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and pharmacy software, improvement in Medicaid and insurance reconciliation, and improvements in client financial screening and collections. Regarding medical interpreter services, they have hired an additional bilingual staff member and they would like to hire one more staff member. Three staff members will be attending immersion training this spring and the language voice mailbox has been set up. There are 23 interpreters on contract. Chair Jacobs made reference to the summit held at UNC, which was about the lack of interpreter service for the Hispanic community in North Carolina. He asked Rosemary Summers if Orange County was an tap of things compared to other places or if we were just starting. Rosemary Summers said that she thinks we are just starting with regard to the Health Department. She said that they have not experienced the pressure in the Health Department as much as Piedmont Health Services has. The community pressure is definitely growing to provide mare interpreter services. She said that there are four bilingual staff members and three additional staff members that are at an intermediate Spanish level. The demand is exceeding the ability to serve the clients. Jonathan Klein spoke about Orange County residences needing specific guidance on nutritional education. A half-time position was approved by the County Commissioners last year and the employee began work on March 5, 2002. Regarding Cardiovascular Health, the Health Promotion Coordinator was replaced. The Health Department received supplemental funds from the state for lay health advisor training utilizing the Women's Health Passport. Mel Hurston spoke about Dental Health Clinical Services. In the last five years the number of Hispanic clients increased from 56 to 140 - a 250°~ increase. The number of visits also increased from 159 to 393 - a 247°~ increase. The revenues have also increased. Some challenges are to replace a dental hygienist that resigned in January. Also, there are problems with retaining dental "attending", and funds will probably be lost from the dental school. They are also participating in the planning for mobile dental care far senior citizens. Alice White talked about environmental health noting that two new positions were approved last year by the Board of County Commissioners. The group has participated in the Heart-Health dining survey and they also continued ServSafe classes far restaurant workers and managers. These classes are available in Spanish and English. Regarding wells and on-site wastewater, a new specialist began work on January 7th. There is currently a backlog of 2-3 weeks for inspections of wells and septic tanks. There is a vacant position, which was advertised in February. They will be assessing some issues around a low interest loan/grant program for repairing failing septic systems. They will soon begin a No Fault Well Repair Fund program, which was a result of the American Stone Company mitigation. Edith Wilder spoke about animal control. They are learning a new software program, which will improve the registration of animals. There was a software glitch, which diverted some revenues to towns and away from the County. This will be tracked and fixed. APS is giving rabies vaccines to age-appropriate new adoptees. Animal sheltering is a large concern at this time. They are developing shelter replacement plans. Regarding dog and cat population control, a barn cat spay/neuter program has been started and there are three interested farmers to date. Chair Jacobs suggested that they work with the Agricultural Preservation Board. Jonathan Klein outlined the other accomplishments including instituting jail health services, performance standards for home visiting staff, the lowest staff vacancy rate in five years, and successful response to a biaterrorism threat. The critical needs include surveillance and communication for bioterrorism and emergency response, response to continual increases in communicable disease, HIPAA Compliance Officer/Billing and Medicaid Specialist, staffing for primary care clinical services, space needs for dental and personal health clinical services and animal shelter, stabilizing dental health staff, and replacing "lost" funding (Smart Start and state funding). Commissioner Gordon asked for mare information an the surveillance system. Rosemary Summers said that the system may include some things such as an automatic reporting system at the hospital of unlikely symptoms (i.e., 20 flu cases in June, etc.). Rosemary Summers presented some photos of the Whitted Center, which showed some of the needs. She said that there needs to be some consideration in the CIP for an intermediate plan to