.

• Call with Rosemary Fournier, national FIMR; monthly call to discus FIMR activities,

etc.

• Meeting with Lauren Dietz, Covering Kids and Families – Including Covering Kids

and Families in the referral process for home visiting is important in order to make sure

mothers are connected to Medicaid and can begin prenatal care. Lauren and Sally

discussed how the flow of information between CKF and home visiting agencies could

take place. This will be incorporated into the home visiting referral process in

development.

• Maternal Infant Workgroup meeting - Discussed new ISDH safe sleep flyers. For next

meeting, Sally will have a draft of flyer to educate about factors that increase risk of

SUID and further aide in making home visiting referrals for families and babies at

increased risk.

• Meeting with Waldo from MHIN and Marti Conrad (Elkhart HD & FIMR) regarding

data that would be helpful to have in EHR.

• Maternal Mortality Review Meeting/Indianapolis; quarterly meeting to discuss

maternal death cases in the State.

• Meeting with Amy Murray (Dir MCH Nursing at SJRMC) and Loretta Schmidt

(Chief Nursing Officer at SJRMC); Discussed having nurses from L&D and/or NICU

joining the Case Review Team as well as assistance with issues regarding facilitating

entry to first trimester prenatal care.

• Meeting with Beth Temple and John Bruinsma (SJHS); discussed home visiting

referrals and CHWs. Plan to collaborate on use of Community HUB Pathways for

pregnant or new moms to connect to home visiting and community resources.

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Priority: Lead Poisoning Prevention

• Internal Lead Grant meeting(s); meeting between environmental, public health

nursing, and health education to discuss Lead grant outcomes and activities. Several were

held as our large community event was in August.

• Lead Affinity Meeting; monthly meeting of stakeholders to discuss lead happenings;

this meeting focused on school-testing events, and ways to increase testing rates.

• Lead 101 Presentation @ Women’s Care Center- Director of HOPE did a Lead 101

presentation for about 30 moms at the downtown location.

• Meeting with N. IN Food Bank; met with Executive Director to discuss cooking demos

and lead awareness education to guests at the Food Bank. Will develop a flier and plan

education days were families can identify foods that help prevent lead and then try

recipes with foods from pantry.

Priority: Obesity

• ROC Meeting- monthly meeting of our Reducing Obesity Coalition, we discussed our

June event, new priority areas, and discussed meeting format. September meeting will

focus on our Walking School Bus program.

Priority: Wellness

• Food Access Council; coordinated by the Department of Health; focuses on creating

connections for food system barriers; meets monthly to discuss learning topics, updates

from community partners; this month’s meeting focused on graduate student work done

by IUSB school of sustainability. The food access council took some of the work and

developed a few small projects to move forward on.

• Food Pantry Summit #2; was hosted on August 19 and had over 30 participants from

local food pantries and community resources. This meeting focused on the next steps

from the first summit in May- pantries were in need of community resources and ways to

get more involved with the community. UDSA/ISDH State representatives gave a

presentation on food commodity program. Next steps were discussed at full food access

council about continuing to keep pantries engaged and meet their needs.

• SJC Health Improvement Alliance ELC; meeting of executive leadership of the

alliance, this occurs monthly to discuss the upcoming full meeting, discuss priorities, etc.

Director of HOPE also met with HIA coordinator to discuss meeting topics; a meeting

with the current chair was also held to discuss next steps for operations and priority areas.

• SJC Age Friendly Community Initiative; the Board of Commissioners hosted AARP

as well as several community partners, about AARP’s age-friendly community initiative.

SJC has the opportunity to the first age-friendly county; more meetings should be

scheduled to discuss what this looks like, and involvement.

Miscellaneous

The Director of HOPE attended a one-day grant wrap-up for the Overdose Response Plan Project

grant in Indianapolis.

The Director of HOPE & FIMR Coordinator presented the annual FIMR report to the South

Bend City Council’s Health & Safety Committee

Annual FIMR Community meeting was hosted and our last 3 year findings were shared with

over 30 community stakeholders.

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The Director of HOPE began interviews for a new health educator to replace Elizabeth Wolff

whom left to pursue her Masters in Public Health at Boston University.

The Director of HOPE attended a community Narcan training in partnership with Oaklawn.

The Director of HOPE hosted a “Hidden in Plain Sight” Training with Purdue Extension as part

of the Overdose Response Plan Project grant. Wasn’t well attended, but in the future will host

again maybe at particular school or with a particular parent group.

Nursing

The Tb Division meets weekly and as needed. Managed 8 active, 1 new case, 30 latent, and

reviewed 30 suspect cases. We sent 2 people for a QFT and 1 for an x-ray. The TB RNs

managed 159 DOT and 17 nurse visits.

The Immunization Division administered capillary lead draws to children 12 months- 6

years. The Medical Foundation provides monthly statistics for the Department of Health ordered

New Cases Received

Closed Cases

Open Cases Being Followed*

Open Cases Being Followed

South Bend clinic:

Patients seen

Immunizations Administered

Mobile clinic:

Patients seen


Combined Totals:

Patients seen


TST Placed

TST Positive

Direct Observed Therapies

QFT Gold Tests Ordered

Suspect Cases

New Active Cases

Total Latent Cases Tracking - 30

<5 6 13

Total Active Cases Tracking - 8

<5 56 N/A

30 133 102

<5 14 9

159 1453 N/A

Aug, 2019 YTD 2019 YTD 2018

56 320 347

Statistics are pulled from State/Local databases.

652 2841 N/A

Tuberculosis

Case Monitoring for 5-9.9 mcg/dL Elevated Blood Levels

Aug, 2019 YTD 2019 YTD 2018

93 110 N/A

Case Management for Elevated Blood Levels

Aug, 2019 YTD 2019 YTD 2018

<5 12 10

0 17 19

23 41 41

42 170 N/A


Immunizations

Aug, 2019 YTD 2019 YTD 2018

244 1097 N/A

84 801 N/A


286 1572 834

736 3642 1941

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capillary and venous draws. The total for August was 92 capillary tests between the South Bend

Clinic and the Mobile Clinic. We had a total of 8 declines with 4 of those previously being

tested in the last 12 months.

The Immunization Clinic placed and read 56 TSTs. We had 2 positive skin tests in the

clinic. Vaccines are administered to qualified children and adults. Current vaccines shortages

include Yellow Fever, some restrictions on Hepatitis A adult, all presentations of Hepatitis B,

and Aplisol. With the Aplisol that is putting a restriction on Tubersol. Continuing to consult

travel patients for recommended vaccines and if needed referring them to Passport Health for

Yellow Fever vaccine. We assisted 54 patients with records. Our Mishawaka Clinic remains

temporarily closed. Furniture removal in Mishawaka started late August and the repairs to the

floors started Tuesday, September 3. We continue with walk-ins in our South Bend

office. Aaron Fox, RN continues with orientation.

The Mobile Clinic had 5 immunization events for August.

1. Clay Church: We provided lead draws and VFC kindergarten vaccines. Lead draws 8 &

and administered 2 vaccines. Connie and Abby provided these services.

2. Healthlinc Summer Community Health Fair: We provided lead draws and VFC child and

teen vaccines. Lead draws 2 and administered 2 vaccines. Danielle and Abby provided

these services.

3. Mount Carmel Missionary Baptist Church: We provided lead and VFC child and teen

vaccines. Lead draws 1 and administered 26 vaccines. Danielle and Abby provided

these services.

4. Indiana Department of Correction Community Re-Entry Center: We provided state

funded Hepatitis A. Administered 21 vaccines. Danielle and Abby provided these

services.

5. Healthy Tailgate @ School City of Mishawaka: We provided lead draws and VFC child

and teen vaccines. Lead draws 3 and administered 33 vaccines. Danielle and Abby

attended these services.

Neiko ordered vaccines and supplies for all clinics. Immunization grant supplied all events with

some materials to pass out to promote our clinic. Burkhart billboards are running “Adults Need

Vaccines Too” campaign.

Aaron presented on immunization at the B.A.B.E. store on Aug. 7.

Carla and Neiko attended the Northern Indiana Immunization Task Force Meeting on Aug.

13. St. Joseph County hosted it at the Logan Center.

Total Communicable Disease investigations started for August were 168. Animal Bites, Hepatitis

C and Campylobacteriosis cases started made up the top 3 conditions with 85, 18 and 16

respectively.

Our meetings continue with the B.A.B.E Store. Aaron Fox and Elizabeth Wolff gave a

presentation on communicable diseases, immunizations and vaccines. Jan continues attending the

Near Northwest Neighborhood (NNN) monthly meetings.

The Public Health Nurses attended ISDH District 2 Education. Presenters discussed Vaccine

Preventable Diseases surveillance and recommendations for varicella, shingles, invasive

meningococcal disease and acute flaccid myelitis. There was separate presentation for Measles

and Mumps.

10

Danielle Laskowski continues to assist preparations along with the HOPE division for Lead

Week which runs October 21st through October 25th.

Events planned: School Events

Ghost and Goblins

Halloween Trunk and Treat

Our PHN presently are monitoring 118 children with elevated lead levels from 5-9.9 and manage

>30 lead cases with levels above 10 mcg/dL.

A total of three Bethel University Senior Nursing students are now with us. The will be job

shadowing all departments within the health department and other community learning

experiences.

Vital Records

RECORDS FILED

IN AUGUST 2019

YTD 2019

OCCURRENCES

YTD 2018

OCCURRENCES

Birth Statistics*

Total Births 410 2823 2905

Death Statistics*

Total Deaths 237 1950 2041

YTD data reflects the date ranges of 01/01/2019-07/31/2019 as of 09/1/2019.

*Statistics are subject to change. Statistics are pulled from State database.

Health Officer

During the month of August 2019, I complied with my duties as executive officer of the

St. Joseph County Department of Health. I provided the managers of the Department of

Health with advice and guidance in their duties during regular working hours and at other

times when required.

I have also held formal and informal meetings with the Nursing Division and with the

Environmental Division.

Respectfully,

Luis N. Galup, M.D.

Health Officer

2019Beginning Balance $1,983,721.52

January February March April May June July August September October November December Year-To-Date

REVENUE

Tax Revenue $0.00 $0.00 $0.00 $0.00 $0.00 $869,781.33 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $869,781.33

Fee Revenue $201,394.73 $233,637.51 $146,776.86 $104,872.71 $142,865.35 $127,933.24 $110,973.91 $125,902.46 $119,890.82 $0.00 $0.00 $0.00 $1,314,247.59

Other Revenue $0.00 $0.00 $0.00 $0.00 $0.00 $2,500.00 $4,783.64 $0.00 $1,201.33 $0.00 $0.00 $0.00 $8,484.97

TOTAL REVENUE $201,394.73 $233,637.51 $146,776.86 $104,872.71 $142,865.35 $1,000,214.57 $115,757.55 $125,902.46 $121,092.15 $0.00 $0.00 $0.00 $2,192,513.89

EXPENDITURES

Salary & Benefits $898,529.42 $177,653.92 $171,437.97 $166,230.23 $261,124.45 $175,749.90 $176,092.34 $176,415.02 $175,195.82 $0.00 $0.00 $0.00 $2,378,429.07

Supplies $3,906.90 $2,963.80 $1,649.01 $3,093.15 $2,059.42 $3,033.50 $3,182.18 $2,286.09 $3,044.14 $0.00 $0.00 $0.00 $25,218.19

Other Services and Charges $26,743.73 $9,127.11 $10,972.72 $19,739.96 $8,794.79 $4,512.37 $5,202.21 $20,693.27 $14,293.86 $0.00 $0.00 $0.00 $120,080.02

Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL EXPENDITURES $929,180.05 $189,744.83 $184,059.70 $189,063.34 $271,978.66 $183,295.77 $184,476.73 $199,394.38 $192,533.82 $0.00 $0.00 $0.00 $2,523,727.28

MONTHLY SURPLUS / (SHORTFALL)

($727,785.32) $43,892.68 ($37,282.84) ($84,190.63) ($129,113.31) $816,918.80 ($68,719.18) ($73,491.92) ($71,441.67) $0.00 $0.00 $0.00

ACCUMULATIVE SURPLUS / (SHORTFALL)

$1,255,936.20 $1,299,828.88 $1,262,546.04 $1,178,355.41 $1,049,242.10 $1,866,160.90 $1,797,441.72 $1,723,949.80 $1,652,508.13 $1,652,508.13 $1,652,508.13 $1,652,508.13

RECEIVABLES OUTSTANDING FROM PRIOR SERVICE PERIODS

(Environmental Services)$0.00 $0.00 $253,466.00 $145,121.00 $69,209.00* $58,386.50 $47,475.00

RECEIVABLES FROM CURRENT SERVICE PERIOD

(Environmental Services)$5,086.00 $8,422.00 $14,655.00 $14,250.00 $12,255.00 $18,890.00 $15,895.00 $12,660.00 $7,845.00

*Includes Receivables Outstanding From Prior Service Periods from 2014 to current (last month).

County Health - Fund 1159

To provide services to the citizens of St. Joseph County, Indiana

Tax Revenue & Fee Revenue

Updated 10/9/2019

2019Beginning Balance $193,975.20


REVENUE

Revenue $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Other Revenue $0.00 $0.00 $500.00 $0.00 $200,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $200,500.00

TOTAL REVENUE $0.00 $0.00 $500.00 $0.00 $200,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $200,500.00

EXPENDITURES

Salary & Benefits $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Supplies $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Other Services and Charges $0.00 $45.98 $0.00 $656.45 $315.83 $1,393.93 $53.77 $49.67 $274.89 $0.00 $0.00 $0.00 $2,790.52

Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL EXPENDITURES $0.00 $45.98 $0.00 $656.45 $315.83 $1,393.93 $53.77 $49.67 $274.89 $0.00 $0.00 $0.00 $2,790.52


$0.00 ($45.98) $500.00 ($656.45) $199,684.17 ($1,393.93) ($53.77) ($49.67) ($274.89) $0.00 $0.00 $0.00


$193,975.20 $193,929.22 $194,429.22 $193,772.77 $393,456.94 $392,063.01 $392,009.24 $391,959.57 $391,684.68 $391,684.68 $391,684.68 $391,684.68

County-Wide Lead Initiative - Fund 4940

2019Beginning Balance $166,931.72


REVENUE

Revenue $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Other Revenue $47,815.65 $0.00 $0.00 $0.00 $0.00 $0.00 $47,815.65 $0.00 $0.00 $0.00 $0.00 $0.00 $95,631.30

TOTAL REVENUE $47,815.65 $0.00 $0.00 $0.00 $0.00 $0.00 $47,815.65 $0.00 $0.00 $0.00 $0.00 $0.00 $95,631.30

EXPENDITURES

Salary & Benefits $3,464.53 $3,464.53 $7,637.28 $4,734.90 $5,679.16 $7,954.89 $3,782.14 $3,782.14 $7,954.89 $0.00 $0.00 $0.00 $48,454.46

Supplies $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $564.16 $0.00 $0.00 $0.00 $0.00 $0.00 $564.16

Other Services and Charges $0.00 $0.00 $0.00 $0.00 $1,350.07 $6,121.01 $5,405.80 $300.00 $11,256.87 $0.00 $0.00 $0.00 $24,433.75

Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

TOTAL EXPENDITURES $3,464.53 $3,464.53 $7,637.28 $4,734.90 $7,029.23 $14,075.90 $9,752.10 $4,082.14 $19,211.76 $0.00 $0.00 $0.00 $73,452.37


$44,351.12 ($3,464.53) ($7,637.28) ($4,734.90) ($7,029.23) ($14,075.90) $38,063.55 ($4,082.14) ($19,211.76) $0.00 $0.00 $0.00


$211,282.84 $207,818.31 $200,181.03 $195,446.13 $188,416.90 $174,341.00 $212,404.55 $208,322.41 $189,110.65 $189,110.65 $189,110.65 $189,110.65

Health Trust Fund - Fund 9111The Indiana Local Health Department Account (LHDTA) was established within the Indiana Tobacco Master Settlement Agreement Fund for the purpose of proving funding for services provided by local Boards of Health in each county. The local Board of

Health seeking to receive funding from the account must file an application with the State Department of Health before October 1 of each year specifying the planned use for the funds and that it is in a manner specified by the State Department of Health. In using money distributed by this fund, the local Board of Health shall give priority to: (1) programs that share common goals with the mission statement and long range state plan established by the state department of health; (2) preventive health measures; and (3) support for community health centers that treat low income persons and senior citizens. The St. Joseph County Health Department has historically utilized our funding to supplement funding for preventative health measures. We continue this effort

this year by funding emergency preparedness personnel and benefits, some immunization supplies, subsidize some HD staff continuing education and travel, pay for immunization equipment repair and maintenance and a ground water level monitoring agreement with the U. S. Geological Service.

Funds based on SJC population

Updated 10/9/2019

Health Officer’s Report of Department Activities

Documents

Transcript of Health Officer’s Report of Department Activities