2001 ~ 2003 Biennial Report

North DakotaDepartment of Health

North Dakota Department of HealthCreative Public Health Solutions

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North Dakota Department of Health

Biennial Report2001 to 2003

John Hoeven, GovernorDr. Terry Dwelle, State Health Officer

Loreeta Leer Frank, Editor

North Dakota Department of Health600 E. Boulevard Ave.Bismarck, N.D. 58505-0200

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Table of Contents

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

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

Organizational Chart .........................................................................................................6

Office of State Health Officer .............................................................................................7

Administrative Support Section ..............................................................................................9

Community Health Section ..............................................................................................14

Emergency Preparedness and Response Section ............................................................23

Medical Services Section ..............................................................................................26

Health Resources Section ................................................................................................34

Environmental Health Section ...........................................................................................38

Local Public Health Units ................................................................................................53

State Health Council .............................................................................................................55

Financial Summary ..........................................................................................................56

Publications ................................................................................................................58

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December 1, 2003

Isn’t it amazing how public health affects our lives every day? We breathe clean air and drink safe,sparkling water. Our garbage is picked up and disposed of properly. We can do our jobs in smoke-freeworkplaces and feel confident that the food we eat at restaurants is safe. Our children are immunized againstmany diseases that we hardly think about today but that struck fear into the heart of every parent just a fewdecades ago – diseases such as diphtheria, measles and polio. All these accomplishments and more are dueto the efforts of public health.

As state health officer, I’m proud of the department’s public health professionals and the work they doto safeguard the health of all North Dakotans. Consider just a few of the many challenges we faced duringthe past two years:

• Emerging diseases such as West Nile virus and severe acute respiratory syndrome (SARS)• Bioterrorism preparedness and response, including vaccinating public and private health-care workers

and others who would be called upon to respond to a smallpox outbreak• Air quality issues such as maintaining North Dakota’s status as one of only 14 states in the nation that

meet all National Ambient Air Quality Standards• The train derailment and subsequent anhydrous ammonia release in Minot

Even as we respond to unexpected challenges, we continue building the state’s public health infrastruc-ture. For example, the department is providing scholarships to several students who are pursuing advanceddegrees in public health. In addition, we have increased our partnerships with a variety of stakeholders, suchas universities, nonprofit organizations, the private health-care community and local public health units.

We look forward to continuing our service to the public and to meeting whatever challenges come ourway during the next biennium. In the meantime, I invite you to read this report and learn more about thegoals and accomplishments of the NDDoH during the 2001–2003 biennium.

Terry Dwelle, M.D., M.P.H.T.M.State Health Officer

State Health Officer’s Message

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A Look at the Department

Mission StatementThe North Dakota Department of Health is

dedicated to ensuring that North Dakota is ahealthy place to live and that each person has anequal opportunity to enjoy good health. We arecommitted to the promotion of healthy lifestyles,the protection and enhancement of health and theenvironment, and the provision of quality health-care services for the people of North Dakota.

We advance our mission by networking,facilitating local efforts, collaborating with partnersand stakeholders, and providing expertise indeveloping creative public health solutions.

The North Dakota Department of Healthemploys about 300 people dedicated to makingNorth Dakota a healthier place to live.

The six sections of the department are underthe administrative supervision of the state healthofficer and the deputy state health officer. Theyinclude:

• Administrative Support• Community Health• Emergency Preparedness and Response• Medical Services• Health Resources• Environmental HealthEmployees in these sections provide the

following core public health services promulgatedby Public Health in America:

• Preventing epidemics and the spreadof disease

• Protecting against environmental hazards• Preventing injuries• Promoting and encouraging healthy

behaviors• Responding to disasters and assisting

communities in recovery• Ensuring the quality and accessibility

of health servicesThe department logo is a representation of

both apples and wheat. An apple is the universalsymbol of good health and well-being; the wheatrepresents the richness of North Dakota’senvironment.

Department Overview

State Health CouncilThe State Health Council serves as the North

Dakota Department of Health’s advisory body.The council’s 11 members are appointed by thegovernor for three-year terms. Four membersare appointed from the health-care providercommunity, five from the public sector, one fromthe energy industry and one from the manufactur-ing and processing industry.

CreativePublic Health

Solutions

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Organizational Chart

*With the passage of 2003 legislation, the Crime Lab was moved to the Attorney General’s office July 1, 2003.**On Sept. 1, 2003, the Community Health Section was reorganized into the following divisions: Cancer Prevention and Control;Chronic Disease; Family Health; Injury Prevention and Control; Nutrition and Physical Activity; and Tobacco Prevention and Control.

June 30, 2003

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State Health Officer Terry Dwelle, M.D.

Deputy State Health Officer Arvy Smith

Accounting Kathy Albin

Public Information Loreeta Leer Frank

Information Technology Darin Meschke

Vital Records Naida Feland (Acting)

Human Resources Kerry Olson

Education Technology Timothy Wiedrich

Local Public Health Kelly Carlson

Community Health** John Joyce, M.D.

Emergency Preparedness and

Response Timothy Wiedrich

Medical Services Craig Lambrecht, M.D.

Health Promotion Sandra Adams

Maternal & Child Health Mary Dasovick (Acting)

Health Resources Darleen Bartz

Environmental Health Dave Glatt

Field Medical Officers Craig Lambrecht, M.D.

State Forensic Examiner George Mizell, M.D.

Air Quality Terry O’Clair

Chemistry Myra Kosse

Municipal Facilities Jack Long

Waste Management Wayne Kern

Water Quality Dennis Fewless

Administrative Support Arvy Smith

Disease Control Larry Shireley

Microbiology Bonna Cunningham

Research Epi Center

Public Health Training Center

Emergency Health Services Timothy Meyer

Food & Lodging Kenan Bullinger

Health Facilities Bruce Pritschet

Roger Unger

Crime Lab* Kenan Bullinger

State Health Council Carmen Toman, Chair

Healthy North Dakota

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Office of the State Health Officer

The state health officer is appointed by thegovernor to be the chief administrative officer ofthe department, as well as a member of thegovernor’s cabinet. The state health officerimplements state laws governing the departmentwithin the guidance of the governor and the rulesadopted by the State Health Council. In addition,the state health officer is a statutory member ofabout a dozen boards and commissions.

This biennium, the state health officer launchedthree initiatives designed to enhance public healthefforts in North Dakota: the Public Health TrainingCenter, the Research Epi Center and HealthyNorth Dakota.

Public Health TPublic Health TPublic Health TPublic Health TPublic Health Training Centraining Centraining Centraining Centraining CenterererererThe Public Health Training Center – a coop-

erative effort among the NDDoH, the Universityof North Dakota, and the University ofMinnesota – is designed to improve public healthpractice in the state through advanced publichealth education.

Approved applicants receive scholarshipsthrough the Centers for Disease Control andPrevention Bioterrorism Preparedness andResponse Grant. Nine students have completed orare enrolled in the program, and about 70 percent

of the state’s public health workforce haveindicated interest in applying for scholarships.

Research Epi CenterResearch Epi CenterResearch Epi CenterResearch Epi CenterResearch Epi CenterThe Research Epi Center is a joint project

between the NDDoH and UND designed toimprove utilization of health data.

Health scientists from both organizations areworking together to ensure that communities,policymakers, health planners and public healthagencies have information needed to understandthe causes of disease and premature death, toensure the effectiveness of public health programsand to provide the best health care possible for allthe state’s citizens.

Beginning in January 2004, UND will take thelead in collecting and interpreting adult behaviorrisk data. Goals include compiling county-specifichealth data and analyzing the health status ofcertain vulnerable populations in the state.

Healthy North DakotaHealthy North DakotaHealthy North DakotaHealthy North DakotaHealthy North DakotaHealthy North Dakota supports North

Dakotans in their efforts to make healthy choicesby focusing on wellness and prevention. Gov.John Hoeven appointed an advisory committeethat launched the initiative at a statewide summit inAugust 2002. More than 130 people from morethan 75 organizations met to define wellness andidentify priorities for North Dakota.

Ultimately, Healthy North Dakota willinspire North Dakotans to establish behaviors andsupport policies that improve health and reducethe burden of health-care costs through innovativestatewide partnerships.

State Health Officer

The Office of the State Health Officermanages the activities of and provides directionand leadership to the Department of Health. Theoffice is composed of the state health officer andthe deputy state health officer.

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Deputy State Health OfficerThe deputy state health officer position was

created in November 2001 to address adminis-trative affairs of the department, allowing the statehealth officer to focus on policy and practice.Legislation passed in 2003 provided statutoryauthority for the deputy to act on behalf of thestate health officer with the limitation that a deputywho does not hold a health degree cannot issuean order regarding public health unless the orderis cosigned by a physician employed by thedepartment or by the state epidemiologist.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Initiated department-wide strategic planning to

guide the efforts and direction of the NDDoH.• Provided leadership and oversight for phase I

of the renovation and addition project for thedepartment’s laboratory facility, which will beoccupied in the spring of 2004.

• Secured funding for phase II of the laboratoryrenovation and construction of state morgue.

• Approved grants and contracts of approxi-mately $32 million in funding to numerous localentities for provision of public health services.

• Completed departmental reorganization tostreamline efforts and communications,including –∗ Establishment of Emergency Preparedness

and Response Section.∗ Streamlining of Community Health Section by

removing middle reporting level.∗ Merger of injury prevention programs.∗ Elimination of central library function.

∗ Consolidation of administrative supportfunctions.

∗ Transfer of Crime Lab to Attorney General’sOffice.

∗ Transfer of OSHA Program to BismarckState College.

∗ Consolidation of medical services functions.∗ Consolidation of non-environmental regula-

tory functions.∗ Establishment of Division of Education

Technology and Office of InformationTechnology.

• Developed system to coordinate effectivedepartmental legislative efforts.

GoalsGoalsGoalsGoalsGoals• Complete strategic planning efforts to include

system to ensure attainment of departmentalstrategic goals and performance standards.

• Secure resources (i.e., funding, staff, space)necessary to implement initiatives of the depart-ment and to comply with state and federal laws.

• Complete remodeling of judicial wing floorspace for adequate, safe and efficient accom-modation of staff.

• Provide systems and strategy to ensure pro-gram efficiency and effectiveness and compli-ance with state and federal laws, contractrequirements and program guidelines.

• Collaborate with the UND Center for RuralHealth on the development and implementationof public health policy.

Phase I of the department’s laboratoryrenovation and addition project is scheduledfor completion in the spring of 2004.

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through training programs on federal and stategrants and appropriation monitoring.

• Reviewed grant applications that resulted inreceipt of about $70 million in federal fundingfor the department.

• Processed about 1,600 contracts providingfunding to a variety of entities for promotion ofpublic health services.

Administrative Support SectionThe Administrative Support Section provides

support services to assist all NDDoH divisions inaccomplishing their missions.

The section consists of the following:• Accounting• Human Resources• Vital Records• Public Information• Education Technology• Information Technology• Local Public Health• Crime Laboratory

Division of AccountingThe Division of Accounting provides account-

ing and financial control records that comply withstate and federal requirements.

This data is distributed monthly to departmentmanagers to help them monitor federal and stategrant expenditures, revenue, and state appropria-tions. The division prepares financial reports,reviews grant applications, collects revenue, paysexpenses, processes the payroll and submits thedepartment’s biennial budget.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Submitted the 2003-2005 biennial budget to

the Office of Management and Budget incompliance with the governor’s guidelines.

• Held general fund spending for the 2001-2003biennium to near the 1999-2001 biennium level.

• Underwent successful annual audit and receiveda clean opinion from the State Auditor’s Office.

• Provided assistance to department personnel

Division of Human ResourcesThe Division of Human Resources provides

a variety of services to the NDDoH, includingemployee relations, employee recruitment,position classification, training and development,salary administration, policy development andsafety.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Reviewed positions to determine exemption

status under the Fair Labor Standards Act.• Assisted in development and implementation of

the Tuition Reimbursement Scholarship Pro-gram for graduate work in public health.

• Provided assistance to management, supervi-sors and employees regarding laws, rulespolicies/procedures, and personnel issues.

GoalsGoalsGoalsGoalsGoals• Develop new employee orientation program.• Utilize a standard format to measure and report

performance.• Continue to provide technical support and

assistance to management and staff.

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Division of Vital RecordsThe two main functions of the Division of Vital

Records are registration and certification of vitalevents that occur in the state, including births,deaths, fetal deaths, marriages and divorces.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Registered 15,883 certificates of live birth;

12,858 certificates of death; 116 certificates offetal death; 8,751 marriage records; 3,724divorce records; and 120 delayed registrationsof birth. More than 141,000 requests forcertified copies, record searches, amendmentsand verifications were processed. The feescollected for providing these services weredeposited to the state’s general fund.

• Compiled annual reports using data collectedfrom vital event certificates. Also compiled datafor specific requests from the public or otherstate agencies.

GoalsGoalsGoalsGoalsGoals• Maintain 100 percent registration of all vital

events in North Dakota. To achieve this goal,extensive querying and follow-up is done.

• Continue to provide timely responses to publicrequests for certified copies of vital eventdocuments. Individuals now can order copieson the department’s website using a credit cardfor payment, which simplifies the orderingprocess. Vital event documents are needed forpassport applications, school entrance, jobapplications, Social Security benefits, etc.

Office of Public InformationThe Office of Public Information supports the

department’s communication of public healthinformation, policies and resources to the citizensof North Dakota. Duties include coordinatingmedia relations; preparing newsletters, brochuresand other materials; coordinating special events;providing or arranging communication training;releasing information through the media; andworking with various groups to promote publichealth.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Provided consultation to NDDoH personnel

concerning communication issues.• Developed NDDoH crisis communication plan.• Developed media-focused website.• Completed statewide public health communica-

tion needs assessment and special populationsassessment.

• Joined working group comprised of healthcommunicators from Canadian provinces andAmerican states adjacent to the border.

• Served on executive board of the NationalPublic Health Information Coalition.

GoalsGoalsGoalsGoalsGoals• Coordinate redesign of department logo and

efforts to brand NDDoH as the leading publichealth resource in North Dakota.

• Plan and host statewide public informationconference.

• Assist regional public information officers indeveloping emergency communication plans.

Vital SignsVital SignsVital SignsVital SignsVital SignsOn an average day day day day day in North Dakota:

••••• 2121212121 babies are born; 66666 of themare born out of wedlock, 2 2 2 2 2 areborn to a teenage mother and 66666are born by Caesarian section.

••••• 1616161616 people die, 55555 of them fromheart disease and 44444 from cancer.

••••• 1212121212 couples are married, and55555 are divorced.

In an average week:week:week:week:week:••••• 11111 infant dies.••••• 22222 people commit suicide.••••• 4 4 4 4 4 die from diabetes.••••• 33333 die from influenza and

pneumonia.••••• 55555 die as a result of accidents.

In an average month:month:month:month:month:••••• 9 9 9 9 9 children younger than 20 die.••••• 77777 people die as a result of motor

vehicle accidents.••••• 33333 babies are born outside of a

hospital setting.

The average age at death is 75.9.75.9.75.9.75.9.75.9.

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Office of InformationTechnology

Division of EducationTechnology

The Division of Education Technology usesadvanced technology to create and distributequality public health information, education andtraining. The division also deploys the Health AlertNetwork, which provides a secure emergencycommunications system for public health services.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Developed and distributed public health educa-

tion programs on a variety of topics, includingsmallpox preparedness, West Nile virus andSARS (severe acute respiratory syndrome).

• Developed and distributed health alerts, adviso-ries and updates regarding anthrax, SARS,West Nile virus, etc.

• Assessed local public health unit communica-tions infrastructure and developed a plan forimplementing connection to the high-speedcommunications network (STAGEnet).

GoalsGoalsGoalsGoalsGoals• Conduct education needs assessment.• Develop training plan and emergency prepared-

ness curriculum.• Provide incident command training.• Implement Health Alert Network communica-

tions system.• Connect all 28 public health units to STAGEnet.• Equip the state’s lead public health units with

video-conferencing equipment that will allowtwo-way interactive video conferencing.

The Office of Information Technology workswith information technology (IT) professionalsthroughout the department to coordinate ITactivities and functions. The office also developsand implements the department’s IT plan; moni-tors IT budgets; assigns IT staff and support; andserves as security officer for the Health InsurancePortability and Accountability Act (HIPAA).

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Implemented HIPAA regulations protecting

individually identifiable health information;implemented 11 HIPAA security policies.

• Worked with Iowa WIC and the North DakotaWIC Program to develop a two-state, web-based information management system.

• Assisted in developing the web-based DiseaseReporting Epidemiologic Assessment andMonitoring System as part of a nationwidepublic health information network.

• Assisted in developing the Health Alert Net-work communication system that allows timelyexchange of critical health information and rapidresponse to any potential health threat.

GoalsGoalsGoalsGoalsGoals• Integrate technology and data collection

throughout the department to ensure efficiency.• Ensure full compliance with HIPAA security

rules by April 21, 2005.• Continue to develop and coordinate IT policies

and procedures.

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Office of Local Public HealthThe Office of Local Public Health acts as

liaison between the NDDoH and local publichealth units and other key public and privatepartners. The local public health liaison adminis-ters the State Block Grant, which providesfunding to local public health units, and advisesthe state health officer about issues related tolocal public health. In addition, the local publichealth liaison works with NDDoH staff membersto assist public health units during disease out-breaks and natural disasters.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Elected to board of directors of the Association

of State and Territorial Local Health LiaisonOfficials.

• Coordinated information for local public healthpersonnel about tuition reimbursement scholar-ships for public health studies.

• Coordinated local public health HealthInsurance Portability and Accountability Act(HIPAA) workgroup and training. CompiledHIPAA questions-and-answers document forlocal public health units.

• Coordinated participation of a four-memberstate and local public health team in a nationalpublic health leadership institute; as a teamproject, the group developed an educationalvideo and brochure about zoonotic diseases.

• Assisted in the development, coordination anddistribution of a local vector-control survey.Presented the results at the NDDoH West NileVirus Conference.

Division of Crime LaboratoryWith the passage of 2003 legislation, the

Crime Laboratory was moved to the AttorneyGeneral’s office July 1, 2003.

Forensic LaboratoryThe Forensic Laboratory provides technical

assistance to the criminal justice system in theinvestigation of crime. The laboratory acceptsevidence from agencies, including prosecutorsand law enforcement officers (local, county, state,federal and military), as well as defense counsels.

Laboratory analysis includes processing ofevidence by the following techniques: examinationfor flammable chemicals used in arsons, drugidentifications, firearm and tool mark examina-tions, biological screening, trace evidence exami-nations, special photographic techniques, devel-opment of latent fingerprints, comparison of tireand footwear impressions, and DNA profiling.

Drug identification is the major area ofanalysis and includes identification of clandestinedrugs, pharmaceuticals and chemical compounds.

GoalsGoalsGoalsGoalsGoals• Assist local public health units in identifying

health-status indicators and develop local publichealth unit health profiles with web-basedaccessibility.

• Facilitate the completion of state and localNational Public Health Performance Standardsassessment tool and the development of apublic health improvement plan.

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AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Processed 18,104 pieces of evidence from

drug cases.• Processed evidence from 5,192 cases and

testified at 26 trials.• Implemented DNA testing, established a DNA

database of convicted sex offenders, andupdated laboratory techniques.

• Received accredidation for DNA testing.• Purchased modern equipment for trace

evidence analysis.• Provided staff training on DNA, firearms, drug

and arson analysis, and crime scene andclandestine lab investigations.

Toxicology LaboratoryThe Toxicology Laboratory provides techni-

cal assistance to the criminal justice system fortraffic safety, death investigations and otherpurposes. Staff members accept evidence fromlocal, county, state, federal and military agencies.Assistance includes training officers in breath-alcohol determination, maintenance of breath-testing instruments, blood-alcohol analysis, andchemical drug and toxic substance analysis. Thelaboratory also provides expert testimony incriminal prosecutions and traffic safety hearings.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Performed 8,017 analyses for alcohol and

other drugs on 5,299 submitted cases.• Inspected, maintained and repaired 165

preliminary and 349 evidentiary breath-alcoholinstruments.

• Conducted 30 classes to train 948 officers whowere responsible for conducting 5,508 breath-alcohol tests.

• Testified at 58 administrative hearings andcourt trials.

• Developed new postmortem kits that increasedcompliance and reporting efficiency on trafficfatalities.

Division GoalsDivision GoalsDivision GoalsDivision GoalsDivision Goals• Provide rapid, accurate analysis of

evidence and minimize case backlog.• Continue staff training and develop-

ment in criminal case work.• Ensure quality breath-alcohol testing.• Provide statewide training for breath-

testing recertification classes via theInteractive Video Network.

• Continue integrating new generationbreath-testing devices capable ofelectronic data transmission.

• Continue expanding drug analysiscapabilities to keep pace with newpharmaceuticals.

• Develop new evidence tracking andreporting process.

• Implement a new laboratory informa-tion system.

• Continue pursuit of Crime Laboratoryaccreditation.

• Obtain additional space to perform statutorymandates.

The Crime Laboratory provides technicalassistance to the criminal justice system.

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Community Health SectionThe Community Health Section is responsible

for maternal and child health and health promotionservices in the state. The section’s goal is topromote health and prevent illness and disease.Many of these services are provided by localpublic health units.

The section includes the divisions of Maternaland Child Health and Health Promotion.

The Department of Health completed strate-gic planning during the biennium, which led toplans to reorganize the Community Health Sec-tion. During the next biennium, the two currentdivisions will be divided into six to improvecommunication at all levels and to meet the needsof the department’s partners more fully.

Division of Maternal andChild Health

The mission of the Division of Maternal andChild Health (MCH) is to ensure healthy women,children and families. The division supports andencourages better health through education,policy development, advocacy and partnerships.

Programs within the division include:• Abstinence Education• Adolescent Health• Arthritis• Coordinated School Health• Early Childhood Services• Domestic Violence/Rape Crisis• Family Planning• Genetics• Injury Prevention

• Lead Program• MCH Nursing• MCH Nutrition• Metabolic Screening• Optimal Pregnancy Outcome Program• Oral Health• Prenatal Risk Assessment Monitoring System• State Systems Development Initiative• Sudden Infant Death Syndrome• WIC (Special Supplemental Nutrition Program

for Women, Infants and Children)• Women’s Health

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAbstinence Education• Provided federal funds to seven Regional/Tribal

Children’s Services Coordinating Committeesand two local public health units to provideabstinence-only education activities.

Adolescent Health• Collaborated with the Arizona Pima County

Health Department to develop the NorthDakota BE AMAZED – Teen Maze PlanningGuide, with activities in which adolescentsexperience both the positive and the negativeoutcomes of specific behaviors.

Arthritis• Provided training through the Arthritis Founda-

tion for leaders certified to teach self-helpcourses to people who have arthritis.

• Collaborated with the Arthritis Foundation tocoordinate an arthritis symposium.

The Community Health Section worksto ensure healthy women, childrenand families by promoting health andpreventing illness and disease.

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Coordinated School Health• Provided technical assistance to the Dakota

Medical Foundation to support its five-yearmodel school nurse program project.

• Collaborated with the North Dakota SchoolNurses Organization to:∗ Produce and distribute Chalkboard on

Health, a biannual newsletter with informationabout school health issues.

∗ Develop guidelines for a school-nurse-of-the-year award.

• Conducted the School Nursing Services Surveyto determine school nurse-to-student ratio.

• Included questions about school nursingservices in the School Health EducationProfile survey.

• Collaborated with the Department of PublicInstruction and the Division of Health Promo-tion to write a successful grant application forthe Coordinated School Health Programs andReduction of Chronic Diseases InfrastructureAgreement from the Centers for DiseaseControl and Prevention.

Early Childhood Services• Collaborated with the Department of Human

Services and Child Care Resource and Referralto provide consultation and educational servicesfor child-care and Head Start entities.

• Facilitated a statewide early childhood meetingwith key stakeholders to gather information forthe Early Childhood Comprehensive SystemsGrant application.

Domestic Violence/Rape Crisis• Provided state and federal funds to local

agencies that serve victims of domestic vio-lence, sexual assault and stalking.

• Sponsored training that focused on the role ofprofessionals during a domestic violenceinvestigation and promoted coordinated com-munity response.

• Distributed STOP Violence Against Womenfunds to law enforcement, prosecution, judicial,victim-service and community agencies thatprovide services to victims.

• Collaborated with partners to submit a SafeHavens: Supervised Visitation and Safe Ex-change Grant application to the U.S. Depart-ment of Justice.

Family Planning• Provided medical and education/counseling

family planning services to more than 20,000North Dakotans.

• Expanded services to the James River Correc-tional facility and the Cass County Jail.

• Redesigned the MCH website to be more userfriendly and informative. The new websitereceived a gold Addy Award from the Advertis-ing Federation of Bismarck.

• Initiated collaboration with the Women’s WayProgram to assess the channels through whichAmerican Indian women hear health messages.

Genetics• Collaborated with the Department of Human

Services to track most major birth defects in thestate through the North Dakota Birth Defects

The Injury Prevention Programcoordinates and assists with carsafety seat checkup events acrossthe state.

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Monitoring System, which helps to ensure thataffected children are linked to needed health-care and other services.

Injury Prevention• Conducted observation surveys to measure

restraint use by children, which indicated that97.2 percent of infants were properlyrestrained, as were 86 percent of toddlers ages1 through 5, and 69.5 percent of children ages6 through 10. Forty-three percent of childrenages 6 through 10 rode in the front seat.

• Conducted eight 32-hour child passenger safetycourses and certified 96 individuals as childpassenger safety technicians.

• Provided about 4,000 car safety seats to 50local car seat programs for distribution toparents of young children.

• Distributed 6,000 bike helmets to about 40local agencies for distribution to children, andprovided instructions about proper helmet fit.

• Coordinated or assisted with car safety seatcheckups, inspecting about 1,600 car seats.

• Coordinated and sponsored statewide InjuryPrevention and Traffic Safety Conference.

• Continued chairing and coordinating theAdolescent Suicide Prevention Task Force.

• Conducted Boost, Then Buckle public infor-mation campaign to increase the use of boosterseats by children who weigh 40 to 80 pounds.

• Assisted the U.S. Consumer Product SafetyCommission with product recalls and effective-ness checks.

• Published and distributed Building Blocks toSafety newletter with Buckle Update insert.

Lead Program• Implemented a nine-month blood lead-screen-

ing program for non-Medicaid children fundedby the Environmental Protection Agency. Noneof the 222 children screened were found tohave elevated levels of lead.

• Received reports of elevated blood lead levelsin 39 children. Testing confirmed that 14 hadtrue elevated levels.

MCH Nursing• Revised the following publications – Services

Offered for Women and Children by Publicand Private Agencies Statewide and the ChildHealth Services manual.

• Provided education and training to school,child-care, Head Start, school nurse and publichealth personnel about issues relating to headlice detection, treatment, management andpolicy development.

MCH Nutrition• Coordinated the Healthy Weight Council

consisting of more than 45 members represent-ing agencies and programs from the public,private and nonprofit sectors.

• Coordinated activities of the Healthy NorthDakota nutrition priority area, including thefollowing committees: Breastfeeding, HealthySchool Nutrition, and Fruit and Vegetable.

• Provided support to local nutritionists toaddress the issues of healthy weight for childrenand adolescents, promotion of increased fruit-and-vegetable intakes (5 A Day for BetterHealth) and increased physical activity.

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• Received approval, but not funding, for anutrition and physical activity grant.

Newborn Metabolic Screening• Increased the number of tests given to all North

Dakota newborns to include the followingconditions: biotinidase deficiency, hemoglobino-pathies (sickle cell disease and other blooddisorders) and several other conditions identi-fied through a new technology called TandemMass Spectrometry.

Optimal Pregnancy Outcome Program(OPOP)• Revised OPOP policies and forms.• Provided services to nearly 1,400 pregnant

women.• Provided training about how to counsel preg-

nant women to quit smoking by implementingthe 5 A’s approach.

• Implemented the Providers Partnership Projecton Maternal Depression pilot project at AltruHospital in Grand Forks, N.D.

Oral Health• Supported the following legislation passed by

the 2003 Legislative Assembly:∗ Donated Dental Services Program, which

supports volunteer dentists who providecomprehensive care for needy, disabled, agedor medicially compromised people.

∗ Dental Loan Repayment Program, whichprovides educational loan repayment dollarsfor three new dentists each year who committo four years of full-time dental service.

• Received $118,557 CDC grant to develop oralhealth infrastructure, education and surveillanceefforts.

• Collaborated with the Dakota Initiatives ongrant applications and recruitment of dentalstudents.

• Supported water fluoridation efforts in the state.Currently, 95.4 percent of North Dakota’sdrinking water contains fluoride.

Prenatal Risk Assessment MonitoringSystem (PRAMS)• Completed the PRAMS survey, which obtains

population-based information about women’sexperiences before, during and followingpregnancy.

State Systems Development Initiative(SSDI)• Assisted in coordination of needs assessment,

data collection and data reporting for the MCHBlock Grant. SSDI is a cooperative programwith the Department of Human Services.

• Developed and distributed fact sheets for MCHpriorities identified from the needs assessment,as well as other reports and newsletters.

Sudden Infant Death Syndrome (SIDS)• Continued to provide education to the public

about Sudden Infant Death Syndrome and howto reduce the risk of SIDS.

The Department of Health’s SIDS Programemphasizes the importance of placing infantson their backs while they sleep to reduce therisk of SIDS (sudden infant death syndrome).

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Special Supplemental Nutrition Program forWomen, Infants and Children (WIC)• Partnered with Iowa WIC to procure a con-

tractor for a new joint information managementsystem, the first such collaboration in the nation.

• Developed the Parents Provide, Kids Decidevideo for parents that focuses on the division offeeding responsibility, the family table andphysical activity.

Women’s Health• Presented at the national Women’s Health

Conference as one of 10 model women’s healthprograms in the nation. The presentationhighlighted what can be accomplished throughcollaboration and coordination.

• Collaborated with partners in the Robert WoodJohnson Covering Kids and Family grant topromote health insurance coverage for eligiblechildren.

• Promoted National Women’s Health Week withdisplay board celebrating 100 years ofwomen’s health. The display compared nationaland North Dakota statistics with significantmilestones.

Division GoalsDivision GoalsDivision GoalsDivision GoalsDivision Goals• Improve the health of North Dakota’s women

and children.• Implement the Community Health Section

strategic plan.• Plan and conduct the Title V Retreat.• Continue to provide prenatal education helping

pregnant women make healthy lifestyle choices.• Continue to coordinate follow-up services for

families who suffer SIDS deaths and to provideSIDS information/education to health-careprofessionals, parents and caregivers.

• Build state education and health agency capac-ity to implement Coordinated School HealthPrograms across agencies and within schools.

• Develop state school health services guidelines.• Continue to provide technical assistance to the

Dakota Medical Foundation to support itsmodel school nurse program project.

• Continue to work to reduce domestic violence,sexual assault and stalking crimes through grantawards, trainings and partnering with otheragencies that address these issues.

• Continue partnership with Iowa WIC toimplement a new MIS system designed toenhance program efficiency and accountability.

• Pursue funding for research on the use ofmotivational interviewing to change dietary andphysical activity behaviors of WIC families.

• Co-sponsor lactation consultant training and thestatewide breastfeeding conference.

• Improve short-term follow-up for the new testsin the Newborn Metabolic Screening Programthrough expansion of professional advisorycommittees and revisions to the metabolicscreening practitioners manual.

• Analyze PRAMS data and disseminate infor-mation in an effort to improve birth outcomes.

• Develop case management plan for use byproviders when a child is diagnosed with leadpoisoning.

• Continue to support legislation to enhance thechild passenger safety law.

• Pursue funding for asthma program.

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Division of Health PromotionThe Division of Health Promotion works to

enable communities to promote behaviors thatprevent and control chronic disease, thus reducinghealth-care costs and improving the quality of life.

Intervention programs in communities,schools and local agencies focus on tobacco-freelifestyles, healthy eating, regular physical activityand use of preventive health services for earlydetection. Support programs collect data abouthealthy behaviors and incidence of disease andprovide educational resources for communities,schools and health professionals.

Programs and services include:• Cancer Prevention and Control• Cancer Registry• Cardiovascular Health• Diabetes Prevention and Control• School Health• Tobacco Prevention and Control

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsCancer Prevention and Control• Continued to focus on breast and cervical

cancer screening for medically underservedwomen by participating in the National Breastand Cervical Cancer Early Detection Program.North Dakota’s program, known as Women’sWay, has maintained its partnerships to providescreening services to a growing number ofeligible women. Through local public healthunits, private health-care providers and astatewide volunteer network, Women’s Wayhas provided screening services to women age

18 to 64 in every North Dakota county and onevery reservation.

• Screened more than 5,300 women for breastand cervical cancer, 12 percent of whom wereAmerican Indian. Detected 59 cases of breastcancer and 413 cases of cervical dysplasiarequiring treatment. Each enrolled womandiagnosed with cancer received treatment.

• Recruited, trained and supported 900 Women’sWay volunteers. The volunteer network useswoman-to-woman and small-group strategiesto encourage annual cancer screening.

• Collaborated with state Medicaid to pay forbreast or cervical cancer treatment for 53Women’s Way clients.

• Continued involvement with North DakotansPartnering for Women’s Health, an organizationchaired by North Dakota’s First Lady; hostedannual Women’s Health Summit.

• Provided professional development for health-care providers, including clinical breast examtraining, program inservice training, and astatewide symposium on cervical health.

• Developed a coordinated approach to enhancebreast and cervical cancer screening of Ameri-can Indian women in North Dakota.

• Supported legislation to make treatment forwomen diagnosed with breast or cervicalcancer or cervical abnormalities a permanentpart of the Medicaid budget.

Cancer Registry• Responded to data requests from university

students, national researchers and the public.• Assisted in development of the Health Registry

The Division of Health Promotionworks with local communities topromote 5 A Day for Better Health,which encourages North Dakotansto eat five to nine servings of fruitsand vegetables each day.

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Network, a secure web-based application forcancer reporting, quality control and analysis.

• Submitted data to the Central Brain TumorRegistry of the United States, the CDC Na-tional Program of Cancer Registry – CancerSurveillance System, and the North AmericanAssociation of Central Cancer Registries,earning Gold and Silver Standard certifications.

• Completed linkage with the Albuquerque IndianHealth Service national database for qualityimprovement and to assist in accurately de-scribing the burden of cancer on the AmericanIndian and Alaska Native populations.

Cardiovascular Health• Worked to improve the cardiovascular health of

North Dakotans by promoting healthy lifestylesand policies that increase physical activity andimprove eating behaviors.

• Collaborated with local nutritionists and countyextension agents to promote 5 A Day forBetter Health, a national nutrition campaignthat encourages Americans to eat five to nineservings of fruits and vegetables each day.

• Recognized 13 communities through the 5 Plus5 Program, which encourages people to eatfruits and vegetables five times a day and to bephysically active 30 minutes, five days a week.

• Conducted a survey of 1,100 worksites toestablish a benchmark of health-promotionactivities offered by North Dakota employers.Data obtained is being used by the HealthyNorth Dakota Worksite Wellness Committeeto identify pilot intervention programs.

Diabetes Prevention and Control• Reorganized the Diabetes Advisory Council and

the North Dakota Diabetes Partnership.• Developed strategic plan with input from the

Diabetes Advisory Council.• Expanded grants to diabetes clinics for imple-

mentation of a diabetes registry and care-tracking system.

• Collaborated with Blue Cross Blue Shield toproduce the Diabetes Care Provider Report;demonstrated a significant improvement indiabetes care provided by physicians anddiabetes care teams.

• Trained core group in Diabetes Today educa-tion and community-engagement techniques.

• Produced Diabetes ... Finding the Balance, adiabetes wellness guide for American Indians.

• Completed a comprehensive analysis of Behav-ioral Risk Factor Surveillance System datarelated to North Dakotans who have diabetes.

• Collaborated with the Montana DiabetesPrevention and Control Program to analyzeprevalence of gestational diabetes.

• Completed estimates of diabetes prevalence bycounty in North Dakota.

School Health Program• Completed a Youth Risk Behavior Survey and

a School Health Education Profile in con-junction with the Department of PublicInstruction. Survey results were provided tolocal decision-makers for help in planningprograms that address common youth healthproblems such as tobacco use, physical inactiv-ity and poor eating habits.

The Tobacco Prevention and Control Programsupports efforts to eliminate exposure tosecondhand smoke.

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• Coordinated the annual Roughrider HealthPromotion Conference, which brings togetherschool and community teams to conduct healthinventories of their schools and develop andimplement plans to protect youth from healthrisks. Plans developed at the conference resultin positive outcomes for school personnel,students and community members and reachmore than 100,000 North Dakotans.

Tobacco Prevention and Control• Developed long-range state tobacco prevention

and control plan for reducing tobacco use.• Convened Best Practices in Tobacco Control

and Communities of Excellence trainings toassist local public health units and communitiesin implementing evidence-based approaches fortobacco-use prevention.

• Implemented the Community Health GrantProgram funded with tobacco settlement dollarsappropriated by the 2001 Legislative Assembly.Funds from the CDC also support state andlocal tobacco control efforts. All 28 local publichealth units, the four American Indian tribes andone Indian Service Area have developedinitiatives to reduce tobacco use, including:∗ About 350 schools implemented evidence-

based tobacco prevention curricula reachingmore than 30,000 students. Nearly 900teachers were trained in use of the curricula.

∗ Nearly 50 individuals were trained to providesmoking cessation programs for students.

∗ The Statewide Public Education Task Forceon Tobacco implemented a statewide publiceducation campaign on secondhand smoke.

Post-campaign evaluation indicates increasedsupport for smoke-free environments inschools, entertainment arenas, restaurants andprivate businesses.

∗ Twenty-three communities formed coalitionsto address local tobacco-use concerns.

∗ Tobacco cessation programs are now avail-able in 56 locations in 37 counties acrossthe state. Seventy-seven individuals havebeen trained to provide cessation services,and more than 850 people have beenserved by local cessation programs.

• Worked with Dickinson to pass a youth-access ordinance. Seventeen communitiesnow restrict vending machines, licensetobacco retailers, require retail compliancechecks, or place tobacco behind clerk-operated counters. These ordinances reachmore than one-half of the youth population.Retailer compliance with the law prohibitingsales to minors increased from 89 percent in2000 to 93 percent in 2002.

• Supported legislation passed requiring tobaccoviolations be reported to schools in the samemanner as alcohol and other drug violations, aswell as legislation outlawing the sale of bidis, aflavored cigarette very popular among youth.

• Conducted the Youth Tobacco Survey incoordination with the Youth Risk BehaviorSurvey. Results will be used to design, imple-ment and evaluate youth tobacco-preventionprograms.

• Developed a tobacco website, listserv andnewsletter to facilitate sharing of informationwith local communities and the public.

The Cardiovascular Health Program promoteshealthy lifestyles and policies that increase physicalactivity and improve eating behaviors.

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• Assisted five communities (Fargo, Minot, GrantForks, Valley City and Jamestown) in imple-menting pilot cessation programs for city andcounty employees reaching 235 individuals.

Division GoalsDivision GoalsDivision GoalsDivision GoalsDivision Goals• Link division programs to the Healthy North

Dakota Iniative.• Provide breast and cervical cancer screening

services to 3,200 eligible North Dakota womeneach year.

• Develop materials for Women’s Way specific tothe state’s American Indian population.

• Develop five-year plan for screening AmericanIndian women through Women’s Way.

• Continue Medicaid treatment program toensure Women’s Way clients diagnosed withbreast and cervical cancer receive treatment.

• Develop a comprehensive cancer controlprogram and a statewide cancer control plan.

• Define the cardiovascular disease burden andassess existing strategies for prevention of heartdisease and stroke.

• Develop state plan for heart disease and strokeprevention with emphasis on developing heart-healthy policies, changing physical and socialenvironments, and eliminating disparities basedon geography, gender, race or income.

• Identify culturally appropriate approaches topromote cardiovascular health.

• Increase awareness of heart attack and strokesymptoms and the importance of calling 9-1-1.

• Provide grants to local public health units tosupport physical-activity and nutrition interven-

tions, as well as policies and conditions thatencourage heart-healthy lifestyle choices.

• Develop and implement a state employeetobacco cessation program and a statewidequitline that will serve all North Dakota resi-dents who want to quit using tobacco.

• Implement a tobacco surveillance and evalua-tion system to track trends and assess progressand outcomes.

• Continue working with communities to developand maintain comprehensive tobacco controlprograms that follow best practices.

• Expand use of the Health Registry Network.• Obtain cancer data from clinics and indepen-

dent physician offices; develop audit processesto ensure all diagnosed cancers are reported tothe state registry.

• Obtain additional data exchange agreementswith other states and/or individual medicalfacilities for the Cancer Registry, and expanddata agreement with Aberdeen Area IHS toinclude all North Dakota reservations.

• Develop a state collaborative to enhancediabetes care in North Dakota.

• Complete a statewide Diabetes Health SystemAssessment.

• Involve NDSU Extension in diabetes educationand community engagement efforts.

• Partner in joint diabetes and cardiovascularprojects.

• Incorporate Healthy People 2010 objectivesinto a comprehensive diabetes indicator report.

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Emergency Preparedness and Response SectionThe Emergency Preparedness and Response

Section was created in 2002 to enhance thepreparedness and response capabilities of thestate’s public health and private medical pro-viders. The section utilizes federal grants providedto all states for this purpose: the Centers forDisease Control and Prevention grant fundsefforts to build the state’s public health infrastruc-ture, and the Health Resources Services Adminis-tration grant funds hospital preparedness.

The section works to create and promote astate of readiness and response to protect thehealth of North Dakotans during catastrophicevents, large-scale disasters and emergencies.Efforts include coordinating assessment, planning,response and support services with public healthproviders, private medical providers, public safetyagencies and government officials.

The section integrates emergency prepared-ness with many other divisions and sections of theNDDoH, including Disease Control, Microbiol-ogy, Chemistry, Public Information and EducationTechnology. In addition, the section chief serveson the governor’s Continuum of GovernmentCommittee and provides training and leadershipto the department in incident command.

The following efforts throughout the NDDoHare funded by emergency preparedness grants.

Emergency Preparedness and ResponseSectionAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Established a grant advisory committee.• Established eight public health emergency

preparedness and response regions that include

The Emergency Preparedness and ResponseSection works with partners across the state toprotect North Dakotans in the event of anemergency, including a terrorist attack.

a regional coordinator and a part-time publicinformation officer in each region.

• Completed assessment of state laws andprovided legislative testimony that resulted inupdates to quarantine and isolation laws.

• Completed assessment of state and local publichealth capacities.

• Developed smallpox response plans.• Provided smallpox vaccine to public health and

hospital response teams.• Participated in statewide emergency exercises.• Completed hospital needs assessment.• Established relationship with North Dakota

Healthcare Association for analysis of needsassessment, facilitation of hospital planning andrecommendations.

GoalsGoalsGoalsGoalsGoals• Develop local and regional health and medical

response plans.• Complete and exercise plans to receive and

distribute the Strategic National Stockpile.• Integrate plans with state and local emergency

management response plans.• Develop a plan for receipt of chemical

antidotes.• Develop health and medical annex template for

augmentation of existing plans.• Fund eight regional environmental health

practitioners and five part-time tribal emergencypreparedness coordinators.

• Develop regional hospital emergency plans thatinclude –∗ Caring for large numbers of patients.∗ Isolation of infectious patients.

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∗ Plans for sharing staff to include supervisionand orientation plans for each hospital.

∗ Decontamination and personal protectiveequipment.

• Complete emergency medical servicesassessment and make recommendations toenhance capacity.

• Establish a hospital wide area network.• Develop pharmaceutical plan.• Develop mental health plan.• Implement credentialing and deployment plan

for all health professionals.

Division of Disease ControlAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Initiated development of a web-based disease

reporting and electronic laboratory reportingsystem.

• Initiated development of syndromic surveillancemonitoring in the state that includes “real-time”monitoring of emergency room visits, poisoncontrol calls and health hotline calls.

• Added CDC-defined bioterrorism agents to thestate’s list of reportable conditions.

• Developed regional epidemiology responseteams to provide coordinated response tooutbreaks and other public health emergencies.

• Increased epidemiology services by employingtwo additional field epidemiologists and twoadditional surveillance epidemiologists.

GoalsGoalsGoalsGoalsGoals• Sponsor “Epidemiology in Action” course.• Integrate animal disease reporting system with

the state veterinarian and the North Dakota

Veterinary Diagnostic Laboratory.• Integrate the state’s major private labs into the

electronic laboratory reporting system.• Develop a “real-time” emergency medical

services response reporting system.

Division of MicrobiologyAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Planned and implemented the microbiology lab

renovation project.• Provided training to upgrade lab capacities.• Purchased equipment for additional testing

capabilities.

GoalsGoalsGoalsGoalsGoals• Provide bioterrorism response training for

sentinel laboratories.• Provide training about packaging and shipping

infectious substances and specimens atupcoming state laboratory convention.

• Collaborate with first responders on collectionand transportation of hazardous materials.

Division of ChemistryThis activity was not funded by the CDC

grant until Aug. 31, 2003.

GoalsGoalsGoalsGoalsGoals• Develop and implement a statewide chemical

terrorism preparedness laboratory program.• Provide chemical terrorism laboratory

coordinator to develop the chemical laboratorypreparedness program.

• Expand testing capacity and expertise throughtraining, developing protocols, updating

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instruments and renovating the laboratory.• Collaborate with statewide partners to respond

to chemical terrorism events.

Office of Public InformationAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Completed special population and public health

communication needs assessments.• Conducted smallpox training for the media.• Developed emergency communication plan.• Joined border working group of health

communicators from Canadian provinces andAmerican states adjacent to the border.

GoalsGoalsGoalsGoalsGoals• Complete local and regional emergency

communication plans.• Coordinate emergency communication planning

with key partners from across the state.• Implement systems to address needs identified

in the special populations assessment; contractwith translation service to adapt basic materialsfor certain special populations.

• Conduct spokesperson training at state andlocal level.

Division of Education TechnologyAccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Awarded contract for system to activate

response resources and send alerting messagesto health-care providers and first responders.

• Developed mobile distance learning productioncapability.

• Collaborated with University of MinnesotaSchool of Public Health and University of North

Dakota School of Medicine and HealthSciences to develop emergency preparednesseducation for physicians, health-care providersand public health professionals.

• Presented educational programs aboutsmallpox, SARS (severe acute respiratorysyndrome), risk communication, andenvironmental and clinical sample collection.

• Established public health education tuitionassistance program.

GoalsGoalsGoalsGoalsGoals• Implement Health Alert Network commun-

ications system that will:∗ Broadcast warning/alert notifications in

multiple formats.∗ Confirm receipt of message.∗ Concentrate on specific areas of the state

through GIS capabilities.• Connect all 28 public health units to the state’s

high-speed communication network.• Provide the lead public health units with video-

conferencing equipment that will allow two-wayinteractive video conferencing sessions.

• Hire education coordinator and conducteducation needs assessment.

• Develop training plan.• Develop emergency preparedness curriculum.• Conduct competency reviews and

documentation.• Provide incident command training.• Collaborate with the UND School of Medicine

and Health Sciences to create biological,chemical and radiological online training.

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The field medical officers provide medicaldirection and support to programs throughout theNDDoH. Areas of emphasis include the healthaspects of environmental pollution, newbornmetabolic screening, communicable diseasecontrol, immunizations, infant mortality, adolescentsuicide, cancer cluster investigations, bioterrorism,long-term care, emergency medical services andthe Children’s Health Insurance Program.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Provided consultation to NDDoH sections

about health-related programs, projects andpatient-care issues.

• Improved communications between theNDDoH and private physicians and clinics.

Field Medical Officers

• Assisted in developing lead poisoning plan forthe state.

• Provided a variety of continuing medicaleducation sessions on public health issues.

• Collaborated on development of a public healthtraining program in conjunction with the Univer-sity of Minnesota.

• Provided pediatric consultation services for thetracking program and Indian Health Serviceclinic at Spirit Lake Nation.

GoalsGoalsGoalsGoalsGoals• Continue to provide enhanced, focused clinical

consultation support to NDDoH divisions.• Provide consultation support for divisional

clinical protocol development.• Continue to provide presentations, as well as

education and dialogue forums, at medicalmeetings.

• Continue to provide direction and supportduring disease outbreaks.

• Continue to provide other specialclinical insight and consultation forNDDoH committees.

Medical Services Section

Division of Disease ControlThe Division of Disease Control identifies

and analyzes disease trends and implementsappropriate intervention activities to reduce illnessand death. The division also acts as a resource forhealth-care providers and the public regardingpublic health issues and often works with themedia to provide timely public education.

The goal of the Medical Services Section is toprevent disease and disability in North Dakota.The section is responsible for disease prevention,surveillance, testing and identification, as well asepidemiologic investigation and forensic examina-tions.

The section includes the following divisionsand offices:

• Field Medical Officers• Disease Control• State Epidemiologist• Microbiology• Forensic Examiner

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Programs within the division include:• Epidemiology and Surveillance• HIV/AIDS• Immunization• Sexually Transmitted Diseases• Tuberculosis Control

Health-care providers and laboratoriesstatewide notify the division of mandated report-able diseases. During the biennium, divisionpersonnel investigated about 2,300 cases ofreportable conditions. In addition, divisionpersonnel work closely with private health-careproviders, health-care facilities, local public healthunits and residents to reduce the incidence ofcommunicable diseases and to help ensurethe public health of North Dakotans.

Division AccomplishmentsDivision AccomplishmentsDivision AccomplishmentsDivision AccomplishmentsDivision Accomplishments• Implemented SARS (severe acute respiratory

syndrome) surveillance program and coordi-nated investigation of suspected SARS case.

• Participated in national investigation of transfu-sion-related West Nile virus with results pub-lished in New England Journal of Medicine.

• Developed regional epidemiology responseteams to provide rapid response to diseaseoutbreaks and other public health emergencies.

• Investigated four outbreaks of gastrointestinalillness involving more than 300 people.

• Investigated a foodborne illness outbreak at aschool involving about 100 students.

• Investigated a cluster of strep throat infections.• Investigated a cluster of appendectomies among

students in a high school.

The Department of Health encouragesNorth Dakotans of all ages to get a flu shotto protect against influenza.

• Supported legislation that was passed to:∗ Change disease reporting statute to include

the state veterinarian.∗ Enable the state health officer to initiate

emergency reporting of public healthconditions.

∗ Clarify implementation procedures forquarantine and isolation.

∗ Mandate chickenpox vaccination for entryinto school and day care.

Epidemiology and Surveillance ProgramThe Epidemiology and Surveillance Program

works to strengthen collaboration betweenepidemiology and laboratory practices throughthe CDC Epidemiology and Laboratory CapacityGrant. The goal of this program is to increasesurveillance and response; build epidemiology andlaboratory infrastructure; provide training andeducation; and increase reporting systems.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Increased laboratory capacity to include DNA

fingerprinting of E.coli 0157:H7, polymerasechain reduction testing for noroviruses, andidentification of parasitic infections. Alsoestablished an area for testing for foodborneillnesses at the Division of Microbiology.

• Increased influenza sentinel physician networkfrom 10 to 16. Partnered with the level Alaboratories to conduct surveillance for influenzaand respiratory synctial virus (RSV).

• Enrolled nine regional schools to report absen-teeism and enlisted long-term care facilities to

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increase reporting of influenza-like illnessoutbreaks in their facilities.

• Provided funding from CDC to enable theNorth Dakota State University VeterinaryDiagnostic Laboratory (VDL) to become alevel C laboratory.

• Coordinated with the VDL to conduct WestNile virus (WNV) testing of birds and horses.

• Facilitated dead bird collection and shipping forWNV testing.

• Implemented statewide WNV surveillanceprogram, and coordinated with the Division ofMicrobiology to expand mosquito surveillance.

• Coordinated and conducted a WNV workshopfor city officials, health-care providers, localpublic health personnel, veterinarians and IndianHealth Service personnel.

• Developed and distributed WNV preventioninformation.

• Established collaboration with VDL to facilitateexchange of Salmonella antimicrobial resis-tance data.

HIV/AIDS ProgramThe mission of the HIV/AIDS Program is to

reduce and prevent the transmission of HIV andto reduce the associated illnesses and deaths ofHIV-infected people. HIV prevention servicesare conducted at 22 contractual sites, includinglocal public health units, family planning clinics,college/university student health centers andsubstance-abuse treatment centers. The servicesinclude HIV testing, pre- and post-test risk-reduction counseling, partner notification, referralsand prevention education.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Implemented new HIV-testing technology using

oral fluid instead of blood.• Collaborated with the UND Department of

Counseling on two Safe Connections work-shops designed to educate gay men about HIVprevention and sexual wellness.

• Developed an HIV-prevention media campaignfor heterosexuals promoting the theme “HIV: ItCan Happen to You in North Dakota.”

• Received a 2002 National Public HealthInformation Coalition Award for Excellence forthe Call Upon Your Spirit of Courage HIV-prevention campaign targeting the state’sAmerican Indian population.

The HIV Surveillance Program monitors thedisease through both surveillance activities andHIV incidence and prevalence studies. The datacollected by the program focuses policy andresource allocation.

North Dakota continues to have the lowestprevalence of HIV/AIDS in the nation; throughJune 30, 2003, a total of 312 HIV infections havebeen reported in the state.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Enhanced surveillance of HIV cases through

addition of viral load test results to the list ofreportable conditions in North Dakota.

• Published HIV/AIDS data semiannually for thehealth-care community and the public.

The Ryan White Care Program assists low-income residents living with HIV/AIDS to access

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confidential health and supportive services.Available services include case management;assistance with purchasing drugs; and assistanceaccessing outpatient, supportive-care and emer-gency services. Case management services areoffered at 10 locations throughout the state.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Developed a television public service

announcement to increase program participa-tion. The PSA won the 2003 North DakotaBroadcaster’s Association Merit Award forBest Ad Agency TV Public Service Campaign.

• Collaborated with North Dakota Medicaid foronline submission of pharmacy claims throughthe drug assistance program, allowing for cost-savings and efficient processing.

• Updated the Ryan White drug formulary toensure client access to the most current HIV/AIDS medications and therapies.

Immunization ProgramThe role of the Immunization Program is to

ensure that children and adults are protectedagainst vaccine-preventable diseases. The pro-gram also investigates suspected and confirmedcases of vaccine-preventable diseases andconducts active influenza surveillance.

Vaccine coverage levels for North Dakotachildren remain high. The National ImmunizationSurvey estimates that 78 percent of children ages19 months to 35 months were up to date on theirimmunizations. The goal for Healthy People 2010is 90 percent.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Received 2002 award for achieving the highest

childhood immunization rates in the nation fromJuly 2000 through June 2001.

• Distributed pneumococcal conjugate vaccinefor all North Dakota children.

• Distributed chickenpox vaccine for all NorthDakota children.

• Expanded provision of influenza vaccine to allhealthy children from 6 to 24 months of age.

• Converted the state immunization registry to aweb-based format.

• Distributed new five-in-one vaccine (hepatitisB/DTzP/IPV) for all North Dakota children.

STD ProgramThe goal of the Sexually Transmitted Disease

(STD) Program is to prevent and control thespread of sexually acquired infections. Staffmembers provide education, partner notification,and referral for screening and clinical services.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Continue to provide chlamydia, gonorrhea and

syphilis medication for infected people and theirpartners who are unable to pay.

• Implemented more sensitive chlamydia andgonorrhea testing technology and more inclusivechlamydia screening criteria.

• Provided funding to UND for development of avideo discussing STD prevention for students.

• Screened more than 22,000 females and 3,200males for chlamydia through the Region VIIIInfertility Prevention Project.

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To test for tuberculosis, a fluid called tuberculinis injected between the layers of the skin. In aperson who is infected with TB, the injectionsite becomes hard and red.

• Observed a 12 percent increase in chlamydiatesting, and continued to investigate reportedchlamydia cases. During the biennium, 2,533sexual-partners were contacted; more thanone-fourth were diagnosed with chlamydia.

Tuberculosis ProgramThe Tuberculosis (TB) Program works to

prevent, control and eliminate TB in NorthDakota. Program activities include identifying andreporting all cases of active TB, ensuring comple-tion of treatment, identifying and screening allpeople who have had contact with infectiouscases of TB and offering laboratory services.

TB continues to be a disease of low incidencein the state, with the number of cases ranging fromfive to 10 each year from 1998 through 2002.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Conducted an investigation involving a college

student who had TB. About 1,000 studentswere tested, with no further cases identified.

• Produced Epidemiological Report on Tuber-culosis with information about TB activity in thestate, treatment or infection-control guidelines,policy changes and laboratory information.

• Conducted annual TB workshop for about 100health-care providers. The workshop provides(1) information about the epidemiology of TB,(2) current treatment and infection-controlguidelines, and (3) techniques for skill building.

• Coordinated with the Minnesota Department ofHealth, Indian Health Service and CDC toinvestigate multi-state transmission of TB.

Division GoalsDivision GoalsDivision GoalsDivision GoalsDivision Goals• Continue to provide quality public and provider

health information and education.• Increase utility of the immunization registry for

better monitoring of vaccinations, and increaseutilization of the registry by providers.

• Maintain high vaccination-coverage levels.• Increase adult vaccination services.• Increase STD screening of high-risk people.• Continue contact tracing and implementation of

disease intervention measures.• Implement innovative STD educational

messages.• Continue progress toward eradiation of

tuberculosis in North Dakota.• Continue to provide screening support of

people at increased risk of tuberculosis.• Improve reporting of communicable diseases.• Provide innovative intervention measures to

prevent WNV infections.• Implement year-round influenza surveillance.• Coordinate with partners to implement

epidemiological intervention activities.• Develop and implement innovative approaches

for HIV intervention.• Increase screening of people engaged in high-

risk HIV activities, and increase identificationand reporting of HIV-infected people.

• Continue to provide necessary services forHIV-infected people.

• Increase community-based HIV interventionactivities.

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State EpidemiologistThe state epidemiologist coordinates epide-

miological studies, investigations and surveillanceactivities; conducts data analysis; and providestechnical expertise and consultation with publicand private health professionals. Additionalresponsibilities include collaborating with otherstate and federal health professionals to conductdisease surveillance, control, prevention andhealth intervention activities and providing publichealth information to health-care providers,community organizations and the media.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Coordinated department response to anthrax

concerns occurring after September 11, 2001.• Coordinated initial statewide bioterrorism grant.• Coordinated epidemiology and surveillance

program for CDC bioterrorism grant.• Coordinated fulltime assignment of CDC

medical epidemiologist to the NDDoH.• Initiated development of a web-based disease

reporting and electronic laboratory reportingsystem known as the North Dakota DiseaseReporting, Epidemiological Assessment andMonitoring System (DREAMS).

• Initiated development of syndromic surveillancemonitoring system that includes “real-time”monitoring of emergency room visits, poisoncontrol calls, and health hotline calls.

• Added CDC-defined bioterrorism agents to thelist of reportable conditions in North Dakota.

• Initiated legislative changes to quarantine-and-isolation and reportable-disease laws.

• Coordinated North Dakota Behavioral RiskFactor Surveillance program.

• Participated in planning and implementation ofthe state smallpox vaccination program.

• Conducted numerous presentations aboutbioterrorism and other public health issues.

• Assisted with coordinating public health assis-tance after Minot anhydrous ammonia release.

• Coordinated follow-up of affected people afteranhydrous ammonia release in Minot.

• Participated as member of a national PublicHealth Leadership Institute team.

GoalsGoalsGoalsGoalsGoals• Complete development of DREAMS with

public and private health-care providers.• Provide epidemiological assistance to the

department.• Provide timely epidemiological response for

health-care providers and the public.

Division of MicrobiologyThe Division of Microbiology (the Public

Health Laboratory) provides diagnostic andreferral services to physicians, veterinarians, localpublic health units, health-care facilities, state andfederal agencies and the public. The laboratoryperforms testing in the areas of bacteriology,mycology, parasitology, immunology, virology,molecular diagnostics, aeroallergens, and dairyand water bacteriology. As the only LaboratoryResponse Network reference laboratory in North

The Division of Microbiology conductstests for a variety of diseases.

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Dakota, the division performs specialty testing todetect new and emerging infections and possiblebioterrorism agents.

The laboratory continues to serve as thestate’s central laboratory and certifying agency forthe Food & Drug Administration (FDA) and theEnvironmental Protection Agency (EPA) dairyand water bacteriological testing programs.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Developed and implemented network-based

laboratory information management system.• Established rapid molecular testing procedures

for detection of infectious diseases and otherpublic health threats.

• Expanded mosquito surveillance program tomonitor for West Nile virus and other encepha-litis-causing arboviruses statewide.

• Centralized tuberculosis testing to reduce turn-around time and improve reporting structure.

• Provided smallpox and anthrax immunizationsfor employees working with biothreat agents.

• Provided health-care and emergency responseagencies with specimen transport systems forbioterrorism and chemical terrorism agents.

• Maintained federal testing certifications for dairyproducts, drinking water and clinical specimens.

• Provided training about procedures to rule outpossible biothreat agents; laboratory safetytechniques; infectious and diagnostic shippingregulations; blood-borne pathogen updates, etc.

• Provided training for mosquito network trapoperators and local vector control personnel.

• Produced newsletters, bulletins, fact sheets,Directory of Services, and a Laboratory

Response to Bioterrorism Agents poster.• Enhanced the North Dakota Laboratory

Response Network, a tiered network of clinicallaboratories trained to recognize and/or rule outpotential biothreat agents, by adding newlaboratories and extending training.

• Participated in the design and construction of anew laboratory that will provide conditions forsafely testing infectious agents.

• Received certification as a PulseNet laboratory,a network of public health laboratories thatperforms DNA fingerprinting on foodbornepathogens.

• Received registration to handle and store selectagents and crossover agents as designated bythe CDC, the Homeland Security Agency, andthe United States Department of Agriculture.

• Became certified by the American Academy ofAllergy, Asthma and Immunology in the collec-tion, counting and identification of aeroallergens.

• Established new distribution plan for supplyingpublic drinking water systems with prelabeledsampling containers to improve safe drinkingwater monitoring.

GoalsGoalsGoalsGoalsGoals• Institute a Public Health Information Network-

compliant information management systemcompatible with the North Dakota DREAMSProject, a national electronic disease surveil-lance system.

• Function as part of the national laboratorynetwork by improving communications with themedical community, local laboratories, publichealth units and state and federal laboratories.

Micr Micr Micr Micr Microbiology Tobiology Tobiology Tobiology Tobiology TestingestingestingestingestingCategory Number of

Tests

Dairy Products 6,958HIV 29,768Tuberculosis 28,632Mycology 848Parasites 2,798Hepatitis A, B, C 12,410Rabies (human exposure) 2,052Food Bacteriology 12,020STDs 68,424Virology/Immunology 12,662Water Analyses 16,818Aeroallergans 376Bacterial/Biothreat 10,056Mosquito Surveillance 1,328

Total 205,150

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State Forensic ExaminerThe role of the state forensic examiner is to

provide medical examiner services to countycoroners and law enforcement officials in theinvestigation of sudden and unexpected deaths inNorth Dakota.

Once a case has been referred to the stateforensic examiner, the body is brought toBismarck for an autopsy. Services providedinclude autopsy or examination of the body,photographic documentation, toxicologicalanalysis, collection of evidence, follow-up withinvestigating agencies, certification of cause andmanner of death, and court testimony as needed.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Accepted 425 cases during the biennium;

performed autopsies on the majority of them.• Provided education statewide to law enforce-

ment officers, county coroners and otheragencies involved in the investigation of deaths.

• Participated in the North Dakota Child FatalityReview Panel, the Mass Fatalities IncidentResponse Course and the National DisasterMedical System.

Suicide25%

Accident31%

Natural Causes38%

Homicide4%

Undetermined2%

Coroner Referrals*Coroner Referrals*Coroner Referrals*Coroner Referrals*Coroner Referrals* 2001–2003 Biennium 2001–2003 Biennium 2001–2003 Biennium 2001–2003 Biennium 2001–2003 Biennium

Manner of DeathManner of DeathManner of DeathManner of DeathManner of Death

*425 total cases; two examined with no autopsy

• Received referrals of cases from all geographi-cal areas of the state, with local county coro-ners responding very favorably to availability offorensic examiner services.

GoalsGoalsGoalsGoalsGoals• Pursue the development of a permanent facility

and adequate number of staff to handle thecaseload.

• Continue to provide educational activities forcounty coroners, law enforcement officers andother officials involved with death investigations.

• Continue to perform duties and to provide vitalinformation to county coroners, law enforce-ment personnel, public health officials andfamilies of the deceased in an effective, timelyand courteousmanner.

• Establish electronic (web-based) reporting tolaboratories and other health-care agencies.

• Relocate laboratory facility with minimal loss ofservices to the public.

• Continue to improve drinking water monitoringby adding barcodes to prelabeled samplingcontainers.

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The Division of Health Facilities strives toensure that the buildings, equipment and staff ofNorth Dakota’s inpatient care facilities andoutpatient programs provide services consistentwith generally accepted practice and meetapplicable standards.

Licensure responsibilities:• General acute, primary care and specialized

hospitals – 51• Nursing facilities – 83• Home health agencies – 32• Hospice programs –15• Basic care facilities – 52• Electrologists and electronic hair removal

technicians – 24

Certification responsibilities:• Long-term care nursing facilities – 83• Hospitals, including swing beds and general

acute services – 47 general acute care andcritical access hospitals; four specializedhospitals

• Intermediate care facilities for the mentallyretarded – 71

• Home health agencies – 32• Hospice programs – 15• Rural health clinics – 63• Clinical laboratories that are state surveyed and

certified – 74• Ambulatory surgical centers – 17• End-stage renal dialysis units – 14• Portable X-ray units – 1

Health Resources SectionThe Health Resources Section consists of

three divisions – Health Facilities, EmergencyMedical Services and Food and Lodging.

The section is responsible for:• Licensing inpatient and outpatient health care

facilities, basic care facilities, home healthagencies, ambulance services, hospice pro-grams, electrologists and electronic hair removaltechnicians; certification of emergency medicaltechnicians; and licensing and inspecting variousestablishments that serve food.

• Licensing and inspecting restaurants, bars,lodging facilities, mobile-home parks, camp-grounds, bed-and-breakfast facilities, retailfood stores, meat markets, bakeries andassisted-living facilities (food services andbuilding safety).

• Certification surveys of all facilities and pro-grams that provide service to people eligible forthe federal Medicare and Medicaid programs;certification is voluntary but required for theprovider or supplier to receive payment throughMedicare and Medicaid.

• Certification of all clinical laboratories that testhuman body substances for medical purposes.

• Administration of the alternative health careprojects program.

• Administration of the nurse aide training andcompetency evaluation programs and registry.

• Administration of the emergency medicalservices system.

• Providing assistance to communities in deter-mining if alternative health care services arefeasible.

Division of Health Facilities

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• Established three community health centers inrural areas of the state.

• Awarded loan repayment dollars to two dentiststhrough the Dental Loan Repayment Program.

• Established 14 foreign physicians in NorthDakota workforce shortage areas through theJ-1 Visa Waiver Program.

• Awarded $489,500 in grants to 84 long-termcare facilities to support scholarship or loan-repayment programs for employees.

Goals• Maintain the average survey interval of 12

months or less for long-term care facilities.• Address complaints in a manner consistent with

federal and state guidelines.• Ensure that new surveyors receive adequate

training to pass the national Surveyor MinimumQualifications Test on the first attempt.

• Conduct surveys of hospitals every three years.• Implement the certification of critical access

hospitals as permitted by the federal RuralHospital Flexibility Act.

Staff members conduct periodic surveys todetermine compliance with state licensure require-ments and federal certification Conditions ofParticipation contained in Title XVIII (Medicare),Title XIX (Medicaid) and CLIA of the SocialSecurity Act. In addition, the division is respon-sible for investigating quality-of-care complaints.

The licensure and certification surveys areconducted by surveyors who represent a widerange of professional disciplines, including certi-fied lab technicians, licensed social workers,licensed registered dietitians, registered nurses,physical therapists, occupational therapists,qualified mental retardation professionals and firesafety surveyors.

The nurse aide training and competencyevaluation programs provide for state approval ofnurse aide training programs in order to beconsistent with federal certification requirementsfor long-term care facilities.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Convened the Long Term Care Advisory

Committee consisting of representatives fromthe long-term care community.

• Conducted several one-day workshops inconjunction with the state’s provider associa-tions. The workshops focused on care-relatedservices identified through the survey process.

• Continued to assist rural hospitals with thecritical access hospital designation, whichallows greater flexibility in the use of nursing andmedical staff, as well as a more favorableMedicare reimbursement process.

Division of EmergencyMedical Services

The Division of Emergency Medical Servicesis the lead agency for North Dakota’s EmergencyMedical Services (EMS) System. The divisionconducts the following activities:• Annually licenses 140 ground ambulance

services that meet standards for service avail-ability, equipment and personnel training.

The Division of Emergency Medical Servicesworks with ambulance and first responderservices across the state.

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• Updates and maintains training, testing andcertification programs for EMS advanced lifesupport and basic life support personnel,including emergency medical technicians andparamedics.

• Administers an EMS grant program of about$470,000 per year for training ambulanceservice personnel.

• Provides technical assistance to local EMSservices regarding patient care issues, as well assystem design, administration and operation.

• Maintains an EMS personnel data system thatcontains about 10,000 certification records.

• Maintains an ambulance run report data systemthat adds about 32,000 ambulance run recordsper year.

• Provides critical incident stress debriefingservices to law enforcement, fire and EMSpersonnel engaged in EMS.

• Coordinates and maintains Emergency MedicalServices for Children (EMSC) Program.

• Provides continuing education to emergencymedical services through distance learning andvideotape presentations.

• Implements and maintains a statewide traumasystem.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Conducted programs that trained, tested and

certified about 2,100 new personnel and 3,000existing personnel. Courses included FirstResponder, Emergency Medical Technician-Basic (EMT-B), Emergency Medical Techni-cian-Intermediate (EMT-I) and EmergencyMedical Technician-Paramedic (EMT-P).

• Provided licensing and inspection services for140 ambulance services.

• Conducted distance learning through avideotape-based system that provides monthlycontinuing education material to 250 sites.

• Provided about 21 critical incident stressdebriefings to EMS personnel; conductedtraining for about 165 EMS providers in healthystress-coping techniques.

• Maintained a trauma system that designates 32trauma centers, develops local trauma transportplans, maintains a trauma registry and trainsEMS and trauma center personnel.

• Conducted emergency medical services forchildren (EMSC) programs that trained about300 EMS providers in special pediatrictechniques.

GoalsGoalsGoalsGoalsGoals• Implement strategies that attempt to minimize

the adverse impact of several negative factorson the state’s EMS system. These factorsinclude reduced population, greater concentra-tions of older citizens, a reduction in the level ofvolunteerism, and inadequate reimbursements.Strategies include the following:* Improved access to training through expan-

sion of Internet- and video-based training.* Revision of service licensure requirements to

facilitate regionalization of EMS services.* Development of quick-response units to

replace struggling ambulance services, whenappropriate.

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Division of Food and LodgingThe Division of Food and Lodging is respon-

sible for protecting public health through licensingand inspection of restaurants, bars, lodgingfacilities, mobile-home parks, campgrounds, bed-and-breakfast facilities, retail food stores, meatmarkets, bakeries and assisted-living facilities.Inspection procedures ensure that these licensedestablishments meet both sanitation and certainfire/life safety standards before opening to thepublic and while in operation.

Under an agreement with the Department ofHuman Services, staff members also inspectpreschools and day-care centers that preparefood. In addition, staff members inspect schoolsand migrant foodservice sites through an agree-ment with the Department of Public Instruction.The division provides educational courses in safefood handling, reviews plans for new establish-ments and extensive remodeling projects, andhelps investigate possible foodborne illnessoutbreaks.

The division serves as the U.S. Food andDrug Administration’s (FDA) liaison in the stateon issues related to manufactured food andpesticide residues in food.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Amended Section 33-33-04 of the North

Dakota Administrative Code to conform withFDA’s 2001 Model Food Code.

• Conducted more than 5,000 inspections oflicensed facilities.

GoalsGoalsGoalsGoalsGoals• Review and update the mobile-home park,

trailer park and campground statutes and rulesto conform with national codes.

• Pursue statewide foodborne-outbreak investi-gation training.

• Develop rules for assisted-living facilities.• Update memorandums of understanding with

local public health units.• Form advisory workgroup for division activities.• Standardize local public health unit inspector

procedures.

488

2,112

358

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FoodEstablishments

Lodging Facilities

Bed & Breakfasts

Establishments LicensedEstablishments LicensedEstablishments LicensedEstablishments LicensedEstablishments Licensedby the Division of Food and Lodgingby the Division of Food and Lodgingby the Division of Food and Lodgingby the Division of Food and Lodgingby the Division of Food and Lodging

Mobile Home Parks

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Environmental Health SectionThe Environmental Health Section’s five

divisions work closely with the federalEnvironmental Protection Agency (EPA) tosafeguard the quality of North Dakota’s air, landand water resources. Staff members deal withissues that affect the comfort, health, safety andwell-being of all North Dakota citizens and theirenvironment. Enforcement of state and federalenvironmental laws is accomplished throughpermitting, inspecting, sampling, analytical ser-vices and monitoring activities.

An important department goal is to maintaindelegation of all federal environmental programsfor North Dakota and to ensure that the regulatedcommunity complies with state environmentalstatutes.

The Environmental Health Section consists ofthe following divisions:

• Chemistry• Air Quality• Waste Management• Municipal Facilities• Water QualityDivision activities are coordinated by the

section chief’s office. Employees in this officeoversee quality assurance procedures andcoordinate computer and data managementactivities, environmental emergency responseefforts and funding requests.

The section’s role in the initial response to anenvironmental incident is one of support to localresponders and the Division of Emergency

Management. The section customarily takes thelead role in post-emergency environmentalcleanup activities.

The section chief’s office coordinates theannual state/EPA agreement, which defines thescope of environmental program responsibilitiesand commitments made by the section andthe EPA.

An assistant attorney general, assigned to thesection chief’s office, provides legal counsel to alldivisions of the section and assistance withenforcement procedures regarding violations ofstate environmental laws. During the biennium,this involved resolving violations of air, waterpollution, hazardous waste and solid wastemanagement statutes and rules.

The section chief’s office also includes a smallbusiness ombudsman. The ombudsman serves asan advocate for small businesses in need ofassistance to understand and comply withenvironmental laws and rules.

The section encourages public participationthrough opportunities for public comment, publichearings and the establishment of ad hoc taskforces and advisory groups.

The Environmental Health Section protectsthe public’s health by safeguarding thequality of North Dakota’s air, land and waterresources.

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Division of ChemistryThe Division of Chemistry provides analytical

services to a variety of environmental protection,public health, agricultural and petroleum regula-tory programs and laboratory certification for avariety of environmental protection programs.The NDDoH’s environmental protection pro-grams use analytical data generated by thelaboratory to regulate air quality; solid andhazardous waste; municipal wastewater; agricul-tural runoff; surface, ground, and drinking waterquality; petroleum products; and other media ofenvironmental or public health concern.

The Department of Agriculture uses analyticaldata generated by the laboratory to regulatelivestock and pet foods, as well as agriculturaland home-use fertilizers.

The division consists of seven analyticallaboratory sections and one laboratory certifica-tion section. The following describes each analyti-cal laboratory:• Biochemical Oxygen Demands Analytical

Laboratory: Performs tests such as biochemi-cal oxygen demand, total suspended solids andpH; provides analytical data used to determinecompliance with permit requirements of munici-pal and industrial wastewater discharges.

• Feed and Fertilizer Lab: Provides analyticaldata to the Department of Agriculture; testsagriculture feeds and fertilizers, as well as petfoods and lawn and garden fertilizers, todetermine compliance with labeling.

• Mineral Lab: Tests a variety of matrices formajor cation and anion parameters. Typical

analyses include fluoride, chloride, chemicaloxygen demand, nitrate, sodium, ammonia andtotal Kjeldahl nitrogen.

• Organic Lab: Provides identification andquantification of insecticides, herbicides, volatileand semi-volatile organic compounds, PCBsand other synthetic organic compounds inmultiple matrices. Matrices include drinking,surface and ground water; soil; river and lakesediments; foliage; fish tissue; sludge; oil; landfillwastes; and other environmental sources.

• Petroleum Lab: Tests petroleum productssuch as gasoline and diesel for product quality.

• Radiation Lab: Identifies and quantifiesradioactive elements in public drinking watersupply systems and radon analysis. The labora-tory also participates in a nationwide monitoringprogram that looks at the trends in atmosphericbackground radiation through bulk air samples.

• Spectroscopy Lab: Identifies and quantifiesmetal concentrations in drinking water sourcesand distribution systems, surface and groundwater resources, fish, hazardous and solidwastes, river and lake sediments, and otherenvironmental media.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Continued to assist the Environmental Health

Section during environmental emergencies. Thelaboratory provides 24-hour services duringmajor emergencies to ensure timely response.Some analysis associated with emergencysituations this biennium included:∗ Testing of Pembina, N.D., water supply after

a suspected tampering of the system.

The Chemistry laboratory testsair, water and soil samples fora variety of substances.

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∗ Analyzing water and soil samples from ananhydrous ammonia chemical release resultingfrom a train derailment near Minot, N.D.

∗ Testing of suspicious materials from potentialterrorist activities following the September 11,2001, terrorist attacks and the subsequentanthrax incidents.

• Provided analytical support to help public watersystems comply with federal and state drinkingwater rules and regulations. About 5,500samples were tested for more than 23,000analytical components, including nitrates, metalssuch as lead and copper, fluoride, pesticidesand volatile organic compounds such asbenzene and toluene.

• Provided the analytical services necessary tomonitor ground water quality across the state.Testing included nitrates, metals, pesticides andgeneral water quality parameters. In addition,the laboratory analyzed samples for the envi-ronmental assessment of ground water andother factors related to feedlot operations.

• Participated in special projects in addition toroutine analyses. For example, the divisionanalyzed ground water from the Oakes Aquiferfor nitrate contamination from various sources,including agricultural production.

• Maintained Internet website to provide informa-tion about the division’s services, samplesubmission procedures, analytical procedures,quality assurance plan and other general topics.

• Continued to participate in several laboratoryperformance evaluation programs, which thedivision regularly completes successfully. Inaddition, the division certifies the state’s envi-

ronmental laboratories and reviews and recog-nizes other states’ certifications for out-of-statelaboratories that meet the requirements ofNorth Dakota’s certification program.

• Continued to provide information to otherlaboratories through training and conferences.

• Analyzed nearly 26,000 samples for more than250,000 analytical parameters.

GoalsGoalsGoalsGoalsGoals• Develop a chemical terrorism laboratory

preparedness component to be included inNorth Dakota’s comprehensive public healthemergency preparedness and response plan.

• Maintain or increase laboratory efficiency andresponsiveness; provide continued analyticalsupport for environmental protection, publichealth, agriculture, and petroleum regulatoryprograms.

• Continue membership in performance evalua-tion programs; maintain current EPA laboratorycertification and obtain certification for newdrinking water components as they becomeregulated by EPA.

• Complete the resolution of critical life-safetyand ventilation deficiencies in the existinglaboratory building via a laboratory additionapproved by the 2001 Legislative Assemblyand the remodeling of the existing laboratoryfacility as approved by the 2003 LegislativeAssembly. Both projects are scheduled forcompletion in 2004.

• Begin providing analytical support to the NorthDakota Water Commission.

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AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Maintained attainment status for all National

Ambient Air Quality Standards.• Complied with all federal program requirements

and maintained federal delegation responsibili-ties for Environmental Protection Agencyprograms.

• Responded to and assisted in the mitigation ofa train derailment that caused a catastrophicrelease of anhydrous ammonia impacting thecity and surrounding community of Minot.

• Participated in an oversight evaluation by theNuclear Regulatory Commission and receivedfindings that the program is adequate forprotection of public safety and compatible withNRC regulations.

• Played an active role in distributing environmen-tal information to the public and providingpublic education and outreach by holding publicinformation meetings; scheduling discussionsessions with local public health units; andparticipating in college and other agencyseminars directed at providing education tothe public on a variety of environmental issues.

GoalsGoalsGoalsGoalsGoals• Maintain delegation and responsibility for

federally mandated programs.• Continue to work with officials at EPA to

resolve issues surrounding the Prevention ofSignificant Deterioration Program.

• Enhance emergency response capabilities.

Division of Air QualityThe Division of Air Quality consists of two

major programs responsible for protecting thestate’s air quality resources and for ensuringcontrol of radiation. Staff members also providetechnical assistance during emergency responseefforts.

Air Pollution Control Program The Air Pollution Control Program is

responsible for protecting and fostering the state’sair quality resources. The program promotesclean air activities and initiates enforcementactions to correct air pollution problems.

Program staff members consist of scientists,engineers and technicians whose primary respon-sibilities include evaluating permit applications,issuing permits that restrict emission levels toensure that standards are met, inspecting facilitiesto ensure compliance, investigating air pollutioncomplaints and operating a statewide ambient airquality monitoring network.

Radiation Control Program The Radiation Control Program monitors

the development and use of ionizing and nonioniz-ing radiation sources to protect the health andsafety of North Dakotans and the environment.Staff members also operate programs to evaluateand address mitigation of asbestos, radon, leadand other indoor air quality concerns.

North Dakota is one of only 14 states thatmeet all National Ambient Air QualityStandards.

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Division of WasteManagement

The Division of Waste Management works tosafeguard public and environmental health in thestate. Division programs are designed for genera-tors of solid and hazardous waste and operatorsof underground storage tanks.

The division includes the following programs:• Hazardous Waste Program• Underground Storage Tank Program (UST)• Solid Waste Program

Hazardous Waste ProgramThe Hazardous Waste Program regulates

facilities that generate, store, treat, dispose ortransport hazardous waste. The program encour-ages practices that minimize or eliminate hazard-ous waste generation and works to ensure that

hazardous waste does not adversely affect humanhealth or the environment.

In addition to other inspections, the programconducts polychlorinated biphenyls (PCB)inspections at facilities or sites known or sus-pected to have equipment containing PCBs.North Dakota is one of only six states thatconducts PCB inspections in lieu of Environmen-tal Protection Agency inspections. The programalso coordinates assessments at Brownfield sites,which are properties owned by a city, county ordevelopment organization that are underdevel-oped due to actual or perceived contamination.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Conducted permitting and routine inspections of

the regulated community, which consists ofabout 750 businesses that have notified thedivision of hazardous waste activity. Thisincludes small- and large-quantity generators;transporters; and treatment, storage anddisposal facilities.

• Inspected about 120 facilities that generate ormanage hazardous waste; provided complianceassistance to other hazardous waste facilities.

• Conducted about 30 PCB inspections; assistedbusinesses and tribes in investigating andmanaging regulated PCB waste; and continuedto promote the management of unregulatedPCB waste as regulated PCB waste.

• Worked with five facilities in investigating andremediating contaminated soil or ground water.

• Worked with the U.S. Drug EnforcementAgency and the N.D. Bureau of CriminalInvestigation to clean up clandestine drug labs.

The Radiation Control Programmonitors X-ray facilities and otherradioactive material users.

• Continue education and outreach activities tokeep the public informed about environmentalissues specific to air and radiation.

• Provide cross training to staff to improveversatility and job satisfaction and to provide aneffective public response.

• Continue to provide responses to indoor airquality concerns by direct intervention andassistance to local public health personnel.

• Coordinate training programs to improveradiation technology education for facilities thatoffer such services to the public.

43

substance storage tanks, establishes technicalstandards for the installation and operation ofunderground tanks, maintains a tank notificationprogram, establishes financial responsibilityrequirements for tank owners and provides forstate inspection and enforcement.

UST regulations are designed to find leaksand spills, correct problems created by leaks andspills, prevent future leaks and spills, and ensurethat owners and operators of USTs can pay tocorrect the problems created by leaking tanksystems. Leaking USTs can cause fires or explo-sions that threaten human safety and can contami-nate nearby soil, ground water or surface water.

The program also works with retailers andmanufacturers to ensure that specifications andstandards for petroleum and antifreeze are met.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Regulated 925 active tank facilities, for a total

of 2,280 tanks. Compliance is monitored by amail-in self-certification process, as well asonsite visitations. The program observed 35tank closures, conducted 500 onsite inspec-tions, and investigated and monitored cleanupof 16 leaking UST sites.

• Collected and analyzed 1,430 petroleumsamples in cooperation with the Public ServiceCommission; processed and notified petroleumretailers of analysis results, including octane,distillation end points, etc.

• Registered 12 antifreeze manufacturers and 136bulk antifreeze retailers.

• Used Leaking Underground Storage Tank(LUST) Trust Fund money to investigate

• Responded to and assisted in the cleanup ofenvironmental spills and citizen complaints.

• Initiated a Brownfields program and raisedawareness of the program among eligibleapplicants and other stakeholders.

• Assessed five Brownfield properties in onecommunity, and provided Brownfield funding toMandan for redevelopment planning for itscentral business district.

• Received recognition from EPA for meeting thenational goal of issuing hazardous waste permitsto all facilities that require them.

GoalsGoalsGoalsGoalsGoals• Reissue appropriate hazardous waste permits.• Continue to review investigation reports,

proposed remedies and remediation progress atfacilities with corrective-action permits.

• Continue to conduct PCB inspections and topromote the proper handling and disposal ofregulated and unregulated PCB waste.

• Seek additional EPA funding for Brownfieldassessment and remediation activities.

• Conduct training that provides a general over-view of regulations and requirements and helpsbusinesses comply with state rules.

• Maintain partnership with the regulated commu-nity. This partnership has had a positive impacton the compliance, which protects public healthand the environment from mismanagement ofhazardous waste in North Dakota.

Underground Storage Tank ProgramThe Underground Storage Tank Program

(UST) regulates petroleum and hazardous-

44

suspected UST releases and to conductcorrective actions when a release had occurredbut the responsible party was recalcitrant,unable to pay or could not be identified. LUSTTrust Fund money also was used to install andoperate a pilot clean-up system for diesel fuelcontamination in downtown Mandan.

• Continued outreach to tank owners aboutproper maintenance and operation of USTs.More than 9,200 USTs have been removedduring the 14 years the UST Program has beenin existence. Many of these tanks leaked or hadthe potential to leak.

GoalsGoalsGoalsGoalsGoals• Assist tank owners with contamination assess-

ment/clean-up activities following upgrade and/or replacement of USTs or when leaks occur.

• Provide compliance monitoring and inspections,along with public outreach, to inform tankowners about the proper operation of USTs(e.g., leak detection, spill reporting, etc.).

• Use LUST Trust Fund money to investigate andproperly close additional abandoned UST sitesthroughout the state; continue with remediationof downtown Mandan.

• Collect petroleum samples from retailers andrespond to product and labeling deficiencies.

• Review antifreeze registration requests andrespond to formulation and labeling deficiencies.

The Solid Waste ProgramThe Solid Waste Program regulates the

collection, transportation, storage and disposal ofnonhazardous solid waste. The program assists

individuals, businesses and communities in plan-ning for and providing efficient, environmentallyacceptable solid waste management systems. Theprogram promotes resource recovery, wastereduction, recycling and pollution prevention (P2)activities that preserve and enhance the quality ofthe state’s natural resources. In addition, theprogram assists in the cleanup of abandonedmotor vehicles and other scrap metal.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Regulated 14 municipal solid waste landfills,

304 waste haulers, 29 transfer stations, fourindustrial waste landfills, 21 special waste(energy and oil industry) landfills, 189 inertwaste landfills and seven compost facilities.

• Conducted more than 600 inspections offacilities; investigated complaints and spills.

• Worked with Grand Forks on a proposedlandfill site; reviewed an environmental impactstudy for Turtle River Township; and approvedand oversaw construction or expansion oflandfill facilities.

• Assisted in clean-up activities, including theanhydrous ammonia release near Minot, scrapmetal and auto salvage facilities, an abandonedrendering plant, and numerous oil product andoilfield releases and spills.

• Worked with the Division of EmergencyManagement and the state veterinarian toevaluate emergency disposal procedures duringan outbreak of chronic wasting disease orlivestock infestations such as foot-and-mouthdisease or mad-cow disease.

The Solid Waste Program promotes recycling tohelp preserve natural resources.

45

• Continued work on tire disposal issues, includ-ing illegal disposal; improper management; andpotential disease, fire and water pollution.

• Conducted annual landfill operator training andcertification sessions attended by about 40landfill operators and solid waste professionals.

• Developed and implemented guidelines for theutilization of coal ash for land stabilization incrop storage areas, feedlots, road construction,and reclamation of abandoned mine lands.

• Met with the EPA, the Office of SurfaceMining, representatives of coal-producing statesand industry stakeholders to discuss pendingFederal regulation of coal combustion material.

• Co-hosted annual Solid Waste Symposium andmade numerous presentations to civic leaders,interested citizens and solid waste professionalsabout waste reduction and recycling,composting, disposal, waste hauling and the useof wood waste material as fuel.

• Worked with various nonprofit organizations todevelop educational materials, host workshops,and partner in federal grant opportunities.

• Developed a pollution prevention (P2) programthat promotes waste reduction and reuse. Theprogram promoted grasscycling (mulching) andcomposting; assisted two agricultural plants inusing 19,000 tons of wood waste as an eco-nomical and clean-burning fuel; coordinated theuse of nearly 30,000 tons of manure in therestoration of the ammonia release site atMinot; and worked with seven food processorsand 17 livestock sales facilities to recycleorganic wastes through nutrient management

plans.• Through the Abandoned Motor Vehicle (AMV)

program, worked with local public health unitsto complete projects in Benson, Ramsey andSioux counties; facilitated priority cleanups inseveral smaller communities; completed asurvey of Bottineau and Renville counties; and,initiated collection activities in Bottineau,Renville and Ward counties. About 4,000 tonsof scrap metal was collected and recycledthrough the program.

GoalsGoalsGoalsGoalsGoals• Conduct education and outreach efforts through

training, workshops, site visits, development ofguidelines and educational materials andimprovement of the division’s website.

• Promote P2 and integrated waste managementthrough cost-effective waste reduction, reuse,recycling and energy recovery.

• Promote the use of AMV program statewideand support local efforts to remove unwantedscrap metal.

• Work with stakeholders to prepare for disastersand emergencies that may involve significantsolid waste issues.

• Work with residents in Grand Forks andnortheastern North Dakota to find an effectiveand environmentally sound solution to thepending closure of the Grand Forks landfill.

• Work with stakeholders and federal agenciesregarding federal regulations affecting coalcombustion material.

46

Four inspectors/trainers annually inspectabout 714 public water and wastewater systemsto ensure that facilities comply with state andfederal public health standards. Program activi-ties contribute to the proper operation andmaintenance of these facilities.

Drinking Water State Revolving Loan FundThe DWSRF Program provides low-interest

loans to help public water systems finance theinfrastructure needed to comply with the SDWA.Funding is expected to continue for the foresee-able future at the rate of about $9.5 million peryear. Through June 30, 2003, loans totaling about$63.9 million have been approved to assist NorthDakota water systems.

Program staff members also review about150 drinking water projects each year. Thereviews ensure that new or modified public watersystem facilities meet state design criteria beforeconstruction. The reviews help ensure that thefacilities achieve desired public health objectivesand can be properly operated and maintained.

Clean Water State Revolving Loan FundThe CWSRF Program provides low-interest

loans to fund conventional wastewater andnonpoint source pollution control needs.

Funding is expected to continue in the fore-seeable future at the rate of about $7.5 millionper year. Through June 30, 2003, loans totalingabout $153 million have been approved to assistNorth Dakota wastewater systems. Eligibleborrowers can obtain financing to build wastewa-ter treatment works at below-market interest

Division of MunicipalFacilities

The division consists of four programs thathelp municipalities and other political subdivisionsmaintain public health and safety: the Public WaterSupply Supervision (PWSS) Program; theOperator Training, Certification and FacilityInspections Program; the Drinking Water StateRevolving Loan Fund (DWSRF) Program; andthe Clean Water State Revolving Loan Fund(CWSRF) Program.

Public Water Supply Supervision ProgramThe PWSS Program works with the 529

public water systems in North Dakota to ensurethat drinking water meets all standards establishedby the Safe Drinking Water Act (SDWA). This isaccomplished by monitoring contaminants,providing operator training and certification,conducting sanitary surveys, reviewing plans andspecifications, and providing technical assistance.The program also administers the state’s fluorida-tion program and provides technical assistance toprivate water systems.

Operator Training, Certification and FacilityInspections Program

The Operator Training, Certification andFacility Inspections Program trains and certifiespeople in charge of the day-to-day operation ofwater treatment and distribution facilities, as wellas wastewater collection and treatment plants.There are 947 certified operators in the state.

The Division of Municipal Facilities helpsto ensure safe drinking water through avariety of programs and activities.

47

Division of Water Quality

rates. In addition, staff members review plans fornew and modified wastewater systems; about150 plans are reviewed each year.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Complied with all major federal program

requirements and maintained federal delegationresponsibilities for EPA programs.

GoalsGoalsGoalsGoalsGoals• Maintain responsibility for federally mandated

programs.• Continue to provide funding for the state’s

drinking water and wastewater needs.

The primary statute providing for waterquality protection is the federal Clean Water Actof 1972. This act and its amendments haveproven to be the driving force behind many recentwater quality improvements. Even before thefederal Clean Water Act, North Dakota had itsown law to protect water quality, the NorthDakota Water Pollution Control Act enacted in1967. The NDDoH is largely responsible formonitoring the quality of the state’s lakes, streamsand rivers. The Division of Water Quality helpsensure that water stays clean for people todayand in the future.

Polluted water may carry certain diseases thatresult in dangerous illnesses and increased health

care costs. Contaminated water costs more totreat and is less appealing for recreational uses.And, of course, there is an environmental costsince polluted water affects the plants and animalsdependent upon it.

Water quality in North Dakota and the nationhas improved since passage of the Clean WaterAct in 1972, but much remains to be done if thegoal of restoring and maintaining the quality of thestate’s and nation’s waters is to be achieved.

Water Quality StandardsThe Water Quality Standards are revised

every three years to accommodate the contempo-rary needs of the state and to incorporate thelatest scientific information. Preliminary review forthe next revision has begun, and final adoption isplanned for 2005. The standards establish thebeneficial uses of the state’s water and assignnumeric criteria for chemical concentrationsnecessary to achieve the designated uses. TheWater Quality Standards provide guidance to theNorth Dakota Pollutant Discharge EliminationSystem Program, as well as set goals for theNonpoint Source Pollution ManagementProgram.

Water Quality Certification ProgramThe NDDoH reviews federal Section 404

dredge and fill applications to determine compli-ance with the State Water Quality Standards.The NDDoH expedites the review of all floodcontrol and infrastructure protection projects.

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Devils Lake FloodingThe NDDoH maintains lead agency status on

monitoring water quality and providing technicalinformation in the Devils Lake basin. The moni-toring consists of seven sites in the Devils Lakechain of lakes. The NDDoH also is involved in

special studies as needed and the U.S.Army Corps of Engineers environmentalimpact statement development process.Implementation of the Devils Lake WaterManagement Plan is necessary to achievelong-term solutions for flooding in theDevils Lake basin. Technical assistancehas been provided for protection andmaintenance of water distribution andwastewater treatment systems. TheNDDoH also has provided regulatoryoversight for threatened fuel storageareas, potential hazardous materials sitesand other environmental threats.

The NDDoH issued a permit to theNorth Dakota State Engineer to discharge waterthrough West Bay of Devils Lake to the SheyenneRiver. The permit restricts the discharge toprotect the water quality and flows in theSheyenne River. An adaptive management planwill also be implemented to further ensure themaintenance of all beneficial uses.

Pollutant Discharge Elimination SystemPermit Program

Point source pollution is defined simply aspollution coming from a specific source, like theend of a pipe. Environmental regulations imple-

mented during the last 20 years have resulted in asignificant reduction in pollution from major pointsources; for example, municipal and industrialwastewater treatment facilities.

Since 1975, the NDPDES Program hasissued about 500 wastewater discharge permits(25 percent industrial and 75 percent municipal).

Beginning in 1992, permits have beenrequired for storm water discharges associatedwith construction activities and industrial facilities.About 750 facilities are covered by generalpermits for storm water discharges. This bien-nium, the primary focus in the area of storm waterdischarges has been meeting the obligations ofPhase II of the Environmental ProtectionAgency’s (EPA’s) Storm Water Rule.

Impacts to water from livestock operationsare an increasing concern in North Dakota.Currently, about 535 livestock facilities have beenapproved to operate. Most of these are cattle-wintering, hog and dairy facilities that are part of afarmer’s total farm operation. In recent years,however, there has been an increase in thenumber of large concentrated animal feedingoperations (CAFOs) proposed in North Dakota.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Implemented the Septic Pumper Program, the

Hydrostatic Testing/De-watering Program andthe Coal Mining Point Source Program.

• Worked with the Office of the Attorney Generalto finalize a program package transferring theregulatory authority for the industrial pretreat-ment program from the EPA to the NDDoH.

Devils Lake’s rising water has caused millions of dollarsin damages.

49

• Issued two new wastewater discharge permitsand re-issued 66. This work included recordreviews at all major facilities (26 per year withcompliance sampling) and 533 wastewaterplant inspections.

• Developed a permit for small municipal sepa-rate storm sewer systems (MS4s), which arethose systems generally operated within cities ofmore than 10,000 people. Revised the existingstormwater permit for construction activities toinclude new areas of construction specified inthe rule. Eighty-six stormwater inspections werecompleted.

• Issued “approvals to operate” to 27 livestockfacilities and conducted 242 inspections atpermitted livestock facilities.

• Conducted 25 public meetings around the statein conjunction with the NDSU ExtensionService to discuss the new EPA/CAFO ruleswith producers and producer groups.

• Issued 154 septic pumper licenses in 2001-2002 and 151 in 2002-2003. Twenty permitsfor de-watering purposes also were issued.

• Revised the department’s Animal FeedingOperation Program to include EPA’s updates tothe CAFO Program.

Nonpoint Source Pollution ManagementProgram

Most threatening to surface water resourcesis nonpoint source (NPS) pollution because thispollution does not come from one point. NPSpollution includes runoff from construction sites,city streets, livestock feedlots and agricultural

lands. Runoff carries pollutants – includingsediment, nutrients and pesticides – and depositsthem in the state’s waters.

Efforts to control NPS pollution primarily areachieved through the North Dakota NPS Pollu-tion Management Program, which came intoexistence in 1987 with the addition of Section319 to the Clean Water Act. Under Section 319,EPA is authorized to award grants to state orlocal groups to control NPS pollution. The NPSPollution Task Force provides input and recom-mendations about local projects funded throughSection 319. The task force is composed ofrepresentatives from a number of public andprivate entities. The Division of Water Quality isresponsible for administering these funds andimplementing the NPS Pollution ManagementProgram in North Dakota.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Provided financial support to more than 90

projects since 1990. Of these projects, 41 arecurrently active.

Surface Water ManagementHistorically, surface water quality monitoring

conducted by the division consisted of a networkof chemical monitoring stations. Typical waterquality variables for which monitoring was con-ducted included temperature, dissolved oxygen,pH, major ions, nutrients (i.e., phosphorus,ammonia and nitrate) and fecal coliform bacteria.Currently, the division has 27 ambient chemicalmonitoring sites across the state. The division will

50

maintain these as long-term monitoring sites toassess water quality trends and to describe thegeneral chemical character of the state’s majorriver basins.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Completed pollution reduction targets (total

maximum daily loads or TMDLs) as requiredby Section 303(d) of the Clean Water Act forRice Lake (Ward County), Patterson Lake(Stark County) and the Sheyenne River(downstream of Valley City).

• Created four regional watershed liaison posi-tions. In addition to developing TMDLs, theseindividuals will help increase the involvement ofsoil conservation districts, water resourcedistricts and local stakeholders in developingwatershed projects.

• Began the Environmental Monitoring andAssessment Program with the EPA’s Office ofResearch and Development and the U.S.Geological Survey to assess the state’s peren-nial rivers and streams. In addition to referencesites, more than 50 randomly selected siteswere sampled throughout the state between2000 and 2003.

• Conducted water quality monitoring on DevilsLake four times each year and maintained anactive water quality monitoring program onLake Sakakawea. Working cooperatively withthe North Dakota Game and Fish Department,the department sampled Lake Sakakaweaweekly during the open-water period in 2002and 2003. Resulting data is being used toprovide estimates of the lake’s cold-water

habitat and to support the state’s lawsuit withthe U.S. Army Corps of Engineers regardingreservoir management.

• Monitored for mercury and other contaminantsby collecting fish from the state’s lakes, reser-voirs and rivers. Issued an updated advisory (AGuide to Safe Eating of Fish in NorthDakota) about eating fish caught in the state’slakes and rivers.

Ground Water ProgramAbout 340,000 North Dakotans depend on

ground water for their household drinking watersupply. Of that number, about 250,000 peopleare served by cities or rural water systems, andslightly more than 90,000 people use privatewater wells for drinking water. Agriculture andindustry also use large quantities of water on aroutine basis.

North Dakota’s ground water protectionprograms are designed to control potentialsources of contamination. This is accomplishedthrough permit programs, waste discharge limits,performance and design standards, contaminantremediation, and best management practices forNPS pollution. The degree to which contamina-tion incidents are investigated or remediateddepends upon the contaminant, its impact on thebeneficial use of the resource and the overall riskto the public or the environment.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Successfully protected human health and the

environment at spill sites, such as the CanadianPacific Railway train derailment in Minot.

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Wellhead and Source Water ProtectionPrograms

The Wellhead Protection Program protectsground water resources by addressing the linkbetween land uses and ground water quality.Potential contaminant sources in a defined protec-tion area around a community’s drinking waterwells are identified. Communities then can deter-mine if these sources should be removed,restricted or monitored.

The 1996 Amendments to the Safe DrinkingWater Act (SDWA) established the Source WaterProtection Program to serve as an umbrella ofprotection efforts for all public water systems,including ground water- and surface water-dependent systems. The Wellhead ProtectionProgram continues for ground water-dependentsystems. The Source Water Protection Programfor surface water-dependent systems involves (1)the delineation of protection areas along rivers orreservoirs that provide source water for thesystems and (2) an inventory of potential contami-nant sources within the protection areas. Underboth the Wellhead and Source Water Protectionprograms, the NDDoH defines the susceptibilityof public water system to potential contaminantsources found in their protection areas.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Completed work on the minimum elements of

wellhead and source water protection (delinea-tion, contaminant source inventory, susceptibil-ity). The 1996 SDWA Amendments required all

states to complete the minimum elements ofwellhead and source water protection by May2003.

Underground Injection Control ProgramThe Underground Injection Control (UIC)

Program helps prevent contamination of under-ground sources of drinking water (USDW) byinjection wells (e.g., domestic waste, industrialwastewater or motor vehicle waste disposal).

There are five classes ofunderground injection wells,defined according to the types offluid they inject and where thefluid is injected. The Division ofWater Quality regulates Class Iand Class V underground injec-tion wells.

AccomplishmentsAccomplishmentsAccomplishmentsAccomplishmentsAccomplishments• Revised state UIC rules to

reduce potential impacts toUSDW resulting from high-riskdisposal wells.

• Identified and inventoriedapproximately 70 new motorvehicle waste disposal wells.

• Conducted inspections at approximately 65facilities located in high risk areas such aswellhead protection areas and other sensitivegroundwater areas.

• Obtained closure of 10 high-risk wells locatedin wellhead protection areas or other sensitivegroundwater areas.

The Division of Water Quality protects the public’s health and theenvironment by monitoring the state’s lakes, streams and rivers.

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Division GoalsDivision GoalsDivision GoalsDivision GoalsDivision Goals• Include a watershed approach in all monitoring,

assessment and control programs.• Complete a triennial review of water quality

standards.• Help local public water supply systems manage

source water protection areas, including well-head protection areas.

• Increase state level funding for NPS pollutionprojects.

• Finalize the revisions to the Animal FeedingOperation Program.

• Increase public awareness of the properconstruction, use and potential hazards ofunderground injection wells.

• Refine and expand the monitoring and assess-ment of aquatic life for lakes and streams.

• Expand monitoring for pesticides, reviseinformation about pesticides and developcriteria that include pesticides currently in use.

• Increase funding for restoration of lakes.Although the list of potential clean lakesprojects is growing, funds virtually havedisappeared.

• Improve Geographic Information System (GIS)capabilities to help ensure multi-agency andpublic access to water quality data.

• Improve communication and data sharingamong local, state and federal agencies.

• Ensure that revised water quality standards areuser-friendly, utilize the most current informationto ensure protection of human and aquatic life,

support the state’s commitment to protect eachbody of water’s designated uses and outlinethe department’s regulation of point sourcedischarges.

• Continue working with local soil conservationdistricts and the North Dakota Game and FishDepartment (“Save Our Lakes” Program) in thedevelopment of TMDLs for Cedar Lake,Indian Creek Dam, Dead Colt Creek Dam,Armourdale Dam, Carbury Dam, NorthgateDam, McGregor Dam, Blacktail Dam,McDowell Dam, Pheasant Lake andRenwick Dam.

• Continue developing TMDLs for the Red Rivernear Fargo, the James River near Jamestown,the Wild Rice River in Sargent and Richlandcounties, the Maple River in LaMoure andDickey counties, the Cannonball River andCedar Creek.

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North Dakota’s public health system is madeup of 28 single- and multi-county local publichealth units (LPHUs).

Services offered by each LPHU vary, but allprovide services in the areas of maternal and childhealth, health promotion and education, diseasecontrol and prevention, and emergency response

preparation and coordination. Some local publichealth units maintain environmental health pro-grams; others partner with the NDDoH toprovide environmental services, such as publicwater system inspections, nuisance and hazardabatement, and food service inspections.

Local Public Health Units

Burleigh

Oliver

Dunn

Slope

Bowman

Billings

Go

lden

Val

ley

Stark

Hettinger

Adams Sioux

Grant

Mercer

Morton

Mountrail

Williams

McKenzie

Divide Burke

McHenry

McLean

Ward

Renville Bottineau

Kidder

DickeyEmmons

McIntosh

Stutsman

LoganLa Moure

Sargent

Richland

Barnes

Ransom

Cass

Ramsey

Eddy

WellsSheridan

Foster

Rolette

Pierce

Benson

Towner

Nelson

SteeleGriggs

Traill

Grand Forks

Cavalier

Walsh

Pembina

Multi-County Health District

Single-County Health District

City/County Health District

Single-County Health Department

City/County Health Department

June 30, 2003

54

Health UnitHealth UnitHealth UnitHealth UnitHealth Unit Location Location Location Location Location AdministratorsAdministratorsAdministratorsAdministratorsAdministrators

Bismarck-Burleigh Public Health Bismarck Paula Flanders, R.N.Cavalier County Health District Langdon Terri Gustafson, R.N.Central Valley Health Unit Jamestown Sharon Unruh, R.N.City-County Health Department Valley City Marcy Grant, R.N.Custer Health Mandan Keith JohnsonDickey County District Health Unit Ellendale Roxanne HolmEmmons County Public Health Linton Bev Voller, R.N.Fargo Cass Public Health Fargo Mary Kay Herrmann, R.N.First District Health Unit Minot Lisa CluteFoster County Health Department Carrington Jean Kulla, R.N.Grand Forks Public Health Department Grand Forks Don ShieldsKidder County District Health Unit Steele Lana FischerLake Region District Health Unit Devils Lake Karen Halle, R.N.LaMoure County Public Health Department LaMoure Tony HansonMcIntosh District Health Unit Ashley Joy GoehringNelson/Griggs District Health Unit McVille Julie Ferry, R.N.Pembina County Health Department Cavalier Eleanor Stuberg, R.N.Ransom County Public Health Department Lisbon Deb Bergstrom, R.N.Richland County Health Department Wahpeton Debra FlackRolette County Public Health District Rolla Barb Frydenlund, R.N.Sargent County District Health Unit Forman Colleen SundquistSouthwestern District Health Unit Dickinson Carlotta EhlisSteele County Public Health Department Finley Diane Jacobson, R.N.Towner County Public Health District Cando Tim TracyTraill District Health Unit Hillsboro Brenda Stallman, R.N.Upper Missouri District Health Unit Williston Mike MeliusWalsh County Health Department Grafton Wanda Kratochvil, R.N.Wells County District Health Unit Fessenden Karen Volk, R.N.

June 30, 2003

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State Health Council

CHAIRCarmen Toman, consumer, Bismarck

VICE CHAIRHjalmer Carlson, Jr., consumer, Minot

SECRETARYJoel Smith, manufacturing and processing industry, Fargo

MEMBERSHoward C. Anderson, R.Ph., health care, Turtle LakeJeff Burgess, energy industry, BismarckLowell Herfindahl, health care, TiogaMarlene Kouba, consumer, RegentLee Larson, consumer, LeedsGordon Myerchin, consumer, Grand ForksGary Riffe, health care, JamestownDennis E. Wolf, M.D., health care, Dickinson

June 30, 2003

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Financial Summary

NorNorNorNorNorth Dakth Dakth Dakth Dakth Dakooooota Departa Departa Departa Departa Department of Healthtment of Healthtment of Healthtment of Healthtment of HealthComparative Statement of Appropriations and ExpendituresComparative Statement of Appropriations and ExpendituresComparative Statement of Appropriations and ExpendituresComparative Statement of Appropriations and ExpendituresComparative Statement of Appropriations and Expenditures

FFFFFor the Por the Por the Por the Por the Period July 1eriod July 1eriod July 1eriod July 1eriod July 1, 200, 200, 200, 200, 20011111, thr, thr, thr, thr, through June 30, 2003ough June 30, 2003ough June 30, 2003ough June 30, 2003ough June 30, 2003

Equity Emergency Emergency CapitalOriginal Salary Commission Commission Allotment Construction Adjusted

Use of Funds Appropriation Adjustment Jan-02 Apr-02 Aug-02 HB 1023 Appropriation

Salaries & Wages 28,636,615$ 292,560$ 158,573$ 519,702$ (156,765)$ 29,450,685$ Operating Expenses 15,647,794 809,937 3,338,251 19,795,982Equipment 1,265,451 424,632 1,690,083Capital Improvements 2,741,704 823,878 1,574,865 5,140,447Grants 24,282,170 4,476,720 2,036,910 30,795,800CDC Tobacco 2,369,934 2,369,934Tobacco Prev. & Cntrl 4,700,000 4,700,000WIC Food Payments 17,000,000 17,000,000Community Hlth Advisory 350,000 350,000Lead-Based Paint 117,000 117,000

Total 97,110,668$ 292,560$ 6,269,108$ 6,319,495$ (156,765)$ 1,574,865$ 111,409,931$

General Funds 14,812,936$ 117,034$ (156,765)$ 14,773,205$ Federal Funds 68,184,658 175,526 6,069,108 6,319,495 80,748,787Special Funds 14,113,074 200,000 1,574,865 15,887,939

Total 97,110,668$ 292,560$ 6,269,108$ 6,319,495$ (156,765)$ 1,574,865$ 111,409,931$

57

NorNorNorNorNorth Dakth Dakth Dakth Dakth Dakooooota Departa Departa Departa Departa Department of Healthtment of Healthtment of Healthtment of Healthtment of HealthExpenditures by SectionExpenditures by SectionExpenditures by SectionExpenditures by SectionExpenditures by Section

FFFFFor the Por the Por the Por the Por the Period July 1eriod July 1eriod July 1eriod July 1eriod July 1, 200, 200, 200, 200, 20011111, thr, thr, thr, thr, through June 30, 2003ough June 30, 2003ough June 30, 2003ough June 30, 2003ough June 30, 2003

BioterrorismAdministrative Medical Health Community Environmental Preparedness Total

Use of Funds Support Services Resources Health Health & Response Expenditures

Salaries & Wages 4,139,316$ 3,623,381$ 4,788,776$ 2,605,860$ 12,708,826$ 116,370$ 27,982,529$ Operating Expenses 1,460,591 4,538,982 1,035,529 3,455,515 6,645,196 116,206 17,252,019Equipment 405,997 418,746 60,011 33,908 605,286 48,478 1,572,426Capital Improvements 927,919 927,919Grants 1,410,245 1,275,498 2,098,960 12,618,447 8,090,646 495,454 25,989,250CDC Tobacco 2,112,764 2,112,764Tobacco Prev. & Cntrl 4,661,077 4,661,077WIC Food Payments 14,116,786 14,116,786Community Hlth Advisory 76,706 76,706Lead-Based Paint 115,744 115,744

Total 7,416,149$ 9,856,607$ 7,983,276$ 39,681,063$ 29,093,617$ 776,508$ 94,807,220$

Total FTE 49.5 42.6 57.0 34.4 139.5 3.0 326.0

58

Publications

Community Health SectionCommunity Health SectionCommunity Health SectionCommunity Health SectionCommunity Health SectionNewsletters• Building Blocks to Safety with Buckle Update

insert• Chalkboard on Health• Focus on Fluoride• Health Care Provider Examiner• Health Data Notes

Reports• Arthritis in North Dakota• Benchmark Worksite Wellness Study• Diabetes and Related Health Factors in

North Dakota Adults: An Analysis of NorthDakota BRFSS Data 1994-2000

• Estimates of Diabetes Prevalence by County• Maternal and Child Health Status• 1997-1998 Cancer Statistics – Cancer

Incidence and Mortality in North Dakotawith a section on Cancer Clusters

• 2001 North Dakota Youth Risk Behaviors

Other• Diabetes ... Finding the Balance wellness

guide• Head Lice – A Lousy Problem booklet• Parents Provide, Kids Decide video• Teen Maze activity kit

Medical Services SectionMedical Services SectionMedical Services SectionMedical Services SectionMedical Services SectionNewsletters• Disease Update• Epi Report• Influenza Weekly Surveillance Report• MicroReport• Pump Handle

Reports• Epidemiology Semi-Annual Update• HIV/AIDS in North Dakota, Mid-Year

Update• 2001 Epidemiological Report on

Tuberculosis

Other• Division of Microbiology Directory of Services

Health Resources SectionHealth Resources SectionHealth Resources SectionHealth Resources SectionHealth Resources SectionNewsletters• CLIA Bits• Dialysis Dialogue• Home Health Update• Long Term Care Highlights

Copies of the following publications can be accessed on the North Dakota Department of Healthwebsite at www.health.state.nd.us or by calling 701.328.2372.

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Environmental Health SectionEnvironmental Health SectionEnvironmental Health SectionEnvironmental Health SectionEnvironmental Health SectionNewsletters• Indoor Air Quality Monitor• Quality Water• Radioactive Newsletter

Reports• Air Quality Monitoring Data Summary 2001• Air Quality Monitoring Data Summary 2002• Cedar Creek: A Water Quality Assessment• Chemical, Physical and Biological Charac-

terization of Devils Lake 1995-2002• Chemical, Physical and Biological Charac-

terization of Lake Sakakawea 1992-2000• North Dakota 2002 Section 303(d) List of

Waters Needing Total Maximum Daily Loads• 2002 305(b)• Water Quality Assessment with Pollution

Reduction Targets for Maple River• Water Quality Assessment with Pollution

Reduction Targets for Nine TownshipsAssessment Project

Other• A Guide to Safe Eating of Fish Caught in

North Dakota fish consumption advisory• “Our Water – Keeping It Clean” monthly article

in the North Dakota Water magazine

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Notes

To learn more aboutthe North DakotaDepartment of Health,visit our website atwww.health.state.nd.us.