Dutchess County Department of Health

Transcription

1 Dutchess County Department of Health AMP Draft 6/25/ Annual Performance Report William R. Steinhaus County Executive Michael C. Caldwell, MD, MPH Commissioner of Health

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3 Dear Community Residents: We are pleased to provide you with the 2007 Annual Performance Report reflecting the achievements of the Dutchess County Department of Health for the various programs implemented during the past year. The Department of Health s competent, well-trained, and motivated employees continue to make strides toward preventing and reducing the burden of chronic and infectious diseases, informing and educating our residents about health issues, advancing community partnerships, and protecting the health and lives of our residents. As you read the 2007 report, several accomplishments should be noted: Launching the HEART Safe Community Initiative, Assessing the burden of cancer and bringing together local Cancer stakeholders to facilitate dialogue and develop a comprehensive local plan, Addressing Childhood Obesity in collaboration with community partners, Promoting the health of infants and their mothers through Nursing home visits, Protecting our Environment through the enforcement of sanitary codes, and Responding to and investigating Disease Outbreaks and emerging issues such as MRSA The Dutchess County Department of Health is accountable to its residents by communicating what it does through its annual performance report. We welcome your input and your participation in making Dutchess County a healthy community. Sincerely, William R. Steinhaus County Executive Michael C. Caldwell Commissioner of Health 3

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7 Dutchess County Department of Health 2007 Organizational Structure Board Of Health Commissioner Of Health Public Health Information Admin Health Planning & Education Environmental Water Laboratory Environmental Health Medical Examiner Clinical Physician Public Health Nursing and Communicable Disease Dutchess County Department of Health Offices Poughkeepsie District Office 387 Main Street - Poughkeepsie, NY Voice: TTY: Fax: Millbrook/LaGrange Collegeview Beacon (Fax) (Fax) (Fax)

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9 DUTCHESS COUNTY DEPARTMENT OF HEALTH VISION AND MISSION STATEMENTS The Dutchess County Department of Health is a diverse group of capable experienced individuals and motivated professionals whose Mission is to protect and promote the health of individuals, families, communities, and the environment of Dutchess County. Our Vision is to build on our tradition of excellence, leadership, and compassion, using the best available science and resources to promote the highest standards of Public Health in response to emerging issues to protect and assist our community. We Value The practice of prevention The on-going assessment of the strengths and health needs of our community Research and its application to Public Health practice The pursuit of innovative solutions to Public Health practice Ethical principals in the work place Culturally sensitive, courteous and respectful treatment of people Excellence in all areas of Public Health Each other s input to guide decision-making Encouragement of staff to develop to their full potential Community service and volunteerism Public and private partnerships Written policies and procedures to guide our daily operations Sensitivity and accommodation of special needs populations Open and honest communications Best use of people and resources Respect for and management of confidential information A quality work environment and safety in the work place 9

10 PUBLIC HEALTH CORE FUNCTIONS The Dutchess County Department of Health is committed to the core functions of Public Health and strives to deliver the essential services necessary for people to live healthy lives. The Core Functions of Public Health are: 1. Assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; 2. Formulating public policies, in collaboration with community and government leaders, designed to solve identified local and national health problems and priorities; 3. Assuring that all populations have access to appropriate and cost effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care. The 10 Essential Services: A Vision for Public Health was released in 1988 by the Institute of Medicine, The Future of Public Health /html/index.html ) identified both the core functions and 10 essential services required to address the mission of public health. The following text and graphic demonstrate how the ten essential environmental health services align with the three core functions of public health (assessment, policy development, and assurance). Assessment 1. Monitor health status to identify community environmental health problems 2. Diagnose and investigate health problems and health hazards in the community Policy Development 3. Inform, educate and empower people about health issues 4. Mobilize community partnerships to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts Assurance 6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of environmental health services when otherwise unavailable 8. Assure a competent public and personal health workforce 9. Evaluate the effectiveness, accessibility and quality of personal and population-based health services 10. Conduct research for new insights and innovative solutions to health problems 10

11 Fiscal Information 2007 Total Receipts by Source $ 22,238,083 General Fund Subsidy Grants Clinic Fees Environmental Health Other Charges Vital Statistics Home Visiting Total Expenditures by cluster $ 36,803,548 Assessment and Health Information Support Services Environmental Health Health Services $40,000,000 $35,000,000 $30,000,000 $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $ Expenditures Revenues Statistics as given by DCDOH Administration These charts illustrate the Dutchess County Department of Health s major sources of income and expenditures for the fiscal years 2000 to They reflect all receipts and expenses incurred by the Department. New York State Aid (Public Health Law, Article 6) continues to be the major funding source for our various Public Health activities. However, the trend in recent years illustrates more reliance on grants and fees for services. Due to the growth in our revenues, we have been able to increase the level of services provided to the community. In 2007, Dutchess County Department of Health received 16 different grants which totaled $1,844,827. These grants have covered a variety of Public Health concerns including diabetes, youth tobacco use prevention, nutrition, Bioterrorism and Emergency Preparedness, Lyme disease, HIV/AIDS, lead poisoning, immunizations, and tuberculosis. The individual amounts of these awards range from $1,900 to $374,000. Note: This budget does not include the Ryan White Title I federal funding to provide services to persons with HIV/AIDS, for which the Department serves as administrative agency. 11

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13 A. PREVENTING AND REDUCING THE THREAT OF DISEASES Flu/Pneumococcal Vaccine Program (Flu Hotline ) For the 2007 flu season, 17 influenza/pneumonococcal clinics were held at various sites throughout the county. A total of 2,891 individuals received Influenza vaccine at these clinics, with 1,823 of participants being ages 65 and older. A total of 169 persons were immunized against Pneumococcal, of which 138 were 65 and older. Additionally, Dutchess County Department of Health s (DCDOH) Immunization Program continued to work with providers to support efforts to vaccinate their high-risk patients. Childhood Immunization Program ( ) The Childhood Immunization Program provides all recommended childhood vaccines to children in Dutchess County. The Program offers clinics throughout Dutchess County as well as educational opportunities to schools, community agencies, health care providers, and parents. As evaluation of immunization rates in private medical practices has been a priority, data is collected from participating medical practices by immunization program staff. The results of the analysis are used to establish accurate immunization levels and to improve immunization rates in private practices. This information is also used to target programs and services to areas with the highest rates of under-immunized children. In 2007, 83% of children seen at public clinics were fully immunized by age two. Adult Vaccine Program ( ) Travel Vaccination Program ( ) The International Travel Vaccination Program and the Adult Vaccination Program provide vaccination and health information to travelers and other adults. In 2007, 381 individuals received important travel advice and vaccinations against at least sixteen diseases: (e.g., typhoid fever, yellow fever, hepatitis A and meningitis). In addition, 393 individuals received adult immunizations at the Adult Immunization Clinics conducted in Immunizations for international travel are available monthly on the second and fourth Wednesday by appointment only at the Department s Poughkeepsie Office. Adult immunizations are also available on these same days. Individuals have the option of calling to make an appointment, but no appointment is necessary for the Adult Immunization Clinic. Children in Foster Care ( ) Public Health Nurses provide developmental surveillance on children newborn to age five years who are placed in foster care. These nurses work with the Department of Social Services workers and foster parents to assure these children are provided routine health assessments, developmental screenings and referral to needed services. A public health nurse is regularly scheduled at the Dutchess County Department of Social Services to review medical records, ensure that those records are ready for adoption proceedings, and make recommendations for needed medical follow-up. In 2007, the nurses provided home services to 34 children and devoted 200 hours for medical record review. 13

14 Rabies Program ( ) Dutchess County Department of Health, in cooperation with the Dutchess County SPCA, offers three (3) pet rabies clinics per year. These clinics are free of charge to pets (domestic dogs, cats, and ferrets) owned by county residents. During 2007, the Department sponsored these free clinics at different locations throughout the county, with one held at the Lagrange Town Hall (175 dogs, 140 cats; 2 ferrets) in the spring, one held at the Wassaic Firehouse (73 dogs, 35 cats, 1 ferret) in the summer, and the last held at the Milan Town Hall (58 dogs, 60 cats) in the fall. This resulted in the inoculation of 544 domestic animals with rabies vaccine at Departmentsponsored clinics. The Department also supports community-partner sponsored low-cost rabies clinics. Three (3) of these clinics were offered during the spring of One hundred and twenty-two pets (42 cats and 80 dogs) were vaccinated at the first clinic; 97 pets (44 cats and 53 dogs) were vaccinated at the second clinic; and 48 pets (17 cats and 31 dogs) were vaccinated at the third clinic. Between the DCDOH sponsored clinic and the low-cost clinics, a total of 811 pets were vaccinated during DCDOH authorized the post-exposure treatment of 49 persons following their exposure to rabid or suspected rabid animals. Public Health Nurses administered rabies vaccine to 34 individuals in Tuberculosis Control Program ( ) In 2007, the Department served 98 individuals through the Tuberculosis Control Program s Pulmonary Clinic. Individuals receive medical evaluations to rule out active tuberculosis as well as provide HIV testing and counseling services. There were only three (3) active cases of TB diagnosed in Dutchess County in All active cases received directly observed therapy. One (1) was managed through the TB control program, one (1) was managed by the private physician, and one (1) was managed by the NYC DOH in consultation with the patient s physician due to complicated medical conditions and the fact that the patient was receiving care in the NYC area at the time of diagnosis. Active TB Cases from 2002 to Community Dept. of Corrections Statistics as reported by Dutchess County Department of Health Communicable Disease Control Division 14

15 Eighty-one (81) individuals were enrolled in the Tuberculosis Control Program s Latent Tuberculosis Infection (LTBI) Program. These individuals do not have the active form of tuberculosis and are not infectious but are still recommended for treatment to ensure they do not develop active tuberculosis later on in life. Patients enrolled in the LTBI Program received a regimen of prescribed medications and regular nursing assessments to evaluate and follow up any complications or side effects from treatment. Screening for tuberculosis through Mantoux Skin Testing continued to be done through weekly clinics. In 2007, 728 individuals were screened through Mantoux clinic. Individuals attending these clinics request screening for employment and school requirements, volunteer activities, and entrance into drug/alcohol rehab centers and homeless shelters. Maternal Child Health Home Visiting Program ( ) Public Health Nurses play an extensive role in monitoring and improving maternal and child health in Dutchess County. In 2007, Public Health Nurses received a total of 1,710 referrals (44% increase from previous year) and made a total of 3,633 home visits (52% increase from previous year) to promote the health of infants and families. Services were provided throughout the county. The Maternal Child Health Program is geographically divided into our three district offices as follows: Poughkeepsie District Office (PDO) Beacon District Office (BDO) Millbrook District Office (MDO) Poughkeepsie City and Town, Hyde Park, Red Hook, Rhinebeck, and Milan East Fishkill, Beekman, Pawling, Fishkill, Wappingers Falls, Beacon Pine Plains, Northeast, Washington, Amenia, Dover, LaGrange, Pleasant Valley, Unionvale, Clinton, and Stanford 2007 Referrals by District Office N = 1,710 MDO 13% BDO 26% PDO 61% The year 2007 saw the continuation of collaborations. Three joint projects of note: 1. Vassar Brothers Medical Center Centering Pregnancy & Parenting classes. 2. Public Health Nurses screening mothers for Postpartum Depression and referring at risk women to a Mental Health professional at Astor Early Childhood Programs and 3. Public Health Nurses providing training and consultation to the staff of other home visiting programs (Teen Partner Program & Dutchess County Healthy Families Program). 15

16 Certified Home Health Agency - CHHA ( or ) Long Term Home Health Care Programs LTHHCP ( or ) Our CHHA and LTHHCP provide skilled nursing, Home Health Aides (HHAs), and skilled therapy services to Dutchess County residents in their homes. In 2007, Public Health Nurses administered flu vaccine to 7 high-risk residents in their homes in addition to their regular caseload. The home care supervisory staff provides consultation and serves in advisory roles on several planning committees, including: The Hudson Valley Home Care Providers Association, Eastern Dutchess County Rural Health Care Network, The Home Care Association of Dutchess County, and the Sharon Primary Health Network. CERTIFIED HOME HEALTH AGENCY (Unit of Services) Type of Service Nursing 5,783 5,573 Physical Therapy 670 1,021 Occupational Therapy Home Health Aide 1,393 1,305 Medical Social Worker 1 4 LONG TERM HOME HEALTH CARE (Unit of Services) Type of Service Nursing 1,205 1,003 Physical Therapy Occupational Therapy 14 4 Home Health Aide Personal Care Aide ,792 Nutrition 3 0 Medical Social Worker Home Delivered Meals 1, Personal Emergency Response Service (PERS) Social Day Care 1,115 1,067 Statistics as reported by the Dutchess County Department of Health Nursing Division 16

17 Newborn Screening Program ( ) Public Health Law sections 2500-a and mandate that all infants born in New York State receive metabolic testing for 44 diseases and an infant hearing screening. The testing and blood specimens are done within the first 48 hours of the baby s life. If repeat testing or additional testing is needed the local health department is notified. A Public Health Nurse follows up to make sure all additional tests are completed. In 2007, there were 93 infants who received these follow-up services. Eastern Dutchess Maternity Clinic- EDMC ( ) In 2007, the EDMC enrolled 49 pregnant women for prenatal care. 18% were teenagers and 36% were Hispanic. Ninety-five percent (95%) the women enrolled were also receiving services from the Women, Infant and Children s (WIC) supplemental nutrition program. All of the participants were counseled on the effects of tobacco use on the pregnant woman and the unborn child, as well as received education and screening for Cystic Fibrosis. Of the women enrolled in this program: 23 delivered lives births, none miscarried, and four were transferred to other Obstetric providers due to high-risk medical conditions. In 2007, 92% of the women enrolled completed postpartum care visits. Children with Special Needs ( ) The Early Intervention Program provided services to 1,379 infants and toddlers with disabilities and their families with an expenditure of $5.6M. The Preschool Special Education Program provided services to 1,009 children ages 3-5 with an expenditure of $14.1M. Both programs have responded to the growing number of Spanish-speaking children and families in each program by contracting with bilingual teachers and therapists in every discipline, and collaborating with St. Francis Preschool on a program of speech therapy groups for young children with severe speech delays in their native language. Parents also attend the sessions to learn techniques in supporting their children s language development. Busing is provided for families unable to supply their own transportation. Childhood Lead Poisoning Prevention Program ( ) The focus of the Childhood Lead Poisoning Prevention Program (CLPPP) continues to be increased testing. In 2007, 61 children were diagnosed with having a lead level between 10-19mcg/dl and 14 children with a lead level of 20mcg/dl or higher. Case management activities were provided as specified by the New York State Department of Health. 17

18 Number of Lead Screenings and Number of Children with Elevated Blood Lead Levels in Dutchess County YEAR # of children 10-19ug/dl # of children >=20ug/dl Data Source: Dutchess County Department of Health # of lead screenings , , , , , , , , ,390 There were more than 160 English and Spanish outreach efforts reaching more than 1,200 people including health fairs for area health care providers, community agencies, parent groups, and Women Infant and Children s Nutrition program sites (WIC) throughout Dutchess County. The major outreach events of the year included the Greater Hudson Valley Home Show and 2007 Kid s Expo where materials and education were made available to the public. The program reached more than 40,000 individuals through these outreach activities. Sexually Transmitted Infections Program ( ) Testing, diagnosis, and treatment of sexually transmitted infections are available twice a week. All services are free, confidential, and available without an appointment. Free Hepatitis A and B vaccines are available to all clinic patients 18 years and older. Cervical, breast and colorectal cancer screening is available for high-risk persons who meet financial/medical criteria established by the New York State Department of Health Healthy Women Partnership program. Referrals are made for all patients with need for additional services. In 2007, there were 1,705 visits to the Sexually Transmitted Infections clinic. STD CLINIC VISITS ,113 1,152 1,245 1,300 1, Data as reported by Dutchess County Department of Health Communicable Disease Control Division 18

19 Dutchess County DOH Sexually Transmitted Disease Data Chlamydia Gonorrhea Primary and Secondary Syphilis Early Latent Syphilis Data as reported by Dutchess County Department of Health Communicable Disease Control Division The number of cases of gonorrhea has been declining in recent years, with a 56% decrease from 2001 to The largest drop was from 2004 to 2005 (37% decrease) and the most recent decrease, from 2006 to 2007 was 23%. It is not possible to identify the causes of this apparent continued decline because the interpersonal dynamics of disease transmission are not well understood. Chlamydia continues to be the reportable STD with the greatest number of cases. While annual cases averaged 433 for the period , the number of cases rose by 25% from 2006 to Chlamydia is now the most frequently reported communicable disease in the county. This may be due in part to improved screening and reporting. New York State mandated reporting of this disease starting in Hepatitis C virus screening services 213 patients were screened for the HCV through the HIV/STD clinics. Five (5) were identified as positive, counseled, and referred for medical services. Clinical Research Vaccine Trials The Department continued its involvement in vaccine clinical research projects. In 2007, the Department partnered again with GlaxoSmithKline to investigate a vaccine designed to prevent avian influenza (bird flu). Ninety (90) participants were enrolled and will be followed into the summer of The Department was also a study site for the extension component of 2006 investigation of a new flu vaccine designed to improve protection against influenza for those persons 64 and older. Eleven (11) women continued to participate in the last year of a four-year study designed to investigate a vaccine to protect women against cervical cancer. Results from this study are expected to be available in the coming year. 19

20 HIV Counseling and Testing Program HIV counseling and testing is available at the Department s Poughkeepsie site by appointment or walk-in. All testing is free of charge and both "anonymous" and "confidential" testing is offered. Confidential counseling and testing is also available in conjunction with STD and TB clinics. Partner Notification Assistance Program (PNAP) and testing is available to persons living with HIV/AIDS who should inform partners of possible exposure to HIV. Number of HIV Tests given by DCDOH from ,543 1,243 1,272 1,076 1, , Data as reported by Dutchess County Department of Health Communicable Disease Control Division This year, colleges were selected as a target for outreach and testing after three students at a local college tested HIV positive in African American faith-based communities were selected following the recommendations of the Center for Disease Control and Prevention to address the disproportionate number of African Americans infected with HIV. In 2007, a total of 1,543 tests were provided, identifying four (4) HIV positive individuals Number of HIV Tests Given by DCDOH By Various Clinic Sites Type of Clinic Number of Tests Provided STD 1,216 HIV 211 High risk off site outreach 109 PNAP 7 Total 1,543 Source: DCDOH, Communicable Disease Control Division 20

21 Ryan White HIV/AIDS Treatment Modernization Act of 2006 Part A Program ( ) Dutchess County first became eligible for Ryan White federal emergency funds in 1995, under the original CARE Act (Comprehensive AIDS Resources Emergency Act). With receipt of Ryan White funding in 1995, the Dutchess County HIV Services Planning Council was created to establish an effective compassionate and comprehensive system of health care and other support for people living with HIV/AIDS in Dutchess County. In 2006, the CARE Act was reauthorized as the Ryan White HIV/AIDS Treatment Modernization Act of As a result, Dutchess County was designated as a Transitional Grant Area (TGA). As a TGA, Dutchess County now receives Part A funds (formerly Title I under the CARE Act) for services for people living with HIV disease. The prevalence of AIDS in Dutchess has steadily increased, from 536 cases in 2000 to 821 in The primary risk factors for disease exposures are Intravenous Drug Use (48%) followed by heterosexual transmission and Men having Sex with Men (14% each). The HIV prevalence rate is 361/100,000 people, which is twice the national HIV rate. The burden of HIV infection falls on minority populations, with approximately 45% of the cases among Blacks and about 27% Hispanics. The epi-centers of HIV infection are the urban areas of Poughkeepsie and Beacon. To face this epidemic, in 2007, the Planning Council allocated funds to a range of interventions aimed at increasing access to the HIV continuum of care. Ryan White Part A funds were allocated to services that would keep People Living With HIV/AIDS in primary care and get into care those who know their HIV positive status but are not in care. The face of HIV knows no race, gender, age, sexual orientation, religion, or politics. It only knows SUFFERING, HARDSHIP, and DEATH. It continues after 25 years because we haven t stopped it. TIME TO OWN IT TIME TO END IT 21

22 2007 RYAN WHITE PART A PROGRAM REPORT (MARCH 1, 2007-FEBRUARY 28, 2008) SERVICE CATEGORY Outpatient/Ambulatory Medical Care is the provision of professional diagnostic and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. AIDS Drug Assistance Program (ADAP) provides FDA-approved medications to low-income individuals with HIV disease who have limited or no coverage from private insurance, Medicaid, or Medicare Mental Health Provides outpatient mental health treatment and counseling services to people living with HIV disease. Substance Abuse Provides medical or other treatment and/or counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting, rendered by a physician or under the supervision of a physician, or by other qualified personnel. Medical Case Management Clientcentered services that link clients with health care, psychosocial, and other support services. The goal is to ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care Activities include assessment of client s needs and personal support system, development of an individual service plan, monitoring and reevaluation to determine the effectiveness of interventions. ACCOMPLISHMENT/OUTCOME Outpatient/Ambulatory Medical Care services were provided to two-hundred and eleven (211) clients living with HIV disease, all of which were also provided with appropriate specialty care referrals. Ninety-five (95) clients received an individualized medication adherence intake, assessment and adherence specific support sessions. In FY2007, thirty-five (35) clients received assistance with medications for the treatment of HIV disease. Eighteen (18) clients received mental health counseling sessions by a Certified Social Worker. The sessions provide intensive support for clients experiencing compounding problems in addition to their HIV diagnosis. Forty-two (42) clients received substance abuse treatment and counseling services. Forty-two (42) clients were linked to to primary medical care and HIV/AIDS service providers as necessary. Forty-two (42) clients were assessed and provided with harm/risk reduction methods and partner notification assistance. In FY 2007, a total of ninety-one (91) clients were served between two providers. Sixty-six (66) of these clients were minorities (i.e. African American or Hispanics). Case managers assess clients needs and personal supports; mutually develop individual service plans, monitors and reevaluates to determine the effectiveness of interventions. Medical and community case managers regularly case conference to support continuity of care and medical adherence. An interdisciplinary team of providers case conferenced forty-eight (48) clients during the reporting period. 22

23 2007 RYAN WHITE PART A PROGRAM REPORT (MARCH 1, 2007-FEBRUARY 28, 2008) SERVICE CATEGORY Treatment Adherence Services Ensures readiness for, and adherence to, complex HIV/AIDS treatments. ACCOMPLISHMENT/OUTCOME In FY2007, a total of fifty-eight (58) clients were provided medication adherence, treatment education, peer-based information, and referrals to HIV health care and support services. Early Intervention Services Includes counseling individuals with respect to HIV/AIDS; HIV testing; and appropriate health care referrals. Medical Transportation Transportation is provided to access health care services, including medical, case management, mental heath and substance abuse services. In FY2007, twenty-five (25) people living with HIV that were not in care were located and engaged. Sixty (60) people with high risk for HIV were provided with HIV counseling and testing. Twenty-five (25) people living with HIV were provided with referrals and follow up to health care and support services. The Transportation program provided two hundred and fifteen (215) rides to health care services for thirty-three (33) unduplicated clients. Emergency Financial Assistance provides consumers with financial assistance for utility, phone and prescription medicine. The program assisted twelve (12) eligible clients, including that required emergency assistance for telephone, utilities and medications, and fifteen (15) clients accessed the program s food pantry. The program notes that all of the prescription assistance requested has been for non-antiretroviral and other non- HIV related medication. Home Delivered Meals provides home delivered meals to those recently released from the hospital or home bound for medical reasons. Nineteen thousand three hundred and forty five (19,345) meals were delivered to fifty-three (53) eligible clients. 23

24 Lyme Disease & Other Tick-borne Infections ( ) Tick-borne diseases remain a prominent health concern in Dutchess County. In the last three years, there has been a significant increase in reports of anaplasmosis, ehrlichiosis, and babesiosis. This is related to public health efforts that targeted awareness of these other tickborne pathogens to both providers and the public. Confirmed Cases of Tick-Borne Disease as reported to the NYS Department of Health Disease Lyme Disease 1,076 1, N/A* Ehrlichiosis/Anaplasmosis Babesiosis Data as reported by New York State DOH *Total Lyme disease cases are currently not available for Dutchess County is currently testing/conducting sentinel Lyme disease surveillance at the behest of the New York State DOH. This method, where the county follows 20% of laboratory reports and 100% of provider reports, will potentially reduce the burden of surveillance activity. Final case numbers will determined based on a formula determined by the NYSDOH. The effectiveness of sentinel surveillance is still being assessed and this method may be discontinued due to the new CDC surveillance case definition for Lyme disease in Reports of Tick-Borne Disease as reported to the Dutchess County Department of Health Disease Lyme Disease 5,783 4,542 3,605 2,775 Ehrlichiosis Babesiosis Rocky Mountain Spotted Fever Data as reported by Dutchess County Department of Health Communicable Disease Control Division Other Common and Emerging Communicable Diseases ( ) Dutchess County Department of Health s Communicable Disease Control Division continues to monitor reports of common and emerging communicable disease. The division interrupts the spread of communicable disease through regular disease surveillance, prompt case investigation, continual education to health care providers and persons effected by communicable disease and the implementation of prophylactic clinics to provide preventative vaccines as well as medications to those persons exposed. 24

25 In the fall of 2007, the Communicable Disease Control Division launched a widespread effort to respond to several outbreaks of Methicillin Resistant Staph Aureus (MRSA) infections in academic settings. Several school districts experienced outbreaks in members of athletic teams or within school personnel. The Department worked closely with school nurses, school administrations, parent groups and the media to educate and develop policy for case assessment, management and prevention. West Nile Virus WNV (WNV Hotline ) In 2007 there were no reported human cases of West Nile Virus (WNV). The Department continues to conduct surveillance of dead birds and mosquitoes. A total of 4,109 mosquitoes were collected with 2,418 mosquitoes in 101 mosquito pools submitted for WNV testing. Mosquito collections were up by 44% and numbers of pools were up by 35% from There were 3 WNV positive mosquito pools from 2 different locations. A total of 206 birds were reported. Of the total reported birds, seventy seven (37%) birds were tested for WNV. The total number of birds reported was reduced by 25% from last year. The total number of birds tested increased slightly (59 in 2006 and 77 in 2007), mostly due to large number of crows collected in December 2007 by New York State Department of Environmental Conservation. One blue jay and one crow were found to be positive for WNV in August The following table is a breakdown of bird sightings by township and by month. Dead Bird Sightings by Township by Month 2007 Township Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Percent Poughkeepsie/C Poughkeepsie/T East Fishkill/T Wappinger/T La Grange/T Beekman/T Red Hook/T Hyde Park/T Rhinebeck/T Fishkill/T Pawling/T Washington/T Beacon/C Pleasant Valley/T Union Vale/T Milan/T Pine Plains/T Clinton/T Dover/T North East/T Unknown Total

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27 B. INFORM AND EMPOWER PEOPLE ABOUT HEALTH ISSUES Health information, health education, and health communication activities designed to reduce health risk and promote better health are crucial to ensure a healthy community. Putting Public Health on the community agenda is one of the critical tasks local health departments are called to do. The Dutchess County Department of Health accomplished this by increasing its communication with the public through the media, participating in health fairs, community events, as well as engaging in direct community educational presentations. Health Communication Activities The Commissioner s Column in the Poughkeepsie Journal appeared on the second Sunday of each month during This regular column provided ongoing communication with the general public on a variety of health topics, raising awareness, and understanding of public health issues. News releases and PSAs were sent out to weekly to all local media. In 2007, a total of 45 news releases and PSAs were sent out on a variety of topics. The Dutchess County Department of Health s web page on the County website was also regularly updated to provide information to the public. In 2007, there were a cumulative number of 210,871 hits recorded for all of the Dutchess County Department of Health s pages. Hotlines were set up and ran for topics such as West Nile Virus (WNV) and Adult Public Flu Clinic Program. All hotlines were heavily used, with variation during seasonal periods (i.e. an increase during the summer months for WNV and an increase in the fall for Flu). The Department worked with the County Executive s Office to issue the Dutchess County Government Winter 2007 Newsletter to all of Dutchess County Households. The mass mailing of the newsletter provided information to the county residents on several topics including winter safety, childhood lead poisoning, and the availability of the county helpline for those who experience anxiety or depression. Dutchess County Department of Health staff also organized and participated in special events such as Lyme Disease Week, Breast Cancer Month, and World AIDS Day. The Dutchess County Department of Health continues to receive requests for presentations for health programs from day care providers, Pre-School, elementary, middle and high schools, colleges, and camps. Public Health Nursing staff, Public Health Advisors, Sanitarians, and Public Health Education Coordinators combined provided more than 400 educational and outreach presentations during 2007, reaching more than 9,000 individuals (combined children and adults). Pre- and post-tests as well as satisfaction surveys were utilized for 80% of these presentations and revealed an overall good satisfaction as well as good retention of the information presented. 27

28 Community Education In 2007, there were a total of 2 Tobacco Use Prevention educational presentations in schools and Community-Based Organizations given reaching a total of 25 students/youths/adults. Evaluation of the presentations conducted revealed the following that 100% felt their awareness was raised as a result of the presentations. Several West Nile Virus educational activities were conducted, ranging from mailings to health fairs, news releases, website posting, telephone hotline, and distribution of information during public events. In 2007, there were a total of 125 WNV hotline calls and five s via the healthinfo website received. Information was offered via mailed packets or referrals to the Dutchess County Website. Additionally there were 3 WNV educationals done for 100 seniors with 100% stating their awareness was raised by offering this program. A total of 101 Nutritional and Physical Activity educational presentations including Eat Well Play Hard strategies, Fit4ever, Fit Kids, Hyde Park Trails, Portion Distortion and Portion Size were conducted, reaching 2,437 students/adults. Additionally the Department joined with other community agencies including Astor Home for Children, the Children s Medical Group, The American Wellness Care, YMCA, and Literacy Connections to encourage children to exchange their Halloween Candy for Books and Family Fun passes to the YMCA. The program was very successful collecting more than 3000 pounds of candy which was donated to the troops in Iraq. Diabetes and Go Red Sunday education/awareness were offered 14 times at Faith-Based Organizations during Sunday services reaching 2,599 parishioners in Diabetes Sunday is a ten-minute educational awareness program offered to the faith community. A simple definition of diabetes, current statistics, risk factors, signs, and symptoms are provided for the audience. There were also 13 presentations offered with regards to diabetes and healthy eating for people with diabetes, reaching 245 individuals. In 2007, 53 presentations were given on Stress Management and Cardio-vascular Health and CPR Heartsaver classes to 425 employees, schools and at risk minority populations in the community and at the local jail. Evaluations consistently reported increased knowledge and satisfaction with the program. In order to promote better life skill choices, a total of 12 teen pregnancy prevention programs using the Empathy Belly were given to 328 Dutchess County middle and high school students. Twenty-three (23) presentations were given promoting good oral care to a total of 518 students and teachers at various elementary and preschools within Dutchess County. A total of 10 Lyme disease educationals/health fairs were done reaching more than 6,000 students and adults. HIV/STD prevention education and outreach is targeted to high-risk populations and offered regularly at multiple sites throughout Dutchess County. These sites include substance abuse treatment centers, centers serving the homeless, soup kitchens, colleges and African American faith based communities, as well as street outreach in areas of the community where high risk populations may be found.. The Department restructured and intensified its outreach program to fit the enhanced outreach model, with the goal of getting high risk individuals to be HIV tested. In 2007, there were 57 prevention education and outreach events reaching over 3,546 individuals. 28

29 Food Service and Outreach and Education During 2007, the Environmental Health Services division fully implemented a two-day food safety training course. This class, which covers the fundamentals of food safety in the restaurant setting, is offered on a monthly basis to owners and workers at food service establishments that were subject to enforcement action. Food service workers who were interested in increasing their knowledge of food safety principles also attended the course. Sixteen certificates were issued to attendees upon satisfactory completion of the two-day class. A sample of 100 restaurants (excluding large franchises) in 19 zip code boundaries was surveyed throughout Dutchess County in the spring of 2007 to assess the use of trans fats among food service providers. Restaurants were asked to identify presence of partially hydrogenated vegetable oils (PHVOs) in oils and fats used for three cooking methods: frying, baking and spreads, as well as in five pre-processed foods: French fries, mozzarella sticks, fish sticks, chicken nuggets and hamburger buns. Within the restaurants surveyed, 54.7% use a least one type of fat (frying, baking, spreads) that contain PHVOs. More than 35% of restaurants use more than one type of fat for each cooking method. Of the 64 restaurants that used all three cooking methods, 37.5% did not use any at containing PHVOs and only 6.25% used fats that contain PHVOs for all three cooking methods. The majority of restaurants surveyed served French fries (73%) and/or hamburger buns (53%). Less than 50% of the restaurants surveyed serve each of the other pre-processed foods (mozzarella sticks, fish sticks, chicken nuggets). Of the restaurants that serve French fries, 80.9% contain PHVOs, and 26% serve French fries containing PHVOs and use frying oils that contain PHVOs. 29

30 Bathing Facilities: Outreach and Education Public Health Sanitarians within the Environmental Health Services division began to provide drowning prevention seminars in 1988, following a drowning at a permitted facility within the County. These educational presentations, focused on drowning victim recognition, were geared primarily towards lifeguards and served to raise their awareness regarding distressed swimmers. In 2007, the Environmental Health Services division continued to promote recreational and bather safety by offering drowning prevention seminars to lifeguards and other members of the general public interested in learning about drowning victim recognition. During the 2007 summer pre-season, the Sanitarian staff conducted nine (9) drowning prevention seminars, educating a total of 133 individuals. In an effort to make this message available to all county residents, at least one seminar was offered in each region of the county and two night seminars were also offered. The Dutchess RX Prescription Drug Discount Program ( ) In 2004, Dutchess County launched a discount card program to help consumers cope with the high price of prescription drugs. The Department of Health was assigned the responsibility for implementing the program. Free prescription drug discount cards are available under a program sponsored by the National Association of Counties (NACo) that offers average savings of 20% off the retail price of commonly prescribed drugs. The program is administered by AdvancePCS, a division of Caremark Rx, Inc. of Nashville, Tenn. The cards may be used by all county residents, regardless of age, income, or existing health coverage, and are accepted at 56 pharmacies throughout the county. A national network of more than 54,000 participating retail pharmacies also will honor the NACo prescription discount card. There is no enrollment form, no membership fee, and no restrictions or limits on frequency of use. Cardholders and their family members may use the card any time their prescriptions are not covered by insurance. As of December 31, 2007, the program cumulatively has served 10,501 people, with 21,737 prescriptions covered, yielding a year-to-date price savings of $358,409 or 26.81% price savings for prescriptions filled. 30

31 Month Dutchess County December 2007 NACo Prescription Discount Drug Program Monthly Status Report Total Residents Served Per Month Total Residents Served YTD Total Prescriptions Covered Per Month Total Prescriptions Covered YTD Price Savings Per Month Price Savings YTD % Price Savings Per Prescription January ,367 1,367 $22,199 $22, % February 704 1,389 1,354 2,721 $21,341 $43, % March 757 2,146 1,531 4,252 $23,685 $67, % April 801 2,947 1,682 5,934 $26,399 $93, % May 824 3,771 1,730 7,664 $28,511 $122, % June 767 4,538 1,557 9,221 $25,269 $147, % July 781 5,319 1,589 10,810 $25,193 $172, % August 922 6,241 1,849 12,659 $31,283 $203, % September 1,023 7,264 2,133 14,792 $35,344 $239, % October 1,108 8,372 2,369 17,161 $39,050 $278, % November 1,062 9,434 2,275 19,436 $39,372 $318, % December 1,067 10,501 2,301 21,737 $40,764 $358, % Current totals include prior months adjustments received from NACo s cumulative totals. To find out more about this program, log onto or call

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33 C. COMMUNITY PARTNERSHIPS Several initiatives addressing chronic diseases were implemented in 2007, including programs addressing childhood obesity, healthy heart, cancer, tobacco use, and diabetes. All of these initiatives involved the community through coalition building and public private partnership. Launching The HEART Safe Communities The program was launched on September 25 th, 2007, at the Culinary Institute of America (CIA). The HEART Safe program is based on incentives and recognition to all those who meet specific criteria that have the potential for saving the lives of sudden cardiac arrest victims through the use of cardiopulmonary resuscitation (CPR) and increased public access to defibrillation (AED). A HeartSafe designation is determined by meeting basic and category specific criteria. Every applicant must complete five basic criteria as outlined in the application form. Additional criteria achieved, such as number of staff trained in CPR, determine the bronze, silver or gold status. Operation Heart Beat The Dutchess County PAD Program has been expanded to nineteen (19) County Government sites with a total of twenty-three (23) Automatic External Defibrillators (AED) located throughout County-owned buildings. The newest placements were at OCIS, EIP Program and 385 Main Street. Each PAD site has a Site Representative to assist with maintenance of the AED s. There are currently 186 trained responders for the buildings. Drills are conducted quarterly at each site. SmokeFree Dutchess ( or ) SmokeFree Dutchess (SFD) is a tobacco control community partnership grant funded by the NYS DOH Tobacco Control Program and administered through the Dutchess County Department of Health. SmokeFree Dutchess goals are to decrease exposure to secondhand smoke, promote cessation from tobacco use, to prevent youth initiation of tobacco use and to decrease the social acceptability of tobacco by running counter-marketing ad campaigns, education, and advocating for changes in social norms. SFD continues to work on its No Thanks Big Tobacco Campaign which encourages organizations in Dutchess County to adopt a policy not to accept direct tobacco industry funding, sponsorship and promotion. This initiative relates to our goal of decreasing the social acceptability of tobacco use. Nine (9) organizations adopted this policy in Another initiative SFD is working on is called Tobacco Point of Purchase Advertising. This initiative educates retailers on the negative effects of tobacco point of purchase advertising on the residents of Dutchess County. In 2007 SFD and the DC Dept. of Health distributed a brochure educating tobacco retailers about what tobacco point of purchase advertising is and how it encourages under age youth to purchase cigarettes at their establishment. SFD plans to continue to encourage retailers to decrease or eliminate tobacco point of purchase advertising in their retail environment in To date 32 retailers signed policies to reduce or eliminate tobacco point of purchase advertising. 33

34 Comprehensive Cancer Coalition In 2007, the Dutchess County Comprehensive Cancer Consortium began the process of assessing the local continuum of care and developing a comprehensive cancer control plan. The plan will include all aspects of the disease, from prevention to quality of life and early detection. The Consortium guided a community-wide cancer needs assessment which identified the strengths and barriers in our local system of cancer prevention, screening, diagnostics, treatment, support services and workforce development. The Needs Assessment results were presented in a community forum held at the Henry A. Wallace Center in October The assessment drew upon information gathered from key informants, focus groups and surveys to care providers in multiple disciplines. The information systematically gathered and analyzed from this assessment will prove to be essential in developing an evidence based work plan for the consortium and the development of a local comprehensive cancer control plan for Dutchess County. Children s Health Initiatives The Department of Health continues to oversee the county-allocated funds for comprehensive Childhood Obesity Prevention & Intervention and Youth Tobacco Use Prevention programs under the auspices of Children s Health Initiative, a committee of the D. C. Children s Services Council. The Department contracted with United Way of Dutchess County in 2007 for administration of the grants which includes overseeing the RFP process, monitoring and evaluating the programmatic and fiscal activities of the service providers. In 2007, $130,000 grant funds served 1,275 youth and 135 adults in obesity programs. $250,000 grant funds served 3,663 youth in tobacco initiatives. Counter marketing was used to enhance and promote awareness and attitude changes on the issue of obesity and tobacco use. A mix of pre-produced Center for Disease Control and Prevention (CDC) commercials and commercials done by the Children Media Project were used and aired on the local Cablevision and Time Warner Cable stations. 34

35 CHILDREN S HEALTH INITIATIVE CHILDHOOD OBESITY PREVENTION GRANTS $30,000 Beacon Community Center Beacon We Can! Number of Youth Served: 206 (5-12 yo) Outcomes: 95% of youth increased knowledge of healthy food choices & nutritious eating and 100% increased knowledge about importance & value of physical activity. This was achieved through a summer camp and after-school programs and utilizing CATCH curricula. $50,000 CAPE The Marathon Program: Empowering Youth Through Running Number of Youth Served: 51 (12-18 yo) Outcomes: 88% of youth increased knowledge of healthy food choices and nutritious eating as well as increased knowledge & value of physical activity. This was achieved through mentors working with the youth, providing education about nutrition and physical fitness as well as training them in distance running. $27,000 Children s Media Project Consumption: Media & Food Number of Youth Served: 230 (10-14 yo) Outcomes: Through after-school & summer workshops, 100% gained awareness and became more media literate about childhood obesity. Projects included researching marketing tools of food advertisers and creation of PSA s. $10,000 Girl Scouts Body By ME! Number of Youth Served: 495 (5-18 yo) Outcomes: Through a variety of Girl Scout program offerings, including fitness & nutrition workshops and the Al kebulan Dance & Drumming Circle, 90% of the girls increased awareness of the importance of physical fitness as well as healthy eating/nutrition. $10,000 North East Community Center Summer Camp / AwareKids! 2007 Number of Youth Served: 24 (8-13 yo) ** 11 yth counted in CMP outcomes, subtract from 24 Outcomes: Through a summer camp with cooking projects and daily physical activity, 13 youth gained awareness of importance of physical fitness and healthy eating/nutrition. Through Children s Media Project (CMP) workshop series, 11 youth achieved CMP s outcome (see above). $3,000 YMCA Kidz Y Challenge Number of Youth Served: 280 youth (all ages) Outcomes: Through participation in the 2 nd annual Obesity Awareness Walk, 381 adults & youth increased awareness of the prevalence and negative impact of childhood obesity. 35

36 CHILDREN S HEALTH INITIATIVE YOUTH TOBACCO-USE PREVENTION GRANTS $60,000 Children s Media Project Take Another Look Number of Youth Served: 82 youth (10-18 yo) Outcomes: 17 out of 21 youth gained knowledge about the negative effects of tobacco & its use as well as gained knowledge & utilized media literacy techniques for tobacco-use prevention. 61 youth participated in focus groups, gaining awareness about the negative effects of tobacco and tobacco media literacy awareness. $90,000 CAPE Tobacco Free Youth Initiative Program Number of Youth Served: 2,409 (8-18 yo) Outcomes: Through LifeSkills & Teens Against Tobacco Use (TATU), 100% of youth gained awareness about the negative effects of tobacco & its use, while 722 of the youth participated in trainings and increased their knowledge. 59 students became peer educators. $20,000 Martin Luther King Cultural Center $15,000 Mid-Hudson Children s Museum The Theatre Project Teens Against Tobacco Use (TATU) Youth Volunteer Program Number of Youth Served: 70 (8-18 yo) Outcomes: Utilizing TNT & Smokescreen curricula and performances, 69% of youth increased their knowledge about the negative effects of tobacco & its use. 35 of those youth created & performed rap music & dance in three public performances. An additional 13 youth gained awareness through a shortened summer program. Number of Youth Served: 45 (10-18 yo) Outcomes: Through TATU training, 96% of youth increased their knowledge about the negative effects of tobacco & its use. Those youth developed and gave presentations to children and adults. $35,000 Mill Street Loft What s Behind the Cigarette? $30,000 St. Francis Preventing Alcohol & Drug Abuse Through Primary Education (PADAPE) Number of Youth Served: 89 (11-18 yo) Outcomes: Through education & creative arts as well as public performances, 80% of youth increased knowledge about the negative effects of tobacco & its use, increased media literacy skills and utilized counter-marketing techniques. Number of Youth Served: 968 (8-15 yo) Outcomes: Utilizing Here s Looking at You and Get Real About Tobacco curricula through in-school classroom teaching, 88% gained knowledge about the negative effects of tobacco and its use. 65% of the youth developed an understanding of how to make healthy choices. 36

37 Diabetes Coalition The Mid Hudson Catskill Coalition for the Prevention of Diabetes meetings are conducted quarterly by the sponsoring agency. Dutchess County Coalition meetings are held bi-monthly or as needed when planning community and professional educational events. The coalition continues to offer community education programs to local residents in senior housing, local churches, and as requested by community organizations. Scheduled programs are advertised through church bulletins and posted in the senior sites. All sessions include standards of care for the persons with diabetes. Diabetes Sunday, a five minute educational awareness program offered to the faith communities has reached 1,348 individuals in the 8 sessions held. In addition to diabetes awareness Sunday, we have conducted a total of 20 community educational programs which includes health fairs reaching 20 children and 425 adults. A County Community Education Program, The 4Ms of Diabetes Self Management was held on April 14, 2007 reaching 41 persons with diabetes and/or family members In 2007, the Outreach & Awareness Educational programs for churches, seniors, work sites, community organizations, and Diabetes Sunday reached 1,983 county residents via 28 programs. Other Coalitions The Department s personnel regularly participated in various other coalitions, including the Eastern Dutchess Rural Health Network, Dutchess County Housing Consortium, American Cancer Society, Dutchess Healthy Partnership, Domestic Violence Prevention Coalition, Youth Development Action Network (previously known as Teen Pregnancy Prevention Network), American Heart Association, Children Services Providers Network, and the Dutchess County Children Services Council, to name a few. 37

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39 D. PROTECTING THE HEALTH & LIVES OF DUTCHESS COUNTY RESIDENTS Enforce laws and regulations that protect health and ensure safety The Dutchess County Department of Health is responsible for the enforcement of sanitary codes, especially in the food industry; the protection of our drinking water supply, the enforcement of clean air standards, and the follow up of hazards and exposure-related diseases identified in occupational and community settings. Enforcement Actions for 2007 Number Type Fines 10 Food service facility actions $9,900 1 Children s Camps $500 1 Sewage disposal system failures $10, Retail tobacco fines (10/1/06-9/30/07) $9,400 Total $29,800 Community Sanitation for 2007 Type Number done Food service inspections and reinspections 3,286 Nuisance FV and complaint investigations 808 Subdivision and individual lot inspection/ reinspection 915 Residential Sanitation (housing) and complaint investigations 564 Residential Lead investigation field services 90 Rabies investigations 375 Rabies specimens to Albany 135 (10 positive) Rabies post-exposures 49 Drowning prevention seminars 9 Clean Indoor Air, Tobacco Sales and Tobacco Use The New York Adolescent Tobacco Use Prevention Act (ATUPA) prohibits selling cigarettes to minors, and requires retailers to obtain positive proof that the person buying the cigarettes is over the age of 18. Additionally, the Dutchess County Sanitary Code requires retailers to obtain a Dutchess County permit to sell tobacco products. 39

40 Dutchess County Department of Health conducts regular compliance inspections, including compliance checks where minors attempt to purchase tobacco. Compliance Checks Results From October 1, 2006 through September 30, 2007 # of retailers # of vending machines # of inspections conducted # of tobacco violation Total fines collected with minors 47 with adults 20 sales to minors $9,400 The Environmental Health Services division also enforces the Clean Indoor Air Act at bars, restaurants, and other places of employment. Between January 1, 2007 and December 31, 2007, 23 complaints of indoor smoking were investigated. Seventeen after-hour compliance checks were also completed at restaurants and bars throughout the County. While enforcement action was taken against one gas station for indoor smoking, the seventeen food service establishments subject to after-hour checks were found to be in-compliance with CIAA regulations. Dutchess County Sanitary Code Article 25 requires all private schools and public school districts each year to file a smoking policy with the DCDOH by September 30 th. Additionally, public and private schools that include grades 6 thru 12 are to report smoking/possession violations on school grounds twice per year. Schools Public School Districts (N=13) Dutchess County Private School and Public School District Reporting (September 1 st August 31 st 2007) % Submitting smoking policies % Submitting violation on 1st report period % Submitting violation on 2nd report period 61% 66% 57% Private schools (N=32) 50% 57% 43% Public schools submitting reports on smoking/possession violations reported 89 students to be in violation during the 2006/2007 school year. Among the private schools reporting on smoking/possession violations, 11 students were found to be in violation. 40

41 Environmental Hazards Lead The Radiological and Environmental Health Program (REHP) conducts environmental lead assessments in homes, schools and daycares where a child with an elevated blood lead level greater than 20 micrograms per deciliter spends a significant amount of time. To date, the department has conducted 20 environmental investigations resulting in 14 Notice and Demand hearings requiring the discontinuance of conditions conducive to lead poisoning saw an expansion of initiatives by the Radiological and Environmental Health Program aimed at improving and increasing efforts in Primary Prevention of Childhood Lead Poisoning by partnering with community agencies and resources. These activities included presentations of Lead Awareness Training targeted to specific agencies and groups, including Section 8 Housing Inspectors, and Family Day Care providers coordinated by the Child Developmental Council. An interagency meeting between Dutchess County Health Department and Dutchess County Social Services Department was held to provide a coordinated agency response to families of children with elevated blood lead levels. Education on the dangers of lead and the prevention of lead poisoning was presented to the public at the annual home show and via the Commissioner of Health s monthly column in the Poughkeepsie Journal. Planning began in 2007 to co-sponsor (with NYS DOH) Lead Awareness Training and Lead- Safe Work Practices Training (Spring 2008) for county code enforcement officers, who have an integral role in Lead Poisoning Prevention. Oil Spills The DCHD reviews spill reports as provided to this department by the New York State Department of Environmental Conservation. These spill reports are evaluated for potential impacts on nearby public and private water supplies. The Health Department also reviews the results of water samples that are collected to monitor water treatment systems installed at spill sites. Radiation The REHP staff is certified by the NYS DOH Bureau of Environmental Radiation Protection to conduct inspections of x-ray producing equipment at hospitals, educational institutions and medical, veterinary and dental offices. These facilities are evaluated for compliance with the NYS Sanitary Code regulations regarding ionizing radiation. The Tanning Program is in its second cycle of inspections of 40 tanning facilities to determine compliance with the Dutchess County Sanitary Code. Other Hazards Additional program activities include responding to public inquiries and complaints regarding radon, indoor air quality, mold, asbestos and other topical environmental health issues. 41

42 Engineering During 2007, the Engineering section of the Environmental Health Services Division accomplished the following: 1. Approval of 991 residential building lots with a total housing value of approximately $400M. 2. Approval of 368 plans for subdivision, individual lots, commercial properties, public water and sewerage systems, and public swimming pools. 3. Investigations of soil pesticides in subdivisions built on lands previously used as orchards. 4. Creation of computer maps indicating levels of drinking water and ground water contaminants in the county. 5. Revision of the Dutchess County Department of Health Design and Construction Standards for Water and Wastewater Systems. Public Water Supplies The Department currently regulates 701 public water supplies (PWS). In the city of Beacon, and the city and town of Poughkeepsie, approximately 100,000 people rely on public water. This represents one-third of the population of Dutchess County. These larger community supplies, along with 90 others, are regulated by the engineering section of the Environmental Health Services division. Water supplies at facilities under permit (restaurants, motels, camps, day care centers, etc.) are inspected by public health sanitarians assigned to one of the three district offices. There are approximately 315 of these water supplies. The remaining 300 supplies are monitored by the Department s Water Enhancement Program staff. During 2007, as a result of 650 inspections at public water supplies, more than 475 violations were issued. The most common violations cited were: unsatisfactory operation of treatment equipment; source water pollution; incomplete or unacceptable reporting by the supplier; the presence of a cross-connection between potable and non-potable water; failure to maintain disinfection chemicals at proper concentrations; failure to monitor for contaminants in a timely manner; modification to the treatment system without approval; and diminished quality or quantity of source water. Throughout the course of the year, organic chemicals were sampled by water suppliers (243 samples) and the Department (58 samples); inorganic samples were also collected by water suppliers (242 samples) and the Department (426 samples). The combined number of bacteriological samples taken by water supplies and this Department was 4,270, of which 10% were repeat samples collected to determine if a violation existed. Samples are taken regularly at PWS to analyze for a variety of organic chemical contaminants. Among the many water supplies that are monitored in this fashion, 41 are at gasoline service stations, generally in association with a convenient mart or a small plaza or mall. The organic chemical of primary concern at these locations is the petroleum additive MTBE (methyl-tertiarybutyl-ether). In the event of a petroleum spill or a leaking storage vessel, MTBE, being highly soluble in water, finds its way quickly into drinking water sources. During 2007, of 43 samples collected at the wells of these vulnerable supplies, 27 returned with an MTBE detect and 16 42

43 returned free of the contaminant. Of those showing a detect, 13 were below the allowable maximum contaminant level (MCL) of 10 ug/l (parts per billion: ppb) and 14 exceeded that limit. Those supplies exceeding the MCL are actively treating the water to remove the contaminant. The range of detects was 0.5 ppb at the low end to 700 ppb at the upper, which represents a decline in the level of source water contamination. This was to be expected, since MTBE has been discontinued as a gasoline additive since January Nevertheless, with sampling recently expanded to include supplies heretofore not surveyed for MTBE, occurrences of the contaminant were recorded for the first time at 9 separate supplies during 2007, most of which were lower than half the maximum contaminant level and thus do not require treatment for removal. At water supplies not located at a service station or in proximity to one, 205 well samples were collected for MTBE. Of these, 115 samples indicated the absence of MTBE; 52 indicated the presence of MTBE at a level less than the MCL. The remainder verified the presence of MTBE at a level requiring continued treatment for removal. A continued emphasis is being placed on the presence of chlorides in drinking water at public water supplies. It is believed that the presence of chloride is attributable to the spreading of salt on roads in winter. Chloride is considered a "secondary contaminant" by EPA in that its presence is not generally a threat to health. It does, however, impart an objectionable taste and can contribute to corrosion of plumbing fixtures and pipes. The overarching difficulty with chloride is that once it reaches high levels and must be removed, the treatment is most often "reverse osmosis," which can be expensive and place an undue burden on sewage disposal fields. During 2007, 574 samples were analyzed for chloride, revealing a range of 1.45 to 1134 parts per million (ppm). Of these, 446 were below the MCL of 250 ppm. The average level detected was 131 ppm. Based upon the results thus far, it appears that chloride is a concern only in a few water supplies. The greater share of the field investigations and data processing tasks involving public water supplies is the responsibility of the division s Water Enhancement Program (WEP), which operated under a grant of $374,000 from New York State. WEP is audited quarterly by the NYS Department of Health s BWSP (Bureau of Water Supply Protection) and evaluated for a variety of field and data processing issues. 43

44 Medical Examiner Program The Medical Examiner s Office, now in its fifth year, is as ever dedicated to serve Dutchess County and its residents. Its good reputation in neighboring counties is such that Orange County has to a large extent modeled its newly created Medical Examiner s Office on the Dutchess County ME system. Now that the ME Office is fully established and adequately staffed, it is able to expand its educational and academic missions and is proud to represent Dutchess County at national and international forensic academic meetings. In November 2007, Deputy Medical Examiner Dr. Dennis Chute and Medicolegal Investigator John Cox were invited to a symposium at the University Medical Center in Tattori, Japan, where they respectively presented papers on Forensic Neuropathology and Death Investigations in Dutchess County which were extremely well received. Also, two scientific papers prepared by medico-legal investigators contracted by the Dutchess County Medical Examiner s Office were presented at the 60 th meeting of the American Academy of Forensic Sciences in Washington DC in February Finally, Dutchess County will be hosting the fall meeting of the New York State Association of County Coroners and Medical Examiners in Fishkill in September The Medical Examiner s Office is up-to-date with all its mass disaster training requirements and participates in County and Regional mass disaster drills on a regular basis. Medical Examiner s Office Case Load (2003 to 2007) Total Number of Cases Reported to the Medical Examiner Postmortem Examinations (Autopsies and External Exams) De ath Certificates only 44

45 DUTCHESS COUNTY DEPARTMENT OF HEALTH PROGRAMS AND SERVICES 45

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47 PROGRAMS AND SERVICES DIRECTORY Home Health Care Programs Certified Home Health Agency Services for homebound individuals who are under the care of a physician include: Skilled nursing and case management, Physical, Occupational and Speech Therapies, Home Health Aide services and assistance with medical supplies and equipment. (845) or (845) Long Term Home Health Care Services for individuals who qualify for nursing home placement and meet the financial eligibility requirements include: Skilled nursing, case management, Physical, Occupational and Speech Therapies, Home Health Aide, Personal Care Aide, Medical Social Worker, Nutritionist, Respiratory Therapy, Personal Alert System, Social Day Care Services, Transportation, and Home Delivered Meals. Please call (845) or (845) Maternal and Child Home Visiting Program Public Health Nurses are available to provide comprehensive home based services, to families, that start during pregnancy or after a child is born. Home visits provide education, support and case management services and are focused on assisting parents to meet the challenges of parenting and to assure the healthy development of children. (845) Childhood Lead Poisoning Prevention Program Public Health Nurses provide individual case management and follow-up to children with elevated blood lead levels. Community education and outreach Environmental investigations are also available. (845) Early Intervention Program Families with infants and toddlers who have special needs meeting NYS criteria are may be eligible to receive services to enhance the child's growth and development. (845) Preschool Special Education Program Services are provided for children with special needs, ages 3-5, in conjunction with the family's school district if they meet NYS criteria. (845) Perinatal Hepatitis B Program Public Health Nurses provide individual case management and follow-up to infants born to mothers who are Hepatitis B positive. (845) Eastern Dutchess Maternity Clinic Prenatal Care Assistance Program (PCAP) provides comprehensive prenatal care, delivery and postpartum care to income eligible women. Includes individual case management, education, counseling and referral services. Assistance with Medicaid application process is provided. (845) Physically Handicapped Children s Program Financial assistance program to parents of physically handicapped children based on eligibility requirements that include both financial and physical conditions. (845)

48 Childhood Immunization Clinics Clinics are held at sites throughout the county on specific days each month with no fee for service. Children under 18 years of age must be accompanied by a parent or guardian. All participants should bring with them any previous immunization records. (845) Adult Immunization Clinic Clinics are held twice a month to provide recommended vaccines to adults. Clinic is ideal for those individuals who need immunizations for employment. (845) International Travel Immunization Clinic Clinics are held twice a month to provide vaccines and health information to adults and children planning international travel. (845) Flu and Pneumonia Immunization Clinic Clinics are held throughout Dutchess County for adults who are eligible for the vaccines. Medicare Part B is accepted or a small fee is charged, however, no one will be turned away because of inability to pay. (845) (Hotline). Communicable Disease Information/Case Reporting Prevention and control of infectious disease. Health providers and the public may call to inquire about infectious disease precautions, symptoms, diagnosis and treatment. (845) Sexually Transmitted Infections (STI) Program Testing, diagnosis, and treatment of sexually transmitted infections is available twice a week. All services are free, confidential, and available without an appointment. Free Hepatitis B vaccine is available to all clinic patients. Referrals are made for those persons needing additional services. (845) HIV Program HIV counseling and testing is available by appointment or walk-in. All testing is free of charge and both "anonymous" and "confidential" testing is offered. On-site educational presentations, with or without testing, are available for schools and community groups. Partner Notification Assistance Program (PNAP) is available to persons living with HIV/AIDS who want to inform partners of possible exposure to HIV. (845) Rabies Post Exposure Program Administration of, or the arrangement for the administration of, rabies vaccine for treatment of rabies exposure. (845) Tuberculosis Control Program Clinic and case management services for the diagnosis and treatment of Tuberculosis. Tuberculosis (Mantoux) testing is provided at specific sites throughout the County at no charge, however, persons under the age of 18 must be accompanied by a parent or guardian. Please call (845) Health Education Programs Health education is provided on request to any group from preschool to seniors. DCDOH educational programs are age appropriate, culturally sensitive and can be tailored to meet specific needs. For more information, contact the Public Health Information, Planning & Education Division at (845)

49 Environmental Regulatory Services The following are regulatory services carried out in accordance with the provisions of the NYS Public Health Laws, NYS Sanitary Code and DC Sanitary Code. For information please call (845) Environmental Health Services Permits and inspects food service facilities, children s camps, hotels, motels, campsites, parks, temporary residences, mobile home parks, public functions with 5000 or more people, swimming pools, bathing beaches, migrant labor camps, daycare centers, and nursery schools. EHS staff also arrange for pre-construction conferences and inspection of individual water supplies and sewage disposal systems for conformance to approved plans; investigate complaints regarding foodborne illnesses, rental dwellings, sewage failures, vermin infestations, and offensive materials; and reports of animal bites and human contact with suspect rabid animals. Engineering Services Conducts inspections, monitors, regulates, reviews, and approves plans for sewage collection, treatment and disposal systems, realty subdivisions, bathing beaches, residential and commercial sewage disposal systems, individual and public water supplies. Conducts a NYSDOH approved certification course for water treatment plant and distribution system operators. Radiation Services and Environmental Health Assessment Program Inspects registered x-ray facilities, conducts investigations and provides technical assistance regarding radon, radiation and chemical emergency response plans, petroleum and chemical spills, asbestos, occupational health, hazardous and medical waste disposal sites, indoor air quality, environmental lead assessments and potential exposure to chemicals and hazardous substances. Also conducts West Nile Virus surveillance and control activities. Tobacco Control Program Permits tobacco retailers and conducts inspections to enforce state and local regulations. Environmental Water Laboratory NYS certified testing lab (ELAP#10189) which provides analysis of samples from municipal, government entities, and the private sector. Fees for services. For more information please call (845) Clinical Research The Department is involved in various clinical research projects. The goal is the development of successful, safe, and effective health interventions with FDA approval. The Department has been and is involved in an investigational adult and pediatric Lyme Disease vaccine, an investigational Herpes Simplex vaccine, a HIV vaccine, and a new combined Hepatitis A and B vaccine. In 2007 The Department began participation as a study site for an investigational avian influenza vaccine study. This project will continue into For information, call (845) Medical Examiner Program Investigates and determines the cause of death in instances of accidental, violent, and suspicious deaths. Call (845) during regular business hours or (845)

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