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HomeMy WebLinkAboutBOH minutes 052406MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 May 24, 2006 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 May 24, 2006 at the Government Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Jessica Lee, Chair; Matt Vizithum, Vice-Chair; Tim Carey; Moses Carey, Jr.; Chris Harlan; Alan Rimer; Alice White; Jim Stefanadis; DeWana Anderson BOARD OF HEALTH MEMBERS ABSENT: Sharon Freeland; Sharon Van Horn, due to schedule conflicts STAFF PRESENT: Rosemary Summers, Health Director; Wayne Sherman, Personal Health Services Division Director; Anne Miles Cassell, Administrative Assistant; Angela Cooke, Dental Health Services Division Director; Nicki Sarris, Senior Public Health Educator; Candice Watkins-Robinson, Volunteer Coordinator; Tom Konsler, Environmental Health Services supervisor. GUESTS PRESENT: Dr. Nona Breeland; Wendy Schwade; Ashley Puleo Schaaf; David Schaaf; Dr. Eugene S. Sandler I. Welcome and Introductions Jessica Lee called the meeting to order at 7:00 P.M. and welcomed the guests. II. Dental Mouthguard Project Dr. Nona Breeland, President NC Dental Society Ashley Puleo Schaaf, 3rd Year Dental Student Dr. Eugene Sandler introduced Dr. Nona Breeland, President of the NC Dental Society who spoke to the Board about the North Carolina Dental Society’s new statewide initiative “ N.C. Dental Society teams up with N.C. High School Athletic Association to Promote Mouth Guard Use”. In an effort to raise public awareness about oral injury, over 400 dentists signed up to be a “resource” dentist to a high school team. If the coach and parent agree, the dentists provide Mouthguard services for a nominal fee or for free. Soccer is the sport with the highest injury rate of any sport that does not mandate Mouthguard protection; therefore, the Dental Society has focused on high school soccer teams in the first phase of the project. In following years, basketball, baseball, and other sports teams will be included in the program. Tim Carey asked about the costs of providing mouthguards. Dr. Breeland replied that each dentist within the program has tailored the costs to fit his needs. Some are able to provide Mouthguard services for free and others for a nominal fee to cover their costs. Dr. Sandler introduced Ashley Puleo Schaaf, a third year dental student and member of ENNEAD, which is a group of Dental/Hygiene student volunteers, under the direction of Dr. Eugene S. Sandler from UNC School of Dentistry. Ms. Schaaf presented a PowerPoint presentation of the Mouthguard Project that was conducted in two Orange County schools in 2005-06. One-third of all dental injuries are sports related and the majority of them are preventable. In a high school sports career one-third MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 May 24, 2006 of the boys and one-quarter of the girls will have some kind of dental injury. There are 5 million teeth knocked out per year because of sports injuries. Athletes are 50% more likely to damage their teeth if they are not wearing a mouthguard. Ms. Schaaf explained that there are three types of mouthguards available, the inexpensive stock Mouthguard available at stores, the boil-and-bite, and the custom made. The custom made mouthguards are made from a cast and these are the type being used in the Mouthguard project. The students are interested in continuing this project next year. Angela Cooke will be working with them to plan next year’s project. III. Approval of May 24, 2006 Agenda The motion to approve the Agenda of May 24, 2006 was made by Alan Rimer, seconded by Moses Carey, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None V. Action Items on CONSENT Agenda A. Minutes approval of April 27, 2006 meeting B. Teen Tobacco Project Grant Contract Approval The Health Department, in partnership with Orange County school districts, will strengthen current programming on youth tobacco-use prevention, cessation, and secondhand smoke elimination. The program will recruit and train diverse high school peer educators to lead prevention education in middle and high schools, and at community events. A new media- based social norms campaign will work to further reduce tobacco use in schools. The program will enhance its advocacy with family-oriented restaurants and partner with the Orange County Asthma Coalition (OCAC) on a smoke-free dining campaign. These activities will lead to an increase in recent declines in youth tobacco-use. Both school systems are active and committed partners and the School Health Coordinators from each school system will continue to act as liaisons. The OCHD program is the only program working to prevent youth tobacco-use in the county. The current program has detected needs to enforce 100% TFS policies within both districts and plans to enhance policy communication, supplement the current middle school-based health curricula with youth- driven educational presentations, develop youth-led social norms/counter marketing activities to reduce the influence of tobacco advertising, and develop a sustainable smoke- free dining campaign. Community and Schools Phase III Tobacco Use Prevention and Cessation Initiative grant funds have been awarded for the three-year period in the amount of $289,000. Nikie Sarris is MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 May 24, 2006 the current coordinator for the grant. C. Receipt of Strowd Roses Grant for Community HIV Testing The Community Health Services Section applied for funds from the Strowd Roses Foundation to implement non-invasive, rapid HIV testing through oral swabs in non-traditional test sites. The OraQuick method of testing oral secretions for HIV has found to be >99% accurate with test results within 20 minutes. It is recommended by the CDC, especially for hard to reach populations. The Department has been providing HIV counseling and testing through non-traditional test sites such as community centers, barbers and beauticians since October 2005 in an effort to reach high-risk communities. There has been limited response to the service in part due to the invasive requirement of drawing blood for testing and not having test results available for up to 3 weeks. We anticipate oral testing with rapid results will encourage more at-risk individuals to be tested. If found to be preliminarily positive on the oral test, venipuncture will still be required for confirmatory results. We are also seeking additional community sites to offer the rapid HIV testing. The Foundation approved $7,895 in funding for OraQuick Advance Rapid HIV Antibody Test kits, control reagents, educational brochures, and literature display racks. D. Dental Fee Adjustments Effective with dates of service October 1, 2005 and after, reimbursement rates for a number of dental procedures were increased. The rate changes were entered into the NC Medicaid system on May 5, 2006. The following resulted in three recommended rate changes to the OCHD Dental Health Service Fee Schedule: D2390 Resin-based composite crown, anterior old rate $79 New Medicaid Rate $123.82 New OCHD Rate $124.00 D2934 Prefabricated esthetic coated stainless steel crown-primary tooth old rate $167 New Medicaid Rate $175.00 New OCHD Rate $175.00 D7310 Alveoplasty extractions per quadrant old rate $70 New Medicaid Rate $82.00 New OCHD Rate $82.00 Motion to approve the minutes of April 27, 2006 and items on the Consent Agenda was made by Alan Rimer, seconded by Alice White, and carried without dissent. VI. Reports and Discussion with Possible Action MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 May 24, 2006 A. Child Fatality and Protection Team Annual Report Darrell Renfroe provided some background of the Child Fatality Prevention Team (CFPT) that was established in every county of the state by the North Carolina Juvenile Code. The charge of the CFPT is to review the records of all child fatalities in the county. Community Child Protection Teams (CCPT) was established in May of 1991. The original purpose and composition of the team was further formalized and expanded in 1993. The mandate to the CCPTs is, in part to review selected active cases in which children are being served by child protective services. Both teams are required by statute to submit reports annually to the State of North Carolina and to the local Board of Health and Board of County Commissioners containing any recommendations, and advocacy for system improvements and needed resources where deficiencies and gaps may exist. One example is the mandate that all children 16 and under must wear helmets when riding a bicycle. Another example is that all rental property must have smoke detectors and another recommendation was made that the legislature to pass a law requiring anyone that rides an all terrain vehicle wear a helmet and a law was passed. Dr. Carey asked what state agency received the recommendations from the committee and Mr. Renfroe explained that the CFPT goes to the Child Fatality Task Force at the state and they send it to the legislature. The review is done differently in different counties. In Orange County the CFPT reviews the most serious cases of maltreatment of young children. Moses Carey asked for clarification of the timeline for case studies. Mr. Renfroe explained that the CCPT review current cases and the CFPT review cases from the previous year. Rosemary Summers explained that the cases selected for study are computer selected based on built-in parameters but this can be overridden due to circumstances. The state requires the committee to be comprised of representatives from social services, the health department, guardian ad litem program, medical examiners office, law enforcement, EMS, the schools, mental health, and the district attorney’s office. Both groups started out separately but are now combined in most counties. The team meets every other month. Moses Carey asked for clarification on the selection and Mr. Renfroe explained that it is the jurisdiction is based on the county in which the child resides. The CPFT really looks at gaps that could have prevented the fatality. If a death is preventable the CPFT has to make a recommendation. The CCPT makes sure the families have resources available to enhance their ability to provide safe environments for their children. The committee reviewed 21 child deaths this last year and the year before 14. In the last 6 years the committee has reviewed 8 SIDS deaths, 3 of which were this year. Prematurity is the most common child death reviewed, (died within 24 hours of birth). Others cases involved cardiomyopathy, asphyxiation, accidental poisoning, car accidents, leukemia, bone cancer, and Edwards Syndrome. Alan Rimer asked if the predominant reason for the premature deaths was lack of adequate prenatal care. Mr. Renfroe explained that many times it is not something that is preventable. MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 May 24, 2006 Sometimes the investigation shows that there has been drug use in the pregnancy. Alice White asked for more information on Edwards Syndrome and Mr. Renfroe explained that is a very rare syndrome resulting in severe mental retardation and always fatal. There have been two cases within the last year, an extremely unusual occurrence. She also asked if the committee had found reasons for the SIDS deaths, to which Mr. Renfroe replied that the biggest contributor to SIDS deaths is co-sleeping. Six of the eight child deaths due to SIDS the child slept with an adult either on the sofa or in the bed at a very young age. SIDS and asphyxiation outcomes look the same. Every year the Orange County CPFT/CCPT has made the recommendation that young children, especially babies, should not co-sleep with an adult. The American Academy of Pediatrics finally made a recommendation in January 2006 and published an article that is distributed to parents with babies and young children. Of the five cases recently reviewed by the CCPT some of the issues found were domestic and family violence, prenatal and parental alcohol and substance abuse, lack of social support and parenting skills, parental mental illness, and shaken baby syndrome. There are currently 123 children in Orange County in DSS custody, some of which are with relatives and others with foster homes. B. Recommendations on Animals in Schools In the fall of 2004 there was a statewide e-coli outbreak resulting from infected animals at a petting zoo at the North Carolina State Fair. Since then, legislation has been developed and passed to encourage healthy practices regarding children and animal interactions in petting zoos. In addition, this has raised awareness of other places that children and animals interact. The North Carolina Division of Public Health Epidemiology Section has worked with the Department of Agriculture to develop possible guidelines or policies for school systems regarding animal/child interactions. Bob Moratto, Animal Services Director, Rosemary Summers, and DeWana Anderson (a member of both boards) met to discuss whether a joint letter to the school boards might be a strategy that would encourage schools to consider developing and adopting policies or guidelines in this area. They discussed the need to offer the schools staff assistance and educational materials for educating administrators, teachers, and students about healthy practices for humans and animals. Consultation on drafting guidelines or policies should also be offered in the letter. There have been several instances of need for guidelines in Orange County. DeWana Anderson reviewed the discussion by the Animal Services Board. There are two parts of the guidelines, the use of animals in schools for education in a science classroom and guidelines for visiting and residential pets and other animals. Board members discussed and made the recommendation that a joint letter be sent to the schools developing guidelines for visiting and residential animals and the Animal Services Board declined comment on the use of animals in schools for science research. Dr. Marotto and the Health Director feel that information can still be provided to the schools MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 May 24, 2006 on proper animal care without endorsing the use of animals for education. Motion to write a joint letter with the Animal Services Board to the school boards offering assistance in developing guidelines for visiting and residential animals was made by Moses Carey, Jr., and seconded by Alice White, and carried without dissent. C. Mill Creek Road Studies Final Report Rosemary Summers reported that in the summer of 2005, environmental health staff was approached by two residents of the Mill Creek Road area with concerns about their water and the water in their neighborhood and the perception of a high incidence of cancer in their neighborhood. The Board of Commissioners authorized the Health Department to undertake a special water study and to gather data on frequency and type of cancer experienced in the neighborhood. The study design included 133 homes and consisted of two separate and distinct parts: 1) total suite of water samples for each household that completed an application and 2) a telephone survey to discover the incidence and type of cancers. The NC Cancer Registry also completed a cancer cluster assessment. The final report was completed in early May 2006 and presented to the community on May 15. Dr. Summers thanked the Board of Commissioners for their financial support of this study, and key team members, Ron Holdway, Candice Watkins-Robinson, Tom Konsler, and Donna King, for their leadership, perseverance, and creativity in eliciting a maximum sample size from the study area and for their professional and scientific approach to the study. Mr. and Mrs. Holloway, Mill Creek community members, also deserve special recognition for their persistence in securing the applications and cooperation from community members in the study area. She presented a power point presentation that outlined the process followed and the results of the study. Matt Vizithum inquired whether the cancer statistics were a result of self-report and/or confirmed by medical records. Dr. Summers replied that all information was self-report by community members but correlates closely with the statistics reported by the NC Cancer Registry. The end result of the study showed no long-term health risks were identified, ground water appears untainted by contaminants, no unusual geology soils or terrains that would affect water quality, and the water quality issues that were found were largely aesthetic and are of continuing concern to the community. Environmental Health staff are working with a few remaining households to further diagnose their particular well problems. Alice White suggested adding a slide to the PowerPoint presentation immediately before the final slide repeating the findings regarding cancer and Tim Carey agreed. Dr. Carey will also forward an article on arsenic and skin cancer to the staff. This report has also been sent to the Board of Commissioners and will be scheduled for a presentation at a future meeting. MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 7 May 24, 2006 D. Policy Recommendation on Community Water Testing Rosemary Summers reported that Health Department staff has been requested by the Board of County Commissioners to develop a strategy and policy statement on when community water testing or septic system survey campaigns are warranted. Staff put together some ideas and Board of Health members were provided with the resulting draft parameters developed by staff. Jessica Lee suggested staff determine “flags” or indicators of problem areas to be alert for and questioned whether the staff could reference department policy for an outbreak as a guideline when a community requests or raises a flag about a health concern. This item will come back to the Board at the next meeting. E. Budget Public Hearings The Board of Commissioners is holding two public hearings on the 2006-20007 budget; May 30 at Southern Human Services Center and June 1 at the Battle Courtroom in Hillsborough. Both begin at 7:30 pm. Traditionally, several Board members have signed up to attend each public hearing and speak about high priority items in the department budget. This year is particularly important since the county budget seems to be stretched thin and the department has several high priority needs. The County Manager directed the budget staff to revert all line items that had been cut 25% in last year’s budget to that amount for this budget with no increases allowed. Those line items were: travel, training, office supplies, departmental supplies, dues, uniforms, and duplicating. The most problematic for the Health Department are training, departmental supplies, dues and duplicating. If no further cuts are made and the department is allowed to transfer between line items after the budget is approved, most divisions should be able to barely manage. The Manager is also proposing the creation of a new line entitled Certification Training that should help protect training funds for those positions that have specific requirements for continuing education and certification. High priority needs for the Health Department to gain approval of this year include: • Transition of the Volunteer Coordinator to county funding • Addition of a food and lodging program supervisor • Addition of an environmental health specialist for the Wastewater Treatment Management Program • Transition of the remaining 25% of the Healthy Carolinians Coordinator salary and benefits to county funding • Technology and equipment needs Jessica Lee volunteered to attend the June 1 meeting and Alan Rimer and Matt Vizithum tentatively volunteered to attend the May 30 meeting. It will also be prudent for the Board to keep watch on the Water Protection strategic plan requests. MINUTES ORANGE COUNTY BOARD OF HEALTH May 24, 2006 Board of Health Minutes Transcription completed by Anne Miles Cassell 8 May 24, 2006 F. Informational Items Items included: Air Awareness for Health Flyer News Articles Letter from the Environment & Resource Conservation Director on Community Health Assessment Welcome to the World Flyer Staff Recognition List for County Service Longevity Public Health Reserve Corp activities update G. Tracking Form Review The Tracking form is a preview of upcoming actions or topics that need Board action or discussion and is intended as a Board planning tool. One item, Summer BOH meeting schedule, was added to Pending Matters for discussion at the June meeting. VII. Board Comments/Announcements None VIII. Adjournment Motion to adjourn the meeting was made by Alice White, seconded by Chris Harlan, and carried without dissent. The next Board of Health meeting will be held on June 29, 2006 at the Government Services Center, Hillsborough, North Carolina. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board