Loading...
HomeMy WebLinkAboutMinutes - 20081124 APPROVED 1/22/2009 MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS JOINT WORK SESSION WITH BOARD OF HEALTH November 24, 2008 5:30 p.m. The Orange County Board of Commissioners met for a joint work session with the Board of Health on Monday, November 24, 2007 at 5:30 p.m. at the Link Government Services Center in Hillsborough, N.C. COUNTY COMMISSIONERS PRESENT: Chair Barry Jacobs and Commissioners Valerie Foushee, Alice Gordon, and Mike Nelson COUNTY COMMISSIONERS ABSENT: Commissioner Moses Carey, Jr. COUNTY ATTORNEY PRESENT: Brian Ferrell COUNTY STAFF PRESENT: Assistant County Manager Gwen Harvey and Deputy Clerk to the Board David Hunt (All other staff members will be identified appropriately below) BOARD OF HEALTH MEMBERS PRESENT: Chair Christina Harlan, and members Timothy Carey, Ernest Dodson, James Stefanadis, Matthew Vizithum and Michael Wood BOARD OF HEALTH MEMBERS ABSENT: Vice Chair Anissa Vines and members DeWana Anderson and Jessica Lee BOARD OF HEALTH STAFF PRESENT: Health Director Rosemary Summers, Wayne Sherman, Angela Cooke, Donna King, Carla Julian, and Tom Konsler NOTE: ALL DOCUMENTS REFERRED TO IN THESE MINUTES ARE IN THE PERMANENT AGENDA FILE IN THE CLERK'S OFFICE. Dinner 5:30 to 6:00 pm Welcome and Introductions Barry Jacobs, Chair Highlights from the Health Department Rosemary Summers, Health Director Rosemary Summers introduced the newest board member, Michael Woods. She gave a PowerPoint presentation. 2007-2008 Year in Review Orange County Health Department Overall Department Finances - Final revenue and expenditures were $7,081,462 for the year - $436,501 in grant funded projects - $241,050 in additional revenue after budget approval, usually for designated purposes - $1,436,813 in fees and reimbursements - County general fund supports 64% of budget; 9% is state and federal Accomplishments - Accredited with 100% benchmarks and activities being met - Community Health Assessment recognized as state and national model for community involvement - National pilot study on water softener effects on septic tanks leading to new national standards initiated by EH staff with NCSU - Coordination and collaboration with community o Central Carolina Community Care Network o Coordination of Diabetes Task Force o Refugee Health Service Collaborative o Latino Health Coalition o Leadership roles in Project Homeless Connect o Four active committees on Health Carolinians priorities o Communities that call on us (bedbugs, biosolids) - Tobacco Reality Unfiltered in 6th year of grant funding has active teen clubs in each high school - Engaged 9 African-American churches in Eat Smart Move More activities through mini- grants - Refocused staffing to be able to serve over 200 refugees - Served 3,642 people in dental clinics, 12% new; 1,801 uninsured; May 08 full-time dentist - Provided dental health education to 5,092 - Served 4,803 patients in preventive care clinics; performed 5,568 tests for sexually transmitted infections; and served 398 with primary care - Over 90% of prenatal patients had newborns with a healthy weight - 51 new volunteers to the Public Health Reserve Corps; 92 volunteers have served in ongoing programs - 32 residents trained through CERT program - Implemented 5 community wide education campaigns - Board has adopted revisions to Well Rules and On-Site Wastewater Rules Challenges - Retirements (3 last year; 2 anticipated)/staff turnover with replacements being inexperienced - Exploding interpretation/translation services for multiple languages - Effects on services using interpretation services - Managing and balancing priorities between mandated services - Shrinking federal and state funds due to Orange's status as "high wealth" county - Shrinking pots of grant funds and inability to sustain proven programs after grant funding - Full funding for two site service model Chair Jacobs asked about the drop in federal and state funds because of being "high wealth" and asked about partners with other counties to attract more State funding. Rosemary Summers said that there is a partnership with Person County because there was an opening and there was interest. There can be more regional collaborations. The problem is that most grant funds are federal and it is not known what will happen. Topical Presentations 1) Prevention, Investigation and Control of Communicable Disease Dr. Tim Carey, MD Mandated Service: Communicable Disease investigation and control is a mandated service of local Health Departments per North Carolina General Statute 130A, Article 6 and North Carolina Administrative Code Communicable Disease Statistics: In 2007-08, Communicable Disease (CD) activities increased significantly: - 11 cases of active TB disease received 6 months of Directly Observed Treatment - 492 TB contacts of the 11 active cases needed follow-up and evaluation - 90 latent TB cases received 9 months of preventive therapy - 4,341 childhood and adult immunizations were provided (other than flu) - 227 refugees received communicable disease screenings - 3 food borne illness outbreaks were investigated and controlled - 139 reported CD cases/conditions (other than TB) were investigated and/or monitored with follow-up to 421 contacts provided - 370 rabies exposure consultations were provided Challenges: - 30% increase in workload related to new North Carolina Electronic Disease Surveillance System (NCEDSS) - Growing foreign-born immigrant and refugee population - 35% increase in demand for childhood immunizations. - Limited opportunities to practice mass vaccination clinics. - Explosion in the number of refugees resettling in Orange County. - Lead testing rates have remained at a very low level with limited ability to focus on gaining compliance from private providers for testing. Response: - Re-directed existing nurse with part-time refugee duties to full-time refugee health - Re-directed the duties of an adult health nurse to provide part-time communicable disease services and lead-based prevention program initiatives. - Severely limited the chronic disease care coordination program for elderly. - Discontinued the community-based rapid results HIV testing program. - Discontinued the lay health advisor program for community HIV education. - Eliminated community-based flu clinics other than for high-risk populations Need: Additional communicable disease nurse to: - Assure timely investigation and follow-up of communicable diseases - Provide nursing follow-up and data management of NCEDSS cases - Provide rapid HIV counseling and testing program in high-risk communities - Provide additional childhood and adult vaccinations - Work with private medical providers to increase the number of children receiving blood lead tests 2) Facilities and Technology Dr. Matt Vizithum, OD Facilities - Renovations needed at Whitted with move of DSS in 2009 - Submitted "Facility/Property Acquisition/Other Infrastructure Needs Annual Operating Impact" to County CIP Team o Health Department move to Hillsborough Commons in 2013 ($10 million) o Dental and medical clinics at SHSC in 2011 ($8.5 million) Questions - Commitment to dual dental facilities in county o Efficiency in 5 day/week operation at both locations o Carr Mill Mall lease and space limitations o SHSC expansion timing and size - Facility planning impacts on service delivery for next 5 years Technology Recent Technology Advancements for Department - Statewide initiatives: Health Information System (HIS), NC Electronic Disease Surveillance System (NCEDSS), NC Immunization Registry (NCIR) - Custom Data Procession (CDP) software for facility inspections - GPS field units for Environmental Health on-site and well programs Continuing an Emerging Needs - Approvals to move forward with digital equipment and software for dental clinics - Replacement of the "Time Study Program" used to account for personnel time in each program area - Mobile hardware for environmental health facility inspections - Training and resource commitment for GPS technology - Replacement needed for Acella Software— Permit Plus for environmental health functionality Commissioner Gordon arrived at 6:22 p.m. 3) Advancing the Strategic Plan for the Health Department Chris Harlan, RN Current Strategic Plan There were four Community Programming focus areas in the Strategic Plan. Three will be addressed this evening. 1) Access to Medical/Dental Services with Emphasis on Disparity Outcomes o Second priority identified by community in 2007 Community Health Assessment o Increasing uninsured/underinsured populations; the 2005 estimate is 32,208 people with no insurance Dental o Patient waiting lists at both locations o 46% of patients are 0-80% of sliding scale and 35.6% Medicaid o Enormous need for interpreter services o Limited access at two sites due to staffing limitations • Next Steps/Needs • Fund permanent staff to support two full-time clinics • Add interpreter to staff to reduced contract interpreter costs • Preventive dental package for local small businesses Medical o 10,000 clinical visits in 2007-08 not counting flu shots o Primary Care medical home for over 400 residents; 75% of sliding scale pts at 0- 40% o Primary Care services supplemented by grants • Next Steps/Needs • Stabilize staffing by transitioning grant funded temporaries to permanent • Collaborate with Piedmont Health Services for preventive service package for small local employers 2) Chronic Disease Prevention o 11,930 children (38.5%) who are obese; 2-4 year olds higher than state average o Diabetes rates are growing in children and adults across the state o Uncoordinated activities throughout county on obesity reduction o Concentrated focus area for all funders both public and private • Next steps/Needs • Collaborate with medical providers to sponsor diabetes self- management programs through Statewide Diabetes Umbrella and on tools for obesity prevention • Work with Health Carolinians to adopt and promote a coordinated county-wide plan and messages for obesity reduction using Eat Smart and Move More Tools • Seek funding resources to increase part-time nutritionist to full- time 3) Protecting Orange County Water Resources o Continues to address a Board of Health Initiative proposed in the early 1990's o Addresses directly human health impacts of water resources • Next steps/Needs • Septic system repair fund for low-income residents • Pursuit of a pilot project to expand WTMP septic system monitoring in critical watershed areas through Clean Water Management Trust Fund grant. Rosemary Summers said that, in looking for grants for building septic systems, sometimes there can be tags on grants for repairing failing septic systems. She asked that the County Commissioners keep an eye out for these grants for septic systems. Clarifying questions were asked by the County Commissioners and answered by Rosemary Summers. Chair Jacobs asked how Orange County works with undocumented people. Rosemary Summers said that she thinks the Health Department does a good job of helping people feel safe. The Latino population really trusts the Health Department to provide services appropriately. The primary medical home for the Latino population is Carrboro Community Health Center. Rosemary Summers asked the County Commissioners for a single issue for the Health Department and the Board of Health to work on. Chair Jacobs said that his issue is the rental at Carr Mill Mall and he wants to identify a funding source for a dental clinic. Commissioner Foushee agreed and spoke in support of a full- time dentist. Commissioner Nelson said that he is very worried about the fiscal situation and he wants to look at the priorities. He would like to be as creative as possible with funding and the services and see if there are programs that are not needed anymore. Commissioner Gordon agreed. Gwen Harvey pointed out that the Health Department has really been conscientious with looking at services that are mandated. Rosemary Summers said that the new County Commissioners would be coming for a visit next week, and she invited any existing County Commissioners to come for a tour of the facilities at any time. A motion was made by Commissioner Foushee, seconded by Commissioner Gordon to adjourn the meeting at 7:02 pm. VOTE: UNANIMOUS Barry Jacobs, Chair Donna S. Baker, CMC Clerk to the Board