November 26, 1974

Mr. Phin Horton

City Manager

#1 High Street

Portsmouth, Virginia 23704

Dear Mr. Horton:

Enclosed is my report for the fiscal year 1973-74.

The achievements are relatively small while continuing deficiencies, although slightly less than previous years, will respond only to more staff to provide services to the approximately 75% of eligible persons not now receiving preventive health services.

The goal of the Health Department activities is to plan for and provide those services necessary to improve the health of the citizens in the community, based on realistic objectives. The objectives of the Health Department have been stated each year and will again be stated here. Progress, however, cannot be maintained when the State does not provide necessary staff to the local Health Department to provide services necessary to improve the health of all individuals in the community.

Progress made during the year was in the area of addictive services and administration.

in the administrative area we were successful, for the first time, in hiring a qualified Director of Nursing Services to fill an open position. We hired Mrs. Martha J Allen who has a Baccalaureate in Nursing Science and a Master’s Degree in Public Health Nursing Administration, plus considerable experience as a consultant nurse to the State of North Carolina. During this fiscal year Mrs. Allen set up program oriented commit tees of the nursing staff to determine what changes were needed, if any, to deliver services more appropriately and what the service deficiencies were. The goals developed for the nursing and preventive care services are stated within the body of the report by Mrs. Allen.

We also developed the need for an addition to the Public Health Center with the objective of obtaining resident physicians in Family Practice, to be assigned to the Portsmouth hospitals and Health Department for training. We hope that some of these resident physicians will settle in Portsmouth and reduce our need for primary health care practitioners. The addition to the Clinic, sponsored by the Beazley Foundation and matched with Hill-Burton hospital funds by H.E.W., will be to provide a family practice ambulatory care setting to complement hospital training of the residents. Considerable cooperation and planning is taking place with the Eastern Virginia Medical School and the Portsmouth Health Department by the Chairman of Family Practice, Doctor Cassidy and the local Health Director, who is acting Chairman of the Department of Community Medicine and Preventive Health Services.

Mr. Gene Larkin, Coordinator of Alcohol Services has completed his first year with the Health Department. He planned renovation of the Flynn Christian Home for Alcoholics with the aid of a grant from the State Bureau of Alcohol Services. He has been working closely with the Flynn Home to develop programs that will make it a model for a halfway house in transitional treatment for alcoholism. He has also been developing close working relationships with community groups interested in alcohol service and defining the needs for further services. He has prepared a plan for a feasibility study for community-wide services for alcoholism, which has been forwarded, to the National Institute of Alcohol Abuse and Addiction. In addition, he has been working closely with the City Grant’s Coordinator, Criminal Justice Planner and the courts to develop an Alcohol Safety Action Program. The study to develop this program was funded and a Program Administrator, Mr. Vincent Burgess (Currently-AD2000- director of safety for DMV ), was hired to develop the program justification for Portsmouth and Suffolk and hopefully to head up the operation of the program once the planning is completed.

A Methadone Program planned in cooperation with the Mental Health and Retardation Services Board and the Criminal Justice Planner was implemented during the year. Mr. Woodrow Manley, a retired Medical Ser vice Corps officer, with a Master’s Degree in Business Administration and many years of experience in the planning and delivery of medical services was hired to operate the program. A separate report is included noting the purposes and accomplishments of the program to date.

A Sickle Cell Program was started within the Nursing Division. A sickle cell coordinator (Counselor) was hired. A report of this program is included.

The final report to the Federal Government (HCFA-Medicaid) on the ‘Case Aide Program’ was delivered during the year showing that indigenous persons in low income areas could be trained to provide certain health, educational and motivational services, provide certain skills to the programs and relieve nursing staff to deliver more advanced services. The use of these personnel actually reduced the amount of health services needed to improve health and provided them at a 30% reduction in cost. In spite of proof of the effectiveness the State Health Department was unable to fund the program and it was transferred to the Department of Social Services with technical supervision from the Director of Nurses to provide certain health related services for Social Service clientele.

A grant application for Family Planning Services was prepared during the year and approved to be partially funded during the 1974-75 fiscal year.

A grant from the State Health Department was provided to prepare a model health information system. (we still don’t have one 25 years later!!) It is hoped that this can be integrated with developing information systems in the Departments of Social Services and other human service agencies to allow better control of services to each individual so they do not drop in cracks between agencies and will be able to obtain services with less confusion and duplication (this is only partly successful in Arlington, Virginia in 2000AD). This will not only provide better information on the level of services provided to individuals, but better define the quality of these services and measure the actual outcome. It should prevent much of the present revolving door syndrome affecting many persons trying to obtain human services from various agencies. The first objective is to ensure provision of data on ambulatory services within the sickness care system, secondly to measure impact of these services in reducing morbidity and mortality; also to ensure that all third party sources of payment are billed to maximize revenue and allow necessary expansion of services at minimal cost to the community.

It is expected that the information system will be tied into the State and Federal Cooperative Health Information Systems with which this department has been working closely. This tie with additional data systems on bed utilization and manpower studies will provide better information for health services planning and placing appropriate emphasis on recumbent care as opposed to ambulatory care. The Director of Health, through the National League of Cities and U. S. Conference of City Health Officers, has been working closely with National Health Planning legislation and provided input to the House Subcommittee on Health and the Environment. It appears that some form of National Health prepayment system will be introduced within the next eighteen months. This should not be confused with the formation of a National Health Delivery System. It will affect only the sickness care system of providing episodic care to sick persons. There is either none, or only minimal emphasis of preventive and health maintenance services. When comparing the proposed programs with the Medicaid and Medicare pro grams it can be expected that the payment programs as presently suggested will increase the cost of delivery of services for sickness, reduce the availability of services and not, for the immediate future, have any impact on health maintenance and sickness prevention.

The foregoing, except for the addictive services, shows that our emphasis on improvement during the past year has been on administration and planning.

In the area of service delivery of preventive health services, which has the immediate impact on citizens, we have made little or no advance. Data included in the body of the report shows that health indicators such as infant death and birth rates have declined overall. There has been little change in the data for the low-income persons at greatest risk, whose illness causes most morbidity and greatest cost and suffering to the individual, family and community.

Other indicators, such as communicable disease morbidity, death rates, population increases (excess of births over deaths) and illegitimacy shows that for low income persons we have had little impact. We have been unable to increase services during this year due to lack of increase in personnel. We find that we are only serving a quarter of the females eligible for Family Planning services, half the women eligible for Maternal Health services and a fifth of the children eligible for screening services. Lack of these services results in increased morbidity and permanent disability, both physical and mental for the women and children deprived of these services, resulting in greater cost to the individuals, deprivation to the family affected and cost to the community for persons who will not be economically productive in their adult years. These individuals will have to come to the ambulatory care programs of the Health Department, the private physicians and the hospital emergency rooms with advanced diseases such as nutritional anemias affecting mental function, hypertension, diabetes, reduced kidney function, stroke and heart disease.

The Case Aide Program demonstrated conclusively, as have other similar studies around the country, that preventive health services save many times the dollar value of the cost of provision of these services. It is essential that in planning for services at the State level that funds be provided for programs of proven worth before funding additional experimental programs.

The cost benefit of projected programs over a lifetime should be determined rather than the cost of episodic delivery of care. During this last year the State Health Department provided through Medicaid over S5,000,000 of care for acute illness but not funds for continued pro grams such as the Case Aide programs to monitor and control service delivery.

There have to be changes in the methods of funding, and removal of duplication and inappropriate control requirements for program delivery, or new programs will never get off the ground.

There needs to be a better evaluation of health education programs in the school system. It needs to relate to the type of health problems and the outcome of the educational programs related to producing a change in the problem.

Sincerely,

C.M. G. Buttery, M.D.

Director of Public Health