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ISDH Long Term Care
Newsletter Issue # 10-15
September 24, 2010

In Today's Issue:
- ISDH Staffing Update
- Security Advisory
- CMS Updates
- Emergency Preparedness
- Director of Women's Health
- Recalls
- Coming Events
The Indiana State Department of Health (ISDH) would like to provide an agency staffing update for theDivision of Long Term Care. Attached is a the long term care survey areas with the supervisorfor each area. Survey Supervisor for Area 4
The ISDH is pleased to announce the promotion of Becky Lemon to Public Health Nurse SurveySupervisor for the Division of Long Term Care. Becky will be responsible for LTC Survey Area 4. Rebecca joins the survey management team with many years of clinical nursing experience as well assupervisory experience. After graduating from a three year diploma program in Champaign, IL, she spenttwenty plus years in clinical nursing. After raising a family, she returned to academia and received a BSfrom St. Francis University, Joliet, Il, and an MSM from Indiana Wesleyan University. Rebecca became a state employee in 1985 and worked at the Indiana Veterans’ Home. As AssistantDirector of Nursing of this large facility, she was responsible for overseeing the care of veterans and thestaff who provided direct care. In September 2001, Rebecca became a Public Health Nurse Surveyorand served on a team that surveyed in the Indianapolis area. In 2005, Rebecca transferred to an in-house position in complaint and incidents intake. Rebecca is looking forward to being back out in the field and looks forward to becoming acquainted andre-acquainted with the facilities and providers in Area 4. New Long Term Care Surveyors
The ISDH welcomes the following new surveyor staff to the Division of Long Term Care: Elizabeth Harper, start date July 26, 2010, assigned to LTC Survey Area 5Cheryl Groth, returning August 9, 2010, assigned to LTC Survey Area 4Kristy Landers, start date August 9, 2010, assigned to LTC Survey Area 6Leia Alley, start date August 23, 2010, assigned to LTC Survey Area 6Christi Jo Davidson, start date October 4, 2010, assigned to LTC Survey Area 4 Intra-Agency Transfers
Mary Jane Fischer transferred to the Division of Acute Care effective July 23, 2010 and will be a statesurveyor for the Home Health, Hospice, End Stage Renal Disease, and Rural Health Clinic licensing andcertification program. Mary Jane was previously a surveyor in LTC Area 4. Charles Stevenson returned to a long term care surveyor position in LTC Survey Area 4 effective August2, 2010 and will serve as a complaint surveyor. He previously served as a LTC Survey Supervisor. Kelly Hemmelgarn was promoted to a supervisor position effective August 23, 2010 in the Division ofAcute Care. Kelly will serve as the Program Director for the Home Health Agency, Hospice Agency, EndStage Renal Disease Clinic, and Rural Health Clinic Licensing and Certification Program. Kelly waspreviously a surveyor in LTC Survey Area 3.
Departures
The following staff are no longer employed by the ISDH as a long term care surveyor. The ISDH wisheseach of them well in their new endevours and thanks them for their service to the state. Debra Bishop, last day July 2, 2010, assigned to LTC Survey Area 1Judy Ray, last day July 2, 2010, assigned to LTC Survey Area 6Sandra Haws, last day July 30, 2010, assigned to LTC Survey Area 1Jennifer Long, last day August 2, 2010, assigned to LTC Survey Area 6Stephanie Toomey, last day August 26, 2010, assigned to LTC Survey Area 0 The ISDH has recently received several reports of breakins at long term care facilities. Most recently,there were several breakins in south Indianapolis around the Madison Avenue and Keystone Avenuearea. These breakins targeted the facility's business offices. Facilities are recommended to review theirsecurity measures and procedures. Special Focus Facilities
The Centers for Medicare and Medicaid Services (CMS) issued regarding special focus facility procedures. The number of special focus facilities has been adjusted toreflect nursing home population changes in each State and provide for a ten percent increase in specialfocus facility slots. Effective October 1, 2010, Indiana will have five special focus facility slots. That is an increase of onefacility. The size of candidate list will increase from 15 to 25. The CMS letter includes a description of new progressive enforcement procedures for special focusfacilities. The letter also includes an introduction of the review process for special focus facilities. INDIANAPOLIS—A recent report from the Centers for Disease Control and Prevention (CDC) indicatesIndiana has made significant progress toward building and strengthening its and the nation’s public healthemergency preparedness and response capabilities. The report, Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State, presents data on a broad range of preparedness and response activities taking place at state and localhealth departments across the nation. Being prepared to prevent, respond to, and recover from all typesof public health threats such as disease outbreaks, chemical releases, or natural disasters – requires thatpublic health departments improve their capabilities in surveillance and epidemiology, laboratories, andresponse readiness.
"Indiana has always strived to be one of the leaders in public health preparedness and response, and the2009 H1N1 flu pandemic was a lesson we won’t soon forget," said State Health Commissioner GregoryN. Larkin, M.D. "The CDC’s report is validation of the progress we’ve made, and I’m confident we willcontinue to work even harder to ensure we are even better prepared in the future than we are today." Accomplishments highlighted in the report for Indiana include: The Indiana State Department of Health had a 24/7 reporting system that could receive urgentdisease reports at any time.
Indiana received a perfect score of 100 from the CDC for its plans to receive stage, distribute, anddispense medical assets received from CDC’s Strategic National Stockpile or other sources. (Note:a score of 69 or higher was acceptable.)To improve readiness to respond, Indiana activated its public health emergency operations center(EOC) as part of an exercise or drill three times, and staff reported three out of three times to theEOC within the target time of 2.5 hours. The Indiana State Department of Health developed four AAR/IPs (after action report/improvementplans) following assessments of our response capabilities during exercises or real incidents. The biological LRN laboratorycould test for specific biological agents. The laboratory passed fourout of four proficiency tests to evaluate their abilities to receive, test, and report on one or moresuspected biological agents to CDC. The chemical LRN laboratory had capabilities for responding if the public was exposed tochemical agents. The laboratory successfully demonstrated proficiency in six out of six coremethods for rapidly detecting and measuring certain chemical agents that can cause severe healtheffects.
"The Indiana State Department of Health Preparedness Laboratory division responds to a variety of publichealth threats by accurately testing environmental materials, food, and human specimens sent by firstresponders, Federal and Indiana law enforcement agencies, and our public health partners," saidAssistant Commissioner for Laboratory Services Judy Lovchik, Ph.D. "This report shows we canaccurately detect biological and chemical threats." Public health threats are always present, whether caused by natural, accidental, or intentional means.
Incidents such as the 2009 H1N1 influenza pandemic and other disease outbreaks and natural disastersthat have occurred recently underscore the importance of communities being prepared for all types ofhazards.
The 2010 CDC report indicates that the surge in effort needed to respond to the 2009 H1N1 influenzapandemic placed an increased strain on a public health system already weakened by workforceshortages and budget shortfalls. Preparing adequately for future outbreaks – and other public healthemergencies that are inevitable and may occur simultaneously – requires predictable and adequate long-term funding to sustain and improve the public health infrastructure, staffing, and training.
The report and state specific information on Indiana is available on CDC’s website at: September 20, 2010 MORGAN MCGILL NAMED NEW OFFICE OF WOMEN’S HEALTH DIRECTOR INDIANAPOLIS—State Health Commissioner Gregory Larkin, M.D. today announced the appointment ofMorgan McGill, J.D. as the director of the Office of Women’s Health at the Indiana State Department of Health, effective September 20, 2010. She replaces Tanya Parrish, M.P.H., who accepted a position atLittle Red Door.
"Morgan’s experience in public health, and in particular women’s health issues, through her work as anattorney here at the agency makes her an ideal fit for director of the Office of Women’s Health, saidState Health Commissioner Gregory N. Larkin, M.D. "She has a lot of great ideas, and I know she willhelp this agency continue to have a positive impact on the health of Indiana’s women." McGill has served as staff attorney for the Office of Legal Affairs at the Health Department since June,2007. Her responsibilities included drafting data share agreements, and being a member andcollaborator with the Health Information Security and Privacy Collaboration (HISPC) project, collectingstate laws and issuing standards and guidance to health information exchange stakeholders. She has also represented the Indiana State Department of Health in administrative proceedings involvingthe Children’s Special Health Care Services program, the Environmental Public Health Division, and theLong Term Care Division.
"I am very excited to assume this position and continue working on strategies to advance women’s healthin Indiana," McGill said. "One of my primary goals is to continue the work of my predecessor, TanyaParrish, in focusing the resources of the Office of Women’s Health even more on the promotion ofpositive behaviors to help prevent chronic disease, working in collaboration with other agency divisionsand stakeholders." "My goal is for the Office of Women’s Health to improve its position as a key policy leader amongstakeholders and be a vocal and visible advocate for women’s health and wellness," McGill said. "Bothmy parents worked in the health industry and it has been something I’ve wanted to continue throughoutmy career." McGill earned a Bachelor of Arts at Barnard College, Columbia University, and her professional doctoratein law from the Indiana University School of Law in Indianapolis.
Avandia (rosiglitazone): REMS - Risk of Cardiovascular Events
ISSUE: FDA notified healthcare professionals and patients that it will significantly restrict the use of the
diabetes drug Avandia (rosiglitazone) to patients with Type 2 diabetes who cannot control their diabetes
on other medications. These new restrictions are in response to data that suggest an elevated risk of
cardiovascular events, such as heart attack and stroke, in patients treated with Avandia.
BACKGROUND: Avandia is in a class of drugs known as thiazolidinediones, or TZDs. It is intended to
be used in conjunction with diet and exercise to improve glucose (blood sugar) control in patients with
Type 2 diabetes mellitus. Rosiglitazone also is available in combination with other diabetes medications,
metformin under the brand name Avandamet or glimepiride under the brand name Avandaryl.
RECOMMENDATION: FDA will require that GSK develop a restricted access program for Avandia
under a risk evaluation and mitigation strategy, or REMS. Under the REMS, Avandia will be available to
new patients only if they are unable to achieve glucose control on other medications and are unable to
take Actos (pioglitazone), the only other drug in this class. Current users of Avandia who are benefiting
from the drug will be able to continue using the medication if they choose to do so.
Doctors will have to attest to and document their patients' eligibility; patients will have to reviewstatements describing the cardiovascular safety concerns associated with this drug and acknowledgethey understand the risks. The agency anticipates that the REMS will limit use of Avandia significantly.
Healthcare professionals and patients are encouraged to report adverse events or side effects related tothe use of these products to the FDA's MedWatch Safety Information and Adverse Event ReportingProgram: call 1-800-332-1088 to request a reporting form, then complete and return tothe address on the pre-addressed form, or submit by fax to 1-800-FDA-0178 October 14, 2010: ISDH Indiana Healthcare Leadership Conference, Caring for Alzheimer's andDementia, Indiana Convention Center, Indianapolis, Indiana. The agenda and registration information isposted on the ISDH Website at. October 14, 2010: Indiana Advanced Wound Care Symposium, Provided by Wound Care Specialists ofIndiana, Indianapolis Marten House.
That is all for this week. Have a nice weekend.
Terry WhitsonAssistant CommissionerIndiana State Department of Health

Source: http://ai.org/isdh/files/ltcnews1015.pdf

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