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HomeMy WebLinkAboutBOH minutes 042110MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 April 21, 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 April 21, 2010 at the Link Government Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Anissa Vines, Chair; Chris Harlan, Vice-Chair; DeWana Anderson; Mike Carstens; Paul Chelminski; Christopher Cooke; Jessica Lee; Jim Stefanadis; Tony Whitaker; Michael Wood; Steve Yuhasz, BOCC BOARD OF HEALTH MEMBERS ABSENT: None 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; Rebekah Herman, Family Home Visiting Coordinator; Annette Moore, Orange County Staff Attorney GUESTS PRESENT: Deborah Flowers, RN, Orange County Child Fatality Protection Team; Emily Leazer, UNC Journalism School I. Welcome and Introductions Anissa Vines, Chair, called the meeting to order at 7:00 P.M. and introduced guests. II. Animal Services and Public Health DeWana Anderson, Veterinarian Representative to the Board of Health also acts as the Board liaison to the Animal Services Committee. A Power Point presentation was provided updating the Board on improvements and changes in shelter facilities and animal services operations. It is a new 15,000 square foot environmentally friendly facility. The improvement in facilities has enabled staff and volunteers to provide services more efficiently and has resulted in less disease transmission and stress on the animals. It was pointed out that rabies outbreaks appear to run in cycles and currently is in a low point of the cycle. Only one confirmed case of rabies has been reported in Orange County this year. Last year Orange County had 12 rabies cases, the lowest Orange County has experienced in several years. In 2008 there were 18 cases and in 2007 there were 24 confirmed rabies cases. Steve Yuhasz asked what action an individual needs to take if they suspect they see a rabid animal. Dr. Anderson replied that the animal should not be approached and to contact Orange County Animal Control. Christopher Cooke asked when the last time a dog or cat transmitted rabies to a person in Orange County. Dr. Anderson stated that no actual human rabies cases were known, but several Orange County residents have been prophylactically treated due to exposure to the rabies virus in the past and there have been no exposures this MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 April 21, 2010 year. Mr. Cooke explained that this was surprising since he noted from the statistics provided to the Board that the difference between the estimate and the number of registration notices issued suggests that there continues to be a significant segment of dogs and cats that are not registered with the County or vaccinated against rabies. III. Approval of April 21, 2010 Agenda The Chair announced that the Department had received a request for an appeal from Adam Bliss. Scheduling for the Adam Bliss Appeal Notice was requested to be added as the first item on the Action Agenda. As a result this would move all other topics to the next letter down. The motion to approve the Agenda of April 21, 2010 as amended was made by Jessica Lee, seconded by Chris Harlan, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None V. Action Items on CONSENT Agenda Wayne Sherman requested removal of Item II.B., 2010-2011 Contract Renewals, from the Consent Agenda for discussion of one of the contracts. A. Minutes approval of March 24, 2010 meeting. The Board reviewed the minutes of the March meeting for accuracy. Motion to approve the minutes was made by Steve Yuhasz, seconded by Jessica Lee and carried without dissent. VI. Reports and Discussion with Possible Action A. 2010 -11 Multiple Contract Renewals There are currently 9 contract renewals for FY 10-11. All have been reviewed by the Staff Attorney and are effective July 1, 2010 to June 30, 2011. The contracts are: 1. Contract Renewal with UNC Family Medicine (UNCFM) for Medical Director Services: OCHD has maintained a contract with UNC Family Medicine for Medical Director Services for a number of years. Dr. Michael Fisher has served in this capacity for the past eight years with back-up from other UNCFM physicians. Dr. Fisher is well received by clients and staff enjoys working with him. However, Dr. Fisher has announced his retirement effective September 30, 2010. A search team has been formed, including representation from OCHD to select his replacement. The FY10-11 contract has several proposed changes to it this year. It continues the contract at 28 hours per week, 22 hours in clinic and 6 hours MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 April 21, 2010 providing phone consultation, administrative duties, and back-up on-call responsibilities. It clarifies several responsibilities including participating in program audits as requested, meeting with nurse practitioners at least every 6 months to identify and document clinical problems, progress toward improving outcomes and recommendations for changes in treatment plans; meeting with new nurse practitioners monthly during the first six months of practice to discuss practice-relevant clinical issues and quality improvement measures; and assuring all medical residents and students are in compliance with OCHD immunization requirements. The FY 10-11 contract does not include a cost increase. The total amount of the contract remains at $145,416 per year. Chapel Hill Carrboro City Schools (CHCCS) is seeking renewal of its contract with the Medical Director for medical supervision of one of its School Nurses who is a qualified Nurse Practitioner to provided limited nurse practitioner services in the Head Start Program. The contract in effect this past year has been deemed successful. The cost and payment arrangement remains the same as previous years. 2. Contract Renewal with Robert DuPuis for Pharmacy Services: The issuance of pharmaceuticals through our clinics or during epidemics/disasters requires the services of a registered pharmacist. Robert DuPuis, Pharm.D., a Clinical Associate Professor in the Division of Pharmacy Practice at UNC School of Pharmacy has served as our Pharmacist for the past eight years. He has fulfilled his responsibilities well and is interested in continuing to serve in this capacity. There are no changes in the FY 10-11 Pharmacy Contract. The total amount of the contract remains at $12,036 per year. 3. Contract Renewal with UNC School of Dentistry for Dental Resident: The Orange County Health Department (OCHD) annually contracts with the UNC School of Dentistry for services of one full-time dental resident for four and one-half days per week. The residents provide services at both the Hillsborough and Carrboro dental clinics. The total cost of the contract for July 1, 2010 through June 30, 2011 is anticipated to be $54,848. This amount was included in the FY10-11 dental budget. This contract cannot be fully executed until the state legislature passes their budget and the rate may be higher as a consequence. 4. Contract Renewal with Elizabeth Krzysztoforska, DDS for Dental Services: OCHD has contracted with Dr. Krzysztoforska for about 10 years to provide dental clinical services on Mondays at Carr Mill. Dr. Day either flexes his schedule on Mondays or provides services at the Hillsborough location on Mondays. 5. Contract Renewal with Diane Shugars, DDS for Dental Services: Dr. Shugars is the back-up dentist when Dr. Day is out for vacation or for planned continuing education. MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 April 21, 2010 6. Contract Renewal with Chapel Hill Training & Outreach, Inc. for Head Start Dental Services: In 2003 Chapel Hill Training and Outreach, Inc. approached the health department with a request to provide required dental screening and treatment services to all children enrolled in the Head Start Program located in Hillsborough. The first contract for services was developed and issued in the fall of 2003 and the program has worked well for both parties. Both wish to renew this contract for services for FY10- 11. The contract amount is reduced by mutual agreement to $6,000 per year since more of the children than anticipated have a private dentist providing care after the initial screening. 7. Contract Renewal with CHCCS for School Nurses and Contract Renewal with Orange County Schools for School Nurses: OCHD has served as the conduit of Commissioner approved funding for school health nurses for both the Chapel Hill Carrboro City Schools and the Orange County School System. The Department enters into a contract with each of the school systems to spend the funding on a specified number of direct service 10- month school nurse positions. In FY 10-11 the proposed contracts provide $428,032 to CHCCS for six school health nurses and $182,697 (increased from $173,220) to OCS for three school nurses. Wayne Sherman explained the amended OCS amount. Per the contracts the Health Department agrees to make quarterly payments upon submission of an invoice and to provide at least 3 continuing education sessions to school nurses. 8. Contract Renewal with Person County for Public Health Preparedness Services: The State of North Carolina has received federal funds from the Centers for Disease Control and Prevention (CDC) to ensure that North Carolina is prepared in the event of a public health emergency. Allocated funds enabled Orange County to employ a full time public health preparedness coordinator, a Public Health Nurse II, from 2003 – 2008. Reductions in funding since 2006 made it impossible to support a full-time position with these funds. To ensure that the deliverables as mandated are met, an agreement was developed with Person County in 2008 to share a Preparedness Coordinator. Upon mutual agreement, Person County hires and supervises this position. Pat Gentry, the Preparedness Coordinator hired by Person County spends 2 to 2 ½ days per week in Orange County. The Agreement began on December 1, 2008 and has been in effect FY 09-10. The amount of the agreement for FY 10-11 remains unchanged. There are sufficient federal funds allocated by the State to Orange County to pay for this agreement. Christopher Cooke asked for clarification on the Public Health Preparedness Contract. It was explained that this is a shared position with Person County. The costs reflected do include salary and benefits and is traditionally a nurse position. He questioned whether the job could be done as well or better by a non-nurse employee at a lesser cost. Carla Julian replied that this position has been held by a nurse from the onset of the program and Person County was responsible for filling this position. MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 April 21, 2010 Steve Yuhasz asked when these contracts would go into effect. Wayne Sherman replied that they would be effective at the beginning of the FY10-11. Motion to approve the multiple contract renewals including school contract changes was made by Jessica Lee, seconded by Mike Carstens, and carried without dissent. B. Adam Bliss Appeal Hearing Request On January 2, 2010 a new law went into effect prohibiting smoking indoors at restaurants and bars in North Carolina. Enforcement and complaint response was delegated to local health departments. The board adopted an enforcement protocol that staff developed based on guidelines issued by the state. Tom Konsler explained that a bar in Chapel Hill, Hookah Bliss, owned by Mr. Adam Bliss, has been inspected several times in response to complaints received that smoking was allowed inside the bar. One educational letter and two violation notices were issued as a result of the inspections and on March 22nd, Mr. Bliss was given a third violation notice. An administrative penalty was issued by the Health Director at that time. The administrative penalty continues to accrue each day that Mr. Bliss operates in violation of the law. On April 19th, Mr. Bliss submitted a notice of appeal challenging the state’s interpretation of the law which does not exclude hookah bars from the indoor smoking prohibition. The Board is obligated to schedule a hearing in response to this appeal in accordance with NCGS 130A-24. Given the constraints of the notification requirements, the hearing must be held either May 3rd or May 4th. In response to clarification by the Board, Annette Moore, County Staff Attorney, stated that the only thing the Board could rule on at an appeals hearing would be whether the Department had correctly acted within the guidelines and protocols of the law in its enforcement. The hearing will be recorded and a transcript prepared following the hearing. Annette Moore stressed the importance that a quorum of Board members be present for the hearing. May 4th was the only date a quorum would be able to attend and a time of 6:30 PM worked best for the Board. Motion to hold the Appeals hearing requested by Mr. Bliss on May 4, 2010 at 6:30 PM at Southern Human Services Center was made by Jessica Lee, seconded by Christopher Cooke. C. Child Fatality Protection Team and Child Protection Team Report/Appointment of Local Health Provider to CFPT The Child Fatality Prevention Team (CFPT) and the Community Child Protection MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 April 21, 2010 Team (CCPT) is a legislated group in every county of the state. State statute grants the Teams the right to review records (medical, mental health, law enforcement, etc.) to carry out its duties. Rebekah Hermann, OCHD Family Home Visitor Coordinator, reported that the CFPT identifies child death patterns, identifies system problems or gaps, and makes and/or carries out recommendations for change to prevent future child fatalities in the county. Community Child Protection Teams (CCPT) were established in 1991 to ensure that families have recourses available to provide safe environments for their children, identifies and informs child protection issues impacting the ability of families to protect their children, and makes recommendations for legislative changes. Both teams are required by statute to submit reports annually to the State of North Carolina and to the local Board of Health and County Commissioners containing any recommendations, including advocacy for system improvements and needed resources where deficiencies and gaps may exist. CFPT and CCPT have functioned as a joint, interagency review team since 1998. Steve Yuhasz noted that all participants are still not as involved as should be. Ms. Herman replied that last year thanks to action by Commissioner Yuhasz an additional participant was now involved in the team. CFPT data is tracked on a calendar year, reviewing deaths from the previous year. In 2009 15 fatalities of children birth through 17 years who died in 2008 were reviewed. Approximately one-third of the deaths appeared to have been preventable. All four of the teen deaths appeared to have been preventable. Ms. Hermann reported that the CCPT reviewed 8 families representing 23 children who were actively involved in Child Protective Services. Findings included substance abuse, mental health issues, sexual abuse, physical abuse, domestic violence, and several children born positive for cocaine. Several system problems have been identified as a result of this report. Barriers exist to access supportive comprehensive mental health services. There are limited resources for children who have experienced severe abuse or neglect where children manifest serious mental health problems and complex medical challenges. Per statute a local health provider shall be appointed to the local CFPT by the Board of Health. Deborah Flowers, MSN, RN – program coordinator/nurse consultant with the UNC Department of Pediatrics’ NC Child Medical Evaluation Program, has been participating since January 2007 and even serving unofficially as co-chair. She is internationally certified as a Sexual Assault Nurse Examiner for Adults and Pediatrics, has 25 years of experience as an Emergency Department nurse, and is very knowledgeable of child abuse/child sexual abuse issues. Staff recommended that a request be forwarded to the UNC Department of Pediatrics NC Child Medical Evaluation Program to appoint Deborah Flowers to the CFPT. The Board thanked Ms. Hermann for the report and had no further MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 April 21, 2010 recommendations. Motion to approve the report and forward the Report to the Commissioners was made by Paul Chelminski, seconded by Christopher Cooke, and carried without dissent. Motion to support the appointment of Deborah Flowers to the Child Fatality Prevention Team was made by Jessica Lee, seconded by Tony Whitaker, and carried without dissent. D. Q2 and Q3 FY 09-10 Financial Reports Letitia Burns presented the 2nd and 3rd quarter Financial Reports and brought some important items to the Board’s attention: • Carry-forward items: after the original budget is approved, carry-forwards including encumbrances such as purchase orders, are approved and posted to the general ledger. These increases are included in the second quarter expenditure totals, but not the revenues. Encumbrances do not increase revenues. Unfulfilled purchase orders are approved funds not used in a previous year, for example, a flu vaccine order placed in the spring and paid in fall. • Deferred revenue items: funds received near the end of the year that the department is unable to spend are put into a deferred revenue account and then placed in the general ledger after the ordinal budget. These increase revenue and expenditures by the same amounts. • Capital purchases: Capital items were purchased in several different ways; a purchase order that was encumbered in the previous year and not paid until this year; a fund transfer from one line item to another; and additional State or Federal grant funds, such as the purchases from the H1N1 funding. E. Budget Update Wayne Sherman reported that the County Manager has informed department heads that there is a need to reduce all departmental budgets for the 2010-2011 year significantly in order to present the county commissioners with a balanced budget that requires no tax increase. Each department was directed to submit a 15% cut in the county support portion of their budget request. He directed departments to first look at non-mandated programs and then to look at reducing services in mandated programs to minimum acceptable levels. The 15% cut is approximately an additional $780,000 reduction of the Health Department budget. The Department budget is comprised of 85% personnel costs and 15% operating costs. The senior management staff has examined all of the options available for cutting additional programs and services. The department submitted $322,157 in capital requests that included technology, furnishings, equipment, and vehicles. A summary of budget cuts from FY08-09 and FY09-10 was provided for Board member information. The County Manager will be recommending a budget to the county MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 April 21, 2010 commissioners no later than May 20 (Hillsborough) which is also the date of the first of two public hearings on the budget. The second public hearing on the budget is May 25 in Chapel Hill. The Board of Health was asked to consider whether the Board: • Supports no further cuts to the Health Department budget • If not, which programs should be considered by the Health Director for further cuts • Should communicate directly with the County Manager and Commissioners about the department’s budget concerns • Should discuss the appropriate timing for communications with the County Manager and Commissioners • Should have a consistent message in communicating with the Manager and Commissioners • Should adopt a strategy for communicating with the Manager, Commissioners and the public. The Board was asked to offer direction to the Health Director on further actions that are needed. Paul Chelminski asked for a further explanation of Orange County’s loss of revenues that is a factor in this year’s budget planning. Commissioner Yuhasz replied that revenue reduction was due to a projected decrease in tax revenues. Steve Yuhasz also stated that the County is expecting a reduction in the Medicaid relief package for counties, sales tax revenues, and personal property taxes; therefore spending must be reduced. There is also a need to fund increased capital debt. Christopher Cooke commented on the options presented and questioned the strategic advantage of going along with the proposed cuts. He stated that as one option it would be better to take a stand that these cuts are unreasonable and deal with the consequences when they are made. Secondly, he pointed out the County’s history of deference to the schools versus healthcare, questioning which the citizens would rather have, protection from an infectious disease or a library completely full of books. He stated that there are different levels of attributes that are important as in Maslow’s Hierarchy of Needs, some things you have to have and some things are nice to have and questioned why county services are exempt from that kind of assessment when it comes to budget cuts. He stated that it seemed fair to make an across the board 15% cut but questioned if that policy was doing the County a service by cutting every department equally. He felt there was an opportunity for pushback and that was where he felt the Board should put its energies. Anissa Vines replied that for the Board members that were on the BOH last year the same kind of issues came up and that the Department operating costs had been cut to the bone at that time and wondered realistically where the 15% could come from. MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 April 21, 2010 Tony Whitaker commented that he did not know the County Manager’s style of management as it would relate to budget, but it seemed a reasonable premise for him to open budget negotiations with a 15% across the board cut knowing that it would not come out that way. To the point of why the Department would offer up anything, he felt the effort should go towards shaping the outcome even if we cannot dictate the outcome. He felt it was important from a credibility standpoint to take a hard look at what can be cut and offering what we are able to cut but then stopping short and taking a stand that the Department cannot go to the 15% level. Anissa Vines pointed out that this was a new County Manager for Orange County. Last year when the Board submitted the budget it was accompanied by a letter from the Board that the FY09-10 Budget was approved by the Board of Health with serious reservations and recognizing that the cuts would tremendously impact the health of the County as Christopher Cooke has pointed out. Jessica Lee stated she would absolutely agree with the observation by Tony Whitaker and that the Department should be at the table shaping that proposal. She also stated that the Board needs to go on record and state that the directive is to look at non-mandated services first and then look at reducing mandated programs to the minimum levels. The Board’s statement should be that the Department is already at the minimum level. Steve Yuhasz said that if the Commissioners were to look at mandated services and look at non-mandated services as potential savings, we are not mandated to provide dental services and the Board needs to keep that in mind. He stated the Commissioners have had discussions about the things that we have to do and the things that are nice to do. If budget restraints require that there be substantial cuts, it would be regrettable, but the dental program would be considered rather than cut the mandated programs to a point where they can barely survive and it is a point to consider. Chris Harlan stated that we are talking about a quality of life and we are talking about health services for everyone, for example, what Environmental Health does affects everyone in this county. A lot of the people that come to the Department for personal health services are people that are at risk already. If you look at any health status indicator dental is at the top. The only reason we don’t have dental in healthcare plans today is that years ago people did not recognize that dental is an important part of health. It is Maslow’s Hierarchy and when money is tight you come down to the basic necessities and going to what is mandated is only the bare minimum. That is not the bar we want to be at. Steve Yuhasz said that he was not arguing that was the bar we want to be at but if we in fact have to be at the bare minimum then we need to look at how we protect the bare minimum. He emphasized that he was not advocating anything but only pointing out that this is the way the Board of County Commissioners is going to have to look at this year’s budget and probably next year’s budget. MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 10 April 21, 2010 Chris Harlan replied that she recognized that the whole issue is about the level taxes are at in Orange County but it doesn’t recognize the whole picture. She emphasized that paying taxes is a part of being a citizen of this world and we should willingly pay taxes if it makes life better for everybody. There is no point living in a society with a huge number of people who have everything they could ever want and a whole other portion that has very little. That is not quality of life for anybody. And this whole premise of taking a stand that “we’re not going to raise taxes” is in her opinion unethical. To make the cuts the way we have to make them at the level of health and human services is not right. We are no longer living in an ethical society. Anissa Vines said that last year the Board did put Carr Mill on the table and that it would be helpful for her to hear from staff why that wasn’t put back on the chopping block for this year. Christopher Cooke asked to briefly respond to some of the comments. He stated that he is not sure what the difference is between accepting a 15% cut and then shaping what we propose to cut or in saying no we don’t accept it, having it cut anyway and shaping what we do with the cut. It seems to be the same thing. This is where public health usually finds itself in these kinds of discussions, which is fighting over the scraps. What he suggested is if there is an opportunity to take this discussion to the next level, maybe we should be doing that. With no pushback how can we expect to have a different conversation next year? There’s no reason to do that because Commissioner Yuhasz is right. The Commissioners know what they have to do. They’re looking at numbers; they are required to do certain things. As important as it is to be cognizant about the pain that is across the community and how we need to be on the team, etc, he stated he has no problem with that. There is also the advocacy side of the coin which is at some point we have to argue with the status quo if we think the status quo is hurting the community from the public health point of view. If we are at the minimum level for services, why aren’t more alternatives on the table? That’s my point. Anissa Vines said she had concerns about the Social Worker II position that was eliminated after listening to the Child Fatality Task Force report and knowing that last year we had to make some major changes to the family home visiting program. One of the reasons why we had advocated for keeping that position was because it was providing services to at-risk families. The chair also said she had concerns about Environmental Health. Currently the Office Assistant position has been eliminated, but prior to that an Environmental Health Specialist position was frozen creating a further backlog in critical food and lodging inspections. Steve Yuhasz commented that he has heard people come out and say “raise my taxes so we can put more money into the schools” but he has not heard people come out and say “raise my taxes so we can put more money into public health.” MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 11 April 21, 2010 Chris Harlan said that was because the department works with vulnerable populations who have a difficult time getting to the Commissioner’s meetings and are not confident with speaking in a public forum. Jessica Lee stated that not enough Board of Health members had come forward to speak on behalf of public health in past years, whereas the schools have been able to garner support from the parents and teachers in much larger numbers, to the point that if only one Board of Health members speaks versus ten or more from the schools, it is the school’s messages that Commissioners remember. Chris Harlan stated that she had been to budget hearings numerous times and she resents coming to the Commissioners and having to beg for health department funding. She felt that the need should be obvious. Wayne Sherman stated that there was another risk that we would face and that would be potential retirees; two are known at this time. Those positions according to the County Manager will be eliminated, which means the rest of the staff will have to take on additional responsibilities. These two positions are critical to the department to be able to function effectively. Mike Carstens said that we need to take a close look at priorities and questioned how many mandated services we can trim. Steve Yuhasz said the county is also looking at support of outside agency funding and duplication of effort and effectiveness. All the public health issues are important. He pointed out that Orange County is two ambulances short and current response time is 17 minutes, which needs to be cut down to 12. Chris Harlan said that she is not talking about ambulances; she is referring to the art councils, parks and the libraries. Those things are what are nice in life and they are valuable, but when times are tough you come down to what is needed to support life and the other things are what can go for now. Steve Yuhasz said the Board needed make sure to tell the County Commissioners that. Christopher Cooke asked if county employees were prohibited from attending budget meetings and advocating for the budget. This was affirmed by the Chair. The Chair asked for the Board to decide what action they would agree to support and called for a motion. Tony Whitaker asked if we had a sense for whether other departments were experiencing an increase in demand for services. It is clear that our demand for services is increasing while we are being asked to cut our budget. Wayne Sherman said that Social Services is also experiencing an increase in demand for services. Tom Konsler stated that to his knowledge planning and inspections was not experiencing an increase in demand for services and there may be others as well. Tony Whitaker asked if we were unique in experiencing an increase in demand. Wayne Sherman stated that being a safety net provider in times of MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 12 April 21, 2010 economic downturn, Social Services and the Health Department, from the standpoint of health and dental services is in greater demand. Chris Harlan stated she felt the Board should take the stand that we have done enough and this is as far as we can go and it is a political decision for the Commissioners to make. She also pointed out that some non-mandated services are revenue producers and questioned the wisdom of cutting revenue producing programs simply because they are not mandated. Motion to draft a letter to the Board of County Commissioners from the Board of Health expressing the Board of Health’s position and objections to proposed budget cuts that would adversely affect delivery of mandated public health services was made by Jim Stefanadis, seconded by Chris Harlan, and carried without dissent. F. Medicaid Audit Findings for Statewide Public Health Each year staff at the NC Division of Public Health gathers information from each local health department and prepares a cost report for all Medicaid services offered by each health department for a fiscal year. These cost reports are averaged across the state to determine a total settlement amount for all of the local health departments. The Division of Public Health uses a formula based on costs and service numbers identified for each department to distribute the funds to each health department. The settlement is based only on the federal share of the Medicaid earnings (approximately 65%), not the state share. Orange County has earned approximately $250,000 each year since the inception of the program in the late 1990’s. These funds have been placed in a capital account and allowed to accrue over the years and are used for renovations, equipment, and furnishings. Earnings must be spent in the program that earned the revenue. In 2006 the NC Division of Medical Assistance Audit Division began conducting desk audits of this process. Orange County Health Department along with 12-14 other departments was audited in 2007 for the FY04-05. The audit letter received in 2008 stated that there were disallowances identified that would affect the calculation of the reimbursement amount. The health director sent a letter to the Audit Division requesting an exit conference to dispute the findings and has received no reply to date. In addition, papers were just submitted for a desk audit for FY08-09. Wayne Sherman reported that last month, 10 health departments across the state received letters from the Audit Division for FY04-05 audits that identified major disallowances in calculating the total costs for each department. Orange County was not one of these. At the March 18th meeting of the North Carolina Association of Local Health Directors (NCALHD), the Association approved a motion from the Reimbursement and Finance Committee to authorize the Association’s President to utilize $25,000 of Association funds to begin the process of appealing Medicaid’s decision to disallow costs for 10 health departments as the result of desk audit reviews for FY04-05. On March 8, 2009 eight health departments MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 13 April 21, 2010 across the state received notification from DMA stating that significant Medicaid costs would be disallowed for FY04-05 secondary to their audit findings. Subsequently two additional departments received letters. The impact of these Medicaid audit findings do not just impact the health departments receiving notice, it impacts the entire local public health community for cost settlement payments. If these Medicaid audit findings prevail, local public health will loose millions of dollars for services provided to citizens across the state beginning with FY05. It is important for all local health directors, Boards of Health, County Managers and County Commissioners to recognize the impact on local cost settlement reimbursement for public health programs across the state. The Association voted to approve a supplemental dues request of $1,000 for all 100 counties to assist in the appeals process. It was agreed that each county should pay an additional $1000 for FY09-10 to support the Associations efforts to appeal DMA’s decision. The Health Department paid this additional amount by reducing other expenses to cover this additional charge. Steve Yuhasz asked if we knew what the payback amount would be for Orange County if the lawsuit was unsuccessful. Letitia Burns stated that the information was not available at this time. Wayne Sherman said that the auditors had not responded back to the Health Director as to what they are disallowing to date. Staff recommended the Board consider sending a letter of concern to Commissioners regarding this situation. The Board took no action on this item. G. Final Report Dental Services Options Angela Cooke presented the Option Financial Spreadsheet provided for Board information and it contained 6 options for delivering dental clinical services by the county. The following factors were considered in making a recommendation for which option to pursue: • Provides dental clinical services to both Medicaid and uninsured Orange County residents • Preserves access to comprehensive dental services for Medicaid and uninsured residents • Efficiencies of service delivery • Distribution of current patients • Current county financial status for providing services Based on these factors the staff recommended the Board consider the following: Recommendation 1: Exercise Option 2 beginning July 1, 2011. Option 2 is a single 8 chair clinic at the Whitted Building utilizing the current staff complement, transitioning those being served at Carr Mill to the Whitted site by providing transportation vouchers. This allows sufficient time for renovation of Whitted for dental after the personal health clinical space is renovated and allows for an orderly transition from providing services at Carr Mill prior to the lease expiration October 2011. MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 14 April 21, 2010 Recommendation 2: Exercise Option 3 beginning July 1, 2012. Option 3 is a single 8 chair clinic at the Whitted Building with increased staff (additional dentist, hygienist, and dental assistant). This maximizes the services that can be delivered for an 8 chair clinic. Exercising this option would allow for full transition to a single location and provides time to recruit new staff. Because of recruitment and orientation times, new staff may not be fully productive during the first year of operation. Recommendation 3: Exercise Option 1 beginning July 1, 2021. Option 1 is two full time clinics at different locations (one south and one north) in the county. This option provides the best access to comprehensive dental services for county residents. Delaying Option 1 for ten years is not ideal, but allows a true test of the one site concept for accessibility to the population, allows the county finances to fully recover, and allows for a deliberate dialogue and engagement for site selection(s) in light of an additional 10 years of population growth. Motion to approve Option 2 (Recommendation 1) as the preferred option by the Board of Health, followed by Option 3, then Option 1 and forward to the Board of Commissioners for consideration was made by Christopher Cooke, seconded by Chris Harlan, and carried without dissent. H. Review Terms of Service for Board Members Each year the Board reviews the Board roll and determines if any member’s term(s) of service expire on June 30 and need to be recommended for renewal or whether recruitment for new members needs to occur. Two members are completing their second three year term of service and are not eligible to serve again by adopted Board of Commissioner policy. Jim Stefanadis, the Pharmacy representative and Jessica Lee, the Dentist representative will be rotating off on June 30, 2010. In addition DeWana Anderson, the Veterinarian representative has resigned from the Board due to work commitments. The Board will be beginning the recruitment procedure under the direction of Chris Harlan, Chair of the Nominating and Bylaws Committee. The Board was informed that applicants have been found for the pharmacist and dentist representative vacancies. There has been difficulty locating a veterinarian to serve on the Board of Health that lives in Orange County. I. Informational Items a. UNC Research Facility-Bingham Township Report: A group called Preserve Rural Orange has been in active communication with UNC regarding the animal research facility located in Bingham Township. There have been many concerns MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 15 April 21, 2010 raised by neighbors regarding expansion of the facility. The wastewater system is permitted by the Division of Water Quality and was recently expanded with a new treatment plant, holding lagoons, and spray irrigation fields. The system has been plagued with problems and UNC has decided to take the system off-line and is using the treatment plant to store wastewater to be hauled by truck to OWASA for treatment and disposal. UNC is preparing an alternative strategy for their wastewater to include advanced treatment and re-use. Although neighbors have raised concerns about possible contamination of their wells, there is no reason to believe that activities at the facility have posed any risk to water supplies. The UNC Environment, Health and Safety office has been keeping county staff advised of their plans as they develop. b. Falls Lake Nutrient Management Strategy: The BOCC abstract describing the Falls Lake nutrient management rules and a PowerPoint slide summarizing the Falls Lake Consensus Principals was provided for further information. The Board of Commissioners adopted the consensus principles in their March 16th meeting. The Division of Water Quality is moving ahead with proposed rules despite concerns from stakeholder groups that the modeling was inaccurate, particularly with respect to the level of nutrient contribution from septic systems. The Board of Health was given this information to be aware of these rules as they develop because these rules will have a future impact on septic systems. Possible outcomes include: • The requirement of costly advanced treatment units on new septic systems • Required surveys of septic system performance, and/or • A significant expansion of our Waste Treatment Management Program (WTMP) to include all septic systems in the Falls Lake Watershed. c. Board of Health Education Plan for 2010: Board members were provided with a schedule with topics as a follow up to discussion at the March Board of Health meeting. d. Committee Reports: Environmental Health/Quality Assurance Committee and the Clinical and Community Program Committee minutes of the April meetings were provided as information. e. Media Clips: Media clips relative to current issues were provided as information. f. Pending and Recurring Items: A table of pending and recurring Board of Health agenda items for reference and future planning. V. Board Comments/Announcements A. None VI. Adjournment MINUTES ORANGE COUNTY BOARD OF HEALTH April 21, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 16 April 21, 2010 Motion to adjourn the meeting was made by Chris Harlan, seconded by Jessica Lee, and carried without dissent. The next Board of Health meeting will be held on May 26, 2010 at the Southern Human Services Center, Chapel Hill, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board