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MINUTES
ORANGE COUNTY BOARD OF COP4MISSIONER5
MAY 2Z, 1978
The Orange County Board of Commissioners met in regular session an
Monday, May 22, 1978, at 6:30 p.m., at Poppa Joe's Restaurant in Hillsborough.
The purpose of the meeting was to hear a budget-program review by the County
Health Board and staff.
Commissioners present were Chairman Richard Whitted, Norman Gustaveson,
Jan Pinney, Norman Walker and Donald Willhoit.
Health Board members present were Chairman Dr. William Mayes, Evelyn
Lloyd, Dr. Morris Shiffman, and Commissioner Willhoit also serves as a member
of the Board of Health.
Others present were S. M.'Gattis, County Manager, Neal Evans, Finance
Officer, Jerry Robinson, Health Director, Tony Laws, Chief Sanitarian,
Margaret McClintock, Nursing Supervisor, Joe Bradshaw, Administrative Assist-
ant, and Agatha Johnson, Clerk to the Board.
Chairman Whitted opened the meeting by expressing the appreciation of
the Board to the Health Board for .their first year of service to the County.
Dr. Mayes stated that the programs which ,are proposed for the future
are necessary to meet the needs of the people of the County. They are so
structured to coordinate with services which are provided by other health
related organizations in the County. He stated that many times one cannot
see direct effects of services immediately, but that definite results are
seen years later.
Dr. Noyes asked the Health Directox, Jerry Robinson, to review with the
Board plans of haw the Health Department should be set up fox the coming year,
and how needs can be met.
Jerry Robinson distributed for the Commissioners' brief review, copies
of Standards for Local Health De artments in North Carolina. He stated
that the Health Board would like to be in concert with these standards,
however, at present the Orange County Health Department is not meeting these
standards, but is making efforts to move in that direction.
Mr. Robinson presented to the Board comparisons of Orange Ccunty''s
Health Department to Departments in nine other counties in the State, with
like populations. The comparisons showed the per capita appropriation per
county, the general tax rate for the counties, the total appropriation per
county for Health Departments and the total staff size of County Departments
as compared to Orange County. Mr. Robinson pointed out that out of the
ten counties compared, Orange County usually is found in number nine position.
He stated that Orange County has been designated as a medically over-
served county and this rating does damage to the Health Department, whereas
the Department is not eligible for certain federal reimbursements. He added
that he had been informed that the Health Systems Agency intended to recom-
ment in July, 1978, thatNorthern Orange County be separated from the remain-
der of the County, and this will open avenues for other funding of programs.
Mr. Robinson asked Tony Laws, Chief Sanitarian, to speak of the Environ~
mental Health Program.
Mr. Laws stated that major services expected from his department are
restaurant inspections and sewer disposal inspections. Sanitarians are
responsible for the quality of milk produced by county farmers. Sanitarians
are involved with the milk processing which includes the quality of water an
animal might drink to evaluating the handling and storage of milk and milk
products sold in retail stores. The Health Department is vitally concerned
with private water supplies. Tt is estimated•'.that 700 wells will be inspected
during 1978-79, resulting in at least 1000 visits to various sites, and taking
about 15~ of staff time. He stated that water supplies and sewer disposal
weigh heavily with the Department's concern by the increase number of migrant
camps in the County. This year there will be more than 35 such camps.
Another concern of the Sanitarians is to provide a program of control of the
storage, collection, transportation, and disposal of solid waste and the
relation of such to rodent control.
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Other programs which the Sanitarians are involved with are: Inspection
of residential care facilities. Training programs are being planned to
educate workers in these facilities regarding food handling. Public Health
will assist with problems with locations of green boxes, in the area of
animal control, and also they are interested in housing standards for the
County. He added that all housing should inezlude an approved water supply
and sewage disposal.
Tn response to a question asked by Chairman Whitted regarding migrant
camps, Mr. Laws stated that migrant workers are the only laborers many
tobacco farmers can get. The workers usually live in tenant houses or
mobile homes located on the farm. There is an average of five workers to
each camp. He stated that these workers are in transit and fxom time to
time bring into the area various health problems. The North Carolina
Employment Security Commission has the responsibility foz placing migrant
workers in the County.
The Health Director introduced to the Board Margaret McClintock,
Supervisor of Nux'ses in the Health Department.
Ms. McClintock stated that the County has a separate population in the
Northern end of the County as compared to the Southern part. 1'he people
in these two areas have different concerns and different health problems.
The fact is not easily recognized, especially when one is looking at
statistics, that the Chapel Hi11-Carrboro area distorts these figures and
Orange County usually comes out looking good, which is not the case in the
entire county.
As far as indicators of health status go, classic indicators are the
causes of illnesses and deaths. Ms. McClintock reviewed perinatal morta- -
lity rates for Orange County, which are rates of children who die, including
fetal deaths through the first year of life. The average range of 24.0 to
49.4 is for the years 1970 through 1974 for Orange County. The County's
average, based against the State average is 29.6 out of 1000 children die
during the perinatal stage. She stated that most of the problems existed
in low income areas and in rural areas of the County.
The Neonatal Mortality rate has to do with deaths which occur between
birth through the first 28 days of life. The average range for Orange
County is 11.7 through 19.0 out of 1000 children. The average mortality
rate for the County is 13.3 out of 1000 children.
In Infant Mortality, the range is 15.1 to 29.0. The County`s aver-
age is 18.2 out of 1000 children. Causes of death in all children ages
1 through 4 are due 99 percent of the times to accidents. The mortality
rate tends to drop as children grow.
She informed the Board that the major cause of death in adults is due
to heart diseases and hypertension, however, hypertension is usually not
listed as a direct cause of death.
Thirty-three thousand (33,000) people in Orange County have one dis-
abling disease, and about half this number have two disabling diseases.
She informed the Board that since 1968, lung cancer has increased by 345
percent in Orange County, cola-rectum cancer is up by 30 percent, breast
cancer is up 44 percent and cancer of the prostate is up by 47 percent.
She stated that Orange County tops all counties in this area in the in-
cidents of sclerosis of the liver.
Chairman Whitted asked that Ms. McClintock speak of Ways in which
the mortality rate in infants can be lowered in the County.
The Health Supervisor stated that good perinatal care at an early
stage is of great value. The mother should receive good care and often.
She .should have good nutrition, have social support, help in the home
when the baby comes home, and that the baby should be a wanted baby.
She stated that recent studies show that the amount of family planning
in a community results in a decline in infant mortalities. Mothers who
are considered high risks are mothers over the age of 35 and under the
age of 18.
The Health Director stated that an agressive approach Wi].1 make an
impact on the infant mortality rate. He added the Family Planning Pro-
gram was such an approach and is tailor to the needs of the County.
Regarding the Maternal Child.Health Program, Ms. McClintock stated
there are a number of high risk mothers in Northern Orange. The Health
Clinic sees between 35 to 50 patients during clinic days. She added that
the Health Department makes a telephone call to all mothers of first horned
babies in the County, and makes a visit if the mother desires this. A
visit is made to all high risk mothers. The present nursing staff is not
sufficient to follow up on all the cases in the Maternal Child Health Pro-
gram.
Ms. McClintock informed the Board of a program known as EP.SDT (Early
Periodic Screening, Detection and Treatment). Children in this, program
are screened four times during their first year~of life and once each
_ year thereafter. She stated the County needs to be doing more of this
type of screening. Medicare prevents these children from receiving dental
care unless they have had a EPSDT Screening. Additional nurses are needed
-- in this program.
The Health Director spoke of the great need in the County for School
Health. He stated the budget narrative speaks to this need and to the
effort the Health Department hopes to make in meeting the need in School
Health.
Other programs which Mr. Robinson mentioned were School Dental Health,
Chronic Diseases, Tuberculosis, Venereal Diseases, vital records, and
efforts to be made by the administrative staff.
Regarding the Venereal Diseases program, Mr. Robinson stated the
Board-of Health hoped to hire a V. D. Control Investigator who will bring
to clinic infection-sources for treatment and education an V.D. avoidance.
~• Further, the Department hopes to add additional clinical services.
Mr. Robinson informed the Board the budget throughout is bias toward
community education in health matters, that the pay off lies in education,
when pedple take control of their lives.
Commissioner Gustaveson expressed his appreciation to the Health
Board for their concern and their effort. He stated one concern of his
was whether or not the programs are meeting the needs and are making a
dent. He asked if the Health Board is closing the gap in providing needed
services.
Chairman Whitted explained that he felt the Health Board and Depart-
ment had made a good start. He reminded the Boards that this is a tight
budget year and asked that the Department help the Commissioners by putting
into perspective the priorities which must be provided immediately.
The meeting was then adjourned.
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'Richard Whitted, Chairman
Agatha Johnson, Clerk
MINUTES
ORANGE COUNTY BOARD OF COMMISSIONERS
MAY 30, 1978
On Tuesday, May 30, 1978, the Orange County Board of Commissioners
met jointly with the Orange County Planning Board for the purpose of con-
ducting a public hearing regarding planning matters. The meeting convened
at approximately 8:OOp.m., in the Superior Courtroom of the Courthouse.
Present were Chairman Richard Whitted, Commissioners Norman Gustaveson,
Jan Pinney, Norman Walker and Donald Willhoit.
Planning Board members present were Chairman Dr. Robert Bonrr, Pat
Crawford, Jean Anderson, Lindsay Efland, Andrew Dobelstein, Col. Tr7illiam
Breeze and Art Cleary.
Staff personnel present were 5. M. Gattis, County Manager, Geoffrey
Gledhill, County Attorney, Hal Minis, Acting Planning Director, members