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HomeMy WebLinkAboutBOH minutes 022509MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 February 25, 2009 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 February 25, 2009 at the Government Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Tim Carey; Matt Vizithum; Michael Wood, Jessica Lee; Ernie Dodson; Steve Yuhasz, County Commissioner BOARD OF HEALTH MEMBERS ABSENT: Sharon Freeland; DeWana Anderson; 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: None I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:15 P.M. and Board members introduced themselves to the new Board of Commissioners representative, Steve Yuhasz. II. Approval of February 25, 2009 Agenda Rosemary L. Summers requested an addition to the Agenda, Item IV.C., Acceptance of Additional Funds. The motion to approve the Agenda of February 25, 2009 as amended was made by Anissa Vines, seconded by Matt Vizithum, and carried without dissent. III. Public Comment for Items NOT on Printed Agenda None IV. Action Items on CONSENT Agenda A. Minutes approval of January 21, 2009 meeting. B. Renewal of Consolidated Agreement with NCDHHS The NCDHHS Consolidated Agreement stipulates the provisions for receiving state and federal support for various programs. Currently most programs are funded at the same levels approved for the current budget year; however there are two funds that are unknown at this time. Availability of federal public health preparedness funds are unknown but anticipated to be at the same level as this current year. The General Aid to County funds from the “Random Moment Time Study” has not yet been determined MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 February 25, 2009 but is anticipated at the same level as this current year as well ($20,130). Final guidance on budgetary amounts will be provided in July. The following program areas receive specific categorical funding and must be spent in that particular program: General Aid to Counties Communicable Disease (incl TB Control) Maternal Health Child Health HIV Testing & Counseling Child Service Coordination Family Planning Immunization Action Plan Food and Lodging Public Health Preparedness Environmental Health Health Promotion Refugee Health Each year supplemental funds become available during the fiscal year in various programs depending on state and federal action and on performance by the county. The total anticipated amount of funding as of July 1, 2009 represents between 8%-10% of the overall health department budget. In the past two years, through General Assembly action, the county has received an additional $63,000 in General Aid to County funds that may be used for any program that relates to the provision of public health essential services as defined by NC General Statute 130A. The state consolidated agreement is anticipated to provide $426,340 federal and state dollars to the county to provide specific services for fiscal year 2009-2010. A spreadsheet provided to Board members detailed the amounts anticipated by program area. C. Acceptance of Additional State/Federal Funding The Orange County Health Department has received notification of additional funding from the State of North Carolina Department of Environment & Natural Resources (NCDENR) for the Food & Lodging program, and Federal funds (Title X) for the Family Planning program as follows: Food & Lodging ($10,100.67): Performance-based distribution of funds based on 2007-08 compliance with mandated inspections of food & lodging establishments. The calculated rate of compliance for Orange County is 94%. OCHD has already received the base amount of $750. An additional distribution of $10,100.67 has been allocated to the Environmental Health Services Division for the FY 08-09 budget year. Family Planning ($4,628): Federal Title X (Family Planning) has approved one-time bonus funding for all local health departments. The WCHS Liaison Committee has approved the method of distribution, which includes a base amount for all counties and an additional amount determined by performance. Each county will receive at least $1,647. Additionally, 57 counties (including Orange County) will receive performance- based bonus funds calculated on an increase in their patient caseload. OCHD’s allocation is $4,628. These funds may be used for any Title X approved expenditure (for example: birth control). Motion to accept items on the Consent Agenda was made by Matt Vizithum, seconded by Anissa Vines, and carried without dissent. MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 February 25, 2009 V. Reports and Discussion with Possible Action A. Rule Amendment for On-Site Wastewater Rules Orange County Board of Health adopted the current Wastewater System Rules in November of 2007. Since implementation, Tom Konsler reported that the following rule is being considered for amendment: The rule that is proposed for amendment is Section 1946 OTHER APPLICABLE FACTORS. When a site evaluation is conducted for a proposed septic system site, factors such as the slope, topography, soil depth, soil wetness, and type of soil are evaluated for suitability for a septic system. In addition, the amount of available space in which to install a system is a factor affecting the decision to issue an improvement permit. These items are detailed in rules .1940 -.1945. Rule .1946 addresses other applicable factors that must be considered when determining the overall site suitability. Item 5 of this rule is proposed for deletion. In its current form, it requires that each lot proposed in a subdivision have enough available space to support a septic system to serve a three-bedroom conventional or gravel alternative system. This requirement was originally incorporated in Orange County regulations: • to prevent developers from proposing unrealistic restrictions on future homeowners who may later be prevented from upgrading to a three bedroom home. • to allow a threshold amount of suitable soil for use on each proposed subdivision lot, and • to prevent homeowners from being faced with exorbitant costs of innovative systems at the time the original system needs to be repaired. While these were worthwhile reasons and offered a level consumer protection, there are several reasons that the requirement should be dropped: • Unintended consequences for large lots (>10 acres) that were not subject to subdivision regulations • The requirement may prove to be an obstacle for small starter homes or affordable housing. • With advances in technology and a much wider range of accepted alternative septic systems, the requirement is no longer vital. In fact, use of the alternative technologies has outpaced the use of conventional gravel system. • Restrictions regarding minimum size or type of systems in newly created subdivisions belong in the subdivision ordinance instead of the wastewater regulations. • The public health necessity of this rule is somewhat questionable as well. The rule amendment has been advertised for public comment as required. Upon adoption of these rules, they will become effective February 26, 2009. Steve Yuhasz asked what had precipitated the decision to eliminate this rule. Tom Konsler MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 February 25, 2009 replied that staff felt that the longer the rule remained in the regulations the more potential would exist for a challenge. Commissioner Yuhasz asked if staff had communicated with planning prior to recommendation to remove this rule and was assured that staff had verified through the Planning Director to be sure there would be no conflicts with Planning and Development prior to making the recommendation. Rosemary Summers pointed out that the local rules for public health must be health related. This rule change is justified by that reason. Chris Harlan asked if a subdivision had been approved for 2-bedroom homes whether it would preclude an addition to the homes because of that restriction. Motion to accept the Rule Amendment as stated for On-Site Wastewater Rules was made by Matt Vizithum, seconded by Jessica Lee and carried without dissent. B. Fee Schedule Approval The approved Fee and Eligibility Policy states that: A. Fees are charged for health and dental services provided to individuals unless prohibited by law or regulation. Fees are established based upon cost analysis, Medicaid and Medicare rates, comparable provider rates and/or state or contractual agreements. B. The Health Director is authorized to adjust fees, rounded to the next highest dollar, on an annual basis: Fees will be adjusted annually by either a) the general rate of inflation calculated based on the current Consumer Price Index (CPI) or b) the percent increase in any new Medicaid/Medicare service rate adjustments, whichever is greater. C. Fee schedules will be reviewed annually during the budget process and adjusted as appropriate; a complete cost analysis for purposes of fee adjustments will be performed every five years. Wayne Sherman reported that a comprehensive Cost Analysis has not been completed since 2003 for Dental Health and since 2000 for Personal Health due to budget constraints. In 07-08 however, the County Budget office undertook a modest cost study of the most frequent CPT codes used by disciplines by comparing OCHD’s rate with regional and/or similar health departments and our costs were quite high. This comparison became the baseline cost used to determine 09-10 fees. The appropriate CPI rate was applied in 08-09 and 09-10 to the baseline fees to determine the recommended 09-10 fees. The 06-07 Medicaid Cost Study was under consideration as a baseline for fees but due to concerns about the accuracy of the data used to determine the OCHD Medicaid Costs, this was not pursued. New fees are to be determined based on the assessed cost of staffing, materials, supplies and/or equipment needed to deliver the service. Funding for another comprehensive Cost study is not anticipated in the near future so the department will be looking for opportunities to work with Financial or Business collegiate students to undertake a year-long, in-depth analysis of our fees. Rosemary Summers explained that these fees are based on 100% pay for services and are lower than private providers. On a sliding scale a 20% pay patient would pay 20% MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 February 25, 2009 of the fee. The Board is required by statute to recommend a fee schedule to Commissioners for approval. Commissioner Yuhasz asked what counties were used for comparisons. Wayne Sherman stated that similar counties, Chatham, Durham, Wake, New Hanover, and were compared for personal health fees and Alamance, Durham, Guilford, and Wake counties were used for dental health fees. Steve Yuhasz inquired if an increase in fees would affect patient load. Dr. Summers replied that it would not because the majority of our patients are below 100% and will not generate significant revenue. Motion to approve the methodology was made by Anissa Vines, seconded by Tim Carey and carried without dissent. Motion to approve the fee schedule was made by Jim Stefanadis, seconded by Matt Vizithum and carried without dissent. C. Budget for FY 09-10 Rosemary Summers explained that a number of items reflect direction by the County Manager and the budget staff. The direction provided was to cut 10% of the overall departmental operating budgets including temporary personnel and overtime. This also applied to all grant funded projects regardless of whether they were 100% grant funded. In addition, in order to be bottom line neutral with county funding we had to propose additional cuts in expenditures beyond the required 10% operating reduction. The Health Department is funded approximately 40% by external revenue sources (fees, third party reimbursements, contracts, state and federal funding, and grants). Changes in our patient pay mix, reductions in reimbursement rates, and the downturn in the building trades are projected to negatively affect our bottom line revenues. The Department was not able to achieve a revenue and expenditure balance without delaying positions for the 09-10 budget year. These were included in the Service Reduction report provided to the Board. The Department was also directed to include the action plan items from the BOCC priorities adopted at their retreat earlier this year. These action plan items were to be “exchanged” or “substituted” for current programs or activities and were directed to be bottom-line cost neutral. We were unable to achieve this in total, although the Department was able to shift resources to partially meet this need. In addition, the department submitted critical capital requests that were approved and funded, but then frozen, for the current budget year. Several of these items have been requested in previous years and unfunded. Some items are rising to critical levels for replacement. The BOCC will receive the Service Reduction Proposals from the “Community Services Team” on March 5 for discussion at a work session. Advice from the Board of Health regarding critical health priorities to the Commissioners would be useful for them to factor in as they begin to make funding decisions later in the spring. NCGS 130A requires the Board of Health to act upon a health department budget and MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 February 25, 2009 forward to the Board of County Commissioners. The Board of Health may choose to: Adopt the budget as presented, including the capital requests, the proposed reductions, and priority plan implementation subject to BOCC action Adopt the budget with recommendations for changes in the budget that would be subject to BOCC action. For example, the Board of Health may choose to not accept certain recommended service level cuts or may propose others not listed as substitutes. Rosemary Summers pointed out some 2008-2009 performance highlights of department services and complimented staff for its outstanding work in a difficult budget year. To date in FY 08-09 the department has: • Investigated and responded to 14 whooping cough (pertussis) cases through February, requiring antibiotics for more than 300 children and over 200 hours of staff time • Averaged 19 new refugee arrivals each month this year requiring 4 – 6 hours of services for each refugee • Mandated prenatal, immunization, and child health services have increased by an average of 15% over the previous year • Demand for the full suite of water tests has exceeded projections by 200% through February • Food, lodging and institutional inspection compliance rate for 07-08 was estimated by the state to be 94% • 1,223 children and adults received a total of 6,194 dental clinical services in the first six months, a 24% increase in services and an 11% increase in unduplicated patients • Increased number of patients receiving language services by reducing costs through additional new telephone interpreting service and by recruiting 5 Burmese/Karin/Chin contract interpreters • More than 270 volunteers are active through the Orange County Medical Reserve Corps • Renewed 3 year grant award for Youth Tobacco Prevention Program (2009-2012) Commissioner Yuhasz asked about the decision to discontinue dental services being provided at the Carr Mill Mall (CMM) location. Chris Harlan explained that the Board had discussed this issue at length in the past and felt that there were limited resources available for the clients that use the CMM clinic. Dr. Summers stated that keeping the Carr Mill dental clinic open is an expensive option because it is only open 2 days per week and staff alternates between offices. She also said that if staff were available to run the CMM clinic Monday through Friday, there would be no shortage of patients at either clinic location. The problem is availability of staff. Commissioner Yuhasz asked for clarification on the discontinuation of the HIV program. Rosemary Summers explained that the testing at community sites currently is being done by a volunteer and by clinic staff in the clinics. In the past the department had a staff member to administer the community testing program and counseling, however that staff retired and because community-based testing is not a mandated program, the department opted to eliminate the program. The department will continue to MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 February 25, 2009 provide testing and counseling in each clinical setting. Chris Harlan stated that the department is currently operating at a barebones level and to make further reductions will seriously jeopardize the health status of those citizens it serves. Tim Carey expressed support of the programmatic approach to budget cuts rather than across the board percentage cuts. Upon further discussion, Board members proposed sending a letter to Commissioners setting forth the Board of Health’s position on critical areas of concern and the long- term effects for Orange County citizens that would be affected by budget cuts. The Board urged retention of positions that are currently being furloughed, to be filled when funds become available and stated that this is a high priority because they felt there will be a strong need due to the impact of the economy. Concerns were expressed on the impact on dental and medical health status, skimping on repairs in environmental health leading to septic failures, and substantially higher infectious disease rates as consequences. Motion to send the budget forward to the Commissioners and to include a letter to Commissioners expressing the Board’s strong concern about the impact of budget cuts on critical areas of health care was made by Jessica Lee, seconded by Matt Vizithum, and carried without dissent. D. Comments on Draft State of the Environment Report Tom Konsler reported that the Environment Resource Conservation Department has been preparing the 2009 State of the Environment Report to be considered by the Commission for the Environment. ERCD staff shared a copy of the draft and is soliciting comments from other boards or agencies. Ernie Dodson stated that he noted several statements that he thinks are misleading and that suggests rewording. He also noted that several statements indicate a bias rather than being simply factual. The Board members expressed an interest in portions of this document as many of the topics overlap existing programs in the Environmental Health Division. They recognize that recommendations coming from the report could have a serious impact on Health Department programs, services, and future budget. The Board directed staff to forward comments to ERCD staff for consideration in preparation of the final draft and that the Board would like to review the final draft before publication, if possible. E. Informational Items Due to time constraints, only Item E.d. only was discussed. a. Board of Social Services Report to Commissioners: Board members received a copy of the report presented to the Board of Commissioners at a joint meeting with the DSS Board on February 10. The Report contains statistics that reflect the rise in service demand for basic needs for county residents. MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 February 25, 2009 b. Meetings with Dental and Medical Safety Net Providers: The Health Director and senior staff met with Dental and Medical Safety Net Providers in two separate meetings in mid February. Summaries of those meetings will be provided to the Board members in March. c. Update on Pertussis at Carrboro Elementary School: An order was given to place all 4th graders, kindergarteners, and bus riders on a certain bus route on antibiotic therapy due to an outbreak of pertussis. As of February 17, 2009, all children have complied with this order and have provided proof of antibiotic therapy to school officials. Judy Butler, Community Services Supervisor was at the school when students returned after antibiotic therapy to assist school personnel with the verification process. At the end of the day only 10 children were without antibiotics but were in the process of acquiring them. These children returned to school the next day in compliance. While these cases were all in vaccinated children, at some point in the future the Board may wish to look more closely at the status of unvaccinated school children (religious and medical exemptions) to determine whether any potential policy action is either necessary or possible. d. Letter from DENR regarding residuals management: The Aquifer Protection Section of the Division of Water Quality recently issued a letter to county health departments explaining the residuals (biosolids) management program in the state and encouraging counties to be active and aware of the permitting and notification process. A draft memorandum from the Commission for the Environment to the Commissioners was also provided to the Board. The CFE is recommending a task force on the issue. Commissioner Yuhasz asked what kind of monitoring process was in effect. Tom Konsler stated that we are the only county in the state that has a monitoring process for biosolids applications, however, due to staff limitations it is impossible to monitor all applications so it is only by spot checking, but he felt that the majority of those using biosolids were now following the guidelines set forth simply because of the possibility of environmental health staff arrival during the application process. Early in the process there was much more non-compliance. Board members agreed that participation in a multi-disciplinary task force would be acceptable, however the CFE suggested memorandum of agreement with the Health Department and the Division of Water Quality (DWQ) should be negotiated between the health department and DWQ based on available health department resources. d. Media clips: News articles featured in local newspapers on public health issues or with health department involvement were provided for the Board’s information. e. Health-related Bills introduced in General Assembly: A listing of health-related bills that have been introduced by the State Legislature to date was provided to Board members. Members were asked to notify the Health Director of interest in further discussion of pending legislation so the discussion could be scheduled for an upcoming meeting. MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 February 25, 2009 F. Pending and Recurring Items This report provides the Board with a look at upcoming agenda items and reminds the Board of items that may have been requested but have not yet been addressed. Staff will be looking at this tool and recommending changes to the tool for the Board to consider at the March meeting. VI. Board Comments/Announcements None VII. Adjournment Motion to adjourn the meeting was made by Ernie Dodson, seconded by Tim Carey, and carried without dissent. The next Board of Health meeting will be held on Wednesday, March 25, 2009 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