# **TO: Area Dental Officers, Headquarters Dental Staff** 

# **FROM: Deputy Director, Division of Oral Health**

**SUBJECT: Dental Conference Call Minutes, 11 Sept. 2007**

**DATE: 14 September, 2007**

# **[Budget Update (Dr. Halliday)]{.underline}**

FY2007: The budget is being closed out. If any funding is identified at
the last minute, it will most likely be obligated into the EDR.

FY2008: No news to report on the National DOH budget. HQ DOH submitted
an acquisition plan a few weeks ago and it is anticipated that we will
need to also submit a prioritized list of projects/obligations in the
near future.

FY2009: IHS HQ DOH have now received several calls for revisions to the
FY2009 budget narrative -- this is a normal occurrence each FY. A
passback was received at HQ on July 26^th^. The lastest information
still shows that IHS DOH has a budget request of \$144,139,000, a 6.18%
increase over the FY08 President's Budget of \$135,755,000. Remember
that these are not final budget figures for FY08 or FY09. The
Secretary's Request for FY09 would provide for increases for pay costs,
population growth, inflation and staffing (PIMC SW Clinic and Lawton
Indian Hospital).

# **[NOHC (Dr. Blahut) (This is not the National Oral Health Council)]{.underline}**

# The next annual National Oral Health Conference is the week of 28 April, 2008, in Miami Florida. This is the premiere dental public health meeting in the world, combining sessions of the Association of State and Territorial Dental Directors (ASTDD) and the American Association of Public Health Dentistry (AAPHD). Your attendance at this meeting is especially appropriate now, as interest in dental manpower issues is very high.

We will submit to the planning committee a proposed session addressing
dental manpower and the composition of the dental workforce in the
future, with perspectives from IHS, ADA, and ADEA. If we can get this
session on an already crowded agenda, a show of support through
attending the meeting would be appreciated.

# 

# 

# **[GPRA Update (Dr. Blahut)]{.underline}**

Final performance data for the 06/07 GPRA year that ended 30 June 07:

-   Access to services: target = 24% 07 performance = 25% MET

-   Sealants: target 246,645 07 performance = 245,449 NOT MET

-   Patients receiving topical F: target 95,439 07 performance = 107,934
    MET

OMB's SOP has been to "raise the bar" when performance exceeds annual
objectives, and leave the objective at the higher, unattained level when
performance falls short of annual objectives.

Strategies for setting annual goals for this year (07/08) were
discussed.

08/09 annual goals were originally postulated that include 6% decreases
in all services relative to the fy08 goals. These draft goals were
accepted by the IHS steering committee. However, subsequent to this
draft the 09 budget was increased by approximately 6%. The 09 goals now
postulate maintenance of current levels of services.

"Hints" for GPRA success identified at the June 07 ADO meeting by ADOs
in Areas currently meeting all dental objectives include:

-   Promote GPRA by promoting prevention.

-   Appoint and support an effective prevention coordinator at every
    clinic.

-   Individual clinics should "do what it takes" to see patients, do
    sealants, and provide topical fluoride applications. Some sites
    might have school-based programs, while others might bus children to
    the clinic.

-   The common characteristic of successful local programs: they seek
    out patients. They do not wait for patients to come to their clinic.
    Patients come to our clinics primarily for treatment, not preventive
    services. In order to provide large numbers of preventive services,
    we must go to the patients.

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-   Encourage youngsters to come to your clinic for preventive
    treatment.

-   Utilize birthday cards, WIC collaboration, Head Start programs, and
    other active promotional strategies to get young patients to come to
    you.

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-   GPRA should be a significant part of all support center trainings.

-   Promote GPRA at every opportunity. Be a cheerleader for prevention.

-   Increase the number of dental hygienists. Where there are
    hygienists, there are prevention programs.

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-   Utilize program reviews to promote preventive services.

-   You cannot overestimate the value of face-to-face encounters with
    the dental personnel of local programs. This is the "grass roots"
    promotion of prevention and GPRA.

**[Recruiting Update (Dr. Lozon)]{.underline}**

-   Dr. Lozon sent an e-mail to all 2007 preceptors and to others that
    have participated in past years to request their participation in
    the 2008 externship program.

-   The Commissioned Officers that participated in the 2006 Externship
    Program as a preceptor or an ADO that supported the program were
    recently awarded an OUC. Dr. Lozon will edit the narrative for that
    OUC for the 2007 participants and Dr. Schaeffer will assist again
    with gathering information from this years nominees and Dr. Lozon
    will submit it to the HQ awards committee for consideration for this
    program with national impact on recruitment/relationship with the 56
    US dental schools. (well at least 34 of the 56---we hope to improve
    that number)

-   The \$60K Accession Bonus is now available for newly commissioned
    dental officers with a CAD date of 8-6-2007 or after. The wording of
    the memo that authorized its use states that the officer must serve
    the OPDIV that paid the bonus. Honestly, most of you would like that
    to say it holds them to the site that paid the bonus....but it does
    not say that. It would require approval by the ASH in consultation
    with the SG and the OPDIV Head for the officer to leave the OPDIV
    that paid the bonus to serve in another OPDIV. It does not seem to
    restrict movement within an OPDIV. Of course, a site losing an
    officer will need to negotiate reimbursement of a prorated amount of
    the bonus when a release date is discussed. IHS DOH continues to
    await an answer to the proposal put forth to allow the bonus to be
    paid \$30K in the 1^st^ year and \$30K in the 3^rd^ year....OCCFM is
    researching to determine if paying in installments is permitted
    (currently the military pays a lump sum). You can view the August 6,
    2007 memo and the August 15, 2007 clarification memo at
    http://dcp.psc.gov .

**[Loan Repayment Program (Dr. Lozon)]{.underline}**

-   As of 9-10-2007 there are 8 matched/ unfunded LRP applicants all
    needing maximum awards. It would take \$51,672 X 8 = \$413,376 to
    fund all 8.

    -   4 Dentists

    -   4 RDHs

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-   Dr. Lozon is only aware of one site that responded to funding a sLRP
    award for a candidate that was already hired and working out. Dr.
    Lozon will follow up with the Area Directors that were addressed at
    the July 17, 2007 presentation in Rockville on the use of lapsed
    dental salary money or salaries that will lapse, to be used to fund
    sLRP awards as early in the recruitment year as possible. Alerting
    students in the early months of fall recruitment visits to view
    those sites that guarantee LR will draw attention to your vacancy
    with a \$ next to it.

# **[Oral Surgery Consent (Dr. Van Pelt)]{.underline}**

The Workgroup (WG) reviewed and revised the consent form. We also
created the reporting form to be used by the testing sites. The
recommended time for testing is 4 weeks with 10 sites.

-   **[Testing Sites]{.underline}**: The WG recommended the form to be
    tested at their sites. Several members of the WG were not present
    for this call.

1.  W.W. Hastings -- Tahlequah, OK (Kip Martin)

2.  Clinton Clinic -- Clinic, OK (Aaron Means)

3.  Pawnee Clinic -- Pawnee, OK (Aaron Means)

4.  Blackfeet Clinic (Gary Pannabecker)

5.  Crow Clinic (Gary Pannabecker)

6.  Pine Ridge (Jose Rodriguez)

7.  Gallup (Hesh Mortazavi)

8.  ACL (Bill Morningstar)

9.  Warm Springs - tentative

10. Crownpoint or Fort Defiance - tentative

The consent and evaluation forms will be emailed to the test sites early
next week to begin testing.

**[Dental Support Center Update (Dr. Blahut)]{.underline}**

Follow-up information on ADOs reviewing Support Center reports.

All ADOs were informed via e-mail if the support center in their Area
was applying for continuation funding, and submitting an annual report.
Each appropriate ADO was given the opportunity to review the Support
Center report for the program in their respective Areas.

**[MCRP Update (Dr. Blahut)]{.underline}**

One new malpractice claim was received last month. Claim centers on
failure to diagnose in a timely fashion an intraoral malignancy.

This case underscores the need to document carefully any professional
advice or instructions given to the patient. In this case, the patient
states she was never told the lesion noted during an emergency
appointment required follow-up. While the provider states that the
patient was alerted of the importance of follow-up, there is no
documentation of this in the record. Nor is there any documentation of
an attempt to contact the patient when two consecutive appointments were
cancelled. It cannot be determined, from our documentation of code
#9140, whether these two key appointments were cancelled by the patient
or the facility.

**[REPORT FROM OSG]{.underline}**

-   RADM Williams reported that ADM Agwunobi's last day in the office
    will be August 29^th^, and his last day as ASH will be August
    30^th^. The Secretary of Health and Human Services, and his Deputy,
    are in the process of naming individuals to be the acting Assistant
    Secretary for Health, the acting Surgeon General, the acting Deputy
    Surgeon General and the acting head of Transformation.

-   RADM Williams also reported that a number of new policies are about
    to be released, and the ASH would like to sign off on these prior to
    his departure. One of these new policies will deal with the topic of
    disciplinary actions against officers. No further details were
    provided.

-   RADM Williams provided a Transformation update and noted that the
    Corps is in the process of positioning itself for fiscal years 2008
    and 2009. Budget proposals have been submitted which include funding
    for strengthening the Corps' Information Technology resources --
    including the use of the U.S. Coast Guard's people soft personnel
    package. More funding has been requested for recruiting efforts,
    including funding for ORC Macro, as well as funding requested for
    the HAMR Teams and to cover training costs for response teams.
    Funding has also been requested for intermediate and executive level
    training for Corps officers.

-   As of August 22^nd^, there was not any news to report on the
    confirmation process for the Surgeon General nominee

-   RADM Williams reported that the field training from Camp Bullis has
    been very impressive and he made note of the fact that the USPHS
    officers participating in the training sessions have been noteworthy
    for the exceptional performance that they have displayed.

**[OCCO REPORT]{.underline}**

-   CAPT Kelly provided a report on the topic of counseling for
    Commissioned Corps officers. OCCO will create and distribute a form
    to capture the information found during the counseling session --
    mainly regarding what was discussed during the counseling session
    and what the "plan of action" will be as a result of the counseling
    session. The counseling session will have the goal of documenting
    the strengths and weaknesses of the officer. Both the officer as
    well as her/his supervisor will be able to express their
    perspectives on the form and during the counseling session.

-   OCCO will provide, to the CPOs as well as the Commissioned Corps
    Liaisons, a list of officers needing to be counseled.

-   The officer receiving the counseling will develop her/his own action
    plan to address identified needs in their performance.

-   The officer developed action plan will be signed off by both the
    officer counseled and the supervisor.

-   The officer counseled is responsible for sending the completed form
    to OCCO, which will then be placed in the officer's e-OPF.

-   A second, instructional form will also be developed. This form will
    be a "check-off" sheet of topics to be covered during the counseling
    session(s). The form will be developed for the benefit of the
    counselor/supervisor.

-   CAPT Kelly is in the process of finishing a PowerPoint slide
    presentation which will function as a training guide for counseling
    sessions.

-   Such counseling will be expected of officers who fall into the
    lowest quartile of their promotion cohort, officers who are "not
    recommended" for promotion, and /or officers who are in their
    probationary period.

-   More details regarding the counseling process will be released soon.

**[HEALTH PRIORITIES UPDATE]{.underline}**

The CPO Board has taken the list of health priorities developed by the
PACs and have consolidated the requests into nine basic tracts (listed
in prioritization):

1.  Overweight and Obesity

2.  Disparities in access to Preventive/Primary Health Care and Health
    Outcome Disparities

3.  Use and Misuse of Medications

4.  Environment and Public Health

5.  Globalization and Health in the U.S.A.

6.  Future of Public Health Workforce

7.  Injury Prevention

8.  Public Health Preparedness

9.  Impact of Scientific and Technological Advances on Health

Each of these nine tracts had "sub-tracts". Both the tracts and
subtracts incorporated virtually all of the suggestions developed by the
PACs. The next step will be for the CPOs to develop narratives for each
of the nine tracts; the narratives will incorporate information from the
tracts as well as the "sub-tracts".

**[OFRD/HUMANITARIAN DEPLOYMENTS]{.underline}**

*In response to both Presidential and Secretarial initiatives, the
Office of Force Readiness and Deployment in the Office of Public Health
and Science's Office of the Surgeon General, is currently deploying
teams of commissioned officers on two separate Navy ships undertaking
health diplomacy missions. The USNS COMFORT is on a 4 month mission to
12 countries in Latin America and the Caribbean. The USS PELELIU is on a
3 month mission to 6 Pacific Rim and Pacific Island countries.*

**[USNS COMFORT]{.underline}** *USPHS Officer-in-Charge (OIC): CAPT
Craig Shepherd*

-   COMFORT arrived in Bahia Malaga, Colombia 22 August 2007. Current
    USPHS detachment (Team 3): 6 physicians, 2 dentists, 4 dental
    hygienists, 2 nurses, 2 environmental health officers (including
    OIC), 1 engineer, 1 veterinarian, 1 pharmacist. A few officers and
    others are going ashore to set-up for the rest of the week. 
    Missions in Colombia will be fully underway in the early morning of
    23 August and will continue through 27 August.

-   While in Ecuador, the USPHS Engineer, CAPT Phil Rapp visited the
    Rodriquez Zambrano Hospital (RZH). While there he consulted and
    provided advice/recommendations regarding the hospital boiler
    make-up line repair (COMREL) and hospital hydro-pneumatic System -
    water hammer phenomenon. He also located the municipal water supply
    feed to RZH, determined sequencing and status of system
    infrastructure, conducted (with LT Sproul, Navy EH Tech) assessments
    of refrigeration and food storage and arranged for use of RZH pipe &
    fittings.

-   Veterinary Services went to Las Lagunas, Aguas Nuevas and to the San
    Juan sector near the Manta, Ecuador landfill. Each family had a
    combination of cattle, swine, dogs, and donkeys and or horses.  The
    treatment encounters included:  deworming, vaccinations (rabies for
    dogs, tetanus for donkeys and horses), wound cleaning, and treatment
    for ectoparasites.  There were a total of 2,391 animal patient
    encounters. In addition, COMFORT veterinary team gave stuffed
    animals to several of the community children. The USPHS preventive
    medicine physician, CAPT Louisa Chapman accompanied the veterinary
    mission to an impoverished community and treated 442 residents aged
    2 years or older for intestinal parasites/roundworms.  

-   LT Jason Mangum, USPHS, Environmental Health Officer and LT Hanley,
    USN presented five topics to a group of young doctors, nurses, and
    EMTs at the RZH.  The team covered the importance of food safety,
    occupational risks at work, fundamentals of integrated pest
    management, disease prevention and disease treatment.  The course
    generated some discussion among the HN physicians, PHS & Navy staff
    as it applied to their work environment. 

**[USS PELELIU]{.underline}** *USPHS OIC: CAPT Kathleen Downs*

-   PELELIU arrived in the Solomon Islands on 19 August 2007. Current
    USPHS detachment (Team 3): 2 physicians, 1 physician assistant, 3
    environmental health officers, 2 environmental engineers, 1
    pharmacist (OIC). Missions are underway aboard ship and ashore.

-   While in Papua New Guinea (PNG), the preventive medicine team made
    many noteworthy accomplishments including the development of an
    emergency disaster plan (developed by LCDRs Dieser and Hanley) which
    will be used as the template for all hospitals in PNG; the well
    point developed, and established under CDR Bosiljevac's direction;
    the implementation of hospital-wide infection control procedures and
    solid (esp. medical) waste procedures under CDR Bates direction,
    and; the assessment and analysis of water throughout Madang (proper)
    and 3 out-lying internally displaced persons camps carried out by
    LCDRs Piontkowski and Treffiletti and LT Hassan.

-   Please note the link below which takes you to a US Navy web site and
    video about the USPHS contribution to the current USNS COMFORT
    mission. CAPT Craig Shepherd, the USPHS OIC is interviewed:

<http://www.news.navy.mil/management/videodb/player/video.aspx?ID=9640>

-   Training of the ready response teams has been taking place at Camp
    Bullis

USNS Comfort Deployments

TEAM 1 (June 13 -- July 16, 2007)

> TEAM 2 (July 13 -- August 14, 2007)
>
> TEAM 3 (August 12 -- September 15, 2007)\*
>
> TEAM 4 (September 12 -- October 15, 2007)
>
> \* on deployment at the time of the submission of this report.

**[Commissioned Corps Transformation/Deployments/CPO
Update]{.underline}**

-   The Department is currently looking for successors (in an acting or
    full time capacity) for the following positions: ASH, SG, Deputy SG,
    Chief of Staff and Head of Transformation.

-   Officers who fell into the lowest quartile of their promotion
    cohort, officers who were not recommended for promotion and officers
    who have had documented poor results while on their probationary
    period will be required to have counseling from their supervisor.
    OCCO will be contacting those officers and providing more
    information about the counseling sessions as well as what
    documentation will need to be submitted to the e-OPF of those
    officers.

-   Reminder from the last three months: If you haven't already viewed
    it, I would encourage you (as well as all of the COs in your area)
    to read the Commissioned Corps Transformation Implementation Plan,
    dated 10/19/06. The document has been placed on the CCMIS website
    (<http://dcp.psc.gov/>) .

-   Also, please remember to inform the Commissioned Officers in your
    area that the Transformation Presentation given by RADM Williams at
    the Commissioned Officers Foundation annual meeting can be found at
    the CCMIS website ( <http://dcp.psc.gov/> ). The direct link to the
    presentation is:
    <http://dcp.psc.gov/TransformationPresentationfrom2007USPHSSymposium.ppt>

-   Team #4 will be deployed to the USNS Comfort later this week. There
    will be two (non-IHS) dentists on the mission. There are also three
    dental hygienists on Team #2, two of whom are from IHS: CDR Sandra
    Furguson and LTJG Dorinda Ball.

-   

Dr. Halliday has sent, via email, his report from the last DePAC
meeting. There was not a Combined Surgeon General's Policy Advisory
Council Meeting and Chief Professional Officers/PAC Chair Meeting in
August, so the report is somewhere abbreviated. This is what he had
intended on covering under the conference call agenda item listed as
"CPO Update".

# 

**[EDR Update (Dr. Chiarchiaro)]{.underline}**

The RPMS Interface contract has been awarded to POD Associates, Inc. A
kick off meeting is scheduled for October 30.

The deadline for proposals for the EDR Implementation Support contract
is September 23. A Technical Evaluation Team has been selected and is
scheduled to review the proposals on Oct 10 and 11.