Publication - North Dakota Department of Health

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					             Department
North Dakota Department of Health
Biennial Report
2009 to 2011
 Jack Dalrymple, Governor
 Dr. Terry Dwelle, State Health Officer




 Stacy Eberl, Editor




          600 E. Boulevard Ave.
          Bismarck, N.D. 58505-0200
          701.328.2372
          www.ndhealth.gov

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                                                                                                                    Table of Contents

State Health Officer’s Message .........................................................................................4

A Look at the Department ..................................................................................................5

State Health Council .............................................................................................................6

Organizational Chart .........................................................................................................7

Office of the State Health Officer .............................................................................................8

Administrative Support Section ..............................................................................................13

Community Health Section ..............................................................................................17

Emergency Preparedness and Response Section ............................................................33

Medical Services Section ..............................................................................................36

Health Resources Section ................................................................................................44

Special Populations Section ...............................................................................................48

Environmental Health Section ...........................................................................................53

Local Public Health Units ................................................................................................74

Financial Summary ..........................................................................................................77

Strategic Map .....................................................................................................................79

Publications ................................................................................................................80
                                                                                                                                        3
    State Health Officer’s Message
                    icer’s
                 Officer’

          December 1, 2011

          North Dakota Department of Health personnel work tirelessly to safeguard the health of every North
          Dakotan. While most people know public health is important, they aren’t always sure what it is or how
          it affects their lives. In fact, the efforts of public health touch every North Dakotan every day:

             •   The NDDoH’s environmental scientists monitor the quality of North Dakota’s air and water,
                 ensuring that we can breathe clean air, drink clean water and enjoy our beautiful environment.
             •   Tobacco use, unhealthy diets and poor exercise habits all contribute to chronic diseases and
                 early death. NDDoH personnel work with local public health units and other partners across
                 the state to promote healthy lifestyles and timely medical screenings.
             •   From H1N1 influenza to norovirus to shigella, disease detectives from the department work
                 hard to identify and contain disease outbreaks. Their efforts to educate the public and track
                 down sources of illness help to protect us all.
             •   NDDoH personnel work to educate the public and enhance the ability of the state’s public
                 health and medical personnel to respond to emergencies such as the emergence of a new
                 influenza virus, tornadoes or floods.
             •   NDDoH personnel travel across the state conducting inspections of nursing homes, hospitals
                 and hospice programs in an effort to ensure that the people of North Dakota receive quality
                 care when they are most vulnerable.
             •   Access to health care has become a challenge for many rural residents in North Dakota. To
                 address this issue, NDDoH personnel work with communities to help them sustain and
                 support local health-care services and attract health-care providers.

          I am so proud of the work of every public health professional on our Department of Health team. I
          invite you to read this report and learn more about the goals and accomplishments of the NDDoH
          during the 2009-2011 biennium.




          Terry Dwelle, M.D., M.P.H.T.M., F.A.A.P., C.P.H.
4         State Health Officer
                                                      A Look at the Department
                                                                    Department
Mission Statement                                Department Overview
   The mission of the North Dakota                   The North Dakota Department of Health
Department of Health (NDDoH) is to protect       employs about 350 people dedicated to making
and enhance the health and safety of all North   North Dakota a healthier place to live.
Dakotans and the environment in which                The department’s seven sections are under
we live.                                         the administrative supervision of the state
   To accomplish our mission, the NDDoH is       health officer and the deputy state health
committed to:                                    officer. They include the following:
   • Improving the health status of the              • Administrative Support
        people of North Dakota.                      • Community Health
   • Improving access to and delivery of             • Emergency Preparedness and Response
        quality health care.                         • Medical Services
   • Preserving and improving the quality of         • Health Resources
        the environment.                             • Special Populations
   • Promoting a state of emergency readi-           • Environmental Health
        ness and response.                           Employees in these sections provide the
   • Achieving strategic outcomes within         following core public health services promul-
        available resources.                     gated by Public Health in America:
   • Strengthening and sustaining stake-             • Preventing epidemics and the spread
        holder engagement and collaboration.              of disease
                                                     • Protecting against environmental
                                                          hazards
Values                                               • Preventing injuries
   The Department of Health values:                  • Promoting and encouraging healthy
   • Excellence in providing services to the              behaviors
      citizens of North Dakota.                      • Responding to disasters and assisting
   • Credibility in providing accurate infor-             communities in recovery
      mation and appropriate services.               • Ensuring the quality and accessibility
   • Respect for our employees, our cowork-               of health services
      ers, our stakeholders and the public.          The department logo is a representation
   • Creativity in developing solutions to       of both apples and wheat. An apple is the
      address our strategic intitiatives.        universal symbol of good health and well-
   • Efficiency and effectiveness in achiev-     being; the wheat represents the richness of
      ing strategic outcomes.                    North Dakota’s environment.                     5
                                State Health Council
                                       State Health Council                                                  Office of Internal Audit assists the department
                                                                                                             in accomplishing its objectives by bringing a
                                           The State Health Council serves as the
                                                                                                             systematic, disciplined approach to evaluate
                                       North Dakota Department of Health’s
                                                                                                             and improve the effectiveness of risk manage-
                                       governing and advisory body. The council’s 11
                                                                                                             ment, control and governance processes.
                                       members are appointed by the governor for
                                                                                                                  The objectives of the Office of Internal
                                       three-year terms. Four members are appointed
                                                                                                             Audit are to provide independent assurance to
                                       from the health-care provider community, five
                                                                                                             the State Health Council and management that
                                       from the public sector, one from the energy
                                                                                                             the department’s assets are safeguarded,
                                       industry and one from the manufacturing
                                                                                                             operating efficiency is enhanced, and compli-
                                       and processing industry. The council also has
                                                                                                             ance is maintained with prescribed laws and
                                       developed several committees to conduct its
                                                                                                             management policies. The Office of Internal
                                       work including the Audit Committee and the
                                                                                                             Audit assists the department with assessments
                                       Data Committee.
                                                                                                             of the department’s risk awareness and man-
                                                                                                             agement of risk, reliability and integrity of the
                                       Office of Internal A udit
                                       Office    Internal                                                    department’s data, and achievement of the
                                           The Office of Internal Audit provides an                          department’s goals and objectives. The Audit
                                       independent, objective assurance and consult-                         Committee of the State Health Council
                                       ing activity designed to add value and improve                        establishes and oversees the Office of Internal
CHAIR
        Marlene Kouba, Regent
                                       the North Dakota Department of Health. The                            Audit.

VICE CHAIR
      Gordon Myerchin, Grand Forks

SECRETARY
      Carmen Toman, Bismarck

MEMBERS
     Dennis E. Wolf, M.D., Dickinson
     Howard C. Anderson, R. Ph.,
     Turtle Lake
     Jerry Jurena, Rugby
     Lee Larson, Leeds
     Gary Riffe, Jamestown
     Hjalmer Carlson, Jr., Minot
     2 vacant positions (Oct. 2011)
                                              Standing (left to right): Dr. Terry Dwelle, Howard Anderson, R. Ph., Dr. Dennis Wolf, Jerry Jurena, Hjalmer Carlson, Jr.,
  6                                           Lee Larson, Gary Riffe. Sitting (left to right): Carmen Toman, Marlene Kouba, Gordon Myerchin
Organizational Chart




                       7
                        Office of the State Health Officer
                        Office                     Officer
                                         The Office of the State Health Officer           Deputy State Health Officer
                                     manages the activities of and provides
                                     direction and leadership to the Department               The deputy state health officer addresses
                                     of Health. The office is composed of the             administrative policy and practice, allowing the
                                     state health officer, the deputy state health        state health officer to focus on medical policy
                                     officer, the local public health liaison and         and practice. The deputy also serves as section
                                     Healthy North Dakota.                                chief for the Administrative Support Section.

                                     State Health Officer                                 Accomplishments
                                         The state health officer is appointed by the     • Updated department strategic plan and
                                     governor to be the chief administrative officer        leadership priorities, including goals and
                                     of the department, as well as a member of the          objectives and health indicators. A copy of
                                     governor’s cabinet. The state health officer           the department’s Strategic Map is on page 79.
    Terry Dwelle, M.D., M.P.H.T.M.   implements state laws governing the depart-          • Approved grants and contracts of more than
         State Health Officer
                                     ment within the guidance of the governor and           $72 million in funding to numerous local
                                     the rules adopted by the State Health Council.         entities and other public health partners.
                                     In addition, the state health officer is a statu-    • Firmly established the Office of Internal
                                     tory member of about a dozen boards and                Audit.
                                     commissions. The state health officer also           • Provided leadership, oversight and training on
                                     supervises the Public Health Training Center.          implementation of North Dakota’s immuniza-
                                                                                            tion strategy.
                                     Public Health Training Center                        • Coordinated department 2011 legislative
                                         The Public Health Training Center – a              efforts including monitoring over 200 bills,
                                     cooperative effort among the NDDoH, the                approving all department testimony, guiding
                                     University of North Dakota, North Dakota               the department budget through the legislative
                                     State University and the University of Minne-          process and briefing various organizations on
                                     sota – is designed to improve public health            the status and outcome of legislation.
                                     practice in the state through advanced public        • Coordinated department interim legislative
                                     health education. As a result of this collabora-       efforts, following activity of 14 interim
                                     tion, several universities and colleges, including     committees and approving all department
                                     many in North Dakota, will be offering public          testimony.
                                     health curricula. The role of the NDDoH is to        • Monitored federal funding issues related to
                                     work with our academic partners to enhance             federal economic stimulus funding, national
                                     their curricula with a practical public health         health care reform legislation, and federal
8                                    approach.                                             program funding cuts.
• Served as President Elect for Association of       • Serve as President of Association of State
  State and Territorial Health Officers Senior         and Territorial Health Officers Senior Depu-
  Deputies Committee.                                  ties Committee.

Goals
• Continue to increase programmatic effective-
  ness through monitoring of health status,
  identifying needs, updating goals and objec-       Office of Local Public Health
  tives, aligning department programs and                  The Office of Local Public Health acts as
  strategies and evaluating results.                 liaison to local public health units and other
• Ensure completion of department fraud risk         key public and private partners. The local
  assessment and implementation of recom-            public health liaison administers the state block
  mended improvements.                               grant, which provides funding to local public
• Continue to monitor implementation of new          health units, and advises the state health                  Arvy Smith
  immunization strategy.                             officer about issues related to local public        Deputy State Health Officer
• Monitor the status of federal funding levels       health. In addition, the local public health
  which are budgeted at 63 percent of the            liaison works with NDDoH staff members to
  2011-13 budget.                                    assist public health units during disease out-
• Monitor the status of federal health care          breaks and natural disasters and with other
  reform and its impacts on the department.          public health issues.
• Coordinate department 2013 legislative
  efforts including monitoring bills, approving      Accomplishments
  all department testimony, preparing and            • Served on board of directors of the Associa-
  guiding the department budget through the            tion of State and Territorial Local Health
  legislative process and briefing various organi-     Liaison Officials.
  zations on the status and outcome of legisla-      • Coordinated completion of the National
  tion.                                                Public Health Performance Standards Pro-
• Coordinate department 2011-13 interim                gram Assessment of local boards of health
  legislative efforts.                                 and the State Health Council.
• Participate in public health emergency             • Developed and presented public health
  response activities.                                 orientation and board orientation to local
• Develop business case for prevention in              boards of health.
  North Dakota.                                      • Facilitated State Health Council performance
• Provide guidance to department on pursuing           improvement planning and implementation
  public health accreditation.                         process.                                                                        9
     • Administered the regional Public Health
       Network Pilot Project.
                                                       Healthy North Dakota
     • Coordinated the establishment of the Depart-        In 2002, then Governor John Hoeven
       ment of Health/Local Public Health Execu-       launched the Healthy North Dakota initiative to
       tive Committee to address critical issues.      provide support, education and encouragement
     • Facilitated Executive Committee strategic       to all North Dakotans seeking to improve their
       planning process. The Executive Committee       health.
       is a planning group consisting of five local         The goal of Healthy North Dakota is to
       public health unit directors, five Department   support North Dakotans in their efforts to
       of Health officials, the local public health    make healthier choices by focusing on wellness
       liaison, and an individual employed by both     and prevention – in schools, workplaces, senior
       local public health and the Department of       centers, homes and anywhere people live,
       Health.                                         learn, work and play. Studies show that focus-
                                                       ing on wellness and prevention will result in a
     Goals                                             healthier population, lower health-care costs
     • Assist in development of a technical assis-     and an improved quality of life.
       tance program to enhance community health            Healthy North Dakota works with partners
       assessments and planning.                       to promote and implement health-related laws,
     • Assist in the development of local public       policies and programs. Currently, the program is
       health unit health profiles with web-based      composed of more than 400 North Dakotans
       accessibility.                                  representing about 150 agencies, organizations
     • Revise and update local public health infor-    and businesses from across the state.
       mation on the NDDoH website.                         During the 2009-2011 biennium, partners
     • Create a coordinated system to assist local     worked in the following focus areas:
       public health and the NDDoH in preparing        • Tobacco use
       for National Public Health Accreditation.       • Healthy weight – nutrition and physical
                                                         activity
                                                       • Health disparities
                                                       • Worksite wellness
                                                       • Oral health
                                                       • Cancer
                                                       • Early childhood
                                                       • School health
                                                       • Aging
10                                                     • Immunizations
• Cardiovascular health                             15 Moving More, Eating Smarter coalitions to
• Injury prevention and control                     increase local opportunities for healthier
• Diabetes                                          eating and more physical activity.
• Environmental quality                           • Piloted a Healthy Kids/Healthy Weight
    The NDDoH administers the Healthy North         program with local public health and health-
Dakota program, providing resources and             care partners.
coordination supporting the program’s partners.   • Assisted with implementation of the State-
The partners work to identify common strate-        wide Vision and Strategy Healthy Kids/
gies to address health issues. This process         Healthy Weight and worksite wellness initia-
ensures continuity and coordination and             tives.
creates a more efficient, cost-effective ap-      • Facilitated implementation of the Creating a
proach to improving health in the state.            Hunger Free North Dakota strategic plan.
     Health and wellness are concerns every-      • Provided information about the benefits of
where – from schools and universities to            prevention to local, state, federal and non-
private businesses to hospitals and nursing         profit leaders and to North Dakota citizens
homes. Healthy North Dakota strives to improve      through the Healthy North Dakota website, as
the health of every North Dakotan.                  well as at meetings and conferences.

                                                  Goals
Accomplishments                                   • Continue to implement Statewide Vision and
• Sustained a statewide worksite wellness           Strategy initiatives for improving health in
 program.                                           North Dakota.
• Developed easy to use resources including a     • Continue to implement statewide worksite
  website (ndworksitewellness.org) and a            wellness initiatives.
  toolkit “Taking Wellness to Work.”              • Increase number of businesses in North
• Collaborated with the NDPERS worksite             Dakota offering worksite wellness programs.
  wellness program director to provide a          • Continue to implement the Creating a Hunger
  cohesive worksite wellness program for            Free North Dakota strategic plan.
  public and private employers.                   • Provide leadership coordination to the
• Provided training and technical assistance to     Patient-Centered Medical Home Coalition.
  more than 50 worksite wellness specialists      • Provide leadership coordination to the state’s
  and more than 450 summit attendees.               “Transforming North Dakota’s Communities
• Conducted a worksite wellness survey of           through Community Engagement” initiative.
  more than 1,100 North Dakota businesses.
• Provided training and technical assistance to                                                      11
     • Connect statewide interventions and re-        Goals
       sources in prevention of early childhood       • Continue to provide clinical consultation
       obesity.                                         support to NDDoH divisions.
     • Identify mechanism to sustain program          • Provide consultation support for divisional
       efforts due to elimination of the Preventive     clinical protocol development.
       Health and Health Services Block Grant.        • Continue to provide presentations, education
                                                        and dialogue forums at medical meetings.
                                                      • Continue to provide direction and support
                                                        during disease outbreaks.
                                                      • Continue to provide other special clinical
     Field Medical Officers                             insight and consultation for the Department
         The field medical officers provide medical     of Health.
     direction and support to programs throughout
     the NDDoH. Areas of emphasis include the
     health aspects of environmental pollution,
     newborn metabolic screening, disease control,
     immunizations, infant mortality, adolescent
     suicide, cancer cluster investigations,
     bioterrorism, long-term care, emergency
     medical services and the Children’s Health
     Insurance Program.

     Accomplishments
     • Provided consultation concerning programs,
       projects and patient-care issues.
     • Improved communications with private
       physicians and clinics.
     • Provided a variety of continuing medical
       education sessions on public health issues.
     • Developed medical director system consist-
       ing of 11 providers who provide guidance to
       the NDDoH during emergencies, including
       quarterly training about medical surge.

12
                                              Administrative Support Section
    The Administrative Support Section, which      • Provided training and assistance to depart-
is supervised by the Deputy State Health             ment personnel on federal and state grants
Officer, provides support services to assist all     and appropriation monitoring.
NDDoH divisions in accomplishing their goals.      • Reviewed grant applications and cooperative
    The section consists of the following:           agreements that resulted in receipt of about
    • Accounting                                     $119 million in federal funding.
    • Education Technology                         • Processed about 1,600 contracts providing
    • Public Information                             funding to a variety of entities for public
    • Information Technology                         health services.
    • Human Resources
    • Vital Records                                Goals
                                                   • Assist staff and management in securing
 Division of Accounting                              additional grants or other funding sources.
     The Division of Accounting provides           • Continue to provide financial information to
 accounting and financial control records that       staff and management on a timely basis.
 comply with state and federal requirements.       • Continue to provide quality financial report-
     This data is distributed monthly to depart-     ing to various state and federal organizations.
 ment managers to help them monitor federal
 and state grant expenditures, revenue and state
 appropriations. The division prepares financial
 reports, reviews grant applications, collects     Division of Education Technology
 revenue, processes contracts, pays expenses,           The Division of Education Technology
 processes the payroll and submits the             provides an infrastructure for communicating
 department’s biennial budget.                     and training public health and medical person-
                                                   nel through distance learning. Some activities
 Accomplishments                                   are in response to emergencies and are immedi-
 • Submitted the 2011-2013 budget request to       ate in nature, and some are delivered over an
   the Office of Management and Budget in          extended period of time. Most training and
   compliance with the governor’s guidelines.      communications are archived and accessible on
 • Provided various financial information          the web.
   requested by the legislature or legislative
   council during the 2011 legislative session.    Accomplishments
 • Served as fiscal agent for the newly created    • Developed and distributed health alerts,
   Tobacco Prevention and Control Executive          advisories and updates to public health and
   Committee.                                        medical professionals across the state using      13
                                                      automated telephone technologies, e-mails        • Provided support to eight regional public
                                                      and faxes.                                         health public information officers.
                                                    • Conducted local, regional, statewide and         • Developed and provided spokesperson and
                                                      national meetings, presentations and trainings     Media 101 training.
                                                      using video conference, desktop conference,      • Served as chair of the awards committee for
                                                      teleconference and webcast technologies.           the National Public Health Information
                                                    • Created video and audio productions distrib-       Coalition (NPHIC).
                                                      uted on DVD and by webcast.                      • Planned and hosted annual statewide public
                                                                                                         information conference in 2009 and 2010.
                                                    Goals                                              • Provided essential communication and media
                                                    • Implement refined query capabilities for the       support during statewide flooding and the
                                                      health alert network.                              emergence of novel H1N1 influenza.
                                                    • Improve the reliability and expand the use of    • Activated the department’s public health
                                                      desktop interactive communication.                 hotline during the H1N1 pandemic and to
                                                    • Maintain existing communications and               support flood response in Minot during 2011
                                                      training capabilities.                             flooding.
                                                                                                       • Coordinated and edited legislative testimony
                                                                                                         during 2011 legislative session.
                                                                                                       • Completed FEMA’s Advanced Public Infor-
                                                    Office of Public Information
                                                    Office           Information                         mation Officer’s Training.
                                                         The Office of Public Information supports
                                                    the department’s communication of public           Goals
                                                    health information, policies and resources to      • Continue to provide timely consultation to
                                                    the citizens of North Dakota. Duties include         staff regarding communication issues and
                                                    coordinating media relations; preparing news-        media events.
                                                    letters, brochures and other materials; coordi-    • Provide public information support to
                                                    nating special events; providing or arranging        NDDoH personnel during emergencies.
The Office of Public information helps coordinate
the release of information to the public. This      communication training; releasing information      • Explore effective strategies and develop a
picture was taken during a news conference held     through the media; and working with various          policy for the use of social media.
to educate about H1N1 Influenza (Oct. 2009).        groups to promote public health.

                                                    Accomplishments
                                                    • Provided daily consultation to NDDoH
                                                      personnel concerning communication and
    14                                                media issues.
Office of Information Technology
Office    Information                               Goals
                                                    • Implement cost-effective technology solu-
    The Office of Information Technology              tions throughout the department.
provides leadership to information technology       • Expand the use of web-based solutions for
(IT) professionals throughout the department          easier access to both internal and external
in coordinating activities and functions. The         customers.
office also develops and implements the             • Continue to develop and coordinate IT
department’s IT plan; monitors IT budgets;            policies, procedures and strategies.
assigns IT staff and support; and monitors the
security component of the Health Insurance
Portability and Accountability Act (HIPAA).         Division of Human Resources
                                                        The Division of Human Resources
Accomplishments                                     provides a variety of services to the NDDoH,
• Implemented the Division of Disease               including employee relations, employee recruit-
  Control’s disease management system known         ment, position classification, training and
  as MAVEN. Maven Electronic Disease                development, salary administration, policy
  Surveillance System (EDSS) allows the             development, and safety.
  NDDoH to enter, manage, process, track and        Accomplishments
  analyze data for disease exposure events.         • Assisted managers with recruitment and
  Maven enables the immediate exchange of             retention issues.
  information between clinics, labs and state       • Provided technical assistance to manage-
  health departments. The Maven EDSS                  ment, supervisors and employees regarding
  security environment displays only the data a       laws, rules, policies/procedures and person-
  user needs and is authorized to see. Through        nel issues.
  data analysis, EDSS can then extract surveil-
  lance data for the identification of a possible   Goals
  public health/environmental emergency.            • Complete personnel policy updates.
  Additional EDSS functions include elec-           • Develop human resource initiatives that
  tronic data exchange and flow of work               support strategic planning efforts.
  among groups working on public health             • Update performance management process.
  disease management, ability for lab reports to    • Continue to provide technical support and
  be imported electronically, data entry capabil-     assistance to management and staff.
  ity, reporting, case management, contact-         • Pursue employee salaries equitable to salaries
  tracing and outbreak management.                    for similar job classifications in other agen-
                                                      cies and organizations.                          15
                                                          extensive querying and follow-up is done.
     Division of Vital Records                          • Continue timely response to requests for
         The two main functions of the Division           certified copies of vital event documents.
     of Vital Records are registration and
     certification of vital events that occur in the
     state, including births, deaths, fetal deaths,
     marriages and divorces. In addition, the divi-
     sion provides certified copies of vital event                       Vital Signs
                                                              On an average day in North Dakota:
     documents as requested by the public. Indi-                25 babies are born; 8 of them
     viduals now can order copies on the                           are born out of wedlock, 2 are
     department’s website using a credit card for                  born to a teenage mother and 4
     payment. Copies are needed for many reasons,                  are born by Caesarian section.
     including passport applications, school                    16 people die, 4 of them from
                                                                   heart disease and 3 from cancer.
     entrance, job applications and Social Security             12 couples are married, and
     benefits.                                                     6 are divorced.

     Accomplishments                                          In an average week:
     • Registered 20,846 certificates of live birth;             1 infant dies.
                                                                 2 people commit suicide.
       12,873 certificates of death; 123 certificates            4 people die from diabetes.
       of fetal death; 8,609 marriage records; 3,940             3 people die from influenza
       divorce records; and 74 delayed registrations               and pneumonia.
       of birth.                                                 6 people die as a result
     • Processed 102,815 requests for more than                    of accidents.
       244,000 certified copies, record searches,             In an average month:
       amendments and verifications. The fees                    3 children younger than 20 die.
       collected for providing these services were               8 people die as a result of motor
       deposited to the state’s general fund.                      vehicle accidents.
     • Compiled annual reports using data collected              4 babies are born outside of a
                                                                   hospital setting.
       from vital event certificates.
     • Compiled data for specific requests from the           The average age at death is 76.3.
       public or other state agencies.

     Goals
     • Maintain 100 percent registration of all vital
16     events in the state. To achieve this goal,
                                                 Community Health Section
    The Community Health Section is com-         • Maintained consistent membership of the
posed of five divisions:                           North Dakota Cancer Coalition with 75
    • Cancer Prevention and Control                percent of the nearly 200 members actively
    • Chronic Disease                              engaged in workgroups.
    • Family Health                              • Completed the second edition of the North
    • Injury Prevention and Control                Dakota Cancer Control Plan for 2011-2016
    • Nutrition and Physical Activity              with more than 75 percent of the Cancer
    The director from each division is a           Coalition members involved in the revision.
member of the Leadership Team and serves         • Utilized over $500,000 of statewide partner
in rotation as section lead.                       contributions to implement the North
    The goal of the section is to promote          Dakota Cancer Plan through cancer
health and prevent illness and disease. Local      prevention activities at the local level.
public health units and other partners across    • Ensured life-saving and cost-saving services
the state provide many of these services.          through the Colorectal Cancer Screening
                                                   Initiative. Through this state-funded
Division of Cancer Prevention                      initiative, 175 low-income North Dakotans
                                                   received colonoscopies; 130 were uninsured
and Control                                        and the other 45 had major medical plans
     The Division of Cancer Prevention and         with no colorectal cancer screening coverage.    The Community Health Section’s programs focus
Control works to reduce the incidence of and       Screening results include: 68 participants had   on the promotion of health and the prevention
illness and death from cancer in North Dakota.     polyps removed and of those, 10 participants     of illness and disease.
Programs include:                                  had polyps which have a greater propensity
     • Comprehensive Cancer Prevention and         to develop into colorectal cancer. Currently,
       Control                                     the average cost to treat colorectal cancer is
     • Women’s Way                                 approximately $250,000.
     • Statewide Cancer Registry
                                                 Women’s Way
Accomplishments                                  • Focused on providing breast and cervical
Comprehensive Cancer Prevention                    cancer screening for medically underserved,
and Control Program                                hard to reach North Dakota women,
• Completed years three and four of                primarily ages 40 through 64.
  cancer plan implementation at the              • Partnered with local public health units,
  state and local level now covering the           private health-care providers and volunteers
  cancer continuum from prevention to              to provide breast and cervical cancer
  cancer survivorship.                             screening and diagnostic education and                                               17
                                               services to eligible women in every North       • Continued to enhance partnerships with
                                               Dakota county and on every reservation.           organizations such as Healthy North Dakota,
                                           •   Screened more than 11,900 women for               the American Cancer Society, North Dakota
                                               breast and cervical cancer since September        Affiliate of Susan G. Komen for the Cure,
                                               1997, and have detected breast cancer in          BlueCross BlueShield, the North Dakota
                                               227 women and cervical conditions                 Medical Association, North Dakota
                                               requiring treatment in 288 women.                 Statewide Cancer Registry, Comprehensive
                                           •   Implemented a Patient Navigation Program          Cancer Prevention and Control, North
                                               at an IHS clinic, resulting in patient            Dakota Cancer Coalition and others.
                                               navigation services for 29 women and 76         • Conducted evidence-based public education
                                               percent (22 women) were eligible for and          and projects focusing on preventing cancer.
                                               received Women’s Way services.
                                           •   Partnered with First Lady Mikey Hoeven on       Cancer Registry
                                               an adherence project. Clients due for           • Achieved gold certification for data timeli-
                                               screening received a letter from the First        ness, completeness and quality.
                                               Lady encouraging them to get screened. The      • Responded to 41 data requests and 11 cancer
                                               letter motivated 81 Women’s Way clients to        cluster inquiries.
Since September 1997, the Women’s              obtain screening.                               • Conducted a childhood leukemia cancer
Way program has screened more than         •   Partnered with DMS Health Technologies,           cluster study.
11,900 North Dakota women for breast                                                           • Continued to enhance partnerships with
                                               Fargo, and Trinity Medical Group, Minot, to
and cervical cancer. The screenings
                                               bring a mobile mammography unit to rural          medical facilities, physicians, clinics, the
detected breast cancer in 227 women
and cervical conditions requiring treat-       areas without access to mammograms,               Comprehensive Cancer Prevention and
ment in 288 women.                             resulting in 132 women receiving a                Control Program, the Northern Plains Epide-
                                               mammogram.                                        miology Center, the North Dakota Cancer
                                           •   Conducted a recruitment intiative where           Coalition and others.
                                               current Women’s Way clients referred friends
                                               to the program, resulting in 175 new clients.   Division Goals
                                           •   Collaborated with state Medicaid to pay for     • Collaborate with other chronic disease
                                                breast and cervical cancer treatment for 244     programs and multi-sector partners to ex-
                                               uninsured clients since the Medicaid-Women’s      change information, augment efforts and
                                               Way Treatment Program was implemented.            enhance capacity for efficient use of re-
                                           •   Helped sponsor four women’s health summits        sources to benefit North Dakota citizens.
                                               through the North Dakotans Partnering for       • Continue strategies identified in the state
                                                Women’s Health Committee. Approximately          Cancer Control Plan for Comprehensive
 18                                             500 women attended each summit.                  Cancer Control.
• Sustain active partnerships in North Dakota      Accomplishments
  Cancer Coalition.                                Epidemiology
• Provide breast and cervical cancer screening     • Monitored and analyzed data to assess
  and diagnostic services to 3,000 Women’s Way       disease prevalance, incidence and impact.
  eligible North Dakota women annually.            • Used performance indicators to monitor and
• Enhance cancer prevention efforts using            evaluate program progress and effectiveness.
  evidence-based strategies to motivate all        • Responded to data requests from partners
  North Dakota citizens to adopt healthy             and the public; distributed data via reports,
  lifestyles.                                        fact sheets, presentations and websites.
• Ensure treatment services are provided to        • Assisted partners with data for research,
  uninsured Women’s Way clients diagnosed            community engagement, quality improve-
  with breast or cervical cancer through Medic-      ment and program evaluation.
  aid-Women’s Way Treatment Program.
• Provide screening colonoscopies to 225           Healthy People 2010
  eligible North Dakotans through the state-       • Provided a framework for prevention by
  funded Colorectal Cancer Screening Initiative.     adopting objectives designed to identify the
• Maintain North American Association of             most significant preventable threats to
  Central Cancer Registries certification.           health.
                                                   • Monitored state and national goals.

Division of Chronic Disease                        Heart Disease and Stroke Prevention
                                                                                                     The Division of Chronic Disease works to
    The Division of Chronic Disease works to       Program                                           improve the health and quality of life for
improve the health and quality of life for North   • Appointed program staff as the State Health     North Dakotans who have chronic diseases
Dakotans who have chronic diseases by pro-           Officer designee on the State Stroke System     such as diabetes or heart disease.
moting healthy behaviors, supporting health-         of Care Task Force, which is charged with
care improvement measures, developing                the responsibility of providing recommenda-
community policies and practices, increasing         tions for and assisting in the implementation
disease awareness and by reducing the negative       of a plan to establish a statewide, coordi-
health and economic consequences of the              nated, efficient system along the continuum
state’s number one cause of preventable              of stroke care (prevention, assessment,
disease and death - tobacco. Programs include:       transport, treatment and rehabilitation).
    • Epidemiology                                 • Implemented the new chapter to title 23 of
    • Healthy People 2010                            the North Dakota Century Code relating to
    • Heart Disease and Stroke Prevention            hospital designation as a primary stroke
    • Tobacco Prevention and Control                 center and related services offered by emer-                                        19
         gency medical services operations. Desig-         • Continued success of the North Dakota
         nated two qualified hospitals as primary            Tobacco Quitline, which provides free
         stroke centers and drafted the standardized         counseling and nicotine replacement therapy
         stroke triage assessment tool.                      to any North Dakota tobacco user interested
     •   Enrolled 33 of the 42 eligible hospitals            in quitting. During the biennium, the Quitline
         (nearly 80%) in the state stroke registry and       served more than 13,000 callers. More than
         provided grants for the registry licensing fee      36 percent of the callers were tobacco free
         and database entry, stroke training and             six months after completing the program.
         community education.                              • Continued to implement the surveillance and
     •   Provided resources, materials and grants to         evaluation system to track progress in
         11 Go Red Action Grant recipients to im-            tobacco prevention efforts. The data is
         prove the cardiovascular health of women            included in the Chronic Disease in North
         and their families living in rural communities.     Dakota: A Status Report of Leading Indicators to
         Reached almost 20 percent of the state’s            report progress and trends in tobacco preven-
         population with heart healthy messages,             tion efforts.
         actions to prevent or control heart disease       • Conducted the Youth Tobacco Survey in
         and opportunities to adopt healthier lifestyle      coordination with the Youth Risk Behavior
         behaviors.                                          Survey (YRBS) to assess youth tobacco
     •   Distributed stroke messages via magazines           attitudes and behaviors and evaluate tobacco
         (reached more than 250,000 readers), news-          prevention program efforts. According to the
         papers, posters, radio and printed materials to     YRBS survey, the percentage of North
         reach the elderly and the general public.           Dakota youth who currently smoke cigarettes
     •   Distributed culturally-sensitive heart disease      significantly decreased from 40.6 percent in
         and stroke prevention messages via tribal           1999 to 22 percent in 2009.
         radio and GoodHealthTV for American               • Continued to support “Baby and Me Tobacco
         Indians.                                            Free” project with six local public health
                                                             units. The program provides tobacco cessa-
     Tobacco Prevention and Control Program                  tion support for pregnant women and ad-
     • Hosted Incorporating Tobacco Into Health              dresses relapse prevention.
       Systems Cessation Conference.                       • Worked with 22 health-care systems to assist
     • Utilized and distributed funding from the             them in developing a tobacco-user identifica-
       Centers for Disease Control and Prevention            tion system as recommended by the U.S.
       to support local tobacco control initiatives in       Department of Health and Human Services
       the four American Indian tribes.                      Public Health Service.
20
• Implemented North Dakota Quitnet in             Division Goals
  February 2010. It is a free, online cessation   • Improve chronic disease prevention, early
  program for all North Dakota residents. The       diagnosis and disease management by work-
  service may be used independently or in           ing with communities, health professionals
  conjunction with the North Dakota Tobacco         and health systems in the areas of policy,
  Quitline.                                         quality improvement and education.
• Developed an awareness campaign address-        • Reduce illness, disability and death related to
  ing the dangers of SIDS and secondhand            heart disease and stroke and related risk
  smoke with the Partnership for Tobacco            factors through education, policy, systems
  Prevention and Cessation for Women of             and environmental changes.
  Reproductive Age.                               • Implement proven public health strategies as
• Updated the North Dakota Comprehensive            outlined in the tobacco and heart disease and
  Tobacco-Free Model School Policy in a             stroke state plans.
                                                                                                      The percentage of North Dakota youth who
  partnership between the North Dakota            • Provide grants, training, education and
                                                                                                      smoke cigarettes has decreased significantly
  Department of Health and the North Dakota         technical assistance to communities and           in recent years, from 40.6 percent in 1999 to
  School Board Association. After the policy        health-care providers.                            22 percent in 2009.
  was updated, the North Dakota School            • Work to eliminate chronic disease disparities
  Board Association adopted the policy as their     based on gender, gender identity, race and
  primary School Tobacco Policy and began           ethnicity, income and education, disability,
  promoting it to member schools statewide.         rural locality, age, and sexual orientation.
• Strengthened the Tribal Tobacco Program in      • Increase the number of nontraditional
  North Dakota by the reformation of the            chronic disease partners.
  Intertribal Tobacco Abuse Coalition. This       • Improve chronic disease surveillance and
  includes membership from every tribe and          evaluation methods; increase epidemiology
  reservation in North Dakota working to-           capacity.
  gether to combine resources and strengthen      • Collect, analyze and report data to assess
  tribal tobacco programs locally and state-        chronic disease prevalance, incidence and
  wide.                                             impact, and to evaluate programs.
                                                  • Share BRFSS and Healthy People 2010 data
                                                    with health department programs and state-
                                                    wide partners; promote use in state plans.



                                                                                                                                             21
     Division of Family Health                          health practices, health conditions and risk
         The Division of Family Health adminis-         behaviors of adults in the U.S. and North
     ters state and federal programs designed to        Dakota yearly since 1984.
     improve the health of North Dakota families.     • Initiated “Advanced Letter Notification” to
     Programs include:                                  inform the randomly selected households
         • Abstinence-Only Education                    they have been selected to participate in the
         • Behavioral Risk Factor Surveillance          survey before they receive the survey call.
            System (BRFSS)                              These letters serve as a courtesy notification
         • Child and Adolescent Health Services/        and provide confirmation that the BRFSS is
            School Nursing                              a legitimate survey.
         • Coordinated School Health                  • Redesigned the BRFSS website so the data is
         • Cribs for Kids Program                       more accessible and user friendly to both
         • Early Childhood Comprehensive                technical users and the general public.
            Systems                                   • Provided data support for a variety of pro-
         • Family Planning                              grams within the department. Significant
         • Fetal Alcohol Syndrome                       support was provided to the Comprehensive
         • Maternal and Child Health/Oral Health        Cancer Prevention and Control Program for
            Epidemiology                                the revision of the North Dakota Cancer
         • Newborn Screening                            Plan and to the Title V/Maternal and Child
         • Optimal Pregnancy Outcome                    Health Grant for completion of a statewide
         • Oral Health                                  needs assessment.
         • Sudden Infant Death Syndrome (SIDS)        • Provided training to staff and partners
         • Title V/Maternal and Child Health            concerning BRFSS, data collection, indicators
         • Women’s Health                               and outcomes for program evaluation and
                                                        datasets.
     Accomplishments
     Abstinence-Only Education Program                Child and Adolescent Health Services/
     • Provided funds to Make-A Sound Choice and      School Nursing
       Northern Lights SADD (Students Against         • Collaborated with the North Dakota School
       Destructive Decisions) to provide abstinence      Nurse Organization to host a conference for
       educational programs.                             school nurses, Head Start Health Coordina-
                                                         tors and child care nurses.
     Behavioral Risk Factor Surveillance System       • Provided consultation, technical assistance
     • Continued the BRFSS survey, a random-digit       and resources to North Dakota school nurses
22     dialing telephone survey that has tracked        and other health professionals in promoting
  health for children and adolescents.              income families to help reduce the risk of
• Served as child and adolescent health liaison     injury and death of infants due to unsafe
  on various disease prevention and health          sleep environments.
  promotion committees.                           • Distributed safe sleep education and a crib kit
                                                    that includes a Graco Pack n’ Play, crib sheet,
Coordinated School Health (CSH) Program             pacifier and a swaddle sack to about 100
• Worked with the Department of Public              families in 2010.
  Instruction (DPI) to apply for a federal CSH
  cooperative agreement. North Dakota was         Early Childhood Comprehensive Systems
  one of 22 states to receive funding.            • Continued updating and implementation of
• Provided a grant to the South East Education      the Early Childhood Comprehensive Systems
  Cooperative (SEEC) for implementation of          State Plan.
  CSH practices and policies.                     • Supported efforts and partnerships that
• Utilized environmental scan results of school     support families through the Healthy North
  districts within the SEEC to guide program        Dakota Early Childhood Alliance (HNDECA).
  planning implementation.                        • Developed an “Early Childhood Messaging
• Determined recommendations through the            Packet” that was used to educate a variety of
  CSH Interagency/Community Workgroup to            audiences on the positive impact of early
  promote healthy lifestyles and educational        childhood programs.
  success.
• Collaborated with DPI on the 2009 and 2011      Family Planning Program
  Youth Risk Behavior Surveys.                    • Provided medical, education and counseling
 • Collaborated with DPI, the Regional Educa-        services to more than 28,000 men and
  tion Association and the North Dakota              women in North Dakota.
  Association for Health, Physical Education,     • Continued services to the Cass County Jail        The Division of Family Health works to ensure
  Recreation and Dance to provide profes-           and to the Spirit Lake and Standing Rock          that every baby born in North Dakota grows
                                                                                                      up healthy and strong.
  sional development to school personnel on         reservations.
  the CSH priority areas of physical activity,    • Received a male service grant for $39,753.
  nutrition, tobacco and health education.          Marketing materials were designed specifically
                                                    to educate males on the importance of family
Cribs for Kids Program                              planning services.
• Implemented the Cribs for Kids (CFK)            • Provided professional development to local
  Program in 2010 in 14 locations throughout        family planning staff on a variety of topics
  the state. The CFK Program is a safe-sleep        including mandatory reporting laws, sexually
  education and distribution program for low-       transmitted infections, implementation of                                              23
                                              new Pap guidelines, the nurse practice act/       screening law that occurred during the 2011
                                              delegation, infant adoption and contraceptive     legislative session.
                                              updates.
                                            • Implemented the Ahlers data system in all        Optimal Pregnancy Outcome Program
                                              Family Planning Clinic sites throughout the      (OPOP)
                                              state, thereby assuring accurate reporting of    • Served nearly 750 pregnant women.
                                              data.                                            • Developed a Client Visit Record for accurate
                                                                                                 data collection.
                                            Fetal Alcohol Syndrome                             • Participated in the Cribs for Kids program (all
                                            • Provided grant oversight of state funds to the     OPOP sites).
                                              University of North Dakota’s Fetal Alcohol       • Participated in the Partnership for the
                                              Syndrome Center for program activities.            Prevention and Cessation of Tobacco Use in
                                                                                                 Women of Reproductive Age.
                                            Newborn Screening Program
                                            • Continued to monitor the statewide courier       Oral Health Program
                                              service to track appropriate turnaround time     • Executed the change of the dental hygiene
                                              from blood collection to lab results.              supervision law that allows public health
                                            • Provided ongoing training and educational          hygienists to practice under general supervi-
                                              resources to providers/facilities throughout       sion. This change was instrumental to imple-
                                              the state.                                         ment the Healthy Smiles fluoride varnish and
                                            • Developed a North Dakota health-care               Seal! ND sealant programs in Sept. 2011.
                                              facility/provider survey. Results were used to   • Awarded a three-year HRSA workforce grant
                                              improve services and processes.                    in collaboration with Bismarck Ronald
The Oral Health Program works to improve
the oral health of North Dakotans through   • Served as the regional educational and quality     McDonald Charities, Bridging the Dental Gap
prevention and education.                     assurance coordinator for North Dakota and         and the State Oral Health Program.
                                              Iowa.                                            • Worked with the Oral Health Coalition to
                                            • Collaborated with the University of Iowa to        hold a policy priority meeting and data/
                                              provide follow-up activities to North Dakota       evaluation committee meeting.
                                              physicians including lab results, follow-up      • Surveyed the Oral Health Coalition regarding
                                              processes and medical consultation.                effectiveness and recruitment of new
                                            • Developed a North Dakota/Iowa newborn             members.
                                              screening newsletter featuring significant       • Presented national training webinar to the
                                             program topics.                                     Association of State and Territorial Dental
                                            • Mailed a memo to health-care providers             Directors to help other states effectively
   24                                         educating them on changes to the newborn           develop and utilize a communication plan.
• Completed a Basic Screening Survey for               programs. The funds are used for activities
  third-grade children to determine basic oral         such as maternal care, well-baby clinics,
  health needs.                                        newborn home visits, car seat safety pro-
• Received additional Centers for Disease              grams, school wellness activities, nutrition
  Control and Prevention (CDC) funding as a            and physical activity education, injury preven-
  result of exceeding program goals/objectives.        tion, immunizations and oral health care.
• Provided grant oversight to the state funded       • Completed a comprehensive, statewide needs
  Donated Dental Services Program, which               assessment of the maternal and child health
  provides essential dental care for disabled,         population to determine 10 state priorities for
  elderly and medically-compromised                    the period of 2011-2015.
  individuals who cannot afford care.                • Formed an advisory committee to assist with
• Provided grant oversight of state funds to           revising the Title V/MCH funding formula.
  Ronald McDonald House Charities to plan a          • Completed a statewide needs assessment to
  mobile dental-care service to provide dental         identify the counties in the state with the
  treatment, prevention and education services         greatest need for evidence-based home visiting
  to low-income and underserved children in            programs/services.
  the state with limited or unavailable dental
  services.                                          Women’s Health Program
                                                     • Promoted National Women’s Health Week.
Sudden Infant Death Syndrome                         • Provided educational resources to a variety of
• Provided education and information about             partners on women’s health.
  sudden infant death syndrome (SIDS) to
  health-care providers, clinics, birthing hospi-    Division Goals
  tals, local public health units and families who   • Promote healthy lifestyle choices through
  suffer a SIDS death.                                 education, awareness and partnerships.
• Collaborated with the Tobacco Prevention           • Continue to collect, analyze and report the
   and Control Program to develop an aware-             BRFSS data.
   ness campaign addressing the dangers of           • Provide training and technical assistance to
   secondhand smoke and SIDS.                          school nurses to promote health for children
                                                       and adolescents.
Title V/Maternal and Child Health (MCH)              • Work with coordinated school health partners
Block Grant                                            to provide training opportunities on best
• Awarded contracts for about $1.6 million to          practice school health models.
  nearly all local public health units, four         • Increase the number of schools that imple-
  nonprofit agencies and three American Indian         ment a coordinated school health model.           25
     • Expand the Cribs for Kids program.                             Injury
                                                          Division of Injury
     • Implement the Early Childhood Comprehen-
       sive Systems State Plan.                           Prevention and Control
     • Reduce the rate of unintended pregnancies.              The Division of Injury Prevention and
     • Continue to provide grant oversight for state      Control is dedicated to reducing the frequency
       funds awarded to the University of North           and severity of intentional and unintentional
       Dakota’s Fetal Alcohol Syndrome Center for         injuries to North Dakotans. Programs include:
       program activities.                                    • Injury/Violence Prevention
     • Continue to develop newborn screening                  • Child Passenger Safety
        program policies, protocols and fact sheets.          • Domestic Violence/Rape Crisis
     • Educate health-care professionals and the              • Suicide Prevention
        public about newborn screening.
     • Increase the number of pregnant women              Accomplishments
        receiving prenatal care in the first trimester.   Injury/Violence Prevention Program
     • Continue to educate pregnant women about           • Provided funding to eight domestic violence/
         healthy lifestyle choices.                         rape crisis agencies to implement and evalu-
     • Implement the school-based Healthy Smiles            ate plans for prevention of sexual violence in
        Fluoride Varnish and the Seal! ND programs.         their communities.
     • Foster partnerships to promote oral health         • Began to implement the State Intimate
        and improve access to dental care.                  Partner/Sexual Violence Prevention Plan
     • Increase awareness about the importance of           with the goals to build capacity for funding,
        preventive oral health care.                        collect data and partner with other agencies
     • Continue coordination of follow-up services          to work on statewide prevention strategies.
        for families who suffer SIDS deaths.              • Participated in the Graduated Driver’s
     • Provide SIDS information and education to            License Task Force to pass a bill in the 2011
        health-care providers, parents and caregivers.      legisative session. The bill wasn’t fully
     • Form and strengthen partnerships with                adopted, but many changes to the current
        families, American Indians and                      license bill for minors took effect.
        underrepresented populations.                     • Presented at statewide and national confer-
     • Form and strengthen a comprehensive system           ences and workshops.
       of age-appropriate screening, assessment           • Distributed bicycle safety information to
       and treatment for the MCH population (i.e.,          three agencies reaching 350 people. Provided
       Bright Futures).                                     each local public health unit with a CD that
     • Collaborate on women’s health issues and             contained an inclusive Bicycle Safety Activ-
26      disseminate women’s health information.             ity Kit for children.
• Distributed a new Consumer Product Safety          child passenger safety technicians.
  Commission Public playground guidelines          • Provided about 3,393 car safety seats to
  publication and a Home Playground publica-         parents of young children through approxi-
  tion to local public health.                       mately 40 car seat distribution programs.
• Chaired the North Dakota State Injury            • Coordinated or assisted with 153 car safety
  Prevention Coalition comprised of partners         checkups, inspecting 1,959 car seats.
  from other state agencies, private businesses,   • Compiled and analyzed car seat checkup data
  public health and private health care.             that showed five out of six car seats were
• Provided 27,108 stickers, 25,256 magnets,          used incorrectly in 2010. Of the seats
  and 16 videos concerning Poison Control to         checked, 87.8 percent had at least one error.
  110 agencies including day cares, hospitals,     • Assisted the U.S. Consumer Product Safety
  clinics, public health agencies, schools and       Commission with 20 product recall effective-
  other interested parties.                          ness checks.
• Prepared a new poison prevention brochure        • Distributed child passenger safety best
  that was distributed statewide.                    practice brochures statewide to agencies         The Child Passenger Safety Program works to
• Provided two Train-the-Trainer sessions for        working with parents/caregivers of children      educate parents about the importance of making
                                                                                                      sure their children always ride buckled up.
  Poison Prevention 101 in conjunction with          and to law enforcement. Continued to
  the North Dakota Safety Council. Each              provide child passenger safety technical
  participant was provided a toolkit for doing       assistance to certified child passenger safety
  presentations in the community and the             technicians, professionals and caregivers.
  workplace.                                       • Assisted with planning and implementing the
• Collaborated with other state agencies to          2010 Injury Prevention and Control Confer-
  provide information and expertise concerning       ence.
  ATV, farm, poison and playground safety and      • Created and provided educational materials
  falls prevention.                                  for Child Passenger Safety Month. Approxi-
                                                     mately 130 partners distributed the materials
Child Passenger Safety Program                       to schools and gave 1,455 presentations to
• Measured restraint use by children in 10           51,367 children.
  communities. Results showed restraint use by
  100 percent of infants (increase from 98.7),     Domestic Violence/Rape Crisis Program
  88.3 percent of toddlers (a decrease from        • Funded three centers for safe visitation with
  92.9), and 83.1 percent of children ages 6         and exchange of children in cases of domes-
  through 10 (an increase from 80.1).                tic violence, child abuse, sexual assault or
• Conducted seven national child passenger           stalking.
  safety certification courses and certified 78    • Provided state and federal funds to twenty-                                            27
        one domestic violence/rape crisis agencies     • Developed suicide prevention public aware-
       serving victims of domestic violence, sexual      ness TV and radio campaigns that ran twice
       assault and stalking.                             statewide, including the tribal areas in 2011.
     • Distributed STOP Violence Against Women         • Developed suicide prevention brochures and
       funds to law enforcement, judicial, victim-       posters as part of the awareness campaign
       service and other agencies that provide           and distributed them statewide.
       services to victims of violence.
     • Collaborated to update model law enforce-       Division Goals
       ment domestic violence policies.                • Continue working to reduce childhood
      • Collaborated to complete the North Dakota        injuries and deaths.
       Model Law Enforcement Sexual Assault            • Collaborate with state partners, the CDC and
       Policy.                                           others to increase program planning and
     • Provided legal assistance to victims seeking      evaluation to address sexual violence.
       to access the protection order process.         • Continue working to reduce domestic vio-
     • Awarded $812,000 in STOP Violence                 lence, sexual assault and stalking crimes
       Against Women Recovery Act Funds and              through grants, trainings and partnerships.
       projects completed in April 2011.               • Collaborate with Suicide Prevention Coalition
                                                         and local grantees to reduce suicides through
     Suicide Prevention Program                          prevention and early intervention efforts.
     • Collaborated with Mental Health America of      • Coordinate a statewide injury prevention
       North Dakota in order for the Suicide Pre-        conference every other year.
       vention Coalition to utilize their non-profit
       status as a mechanism to receive funding.
     • Completed three-year, $1.2 million Garrett
       Lee Smith Youth Suicide Prevention Pro-
       gram; established community-based programs
       in six areas of the state with high rates of
       youth suicide, including two rural and four
       tribal projects. Additional state funding was
       provided to supplement the federal proposed
       projects.
     • Provided state funding to four other agencies
       to provide prevention training in one tribal
       and three non-tribal areas of the state.
28
Division of Nutrition and                         • Provided training to the Local Vendor Coor-
                                                    dinators on their annual vendor duties, such
Physical Activity                                   as training, monitoring, renewing contracts,
     The Division of Nutrition and Physical         managing price surveys and handling new
Activity (NPA) supports growth and develop-         store applications.
ment; prevents overweight and obesity; and        • Implemented new food packages for all WIC
prevents and controls diabetes through pro-         participants that included adding fresh fruits
grams designed to improve healthful eating and      and vegetables, whole grains and baby food
physical activity. The vision of NPA is for all     fruits and vegetables and other changes and
North Dakotans to be physically active, eat         revisions. This project took over two years to
healthy foods, and live in communities that         complete and included researching and
support those behaviors. Programs include:          approving foods, developing materials for
    • Special Supplemental Nutrition Program        staff and participants, updating WICnet,
      for Women, Infants and Children (WIC)         revising policies and procedures, and training    The Division of Nutrition and Physical Activity
    • Maternal and Child Health Nutrition           staff.                                            emphasizes the importance of eating healthy
    • Healthy Communities                         • Used the WIC annual participant survey to         and being physically active.
    • Diabetes Prevention and Control               assess participant satisfaction with services,
    • Epidemiology                                  share any concerns with the new food pack-
    • Healthy People 2020                           ages and solicit ideas for nutrition education.
                                                  • Developed nutrition education cards, based
                                                    on input from local agency staff, focusing on
Accomplishments
                                                    the topics of healthy childhood weight, juice,
Special Supplemental Nutrition Program
                                                    low-fat milk, whole grains, starting cereal and
for Women, Infants and Children (WIC)
                                                    other baby foods, postpartum nutrition,
• Provided healthy food, nutrition education,
                                                    feeding toddlers, picky eaters and healthy
  breastfeeding support and referrals to more
                                                    snacks.
  than 41,000 women, infants and children.
                                                  • Continued to promote and support
• Tested and released multiple builds to
                                                    breastfeeding as the optimal method for
  WICnet, including upgrading the database
                                                    feeding children by offering the Grow and
  from SQL Server 2000 to SQL Server 2008,
                                                    Glow breastfeeding training for WIC staff,
  fixing over 100 system defects and making
                                                    supporting staff participation in the state-
  several enhancements to the system function-
                                                    wide biennial breastfeeding conference,
  ality. Also tested over 25 reports, including
                                                    offering training and technical support to the
  the approval of approximately 10 new
                                                    three breastfeeding peer counseling sites,
  reports going into production.
                                                    leading the HND Breastfeeding Committee                                                    29
       (statewide breastfeeding coalition) and           serving on breastfeeding coalitions and
       working with the Healthy Communities              promoting physical activity with Head Start,
       Program on the breastfeeding in the work-         and child care.
       place statewide initiative.
     • Added a new fruits and vegetable buying tips     Healthy Communities
       section to the monthly participant newsletter,   • Provided technical assistance and training to
       “Pick-WIC Paper,” which continues to be            13 Moving More, Eating Smarter community
       popular with WIC families.                         coalitions to support activities related to
     • Ensured program quality by developing staff        healthy eating and active living.
       professional capacity through trainings          • Provided technical assistance and training to
       offered in a variety of program areas like the     state and local partners on effective obesity
       new food packages, nutrition risk codes,           prevention strategies, with a focus on policy
       vendor management, breastfeeding promo-            and environmental change strategies.
       tion and support, and WICnet.                    • Established the Infant-Friendly Worksite
     • Prepared for WIC Electronic Benefit Transfer       Designation Program, recognizing businesses
       (mandated by 2020 for all states) by prepar-       that have established breastfeeding support
       ing an EBT planning grant application which        policies.
       was funded $370,500 for 30 months by the         • Promoted breastfeeding in the workplace
       U.S. Department of Agriculture.                    through television and online ads, print
                                                          materials, and displaying and presenting at
     Maternal and Child Health Nutrition                  various conferences.
     • Participated as a core team member in the        • Developed a breastfeeding website to share
       MCH Title V Block grant needs assessment           information with the public and partners.
       planning process and development of perfor-      • Trained child care consultants and providers
       mance measures for the next five years.            about increasing physical activity in child
     • Collaborated in the collection of BMI and          care settings.
       nutrition data from N.D. third graders in the    • Promoted physical activity in child care
       Oral Health Basic Screening Survey.                settings through television and online ads.
     • Developed the Healthy Eating and Physical
       Activity resolution for NDPHA and submit-        Diabetes Prevention and Control Program
       ted to NDPHA the request for nutrition to be     • Transitioned the partnership with BlueCross
       reinstated as an official section of NDPHA.        BlueShield of North Dakota from the North
       Both were approved.                                Dakota Diabetes Care Provider Report to a
     • Supported local public health nutritionists in     MediQHome system.
30     addressing healthier school environments,
• Provided technical assistance and consul-        Healthy People 2020
  tation to the Dakota Diabetes Coalition in       • Provided a framework for prevention by
  addressing diabetes prevention, access             adopting objectives designed to identify the
  and technology. Helped the Dakota                  most significant preventable threats to health.
  Diabetes Coalition receive and maintain          • Monitored state and national goals.
  its 501 (c) (3) status.
• Distributed prevention messages via              Division Goals
  magazines, newspapers, posters, television       WIC
  and printed materials to reach American          • Ensure that North Dakota WIC is ready for
  Indians, the elderly and the general public.       EBT by the 2020 deadline by working with
• Started a partnership with the Great Plains        stakeholders (staff, vendors, ITD, etc.) and
  Tribal Chairman’s Health Board and the             using the Vendor Advisory committee as a
  Indian Health Services to coordinate a             conduit to the vendor community.
  data-sharing agreement with the tribes           • Continue to provide quality nutrition services
  regarding diabetes audit data.                     to WIC participants by using participant-
• Redesigned the Diabetes Prevention and             centered counseling strategies and providing
  Control Program and the Dakota Diabetes            state-developed nutrition education materials.
  Coalition websites into one website that is      • Continue to provide vendors information on
  user-friendly and can be used as a resource        food product changes and WIC eligibility.
  for state partners.                              • Continue to work with the Healthy Communi-
                                                     ties Program on the North Dakota Depart-
Epidemiology                                         ment of Health’s breastfeeding in the work-
• Monitored and analyzed data to assess              place initiative, as well as promoting the
  disease prevalence, incidence and impact.          federal and state laws related to breastfeeding.
• Used performance indicators to monitor and       • Continue to support the WIC breastfeeding
  evaluate program progress and effectiveness.       peer counseling program.
• Responded to data requests from partners and     • Continue to help address obesity prevention
  the public; distributed data via reports, fact     through personalized nutrition education and
  sheets, presentations and websites.                counseling and referrals to appropriate health-
• Assisted partners with data for research,          care providers for additional services as
  community engagement, quality improvement          needed.
  and program evaluation.


                                                                                                        31
     Diabetes                                                 ways to address other breastfeeding promo-
     • Increase the number of patients being served           tion and support issues.
       by MediQHome and the number of providers             • Participate in Healthy North Dakota commit-
       participating in MediQHome to improve the              tees (including breastfeeding, coordinating,
       quality of care for those living with diabetes.        healthy eating/physical activity and early
     • Develop and maintain a comprehensive                   childhood) and other appropriate coalitions
        diabetes surveillance and evaluation system           and task forces to ensure nutrition and
       that includes the identification of disparities,       physical activity issues are represented.
       is accessible to partners, supports comprehen-       • Ensure the NPA coalitions, committees, etc.,
       sive data analysis, results in strategic interpre-     have broad and diverse representation among
       tation and dissemination of findings,                  the members.
       addresses programmatic goals and objectives          • Support work toward achieving the MCH
       and is utilized for planning, implementing and         national goals of increasing the percentage of
       evaluating Diabetes Prevention and Control             mothers who breastfeed their infants at
       Program activities.                                    hospital discharge and increasing the percent-
                                                              age of healthy-weight adults.
     All                                                    • Encourage healthier communities by collabo-
     • Address increasing childhood obesity rates by          rating with health-care providers, public
       encouraging physical activity and healthy              health, tribes and non-traditional partners to
       eating habits, encouraging physical activity           implement local policies and environmental
       and education in schools and child care                change to improve nutrition, increase physi-
       settings, promoting and supporting                     cal activity and reduce chronic diseases.
       breastfeeding, and promoting fruits and              • Monitor nutrition, physical activity and
       vegetables.                                            weight data, and assess need for additional
     • Continue to provide resources, information,            data sources.
       and training to NPA Program partners to
       build their capacity to provide quality educa-
       tion, information and services.
     • Continue to work with the Healthy North
       Dakota Breastfeeding Committee to dissemi-
       nate breastfeeding promotion and support
       information throughout the state, provide
       technical assistance to local breastfeeding
       coalitions and promote the infant-friendly
32     worksite designation program and explore
                                    Preparedness
                          Emergency Preparedness and Response Section
    The Emergency Preparedness and                 • Provides technical assistance to EMS ser-
Response Section is responsible for the               vices regarding patient care, system design,
planning and coordination of the public health       administration and operation issues.
and medical response to daily emergencies as       • Maintains data system with about 20,000
well as large-scale disasters.                       EMS certification and licensure records.
    The section consists of the following:         • Maintains ambulance run-report data system
    • Emergency Medical Services and Trauma          that adds about 65,000 records per year.
    • Hospital Preparedness                        • Provides critical incident stress debriefing
    • Public Health Preparedness                     services to EMS, law enforcement and fire
                                                     personnel engaged in EMS.
                                                   • Coordinates and maintains Emergency
Division of Emergency Medical                        Medical Services for Children Program.
                                                   • Inspects and licenses EMS training institu-
Services and Trauma                                  tions.
     The Division of Emergency Medical             • Approves continuing education curricula.
Services and Trauma is the lead agency for
North Dakota’s emergency medical services          Accomplishments
(EMS) system. The division conducts the            • Trained, tested and certified about 1,550 new
following activities:                                personnel and 3,300 existing personnel.          The Division of Emergency Medical Services
• Annually licenses 134 ground- and six air-         Courses included first responder, emergency      and Trauma provides training for the state’s
                                                                                                      emergency medical responders.
  ambulance services that meet standards for         medical technician, emergency medical
  service availability, equipment and training.      technician – intermediate and paramedic.
• Updates and maintains training, testing,         • Provided licensing and inspection services for
  certification and licensure programs for First     141 ambulance services.
  Responder, EMS basic and advanced life           • Conducted distance learning through a
  support personnel, including emergency             videotape-based library system that provides
  medical technicians and paramedics.                continuing education material to 250 sites.
• Administers an EMS grant program of              • Provided 34 critical incident stress
  $600,000 ($470,000 starting July 1, 2011)          debriefings to EMS personnel; conducted
   per year for training ambulance service           training for 366 EMS providers in healthy
  personnel.                                         stress-coping techniques.
• Administers a grant for “access-critical”        • Maintained a trauma system that designates
  ambulance services to assist with staffing.        43 trauma centers, develops trauma transport
• Implements and maintains a statewide trauma        plans, maintains a trauma registry, and trains
  system.                                            EMS and trauma center personnel.                                                       33
     • Conducted emergency medical services for         • Offer guidance and assistance to those
       children programs that advocate specialized        ambulance services who are dramatically
       training and recommend equipment for               affected by oil exploration and development.
       pediatric emergency care.
     • Awarded a total of $1.25 million in staffing
       grants to 38 rural ambulance services helping
                                                        Division of Hospital
       to ensure continuous availability to respond     Preparedness
       to medical and traumatic emergencies.                 The Division of Hospital Preparedness
     • Administered and assisted in the implementa-     facilitates emergency planning activities with
       tion of the Rural EMS Improvement Project        hospitals, long-term care facilities, emergency
       throughout the state ending June 30, 2011.       medical services and clinics. Through contracts
     • Provided guidance and education to EMS           with the North Dakota Healthcare Association
       Instructors throughout the state to adapt to     and the North Dakota Long Term Care Asso-
       new EMS Education Standards.                     ciation, the division encourages and assists
                                                        medical facilities to develop and exercise
     Goals                                              emergency response plans and to integrate
     • Maintain or strengthen EMS in rural North        response with the NDDoH’s emergency opera-
       Dakota through policymaking, technical           tions center.
       assistance and grant opportunities.
     • Improve rural EMS with a grant to develop        Accomplishments
       access-critical services that supplement         • Developed hospital evacuation and shelter-
       staffing. Strategies include:                      in-place plans.
       * Implementation of new grant-dispersal          • Integrated long-term care facilities into
          policies that focus on the most vulnerable      Hospital Preparedness Program activities.
          ambulance services.                           • Sponsored and coordinated Health and
       * Revision of licensure requirements to            Medical Emergency Preparedness Conference.
          facilitate regionalization of EMS services.
       * Development of quick-response units to         Goals
          replace struggling ambulance services,        • Strengthen facility capacity for management
          when appropriate.                               of mass fatalities.
     • Carry out the recommendations of the Rural       • Strengthen response partnership through
       EMS Improvement Project.                           education and training on specific response
     • Promulgate administrative rules based on           resources and capabilities.
       statutory changes made in the 2011 legisla-
34     tive session and other rules as needed.
Division of Public Health                         Goals
                                                  • Establish plans and acquire resources for
Preparedness                                        state medical shelters and pre-hospital staging
    The Division of Public Health Prepared-         areas.
ness coordinates emergency preparedness and       • Maintain secure state medical cache.
planning activities with local public health      • Maintain essential public health and medical
units and tribal nations. Through a partnership     emergency response and recovery infrastruc-
and contractual relationship, the division          ture.
establishes systems that enhance the ability of   • Continue development and enhancement of
public health to respond to emergencies in a        mass prophylaxis and countermeasure
manner that protects and restores the health of     distribution and dispensing operations.
North Dakotans.

Accomplishments
                                                                                                      The Emergency Preparedness and Response
• Coordinated public health response to 2010
                                                                                                      Section conducts exercises with partners across
  and 2011 spring floods, including establish-                                                        the state in an effort to ensure North Dakotans
  ment of medical shelters.                                                                           are protected during a public health emergency,
• Successfully implemented Department                                                                 including an influenza pandemic.
  Operations Center communications and
  activity during response.
• Acquired and implemented patient transpor-
  tation assets and electronic vehicle staging
  system.
• Established 100 percent rating for Strategic
  National Stockpile program.
• Acquired mobile clinic capacities in state
  medical cache.
• Established and exercised primary receiving,
  staging and storing site for mass prophylaxis
  and countermeasure distribution.




                                                                                                                                            35
                                    Medical Services Section
                                                   The goal of the Medical Services Section is    health-care providers and facilities, local public
                                               to prevent disease and disability in North         health units, and the public to reduce the
                                               Dakota. The section is responsible for disease     incidence of communicable diseases and help
                                               prevention, surveillance and identification, as    ensure the health of North Dakotans.
                                               well as epidemiologic investigation and foren-
                                               sic examinations.                                  Epidemiology and Surveillance Program
                                                   The section includes the following:                 The Epidemiology and Surveillance
                                                   • Disease Control                              Program works to strengthen collaboration
                                                   • State Epidemiologist                         between epidemiology, laboratory and health
                                                   • Forensic Examiner                            information system practices through the CDC
                                                                                                  Epidemiology and Laboratory Capacity Grant.
                                                                                                  The goal of this program is to increase disease
                                               Division of Disease Control                        surveillance and response, build epidemiology,
                                                     The Division of Disease Control identifies   laboratory and health information systems
                                               and analyzes disease trends and implements         infrastructure, provide training and education,
                                               appropriate intervention activities to reduce      and improve disease reporting systems.
                                               illness and death. The division also acts as a
                                               resource for health-care providers and the         Accomplishments
                                               public regarding public health issues and often    • Conducted enhanced surveillance and
The Medical Services Section works to safe-    works with the media to provide timely public        responded to the 2009 H1N1 influenza
guard all North Dakotans by reducing illness   education. Programs include:                         pandemic, including the follow-up of more
and death caused by infectious diseases.
                                                    • Epidemiology and Surveillance                 than 3,250 reported cases during the 2009-
                                                    • HIV/AIDS/Ryan White                           2010 influenza season.
                                                    • Immunization                                • Participated in Influenza Incidence Surveil-
                                                    • Sexually Transmitted Diseases and             lance Project to determine the incidence of
                                                      Hepatitis                                     medically attended influenza-like illness, as
                                                    • Tuberculosis                                  well as the incidence of influenza and other
                                                                                                    respiratory virus pathogens.
                                                    Health-care providers and laboratories        • Participated in a multi-state collaboration for
                                               statewide notify the division of mandated            evaluating a distributed model for influenza-
                                               reportable diseases. During the biennium,            like illness surveillance.
                                               division personnel collected information about     • Participated in multi-state investigation
                                               or conducted investigations into about 13,800        regarding Native American/Alaskan Native
                                               cases of reportable conditions. In addition,         increased mortality with 2009 H1N1 influ-
   36                                          division personnel work closely with private         enza virus and the investigation was pub-
   lished in the CDC’s Morbidity and Mortality      • Collaborated with the North Dakota State
   Weekly Report. The outcome of this publica-        University Veterinary Diagnostic Laboratory
   tion was the addition of Native Americans          on testing of equine and avian samples for
   and Alaskan Natives on the list of groups at       West Nile virus.
   increased risk for severe influenza.             • Developed a Healthcare-Associated Infections
• Investigated and responded to a rabid dog in        website.
   a North Dakota animal shelter in collabora-      • Completed the North Dakota Healthcare-
   tion with the Minnesota Department of              Associated Infections prevention plan and
   Health and the CDC and the investigation           manual.
   was published in CDC’s Morbidity and             • Hosted Healthcare-Associated Infection
   Mortality Weekly Report.                           trainings and developed educational materials.
• Facilitated surveillance of flood-related         • Developed case definitions for Carbapenem
   illnesses, injuries and deaths.                    Resistant Enterobacteriaceae (CRE) and imple-
• Implemented new electronic disease surveil-         mented a surveillance protocol.
  lance system called MAVEN.                        • Assisted a long-term care facility in the state The NDDoH encourages North Dakotans to take
• Completed migration of historical reportable        with a point prevalence survey for              precautions to avoid contracting West Nile virus.
   disease condition data into new electronic         Carbapenem Resistant Enterobacteriaceae
   disease surveillance system.                       (CRE).
• Developed tickborne disease website.              • Revised the North Dakota Department of
• Collaborated with the North Dakota Game             Health’s mandatory reportable conditions list
   and Fish Department, University of North           and created updated morbidity report cards.
   Dakota, and North Dakota State University        • Coordinated with the Division of Food and
   to conduct statewide tick surveillance that        Lodging and Division of Laboratory Services
   identified areas in the state with endemic         to host a foodborne outbreak investigation
   populations of the deer tick (tick that trans-     training for epidemiologists, laboratorians and
   mits Lyme Disease and other tickborne              environmental health inspectors.
   pathogens).                                      • Collaborated with the CDC on two multistate
• Collaborated with the Minnesota Department          outbreaks of Salmonella in Italian-style meats
   of Health, Wisconsin Department of Health          and eggs.
   and the CDC to investigate human infections
   with a newly identified Ehrlichiosis muris-      HIV/AIDS/Ryan White Programs
   like pathogen transmitted by ticks.              HIV/AIDS Prevention Program
• Developed tribal-specific public service              The mission of the HIV/AIDS Program is
   announcements concerning rabies exposure         to reduce and prevent transmission of HIV and
   and risk and about food safety.                  to reduce the associated illnesses and deaths of                                           37
     HIV-infected people. HIV prevention ser-           HIV/AIDS Surveillance Program
     vices are conducted at 30 contractual sites,           The HIV/AIDS Surveillance Program
     including local public health units, substance     monitors the incidence and prevalence of
     abuse treatment centers, college/university        HIV/AIDS in North Dakota residents through
     student health centers, family planning            active disease surveillance activities. North
     clinics, a homeless clinic and Community           Dakota statute has mandated HIV and AIDS
     Action Agencies. The services include HIV          reporting since 1984. The data collected
     testing, pre- and post-test risk-reduction         through surveillance activities assists in the
     counseling, partner notification, referrals,       planning of HIV policy and resource alloca-
     education and prevention case management.          tion.
                                                             North Dakota continues to have one of the
     Accomplishments                                    lowest incidence and prevalence of HIV/AIDS
     • Completed annual Comprehensive HIV               in the United States. From 1984 through June
       Prevention Plan in collaboration with the        30, 2011, 510 infections have been reported in
       North Dakota Community Planning Group.           the state.
     • Continued to implement a quality assurance
       (QA) program for the 30 state-funded HIV         Accomplishments
       counseling and testing sites. Compliance         • Updated the Epidemiological Profile for HIV.
       with written protocols, record keeping,          • Updated the policies and procedures manual.
       specimen collection and handling, appropri-      • Began using Maven for HIV case related data.
       ateness of services and referrals, and staff
       training and education are reviewed. To          Ryan White CARE Act Part B Program
       date, 19 sites have received a QA assess-             The Ryan White Program assists eligible
       ment and are doing an excellent job.             low-income HIV-positive North Dakota
     • Accomplished a 98 percent rate of HIV            residents in accessing and maintaining health
       results given at counseling and testing sites.   care and supportive services. Services available
     • Conducted a retreat for HIV positive indi-       include case management, financial assistance
       viduals that focused on increasing health        to obtain HIV medications and primary medi-
       knowledge and improving quality of life          cal services. As of June 30, 2011, there were
       utilizing a whole health approach.               105 clients receiving services through the Ryan
     • Provided HIV education and awareness at          White program.
       the Fargo and Bismarck Pride Fests.
                                                        Accomplishments
                                                        • Administered a Ryan White client satisfaction
38                                                        survey to all clients.
• Conducted client audits on all Ryan White       vaccine, 77 percent for meningococcal vaccine,
  clients to ensure the program is compliant      and only 26 percent of girls were up-to-date for
  with the federal rule of being “the payer of    human papillomavirus (HPV) vaccine in 2010.
  last resort.”                                   The goal for Healthy People 2020 is 80 percent
• Developed a tiered formulary for the AIDS       for each vaccine.
  drug assistance program.
• Updated the quality management plan.            Accomplishments
• Incorporated the Ryan White comprehensive       • Collaborated with BlueCross BlueShield of
  plan with the Comprehensive HIV Prevention        North Dakota, the University of North
  Plan.                                             Dakota and local public health units to bill
• Received award for innovation in program          insurance for vaccinations.
  during the poster session at the All Titles     • Worked to integrate the North Dakota
  Conference in Washington, D.C. for Optimizing     Immunization Information System (NDIIS)
  Existing Programs through Client Audits.          and electronic medical records.
                                                  • Utilized the media and coalitions to educate
Immunization Program                                about the importance of childhood immuni-
    The Immunization Program works to               zations.
ensure that children and adults are protected     • Implemented upgrades to the NDIIS, includ-
against vaccine-preventable diseases. Program       ing adding forecasting and reminder/recall for
staff investigate cases of vaccine-preventable      immunizations.
diseases, provide education to providers and      • Held a statewide immunization conference in
the public, monitor immunization rates, man-        2010 with more than 300 providers in atten-
age the federal Vaccines For Children (VFC)         dance.
program and maintain the North Dakota             • Implemented the new 13-valent pneumococ-         The Immunization Program works to ensure
                                                                                                     that children receive lifesaving vaccinations.
Immunization Information System (NDIIS).            cal vaccine.
     The National Immunization Survey (NIS)       • Conducted site visits at 70 percent of
estimates that 77.6 percent of North Dakota         enrolled providers in the state.
children ages 19 to 35 months were up-to-date     • Investigated the first case of measles in the
on their immunizations (DTaP, polio, MMR,           state since 1987.
haemophilus influenzae type B, hepatitis B,       • Coordinated the North Dakota Immunization
chickenpox, and pneumococcal) in 2010. The          Advisory Committee.
goal for Healthy People 2020 is 80 percent.       • Responded to a national shortage of
     The NIS estimates that 83 percent of            Haemophilus influenzae type B vaccine.
North Dakota adolescents were up-to-date on       • Provided tetanus-containing vaccines to
tetanus, diphtheria, and pertussis (Tdap)           uninsured and underinsured adults in response                                            39
                                                 to flooding.                                        who are at risk and unable to pay.
                                               • Coordinated the H1N1 influenza vaccination       • Followed-up or investigated nearly 5,000
                                                 effort during the 2009-2010 pandemic,              cases of chlamydia, gonorrhea and syphilis.
                                                 including distribution of vaccine, provider      • Screened more than 33,000 females and
                                                 and public education and promotion.                7,000 males for chlamydia and gonorrhea.
                                               • Assisted in the response to flooding in the      • Established expedited partner therapy to
  www.ndhealth.gov/knowyourrisk                  Red River Valley, Minot and Bismarck/              improve services and access to treatment.
                                                 Mandan, including staffing a hotline to          • Performed data quality control of STD data
                                                 respond to questions about tetanus and             in the electronic disease surveillance system.
                                                 providing tetanus-containing vaccine to          • Developed a new educational STD brochure
                                                 uninsured and underinsured adults.                 for statewide distribution.
                                               • Presented at national conferences, including
                                                 the National Immunization Conference,            Viral Hepatitis Program
                                                 Association of Immunization Managers                  The goal of the Viral Hepatitis Program is
                                                 Conference, American Immunization Registry       to reduce and prevent the transmission of viral
                                                 Association Regional Forum and the Ameri-        hepatitis and associated illnesses, including
                                                 can Public Health Association Conference.        cirrhosis and liver cancer. Eleven sites are
                                                                                                  contracted to provide testing, counseling,
                                               STD Program                                        referrals, vaccinations and education.
                                                   The goal of the Sexually Transmitted
The department’s HIV/AIDS, STD and Viral       Disease (STD) Program is to prevent and            Accomplishments
Hepatitis programs provide services designed   control the spread of sexually acquired infec-     • Updated the Viral Hepatitis Epidemiology
to reduce and prevent the transmission of      tions. Staff members provide education,              Profile.
STDs and to reduce illnesses and deaths of                                                        • Coordinated educational campaigns for
                                               partner notification, and referral for screening
North Dakotans infected with STDs.
                                               and clinical services. Program staff provide         American Indians, veterans and the public.
                                               technical assistance and issue guidance regard-    • Provided hepatitis counseling training for
                                               ing prevention, testing and treatment of STDs.       HIV/hepatitis C counselors.
                                                                                                  • Performed data quality control of the elec-
                                               Accomplishments                                      tronic disease surveillance system.
                                               • Continued to provide free chlamydia, gonor-
                                                 rhea and syphilis medication for infected        Tuberculosis Program
                                                  people and their partners unable to pay.            The Tuberculosis (TB) Program works to
                                               • Provided free examinations, testing and          prevent, control and eliminate TB in North
                                                  counseling in six North Dakota cities for       Dakota. Program activities include identifying
   40                                             chlamydia, gonorrhea and syphilis to patients   and reporting all cases of active TB, ensuring
completion of treatment, identifying and          • Increase partner follow-up of HIV-positive
screening all people who have had contact with        individuals.
infectious cases of TB and offering laboratory    • Develop a medication adherence plan for
services.                                           Ryan White Program clients.
    TB continues to be a labor intensive          • Continue conducting biennial client audits
program requiring long term, directly observed       to continue to ensure the Ryan White Pro-
therapy for active disease and close monitoring      gram is “the payer of last resort.”
of preventive therapy. In addition, cases tend    • Ensure all Ryan White Program clients that
to occur in populations that present challenges      do not have insurance, Medicaid or Medicare
which include substance abuse, homelessness          apply for the pre-existing condition insurance
and language barriers. Drug resistant TB also        plan.
remains a concern.                                • Increase immunization rate for children 19
     TB continues to be a disease of low inci-       months to 35 months to 90 percent.
dence in the state, with seven cases being the    • Increase immunization rates for adolescents
average annual number of reported cases              to 90 percent for Tdap, meningococcal and
between 2006 and 2010.                               HPV.
                                                  • Collaborate with stakeholders and connect
Accomplishments                                      the NDIIS to electronic medical records
• Continued to hold TB advisory board meeting        throughout the state.
  twice a year.                                   • Connect the NDIIS to CDC’s new online
• Completed the final draft of the TB elimina-       vaccine ordering system, VTrcks.
  tion plan and TB outbreak plan.                 • Ensure accountability for vaccines supplied
• Investigated a cluster of TB in northeastern       through the federal VFC program.
  North Dakota and one case of drug-resistant     • Develop strategic plan for Viral Hepatitis
  TB.                                               Program.
• Worked with 2011 legislature to update the      • Ensure data quality in electronic disease
  TB control statute.                               surveillance system.
                                                  • Conduct quality assurance site visits for TB
Division Goals                                       programs at local public health units.
• Develop a new HIV state plan in coordination    • Conduct an annual training and educational
  with federal guidelines.                           meeting for TB nurses.
• Identify more avenues to utilize rapid HIV      • Coordinate and participate in the HIV/TB/
   testing in high-risk populations.                STD/Hepatitis Symposium.
• Continue to increase HIV education and          • Promote rapid treatment of diagnosed cases
  awareness in North Dakota.                        of STDs.                                          41
        • Ensure rapid notification of partners for        conduct tick surveillance, which documented
          syphilis and gonorrhea.                          the tick that transmits Lyme disease is well
        • Provide health-care providers with accurate,     established in northeastern North Dakota.
          updated information regarding the diagnosis,   • Participated in continued injury and illness
          treatment and management of STDs.                surveillance during statewide flooding.
                                                         • Collaborated with partners to assess injuries
                                                           and illnesses related to energy development.
     State Epidemiologist                                • Conducted multiple educational programs,
          The state epidemiologist coordinates epide-      news conferences and issued several news
     miological studies, investigations and surveil-       releases before, during and after the 2009
     lance activities; conducts data analysis; and         H1N1 influenza pandemic.
     provides technical expertise and consultation.
     Additional responsibilities include collaborating
     on disease surveillance, control, prevention and    Goals
     health intervention activities and providing        • Increase the number of national, local and
     information to health-care providers, commu-          private laboratories reporting electronically.
     nity organizations and the media.                   • Improve epidemiological assistance to Indian
                                                           Health Service (IHS), tribal health clinics and
                                                           Great Plains Tribal Health Board.
     Accomplishments                                     • Evaluate electronic reporting to identify
     • Co-authored rabies outbreak, H1N1 among             areas of improvement.
       American Indians, and West Nile virus             • Increase surveillance for occupational health
       articles for Morbidity Mortality Weekly Report.     related data.
     • Co-authored West Nile virus article in Public     • Provide epidemiological consultation to
       Health Reports.                                     Department of Health personnel, private
     • Co-authored Cipro-resistant meningitis article      providers, and the public.
       in New England Journal of Medicine.
     • Presented at Council of State and Territorial
       Epidemiologist’s conference on increased
       influenza risks among N.D. American Indians.
     • Provided several poster presentations at
       various conferences.
     • Served as Region VIII director, National
       Association of Vector-Borne Disease Control
       Officials.
42   • Collaborated with two state universities to
State Forensic Examiner                              Goals
     The role of the state forensic examiner is to   • Pursue adequate system to handle the signifi-
provide medical examiner services to county            cantly increasing caseload.
coroners and law enforcement officials in the        • Continue to provide educational activities
investigation of sudden and unexpected deaths          including periodic statewide seminars for
in North Dakota.                                       county coroners, law enforcement officers
     Once a case has been referred to the state        and other officials involved with death
forensic examiner, the body is brought to              investigations.
Bismarck for an autopsy. Services provided           • Continue to perform duties and to provide
include autopsy or examination of the body,            vital information to county coroners, law
photographic documentation, toxicology                 enforcement personnel, public health officials
analysis, collection of evidence, follow-up            and families of the deceased in an effective,
with investigating agencies, certification of          timely and courteous manner.
cause and manner of death, and court testi-          • Continue to participate in planning and
mony as needed.                                        preparedness for mass fatality events.
                                                     • Achieve certification by national accrediting
Accomplishments                                        organization.
• Accepted 598 cases during the biennium (an
  increase of 9% over previous biennium);
  performed autopsies and examinations.
• Provided education statewide to law enforce-
  ment officers, county coroners and other
  agencies involved in death investigations.
• Participated in the North Dakota Child
  Fatality Review Panel, the Mass Fatalities
  Incident Response Course and the National
  Disaster Medical System.
• Received referrals of cases from all geo-
  graphical areas of the state, with local county
  coroners responding very favorably to avail-
  ability of forensic examiner services.
• Worked toward an expanded role for the state
  forensic examiner in a statewide death
  investigation system that includes centralized
  reporting of all suspicious and violent deaths.                                                       43
                                Health Resources Section
                                                    The Health Resources Section consists of       Division of Health Facilities
                                                the divisions of Health Facilities, Food and
                                                Lodging and Life Safety and Construction. The            The Division of Health Facilities strives to
                                                section works to promote quality care and          ensure that North Dakota’s inpatient care
                                                services for the people of North Dakota by:        facilities and outpatient programs and staff
                                                • Licensing inpatient and outpatient health-       provide services consistent with generally
                                                  care facilities, basic-care facilities, home-    accepted practice and meet applicable health-
                                                  health agencies and hospice programs.            care standards.
                                                • Licensing and inspecting restaurants, bars,
                                                  lodging facilities, mobile-home parks, camp-         The division licenses the following:
                                                  grounds, bed-and-breakfast facilities, retail    • General acute, primary care and specialized
                                                  food stores, meat markets, bakeries, and           hospitals – 50
                                                  assisted-living facilities (food services and    • Nursing facilities – 84
                                                  building safety).                                • Home-health agencies – 27
                                                • Licensing and inspecting tanning and body        • Hospice programs – 15
The Division of Health Facilities conducts        art establishments and electrologists.           • Basic-care facilities – 67
surveys of nursing homes to ensure the safety   • Conducting certification surveys of all
and health of residents.
                                                  facilities and programs that provide service          The division certifies the following:
                                                  to people eligible for the federal Medicare      • Long-term care nursing facilities – 84
                                                  and Medicaid programs; certification is          • Hospitals, including swing beds and general
                                                  voluntary but required for the provider to         acute services – 32 critical access hospitals;
                                                  receive payment through Medicare and               one psychiatric hospital and two transplant
                                                  Medicaid.                                          hospitals
                                                • Certifying clinical laboratories that test       • Intermediate-care facilities for the mentally
                                                  human body substances for medical purposes.        retarded – 67
                                                • Administering alternative health-care projects   • Home-health agencies – 21
                                                  program and nurse aide training and compe-       • Hospice programs – 14
                                                  tency evaluation programs and registry.          • Rural health clinics – 58
                                                • Conducting onsite inspections of new con-        • State-surveyed clinical laboratories – 61
                                                  struction and remodeling in health-care          • Ambulatory surgical centers – 12
                                                  facilities licensed by the Division of Health    • End-stage renal dialysis units – 16
                                                  Facilities.                                      • Portable X-ray units – 1
                                                                                                   • Comprehensive outpatient rehabilitation
                                                                                                     facility – 1
    44                                                                                             • Psychiatric residential treatment facilities – 6
     Staff members conduct periodic surveys to       with the state’s provider associations. The
determine compliance with state licensure            workshops focused on care-related services
requirements and federal certification Condi-        identified through the survey process.
tions of Participation or Conditions of Cover-     • Maintained state approval for 33 paid feeding
age contained in Title XVIII (Medicare), Title       assistant programs to assist with nourishment
XIX (Medicaid) and the Clinical Laboratory           and hydration of dependent long-term care
Improvement Amendments of the Social                 residents.
Security Act. In addition, the division is re-     • Developed and implemented an online nurse
sponsible for investigating quality-of-care          aide registry that allows name and address
complaints.                                          changes and online renewals.
     The licensure and certification surveys are   • Maintained website to house program-specific
conducted by surveyors who represent a wide          information accessible by the public.
range of professional disciplines, including
clinical laboratory scientists, licensed social    Goals
workers, licensed registered dietitians, regis-    • Maintain the average survey interval of 12
tered nurses, physical therapists, speech thera-     months or less for long-term care facilities.
pists and qualified developmental disabilities     • Address complaints in a manner consistent
professionals.                                       with federal and state guidelines.
     The division approves nurse aide training     • Ensure that new surveyors receive adequate
and competency evaluation of 56 programs             training to pass the national Surveyor Mini-
plus 15 medication assistant training programs       mum Qualifications Test on the first attempt.
consistent with state licensing rules and/or       • Certify critical access hospitals as permitted
federal certification requirements for long-term     by the federal Rural Hospital Flexibility Act.
care facilities. The department’s nurse aide       • Promote consistency in the survey process.
registry maintains a record of individuals who     • Train all long-term survey staff to use the
successfully complete an approved competency         quality indicator survey (QIS) process. The
evaluation.                                          QIS process incorporates the use of com-
                                                     puter software to standardize and increase
Accomplishments                                      the consistency of the survey process for all
• Continued to convene quarterly meetings of         long-term care facilities.
  the Long Term Care Advisory Committee,           • Transition the nurse aide registry and billing
  which consists of representatives from the         system to the Department of Health.
  long-term care community and other stake-
  holders.
• Conducted several workshops in conjunction                                                          45
                                                  Division of Food and Lodging                          Accomplishments
                                                                                                        • Conducted more than 6,557 inspections of
                                                       The Division of Food and Lodging is                licensed facilities.
                                                  responsible for protecting public health through      • Continued standardization of local public
                                                  licensing and inspection of 578 restaurants,            health inspectors.
                                                  397 bars and limited restaurants, 479 lodging         • Drafted administrative rule changes for the
                                                  facilities, 578 mobile-home parks and camp-             state food code, assisted living facilities and
                                                  grounds, 67 bed-and-breakfast facilities, 586           bed and breakfasts.
                                                  retail food stores, 48 meat markets, 23 baker-        • Stayed current in plan reviews and pre-
                                                  ies, 64 assisted-living facilities, five tattoo/        operational inspections with the heavy,
                                                  body art facilities, 112 tanning facilities, and 19
                                                                                                          increased workload affiliated with new food
                                                  electrologists. Inspection procedures ensure
                                                                                                          and lodging facilities in oil country.
                                                  that these licensed establishments meet both
                                                  sanitation and certain fire/life safety standards
                                                                                                        Goals
                                                  before opening to the public and while in
                                                                                                        • Update memorandums of understanding with
                                                  operation.
                                                                                                          local public health units.
The Division of Food and Lodging protects the          Under an agreement with the Department
                                                                                                        • Continue to standardize local public health
public’s health by inspecting restaurants to      of Human Services, staff members also license
                                                                                                          unit inspector procedures.
ensure the food is cooked and handled properly.   and inspect 23 preschools and day-care centers
                                                                                                        • Continue exploring the possibility of posting
                                                  that prepare food. In addition, staff members
                                                                                                          inspection results for various facilities on
                                                  license and inspect 70 schools and migrant
                                                                                                          department website.
                                                  food-service sites through an agreement with
                                                                                                        • Finalize rule adoption for changes to the state
                                                  the Department of Public Instruction. The
                                                                                                          food code, assisted living facilities and bed
                                                  division provides educational courses in safe
                                                                                                          and breakfast facilities.
                                                  food handling, reviews plans for new establish-
                                                  ments and extensive remodeling projects, and
                                                  helps investigate possible foodborne illness
                                                  outbreaks.
                                                       The division serves as the U.S. Food and
                                                  Drug Administration’s liaison in the state on
                                                  issues related to manufactured food, adulter-
                                                  ated and misbranded food, and food recalls.



    46
Division of Life Safety and                           Accomplishments
                                                      • Created the Division of Life Safety and
Construction                                            Construction. The Life Safety Code Program,
      The focus of the Division of Life Safety &        which was previously located within the Divi-
Construction is to protect and safeguard the           sion of Health Facilities, was moved to this new
citizens of North Dakota by ensuring a safe             division.
environment for the elderly and disabled living       • Created the construction inspection program
in institutional settings.                              after approval and funding from the 2009
      Several types of health-care facilities are       legislature.
required to meet specific construction and Life       • Hired and trained staff to complete the work
Safety Code (fire safety) requirements in order         of the division.
to be licensed and participate in the Medicare/
Medicaid programs. Life Safety Code surveys           Goals
are done in the following types of facilities:        • Continue working to solidify the structure of
                                                                                                             The Division of Life Safety and Construction
nursing facilities, hospitals, critical access           the division                                        helps to ensure a safe environment for the
hospitals, basic care facilities, ambulatory          • Work to improve the delivery of services to          elderly and disabled living in institutional
surgical centers, end stage renal dialysis units        our customers (Centers for Medicare and Med-         settings.
and intermediate care facilities for the intellec-      icaid Services, health-care providers, architects,
tually disabled.                                        engineers, contractors and the public).
     The division also reviews construction
plans and specifications for licensed health-
care facilities for compliance with licensing and
construction standards. Construction inspec-
tions are conducted to verify compliance with
these standards. Additions, remodeling and
installations in nursing facilities, hospitals,
critical access hospitals and basic care facilities
require review and approval.




                                                                                                                                                     47
                                  Special Populations Section
                                          Populations
                                                     The Special Populations Section works to        • Information Resource Center
                                                improve access to medical services for indi-         • Children with Special Health Care Needs
                                                viduals and families in North Dakota through           Service System
                                                (1) assistance to help pay for evaluation and        • State Systems Development Initiative
                                                treatment of children with special health-care
                                                needs and for support of their families; (2)      Accomplishments
                                                assessment of inequities in health status and     Specialty Care Diagnostic and Treatment
                                                utilization and support of programs that strive   Program
                                                to eliminate health disparities; and (3) assis-   • Assisted more than 300 families each year to
                                                tance to communities to plan and sustain high-      pay for medical services for their eligible
                                                quality health-care systems, especially in          children, helping to ensure early diagnosis
                                                underserved areas.                                  and access to specialty care.
                                                     The section consists of the following:       • Administered a special program for children
                                                     • Division of Children’s Special Health        with Russell-Silver Syndrome.
                                                       Services                                   • Continued to collaborate with the North
                                                     • Primary Care Office                          Dakota Medicaid Program in the develop-
                                                     • Office for the Elimination of Health         ment of the new Medicaid Management
                                                       Disparities                                  Information System.
                                                                                                  • Revised and updated the CSHS eligibility and
                                                                                                    claims procedures manual.
                                                            Children’
                                                Division of Children’s Special
                                                Health Services                                   Multidisciplinary Clinics
                                                      The Division of Children’s Special Health   • Supported multidisciplinary clinics coordinat-
                                                Services (CSHS) provides services for children      ing management of chronic health conditions
The Division of Children’s Special Health       with special health-care needs and their fami-
Services provides services for children with                                                        for about 1,100 children each year.
special health-care needs and their families.   lies and promotes family-centered, community-     • Disseminated an annual clinic directory to
                                                based, coordinated services and systems of          about 2,000 providers across the state.
                                                health care. Programs include:                    • Incorporated use of “Ages and Stages” ques-
                                                     • Specialty Care Diagnostic and Treatment      tionnaires in cleft lip and palate clinics to
                                                       Program                                      enhance monitoring of young children’s
                                                     • Multidisciplinary Clinics                    physical, social and emotional development.
                                                     • Metabolic Food Program
                                                     • Russell-Silver Syndrome Program
   48                                                • Care Coordination Program
Metabolic Food                                       Children with Special Health Care Needs
• Provided metabolic food and low-protein            Service System
  modified food products for about 25 indi-          • Continued partnering with the North Dakota
  viduals who have phenylketonuria (PKU)               Center for Persons with Disabilities
  and maple syrup urine disease (MSUD).                (NDCPD) to implement early hearing detec-
• Provided informational support to                    tion and intervention grants.
  policymakers and Medicaid staff regarding          • Participated on more than 30 committees
  coverage of disease-specific formula (medi-          advocating for a community-based system of
  cal food) for individuals with inborn errors of      services for families, children and youth with
  metabolism.                                          special health-care needs.
                                                     • Partnered with the NDCPD on Integrated
Care Coordination                                      Services grant activities focusing on medical
• Provided technical assistance and training to        home, healthy transition and family partner-
  local staff to enhance delivery of CSHS              ships.
  programs.                                          • Added a module to the early hearing detec-
• Funded care coordination services through            tion and intervention web-based information
  medical home pilot practices serving children        system that enables physicians to access
  and youth with special health-care needs.            infant hearing test results.
                                                     • Enhanced family partnerships by supporting a
Information Resource Center                            CSHS Family Advisory Council, family
• Completed review of the information re-              leadership training opportunities, and devel-
  source center to ensure materials provided           opment of a family support network.
  are current and of good quality.
• Provided funding to Family Voices of North         State Systems Development Initiative
  Dakota to support health information and           • Developed and disseminated the following
  education center activities.                         reports: North Dakota Birth Defects Moni-
• Developed and disseminated three condition-          toring System Summary Report 2001-2005,
  specific resource booklets.                          North Dakota Five-Year Needs Assessment
• Provided requested health information that           (2011-2015) for the Maternal and Child
  linked families to needed services and               Health Services Title V Block Grant Pro-
  resources through a variety of strategies (e.g.,     gram, and North Dakota Five-Year Needs
  outreach mailings, toll-free number, e-mail,         Assessment (2011-2015) for the Maternal
  website, Facebook, etc.).                            and Child Health Services Title V Block
                                                       Grant Program Executive Summary.
                                                                                                        49
                                             • Maintained the North Dakota Birth Defects        • Disseminate results of a comprehensive five-
                                               Monitoring System.                                 year needs assessment and actively engage
                                             • Helped conduct a comprehensive Title V             partners in collaborative work efforts to
                                               needs assessment and planning process for          improve the health of North Dakota’s
                                               the maternal and child health population.          maternal and child population.
                                                                                                • Continue monitoring health status of the
                                             Division Goals                                        maternal and child health population.
                                             • Provide direct services to 2,000 children each
                                               year.
                                             • Continue eligibility and claims payment for
                                               children enrolled in the Specialty Care
                                               Diagnostic and Treatment Program while           Primary Care Office
                                               transitioning to the new Medicaid Manage-            The Primary Care Office is responsible for
                                               ment Information System.                         providing technical assistance and
                                             • Expand multidisciplinary clinic services         administrative support to communities to help
                                               available within the state.                      maintain local health-care infrastructures.
                                             • Work with partners to expand coverage of         Duties include:
                                               disease-specific formula and low-protein         • Designating workforce-shortage areas.
                                               modified food products for individuals with      • Managing dental, physician, advanced-
                                               inborn errors of metabolism.                       practice nursing and veterinary loan repay-
                                             • Collaborate with partners to promote avail-        ment programs.
                                               ability of health benefits counseling services   • Managing the J-1 Visa Waiver program for
The Primary Care Office manages loan           for children and youth with special health-        foreign medical graduates.
repayment programs that help place             care needs.
physicians, dentists and other health-care
                                                                                                • Promoting the development of Federally
                                             • Enhance daily operations of the Information        Qualified Community Health Centers.
providers into North Dakota communities.
                                               Resource Center by using electronic outreach     • Partnering with the UND School of Medicine
                                               and information dissemination.                     and Health Sciences (Center for Rural
                                             • Support initiatives that lead to a community-      Health) to administer the National Health
                                               based system of services for children with         Service Conference in North Dakota.
                                               special health-care needs. Focus areas include   • Serving on the North Dakota Oral Health
                                               screening, medical home, family partnership        Coalition and Health Disparities Committee
                                               and satisfaction, adequate insurance, commu-       to improve access to oral health services and
                                               nity-based service systems, and transition.        reduce health disparities.
 50
Accomplishments                                    Office for the Elimination of
• Placed five physicians, four midlevel practi-
  tioners, six dentists and six veterinarians in   Health Disparities
  North Dakota communities through the                   The Office for the Elimination of Health
  dental, physician, advanced-practice nursing     Disparities was established in July 2007, with a
  and veterinarian loan repayment programs.        mission to provide leadership to raise the
• Placed 20 foreign medical doctors in areas of    awareness of and to eliminate health disparities
  need through the J-1 Visa Waiver program.        affecting North Dakota citizens. The vision of
• Continued support of Federally Qualified         the office is health equity for all North Dako-
  Community Health Centers serving 11              tans. In order to fulfill its mission, the office
  North Dakota communities.                        works to address quality care in health status,
                                                   utilization or access due to structural, financial,
Goals                                              personal and cultural barriers.
• Place six dentists, eight physicians, eight
  midlevel practitioners, six veterinarians
  and 10 foreign physicians in areas of need.      Accomplishments
• Award four dentists with grants to practice in   • Expanded membership of the Health
  underserved areas.                                 Disparities Committee.
• Designate six dental shortage areas.             • Expanded the network of stakeholders to
• Conduct six community meetings for the             include partnerships with tribal, state, federal,
  development of Federally Qualified                 and local health agencies; the Great Plains
  Community Health Centers.                          Tribal Chairmen’s Health Board; Northern
• Serve on health policy committees.                 Plains Tribal Epidemiology Center; Office of
• Develop two Community Health Centers.              Minority Health, Region VIII Office; and the
                                                     Migrant Services Network.
                                                   • Increased the online library holdings.
                                                   • Developed website located at
                                                      www.ndhealth.gov/oehd.
                                                   • Sponsored two North Dakota Tribal Forums
                                                     on Health Disparities in partnership with
                                                     tribal leaders, and state and federal agencies.
                                                   • Expanded partnerships with tribal diabetes,
                                                     emergency preparedness and dental programs.

                                                                                                         51
                                                      Goals                                            • Expand partnerships to include private
                                                      • Increase awareness of health disparities.        medical providers, migrant services and tribal
                                                      • Strengthen leadership at the community,         programs.
                                                        local and state levels for addressing health   • Strengthen health care through collaboration
                                                        disparities.                                     and coordination of culturally-appropriate
                                                      • Improve coordination and utilization of          and integrated programs; addressing the
                                                        evidence-based promising practices with          changing health needs of tribes, rural resi-
                                                        evaluation.                                      dents and the elderly; and ensuring the
                                                      • Seek permanent funding for the Office for        development of programs.
                                                        Elimination of Health Disparities.




The vision of the Office for the Elimination of Health
Disparities is to achieve health equity for all people.




   52
                                                    Environmental Health Section
     To safeguard North Dakota’s air, land and      management activities, emergency response
water resources, the Environmental Health           efforts and funding requests.
Section’s five divisions work with federal               The section supports local responders, the
agencies (e.g., Environmental Protection            department’s Emergency Preparedness and
Agency, Department of Agriculture, Centers          Response Section and the Department of
for Disease Control and Prevention, Nuclear         Emergency Services during initial response to
Regulatory Commission, and Food and Drug            environmental incidents. The section custom-
Administration), special interest groups, local     arily takes the lead role in post-emergency
governments, health-care providers, veterinar-      environmental clean-up activities.
ians and the citizens of the state.                      The section chief ’s office coordinates the
     Staff members deal with issues that affect     annual state/EPA agreement, which defines
the comfort, health, safety and well-being of all   the scope of environmental program responsi-
North Dakota citizens and their environment.        bilities and commitments.
Compliance with state and federal environmen-            An assistant attorney general assigned to
tal laws is accomplished through permitting,        the section chief ’s office provides legal counsel
inspecting, sampling, analytical services and       to the section and assistance with enforcement       The Environmental Health Section protects the
monitoring activities. Laboratory services          procedures regarding violations of state envi-       public’s health by safeguarding the quality of
ensure a rapid response to public health threats.   ronmental laws. During the biennium, this            North Dakota’s air, land and water resources.
     An important section goal is to maintain       involved resolving violations of air, water
delegation of all federal environmental pro-        pollution, hazardous waste and solid waste
grams for North Dakota and to ensure that the       management statutes and rules.
regulated community complies with state                  The section encourages public participation
environmental statutes.                             through opportunities for public comment,
     The Environmental Health Section consists      public hearings and the establishment of ad
of the following divisions:                         hoc task forces and advisory groups.
     • Air Quality
     • Waste Management
     • Municipal Facilities
     • Water Quality
     • Laboratory Services
     Division activities are coordinated by the
section chief ’s office. Employees oversee
quality assurance procedures; help coordinate
public information efforts; assist with staff
training; and coordinate computer and data                                                                                                      53
                                                   Division of Air Quality                              indoor air quality concerns, as well as imple-
                                                                                                        menting a public awareness and education
                                                        The Division of Air Quality consists of
                                                                                                        program concerning these health risks.
                                                   two major programs responsible for protecting
                                                   the state’s air quality resources and for ensuring
                                                   control of radiation. Staff scientists, meteo-       Accomplishments
                                                                                                        • Maintained attainment status for all state and
                                                   rologists, engineers and technicians also pro-
                                                                                                           national Ambient Air Quality Standards.
                                                   vide technical assistance during environmental
                                                                                                        • Worked to ensure that North Dakota meets
                                                   emergencies.
                                                                                                           all federal ambient air quality standards
                                                   Air Pollution Control Program                           during the 2009-2011 biennium, one of only
                                                        The Air Pollution Control Program is               10 states to do so.
                                                   responsible for protecting and fostering the         • Evaluated 128 applications for Permits to
                                                   state’s air quality resources. The program              Construct to determine effects on air quality,
                                                   promotes clean air activities and initiates             including ethanol plants, grain elevators,
                                                   enforcement actions to correct air pollution            natural gas processing facilities and compres-
                                                   problems.                                               sor stations.
                                                        Program staff members’ primary responsi-        • Responded to and assisted in the mitigation
North Dakota is one of only 10 states that met     bilities include evaluating permit applications,        of environmental and public health emergen-
all federal ambient air quality standards during
the 2009-2011 biennium.                            conducting computer modeling of potential               cies involving industrial mishaps, flood
                                                   impacts to air quality, issuing permits that            evacuations and medical supply distribution.
                                                   restrict emission levels to ensure that standards    • Distributed environmental information to the
                                                   are met, inspecting facilities to ensure compli-        public and provided education and outreach
                                                   ance, investigating air pollution complaints,           on a variety of environmental issues by
                                                   and operating a statewide ambient air quality           holding public information meetings, sched-
                                                   monitoring network.                                     uling discussion sessions with local public
                                                                                                           health units, and participating in college and
                                                   Radiation Control and Indoor Air Quality                other agency seminars.
                                                   Program                                              • Finalized the State Implementation Plan for
                                                       The Radiation Control and Indoor Air                Regional Haze.
                                                   Quality Program performs two major functions:        • Updated Radiological Health Rules to reflect
                                                   (1) monitoring the development and use of              the latest technology used in the state and
                                                   ionizing and nonionizing radiation sources to          adopted the Nuclear Regulatory Commission
                                                   protect the health and safety of North Dako-           rules by reference.
                                                   tans and the environment and (2) evaluating          • Implemented medical X-ray operator training
    54                                             and mitigating asbestos, radon, lead and other          requirements for nonregistered technologists.
Division Goals                                      Division of Waste Management
• Maintain delegation and responsibility for
  federally mandated programs.                          The Division of Waste Management works
• Further define and develop radiological           to safeguard public health through programs
  emergency response capabilities.                  designed for generators of solid and hazardous
• Continue education and outreach activities to     waste and operators of underground storage
  keep the public informed about environmen-        tanks. Programs include:
  tal issues specific to air and radiation.             • Hazardous Waste Program
• Provide cross training to staff to improve            • Underground Storage Tank Program
  versatility and job satisfaction and to provide       • Solid Waste Program
  an effective public response.                         • Abandoned Motor Vehicle Program
• Continue to respond to indoor air quality
  concerns by direct intervention and assis-        Hazardous Waste Program
  tance to local public health personnel.                The Hazardous Waste Program regulates
• Coordinate training programs to improve           facilities that generate, store, treat, dispose of
  radiation technology education for facilities     or transport hazardous waste. The program
  that offer such services to the public.           encourages practices that minimize or eliminate
• Develop staff capabilities for greenhouse gas     hazardous waste generation and works to
  reporting, regulation and permitting of           ensure that hazardous waste does not adversely
  greenhouse gas sources.                           affect human health or the environment.
• Expand modeling capability through imple-              In addition to other inspections, the pro-
  mentation of new air quality models and           gram conducts polychlorinated biphenyls
  updating of input databases.                      (PCBs) inspections at facilities or sites known
• Help state sources comply with new EPA            or suspected to have equipment containing
  rules.                                            PCBs. The program also coordinates assess-
• Enhance public outreach by providing more         ments and cleanups at Brownfield sites, which
  air quality modeling guidance and tools on        are properties owned by a city, county or
  the division’s website.                           development organization that are underdevel-
                                                    oped due to actual or perceived contamination.

                                                    Accomplishments
                                                    • Inspected about 80 facilities that generate or
                                                      manage hazardous waste; provided compli-
                                                      ance assistance to other similar facilities.
                                                                                                         55
                                                 • Conducted free-of-charge compliance train-          regulated and unregulated PCB waste.
                                                    ing for about 250 attendees at six locations.    • Seek additional funding for Brownfield
                                                 • Conducted 31 PCB inspections; assisted              assessment and remediation, if needed.
                                                   businesses and tribes in investigating and        • Conduct training that provides a general
                                                   managing regulated PCB waste; and pro-              overview of regulations and requirements
                                                   moted the management of unregulated PCB             and helps businesses comply with state rules.
                                                   waste as regulated PCB waste.                     • Maintain partnership with the regulated
                                                 • Conducted permitting and inspections of the         community to positively impact compliance.
                                                   regulated community of about 700 busi-
                                                   nesses that have notified the division of         Underground Storage Tank Program
                                                   hazardous waste activities. These include              The Underground Storage Tank Program
                                                   hazardous waste generators; transporters; and     (UST) regulates petroleum and hazardous-
                                                   treatment, storage and disposal facilities.       substance storage tanks, establishes technical
                                                 • Worked with five facilities to investigate and    standards for the installation and operation of
                                                   remediate contaminated soil or ground water;      underground tanks, maintains a tank notifica-
                                                   one facility completed corrective action.         tion program, establishes financial responsibil-
                                                 • Responded to citizen complaints and assisted      ity requirements for tank owners, and provides
                                                   in the cleanup of environmental spills.           for state inspection and enforcement.
                                                 • Assessed eight Brownfield properties in                UST regulations are designed to find and
                                                   seven communities and removed contamina-          correct problems created by leaks and spills,
                                                   tion at two sites in two communities. These       prevent future leaks and spills, and ensure that
The Division of Waste Management responds          activities were conducted at the request of a     owners and operators can pay to correct the
to and assists in the cleanup of environmental     community, county or other governmental           problems created by leaking tank systems.
contamination.
                                                   entity.                                           Leaking USTs can cause fires or explosions that
                                                                                                     threaten human safety and can contaminate
                                                 Goals                                               nearby soil, ground water or surface water.
                                                 • Continue to inspect facilities that generate or        The program also works with retailers and
                                                   manage hazardous waste and to provide             manufacturers to ensure that specifications and
                                                   compliance assistance.                            standards for petroleum and antifreeze are met.
                                                 • Reissue appropriate hazardous waste permits.
                                                 • Continue to review investigation reports,         Accomplishments
                                                   proposed remedies and remediation progress        • Regulated more than 900 active tank facilities
                                                   at facilities conducting cleanup activities.        for a total of 2,300 tanks. Compliance is
                                                 • Continue to conduct PCB inspections and to          monitored by on-site visits at least once
   56                                              promote the proper handling and disposal of         every three years, as well as mail-in self-
  certification. Program staff observed 70 tank      leak detection, spill reporting, etc.).
  closures, conducted upwards of 900 on-site      • Provide online owner/operator training to the
  inspections, and investigated and monitored       tank owners to comply with the EPA guide-
  cleanup of more than 23 leaking UST sites.        lines regarding delivery prohibition, second-
• Conducted routine collection and analysis of      ary containment and owner/operator training.
  520 petroleum samples; notified petroleum       • Use LUST Trust Fund money to investigate
  retailers of analytical results, including        and properly close additional abandoned UST
  octane and distillation end points.               sites throughout the state.
• Registered all antifreeze manufacturers and     • Collect petroleum samples from retailers and
  136 bulk antifreeze retailers in the state.       respond to product and labeling deficiencies.
• Utilized Leaking Underground Storage Tank       • Review antifreeze registration requests and
  (LUST) Trust Fund money to investigate            respond to formulation and labeling deficien-
  suspected UST releases and to conduct             cies.
  corrective actions when a release had oc-
  curred but the responsible party was recalci-   Solid Waste Program
  trant, unable to pay or could not be identi-         The Solid Waste Program regulates the
  fied. LUST Trust Fund money was used to         collection, transportation, storage and disposal
  provide safe drinking water to two homes        of nonhazardous solid waste. The program
  and to remove petroleum vapors from the         promotes resource recovery, waste reduction
  lower level of a commercial building.           and recycling activities that preserve and
• Continued outreach to tank owners about         enhance the quality of the state’s natural
  proper maintenance and operation of USTs.       resources. The program also assists individuals,
  More than 9,400 USTs have been removed          businesses and communities to provide effi-
  during the 20 years the UST Program has         cient, environmentally acceptable solid waste
  been in existence. Many of these tanks          management systems and administers the state
  leaked or had the potential to leak.            Pollution Prevention (P2) program to increase
                                                  efficiency and reduce pollution at the source,
Goals                                             rather than after it is produced.
• Assist tank owners with contamination
  assessment/cleanup activities following         Accomplishments
  upgrade and/or replacement of USTs or           • Regulated 13 municipal solid waste landfills,
  when leaks occur.                                 26 transfer stations, three industrial waste
• Provide compliance monitoring, inspections        landfills, 12 coal-combustion waste landfills,
  and public outreach to inform tank owners         24 coal-combustion waste impoundments,
  about the proper operation of USTs (e.g.,         four oilfield waste treatment and disposal       57
                                                  facilities, 215 inert waste landfills, six land-   • Conducted outreach and technical assistance
                                                  treatment operations and numerous compost            regarding abandoned and dangerous buildings
                                                  facilities.                                          and emergency disaster debris.
                                                • Implemented nutrient management require-           • Worked with the Green Building Committee
                                                  ments to help food processing and livestock          to investigate and provide information about
                                                  facilities manage and recycle organic waste          ways the NDDoH can increase building
                                                  materials.                                           efficiency and reduce energy consumption.
                                                • Worked with sugar beet plants to improve           • Provided more than 20 training sessions
                                                  management of nutrient-rich materials so as          about solid waste and recycling issues to
                                                  to recover and use nutrients in a more sus-          local and regional groups, North Dakota
                                                  tainable and environmentally favorable               Department of Transportation training
                                                  manner.                                              sessions, regional North Dakota Local
                                                • Approved permit for Petrocomp Oilfield               Technical Assistance Program workshops and
                                                  Waste landfill in Bowman County that will            tribal workshops.
                                                  provide treatment and disposal capacity for        • Worked with nonprofit organizations to
                                                  much of the oilfield waste in southwest              develop educational materials, host work-
                                                  North Dakota.                                        shops and partner in grant opportunities.
                                                • Worked to upgrade the design and operation         • Encouraged auto scrap-metal companies to
                                                  requirements and increase capacity for               adopt pollution-prevention practices.
                                                  oilfield waste facilities in the energy develop-   • Initiated compliance and enforcement actions
                                                  ment areas.                                          on two releases of fly ash in oilfeld waste
                                                • Responded to emergencies, particularly               treatment activities and on issues at a
                                                  related to debris cleanup from floods in              municipal solid waste landfill.
                                                  Minot, Jamestown, Valley City, Fargo, Bis-         • Worked to resolve issues concerning scrap-
                                                  marck, Mandan and other communities.                 tire accumulations and stockpiles.
                                                • Conducted annual landfill operator training        • Provided education concerning volume-based
The Solid Waste Program promotes recycling to
                                                  and certification sessions attended by solid         waste services, product stewardship, elec-
help preserve the state’s natural resources.      waste professionals from around the state.           tronic waste issues and recycling; cospon-
                                                • Promoted recycling and beneficial use of             sored recycling and inert-waste workshops
                                                  construction and demolition materials, use of        and annual solid waste symposiums; and gave
                                                  wood for landscaping and energy recovery,            presentations concerning waste reduction,
                                                  use of compost for landscaping, use of coal-         recycling, composting, disposal and waste
                                                  combustion material for construction, and            hauling.
                                                  use of agricultural processing byproducts for
   58                                             animal feed or soil amendment.
Goals                                                final closure and integrated waste manage-
• Promote integrated waste management,               ment.
  including waste reduction, reuse, recycling,
  composting and energy recovery.                   Abandoned Motor Vehicle Program
• Promote “Pay as You Throw” or volume-                 The Abandoned Motor Vehicle Program
  based waste services and fees which are           focuses on assisting political subdivisions in
  perceived as more fair, and encourage waste       the cleanup of scrap metal.
  reduction and recycling.
• Continue implementing beneficial uses of          Accomplishments
  materials to help reduce the need for newly       • Worked with local public health units to
  manufactured products, as well as the               complete projects in Stark, Grand Forks and
  amount of waste in landfills.                       Emmons counties, as well as in several
• Promote development of effective solid              smaller communities.
  waste practices and facilities, including long-   • Completed a survey of Wells County.
  term solutions for solid-waste needs.             • Collected and recycled about 1,000 tons of
• Evaluate and implement improvements in              scrap metal.
  operation of oilfield waste processing and
  disposal facilities.                              Goal
• Continue education efforts through training,      • Promote the use of Abandoned Motor
  workshops and educational materials.                Vehicle Program funds to clean up unwanted
• Work with counties and cities to evaluate           scrap and to evaluate alternative uses and
  options for abandoned and dangerous build-          management of scrap tires.
  ings, emergencies, economic development
  and sustainable growth.
• Work with solid-waste facilities to preserve
  and enhance capacity and reduce disposal.
• Continue implementation of the National
  Vehicle Mercury Switch Removal Program
  for auto recyclers and scrap-metal facilities.
• Work with new and expanding industries on
  sound, integrated and sustainable waste
  management practices.
• Evaluate and update solid waste guidance
  and rules regarding landfill development,
                                                                                                     59
                                             Division of Municipal Facilities                   Drinking Water State Revolving Loan Fund
                                                                                                (DWSRF)
                                                  The Division of Municipal Facilities              The DWSRF Program provides low-interest
                                             administers programs that help communities,        loans to help public water systems finance the
                                             industries and citizens of North Dakota in the     infrastructure needed to comply with the Safe
                                             areas of water supply and treatment and            Drinking Water Act. Eligible borrowers can
                                             wastewater collection and treatment: (1) the       obtain financing to construct water treatment
                                             Public Water Supply Supervision Program;           works at below-market interest rates. Through
                                             (2) the Drinking Water State Revolving Loan        June 30, 2011, loans totaling about $286
                                             Fund Program; and (3) the Clean Water State        million have been approved to assist North
                                             Revolving Loan Fund Program.                       Dakota water systems. Program staff members
                                                                                                also review about 150 drinking water projects
                                                                                                each year to ensure compliance with state
                                             Public Water Supply Supervision (PWSS)             design criteria before construction.
                                             Program
                                                  The PWSS Program works with the 541           Clean Water State Revolving Loan Fund
                                             public water systems in North Dakota to            (CWSRF)
                                             ensure that drinking water meets all standards         The CWSRF Program provides low-interest
                                             established by the Safe Drinking Water Act.        loans to fund conventional wastewater and
                                             This is accomplished by monitoring contami-        nonpoint source pollution control needs.
                                             nants and providing technical assistance to the    Eligible borrowers can obtain financing to
                                             systems. The program provides training for and     build wastewater treatment works at below-
                                             certification of operators in charge of water      market interest rates. Through June 30, 2011,
                                             treatment and distribution facilities and waste-   loans totaling about $312 million have been
                                             water collection and treatment plants. There       approved to assist North Dakota wastewater
The Division of Municipal Facilities helps
                                             are 1,061 certified operators in the state.        systems. Program staff members also review
to ensure safe drinking water through a
variety of programs and activities.          Program staff members also administer the          about 150 projects each year to ensure compli-
                                             state’s fluoridation program and provide           ance with state design criteria before construc-
                                             technical assistance to private water systems.     tion.
                                                  Four inspectors/trainers inspect 398 public
                                             water and wastewater systems to ensure that        Accomplishments
                                             facilities comply with state and federal public    • Complied with all major federal program
                                             health standards. Program activities contribute      requirements and maintained federal delega-
                                             to the proper operation and maintenance of           tion responsibilities for EPA programs.
60                                           these facilities.                                  • Maintained a community water system
  compliance rate of 96 percent with health-      quality – the North Dakota Water Pollution
  based standards under the Safe Drinking Water   Control Act of 1967. The NDDoH monitors
  Act; this rate is among the highest in the      lakes, reservoirs, rivers, streams and wetlands,
  region and the nation.                          helping to ensure that the water stays clean for
• Issued loans totaling about $598 million        people today and in the future.
  through the Drinking Water and Clean Water          Polluted water may carry diseases that
  State Revolving Loan Fund programs to North     cause illness and increase health-care costs.
  Dakota communities through June 30, 2011,       Contaminated water costs more to treat and is
  for addressing drinking water and wastewater    less appealing for recreational uses. In addition,
  compliance and infrastructure needs.            polluted water affects the plants and animals
• Obligated successfully all funds available to   that depend upon it.
  North Dakota’s CWSRF and DWSRF Pro-                 Water quality has improved since passage
  grams for drinking water/wastewater infra-      of the Clean Water Act in 1972, but much
  structure improvement projects through the      remains to be done to achieve the goal of
  American Recovery and Reinvestment Act of       restoring and maintaining the quality of the
  2009 (29 projects totaling about 37 million).   state’s and nation’s waters.
Goals
                                                  Water Quality Standards
• Maintain state delegation and responsibility
                                                      Water quality standards establish the
  for the PWSS, DWSF and CWSRF Programs.
                                                  beneficial uses of the state’s water and assign
• Maintain or increase community water system
                                                  numeric criteria for chemical concentrations
  compliance with health-based standards
                                                  necessary to achieve those uses. The standards
  under the Safe Drinking Water Act.
                                                  provide guidance to the North Dakota
• Continue to assist North Dakota communi-
                                                  Pollutant Discharge Elimination System
  ties in addressing drinking water and waste-
                                                  Program and set goals for the Nonpoint Source
  water compliance and infrastructure im-
                                                  Pollution Management Program and the
  provement needs through the DWSRF and
                                                  Section 303(d) Total Maximum Daily Load
  CWSRF programs
                                                  Program.
                                                       The Clean Water Act requires that the
Division of Water Quality                         standards be reviewed and, if necessary,
    The main statute providing water quality      revised every three years to meet the needs of
protection is the federal Clean Water Act of      the state and to incorporate the latest scientific
1972, which has resulted in many water quality    information. EPA has provided guidance for
improvements. Even before the federal act,        the review process, which is under consider-
North Dakota had its own law to protect water     ation by the NDDoH.                                  61
                                                    Special Project: Devils Lake                        industrial wastewater treatment facilities.
                                                        The NDDoH is the lead agency for moni-                Since 1975, the program has issued about
                                                    toring water quality and providing technical        500 wastewater discharge permits (25 percent
                                                    information in the Devils Lake basin. Monitor-      industrial and 75 percent municipal) and 287
                                                    ing consists of seven sites in the basin’s chain    notices of intent for coverage under the tempo-
                                                    of lakes. The NDDoH also conducts special           rary discharge permit. Starting in 1992, permits
                                                    studies as needed. Implementation of the            have been required for stormwater discharges
                                                    Devils Lake Water Management Plan is neces-         associated with large construction activities
                                                    sary to achieve long-term flooding solutions.       and industrial facilities. Since 2003, permits
                                                         The NDDoH provides technical assistance        have been required for stormwater discharges
                                                    for protection and maintenance of water             from designated small municipal separate
                                                    distribution and wastewater treatment systems       storm sewer systems (MS4s) and small con-
                                                    and provides regulatory oversight for threat-       struction activity.
                                                    ened fuel storage areas, potential hazardous              A total of 2,002 facilities are covered by
                                                    materials sites and other environmental threats.    general permits for stormwater discharges;
                                                         The NDDoH implemented an emergency             1,594 for construction activity, 390 for indus-
                                                    rule changing the sulfate limit from 450 to 750     trial activity and 18 for MS4 discharges. The
                                                    milligrams per liter in the river from its head-    primary focus continues to be meeting the
                                                    waters to 0.1 mile downstream from Baldhill         obligations of Phases I and II of EPA’s
                                                    Dam. This change was incorporated to the            Stormwater Rule.
                                                    Standards of Quality for Waters of the State in          Impacts to water from livestock operations
                                                    January 2011. An outlet from East Devils Lake       are an increasing concern in North Dakota.
                                                    to the Sheyenne River is being built and will be    Currently, 792 livestock facilities are approved
                                                    operational during the spring of 2012. The          to operate, most of which are cattle, hog and
                                                    NDDoH will provide estimates of downstream          dairy facilities that are part of a farmer’s total
The Division of Water Quality protects the
                                                    water quality and potential effects to beneficial   farm operation. In recent years, the number of
public’s health and the environment by
monitoring the state’s lakes, streams and rivers.   uses of the water.                                  large concentrated animal feeding operations
                                                                                                        (CAFOs) proposed in the state has increased.
                                                    Pollutant Discharge Elimination System                    With all the recent oilfield activities in the
                                                    (NDPDES) Permit Program                             northwestern part of the state, the NDPDES
                                                        Point source pollution comes from a             Program has been actively involved with
                                                    specific source, like the end of a pipe. Envi-      wastewater issues associated with temporary
                                                    ronmental regulations in the last 30 years have     housing. The program has provided assis-
                                                    resulted in a significant reduction in pollution    tance/permitted more than 40 temporary
    62                                              from major point sources like municipal and         housing systems (man-camps).
Accomplishments                                         Determination and Whole Effluent Toxicity
• Provided assistance to communities and               implementation document for use in determin-
  individuals during 2009, 2010 and 2011               ing permit limits.
  spring flooding. Worked closely with Fargo,        • Developed guidance for enforcement penalty
  Valley City, Jamestown, Bismarck, Mandan             calculations.
  and Minot on wastewater-related issues.            • Revamped and expanded General Permit for
• Maintained less than 1 percent backlog of            Temporary Discharges to cover more dis-
  NDPDES permits.                                      charges and meet the needs of the program.
• Issued 662 municipal and stormwater general        • Implemented updates and improvements to
  permit renewals and 67 new permits.                  data management system, monitored compli-
• Conducted 275 stormwater inspections and             ance in the NDPDES Program, including
  five stormwater audits, six industrial pretreat-     stormwater, pretreatment, majors/minors,
  ment inspections, and 88 industrial and              animal feeding operations, septic pumpers,
  municipal wastewater compliance evalua-              hydrostatic testing and dewatering; tracked
  tions; processed 958 requests to discharge,          12,598 significant correspondences.
  including follow-up correspondence. The            • Inspected 314 animal feeding operations;
  Discharge Monitoring Report - Quality                issued 64 “approvals to operate,” including 11
  Assurance Program reviewed 60 studies.               large CAFOs.
• Reviewed and entered data from 6,854               • Inspected more than 90 percent of state-
  discharge monitoring reports.                        permitted CAFOs annually.
• Issued 274 pumper licenses for 473 units           • Updated and standardized NDPDES permit
  through the Septic Pumper Licensing                  and fact sheet consistent with EPA; updated
  Program.                                             standardized sample-identification and
• Reissued stormwater general permits for              sample-collection forms consistent with the
  construction and industrial activity.                Division of Laboratory Services-Chemistry.
• Revised industrial, mining and construction        • Provided information and presentations about
  stormwater permit forms to improve compli-           stormwater permit requirements at 13 events,
  ance with permit conditions, including               including workshops for homebuilders, con-
  developing templates for stormwater pollu-           tractors, highway department supervisors and
  tion prevention plans and site inspection            engineers.
  records.                                           • Developed an information document about
• Conducted annual conferences on stormwater           stormwater permitting for residential construc-
  management, erosion and sediment-control             tion.
  practices, and permit requirements.                • Held 24 producer-group/public meetings;
• Developed guidance for Reasonable Potential          conducted 50 site visits at producers’ requests.   63
     • Conducted ground water sampling at 30 large       Surface Water Quality Monitoring and
        CAFOs and soil sampling at more than 10          Assessment Program
        CAFOs to verify permit compliance.                    The state’s surface water resources are
      Participated/presented program materials at      significant. Currently, the NDDoH recognizes
        the annual operator training and the North       247 public lakes and reservoirs totaling 761,674
        Dakota Water Pollution Control Conference.       surface acres. The two largest are Lake
                                                         Sakakawea and Devils Lake. There are 54,606
     Nonpoint Source (NPS) Pollution Manage-             miles of rivers and streams in the state. Esti-
     ment Program                                        mates of river and stream miles are based on
         One of the main challenges to maintaining       the National Hydrography Dataset and include
     or improving the quality of the state’s surface     ephemeral, intermittent and perennial rivers and
     water is NPS pollution, which does not come         streams. In addition, the state contains about
     from one point. It includes runoff from con-        2.5 million acres of wetlands, the majority of
     struction sites, city streets, livestock feedlots   which are located in what is commonly called
     and agricultural lands. Runoff carries pollutants   the Prairie Pothole Region.
     – including sediment, nutrients and pesticides –
     and deposits them in the state’s waters.            Total Maximum Daily Load (TMLD)
                                                              Section 303(d) of the Clean Water Act
     Accomplishments                                     requires pollution-reduction targets to be
     • Maintained more than $7 million in Section        developed for surface waters considered water-
       319 financial commitments with 40 local           quality limited and requires load allocations,
       projects to cost-share agricultural practices,    waste load allocations and TMDLs. Typically,
       provide education, deliver technical assis-       surface waters not meeting their designated
       tance to agricultural producers, design           beneficial uses are included on the TMDL list.
       manure management systems and evaluate                 Regional TMDL/watershed liaison staff
       water quality trends or conditions.               work with local stakeholders to develop water
     • Provided technical assistance to develop 10       quality assessments and TMDLs based on the
       new projects seeking FY 2012 funding.             Section 303(d) list of impaired waters. Regional
     • Expended more than $6 million in Section          staff provide technical assistance to local soil
       319 funding to support local projects that        conservation districts and water resource
       cost share best management practices, such        boards, assist in the development of nonpoint
        as manure management systems, livestock          source pollution management projects, provide
       watering facilities and fencing, riparian         technical expertise to local stakeholder groups
       buffers, septic systems and nutrient manage-      and assist with youth and adult information/
64     ment.                                             education events.
Accomplishments                                       Working with researchers at North Dakota
• Maintained a network of 34 monitoring sites         State University, 53 wetland sites were
  on 19 rivers to assess trends and to describe       sampled in 2011. Results will be used to
  the general chemical character of the state’s       assess the overall condition of wetlands in
  major river basins; cooperated with the U.S.        the U.S. and in North Dakota.
  Geological Survey in maintaining seven of         • Sampled 15 lakes and reservoirs each year as
  the 34 sites.                                       part of the Lake Water Quality Assessment
• Facilitated the formation of the North              Project. These data and the water quality
  Dakota Water Quality Monitoring Council,            assessment which will be derived from these
  made up of water quality researchers, scien-        data will be used to support: (1) Section
  tists, engineers and managers from federal,         305(b) reporting; (2) Section 303(d) listing
  state, university, local government and             and de-listing decisions; (3) water quality
  private organizations. The Council’s mission        standard development; and (4) fisheries
  is “to promote and facilitate collaboration for     management.
  effective collection, analysis and sharing of     • Submitted the 2010 Integrated Section 305(b)
  water quality data.”                                Water Quality Assessment Report and Section
• Completed a comprehensive biological                303(d) List of Waters Needing Total Maximum
  assessment of the Red River mainstem,               Daily Loads, which summarizes the state’s
  including sampling macro-invertebrates and          water quality conditions and fulfills CWA
  fish at 54 sites. Data will be combined with        reporting requirements by providing a list of
  other available data and used to develop a          impaired waterbodies needing TMDLs.
  report describing the current ecological          • Received EPA approval for 35 TMDLs,
  condition of the Red River in the U.S. and, to      including one nutrient TMDL for Fordville
  the extent possible, identifying major stres-       Dam, two dissolved oxygen TMDLs, and 32
  sors affecting these aquatic communities.           bacteria TMDLs for rivers and streams.
• Monitored water quality in Devils Lake four       • Worked with local stakeholders on TMDL
  times a year and maintained monitoring              projects and watershed assessments for
  program on Lake Sakakawea. In conjunction           Homme Dam, Braddock Dam/Long Lake
  with the North Dakota Game and Fish                 Creek, Brush Lake/Crooked Lake/Turtle
  Department, the NDDoH sampled Lake                  Creek, the upper Sheyenne River, Danzig
  Sakakawea weekly during the open-water              Dam/Hailstone Creek, Harmon Lake and the
  period to assess the lake and provide esti-         upper James River.
  mates of its cold-water habitat.
• Participated in the U.S. EPA-sponsored
  National Wetlands Condition Assessment.                                                             65
                                                 Ground Water Program                               • Eliminated Safe Drinking Water Act viola-
                                                      North Dakota’s ground water protection          tions for several water systems through
                                                 programs are designed to control potential           hydrogeologic investigations and studies.
                                                 sources of contamination and to restore ground     • Conducted meetings with community water
                                                 water impacted by contaminants. The degree to        systems to develop proactive approaches for
                                                 which contamination incidents are investigated       safeguarding drinking water supplies. Worked
                                                 or remediated depends upon the contaminant,          in conjunction with North Dakota Rural
                                                 its impact on the beneficial use of the resource     Water in public outreach and meetings.
                                                 and the risk to the public or the environment.     • Educated community water systems about
                                                                                                      zoning issues and the impacts of new facili-
                                                 Wellhead and Source Water Protection                 ties within wellhead protection areas.
                                                 Programs                                           • Provided new wellhead delineations and
                                                      The Source Water Protection Program             updated reports for water systems that
                                                 serves as an umbrella of protection efforts for      installed new wells or plugged existing wells.
                                                 all public water systems, including ground
North Dakota contains 247 recognized lakes       water- and surface water-dependent systems.
and reservoirs totaling 761,674 surface acres.                                                      Underground Injection Control Program
                                                 The Wellhead Protection Program continues for
                                                                                                        The Underground Injection Control (UIC)
                                                 ground water-dependent systems. The Source
                                                                                                    Program helps prevent contamination of
                                                 Water Protection Program for surface water-
                                                                                                    underground sources of drinking water by
                                                 dependent systems involves (1) the delineation
                                                                                                    injection wells (e.g., domestic waste, industrial
                                                 of protection areas along rivers or reservoirs
                                                                                                    wastewater or motor vehicle waste disposal).
                                                 and (2) an inventory of potential contaminant
                                                                                                         The five classes of underground injection
                                                 sources within the protection areas. These
                                                                                                    wells are defined according to the types of
                                                 programs help the NDDoH define the suscepti-
                                                                                                    fluid they inject and where the fluid is injected.
                                                 bility of public water systems to potential
                                                                                                    The Division of Water Quality regulates Class I
                                                 contaminant sources.
                                                                                                    and Class V underground injection wells.
                                                 Accomplishments
                                                                                                    Accomplishments
                                                 • Maintained 100 percent compliance with           • Conducted inspections at two facilities that
                                                   Source Water Protection/Wellhead Protec-           inject waste into Class I injection wells.
                                                   tion Program requirements.                       • Conducted about 40 inspections at facilities
                                                 • Continued to work with consultants and             located in high-risk areas such as wellhead
                                                   oilfield-related issues regarding wellhead         protection areas and other sensitive areas.
                                                   protection areas and placement of activities
    66                                             and projects.
• Increased oversight in the northwestern part      Accomplishments
  of the state due to the increase in oilfield     • Sampled about 350 wells in 29 aquifers for
  activities.                                        trace metals, general water chemistry param-
• Obtained closure of several high-risk wells        eters, nitrates and pesticides; summarized all
  located in wellhead protection areas or other      collected data in annual reports.
  sensitive ground water areas.                    • Continued working with the State Water
• Conducted public outreach to UIC well              Commission, area irrigators and producers to
  owners and other state agencies concerning         mitigate the nitrate contamination in the
  new rule requirements.                             Karlsruhe aquifer.
• Continued to work with licensed sewer and
  water contractors concerning Class V wells.
                                                   Spill Reporting/Emergency Response/
Ambient Ground Water Monitoring                    Environmental Investigation and Cleanup
Program                                                 Any spill or discharge of waste that may
     The maintenance of a baseline description     pollute the state’s water must be reported
of ground water quality is an essential element    immediately. Some releases may require imme-
of any statewide, comprehensive ground water       diate response by trained personnel; others may
protection program. In recent years, concern       require investigation beyond initial cleanup to The NDDoH works to ensure that North
for the quality of the environment and drinking                                                    Dakota’s water stays clean for people
                                                   determine the full environmental impact.        today and in the future.
water has increased as many states have
experienced ground water contamination from         Accomplishments
a variety of point and nonpoint sources of         • Responded to many spills and releases as a
pollution. The goal of the Ambient Ground            result of the large increase in oilfield activity
Water Monitoring Program is to assess the            within the state. Spills resulted from pipeline
quality of North Dakota’s ground water re-           breaks, vehicle accidents, reserve pit over-
sources with regard to agricultural chemical         flows and materials-handling mishaps.
contamination.                                     • Worked with the Safe Drinking Water Pro-
     Several glacial drift aquifers have been        gram to investigate the occurrence of an
monitored since 1992. Fifty aquifers consid-         agricultural herbicide in a municipal water
ered most vulnerable to contamination are            system; conducted soil and well sampling and
included in the program. Conducting the              provided advice concerning the issue.
monitoring on five-year cycles, preferably using   • Evaluated impacts during statewide flooding
most of the same wells for sampling, provides        events, including release of oil and drilling
a temporal assessment of agricultural chemical       fluids resulting from flooding of the Little
occurrence in specific aquifers.                     Missouri River.                                                                       67
     • Worked with livestock producers to locate          special populations such as children and
       new facilities in areas with minimal risk to       pregnant women when consuming fish caught
       ground water and to upgrade waste-handling         in the state.
       systems at existing facilities.                  • Expand monitoring for pesticides in surface
     • Continued working with EPA, the local rural        and ground water to ensure that drinking
       water district and rural residents on the          water supplies are not contaminated and that
       Arsenic Trioxide Superfund site in southeast-      they stay safe for North Dakota residents.
       ern North Dakota; provided safe drinking         • Continue to complete TMDLs consistent
       water to several communities through the           with EPA’s expected schedule.
       Southeast Water Users District system;           • Continue to improve the biological monitor-
       sampled private wells to evaluate arsenic          ing program for rivers and streams by select-
       concentrations.                                    ing and sampling additional reference sites.
                                                        • Increase monitoring of emerging contami-
     Division Goals                                       nants, such as pharmaceuticals and personal
     • Provide necessary and increasing oversight on      care products in water.
       pipeline breaks, tanker truck rollovers, and
       numerous miscellaneous oil and saltwater
       spills in the oil patch of western North
       Dakota.
                                                        Division of Laboratory Services
     • Maintain state funding for Nonpoint Source           The Division of Laboratory Services has
       pollution projects.                              two principal programs: Chemistry and
     • Continue to use a watershed approach in all      Microbiology.
       monitoring, assessment and control programs.     Chemistry
     • Provide education about the public’s impact           The chemistry laboratory provides analyti-
       on water quality; increase awareness of local    cal chemistry data to environmental protection,
       and state efforts to provide the quality of      public health, agricultural and petroleum
       water necessary to meet all beneficial uses,     regulatory programs in the state. The laboratory
       such as drinking, fishing and swimming.          also maintains a certification program for
     • Increase educational outreach to building        North Dakota laboratories that provide envi-
       contractors regarding stormwater issues.         ronmental testing services.
     • Continue dialogue with local zoning authori-         The NDDoH’s environmental protection
       ties on issues such as water quality and odors   programs use laboratory data to monitor and/
       related to large CAFOs.                          or regulate air quality; solid and hazardous
     • Continue monitoring mercury and other            waste; municipal wastewater; agricultural
68     contaminants in fish to ensure protection of     runoff; surface, ground and drinking water
quality; petroleum products; and other media        • Petroleum Lab: Tests products such as
of environmental or public health concern. The        gasoline and diesel for product quality.
Department of Agriculture uses data to regu-        • Spectroscopy (or Metals) Lab: Identifies
late livestock feed, pet foods, and agricultural      and quantifies metal concentrations in
and home-use fertilizers.                             drinking water sources and distribution
     The laboratory consists of six analytical        systems, surface and ground water resources,
sections and one certification section. The           fish, hazardous and solid wastes, river and
analytical sections include:                          lake sediments, and other environmental
• Demands Lab: Performs biochemical                   media.
  oxygen demand, total suspended solids and
  pH tests; provides analytical data used to        Accomplishments
  determine compliance with permit require-         • Provided analytical support to help public
  ments of municipal and industrial wastewater        water systems comply with federal and state
  discharges.                                         drinking water rules and regulations. Almost
• Feed and Fertilizer Lab: Provides analyti-          8,000 samples were tested for more than           The Division of Laboratory Services conducts
  cal data to the Department of Agriculture;          36,000 analytical components, including           tests to identify diseases that may threaten the
                                                                                                        public’s health or chemical compounds that
  tests agriculture feeds and fertilizers, pet        nitrates, metals such as lead and copper,
                                                                                                        may threaten the state’s environment.
  foods, and lawn and garden fertilizers to           fluoride, pesticides, and volatile organic
  determine compliance with labeling.                 compounds such as benzene and toluene.
• Mineral Lab: Tests matrices such as water           Included in this program were:
  and soil for major cation and anion param-              o Testing of drinking water systems for
  eters or general chemical quality. Typical                 haloacetic acids and trihalomethanes –
  analyses include sulfates, fluoride, chloride,             some of the more common byproducts
  chemical oxygen demand, nitrate, sodium,                   of chlorination disinfection.
  ammonia and total Kjeldahl nitrogen.                    o Analytical demonstration of capability
• Organic Lab: Provides identification and                   tests, determinations of method
  quantification of insecticides, herbicides,                detection limits and proficiency testing
  volatile and semi-volatile organic com-                    for renewal and maintenance of
  pounds, polychlorinated biphenyls (PCBs)                   certification under the Safe Drinking
  and other synthetic organic compounds in                   Water Act.
  drinking, surface and ground water; soil; river   • Continued to participate in and successfully
  and lake sediments; foliage; fish tissue;           complete several laboratory performance
  sludge; oil; landfill wastes; and samples from      evaluation programs. In addition, the labora-
  other environmental sources.                        tory certifies the state’s other environmental
                                                      laboratories and reviews and recognizes other                                              69
         states’ certifications programs for out-of-state               Oil leaks near Killdeer in October
         laboratories that meet the requirements of                       2009 and September 2010
         North Dakota’s certification program.                          Oilfield brine spills in April and
     •   Continued to provide analytical chemistry                        May 2010
         data to the State Water Commission.                            Site used by well-drilling opera-
     •   Provided water quality and sulfate testing on                    tions to clean equipment
         1,849 samples from above and below the                         Area suspected as being used for
         Devils Lake outlet.                                              improper oilfield disposal in
     •   Continued to provide analytical support to                       December 2010
         the environmental programs within the                          Possible inappropriate dumping
         department.                                                      from an oilfield water/brine truck
     •   Continued to assist the Environmental                            in March 2010
         Health Section during environmental emer-                      Continued increasing cases since
         gencies, including providing 24-hour services                    April 2011
         during major emergencies to ensure timely             Analyzed about 26,000 samples for about
         response. Analyses associated with emer-               340,810 chemistry analytes.
         gency situations were performed on the
         following:                                         Goals
             o Samples related to major flooding in         • Maintain or increase laboratory efficiency and
               many areas                                     responsiveness.
             o Several unknown white powder and             • Provide continued analytical support for
               suspicious substances and mail events          environmental protection, public health,
             o Response samples to a liquid fertilizer        agriculture and petroleum regulatory pro-
               release in June 2010                           grams.
             o Samples from possible pesticide misap-       • Continue membership in performance evalua-
               plications in 2010                             tion programs; maintain current EPA labora-
             o Response samples taken from a pesti-           tory certification and obtain certification for
               cide spill area                                new drinking water components as they
             o Water samples from an area near                become regulated by EPA.
               Columbus, site of a July 2010 fish kill      • Continue to develop and update the chemical
             o Samples from an oil well fire near             all-hazards laboratory component of the
               Arnegard in March 2011                         state’s comprehensive public health emer-
             o Response samples from oilfield-related         gency preparedness and response plan.
                investigations (increased significantly
70             this biennium)
Microbiology                                       • Renewed registration of the laboratory
     The microbiology laboratory (i.e., the          facility to handle and store select agents. This
public health laboratory) performs testing in        included two on-site visits by Centers for
the areas of bacteriology, mycology, parasitol-      Disease Control and Prevention select agent
ogy, immunology, virology, molecular diagnos-        program inspectors, numerous upgrades to
tics, bioterrorism response, and dairy and water     the HVAC system, and additions to policy
bacteriology. The laboratory is responsible for      and procedure manuals.
providing rapid, accurate detection and identi-    • Developed and implemented a clinical
fication of organisms that may threaten the          laboratory technician internship program.
public’s health. Outbreak response and control       This provided a curriculum, training material
is dependent upon the laboratory’s continuing        and expertise in support of clinical rotations
commitment to maintain and develop new               for Rasmussen College laboratory science
technologies and advanced testing capabilities       students. Four students have participated in
in advance of new and emerging organisms and         the intensive four-week training and educa-
biothreat agents. In addition, the laboratory        tion program.
provides training and consultation expertise       • Instituted a molecular respiratory virus panel
regarding safety and testing methodologies.          assay capable of detecting 12 different
                                                     respiratory viruses simultaneously from a
Accomplishments                                      single sample.
• Received and processed 119,284 specimens         • Implemented a statewide courier system to
  resulting in 216,424 analytical tests.              transport clinical laboratory specimens from a
• Maintained mosquito surveillance program           network of hospitals/clinics/public health
  for West Nile virus and other arboviruses.         units to the Division of Laboratory Services-
• Updated and distributed service directory and      Microbiology on a daily basis. This network
  customer satisfaction survey.                      has reduced shipping costs, reduced speci-
• Maintained federal testing certification for       men transport times, provided more timely
  clinical specimens, dairy products and drink-      lab analysis and served in times of urgent
  ing water.                                         need for rapid specimen/supply transport.
• Continued National Laboratory Systems grant      • Instituted HL7-based electronic reporting
  to promote education and training on antimi-       from the Division of Laboratory Services-
  crobial susceptibility testing and molecular       Microbiology LIMS to the Ahlers system,
  based tuberculosis testing.                        which supports public health and family
• Completed the Clinical Laboratory Improve-         planning facilities. This process reports
  ment Amendments laboratory inspection and          electronic laboratory results in real time to
   recertification process.                           21 local public health and family planning        71
        facilities, which import the electronic labora-   • Participated in multiple exercises with the
       tory report data directly into their electronic      Civil Support Group.
       medical records systems.                           • Continued to build strong partnerships with
     • Enahanced biosafety and security systems to          North Dakota LRN sentinel site laboratories
       improve system performance in meeting new            to respond to disease outbreaks and
       select agent requirements.                           bioterrorism.
     • Reported, via HL7 message, 10,924 report-          • Presented information at annual North
       able condition results electronically to the         Dakota Clinical Laboratory Science meetings.
       Division of Disease Control’s Maven system.        • Provided ongoing training to National Guard
     • Added capacity for testing for seasonal and          Civil Support Team concerning use of kits
       novel influenza viruses.                             for collecting and transporting chemical or
     • Submitted a total of 376 bacterial DNA               biological agent samples.
       fingerprint patterns to the Centers for Dis-       • Designed five exercises to test laboratory
       ease Control and Prevention’s national               security, biosafety, incident response and
       PulseNet database to assist in nationwide,           interoperability between the Division of
       foodborne outbreak disease detection efforts.        Laboratory Services and the National Guard
     • Responded to multiple foodborne outbreaks.           Civil Support Team.
     • Provided bacterial water testing and support       • Hosted multiple workshops on rule-out
       during flood and flood recovery efforts.             testing of biothreat agents with personnel
     • Laid the framework for cooperative agree-            from the state’s sentinel site laboratories. The
       ments with border states for continuation of         Division of Laboratory Services-Microbiol-
       operations during emergencies. A border-             ogy also hosted a packaging and shipping
       state courier specimen exchange and a                workshop and developed a new online
       proficiency round-robin exercise were coordi-        packaging and shipping course featuring a
       nated by the Division of Laboratory                  national subject matter expert. Training and
        Services-Microbiology to test its intrastate        certification through this online course are
       continuance of operations plans. Multiple            provided free of charge to about 100 partici-
       trainings were developed or provided through         pants annually.
       the partnership developed with the health          • Participated in Department Operation’s
       department laboratories in South Dakota,             Center exercises and as part of incident
       Montana and Wyoming. These trainings                 command during flood and influenza events.
       included information and guidance on               • Responded to eight white powder and suspi-
       antimicrobial susceptibility testing, molecular      cious substance events.
       diagnostics and tuberculosis educational
72     campaigns.
Goals
• Maintain or increase laboratory efficiency and
  responsiveness.                                        Microbiology Testing
                                                         Microbiology Testing
• Provide continued support to department            Category              Number of
  staff, physicians, health-care facilities, local                           Tests
  public health units, veterinarians, state and
  federal agencies, and the public.                  Dairy Products                   5,060
                                                     HIV                             39,332
• Continue membership in proficiency pro-            Tuberculosis                    13,876
  grams and maintain current certifications,         Mycology/Legionella/Parasites    3,304
  including CLIA and state licensure.                Hepatitis A, B, C               18,273
• Maintain statewide courier system.                 Rabies (human exposure)          1,161
• Upgrade biosafety and security to meet new         STDs                            87,324
                                                     Virology/Immunology             13,964
  select-agent requirements.                         Water Analyses                  20,671
• Continue to enhance data management                Bacterial/Biothreat             10,862
  systems developing electronic capabilities to      Mosquito Surveillance            2,597
  improve efficiency and accuracy in laboratory
  test ordering and reporting with customers.
                                                     Total                       216,424




                                                                                              73
     Local Public Health Units
                 North Dakota’s public health system is                                   tion. Some local public health units maintain
            made up of 28 single- and multi-county local                                  environmental health programs; others partner
            public health units (LPHUs).                                                  with another local public health unit or the
                 Services offered by each LPHU vary, but                                  NDDoH to provide environmental services,
            all provide services in the areas of maternal                                 such as public water system inspections,
            and child health, health promotion and educa-                                 nuisance and hazard abatement, and food
            tion, disease control and prevention, and                                     service inspections.
            emergency response preparation and coordina-



                         Divide                     Renville
                                       Burke                            Bottineau         Rolette Towner                Cavalier          Pembina


                                                                                         Pierce
                                                                                                                 Ramsey               Walsh
                        Williams
                                        Mountrail        Ward               McHenry


                                                                                                      Benson
                                                                                                                           Nelson         Grand Forks
                        McKenzie
                                                                                                               Eddy
                                                               McLean
                                                                               Sheridan        Wells
                                                                                                               Foster                 Steele         Traill
                                      Dunn                                                                                 Griggs
                                                    Mercer
                   ey
                  ll




                         Billings                              Oliver
             en Va




                                                                              Burleigh       Kidder       Stutsman
                                                                                                                                 Barnes             Cass
            Gold




                                     Stark
                                                               Morton


                         Slope         Hettinger                                                                   La Moure           Ransom
                                                                                                      Logan
                                                       Grant                                                                                          Richland
                                                                                    Emmons
                        Bowman        Adams                         Sioux                         McIntosh              Dickey            Sargent



                             Multi-County Health District                                                    City/County Health Department

                             Single-County Health District                                                 Single-County Health Department

74                           City/County Health District
Health Unit                               Location      Administrators

Bismarck-Burleigh Public Health           Bismarck      Paula Flanders, R.N.
Cavalier County Health District           Langdon       Terri Gustafson, R.N.
Central Valley Health District            Jamestown     Robin Izler, R.N.
City-County Health District               Valley City   Theresa Will, R.N.
Custer Health                             Mandan        Keith Johnson
Dickey County Health District             Ellendale     Roxanne Holm
Emmons County Public Health               Linton        Bev Voller, R.N.
Fargo Cass Public Health                  Fargo         Ruth Bachmeier, R.N.
First District Health Unit                Minot         Lisa Clute
Foster County Public Health               Carrington    Lisa Solwey, R.N.
Grand Forks Public Health Department      Grand Forks   Don Shields
Kidder County District Health Unit        Steele        Janel Brousseau
Lake Region District Health Unit          Devils Lake   Karen Halle, R.N.
LaMoure County Public Health Department   LaMoure       Tony Hanson
McIntosh District Health Unit             Ashley        Cathy Brendel
Nelson/Griggs District Health Unit        McVille       Julie Ferry, R.N.
Pembina County Health Department          Cavalier      Jeanne Chaput
Ransom County Public Health Department    Lisbon        Julie Barker
Richland County Health Department         Wahpeton      Debra Flack, R.N., M.S.
Rolette County Public Health District     Rolla         Barb Frydenlund, R.N.
Sargent County District Health Unit       Forman        Colleen Sundquist
Southwestern District Health Unit         Dickinson     Sherry Adams
Steele County Public Health Department    Finley        Brittany Ness. R.N.
Towner County Public Health District      Cando         Sherry Walters, B.S.N., R.N.
Traill District Health Unit               Hillsboro     Brenda Stallman, R.N.
Upper Missouri District Health Unit       Williston     Javayne Oyloe
Walsh County Health District              Grafton       Wanda Kratochvil, R.N.
Wells County District Health Unit         Fessenden     Karen Volk, R.N.




                                                                     August, 2011      75
                                    Local Public Health Unit Expenditures
                                For the Period July 1, 2009, through June 30, 2011
                                        Period      1,       through          201
                                                           Total            Annnual Per Capita
                                                         Expenditures           Expenditures
     District Health Units
          Cavalier County Health District            $     558,976            $           69.99
          Central Valley Health Unit                     3,984,675                        86.29
          City County Health Department                  1,760,117                        79.53
          Custer District Health Unit                    2,718,995                        27.27
          Dickey County Health District                  No Report                    No Report
          Emmons County Public Health                      345,022                        48.59
          First District Health Unit                     6,925,948                        39.25
          Kidder County District Health Unit               175,347                        36.01
          Lake Region Dist Health Unit                   3,118,023                        62.73
          McIntosh Dist Health Unit                        252,987                        45.03
          Nelson Griggs District Health                    528,015                        47.60
          Rolette County Public Health                     721,213                        25.87
          Sargent County District Health                   374,006                        48.84
          Southwestern Dist Health Unit                  3,976,453                        51.12
          Towner County Public Health                      130,108                        28.96
          Traill District Health Unit                      539,735                        33.23
          Upper Missouri Dist Health Unit                3,419,977                        44.41
          Walsh County Health Department                   859,510                        38.65
          Foster County Health District                    205,845                        30.79
          Wells County Dist Health Unit                    425,565                        50.58
     City/County Health Departments
          Bismarck-Burleigh Public Health                 6,264,700                       38.52
          Fargo Cass Public Health                       15,422,253                       51.48
          Grand Forks Public Health Dept                  7,115,772                       53.21

     County Health Units
        LaMoure Public Health Unit                       No Report                    No Report
        Pembina County Health Unit                         157,333                        10.61
        Ransom County Health Department                  No Report                    No Report
        Richland County Health Department                2,330,277                        71.39
        Steele County Public Health                        115,544                        39.38


          Total Local Public Health Funding          $62,426,396                  $      49.20
76
                                                            Financial Summary
                                                       Nor th Dakota Depar tment of Health
                                                       North Dako Department
                                                             Appropriations Summary
                                                             Appropriations Summar y
                                               For the Period July 1, 2009, through June 30, 2011
                                                       Period      1,       through          201



                                                        Carryover     Emergency       Emergency     Internship   Emergency     Emergency     EPA Litigation      Total
                           Original          Equity     Colorectal    Commission      Commission     Program     Commission    Commission     Emergency       Department
    Use of Funds         Appropriation    Adjustments    Cancer         Sep-09          Dec-09        Feb-10       Mar-10        Mar-10        Clause         Appropriation

Salaries & Wages         $   44,861,868   $ 320,940                   $     480,000                 $    2,600                                                $ 45,665,408
Operating Expenses           44,635,794                                     640,000                                                                500,000      45,775,794
Capital Assets                1,813,268                                     200,000                                                                              2,013,268
Grants                       63,831,510                      38,233       3,600,000                                                                             67,469,743
Tobacco Program               9,079,685        1,060                                                                                                             9,080,745
WIC Food Payments            25,063,375                                                                                                                         25,063,375
Federal Stimulus Funds       13,247,325                                                 7,076,990                    364,148       548,470                      21,236,933
Community Health Trust        2,405,371                                                                                                                          2,405,371
Fund Contingency
          Total          $ 204,938,196    $ 322,000     $    38,233   $ 4,920,000     $ 7,076,990   $    2,600   $   364,148   $   548,470   $     500,000    $ 218,710,637




General Funds            $  27,081,665    $ 150,000                                                 $    2,600                               $     500,000    $ 27,734,265
Federal Funds              138,272,849      172,000                       4,920,000     7,076,990                    364,148       548,470                      151,354,457
Special Funds               39,583,682                       38,233                                                                                              39,621,915
          Total          $ 204,938,196    $ 322,000     $    38,233   $ 4,920,000     $ 7,076,990   $    2,600   $   364,148   $   548,470   $     500,000    $ 218,710,637




                                                                                                                                                                  77
                                              Nor th Dakota Depar tment of Health
                                              North Dako Department
                                                    Expenditures by Section
                                          For the Period July 1, 2009, through June 30, 2011
                                                  Period      1,       through          201


                                                                                                            Emergency
                                            Medical         Health          Community      Environmental   Preparedness       Special
                         Administrative     Services       Resource           Health          Health        & Response      Populations      Total
     Use of Funds          Services         Section         Section          Section          Section         Section         Section     Expenditures

Salaries & Wages         $   5,056,189     $ 3,791,315    $ 5,926,611   $      4,948,414   $ 19,012,963    $    2,197,521   $ 1,303,870   $ 42,236,883
Operating Expenses           1,320,886       4,647,376      1,263,005          6,558,757      7,269,150         5,036,246       475,341     26,570,761
Capital Assets                   6,517         254,259                            24,714        950,457           357,873             0      1,593,820
Grants                       2,675,000       2,469,378                        17,492,836     17,054,051        13,574,237     2,263,070     55,528,572
Tobacco Program                                                                4,900,218                                                     4,900,218
WIC Food Payments                                                             17,915,331                                                    17,915,331
Federal Stimulus Funds         117,512         603,614         17,191          1,061,704       8,834,372                         42,300     10,676,693
Community Health Trust                                                           407,956                                                       407,956
Fund Contingency
           Total         $   9,176,104     $ 11,765,942   $ 7,206,807   $     53,309,930   $ 53,120,993    $ 21,165,877     $ 4,084,581   $ 159,830,234


         Total FTEs          38.43            30.25          46.00            47.80           156.25           13.50           11.27            343.50




    78
            Strategic Map 2007 – 2009
                                 Protect and Enhance the Health and
                                   Safety of All North Dakotans and
                                  the Environment in Which We Live


    Improve the                   Improve Access              Preserve and             Promote a State
  Health Status of                 to and Delivery             Improve the              of Emergency
   the People of                      of Quality              Quality of the              Readiness
   North Dakota                      Health Care              Environment
                                                                                        and Response


      Decrease                   Promote and Maintain
                                                                     e
                                                                Preserve              Prepare Public Health
 Vaccine-Preventable             Statewide Emergency           and Improve           and Medical Emergency
       Disease                     Medical Services             Air Quality            Response Systems


   Achieve Healthy
                                  Enhance the Quality             Ensure                Maintain Hazard
       Weights
                                    of Health-Care             Safe Public               Identification
      Throughout
                                        Services              Drinking Water               Systems
     the Lifespan


 Prevent and Reduce               Improve Access to        Preserve and Improve       Maintain Emergency
Chronic Diseases and               and Utilization of          Surface and            Communication and
 Their Complications               Health Services         Ground Water Quality        Alerting Systems


 Prevent and Reduce
                                                                                      Coordinate Public
   Intentional and                  Improve Health               Manage               Health and Medical
    Unintentional                       Equity                  Solid Waste
                                                                                     Emergency Response
        Injury

  Prevent and Reduce
                                                               Ensure Safe
Tobacco Use and Support
   Other Substance-
                                                                Food and
   Abuse Prevention                                          Lodging Services



  Reduce Infectious
     and Toxic
   Disease Rates




                          Achieve Strategic Outcomes Using All Available Resources



                                           Healthy North Dakota
                     Strengthen and Sustain Stakeholder Engagement and Collaboration
                                                                                                              79
     Publications
                Copies of the following publications can be accessed on the North Dakota Department of Health
             website at www.ndhealth.gov or by calling 701.328.2372.

             Community Health Section                             • Oral Health Third-Grade Basic Screening
             Newsletters                                            Body Mass Index Data Tables
              • Building Blocks to Safety/Buckle Update           • 2009 Oral Health Facts Summary
              • Focus on Oral Health                              • Oral Health Facts - Trends in Youth Oral
              • Heel Stick News                                     Health, March 2011
              • Parenting Newsletter                              • Oral Health Healthy People 2010 Indicators
              • Healthcare Provider Examiner                      • Oral Health Program Accomplishments
              • Pick-WIC Paper                                      2010-2011
                                                                  • Oral Health Program Policy Tool Workshop
             Reports                                                Report, June 2010
              • Chronic Disease in North Dakota – A               • North Dakota Health Disparities Diabetes
                Status Report for 2010                              September 2011
              • North Dakota State Stroke Registry –              • The Burden of Cancer in North Dakota
                January 2011 Report                               • The Burden of Cardiovascular Disease in
              • Healthy People 2010 North Dakota Final              North Dakota
                Report (Feb. 2011)                                • North Dakota Oral Health Surveillance Plan
              • Affordable Care Act Maternal, Infant and          • North Dakota WIC 2010 Annual Report
                Early Childhood Home Visiting Needs               • WIC Food Consumption and Buying Habits
                Assessment for North Dakota (Sept. 2010)          • On the Path to a Healthier Tomorrow –
              • North Dakota Five-Year Needs Assess-                North Dakota’s Strategic Plan To Prevent
                ment (2011-2015) for the Maternal and               and Reduce Tobacco Use (2008-2013)
                Child Health Services Title V Block Grant         • 2009 North Dakota Youth Tobacco Survey
                Program                                             Summary
              • North Dakota Five-Year Needs Assess-              • The Impact of North Dakota’s Smoke-Free
                ment (2011-2015) for the Maternal and               Law on Restaurants and Bar Taxable Sales
                Child Health Services Title V Block Grant         • North Dakota Suicide Prevention Plan
                Program - Executive Summary                       • Child Restraint Misuse In North Dakota
              • North Dakota Family Planning Annual               • North Dakota Injury Plan 2010
                Reports (2009 and 2010)                           • 2010 North Dakota Affordable Care Act
              • 2009 Youth Risk Behavior Survey                     Maternal, Infant and Early Childhood Home
              • Oral Health Third-Grade Basic Screening             Visiting Program Needs Assessment
80              Survey Data Tables
Other                                          • Guidelines for Becoming a Recognized
 • Newborn Screening Healthcare Guide-           Infant-Friendly Worksite (brochure)
   lines
 • Emergency Guidelines for North Dakota      Medical Services Section
   Schools Manual                             Newsletters
 • Health Guidelines For North Dakota          • Epi Report
   Schools Manual                              • Immunization Newsletter
 • Dental Care for Your Child (brochure)       • Pump Handle
 • Dental Sealants (fact sheet for parents)
 • Directory of Dental Access Programs        Reports
   (fact sheet)                                • HIV/AIDS/STD/Hepatitis/TB Annual
 • Fluoride Facts for Parents (brochure)         Profile
 • Oral Cancer, Are You at Risk? (brochure)    • Ryan White Care Plan
 • Oral Health Facts - Programs and Ser-       • Comprehensive HIV Prevention Plan
   vices (fact sheet)                          • Weekly Influenza Summary (during flu
 • Oral Health and Diabetes (fact sheet)         season)
 • Oral Health for Children with Special
   Health Care Needs (fact sheet)             Other
 • Your Own Special Goodbye (booklet)           • Healthcare-Associated Infections Preven-
 • Diabetes in Children Fact Sheet 2009           tion Plan and Reference Manual
 • Diabetes Fact Sheet 2011
 • Comprehensive Tobacco-Free School            dministrative
                                              A dministrativ e Suppor t Section
   Policy Tool Kit                            Reports
 • Home Safety Checklist                        • North Dakota Department of Health
 • A Connection for Families and Agencies         2007-2009 Biennial Report
   – Resources for North Dakota Children        • Vital Events Summary
   Ages Birth to 8                              • C-Section Report
 • Coordinated School Health Blueprint          • Induced Termination of Pregnancy Report
 • Coordinated School Health Guidebook
 • Handbook for Public Playground Safety      Environmental Health Section
 • Poison Brochure                            Newsletters
 • Easy Steps to Properly Fit a Bicycle        • Official Bulletin
   Helmet                                      • Green Apple newsletter
 • A Bicycle Helmet for My Child               • The MicroChem Connection newsletter
 • Helmet Fit Checklist                                                                      81
     Reports                                                - Compost Facility Guidelines
      • Air Quality Monitoring Data Summary                 - Environmentally Friendly Auto and
        (2009 and 2010)                                       Metal Salvage Facilities
      • Annual Drinking Water Compliance Report             - Beneficial Use of Inert Waste
        (2009 and 2010)                                     - Septage, Sump and Pit Waste and
      • State of North Dakota Capacity Develop-               Restaurant Grease Trap Waste Manage-
        ment Program Report (2009 and 2010)                   ment
      • North Dakota Hazardous Waste Compli-          •    Solid Waste Fact Sheets:
        ance Guide                                          - Pay as You Throw in North Dakota
      • North Dakota 2010 Integrated Section                - Using Compost and Wood Chips
        305(b) Water Quality Assessment Report              - Electronic Recycling Facilities
        and Section 303(d) List of Waters Needing           - Glass Recycling
        Total Maximum Daily Loads                     •   Land Application Worksheet
      • State/Industry Ambient Monitoring Net-        •   Department of Transportation Projects
        work Air Quality Reports                          Inert Waste Disposal Variance Application
      • Annual Mosquito Report (2009 and 2010)        •    North Dakota’s Pharmaceutical Waste
                                                          Guidance
     Other                                            •    North Dakota Solid Waste and Recycling
      • North Dakota Air Pollution Control Rules          newsletter and e-newsletter articles
      • Standards of Quality for Waters of the        •    Flood Fact Sheets:
         State                                              - Emergency Health Precautions for
      • “Our Water – Keeping It Clean” articles in            Flooded Areas
         the North Dakota Water magazine                    - Flood Preparedness and Response for
      • Directory of Services 2011-2013                       Food Establishments
        (Division of Laboratory Services-Microbiol-         - Home Heating Oil
         ogy)                                               - Mold in Homes
      • A Guide to Understanding North Dakota’s             - Proper Waste Disposal
         Infectious Waste Regulations                       - Proper Well Disinfection
      • Air Regulations for Grain Facilities Guide          - Sandbag Cleanup After a Flood
      • Oil and Gas Production Facilities Permit-           - Private Sewer and Septic Systems
         ting and Compliance Guide                          - Asbestos Hazards Due to Flooding
      • Solid Waste Guidelines:                             - Commercial Underground Storage
           - General Native Grass Seeding                     Tanks
           - Evaluating Final Vegetative Cover of           - Debris Removal Guidelines
82           Closed Landfill Areas
Health Resources Section                       Emergency Preparedness and
Newsletters                                    Response Section
 • CLIA Bits                                   Newsletters
 • Dialysis Dialogue                            • DEMST Newsletter
 • Hospital Happenings
 • Long Term Care Highlights                   Reports
                                                • North Dakota Data Report (2006-2007;
Special Populations Section                       2007-2008)
Reports                                         • Rural EMS Improvement Project
 • North Dakota Birth Defects Monitoring         (REMSIP) Final Report
   System Summary Report 2001-2005              • REMSIP Pembina County Report
 • North Dakota Five-Year Needs Assess-         • REMSIP Cass County Report
   ment (2011-2015) for the Maternal and        • REMSIP Oil Impact Report
   Child Health Services Title V Block Grant
   Program                                     Other
 • North Dakota Five-Year Needs Assess-         • North Dakota Briefing Book (2008)
   ment (2011-2015) for the Maternal and        • 2009 Response Areas Map Book
   Child Health Services Title V Block Grant    • REMSIP Medical Director Guide
   Program Executive Summary                    • REMSIP Quality Guide-How Good Is Your
                                                  Ambulance Service?
                                                • REMSIP Quality Checklist
                                                • REMSIP Leader’s Survival Guide




                                                                                          83
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