AFA Leech Lake Health Report to the People

2013 Health Planning Report to the People

This year has been another progressive year of managing 58 programs within the Leech Lake Health Division. Enhancements to the clinics have included the addition of a part time chiropractor who also provides acupuncture services, full staffing of nurses within the 6 clinics, equipping each clinic with new defib’s, and the revision of Mass Vaccination Plans for emergency preparedness. We have held training sessions for all HD clinic and clinic support staff for the mandatory utilization of the Electronic Health Records charting for all patients cared for within our clinic systems, and for the integration of an electronic referral system between the I.H.S. Cass Lake Hospital and the LLBO Health Division to ensure quality patient care. The Minnesota Market Place ( MNSURE) conversion was a priority for our department this year which resulted in the specialized training of staff, finalizing of Memorandum of Agreements with the State of Minnesota, and reservation wide education regarding MNSURE for all constituents. The Health Division played a critical role in the finalization of the State ARMER conversion and successful implementation for the Leech Lake Band. The training and preparation for the implementation of the MNCHOICE assessment system was another priority for our Division in efforts to ensure that we are prepared to conduct assessments on all patients referred to our Department for health care needs. In addition, our program expanded our waiver programs to include facilitating case management and care coordination for constituents living on the reservation who are diagnosed with Developmental Delays. We are proud to report we have successfully implemented all phases of the MN Heath Care Access Plan contract which ensures constituents who are receiving MA and MNCARE have the ability to attend medical appointments and meet the medical transportations needs for themselves and their families. Finally, we have enhanced our staff development priorities to include annual training practices that include vulnerable reporting education, patient confidentiality training and policy and procedure updates in efforts to keep all Health Division staff educated in the most recent laws and policies designed to enhance patient outcomes.

Ambulance

The ambulance service had a call volume of 1,227 requests for Emergency Medical Services with a total of 1,257 patient contacts for the year.

Dr. Antonio Guimaraes is the Medical Director for Leech Lake EMS

The Leech Lake EMS Training Center (an extension of the ambulance program) held 2 EMR (First Responder) classes which were 44 hours of class time. 2 EMR Recert (12 Hrs) All Instructors completed AHA and DOT Instructor updates. We also held 2 basic EMT (160 hr) classes, and 1 EMT Recert (24 hr) Class.

The Leech Lake EMS Training Center and Leech Lake Gaming signed a Memorandum of Understanding. We will be instructing all three LLBO Casino’s AHA-CPR, EMR, EMT and Monthly In-services under Protocols and Medical Direction.

Many requests for classes in CPR and First Aid came in over the year. Training was held for Bug ONay Ge Shig School, I.H.S. Hospital Staff, LL Human Resources, L.L. Health Staff and the University Of Minnesota Duluth (NAIM) just to name a few. Our AHA instructors taught 48 classes this past year, 423 in Heartsaver & 106 in Healthcare Provider CPR, for a total of 529 constituents certified.

We applied to the National AHA (American Heart Association) to become our own CPR CTC with Tribal Council Resolution. We we’re notified that we have the most CPR Trained people per capita for the entire State of MN.

The EMS staff held monthly in-service sessions/training. A Hazardous Material Class was presented by the EPA, Lifeflight Safety by North Air Care and Sanford Lifeflight. We had our Annual Ice Rescue Exercise, All Hazard Medical Unit Leader & Communication Unit Leader assignment, Tabletop & Live Emergency Drills, Interagency COMMEX Exercise, Interop Conference and many ARMER Meetings, and Fit Testing. Several staff attended various workshops, conferences and classes throughout the year.

This past year we completed the LLBO Full Participation Plan by All our Public Safety ( LLBO PD, LLBO CO’s & LLBO EMS) going to the ARMER Radio System. Also, incorporated all LLBO Programs that use two-way radio systems (800, UHF & VHF NB) to be tied into LL PD Dispatch. We are the Only Band/Reservation in MN to accomplish this.

LLBO TERC-Tribal Council Resolution to enter into agreement with MN DOT for the construction of an ARMER Radio Tower on Tribal Land. This is also a First in MN.

One Staff person has completed his COMT ( Communication Technician) Task Book, LLBO has 2 Qualified persons now. He also completed his COML (Communication Leader) Task Book. He’s also designated System Administrator for the LLBO Interop Working Group.

The program staff provided medical coverage to many community events over the year including; Pow-Wows for Leech Lake, CLB School, LL Tribal College, Onigum, Ball Club, Inger, S.Lake, Boys & Girls Club, Battle Point and Headstart, school sporting events, Local LIC’s, Ribfest, Elders Expo, Spirit Run and Sobriety Run, Head Start activities, Triathlon, Bike the Bay and many other events that request EMS coverage.

Carseat Program

The Leech Lake Car Seat Program operated several grants that provided car seats to children 0-8 years of age, who were enrolled Leech Lake Band member or the caregiver was enrolled at no cost. This report will reflect all activities of these grants that include Ride Safe, BIA Highway Safety Grant, Injury Prevention, and Car Seat Program.

There were approximately 337 families that received hands on installation instruction, education of use and misuse, educational materials and there were approximately 500 child restraints issued over the reporting year. The coordinator attended and participated in the Health Division REACH sessions in outlying communities with a booth that provided educational materials to community members. The coordinator also collaborated with tribal police and EMS on seat belt use issues. Other on-going successful collaboration includes the NEST and WIC Programs where many families are served. Objectives completed this year include training and presentations to tribal owned daycares, Foster Care Program and MFIP clients on a quarterly basis or as requested.

We continue to collaborate with the Leech Lake Head Start Program and staff to get car seats to this group of children. We continued collaboration with Leech Lake Tribal Police and EMS to gather data on car seat use and failure to use child restraints. A new collaboration and working MOU is with the Leech Lake Tribal Court on Child Restraints. When a ticket is issued for failure to use child restrains/seat belts the offender will have the opportunity to attend a Car Seat Class and receive education, instruction, and a car seat. By completing the class the courts will waive the fines.
Programmatic duties are on-going, continued updating and revising policies, reviewing memorandums of understanding, and reviewing program goals and objectives and strategic plans have been accomplished as necessary or needed.

Community surveys have been conducted that showed children 5-8 years of age were less likely to be belted, approximately 65% of children in the survey conducted in the Cass Lake area were not restrained properly. This is an improvement over the past year that showed 85% non-use. The strategic plan for the car seat program has been revised to reflect this area of concern.

Indian Health Service Maintenance and Improvement Program

The purpose of M&I funding is targeted for maintenance of tribal clinics:

Ball Club Clinic: In FY 2012 a new remodeled area was improved with flooring, electrical, heating and ventilation, and internet and phone service for the all health division programs. Chiefly, Women infants and children; public health nursing, leech lake diabetes center, patient benefits, occupational therapy, chiropractic and general patient oriented clinics ranging from prenatal through adult populations.

At the Cass Lake administration offices and public health office spaces and lab/clinic received /performed: Remove and tear out old roofing metal cornices and roofing sheets; inspect current condition of the roof drain areas that cause ice dams to occur during cold months, performed internal ceiling condition for evidence of water intrusion and water damage. Community sanitarian conducted a walk through inspection and compiled photos. Roof repairs were made by community services. Labor only. Cost of products for rubberized roof tack, silicone, plywood sheeting, and other as necessary items were purchased by the M&I. condition are still yet fully repaired. Facilities condition remains below standards as reported FY 2001. Leech lake ambulance service had one item: Overhead door repair; vehicular damage causation.

Routine items such as replacement door closers, entry door locksets, Trowels for adhesive flooring, vinyl flooring, security access doors and security vendor repairs to system cameras at health division 2 office spaces; women infants and children program/clinic window replacement materials only; plumbing items from area home renovations retail stores; Cabinets for new clinic spaces at ball club clinic; health division 2 new signage for advertising services in the Cass Lake area. Ignition switches for program truck 2605; keys made at local hardware store; electrical parts for renovation at Ball Club Clinic; Leech lake community services for service call: heating issue; are typical annual expenditures.

The NEST: new vinyl flooring for the WIC office; New room dividers; window replacement; numerous heating and ventilation issues continuous. NEST clinic: new install of ventilator exhaust fan to ensure adequate airflow circulation for the medical refrigerator to protect vaccination supply.
FY 13 expenses are expected to become higher in cost due to continuing aging of HD1, and NEST clinic areas due to deficient building conditions.

Addendum:

Health Division administration/clinical and NEST location buildings are in need of repair by replacement.

Indian Health Service Clinical Equipment Program

The majority of unscheduled biomedical preventative maintenance work orders are primarily incoming inspections of new equipment purchased by Leech Lake Ambulance Service and Clinical Engineering/Biomedical programs during this fiscal year.

Scheduled preventative maintenance work orders typically consist of work items that require periodic service and repair. Total number of active and current medical devices: 340.
Protocols created:

-Comprehensive master medical device inventory list. Still underway with estimated time of completion 29SEPT14. Clinical Engineering is utilizing the Medi-Mizer biomedical equipment management system as of September 2013. Conversion from paper to electronic and posted on local network server planned 2014. All new medical equipment purchases must be approved by clinical engineering.

Projects completed: Conversion of abandoned bathroom spaces at the Ball Club community center into clinical areas for W.I.C., PHN, Occupational Therapy, Patient Benefits, Leech lake Diabetes Center, Dietitian, Social worker, and serves as extra clinic space for patient overflow.> New Zoll automated external defibrillators for six tribal clinics. This is an equipment upgrade from LP 500 to the Zoll units. New Burdick Electrocardiograms installed at all tribal clinics effective September 2013.> Improved biomedical program by becoming full time effective June 20, 2013.>
New medical information server on line and in place located at the LLBO M.I.S. department.
Program Expansion: obtained and purchased audiometers, weight scales, tympanograms, eye charts, and accessories for the Child and Teen Checkup program. This program is now operating with full functioning equipment to improve State of Minnesota requirements for program compliance and to meet billing requirements for tribal reimbursement.
Leech Lake Ambulance provided Automated external defibrillation to health staff during monthly nursing and provider (clinicians) meeting. New station defibrillators placed at EMS July 2013.
The I.H.S. clinical equipment program specifies medical equipment purchase and maintenance purposes only.

The I.H.S. clinical equipment program funding is derived from the Indian Health Service allowable space formula. For the near future, a fitness center will become active during the 2014 fiscal year. Allowable changes to increase supportable space to the Indian Health Service will be calculated and forwarded to the I.H.S. for consideration.

Clinics AFA Funding Annual Report 2515

AFA funding helps to fund our community health nursing/public health nursing program. Licensed Registered or practical nurses and certified public health nurses provide in- home skilled nursing care, clinic support, community based intervention, health education, disease prevention, maternal and child health, and womens health education to eligible individuals who live on or near the Leech Lake Reservation.

We are currently trying to get staff trained in EHR and to use the tabs for referrals and to track services performed in the home. Trainings will start in December of 2013. The community health nurses are currently seeing approximately 200 visits a week.
There has been a transition of supervisory nursing staff within the tribal health clinics. The current staff are trying to get programs back on track and within funding guidelines. This has been taking some time, but things are improving every day, staff are happier and have more direction, everything is moving forward in a positive progression.

Clinics AFA Funding Annual Report 2501

The AFA Funding helps fund our clinics. We have Clinics in outlying communities which include Bemidji, Inger, Bena, Ball Club, Onigum and the Nest in Cass Lake. These clinics provide a wide range of acute and primary health services with a strong emphasis on health education. Services are provided by a board certified Medical physician, nurse practitioners, nurses and support staff.
We are currently working to make sure every staff member is using EHR with some trainings coming up in December for staff on registration and tabs in EHR. The clinics are seeing on average 750/month patients in these outlying clinics. Tribal staff are currently working with IHS staff to develop a protocol for ordering supplies from IHS to be implemented in December. Staff will get training on this in December of 2013. Tribal staff are also working on general protocols to be implemented into the clinics so all clinics are doing things the same way.
There has been a transition of supervisory nursing staff within the tribal health clinics. The current staff are trying to get programs back on track and within funding guidelines. This has been taking some time, but things are improving every day, staff are happier and have more direction, everything is moving forward in a positive progression.

Nutrition Program

The Nutrition Program goal is to provide expert nutrition education and consultation to the people of Leech Lake Reservation, to work on programs to help improve the obesity problem, to supervise the nutrition supplement program and to manage and conduct day to day administrative duties, including budgets and all reports.

Medical Nutrition Therapy patient contacts: 330 patients. Community Nutrition Education contacts: 7,573 by the Tribal Dietitian.

Types of services offered by the nutrition program this year:

Medical Nutrition Therapy referrals are from the health providers, WIC, Head Start programs, HIS providers and all outlying Tribal Health Clinics.

Weight loss programming due to the high obesity rate of our population. Weight taker for the Leech Lake housing. Each challenge was 10 weeks long. 4 challenges over the report year. Gaming TOPS open house. I Began working on a Community Biggest Loser challenge to take place Oct 31, 2013 – Jan 10 2014. Was able to attend the 2013 Weight Management PDG Symposium to keep up what is available to fight Obesity.

We had the Third Annual Nutrition Expo. This year everyone received a gift when their card with each booth was covered with a sticker. There seemed more interaction and learning this way. There were breakout sessions also.

Attended Indigenous Food Coalition meetings and webinar. Helped fund the Maple Syrup Camp.
Over the past year presented nutritional information to the following groups: Alternative Learning Center Women’s Half Way House, Quarterly at Foster Care Training, ENP.

Meet monthly with the Food Distribution on nutrition information.

Had a booth at the Diabetes Expo.

Participated in the CSBG/MN Community Action meeting, SHIP/CSBG meeting, Head Start Health Advisory meeting, MAC & NAP , Human Resource Wellness Meeting, MATTS, ENP, Title VI
Analyzed Head Start menus – annually and ENP menus seasonally.

Attended the Practical Advice and Tips for implementing the New USDA to schools for SHIPS.

Worked for the Memorial Walk/Run

Worked with NDSU to be a site where Registered Dietitians can complete their 8 week intern ship here. There could be 2 interns each working different 8 weeks in the Winter/Spring semester if they choose Leech Lake.

Helped out in WIC as a CPA till new CPA was hired in July. Worked more hours in WIC when the WIC director was out for 6 weeks on medical leave. Receive all nutritional WIC referrals, meet with them or send them information if not available.

Filling in as the ENP Director since July 15, 2013 . Working on the protocol for the ENP so it runs smoother.

Received my PNI so I can receive reimbursement from my MNT charting. The money received is used to have adequate funding for the unintentional weight loss program. There is an average of 15 participants per month receiving supplements.

Assist SHIP with nutritional information and phone consults.

Chemical Dependacy

Ball Club Relapse Prevention- Serviced Clients on a weekly basis which included facilitating Groups and conducted Individual Therapy Sessions. Service Coordination is provided as determined by Treatment Planning decision from appropriate Rating of Severity Risks according to Dimension(s) that qualifies the Individual. Services ranged from Outreach and support, Medical and Behavioral Health connections to resources and help to obtain Drivers Licenses including Probation Officer visits when needed and seek employment, housing, and education of Drugs and Alcohol including Traditional Teachings to utilize as prevention and coping skills.

Cass Lake Recovery Maintenance- Virtually the same as above.
But the groups had Guest Speakers to attend and volunteer their time to share their knowledge about Cultural Teachings and/or personal recovery stories; (Elders, Community Leaders, members of the community, Educators, Spiritual Advisors/Leaders including Alumni). They also attended and participated at Cultural functions and activities including Ceremonial events outside the Reservation and locally; ie., Harvesting Medicines, Talking Circles, Sweat Lodges, Drumming and PowWows. This is to include Sobriety Feast Events which occurs up to twice a month. One of the Feast events the group attends a Sobriety Feast in Ball Club once a month. They participate in other Community functions as well.

A few individuals had been participating with Leech Lake/ Cass Co. Wellness Court.
Both groups provide Cultural sensitive related activities with Education.

Fitness Center

The Leech Lake Diabetes Fitness Center’s mission statement is “To provide a quality and creative approach to individual and community based exercise programming to ultimately control and prevent diabetes.” The Fitness Center continues to strive to give as many options as possible to attain this goal.

We are very excited to report that with the help of the Diabetes clinic, there has been funding provided for the purpose of expanding the Fitness Center. When all is said and done we will double our size. The new area will contain another office for an occupational therapist, a diabetes education room, a weight lifting area and a studio for different types of fitness classes. The older section will contain all of the cardio equipment for our cardio area. Along with more room for clients, we will also look to add some more cardio and weight lifting equipment.

The Fitness Center continues to offer many group classes for all to attend. We offer a class everyday at 11:30 at the Facility Center. On Monday it is Boot Camp, Tuesday is circuit training, Wednesday is core strengthening, Thursday is circuit training and Fridays is another core strengthening class that is a circuit style class. Lisa Hemachandra started teaching a yoga class at the Ball Club Fitness Center after work on Monday nights. The Fitness Center is also helping out with the community wide Biggest Loser challenge, in which there are 264 people who signed up for the challenge.

The 20th Annual Walk/Run was well attended once again, with over 900 participants. We also continue to be an active participant in the Transform Rez program, offering our help to the Diabetes Clinic whenever possible. We once again helped out with Diabetes Family camp this summer, and it was a blast! We replaced an older elliptical machine with an adaptive motion trainer, and we added another upper arm bike machine.

The total number of participants for the fitness this year was 10,834. The numbers break down as follows: CVD-11, Diabetes- 1526, General -7750, Hypertension- 1279, Fitness Classes- 77, Personal Training- 80, Pay Per Visit- 55.

Medical Transportation Program CHR

We are currently running twelve regular CHR’s and utilizing six volunteer drivers through our medical reimbursement programs. There are many options for people to be transported to their appointments and for the people who transport them to be reimbursed.

Our Bus ticket program has not been used as much as we had hoped although it does work. We still have the other programs such as the Tribal Assistance partnership, Foster care; we have been able to add a reimbursement program for opiate, A&D/Outpatient, as well as Behavioral Health.
The CHR’s have had an increase in the Dialysis patients we transport. Not only do we run them Mondays Wednesdays and Fridays now it is every day. Including Saturdays but we use our volunteers for the weekend transports. There are 14 Dialysis clients currently.

On average we transport well over 200 clients each month. Our volunteers can transport as many as 40 clients, some of which also transports for the county. Our volunteers usually accept the trips that are 60 miles plus because that’s what pays. We will be looking in the communities for local drivers as well, we do have one volunteer to do the sugar point community but they are also interested in the long distant runs.

We are in the process of running another advertisement through the KOJB station in the next month. We may be advertising a CHR position as we will most likely lose one to another position.

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