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BCC Minutes 03/22/1988 W -'--'-""" Naples, Florida, March 22, 1988 LET IT BE REMEMBERED, that the Board of County Commissioners in and for the County of Collier, and also acting as the Board of Zoning Appeals and as the governing boardCø) of such special districts as have been ~reated according to law and having conducted business herein, 8et on this date at 3:00 P.M. in WORKSHOP SESSION in Building "F" of the Government Center, East Naples, Florida, with the following ~rs present: CHAIRMAN: Arnold Lee Glass ABSENT: John A. Pis tor Max A. Hasse, Jr. Burt L. Saunders Anne Goodnight ALSO PRESENT: Beverly Kueter, Deputy Clerk; Neil Dorrill, County Manager: Kevin O'Donnell, Public Services Administrator, Jane Polkowski, H.D., Public Health Unit Director: and Martha Skinner, Social Services Director. DISCUSSIOK 07 HIaB RISK PREGNANCIES Health Services Director Polkowski stated the purpose of this workshop is to provide the Board with information on high risk pregnancies and review some of the causes. She advised that tremen- dous progress has been made in maternal care, however, there is room for quite a bit of improvement needed for infants. Dr. Polkowski stated a poor pregnancy outcome can occur in any family and is defined as early death or survival with significant medi- cal problems to either mother or child. She stated that some of the Pðge I 'OO( 112~I'.i647 ;¿~ 112 ': ~ 648 March 22, 1988 consequences, of a baby that has medical problems, on the family is emotional stress and severe financial burden: and some of the con- sequences to the affected baby are decreased capacity to achieve potential and dependency: consequences on society are loss of a pro- ductive individual and financial concern with institutionalization, She said the average cost of institutionaliza- and special education. tion is $47,000 per year and special education programs cost two to three ti8es that of regular education. Dr. Polkowski gave the Board the following definitions: l. 2. 3. Infant Mortality - death within one year of birth Neonatal Mortality - death within 28 days of birth Postnatal Mortality - death immediately following birth Dr. Polkowski displayed a chart showing the United States ranking in poor pregnancy outcome. She said that in using other industrialized nations, the United States ranks near the bottom or has a .uch higher percentage of poor pregnancy outcome. She said: 1950 per 1,000 POPulation 1980 per 1,000 population Canada Hong Kong United States 36 79 28 09 10 11 Dr. Polkowski stated the bulk of poor pregnancy outcomes are babies with significant medical problems. She said low birth weight is a major determinant of infant mortality in the United States and babies who weigh less than 5.5 lbs. at birth are 40\ more likely to have problems. She advised the other factors involved are: socioeco- Page 2 - -_._,,~.., March 22, 1988 nomic and demographic factors, income, marital status, and housing. She reported that women with lower income level, unmarried, poorer housing conditions, minority status, less than 17 years, over 3S years, too thin for their height, less than 5 ft. tall, and education levels are more likely to have problems. Dr. Polkowski stated that the previous pregnancy history is also ð factor and higher risks include diabetics, hypertension, current pregnancy status, twins, placenta, eating habits, and smoking, alcohol and drugs. She stated that if the Health Department can determine the mother is in a high risk category, she m~y be transported to a high risk hospital. She stated there are three levels of hospitals, Level I handling normal deliveries, Level II handles more complicated deli- veries, and Level III handles the most severe problems. She stated that Naples Community Hospital is currently preparing to be a Level II hospitaL She said there are currently 10 Level III hospitals in the State of Florida and they are located: Miami Ft. Lauderdale West Pðlm Beach Or lando Lee St. Petersburg Tampa Gainesville Jacksonville Pensacola Dr. Polkowski advised that Lee County is no longer under contract with EMS and Collier County cannot take their Level III patients to that hospital, but have to go to Tampa or St. Petersburg. Dr. Polkowski advised that what they want to do is prevent poor aoû( 112,,1':[ 649 Page 3 ~_._.._- ",,- ,,;( 1121"".(630 March 22, 1988 do occur. pregnancy outcomes and provide the proper type of care for those that encompass: She said there are several areas that prevention must preconceptual and prenatal care, nutrition, spacing between tification of risk factors and problems. children, i~unization, early care during pregnancy, and early iden- Answering Commissioner Pistor, Dr. Polkowski stated that poor nutrition is seen most among teenagers and it is important to educate the mothers as early as possible, preferably when they are children. Also answering Commissioner Pistor, Dr. Polkowski stated teen pregnancies cross eth- nic lines, however, it is seen most among blacks in the United States. Ms. Sharon Warnke stated that when she last spoke to the Board she was the Director of the Improved Pregnancy Outcome Program for Collier County, but now she is on the faculty of the University of South Florida. She stated they are offering a program called Healthy to grant incentive programs in education. Beginnings which is ð community awareness program and may be extended from the Board of County Commissioners. it will take some of the big dollar cost for indigent health care away S~e stated that hopefully She said that her experience has shown that most teenagers ~ho become pregnant are victims. She said they really had been unsuccessful throughout their teens and middleschool time and feel that becoming pregnant was the only posi- tive thing they could do. Ms. Warnke stated the quality of care in Collier County continues - - Page 4 - ----.." March 22, 1988 to iI'prove. She said there is a high risk clinic, an obstetrician is seeing the clients on Wednesday afternoons, and that many of the poor outcO8es are going to be affected by the clinic. Ms. Warnke stated that the most detrimental factors in Collier County affecting poor pregnancy outcome are cocaine, crowded and ina- dequate housing in Immokalee, and some pesticides and chemicals being used in the soil to improve crops. In response to Chairman Glass, Ms. Warnke stated that while she cannot prove it, she feels the chemicals being used in the soil do have an effect because in tracking the poor pregnancy outcomes, it seems they were in clusters and at certain times of the year which al~ays appeared to have followed the time they prepared the soil for crops. She added that in 1987, Collier County's percentage of poor pregnancy outcomes was the same as that of the Uni ted Sta tes. Ms. Warnke advised that a grant has been developed which looks as though it will become a reality, called Project Impact. She stated it has been targeted (or Collier and Polk Counties and will mean inten- sified screening and care for high risk pregnancies. She stated it will bring greater skills to obstetricians also through a consultation board which will be available to consult by phone during the prenatal pP.r fed. She said there may be a medical home for high risk infants in Collier County within the next three or four years. Ms. Warnke then explained how cocaine affects pregnant women and &OO( 112 Pl'.{ 651 Page 5 -'--"'-"-"". ""' 112 ,1'.( 652 March 22, 1988 infants. She stated that in a few years these infants are going to prove to be very detrimental on the educational system in two ways: increased costs fer special classes, and the children will max-out intellectually at two. She stated that last year in Collier County, she personally worked with 13 of these drug abuse babies, 7 from the I880kalee area and 6 from the Naples area. She said of the 13 babies, only 2 weighed over 6 Ibs. at birth, 11 were under 6 lbs. and 9 were under 5.5 Ibs, four of the mothers from Immokalee had no prenatal care, two in Immokalee turned out to be HIV Positive, one was small for the gestation age, one had a sexually transmitted disease, one had intra-uterine non-maturity, and one delivered by a C-Section had poor respiration. Ms. Warnke stated that Lee County is having more of a problem than Collier County and the cheapest poor pregnancy outco~~ baby in their special neonatal nursery costs 51,800 per day. Ms. Warnke stated that they treateJ a mother who was identified as an intravenous cocaine user. She stated the woman was addicted and they could not get her help. She said there was no program in Southwest Florida that would accept her for treatment. She said it is her feeling that funds have to be allocated federally or state-wide to commit these women for treatment. She stated she believes this is a moral responsibility because someday our children will be paying because we are not doing anything about the cocaine babies. Page 6 . ""--","-,"",,, March 22, 1988 A brief discussion followed on abortion and how the women are counseled. Dr. Polkowski stated that it is important for the Board to know the situation in Collier County and what progress is being made. She again pointed out that of the other industrialized nations, the United States if far behind in assuring that women get the care needed for the prevention of poor pregnancy outcome. '* . '* There being no further business, the meeting was adjourned by Order of the Chair - Time: 3:55 P.M. aoo( 112 Pl':£ 653 Page 7