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HomeMy WebLinkAboutMinutes 03-04-2010 APPROVED 4/6/2010 MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS JOINT MEETING WITH BOARD OF HEALTH March 4, 2010 5:30 p.m. The Orange County Board of Commissioners met for a joint meeting with the Board of Health on Thursday, March 4, 2010 at 5:30 p.m. at the Southern Human Services Center in Chapel Hill, N.C. COUNTY COMMISSIONERS PRESENT: Chair Valerie P. Foushee, and Commissioners Alice Gordon, Pam Hemminger, Barry Jacobs, Bernadette Pelissier, and Steve Yuhasz COUNTY COMMISSIONERS ABSENT: Mike Nelson COUNTY ATTORNEYS PRESENT: John Roberts BOARD OF HEALTH: Dr. Anissa Vines, Chair; Chris Harlan, Vice- Chair; and BOH members Dr. Paul Chelminski, Mike Carstens, Christopher Cooke, Tony Whitaker, and Jim Stefanadis HEALTH DEPARTMENT STAFF PRESENT: Health Director Rosemary Summers COUNTY STAFF PRESENT: County Manager Frank Clifton, Assistant County Manager Gwen Harvey, and Clerk to the Board Donna S. Baker (All other staff members will be identified appropriately below 1. Introductions Introductions were made. 2. Message from Board of Health (BOH) Chair Anissa Vines, Chair of the BOH, said that they are here to bring to the Board of County Commissioners' attention issues that are of concern to them in reference to public health issues. She went through the great works within the Health Department and spoke of the accomplishments of various staff. She said that Orange County has a lot to be proud of as it relates to public health. She said that the Board of Health wants to have an engaged discussion with the Board of County Commissioners. Christopher Cook said that one of the challenges in public health is how to talk about public health with the normal person who does not know the lingo. He said that they want to think about health from a collective health perspective and not just individually and within the family. He said that public health is a provider of last resorts for those who cannot afford personal health providers. He said that the Board of Health sees resources in public health as investments, such as prevention health measures, etc. He made reference to a handout that shows that a $10 per capita investment over several years in a series of prevention programs yields, in North Carolina's case, a return of 5.6 to the dollar invested. 3. Statistical Update from Department Health Director Rosemary Summers made a PowerPoint presentation. 2008-2009 Year in Review 2009-2010 Progress Overall Department Finances •Final revenue and expenditures were $7,348,586 for the year (inc. grants) •$456,500 in grant funded projects •$2,120,785 in fees, reimbursements, state &federal •County general fund supports 64% of budget Comparative Funding Data 07-08 •Orange ranked 71/85 health departments for per capita spending for public health •Statewide average per capita was $62.40 •Orange was $43.93 •Local per capita spending for Orange was $38.39 and the average local per capita was $50.17 (ranking 571h) Statistics-Dental 2008-09 • 4,175 patient visits in dental clinics & provided 12,830 services -16% new patients -46% sliding scale patients 2009-2010 (6 months) 02,064 patient visits & 5,850 services provided -48% are sliding scale patients most at the 20% pay level Statistics-Dental •Number of patients waiting for a dental appointment averages 52 a month in Hillsborough and 28 a month in Carrboro •Twice as many children in Hillsborough are waiting for an appointment than in Carrboro Statistics-Medical •Chapel Hill clinic (comparing 6 months) -Prenatal patients increased from 36 to 68 (59%) -Prenatal visits increased from 187 to 375 (100%) -45% all prenatal patients are Hispanic and require language services (2 appointment slots) -58% increase in primary care -89% self-pay patients in primary care are 0-20% pay -DECREASED appointment slots available for other services because of the 2 slots needed for interpreters -338 patients unable to get same day appointments measured during a one month period in fall 09 Statistics-Medical •Hillsborough Clinic (first six months) -15% increase in sexually transmitted disease patients -9% increase in primary care -92% primary care self-pay are 0-20% pay -Higher% patients have Medicaid in Hillsborough clinic -115 patients unable to get same day appointments (measured in 4 week span in fall 09) •Both Clinics -Overall 10% increase in self-pay patients (as opposed to Medicaid) in all clinic service categories (child health, family planning, -Majority of self-pay patients are 0-20% pay Communicable Disease (not STDs) •25 patients with latent TB infections beginning 6 mo. directly observed therapy •38 refugee communicable disease screenings •4376 seasonal influenza vaccinations (3x the usual number!) •2256 H1 N1 vaccines given; 1600 doses redistributed to other practices •6 outbreaks; 1 product recall; H1N1 response continues •Cited by state for not having functional negative pressure room for collecting sputum samples safely Statistics-Environmental Health •Food & Lodging software allowed better tracking of inspection of establishments -Achieving only 35% of inspections on time -New or"changing" restaurants continue to require plan reviews •Public swimming pool inspections -New federal rules that required most pool owners to fix/install new drains and intakes -Need to increase inspection frequency during the "season" Statistics- Environmental Health •Well and Septic Program -Permits for all program areas were flat until October 2009 when the numbers started to climb -December numbers were at the 7-year average -Wastewater treatment management program inspections still increasing -Water testing requests remains stable over time Any "Good News?" •Received over$500,000 in grant funds already this year •Teen Tobacco grant renewed until June 30, 2013 •Management Academy team completing business plan for diabetes self-management program •Staff team selected to be trained in quality improvement techniques and apply to internal project *Healthy Carolinians received re-certification •Staff members continue to win professional awards •Orange County ranked 2nd healthiest county in state Challenges •More demand for services than can be provided with current staff in dental and personal health •Reductions in Medicaid reimbursement required service consolidation for home visiting services and re-assignment of staff •Reductions in Medicaid reimbursement for dental services and for some medical services will impact some revenues •New Smoke Free Restaurant and Bar Law requires additional staff time 4. Issues Discussion for 2010-2011 a. Two-Service Center Model b. Future Planning for Facilities Rosemary Summers said that the Board of County Commissioners has talked about the two-service center model. She thinks that the intention was to have an open discussion. Commissioner Yuhasz said that he has a foot in each board and he started with the dental clinic. He said that the Board of County Commissioners does not want to lose services that they have now and the Board of Health wants to put the resources to the best possible use and these two are in conflict. He said that there are both efficiencies and health concerns involved and there are political concerns involved and those two do not always lead to the same conclusion. Dr. Paul Chelminski said that, in a period of strained resources, the idea of focusing energies at one center is more efficient. The most efficient center might be Hillsborough. Anissa Vines said that the Board of Health gets complaints from the dental clinic in Carr Mill Mall about not being able to get appointments or call backs. She said that they have talked about the limitations of the dental clinic for the past 2-3 years. She said that there is not the space or the resources to provide the services that are needed. Commissioner Gordon said that if there is only one center in Hillsborough then people will have to travel to get to the clinic in Chapel Hill. Chapel Hill and Carrboro have fare free buses and there is a 420 bus service between Chapel Hill and Hillsborough. She said that the geographical center is in Hillsborough but the population center is in Chapel Hill and Carrboro. There is a part of the CIP to build a dental clinic at the Southern Human Services Center. She said that it is a complex issue to have only one center since travel is the main concern. She said that most people coming into Hillsborough will most likely be driving. She thinks that these things have to be considered and transportation is the key issue. Commissioner Hemminger asked about the expansion of moving into the other part of the Whitted Building and if this would enable them to increase services in Hillsborough and Rosemary Summers said that the combination of the resources and the two clinics is what would enable them to see more patients. It would be more efficient to have one site and they could see more patients at the one site than they can at the two separate sites currently. Commissioner Hemminger asked Rosemary Summers to walk through how someone living in Carrboro could get an appointment at the Hillsborough dental clinic. Rosemary Summers said that they schedule the appointments in one-hour slots and they pretty much keep to that pace. She said that the fact is that there are many more resources in the southern part of the County for people to access than there are in the northern part of the County. This is one of the factors taken into consideration in making the proposal to locate the service in the northern part of the County. Dr. Paul Chelminski said that unless there is a commitment to fund the ability to have two sites and to get better quality equipment, then there cannot be two sites. He said that something has to change because the dental school is not carrying its weight and Piedmont Health cannot cover everyone else. He is very concerned about access to care. Commissioner Jacobs said that the Board of County Commissioners discussed this at a work session and there was a suggestion of surveying the users and seeing where they come from and getting a better demographic picture. He said that this bleeds into the discussion of whether or not to plan to build a dental clinic at the Southern Human Services Center. This has been in the CIP. He asked if the Board of Health has discussed this. Annisa Vines said that the Board of Health has talked about the extra footprint that is at Southern, but the issue is complex (funding, why should it be at this location, etc.). She said that staff is running ragged and it is a strain and not satisfying to patients. Frank Clifton said that it has been pointed out that jurisdictions with a considerable population and a considerable land area find it more effective to concentrate resources at some location and make the best of it. He said that if you are going to have a double service, then you need to buy duplicate equipment and the County cannot afford that now. He said that the County should not provide second rate service with second rate equipment. At this time, there are two facilities, but only one is open at a time. Commissioner Pelissier agreed that they need to understand where the clientele is coming from. She said that it is an assumption that the population is in Chapel Hill but the ones with the most poverty are out in the County. She said that it may be good to look at other health users and whether they need a one-stop shop with the human services. Commissioner Yuhasz said that there is an apparent greater need in the Hillsborough area. He said that he does not think that a consolidation in Hillsborough now should be read as an abandonment of the two-service model. The County does not have any funds to build a new facility but it could expand the current dental clinic at the Whitted Center site for the short-term. He suggested consolidating it for the short-term and seeing how efficient it is and looking at how to provide transportation to Hillsborough for those living in Carrboro and Chapel Hill. Chair Foushee said that it would seem that it is the County's responsibility to ensure that the situation does not deteriorate. Her fear is that if they do not seriously look at how to be more efficient, then the current situation will worsen. Tony Whitaker said that he was shocked to learn the amount of money they were paying for rent for the Carrboro dental clinic and it is not even used three days of the week. Frank Clifton said that he met with the President of Durham Tech recently and he brought up this subject about possibly partnering and having a joint-use facility with the community college and health clinic facilities. The idea was floated for future reference and the response was positive. He said that if UNC Hospital sites at Waterstone, this could really be a partnership. Commissioner Gordon reiterated that they need to consider access for the people in Chapel Hill and Carrboro because 2/3 of the population is there and they pay 2/3 of the taxes. She said that you cannot just consolidate in one area without thinking of the other areas. Commissioner Hemminger verified that the lease at Carr Mill Mall is up in October 2011 and they will need to pay out if they leave early. Rosemary Summers said that they could vacate earlier if there was a sublease. Commissioner Hemminger asked when a decision had to be made. Frank Clifton said that staff is doing an analysis of where the clientele is and this may help to determine the other variables such as transportation. He said that he would not let the lease be the determination and he would go ahead and make the move if the County Commissioners agreed. Commissioner Jacobs asked about the inadequacy of engagement of the dental school and if the County has recently approached the dental school. Dr. Paul Chelminski said that the Health Department cannot internally make referrals within UNC for dental patients with serious issues because they have to have cash to be seen. He said that it is not part of the stated mission of the dental school to be a safety net provider. Rosemary Summers said that they did ask the dental school directly about partnering with the County for services. There have also been discussions with Piedmont Health about this. The dental school said that it would be glad to provide the services, but it would charge on a dollar for dollar basis. This would be more expensive than how the Health Department currently operates. Piedmont is considering this as an option, but it is still in discussion. Chris Harlan said that she heard that Piedmont Health is only accepting patients with insurance. This will have a huge impact on the safety net issue. As far as analysis, she said that they need to look in the community and identify people who need dental services but are not seeking them. Anissa Vines said that the Board of Health selected two issues to discuss this evening, but there are other needs. She said that they need to think short-term and long-term and efficiencies. This is a very complex issue. She said that they do have a sense of urgency to be responsive to the residents of Orange County as it relates to dental care and public health. 5. Closing Remarks Annisa Vines thanked the Board of County Commissioners for the opportunity to be here tonight and to share the issues. With no further items to discuss, the meeting was adjourned at 7:06 PM. Valerie Foushee, Chair Donna S. Baker, CMC Clerk to the Board