# Presentation: 725073

## Local Health Department Perspectives

***Dorothy Gonzales, REHS/RS***
- Food Safety Program Manager
- Genesee County Health Department
- Michigan

**Notes:**
Good Morning.  My name is Dorothy Gonzales.  I am a Food Safety Program Manager for a local health department in Flint, Michigan. Thank you for the opportunity to speak on the subject of  our challenges with multi-jurisdictional outbreaks.

## Genesee County, Michigan

- _Location:_ Mid-State, Lower Peninsula
- _Population of Genesee County:_ 439,000*
- _Health Department:_ 160 staff, 3 locations
- _Food Safety Program:_ 1500 facilities. We do not inspect retail/grocery stores
- _Staff size_:  10 inspectors, 2 plan reviewers, 1 coordinator, 2 clerical
- *U.S. Census Bureau, 2004 American Community Survey)

**Notes:**
A few statistics about where I am from:

## LHD Challenges

- Outbreak Collaboration
- Communication
- Federal Protocols
-  Recall Steps

**Notes:**
These are the challenges I wish to discuss today.

From a LHD perspective, we have challenges with outbreak collaboration.  We tend to work in our own silos, doing things according to our own, local protocols.  We currently have only basic procedures in place to collaborate with other locals and our State, and really no procedures in place to work with USDA or the FDA.  We tend to look to our Department of Agriculture to liaise with the Feds.

We communicate well with in our division and department, and with our State outbreak coordinator.  But again, we are challenged when it comes to reaching out to our federal counterparts.

We no virtually nothing about Federal protocols regarding outbreak response and investigation.

And LHD’s are not familiar with the protocols involved in national recalls.

## Local Collaboration

- 1 LHD has many ill residents – they ate at facility in another LHD jurisdiction.
- People ill in several local jurisdictions and 1 county refuses to coordinate with others. They want to be in charge of their jurisdiction.
- .........Is mostly non-existent

**Notes:**
This slide might be better titled ‘Local Non-Collaboration”.
Anecdotally, I have heard of LHD’s having problems with others when ill complainants are across county lines from the facility they ate at.
I have also heard there have been several LHD”s involved in a regional outbreak and one simply won’t play well with others because they want to maintain control.

So, local collaboration is mostly non-existent, because we do not have concrete procedures in place.

## Local Experience

- How do you accurately and in a timely manner identify the appropriate people from each agency that need to be involved?
- Chain FSE’s have their own quality assurance protocol and sometimes attempt to investigate internally and not notify the LHD at all.

**Notes:**
Other challenges locals face:  this was brought to  my attention by epidemiologists in Minnesota, but we also have problems with this in Michigan.  [Read first question]  GCHD uses Sanitarians to investigate – other locals use CD nurses.
MN also have experienced chain facilities attempting to conduct their own investigations, circumventing the law by not notifying LHD.

## Local Experience

- Dickinson-Iron District Health Department
- Honduran Cantaloupes
- Michigan NOT in original recall notice
- Slow Communication to locals

**Notes:**
Later that day, they found out from other local health representative at a conference that some may have came to a hospital in Dickinson County.  Investigation revealed the local hospital did receive a shipment of the cantaloupes. [They were notified by the company and fruit was discarded.]  This is an example fo slow communication to locals.   

## Local Experience

- Saginaw & Oakland Counties participated in  Food Defense Surveillance Assignment 2007
- Conduct routine inspection, discuss alert, & collect trace back/trace forward info.
- 1st Issue:  accurately and confidently reading labels on packaging.
- 2nd Issue:  locals do not have proper forms.

**Notes:**
The exercise was designed to evaluate all stakeholder communications and identify gaps and areas of increased risk during a recall initiative that spanned all levels of food safety jurisdiction. Regulators were asked to conduct routine inspections, discuss the food safety alert with proprietors, and collect trace back/trace forward info on the targeted commodity.
1st issue:  most locals are not experienced in reading packaging.
2nd issue:  we do not routinely use forms listing trace back info.

## Local Experience

- Genesee County participation in Recall Effectiveness Checks
- Davis Creek Meats & Seafood
- Site visit required
- 7 of 10 facilities had not heard of recall and had product to be discarded.
- How many more facilities had product in our county?

**Voluntary = Good Public Health**

**Notes:**
Our State MDA sometimes asks for local’s help in conducting recall effectiveness checks. We participated in 2 state-wide recalls: Abbott’s Meats and Mark’s Meats; and we participated in the national  Davis Creek Meats & Seafood in Kalamazoo recall.

## Local Collaboration

- Metro Atlanta area
- “Infectious Disease Case Management Across Jurisdictions” Protocol
- 5 health districts, GDPH
- [Ill person in one district, FSE located in another.  Other ill people in 2 or 3 other districts.]
- Protocol designates who is the lead, which districts investigate at establishment & which administer questionnaires.

**Notes:**
A success story:  Epidemiologist from 5 health districts encompassing 8 counties got together and worked out a strategy to investigate foodborne illnesses when they cross jurisdictional lines.  It has been in place since 2004. Five health districts participate.

It is simple and straightforward.  I love it.

## Local Needs

- Training on recall trace back of product; reading packaging; forms
- Knowledge of federal protocols
- Communication strategies
- Collaboration protocol

**Notes:**
Open recall distribution lists.  CIFOR working on multi-jurisdictional outbreak response – very timely.