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HomeMy WebLinkAboutMinutes - 20071113APPROVED 12/11/2007 MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS JOINT WORK SESSION WITH BOARD OF HEALTH November 13, 2007 5:30 p.m. The Orange County Board of Commissioners met for a joint work session with the Board of Health on Tuesday, November 13, 2007 at 5:30 p.m. at the Link Government Services Center in Hillsborough, N.C. COUNTY COMMISSIONERS PRESENT: Chair Moses Carey and Commissioners Valerie Foushee, Alice Gordon, Barry Jacobs, and Mike Nelson COUNTY COMMISSIONERS ABSENT: COUNTY ATTORNEY PRESENT: Geoffrey Gledhill COUNTY STAFF PRESENT: County Manager Laura Blackmon and Assistant County Manager Gwen Harvey and Clerk to the Board Donna S. Baker (All other staff members will be identified appropriately below) BOARD OF HEALTH MEMBERS PRESENT: Chair Matthew Vizithum, Vice Chair Christina Harlan, and members Timothy Carey, Rev. Sharon Freeland, Ernest Dodson, Jessica Lee, James Stefanadis, and Sharon Van Horn BOARD OF HEALTH MEMBERS ABSENT: Anissa Vines and DeWana Anderson 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. The meeting began at 6:05 p.m. I. Welcome and Introductions Introductions were made. FY 2006-07 Brief Annual Health Department Activity Review Rosemary Summers made a PowerPoint presentation. Orange County Health Department Service Statistics Overview Healthy Carolinians Priorities Highlights from 2006-2007 • Provided direct services to 22,075 persons, households or facilities • Provided educational services to more than 12,286 persons • 196 active volunteers in Medical Reserve Corps • 45 residents trained through CERT • 53 attended the Pandemic Influenza Planning Forum Dental Health • Over 6,600 children's teeth were screened • 52% of patient visits are 20-80% pay • 30% were Medicaid recipients • 3,722 patient visits • 10% preschoolers have dental needs • 18% of 2nd graders have dental needs • Free SHAC clinics 2 nights/week in Carr Mill • Mouthguards for Athletes Program Environmental Health • 1,714 inspections in food and lodging • 450 consultative visits to establishments • 431 WIMP inspections, 249 new septic systems and 243 new wells permitted • More than 3600 consultative visits made • Over 1,117 water samples were drawn for testing for more than 500 homes Health Promotion and Education • 17 Health Promotorers participated in Leadership training • 100+ professionals attended brown bag lunch sessions on domestic violence, gangs, family violence • 13 churches part of the Eat Smart Move More Project • Nutrition education for more than 321 • Community Health Assessment process • Personal Health Services • 5,087 patients received preventive clinical care in 10,745 clinic visits • 342 patients received primary care in 664 visits • 40% of patients in primary care 0-20% pay • 5,171 tests for sexually transmitted infections • 1,156 received family planning services • 354 developmentally delayed or at-risk kids served through child service coordination • Meningococcal vaccine, rapid HIV tests in community, 4 TB cases, 44 on preventive therapy Healthy Carolinians Priorities 2008-2011 • Health Promotion (Chronic Disease Prevention) o Obesity, Physical Activity, and Tobacco • Access to Health Care and Health Insurance • Adult Substance Abuse and Mental Health • Child and Adolescent Health What's Coming Up? • Accreditation in Spring 2008 • Biosolids and water softener studies • Implementation of new well rules • Tobacco rules/ordinances Refugee and immigrant health surge Increases in communicable disease tracking and follow up Commissioner Foushee asked about active TB cases, and the number since July 1St has doubled. Rosemary Summers said that there were eight confirmed or suspected cases since July 1St Chair Carey asked about the 44 cases on preventative therapy and Rosemary Summers said that the Health Department follows up with these on a regular basis. Commissioner Jacobs asked about sexually transmitted disease cases. Rosemary Summers said that STD services are available to any Health Department regardless of where a person lives in the State. Orange County Health Department does not track the location, but there are people from Durham and Alamance, and there are students. Commissioner Jacobs asked if student health does outreach and Rosemary Summers said that the schools do some, but there is not enough outreach and education. Commissioner Nelson said that at the Commission for Women meeting they were given rates for women with STD's and HIV, and the numbers for minorities were much higher than for white women. He asked if Orange County had programs aimed at African American women and Rosemary Summers said not at this time. Commissioner Nelson asked about rapid HIV testing and Rosemary Summers said that there are a couple of beauty and barbershops that are testing and there was one in a bar last year. She said that the HIV Counselor set this program up for HIV training in these locales to be creative to be able to reach more people. III. Topics for Discussion (Attachments included) Matthew Vizithum thanked the Board of County Commissioners for meeting with them. He said that the Board of Health's goal is to have a healthy community with the core functions. • Core Services Dr. Tim Carey Selected Core Health Services Orange County Health Department November 13, 2007 The Orange County Health Department (OCHD) is charged with providing services as listed in North Carolina General Statute 130A and in North Carolina Administrative Code 10A. In addition, there are a number of local rules and ordinances that impact service delivery to residents. There are two overarching responsibilities for OCHD. First is to prevent disease and the spread of disease. These are primary functions that cannot be delegated. Second is to act as a safety net for the provision of certain specific clinical services for community residents in the event that adequate services are not provided within the community. Health Statistics for Orange County - 36% of all 2-4 year olds seen in WIC and health department clinics are obese (NC is 28%); 39% of kids 2-18 are obese (NC is 36%) - Orange County continues to be in the lower percentile of the state for lead screening rates among children - 15% of Orange County residents are uninsured - According to the NC Immunization Registry, 37% of children are immunized age appropriately; the state rate is 44% - In 2005, 42.6% of the uninsured NC population were minorities; 24% of the uninsured were African American - Orange County has the highest rate of breast cancer in women for the state Service Trends - Since July 1, the number of confirmed tuberculosis (TB) cases is double that of the entire previous year and the number of latent TB cases exceeds the entire year. - 107 Karin refugees have been referred for communicable disease screening since July 1. In previous years, the Department may have received 12-15 for the entire year. Best estimates give us an additional 100 before the end of the fiscal year. - Since July 1, 15 new cases of Hepatitis B referred to us for follow-up. - Rising rates of HIV cases, but fewer residents presenting for testing and counseling. - Dental service provision is limited by staff and facilities. Compared to the last five years, there was a 2% drop in overall number of visits; the percentage of low-income clients (below 80% pay) rose by 7%. Emergency visits continue to rise. - Since 2002, patient visits for sexually transmitted infections have increased by 14% in each clinical location; in 2006-2007 more than 1200 persons presented for testing - Patient visits for immunizations have increased by 20% (Chapel Hill) and 10% (Hillsborough). - Maternal Health (prenatal) visits increased 47% in Hillsborough and 39% in Chapel Hill. Approximately 70% of these patients have a substance abuse or mental health need. - Well Child visits increased 112% (Hillsborough) and 51% (Chapel Hill). - Family Planning visits have remained steady with small variations from year to year. - Primary care in Hillsborough more than doubled in 18 months from 126 patients to 291. Chapel Hill primary case without any "marketing" had 51 patients at year's end. Commissioner Gordon arrived at 6:31 p.m. Rosemary Summers said that another 100 refugees from the Karin community will be coming to the Triangle area. • Facilities Dr. Matt Vizithum, Chair Facilities Orange County Health Department November 13, 2007 The Orange County Health Department (OCHD) provides services from four primary locations in the county: Carr Building, Carr Mill Mall, Southern Human Services Center and the Whitted Human Services Center. Statistics and Projections for Orange County • Orange County has a "medium-high" poverty rate compared to similar US communities. • Extrapolating for modest population growth, estimate the number of patients served by medical services to yield another 41 % increase in visits by 2020. • Currently serve 2% of total population for dental services, and estimate serving 49% of total uninsured population (based on serving those at 80% or below of sliding scale.) • 3-6 month delay for regular recall visits for dental patients. • Average of 165 patients per year referred for simple endodontic services (root canals or crowns) because providing the service limits the total number of patients that can be seen. Facility Limitations • Carr Mill (Dental) o Inadequately sized waiting room, patients at times must wait in the hall o Patient check in and check out is in the waiting room, with little patient privacy o No space for pre and post visit consultation with dentist, must be done chairside o Double operatories are not adequate for patient privacy o Insufficient number of operatories to maximize staff o Supply and record storage inadequate • Whitted (Dental and Medical) o Inadequately sized waiting room for facility, dental has too small interior waiting o Well and sick patients must wait together o No exterior entrance directly to an exam room for potentially infectious patient o Poor patient flow with dental patients traipsing through the medical area o Only one shared office space for all dental staff, no consultation room for dentist o Inadequate number of operatories for number of providers and patients per day o Inadequate patient protection for privacy issues o No negative pressure rooms in medical clinic (external HEPA fan in one room) o Long wait for scheduled patients (average of 45 minutes) before exam/interview room clears o Laboratory very small without separate blood draw area o Interview and exam rooms too small for patient, families, interpreter, & provider o Inadequate handicapped entrances to clinic space o No clinical space for ancillary services (nutrition, clinical social work, health education) o Inadequate storage for medical supplies SHSC (Medical) o Well & sick patients wait together in waiting room with other residents seeing social services o No exterior entrance directly to an exam room for potentially infectious patient o Only one negative pressure interview room that is too small for interpreter, patient, and provider or multiple family members o No clinical space for ancillary services (nutrition, clinical social work, health education) o No work room for clinical staff conferences on individual patients o Medical record room at maximum capacity Chair Carey said that the Board of County Commissioners knows that the facility needs are real. He asked about the timeframe for an initial dental appointment and a staff person said at least a couple of weeks. Commissioner Jacobs asked if the leaser was responsible for anything, since the County is renting the space at Carr Mill and Rosemary Summers said that the Health Department is responsible for carpeting. The contract expires in 2008. Commissioner Jacobs said that this is the County's most expensive lease. Commissioner Jacobs suggested that in the spring, the County Commissioners can take the new UNC Chancellor to visit some County facilities as was done previously. Jessica Lee made reference to providing services at both Carr Mill Mall and Whitted and said that they try not to compromise care, and they try to work as efficiently as possible under the circumstances. Commissioner Gordon said that the county has principles with respect to space needs and they include consolidating into fewer sites and also getting out of rental spaces and into facilities owned by the county. • Technology & Equipment Ms. Chris Harlan, Vice-Chair Christina Harlan said that she is a public health nurse by profession and she has watched technology over the years. She said that the Board of Health feels an ethical obligation to make sure that quality care is provided. Technology & Equipment Orange County Health Department November 13, 2007 The development of health care technology over the past 10 years has far outstripped the ability of Orange County Health Department to keep at a basic level of adequacy. This is true for all aspects of service delivery as well as data analysis in order to form good policy development. Clinical Technology • The NC Division of Public Health will be completing the customization of a new vendor purchased statewide software for all clinical and home visiting services. This software has an individual electronic health record for each patient. While not a requirement, maximizing the effectiveness for patients and providers will require mobile PC "tablets" or a workstation in each exam and interview room. • At its fullest and highest use it will require the ability to affix and read bar codes for services that would automatically be tagged to a patient record and then billed. • The logical expansion is the purchase of avendor-supported add-on for a true electronic medical record, facilitating the transfer of referral information for patients. • The standard for most dental offices, including the UNC School of Dentistry is the provision of digital dental x-rays that are available to the dentist chair side and become an easily integrated part of the patient's dental record. This would require software purchase and equipment for each operatory. Field Based Services Home visiting staffs are restricted from taking paper patient records into the field. Mobile technology would allow access to "last progress notes" and enable the staff member to update notes in field and begin the service coordination process more quickly. Linking to appointment vacancies could improve service provision. Software that enables Environmental Health Specialists (EHS) conducting institutional inspections in the Food and Lodging Program would allow the final "grade sheet" to be printed for the establishment. It would allow more timely uploading to the state and to the website for the public. 30 North Carolina counties have already purchased this vendor- supported software. It would also provide more information on a historical basis for better education of the food service managers. EHS field staffs still need vendor-supported software for the on-site wastewater, well and WIMP programs to conduct permitting operations in the field and then download and process the information back in the office. Data Analysis and Management • Need to create GIS layers & utilize other data analysis tools in order to better target service delivery & analyze where the department needs to concentrate efforts. Equipment • This is a particular need in the dental clinical program, where our equipment is aged beyond use. There is no panorex x-ray machine in either clinic (a standard of care). There are too few of the same kind of hand pieces, making sterilization twice a day a necessity. Equipment is replaced only when broken and then cannot be repaired because there are no parts. Chair Carey asked about the Environmental Health field base software units, and asked if the State would be expanding to all counties so that every county would be using the same equipment. Rosemary Summers said that the State would not build a statewide software system, but it is avendor-supported product. The vendor works to meet all State requirements. Commissioner Jacobs said that the Board discussed this during the 2006-07 budget process regarding field laptops and having the same equipment. Rosemary Summers said that they did get some handheld units, and these are used for wells and some other Environmental Health programs, but the software does not work in the way that would be useful without a lot of work. Chair Carey asked about the high-speed hand pieces that were needed to prevent having to sterilize them at each of the operatories, and it was answered anywhere from 14-21 per day. At this time, there is only half that amount in working order. The cost is $1,000 each. • Comparison of Expenditures Dr. Jessica Lee Comparison of Local Health Department Expenditures for Selected Counties North Carolina Division of Public Health November 13, 2007 Each year the North Carolina Division of Public Health prepares an expenditure report that compiles expenditures for all counties receiving funds through the annual agreements with the NC DHHS. The most recent published report was for FY 2005-2006. The attached tables show expenditures comparisons for selected counties in North Carolina. Counties were chosen for comparison purposes based on size of population, presence of a university (related to size of population), and those that generally have the same program mix. Health Departments across the state have different mixes of programs depending on the needs of their populations and the services offered in their communities. There was an attempt to identify programs that would have a major budgetary impact. These are listed in the "Service Comparison by County" chart for the counties selected. Robeson County is the leader in this group, since it provides all services except a well program. • Expenditures in this chart include Aid to County Funds (Aid), Environmental Health (EH) and Categorical (Cat) funds. It does not include outside funded grant programs such as the Smart Start grants (except for the local portion) and direct federal grants (Medical Reserve Corps). It does include the public health preparedness funds. • Categorical funds can generally be thought of as "program" funds that are in service categories such as family planning, women and children's health, communicable disease, etc. • Local funds include receipts from fees, Medicaid and other third party reimbursement sources and any county general funds. • Orange County ranks the lowest in state and federal funds allocations. One historic reason for this is the Women's, Children and Infants (WIC) nutrition program. It is offered by all health departments except for Orange, Chatham, and Person counties. Piedmont Health Services, Inc. applied for and received the contract for services in these counties in the early 90's. • The county ranks 61St in per capita local funding. • The chart shows that in overall funding for public health services, Orange County ranks 74 among the 85 health departments that reported data for this report. • The Statewide average per capita funding was $59.45 and Orange County's per capita funding was $37.97. Commissioner Jacobs referred to the Local Health Department Expenditures -Selected County Comparison chart in their agenda packet and said one of the things that occurred to him as he looked at the chart was the education spending for the same counties listed on the chart. Orange County spends $354 more per capita than Alamance County, $359 more than Davidson, $434 more than Harnett, $324 more than Pitt, $187 more than New Hanover, $446 more than Robeson, $303 more than Rowan, and $404 more than Wayne. He said that schools are a huge constraint, because half of the budget goes to education in Orange County. This affects the flexibility for other services. He said that the Board needs to show the Health Department what the County's restraints really are. He said that the numbers are useful and sobering, but there has been a choice as a County for how to spend the budget. Timothy Carey said that the demographics trends are not going away and planning should start now rather than later, when they cannot meet core services, because they would be broke. Christina Harlan said that she does not want to compete with the schools or other services. She also does not want to blame immigrants. She said that Orange County has one of the widest splits in income of any county in the United States. She said that nobody could have quality of life if the community has terrible diversity issues. Chair Carey said that these are good points and the comments from Board of County Commissioners are just the facts. At first glance, he is depressed at the figures from the BOH, but they have to be put into context. He asked the Board of Health to keep this in mind and convey the need to voters about the referendum for the local option revenue source. With no further items to discuss, the meeting was adjourned at 7:15 p.m. Moses Carey, Jr., Chair Donna S. Baker, CMC Clerk to the Board APPROVED 12/11/2007 MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS WORK SESSION November 13, 2007 7:30 p.m. The Orange County Board of Commissioners met for a Work Session on Tuesday, November 13, 2007 at 7:30 p.m. at the Link Government Services Center in Hillsborough, North Carolina. COUNTY COMMISSIONERS PRESENT: Chair Moses Carey, Jr., and Commissioners Valerie P. Foushee, Alice M. Gordon, Barry Jacobs, and Mike Nelson COUNTY COMMISSIONERS ABSENT: COUNTY ATTORNEYS PRESENT: Geof Gledhill COUNTY STAFF PRESENT: County Manager Laura Blackmon, Assistant County Managers Willie Best and Gwen Harvey, and Clerk to the Board Donna Baker (All other staff members will be identified appropriately below) TETHERING COMMITTEE MEMBERS PRESENT: Chair Kris Bergstrand, Ross Oglesbee, and Jean Connerat-Austin. Director of Animal Services Bob Marotto was also present. NOTE: ALL DOCUMENTS REFERRED TO IN THESE MINUTES ARE IN THE PERMANENT AGENDA FILE IN THE CLERK'S OFFICE. The meeting began at 7:31 p.m. 1. Tethering Committee Final Report and Recommendations Chair Carey welcomed the Tethering Committee members and explained to them that a work session is generally not for general public input, but he thought it was important enough to receive the report publicly rather than in writing. Commissioner Nelson was the County Commissioner representative and said that the committee was excellent and it spent about 4-5 months on this topic, and the staffs were great in putting together information and doing research. He said that there were two public hearings and it was a very thorough process; one of the best committees he has worked on. Introductions were made. Kris Bergstrand said that the committee was formed when some citizens approached the Animal Services Advisory Board with concerns about dogs being tethered in the County. The committee looked at other counties' ordinances in order to see what this type of ordinance does in these counties. She said that the public input was diversified from no tethering at all to those who do not want any more laws. She said that the committee tried to do what was appropriate for animal welfare, safety for children, unwanted puppies, etc. The recommendations were approved by the ASAB. The committee is recommending that the County's current animal ordinance be amended to include the following with regard to tethering dogs: - a three-hour limit within a 24-hour period; - a specification of the types of collars and equipment that are allowed when a dog is tethered; - a requirement for minimum kennel size for outdoor housing of dogs; - an exemption for organized and lawful animal functions such as hunting, obedience training, and law enforcement training of a duration of not more than seven days; - an 18-month education period, including twelve months of public outreach and six months of issuing warnings before citations would be issued. Chair Carey agreed that this issue was thoroughly discussed at the ASAB, because he attended some of these meetings. Commissioner Jacobs asked if this recommendation was only talking about tethering dogs, since farm animals also get tethered. Kris Bergstrand said that the focus is on dogs. Commissioner Jacobs said that he did not serve on any of the animal boards but he does care about animals. He asked that this summary be put in some rural stores, etc. He wants to be clear that it is only talking about dogs. Chair Carey said that this is a recommendation, but it is incumbent upon the Board to have discussions about this and to hold public hearings before the changes are adopted. This is the County's current policy. Commissioner Jacobs said that the title should read, "Proposed Orange County Dog Tethering Ordinance." Commissioner Jacobs asked Animal Services Director Bob Marotto about any additional demand on animal control with this proposed change. Bob Marotto said that as he talked with other counties, it does not seem to be a lot more and it even helped to curb other infractions to the ordinance. He said that on the outset there will be an increase in workload, but as familiarity increases, the workload will even out. Kris Bergstrand said that there was aknee-jerk reaction from a lot of people that dogs would overrun the area, but this is not the case. Commissioner Jacobs asked if there were other counties that considered a tethering ordinance but did not enact one. Kris Bergstrand said that one of the counties had to reword portions of their ordinance due to complaints but other than that, there are none. Commissioner Gordon said that she is interested in the rationale of the three-hour limit per 24 hours. Kris Bergstrand said that they were trying to balance the need for legitimate tethering -such as people with disabilities who cannot walk their dogs and for those animals that enjoy being outside and can be tethered humanely. Kris Bergstrand said that there were also discussions about mini non-profits that could help people get fences or kennels and stop tethering. Jean Connerat-Austin said that two counties they talked with had aphase-in for the ordinance. The ASAB does not want canine ownership to be an elitist situation. Commissioner Nelson said that the 18-month education period is one of the most important aspects of this recommendation. He asked about the next step and said that it would be in the best interest to have a draft ordinance at the public hearing. Chair Carey suggested an FAQ and answers segment with the draft ordinance. 2. Review of Personnel Ordinance Laura Blackmon said that this ordinance was originally developed in the 1980's from a policy. Certain segments have been revised over the years. She said that staff thought it would be good to have a complete look at the ordinance and suggest revisions. Policy and Compliance Officer Annette Moore said that the ordinance in 1975 was brought forward when Manpower asked the Board of County Commissioners to develop policies, and the Board looked to the Office of State Personnel and received a grant to write the first Personnel Policy. There were changes and updates, and in 1985, the Board revised the policy and changed it into an ordinance. The staff is bringing this to the Board for review because, as the staff began to review sections of the ordinance, certain issues began popping up, and there have been law changes in multiple sections. Also, technology has changed the way business is done. The objectives are as follows: • Update changes in state and federal law -include language in the Ordinance consistent with the Family and Medical Leave Act of 1993 and Americans with Disabilities Act. • Adopt best practices for specified benefits - develop a bank for shared leave where employees could deposit leave into the bank not only for their benefit but also for the benefit of others. This would allow recipients of the shared leave donation to receive the leave that they require while retaining their privacy. • Modernize the terminology -change the name of the Personnel Department to the Human Resource Department and Department Heads to Department Directors. • Remove items that are no longer relevant -take out of the ordinance references to the Employee Interest Card in Article I and Position Interest Cards in Article II. These items are no longer used -the job line and Internet are now used to keep potential applicants aware of vacancies. • Create a Rules and Regulations Manual -provide for a rules and regulations manual developed and maintained by the County Manager that would instruct department heads, supervisors, and employees on "how to" carry out the instructive language in the ordinance. This manual, and any future revisions to the manual would be reviewed with the Board. The manual would also enable the Board to keep the language in the ordinance specific enough to give direction but general enough so that the ordinance would not become outdated with minor changes to state and federal law. In other words, the ordinance would contain language on what the Manager, Department Directors and other were required to do as it relates to personnel and the manual would direct them as to "how" to carry out those requirements. Laura Blackmon made reference to the proposal on page 39 with a timetable to review the different articles of the ordinance through some previously scheduled work sessions. The various sections could be brought back piece meal, and then the entire ordinance could be adopted all at once. It is an aggressive timeline. In answer to a question from Chair Carey, Annette Moore said that the ordinance is "what to do" and the rules and regulations are "how to do it." The rules and regulations can be changed without the process that an ordinance revision requires. Geof Gledhill said that right now the ordinance tries to capture public records requirements and other state and federal law requirements, and the proposal would be not to do that anymore, but to have the ordinance say that the personnel records are public or not as required by state and federal law. The rules and regulations are the things that the employees would use on a daily basis. Chair Carey said that he has concerns about the Manager making changes and Laura Blackmon said that part of the process would include how these changes would be made. Commissioner Foushee made reference to the Manager having the ability to determine the standard operating procedures would be more appropriate than the Board determining the day-to-day operations. These issues should be left to the staff. Chair Carey said that the Board does not have the time to get into the details of the operating process, but the Board does need to know what the changes are and Laura Blackmon needs to bring the process she will follow to make the changes. He wants the process to remain transparent. Laura Blackmon said that some of that, including the Board's expectations, should be included in the ordinance. Commissioner Gordon said that it is admirable to update this ordinance. Her concern is about the timetable on page 39 because the Board of County Commissioners will be doing a site search on the transfer station. Laura Blackmon said that the timetable could be tweaked, because she wants the Board to be able to discuss this issue in detail. Commissioner Jacobs agreed with Commissioner Gordon and said that this was done with the Library Services Task Force, and two months turned into eight months. The Board has a tendency to be overambitious, and then people are disappointed. He would like to have a more realistic schedule. Laura Blackmon said that she would revise the timeframe. Commissioner Foushee said that she did not see a reference to use of County vehicles, and this needs to be addressed. Annette Moore said that this is a separate policy. Chair Carey said that the first discussion of this should include what a policy is and what should be in the ordinance. 3. Discussion of Recommended 2008-18 County Capital Investment Plan Laura Blackmon said that this is just a plan, and staff has put a lot of work into this. She said that this would be discussed in January, but tonight she would like to focus on some of the assumptions, the list of projects, etc. Chair Carey asked how the Board would like to approach reviewing this information. Commissioner Gordon said that the Board was being asked to approve this on December 3~d, and she does not want to do this without knowing how some projects are going to be funded. Laura Blackmon said that the Board would be approving this as a plan only. The Board would not be committed to the projects until the funding is approved. Commissioner Gordon is concerned that this timeframe for approval is too fast because the Board and the public have not enough time to review it thoroughly. Commissioner Jacobs made reference to the tab "County Facilities and Technology" and asked if this would be a given, and Laura Blackmon said yes, that these for the most part are what have been approved. Commissioner Jacobs asked what page 1-2 was referring to and Donna Coffey said that this is the debt service payments for the next ten years, and does not include unfunded projects. Donna Coffey said that page 1-5 is the summary of all of the County projects. Commissioner Jacobs said that one thing that has disappeared from the CIP was the $10,000 a year for ten years for replacement of water fixtures in County buildings. He said that this is beyond embarrassing because this has been discussed for years, and there is a terrible drought. Donna Coffey said that there is $125,000 in a capital project right now for utilities reduction, which would include water reduction projects. Staff is working with Public Works to settle on a work plan to expend the $125,000. Anything in the future would be incorporated into the annual general fund budget. Commissioner Jacobs said that his experience is that this money disappeared and nobody told him where it went. He would like to know how it got there and how it will be expended. Laura Blackmon said that what Commissioner Jacobs is talking about is not a capital project, but an operational project. She said that one of her concerns was that there was money budgeted each year that was not being expended, and she asked Public Works to do a work plan for accountability of these funds. Donna Coffey made reference to pages 1-3, which outlines the County's maintenance projects. This is a transition year of trying to move things around into new categories. Commissioner Jacobs suggested putting an asterisk next to the part that says, "Need to develop policy and thresholds for what is in CIP versus what is in Operating." Laura Blackmon said that her initial plan was to present this in October, but the more she looked at the issues, the more they grew. She said that her biggest concern was for the Board to see what has been agreed to and what there is funding for. Donna Coffey said that it was important this year, with all of the projects going on, to take a holistic look at everything so that the Board could make informed decisions. She said that she was at a meeting with the NCACC (N.C. Association of County Commissioners) today, and she said she can guarantee that the State will continue to pass things back to the counties such as transportation and road needs. Laura Blackmon said that the next step is to look at future projects and whether or not to issue bonds. The idea of how to fund these items will tie into the local revenue options. Chair Carey said that this is a transition document, and the Manager has already made some assumptions about capital versus operating, and this has been incorporated into the document. He said that this should be provided to the Board in writing so that the County Commissioners can let her know whether they agree or not. He said that it is important to focus on things that the Board has already made decisions about regarding funding. Chair Carey said that it is good to be aware of the operating costs of new projects. Laura Blackmon said that when the County starts moving into the newer buildings, the Board might want to start looking at some of the smaller buildings that are not used anymore that need a lot of maintenance, upgrades, etc. Some of the facilities could be put on the market, etc., so that they are not a drain on the operating budget. Commissioner Gordon clarified that the staff were going to provide a written overview of the CIP document explaining the assumptions used and the rationale for what was presented. Commissioner Gordon said that the County does have principles with respect to space needs and they include getting out of rental property and into county-owned facilities, and also consolidating county resources into fewer sites. She wants to seriously consider these as guiding principles for planning capital projects. Chair Carey asked what the Board should decide tonight. Laura Blackmon said that pages 1-5 and 1-6 are summary pages on revenues and appropriations. Number 14 is the total projected costs over the next ten years, and in the next three years, there is a potential for an increase of 15 cents on the tax rate. Commissioner Jacobs asked why fees go down from $606,000 to $92,000. Donna Coffey said that these are all Register of Deeds fees. The $92,000 is Register of Deeds fees that are dedicated to automation projects, and the $606,000 is a cumulative total. Commissioner Jacobs suggested that there be some definitions for the fees, what the 1997 bonds were, what the 2001 bonds were, etc. He said that citizens would not understand this information. Laura Blackmon continued and said that the capital projects are starting on lines 17 and 18 on page 1-7. She asked for feedback on lines 18-22. Commissioner Jacobs asked if the Animal Services Facility Construction reflects the original estimate or the new sizing, and if the Board had adopted the changes. Purchasing and Central Services Pam Jones said no, the Board has not adopted the changes. She said that the numbers coming in are substantially more than what was adopted. Commissioner Jacobs asked if this says that these are numbers that the Board has not approved yet. The numbers are speculative. Pam Jones said that in February the guaranteed maximum price would come forward. Commissioner Jacobs said that he is supportive, but there is some mixing of things with a fixed amount and another amount that might have to be spent, but the Board has not agreed on it. He would like to flag the Animal Services Facilities as something in process. Laura Blackmon said that the goal is to have good numbers, but the further out you go, the less precise the numbers are. The rest of the page is accurate. Commissioner Gordon asked for clarification of what projects and dollar amounts are included in this CIP. The answer was that the CIP document was generated by staff and includes projects and costs that have not yet been approved by the Commissioners. Commissioner Gordon said that December 3~d is way too soon to approve this plan with so much information for them to digest. She said that she wants documentation of which projects and cost figures the Board has and has not approved. Laura Blackmon said that this is only a plan. Commissioner Gordon said that she understands this, but if there are inaccurate numbers in the plan, then accurate decisions cannot be made. Donna Coffey said that this is a living document that is brought back every year to the Board, because the numbers are constantly changing and the plan must be updated. She said that this is the same CIP process that the Board went through up until 2002. Commissioner Gordon said that her concern is that when you have numbers that increase by this percentage from original cost estimates, there is not a good method for dealing with them. Commissioner Gordon said that there should be a Commissioners' decision about how the Animal Services Facility is handled, because the recent cost increase for this facility is almost one cent on the tax rate. Chair Carey said that the Board needs to know the acceleration in costs and how they are incorporated, because this has been a trap. He asked what needed to be done between now and December 3~d Laura Blackmon suggested looking through lines 18-79 to see if the Board is comfortable with these items. Commissioner Nelson made reference to # 64, Twin Creeks Park, which is listed as $1.8 million, but it will cost a lot more than this. He asked if there was a projected figure in this document. Donna Coffey said that Appendix A includes the unfunded portion. Commissioner Nelson said that it would have been helpful to have had the unfunded amount listed on the same sheets. Commissioner Nelson made reference to Future County Projects Reserves, # 67, and asked why these projects are funded and the reserves are accumulating each year. Donna Coffey said that these monies could accumulate to a point that there were sufficient funds to build them, or the monies could be dedicated to debt service to build the facilities. Commissioner Nelson said that he loves this conversation on the CIP, and the staff did an excellent job. He said that it is dense and informative, but worth it. Commissioner Jacobs suggested giving these items the number that is indicated on page 1-8, so that it is easier to be cross-referenced. He also said that the project description is confusing about the library on page 2-13. Commissioner Jacobs made reference to the County Telephone System Replacement, #25, and asked about the back page where there are no operation or maintenance costs. He asked if this was included in someone's operating budget. Pam Jones said that it depends on future decisions that are made. Commissioner Jacobs made reference to #30 on page 2-25, Efland Rescue Building, and said that it strikes him that when the Fire and Rescue Strategic Plan is done, there will be a lot of implications. He does not remember seeing this as a placeholder in future County projects. Commissioner Jacobs made reference to page 2-27, #31, which is Efland Sewer Extension Construction, and asked why it is taking so long and what happened to the money from the federal government. He asked if there was danger of losing this money since it is taking so long. Commissioner Jacobs made reference to #32 on page 2-29, and said that he thought that in the space needs study there was discussion about upgrading the 911 center for Recreation and Parks Operations. He does not remember the County Commissioners deciding not to do this. He does not see any mention of this here. Commissioner Jacobs made reference to # 40 on page 2-45, which is Link Government Services Center Renovations, and asked why there is no money in 2010 to complete this. Pam Jones said that it would cross fiscal years and Commissioner Jacobs asked if all money would be spent in 2008-09. Laura Blackmon said that she wants to move toward spreading projects out over fiscal years. Commissioner Jacobs made reference to #42 on page 2-47, which is the Northern Human Services Center. He said that he has heard the Manager question the utility of this building, and the Board should have a discussion about the future of this building before more money is invested. Commissioner Jacobs made reference to 2-53, which is Register of Deeds Automation, and said that he has heard complaints from a number of attorneys who say that it is very difficult to use the Register of Deeds online service because it is complicated and unresponsive. He suggested speaking with members of the legal community before money is invested in automation. Commissioner Gordon flagged for further discussion projects #18 (Animal Services Facility Construction); #40, #42, and #43 (renovation projects); #47-50 (whole section dealing with land opportunities); #64 (Twin Creeks Park); #73-74 (Reserve for Human Services Space and Library Task Force implementation- these need to move forward quicker). Commissioner Jacobs made reference to Lake Michael and said that he thought it was included in the bond and Donna Coffey said that this information was very late getting in to staff, and the County Commissioners have agreed to give the City of Mebane $75,000 over a three-year period. There are some preliminary plans and there will be a presentation to the Board of County Commissioners about next steps. Commissioner Jacobs made reference to page 5-3, which is ADA accessibility, and said that he was told that this was being worked on and it should be happening fast. He said that this is overdue, Orange County is not in compliance with the law, and it is an embarrassment. He wants to make this a priority. Commissioner Jacobs made reference to page 5-5, Reserve for Arts and County Facilities, and said that $5,000 a year is an insult to the arts community. He understands that it is a placeholder, but it almost seems like it is not worth putting in. Commissioner Jacobs made reference to page 5-7, Reserve for Future Court and Detention Needs, and asked about the status of the post office. Laura Blackmon said that the ball is in Chapel Hill's court. Pam Jones said that if the Town decides for the County to use the facility, there will have to be a feasibility study. The judges have said that they would like to see the impact of the new facilities in Hillsborough first before deciding about facilities in Chapel Hill. Laura Blackmon said that there is a note that once the justice facilities building has been in operation, then the other court needs can be reassessed. Commissioner Jacobs made reference to page 5-9, Reserve for Future Land Purchases, and said that this is not a lot of money. He said that the Board is a lot more committed to land purchases and conservation easement purchases than $2.9 million over ten years. He would like to beef this amount up considerably. Commissioner Jacobs made reference to page 5-11, Reserve for Heating, Ventilation, and Air-Conditioning Systems Replacement, and suggested doing these things in a more energy efficient, green, cutting-edge way instead of putting in the same systems. Chair Carey said that a lot of these things that Commissioner Jacobs is commenting on are not getting responses from the other County Commissioners because they include moving money around between years. He said that he is not prepared to do this tonight. Commissioner Jacobs said that he recognizes this, but he wanted to bring attention to some of these projects. Laura Blackmon said that the next step is to look at how to finance these things and the philosophy in how to fund items. Donna Coffey said that the County has undertaken in the last 5 years some hefty projects, so it did not get into debt overnight and will not get out of debt overnight. Commissioner Gordon said that the County has made wise investments to meet pent up needs and incurred debt in doing so. Chair Carey asked staff if there was enough direction from the Board and Laura Blackmon said yes. Commissioner Jacobs pointed out the letter from Mary Kruter in reference to requesting usage of and that she has been waiting. He encouraged the staff to make a list of what the buildings that the County might be moving out of. Laura Blackmon asked about the Board's availability for meeting for amini-retreat in December. Commissioner Nelson said that the only date that he is unavailable is December Stn for the mini retreat. Commissioner Foushee said that she is not available on December 14tH After further discussion, it was agreed to that the Board would meet for their mini-retreat on Friday, December 7, 2007 from 1:OOpm-5:OOpm at the Government Services Center in Hillsborough. The meeting was adjourned at 10:07 p.m. Moses Carey, Jr., Chair Donna S. Baker, CMC Clerk to the Board