2010annualreport · time reduction in conducting point of sale home septic and well inspections...

2010AnnuAlRepoRt

2010 Annual Report 1

Through hard work, planning and investment in preparedness, in 2010 the District Board of Health rose to meet the challenge of an influenza pandemic that began in 2009 and took advantage of a unique opportunity to measure and improve our performance by participating in the national movement to accredit local health departments. Throughout the year the District Board of Health maintained the standard of excellence, responsiveness and continuous improvement in all of our public health services that our townships and municipalities have come to expect from their local health department. These achievements in the past year are especially noteworthy:

• We completed a 2nd round of school-based immunization clinics - more than 18,000 children and adults received H1N1 flu vaccine at school-based clinics in 13 Mahoning County school districts in 2009-2010.

• We were designated as an academic health department affiliated with the Northeastern Ohio Universities Colleges of Medicine and Pharmacy.

• We took enforcement actions against more blighted dwellings - 138 condemned structures were demolished in the health district in 2010

• We met 87% of performance measures in a “beta test” of national voluntary accreditation standards for local health departments in June.

• We used quality improvement processes to shorten turn-around times for communicable disease investigations and point-of-sale home inspections.

• Our fully accredited environmental public health laboratory served more than 150 clients in the public and private sectors and tested drinking water for more than 200 families living near landfills.

We are proud of these and the many other achievements of our board, staff, volunteers and community partners and remain committed to continuously improving our organization and the health of our community in the year ahead.

Lisa Noble Weiss, M.D. Matthew Stefanak, M.P.H.President Health Commissioner

FROM THE DISTRICT BOARD OF HEALTH AND COMMISSIONER


During the first quarter of 2010, District Board of Health management worked through a self-assessment process that encompassed 101 measures for the demonstration of competency as a local health department. A number of public health professionals from around the country converged at the District Board of Health offices on June 7-8, 2010 to conduct a site visit as a part of the “Beta-Test” of the Public Health Accreditation Board (PHAB) process for voluntary accreditation. The site visitors were here on those two days to evaluate our work on the self-assessment and to assess our readiness to become an accredited health department when the opportunity for voluntary accreditation becomes available in late 2011.

ACCREDITATION OFFICIALS AND BOARD OF HEALTH STAFF during the June 2010 site visit

After the site visit, we were provided a report from the site visitors that outlined their findings. We fully or at least partially demonstrated 94 of the 101 measures. Using their scoring criteria, we received an 87%. “Overall the department has adequately addressed many of the PHAB measures and indicated a commitment to continuous quality improvement of programs and services,” the site visitors noted in their report. “One of the items for improvement they noted, which we also found in our self-assessment, is that the District Board of Health needs a more current community health assessment and community health improvement plan. Each of these are slated to be complete in early 2011,” according to accreditation coordinator Nick Cascarelli. The District Board of Health is positioning itself to become one of the first local health departments in the country to become an accredited health department.

DISTRICT BOARD OF HEALTH GETS READyFOR ACCREDITATION IN 2011

demonstratedpartiallynot demonstrated

PuBLIC HEALTH ACCREDITATION BOARD ASSESSMENT RESuLTS

Below is a graphic representation of the Accreditation Board site visitors’ assessment of the District Board of Health’s performance on accreditation measures.

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*81 demonstrated, 13 partially demonstrated, 7 not demonstrated

ALL 101 MEASuRES


The District Board of Health, as part of its voluntary accreditation “beta test,” undertook a quality improvement project involving septic and well inspection times for home sales in 2010. The QI team consisted of Mary Helen Smith (team leader), Tina Schneider, Michele Olin, Ryan Tekac and Nick Cascarelli (facilitator). The team arose out of the District Board of Health’s commitment to timely septic and well inspections to local realtors. The team also invited and solicited input from the Youngstown Columbiana Association of Realtors (YCAR). Three of their members, Sharyn Braunstein (YCAR Executive Director), David Klacik (YCAR President) and Debbie Parisi (YCAR Secretary) were present for team meetings to provide input to the quality improvement process. While looking for ways to decrease inspection times, the team noted that the one sanitarian whose inspections were taking longest also had the most inspections assigned to him. As a result, the team settled on a more equitable redistribution of the workload among the sanitarians in this program as a solution to test. Six weeks after the redistribution the District Board of Health reduced the average time it takes to conduct a point-of-sale inspection from 11.8 to 7.1 calendar days, a 40% decrease. This by far exceeded our anticipated 15% decrease (11.8 to 10.0 calendar days).

For this process, District Board of Health team members used the Plan-Do-Check-Act (PDCA) cycle for quality improvement. Because of the success we experienced using the PDCA cycle for this project, the agency has decided to adopt the cycle for future QI initiatives and has incorporated it in the newly developed QI Plan. Below is a storyboard, which is a snapshot and common representation of completed QI projects that use the PDCA cycle, for this particular project.

TIME REDuCTION IN CONDuCTING POINT OF SALE HOME SEPTIC AND wELL INSPECTIONS

PLAN Identify an opportunity and Plan for Improvement

1. Getting StartedThe District Board of Health, in wanting to keep a promise to local realtors, wanted to ensure timely inspections of residential septic and well systems when properties are to be sold. So a decision was made to examine our current processes to see if we were fulfilling our promise.

2. Assemble the TeamThe team members who were District Board of Health employees were chosen because they specifically work in or frequently with septic and well inspection programs with the exception of the facilitator who was chosen because he has experience facilitating quality improvement teams. We also wanted to involve some realtors as they are key external stakeholders to this process. As a result, we invited members from the local Board of Realtors Association.

We did have some difficulty with getting members of the Realtors Association to attend due to scheduling conflicts. This was one of the major barriers in getting the process started. The way we overcame this barrier was to have a meeting at their location early in the process to engage them and express the value of their input to our process. We also reduced the requirement to attend all meetings. Ever since having the meeting at their office they became fully engaged.

AIM Statement: Between October 18th and November 30th, we will reduce the average time it takes to conduct septic and well evaluations for real estate transactions by 15% (from 11.8 to 10 calendar days).

3. Examine the Current ApproachOur flowchart is a representation of the current process for septic and well inspections as a result of real estate transactions. Each inspector is assigned different parts of the county to conduct inspections using this process. We chose to do a force field analysis to look at where the process tends to slow

down and maybe cause the process to unnecessarily take longer. Below is a list of the restraining forces identified in the force field analysis.

• The step in the process whereby the lab secretary is supposed to notify the inspector of the results of the well test sometimes takes longer than expected.

• The time it takes for the inspector to schedule the inspection.• The time it takes for the septic pumper to send the report to the District

Board of Health.• No system in place to follow up on the Clearwater Inspection Report for

those properties who are required to tie into the sanitary sewer and cease using their septic system.

• Realtors wait too long to apply for inspections.• Waiting on external parties when the case dictates - the involvement of

the EPA, a soil scientist, District Board of Health approval or engineers.• The lack of follow through on the part of the homeowner.• The inspector forwards hand-written notes to be typed by secretary.• Each inspector may do this process a little differently. • We require the septic system pumped even if it is functioning properly.• Variance in inspector workloads.

4. Identify Potential SolutionsWe evaluated whether or not some of the items indicated as restraining forces were changes in our control and could be changed in a short timeframe so that they could be tested. The team decided by consensus the change to test using this criterion. In examining the baseline data below, we will test a more equitable redistribution of the workload among the three inspectors to reduce the time it takes to conduct the inspection.

We looked at two sets of baseline data. The first set of data was to collect the time it took for various critical points in the process from the time it takes for the applicant to apply for the septic and well inspection to the time the process was complete. We collected baseline data on 55 properties on three particular time frames beginning at the end of July through beginning of October where the processes have been completed.

• The average time it takes from application to scheduling is 7.4 days.• The average time it takes from application to inspection is 11.8 days.• The average time it takes from application to process completion is

22.3 days.

The second set of baseline data was to examine the variance in workloads. One thing in looking at the data was that many of the areas where these time frames took longer to inspect were the townships furthest from the health department. We then analyzed the workload data of the three inspectors who worked in that program. Many of these inspections were conducted by the same inspector and when looking at the total workload (this includes other types of inspections beyond this process), this inspector had completed more inspections than any other in the program.

• Inspector 1 conducted 41% inspection activities. Many of this inspector’s real estate evaluations took longer than the other two.

• Inspector 2 conducted 29.5% inspection activities.• Inspector 3 conducted 29.5% inspection activities.

Through a more equitable redistribution of the workload, we believe we can reduce the time it takes from when the realtor or homeowner applies for an inspection to when the inspection is conducted by reducing the time from 11.8 to 10 days.

5. Develop an Improvement TheoryIf the workload is redistributed among the inspectors more equitably, then we can reduce the average time it takes to conduct the septic and well inspection from 11.8 to 10 days. The time it takes to both schedule and conduct all septic and well inspections as a result of real estate transaction was calculated to determine if the redistribution of workload had the desired effect.

QuALITy IMPROvEMENT INITIATIvE REDuCES TuRNAROuND


DO Test the Theory for Improvement

6. Test the TheoryThe improvements were run according to plan. The redistribution of the workload began on October 18th, 2010 as proposed in the plan stage. We collected the dates of various critical incidents in the process. The date the applicant applied for a septic and well inspection, the date they were contacted by an inspector to schedule the inspection, the date the initial inspection was conducted and the date the approval/disapproval letter was mailed out to the applicant.

CHECk Use Data to Study Results of the Test

7. Check the ResultsThe data collected was sufficient to conclude that the improvement tested was effective. We were able to collect all the information needed on 24 properties in the six-week time frame after the improvement was put into place. The time it takes from application for a septic and well real estate evaluation to when the inspection was conducted was reduced from 11.8 to 7.1 calendar days, a 40% decrease in time. This far exceeded our final AIM statement goal of 10.0 days or a 15% decrease. Below is a summary of post-test data.

• The average time it takes from application to scheduling is 2.7 days.• The average time it takes from application to inspection is 7.1 days.• The average time it takes from application to process completion is

13.8 days.

TIME FOR POINT-OF-SALE HOME INSPECTIONSACT Standardize the Improvement and Establish Future Plans

8. Standardize the Improvement or Develop New TheoryAs a result of the success with reassigning the more equitable distribution of the workload, it was appropriate to adopt the workload changes among staff during the test of the improvement theory. There were no major challenges or obstacles with the change because the redistribution was actually decided and agreed upon among the three inspectors doing the work.

9. Establish Future PlansWe will continue to monitor this improvement theory because home sales in this part of the country tend to be seasonal in the warmer months. It is during the spring and summer when this program is the busiest. We will continue to monitor the gains for this program through the summer of 2011 to see if there are any seasonal fluctuations.

POINT OF SALE TASk DIAGRAM

REvENuES LOCAL REVENUES Local Taxes: Inside Millage and Tuberculosis Levy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,126,101 Environmental Health License, Registration, and Permit Fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749,140 Contracts with Governmental Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705,996 Laboratory Services Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163,919 Personal Health Services Patient Paid Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90,064 Donations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,046 Rental Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,341 Miscellaneous Revenues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,380

SUB-TOTAL LOCAL REVENUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,962,987

STATE AND FEDERAL REVENUES Ohio Department of Health Funded Grants/Projects State Funded Dollars Include:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $26,980 Child and Family Health Services Block Grant Ohio Smoke Free Workplace Funds Rabies Surveillance Contract

Federal Funded Dollars Include: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,070,180 Child and Family Health Services Block Grant Childhood Lead Poisoning Prevention CDC Grant Lead Regional Resource Center Grant Public Health Infrastructure Grant WIC Program

Medicaid/Medicare Reimbursement for Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93,368

Other State and Federal Dollars Include: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243,331 Adult Day Services Grant - Area Agency on Aging Passport Program - Area Agency on Aging Medical Reserve Corps Grant - NACCHO Lead Abatement Grant - HUD Homestead and Rollback Reduction Funds

State Subsidy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,336

SuB-TOTAL STATE AND FEDERAL REvENuES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,464,195

TOTAL REvENuES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$4,427,182

DISTRICT BOARD OF HEALTH - MAHONING COuNTy

2010 FINANCIAL STATEMENT

EXPENDITuRES FEDERAL/STATE LOCAL TOTALS

Personal Health Services . . . . . . . . . . . . . . . . . . . . . . . $1,230,036 . . . . . . . . . . . . . . . . $672,416 . . . . . . . . . . . . . . $1,902,452 Environmental Health Services . . . . . . . . . . . . . . . . . . . . . . 59,026 . . . . . . . . . . . . . . . 1,249,635 . . . . . . . . . . . . . . . 1,308,661 Administrative & Support Services . . . . . . . . . . . . . . . . . . 259,220 . . . . . . . . . . . . . . . . . 629,415 . . . . . . . . . . . . . . . . . 888,635 Laboratory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40,949 . . . . . . . . . . . . . . . . . 390,224 . . . . . . . . . . . . . . . . . 431,173

TOTAL EXPENDITuRES. . . . . . . . . . . . . . . . . . . . . . . . . $1,589,231 . . . . . . . . . . . . . . . $2,941,690. . . . . . . . . . .$4,530,921this is An unAudited FinAnCiAL stAteMent

ChILD DEAThS IN MAhONING COuNTy — 1992-2009

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009yEAR

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LEADING CAuSES OF DEATh, 2006-2008Age-Adjusted Rate*

Cause of Death . . . . . . .Mahoning County . . . OhioHeart Disease . . . . . . . . . . . . . . . . . . 229.6 . . . 209.0Cancer . . . . . . . . . . . . . . . . . . . . . . . 205.6 . . . 195.9Cerebrovascular Disease . . . . . . . . . . . 48.0 . . . . 44.1Chronic Lower Respiratory Disease. . 41.3 . . . . 50.5Accidents/Unintentional Injuries . . . . 39.1 . . . . 40.6Diabetes . . . . . . . . . . . . . . . . . . . . . . . 29.8 . . . . 28.6Alzheimer’s Disease . . . . . . . . . . . . . . 23.4 . . . . 28.6Liver Disease . . . . . . . . . . . . . . . . . . . 17.7 . . . . 13.7Influenza and Pneumonia. . . . . . . . . . 13.6 . . . . 14.7Septicemia . . . . . . . . . . . . . . . . . . . . . 12.8 . . . . 10.2

*Per 100,000 population

2008 bIRThS

Live Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,593Low Birth Weight Births* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13.1%Prenatal Care During 1st Trimester . . . . . . . . . . . . . . . . . . . . . . . . . .64.6%

*Less than 2,500 grams or 5.5 pounds

2008 DEAThS

Total Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3,066Infant Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

HEALTH REPORT CARD

MAHONING COuNTy*

COMMuNICAbLE DISEASES. . . . . . . . . . . . . . . . . . . . .2009. . 2010Botulism, Infant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . 0Campylobacter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . 13Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 . . . 351Creutzfeldt-Jakob Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . 0Coccidioidomycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Cryptosporidiosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . 9Dengue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0E. coli - enterohemorrhagic (shiga toxin producing) 0157:H7 . . . 0 . . . . . 1E. coli - enterohemorrhagic (shiga toxin producing)Non-typed. . 1 . . . . . 0Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Giardiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . 7Gonococcal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . 53Haemophilus influenzae (invasive disease) . . . . . . . . . . . . . . . . . . 0 . . . . . 3Hepatitis A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 2Hepatitis B (including delta) - acute . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . 4Hepatitis B (including delta) - chronic. . . . . . . . . . . . . . . . . . . . . 9 . . . . 14Hepatitis C - acute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Hepatitis C - chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 . . . . 95Kawasaki disease (mucocutaneous lymph node syndrome) . . . . . 0 . . . . . 0Influenza (Novel strain)** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . 0Influenza (Hospitalization)***. . . . . . . . . . . . . . . . . . . . . . . . . . . 52 . . . . . 0Legionellosis - Legionnaires’ Disease . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . 3Lyme Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . 4Meningitis - aseptic/viral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . 5Meningitis - bacterial (Not N. meningitidis) . . . . . . . . . . . . . . . . 1 . . . . . 4Meningococcal disease - Neisseria meningitidis . . . . . . . . . . . . . 0 . . . . . 0Mumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Mycobacterial disease - other than tuberculosis . . . . . . . . . . . . . . 1 . . . . . 8Pertussis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . 22Q fever, chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Rocky Mountain spotted fever (RMSF). . . . . . . . . . . . . . . . . . . . 0 . . . . . 1Salmonellosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . 18Shigellosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . 1Streptococcal - Group A -invasive . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . 3Streptococcal - Group B - in newborn. . . . . . . . . . . . . . . . . . . . . 1 . . . . . 2Streptococcus pneumoniae . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . 24Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . 2Varicella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . 20Vibrio parahaemolyticus infection . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0Yersiniosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 0

* Mahoning County townships, villages, and cities of Canfield, Campbell and Struthers

** H1N1 was reported as Novel Influenza until August 5, 2009

*** Mahoning County Influenza Hospitalization: 8 cases January-March, 44 cases August-December

yEARS AGO IN PuBLIC HEALTH ...


75 yEARS AGOJanuary 14, 1936 — health commissioner Dr. George Davis reports on a federal project to provide sanitary outside toilets in the health district. April 14, 1936 — the District Board of Health memorializes deceased member S.A. Renkenberger, observing that “in the passing of Mr. Renkenberger the District Board of Health has lost a faithful member and Mahoning County has lost a substantial citizen.” June 9, 1936 — the District Board of Health sets nurses salaries at $150 a month and the sanitary inspector’s salary at $125 a month. 50 yEARS AGOSeptember 1, 1961 — the District Board of Health authorizes health commissioner Dr. Ray Fenton to close the Sebring dump immediately. October 3, 1961 — the health commissioner recommends purchasing vaccine to immunize all employees to ward off a probable influenza epidemic. December 1, 1961 — responding to appeals from Sebring and Smith township officials, the District Board of Health allows the Sebring dump to remain open and imposes conditions under which it must operate. 25 yEARS AGOJanuary 7, 1986 — the District Board of Health appoints Dr. Robert Parry as health commissioner, the 8th person to hold this post since health districts were created in 1919. Linda Ewing is appointed as a public health nurse. February 4, 1986 — nursing director Helen Mager reports that staff have been asked to advise local boards of education as they develop policies to deal with AIDS in their districts. June 3, 1986 — the District Board of Health appoints James Petuch as educational specialist for its litter control program. December 2, 1986 — Browning-Ferris Industries vice-president Mike Heher announces that his company has purchased the Lewis landfill in Green township. After hearing objections from residents near the Mahoning landfill in Springfield township, the District Board of Health tables the request for operating licenses for all landfills in the health district. 10 yEARS AGOJanuary 18, 2001 — deputy nursing director Linda Ewing reports that 5,700 persons received flu shots during the 2000-2001 flu campaign. Health promotion director Jane Warga reports that 26% of tobacco vendors sold cigarettes to children during a recent “undercover buy” operation. April 26, 2001 — the District Board of Health recognizes Cleveland Browns great Dick Schafrath, who is visiting the area to promote the Healthy Ohio program by exercising with Springfield school district students. Health commissioner Matthew Stefanak asks the District Board of Health to accept a 3rd amendment to the 1991 host community agreement with the BFI Carbon-Limestone landfill in which BFI agrees to purchase testing equipment for the District Board of Health’s laboratory. June 28, 2001 — the District Board of Health is briefed on the West Branch meningitis outbreak that killed two high school students and resulted in the vaccination of 4,400 students and staff in early June. December 27, 2001 — health commissioner and child fatality review board chair Matthew Stefanak presents the review board’s first report of child deaths in Mahoning county.


LABORATORy OFFERS ENvIRONMENTAL TESTINGTO LOCAL RESIDENTS AND AGENCIES

The District Board of Health’s Laboratory Services Division provides a full range of environmental laboratory testing for local residents and agencies. The laboratory has over 150 clients in the public and private sectors and has provided services to agencies and individuals since it opened in 1993. The laboratory was initially developed to provide testing for the District Board of Health’s groundwater monitoring program. This program, which has been in existence for 17 years, serves residents living within a one-mile radius of the seven open or closed landfills in Mahoning County. Residents who have well water can have their water tested for 28 chemical and biological parameters at least once yearly to determine if the landfills are having any impact on the groundwater in the area. In 2010, 212 households participated in the program. Homeowners are provided a detailed report explaining the test results and are provided information if specific parameters exceed water quality standards. Homeowners who live within a one-mile radius of any of the landfills may sign up for the program by contacting the District Board of Health.

NuMBER OF PARTICIPANT wELLS SAMPLED

The laboratory also provided extensive testing for the Mahoning County Healthy Homes, Lead Hazard Control Program and the Mahoning Valley LEAP Grant Program. These programs evaluate homes and rental properties for lead paint hazards. Testing determines the level of lead in the home and whether it presents a hazard to young children living in the home. If lead is present the Healthy Homes, Lead Hazard Control Program or the Mahoning Valley LEAP Grant Program work with an approved contractor to abate the lead hazard to make the home safe and prevent lead poisoning in young children. In 2010 the laboratory, which is accredited by the American Association for Laboratory Accreditation (A2LA) to perform lead testing, analyzed approximately 6,800 lead dust wipe and soil samples.

Central waste Inc. 20

County Land Development

32

TothHilltop & Crory Rd.

Landfills

47

Mahoning Landfill

46

Carbon Limestone

Sanitary Landfill

67RALPH wIDGER AnALyzing groundwAter sAMpLes

JANINE SOuBRA proCessing LeAd dust wipe sAMpLes prior to AnALysis

In 2010 the laboratory was also busy performing testing for other health departments and several water and wastewater facilities. The Trumbull County General Health District, which has an extensive maintenance program for home sewage systems, brought in approximately 1,800 samples to be tested for several parameters to assure that these septic systems were functioning properly. Malfunctioning septic systems can contaminate our local water supplies, streams and lakes therefore it is important to evaluate their function.

Other local agencies, such as the Mahoning County Sanitary Engineers, the Village of Leetonia, Columbiana County Wastewater Treatment Plant and Washingtonville Wastewater Treatment Plant, used the lab’s services to perform testing required of them by the Ohio Environmental Protection Agency (EPA). The laboratory is certified by the Ohio EPA for several chemical and biological parameters and performs tests in accordance with EPA protocols.

kAREN STANGL perForMing bACterioLogiCAL testing oF wAter sAMpLes

The laboratory continues to serve the residents of Mahoning County along with other agencies both within and outside of the county.“Our clients have come to rely on the District Board of Health laboratory for dependable, affordable and local testing services,” said the lab’s director Sandy Senedak.

ENHANCED FOOD SAFETy PROGRAM INSPECTION TRACkING

A simple stroke of a key on the computer can provide staff in the Food Safety Program with important inspection information within seconds, improving the overall efficiency of the program while fulfilling Ohio Department of Health requirements. Sanitarians utilize computer software called Health Department Information Systems (HDIS) to track the date and the number of times that a restaurant or grocery store has been inspected during a licensing period. The system enables staff to request a list of establishments whose inspections are due within a certain time frame helping to ensure that the minimum number of required inspections for all establishments have been completed as mandated in the Uniform Food Safety Code.

The Uniform Food Safety Code provides for the specific classification of restaurants based on the level of food preparation being conducted. The classification levels range from level one to level four and the number of inspections varies as well with specific time lines for completion. The health department began utilizing HDIS as a quality improvement tool to ensure that the Food Safety Program met their goal for the required number of inspections during the appropriate times but received the added benefit of having a presence on a more consistent basis in the establishments. Conducting the required number of inspections on a more consistent basis assists both the operator and the Food Safety staff in maintaining safety of the public.

DISTRICT BOARD OF HEALTH

RESPONDS TO OPEN DuMPING COMPLAINTSIn addition to providing for oversight of landfills in Mahoning County, the District Board of Health’s Solid and Infectious Waste Program conducts investigations in response to complaints about the improper storage and disposal of waste. Typical complaints involve the open dumping of solid waste or construction and demolition debris (C&DD), illegal landfilling of waste, improper storage or disposal of scrap tires, mismanagement of infectious wastes and storage of residential trash when it contributes to rodent harborage or conditions that create a nuisance or health hazard.

The receipt of a complaint triggers a physical investigation of the premises by sanitarians Angelo Italiano, Dave Fetchko or Jessica Tyree, followed by a written abatement notice addressed to the property owner. The notice includes a description of the complaint and the date investigated, the findings of the investigation, a statement of the laws and rules violated and recommendations for remediation in order to avoid escalated enforcement. Enforcement for non-compliant parties progresses to an appearance at a hearing before the Health Commissioner followed by an order to abate the nuisance issued by the District Board of Health. Continued non-compliance results in the filing of charges in the appropriate court with the assistance of the Mahoning County Prosecutor. Progress toward remediation is monitored throughout the process, with the primary objective being the protection of the environment and the public health.

The Solid and Infectious Waste Program responded to 84 complaints in 2010 and is committed to continuing its prompt response to complaints and their resolution.

NEw BOOSTER SHOTREQuIRED FOR SEvENTH GRADERS

The Ohio Department of Health issued a new immunization requirement for school children beginning with the 2010/2011 school year. All incoming seventh graders are now required to have a TdaP (tetanus, diphtheria and pertussis) vaccination prior to starting school. Most adults have received a pertussis shot as children to protect them from whooping cough. Researchers have found that over time immunity to pertussis wanes and although adults are not usually at risk for whooping cough, infants and children are. Adults may carry the pertussis germ and pass it on to infants and children who have not yet been vaccinated. The Ohio Department of Health is following the U.S. Centers for Disease Control and Prevention’s (CDC’s) recommendation to require seventh graders to get a booster shot of TdaP in an attempt to extend their immunity against pertussis into adulthood. “In addition, we encourage parents, grandparents and other adults who are in contact with infants and children to get a booster shot of TdaP to prevent them from passing on the pertussis germ to the very young who may not yet be protected by vaccination,” said nursing director Diana Colaianni.

To help parents meet this new immunization requirement for their children, the Mahoning County District Board of Health held special TdaP vaccination clinics in 2010, opening early evening clinics to accommodate parents who work during the day. Children were able to receive the newly required TdaP booster shot as well as any other vaccines they may have needed. Plans are in progress to offer TdaP vaccinations to teachers and students in the school setting in 2011 to help provide as much vaccination coverage as possible and in turn to reduce the spread of pertussis.

TdaP shots or any childhood or adult immunizations are available at the Mahoning County District Board of Health nursing division, (330) 270-2855, ext. 125.

2010 LICENSING COuNCIL MEMBERS

William booker (manufactured home parks)Thomas Carney (swimming pools and spas)bev Fisher (campgrounds)Michael heher (solid waste disposal facilities)John Kotchmar (retail food establishments)Tony Olin (food service operations)

Licensing councils were created by the Ohio General Assembly in 2001 to appoint one board of health member who represents entities licensed by the board of health. Licensing councils also review and provide recommendations to boards of health about fees charged to entities licensed by the board of health.


FIGHTING BLIGHTThe Neighborhood Stabilization Program (NSP) grant was established for the purpose of stabilizing communities that have suffered from foreclosures and abandonment. Authorized through the passing of the Housing and Economic Recovery Act of 2008, the NSP grant made $3.92 billion dollars of emergency assistance available to state and local governments to acquire and redevelop foreclosed properties in targeted areas.

The targeted areas that are eligible for NSP grant money in Mahoning County are Campbell, Struthers, Lowellville, NE Austintown, NE Boardman, Sebring, East Alliance and Craig Beach/Milton.

Responding to complaints, the Mahoning County District Board of Health condemned 103 dwellings in 2010 after finding them unfit for human habitation and unsafe. These condemned dwellings then become candidates for demolition with NSP funds administrated by Mahoning County Commissioners.

MS Consultants, Inc. is responsible for the process of selecting dwellings eligible for demolition using criteria established by the Department of Housing and Urban Development (HUD). These dwellings are then placed onto bid packages to be awarded to contractors participating in the process of demolishing the abandoned dwellings.

Demolition of NSP-eligible dwellings in the targeted areas of Mahoning County began in February 2010 with Campbell spearheading the program by having the first completed demolition on February 16, 2010. Since then a total of 138 abandoned dwellings have been demolished using NSP grant dollars. This does not include 130 demolitions in the city of Youngstown during the year.

In addition to the demolitions, three units have been assisted under the rehabilitation program, with two additional units in progress. One new dwelling was constructed through Habitat for Humanity, with three additional units in progress.

The Neighborhood Stabilization Program was created in response to economic emergencies and by removing blighted homes the program is also improving the public health of the community.


DISTRICT ADvISORy COuNCIL

David Mannion, Chair

Jodi Kale, Secretary

BOARD OF HEALTHLisa Noble Weiss, MD, President

Leonard Perry, Vice PresidentDonald SomersMargot Baird, RNBev FisherMichael Heher, Alternate

HEALTH COMMISSIONER

Matthew Stefanak, MPH

MEDICAL DIRECTOR

John Venglarcik, III, MD

FINANCE & HuMAN RESOuRCES

Edward Janik, CPA, DirectorKathy Affagato, Grants Fiscal Manager

Darlene Sawyers, Fiscal/Personnel Officer

Kathleen Svasta, Administrative Assistant

Michele Olin, Office Manager

Lori Keller, Account Clerk II

Tina Schneider, SecretaryLinda Zmith, Secretary

Diane Zagorsky, Secretary

ENvIRONMENTAL HEALTH DIvISONMary Helen Smith, MPH, RS Director

David Beaver, CPI, Plumbing InspectorEleanor Cegan, RS, Sanitarian

David Fetchko, RS, Sanitarian

Angelo Italiano, MA, RS, SanitarianJohn Hallas, RS, SanitarianKimberly Hobbs, MS, RS, SanitarianDantan Hutton, RS, Sanitarian

Joseph Mansky, Plumbing InspectorDeanna Maurer, RS, SanitarianAndrew Stefan, RS, SanitarianRyan Tekac, RS, Sanitarian

Anthony Veitz, RS, Sanitarian

Jessica Tyree, RS, Sanitarian

NuRSING DIvISION

Diana Colaianni, MSN, RN, DirectorLinda Ewing, MSN, RN, CPNP, Deputy Director of Nursing for Clinical Services

Public Health Nurses Brenda Christensen, RN

Amanda Morningstar, RN

Marianne Evans, RN

Debra Moss, RN Laura Scalise, Secretary

ADuLT DAy SERvICES Rita Nolfi, M.Ed, RN

William Michael, Van DriverJoyce Naymick Activities Coordinator

TuBERCuLOSIS

ELIMINATION PROGRAMShawn Hunter-Little MA,TB Registrar

Denise Walters, Public Health Nurse

COMMuNITy HEALTH DIvISIONJoseph Diorio, MS, RS, Director Susan Kovach, MPH, Community Health Education Specialist

Nicholas Cascarelli, MHHS Outreach Educator

Stefano Napolitano, RS Sanitarian

Kathleen Terreri, RN Pediatric Coordinator

Rosemary Totterdale, SecretaryTracy Styka, MS, Community Health Education Specialist

LABORATORy SERvICES DIvISION

Sandra Senedak, RS, DirectorJanine Soubra, Lab Technician

Karen Stangl, MS, Lab TechnicianJulie Thompson, SecretaryRalph Widger, Lab Assistant

2010officers

staff&


Toll-free in Mahoning County1.800.873.MCHD

Health CommissionerEnvironmental Health & Plumbing

Lead Poisoning Prevention ProgramNursing & Clinics

Solid & Infectious Waste Program330.270.2855

Adult Day Services330.782.1749

Laboratory Services330.270.2841

Tuberculosis Clinic330.744.4246

District Board of HealthMahoning County

50 Westchester DriveYoungstown, OH 44515

www.mahoninghealth.org

2010AnnuAlRepoRt

2010annualreport · time reduction in conducting point of sale home septic and well inspections...

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