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HomeMy WebLinkAboutMINUTES - 07121994 - IO.5 } TO: r BOARD OF SUPERVISORS I .O._5 5....._. Contra FROM: INTERNAL OPERATIONS COMMITTEE Costa r° DATE: June 27, 1994 �- ,.,�_.,.,,�'� County ' CUUN� SUBJECT: STATUS REPORT ON COMMUNICABLE DISEASES IN CONTRA COSTA.COUNTY I SPECIFIC RECUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . ACKNOWLEDGE receipt of the attached report from the Public Health Director on the status of communicable diseases in Contra Costa County. 2 . REQUEST the Public Health Director to report to the Internal Operations Committee on August 23, 1994 on the results of his staff ' s efforts to evaluate historical hospital utilization data in order to project the anticipated use by AIDS patients of hospitals in the County over the next five years . 3 . REQUEST the Public Health Director to make his next quarterly report to the Internal Operations Committee on the status of communicable diseases in Contra Costa County on September 26, 1994 . BACKGROUND: We have been asking the Health Services Department staff to report to our Committee on a quarterly basis on the status of communicable diseases in Contra Costa County, including AIDS, tuberculosis and childhood immunizations . On April 19, 1994, the Board of Supervisors asked staff to make their next quarterly report to our Committee the latter part of June, 1994 . CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF U T D IN TRATO RECOMMENDATION OF BOARD COMMITTEE APPROVE 0 E 4G SIGNATURE(S): MARK NIER ACTION OF BOARD ON APPROVED AS RECOMMENDED _ OTHER The Board APPROVED Recommendations 1, 2 and 3 above, and in addition, DIRECTED the Health Services Department to prepare Certificates of Recognition for presentation to groups and individualsl who have helped to distribute immunization flyers. VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. J ATTESTED / cl Contact: County Administrator PHIL BAT ELO LERK OF THE BOARD OF cc: Health Services Director SUPERVI ORS AND COUNTY ADMINISTRATOR Public Health Director Francie Wise, Director of Communicable Diseas M=, SD H BY ,DEPUTY I .O.-5 -2- Attached is the most recent quarterly report on this subject. Our Committee met with Dr. Wendel Brunner, Public Health Director; Francie Wise, Communicable Disease Control Director for the Public Health Division; and Rusty Keilch, AIDS Program Director, on June 27, 1994 . Dr. Brunner reviewed the attached report with us and also distributed the attached charts outlining which hospitals are seeing the most AIDS patients and from which areas of the County these patients are coming. The attached report outlines the additional AIDS programs which are being undertaken with the new Ryan White funds which have been made available this year by the Federal Government. Also included in the attached report is information regarding the increased emphasis which Public Health is placing on homelessness as a Public Health issue, not just as a housing issue, a theme which was followed in the Board's Workshop on Homelessness on June 28 . In regard to tuberculosis, the attached report noted the concern of health care professionals due to the number of school-age children who are being diagnosed with active tuberculosis - three cases in this County. In Contra Costa County, the total number of cases was the same in 1993 as in 1992 . However, with the increase in the number of school children being exposed to tuberculosis, the risk is always there that the numbers will again increase. Public Health staff are also mounting a campaign to remind parents of the importance of having childhood immunizations completed "on time - every time" , at the ages of 2-4-6-12-15 months . More information about this campaign is included in the attached report. The sheets documenting patient discharges from Contra Costa County hospitals during 1992 demonstrates the extent to which Merrithew Memorial Hospital is handling a disproportionate share of AIDS patients countywide. Merrithew had 40% of the discharges and 40% of the patient days countywide. In line with a request from Supervisor Torlakson in April, we have asked staff to evaluate this data, along with other historical data they may have available in order to project what the hospital utilization rates can be expected to be over the next five years . All indications are that the current shift in the type of populations which are contracting AIDS now will result in fewer patients having insurance in the next few years, probably resulting in ever heavier utilization of Merrithew Memorial Hospital . We are asking that Dr. Brunner present this utilization data to us on August 23, 1994 and then make a regular quarterly report on communicable diseases to our Committee on September 26, 1994 . Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Tom Powers, 1st District Mark Finucane, Director Jeff Smith,2nd District Gayle Bishop,3rd District 20 Allen Street Sunne Wright McPeak,4th District s L Martinez,California 94553-3191 Tom Torlakson,5th District E= -=''OF (510)370-5003 { FAX(510)370-5098 County Administrator - Phil Batchelor County Administrator •, Sra'cotiK'� June 21, 1994 To: Internal Operations Committee From: Mark Finucane, Director, 'Health Services Department by Wendel Brunner, M.D.,Assistant Health Services Director for Public Health Subject: Quarterly Report on Communicable Diseases AIDS Current AIDS Cases in Contra Costa County As of June 20, 1994, there have been 1,395 persons diagnosed with AIDS reported to the Health Services Department. At least 829 people with AIDS have died since the beginning of the epidemic. Regional Planning for HIV Health Services Community members and Health Services Department staff participate on the legislatively mandated HIV Health Services Planning Council for Contra Costa and Alameda Counties, which constitute the eligible metropolitan area under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Council is in the process of restructuring and will immediately begin development of a comprehensive service plan for the East Bay region, recognizing the particular needs of each health jurisdiction within the region. Federal funding to the region for HIV services is based on the quality of this plan and the priorities established by the Council for services. Merrithew Memorial Hospital&Clinics Public Health • Mental Health • Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics A-345 (2/93) Report to the Internal Operations Committee Page 2 On Communicable Disease in Contra Costa County Ryan White CARE Act Funding As we reported to you earlier this year, the funding to Contra Costa County from the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act increased again this year to a total of $1.2 million. As in previous years, this funding supports Health Services Department and community-based services. This year we are able to continue funding to support Department of Health Services programs to serve people with HIV. Specifically, medical social workers at Merrithew Memorial Hospital, Richmond Health Center and Pittsburg Health Center and additional social workers in the Public Health HIV/AIDS Program have been funded for the current year. Funding which began April 1: • doubles the funding to the Diablo Valley AIDS Center for groceries to finan- cially eligible people with HIV in the county; • increases the level of funding for attendant care for home-bound people with HIV by over 40% - from $70,000 last year to $125,000 this year. This funding allows people to stay home and to avoid unnecessary hospitalizations; • more than doubles funds for rental assistance, emergency housing and housing advocacy for people with HIV in the county. This funding was awarded through a competitive process to Pittsburg PreSchool Coordinating Council; • increases case management support available to Central County people with AIDS provided by the AIDS Project of Contra Costa; With funding which will begin July 1, we will be able to: • maintain two HIV case managers at the two BAART methadone clinics in the county -- one, in Richmond and one in Pittsburg; • maintain case management services at Pittsburg Preschool Coordinating Council and Familias Unidas in Richmond; • increase support to the drop in center for people with HIV in Richmond, Tranquillium Center, operated by AIDS Community Network, so that they will be able to provide congregate meals at Tranquillium; • continue to support mental health services for people with HIV at Familias Unidas; Report to the Internal Operations Committee Page 3 On Communicable Disease in Contra Costa County • continue to provide home-delivered meals to home-bound people with HIV in the County; • support home IV therapy for people who need it, who cannot make it into one of the clinics and who cannot self-administer the required treatment to prevent blindness; • support In-Home Support Services workers through Family and Community Services of Contra Costa by providing training and maintaining an up-to-date registry of training workers; • increase funding for food certificates, transportation vouchers,, and utili payments to financially eligible Contra Costans with HIV; • develop a van service for residents of East County from their homes to medical appointments in East or Central County. The planning group mandated by the CARE Act to set priorities and make allocations of these funds in our county is the Contra Costa Component of the Oakland EMA HIV Planning Council. We would particularly like to thank the members of the Planning Council for their tremendous work in this effort. They are Daniel Alston, Ronald Baer, Judy Bliss, M.D., John Camp, Deborah Card, Genoveva Calloway, Frances Greene,Alan Johnson, Rusty Keilch, Gary Parkison, M.D., Robert Rybicki, and Robert Tsu. (SIV/AIDS Program Case Management Program The interdisciplinary team of Public Health Nurses and Social Workers who comprise the Case Management Program in the HIV/AIDS Program continues to serve increasing numbers of Contra Costans with AIDS and disabling HIV. When the program first began with funding from the State of California Office of AIDS, the monthly average caseload for the team was 35 people. It has now grown to 85 clients per month. Recent additional funding from the CARE Act allowed the program to add additional social work time to support this vital program which allows people to avoid unnecessary hospitalizations and to remain in their homes as long as possible. Report to the Internal Operations Committee Page 4 On Communicable Disease in Contra Costa County HOMELESS Exact numbers of the homeless in Contra Costa are not known; however, estimates are as high as 15,000. The Contra Costa County homeless health team gave health care services to 658 people in the second quarter of 1994. Services to this population included alcohol counseling, dental evaluation, physical assessment, referral to primary care, mental health support and other services/referrals as needed. Problems identified and cared for in this population included: 18 people with active tuberculosis, six persons with STDs. Respiratory and circulatory problems were identified in 76 persons; thirty persons required mental health support and 426 people with substance abuse (alcohol or drugs) of one or more substance. Communicable disease is emerging as a significant issue in this population. The transient nature of living/housing, eating and socialization locations permits and encourages the transmission of communicable disease, specifically tuberculosis and other respiratory illness. The Health Care for the Homeless team is expanding services from one team to two teams in order to increase visiting to the Souper kitchen, homeless shelters and socialization locations frequented by the homeless population. In these visits they provide physical assessment, .minimal treatment and medications as well as doing TB testing, offering counseling.and referral for HIV testing and providing immunizations to both children and adults. This expanded service and increased testing allows for early identification and treatment of a communicable disease before an outbreak situation develops. In the last quarter 22 children were provided with immunizations and 476 TB tests were administered by the team. IMMUNIZATION As we have reported previously, the level of childhood immunizations is very poor throughout California and the nation. Our immunization program is meeting this challenge through expansion of immunization services to daily clinics in each area of the county. We have augmented our cooperative efforts with community-based organizations to hold immunization clinics at community sites throughout the county. Additionally through cooperative agreements with the community agencies, immunization outreach for these clinics is being provided by the outreach workers from these agencies. Attached is a sample of the pamphlet that will be in available in eight languages. Also attached is the art work for the insignia to be used on infant cups and refrigerator magnets. All materials will include the numbers '2-4-6-12-15' to remind parents of the months when childhood immunizations are needed. This community information and education campaign will be used throughout the county in conjunction with expanded clinic services. Distribution Report to the Internal Operations Committee Page S On Communicable Disease in Contra Costa County of these articles will be through the Women, Infants and Children (WIC) Program, door-to- door campaigns and in special immunization clinics throughout the community. We are also continuing to use 'shot coupons' to enable children who, due to their parents' lack of financial resources, do come to clinic to get up-to-date with their immunizations. Success rates for childhood immunizations are being measured by the rate of children receiving a fourth DPT shot on time, after the second birthday. Currently the rate of children under two who are under-immunized is 48%. Through these enhanced efforts we believe the rate of children adequately immunized will improve. TUBERCULOSIS The Directly Observed Therapy (DOT) program has expanded from 15 patients on the program, at any one time, to 40 persons currently being assisted through this program. We are following inmates who have been started on tuberculosis preventive therapy in the detention facilities and released before completion of therapy. We will also begin following people released from juvenile detention who are getting tuberculosis therapy or preventive therapy, with DOT. Funding through the State has been renewed and will allow us to purchase additional equipment for the Public Health Laboratory to offer more rapid testing. -The laboratory will also be able to offer testing services to private providers and community hospitals in the near future, for more rapid turn around and the highest quality testing for all suspected tuberculosis cases. The Tuberculosis program is working with CDC to study tuberculosis cultures through the use of DNA fingerprinting. All culture positive tuberculosis isolates will be tested through this DNA process to identify persons with tuberculosis who have identical organisms. This will enable us to identify clusters of infection, to recognize previously unidentified transmission routes and to track sources of infection. Although tuberculosis decreased during 1993 in many states nationwide, this is not expected to be a trend. In Contra Costa County we saw the identical number of cases in 1993 as we did in 1992. Although this year our numbers appear to be the same, we have witnessed a disturbing occurrence. Three cases of active tuberculosis have been diagnosed in children in school. Two were in high school and one was in the sixth grade. This required a coordinated response with the school staff, all parents and the Public Health Department. We have had mass testing in the involved schools with portable chest x-ray screening at the school sites, notices and information with consents sent home to parents and hours of phone calls by school and Public Health staff to ensure that all children were tested and medically followed as needed. All of the schools were extremely cooperative and helpful in these efforts and are to be commended for their work. There have not been any secondary cases identified in any of the schools. 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CLI oi ro. o IS4 -0 U O MQ �rOtn � «�� � •° y wo�o >~0 � � G Cf) tv m �pa Q0 UNUxi W N N s+ tn64 41 W M�W ►�i QaSCO xi O a" 0 P . 02 _Tu"-=3- 19 THU H!B:D ADMIN AIDS DISCHARGES FROM CONTRA COSTA HOSPITALS, 1992 HOSPITAL DISCHARGES PATIENT AVERAGE DAYS LENGTH OF STAY Delta Memorial Hospital 3 10 3.3 John Muir Medical Center 9 59 6.5 Los Medanos Community Hosp 16 115 7.1 Kaiser - Richmond 18 137 7.6 San Ramon Regional Med Ctr 18 107 5.9 Kaiser - Martinez 24 171 7.1 Mt. Diablo Medical Center 27 268 9.9 Brookside Hospital 31 329 10.6 Kaiser - Walnut Creek 45 458 10.1 Merrithew Memorial Hosp. 131 1,121 8.5 COUNTY TOTAL 322 2,775 8.6 Report includes all discharges with an AIDS DRG (ORG 488, 489, & 4901 -TU"-24- 1 '9 FR I I eq HSS ADM I N AIDS DISCHARGES FROM CONTRA COSTA H0$PvrALS, 1992 DISCHARGES BY AREA OF PATIENT RESiDENCE EAST CO. CENTRAL CO. WEST CO. OUT OF CO. TOTAL Delta Memorial Hospital 3 0 0 0 3 John Muir Medical Center 0 8 0 1 9 Los Medanos Community Hosp 12 3 0 1 16 Kaiser - Richmond 0 0 17 1 18 San Ramon Regional Med Ctr 5 5 0 8 18 Kaiser - Martinez 15 5 3 1 24 Mt. Diablo Medical Center 5 22 0 0 27 Brookside Hospital 0 0 29 2 31 Kaiser - Walnut Creek 7 30 0 8 45 klerrithew Memorial Hosp. 53 26 39 13 131 TOTAL 100 99 88 35 322 ti ��YV rithew +enmodai CaPO4Qd AND CLINICS TO: Chris Grazzini, RN DATE. February 22, 1994 Associate Executive Director for Patient Care FROM: Cynthia Abram, RRA �~ SUBJ: January 1994 Director, HIM AIDS Statistics For patients discharged during the month of 'January, our records show the following statistics regarding AID and ARC patiants in the Hospital: �� Jan 1994 Jan 1993 TOTAL INPATIMS 22 1.4 TOTAL ADMISSIONS 23 20 TOTAL DAYS 182 ! 145 AVERAGE L.C.B. 8.27 Days 10.35 Days YTD 94/95 YTD 93/94 TOTAL INPATI3I T1' STAYS 110 138 TOTAL DAYS . 1118 1268 AVERAGE L.O.S. 10.16 Day! 9.18 Days I� During the month of January 1994, there were-27 outpatient visits at the Martinez Clinic (Family Practice, ER, d�D) with a documented I. diagnosis of AIDS or ARC. Out of this total j.* 17 were seen in.the Infectious Disease Clinic with a diagnosis of AIDS or ARC. Also, there were 12. patient visits in the Rilhmond Health Center, and 3 in Pittsburg Health Center. 1, reporting for January due to 'ol action. Note: Under p g �"� 7 i gk cc: Frank J. Puglisi, Jr. LeAnn Winton Contra Costa County \.7M A IMM11 ` TOTAL P.01