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MIDTUTES
ORANGE COUNTY BOARD OF COMMISSIONERS
FEBRUARX 1, 1977
The Orange County Board of Commissioners met in special session on
Tuesday, February 1, 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 Pinney, Norman Walker and Donald Willhoit.
Others present were S. M. Gatos, County Administrator, Neal Evans,
County Finance Director, and Agathat Johnson, Clerk.
The Chairman stated that the purpose of the meeting tonight was to
reach a consensus of how Orange County thinks the District Health Depart-
ment can be strengthened in order for Orange County to remain in the
District.
Commissioner Gustaveson stated that he felt it would be useful to
highlight some of the basic conerns which had been pointed out to the
District Health Board. He suggested that the Board look at the present
District Health structure and haw it should be in the future and then
look at a single county structure and decide which structure would best
meet the needs of Orange County.
Commissioner Willhoit stated that he felt the health needs of Orange
County could be met by either structure, the District Health arrangement
or a single county district. He added that his question was how to re-
structure the present District Board to be certain they are responsive
to the needs of citizens. He sited one of the problems with the District
Health Board is the lack of administrative leadership. He added that the
composition makeup of the Board should reflect the population of Orange
County, which he felt should be 35 percent.
There was discussion of methods of re-organizing the present Board.
Mr. Willhoit suggested that a search committee be formed, composed of
appointees by the School of Public Health, Schaol of Medicine and one
appointee from each of the five counties within the District to work to
find a new Health Director.
Another concern Mr. Willhoit pointed out was the need to seek a
better working relationship with the UNC Schools of Public Health and
Medicine. To utilize more fully the resources available from these
schools. He suggested that a task force be organized to explore how
the District can use these resources in order that both the Counties and
the university could mutually benefit.
Commissioner Walker informed the Board that the District Health
Board would make certain recommendations to the County at the February
2nd meeting. He stated that the District Health Board had made it clear
that Orange County would not control the district.
Discussion ensued regarding the membership to the District Board
based on the populations of the five counties. Some members of the
Orange County Board stated that they felt Orange County should have
35 percent representation to the District Board of Health.
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Commissioner Gustaveson stated that the heart of the problem was
that Orange County was a rapidly growing County with various health
problems and changing situations. Also, Orange County has citizens
who are concerned abeut these problems, the health care, and the pro-
grams within the County. He stated that he was wondering if a sati-
factorily situation could be worked out so that the unique needs of
each of the Counties could be taken into account.
Commissioner Willhoit stated that the Board of Health in conjunc-
tion with the different counties should specify and offer program which
are carried on. The District Health Board then should offer ideas and
ways to meet these needs and then further evaluate the needs of the
community.
Commissioner Gustaveson stated that the Board should take a leader-
ship role in pursuing the needs and ideas of good health delivery. He
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added that this is a continuing process, and asked what assurance do we
have that this Board of Health is the Board to do what we ask?
Discussion ensued between Commissioners Gustaveson and Walker con-
. cerning the different policies and the philosophy which the Board of
Health should have. Commissioner Walker stated that'he felt the Board
was pursuing the health needs of citizens, that the measure of effective-
ness depended an the philosophy of the Berard .
Commissioner Gustaveson stated that there was a feeling that this
body, which is a public body, is not actively involved in setting policy.
He added that erne of his problems was how to move from a Board which was
used to working one particular way in the past and which now must make
a change to be•active and take seriously the concerns of citizens.
Commissioners Walker responded that the District Board was trying
to do the things which had been pointed out. He added that the Orange
County Board must take the District Health Berard on their word.
Commissioner Pinney stated that as long as Orange County was getting
its share of programs and services, it could form its own mini-board and
work with this arrangement.
Other concerns which Mr. Gustaveson pointed out were the serious
problems with inter-agency coeperation, and the high turn over of per-
sonnel within the Health District. He said there were structural pro-
blems in the administration in terms of how the staff is involved in
carrying on programs and in staff training.
Commissioner Walker stated that the Board should decide if its
concerns were health needs, the philosophy of the Board, administrative,
or what.
Commissioner Gustaveson stated that all of these issues should be
concerns of the District Board.
Chairman Whitted stated that with the responsibility of the Cammis-
sioners to appropriate monies to the District Health Department on an
annual basis, that the local Boards should have some indication of how
effective programs are. He added that information of this sort is not
being received and the Commissioners have no way to measure the effec-
tiveness of health services in Orange County. The Chairman stated
further that with all the discussions with the District Board, they still
failed to see the problems. He continued that just one problem can nvt
be cited, there is a broader range of problems.
Commissioner Pinney suggested that an outside evaluation be made of
the programs within the District Health Department.
Mr. Gustaveson stated that there were State Consultant Teams available
to undertake studies of this type.
Commissioner Gustaveson summarized at this point, what problems had
been cited thus far by Commissioner Willhoit and the solutions:
1. Lack of administrative leadership. Solution - The Nixing of a
professional health director.
2. Need for an active policy making Board of Health with 35 percent
representation for Orange County. Solution - To adolish or re-
organize the present Board and establish an active Board.
3. The slowness of hiring a Health Director. Solution - to establish
a Search Committee to find a competent Health Director.
4. Failure to utilize available resources of UNC Schools of Public
Health, Medicine and Nursing. Solution - To organize a task force
to explore ways in which the district can utilize these resources
so that both the University and the District would mutually benefit.
Commissioner Gustaveson proceeded to add to the list the following:
5. The problem of Tnter-agency cooperation between Health Depart-
ment personnel and other service agencies within the community.
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Solution - An active Board of Health would be aware of these problems
and establish and enforce a practical policy designed to prevent this
situation.
6. There is a problem with policy concerning staff training within
the Health Department. Solution - Establish a policy and develop a
budget item designed to implement staff training.
7. The problem of providing environmental services through the
Health Department was pointed out by Commissioner Willhoit. He
stated that he would like to see an engineer rehired to provide
back-up technical knowledge, particularly in view of the Subdivision
Ordinance and Zoning Ordinance which the County proposes to enforce
County-wide.
$. Commissioner Willhoit pointed out that salaries of the employees
within the District should be raised to attract and maintain com-
petent personnel. Solution - Funds must be committed from the other
counties to provide this to personnel.
9. Commissioner Pinney requested that an outside evaluation of
the effectiveness of the District Health Department's programs
be undertaken. Solution - To request an outside evaluation of the
Department's programs.
10. Commissioner Pinney stated that a financial commitment from the
other four counties to salve the financial portion of the problems
cited. Solution - Funds must be committed from member counties over
a reasonable period of time.
Discussion ensued regarding the method of presenting these concerns
to the District Health Board. Chairman Whitted stated that the two keys
would be the hiring of a Health Director and an active governing Board.
If the Board of Health agreed to these two items, the other concerns
would fall in place. He added that he felt these concerns could be
answered quickly, and if these two things are accomplished, Orange
County could agree not to withdraw as of July, 1977.
Members of the Board agreed to list these concerns and solutions in
a letter tc be sent to the Chairmen o£ the Boards of Commissioners of
Caswell, Chatham, Lee, and Person Counties with copies going to the
District Health Board and the District Health Director. The letter should
state that Orange County is sensitive to the positions of the remaining
counties in the District, however, our prime concern must focus on what
the Commissioners feel is in the best interest of Orange County. The
letter should also state that the Chairman of the Orange County Board of
Commissioners will schedule a meeting within the next two weeks with the
Chairmen of the other four Boards to discuss appropriate action. Orange
County will then decide whether to remain in or withdraw from the district.
Upon motion of Commissioner Gustaveson, seconded by Commissioner
Willhoit, it was moved that the Chairman sign a letter listing these con-
cerns and solutions and that the letter be sent to the Chairmen of the
four Boards.
The Chairman called far the vote on the motion. Voting aye were
Commissioners Gustaveson, Pinney, Willhoit and [4hitted. Voting nay was
Commissioner Walker. The Chairman declared the motion passed.
In other discussion, the County Manager requested the Board's authori-
zation to enclose a porch at the East entrance to the Courthouse and to
install a set of doors to seal off the back entrance to the Courthouse.
Upon motion of Commissioner Willhoit, seconded by Commissioner
Gustaveson, it was moved and adopted tc authorize the County Manager to
proceed with necessary renovations to the entrances of the Courthouse.
The Fiannace Director presented to the Board a draft of a Budget
Calendar for the Board tc comment an the first Manday in February. The
Chairman asked that the Board members review the calendar and decide what
agencies they with to talk with and the information that is needed.
Upon motion of Commissioner Gustaveson, seconded y Commissioner
Walker, the meeting was adjourned.
v u' I~
Richard E. Whitted, Chairman
Agatha Johnson, Clerk