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HomeMy WebLinkAboutBOH minutes 062409MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 June 24, 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 June 24, 2009 at the Southern Human Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Tim Carey; Matt Vizithum; Steve Yuhasz; Michael Wood; DeWana Anderson BOARD OF HEALTH MEMBERS ABSENT: Sharon Freeland; Ernie Dodson; Jessica Lee; 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; Nidhi Sachdeva, Senior Public Health Educator; Iole Nall, Medical Interpreter/Translator; Pat Gentry, Emergency Preparedness Coordinator GUESTS PRESENT: None I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:00 P.M. Ms. Harlan thanked the retiring Board representatives for their service and presented each with a framed certificate for their service to the Health Department and the Board of Health. She also welcomed new staff members who were in attendance. II. Educational Presentation: Practice-Based Research Network Rosemary Summers reported that as part of the NC Incubator Program, Orange County participates with eight other counties, both large and small, as part of the Central Partnership for Public Health. The goal of the voluntary collaborative in this region is to improve workforce recruitment and retention and to improve public health systems. In 2008, the collaborative partnered with the UNC Institute for Public Health in a 2-year grant application (PBRN) to the Robert Wood Johnson Foundation for the development of a practice-based research network. The NCIPH is the fiscal agent for the grant and the project director and coordinator. There were five grants awarded nationwide; the others are Washington, Colorado, Kentucky, and Massachusetts. The other projects are focused at the university level, whereas, ours is the only project that starts at the practice level and works up to the university level. The grant was awarded in January 2009, and fit with an existing goal of the incubator counties to develop a research agenda developed by the practice community for researchers to consider as they develop future projects. As the co-principal investigator along with Dr. Ed Baker, the NC Institute for Public Health Director, Dr. Summers stated she has been involved in advising the project staff on the details of the project and in making presentations, both locally and nationally about the proposed network. The Steering Committee is made up of Health Directors from each of the participating counties plus a representative from the State Division of Public Health, a state liaison and a MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 June 24, 2009 faculty liaison to the School of Public Health. The steering committee will probably be expanded later in the summer to include other universities. Dr. Summers gave a short power point presentation that reviewed the objectives, process, and progress of the project. Included was a draft of high priority practice topics identified through focus groups with local health department staff members from all nine counties. The focus was around the 10 essential health services that the Department is mandated to provide. One of the next steps is to identify faculty that would be interested in public health systems research. The project year is a calendar year and is funded for 2 years. There is no direct cost to the Department or to the county. All travel related to the grant is paid by the grant. Chris Harlan asked if faculty have been alerted to this program for possible doctoral and master student dissertations. Dr. Summers stated that this would be acceptable, however, the project is seeking credible research so most student projects would include a great amount of faculty supervision. Feedback from the Board was requested. Tim Carey discussed the focus on systems research and suggested a contact person at the Shepp’s Center with background experience in this type of healthcare system research to avoid duplication of efforts. III. Approval of June 24, 2009 Agenda The motion to approve the Agenda of June 24, 2009 was made by Matt Vizithum, 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 May 27, 2009 meeting. B. CHCCS and OCS School Nurse Contract Renewals The Health Department has served as the conduit of Commissioner-approved funding for school health nurses since July 2004 for both the Chapel Hill-Carrboro and Orange County School Systems. The Health Department enters into a contract with each school system to spend the funding on a specified number of direct service 10-month school nurse positions. In FY 09-10, the proposed contracts provide $430,356 to CHCCS for six school nurses and $187,378 to OCS for three school health nurses, for a total of $617,734. 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. In addition, the Department develops an annual Memorandum of Agreement with each school district that details operating procedures and protocols. This Memorandum of Agreement is an annual requirement and is only indirectly related to the funding source for school nurses. MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 June 24, 2009 C. Modify the Annual Board Meeting Schedule to Cancel July Meeting The Board in past years has made a decision to either hold or cancel the July meeting depending on specific needs. At the current time there is nothing for the agenda that cannot wait until the August Board of Health meeting. The motion would be to cancel the July 23, 2009 meeting of the Board of Health. The next meeting of the Board would be August 27, 2009. D. Accept Kate B. Reynolds Funds for Diabetes Self-Management The Department recently received notification of the award of $202,532 for a two-year grant period to start a diabetes self management education program serving low income individuals in the County. In addition, a special NC Program allows local health departments meeting certain qualifications to bill Medicaid and private insurance for diabetes education services. The grant provides a bridge for services to be started while qualifications are obtained. Grant funds may be used to hire part-time or full- time, time limited, non permanent, or contract staff; required software; and initial supplies as the program is developed. The team that will be planning and implementing this program is also attending the UNC Management Academy. As a requirement of that program, the team will develop a full business plan for the program. The grant period will be from July 1, 2009 through June 30, 2011. Upon approval of the Board of Health, the Department will request the establishment of a grant ordinance at the Commissioners’ August meeting. The Board accepts this grant as one means of meeting an important health need in the county and recommends that Commissioners concur by authorizing the creation of a grant ordinance to receive these funds. E. Accept Immunization Stimulus Funds The NC Division of Public Health is receiving stimulus funding from the CDC for influenza vaccinations for school age children. Recently counties were requested to indicate interest in providing off-site (in schools) influenza vaccine during the upcoming influenza season if funds became available. The Department responded affirmatively and received notice this week that it had been awarded $44,228.37 for administration of the vaccine. The vaccine will be provided free by the state. A small portion of the funds, $2,211.42, is designated for the school systems, the remainder may be used for supplies and staff, $42,016.95. Creation of jobs in especially encouraged. Staff is currently considering the specific plan for accomplishing this task. Preliminary plans are to target all public school elementary age children in grades 3-8. The Board recommends the receipt of these funds for the purpose of immunizing school age children against seasonal influenza during 09-10 and requests that the Board of Commissioners accept and budget the funds for this purpose. Motion to accept items on the Consent Agenda for purposes specified was made by Anissa MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 June 24, 2009 Vines, seconded by Steve Yuhasz, and carried without dissent. VI. Reports and Discussion with Possible Action A. Annual Communicable Disease Report An annual report on the status of communicable diseases is required to comply with accreditation standards. Judy Butler, the Community Health Services Supervisor, reported on disease issues impacting the community in 2009 as well as a summarization of activities for the calendar year 2008. In 2008 there were outbreaks of pertussis and TB that kept the department especially busy. Chris Harlan commented that she was unaware that dengue fever had been reported in Orange County. Ms. Butler said that malaria and dengue fever were mainly a result of travelers to foreign countries. She noted that state requirements for STD testing have changed; therefore statistics have increased for HIV and other STD’s. HIV will now be more widely tested. Also pelvic inflammatory disease became reportable. The early diagnosis of HIV and other STD’s will result in more favorable outcomes. All TB cases must be directly observed by a medical professional for medication administration. This is a 6 month treatment in most cases. Latent cases are treated for 9 months in the same manner. This requirement increases the workload of the communicable disease nurses and in some cases also requires an interpreter. This year the state has initiated a web-based reporting system for reportable communicable diseases that is accessible by all counties. This has led to a more rapid response and treatment as cases are reported sooner to the counties, and as a result helps limit the spread of infectious disease. The reporting system is also a good surveillance tool because staff can access data for outbreaks in other counties that could possibly affect Orange County. Ms. Butler stated that during the current calendar year the department has had to deal with several health law violators and cases of parental refusals to vaccinate their children due to religious beliefs. Staff members have worked with each of the school districts who will be distributing a letter to parents of children with religious exemptions about the exclusions that will be necessary if there is a case(s) of infectious disease in the school. Tim Carey complimented Ms. Butler on an informative and comprehensive report. B. Annual Preparedness Update Pat Gentry, Preparedness Coordinator, reported that Orange County Public Health Preparedness efforts in 2009 have been focused on the timely update of the county’s Strategic National Stockpile (SNS) Plan and the recent response and mitigation of the novel influenza H1N1 flu outbreak. The SNS Plan revisions are an annual requirement of State Division of Public Health submission. This year, Orange County Public Health has been selected as one of seven MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 June 24, 2009 randomly chosen counties statewide for onsite assessment on the County SNS Plan. The SNS Plan describes Orange County’s systems used to request, receive, store, distribute and dispense large quantities that make up the SNS assets. It sets forth lines of authority, roles and responsibilities, and organizational relationships between Federal, State and local governments. The plan was successfully activated for the H1N1 Flu event this past spring, as all North Carolina counties received 25% of our SNS supplies (anti-virals, masks) from the federal government in May. The recent novel influenza H1N1 flu outbreak has been widely covered by the national and local media. On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza H1N1 virus. A Phase 6 designation indicates that a global pandemic is underway with more than 70 countries now reporting cases of human infection with novel H1N1 flu. Orange County has confirmed cases that are being successfully treated by UNC Hospital and local practitioners in the same manner as they would treat the seasonal flu. State public health says to expect increased numbers of H1N1 flu cases, and Orange County Public Health is being proactive in communicating best practices of safe hygiene with the hospital, private practitioners and the general public. State public health has released their flu plan, which Orange County will be reviewing. The current plan is to have 95% of the Department staff as well as school nurses fit- tested by August and to exercise a point of dispensing portion of the SNS plan. Tim Carey asked how many shots would be likely to be required. Dr. Summers stated that it is unknown at this time but possibly 2 separate vaccinations for H1N1 and one for the seasonal influenza. The H1N1 vaccine is still under development. C. Nominating Committee: At-Large Recommendation Anissa Vines reported that Sharon Freeland, a current At-Large representative of the Board is completing her first full term June 30, 2009 and has declined a second term. The Nominating Committee has screened all current applications that qualify for the at large slot and met with the candidates recommended at the May Board of Health meeting. Anissa Vines reported that the nominating committee recommended the name of Christopher Cooke to be forwarded to Commissioners for appointment. The committee felt Mr. Cooke’s vast experience in the public health arena would bring added dimension and be a great asset to the Board. The Commissioners will not be acting on any of our new appointments until their August meeting. The staff will likely try to proceed with orientation of the nominees this summer if the recommended nominees are willing to invest the time without being formally appointed until August. This will enable the Board to get a good start in August with four brand new members and two current members with less than a year of experience. Motion to forward the recommendation of Christopher Cooke to fill the At-Large vacancy on the Board of Health to the Board of County Commissioners for action was made by Tim Carey, seconded by Matt Vizithum, and carried without dissent. MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 June 24, 2009 D. Strategic Plan Review Sections IV. And V. Rosemary Summers reported that each year the Board and staff review the Strategic Plan to determine progress toward completing high priority items and to determine whether the plan requires alterations. The extended management team reviewed Sections IV. And V. of the 2006-2011 Strategic Plan in early June and had several comments and suggestions for the Board to discuss. The Board was provided with copies of the report and staff notes as a result of this meeting. Recommendations included dropping certain activities, acknowledging delays because of budgetary issues, and altering other activities due to changes in the environment. ‘Changes in the strategic plan’ is suggested as a possible topic for a joint Board of Health Board of Commissioners meeting. Chris Harlan asked if staff felt good about the status of various goals. Dr. Summers commented that some of the objectives are resource intensive in terms of financial resources that we do not have, therefore it has been difficult to reach goals such as expansion of the dental program. Chris Harlan commented on the meeting she had with County Manager Laura Blackmon. Ms. Blackmon made a point to indicate her appreciation and recognition of the lengthy discussions by staff and the Board to find creative ways to reduce costs in order to meet budget guidelines for FY 09-10, specifically the offer by the Department to eliminate services at the Carr Mill dental clinic. Rosemary Summers said that the TRU and Health and Wellness Trust programs have proven results. This is clear evidence of positive results when the resources are available. The Diabetes Self Management is part of the plan and we currently have the resources. Eventually the Department will be able to bill for these services with the hope the program will eventually be self sustaining. Steve Yuhasz inquired about where he could find the section mentioned in the agenda. The entire Strategic Plan is available on the Department website and each Board member should have either a CD with the plan (if you were appointed after 2006) or a hard copy. E. 09-10 Budget Update The Board of Commissioners adopted budget ordinances on June 16, 2009. The cuts proposed by the Health Department were accepted with one exception. Projections indicated that closing Carr Mill Dental Clinic would have cost more than it saved because of the provision to buy out the current lease and was not accepted. The Commissioners accepted the year long freeze for an environmental health specialist in the on-site/well program; an environmental health program specialist in the food and lodging program that will be retiring this year; an office assistant in environmental health; and a medical office assistant stationed at Southern Human Services Center. The Department is unaware of any other county department that offered to freeze four positions in order to balance anticipated revenue shortfalls. All MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 June 24, 2009 vacant positions or those becoming vacant during the year will be frozen for the remaining year unless they are granted a waiver as a critical position. The employee provisions include voluntary retirement incentive for those that quality, voluntary reductions in hours for one year; loss of county contribution to 401k; no cost of living or merit increases; increased benefits cost sharing to be determined In the fall. There are major threats on the State side of the budget. Some programs have partial restoration of proposed cuts but not at prior levels. Accreditation was partially restored. Oral Health was restored at the state level. Consolidation of case management services, diverting the majority to the Community Care Networks across the state will have serious consequences for Child Service Coordination. Maternal Care Coordination Programs and Maternal Outreach Program. Board members were asked to be aware of the conference committee work and be prepared to respond appropriately. F. Request for Joint BOCC/BOH Work Session The Board of Health usually requests an annual joint meeting with the Board of Commissioners to enable the exchange of dialogue on various topics of interest to both parties. The Chair of the Commissioners approves the request and the Clerk places the meeting in any available agenda slot. Rosemary Summers explained that joint meetings last approximately one hour, occurring prior to an already scheduled work session. The best results have been achieved by limiting the number of topics to three. Potential topics for discussion considered were: • UNC Health Care/Health Department Concept Paper (to be developed) • Dental Health Facility Planning at SHSC • Expansion of Dental Health Clinics to Full-time • Health Status of Orange County Residents • Biosolids/Pharmaceutical Disposal/Water Protection The Board discussed whether a fall or spring request would be preferable. Steve Yuhasz recommended an early spring meeting because the County currently has an interim manager and the new county manager should be hired by early next year. By consensus the Board decided a spring meeting would be the better option because by spring the new County Manager will have been hired and the department would be in the midst of budget planning. Discussion of topics was deferred. G. Informational Items a. H1N1: As of the Board meeting the latest case count for Orange County was 14. The Board was provided with a June 16 report to the Commissioners on the H1N1 response by the department since the beginning of the outbreak. Staff members have spent a total of 332.5 hours in April and 569.75 hours in May for this response. Operational costs were also estimated for a total staff and operational cost of $54,543 for April and May. Many staff worked very long hours and into the weekends to continue to do what was required. Volunteers from the Orange County Reserve Corps assisted in distributing community education MINUTES ORANGE COUNTY BOARD OF HEALTH June 24, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 June 24, 2009 materials. OCHD plans to continue prevention messaging throughout the summer and into next year’s typical flu season. Orders have already been placed for seasonal influenza vaccine and as usual high risk individuals will be vaccinated before making vaccine available to the general public. It is unknown at this time whether there will be a vaccine available for the H1N1 swine influenza. The CDC and researchers are alert for any indications that the virus may mutate to an alternate form. b. Management Academy Team: Renee Kemske, Pat Dodson, Barbara Pringle, Bobbie Jo Munson, and Candice Watkins Robinson will be attending UNC’s Management Academy for Public Health. The team will be formulating a business plan around Diabetes programming and services with an emphasis on sustainability. The anchor will be the Diabetes Self Management Education program and our work towards becoming a Recognized American Association program. This training opportunity will also benefit the department’s succession planning by building the skills of future leaders. Additional information can be found on the web at http://www.maph.unc.edu/. c. Pending and Recurring Items: The Board is provided with a chart of recurring and pending items each month to provide a forward look at upcoming Agenda items discuss any changes to the scheduled items. d. Media Clips: Media clips on topics of interest, several of which cited OCHD programs and staff were provided to the Board for informational purposes. e. Biosolids Forum: Tom Konsler reported that work will begin soon on planning a biosolids forum to replace the research study that was unable to be carried through as reported at the May meeting. There has been interest expressed by UNC, NCSU, and Cooperative Extension VII. Board Comments/Announcements A. None VIII. Adjournment Motion to adjourn the meeting was made by Anissa Vines, seconded by Matt Vizithum, and carried without dissent. The next Board of Health meeting will be held on August 27, 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