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HomeMy WebLinkAboutBOH minutes 092309MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 September 23, 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 September 23, 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; Mike Carstens; Steve Yuhasz; Michael Wood, Tony Whitaker BOARD OF HEALTH MEMBERS ABSENT: Dr. Paul Chelminski, out of town; DeWana Anderson; Christopher Cooke; 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; Anne Miles Cassell, Administrative Assistant; Deborah Griffin, PHN; Dr. Michael Fisher GUESTS PRESENT: Gail Harris, Durham County Health Director I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:00 P.M. and introduced new staff present at the meeting and also guest, Gail Harris. I. Review of Health Department Organizational Structure Rosemary Summers reviewed the Health Department organizational structure. Dr. Summers reviewed each division and an overview of responsibilities of the various staff positions. Vacant positions due to early retirement incentives were pointed out and it was explained that some deadlines were becoming difficult to meet with a shortage of staff. Some of the vacated positions were frozen due to budget reductions and will not be filled until either January 2010 in the case of one critical position (Healthy Carolinians Coordinator) or July 1, 2010 for other vacated positions. Steve Yuhasz asked if the FNP’s were assigned to a specific clinic or if they floated between clinics. Dr. Summers explained that they basically worked out of an assigned clinic however, when needed for coverage would work out of the other clinic. Commissioner Yuhasz inquired if the grant funded positions included funds for administration. Rosemary Summers stated that most do not include overhead, but if a grant funded position can earn revenue through third party reimbursement that can cover operating or supervisory costs. Generally government agencies providing grants do not allow other government agencies receiving the grant to charge overhead to a grant. Commissioner Yuhasz asked if the Department anticipated any other retirements occurring. Dr. Summers stated that she has not received notice of any additional retirements due to the incentive however, she has been told by several staff that they did not take advantage of the incentive but intend to retire within the next year. II. Approval of September 23, 2009 Agenda MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 September 23, 2009 The motion to approve the Agenda of September 23, 2009 was made by Jim Stefanadis, seconded by Steve Yuhasz, and carried without dissent. III. Public Comment for Items NOT on Printed Agenda None IV. Action Items on CONSENT Agenda A. Minutes approval of August 27, 2009 meeting. B. Receipt of Funds for H1N1 Phase I and II The Health Department has received notification from the NC Division of Public Health, Epidemiology/Public Health Preparedness & Response Branch (PHP&R) of additional funding in the amount of $80,000 for Phase I and II for Public Health Emergency Response – H1N1 Planning and Enhanced Surveillance. In the period from April 24 through May 15, 2009, North Carolina’s public health system responded to the identification of a novel H1N1 influenza discovered in California and Texas. In April, the Acting Secretary of Health and Human declared the first public health emergency in US history related to this virus. The State of North Carolina needs to plan and prepare for an expected second outbreak and to reduce the number of reported H1N1 cases. The purpose of the funding is to support expedited revisions and expansion of pandemic influenza plans for activities that will enable the health departments to rapidly detect and respond to the second outbreak of H1N1 expected to occur this fall. • Phase I includes hiring temporary staff to develop, update & revise pandemic flu plans to comply with certain benchmarks. These benchmarks include updated vaccination plans, policy and procedure to ensure cold chain security for vaccine transport and storage, data entry into North Carolina immunization Registry (NCIR), training surge staff on data entry and other H1N1 activities and documentation as directed by Public Health Emergency Response program guidance. • Phase II includes hiring temporary epidemiology staff to develop, update and revise plans to comply with benchmarks and allow for training for staff, including acquisition of training, time spent in training and facility costs for training venues. Benchmarks include pandemic flu response plans that include epidemiologic response plans and provide surge capacity to investigate cases in the community. These plans should also include enhancement of Epi Teams, cross training of current staff and identification of non-Health Department staff as part of the Epi Team. The service period for this funding is August 17, 2009 through May 31, 2010. This funding is by reimbursement only, and strict financial recordkeeping is imperative. In order to receive the full amount of $80,000, all of the money must be spent by the May 31, 2010 deadline and claimed by the June 20, 2010 report deadline. MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 September 23, 2009 Motion to accept items on the Consent Agenda was made by Steve Yuhasz, seconded by Jim Stefanadis, and carried without dissent. V. Reports and Discussion with Possible Action A. 2008-09 End of Year Financial Report The Fiscal Year 08-09 Financial Report was presented to the Board showing the original and revised budgets for the Health Department by division and category. Rosemary Summers brought several items to the Board’s attention. • Personnel costs for several divisions were at or exceeded 100% of the budget. This was due to the fact that the budget office calculates personnel costs at 96% rather than 100% to allow for vacancies. When there are no vacancies, the budget will run over. The Department had only a few vacancies last year. • The original Dental budget included 1 FTE Hygienist position, partly funded by Smart Start. Revenues were also increased in expectation of this hygienist working in clinic and additional hours were also budgeted for the current hygienist. Smart Start funding was unstable for the year and the department elected not to fill the position given the instability of both grant and county funding. This then left a shortage in the projected revenue which was balanced/neutralized by reduced expenses for salary and benefits. The current hygienist did not start working extra hours until mid-year. The county’s current financial system (MUNIS) does not adequately explain this situation. • Revised revenue budgets include additional state/federal and grant funding received throughout the year. • Revised expenditure budgets include a 2% reduction in operations requested by the budget office near the end of the fiscal year. • Capital was requested and approved in June. Several months into the year, that money was frozen and we were directed not to spend the capital. Any capital that was spent was either carry forward encumbrance from the previous year or equipment needed due to emergency breakdowns. • Original approved county appropriation was $5,209,942, however, for the revised budget the appropriation was decreased by $43,283 due to the 2% decrease. • Unexpended county appropriation is $372,810. These funds will revert back to the general fund to be used elsewhere in the county. • The total capital approved was $416,260. If the department had spent all of the approved capital, the budget would still have resulted in a return of $56,550 to the general fund. Steve Yuhasz commented that although the County budgeted salaries at 96% this fiscal year they would most likely not be doing this in the future. Commissioner Yuhasz asked about where the $10,000 that was set aside for the biosolids study appeared in the report. Rosemary Summers stated that those funds are encumbered (carried forward from previous years and not expended) and are not on the report. B. Rogers Road Community Request for Environmental Services MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 September 23, 2009 Last month, staff reported to the Board that the Rogers Eubanks Neighborhood Association (RENA) approached the Health Department and expressed concerns over the safety of well water supplies and septic systems in this neighborhood. They also expressed concerns about illnesses in the area. Tom Konsler reported that Rev. Campbell, the RENA spokesperson, would like the health department to conduct an environmental assessment of the wells and septic systems in the neighborhood. Students from the UNC School of Public Health may be included in the effort as well as representatives of the community in a team effort. The Board was provided with meeting minutes from two recent meetings of RENA with the Department present. Because of the size of the area of concern and the anticipated cost of the study, there are not adequate resources to accommodate this request within the current Departmental budget. An estimate of cost and time involvement will be developed pending further information from the community representatives. In accordance with the policy that was developed in 2006, it is anticipated that a request will be made of the Board of Commissioners by Rev. Campbell to consider appropriation for money to fund this request. Tom Konsler estimated the number of homes in the study to be approximately 107, the cost of supplies to be roughly $9,000 of operating costs, travel costs of $1,000, and $16,000 in staff time. He stated that Engineers Without Borders might be able participate as members of the survey teams for the study. Steve Yuhasz asked a hypothetical question that if a home had a failing septic system and it was determined that there was no good soil to install a new system, how long can we search for alternative solutions before the county would have to take action if there were no viable repairs. Tom Konsler replied that each case would be case specific and there is a long list of interim measures that can be taken. If there is no viable repair the NC Division of Water Quality can authorize a system with a treatment and a discharge, costing about $20,000. Rosemary Summers stated that a suggestion was made by the Interim County Manager to the Board of Commissioners that a special fund much like the No Fault Well Repair Fund (NFWRF) be set up to repair septic systems and wells that are failing. Dr. Summers reported that what the residents were requesting was not repairs but hookup to public water and sewer. The Department has been clear with residents from the outset that our goal is to identify possible repairs to existing systems where possible and that moving forward with public connections were outside the realm of the health department’s purview. Tony Whitaker commented that according to an article included in the packet from a UNC study, the area had no higher rate of failure than other areas in the county. He asked if it was true that the department might not know of some failures because they were unreported. Mr. Konsler stated that staff had recently evaluated their files and concluded that was possible. He stated that no data was available on septic systems or wells installed prior to 1980. MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 September 23, 2009 Rosemary Summers asked the Board for their thoughts on going forward with a request to the Commissioners for a study. Chris Harlan wanted to know how many homes were needed to have a viable study. Steve Yuhasz replied that a very high percentage would be necessary for a grant and unless enough property owners were willing to work together the County would be reluctant to expend funds for a grant. Ms. Harlan stated that there is a system in place to take care of failing systems. Mike Carstens asked about the homeowners association? Tom Konsler responded that it is not participated in by all property owners. Michael Wood stated that sewer and water hookups would be an advantage to the community. Jim Stefanadis noted that there were water lines already in existence in parts of that area. Anissa Vines said that it was important for the Board and Environmental Health to remain non-political in this debate and that the residents understand clearly what the Health Department can and cannot do. Steve Yuhasz asked what was included in the Mill Creek Study. Tom replied that a door to door effort was done by local residents to achieve a 100% participation by the area residents, but that it took several months to achieve this. The study included water sampling by environmental health staff and analysis of all water parameters by the state public health lab, a health questionnaire conducted by phone interview, and a cancer cluster analysis conducted by the NC Cancer Registry. C. Medicaid Case Management Reductions During the 2009-2010 Legislative Session, the General Assembly faced a severe shortfall of funds to balance the state budget. As one means of balancing the budget, the Legislature directed the Division of Medical Assistance (DMA) to cut $41 million in state funds from case management services in the 09-10 fiscal year and $72 million in the 10- 11 year. These services include 22 separate case management programs in health, social services, community based organizations, and mental health. Health Department programs affected by this are Child Service Coordination (CSC), Maternity Care Coordination (MCC), Maternal Outreach Workers (MOW), and Health Check. Populations affected include: pregnant women, children from 0-3 at-risk for development delays, and all Medicaid recipients of these services in Orange County. 509 women and children in Orange County received either MCC or CSC services in 2008-2009, and that was with long-term vacancies in 3 positions. The DMA staff was directed to return to the Legislature with a plan for achieving the savings by August 1, later extended to September 1, to accommodate a stakeholder approach to developing a plan. During July and August a stakeholder group met weekly to discuss definitions and data presented by DMA. Models of case management coordination were discussed, with DMA clearly favoring a single entity managing all case management and care coordination services and with a feeling that a single case manager should be able to handle any client, regardless of MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 September 23, 2009 their specific need. Experiencing frustration with the lack of movement on actual development of a plan, the Division of Public Health in conjunction with the Health Director’s Association developed and presented a plan to the Division of Medical Assistance that met many of DMA’s goals over the biennium with a phased approach. DMA rejected the plan outright. Upon learning about the rejection and some of the reported conversation that went with the rejection, the Brunswick County Health Director wrote a letter of appeal to the Secretary of DHHS, Lanier Cansler and copied Governor Perdue. Secretary Cansler responded with a letter that basically says that he believes that public health is not willing to be a part of the solution. However, for the first time, public health has a target figure for “our” portion of the reduction. Board members were provided a copy of Secretary Lanier’s letter. The President of the Health Director’s Association at the direction of the Association responded to Secretary Cansler’s letter and as of the Board of Health meeting the Association had not received a response. The DMA is sending all Medicaid recipients a letter informing them that case management services will be changing and they need to ask their case manager about the changes. Child advocacy groups believe that compromise may still be possible in phasing in changes that will improve the system and have communicated with both the Governor and the Secretary. The Health Department has 12 positions “at-risk” through these reductions in Medicaid reimbursement. These 12 positions are partially supported by Medicaid receipts and partially supported by county funding; on average funding is a 50/50 split. The Department will continue to work with advocacy groups and citizens to communicate with legislators, the Secretary, and the Governor concerning the impact this will have both on our citizens and on our fragile infrastructure. The Department relies on these positions during an emergency response as it represents 13% of our total workforce. We are actively examining our mandate to ensure that we continue to have healthy mothers and births in our vulnerable populations. We are identifying alternative means to achieving those goals that will also allow us to retain the greatest number of staff members possible. This draft plan was presented to the Board and discussion followed. Steve Yuhasz asked for clarification, that the state took away the sales tax from the counties, and in return took on the burden of Medicaid, then now is reducing the Medicaid reimbursement and in turn this is putting the burden of picking up these Medicaid cuts again? This was affirmed as the outcome. Michael Wood asked if case management was a mandated service. Rosemary Summers stated that case management itself was not mandated, but that we are mandated to provide or assure the provision of services to pregnant women and children to ensure healthy births. Steve Yuhasz asked what the bottom line is. Rosemary Summers stated that with the present proposal and assumptions the County would save money but we would be reducing the workforce by 4 positions unless they could be placed elsewhere in either the Department or the County. D. Excerpts From Interim County Manager’s Report to Commissioners MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 September 23, 2009 The Interim County Manager was given an assignment from Commissioners to examine various aspects of county government operations and to provide the Commissioners with his observations and recommendations. The full report is 65 pages long. The attached excerpts apply primarily to the Health Department. The Interim County Manager, Frank Clifton, reviewed the report at a work session on September 10. Discussion and comments by Commissioners were offered after the presentation. Mr. Clifton spent about 2 hours with the Health Director touring all facility locations and discussing the Department’s services and future facility plans prior to writing his report. The Board of Health was invited to discuss the Interim Manager’s recommendations and observations and given the opportunity to provide comments back to the Commissioners. The full report is available in the BOCC September 10 meeting agenda on the Orange County website. Chris Harlan asked the Board if they felt a response to the report would be appropriate. Commissioner Yuhasz stated that the report consisted of observations, not recommendations and no immediate reaction is required of the Board. He also stated the Commissioners have not endorsed any of the observations at this point. E. Report on Cabarrus County Facility Visit Mary Beck, Senior Consultant for UNC Health Care, Amy Bragg, Planning Director for UNC Health Care, Pam Jones, Asset Management Director, and Rosemary Summers, Health Director took a field visit to the Cabarrus Health Alliance in late August. The purpose of the visit was to discuss the relationship between the Cabarrus Health Alliance and the local hospital. Cabarrus County is home to a “NC Research Campus” conceived of and sponsored by David Murdoch, the owner of Dole, Inc. This is a public-private partnership in that the land is donated by Mr. Murdoch, and one central building was built by him. The concept he had is that that researchers from many different universities will be housed on this campus and the synergy between these research topics, primarily in the prevention arena, will yield better results. Each university that wishes to have a presence must fund their own building or a portion of a building. It will also eventually become a community with all basic services being provided on or near the campus. To date, UNC Chapel Hill, NC State, NC Central, NC A&T, UNC-G, and Appalachian State already have a presence on the campus. The Cabarrus Community College has also broken ground on a building. The Cabarrus Health Alliance will be constructing a new facility at the edge of the campus to replace their current facility. The hospital will be constructing a diagnostic facility across the street from the new Alliance building. While each organization is funding their own construction, the collaboration between the two organizations appears to be strong. Hospital representatives have a clear and vital connection to the governing board of the Alliance. Both entities have clear referral practices in place to ensure that residents receive services that they need, an example is that some specialty clinics are provided in the health department on a regular basis. MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 September 23, 2009 There are many features of the proposed building that would be attractive to Orange County as it incorporates many “green” features and is aiming toward the highest level of that designation. The slides show some of these features. It was agreed by the site visit team that we should continue conversations on possible collaborations and include more individuals from the Health Care System and from Piedmont Health Services, Inc. Follow up on this should occur in early October. Steve Yuhasz asked to be included in these discussions and there was no objection from the Board. The Board agreed by consensus to defer discussion on this item due to lack of time for adequate discussion. F. Committee Reports The Environmental Health and Quality Assurance Committee was the only committee that met in September. The meeting notes were provided for the Board’s review. Michael Wood summarized the highlights of the meeting for the Board. The Clinical and Community Programs Committee did not meet this month. VI. Board Comments/Announcements A. None VII. Adjournment Motion to adjourn the meeting was made by Anissa Vines, seconded by Tony Whitaker, and carried without dissent. The next Board of Health meeting will be held on Thursday, October 22, 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