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HomeMy WebLinkAboutBOH minutes 032509MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 March 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 March 25, 2009 at the Southern Human Services Center, Chapel Hill, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Tim Carey; Michael Wood, Ernie Dodson; Steve Yuhasz; Sharon Freeland; BOARD OF HEALTH MEMBERS ABSENT: DeWana Anderson, out of town; Jessica Lee, out of town; Matt Vizithum, meeting conflict. STAFF PRESENT: Wayne Sherman, Personal 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; Beckie Hermann, Family Home Visiting Coordinator; Renee Kemske, Nutritionist; Kathleen Goodhand, Family Home Visiting Supervisor; Dr. Michael Fisher, Medical Director. GUESTS PRESENT: Rhea Colmar, UNC School of Nursing/Community Health student I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:20 P.M. and introduced the guests present at the meeting. II. National Nutrition Month: Educational Presentation Renee Kemske, MPH, RD, talked to the Board about National Nutrition Month, a nutrition education and information campaign sponsored annually by the American Dietetic Association which is the nation’s largest organization of food and nutrition professionals. The campaign focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits. Registered Dietitian Day, celebrated March 11th, increases awareness of registered dietitians as the indispensable providers of food and nutrition services and recognizes RDs for their commitment to helping people enjoy healthy lives. The theme for 2009 is “Eat Right” and focused on three age groups; children, adults and older adults. The American Dietetic Association encourages all Americans to eat right and stay fit no matter what your age and to help yourself feel your best by making healthy food choices and being physically active every day. Renee also provided additional information on the following services provided by the Health Department: 1. Medical Nutrition Therapy, not only for obesity, but also malnutrition sometimes seen in refugees. This is a mandated service. 2. Increase in both clinic and community demand for nutrition services 3. Client trends: 0-20% pay, obesity, chronic disease co-morbidities, substance abuse, mental health, etc. MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 March 25, 2009 4. Increase/impact of Limited English Proficiency (LEP) clients, need twice the length of service time. 5. Diabetes Self-management Education Program. There has been an increased demand in the last 5 years. The state has a diabetes education program set up and has actively sought Orange County participation this year. After the criteria have been met under this program, the department should be able to begin billing for this service. Ms. Kemske added that the program hoped to reach the citizens in the northern part of Orange County where the program was more needed. Dr. Carey thanked Renee and commented that the ADA program was great and the benefit of nutrition counseling has proven itself in reduced hospital stays by diabetics. He also commented that it has always been extremely difficult to get patients to come to a class. Ms. Kemske stated that the Department has a very resourceful staff and will work on some incentives. III. Approval of March 25, 2009 Agenda The motion to approve the Agenda of March 25, 2009 was made by Sharon Freeland, seconded by Anissa Vines, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None V. Action Items on CONSENT Agenda A. Minutes approval of February 25, 2009 meeting. B. Contract Renewal with UNC Family Medicine for Medical Director OCHD has maintained a contract with UNC Family Practice for Medical Director services for a number of years. Dr. Michael Fisher has served in this capacity for the past seven years, with back-up from Dr. Lauren Lingley and other physicians. Dr. Fisher is well received by clients and staff and enjoys working with him. The 09-10 contract has no significant changes this year. It continues the contract at 28 hours per week, 22 hours in clinic and 6 hours providing phone consultation, administrative duties, and back-up on-call responsibilities. The only changes to the contract are that Refugee Health has been added as a Clinical Services Program and an additional ½ time FNP has been added to the after-hours rotational call such that the Medical Director shall provide such consultation every 4-5 weeks. The 09-10 contract does not include a cost increase. The total amount of the contract remains at $145,416 per year. In addition, 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 provide limited nurse practitioner services in the Head Start Program. The contract in effect this past year has MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 March 25, 2009 been deemed successful. Addendum A outlines the expectations of each party in this agreement. The cost remains the same ($1000) as does the payment arrangement. C. Contract Renewal with Dr. Bob Dupuis for Pharmacy Services The issuance of pharmaceuticals through our clinics or during epidemics/disasters necessitates the services of a registered pharmacist. Robert Dupuis, Pharm D., a Clinical Associate Professor in the Division of Pharmacy Practice at the UNC School of Pharmacy, has served as our Pharmacist for the past seven years. He has fulfilled his responsibilities well and is interested in continuing to serve in this capacity. There are no changes in the 09-10 Pharmacy Contract. It does not include a cost increase. The total amount of the contract remains at $12,036 per year. D. Contract Renewal with Chapel Hill Training and Outreach for Head Start Social Worker II Position The Head Start contract represents a collaborative relationship to provide family service coordination services to families eligible for and enrolled in Orange County Head Start and Orange County Health Department’s Child Service Coordination Program. The collaboration for one social worker position presents parents with one unified program case coordinator who provides regular contacts to the family in order to identify and follow-up on child and family needs. The Family Service Coordinator supports the development of family self- sufficiency and promotes skill development in the areas of problem solving, decision making and accessing needed health and human services. The Contract has been in existence since 1999 and is renewed annually. Changes in the contract from 2008 include identification of new personnel in key positions and a 2.8% increase in payment to OCHD, from $58,500 to $60,120 per year for the services of a Social Worker II. The contract is in effect from January 1, 2009 to December 31, 2009. E. Contract Renewal with Head Start for 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 entities. Both parties wish to renew this contract for services for the coming fiscal year. The contract amount is reduced by mutual agreement to $8,000 per year since more of the children than planned have a private dentist providing care after the initial screening. F. Contract Renewal with UNC School of Dentistry for Graduate Program Resident The Orange County Health Department (OCHD) annually contracts with UNC MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 March 25, 2009 School of Dentistry for services of one full-time equivalent 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, 2009 through June 30, 2010 is anticipated to be $54,168, a 5% increase. This amount was included in the 2009-10 dental budget. This contract cannot be fully executed until the state legislature passes their budget and since this is a state employee, the rate may be higher as a consequence. G. Receipt of NACCHO Grant Funds for Medical Reserve Corps (MRC) The Orange County Health Department recently received a $5,000 grant from the National Association of County and City Health Officials (NACCHO) for support of the Medical Reserve Corps program. The funds that NACCHO received were from the Department of Health and Human Services for the purpose of building the capacity of local MRC units. A signed agreement with OCHD and NACCHO obligates the Health Department to continue to work towards National Incident Management System (NIMS) compliance, use funds for approved purposes, maintain registered status with the OSG/OCVMRC, and agree to participate in an evaluation review by NACCHO. The term of the agreement is January through June 2009, however the cover letter sent with the check indicates that there is no deadline for spending the amount received. As this money must be approved by the BOH and BOCC, the budget will not be able to be amended until very close to the annual spending cut-off/fiscal year end. The Department will request that Finance and Budget Departments work with us to put this money in a deferred revenue account until July 1st. At that time, the revenue and expenditures will be placed on the Risk Management/QA budget. H. Grant Application to Kate B. Reynolds Foundation for Diabetes Umbrella The Health Department has been collaborating with the Department on Aging for the past six years, offering community diabetes education classes. The classes have been well received with positive evaluation results. The instructors include a registered dietitian, pharmacist, nurse and exercise physiologist. This team of volunteers is limited in the amount of time they can dedicate to the classes and there is no formal marketing, recruitment and referral system in place, resulting in a waxing and waning in participation. The Health Department has been asked to apply to the NC Diabetes Education Recognition Program’s (NCDERP) ‘umbrella’ recognition with the American Diabetes Association (ADA). Health Departments that successfully complete all recognition requirements may be certified as an ADA recognized DSME program. ADA recognition would allow the department to bill for DSME. Funds are needed to start up DSME, create a marketing deferral system, acquire needed staff resources and train providers on the benefits of DSME and Medical MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 March 25, 2009 Nutrition Therapy. Renee Kemske, Barbara Pringle, Bobbie Jo Munson, Wayne Sherman and Donna King submitted a grant application to Kate B. Reynolds. Requested amount: Year 1; $98,351 and Year 2; $85,769. Notification is expected in May. Motion to accept items on the Consent Agenda was made by Jim Stefanadis, seconded by Anissa Vines, and carried without dissent. VI. Reports and Discussion with Possible Action A. Child Fatality and Child Protection Task Force Annual Report The North Carolina Juvenile Code established a Child Fatality Prevention Team (CFPT) in every county of the state charging each team to review the records of all child fatalities in the county. Community Child Protection Teams (CCPT) were established by Executive Order in May of 1991 and the duties and responsibilities of the CCPT were adopted as North Carolina Administrative Code 411.0400 and was further formalized and expanded in 1993. The mandate to the CCPT is to review selected active cases in which children are being served by child protective services. Both teams are required by statute to submit reports annually to the State of North Carolina and to the local Board of Health and Board of County Commissioners containing any recommendations, and advocacy for system improvements and needed resources where deficiencies and gaps may exist. Rebekah Hermann, Family Home Visiting Coordinator, reported the Team’s findings to the Board. The CFPT reviewed a total of 22 fatalities a significant increase from 8 the prior year. Findings determined that 18 of the 22 deaths reviewed appeared to be not preventable at the time of death. • Thirteen of the deaths were premature infants of less than 38 weeks gestation. Of these 6 were born at less than 23 weeks gestation, 3 at 19 weeks, 1 at 21 weeks and 2 at 22 weeks. Eight of the infants had mothers with identified risks. • Five of the deaths were teenagers, three of which may have been preventable; 1 possibly gang-related, 1 a suicide, and 1 was a result of a drug overdose. • Four families had documented histories of extensive psychosocial issues and involvement with community support agencies. • One infant died co-sleeping with an adult. • Ten children had Medicaid. • Three mothers of infants dying soon after birth had no insurance during their pregnancies. Ms. Hermann stated that several potential system problems had been identified as a result of this study: • Barriers exist for high risk women of childbearing age to access pregnancy prevention services. • Access to prenatal care/education for women with limited or no medical MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 March 25, 2009 insurance is limited – including the immigrant population and socially at- risk women. • Women smoking during pregnancy • Adults co-sleeping with infants • Ongoing availability of guns to people who will misuse them • Barriers to access of supportive mental health services for teens suffering substance abuse, depression, and other mental health issues. Ms. Hermann reported that the Community Child Protection Team (CCPT) had reviewed the cases of 13 families with 27 children who were actively involved with Child Protective Services (CPS). The review found that: • Mental Health was an issue for 9 families and 4 children • Substance abuse was an issue for 8 families and 1 child • Domestic violence was an issue for 5 families • There was sexual abuse of one of these children • Medical factors were present for one child • Severe long term abuse and neglect were present for 3 children Potential system problems were identified: • Barriers to accessing supportive comprehensive mental health services. • Challenges in maintaining substance abusers in treatment • Limited resources for medical involved children requiring substitute care • Limited resources for the abusers in domestic violence cases • Limited resources for children who have experienced severe abuse/neglect where the children manifest serious mental health problems as well as complex medical challenges. Rosemary Summers stated that previously the mortality rate of infant deaths had been as low as 8 in previous years; therefore this is a large increase. Dr. Carey asked if any of the infant deaths had been multiple births. Ms. Herman replied there was a combination of twin and single births; two were twin births where one infant survived. Steve Yuhasz noted that there were several people that were supposed to be members of this group and are not and wanted to know is there was a problem recruiting. Ms. Hermann replied that the district attorneys and judges are difficult to get to the table. Across the state, Orange County has a high percentage of the required representation and good representation of groups compared to other counties. He also asked about the community action organizations. Ms. Hermann replied that they have recently identified several new members from community organizations that will be joining the Team. Jim Stefanadis asked for clarification of the definition of Orange County residents. Ms. Herman replied that if a child was a resident of another county but died at UNC Health Care; the death record would go to the county of residence. Chris Harlan asked if there was a tracking system for a pregnant woman that had been determined to be high-risk and moved to the county for healthcare at UNC but may have only been here for a few months. Ms. Hermann replied that these were difficult to break out and therefore were not MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 March 25, 2009 tracked at this time. Ms. Harlan also asked if comparisons to other counties were made for these statistics. Ms. Hermann noted that these are usually reflected in the following year’s infant mortality rates published with comparisons by county. Motion to approve and forward the Child Fatality and Child Protection Task Force Annual Report to the Board of Commissioners was made by Tim Carey, seconded by Anissa Vines, and carried without dissent. B. Proof of Residency – Eligibility and Fee Policy Revision Wayne Sherman reported that the Billing Committee of OCHD discussed the concern that, by policy, we were unable to determine if a client was a true Orange County resident. The Eligibility and Fee policy directed staff to determine proof of residency by checking the US Postal Service website or the Orange County GIS system. However, checking one of these resources only confirmed that the address existed; it did not confirm that a client lived at that address. The Billing Committee proposed strengthening the process by requiring clients to show proof of residency by submitting an additional document or ID that indicates the client’s address. These include a driver’s license, recent pay stub, utility bill, current rental or lease agreement, personal property tax bill, or student identification. Clients who did not have one of the above identifying information sources but who reported they lived within the county would be required to produce a written statement or letter from the head of the household where they lived as verification. Special cases would be referred to the Clinic Manager or Supervisor. Failure to provide proof of residency would result in referral to another resource. If approved, Section VI of the Eligibility and Fee Policy will be revised to reflect the change and staff will begin implementing the process. Ernie Dodson asked if Orange County employees still be eligible for services if they lived in another county. Wayne Sherman and Dr. Summers both stated that they would be eligible as a matter of convenience for the employee. Some services would be available to persons regardless of residency as mandated by state or federal statute. Motion to approve the proposed residency requirement documentation to Section VI of the Eligibility and Fee Policy was made by Jim Stefanadis, seconded by Sharon Freeland, and carried without dissent. C. Board of Health Annual Education Plan Accreditation standards require the Board of Health to engage in regular education that pertains to the specific duties of the Board. Rosemary Summers explained that each year, the Board adopts a general topical plan and schedule for addressing this standard. In general, the Board tries to have six educational topics throughout the year. The Board policy manual requires each MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 March 25, 2009 board member to be present for three educational sessions. The schedule is fluid depending on the length of a particular agenda. Staff has suggested the proposed topics based on what is going on in the health department at the current time. The following topics were proposed for 2009: • Refugee Health • Are We Our Brother’s Keeper Project • Wells and Groundwater Update • Practice-Based Research Project • Electronic Medical Records • On-Site Program Update Possible alternative topics were: • Workforce Recruitment and Retention • Quality Improvement; Open Access Project • Head Start Dental Research Project (Dr. Lee) • Report on Public Health Funding Streams for State – Commissioner Steve Yuhasz expressed a strong interest in this topic. Tim Carey expressed an interest in 1) School Immunization Rules Exemptions and also 2) TB and Communicable Disease Update. Chris Harlan suggested that some of these topics could be included as agenda items rather than educational topics. Motion to approve the schedule of educational sessions was made by Tim Carey, seconded by Ernie Dodson, and carried without dissent. D. 09-10 Budget Update Rosemary Summers reported that the Community Service Departments presented proposed budget reductions to the Board of Commissioners at their March 5 work session. Commissioners have requested that departments prioritize the proposed reductions. Staff will do so based on the Board’s direction from the February meeting. The Commissioners also received an updated revenue projection for the county as a whole. The Board of Commissioners is scheduled to have two additional work sessions for county departments, one for Community Development Departments and one for Internal Service Departments. The Budget office is working on amending the format to be more understandable. As an update, Commissioner Steve Yuhasz stated that the Commissioners had recently met and discussed the possibility of rescinding the revaluation and the implications and decided against it. The County Manager was instructed to come back to the Commissioners with a Budget that is no more than revenue neutral and include additional potential cuts beyond that. Therefore, he explained, there is potential for coming back to this department and all MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 March 25, 2009 departments for additional cuts, including salary cuts, furloughs, and reduced hours. He stated that the Commissioners would look at the budget requirements and see where cuts can be made to minimize the impact on county services. He stated that no budget discussion occurs without recognition that there are safety net services that must be maintained. Anissa Vines pointed out that there are no more areas where Health Department funds can be cut without serious consequences. Rosemary Summers reported that Smart Start grants are not going to be cut as much as originally thought so Health Department Smart Start projects will be fully funded. E. Committee Reports Each of the two standing committees met since the Board last met. Jim Stefanadis reported that the Clinical and Community Programs Committee reviewed renewal of contracts, all presented in the Consent Agenda. Rosemary Summers pointed out that there were no increases in contract amounts this year. Ernie Dodson reported that the Environmental Health, Preparedness and Quality Assurance Committee met and discussed identification of research needs for Environmental Health; new requirements for public pools; and GPS capabilities for wells and septic systems. Commissioner Yuhasz asked about changes in wording to the State of the Environment Report draft. Rosemary Summers replied that staff has met with Environmental Resources staff and submitted suggested revisions. None have been made to date due to lack of quorum at the Environmental Resource board meeting. F. Informational Items a. Kick Butts Day Carnival: Donna King reported that on March 21, TRU students from Orange County hosted an educational carnival with games and prizes at Wal-Mart from 10am – 4pm. Reena Roberts, cancer survivor featured on the TRU TV ads shared her story with those in attendance. Ms. King stated that there was an exceptional turnout and great public participation. b. Public Health Month Promotional Plan: Donna King stated that the Health Department has invited UNC Gillings School of Global Public Health students to join us for the “This is Public Health” sticker campaign. Students and their staff will use the stickers to identify and photograph ‘public health’ in action in honor of Public Health Month. Photos will be uploaded to the national campaign’s Flickr website and to the Department’s Public Health month web page. For more information members were urged to go to: Association of Schools of Public Health www.asph.org and http://www.thisispublichealth.org/ . c. Dental Research Project: Angela Cooke reported on the Pilot Study of the MINUTES ORANGE COUNTY BOARD OF HEALTH March 25, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 10 March 25, 2009 Evaluation of the Alaska Dental Health Therapist Workforce Model with Dr. Jessica Lee and RTI International. d. Media Clips: Newspaper articles on various topics of interest to the Health Department were provided to Board members. G. Pending and Recurring Items The Board has been receiving the table of recurring and pending items for about 2 years. The staff felt that it could be improved to help the board look at upcoming work quickly by month. Feedback on the new format was requested and the new format met with approval. VII. Board Comments/Announcements A. None VIII. Adjournment Motion to adjourn the meeting was made by Sharon Freeland, seconded by Tim Carey, and carried without dissent. The next Board of Health meeting will be held on Thursday, April 23, 2009 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