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HomeMy WebLinkAboutAgenda - 08-16-2005-7cORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: August 16, 2005 Action Agenda Item No. ~~ G SUBJECT: Mill Creek Road Area Community Health Study Proposal DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: Mill Creek Road Area Community Health Rosemary Summers, ext 2411 Assessment Plan Ron Holdway, ext 2360 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To receive a proposed community health assessment plan for the Mill Creek Road area, provide direction to staff, and consider funding from the Social Safety Net/Critical Needs Reserve to address water sampling costs, BACKGROUND: Earlier this spring, Environmental Health staff met with a small number of residents from the Mill Greek Road area located in Cedar Grove Township. These residents voiced concerns at that time about well water problems in their neighborhood and what options were available for relief including well repairs, well replacements and the extension of public water lines. Subsequent to that meeting, one community member in attendance at a Board of County Commissioners meeting asked the board to authorize a groundwater study based an the fact that several community members had developed cancer as a result of the water, The BOCC members agreed to attend a community meeting to further discuss the matter with the residents and to authorize a study of the problems, That meeting occurred on June 29th, All five commissioners were in attendance as was Orange County Environmental Health staff, the Orange County Engineer and an Orange County Planning Department representative. Local media was also present, The Commissioners committed to the community that the Health Department would spearhead a study of the water problems and other possible environmental exposures in the area and provide a report to the Commissioners and to the community. Commissioners asked that the County be provided with a list of past cancer patients in the area, which has been provided to Health Department staff. The attached proposal is for an assessment of health conditions in the area where residents are expressing concern. The Health Department will utilize current Environmental Health and Community Services staff who have expertise in this area to gather samples, to conduct the assessment proposed in the study and to analyze the data, Consultation has been sought from the North Carolina Department of Health and Human Services to ensure that the Department is utilizing the best information possible. The Health Department will be using a stepwise, epidemiological approach to this assessment, The assessment plan calls far atwo-pronged approach -one is laboratory analysis of the water in private wells that are currently in use and the second prong is an assessment of a health history and other demographic information on area residents. This is proposed to take place through a structured questionnaire and may be followed up with fiuther questionnaires depending on the results of the first questionnaire, Data that is gathered will be analyzed and compared to results that would be considered to be "normal" incidences of disease, FINANCIAL IMPACT: The total casts of performing the study cannot be determined at this time. Water samples for the entire suite of tests (inorganic, bacteriological, semi-volatile and volatile and pesticides) are at a cost of $185 per well tested, Radon kits are $20 for the water sampler and $10 for the air sampler per household. The total cost per household will be $215.. The Health Department is estimating 100 households for an out of pocket cost of $21,500, It is estimated that there will be staff time to gather the samples and staff time for conducting the questionnaire, analysis and report compilation for the first phase of the assessment, It is difficult to estimate the staff cost because more than one person will be involved in the assessment, At present, it is estimated that at least five persons will be involved in various phases of the assessment over the next six months. At this time, one FTE equivalent far six months of an environmental health specialist would be a low estimate for staff costs for this effort (approximately $34,000). These costs do not include any external contracts far data analysis or consultation that are not anticipated at this stage of the investigation, Indirect costs would also include the staff time diverted from other duties such as septic and well permits and communicable disease tracking. The out of packet costs of $21,500 for the water samples were not included in the Department's approved budget for FY05-06. RECOMMENDATION(S): The Manager recommends that the Board receive the Report and provide direction to the staff, Should the Board authorize staff to proceed, it is recommended that the $21,500 for the water sampling component of the proposal be paid through a transfer from the Social Safety Net/Critical Needs Reserve. MILL CREEK ROAD AREA COMMUNITY HEALTH ASSESSMENT PLAN August 8, 2005 Sequence of Actions with Associated Timelines I. Convene OCHD Epi Team and selected NCDHHS personnel August 8~~'). The OCHD Epi Team consists of staff from multiple divisions with relevant expertise in disease surveillance and investigation. We intend to augment the team for this situation by including members of the Region Four Public Health Surveillance Team (PHRST4). The Epi Team will have the following charges for this investigation. • Review situation and establish Incident Command System (ICS) structure for response. Rosie Summers will be the incident commander for this investigation and response. • Discuss and develop study framework and establish parameters for personal questionnaire including possible exposures routes, health history and time in community, • Develop a sampling plan for all environmental testing regimes, including water and air (radon).. • Consider additional state and federal resource agencies to be contacted. II. Defiue Area of Study The exact area to be studied will be determined by staff based on the geographic distribution of residents reported to be affected in the community. Staff will log all the households into the GIS system in order to define the area.. III. Questionnaires (by end of August) The initial questionnaire allows for gathering of preliminary data used in the epidemiological evaluation. It will contain general information such as name, address, age and contact information and will also ask for other information to determine current and past chronic diseases and specific cancer types in the community.. Once this initial data is gathered, staff will review it in consultation with state cancer experts and epidemiologists. If the initial findings indicate rates higher than would be expected, staff will seek assistance from experts in the cancer field to develop a more intensive questionnaire covering possible environmental exposures including water supplies, work history, length of time at their current residence, age of residence, and possibly travel history. If a follow-up questionnaire is warranted, it will contain a section for medical history including known malignancies, medical providers and current disease status. Participating residents will be asked for a medical release for review of medical records if a diagnosis of cancer is listed. For deceased residents from the area, we will attempt to piece the information together through relatives and medical providers or from the NC Cancer Registry. Participation by community members will be on a voluntary basis with strict control of privacy of all data related to individuals in the study. IV. Environmental sampling plan (samples collected by end of September and results back to OCHD by end of October) OCHD staff will secure vohmtary permission to sample wells at the residences in the def ned geographical area for a variety of contaminants. The routine tests are for pathogenic bacteria presence and inorganic chemicals, which includes arsenic, lead and other toxic constituents. We will expand the tests for this area to also include pesticides, semi-volatile and volatile organic chemicals and radon (both from water and air). The well video camera will be used to assess wells with questionable construction and those with sample results indicative of construction problems. Furthermore, once we have a better understanding of the diseases involved in the conununity, we will consult with state toxicologists and environmental specialists to determine if any additional environmental sampling is indicated or warranted. All the homes involved in the study along with sample results will be logged into the GIS system for fiirther regional evaluation and potential ]ong-term tracking and monitoring.. V. Preliminary results, evaluations, and next actions (by end of November) Once the initial data is compiled, it will be analyzed for statistical association to the known diseases in the Mill Creek community. We will also ask for the statistical results to be reviewed by state epidemiologists for confirmation of our analyses. If there appears to be any significant correlations between the studied exposures routes (e.g., well water), we will prepare recommendations and possible options for amelioration of those problems. If further undiagnosed disease incidence is discovered, those affected will be either recommended or referred for treatment. For those residents with well problems only (i.e., no current or past disease), staff will advise them on what options they have to remedy their problems. If there is a finding of widespread groundwater contamination that limits the use of individual wells, staff will work with the County Engineer and other appropriate agencies to explore other water supply options. Further study maybe indicated during this time period and staff will coordinate those efforts. Regardless, we will report all findings and recommendations (except those subject to confidentiality regulations) to the community, the Board of Health and the BOCC for their considerations.. VI. Known and Potential Collaborators • PHRST 4 -Public Health Regional Surveillance Teams are multidisciplinary teams established by the state to support and enhance local public health capacity for disease and disaster responses. Their technical staff members are comprised of a physician, an epidemiologist, and an industrial hygienist. • NC State Laboratory of Public Health • NC Department of Health and Human Services, Division of Public Health, Cancer Prevention and Control Section • NC Department of Health and Human Services, Division of Public Health, Occupational and Enviromnerrtal Epidemiology Section • NC Department of Health and Human Services, Division of Public Health, NC State Center for Health Statistics, Cancer Registry Branch VII. Contacts by Expertise • Rosemary Summers, MPH, DrPH, Orange County Health Director, Incident Commander for the investigation, 919-245-2411 • Judy Butler, RN, Communicable Disease Supervisor, Epi Team Leader 919-245-2425 • Ron Holdway, Environmental Health, 919-245-2360 • Karen I{tright, Epidemiologist, DPPH Cluonic Disease Branch • Ricky Langley, MD, State Occupational and Enviromnental Epidemiology Branch • Heidi Swygard, MD, MPH, PHRST 4 Team Leader • Paul Thames, PE, Orange County Engineer (for questions about public water extension)