Loading...
HomeMy WebLinkAboutBOH minutes 012710MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 January 27, 2010 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON January 27, 2010 at the Southern Human Services Center, Chapel Hill, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Anissa Vines, Chair; Chris Harlan, Vice-Chair; Jim Stefanadis; Paul Chelminsky; Tony Whitaker; Steve Yuhasz; Michael Wood: Jessica Lee; Christopher Cooke; DeWana Anderson BOARD OF HEALTH MEMBERS ABSENT: Mike Carstens, out of town STAFF PRESENT: Wayne Sherman, Personal Health Services Division Director; Tom Konsler, Environmental Health Services Division Director; Donna King, Health Promotion and Education Services Division Director; Angela Cooke, Dental Health Services Division Director; Carla Julian, Risk Management/Quality Assurance Director; Letitia Burns, Business Officer; Anne Miles Cassell, Administrative Assistant; GUESTS PRESENT: Emily Leazer, UNC journalism student; Rebecca Patterman, UNC journalism student, Daily Tar Heel; Jean Davidson, Chapel Hill homeowner; Cameron Park Elementary School Robotics Club students I. Educational Presentation: Billing and Collecting Fees Process Letitia Burns, Business Officer, gave a Power Point presentation and highlighted the fee collection process within the department. Various services are governed by state and federal mandates for setting and collecting fees. The department’s services are funded through federal block and special grants, state appropriations, county appropriations, third party reimbursements, special project grants and fees. Ms. Burns provided the Board with information regarding fee structures and policies within the different divisions of the department. Tony Whitaker asked if the department has an established policy for fee recovery and if the department was able to charge only the minimal cost or was able to charge the full amount of services. Ms. Burns explained that our fees are at or above the Medicaid rate as required. Care is given to maximize the returns based on insurance co-pays, if any, and the fees charged. Traffic Problems in Hillsborough, a report by Mr. Wood Michael Wood introduced students from Grady Brown Elementary School Robotics Club who presented a short skit for Board members reflecting traffic patterns in Hillsborough as they relate to environmental concerns. II. Welcome and Introductions Anissa Vines, Chair, called the meeting to order at 7:00 P.M. MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 January 27, 2010 III. Public Comment for Items NOT on Printed Agenda Jean Davidson, an Orange County citizen from Chapel Hill addressed the group citing problems she has been experiencing with the permitting process and regulations holding up completion of a geothermal heating and cooling system. She asked the Board for help or direction to resolve issues that are causing the delay in completion. IV. Approval of January 27, 2010 Agenda Rosemary Summers requested that Agenda Item V.H. Possible Topics for Joint Board of Health/Commissioners Meeting be added to the Agenda. The motion to approve the Agenda of January 27, 2010 as amended was made by Chris Harlan, seconded by Steve Yuhasz, and carried without dissent. V. Action Items on CONSENT Agenda A. Minutes approval of November 18, 2009 meeting. B. New and Updated Fees Several new fees and one updated fee were requested mid-year to assure potential revenue could be realized. The Tdap vaccine (Tetanus, Diptheria, Pertussis) is no longer provided free by the State for adults with the exception of post-partum women. It is recommended for all adolescents/adults to help prevent the spread of pertussis to infants/children. The cost is $32.45 per dose and the fee would be $45 (vaccine plus administration cost). Private providers are charging between $90 - $160 per dose. Five new diagnostic lab fees were requested for approval. These fees represent the cost of the laboratory service at UNC McClendon Labs and are provided by our clinic at cost to clients. The Health Department has a standing “at cost” agreement with UNC Labs for reference tests. Two fees will allow the department to bill for Diabetes Self Management Education (DSME) services; 1 hour initial assessment at $22 per half hour, 8 hours of group class instruction at $12 per half hour and 1 hour individual three month follow up visit at $22 per half hour. The State was providing pediatric Hepatitis A vaccine free for a period of time but is no longer. The Department proposes a fee of $25 (vaccine and administration). C. Accept New Funds Diabetes Self Management Education Program (DSME): The Kate B. Reynolds Foundation sent an additional $750 to support the start up of the DSME Program. Family Planning Bonus Funds: Federal Title X (family planning program) has approved MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 January 27, 2010 one-time bonus funds for all local health departments. The method of distribution includes a base amount and additional amount based on performance. Orange County has been advised that it will receive $1,250 for family planning purposes. National Association of County and City Health Officials (NACCHO) Capacity Building Award for Medical Reserve Corps (MRC): The Health Department was notified at the beginning of January that our application for the Capacity Building Award was approved in the amount of $5,000. This money is to help support the MRC program with money for training and supplies. NC Citizen Corps (MRC/PHRC Grant): Orange County has been notified that our proposal was approved for the amount of $8,741.03 to support the goals and objectives of our Public Health Reserve Corps (PHRC) program. The funding is to be used for equipment, training, recruitment and planning. Training includes American Red Cross (ARC) First Aid and ARC Psychological First Aid training. NC Citizen Corps (CERT) Grant: Orange County has been notified that our proposal was approved for the amount of $8,663.14 to support the goals and objectives of our Community Emergency Response Team (CERT) Program. The funding is to be used for equipment, training and planning. Motion to accept items on the Consent Agenda was made by Jessica Lee, seconded by Jim Stefanadis, and carried without dissent. VI. Reports and Discussion with Possible Action A. Customer Service Reports Each division shared the results of customer service surveys conducted by each program in the last year. A Power Point presentation encapsulated the highlights of the survey results for each division of the department and provided solutions to areas of concern. Paul Chelminski asked Tom Konsler how many surveys were sent out. Tom replied that this year Survey Monkey was used and thousands were sent out by way of a link on the website and emails. He pointed out that Environmental Health staff reduction of 3 has required the office to close during the lunch hour so that staff could go to the bank and have lunch. The survey asked specifically about this and feed back was that it had not affected service significantly. Each report had specific actions that had been implemented as a result of the feedback. B. Landfill Area Assistance Fund Proposal Tom Konsler reported that at the November 17, 2009 BOCC meeting, the County Manager proposed the creation of a fund to assist residents who live near the Orange County Landfill. The fund would provide financial assistance to residents who experience problems with their wells. The Manager compared this fund to the No-Fault Well Repair Fund (NFWRF) which was established to assist residents near the American Stone Quarry who experienced well failures that are not attributable to the quarry MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 January 27, 2010 operation. The NFWRF program relies on money from Martin Marietta and OWASA to replenish the fund. The Orange County Health Department administers the NFWRF policy by providing the testing, determining the available remedies, and overseeing contractors, repairs, and permitting. A resolution is being prepared by the County Manager for consideration by the BOCC. The Manager proposes that the landfill area funding source would be from the Solid Waste Enterprise Fund. It is anticipated that this program would operate similarly to the NFWRF. The Board was provided with a draft copy of a policy that is adapted from the NFWRF to consider as a possible policy for adoption by the BOH and the BOCC. The staff is recommending inclusion of septic systems in this proposal. The basis for the Manager’s recommendation for such a fund is a 1999 multi- governmental agreement to provide for community improvements within the ‘areas’ neighboring the existing landfill. The Manager is generally only considering wells in his proposal to Commissioners. While safe drinking water is of primary importance, another necessary community benefit is identification of and repairs to failing septic systems. Staff recommended that the Board of Health request that the resolution for the landfill assistance fund include considerations for failing septic systems in addition to failing wells. Tom Konsler stated that there is no requirement to have a well that produces potable drinking water; however, a working septic system in the absence of sewer hookup is required. Steve Yuhasz asked how the NFWRF applied to undeveloped lots. Tom Konsler stated that there is no provision in the NFWRF for undeveloped property. Commissioner Yuhasz stated that we should be cautious in how we commit these funds since they will be needed for monitoring the closed landfill. Jessica Lee stated that it was important from a public health perspective to include septic systems in any fund policy and suggested that the Board consider including this perspective in any recommendation sent forward. Tony Whitaker referenced the phrase “No Fault” in the fund policy and suggested amended language to be used in a letter to Commissioners. Paul Chelminsky stated that it was intuitive to see the cause and effect of how a landfill could affect water quality but to scientifically prove septic system failure due to landfill would not be possible. He also pointed out that a septic system could fail anywhere else in the county and the property owner would be responsible for repairs and receive no assistance. Dr. Chelminsky stated that this is setting a dangerous precedent and is more political than health related. Anissa Vines suggested that due to time limitations for further discussion a letter be sent to the County Manager pointing out the importance of septic systems and outlining concerns. Rosemary Summers stated that a Resolution is set to go forward at the BOCC February 2nd meeting and that it would be helpful in their final consideration of this Resolution to have the Board of Health input. MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 January 27, 2010 Christopher Cooke felt that it was dangerous to put this health issue under the umbrella of “no fault” with a lack of scientific evidence as is stated in the documentation. There being no motion to move on any recommendation until further discussion this topic was deferred for consideration at a future meeting. C. Update on H1N1 and Seasonal Flu Vaccinations In the interest of time, no verbal report was presented. The Chair directed the handout be shared with Board members. D. Implementation of the New Smoke-Free Law North Carolina’s new smoke-free law went into effect January 2, 2010 prohibiting smoking in enclosed areas of bars, restaurants and portions of lodging establishments. The NC General Assembly passed the law based on findings that secondhand smoke has been proven to cause cancer, heart disease, and asthma attacks. Under the law, a business owner must: • Post required no-smoking signs in conspicuous locations • Remove indoor ashtrays and other smoking receptacles, and • Direct any person who is smoking to extinguish the cigarette, cigar or other lighted tobacco item Enforcement measures for noncompliance with the law include: • For an individual who smokes in prohibited areas – a $50 fine for infraction to be issued by a law enforcement officer • For a business owner who fails to comply – an administrative penalty issued by the Health Director of not more than $200 per day of violation after two written warnings. Orange County applied for and received a small grant to assist in disseminating materials and educating restaurant and bar owners about the upcoming law. The state has encouraged county health departments to engage in a substantial amount of education prior to enforcement of this law. They recommend that enforcement be primarily applied on a complaint-only basis. A statewide complaint reporting system is in place to allow the public to register complaints online or by phone. Complaints are forwarded to Health Departments on a weekly basis. The public may also complain directly to the local health department and then we would report these complaints to the state as well. In the first week, Orange County received one complaint for violation of the law by the owner of a hookah bar. A warning letter was delivered to the business in accordance with protocol which was developed for enforcement. The Board of Health should be aware that there is a provision for an appeal to the Board of Health as part of the statewide process for enforcement implementation. The same rules apply to this appeal process as currently applies to appeals for well or septic permits. MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 January 27, 2010 The law also allows for local governments to adopt more stringent rules and ordinances governing smoking. If Board of Health rules are adopted that are more stringent, they must be followed by an ordinance that is also adopted by the Board of Commissioners. Boards of Commissioners may adopt ordinances in this area independent of Board of Health action. The current ordinance adopted by the Board of Commissioners limits smoking and tobacco use to all county buildings and grounds within 50 feet of Health and Social Service building entrances. This new law would enable this ordinance to be revised and could provide for all grounds owned or operated by the county to be tobacco free. The staff recommended that the Board of Health send a letter to the Board of Commissioners requesting that the current ordinance be amended to require all buildings and grounds owned or operated by the county to be tobacco free. In addition, it is recommended that the Board of Health send a letter to all municipalities in Orange County encouraging them to adopt similar ordinances for their buildings and grounds. The Board felt that it had insufficient information to act on this request. Emily Leazer, UNC School of Journalism, asked if enforcement was reactive or proactive. Tom Konsler replied that complaints are submitted to the state or directly to the health department. The department responds with an educational letter and a copy of a Business Guide. The first letter is hand delivered by a staff member who is then available to answer any questions the bar or restaurant owner may have. Christopher Cooke asked how a fine is enforceable. Rosemary Summers stated it is enforceable through the court system and law enforcement. The responsibility to enforce the law is on the restaurant or bar owner. Paul Chelminsky asked how an appeal is handled. Rosemary Summers stated that once an individual is fined for non-compliance they would be able to appeal to the Board of Health to assure that proper procedure was followed. Motion to adopt Orange County Health Department Protocol for Enforcement of the NC Smoke-Free Restaurants and Bars Law was made by Michael Wood, seconded by Jessica Lee, and carried without dissent. Motion to send a letter to the Board of Commissioners recommending expansion of the tobacco-free ordinance to be campus-wide was made by Jessica Lee, seconded by Chris Harlan. The motion was not voted on and deferred for further discussion. E. Whitted Space Assignment The Department of Social Services and the Library completed their move out of the Whitted Building in mid-January. At the Department’s request, the Manager has proposed to the Board of Commissioners that the Health Department be assigned additional space in the Whitted Building that includes all of the ground floor of Building A. The Housing and Community Development Department will be moving to the second floor above the current Health Department space and the remaining space is proposed to be offered to the Orange County Schools for relocating some of their MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 January 27, 2010 central office staff. It is the department’s intent to renovate and expand the personal health clinical space by moving that operation to the A building ground floor. This will enable 3 additional exam and interview rooms and larger laboratory, pharmacy and counseling spaces. The current clinical space will be occupied by additional dental operatories and office space for staff that provide direct patient services. We are planning on using Medicaid cost settlement funds that we have saved for this purpose. We estimate that we will use $200,000 to $250,000 for these changes. As a part of this temporary expansion, it is proposed that Carr Mill Dental Clinic be closed at the completion of the renovation. As was discussed with the Board last year, it will be more efficient to have the full-time staff stay in one location to provide services and for the county to save the rent that it currently pays at Carr Mill. The lease on the Carr Mill space expires in October 2011. The County is exploring whether that space could be sublet or filled with another tenant without penalty to the County. The equipment from Carr Mill will be moved to the Hillsborough location. The renovation is estimated to take 6 – 9 months. This space will take the department through the planned county purchase of the Mayo Street property in 2012. The renovation and upfit of that space will likely take until 2014 to complete. The department has acquired through donations, two used panorex machines for dental services, two exam tables, and a medical records unit similar to the one currently being used. The exam tables and medical records unit were donated by Nortel as it downsized its employee health program with the reduction in staffing this year. The department is continuing discussions with UNC regarding their plans for the designated “medical office building” at the Hillsborough Hospital campus. There is no further information available at this time. F. Committee Reports The Environmental Services and Quality Assurance Committee met this month; the minutes were provided to the Board for possible discussion. The Clinical and Community Programs Committee did not meet this month. G. Informational Items a. SOTCH Report: The 2009 State of the County Health Report (SOTCH) provides an update of health concerns, and actions, being taken to address them. It uses the most recent data to highlight county demographics, the leading causes of morbidity and mortality, and progress toward addressing the leading health concerns identified in the 2007 Community Health Assessment. The prioritized health issues are 1) Access to health care; 2) Health promotion; 3) Adolescent health; 4) Mental health; 5) Transportation. Highlights include: Immigrant and Refugee Health, Mental Health and Substance Abuse, H1N1, Pertussis, Project Homeless Connect, as well as, reports from the various Healthy Carolinian subcommittees. MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 January 27, 2010 b. Quality Improvement Project: Orange County has been accepted to be one of the first group of counties to be trained in quality improvement techniques by the new Public Health Quality and Performance Improvement Center. The orientation sessions begin in February with the first training to take place in April followed by an implementation phase and then a follow up workshop in August. The Department will be choosing an improvement project and team in February. Under consideration as a project is to improve collections for the Wastewater Treatment Management Program. c. MMWR Report: This past summer Orange and Alamance Counties were invited to be part of a “Quick Strike” research project funded by the Robert Wood Johnson Foundation through the Practice Based Research Network that the department has been a part of. The project was to predict uptake of the H1N1 vaccine which was to be released this past fall and to determine what methods of communication would be effective. The results of the study were recently published in the CDC’s Morbidity and Mortality Weekly (MMWR) and a copy of the article was provided for the Board. d. Media Clips: Media clips relative to current issues were provided for Board information. e. Pending and Recurring Items: A table of pending and recurring Board of Health agenda items for reference and future planning. H. Possible Topics for Joint Board of Health/Commissioners Meeting The Joint Meeting of the Board of Health and Board of Commissioners is scheduled for March 4, 2010. The meeting is a dinner meeting, where the dinner starts at 5:30 and ends no later than 6:45. The Commissioners have a work session immediately following the meeting with the Board of Health. Generally, this meeting affords an opportunity for the two Boards to engage in discussions about issues of mutual interest. In the past, Board of Health members have presented short informational background to start the discussion. Usually there is only time for 2 or 3 topics. After discussion the Board agreed on: • Recession impacts on service • Two-service Model and the Impact on Budget; i.e. the costs of providing services in two locations without dedicated staff for both locations (dental); plus the commitment of the county to adequately fund equipment for a two service model. The Board felt that these two topics would take all of the time allotted. VII. Board Comments/Announcements A. None VIII. Adjournment Motion to adjourn the meeting was made by Chris Harlan, seconded by Paul Chelminsky, and MINUTES ORANGE COUNTY BOARD OF HEALTH January 27, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 January 27, 2010 carried without dissent. The next Board of Health meeting will be held on February 24, 2010 at the Government Services Center, Hillsborough, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board