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TABLE OF CONTENTS
Mission, Vision, Goals and Strategies............................................................................ 1 Board of Health and Advisory Groups.......................................................................... 4 Health Department Staff................................................................................................. 5 Organizational Chart ...................................................................................................... 7 Reported Disease ............................................................................................................. 8 Environmental Health Division.................................................................................... 15 Health Education Division ............................................................................................ 21 Home Care Nursing Division........................................................................................ 24 Laboratory Division ...................................................................................................... 28 Nutrition Division .......................................................................................................... 31 Public Health Nursing Division.................................................................................... 39 Public Health Preparedness...........................................................................................00 Vector Control Division ................................................................................................ 47 Budget............................................................................................................................. 50
La Crosse County Health Department
www.co.la-crosse.wi.us/Health.htm
VISIT US ON THE WEB!
MMiissssiioonn SSttaatteemmeenntt
The Mission of the La Crosse County Health Department is to improve the quality of life and health
of all people in La Crosse County.
Vision Statement The Department Will:
Provide services that assist La Crosse County residents in realizing the opportunity to live a long and productive life, free of preventable disease and the effects of preventable injury.
Be recognized as a catalyst working with individuals and public and private organizations to bring about
positive changes in the health status of La Crosse County residents.
Assure that people have access to health services regardless of their ability to pay.
Continue to develop innovative public health services that meet the changing needs of La Crosse County residents.
GGOOAALLSS AANNDD SSTTRRAATTEEGGIIEESS
HHeeaalltthh DDeeppaarrttmmeenntt
11.. PPRRIIOORRIITTYY AARREEAA:: MMaaiinnttaaiinn tthhee ccuurrrreenntt hhiigghh ssttaannddiinngg ooff tthhee ppuubblliicc hheeaalltthh ssttaattuuss ooff LLaa CCrroossssee CCoouunnttyy cciittiizzeennss..
CCRRIITTIICCAALL IISSSSUUEESS::
TThhee LLaa CCrroossssee CCoouunnttyy HHeeaalltthh DDeeppaarrttmmeenntt pprroovviiddeess aabboouutt 3355 ddiiffffeerreenntt pprrooggrraammss tthhaatt pprreevveenntt oorr rreedduuccee tthhee ppootteennttiiaall ffoorr ssiiggnniiffiiccaanntt ddiisseeaassee aanndd ddeeaatthh iinn LLaa CCrroossssee CCoouunnttyy.. TThhee ddiilleemmmmaa ooff pprreevveennttiioonn pprrooggrraammss iiss tthhaatt wwhheenn tthheeyy aarree eeffffeeccttiivvee,, tthheerree iiss iinntteerreesstt iinn eennddiinngg tthhee pprrooggrraammss bbeeccaauussee tthhee ddiisseeaassee iiss nnoott ““sseeeenn”” iinn tthhee ccoommmmuunniittyy.. TThhee ccoosstt iinn lloosstt lliivveess,, wwoorrkk ddaayyss,, eettcc..,, ccaann bbee ssiiggnniiffiiccaanntt bbeettwweeeenn tthhee ttiimmee aa pprrooggrraamm iiss eennddeedd,, tthhee ppuubblliicc hheeaalltthh iiss jjeeooppaarrddiizzeedd,, aanndd tthhee pprreevveennttiioonn pprrooggrraamm iiss rreeiinnssttaatteedd.. AA rreecceenntt ddeeppaarrttmmeenntt sseellff eevvaalluuaattiioonn bbaasseedd uuppoonn nnaattiioonnaall gguuiiddeelliinneess iinnddiiccaatteedd tthhaatt tthhee ddeeppaarrttmmeenntt hhaass mmaannyy oorrggaanniizzaattiioonnaall ssttrreennggtthhss,, bbuutt iimmpprroovveemmeennttss ccaann bbee mmaaddee ttoo eennaabbllee iitt ttoo bbee eevveenn bbeetttteerr..
GGOOAALL ##11:: MMaaiinnttaaiinn tthhee ccuurrrreenntt lleevveell ooff ppuubblliicc hheeaalltthh sseerrvviicceess.. SSTTRRAATTEEGGIIEESS:: IInnccrreeaassee tthhee ppuubblliicc uunnddeerrssttaannddiinngg ooff tthhee ttyyppeess ooff sseerrvviicceess pprroovviiddeedd iinn tthhee HHeeaalltthh DDeeppaarrttmmeenntt..
CCoonnttiinnuuee ttoo hhaavvee tthhee llooccaall ppeerr ccaappiittaa ttaaxx lleevvyy ssppeenntt oonn ppuubblliicc hheeaalltthh bbee wwiitthhiinn 1100%% ooff tthhee SSttaattee ooff WWiissccoonnssiinn aavveerraaggee bbuutt ttoottaall eexxppeennddiittuurreess aabboovvee tthhee SSttaattee aavveerraaggee.. EEnnccoouurraaggee tthhee ccoommmmuunniittyy ttoo bbee aaccttiivveellyy iinnvvoollvveedd iinn ppllaannnniinngg ffoorr aanndd eevvaalluuaattiinngg ppuubblliicc hheeaalltthh..
GGOOAALL ##22:: UUttiilliizzee eexxiissttiinngg tteecchhnnoollooggyy ttoo iinnccrreeaassee tthhee aammoouunntt ooff sseerrvviicceess pprroovviiddeedd.. SSTTRRAATTEEGGIIEESS:: CCrreeaattee aanndd iimmpplleemmeenntt aa ffoorrmmaall ppllaann ffoorr mmaarrkkeettiinngg tthhee sseerrvviicceess ooff tthhee HHeeaalltthh DDeeppaarrttmmeenntt..
IImmpprroovvee tthhee mmaannaaggeemmeenntt iinnffoorrmmaattiioonn ssyysstteemmss,, eessppeecciiaallllyy iinn tthhee aarreeaass ooff uunniittss ooff sseerrvviiccee aanndd ffiissccaall aaccccoouunnttiinngg ooff ffeeeess aanndd ccoonnttrraaccttss.. AAssssuurree eeaacchh ssttaaffff ppeerrssoonn iiss ggiivveenn aann aavveerraaggee ooff 22%% ooff tthheeiirr ttoottaall wwoorrkk hhoouurrss ffoorr ccoonnttiinnuuiinngg eedduuccaattiioonn aanndd 11%% ooff tthhee ddeeppaarrttmmeenntt ttaaxx lleevvyy bbee sseett aassiiddee ffoorr rreellaatteedd eedduuccaattiioonn ssuupppplliieess,, rreeggiissttrraattiioonnss aanndd rreellaatteedd eexxppeennsseess
GGOOAALL ##33:: BBee ddeessiiggnnaatteedd bbyy tthhee SSttaattee ooff WWiissccoonnssiinn aass tthhee hhiigghheesstt ccaatteeggoorryy ooff ppuubblliicc hheeaalltthh aaggeennccyy..
SSTTRRAATTEEGGIIEESS::
MMeeeett oorr eexxcceeeedd aatt lleeaasstt ffoouurr ooff tthhee YYeeaarr 22001100 hheeaalltthh oobbjjeeccttiivveess ffoorr tthhee SSttaattee aanndd NNaattiioonn iinn eeaacchh ooff tthhee ffoolllloowwiinngg ccaatteeggoorriieess –– ccoommmmuunniiccaabbllee ddiisseeaassee,, cchhrroonniicc ddiisseeaassee,, iinnjjuurryy pprreevveennttiioonn,, eennvviirroonnmmeennttaall hheeaalltthh,, rreepprroodduuccttiivvee hheeaalltthh,, iinnffaanntt aanndd cchhiilldd hheeaalltthh aanndd aaddoolleesscceenntt hheeaalltthh..
22.. PPRRIIOORRIITTYY AARREEAA:: EExxppaannssiioonn ooff sseerrvviicceess ttoo rreessppoonndd ttoo ccoommmmuunniittyy nneeeeddss.. CCRRIITTIICCAALL IISSSSUUEESS::
AAnn aasssseessssmmeenntt ooff ccoommmmuunniittyy nneeeeddss bbyy aa cciittiizzeenn’’ss aaddvviissoorryy ccoommmmiitttteeee rreeccoommmmeennddeedd iimmpprroovveemmeennttss oovveerr tthhee nneexxtt 55--1100 yyeeaarrss iinn tthhee ssiixx hhiigghh pprriioorriittyy aarreeaass lliisstteedd iinn tthhee ggooaallss bbeellooww..
GGOOAALL ##44::
DDeetteerrmmiinnee tthhee mmoosstt eeffffeeccttiivvee wwaayyss ttoo iimmpplleemmeenntt eexxppaannssiioonn ooff ppuubblliicc hheeaalltthh sseerrvviicceess iinn tthhee hhiigghh pprriioorriittyy aarreeaass ooff:: aaddoolleesscceenntt hheeaalltthh,, aallccoohhooll,, ttoobbaaccccoo aanndd ootthheerr ddrruugg aabbuussee pprreevveennttiioonn,, hheeaalltthh iinnssuurraannccee sseerrvviicceess,, iimmpprroovveedd hhoouussiinngg,, mmeennttaall hheeaalltthh aanndd eedduuccaattiioonn ffoorr tthhee ppuubblliicc oonn pprreevveennttiivvee hheeaalltthh sseerrvviicceess..
SSTTRRAATTEEGGIIEESS:: EEnnccoouurraaggee tthhee pprriivvaattee sseeccttoorr ttoo eexxppaanndd tthheeiirr pprroovviissiioonn ooff ppuubblliicc hheeaalltthh sseerrvviicceess..
CCoonnttiinnuuee ttoo ssuucccceessssffuullllyy ccoommppeettee ttoo oobbttaaiinn pprriivvaattee aanndd ppuubblliicc ffuunnddss ttoo ssuuppppoorrtt ppuubblliicc hheeaalltthh iimmpprroovveemmeennttss iinn LLaa CCrroossssee CCoouunnttyy..
EExxppaanndd CCoouunnttyy HHeeaalltthh DDeeppaarrttmmeenntt pprrooggrraammmmiinngg aass ddeemmoonnssttrraattiioonnss ooff hhooww ppuubblliicc hheeaalltthh pprrooggrraammss ccaann bbee ddeelliivveerreedd aanndd ssppiinn tthheemm ooffff ttoo tthhee pprriivvaattee sseeccttoorr wwhheenn ffeeaassiibbllee..
22000044
Health and Human Services Board
Tara Johnson, Chair Loren Kannenberg Sharon Hampson, Vice Chair Luke Naegele Jill Billings JoAnne Scharpf Anita Froegel Margaret Wood James Glasser, M.D.
AAddvviissoorryy GGrroouuppss
Nursing Audit Committee
CMB Rehabilitation , Inc. Carol Bloom, P.T. Sigrid Dooley, R.N.
La Crosse County Breastfeeding Council
Karla Fennie Sue Murvich Sherry Stoskopf Aggie Hoeger, C.N.M. Beth Padesky Donna Sullivan Kelly Kinstler Glenda Pinkham Jackie Thingvold Kim Kochenderfer Stephanie Ryan Kim Welvaert Linda Lee Dorothy Schmaltz Jennifer Wheeler Dawn Mc Fadden
Home Health Professional Advisory Committee
Carol Bloom, P.T. Doug Mormann, Director Connie Eide, R.N., Home Care Supervisor Michael O’Brien, M.D. Mary Faherty, M.S.W. Kathy Rice, O.T. Stephanie Genz, R.N. Patsy Quick, R.N. Helen Harms, S.T. Jean Walleser, R.H.I.T. Susan Jostad, L.P.N.
Collaborative Efforts
Coulee Region Childhood Obesity Coalition
Beth Balder PNP Carol Klitzke Karen Rude Ann Budzak MD Linda Lee Fran Swift Jeannie Groskreutz Kris Litscher-Lee PNP Connie Troyanek RN Angie Hansen Donna Loveland RD Barb Van Dreese Ginger Horth Joni Ralph RD Andi Van Sickle RN Diane Kelber RD Jayne Rifenberg
La Crosse Area Health Initiative
Kay Adams Shawn Kudron Lisa Sauer Kathy Berger Roger Kwong Ellen Schafer Jerry Berns Doug LeClair Sharon Schulz Pat Breslin Lynn Lenz Beth Seebach Mary Carskadon Susan Lundsten Nancy Stevenson Kathy Curtis Sue Lynch Tom Trudeau Doris Doherty Todd Mahr Shoua Vang Steve Doyle Doug Nelson Kathy Volden Bret Emmel Heather Quackenboss Marie Walter Lori Francis Silvana Richardson Paul Weibel Gary Gilmore Pam Ristow Mary Ellen West Bill Jones Brenda Rooney Ruth West Pat Karpinsky
Youth Advisory Council Members
Jamie Barnes Carolyn Leach Lee Weiss John Brown Nicky Morstatter Eva Wintersteen Molly Fitzpatrick Hans Pieper Kielty Wintersteen John Geary Nick Rooney Amber Zabel Dan Gerber Kristina Schubert Sarah Zietlow
Safe Communities
Rob Abraham Mike Horstman Bill Lubinski Karon Anderson Mary Ihle Susan Lundsten Bob Augedahl Carol Immermann Susan Miller Pat Breslin Rick Jeske Vicki Otto Deb Cowan Jim Kerr Randy Rank Cecile D’Huyvetter Don Kimlicka Phoebe Sorenson Anne Ellefson Fawn King Patricia Spain Terry Erickson Carrie Kolman Donna Sullivan Frank Hefti Tom Lang Kimberly Tabbert John Helfrich Jill Larson Ron Walker Barry Holme
HABIT (Hmong Against Big Industry Tobacco) American Legacy Grant Members
Pat Breslin Shao Lee Pao Vang Por Ge Chang Linda Litka Shoua Vang Lori Francis Muaj Lo, MD Tanya Vaughn-
Greenwold Kris Hayden Heather Quackenboss Thai Vue Cheng Her, MD Brenda Rooney Nevin Xiong Bruce Lee Bob Sanders Ter Yang Choncher Lee Denis Tucker Tony Yang Moua Lee
2004 Staff
Douglas Mormann, Director Michael O’Brien, M.D., Medical Advisor
NURSING Environmental Health Billing Home Care Ron Berg, Manager Camille Ellenz, Fiscal Manager Connie Eide, Home Care Supervisor Pat Danielson, Sanitarian Jennifer Mullin, Health. Dept. Clerk* Judy Been, C. H. Aide Sheri Hanson, Environ. Sanitation Secretary Lynn Role, Clerk Senior* Carol Griswold* C.H. Nurse David Sawvell, Sanitarian Karen Havey, C.H. Aide Doug Schaefer, Sanitarian Rachael Hugo, C.H. Aide* James Steinhoff, Sanitarian Coulee Region Public Health Dan Kaminski, C.H. Nurse Sam Welch, Sanitarian Preparedness Consortium Lisa Knutson, C.H. Aide Greg Breen, Consultant* Gwen Kuhnke, C.H. Aide Brenda Hanson, Health Educator Casey Leis, C.H. Aide* Laboratory Derek Moore, Epidemiologist Ellie Meyer, C.H. Nurse* Richard Matushek, Manager Diane Panzer, Secretary* Alyce Stark, C.H. Nurse* Patty Dayton, Lab Technologist Jean Walleser, R.H.I.T.* Stephen Lenser, Lab Technologist Linda Massa, Lab Technologist* Administration Sue Schreiner, Lab Technologist* Karen Knox, Office Supervisor I Public Health Darlene Kissel, Clerk Senior Laura Gambino, P H Nursing Supervisor Kitty McIntee, Clerk Advanced Sara Christianson, C.H. Nurse Vector Control Pat Mulrine, Clerk Senior Sue Conard, C. H. Nurse Dave Geske, Manager Kathy Runningen, Clerk Senior Mary Dahlby, C.H. Nurse Don Addington, Vec. Cont. Monitor** Kathy Schank, Clerk Entry* Julie Fisher, C.H. Nurse Taylor Addington, Vec. Cont. Monitor** Maichor Lee, C.H. Aide* David Danforth, Vec. Cont. Monitor** Maureen O’Brien-Thompson, C. H. Nurse* Ryan Hoffman, Vec. Cont. Monitor** Persons Leaving in 2004 Sarah Peterson, C. H. Nurse Craig Jackson, Vec. Cont Monitor** Kay Bevington, C. H. Nurse John Snyder, C. H. Occupational H. Nurse Emily Jensen, Vec. Cont. Monitor** Holly Britain, C. H. Aide Marissa Warnke, C.H. Nurse Jeremy Jensen, Vec. Cont. Monitor** Susan Cieslicki, C. H. Nurse William Jensen, Vec. Cont. Monitor** Pat Coates, Hlth. Dept. Billing Clerk Curt Riley, Vec. Cont. Monitor** Julie Dietz, C. H. Nurse* Nutrition Ben Schrader, Vec. Cont. Monitor** Jean Edsall, Sanitarian Linda Lee, Manager Dan Szymaszek, Vec. Cont. Monitor** Susan Kramer, C. H. Nurse Judy de Back, Clerk Senior William Thoftne, Vec. Cont. Monitor** Robin Perry, Health Educator April Graewin, C. H. Aide Rita Severson, C. H. Aide Teresa Holtze, C.H. Aide* Mary Tabbert, C. H. Nurse Kelly Kinstler, Nutrition Ed. Health Education May Vang, C. H. Aide Kim Kochenderfer, Nutrition Ed. Al Graewin, Manager Lynn West, C. H. Nurse* Dawn Mc Fadden, Nutrition Ed. Al Bliss, Health Educator Nor Moua, C. H. Aide Josalyn Gloyd, Health Educator Robin Oehrle, C. H. Aide* Paula Silha, Health Educator* Dorothy Schmaltz, Nutrition Ed.* John Pieper, Health Ed. Asst.* Lindsey Schwarz, Social Worker Anne Winegarden, Health Educator *Denotes Part-Time Maomoua Vue, Nutrition Ed. Judi Zabel, Health Educator **Denotes Temporary Position
DDIISSEEAASSEE RREEPPOORRTTIINNGG AANNDD IINNVVEESSTTIIGGAATTIIOONN State law in Wisconsin requires reporting, investigation and control of 84 communicable diseases. The public health department collaborates with local medical personnel, schools, and day care centers that report by disease and demographic information. Staff provides public education and recommendations for management of individuals with disease to prevent further spread of disease in the community.
SELECTED HEALTH STATUS GOALS FROM “HEALTHY PEOPLE 2010”
Disease Category Nation 2010 Goal Cases/100,000
La Crosse County 2004 Actual Cases/107,000 Approx.
Chlamydia
500
396
Gonorrhea
19
63
Measles
0
0
Pertussis
0.1
45
Hepatitis A
4.5
13
Hepatitis B
9
28
Salmonella
6.8
7
Campylobacter
12.3
40
Lyme Disease
9.7
231
Tuberculosis
1
1
REPORTABLE COMMUNICABLE DISEASE
The State of Wisconsin requires reporting, investigation and control of communicable diseases. The following table identifies these cases by number and year in La Crosse County:
DISEASE 2000 2001 2002 2003 2004AIDS 2 2 0 3 3Amebiasis 0 0 0 0 1Anthrax 0 0 0 0 0Arboviral infection (encephalitis/ meningitis) 2 3 0 0 4Babesiosis 0 0 0 0 0Blastomycosis 1 0 0 2 1Brucellosis 0 0 0 0 0Botulism 0 0 0 0 0Botulism, infant 0 0 0 0 0Campylobacter 25 25 28 16 40Cat Scratch Disease (infection caused by Bartonella species) 0 0 0 2 1Chancroid 0 0 0 0 0Chlamydia 213 266 281 314 396Cholera 0 0 0 0 0Cryptosporidiosis 7 25 30 20 13Cyclosporiasis 0 0 0 0 0Diphtheria 0 0 0 0 0E. coli 0157:H7 and other enterohemorrhagic E. coli,
enteropathogenic E. coli, enteroinvasive E. coli, enterotoxigenic E. coli.
11 5 6 3 2
Ehrlichiosis 0 1 0 2 1Encephalitis viral (other than arboviral) 0 2 0 0 1Foodborne or waterborne investigations 30 23 26 19 22Genital Herpes (1st episode) 49 51 70 72 77Giardiasis 13 26 14 15 30Gonorrhea 78 55 39 19 63Haemophilus influenzae invasive disease (including
epiglottitis) 0 1 0 1 1
Hantavirus infection 0 0 0 0 0Hemolytic uremic syndrome 0 1 1 0 0Hepatitis A 0 4 1 0 13Hepatitis B 15 6 6 13 28Hepatitis C 20 41 41 55 46Hepatitis D 0 0 0 0 0Hepatitis E 0 0 0 0 0Hepatitis non-A, non-B (acute) 0 0 0 0 0Histoplasmosis 0 0 1 0 0HIV 5 3 3 2 2Infant methemoglobinemia 0 0 0 0 0Kawasaki disease 2 0 0 0 0Lead intoxication (specify Pb levels) 27 12 30 27 30Legionellosis 1 0 1 1 0Leprosy (Hansen Disease) 0 0 0 0 0Leptospirosis 0 0 0 0 0Listeriosis 0 0 0 0 0Lyme disease 71 84 101 120 231Malaria 1 0 0 0 0
DISEASE 2000 2001 2002 2003 2004Measles 0 0 0 0 0Meningitis, bacterial (other than Haemophilus) 0 2 1 1 0Meningitis, viral (other than arboviral) 1 2 0 1 3Meningococcal disease 1 1 1 1 0Mumps 0 0 0 0 0Mycobacterial disease (nontuberculous) 2 2 8 2 9Metal & Pesticide poisonings 0 0 0 0 0Pelvic inflammatory disease 0 0 0 1 0Pertussis (whooping cough) 2 4 13 5 45Plague 0 0 0 0 0Poliomyelitis 0 0 0 0 0Psittacosis 0 0 0 0 0Q Fever 0 0 0 0 0Rabies (human) 0 0 0 0 0Reye syndrome 0 0 0 0 0Rheumatic fever (newly diagnosed and meeting the Jones
criteria) 0 0 0 0 0
Ricin toxin 0 0 0 0 0Rocky Mountain spotted fever 0 0 0 0 0Rubella 0 0 0 0 0Rubella (congenital syndrome) 0 0 0 0 0Salmonellosis 16 16 9 14 7Shigellosis 1 3 0 0 1Small pox 0 0 0 0 0Streptococcal disease (all invasive disease caused by Groups
A and B Streptococci) 3 14 7 16 9
Streptococcus pneumoniae invasive disease (invasive pneumococcal)
2 12 21 13 15
Suspected outbreaks of other acute or occupationally-related diseases
0 0 0 0 0
Syphilis 0 0 0 1 4Tetanus 0 0 0 0 0Toxic shock syndrome 0 0 0 0 0Toxic substance related disease 0 0 0 0 0Toxoplasmosis 0 0 0 0 0Trichinosis 0 0 0 0 0Tuberculosis 2 1 1 0 0Tularemia 2 0 0 0 0Typhoid fever 0 0 0 0 0Typhus fever 0 0 0 0 0Varicella (chicken pox) – reported by number of cases only 107 57 1 1 0Yellow fever 0 0 0 0 0Yersiniosis 0 0 1 1 0
TOTAL 712 750 742 763 1067
Reportable Disease 1998 – 2003
Based on 100,000 Population Case Rate (Note: Rate for State in 2003 and 2004 is 2002 – Data for 2003 and 2004 Not Available
AIDS
0
1
2
3
4
5
6
7
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
AMEBIASIS
0
0.5
1
1.5
2
2.5
3
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin ARBOVIRAL INFECTION
0
0.5
1
1.5
2
2.5
3
3.5
4
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
BLASTOMYCOSIS
0
0.5
1
1.5
2
2.5
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin CAMPYLOBACTER
0
5
10
15
20
25
30
35
40
45
50
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
CHLAMYDIA
0
50
100
150
200
250
300
350
400
450
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
LA CROSSE COUNTY REPORTABLE DISEASE 1 9 9 9 - 2 0 0 4
0
200
400
600
800
1000
1200
1999 2000 2001 2002 2003 2004Year
Rep
orte
d C
ases
CRYPTOSPORIDIOSIS
0
5
10
15
20
25
30
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsi
E-COLI 0157:H7
0
2
4
6
8
10
12
14
16
18
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin ENCEPHALITIS, VIRAL
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
GENITAL HERPES (1st Episode)
0
10
20
30
40
50
60
70
80
90
1998 1999 2000 2001 2002 2003 2004C
ase
Rat
e Pe
r 100
,000
Pop
ulat
ion
La Crosse County Wisconsin GIARDIASIS
0
5
10
15
20
25
30
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
GONORRHEA
0
20
40
60
80
100
120
140
160
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin HEPATITIS A
0
2
4
6
8
10
12
14
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
HEPATITIS B
0
5
10
15
20
25
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
HEPATITIS C
0
10
20
30
40
50
60
70
80
90
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
HISTOPLASMOSIS
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin HIV
0
1
2
3
4
5
6
7
8
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
KAWASAKI DISEASE
0
0.5
1
1.5
2
2.5
3
3.5
1998 1999 2000 2001 2002 2003 2004C
ase
Rat
e Pe
r 100
,000
La Crosse County Wisconsin LEGIONELLOSIS
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
LYME DISEASE
0
50
100
150
200
250
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin MALARIA
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
MENINGITIS - BACTERIAL
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
MENINGITIS - VIRAL
0
1
2
3
4
5
6
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
MENINGOCOCCAL DISEASE
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin PERTUSSIS
0
5
10
15
20
25
30
35
40
45
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
SALMONELLOSIS
0
5
10
15
20
25
1998 1999 2000 2001 2002 2003 2004C
ase
Rat
e Pe
r 100
,000
Pop
ulat
ion
La Crosse County Wisconsin SHIGELLOSIS
0
2
4
6
8
10
12
14
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
SYPHILIS
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin TUBERCULOSIS
0
0.5
1
1.5
2
2.5
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per
100
,000
Pop
ulat
ion
La Crosse County Wisconsin
YERSINIOSIS
0
0.5
1
1.5
2
2.5
3
3.5
1998 1999 2000 2001 2002 2003 2004
Cas
e R
ate
Per 1
00,0
00 P
opul
atio
n
La Crosse County Wisconsin
EENNVVIIRROONNMMEENNTTAALL HHEEAALLTTHH DDIIVVIISSIIOONN
The Environmental Health Division’s 2004 report is listed below. This Division has contract agreements with the Wisconsin Division of Health, Wisconsin Department of Agriculture, Wisconsin Department of Commerce and Wisconsin Department of Natural Resources. A. Licensed Establishments
This Division licenses and inspects the following establishments for the Wisconsin Division of Health: • Restaurants • Hotels and Motels • Tourist Rooming Houses • Bed and Breakfast • Campgrounds
• Recreational and Educational Camps • Swimming Pools • Tattoo and Body Piercing Practitioners
and Establishments • Schools
Department of Agriculture establishments licensed and inspected include:
• Retail Food Stores • Bakeries • Convenience Stores
The Mobile Home Park licensing and inspection program is under the Wisconsin Department of Commerce.
County Licenses are issued for:
• Taverns (without food) • Outdoor/Indoor Foodstands
• Farmer/Flea Markets • Massage Technicians and Establishments
This Division also inspects carnivals, fairs and other seasonal/special events.
The licensed establishments are listed below.
La Crosse County Licensed Establishments LICENSED ESTABLISHMENTS 2000 2001 2002 2003 2004Restaurants 330 302 304 318 307Pre-packaged Food Restaurants 45 55 49 48 54Temporary Restaurant Permit 45 21 38 55 63Hotels/Motels/TRH/B&B 45 47 43 41 40 Number of Rooms (1,954) (1,994) (1,957) (1,914) (1961)Mobile Home Parks 29 29 30 30 30Campgrounds 8 10 7 7 7Temporary Campgrounds 2 4 2 2 1Rec. and Ed Campgrounds 2 2 2 2 2Swimming Pools 68 73 74 74 74Food Retail 94 95 97 99 99Tavern 24 22 19 22 20Indoor Foodstands 17 20 20 22 21Outdoor Foodstands 7 4 8 9 6Tattoo 4 3 4 4 5Massage 13 10 10 8 9Farmers/Flea Market 75 82 83 95 104Schools 47 47 47 47 45Totals 856 826 837 883 887
B. Environmental Health Inspections
Inspections are made in all food establishments including restaurants, taverns and retail food establishments. This is to ensure that clean and sanitary conditions are achieved and maintained, that food service operators are properly trained and that defective equipment is brought into compliance. It is through these efforts that the health of the public is protected and possible food borne illness is prevented. Reinspections are conducted when major violations are detected or when a complaint is received pertaining to the sanitary practices or conditions of an establishment. The following are number of inspections made. We were standardized by DHFS in 2004 to ensure uniform practices. Fifty-nine tattoo practitioners and body piercing practitioners were inspected and licensed at the 2004 Shades of Blue Tattoo Show.
HEALTH INSPECTIONS 2000 2001 2002 2003 2004Temporary Licenses 68 60 84 120 139Farmer / Flea Market 85 82 61 130 240Lodging Establishments 55 43 49 50 52Outdoor Foodstands 9 4 10 15 20Indoor Foodstands 18 20 20 22 28Vending Machine Operators/Commissaries 5 3 1 1 2Vending Machine 52 4 30 30 35Eating & Drinking Establishments 850 820 703 624 719Mobile Home Parks 46 38 40 33 56Recreational Facilities 550 585 337 265 225Fires at Licensed Establishments 4 0 2 3 4Food Retail 205 142 124 160 171Housing 73 103 154 94 115Animals 40 39 20 22 35Human Health Hazards 24 20 29 63 21Garbage and Refuse 29 54 30 29 27Food borne Illness 13 10 16 19 16Lead 84 27 24 7 13Mold - - - 36 28Tattoo 36 61 54 74 65Massage Establishments 13 10 10 8 9Schools 47 47 54 54 95TOTALS 2,306 2,209 1,852 1,861 2,115
C. On-Site Waste Disposal Program
This Division regulates and issues sanitary permits for all private on-site waste disposal systems in La Crosse County. We review and make on-site inspections on all soil tests, and all septic system installations are inspected for compliance prior to backfilling. The Maintenance Program, started in 1983, requires owners of new systems to have their septic tanks inspected or pumped every three (3) years after installation of their system. There were 1,502 notices sent out. County Sanitary Permits new in 2001 for privies; reconnections are no longer required in State Code. Non-Plumbing (portable restrooms) requires a County Permit for cabins with no water to dwelling—new 2002.
SANITARY PERMITS ISSUED 2000 2001 2002 2003 2004 New Construction 163 155 146 203 207 Replacement 76 87 78 62 63 Tank Replacement Only 2 1 2 3 1 Repair 2 2 3 0 1 New County Reconnection ** 4 7 4 8 10 New County Privy ** 1 0 2 0 2 New Non-Plumbing ** 4 4 0
Sanitary Permit Transfer Landowner * (3) (6) (2) (0) (0) Sanitary Permit Plumber Revised * (7) (7) Sanitary Permit Renewal * (6) (0) (0) (1) (1)
TOTAL 248 252 239 280 284 Septic Systems Installed: Conventional
New 68 61 64 106 108 Replacement 55 55 51 34 41
Mounds New 7 11 18 14 14 Replacement 6 8 12 13 9
In-ground Pressure New 1 0 1 0 1 Replacement 1 1 1 1 0
At-Grade (Experimental) New 74 87 58 67 64 Replacement 19 19 14 12 24
Holding Tank New 6 5 4 4 3 Replacement 0 2 0 0 2
Septic Tank Replacement 3 1 2 4 1 Relocate Tank 0 0 0 0 1 Privies** 0 0 2 0 2 Repairs 2 2 1 0 1 Additions 0 0 0 0 1 Non-Plumbing ** 4 3 0 Reconnections** 1 8 4 3 1 Total Systems Installed 243 260 236 261 270 Total Number of Inspections 405 437 418 446 460 Wisconsin Fund Applications
Orders Issued 2 8 9 11 8 Grants Applied For 2 8 9 11 6 Grants Approved 2 8 9 10 6 Systems Installed 2 8 9 11 8 Funds Distributed $6,258 $31,729 $22,068 $31,416 $20,698
2000 2001 2002 2003 2004 Enforcement Actions Construction Directives & Orders
Field Directives 37 9 33 28 28 Directives Complied With 9 6 31 18 25 Written Notices 22 21 20 31 28
Replacement System Inspections Replacement Systems 87 91 83 64 65
Systems Replaced without Orders
85
83
81
57 57
Orders for Replacement 2 8 20 23 8 Soil Tests
Reports Filed 277 261 247 290 279 Reports Verified 264 255 250 290 279 Written Notices 11 16 11 14 6
* Sanitary Permit Transfers, Renewals, Revisions and Rescinded Permits are issued as defined and valid for continuation of sanitary permit until expiration – not part of total. ** County Sanitary Permits (New 2001)
D. Well Program – Level I The program allows us to review all well locations before the well is installed. We check the proposed well elevation, site location, distances from contamination sources, buildings and property lines. A follow up inspection is made after the well is installed. This includes verifying the location, heights
and setbacks of the new well and checking the well cap and the wiring for proper seals. We also order abandonment of all wells being replaced.
2000 2001 2002 2003 2004
Well Permits Issued New 135 159 129 206 184 Replacement 38 53 47 54 69 Reconnect/Rehab 2 3 0 2 1 TOTAL 175 215 176 262 254
Inspections Conducted 243 258 299 200 277 Orders for Abandonment 37 35 37 52 66 Written Orders 6 28 10 50 28 Citations 0 1 0 0 0
E. Environmental Sampling
Samples for laboratory analysis (941) were collected in the following areas: 1. All swimming, wading and whirlpools are tested monthly for pH and chlorine/bromine levels for
bacteriological counts. Seasonal water samples are also collected twice a week from all beaches. 2. We collect random retail food samples including the following: ice cream, frozen desserts, cut melon salad,
sliced deli meat, ready-to-eat lettuce salad, oysters and deli salads. All samples with elevated bacteria levels are followed up by a Sanitarian.
3. All licensed establishments served by private wells are sampled yearly. 4. Through a contract with the State, we collect bi-monthly radiation samples. The samples measure the
background radiation in the La Crosse and Genoa areas. 5. We collected 100 mold samples from homes to resolve mold related illness complaints. 6. Forty-nine samples of deli meat, melons, oysters, lettuce salad and deli salads were collected for the
Department of Agriculture and analyzed at their laboratory. 7. The Environmental Health Division has a contract with the Wisconsin DNR for the purpose of assuring
compliance with the Safe Drinking Water Code as it applies to public transient non-community water systems. Work includes collecting drinking water quality samples, conducting all required follow-up needed based on sample results and evaluating the sanitary condition of the well and pump installation. Eighty-eight wells were sampled. We issued boil water notices on 4 water systems.
8. We collected 109 lead/dust samples in homes with lead poisoned children. We also sent eight nitrate maximum contaminant level violation letters for new or continuing violations.
F. Environmental Complaints
Environmental complaints include waste disposal, open storage, animals, insects, pollution control and other citizen complaints. We investigate all housing complaints in La Crosse County and work closely with the La Crosse City Housing Inspection Program. Complaints received are investigated by the following workday.
2000 2001 2002 2003 2004 Complaints 204 447 425 425 313 G. Environmental Health Education Programs
Most of our public health educational training programs are focused on prevention. In addition to working with individuals about their specific concerns, the Department conducted education programs in several areas including a soil tester/plumber seminar, food protection to restaurant and grocery staff and various business groups and bioterrorism and foodborne illness presentations at UW-L. Presentations: Lutheran Hospital nurses (tattoo infection), WWTC food safety classes, UWL-epidemiology classes, UW-Madison nursing students. We investigate foodborne illness complaints working closely with the Health Education Manager. All food borne illness complaints are listed in our report. All cases are fully investigated and all outbreaks are reported to the State Epidemiologist. We investigated 10 cases of cryptosporidium infections reported by local physicians. We participated in TV interviews on the dangers of carbon monoxide, radon testing, lead poisoning and egg safety.
H. Lead The Environmental Health Division continued to work with the Public Health Nursing & Nutrition Divisions to reduce childhood lead poisoning in La Crosse County. Six homes, two day cares and two schools were evaluated for lead hazards and many families were educated on lead poisoning prevention. Staff members continued to educate the general public through newspaper articles, informal programs and classroom instruction. The HEPA vacuum was loaned out to 14 families to reduce lead dust exposure. One staff member was recertified as a lead risk assessor by DHFS.
I. Mold
The Health Department investigated 27 mold complaints. Mold samples were collected and analyzed by Environmental Health staff. A moisture meter and humidity meter were used to identify sources of water leakage into homes.
J. Radon
We have continued the Radon Grant and the Radon Information Center activities by informing numerous people about the origins of radon, concerns over levels, availability of test kits and mitigation strategies. Radon related activities included radio and newspaper interviews. Staff attended recertification courses for radon measurement and mitigation in Wausau in October. There were 101 radon consultations with home owners and seven detectors were distributed. Several radon displays were provided to the public at educational events.
HHEEAALLTTHH EEDDUUCCAATTIIOONN DDIIVVIISSIIOONN
Health promotion activities include a variety of educational and training activities aimed at helping people to improve their health. Health promotion can go by many names – wellness, prevention, injury, illness prevention and physical fitness are some of the terms that are used in today’s popular press. The health promotion programs within the Health Department are grouped in the following major categories:
HHeeaalltthh EEdduuccaattiioonn AAccttiivviittiieess
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TOBACCO PREVENTION PROJECT
HMONG Tobacco Prevention Program: • LCHD was awarded a $328,000 two-year grant from American Legacy Foundation to promote
tobacco prevention education and cessation programs for Hmong living in La Crosse, Eau Claire and Dunn Counties and we are in the last year of that contract.
• Decreased tobacco use in 300 Hmong smokers by 20% through nicotine patch distribution and
cessation programs. • Reduced exposure to second hand smoke in homes and vehicles by 10%. • Increased knowledge of dangers of tobacco use and second hand smoke to 750 Hmong living in La
Crosse, Dunn and Eau Claire counties. • Met with HABIT (Hmong Against Big Industry Tobacco) to develop relationships and cultural
acceptability of program goals. • Continued expansion of the program into Dunn and Eau Clair counties with expansion of the grant. • Awarded 10 sub-contracts totaling over $85,000 to Hmong serving organization. • Increased the knowledge of 375 Hmong regarding the harmful effects of tobacco by 10% compared to
a 2002 survey. • Developed and produced a Hmong Tobacco Cessation and Prevention video.
Youth Program: • Implement Teens Against Tobacco Use (TATU) at the following schools: Onalaska Luther High, La
Crosse Central High, La Crosse Logan High, Longfellow Middle, Lincoln Middle School Logan Middle and Franklin Elementary.
• Ninety-five per cent of the youth we worked with demonstrated an increase in knowledge on adverse
health issues related to tobacco. • Conducted Community Ad Watch with youth to encourage 25 store owners to reduce storefront
advertising and place tobacco products behind the counter. • Established a Youth Advisory Council with representatives from three area high schools. Community Outreach: • Three La Crosse rental property units adopted a smoke-free policy. • Updated, printed and distributed the Coulee Region Smoke-free dining guide during 2004. The guide
currently contains 200 restaurants. The 2000 copies are distributed through medical clinics, dental and chiropractic offices, libraries, voluntary health agencies and post secondary schools.
• The Coulee Region Smoke-free Worksite listing was updated, with 10 new smoke-free businesses added to the listing of over 800 smoke-free coulee region businesses.
• Promotion of the WI Tobacco Quit Line through community outreach with local agencies, health care
providers, pharmacies and dental offices helped secure calls to the WI Tobacco Quit Line from La Crosse County residents.
• Eight La Crosse area festival boards adopted a policy to have no advertising/promotions during the festival.
• Five worksites adopted no smoking policies. • Ten residents became active participants in our Health Initiative program. • Two hundred sixty-eight programs to 4,296 people. • A survey of all hotels and motels was conducted and over 73% of the rooms are smoke-free. • Eight hundred smoke-free homes and vehicle kits were distributed through 5 ZZip Lube locations.
Employee Health Program
• Personnel Department contracts with Health Education division to provide various health
promotion/education to county employees. • Provide fitness testing on blood pressure, body composition, flexibility and goal setting education for
employees.
• Health Fair coordination—activities included body fat analysis and blood pressure readings.
Maternal and Child Health • Staff conducted 40 injury prevention outreach educational activities to childcare providers, home
visiting professionals, community coalitions and the general public via media events to reduce the risk of unintentional injury to children from birth to age 21 in La Crosse County.
• Staff conducted 30 unduplicated safety compliance checks to homes in La Crosse where children from
birth to age 8 were present to reduce the risk of unintentional injury to children. Two hundred thirty parents and care givers of children birth through 8 years of age contacted us for proper installation and use of a child restraint system for their vehicle.
Adult Health Program
• Staff coordinated educational programs and activities at 9 businesses to increase awareness of major
risk factors of cardiovascular disease. • Staff provided outreach and education on reducing cardiovascular disease to residents utilizing
coalition meetings, group presentations and community health fairs. • Four worksites adopted one policy change to support health promotion at the worksite.
WI Wins
• Five hundred sixty-eight tobacco retailer compliance checks completed. • Completed 10 retail education programs.
SAFE Communities
• We increased seat belt restraint use by 2% by conducting educational campaigns and we assured success through observational studies at various locations.
• Worked with local law enforcement during speed wave campaigns to reduce speed related crashes by
2%. • Coordinated the Safe Communities Coalition through grant writing, data collection and analysis and
staff coalition made up of community partners.
AIDS Project
• We served the at-risk population at the following locations: Men’s and Women’s jail, Men’s and Women’s Unity House, Huber Center, LAAR House, Attic Correctional and Salvation Army. We conducted educational group education and behavioral risk assessment for individuals.
• We continued to provide counseling and testing for HIV as well as partner referral and case follow-up. • Four hundred five HIV tests were conducted. • Three hundred eight educational programs to 2,013 persons.
HOME CARE NURSING DIVISION
The mission of the La Crosse County Home Care Nursing Division is to provide skilled health care to residents of La Crosse County in their homes, fostering their independence to attain the highest quality of life. The challenge remains to provide quality service to patients who are being discharged quicker and sicker from the hospitals with increased and often complex needs at home. This is done within the parameters of federal and state regulations. This annual report provides a statistical analysis of the La Crosse County Home Care Program. The role of La Crosse County Home Care is to:
♦ provide patient choice in home health services. ♦ provide a viable option for people who need to private pay for services. ♦ provide for exceptional coordination of services between La Crosse County Human Services,
Hillview, Lakeview, other parts of the County Health Department and county governmental offices. ♦ provide continuity of care for current and future clients. ♦ provide staffing to be drawn on in the event of a significant public health emergency. ♦ provide for quality home care services to residents of La Crosse County and a commitment to
serving them. Home care services include skilled nursing, home health aide, occupational therapy, speech therapy and physical therapy. During 2004, the agency cared for 60 home health nursing patients. Additional patients were evaluated, but if found not to need home care service; they were referred to other community resources. The Division also cared for 41 home health aide, 10 therapy and 25 personal care patients.
HHOOMMEE HHEEAALLTTHH CCAARREE SSEERRVVIICCEESS The number of patients served remains stable due to RN staffing. The number of RN skilled visits increased due to the higher level of acuity of the patients. The CMO case management process continues to affect the number of clients on the Agency caseload:
2000 2001 2002 2003 2004Admissions 68 16 29 19 45Discharges 102 43 29 25 28Home Health Patients 208 81 66 55 64Home Health Nursing Visits 3,032 2,164 1,406 2,169 2,320Home Health Aide Patients 103 46 39 45 41Home Health Aide Visits 7,422 5,901 5,121 5,702 5,842Home Health Speech / Occupational Therapy Patients 9 1 2 3 1Home Health Speech / Occupational Therapy Visits 31 29 2 31 15Home Health Physical Therapy Patients 30 5 9 5 10Home Health Physical Therapy Visits 174 142 78 103 60Nutrition Visits 22 4 1 0 7
AADDMMIISSSSIIOONN PPAAYYEERR SSOOUURRCCEESS
Medicare Medicaid Self-Pay Private Insurance
CMO
2000 47% 25% 14% 7% 7% 2001 25% 6% 25% 19% 25% 2002 48% 10% 4% 4% 34% 2003 40% 17.5% 17.5% 0 25% 2004 14% 9% 4% 2% 71%
Total Discharges in 2001 = 43
PPEERRSSOONNAALL CCAARREE SSEERRVVIICCEESS
2000 2001 2002 2003 2004
Personal Care Clients 188 37 27 29 25Personal Care Hours 37,256.50 12,668 14,656 9,749 5,036.5Personal Care Supervisory Visits 554 100 157 136 81
Discharge Type
0%5%
10%15%20%25%30%35%40%
Nursing
HomeCMO
Private
Reside
nce
Hospita
lOther
Death
Discharge Type
HHOOMMEE CCAARREE VVIIGGNNEETTTTEESS
HHoommee ccaarree iiss vviittaall ttoo aa nnuummbbeerr ooff ppeeooppllee iinn tthhee ccoommmmuunniittyy.. TThhiiss sseerrvviiccee aalllloowwss tthheemm ttoo rreemmaaiinn aatt hhoommee,, wwhhiicchh iiss tthhee bbeesstt ppllaaccee ttoo eennjjooyy lliiffee,, rreeccuuppeerraattee ffrroomm ssuurrggeerryy,, aann aaccuuttee iillllnneessss oorr ccooppee wwiitthh aa cchhrroonniicc ddiisseeaassee.. TThhee aalltteerrnnaattiivvee ffoorr mmoosstt wwoouulldd bbee aassssiisstteedd lliivviinngg,, aa nnuurrssiinngg hhoommee sseettttiinngg,, oorr wwoorrssee,, nnoo aassssiissttaannccee aatt aallll.. JJuussttiinn iiss aa ttwwoo yyeeaarr oolldd cchhiilldd wwiitthh pphhyyssiiccaall aanndd ccooggnniittiivvee ddiissaabbiilliittiieess.. HHee rreeqquuiirreess ccoonnssttaanntt ssuuppeerrvviissiioonn ttwweennttyy--ffoouurr hhoouurrss aa ddaayy ttoo bbee ssaaffee.. HHee ddeeppeennddss oonn aa ffeeeeddiinngg ttuubbee ffoorr hhiiss nnuuttrriittiioonnaall nneeeeddss.. TThheerree aarree ootthheerr ssiibblliinnggss iinn tthhee hhoouusseehhoolldd aanndd mmoomm rreecceeiivveess hhoommee hheeaalltthh aaiiddee vviissiittss tthhrreeee ddaayyss aa wweeeekk ttoo aallllooww hheerr ttoo ssppeenndd ttiimmee wwiitthh tthhee ootthheerr cchhiillddrreenn oorr ttoo rruunn eerrrraannddss.. IInn tthhee ppaasstt hhee hhaass rreecceeiivveedd sskkiilllleedd nnuurrssiinngg vviissiittss ffoorr ddaaiillyy aasssseessssmmeennttss dduuee ttoo hhiiss ffrraaggiillee hheeaalltthh.. JJoohhnn aanndd MMaarryy aarree aann eellddeerrllyy ccoouuppllee rreeqquuiirriinngg sskkiilllleedd nnuurrssiinngg ttoo aallllooww tthheemm ttoo rreemmaaiinn ssaaffeellyy iinn tthheeiirr hhoommee.. TThheeyy ddoo nnoott wwaanntt ttoo ggoo ttoo aa nnuurrssiinngg hhoommee oorr aassssiisstteedd lliivviinngg ssiittuuaattiioonn.. WWiitthhoouutt hhoommee ccaarree tthheeiirr cchhooiicceess wwoouulldd bbee lliimmiitteedd aanndd tthhee ccoosstt eexxtteennssiivvee.. JJeennnniiffeerr iiss aa yyoouunngg wwoommaann iinn hheerr llaattee ttwweennttiieess wwhhoo hhaass bbeeccoommee ccoommpplleetteellyy ddiissaabblleedd aanndd rreeqquuiirreess aa nnuummbbeerr ooff hhoommee ccaarree wwoorrkkeerrss ttoo kkeeeepp hheerr iinn tthhee hhoommee sseettttiinngg.. SShhee rreeqquuiirreess sskkiilllleedd nnuurrssiinngg sseevveerraall ddaayyss aa wweeeekk ttoo pprroovviiddee wwoouunndd ccaarree ssoo hheerr hhuussbbaanndd ccaann wwoorrkk oouutt ooff tthhee hhoommee aanndd ttoo aassssuurree ggoooodd aasssseessssmmeenntt ooff tthhee ccoonnddiittiioonn ooff tthhee wwoouunndd.. HHeerr aalltteerrnnaattiivvee wwoouulldd bbee aa nnuurrssiinngg hhoommee ssttaayy uunnttiill tthhee wwoouunndd iiss hheeaalleedd wwhhiicchh ccoouulldd ttaakkee sseevveerraall mmoonntthhss.. EElliizzaabbeetthh iiss aann eellddeerrllyy wwoommaann wwhhoo lliivveess aalloonnee iinn aa rruurraall aarreeaa.. SShhee rreeqquuiirreess sskkiilllleedd nnuurrssiinngg ttoo pprroovviiddee IIMM iinnjjeeccttiioonnss eeaacchh mmoonntthh.. HHeerr eeyyeessiigghhtt iiss vveerryy ppoooorr.. SShhee aallssoo rreecceeiivveess hhoommee hheeaalltthh aaiiddee vviissiittss ttoo aassssiisstt hheerr wwiitthh bbaatthhiinngg,, hheerr eexxeerrcciissee pprrooggrraamm aanndd mmeeaall pprreeppaarraattiioonn.. SShhee ssppeenntt oonnee wwiinntteerr iinn aann aassssiisstteedd lliivviinngg aarrrraannggeemmeenntt aanndd wwaass ssaattiissffiieedd wwiitthh tthhee ccaarree,, bbuutt wwaass aannxxiioouuss ttoo rreettuurrnn ttoo hheerr hhoommee aanndd ddiiddnn’’tt wwaanntt ttoo bbee aaddmmiitttteedd ttoo tthhee ffaacciilliittyy aaggaaiinn.. HHoommee CCaarree ggiivveess tthhee ppeeooppllee ooff tthhee ccoommmmuunniittyy mmoorree cchhooiicceess wwhheenn iitt sseeeemmss tthhee oonnllyy cchhooiiccee wwoouulldd bbee ttoo ggiivvee uupp tthheeiirr iinnddeeppeennddeennccee aanndd mmoovvee ffrroomm ffaammiilliiaarr ssuurrrroouunnddiinnggss ttoo tthhee iinnssttiittuuttiioonnaall ccaarree ooff aa nnuurrssiinngg hhoommee oorr aassssiisstteedd lliivviinngg.. HHoommee CCaarree eemmppoowweerrss ppeeooppllee ttoo rreemmaaiinn iinnddeeppeennddeenntt iinn tthheeiirr hhoommee wwiitthh aa sseennssee ooff oonnee’’ss sseellff aanndd aa nnoorrmmaallccyy ooff nnoott bbeeiinngg aa ““ppaattiieenntt””..
LABORATORY DIVISION The Health Department Laboratory is certified by the Wisconsin Department of Agriculture for the examination of food and water. The Laboratory is also certified by the Wisconsin Department of Natural Resources for groundwater chemical analyses and is certified for clinical specimen testing through the federal Government’s Clinical Laboratory Improvement Act. In addition to providing technical support for the Environmental Health, Nursing and Communicable Disease divisions, the Laboratory analyzes numerous samples throughout the year submitted by private citizens, municipalities and other organizations. Surface water chemistry and microbiology continued with our analyses of samples for the County’s Land Conservation Department, along with special projects to detect product contamination. Our Laboratory also provided testing services for surrounding counties by analyzing samples from swimming areas for the presence of Escherichia coli and fecal coliform bacteria to enable evaluations of the sanitary quality of the swimming water. Concerns about road salt storage situations provided opportunities for analyses of drinking water for sodium and chloride levels. Test results indicated salt infiltration into some shallow wells in our area. As part of our Laboratory plan to provide accurate and timely analytical test results, we upgraded some of our bacteriological testing methodology by adding defined substrate enzyme technology and an improved method for the detection of Escherichia coli. We also saw continued and increased participation by Laboratory staff in Public Health Emergency Preparedness efforts in our region.
2000 2001 2002 2003 2004 Sexually transmitted disease Neiserria gonorrhea 3,203 3,457 2,017 1,481 758 Genetic Testing 254 394 328 208 417
Food Product Tests
2000 2001 2002 2003 2004 Food, Milk, Bottled Water 153 20 507 184 467
Nonpotable Water Tests
2000 2001 2002 2003 2004 Nonpotable Water—Beaches Bacterial 155 143 142 147 150
Nonpotable Water—Rivers & Streams Chemical
724 1006 839 1,247 688
Nonpotable Water—Pools Bacterial 1,733 1,781 1,616 1,708 1,591
Nonpotable Water—Sewage Effluent & Sludge Bacterial
161 147 158 176 174
Nonpotable Water—Landfill Monitoring Wells-Chemical 1,937 1,936 1,676 2,337 3,109
Testing other than Potable Water—Total 4,863 5,033 4,938 5,002 5,712
STD LABO RATO RY TESTIN G
1000200030004000
2000 2001 2002 2003 2004Gonorrhea tests conducted
Drinking Water Test
2000 2001 2002 2003 2004
Public Water Supply Bacterial
2,187 2,386
2,268
2,111 2,105
Private Water Supply Bacterial Nitrates
2,2251,033
2,236700
2,334
628 2,167
6831,624
713
Potable Water—Totals 5,445 5,322 5,230 4,961 4,442
17,096
16,746 16,74616,816 16,816
16,50016,60016,70016,80016,90017,00017,100
2000 2001 2002 2003 2004
Laboratory Certification & QA Tests
Number of tests
NUTRITION DIVISION The Nutrition Division works within the community to develop and implement programs that help area residents achieve optimal nutritional health. During 2004, the Nutrition staff’s activities were focused on the following health priorities from the Healthiest Wisconsin 2010 public health plan:
1.Adequate and appropriate nutrition 2.Overweight, obesity and lack of physical activity 3.Social and economic factors that influence health 4.Access to primary and preventive health services
To accomplish these goals, the division offered the following public health programming Health priorities: 1. Adequate and appropriate nutrition 3. Social and economic factors that influence health
La Crosse WIC Program: WIC is a supplemental nutrition program for women, infants and children that has been proven to reduce the incidence of low birth weight among participating families. The program focuses on preventing nutrition related health problems and improving the health status of low-income, at-risk pregnant/post-partum/breastfeeding women and children up to age 5. WIC accomplishes this through the provision of supplemental foods, nutrition counseling and referrals to other area services.
During 2004, the La Crosse WIC Program served 3,663 people. Each month an average of 2,037 participants were served.
Average Monthly Participation
2000 2001 2002 2003 2004 2,049 2,016 1,997 2024 2,037
1000
1500
2000
25002000
2001
2002
2003
20042049 2016 1997 2024 2037
2000 2001 2002 2003 2004
Of the 3,663 participants served, 31% were women, 31% were infants and 38% were children 1-5 years of age.
Caseload Distribution
2000 2001 2002 2003 2004 Women 29.0% 29% 30% 30% 31% Infants (0-11 mos.) 28.5% 29% 30% 30% 31% Children (1-5 yrs.) 42.5% 41% 40% 40% 38%
During 2004, WIC families spent a total of $1,290,223 at area grocery stores.
Actual Food Dollars Spent in 18 La Crosse County WIC Approved Grocery Stores
2000 2001 2002 2003 2004
$1,170,028 $1,214,130 $1,178,963 $1,255,200 $1,290,223
The Prenatal Care Coordination Program Prenatal Care Coordination is a case management program for high-risk pregnant women enrolled in the Medicaid Program. The goal of the program is to improve pregnancy outcomes and help women have healthy babies. Case managers provide health and nutrition information, breastfeeding information and support and help women connect to needed services. In 2004, 138 women were enrolled in the program and staff served an average number of 56 women each month.
Annual Participation
2000 2001 2002 2003 2004 Number of women enrolled in the program this year 105 87 118 130 138 Average number of women care coordinated each month 44 46 44 49 56
The WIC & Prenatal Care Coordination Programs make a difference in the health of those who participate. Breastfeeding rates rise and the incidence of low birth weight decreases with participation in these programs. IIMMPPRROOVVIINNGG BBIIRRTTHH WWEEIIGGHHTT::
IInnffaannttss’’ BBiirrtthh WWeeiigghhtt SSttaattuuss
2000 2001 2002 2003 2004
% of infants weighing less than 5.5 lbs. at birth whose mothers were low income but not on WIC 9.0% 12% 10.7% 9.8% 13.9%
% of infants weighing less than 5.5 lbs. at birth whose mothers were on WIC prenatally 6.75% 2.7% 2.5% 2.0% 7.6%
% of infants weighing less than 5.5 lbs. at birth whose mothers were enrolled prenatally in the Prenatal Care Coordination and WIC Programs
5.4% 1.5% 1.2% 2.9% 5.2%
Breast milk is the ideal food for a child under 1 year of age. WIC and prenatal care coordination staff promote breastfeeding with all the families they serve. Following is a chart showing breastfeeding rates among women participating in the WIC and Prenatal Care Coordination programs. Improving Breastfeeding rates: (2010 goal: 75% of women breastfeed their infants at birth, 50% will continue breastfeeding until their infant is 6 months of age)
Population 2000 2001 2002 2003 2004 % of infants born to WIC mothers who were initially breastfed
52%
57%
56%
62%
69%
% of infants born to Prenatal Care Coordination mothers who were initially breastfed
67.5%
55.4%
69%
74.6%
74% % of infants born to WIC mothers who were breastfed at 6 months of age
34.5%
32.5%
41%
37%
35%
Bilingual WIC Certifier Training La Crosse has a sizable Hmong population & only a few Hmong health care providers. Providing culturally appropriate healthcare & nutrition services to another culture can be challenging. Statewide these challenges are being recognized. In 2004, the State of Wisconsin continued to train bilingual Hmong and Hispanic paraprofessional staff working in WIC to perform some duties heretofore assumed only by professionals. The State staff believes that by providing nutrition information in a person’s own language and in a culturally sensitive manner, WIC staff will realize increased compliance among Hmong and Hispanic families to WIC nutrition recommendations. The Hmong nutritionist from our department coordinated the training program, developed the curriculum used in the training and then worked with the Hispanic trainer to adapt it for use with the Hispanic paraprofessionals being trained.
During 2004, 14 Hmong and Hispanic paraprofessionals received obesity prevention training and 6 received translator training to assure more accurate translation of nutrition information. Wellness Education for Hmong Women Through a grant from the March of Dimes, 300 Hmong women of childbearing age received nutrition/health education through the Healthy Babies Begin with You campaign. In La Crosse and Marathon counties, education focused on obesity prevention and in Dunn County and the cities of Madison and Milwaukee, education focused on the importance of folic acid to a healthy pregnancy. After the training, ninety-nine percent (99%) of the 157 Hmong women receiving obesity prevention education in La Crosse and Marathon counties stated that as a result of the training, they planned to make at least one change in their eating/activity habits. The top goals of those involved were to increase calcium intake, increase fruit intake and increase their daily activity. Follow up after educational sessions in Dunn County and the cities of Madison and Milwaukee found that 32% of those who participated in the folic acid education sessions were now eating the recommended 400 mcg guideline. Prior to the education sessions, only 23% knew about the benefits of folic acid and its connection to a healthy pregnancy and almost none were eating recommended amounts. Lead Poisoning Prevention The Health Department’s Lead Poisoning Prevention Program is a partnership between the Nursing, Nutrition & Environmental Health divisions in the Department. Children between 1-5 years of age who are enrolled in the WIC Program are screened for lead poisoning. Those found to have elevated blood lead levels receive a home visit from the lead team (a nutritionist, nurse & sanitarian) who provide information on how to alter the families’ environment & diet to reduce lead problems. Lead activities in the Nutrition Division included:
Lead Activities 2000 2001 2002 2003 2004 Screening 348 720 603 585 693 Nutrition follow up for diet counseling 30 13 12 23 4
Food Insecurity A statewide hunger survey conducted in January 2002 found WIC families in La Crosse County continue to be at considerable risk for hunger and food insecurity. Hunger is defined as regularly not having access to adequate food to maintain health. People who experience hunger decrease the quantity and quality of food they consume and are likely to be hungry on a frequent basis. Food insecurity is defined as having uncertain or limited access to food through normal channels. People who are food insecure skip meals to make their food stretch, eat less than they should because money for food is tight and frequently run out of food during the month. While hunger is a more serious and chronic condition than food insecurity, it is always serious when a pregnant woman or child’s access to food is not secure. The survey conducted in January 2002 found 48% of La Crosse WIC families were food insecure and 19% were identified as food insecure with hunger. Because La Crosse WIC families continue to have food security concerns, the La Crosse WIC Program continued their partnership with the Hunger Task Force of La Crosse in 2004 to offer foods from the Kane Street Community Garden and the Hunger Task Force’s Food Recovery Program to WIC families in need. In all 7,667 pounds of additional fruits, vegetables, meats, breads and dairy products were distributed to 290 WIC families.
Occupational Health In 2004, nutrition services continued to be offered to all county employees as part of County wide occupational health services programming. During the year a nutrition tips listserve (called Health Tips) was sent monthly to interested county employees (visit the Department’s web site for back issues of the newsletters at www.co.la-crosse.wi.us/Health/Index.htm and click on newsletters). Two walking challenges were held to promote an active lifestyle among employees as well as two health fairs. Nutritional Support for Seniors The nutritionist providing support to the Health Department’s home care program and the Human Services Department’s Care Management Organization provides direct nutrition counseling to seniors referred to her and consults with nurses/social workers who care for seniors with nutrition concerns.
2000 2001 2002 2003 2004 Seniors referred for nutrition follow up counseling
25
30
35
15
20
Wellness Center Located at Carroll Heights, the Wellness Center is a weekly program that provides seniors living in Carroll Heights with preventive nutrition information designed to help them improve their eating habits & maintain their health. Programming includes a monthly newsletter, individual nutrition counseling for those interested & a monthly nutrition or health focused class. Bone Density Screening In 2004 the Nutrition Division in partnership with the Aging and Disability Resource Center began offering bone density screening/assessments to adults in the community. Twenty screening were held between April and December 2004 with 162 adults receiving bone density screening. Of those screened 84 or 52% were found to be at risk for osteoporosis. All at risk participants had the opportunity to talk with the division nutritionist involved regarding lifestyle changes they could make to improve their bone health. Health priority: 2. Overweight, obesity and lack of physical activity Coulee Region Childhood Obesity Coalition: The Coulee Region Childhood Obesity Coalition was formed in 2000 to address the issue of childhood obesity in the Coulee Region. The Coalition is co-facilitated by the Health Department Nutrition Division and Viterbo University. The mission of the Coalition is to improve child health by encouraging healthy eating habits and regular physical activity. Coalition members used the following strategies in 2004 to help achieve their mission:
1. Maintenance of the Coalition’s web site (www.childhoodobesitycoalition.org). 2. Continued distribution of their quarterly consumer newsletter 3. Monthly media work (35 spots on adult/childhood obesity aired in the local media).
4. Community presentations—7 presentations that reached families, children, teachers & the general community
5. Partnering with area schools to develop wellness policies that promote the development of healthy eating habits and an active lifestyle.
6. Partner in the Healthy Living-Today Not Tomorrow initiative sponsored by TV 19 and the La Crosse Tribune. The initiative encouraged participants to set healthy eating and activity goals during the 6 month initiative. Over 1600 community members participated in the initiative. Coalition members provided health tips for the weekly TV broadcasts focused on the initiative and taught 6 of the 12 education sessions offered to initiative participants. We also participated in the Town Hall meetings broadcast by TV 19 that launched and wrapped up the Healthy Living initiative.
7. Partnering with the Onalaska Planning Department and Irving Pertzsch Elementary school to initiate a Safe Routes to School Program to encourage children at the school to walk.
8. Participation in the Wisconsin Department of Transportation study of South Avenue advocating for bicycle and pedestrian friendly changes.
Healthy Living for a Lifetime Program As a follow-up to the La Crosse Tribune and TV-19 sponsored Healthy Living effort launched in October 2003, the Nutrition Division initiated a Healthy Living for a Lifetime series in April 2004. This 6-month series offered bimonthly community education sessions—one focused on healthy eating and one focused on physical activity. Between April and September over 230 people participated in one or more of the 11 sessions. An evaluation conducted in September found that the sessions motivated most attending (93%) to make changes in their eating and physical activity habits. The Nutrition Division followed up the 6-month series with a community walking challenge (Walktober) in October and two holiday sessions in November and December focused on maintaining healthy habits during the holidays. One by One Weight Management Program: The number of overweight & obese people in La Crosse County is rising. Overweight & obesity can put one at increased risk for heart disease, high blood pressure, diabetes & stroke. To assist county residents wishing to lose weight, the division offers an individualized weight management program called One by One. The goal of the One by One program is to provide participants with practical, healthy ways to lose weight & maintain the weight lost.
1998 1999 2000 2001 2002 2004 # of individuals enrolled in the One by One Weight Management Program
13
27
26
27
23
12
Health priorities: 3. Social and economic factors that influence health 4. Access to primary & preventive health services While La Crosse has a wide variety of services to help meet community needs, many individuals and families are unaware of their existence. To help people learn about resources in our community, the Division provides information through the Community Liaison Program.
Community Liaison Program Begun in 1999 and funded through funds from the La Crosse Community Foundation, La Crosse County Human Services Department and private donations, the Community Liaison Program connects people with unmet needs to available community services. Using First Call for Help’s data base & the Coordinator’s own extensive knowledge of the community, the Program helps connect people to community services they want & need. In 2004, the Coordinator received 776 requests for assistance. Of those, 489 occurred during outreach at 8 sites in the County. The Coordinator also received 287 direct referrals to the program for help. The most common request from those directly referred to the program was for help with housing or rental assistance. Requests for transportation assistance were the second most common request, while requests for help obtaining furniture and appliances, baby items, utility assistance, clothing, health care and food assistance followed. Of those referred to the program, 77% had their needs partially or fully met, 15% could not be reached, for 9% a gap in services existed and 4% were given assistance but did not follow through. For Goodness Sakes Started as a holiday project, the For Goodness Sakes project evolved into a year round program in partnership with the La Crosse Tribune. The project matches people whose needs can’t be satisfied through traditional channels with people or funds that can satisfy their need. It may be things like car repairs, furniture or baby items that people from the community step forward and help with or donate. In 2004, needs were posted each week in the Sunday paper. Over 400 needs were posted during 2004 with 80% being met. La Crosse truly has a caring community! The holiday For Goodness Sakes program served over 700 people in 2004. People in need are referred to the program by community professionals who work with them. The person referring the family identifies the family’s needs & then that individual or family is “adopted” by a business or community member for the holiday. Covering Kids & Families Covering Kids and Families is a project funded through the Robert Wood Johnson Foundation that works to reduce the number of uninsured children and adults in the La Crosse area. Through outreach, increasing the number of places people can go to apply for government health care assistance and developing systems to facilitate sharing of information so people can go to 1 place to apply for several programs, more people in La Crosse County have health insurance. We have also established a local coalition to advocate for coverage for the uninsured and to facilitate the sharing of information. Outreach efforts have included information booths at area child development days, kindergarten orientation, a back-to-school campaign, the Veteran’s Stand and 10 conferences/local festivals, unlike other areas in the state, La Crosse County has seen a 9% increase in the number of people participating in state sponsored health insurance programs.
PUBLIC HEALTH NURSING DIVISION
The La Crosse County Public Health Nursing Division offers services that promote health, protect against unhealthy conditions and prevent disease in individuals, families and our community based on the core functions of Public Health. Services are provided in clinic, home, and community settings. Public Health Nursing Services are based on the health promotion/disease prevention needs of the citizens of La Crosse County. The Public Health Nursing Division collaborates with other Health Department divisions, Human Services and community partners to ensure that systems for providing health services are coordinated. The funding sources for Public Health Nursing services include contracts, grants, third-party payers, tax levy funds, and private pay. The following report provides a statistical and narrative report of these services.
PUBLIC HEALTH NURSING SUPERVISION SERVICES
2000 2001 2002 2003 2004General Public Health Nursing Visits 41 45 38 30 13Maternal Child Health Nursing Visits 226 257 131 142 70Communicable Disease Follow-up Cases
38 59 125 124 206
Birth to Three Visits 32 69 60 48 44Lead Follow-up Visits 42 41 26 49 12INH Nursing Visits 123 107 103 63 205Health Supervision/Home Foot Care 412 226 210 95 201
Foot Care Visits 553 586 486 577 546Children with Special Health Care Needs
37 62 30
Brunk House/Attic Visits 41 41 43
Refugee Assessments/Visits 489
ADULT HEALTH PROGRAMS: Adult Health Screening clinics were held quarterly at the La Crosse County Health Department. The Adult Health Screening consists of a physical assessment, vision, hearing, blood pressure, cholesterol, and diabetes screening conducted by a registered nurse. Health Fairs were offered at various locations throughout the community during the year, offering screenings for cholesterol, diabetes and blood pressure. TB screenings are offered every Monday through Wednesday. The clientele for TB screening included college students, businesses and community members. In-home services for nursing assessment and foot care were also provided throughout the year.
2004 NURSING TIME BY PROGRAM
Tuberculosis, 1412, 51%
Blood Pressure, 403, 14%
In-Home Services, 201, 7%
Foot Care, 546, 20%
Pregnancy, 97, 3%Cholesterol/Diabetes,
106, 4%
Senior Citizen Screening, 15, 1%
CARING, INC. Caring, Inc. is a collaborative grant funded project among the Salvation Army, Viterbo University-School of Nursing, and our department. Health education, screening services, and assistance with referrals are some of the services provided to homeless families utilizing the Salvation Army shelter. Two days a week, nursing students work with a public health nurse to provide care and education to these clients.
2002 2003 2004 Clinic Visits 541 559 516
In July of 2004 we began a collaborative effort with the Aging and Disability Resource Center to increase mental health screenings and services at the Salvation Army. This is a grant funded project from 7/1/04 to 12/31/05. This project has allowed us to increase nursing services on Thursdays from 12:00-5:00 p.m. WOMEN’S HEALTH PROGRAM Wisconsin Well Woman Program (WWWP) The WWWP program promotes the early detection of chronic diseases in women including heart disease, diabetes, mental health issues, osteoporosis, breast cancer, and cervical cancer. Women 35-64 years of age were served in 2004. Women also must have a household income at or below 250% of the Federal Poverty Guidelines and be uninsured or underinsured to be eligible for this program.
Error! Objects cannot be created from editing field codes. CHILD AND ADULT IMMUNIZATION SERVICES 2000 2001 2002 2003 2004Diphtheria/Tetanus/Pertussis 413 356 293 193 211Polio 309 278 250 121 161Tetanus/Diphtheria 275 111 113 254 311Measles/Mumps/Rubella 294 240 229 165 225Pneumococcal (Adult) 68 62 65 52 1Pneumococcal (Infant) N/A 185 100 109 88
Influenza 5,116 3.650 4,413 4,271 1,073HIB 224 171 151 95 110Hepatitis B 2,155 2,549 2,083 1,128 611Varicella 70 192 119 59 213TOTAL 8,937 7,794 7,816 6,447 3,004
LEAD PROGRAM Lead Screening continued to be an important focus in 2004. The Public Health Nursing Division provided education and care coordination to all children with elevated blood lead levels of 10 mcg/dl or greater. Statistics are as follows:
2000 % 2001 % 2002 % 2003 % 2004 %Total Tests 997 768 1,350 509 5090-9 mcg/dl 975 97.8 726 95.5 1,279 95.0 482 95.0 479 9410-14 mcg/dl 14 1.4 22 2.9 47 3.0 12 2.0 23 415-19 mcg/dl 6 0.6 4 0.6 10 1.0 13 2.0 3 1Over 20 mcg/dl 2 0.2 7 1.0 12 1.0 2 1.0 4 1
SCHOOL BASED VISION AND HEARING PROGRAMS The Public Health Nursing Division collaborates with the La Crosse County Public and Parochial Schools to perform vision and hearing assessment on all students’ grades pre-school, 1, 3, 5, and any referrals. In 2004 vision-screening volunteers were trained by the Health Nursing Division staff to perform initial vision screens. The Health Nursing Division staff performed re-screenings for vision and, for some schools, hearing re-screenings as well. Referrals were sent and Health Nursing Department staff conducted follow-up. Health Division staff also trained hearing screening volunteers. The volunteers performed initial screenings, and the Health Division staff completed re-screenings. Referrals were sent, and Health Division staff conducted follow-up. In 2004 the Health Division collaborated with Head Start to perform the vision and hearing screening.
Error! Objects cannot be created from editing field codes. School Age Vision Screenings
1999 2000 2001 2003 2004 # of schools in program 24 30 29 28 30 # of children screened 4,395 3,495 4,272 3,849 4,226 # referred to professional 147 41 116 150 90
School Age Hearing Screenings
1999 2000 2001 2003 2004# of schools in program 17 14 11 28 20# of children screened 720 672 704 1,294 1,537# referred to professional 31 28 13 61 54
MATERNAL AND CHILD HEALTH PROGRAM The Maternal and Child Health Program in the Public Health Nursing Department provides clinic and home visitation services to mothers, infants, and children. Funding sources include MCH grant funds, a Wisconsin special health care needs funds and county tax funds. Child Health Assessments
CHILDREN WITH SPECIAL HEALTH CARE NEEDS A program that assists families that has a child or children with special health care needs. The assistance may consist of home visits, accompanying the family on medical appointments, connecting families to resources in community or providing information regarding the child’s special needs. Brunk House/Attic
Child Health Assessements
0
50
100
150
200
250
300
2000 2001 2002 2003 2004
Maternal Child HealthRN Visits
Well ChildAssessments
MCH Grant Visits
Children W/SpecialHealth Care Needs
La Crosse County Health Nursing Department provides nursing assessments for Brunk House, a halfway correctional facility for men in the city of La Crosse. We also provide nursing assessments to new employees at Attic. This is a fee for service program. When there is an admission to the home or a new employee, we are notified and provide a nursing physical assessment and administer a TB skin test within seven days. Our numbers are dependent on admissions, ranging from 0-6 monthly. We also take the opportunity to do some basic health education and assist with informing of appropriate community resources. In 2004, we completed 43 physical assessments.
EMPLOYEE HEALTH PROGRAM
2000 2001 2002 2003 2004 Employee Physicals 252 244 176 192 240 TB Screening 383 Immunizations 226 Miscellaneous Walk-in 203 Adult Health Screening 523 The Employee Health Nurse performs new employee physicals, schedules and performs health screening clinics, provides health and safety education in groups and with individuals, provides basic first-aid, provides various employee immunizations and employee counseling. The Employee Health Program also coordinates the following programs: Respiratory Protection, Bloodborne Pathogen Protection, Smoking Cessation, Corporate Fitness Centers and annual health fairs. Approximately 100 fit tests were provided to employees in 2004. Bloodborne pathogen training for approximately 250 employees and Mantoux testing for those employees that require it were also provided. Other responsibilities of the Employee Health Program include serving on various committees such as Health and Safety, Employee Health, Immunization Coalition and submitting quarterly articles to the County Edition newsletter. The funding sources for Employee Health Nurse Services include a contract with La Crosse County Personnel Department and private pay. REFUGEE RESETTLEMENT PROGRAM The Refugee Resettlement Program began in July of 2005 with the arrival of our first Hmong family in La Crosse County. Public Health Nursing Division’s role in the resettlement effort was to provide the initial education on hygiene, sanitation, access to medical services and basic communicable disease. Registered nurses with the assistance of an interpreter provided, physical assessments, Laboratory specimen collection and testing, immunizations, TB screenings, pre-natal follow-up, communicable disease investigation/follow-up and case management services. A total of 167 clients received services through the Refugee Resettlement Program in 2004. This number includes secondary migration families that moved to La Crosse County from another community within the U.S.
Refugee Assessments 167 Other RN Visits 322 Interpreter Hours 310
PUBLIC HEALTH PREPAREDNESS The Public Health Emergency Plan was re-written and adopted into the County’s Emergency Operations Plan. A mass vaccination exercise was conducted in La Crosse on October 9, 2004. Many volunteers and 22 agencies were involved and 599 citizens received vaccination. This exercise included public health partners from four surrounding counties and the Ho Chunk Nation. We exercised receipt of the Strategic National Stockpile and mutual aid agreements among partners. We participated in the planning of the “Heartland Defense” drill on August 8, 2004 in West Salem. Over 40 agencies and 1,000 volunteers participated in this unique opportunity. The Consortium conducted a table top exercise concurrent to the Heartland scenario to test local/regional public health emergency plans. Staff received training in AED, CPR, CERT, ICS, EOP, forensic, epidemiology, HAN and TRAIN to assure that an appropriate capacity of core public health competencies will be met. The Public Access Defibrillation Program was established for the downtown campus of La Crosse County with plans to expand to Hillview and Lakeview Homes. A trained post event response team was established. The department has established and is maintaining a 24/7 emergency response protocol.
VECTOR CONTROL DIVISION
The Vector Control Program has three main areas of activity: 1) Mosquito control for both disease carrying and pest species. 2) Animal control, which includes enforcement of laws dealing with the humane treatment of animals,
animal licensing, owner’s responsibility, and the public health aspects of animal borne disease, rabies control, and animal bite investigations and quarantine.
3) Lyme disease education, tick monitoring program for the tick Ixodes scapularis, the carrier of Lyme disease.
Mosquito Control
Encephalitic Mosquito Control Habitat Management Artificial and natural habitat for the mosquito vectors of La Crosse Viral Encephalitis and West Nile Virus (tires, tree holes, etc.) which were removed or properly managed to control mosquito hatch.
L a C r o s s e C o u n ty M o s q u ito H a b i ta t S i te s
2 3 92 1 4
3 9 1 4 2 2
4 6 3
05 0
1 0 01 5 02 0 02 5 03 0 03 5 04 0 04 5 05 0 0
2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4
Sites Monitored
2000 2001 2002 2003 2004La Crosse County 214 239 391 422 463Houston County 244 267 0 0 0Crawford County 173 178 219 239 214Monroe County 205 194 237 301 303Winona County 253 271 311 462 486Vernon County 167 146 187 231 273 Orders Issued 784 798 767 866 930Complaints investigated 517 593 622 666 841Follow-up 354 411 431 464 599
Oviposition Traps: Oviposition traps are controlled artificial habitat for Ochlerotatus triseriatus. These traps are placed in endemic areas to reduce Ochlerotatus triseriatus population and viral activity. These traps are normally monitored and eggs harvested approximately every ten days.
Oviposition Traps
2000 2001 2002 2003 2004Number of Traps 1,365 1,375 1,425 1,480 1,510Total Traps Collected 10,255 15,125 13,965 14,356 14,680
Educational Programs: Educational programs concerning the habitat and control of the vectors of La Crosse Viral Encephalitis, West Nile Virus and Lyme disease as well as symptoms, treatment and precaution to reduce risk of these diseases were given in La Crosse, Crawford, Monroe, Winona and Vernon Counties.
Educational Programs
2000 2001 2002 2003 2004Number of Programs 51 60 44 87 61
Pest and Encephalitis Mosquito Control Light Traps: Light trap stations are used to determine numbers and species of adult mosquitoes in an area. In county parks, light traps are checked daily to determine need and affect of adulticide. In endemic areas light traps are used to determine numbers of adult Ochlerotatus triseriatus as well as other problem species. Our data indicates that if 20 female pest mosquitoes are caught per night in a light trap, there is a pest problem. U.W.L. trap data from years prior to this program document evenings with over 4,000 female pest mosquitoes collected per trap. 2000 2001 2002 2003 2004Number of Trap Sites 6 6 6 13 11Total Samples Taken 692 462 482 179 87 Bite Counts: Bite counts are used in areas without light traps to determine types and numbers of adult mosquitoes. Mosquitoes are allowed to land; the mosquito is then picked up by use of an aspirator. 2000 2001 2002 2003 2004Bite Counts 291 283 389 441 612
Wetlands: Wetland sites are monitored on a weekly basis (depending on weather conditions), to determine level of mosquito larval activity, species and need for control activities. 2000 2001 2002 2003 2004Wetland Sites 314 317 353 366 402
Adult & Larval Control of Mosquitoes: Using collected data, sites are treated with adulticide and larvacide to reduce the mosquito population. 2000 2001 2002 2003 2004Adulticide Treatment 74 44 41 27 21No. Sites Treated with Adulticide 248 122 117 81 58Wetland Areas Treated 209 141 139 138 202Number of Sites Treated with Larvicide to Control Ochlerotatus triseriatus or Culex Species of Mosquitoes
513
523
453
695
808
Ixodes scapularis (Deer Tick) Monitoring 2000 2001 2002 2003 2004Sites Monitored 52 44 59 78 91
Animal Control Activities
2000 2001 2002 2003 2004Animal Bites of Humans Investigated 203 243 234 247 242Stray Animals Collected – Total 1,435 1,782 1,830 1,719 1,577 City of La Crosse 1,021 1,042 1,076 962 916 La Crosse County outside of City 414 740 754 757 661Animal Complaints Investigated – Total 1,744 2,025 2,096 2,302 2,028 City of La Crosse 1,323 1,374 1,469 1,672 1,427 La Crosse County outside of City 421 651 627 630 601Specimens sent to State Lab for Rabies Analysis 9 19 33 25 30Rabies Quarantines Ordered NA NA NA 212 213 Educational Programs Programs entitled, “Humane Treatment of Animals,” “Animal Rights and Responsibilities,” and “Animal Health Concerns and Their Importance to the Community,” were presented to local schools and civic groups. 2000 2001 2002 2003 2004Number of Programs 339 306 316 328 363
ANIMAL LICENSING
2000 2001 2002 2003 2004License Action (Persons ordered to properly license animals) 1,538 1,847 2,401 3,720 1,789License Reminder cards sent 4,471 4,654 7,320 3,303 4,926License Warning cards sent 1,083 1,605 0 0 0 Citations issued – mailing program 451 329 635 120 893Citations from day-to-day animal control program 47 93 105 142 152Total citations issued 498 422 740 262 1,045 Orders Issued Orders are issued regarding humane treatment of animals, animal responsibility laws, commercial animal establishment standards, animal health regulations and the rabies control program, including animal bite follow-up, quarantine, and testing. 2000 2001 2002 2003 2004Orders issued 3,059 3,569 3,874 5,034 6,200 Animal Control License Fees The County Health Department has been asked by the County Board to monitor the collection of animal license fees and related animal control expenses to the County. Local municipalities are responsible for issuing and collecting fees for animal licenses.
3,61
78,
305
3,56
38,
375
3,68
08,
618
3,68
08,
850
3,52
99,
134
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Dog Licenses Issued
City of La Crosse Rest of La Crosse County
20012000 2002 2003 2004
2000 2001 2002 2003 2004
TOTAL REVENUE RECEIVED $88,575 $88,827 $90,369 $116,668 $131,958Fees Retained by Local Treasures 12,220 11,551 12,246 9,547 9,302State Fees 2,561 2,525 2,580 2,588 2,625Animal Control County 47,990 57,026 60,650 60,788 74,063Damage Claims 0 0 0 0 0Dog License Program Expenses 18,441 6,764 3,028 3,152 3,124Dog License Money Returned City of La Crosse 15,328 15,511 15,627 14,831 14,761 City of Onalaska 7,133 7,446 7,931 14,497 15,446Rabies Control 2,377 1,736 132 165 129Other 0 0 0 0 0TOTAL EXPENSES ($106,050) ($102,559) ($102,194) ($105,568) $(119,450) COUNTY TAX LEVY SUPPORT ($17,475) ($13,732) ($14,860) $11,100 ($12,508) La Crosse Co Clerk Revenue $14,235 $15,168 $24,971 $14,448 $15,055 City of La Crosse 3,617 3,563 3,680 3,680 3,529Rest of La Crosse County 8,305 8,375 8,618 8,850 9,134TOTAL LICENSES 11,922 11,938 12,298 12,530 12,663 ½ Price Pups 26 33 55Duplicate Tags 33 25 14 40 32Free Tags for Leader Dogs for the Blind 1 5 1 3 4Kennel License Tags issued 272 356 262 235 250 TOTAL LICENSE TAGS ISSUED 12,229 12,324 12,601 12,841 13,004 OTHER LICENSES Kennel Licenses issued 27 27 30 44 33Over 12 kennel dogs 26 32 29 24 26 Licenses issued with penalty 870 948 921 888 940Multiple tags w/Penalty NA NA NA 25 0(City of La Crosse not included)
HEALTH DEPARTMENT BUDGET
2000 2001 2002 2003 2004 COUNTY TAX LEVY $1,262,652 $1,446,956 $1,475,474 $1,373,127 $1,451,827 Total Outside Revenue Sources Health Administration 18,560 27,844 48,136 261,550 549,935 Environmental Health 237,260 256,489 295,084 353,206 380,001 Health Education 198,318 244,580 281,470 396,897 385,967 Home Care/Personal Care 1,175,276 754,052 654,012 638,328 629,218 Laboratory 122,247 142,773 120,160 125,827 133,510 Public Health 631,608 944,743 936,653 197,520 214,513 Nutritional Health 459,637 502,855 469,040 535,812 447,393 Vector Control 17,941 20,507 18,845 39,442 61,077 Animal Control 37,092 36,638 37,826 60,799 74,851 TOTAL OUTSIDE REVENUE $2,897,939 $2,930,481 $2,861,226 $2,609,381 $2,876,465 TOTAL LEVY/OUTSIDE REVENUE $4,160,591 $4,377,437 $4,336,700 $3,982,508 $4,328,292 EXPENSES Health Administration (320,259) (384,975) (368,759) (601,239) (800,779) Environmental Health (395,945) (405,184) (416,877) (471,669) (443,055) Health Education (314,444) (357,362) (370,294) (414,972) (429,867) Home Care/Personal Care (1,347,104) (866,897) (812,981) (740,911) (703,558) Laboratory (252,559) (260,795) (259,294) (267,187) (255,930) Public Health (1,060,251) (1,298,622) (1,290,173) (598,687) (551,779) Nutritional Health (523,210) (552,897) (567,706) (586,990) (570,404) Vector Control (96,762) (111,391) (103,343) (119,086) (164,151) Animal Control (54,473) (65,527) (66,889) (65,792) (74,807) TOTAL EXPENSES $(4,365,007) $(4,303,650) $(4,256,316) $(3,866,533) $(3,994,330) Income/(Loss) $(204,416) $73,787 $80,384 $115,975 $333,962 OTHER FINANCING SOURCES(USES) DEFICIENCY IN REVENUE/EXPENDITURES 109,179 - - - GENERAL FUND TRANSFER (1996-2000) - 445,889 - - WORKMANS COMP TRANSFER 25,000 - - OPERATING TRANSFER IN (OUT) - (11,460) 15,662 85,982 (30,000) $109,179 $459,429 $15,662 $85,982 $(30,000) REVENUES OVER (UNDER) EXPENDITURES $(95,237) $533,216 $96,046 $201,957 $303,962 FUND BALANCE $(445,889) $87,327 $183,373 $385,330 $689,292
2004 Health Department Revenue
Home Care22%Administration
19%
Laboratory5%
Public Health7%
Environmental13%
Health Education13%
Vector Control2%
Nutrition16%
Animal Control3%
2004 Health Department Expenditures
Administration20%
Home Care18%
Health Education11%
Vector Control4%
Environmental11%
Animal Control2%
Laboratory6%
Public Health14%
Nutrition14%