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1966 Blue Book

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Advisory Council on Hospitals and Medical Facilities

      The Nebraska Statutes provide for an Advisory Council consisting of the Director and ten members. The ten members are appointed by the Governor for a three-year term each. Council members, while serving on business of the council, receive compensation at the rate of $20.00 a day, also actual travel and subsistence expenses. The Director serves as chairman ex officio.

     The council advises with the Department of Health concerning the allocation of any federal funds which may become available to Nebraska to aid in the construction of hospitals and other medical facilities. The council also acts in an advisory capacity on all regulations and standards promulgated under the licensure program.

     The Department of Health has been designated as the agency responsible for the administration of Title XVIII, P.L. 89-97 (Medicare). A new division established for this purpose and funded entirely with federal funds is headed by a trained lay administrator on loan from the Public Health Service and under the professional supervision of a part-time medical consultant.

     This division makes surveys of, and recommends certification of the several kinds of providers of services under Part A of Title XVIII. It provides consultation upon request to assist the providers of services to qualify for certification. It provides the opportunity for coordination between the many levels of government and the many kinds of providers of services, so that the beneficiaries receive maximum service with a minimum of difficulty.

     The division is assisted in its many duties, especially in relation to coordination, by a "Medicare Advisory Committee", appointed by the Governor and representing the many organizations closely allied with Medicare. The committee members and the organization each represents are shown below:

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     This program has been established under the terms of a contract with the federal government. It provides for an immediate interview of each person who is rejected for service in the Armed Forces for medical or psychiatric reasons. The interview is performed at the Armed Forces Examining Station, and is designed to give the rejectee insight into the condition for which he was rejected, the possible effect on his future health status, and the means available to secure correction of the defect.

     An attempt is also made at a later date to determine whether or not the rejectee has sought medical help for his condition, and if not, to help him secure what care he needs from his own, or from community resources. For these follow-up services the department has entered into a sub contract with the Division of Rehabilitation Services of the Department of Education, in order to avoid duplication of effort.

     This section has grouped under it the services which come under the heading of "Preventive Medicine", and includes the communicable diseases as well as some which, while not communicable, are wholly or partially preventable or whose effects can be minimized through early detection. For administrative convenience, the section is subdivided into functional divisions. They are: Communicable Disease Control, Chronic Disease Control, Mental Health, Maternal and Child Health, and Dental Health.

     This division of the department collects, analyzes and publishes morbidity statistics, investigates epidemics and gives recommendations for their control to local health officials. The "Rules and Regulations Relating to Public Health", published by the department, frequently need interpretation as to their application to local situations. An educational program is carried on continuously aimed at better utilization of the known preventive measures against disease.

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     The activities concerned with venereal disease control are both medical and educational. The work is carried on in cooperation with the United States Public Health Service. Much work is involved in tracing contacts of reported venereal diseases, and in getting them examined and under treatment if they are found to be infected. Physicians are assisted in keeping the infectious cases under care until they are no longer a danger to others. Drugs are furnished and a fee is paid for the care of indigent cases. Education programs, consisting of lectures and films, are presented in high schools and colleges, as well as before adult groups.

     Tuberculosis was the first of chronic diseases toward which the department directed specific control measures. Statistical studies and educational programs were later supplemented by tuberculin skin testing, chest x-ray surveys with mobile photofluorographic units, the establishment of a central case register and the provision of public health nursing services to tuberculous cases, contacts, and suspects. As a result of these activities, more and more cases have been found early in the course of the disease when the treatment is effective and before the disease can spread to others.

     Recognizing the possibility of complete eradication of tuberculosis as a public health problem if the tools at hand could be used more effectively, the Public Health Service has provided additional personnel and funds for an accelerated program under the "Special Project" technic. A tuberculosis physician and a tuberculosis program advisor have been assigned to Nebraska by the federal agency, and with the additional federal funds tuberculosis clinics will be operated in Lincoln and Omaha, where over one-half of the cases are located. Intensified case follow-up and case finding activities will be provided on a statewide basis, also.

      In recent years, public health principles have been applied to additional chronic diseases. Better education leading to earlier recognition and treatment is important to better control of cancer, heart disease and diabetes. The mobile chest x-ray survey finds cases of tumors of the chest and abnormalities of the heart, which are referred to private physicians for further study and evaluation. Funds are provided for cytology screening studies of clinic patients at the two medical schools in Omaha. Social service follow-up is provided for those persons with a positive test as well as to patients receiving cancer chemotherapy at the tumor clinic at the University of Nebraska School of Medicine. A research assistant is attached to the Eppley Cancer Research Institute to work in cooperative studies of cancer epidemiology in Nebraska.

     The department is actively cooperating with other agencies and

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organizations in the Regional Heart, Cancer and Stroke program development.

     The Division of Mental Health is supported by funds made available to the state under the National Mental Health Act. The Director of the Department of Health acts as Director of the Division, assisted by a Mental Health Consultant, who is the Director of Community Services for the Nebraska Psychiatric Institute, and by the staff of the Community Services Division.

     The programs of the Division of Mental Health include: (1) Mental health institutes, seminars and courses for various professional and lay groups. (2) Operation of a mental health information center which makes available to community groups of any kind in Nebraska, mental health programs, speakers, films, and various audio and visual aids for instruction. (3) The creative use of the mass media (newspapers, magazines, pamphlets, radio, television, and movies) for the purpose of public education in mental health. (4) A community mental health research project on staff experimentation in a Community Services Division. (5) A cooperative training and service program involving the Community Services Division of the Nebraska Psychiatric Institute and selected private practitioners of medicine. (6) Partial support of community clinic services including the Lincoln-Lancaster Child Guidance Center. (7) Consultation activities with ministers, nurses, teachers, welfare workers, physicians, and voluntary workers and agencies. (8) Planning and evaluation of problems related to mental health and mental retardation, supported through special federal grant-in-aid funds.

     The Division of Child Hygiene was set up in the Bureau of Health in 1921 for the purpose of administering the funds supplied under the Sheppard-Towner Law. These appropriations ceased in 1929, and no further work was done in maternal and child health until the Legislature in special session in 1935 created the Maternal and Child Health and Public Health Fund. The law provides that seventy-five per cent of the fund is to be expended for maternal and child health as follows: (1) Promoting health of mothers and children especially in rural areas by direct services, immunization programs and postgraduate medical and dental activities. (2) Establishing and improving local maternal and child health services to be administered by local health units. (3) Demonstration services in needy areas to lower infant, child and maternal mortality and morbidity.

     This division provides much of the popular literature on maternity, infancy and child care which most of the mothers of our state have received. The division furnishes immunizing biologicals to physicians upon request for group immunization programs, supports well

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child conferences, maternity classes and public health nursing services in local health departments.

     The division also participates in the operation of the Nebraska State Master Poison Control Center located in the Children's Hospital in Omaha, and in a Hearing Conservation program for children in which it provides the trained consultant.

     The division also conducts studies of infant and maternal mortality, and provides training courses to public health nurses, hospital maternity service nurses and teachers in nurse training schools.

     Financial support is also provided to the public health nutrition services and dental health services available from the State Health Department, to the extent that these services are provided to infants and mothers.

Dental Health

     A separate Division of Dental Health within the State Department of Health was created by an act of the Legislature in 1949.

     The activities of the Division of Dental Health are largely educational, through conferences with the teaching profession in schools, teacher training colleges, health workshops, teacher institutes, etc. The division also conducts refresher and postgraduate courses in dentistry for children for practicing dentists.

     The division is actively engaged in the promotion of fluoridation of public water supplies and all other approved and accepted measures of dental caries control.

     Research on methods of prevention and control of dental diseases is another activity of the division.

     The responsibility of this section is that of developing and maintaining a clean and pleasant environment which is not only safe biologically and chemically, but also satisfying to us as thinking, feeling human beings. The program envelops water supply, waste disposal, swimming pools, air pollution, stream pollution, camp sanitation, insect and rodent control, and advisory service to state and local agencies on matters of environmental health as controlled by specific regulations or ordinances.

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      The 1957 Legislature created within the State Department of Health a Water Pollution Control Council composed of nine members, six of whom are appointed by the Governor and three are ex officio. The appointed members must be representatives of industry, agriculture, and municipal government and they serve for three year staggered terms. The ex officio members are the Director of Health, Director of Game, Forestation and Parks Commission, and the Director of Water Resources. The purpose of the council is to advise the State Department of Health in matters relating to abatement and prevention of pollution of the waters of the state.

     The following powers and duties are conferred upon the council: 

1. To hold hearings.

2. To formulate and adopt programs for the abatement of pollution.

3. To adopt, modify or repeal standards of quality of sewage plant effluents and waters.

4. To classify waters for their best intended use.

5. To issue, modify or revoke orders regulating the discharge of wastes in violation of water quality standards.

      The council operates through the State Department of Health which supplies necessary personnel to carry out the intent of the law.

     The major role of this section is the promotion and development of locally supported health services of the type now provided in the four areas covered by full-time approved local health departments, or the development and administration of state regional public health offices. This section also serves as the liaison between all State Health Department staff members whose services are available to local officials, and all of the local officials at county, city and village level who are responsible for or interested in public health activities in their own jurisdiction. Although not staffed at present, provision is made in the organization of the department for a public health trained physician as the head of this section.

     Administratively, under this section are grouped those divisions of the Department of Health whose activities are primarily directed toward coordination with local public health activities. These are: Public Health Education, Public Health Nursing, Nutrition, and Health Mobilization (Civil Defense).

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Public Health Education

     This division was established August 1, 1941, as an agency of the department to help the public to better understand and use the services of all divisions of the Department of Health. The division cooperates with the Department of Education, colleges and universities, and with federal, state and community organizations interested in any phase of public health education and safety.

     Among the services are: Publications; news releases, educational film programs and loan library of films; consultant service to rural, elementary and high schools on planning their health education programs, and to community groups requesting assistance; conducting one-day institutes for teacher groups; health education workshops in colleges and universities; planning with community groups the educational programs which precede either the x-ray units or the immunization projects; building a reference library on public health; purchasing and distributing materials on public health.

     The accident prevention program and the migrant agricultural health service project of the department are centered in health education.

     Literature, films, filmstrips and slides are furnished members of the department and others on phases of accident prevention and other subjects.

     Speakers from the health education division and the department are available on the topics suggested above.

     Public Health Nursing and Home Health Services

     This division was organized July 1, 1942. The Director of the division gives technical supervision to public health nurses in the other divisions of the Health Department. She is available for consultation to all nurses employed to do public health work in Nebraska. Public health nurses' activities include communicable disease control--including venereal diseases and tuberculosis-maternal and child health, dental health, mental health, nutrition, school health and teaching home nursing and motherhood classes. At present nurses in the Department of Health are located in the areas of the state where people are interested in having and supporting such a service. The public health nurses employed are all graduate, registered nurses, many with special training in public health.

      This division was assigned the responsibility of directing Home Health Services, one of the integral parts of the Medicare program which was initiated July 1, 1966. Four such agencies have been established in Omaha, Lincoln, Beatrice and Scottsbluff.

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Nutrition

     Through this division nutrition services are available on a consultative basis to health personnel, to schools, to children's institutions, to small hospitals, to homes for the aged and to others.

     Examples of services to schools would include nutrition surveys, analyzing the nutritional value of school lunch menus, checking the sanitation methods practiced in school lunch kitchens; consulting with architects and school boards on the planning of school lunch kitchens; conducting classes for cooks; coordinating the school lunch programs with school programs and supplying teaching materials to schools.

     Nutrition services are also available through the Section of Hospitals and Medical Facilities of the State Health Department, for the institutions served by that section.

     The purpose of this program is to assure the availability of adequate health services for the civilian population of the state in the event of national or natural disaster. This activity requires extensive coordination with the State Civil Defense Agency, State Medical Association, American Red Cross and many other professional, governmental, educational and civic groups.

     The major areas of activity currently included in this program are:

     PACKAGED DISASTER HOSPITAL. Twenty-four of these units are now prepositioned in the following Nebraska communities: Alliance, Aurora, Beatrice, Blair, Broken Bow, Chadron, Fremont, Grand Island, Hastings, Kearney, Lincoln, Norfolk, North Platte, Ogallala, Omaha, O'Neill, Schuyler, Scottsbluff, St. Paul, Superior, Valentine, Wahoo, West Point and York. In addition to providing very valuable emergency resources, these hospitals provide focal points for training and familiarization for disaster preparedness on the part of medical, allied and supporting personnel. So far 22 Packaged Disaster Hospital training exercises have been held in communities in which Packaged Disaster Hospitals are located.

     MEDICAL SELF-HELP. This program provides individual preparedness for emergency medical (life saving) care when professional medical care is not available. It is broader in scope than Red Cross First Aid and the 5 lessons not included in First Aid may be given in conjunction with First Aid. The lessons may be taught by a competent non-professional instructor and understood by the average person. Medical Self-Help materials are furnished by the federal government and distributed free of charge by the Health Department or Civil Defense Agency to schools, industrial, civic or other groups. Many schools, public and parochial have integrated Medical Self-Help into their regular curricula.

     EMERGENCY PLANNING FOR HEALTH RESOURCE MANAGEMENT. In conjunction with the Nebraska Emergency Resource Man-

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agement Planning Committee which constitutes a part of this activity by the (Federal) Office of Emergency Planning, staff assistance is furnished to the Director of Health in the planning and implementation of emergency use of health resources. Meetings have been conducted in the 8 Civil Defense Areas of Nebraska to initiate planning and organization for emergency management of Health Resources in these areas.

     EMERGENCY HEALTH SERVICE. The major objective of this program is the organization of an Emergency Health Service in each locality in Nebraska. This is required as a part of the local Civil Defense Plan.

     FEDERAL ASSISTANCE TO DISASTER AREAS. This division in conjunction with the Division of Environmental Health conducts damage assessment estimates and final inspections relative to public health facilities following natural disasters when requested by the Office of Emergency Planning for the purpose of administering Public Law 875.

     The State Board of Health created the Division of Radiological Health on September 17, 1962. The initial function was to conduct an environmental surveillance program of radiation in air, water and precipitation.

     The 1963 Radiation Control Act designated the Department of Health as the agency responsible for radiation control programs designed to protect the public health and welfare. The act created a nine-member Radiation Advisory Council, appointed by the Governor. It also authorized the department to conduct radiation safety inspections, to register sources of radiation and develop radiological health regulations. The act permitted an agreement between the Governor and the federal government to transfer licensing of radioactive material to the state.

     Provisions of the act were implemented by the Division of Radiological Health in 1966. Radiological Health Regulations became effective October 1, 1966. Functions of the Division of Radiological Health are:

      a) Environment surveillance of radiation in air, precipitation, surface water and milk.

     b) Radiation protection surveys of radiation sources to minimize radiation exposures to workers and the public.

     c) Licensing of radioactive material since October 1, 1966, via an Agreement between the Governor and the U. S. Atomic Energy Commission.

     d) Registration of non-licensed radiation sources, such as radium and X-ray equipment, since January 1, 1967.

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     e) Assistance, advice and educational service to radiation users and interested professional, civic and educational groups.

Assistant Director and Chief Examiner-Walter J. Madden

Chief Actuary---Gary C. Robinson

Department Attorney---Bernard Wishnow

Assistant Department Attorney---James F. Janke

Claims Attorney---Joseph Badami

Supervisor, Property Division---Gayle R. Voller

Supervisor, Casualty Division---Howard Christensen

Rate Analyst---Tim Wagner

Supervisor, Health Division---Warren E. Jennings, Jr.

Claims Supervisor, Earl B. Nelson

Total number of employees: 34.

     Publications: Summary of Insurance Business in Nebraska, annual; Official Biennial Report; Insurance Laws; Agents Manual; Monthly Report.

     The first complete Insurance Code to be enacted in Nebraska was in 1913. It provided for an Insurance Board to administer the code. Prior to 1913 the Territorial Auditor and later the State Auditor had issued certificates to insurance companies and exercised some powers in connection with investigation and inspection of insurance companies. (For a complete history see earlier editions of the Blue Book.) The duties of the Insurance Board were given to a Bureau of Insurance in the Department of Trade and Commerce by the Civil Administrative Code of 1919. In 1933 the bureau was made the Department of Insurance. In 1947 the Legislature enacted a group of laws which modernized the 1913 code. Two rate regulation laws were passed to make it mandatory for all casualty and fire insurance companies to file their

     _____
     ¹Mr. Barrett will resign June 30, 1967. Benjamin C. Neff, Jr., Lincoln; will become director on July 1, 1967.

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rates with the newly formed Rating Division of the Department of Insurance. An Unfair Trade Practices Bill defining unfair trade practices in insurance and a law governing the contents of accident and sickness policies were passed. Provision was made by these 1947 laws for the Insurance Department to employ an actuary, actuarial examiners, a chief examiner and junior and senior examiners. Qualifications for each position were defined and a committee on Insurance Department Personnel was established.

     The Committee on Insurance Department Personnel is composed of four persons appointed by the Governor for four-year overlapping terms. The members must be actively engaged in the business of insurance and must advise on the selection of examination and actuarial staff. The members of the committee serve without compensation.

     Many important pieces of insurance legislation were also enacted by the 1949 and 1951 sessions of the Legislature. These included such important statutes as the provision for service of process on unauthorized insurers, amendment of reserve requirements of fire and casualty companies, changes in the laws relating to investments, new statutes governing reciprocal exchanges, the writing of group life insurance, multiple line underwriting authority, revision of the premium tax law, valuation of securities participation, and adoption of a new uniform health and accident standard provision law. The 1955 Legislature transferred from Board of Educational Lands and Funds to Director of Insurance the duty of the bonding of state officials and employees.

      At the 1959 legislative session reserve requirements for fire and casualty companies were further strengthened. Also at this session important legislation was passed to provide for the regulation of life, accident and health insurance sold in connection with installment loans or other credit transactions.

     The 1961 Legislature amended prior laws governing the licensing of insurance agents providing that they be certified as to their training and setting forth the grounds upon which such licenses should be denied and cancelled. In addition, a separate accounts law was passed providing for the issuance by insurance companies of certain annuity-type contracts subject to relaxed investment limitations.

     The 1963 Legislature subjected unincorporated mutuals to limited regulation by the Department of Insurance. In addition, a bill was

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enacted in the 1963 Session requiring protection against uninsured motor vehicles and hit and run vehicles be offered with each motor vehicle liability policy. This session also provided for the filing and approval of life insurance and annuity forms issued in Nebraska.

     The 1965 Legislature enacted a securities registration law which subjects insurance company securities sales to regulation by the Department of Insurance. The Legislature also increased the capital and surplus requirements for companies newly organized or applying for admission to do business in Nebraska.

     The Department of Insurance reports that there were 37 domestic life and 250 foreign life companies doing business in Nebraska in 1965, along with 77 domestic fire and casualty companies, 405 foreign fire and casualty companies, 2 domestic fraternals and 40 foreign fraternal societies. The total premium income in Nebraska of 116 domestic and 695 foreign insurance companies in 1965 amounted to $430,022,169, a substantial increase over any previous year. During 1965 these companies made the following payments to Nebraska policyholders:

     Nebraska companies received a 1965 total premium income from their business in Nebraska and throughout the Nation and Canada of $707,231,695. The total of premium tax and miscellaneous fees paid to the State of Nebraska by the 116 domestic and 695 foreign insurance companies doing business in Nebraska for the year 1965 was $5,721,869. The insurance industry in Nebraska is recognized nationally as one of the rapidly growing leaders in the Nation, exceeded in total income only by the income of companies in the largest states.

State Fire Marshal---Don H. Venter.

Total number of employees: 9.

Publications: Annual Report.

     The Fire Commission was created by the Legislature of 1909. The Governor was the Fire Commissioner, and appointed two deputies, one of whom was required to live in Lincoln and manage the office. These duties were transferred to the Division of Fire Prevention in the Department of Trade and Commerce by the Civil Administrative Code. In 1925 the law was rewritten and provision was made for a State Fire Marshal to be appointed by the Governor. The State Fire Marshal was placed under the general direction and supervision of the Secretary of the Department of Trade and Commerce. In 1933 when the Department of Trade and Commerce was abolished the State Fire Marshal was placed

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