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HomeMy WebLinkAboutMinutes - 19770125so P'iINUTES ORANGE COUNTY BOARD OF COP9MISSIONERS JANUZ~RY 2 5 , 19 7 7 The Orange County Board of Commissioners met in special session on Tuesday, January 25, 1977, at 7:30 p.m., in the Commissioners' Reom of the Courthouse in Hillsborough. Members persent were Chairman Richard Whitted, Commissioners Norman Gustaveson, Jan Pinney, Norman taalker, and Donald Willhoit. Others present were S. M. Gattis, County Manager, Neal Evans, Finance Officer, and Tom Johnson, Director of the Southcentral Office of the Division of Health Services at Fayetteville, N. C. Chairman Glhitted stated that the the January 10th meeting, the Board of Commissioners had scheduled a meeting with Mr. Johnson to discuss specific programs and the impact on these programs should Orange County decide to withdraw from the health district. Mr. Whitted introduced Mr. Johnson, who stated that he had reviewed major programs in the district which received categorical State ar Federal funds through the Division of Health Services. He stated that there was currently $31,382 of chronic disease funds coming into the District Health Department. Services being provided with these funds are glaucoma testings and multiphasing screening provided by Ferson County. Lee and Chatham Counties have glaucoma testings with Chatham County providing a cancer detection program in Siler City. Orange County has glaucoma testings and multiphasing screening and these programs are supported through the general district funds rather than through categorical grant funds. Mr. Johnson stated that the program manager for chronic diseases had indicated that an effort would be made if there is a change in the district to continue funding the staff which is now being funded, therefore, in regard to chronic dis- ease funds in Orange County, the majority of funds would go to the district instead of Orange County. Tn the area of Family Planning, Orange, Chatham and Lee Counties are receiving a grant Pram the Division of Health Services in the amount of $68,209. Mr. Johnson estimated that Orange County received approxi- mately $26,000 of these funds. He added that Person County is currently receiving $32,000 from Region K and Caswell County, though not receiving such funds, is eligible. In the Home Health Agencies, Orange County, Person and Chatham Counties receive $48,000 in fees. These counties operate as independent county agencies so there would be no effect should there be a split, except far some arrangement for the continued servide of a physical therapist. He added that fees were collected on the basis of services rendered, so the funding level would remain the same. Mr. Johnson stated that the largest grant coming into the District Health Department is the Maternal and Child Health Fund which amounted to $132,610 far this year. Funds are distributed statewide based on a formula. Should Orange County withdraw from the district, this formula would be reapplied to the district and to Orange County. A redistribu- tion would result in Orange County getting 25.7 percent oz" the original funds. Based on the existing personnel being funded by Maternal/Child Health in the district, Orange County could expect an increase of 10 per- cent or $13,000 and a like decrease for the district. He stated there were $27,433 School Health Funds which are allocated, on a County by county basis. He spoke of a Hypertension Program in Lee County which would not be affected. Mr. Johnson stated that any change in the District Health Department would not result in the sacrifice of services or any. loss in State or Federal funds needed to provide those services. In general, he added that Orange County would neither earn or lose funds by withdrawing from the district. Commissioner tdillhoit asked how is funding determined for specific programs such as the Hypertension Program in Lee County. Mr. Johnson stated that decisions axe made by the State Project DRanagers based on a variety of factors such as level of need, population, existing services, etc. 61 Commissioner Gustaveson asked what would be the consequences to the other counties should Orange County withdraw from the district in regard to the on-going programs. Mr. Johnson replied that the only effect he could speak to would 'be the effect of cost. He added that the Counties could assume that the administrative, cost would increase. Mr. Gustaveson asked if Mr. Johnson knew of other counties who were not part of a district, but had joint programs to provide professional services through an inter-local agreement. Mr. Johnson stated he know of services being provided only in the administrative area. Commissioner Gustaveson inquired if Mr. Johnson had any experience of negative impact to other counties in terms of programs. Mr. Johnson stated that there would be little ar no effect, except the fact that since Orange County had the Medical Center located here, it could be more difficult for other counties within the district to obtain the special medical expertise, since the Medical School would no longer be within their district. This is a concern particularly within the Prenatal Program. Chairman Whitted summarized Mr. Johnson's presentation. He stated that from what he had heard, should the district split, there would nd~. be any serious curtailment of programs provided by the State in the District. The increase cost would be in administrative cast of personnel. Commissioner Pinney asked if it was not true that there was a cost saving by use of district personnel. Mr. Johnson replied, "yes". Chairman Whitted asked Dr. Fuller the number of personnel that is shared by more than one county within the district. Dr. Fuller stated there was a nurse supervisor, an assistant supervisor, a sanitarian and health director, two secretaries, one physical therapist, one health educator, a dental hygienist and a dentist. . Mr. Johnson stated that additional concerns were should Orange County withdraw from the district, it could possible result in further split of other counties from the district and a further split would cause severe proglems, since the other counties were small. Another concern was the existing personnel. Some serve the entire district and some work only for Orange County. He added that if Orange County withdrew there would be a suzplus of employees within the District Health Department. These employees are those working for the district within Orange County. He suggested that the Orange County Board of Commis- sioners go on record stating that employees would be rehired to work for the Orange County Health Department. He stated that the reasons the Orange County Commissioners had stated for desiring to withdraw were somewhat obscure. He urged the Board to be as specific as possible in identifying the problems and to be logical in seeking a solution. Chairman Whitted read a resolution from the Chatham County Board of Commissioners expressing the desire that the five county health district remain as it is presently constructed. Representatives from Lee and Person Counties stated that their Boards - of Commissioners concurred with the resolution presented from Chatham County. Jack Woods, a Commissioner from Caswell County stated that Caswell County had some question of the possibility of Caswell County joining with Region G for health services. The Orange County Finance Director reviewed with the Board a financial feasibility report of the County's withdrawing from the Health District. He stated that it appears that it would cost Orange County approximately $-80,000 additional dollars over and aboard what is being allocated now to fund a health department similar to what the County is now receiving and with additional administrative staff. He added that if Orange County chose to remain in the district, and to work to strengthen the present arrange- ment, the cost would be approximately $42,OOD to pay for programs the County had stated they desired. sz He added that according to General Statutes, Orange County would be entitled to 35 percent of any fund balance within the District Health Department. The County Manager stated that he had talked with sevezal counties who had withdrew from the district arrangement. Their reason for with- drawing was the lack of a response from the district board. Financially, the counties felt that the split had not cost any extra dollars. Dr. Fuller informed the Board of a meeting scheduled for February 2, 1977, at 8:00 p.m., at the Pines in Chapel Hill. This meeting is with the District Health Board. The Chairman stated that the Board was now ready to explore con- ditions for Orange Gounty to remain within the district. He stated that his concerns were: (1) The inability to evaluate the health needs and budget needs for the County of Orange. (2) The structure of the District Health Board, the lack of Board meetings, and the lack of Advisory Boards to meet the health needs in the County. He apoke that there was a need for an active viable District Board. (3) He spoke of his experience on the Health Task Force, which indicated insufficient efforts to search out the health needs of the County. He stated if Orange County stayed in the District, these needs should be met. Commissioner Gustaveson stated that he felt the District Health Board failed to see its role as a active viable planning agency, which is responsibe to the changing character of the delivery of health cane. He added that citizens should have na input in identifying health pro- blems. The staff of the Orange County Health Department has had diffi- culty in contacting the District Board of Health to develops their own ideas. Commissioner Gustaveson stated that Orange County must be assured it has a responsibe District Bord. Responsive to the concerns of the staff, the governing body, and the citizens of Orange County. Commissioner Pinney stated if Orange County stayed in the district, all Counties would be required to allocate more monies to the District Health to pay for the changes and additions recommended. He added that the other counties should recognize that Orange County could withdraw at any time from the district, if these recommendations were not instituted. Commissioner Willhoit stated that the composition of the District Board should provide equitable district-wide representation. He added if Orange County is providing 35 percent of funding, he felt Orange County could expect 35 percent representation on the Board. He spoke of the salaries which were at the botton of the scale. Mr. Willhoit stated that the fund balance within the Health: Depart- ment's budget was not a measure of effectiveness, and that a primary concern of his was a working relationship between the School of Medicine ,• School of Public Health and the Health Department. He added that Orange Chatham Comprehensive Health Services had not been utilized effectively. Mr. Willhoit reminded the Board that at one time an engineer had been employed by the Health Department and he felt there was a need for the hiring of another engineer. Commissioner Walker stated that the District Hoard of Health was moving to correct some of the concerns which the Commissioners had expressed and hoped Orange County would stay in the District. Commissioner Gustaveson stated that some of the members of the Board of Commissioners had serious concern about withdrawing from the District and were trying to take a serious look at the consequences for the other remaining counties. He added that the Board would look for possible options and alternatives from withdrawing from the district. xe stated that if withdrawing looked as if it would create a real dis- aster in some of the smaller counties, he certainly would want to look at another option, other than a single county district. He suggested further that some of the Commissioners from the other counties respond concerning their estimates of health needs of their county. u3 Commissioner Willhoit stated that he would like to see this Board attempt to arrive at what we think the basis problems ara, and then see if these problems can be worked out. Commissioner Finney suggested that if the Orange County Board agreed to remain in the district, they should guarantee the other Boards to stay in the district for a certain period of time and then take a later look at the situation. The Board of Commissioners agreed to compile a "laundry list" of con- cerns within the District Health Department. The first item discussed was a mox'e active District Berard of Health. Discussion ensued concerning laymen - serving on the District Health Board. Chairman Whitted spoke of a commitment on the part of board members to be active and interested in the positions they held. He asked that the other counties evaluate their membership to the Health Board.. Representa- tives from Chatham, Person and Caswell Counties stated that they would like to see a more active board. The second matter discussed for the "laundry list" was the position of a Health Administrator. Commissioner Walker stated that no decision had been made regarding the position, however, recommendations would be made to the Health Board. Chairman Whitted stated that he felt the Health Administrator and the Health Director shauld be two separate positions with one position respon- sible to the administrative duties and the other responsible to the clinical duties. Commissioner Gustaveson stated that he felt there was a cluster of problems within the structure of the District Health Department which needed to be re-organized and input was needed from all five counties in order to work out these problems. He stated further that Orange County needed assurance that the District Health Board would listen to citizens' concerns or even concerns of this Board about inadequate health delivery of services. -.-. Chairman Whitted stated that his earnest desire was far Orange County to have a viable Health Department which was a responsible agency within the community, whether it was a four county, three county, two county dis- rict or a one county district. He stated that Orange County would meet with the District Health Board on the 2nd of February and would reach a decision as soon as possible. The Board discussed briefly a.._work session for either January 31th, or February 1, 1977, to reach a consensus regarding the District Health matter. The meeting was then adjourned. ~ 1. ~~ ~Richar~ Whitted, Chairman Agatha Johnson, Clerk