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HomeMy WebLinkAboutBOH minutes 112008MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 November 20, 2008 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 November 20, 2008 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; DeWana Anderson; Matt Vizithum; Moses Carey, Jr.; Michael Wood BOARD OF HEALTH MEMBERS ABSENT: Sharon Freeland; Jessica Lee, out of town; Ernie Dodson 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; Jeanette Merritt, Dental Assistant, Dental Health Services Division; Michelle Dorminy, RN, Eileen Welsh, FNP, Personal Health Services Division; Jaymin Patel, Shaquetta Cooper, Environmental Health Specialists GUESTS PRESENT: Dr. Brett Nishikawa, MD, UNC Preventive Medicine Resident I. Welcome and Swearing In of Michael Wood Chris Harlan, Chair, called the meeting to order at 7:00 P.M. Newly appointed Board of Health At-Large Representative, Michael Wood, was sworn in. Board Members introduced themselves indicating the position they represent. New staff present were introduced to the Board by their division directors. In the absence of the Health Director (due to illness) Wayne Sherman will act as Board Secretary for this meeting. II. Approval of November 20, 2008 Agenda The Chair requested a change in the order of topics under V. Reports and Discussion with Possible Action: reverse the order of G. Nominating Committee Report and H. December BOH Meeting. The motion to approve the Agenda of November 20, 2008 as revised was made by Moses Carey, Jr., 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 September 17, 2008 meeting. B. Fees for Additional CPT Codes MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 November 20, 2008 New fees are routinely recommended for approval during the annual budget process. This year, several new fees are being recommended due to rule changes, state recommendations, or new products. Wayne Sherman announced the addition of several new fees and Board members were given a revised list of changes. C. Primary Care Grant/ Nutrition Expansion The department goal is to provide optimal healthcare to clients receiving primary care services by expanding clinical nutrition services (Medical Nutrition Therapy services) to those clients referred with high risk conditions (obesity, diabetes, malnourished etc.). To successfully achieve this, the department plans to provide an additional 0.5 FTE of a Registered Dietitian (RD), 0.5 FTE of a Lab Technician, and 0.5 FTE of a Management Support Office Assistant. These professionals will work collaboratively with department clinicians and community providers using a multidisciplinary approach to treat and manage the health conditions of those in need of primary care services. Motion to accept items on the Consent Agenda was made by Tim Carey, seconded by Matt Vizithum, and carried without dissent. V. Reports and Discussion with Possible Action A. Assurance Methodology Report – Family Planning, Child Health and Maternal Health In the current economic climate community Safety Net providers are finding it challenging to meet the growing health needs of the uninsured. The Health Department provides both mandated and non-mandated programs and services. These programs include Adult Health, Home Health, Child Health, Family Planning, Dental Public Health, and Public Health Laboratory Support. In the past the department has done an inadequate job of assessing the availability of health services within the community to know whether individuals have adequate access to services and whether OCHD needs to directly provide the services or encourage other providers to increase service availability. This assessment process is becoming increasingly important as resources are diminishing and the department needs to target our efforts and funding to the greatest need. In Spring 2008 an initial Assurance Methodology tool was developed and implemented to measure the availability of health services for Home Health, Adult Health, and Dental Health within the community. A report of that assessment was provided to the Board by Dr. Karyn Leniek, MD, in May 2008. Several recommendations to the tool were implemented with the second iteration of the tool which was used to assess Family Planning, Child Health and Maternal Health Services. Content of the 2-page questionnaire to providers included questions regarding practice size, scope of services, and description of enrolled population by characteristics of payer-type and zip code of residence. Dr. Brett Nishikawa, Preventive Medicine Resident, discussed the application of the refined tool, the findings, strengths and limitations of the tool, and future recommendations. Dr. Nishikawa gave a Power Point presentation and commented that the definition of MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 November 20, 2008 “safety net” provider was redefined for this study. Anissa Vines asked how many practices were involved in the study. Dr. Nishikawa stated that 32 questionnaires were distributed. Of these, 19 were returned, an overall response rate of 59%. Wayne Sherman noted that all providers participating in the survey served all zip codes in the area. Basic healthcare services are being provided fairly universally among the safety net practices. The areas where service is lower are ancillary services, such as x-ray, pharmaceutical, etc. One of the driving factors in developing this tool was to make it less labor intensive to the user. Wayne Sherman said the tool does not allow making the determination if there is enough of a specific type of service provider available. In spite of the mentioned limitations of the tool, it does have value as an initial effort to assess availability and accessibility of medical services to the residents of Orange County as required by the North Carolina Administrative Code. No other tool is known to be developed or in use by the state or county health departments. It was suggested that this tool be shared at the state level for consideration of enhancements in order for it to be useful as a template for other health departments to meet their mandated responsibilities. Chris Harlan commented that the role of the health department is to assure that the services are available to the community and that it was surprising that no one had come up with a tool to determine what the needs are and how they were being met before now. B. Well Rules Amendment Orange County Board of Health adopted the current Groundwater Protection Rules in June of 2008. Since implementation of July 1st, there are two areas of the rule that staff recommend be considered for amendment. Tom Konsler explained the following: Section II (D) Well Casing: There is currently no requirement in the regulation for any protection of the well opening upon completion of the drilling. Because several weeks or months can pass before the pump and the seal are installed, in order to protect the groundwater from contamination, a requirement was proposed that a cover or cap be used on the top of the casing for protection. Section II (I): Subparagraph 3 was added, which is a requirement in the state 02C rules. Reinserting this language is necessary to retain rules at an appropriate stringency level. The requirement for an enclosure is being eliminated as there is no public health significance for this and the requirement delays staff approval of the completed well. The requirement for specifications for a slab around the well head was eliminated because the slab is not required by the rules. Details regarding recommended slab construction and an enclosure will be given to the well owner or permit recipient as informational recommendations as apposed to requirements. These rules have been advertised for public comment as required. Upon adoption of these rules, they will become effective November 21, 2008. MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 November 20, 2008 Motion to approve the changes as presented was made by Anissa Vines, seconded by Moses Carey, Jr. and carried without dissent. C. 2009 Calendar for Board of Health Meetings The Board adopts a calendar of meetings for the upcoming calendar year in order to ensure maximum attendance at Board meetings and to let the public know well in advance of meetings should they wish to address the Board on a particular topic. Commissioners have asked the Board to avoid dates that conflict with Commissioner meetings on the schedule to enable the Commissioner Representative to attend the Board of Health meetings. The County Commissioners’ calendar was finalized and published prior to the Board of Health meeting. The Draft BOH calendar contains many conflicts with Commissioners meetings. Chris Harlan requested suggestions from Board members for alternate meetings dates. The consensus of Board members agreed that the 4th Thursday dates that conflict with Commissioner meetings be moved to Wednesday of the same week. Anne Cassell will revise the meeting schedule as needed and finalize locations prior to the next Board meeting. D. Dental Preschool Screening Project Agreement Renewal Angela Cooke reported that the Health Department has received funds from the Orange County Partnership for Young Children (OCPYC) for a preschool dental screening, education and referral program for child care centers and family child care homes in Orange County. For FY 08-09 a new full time position was approved for the Community Dental Care Coordinator/Dental Hygienist position. The position is partially funded by OCPYC for $33,850. Due to lack of recruitment of qualified applicants, the OCHD requested to use the grant funds for a contract for a coordinator, temporary personnel and operating expenses. This renewal contract is with Ginger Mann for $14,500 who will be responsible for scheduling dental screenings with facilities, UNC School of Dentistry Hygiene Students, private dental providers, calibration for students and dentists, data entry, quarterly and final reports. The temporary personnel budget line would pay a Public Health Dental Hygienist to provide additional screenings in child care homes, and educational workshops for directors, teachers and parents. The Dental Program will continue to recruit for the hygienist position and should the department be successful will develop a transition plan between Ms. Mann and the new hire to ensure that the services required by this grant continue to be provided. Motion for approval of Dental Project Coordinator contract to be forwarded to the Board of County Commissioners for action was made by Jim Stefanadis, seconded by Jessica Lee, and carried without dissent. E. Agreement with Person County for Preparedness Services Since 2002, the State of North Carolina has received federal funds from the Centers for MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 November 20, 2008 Disease Control and Prevention (CDC) to ensure that North Carolina is prepared in the event of a public health emergency. Each year an amount is allocated to each local health department to meet deliverables as required by the federal and state government to ensure that local health departments and counties are prepared in the event of a local or state public health emergency. Orange County has employed a full-time position public health preparedness coordinator (Public Health Nurse II) since 2003. There have been sufficient state and/or federal funds available in previous years to support a full time position. Beginning in 2007-2008, as federal funds were not allocated at previous levels to the CDC there was a corresponding reduction in funds to the state and the state began passing along those reductions to the local level. In addition, supplemental funding such as the pandemic flue supplements are no longer available for the local level. Carla Julian reported that in FY 07-08, the Preparedness Coordinator for the Health Department received a promotion internally. After three unsuccessful attempts to recruit for the vacancy, the position was filled on July 1, 2008 with an internal transfer of a public health nurse that was a reduction-in-force from the loss of grant funds for the Help 4 Kids Project (Smart Start funding). This nurse recently resigned to accept another position leaving the position vacant again. The current allocation from the state of $51,836 annually is not sufficient to support the salary and benefits of a full-time public health nurse II position. The requirements that this position fulfills are mandated through the agreement addenda between the NC Division of Public Health and the Health Department. The health director made inquiries to several geographically contiguous counties to determine whether there was interest or need for a shared position in the public health preparedness area to fulfill the local requirements. Person County recently approved a full time Public Health Nurse III position funded in part by their allocation of preparedness funds and through their additional Aid to County funds. Person County Health Department is interested in an agreement between our two counties that would allow for a single person to accomplish most of the deliverables required by the State. This would also enable efficiencies in planning and executing training and required drills and exercises. Upon mutual agreement, Person County will hire and supervise the position, authorized at a higher level than the current Orange County position. The person in this position is estimated to spend at least 2 to 2 ½ days per week on-site in Orange County at the Health Department and will perform additional duties as needed to fulfill the responsibilities outlined in the agreement. The agreement will begin on an annual basis if mutually agreeable and upon evaluation of completion of agreement deliverables. Funding will be prorated for this year and a new annual amount established for the next fiscal year. Chris Harlan stated that this would be a good way to share resources. Ms. Julian stated that there are several counties in the state that have successfully developed such shared arrangements between counties for the preparedness area. This arrangement will also allow Orange County to live within the allocation provided by the state and still meet its obligations. Moses Carey asked what other counties had experience in shared resources. Ms. Julian stated that they were the smaller counties because the allocation is based in part on population and square miles. She pointed out that larger counties with a denser population would have needs greater than a MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 November 20, 2008 shared resource could provide. The vacant FTE at the Orange County Health Department will be re-used with additional recurring state funding obtained this year to enable critical immunization and refugee health needs to be met. Motion to Approve the Services Agreement between Orange County Health Department and Person County Health Department for Public Health Emergency Preparedness was made by Moses Carey, Jr., seconded by Anissa Vines, and carried without dissent. F. Health Department Realignment Plan Wayne Sherman reported that since the beginning of FY 2008-09, the Health Department has continued to experience trends that began in FY 07-08 that are impacting the ability to provide services to the populations that need them. The following factors continue to be problematic: Continuing to have approximately 12 – 14 new arrival refugees per month Immunization demand continues to be extremely high, especially in the Chapel Hill site NC Immunization Registry and the NC Electronic Disease Reporting System are requiring additional time from nursing staff to adequately enter and follow-up on information Experienced an increase in child service coordination and maternal care coordination needs The Department has recently experienced a resignation in the PHN II that was responsible for Public Health Preparedness. The person in this position was a transfer from the reduction in force (RIF) due to the discontinuation of the Help 4 Kids project that was grant funded last year. We funded that position with a 75% state allocation/25% county funding. The state deliverables for preparedness still need to be accomplished by the department and are an important public health function. Jessica Lee offered praise and commendation, recommending that it be added to the minutes, for the necessary realignment with budget neutral impacts made by the department. G. December BOH Meeting The Board agenda for the December meetings has typically been short with only a few items of business and the annual officer election. In past years the Board has catered in a simple meal to share for the upcoming holidays or met in a restaurant for dinner at the Board member’s individual expense. After discussion the Board reached a consensus to not hold a December meeting for lack of business items was reached. Motion to cancel the Board of Health December 16, 2008 meeting was made by Anissa Vines, seconded by Matt Vizithum, and carried without dissent. MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 November 20, 2008 H. Nominating Committee Report According to the Board’s operating procedures, the Nominating Committee makes recommendations at this meeting regarding the Chair and Vice-Chair for the next calendar year. Anissa Vines stated that typically the Vice-Chair has moved into the Chair role and a new Vice Chair is selected to serve one-year term but there is no requirement in the operating procedures regarding that. Also, many members will be rotating off the Board at the end of June 2009. The actual vote takes place the following month (December) assuming that is the last meeting of the calendar year. Due to the December meeting being cancelled, the nominating committee presented several alternatives to the board members. One alternative offered was to extend the terms of office of the current Chair and Vice- Chair another year if they are willing to serve. Another alternative submitted was to submit nominations of volunteers to serve as Chair and Vice-Chair. After discussion the Board agreed by consensus to extend the terms of the current Chair and Vice-Chair for 2009. A separate voice vote was taken for Chris Harlan to serve as Chair and Anissa Vines to serve as Vice-Chair for an additional year. Both were unanimously elected to serve an extended term as Chair and Vice-Chair. I. Inventory of Services Report The County Manager and the Budget Office began a new process this year to begin to define core services provided by county departments in anticipation of a different budgeting process than previous years. Each department was asked to complete an inventory of essential services in priority order that also assigned staff equivalencies and budgetary figures to each service. There were many challenges in completing this since many of our clinical services are integrated across categorical program lines and there are also several efforts that cross divisional lines. Wayne Sherman reported that the Health Department completed work on this project in September but has not heard any feedback on anticipated uses. The staff felt it was important for the Board to review and have a chance to ask questions about and make comments on the completed inventory. Jessica Lee commended the staff for their work on realignment of staff assignments to accommodate the new guidelines without disruption of services. J. Pending and Recurring Items Review The pending and recurring items review allows the Board members to plan future agendas and direct the staff on special work items. Two new non-recurring agenda items were added for January. The Budget presentation will be given in January as there is no information to date from the budget office. Tim Carey asked about the status of forthcoming budget cuts. Donna King replied that Smart Start funding will be cut by 5%. It is anticipated that the County will request the department reduce its budget by 10%. MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 November 20, 2008 K. Informational Items a. Environmental Health Existing System Authorization Procedures At the August 28th meeting the Board heard about the policy and procedures employed by environmental health staff when evaluating septic systems and wells at existing homes for renovations, rebuilds, and additions. Tom Konsler stated that whenever a project is proposed that requires a building permit on property served by a septic system, the law and rules require Environmental Health to make a determination: • That the existing septic system is functioning properly • That the construction will not encroach upon the existing septic system • That the proposal does not exceed the conditions of the Operation Permit or, in the absence of documentation, that the proposal does not exceed the apparent and reasonable wastewater flow capacity. This process is in place to assure that whenever a structure is built or rebuilt, that the public’s health will be protected by verifying that the structure will be served by an approved and adequate wastewater system. The Existing System Authorization policy and procedures has been revised to shorten and simplify it from that earlier version to: • Result in a document that is less cumbersome and more closely represents the decision tree that has been used by staff to respond to applications, • Adjust the period of time at which a septic system is considered to be out-of-use and hence subject to a more stringent evaluation criteria, (the time period went from 30 days to 180 days) • Incorporate an early visit prompted by notification from the fire marshal when a home has been destroyed by fire or storm, and • Formalize a prescriptive “stress test” as an option so that a system that has been out of use can demonstrate whether it can perform in a satisfactory manner once put back in to use. Moses Carey, Jr., commended the Environmental Health staff for making the changes to simplify the policy for the citizens of Orange County. b. Social Justice Goal The Board of Health provided input on the development of the Social Justice Goal for the Human Rights Commission. They recently issued a final draft report to the Board of Commissioners for adoption. The report was provided to the Board as an informational item only. c. Fiscal Outlook Board members were provided an email from the NC Association of County Commissioners on the current state of the economy in North Carolina. The first budget cut experienced by the various departments in the state, yielded a 16% cut for the Division of Public Health. They were assigned a disproportionate share of the cut to hold mental health and Medicaid harmless. While they strove to MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 9 November 20, 2008 take the majority of the cut internally, they did need to cut local appropriations by $3.2 million statewide. The Health Directors Association asked that these cuts be taken “off the top” from the annual cost settlement allocation. The remainder will then be distributed to counties proportionately as they have earned the reimbursement. Our cost settlement funds are generally received in the late spring and are placed into a capital account that has enabled us to save funds towards renovation and new equipment purchases. This cut will not affect our operating budget, although future cuts may. VI. Board Comments/Announcements A. Chris Harlan reminded Board members about the Joint BOCC/BOH meeting on November 24, 2008. VII. Adjournment Motion to adjourn the meeting was made by Anissa Vines, seconded by Jim Stefanadis, and carried without dissent. The next Board of Health meeting will be held on Wednesday, January 21, 2009 at the Southern Human Services Center, Chapel Hill, North Carolina at 7:00 PM. Respectfully submitted, Wayne Sherman, BSN, MSPH Personal Health Services Division Director Acting Secretary to the Board