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HomeMy WebLinkAboutBOH minutes 062608MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 June 26, 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 June 26, 2008 at the Hillsborough Town Barn, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Tim Carey; Ernie Dobson; DeWana Anderson; Matt Vizithum; Jessica Lee BOARD OF HEALTH MEMBERS ABSENT: Anissa Vines, Vice-Chair; Jim Stefanadis; Sharon Van Horn; Sharon Freeland; Moses Carey, Jr.; STAFF PRESENT: Rosemary Summers, Health Director; Wayne Sherman, Personal Health Services Division Director; Tom Konsler, Environmental Health Services Division Director; Andy Adams, Environmental Health Supervisor; Donna King, Health Promotion and Education Services Division Director; Angela Cooke, Dental Health Services Division Director; Carla Julian, Quality Assurance/Risk Management Director; Anne Miles Cassell, Administrative Assistant; GUESTS PRESENT: Judy Truitt, OPC Mental Health; Darlene Toney, Triumph Healthcare; Dr. Anthony Lindsey, UNC School of Medicine; Paul Caldwell, Triumph Healthcare; Katie Tise, Freedom House; Erwin Merritt, Right Direction, Inc.; Jesse Chavis, Right Direction, Inc.; Mark Sullivan, Mental Health Association of Orange County; John and Conner Michos, Orange County residents; David Hudson, Acme Well Co. I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:15 P.M. and introduced guests. II. Panel Discussion: Mental Health Services in Orange County With current Mental Health reform efforts under scrutiny, the Board of Health requested an exploration of the status of mental health services in Orange County with those involved. The Board requested a panel discussion to address: 1) Problems/issues with the current system (organization, services, funding, etc). 2) Most urgent mental health needs of Orange County residents. 3) What the role of the Health Department should be as the state begins to consider mental health reform again. Invited guest panelists were Judy Truitt, OPC Mental Health Director, Mark Sullivan, Mental Health Association of NC, and Dr. Tony Lindsey, UNC Health Care. Ms. Truitt introduced three mental health providers in the OPC Mental Health Network she invited to provide additional input and answer any questions. Ms. Truitt distributed information and material for board members to review at their leisure: MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 June 26, 2008 • A Community Mental Health Needs Assessment, • a power point overview summarizing the OPC Crisis Plan, • OPC Mental Health 2nd and 3rd quarter reports on access, triage for referral to emergent, urgent, and routine care, indicating how many people accessed care and their needs. Ms. Truitt said the state has created an unnatural split between consumers who are indigent and need state funded services and Medicaid funded consumers. OPC is only able to access information on Medicaid funded consumers, therefore OPC is unable to capture information on the latter and it creates a gap in information. Despite the fact that the legislature has put millions of dollars into the system it is a major issue. This fiscal year OPC lost approximately $1.5 million dollars. OPC Mental Health in 9th in the state in the amount of funds allocated to mental health. She stated that transportation, transitional services, and crisis services are several of the most pressing issues. Currently cooperation with UNC has helped with stabilizing patients before OPC can provide services. One hour of clinical service per month for severely and persistently mental ill people is not enough. There is a need for more psychiatrists that are dedicated to public health sector. She says the state feels strongly that there are too many local mental health entities and favors a regional reorganization to manage mental health as being more cost effective. OPC feels a local degree of governance brings better results. In the area of mental health OPC ranks 9th in state in the amount of money expended per county. The others in the top 9 are all single county programs. Orange, Person, and Chatham Counties are actively involved and actively support OPC and mental health. She noted that Orange County puts millions of dollars in the public mental health system. Mark Sullivan, Executive Director of the Mental Health Association of NC, stated that in addition to points brought up by Ms. Truitt, system instability and service quality are issues due to state reform of the mental health system. Many citizens do not know how to access the services they need and many have complex medical needs in addition to their mental health needs. Psychiatry for the target group population and quality case management for the non-target population are two of the most pressing issues. He commended Healthy Carolinians involvement and support of the mental health needs of the county. He asked the Health Department to add mental health to its chronic disease program. He would like to see UNC, the county and the Orange County Health Department to work more closely to this end. Dr. Anthony Lindsey, UNC Psychiatrist, said he felt fragmentation of services is a serious problem. Patients do not know how to access the services they need after they are released from the hospital. This is especially problematic with those suffering from a mental illness. For severely ill patients there is a benefit to a broad array of services being in one location. UNC sees about 30,000 outpatient visits per year in a clinic that was designed for 26,000 and services are available MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 June 26, 2008 24/7. UNC wants to continue onsite clinics and does not screen for payment ability. Sometimes there is a wait period. There is also a problem retaining qualified practitioners who are leaving to take better paying positions in other states. He would like to see more settings where there would be a broader array of services. One step to developing a better system to serve these needs is establishment of regional care centers where all the core services would be in one place. Many rural hospitals have licensed psychiatric beds that are not utilized because they are large money losers. The state hospital used by UNC to receive patient overflow is John Umstead State Psychiatric Hospital, built in the mid-40’s. He stated that Umstead is not the place for a mentally ill patient to be when they are suffering the way they are suffering. He reemphasized a need for a more modern facility where all services would be in one location. Dr. Carey asked if Orange County had any oversight responsibility other than funding. Ms. Truitt answered that under the community support system currently in effect, county authority is statutorily governed by a board with a commissioner representative from each county within the region served plus representation from citizen at-large representatives and professionals. Dr. Carey asked if there was a reduction in services due to the restructuring, visits not necessarily being restricted but the amount that can be reimbursed by Medicaid is restricted. Ms. Truitt replied that value options authorizes the amount of services the provider can give to the consumer. She stated that when mental health support was reorganized in March 2006, Medicaid reimbursed services were reduced and severely limited available services, although most providers do pro bono work. Now, full service array is being looked at more closely. Rosemary Summers asked if the definition for Community Support services is case management support service that enhances the actual psychiatric treatment. Ms. Truitt replied that for years Case Management was the service that was presented to consumers. Generally Case Management is considered the professional level and Community Based Intervention (CBI) is the paraprofessional skill building level. In 2006 these two services were combined into a new service called Community Support. The expectation was that both would be provided to the consumer but what happened was that there was a tendency with some agencies to shift much of the case management duties to the paraprofessional workers. Dr. Lindsey stated that case management is an important core service for the mentally ill population because many experience additional health needs. Tracking is done by the amount of paid claims. A specified percentage of care must be provided by the professional and the balance by the paraprofessional or the provider will lose their certification. The federal government thinks that there should only be one case manager in an individual’s care management. This tends to shut out health, social services, or mental health depending on which system began management. Dr. Lindsey said that the case manager is crucial in the mentally ill population because of additional health needs that are common in this group. MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 June 26, 2008 Dr. Lee asked about early intervention. Dr. Lindsey stated that early intervention was extremely important in psychosis in limiting and controlling the severity of illness. He stated that UNC has done a lot or work in the disorders related to pregnancy and has several physicians with expertise on staff. He expressed a desire to coordinate with the Health Department in this area. Chris Harlan thanked the panel members for excellent presentations for the Board. III. Approval of June 26, 2008 Agenda The motion to approve the Agenda of June 26, 2008 was made by Matt Vizithum, seconded by Jessica Lee, 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 24, 2008 meeting. B. Renewal Agreements for School Nursing Services Since July 2004, the Health Department has served as the conduit of Commissioner-approved funding for school health nurses for both the Chapel Hill-Carrboro and Orange County School Systems. The Health Department enters into a contract with each of the school systems to spend the funding on a specified number of direct service 10-month school nurse positions in conjunction with the annual Memorandum of Agreement. In FY 08-09, the contracts provide $404,451 to CHCCS for six school health nurses and $188,696 to OCS for three school health nurses, for a total of $593,147. Per the contract, 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. Motion to accept items on the Consent Agenda was made by Tim Carey, seconded by Jessica Lee, and carried without dissent. VI. Reports and Discussion with Possible Action A. Rule Adoption – Orange County Groundwater Protection and Well Construction Rules Orange County Board of Health adopted well construction rules in 1980 which have been administered by the Environmental Health staff since that time. As of July 1, 2008, all counties in North Carolina must either enforce state regulations recently adopted by the Environmental MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 June 26, 2008 Management Commission (EMC), or they must adopt local rules to replace those regulations. The North Carolina General Statutes (Chapter 130A) grants boards of health the general authority to adopt rules necessary to protect public health. Additionally, Article 7 of NCGS Chapter 87 gives boards of health specific authority to adopt rules that are more stringent than those adopted by the EMC in the area of well construction when necessary to protect public health. Board members were provided with a summary detailing the differences between the rules proposed for local adoption and the state rules and a copy of the proposed rules for adoption with highlights of the comparison with the state rules where these rules are more stringent. A justification was detailed for each difference. The OCHD will enforce the State rules and local rules where more stringent than the state rules. The proposed rules have been advertised for public comment as required. Staff has also met with two well contractors to gather and incorporate their feedback along with feedback from two hydrogeologists. Upon adoption, the rules will become effective July 1, 2008. Motion to accept the Orange County Groundwater Protection and Well Construction Rules as amended was made by Jim Stefanadis, seconded by Matt Vizithum, and carried without dissent. B. Recommendation for At-Large Member The Board has an upcoming vacancy in an at-large slot with the last term service completion of Sharon Van Horn. The Nominating Committee reviewed all of the available applicants and determined that they are recommending an individual to strengthen the Board’s expertise in the environmental area. Due to the absence of key members of the nominating committee the Board agreed by consensus to postpone their discussion and recommendation until the August meeting. C. Information Items 1. Primary Care Grant Information: Wayne Sherman reported that OCHD applied for the 3rd year of a 3-year continuation grant funding cycle for Primary Care at SHSC in the amount of $70,370. The department received notice of additional funding in the amount of $44,769 effective July 1, 2008 for FY 08-09. The same amount was received in FY 07-08 for program functions. 2. Legislative Update: Rosemary Summers reported that currently both the House and Senate have recurring MINUTES ORANGE COUNTY BOARD OF HEALTH June 26, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 June 26, 2008 additional funds in the budget for Aid-to-County non- categorical funding; the House has $5 million and the Senate has $4.8 million. There is $1.8 million in demonstration projects for obesity reduction still in the budget. The department is not aware of any cuts to current state funded programs. Notice was received in the beginning of the month that there has been a 10% reduction in public health preparedness funds, reducing our share of that funding to just under $49,000. 3. Pharmaceuticals are in the Drinking Water: What Does It Mean?: A report from the Rapid Public Health Policy Response Project of George Washington University School of Public Health on the health effects of pharmaceuticals in the drinking water. D. Pending and Recurring Items Review The pending and recurring items review allows Board members to plan future agendas and direct the staff on special work items. Board members reviewed the items and no changes were made. V. Board Comments/Announcements A. None VI. Adjournment Motion to adjourn the meeting was made by Tim Carey, seconded by Jim Stefanadis, and carried without dissent. The next Board of Health meeting will be held on August 28, 2008 at the Hillsborough Town Barn, Hillsborough, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board