4C’s Clinic Updates
  Nursing Vacancies
   Status of Dental Director Position
   Current 4C’s Clinic Trends
   4C’s Open House
   Tour of Ft. Bend Health Center

   Fall Influenza Prevention Campaign

Operational Issues
   Local Public Health System Grant
    City of Texas City Water Pollution Control Services Contract
    TDH State Services Grant for HIV Administration
    On-going Operational Initiatives
    Plan for Telephone System Improvements

   Tuberculosis (TB) Program Review
   Animal Control Program Review   

Possible Collaboratives for Health Disparity Priorities
  Healthy Eating and Exercise Among African American Women and Their Families
   A Training Program to Provide Collaborative Mental Health Services to Indigent Minorities

Texas City Resident Diagnosed with West Nile Infection
	On September 5, 2003, the Health District was notified by the Texas Department of Health that a human case of West Nile Virus had been identified in a Texas City resident. The resident was diagnosed and treated in a Louisiana hospital. Chuck Chambers, Chief Epidemiologist, conducted an investigation to determine the probable location of transmission as Galveston County and sent a health advisory to the medical community. Dr. Guidry notified Galveston county elected officials and Carlos Garza, Mayor of Texas City, who arranged to have public prevention information to be posted on the city information channel. Health district staff responded to citizen and media inquiries, and a press release (http://www.gchd.org/press/WestNileFound0903.htm) was issued to local media outlets. The Texas City Sun, Guidry Gulf Coast E-News, and The Galveston County Daily News all reported the information. For more information, contact Kurt Koopmann kkoopman@gchd.org or call (409) 938-2211
Public Health Preparedness: Superbowl XXXVIII
	On October 2nd, Galveston County Health District staff will join the City of Houston, Harris County, Ft. Bend County, and Montgomery County Officials to begin planning for Superbowl XXXVIII population influx for scheduled game activities around February 1, 2004. The goal of the multiple jurisdictional planning group is to prepare for a rapid response to any health impacts which might result from an emergency or disaster situation. Public health officials will be responsible for disease detection and investigations, for mobilizing resources to address health threats & concerns, and for disseminating health advisories to the public and medical community. In accordance with State law, public health officials follow the State's emergency command's line of official communications in disaster situations. Dr. Guidry (appointed by the Texas Association of Community Health Centers) serves on the State's Public Health Response Committee that serves to develop and recommend a model plan for a coordinated response to bioterrorism and other disasters. The model plan will be submitted to the Governor-appointed Preparedness Coordinating Council (PCC). For more information, contact Harlan "Mark" Guidry, MD, MPH, Chief Executive Officer mguidry@gchd.org or call (409) 938-2401.
Strategic Health Planning
	This month, Dr. Guidry and Charles Kelly, Senior Health Coordinator, continued to meet with member city officials, namely in Clear Lake Shores, Jamaica Beach and Bayou Vista. Common themes discussed by member cities include animal services, senior health, and the need for community awareness about the scope of services provided by the Health District. The last member city (Friendswood) is scheduled for October 15. Dr. Guidry has prepared a summary of key issues discussed with member cities, which serves as a guide for future collaborations and improvements. As a result of these meetings, member city perspectives will be included into the District Health Plan. Dr. Guidry, Kurt Koopmann, and Marty Entringer attended a Kemah city council meeting on September 11, where Dr. Guidry presented an overview of health district services and summary statistics on services provided to residents. A similar presentation is planned for September 25 to City of Galveston City Council. District meetings to finalize the draft District’s Health Plan are scheduled for the week of October 1st when stockholder perspectives from the three month feedback (involving extensive meeting in all parts of the county among diverse public and private groups) will be synthesized into goals and objectives. The draft priorities established at the Health District’s retreat on May 16 would guide the development of the Plan. To assure a community-oriented product, information from the Immunization Summit of July 15, the Environmental Health Summit of September 11, the website, District employees Town Halls, and many other routine forums, will be used to develop the Plan. The finalized District Health Plan will be presented for Board review and deliberation during the October board meetings. For more information, contact Brian Rutherford, Health Planner, brutherford@gchd.org,  or call (409) 938-2275.
Environmental Health Summit
	The Environmental Health Summit was held on September 11 and attended by a diverse group of community participants representing food service industry, business owners, city officials, state officials, District managers, and Board members, including Carlos Zamora, DVM and Walter Treybig, III. In consideration of the three program areas under review (Environmental and Consumer Health, Animal Services, & Air/Water Pollution), the group identified common themes for future enhancement: Public and Employee Education; Resource Limitations; Geographic differences; Data Limitations; and Public & Political Relations. Among the perspectives shared, feedback was offered regarding food service inspections and the need to develop standard operating guidelines for common issues, training programs, and enhanced monitoring practices. Information gathered from this summit and otherwise will be used to develop related goals and objectives in the draft Galveston County Health Plan. For more information, contact Brian Rutherford, Health Planner, brutherford@gchd.org, or call (409) 938-2275.
4C’s Clinic Updates
	Nursing Vacancies - Currently, there are three vacancies for one registered nurse (RN) and two licensed vocational nurses (LVN). One of these LVNs was responsible for our bilingual diabetes classes and support groups. This vacated position will be reviewed and appropriately classified to a bilingual Clinic Health Educator/LVN position in order to meet Health District priorities. Several applications have been received for these openings will be filled as soon as possible. For more information, contact Kathrine Hall, Human Resource Director, khall@gchd.org or call (409) 938-2230.
	Status of Dental Director Position - After the position was vacated by Dr. Lisa Jacobs on June 11, 2003, the position was posted and currently has three applicants. The interview process and the selection of a candidate is expected to be completed in early October. For more information, contact Kathrine Hall, Human Resources Director, khall@gchd.org or call (409) 938-2230
	Current 4C’s Clinic Trends -Continuing the tracking of clinic productivity, data shows that provider productivity was 7.6 patients seen per clinic half-day for the month of August. Appointment capacity has been tracked since February 2003, and shows some improvement for the month of August in Texas City (78%) and no significant change at the Galveston Clinic (68%). This indicator has shown variability over the last six months, possibly due to system changes at 4C's, including implementation of nursing triage, changes to provider templates, and improvements in the appointment-making process. Monitoring of this indicator will continue. Additionally, two new indicators are being tracked: nursing triage and calls to the Appointment Call Center. Since August 7, 2003, nurses have been triaging approximately 44 patients daily at both clinic sites combined (29 at Texas City and 15 at Galveston, respectively). Approximately 2/3 (66%) of patients being triaged are being given same day appointments. Walk-ins continue to account for about 25% of total patients seen. For the first ten working days of September, the Appointment Call Center handled 3215 calls (approximately 320/day), of which 1325 appointments were made, and 92 calls were transferred to the triage nurse for further disposition. Summary reports will be provided on a regular basis. For more information, contact Susan Studebaker, Director of Clinical Services, sstudebaker@gchd.org  or call (409) 949-3406.
	4C’s Open House – In conjunction with the Fall Flu Prevention campaign and in recognition of National Community Health Center Week, the 4C’s Clinics will host Open Houses at both clinic sites on October 8, 2003 between 9:00 a.m. and 11:30 a.m. Flu vaccines, BP checks, blood sugar checks and education regarding Health District programs, services and general health concerns will be provided. A letter director to 4C’s Seniors will be mailed later this week and all seniors will be encouraged to sign up for the Seniors Health Corps’ Passport to Good Health. For more information contact Umair Shah, MD, MPH, Chief Medical Officer or call (409) 949-3406.
	Tour of Ft. Bend Health Center - As part of the effort to increase clinic access, district staff toured the Ft. Bend Health Center, which underwent clinic re-engineering five years ago, and has shown interval improvements in clinic flow and patient satisfaction. Improved eligibility screening and team-oriented approaches to care were also implemented. Lessons learned from this visit will be incorporated, as appropriate, in ongoing planning efforts. For more information, contact Umair Shah, MD, MPH, Chief Medical Officer, or call (409) 949-3406.
Fall Influenza Prevention Campaign
	The Health District will kick off its annual Influenza Prevention Campaign on Monday, October 6 offering influenza vaccinations to citizens of Galveston County who want to reduce their chances of getting the flu. As a priority, high risk groups will be targeted through a number of scheduled events. The events will include a number of Senior Health Corps Fest sites, the 4C’s Open House on Wednesday, October 8 from 9:00 to 11:30 at both clinic sites, and at the traditional immunization sites visited by Community Health Nurses. The cost of flu shots will be $16.00 with no cost to Medicare Part B recipients. In anticipation of this prevention campaign, standing delegation orders have been updated and a news release will be distributed. For more information, contact Kurt Koopmann, Public Information Officer, kkoopman@gchd.org or call (409) 938-221.
Operational Issues
	The Health District executed the Local Public Health System Grant this month with no change in the total funding of $344,972 from last year. This grant is available to assist local health departments in providing the ten essential public health services in Statute. There is a potential to lose state funded positions from this grant in FY04.
	A contract with the City of Texas City for Water Pollution Control Services for a total of $26,988 was signed with an increase of $5,534.65 from last year. This increase is due to the fees being charged on a per capita basis instead of per water connection.
	Three Memorandums of Understanding (MOU) understanding were signed with subcontractors under the TDH State Services Grant for HIV Administration. One for client transportation in the amount of $2,420, one for client dental care in the amount of $7,431, and one for case management and the food pantry in the amount of $72,183.
	On-going operational initiatives: updating job descriptions and the performance appraisal process; preparing a draft organizational chart; planning to review, categorize, and monitor all contracts with the District; developing and implementing a policy regarding various types of volunteers at the Health District; and exploring potential cost reduction measures such as reducing utility expenditures.
	Plan for Telephone System Improvements: a bid has been developed and reviewed by the Executive team to make telephone system improvements. The overall goals are to upgrade the telephone system in order to improve capacity; to serve increased citizen callers; improve internal communications; and improve ability to communicate with the public and employees in disaster/emergency situations. For more information on all operational issues, contact Jay Holland, Chief Operating Officer, jholland@gchd.org or call (409) 938-2260.
Tuberculosis (TB) Program Review
	Due to the State’s initiative to reduce state employee FTE’s, the District’s Tuberculosis program reduced a net $14,857 decrease in state support with the loss of one state-paid employee assigned to the Health District. As a result, the District is reviewing the program to focus its activities on mandated activities and contractual requirements. Once impending program changes are identified, the District will notify its community partners on any potential impacts. The goal of the review is to maintain the essential program services within the funds allocated to TB Program activities, and to provide cross-training of additional staff to serve as a backup in circumstances of increased TB case loads and the need for high risk screening. Last month, Dr. Guidry issued three Health Authority Orders for testing, treatment, or hospitalization of persons suspected of being infected with TB and determined to be a public health threat due to non-compliance with medications. For more information, contact Jay Holland, Chief Operating Officer, jholland@gchd.org or call (409) 938-2260.
Animal Control Program Review
	On May 27, the Health District initiated a comprehensive review of the Animal Control Program to include personnel, fiscal, programmatic and management aspects. The goal of the review is to identify opportunities to improve program operations and services, and to plan for projected future needs. For more information, contact Jay Holland, Chief Operating Officer, jholland@gchd.org or call (409) 938-2260.
Possible Collaboratives for Health Disparity Priorities
	Healthy Eating and Exercise Among African American Women and Their Families – The Health District prepared a budget and issued a letter of support on September 19 to Martha Hargraves, Ph.D, Director of Health Policy and Health Services Research at the University of Texas Medical Branch who has written a $267,000 grant to the Texas Higher Education Coordinating Board. The grant will support faith-based, community nutrition and exercise programs among at-risk African American women to reduce obesity, increase fitness, and decrease longer-term morbidity and mortality. For more information, contact Jay Holland, Chief Operating Officer, jholland@gchd.org  or call (409) 938-2260.
	A Training Program to Provide Collaborative Mental Health Services to Indigent Minorities - The Health District will issue a letter of support to Dorothy Trevino, LMSW, Ph.D., Director of Behavioral Medicine at the University of Texas Medical Branch, who is writing a grant to the Texas Higher Education Coordinating Board to establish a 4C’s Clinic-based mental health service targeting at-risk minorities with chronic conditions, such diabetes, and depression or other mental health conditions. The grant is requesting approximately $160,000 to support mental health services and case management. UTMB residents and Marriage and Family Therapy interns under the supervision of UTMB Faculty would provide the mental health service to targeted 4C’s Clinic patients. For more information, contact Susan Studebaker, Director of Clinical Services, sstudebaker@gchd.org or call (409) 938-3406.