North Dakota Department of Health
2009 to 2011
Jack Dalrymple, Governor
Dr. Terry Dwelle, State Health Officer
Stacy Eberl, Editor
600 E. Boulevard Ave.
Bismarck, N.D. 58505-0200
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
State Health Officer’s Message
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
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
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
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
Marlene Kouba, Regent
the North Dakota Department of Health. The Audit.
Gordon Myerchin, Grand Forks
Carmen Toman, Bismarck
Dennis E. Wolf, M.D., Dickinson
Howard C. Anderson, R. Ph.,
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
Office of the State Health 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-
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.
• 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
• Health disparities
• Worksite wellness
• Oral health
• Early childhood
• School health
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.
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
• 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.
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.
• 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
from vital event certificates.
• Compiled data for specific requests from the The average age at death is 76.3.
public or other state agencies.
• 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
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.
• 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.
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
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.
• 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.
• 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
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
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
• Provided state funding to four other agencies
to provide prevention training in one tribal
and three non-tribal areas of the state.
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
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
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.
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
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.
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
• Established 100 percent rating for Strategic
National Stockpile program.
• Acquired mobile clinic capacities in state
• Established and exercised primary receiving,
staging and storing site for mass prophylaxis
and countermeasure distribution.
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.
• 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
• 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
• Served as Region VIII director, National
Association of Vector-Borne Disease Control
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
• 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
• 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-
• 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
before opening to the public and while in
• Update memorandums of understanding with
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
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
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.
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.
Special Populations Section
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.
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.
• 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
• 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.
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
• 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.
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.
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
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.
• Inspected about 80 facilities that generate or
manage hazardous waste; provided compli-
ance assistance to other similar facilities.
• 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.
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
• Evaluate and update solid waste guidance
and rules regarding landfill development,
Division of Municipal Facilities Drinking Water State Revolving Loan Fund
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.
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.
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
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
and Class V underground injection wells.
• 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
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
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
• Maintain or increase laboratory efficiency and
responsiveness. 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
• 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
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.
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-
Burke Bottineau Rolette Towner Cavalier Pembina
Mountrail Ward McHenry
Nelson Grand Forks
Foster Steele Traill
Burleigh Kidder Stutsman
Slope Hettinger La Moure Ransom
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
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
Nor th Dakota Depar tment of Health
North Dako Department
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
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
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
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
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
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
Decrease Promote and Maintain
Preserve Prepare Public Health
Vaccine-Preventable Statewide Emergency and Improve and Medical Emergency
Disease Medical Services Air Quality Response Systems
Enhance the Quality Ensure Maintain Hazard
of Health-Care Safe Public Identification
Services Drinking Water Systems
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
Intentional and Improve Health Manage Health and Medical
Unintentional Equity Solid Waste
Prevent and Reduce
Tobacco Use and Support
Abuse Prevention Lodging Services
Achieve Strategic Outcomes Using All Available Resources
Healthy North Dakota
Strengthen and Sustain Stakeholder Engagement and Collaboration
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
• 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)
• 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
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
• 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
• REMSIP Quality Checklist
• REMSIP Leader’s Survival Guide