Citizens For A Better Norwood

Friday, August 01, 2008

What we’ll lose if we lose the Norwood Health Dept.

Just when we needed to know what would happen to each of our current Norwood Health Dept. services should City Council vote to contract for services with Hamilton County, a thorough accounting was available via a public document Health Commissioner Donna Laake produced this past Tuesday. Donna sent the following email, dated 7/29/08, to Gary Arthur, President Pro Tem of Norwood Health Commission. By our count, of the 23 services listed, only 5 or 6 would be duplicated or nearly so, and the status of 1 is unknown. That means about 16 services would either be lost entirely or significantly diminished, many, many more than we imagined. Among services that would be cut is the School-Linked Dental Program, which served nearly 500 Norwood students last year. This is a lengthy document, but we hope everyone will take the time to read it.

Immunization Clinics
While we hold formal, walk in clinics on the 2nd and 4th Monday of each month, the vast majority of our immunizations, including TB testing, are done on an appointment basis. We also provide a large number of adult immunizations that are prepaid by the recipient, ordered by the NHD and kept at our facility until administered per the timeline of the vaccine.

Hamilton County Public Health (HCPH) offers one a month immunization clinics in SOME of their 43 political jurisdictions for childhood immunizations only. They do not offer adult immunizations. Fees are similar to ours and folks are expected to pay for immunizations. We also do a large number of immunizations for immigrants who are in the process of becoming citizens. They are referred to us from Bethesda Care. Hamilton County Public Health (HCOH) does not offer this service to my knowledge. We also do month TB testing of residents at the Salvation Army facility. HCPH would NOT provide this service.

Blood Pressure Clinics
We conduct 2 blood pressure clinics each month - 1 here at the NHD and 1 at the Community/Senior Center.

To my knowledge, HCPH does not offer this service.

This is a program administered through the Ohio Department of Health (ODH) that is similar to a 3rd party insurance for children with special health needs. Public health nurses act as case managers to make sure that families can navigate through the medical system to get medical appointments and equipment for their children. Health Depts. are reimbursed for their time doing home visits, telephone calls and advocacy for patients and families.

HCPH does provide this service and no change would take place other than a new nurse doing the home visits.

Home Visits
Our nurses currently assist many folks, especially the elderly, in setting up medications, assisting with health needs following hospitalization, especially when their Medicare coverage does not allow for more home visits by paid home health nurses. The nurses check blood pressures, check medications, conduct simple blood tests for diabetes, assist in coordination of physician appointments and act on referrals from hospitals and local physicians for follow up care.

HCPH does not provide this service.

Flu Clinics
Each fall, we offer flu and pneumonia vaccine for anyone who makes an appointment. We will bill Medicare and Medicaid. Others are asked to pay a modest fee (about ½ the cost of Walgreens, etc.) to cover the cost of the vaccine. We also provide flu shot FREE OF CHARGE FOR ANY CITY EMPLOYEE.

HCPH contracts with a private company to administer flu and pneumonia vaccine at some of their senior centers, but you must pay the $25 to $30 fee for the vaccine (similar to getting a flu shot at Krogers).

Communicable Disease Control
All health departments are required to follow up with reports of communicable diseases. We attempt to do so with a home visit.

HCPH mails letters to patients and does follow up primarily by phone.

Lice Free and Rid Shampoo
This is a partnership with Norwood City Schools where students and families can purchase treatment for head lice at the NHD.

HCPH has no such program.

Lead Investigation
We conduct nursing home visits for children with elevated lead levels. In addition, the ODH will send someone to Norwood to conduct an environmental inspection of the home with our nurses as assistants with a very specialized piece of equipment.

HCPH would conduct investigations in the same manner (not certain if nurses do home visits).

Food Service Inspections
The ODH oversees the FSO program and the number of inspections is determined in rule. For instance, if a restaurant prepared food, serves that food, has left over portions that are refrigerated and then reheated for sale at a later time, the establishment would be a “Level 4.) A bar that serves only snacks or repacked foods would be a “Level 1.” The number of required inspections is determined by the classification of the establishment. Level 4 facilities require 4 inspections a year. 2CCP (Critical Control Point inspections look at food from where it is ordered until it is served to the public. There are 14 “critical” steps in securing the quality of food) and 2 regular inspections. The law allows for a regular inspection to be done on the same day as a CCP inspection, thus only being in the facility only twice a year. NCH does not do this…we believe it is important to be in facilities such as these at least 4 times a year due to the potential for food borne illness. Fees are charged according to the actual cost of providing these services and a Cost Methodology is required each year.

HCPH has fees very similar to our and they would collect those fees for themselves if they took over the health department. Understand that HCPH conducts the MINIMUM number of inspections required by law.

Pool Inspections
The ODH oversees this program and requires that public swimming pools be inspected once before opening and once during the swimming season. Fees are charged per the cost of the program. Our fees are very similar to HCPH. However, the NHD conducts the pre-opening inspection and at least every other week during the swimming season, sometimes weekly if necessary. We feel that this is necessary to prevent waterborne illness and to establish relationships with life guards who report activities to us that we might not normally know about.

HCPH conducts the MINIMUM number of inspections as required by law. It would be VERY IMPORTANT for Norwood Recreation to have ALL pools ready for pre-opening inspections at the same time since HCPH has as large list of pools for pre-opening with a limited number of sanitarians assigned to an area.

Food Establishment Inspections
Same as Food Service Inspections above except the program is administered through the Ohio Department of Agriculture.

HCPH conducts the MINIMUM number of inspections and fees would go to HCPH.

Infectious Waste
The Ohio EPA requires that infectious waste facilities be inspected annually. Our environmental staff conducts these inspections.

HCPH has the nursing division conduct these inspections. Fees would go to HCPH.

Animal Bites
Our registered sanitarian conducts animal bite investigations. He visits the home personally to observe the animal for signs of rabies, inform of quarantine requirements and check for rabies vaccination and dog license. This is an unfunded requirement from the ODH.

HCPH sends letters to the owners of animals who have bitten asking for documentation.

School Inspections
“Jared’s Law” now requires that schools be inspected once a year while school is in session. In the past, the NHD would conduct inspections during summer and winter breaks. All local health departments conduct school inspections in the same manner, and there is no reimbursement for the inspections. We have had very good cooperation with NCS over the years in getting repairs completed because of our relationship with them over the years.

HCPH would conduct inspections in the same manner.

Nuisance Inspections
By the end of 2008, the NHD will have logged and investigated over 2,500 complaints ranging from high grass/weeds and housing issues to child endangerment and concern for occupant. The NHD is charged with following up with posting houses for high grass, having Public Works cut, billing the owner and placing the lien on the tax duplicate if not paid. We are able to cite people to Mayor’s Court for non-compliance. Staff is often called during the day from the Police and Fire Departments to respond to property where there is a concern. We are there within minutes of the request.

HCPH has 43 communities to cover and does very few nuisance complaints which are “prioritized” according to greatest public health threat. For non-compliance, HCPH is required to use Hamilton Municipal Court (stand in line!) Good luck with that!

Water Testing
The NHD conducts chlorine testing 365 days a year. We also do 20 water samples each month for bacteria. The health commissioner conducts Phase 1 TTHM and HAA5 testing quarterly and Phase2 testing every other month at 8 facilities. The H.C. also conducts testing for Lead and Copper every 3 years and prepares a yearly “Consumer Confidence Report” as required by the OEPA.

HCPH does not conduct these tests or write the assemble/print/mail the Consumer Confidence Report for their jurisdictions as it is really the responsibility of the Water Purveyor in each jurisdiction.

Vital Statistics
The NHD maintains birth and death certificates for those folks who were born or died in Norwood. The cost for a birth or death certificate is $17. We also provide burial permits for local funeral directors.

All records would need to be transferred to HCPH. The cost of birth/death certificates at HCPH is $20.

Car Seat Checks/OBB Program
Currently there are 3 of us at the NHD certified as child passenger safety technicians. I originally got certified as a requirement for an NPD grant from the Ohio Dept. of Public Safety for DUI checks and seat belt checks, et. At least one person from the jurisdiction was required to be certified through NHTSA. I have no idea if that requirement is still in place. In 2007 we conducted about 250 car seat checks. Because of my certification as an instructor and my affiliation with CCHMC (Children’s Hospital), the NHD is the Hamilton County site for the “Ohio Buckles Buckeyes” (OBB) program that distributes 60 car seats per year to folks who are on WIC or are WIC-eligible.

HCPH does not do car seat checks.

Yard Waste Bags
Because of application for grant funds to the Hamilton County Department of Environmental Services, the NHD uses grant funds to purchase approximately 15,000 yard waste bags per year for distribution to Norwood residents.

HCPH would not be eligible to apply for those funds, nor would they give out yard waste bags to Norwood residents. This would have to be absorbed by another department or discontinued.

H.E.P.A. Vacuum
This HEPA vacuum is a grant from the ODH. We lend it out to Norwood residents to clean up during construction to prevent lead dust, for cleaning after head lice and for bed bugs. The vacuum is used frequently and there is occasionally a waiting list.

I have no idea if the HCPH has a HEPA Vacuum

School-Linked Dental Program
The NHC receives funds from CDBG funding to provide dental services in the schools. A dentist oversees the program and conducts initial exams on students whose parents have completed an enrollment form. A dental hygienist then returns to the schools throughout the year to do cleanings, fluoride treatments and sealants where appropriate. In 2007, nearly 500 students took advantage of this program.

HCPH does not have any such program, nor would they be eligible to spend the City of Norwood’s CDGB funds. This program would cease to exist.

Handicap Parking Sign Committee
Volunteers appointed to this committee review applications for placement of handicap parking signs in front of their homes. Nurses conduct home visits to determine if applicant meets eligibility requirements.

HCPH does not have this service, nor would their nurses go to homes to conduct medical assessment on applicants.

Tree Board
By city ordinance, the health commissioner is the Liaison between the City of Norwood and the Tree Board because of the expenditure of CDBG funds.

I can almost guarantee that Commissioner Ingram would NOT take part in a Tree Board meeting.

1. The NHD routinely secures grants to conduct Freon removal and tire drop off events.
2. The NHD provides “Have-A-Heart” traps to Norwood residents for trapping animals at no charge.
3. The NHD surveys restaurants for “heart healthy” menus each year and awards “GOLD Plate Awards” to restaurants who offer heart-healthy” options in low fat dining.
4. The NHD received a silver “Healthy Community” award from the ODH in 2006 and a gold award in 2007. Awards for 2008 have not been announced as of this date.
5. The NHD works with the Norwood City Schools each year to conduct cholesterol and blood sugar screenings for staff as part of their “Wellness Policy.”
6. The NHD provides “LifeSkills” tobacco prevention programs to 3rd and 6th grade students in Norwood City Schools. As a result, polls show that students have delayed the start of smoking or have not started smoking. We worked with the Norwood City Schools to have them adopt a “Tobacco Free Policy,” the first district in Hamilton County to do so.
7. The NHD was honored by the National Association of City and County Health Officers as a model program for collaboration between local health departments and public schools.

In 2007/2008 the NHD received $26,678.14 in grant funds to conduct preparedness activities. After working for 6 months with Xavier University, the NHD signed a Memorandum of Understanding (MOU) with Xavier to use the Cintas Center in the event of an emergency when medicine or vaccines need to be administered. We are collaborating with the Cincinnati Health Department to staff the “Point of Dispensing” (POD) because we know that it will be a very popular and accessible site for Cincinnati and Norwood residents. We are also working with Xavier to have them take responsibility for dispensing medications to their students through their own medical facilities, thus reducing the number of students coming through our POD. The NHD has on hand sufficient medication to dispense medication to police, fire, health and elected officials and their families in the event of an emergency so that governmental activities can continue. We have also secured sufficient medicine for Xavier police and their critical staff because they would rather deal with us vs. Cincinnati.

HCPH covers 43 governmental units. Their preparedness plans call for each community to find their own site for dispensing medications to their residents. Staffing these PODs are the responsibility of the community that is charged with finding someone to lead the POD and sufficient residents to “man” the site. HCPH will provide 1staff person as a Liaison between their health department and the community. And HCPH WOULD RECEIVE ALL FUTURE GRANT FUNDS despite the fact that the community still does all the work. I would NOT recommend that Cintas Center be used because then ANYONE could come to that site for medication dispensing.

In the 2 hours that I have been working on this email, I was called twice about problems in the city: uncapped syringes at the curb on Kenilworth Avenue and a concern for occupant. I responded immediately to each call for service. I have also arranged for C.E.R.T. (Community Emergency Response Team) training to potentially take place in Norwood so that volunteers could be trained to assist in any emergency in the city. You will NOT get that kind of service from HCPH, not because they don’t want to provide it, but because they have 43 other communities clamoring for the same service. If the city keeps the police, fire, dispatch and Public Works departments because of the immediate and personal service for Norwood, then the NHD should rank right at the top of the list.