Case Study 4

Municipal Health Department Leadership Inside Out

Ted Kross

Experience, education, and training in one's personal life as well as professional career can bridge many gaps in one's quest through a life span. I entered into my nursing life in 1979 at the age of eighteen when I began school at Pittston School of Nursing in Pittston, Pennsylvania. The three-year diploma program had an emphasis on hands-on training in a hospital or other clinical environment enriched with classroom education. My grandmother and parents persuaded me in this direction due to my inherent ability to communicate with and help people. I was told, “No one could ever take your education away from you.” Uncertain if I would succeed, I forged through many uncomfortable and difficult times as a nurse and a human being. I can remember my initial encounters with patients when I had no prior professional training or experience. The first person I cared for could not speak as a result of a stroke. I can picture him almost perfectly today, thirty-two years later, and can visualize his appreciation when I had to help him with breakfast because his dominate side was paralyzed. I fed him scrambled eggs, and was amazed how much he swallowed—at least, so I thought. I had not been told that his swallowing reflex was also affected; he began to choke, but fortunately he expelled the eggs all over his beside table and food tray before any further complication. Training, education, and experience might have led me to a different approach to feeding him that morning.

I have worked in the private sector of health care in a hospital setting for most of my career to date as an emergency department registered nurse. I gained insurmountable personal satisfaction by challenging myself daily with critically ill persons. I took the next step and worked as a prehospital nurse and flight nurse to satisfy my ambition to help people and save lives. I returned to school and attended King's College in Wilkes-Barre, Pennsylvania, to attain both an undergraduate and graduate degree in health care administration. I wanted to teach people how to not only care for individuals but also take health care in a direction of both professional and ethical excellence. I managed in emergency nursing for nearly fourteen years in Pennsylvania and nearby Maryland. Change is critical to success in family life and one's career; therefore, I sought a new direction in health care!

Approximately two years ago I entered into a much different health care environment, public health (or community health). Personal satisfaction remains high on my radar, along with the pursuit of helping people. Community health deals with different challenges to a much larger and more diverse population with unique diseases ranging from influenza to tuberculosis. Managing a municipal health department is exciting and has offered me opportunities in the form of new challenges, experience, and education. As director of this health department I am responsible for the health care of Wilkes-Barre residents, in addition to my financial responsibilities of grant writing and balancing a budget. Pennsylvania has three other municipal health departments (York, Allentown, and Bethlehem) along with six county departments. Philadelphia's local health department is responsible for many lives and acts almost independently of the entire state.

The city of Wilkes-Barre has a population of more than forty-one thousand individuals in a geographic area of approximately nine square miles. The Wilkes-Barre City Health Department comprises several different divisions and types of personnel. The health department is located in the Kirby Health Center near the city's center. The Kirby family built this facility in the early 1930s and currently operates the health center, which houses various public entities to meet the needs of Wilkes-Barre residents and the surrounding communities. A board of health directs our activities and is made up of several local physicians, a school nurse, community members, and a medical director. The health department comprises four nurses—an associate director of nursing, two community health nurses (a registered nurse and a licensed practical nurse), and a director chosen and supported by not only the city of Wilkes-Barre but also the state health department's leadership. Two health educators promote several programs under three separate state and federal grants: Maternal and Child Health, Injury Prevention, and chronic disease funding (osteoporosis, diabetes, and heart and lung diseases). An animal enforcement officer is part of the department, which controls many aspects of animal surveillance in the city including licensing animals, monitoring animal bites (rabies prevention), and ensuring animal control and behavior as outlined by the ordinances set forth through its local government (Mayor Thomas Leighton and an elected city council). Three health inspectors are responsible for inspecting and licensing over three hundred restaurants and caterers on both an annual basis and throughout the year. The health inspectors and department ensure all aspects of any health-related issue in the geographic confines of the city of Wilkes-Barre. A public health preparedness coordinator actively ensures readiness of the city of Wilkes-Barre to react to any natural or bioterrorist public health threat. Many of the city's employees and community volunteers are educated and trained to prepare and practice for these events. Federal and state funding allows for this training and ability to practice planning and procedures in preparation for a bioterrorism event. The events of September 11, 2001, prompted department members to devise a plan to better prepare for and react to acts of terrorism through improved communication. Although the events surrounding this tragedy in New York that affected the world were courageously conquered by many employed and volunteer emergency medical services (EMS), police, fire department, and health care workers, a few fundamental issues were uncovered. Number one was the need for a common communication network to allow all personnel involved to communicate with each other and with leaders. Police, fire, EMS, and command personnel were on different radio frequencies and communication devices, and the health and welfare of many of these heroes were in jeopardy. The state and federal government subsequently introduced an 800 MHz radio tool that all personnel can use for emergency communications. E-mail messages and emergency personnel radio discussions can take place with field and hospital personnel. The country has pushed all kinds of emergency response personnel to train, educate, and exercise many community groups to prepare for continued threats to our homeland security.

Most recently, in spring 2009 the world was confronted with an apparent epidemic of a new strain of influenza virus termed novel influenza A (H1N1). With H1N1 positioned to be one of the biggest threats and challenges in today's world, our country began vigorously preparing to battle this respiratory disease and engage four pharmaceutical companies worldwide to begin careful research in and development of a vaccine. Concurrently, the Wilkes-Barre City Health Department began to plan for vaccine distribution to large numbers of individuals through Points of Distribution (POD) and patient care delivery disaster plans. Weekly planning meetings with leadership of the various departments (EMS, police, fire, health, and administration) in the city of Wilkes-Barre began in late spring 2009 and continued throughout the summer.

The health department was challenged in October 2009 by being one of the region's first public health entities to receive the H1N1 vaccine and distribute it to residents and nearby communities for high-risk individuals (children six months to twenty-four years, pregnant women, persons twenty-five to sixty-four with certain chronic health conditions, health care workers, and caregivers of children under six months). The philosophy of this health department, expressed through its leaders and nursing personnel, was to receive and distribute this scarce vaccine in the early availability era to the residents of Wilkes-Barre. We scheduled several clinics in cooperation with the Kirby Health Center leadership at our building on North Franklin Street. Three nurses and various health department and city personnel organized one of the country's first vaccine distribution efforts from 1:00 A.M. to 6:00 P.M. We were immediately challenged with many issues ranging from nonresidents seeking the vaccine to people outside the risk groups identified nationally pursuing our services. Great communication and organization allowed the handful of personnel to distribute over six hundred doses of the vaccine in mid-October. The media had been anticipating these events and promoted the vaccine and distribution over the next several weeks. Shortages of the vaccine quickly became an issue, and cooperation from nearby Allentown to share five hundred additional doses of the vaccine with Wilkes-Barre allowed continued distribution. In early January 2010 the state health department partnered with the Wilkes-Barre City Health Department to implement a state-organized mass immunization clinic at the Kingston Armory just outside of Wilkes-Barre. Thousands of nasal and injectable vaccine doses were distributed to all citizens from the region through a well-organized pre-event registration and this mass immunization clinic.

Cooperation, knowledge, leadership, training, and education led our health department to a very successful program that saved many lives and decreased morbidity caused by this new strain of influenza. The personnel involved were left with a huge sense of accomplishment both personal and professional, having contributed to a humanitarian effort not experienced in community health in the recent past.

Leadership has been my passion for the last fifteen years and has led to my personal satisfaction as a public service provider and humanitarian. Experience in the many facets of my professional career has been crucial to the achievement of my goals.

Discussion Questions