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HomeMy WebLinkAboutBOH minutes 052610MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 May 26, 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 May 26, 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; Michael Wood; Steve Yuhasz, BOCC; Paul Chelminsky; Tony Whitaker; Mike Carstens; Christopher Cooke BOARD OF HEALTH MEMBERS ABSENT: Jessica Lee, out of town STAFF PRESENT: Rosemary Summers, Health Director; 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; Anne Miles Cassell, Administrative Assistant; Susan Young, RN, GUESTS PRESENT: Bernice Nogueira, Faculty, Macao nursing school; Mandy Wan and Marietta Wong, nursing students from Macao; Anne Thornhill, NC Prevention Partners Chris Harlan introduced her guests from Macao who are visiting UNC School of Nursing for a short period of time. Rosemary Summers then introduced the guest speaker, Anne Thornhill, Senior Health Promotion Manager from NC Prevention Partners. I. Advocacy Strategies for Health Anne Thornhill, MPH, Senior Health Promotion Manager with NC Prevention Partners, presented an overview of advocacy techniques and strategies for public health. Using her extensive experience in policy development, implementation and evaluation, Ms. Thornhlil gave useful examples of different ways to get the maximum results for the effort when faced with limited funds and staff. She suggested several ways Boards of Health can have an impact on public health legislation and ways to leverage community support. Ms. Thornhill said that the first step is to prepare using the following steps: • Develop a policy agenda • Consider getting some training • Sharing your voice o Become a reliable source of information o Practice simple measures o Join with others to build relationships • Become an advocate Paul Chelminski asked how the North Carolina Smoke-Free law compared in restrictiveness to other states, this state being a prime grower of tobacco. He also wanted to know what the next step would be in expanding the Smoke-Free Law beyond restaurants and bars now that the state passed the Smoke-Free law. Ms. MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 May 26, 2010 Thornhill replied that North Carolina was one of 28 states with a comprehensive smoke- free law in effect. NC is the number one tobacco producer in the nation and advocacy for smoke-free air laws has been going on for eighteen years in this state through incremental policy changes over time, whereas the other states only had a few years to work on it. One of the important parts of NC House Bill 2 is that it annulled the law that did not allow local governments to pass their own clean air ordinances. She strongly suggested the next step be educating employers to the benefits of smoke-free workplaces. Christopher Cooke, speaking from his background in advocacy, asked Ms. Thornhill why there was no grassroots movement in public health considering all the benefits public health bestows to everybody in the community. Ms. Thornhill replied that she felt there was a strong grassroots network around certain public health issues. Sometimes it boils down to what it takes to motivate a person to become engaged. She also stated that sometimes public health issues are not as visceral as other issues that gain an activist’s attention more easily. Paul Chelminsky made reference to the obesity problem in this country, stating that its roots go back to policies developed in the 70’s and that as a result we have cheap calories without food inflation. He stated that this is the first country in the history of the world to make its poorest people the fattest. Ms. Thornhill stated that in addition we are one of the first countries in the world where the fattest people are also the most malnourished. She said that public health can work effectively with food industry partners to turn some of these issues around. Policy mandates may not be the best strategy; access to food may be a better approach to take. Rosemary Summers asked how, because of the broad reach of public health issues, the Board should deal with issues that cross lines of departmental responsibilities that others think you should not be a part of and to promote teamwork among those involved. Ms. Thornhill said that a focus on the problem you are meeting about should help and all rivalries should be left behind. The purpose of solving the one issue should be clearly stated at the beginning of the meeting. Steve Yuhasz said that at one point it was mentioned that Orange County had some opportunities to do things that the other counties might not and he asked Ms. Thornhill to elaborate. She stated that Orange County has a reputation for being more progressive due to the fact of the large percentage of its population base is rooted in academics and that base is generally interested in being more progressive. Looking back on the historical record, Orange County was one of the first to improve mobility and access to the community. Orange County was the first to pass a comprehensive smoke-free worksite policy in 1992, and in fact, became a model for other county’s smoke-free policies. Commissioner Yuhasz asked if other jurisdictions look to Orange County to be a test bed of policy. Ms. Thornhill replied that other counties look to Orange County for innovation but they are also going to question it on occasion. II. Welcome and Introductions MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 May 26, 2010 Anissa Vines, Chair, called the meeting to order at 7:30 P.M. Rosemary Summers introduced a new staff member, Susan Young, RN, a nurse on the Family Home Visiting staff. III. Approval of May 26, 2010 Agenda The motion to approve the Agenda of May 26, 2010 was made by Steve Yuhasz, seconded by Chris Harlan, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None V. Reports and Discussion with Possible Action A. Minutes approval of April 26, 2010 meeting Minutes of all official Board meetings must be reviewed and approved by the Board. Motion to approve the minutes of the April 26, 2010 meeting was made by Chris Harlan, seconded by Paul Chelminski, and carried without dissent. B. Uncollected Debt Write Off The Health Department’s Administrative Policy & Procedures Manual, Policy 15.0 – Delinquent and Uncollectible Accounts requires OCHD to remove delinquent and uncollectible accounts from the Accounts Receivable system on an annual basis. In the absence of Letitia Burns, Business Officer, Wayne Sherman reported that anticipation of “going live” on the new state health information system (HIS) by the end of the calendar year; this policy has been updated to reflect an exception to the current write-off procedure due to the changing software system. The Board was asked to approve removal of these accounts from “active” to “inactive” status in preparation for the change. Dental Health Services: $ 7,100.95 Personal Health Services: Child Health $ 1,071.60 Primary Care $ 766.80 Maternal $ 2,001.22 Family Planning $ 12,096.96 Adult Health $ 377.13 Epi (incl. MM, STD, CD) $ 381.06 Refugee Health $ 398.60 Nutrition $ 144.80 The total amount of client balances to move to “inactive” status is $24,339.12. MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 May 26, 2010 Rosemary Summers reminded the Board that Title X has a very strict collection policy that dictates how actively we can pursue collection of fees. Steve Yuhasz asked if the Board needed to vote on the policy change. Rosemary Summers replied that this was an administrative policy change and did not require Board approval however Board comments or suggestions are welcomed. Paul Chelminski said that it appears to be a normal cost saving way of clearing the books; that staff could spend more productive time devoted to other public health duties than tracking people down for non-payment. Steve Yuhasz asked if the Department has a denial of service policy. Dr. Summers explained that only the dental services exercised such a policy, however emergency services were never denied any dental client. Tony Whitaker questioned the May 2009 date. Wayne Sherman stated that the 1-year delinquency is historically what has been done and rarely are debts over a year old collected. However, if a patient comes in that has a balance due, it will be on their record and an attempt would be made to collect the unpaid amount at that time. Michael Wood asked if the average write-off amount was $8,000 each 6 months. Wayne Sherman acknowledged that the amount has averaged in that range for the last several years. Motion to approve moving delinquent and uncollectible accounts in the amount of $24,339.12 from active to inactive status was made by Paul Chelminski, seconded by Michael Wood, and carried without dissent. C. Board Vacancy Recommendations The Board has several upcoming vacancies, DeWana Anderson, Veterinarian; Jim Stefanadis, Pharmacist; Jessica Lee, Dentist; and Paul Chelminski, Physician representative as of June 30, 2010. Chris Harlan reported that the Nominating/Bylaws Committee has considered all current applicants and recommended the Board consider recommending Matthew Kelm as the Pharmacist representative to the Board, and Dr. Carol Haggerty as the Dentist representative to the Board. Both candidates have expressed a strong interest in serving and meet the residency and professional requirements. It was felt by the nominating committee that their experience was a good fit with what the Board did. Dr. Anderson and the nominating committee are still in the process of soliciting appropriate veterinarian candidates for the veterinarian position. Steve Yuhasz inquired who had filled the veterinarian representative position in MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 May 26, 2010 the past and clarified that the veterinarian representative would also serve on the Animal Services Committee as liaison. Physician representative Paul Chelminski will complete the partial term left by Dr. Tim Carey on June 30, 2010. Dr. Chelminski will be eligible for reappointment to his first full term and has agreed to serve. Motion to recommend Dr. Paul Chelminski for re-appointment to his first full term as Physician Representative; recommend appointment of Matthew Helm as Pharmacist Representative, and Dr. Carol Haggerty as Dentist Representative and forward recommendations to the Board of County Commissioners for consideration was made by Christopher Cooke, seconded by Mike Carstens, and carried without dissent. D. Budget Updates The County Manager’s recommended budget was presented to Commissioners on May 18, 2010. The budget situation has evolved over the last few months and several recommendations contained in the budget are causing concern for the department. Rosemary Summers reported that the Governor’s budget has a recommendation from the State Division of Medical Assistance (DMA) to discontinue Medicaid reimbursement for maternal outreach services as of July 1, 2010. This is a continuation by DMA to downsize or eliminate all case management programs. OCHD has one remaining maternal outreach worker providing services to support pregnant women in receiving services to ensure a healthy birth outcome for both mother and child. With little support for fighting this recommendation, the department has chosen to eliminate the program as of June 1, 2010. Dr. Summers said that the remaining maternal outreach worker will be transferring to a medical office assistant position as of June 1, 2010. The medical office assistant vacancy was created through the retirement of an individual that has been with the county for 30 years. This transfer was agreed to by the County Manager. It should be pointed out that this is a reduction in services to pregnant women and it will remain to be seen whether birth outcomes will be affected in future years. This is the second downsizing of this program during this fiscal year. Other possible effects as a result of the Governor’s budget include a recommendation to limit adult dental Medicaid reimbursement to only emergency care. The OCHD dental clinic sees 300 adult Medicaid visits per year, with an average charge of $100 per visit. This would be a loss of $30,000 in production and revenue due to the cut. If that passes the dental clinic would have some adult Medicaid revenue for emergency treatment, but that would be limited only to medications, x-rays, and tooth extraction. The likely scenario is that these patients would still be coming to us but now they would be 0% pay and instead of $100 per visit and the clinic would be receiving $25 per visit. Smart Start funds are proposed to be cut 4%. The cuts cannot come from day care subsidy so it is likely the cuts to the programs will be in the 6% range. We MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 May 26, 2010 have three projects funded through Smart Start; two are full time positions with some operating funds. The third is the dental preschool screening project and the personnel are all contract or non permanent temporary staff. With some operating fund reductions the department will be able to maintain enough funding for the staff positions. Additionally, there will be three retirees from the department; Environmental Health Program Specialist in the onsite program, Administrative Assistant II/Board of Health Support, and Dental Health Division Director. At this time the County Manager has recommended leaving the Environmental Health Program Specialist and the Administrative Assistant positions vacant until January 2011 to achieve some savings. Anissa Vines asked if the County Manager had reservations about filling the Dental Health Division Director’s position. Rosemary Summers said she was not aware of any reservations at this time. The policy in place at present is that any positions vacated due to retirement would not be filled this fiscal year. The department has experienced cuts in personnel that exceed 10% of its workforce in the past two years. The core functions will be seriously compromised if the Department loses these additional positions. The core functions that require substantial pre-work in the next year include: • Community health assessment due December 1, 2011 • Community health improvement plan due January 1, 2012 • Health department strategic plan due January 1, 2012 • Re-accreditation process; self-assessment and site visit due October 2012 Steve Yuhasz questioned the benefits of the HIS to the department and if there was an offsetting benefit if it was taking much longer to register patients at each visit, Rosemary Summers replied that it was 3 years beyond its scheduled rollout statewide and that Orange County is one of the last to go on the HIS system. There were some counties that were pleased with the system as their staff had been amply trained; others were not as favorable. She stated that if it is found the HIS does not improve service, then another software solution would be pursued. Commissioner Yuhasz also asked about the nonfunctional CNG vehicles; if the decision had been made to not use the vehicles or refit to standard available fuel. Rosemary Summers said that it had been determined that it would be too expensive to retro-fit the vehicles, therefore they will be parked at public works and left there as it will be safer. The Board accepted as information and there was no action taken. E. Board Report on Public Hearing Comments Several Board of Health members attended the May 20 and May 25 public hearings on the 2010-2011 manager recommended budget. MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 May 26, 2010 Christopher Cooke said that he thought it went fine. He noted the education people are very well organized and filled the room. He said he felt some of the presentations were pretty good; others were totally off the wall and he did not understand them, but they had a large attendance and that sends a very loud and clear message. He stated that he and Jessica Lee focused on several strategic points and stressed them a couple of times, notably the restaurant inspection issue. Chris Harlan said she took a broader approach and thought her comments were well received. She remarked that she did not see how the Commissioners were able to sit through public hearings. Commissioner Yuhasz said that it was important that the citizens have an opportunity to speak; that it is always anticipated the education segment will show up in force, however, when a member of the Board of Health shows up to speak it is an unusual situation and has a greater impact. He stated that the BOCC was not aware that the Department had been asked to make an additional 15% budget cuts to their proposed budget. Christopher Cooke asked whose job it was to make sure the Commissioners had all the correct information in order to consider the comments clearly. Chris Harlan stated that she had assumed the Commissioners already knew what kind of cuts the departments had been asked to make. Commissioner Yuhasz stated that it was the County Manager that was responsible for presenting a recommended budget to the Commissioners for action and that the Commissioners had not received the budget until the Monday prior to the public hearings. That is where the confusion arose regarding the additional 15% cut the Board of Health representatives addressed at the public hearings. Chris Harlan asked and received clarification that it would be best to begin by making a brief statement to put what the Board members had to say at a public hearing into a context the Commissioners would understand. Rosemary Summers clarified that the Health Department usually has its budget prepared before other departments because the Board of Health must approve it. The Manager’s direction to cut 15% came after the Board of Health had approved the budget for the department. Jessica Lee attended the first budget hearing, however, was out of town for the Board of Health meeting and was not available for comment. Rosemary Summers said the County Manager has requested a list of detailed reports and cost studies of each service within the Health Department. Staff is gathering the data requested and anticipate completion concurrent with the upcoming Commissioners budget work sessions. Steve Yuhasz suggested that the gathered data might be a good topic for the next joint BOCC/BOH meeting since it is being received so late in the budget planning stage. Chris Harlan stated that in educating Commissioners it is false to draw the line at MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 May 26, 2010 what is mandated. There are many programs and services that are not mandated but integral to public health and it is advantageous to set the bar higher than only mandated services. Christopher Cooke said that the request for information can be perceived as the County Manager’s attempt to choose the best option for further cuts as the budget process proceeds. F. Public Health Improvement Plan The NC General Assembly created a special task force appointed by the Secretary of DHHS to develop a “five year public health improvement plan”. The final report to the General Assembly was provided for Board members. The report reviews the background and steps that have led to the plan. This document will be considered by the General Assembly for possible implementation steps. Rosemary Summers stated that it is important that the Board carefully review and discuss the implications contained in this report. If adopted, the report could have the following impacts on Orange County: • Reduced state and federal funding due to county ranking • Addition of local fees for food and lodging • Additional reporting and evaluation requirements • Additional accreditation requirements The Board was asked to review the report with the county health ranking data in mind that places Orange County as the second highest ranked county in the state and be aware of how this will impact Orange County, i.e. less funding from state and federal sources. Redistribution of public health funding is being seriously considered. The Board was asked to consider how to inform the Board of County Commissioners of potential impacts and consider messages that should be sent to legislative delegation. Tony Whitaker asked if there was an executive summary available as he had difficulty after reading this report in parsing out the information someone new to the Board might understand more easily. He also asked what the biggest concern was with the Public Health Improvement Plan. Rosemary Summers replied that one of her largest concerns is the single stream funding concept that the legislature seems to want. The legislature’s concept of single stream funding is to take the small pots of money that they receive a request for, roll them up and provide that funding back out to counties based on risk factors. It was pointed out that one of the biggest problems is that North Carolina has little to no investment in public health, therefore resulting statistics show that NC ranks 40th in the nation for healthy population and is obviously not enough investment to make a difference in outcomes. Christopher Cooke stated that the report also gives one an insight into the MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 May 26, 2010 thinking because the topic of additional revenue options is included in the report as an appendix rather than a formal recommendation. Tony Whitaker said he had a question regarding the risk factors; whether it is because there are many good providers available or because many very sick people have moved here from other parts of the country to live in this area because of the availability and proximity of good medical care. He asked if a county like Orange would be penalized because we have per capita some very sick people that are here because we have really good health care; that the risk factor could possibly be misapplied. Rosemary Summers stated that it could be. One thing from the last Community Health Assessment that staff is trying to research is the higher than usual breast cancer rates in Orange County. What is not known is if it is a result of better screening programs or is it something else. Commissioner Yuhasz also observed that since NC health rankings are low on a nationwide scale, it should follow that federal public health funding in the state would be higher and he raised a question on data supplied regarding what is spent per capita on public health and if those figures included federal funding. Rosemary Summers stated that $14.13 per capita is only state allocated funds. Steve Yuhasz asked for clarification of exactly what single purpose advocacy is and what that influence could have on the final budget result. Rosemary Summers gave several examples of advocates that would be focused on only one single issue and requesting funding specifically for that issue. Rosemary Summers said that flexibility, the ability to identify primary needs and shift funding into the areas of most need is ideally what would work best. It would be dependent on what each community identified as their primary needs. Commissioner Yuhasz commented that this report as it stands did not seem to give any flexibility to local public health and Dr. Summers agreed. Commissioner Yuhasz also expressed his unfamiliarity with how other states fund public health and asked if there was more responsibility placed on municipalities for funding so that the state itself doesn’t have a larger role. Rosemary Summers stated that some large municipalities have their own public health department, however nationally other states all have similar public health structures as North Carolina. Massachusetts is the only state that has the most disperse system known. Every municipality and every county has a public health agency in that state. They have a totally different system than anyone else. She stated that there are three types of systems; 1. Disperse system, such as Massachusetts 2. State operated system, such as South Carolina 3. Locally operated system, such as North Carolina It was pointed out that as late as 2001 there were states such as Nebraska with no public health presence. Steve Yuhasz asked if it is anticipated that Orange County would receive any of the federally funded Health Information technology money. Rosemary Summers stated that North Carolina will receive some of that money but most of the money will go toward bridging technology to enable healthcare providers to MINUTES ORANGE COUNTY BOARD OF HEALTH May 26, 2010 Board of Health Minutes Transcription completed by Anne Miles Cassell 10 May 26, 2010 share information more easily. G. Informational Items 1. Media clips: Recent local news articles relative to the Department and public health issues were distributed. 2. Hookah Bliss Appeal: The Board received information by email of the withdrawal of the appeal by Mr. Adam Bliss regarding his violation of the Smoke Free Bar and Restaurant Law. The Health Director withdrew the administrative penalty since Mr. Bliss surrendered his ABC Permit and the law no longer applied to his establishment. A copy of the Health Director’s letter was provided for the record. 3. Letter from the Town of Chapel Hill: The Health Director received a letter in reply from Chapel Hill Town Manager, Roger Stancil, in response to procedures and coordination not being followed by Chapel Hill planning and inspections department that resulted in an appeal hearing filed by the homeowner with the Health Department due to a geothermal well being drilled inside the setback requirement. 4. Pending and Recurring Items: A current table of pending and recurring agenda items was provided to enable future planning. 5. The Board was reminded that there will be no Board of Health meeting in July. The next scheduled meeting will be in August. The Board was encouraged to look over the Board of Health policy manual in preparation for any revisions deemed necessary when reviewed at the August meeting. VI. Board Comments/Announcements None VII. Adjournment Motion to adjourn the meeting was made by Jim Stefanadis, seconded by Tony Whitaker, and carried without dissent. The next Board of Health meeting will be held on June 23, 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