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HomeMy WebLinkAboutMinutes - 19770110~s MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS JANUARY 10, 1977 The Orange County Board of Commissioners met in special session on Monday January 10, 1977, at 7:30 p.m., in the Commissioners' Room of the Courthouse in Hillsborough. Members present were Chairman Richard Whitted, Commissioners _ Norman Gustaveson, Jan Finney, Norman Walker and Donald Willhoit. --' Others present were S. M. Gattis, County Manager, Neal Evans, _ Finance Director, and Agatha Jahnson,Clerk to the Boad. Representatives from Caswell County were R. L. Honeycutt, John B. Woods, Bobby Aldridge and Maud Gatewood. Representatives from Chatham County were Perry Harrison, Gus Murchison, Jr., Earl bark, Earl Thompson and R. E. Beauchaine. From Lee County were representatives Gordon Wicker, Frank Wicker, and Elvin Buchanan. Representatives from Person County were Roy L. Lowe, J. B. Oakley, C. W. Hughes, and George Jackson. Also present were Dr. CoroDon Fuller and members of the District Health Department staff and members of the Orange County Community Health Task Force. Chairman Whitted stated that the Orange County Board of Commissioners had decided at their January 4, 1977, meeting to gather information of the effects of Orange County withdrawing from the district arrangement as it currently exist. He stated that the question of whether the district arrangement was the best method of health delivery for Orange County citizens had been consider over the years and the Commissioners had decided in December of 1976, to look at the entire issue of health services in Orange County. Chairman Whiffed recognized Mr. John Perkinson from the Division of _ Health Services in Raleigh. The Chairman stated that his concern in withdrawing from the district is the effect of funding which counties receive from the State and Federal sources and the feasibility of such __ a move and how this move would effect the delivery of services in Orange County. Commissioner Willhoit stated that he felt it was important to in- form the people present from other counties that Orange County basically feels that health needs of the county are not being met through the pre- sent arrangement, and that this meeting tonight is a fact finding meeting of the implications, should Orange County decide to withdraw. Commissioner Gustaveson stated that Orange County needed the wisdom from the Division of Health Services as to what is involved in withdrawing from the district arrangement. He added that he would like to hear of other counties who have made similar moves and the problems involved as well as the consequences. He pointed out that Orange County was concerned for the other counties within the district and would like to look at some of the problems they would face by Orange County withdrawing. He added that he was hopeful that Mr. Perkinson would help the County to come to some good policy decision at same later point. Mr. Perkinson stated that this district had been the largest district in the State for a number of years, and perhaps the oldest district in the State. He added that the Board would need to talk further with representa- -- fives from the Division of Health Services as well as representatives from the Southeastern Regional Office in Fayetteville. He introduced to the Board Mr. Tom Johnson, Director of that office. - Mr. Perkinson stated that in the area of delivery of services, Orange County would have to look at the individual needs of Orange County as compared to the individual needs of other counties within the district. He stated that Orange County may have health needs which did not exist in some of the smaller counties. He added that in general, the Division of Health Services supported the concept of district affiliation, however, this is not a hard and fast rule for delivery of services. He said that smaller counties had more to gain with affiliating with larger counties because smaller counties do not have the large tax base. ~"~ Mr. Perkinson stated that concerning the financial aspect, he had talked with program directors regarding the monies in the district and how these funds might be handled and what might be available if Orange County withdrew from the district. He added that exact dollar figures were not available at this time. Should there be a separation from the district, there would be no lessening of revenues available to the five counties as a total. Orange County would continue to receive its pro rata share of what goes into the district. He added that the Health Aid to Counties monies which came through. his office amounted to $137,000 for the entire district. If Orange County withdrew from the district, $42,300 would remain with Orange County. These monies 'are available through a base allocation established prior to fiscal year 1970 and 1971. At that time,, monie~ were allocated on a Gounty basis. All counties in the State were allocated a flat $4,000 per county, regardless of size. Another $1,000 per county was allotted for the retirement system for employees in the Health Department. The. remainder of appropriation from the General Assembly was distributed on a per capita basis. In 1971, this was approximately 33 cents per capita. Orange County's share of the }case allocation would be a little more than $37,000. He added that since 1971, other monies have been allocated to the district. The population base used is the 1970 census and historically, this figure will be used until 1980. Tom Johnson from the Regional Office of Health Services in Fayetteville, stated that there was a limited amount of moves available on the formula quoted by Mr. Perkinson, and only a portion is determined by population. He added that the district had an excellent record for obtaining funds and that since Orange County had the N. C. Memorial Hospital and the School of Public Health, the health needs of some of the smaller counties helped to attacht funds to the entire district. He spoke of the funds for special programs and stated that it was an advantage to have a wide variety of population combined in one district when seeking funds. Mr. Perkinson informed the Board that program monies received in the district had almost tripled. There :is $327,000 of programatic monies going into this district. Commissianer Gustaveson asked what is the State's role related to problems in other counties in the district should Orange County decide to withdraw? Mr. Perkinson replied that the primary concern would be to continue operation of existing programs. He added that people were available on all levels within the State to help counties with problems. Chairman Whitted asked if the State contracted for specialized services within the different counties? Mr. Perkinson replied that all attempts would be made to continue services which are now available. Commissioner Gustaveson asked how much lead time is necessary to withdraw from the district for the upcoming budget year to enable the other counties to deal with the withdrawal in their budgets? Mz. Perkinson replied that from past experience, discussion would have begun six to nine months prior to the separation. He added that most separations had brought about problems such as inadequate budget preparation. He emphasized that all cast factors should be considered beforehand. Mr. Perkinson stated that many of the questions are not going to be answered until individual counties consult with representatives of the specific programs on an individual basis. Mr. Johnson added that many of the problems in the program area would have to be worked out by the health departments themselves. He urged the Board to decide what they wished to do and then work to accomplish that goal. Commissianer Willhoit asked Mr. Perkinson if he had said that there was $324,000 allocated to the district for programs, $137,000 is the base for funding, and that Orange County would be eligible for a pro rata share of the programs for which we have a need? 48 Mr. Parkinson replied that this was correct. Commissioner Gustaveson asked if one county could contract with another county with an inter-local agreement to provide program ser- vices? Mr. Parkinson replied, "Xes, this is being done with some scattered incidents in North Carolina." Mr. Gustaveson inquired of potential problems that the County might encounter. He stated that he had listed inadequate budget propagation, the transition problem of administration and recruiting. "What other pitfalls are there?" - Mr. Parkinson stated that one problem would be the redistribution of the existing staff and the administrated problems such as retire- ment system and social security: These matters xequire resolutions by the Board of Commissioners in the district. xowever, he added thak the biggest problem is the financial area. He added that each program will be looked at separately by the funding source as to which County the program will remain in. Chairman whitted stated that Orange County should schedule a meeting with representatives from the Regional Office to talk about these specific programs and determine the district arrangement of the specific program and haw they relate to other counties. The question was asked that if Orange County withdrew and this left two counties to the North and two counties to the South of Orange County, could these four counties continue as a district. Mr. Parkinson replied "yes" they could continue to operate as a four county district. Discussion ensued as to why Orange County was considering options for providing health services other than the district arrangement. Chairman Whitted stated that for a number of years this Board has been concerned with making appropriations to the district agency and had felt we were not getting the type of information to judge as to whether or not the district health arrangement was cost effective or not. He spoke of the formation of the Orange County Community Health Task Force which had experienced problems in gathering information from the District Health Department to provide to the Commissioners. He stated that one concern of the Board was the representation on the District Health Board. That this representation was not broad enough to speak to all the needs in Orange County. Dr. Fuller had advised the Board that Advisory Boards would be set up for the district to provide broader repre- sentation (this was told to us in October of 1975). The Board has express- ed the need for a Health Administrator and no movement has been made on the Advisory Boards nor the Health Administrator. Mr. Whitted added that Orange County has been concerned about the district board involving itself in the policy and decision making of the District Health Board. Further, he stated that the County Task Force appeared before the District Health Board to present an interim report and came away with less than a favor- able impression because of the reception they received. Commissionez Gustaveson stated that he felt` the leadership role of the Director is tao much for one man who also does the clinical work. Dr. Fuller admitted this at past meetings and has said that a top priority is to hire a Health Administrator. This has been said many times, however, no movement has been made to carry out these top priorities. He added that over the years, the District Board has not been responsive to the particular needs of Orange County and the leader- ship of the Department has not been responsive .to this Board of Commis- sioners. He added that the people we represent in Orange County are deeply concerned. He said it was his feelings, and the feelings of other members of this Board that the County should consider the question of moving on some important questions of health care in Orange County. He reiterated that the Board had not come to this question hastily, but had given it much consideration and wants to look at all the implications and consequences involved, not only to Orange County, but to the other ~~ counties in the district. He added that there were many organizational structures to be put together, however, Orange County's first concern was to provide the best health delivery of services to its citizens. Commissioner Walker asked what could be done to strengthen the district to satify this Board without withdrawing from the district. He stated that he had been happy with the district arrangement and wanted to work to cooperate in any way. Commissioner Gustaveson stated that this would involve a number of major changes because the present structure is not sensitive to the needs of Orange County. He added that he wanted to consider all options. Chairman Whitted stated that Orange County was rapidly becoming an urban county and that some of the problems that relate to the sanitarian could best be met by a single county. He added that one question which has arose was.."can the district have separate ordinances or regulations for one particular county and one answer has been that it has to be on a district-wide basis. If this be the case, do we have enough similar problems to have these kinds of single regulations to apply district wide? Discussion ensued. It was pointed out that the District Board of Health had the authority to pass regulations which apply to the entire district, but does not have the authority to pass regulations for parti- cular counties. This action is left to the Board of Commissioners in the individual counties. Mr. Hezekial Dobson of the Health Department informed the Board of a Public Hearing scheduled for January 19th at 4:00 p.m., at the Research Triangle concerning "Drinking Water Standards," Commissioner Pinney asked if 'the other counties within the district would express their feelings concerning the District Health arrangement. Discussion ensued. Members from the other counties, many of whom are members to the District Health Board, stated that they felt the district had delivered health care efficiently over the years and they urged the Orange County Board to submit their concerns to the District Health Board to see if a solution could be reached within the District before finally deciding to withdraw. Commissioner Willhoit stated that there seemed to be a problem with the concept of what public health is about., He stated that his feeling was that the District Health Board had been unresponsive to the changing needs in public health. He added that a forward looking Board is needed. He asked if there were any analysis of the quality of different health boards in North Carolina and how does Orange County measure? ASr. Whitted stated that a genuine concern of the Orange County Board of Commissioners was to have a responsive delivery of health services for the citizens of Orange County. Commissioner Pinney suggested that the Board meet with the District Health Board and discuss problems and to get answers. Commissioner Walker stated that he agreed with Mr. Pinney's suggestion. The Board requested Tom Johnson of the Regional Office to attend the scheduled January 25th meeting to discuss with the Board the ser- vice programs. The other four counties within the district were also invited to attend this meeting. Commissioner Walker was requested to inform the Board of the next .. - meeting of the District Health Board. Commissioner Walker moved that they/m~eetSi!ing~~{ad'. u n Richard Whitted, Chairman Agatha Johnson, Clerk