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HomeMy WebLinkAboutBOH minutes 082808MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 August 28, 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 August 28, 2008 at the Southern Human Services Center, Chapel Hill, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Tim Carey; Ernie Dodson; DeWana Anderson; Matt Vizithum; Moses Carey, Jr.; Jim Stefanadis; Jessica Lee BOARD OF HEALTH MEMBERS ABSENT: Sharon Freeland STAFF PRESENT: Rosemary Summers, Health Director; 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; GUESTS PRESENT: Sue Dayton, Blue Ridge Environmental Defense; Dr. Pamela Groben, Carolina Concerned Citizens League; Nancy Holt, Carolina Concerned Citizens League; Beverly Kerr, Blue Ridge Environmental Defense I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:10 P.M. and introduced the guests present at the meeting. II. Approval of August 28, 2008 Agenda The motion to approve the Agenda of August 28, 2008 was made by Moses Carey, Jr., seconded by Tim Carey, and carried without dissent. II. Public Comment for Items NOT on Printed Agenda The guests spoke to the Board on the topic of biosolids applications and its affects on the environment and health of area residents. Sue Dayton, state coordinator for NC Healthy Communities, a project of the Blue Ridge Environmental Defense League, spoke on behalf of the League, Carolina Concerned Citizens, and residents of Orange County. Ms. Dayton said that hundreds of millions of gallons of sewage sludge are spread on farmlands in Orange County. She explained that sludge is the semi-solids filtered from wastewater at municipal wastewater treatment plants and offered to farmers free of charge to be used as fertilizer. Ms. Dayton stated that in addition to OWASA, five counties dispose of their sewage sludge in Orange County. Ms. Dayton stated their concern that in addition to being an economical and inexpensive alternative to commercial fertilizers, sludge can contain thousands of unregulated chemicals of concern that cannot be removed by conventional treatment at Waste Water Treatment Plants. Many of these chemicals have been found in surface waters in the area. She stated that although the impact on humans is unknown the endocrine disrupting compounds that concentrate in sludge cause deformities and reproductive disorders in fish and other aquatic species. She stated that land application of sewage sludge poses a significant threat to the MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 August 28, 2008 health, safety and welfare of the citizens of Orange County. The Federal Clean Water Act states that the use of sludge is to be determined by counties. The Orange County Board of County Commissioners requested a hearing on the City of Burlington’s permit renewal to spread sludge be held in Orange County. The BOCC’s request was denied. Recommendations were submitted to DWQ concerning the City of Burlington’s permit to spread sludge and were denied. She stated that the potential threats from sludge can only be alleviated by county government and environmental health leadership. Dr. Pamela Groden, Carolina Concerned Citizens, is a physician and pathologist. She stated she was aware of the treatment, prevention, and the value of informed consent. What Carolina Concerned Citizens wants to do is to provide educational information for farmers that will enable them to give informed consent to use bio-solids. Annual testing is done for approximately ten common toxins; however, no testing is done for many other toxins that are in everyday use. Toxic heavy metals can build up in the soil and be passed to food production or livestock grazing, as evidenced by the loss recently experienced by a Georgia dairy farmer of 300 cattle and thousands of acres of pastureland due to years of sludge application. She stated that even the milk was contaminated. Certified Organic produce cannot be grown on sludge fertilized land. Nancy Holt, Carolina Concerned Citizens, directed the Board’s attention to the fact that many people have no idea that sludge application is going on. She spoke of the many ways our food can be compromised and pointed out that many food sources contain contaminants that are above the safe levels ascribed by the FDA. There are many major food manufacturers that now refuse to accept products from producers that utilize sludge as fertilizer. She also emphasized the connection between sludge and health concerns. Beverly Kerr, Blue Ridge Environmental Defense, provided the Board with a handout that included studies and articles related to land application of sewage sludge. Moses Carey said that the County Commissioners were made aware of the sludge issue from a presentation given at one of the BOCC meetings and appreciated the group’s persistence with this issue. He stated that as a result of the presentation to the Commissioners he had been doing much reading up on the topic to become better informed and said the Commissioners are concerned about it. He asked about the Federal Law statement earlier in the presentation; if there is anyone regulating sludge application? He also asked about nuisance suits. Ms. Dayton replied that there is a process for filing a complaint that was many steps and is cumbersome to get to a lawsuit stage. Dr. Carey asked if there is a county in NC that is currently regulating application of sludge. Ms. Holt replied that no counties in the state regulate it however; Orange County is the only county doing anything at all. Rosemary Summers explained that our environmental health division monitors all sludge applications to ensure that conditions of the permit are met. We do not have the authority to regulate sludge application. Fields using sludge applications may not be used to grow food products. Chris Harlan thanked the speakers for coming to the meeting and that the Board of Health would study the information provided and decide what course of action would be best. III. Action Items on CONSENT Agenda A. Minutes approval of June 26, 2008 meeting. MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 August 28, 2008 B. Approval of New Fee for Adult Measles, Mumps and Rubella Vaccination The Orange County Health Department (OCHD) provides a variety of vaccinations to adults and children. The measles, mumps, and rubella (MMR) vaccination is typically provided to children as part of their routine childhood immunizations. Since North Carolina is a universal vaccine provider, the State of North Carolina provides funding to providers to ensure that all children receive required vaccinations. The State prohibits charging for vaccine provided through this program. OCHD has provided adult MMR vaccinations subsequent to an identified outbreak of measles or rubella; however there is no charge for this because typically the state supplies the vaccine for prevention of further cases. In recent years, a requirement of a second dose of the vaccine components was implemented in certain situations. One of those situations is health care providers who may interact with pregnant women. Exposure to the unborn fetus to these diseases can cause serious effects. Adults who are providers of health related services are now required to provide proof of either immunity or two MMR vaccinations before they may provide services in a health care setting. OCHD requires employees, contract staff, students, and volunteers who have direct patient or client contact on behalf of the health department to meet this clinical standard. This prevents any inadvertent exposure to our patients or clients from these three diseases, especially young children that may not yet be vaccinated or pregnant women that could expose their unborn child. OCHD has not previously provided this vaccination to adults for a fee; however a number of volunteers and contractors, especially contract interpreters need a second vaccination before they can provide services for OCHD. It is anticipated that 15-20 persons will require or request this service from us. The vaccine costs are $48.00 per dose. A flat fee of $55 per vaccination covers the cost of the vaccine to OCHD, plus $7 for administration costs. C. Accept New State Funds for FY 08-09 The North Carolina Department of Health & Human Services (NCDHHS), State Division of Public Health (DPH) sent notification that OCHD would receive an additional $48,000 in Aid-to-County funding. These funds are unrestricted, and may be used for any locally determined need, or for the 10 Essential Services of public health. These funds may not be used to supplant current state, federal or local funding to the agency. The funding period is June 1, 2008 through May 31, 2009. NCDHHS-DPH notified certified Healthy Carolinian partnerships of newly appropriated funds for local health departments. OCHD is eligible to receive $5,727 of non- recurring, non-competitive funds. Funding can only be used for salary for coordinator, training & skill development, sustainability plan, and/or implementing Health Carolinians programs. An application for funding will be submitted by OCHD’s Healthy Carolinian program coordinator. D. Early Head Start Agreement Renewal The Early Head Start contract has represented a collaborative relationship to provide family service coordination services to families eligible for and enrolled in Orange County Early 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 regularly contacts MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 August 28, 2008 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 most recent contract for the period January 1, 2008 to December 31, 2008 was approved by the Board of Health on January 17, 2008. Angela Wilcox, Director of the Orange County Head Start/Early Head Start Program, informed us in July 2008 that family enrollment in the Early Head Start program had changed substantially such that there is now need for a bilingual English/Spanish Family Service Coordinator to adequately serve the families participating in the program. Having recently recruited a bilingual Social Worker, and having need for an English speaking Family Service Coordinator in the Head Start program, she requested to transfer the OCHD Social Worker covered under the Agreement into the Family Service Coordinator position in the Head Start Program. Following discussion with the OCHD Social Worker and management staff of both OCHD and Head Start/Early Head Start, it was agreed that this change in responsibilities would not impact negatively on family services nor change the role of the Family Service Coordinator substantially, but in effect, enhance program function and efficiency. Therefore the shift for the OCHD Social Worker from Early Head Start to Head Start program responsibilities was recommended for approval. The major revisions to the previously approved agreement are the following: 1) Reference to Early Head Start has been changed to Head Start throughout the document 2) Yvonne Upshur, Child Special Services Coordinator, has been removed as a support staff to the agreeement due to discontinuation of her program, Help 4 Kids, and subsequent ending of her position 3) Head Start programs are identified as being at Central, Efland, New Hope and Pathways Elementary Schools. 4) An increase is noted in the average number of families receiving case management and coordination services from 25 to 35 families, including an increase from 10 to 12 in the maximum average families who receive OCHD Child Service Coordination program services. Motion to accept the Minutes of June 26, 2008 meeting and items on the Consent Agenda was made by Time Carey, seconded by Moses Carey, Jr., and carried without dissent. IV. Reports and Discussion with Possible Action A. Recommendation on Board Vacancy The Board has a vacancy in an at-large slot with the last term service completion of Sharon Van Horn. The Nominating Committee has reviewed all of the available applicants and has determined that they are recommending Mr. Michael Wood to strengthen the Board’s expertise in the environmental arena. Mr. Wood is an environmental consultant working on a wide range of environmental issues. The Board felt that his skills as an environmental consultant would be an important resource and give added depth to the Board and the Department in its work on environmental issues. The Board of Commissioners makes the final decision on the appointment and may or may not honor this Board’s recommendation. MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 August 28, 2008 Motion to recommend appointment of Mr. Michael Wood at the At-Large Representative to the Board of Health and forward the recommendation to the Board of County Commissioners was made by Anissa Vines, seconded by Jessica Lee, and was carried without dissent. B. Local Rules in Environmental Health The implementation of the statewide well rules requires that environmental health specialists working in local health departments are properly trained, qualified, and are delegated authority by Department of Environment and Natural Resources (DENR) to implement and enforce the state rules. This is true for all Environmental Health (EH) programs that operate under state rules. Until recently, it was our understanding that the state would also delegate authority for staff implementing our local well program as has been the case for staff enforcing our local onsite wastewater program. EH staff provided the documentation of qualified experience, passed the exam administered by DENR, and applied for delegation of authority to DENR. While there has been no official action on the applications, a guidance letter indicates that they will not be granting authority for local programs. Dr. Summers has requested a specific response to the Orange County applications. On the advice of the county attorney, the Board did not adopt the state well rules by reference. The Orange County rules that were adopted in June 2008, while more specific and stringent than the state rules, are being enforced concurrent with the state rules. It is the Department’s opinion that authorization is desirable and warranted in order to assure that minimum and standardized qualifications are met for the enforcement of the portion of the Orange County program that is equivalent to the state rules. While the State’s refusal to grant authorization for staff is understandably a move to reduce their liability through state tort claims, it causes many problems for local health departments, including: • A disadvantage in recruitment of candidates from other counties who would have to surrender their authorization to work in a county with a local well program • A disadvantage to our staff lacking well authorization who may want to seek opportunities in other counties with a state well program • Inability of staff to work in other counties during disaster relief efforts or for contract work • Lack of standardized program reviews administered by the state that assure appropriate implementation of programs • If delegation of authority by DENR is not required to implement a well program, there is cause for concern that some counties may divest well programs away from the health departments and boards of health and • DENR will also likely revoke authorization for counties that choose to adopt local rules for on-site wastewater. In addition, this puts the state in a position of not being able to assure that local well programs are carried out in accordance with the required minimum standards. Rosemary Summers suggested that the Board request the County Attorney’s review of the matter and to provide a legal opinion as to whether the State’s response affects the ability of Boards of Health to adopt and implement local rules. MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 August 28, 2008 Moses Carey agreed that it would be good to get an opinion from the county attorney. Tim Carey moved and the Board decided by consensus to have staff draft a request to the County Attorney for a legal opinion and to also contact other counties with similar circumstances. C. Immigrant Health Update Donna King reported that news articles, Op Ed pieces and emails are circulating in response to the Alamance County Health Department’s work note investigation and the subsequent arrest of a local Alamance librarian. (See the News & Observer and Burlington Times News archives for more details) It is the practice of the Orange County Health Department to write work notes only to the names recorded in our patients’ records. By law we are to serve all residents regardless of immigration status, therefore we do not inquire or attempt to verify citizenship. We have placed a Spanish message on our website to reassure clients of their privacy and our mission to serve and protect the health of all those living in Orange County. The events in Alamance County have also resulted in Latinos in the Triangle, especially Orange County, reporting rumors of white vans picking up people at worksites, Wal-Mart, Carrboro Plaza, etc. Families have been limiting travel outside their homes and have talked about returning to Mexico. Promotion of the statewide August 8th traffic stops (08.08.08 Drunk Driving Prevention Campaign) fueled many more rumors and fear of raids. We had several clients cancel their August 8th clinic appointments for fear of being stopped without proper documentation. El Pueblo Inc., N.C. Latino Coalition and the N.C. Justice Center investigated the various rumors and did not substantiate any of the reports. This group did distribute information with guidelines regarding traffic stops, an explanation of the 08.08.08 Campaign and Immigration and Customs Enforcement /ICE’s 287(g) Criminal Alien Program. Additional information may be had at http://www.ncimmigrants.org/update-to-advocates-leaders-06aug08.pdf D. Potential Topics for Joint BOCC/BOH October Meeting Staff presented some preliminary topics for the joint meeting with Commissioners on October 14 from 5:30 to 6:30 will be the date and Board members were reminded to keep this on their calendars for this joint meeting. The Board will meet for its regular monthly meeting right after this joint session. It will be important to have as many Board members as possible at this meeting. By consensus the Board expressed their desire to study the wide range of discussion topics presented and defer a decision on specifics until the next meeting. E. Review of Existing Systems Policies and Procedures The Board recently received copies of a report to the BOCC regarding existing system authorization process for Environmental Health and a summary of a permit denial for the Samuel Thompson property. 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, and MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 August 28, 2008 • 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 of the system. 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. Tom Konsler said that one challenge of applying this policy is judging the functionality of a septic system that has not been in use for more than 30 days. The policy allowing re-use of an out-of-use system requires that it be located in suitable soils or that a repair area that meets suitable criteria be available. Another option allows that the septic system in question can be subjected to a “stress test” to prove that it is functionally capable. He stated that this policy has worked well but has presented some difficulty when a house or business has been destroyed or partially destroyed by fire or similar events. The owner is rarely in the position to apply for permits within the 30 day time period and many of these systems must then meet the more stringent criteria since they are out-of-use. Moses Carey asked whether a notification of intention to rebuild within 30 days of a home destroyed by fire could be a solution. Tom Konsler stated a notification protocol has recently been established with Emergency Services whereby Environmental Health will be notified when houses on septic systems are damaged. EH will respond by contacting property owners and conducting an existing system check at no charge within 30 days. System performance will be documented in the file for future reference when the application for services is later received. Staff is also re-working the existing system policy and procedure document to make it a more readable and to clarify some aspects. The Board Committee will be reviewing the proposed changes by staff. Consideration will be given to extending the length of time for disuse of septic systems. In the case of the denial of the permit for the Samuel Thompson property, although the system was defined as out-of-use, the denial was due to the system being classified as malfunctioning due to the presence of pipes that had been installed to discharge wastewater to the surface ditches. The severe limitation of the soil at the site precludes the permitting of a repair or replacement of the system. It is staff’s determination that an alternative system would be the Thompson’s best option. Tom Konsler reported that the Thompson’s would be seeking an alternative state approved system and that staff are working to help facilitate that process. F. Final Approved 08-09 Budget In June, the Board of County Commissioners approved a county-wide budget for FY 08-09. The approved budget for the Health Department includes changes to our original request, which we presented to the Board of Health in February. Final dollar amounts and summary was provided in a hand-out at the meeting. By consensus the Board elected to move this item to the September agenda to allow time for study and questions. G. Informational Items MINUTES ORANGE COUNTY BOARD OF HEALTH August 28, 2008 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 August 28, 2008 a. News clips of articles featuring either a health department program or a topic of interest were provided for Board members to review. b. September is “Emergency Preparedness Month”. This proclamation was approved by Commissioners at their August 19 meeting and a list of activities planned jointly by the Health Department and Emergency Services. This is one of our major community education campaigns for the year and focuses on family preparedness. c. Dr. Jessica Lee, Board of Health Dentist Representative, recently received the Jerome B. Miller “For the Kids” Award at the 61st American Academy of Pediatric Dentistry (AAPD) Annual Session in May for her work on how oral health literacy of caregivers and parents affects the oral health outcomes of their preschool- aged children. Staff and Board members congratulated Dr. Lee on her accomplishments. We are proud to have her as a member of the Board the Health. d. Accreditation plaques were received at the BOCC meeting on August 19. Each of our four main locations will have a plaque mounted showing our accreditation status. Our website already contains the accredited designation. Rosemary Summers thanked the Board members who were able to attend the presentation ceremony! The Site Visitors’ Report Form – Revised with supporting documentation was included in the Board members meeting packet for information. H. 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. No changes were made. V. Board Comments/Announcements A. None VI. Adjournment Motion to adjourn the meeting was made by Ernie Dodson, seconded by Tim Carey, and carried without dissent. The next Board of Health meeting will be September 17, 2008 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