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HomeMy WebLinkAboutBOH agenda 082416 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: August 24, 2016 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Rooms 300 West Tryon Street Hillsborough, NC 27278 TIME ITEM 7:00 p.m. I. Welcome New Employees 7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda Public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on sheet near the entrance to room.) Please limit your comments to 3 minutes. 7:05 – 7:10 III. Approval of August 24, 2016 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of May 25, 2016 7:15 – 7:45 V. Educational Sessions A. 4th Quarter Financial Reports Rebecca Crawford B. 4th Quarter Billing Dashboard Reports Rebecca Crawford C. 2014-16 Strategic Plan Accomplishments Coby Austin D. NALBOH Update Susan Elmore/Timothy Smith 7:45 – 8:00 VI. Action Items (Non Consent) A. FY15/16 Environ. Health Delinquent Accts Alan Clapp 8:00 – 8:25 VII. Reports and Discussion with Possible Action A. BOH Policy Review Coby Austin & Rebecca Crawford B. Health Director Report Colleen Bridger C. Media Items 8:25 – 8:30 VIII. Board Comments 8:30 IX. Adjournment BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your attendance at this meeting OR CALL 919-245-2411. Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 25, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ May Page 1 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 25, 2016, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Vice Chair; Nick Galvez – Vice- Chair, Commissioner Mia Burroughs, Paul Chelminski, Dan Dewitya, Susan Elmore, Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith. BOARD OF HEALTH MEMBERS ABSENT: Barbara Chavious. STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Senior Health Public Educator; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance & Administrative Services Division Director; Donna King, Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Meredith Stewart, Public Health Program Manager and La Toya Strange, Administrative Assistant II. GUESTS PRESENT: None. I. Welcome Liska Lackey, Chair, called the meeting to order. There were no new employees in attendance. II. Public Comment for Items NOT on Printed Agenda: None III. Approval of the May 25, 2016 Agenda Motion was made by Mia Burroughs to approve the agenda, seconded by Susan Elmore and carried without dissent. IV. Action Items (Consent) A. Minutes Approval of April 27, 2016 Meeting Motion to approve Consent Agenda without corrections to the April 27, 2016 minutes was made by Sam Lasris, seconded by Jessica Frega and carried without dissent. V. Educational Sessions A. Innovation Grant Update Meredith Stewart, Public Health Program Manager, provided updates on the progress of the ten projects. As the 2016 Innovation Grant Cycle is at its midway point, the updates are as follows: MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 25, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ May Page 2 • Mindfulness Training – Employees attended mindfulness classes held onsite on Friday afternoons. • Transportation Solutions for FSA Families – The funds are to perform feasibility trials for using Uber as a source of transportation for FSA families. Transportation is an issue primarily for FSA families living in northern Orange County. FSA Navigators performed trial runs. There are still logistic challenges: Uber only accepts credit cards, the use of the Uber application is required (some families don’t have great cellular service in their area or sufficient data plans) and there is a lack of Uber drivers working in northern Orange County. • Food Establishment Excellence Program – Literacy needs are being considered. Infographic stickers have been designed and are being distributed to provide food safety information. • Nutrition Marketing Tool – Kudos cards for OCHD nutrition patients are being designed as a positive reinforcement feedback tool to be sent back to the medical provider that referred them to see a nutritionist. • Technology Access for Patient Education – Two Chromebooks are being purchased for trial use to provide patient education and pre/post tests in clinic. OCHD have partnered with Duke AHEC to develop educational model and test software. • Corrective Action Stickers – Infographic stickers for food establishments have been created, printed and are being used in establishments. • Double Handle Lift Tool – This tool would be used to assist Environmental Health staff with lifting septic tank lids. It’s currently in the design and testing phase. • Prenatal Oral Health Incentive Program – Incentive structure has been established to encourage prenatal dental visits. A community event was held on May 6, 2016 in which information on this program was given. • Project Safe Sleep – This project will provide supplies for parents to practice safe co-sleeping and provide education on SIDS awareness. Ten cribs were purchased this month. • Septic Maintenance Application – A how-to smartphone application will be developed to inform homeowners on septic maintenance. Ms. Stewart also spoke on how innovation at the OCHD has improved. This is the first time that 100% of funds were spent this fiscal year. Dr. Bridger added that this is the most innovative batch of projects the OCHD has seen in the last three years. The BOH members had questions that were addressed by Ms. Stewart and Dr. Bridger. B. Child Fatality Task Force Report Pamela McCall, Public Health Nursing Director, gave the highlights of the 2015 Child Fatality Prevention Team (CFPT) Annual Report. She began with a brief introduction of the general statutes that led to the creation of the CFPT and the Community Child Protection Team (CCPT) and its charge to reduce preventable deaths in the state of North Carolina. The CFPT meets to MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 25, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ May Page 3 identify child death patterns, system problems or gaps in services to children and families and to make and carry out recommendations for change that will prevent future child deaths. The CFPT reviewed 10 fatalities in 2015. Most were unpreventable. Potential system problems identified were undiagnosed genetic disorders and prenatal tobacco use contributing to the premature birth. Recommendations by the CFPT and CCPT were that new and potential parents be counseled and screened for genetic disorders and that pregnant women be encouraged and supported in stopping tobacco use. C. 3rd Quarter Financial Reports and D. 3rd Quarter Billing Dashboard Reports Rebecca Crawford, Finance & Administrative Services Division Director, gave a report on the 3rd quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Revenue: Average YTD monthly revenue in FY16 after the 3rd Quarter is $230k/month or $2.8 million YTD, representing 70.6% of our overall budgeted revenue for the year. This is an increase from an average of $218k/month in FY15. Expenses were slightly lower than revenues at 67.8%. • Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-15, the average billing accuracy rate for medical three quarters of the way through FY 15-16 is 86% as compared to 92% in FY 14-15 and the average rate for dental for FY 15-16 is 93% as compared to 94% in FY 14-15. • Dental Earned Revenue by Source: The FY 15-16 average monthly revenue ($40k/month) is slightly below our budget projection ($45k/month) but still above our FY 14-15 average of $36k/month. FY 15-16 dental revenue totaled $483k at the end of the third quarter. Dental earned revenue will most likely continue to increase each month as our new dentist adds more clients to her schedule. • Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 15-16. The monthly average after the third quarter ($46k/month) is lower than FY15 ($50k/y) and our budget projection ($50k/month). This was mainly due to holding Maternal Health encounters for Global Billing (billing multiple encounters at the end of the pregnancy) and holding multiple program encounters until we come to a resolution with Medicaid of an acceptable method to bill same day appointments, which we resolved in late December. March and April showed monthly revenue totals of $50k and $57k respectfully and we anticipate these monthly totals will stay at this level for the remainder of the fiscal year. VI. Action Items (Non-Consent) A. 2016-2018 Strategic Plan Meredith Stewart, Public Health Program Manager, began by stating that the three subcommittees (Physical Activity and Nutrition, Substance Abuse and Mental Health, and Social Determinants of Health) met and their representatives provided their recommended focus areas and action steps for inclusion in the 2016-2018 Board of Health Strategic Plan. The recommendations were formed using guidance and data obtained from the 2015 Community MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 25, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ May Page 4 Health Assessment as well as input from staff and Board subcommittees. The BOH members discussed each subcommittee’s focus areas and action steps. The 2016-2018 Strategic Plan can be assessed on the Board of Health website or by clicking the link below http://www.orangecountync.gov/departments/health/BOH%20Strategic%20Plan%202016 -2018%20-%20FINAL.pdf The BOH members had questions that were addressed by Ms. Stewart, Ashley Mercer, Healthy Carolinians Coordinator, and Dr. Bridger. Motion to accept the 2016-2018 Strategic Plan was made by Sam Lasris, seconded by Jessica Frega and carried without dissent. VII. Reports and Discussion with Possible Action A. Health Director Report In addition to the Health Director’s report, Dr. Bridger thanked Meredith Stewart for her contributions while at the OCHD. This BOH meeting will be her last as she will be leaving the OCHD to attend law school. Dr. Bridger also introduced Coby Austin who will act as the interim after Ms. Stewart’s departure. B. Media Items Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments Susan Elmore congratulated the OCHD on winning the walking challenge. Dr. Bridger mentioned that the integrated behavioral health position has been filled and that she’ll start within one month. IX. Adjournment A motion was made by Jessica Frega to adjourn the meeting at 8:30 p.m., was seconded by Mia Burroughs and carried without dissent. The next Board of Health Meeting will be held August 24, 2016 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Colleen Bridger, MPH, PhD Orange County Health Director Secretary to the Board Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 24, 2016 Agenda Item Subject: 4th Quarter Financial Report FY 15-16 Attachment(s): 4th Quarter Financial Report 4th Quarter Billing Dashboard Staff or Board Member Reporting: Rebecca Crawford Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: Total Health Department Revenue: Average YTD monthly revenue in FY16 after the fourth quarter is $242k/month or $2.8 million YTD, representing 97% of our overall budgeted revenue for the year. This is an increase from an average of $210k/month in FY15. Expenses were slightly lower than revenues at 94%. Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14- 15, the average billing accuracy rate for medical at the end of FY 15-16 is 91% as compared to 92% in FY 14-15 and the average rate for dental for FY 15-16 is 100% as compared to 86% in FY 14-15. Dental Earned Revenue by Source: The FY 15-16 average monthly revenue ($40k/month) ended the fiscal year slightly below our budget projection ($45k/month) but still above our FY 14-15 average of $35k/month. FY 15-16 dental revenue totaled $485k at the end of the fourth quarter. Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 15-16. The monthly average after the fourth quarter ($50k/month) leaving us level with FY15 and on target with our budget projection ($50k/month). Medical revenue totaled $596k for FY 15-16. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ____________________ _X_Accept as information ___Revise & schedule for future action ___Other (detail): Orange County Health Department Profit Loss Budget Performance 2015-2016 TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Revenue Donations Dental Health 0 (338)0 0.00% Finance and Admin Services (1,319)(1,319)(30,000)4.40% Health Promotion & Edu 0 (2,000)(11,000)18.18% Personal Health (4,583)(7,222)(24,014)30.07% Donations Total (5,902)(10,878)(65,014)16.73% Internal Allocations Dental Health (18,000)(18,000)(18,000)100.00% Finance and Admin Services (23,500)(23,500)(23,500)100.00% Health Promotion & Edu (25,000)(25,000)(25,000)100.00% Internal Allocations Total (66,500)(66,500)(66,500)100.00% Service Revenue Dental Health (123,562)(504,963)(536,847)94.06% Environmental Health (128,998)(478,327)(450,880)106.09% Personal Health (179,006)(596,785)(606,484)98.40% Service Revenue Total (431,565)(1,580,075)(1,594,211)99.11% State Allocations Dental Health (15,633)(16,000)(16,000)100.00% Finance and Admin Services (13,113)(46,495)(42,885)108.42% Health Promotion & Edu (34,631)(61,034)(55,832)109.32% Environmental Health (36,523)(38,399)(39,443)97.35% Personal Health (123,429)(511,170)(482,511)105.94% State Allocations Total (223,329)(673,098)(636,671)105.72% Grants Project Revenues NACCHO Grant 0 (3,021)(6,521)46.33% Piedmont Hlth Srv - Nutr (10,952)(24,003)(28,938)82.95% Meaningful Use Incentive 0 (72,250)(72,250)100.00% CC4C Accesscare (36,909)(147,211)(149,624)98.39% PCM Accesscare (36,883)(152,058)(155,952)97.50% Health Disparities (9,133)(53,962)(87,170)61.90% Dental Health 0 (1,500)(1,500)100.00% Susan G. Komen Grant (1,444)(26,256)(24,812)105.82% DSME Grant (3,500)(3,500)(3,500)100.00% Grants Project Revenues Total (98,821)(483,761)(530,267)91.23% Revenue Total (826,117)(2,814,312)(2,892,663)97.29% Orange County Health Department Profit Loss Budget Performance 2015-2016 TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Expenditures Salaries 1,456,247 5,174,102 5,212,472 99.26% Benefits 514,891 1,846,541 1,954,872 94.46% Travel 4,501 8,534 11,695 72.97% Training 10,881 35,591 37,656 94.52% Certifications & Licensing 1,259 7,822 12,542 62.37% Mileage 8,143 28,961 33,636 86.10% Telephone 21,650 85,437 75,714 112.84% Postage 3,638 13,633 15,957 85.44% Motor Pool 13,391 46,295 48,807 94.85% Equip Repairs 1,714 5,512 9,675 56.97% Equip Rent 294 999 1,200 83.28% Duplicating 5,759 14,429 12,765 113.03% Printing 2,942 7,396 14,564 50.78% Advertising 1,607 4,250 6,296 67.50% Dues 489 5,590 6,134 91.14% Subscriptions 0 865 1,327 65.19% Dept Supplies 18,477 30,163 45,485 66.31% Edu Supplies 2,815 10,216 22,755 44.89% Office Supplies 7,939 29,702 39,694 74.83% Medical Supplies 39,931 139,613 164,616 84.81% Bloodborn Path Supplies 348 539 5,034 10.70% Pharmacy Supplies 32,087 163,088 204,276 79.84% Comp Supp/Software 0 574 1,576 36.43% Other Supplies 0 420 488 86.06% Contracted Srv 138,654 415,899 589,714 70.53% X-Ray 6,542 11,818 25,125 47.04% Lab Srv 16,454 79,197 82,152 96.40% Bonds & Insurance 10,602 10,602 10,602 100.00% Uniforms 1,242 6,854 9,006 76.11% Community Proj 19,113 28,461 51,536 55.23% Employee Wellness 0 0 0 0.00% Innovations Project 12,208 17,566 20,430 85.98% Accreditation Project 0 2,750 2,750 100.00% Preparedness BT 0 0 0 0.00% Family Success Alliance 77,949 183,857 279,008 65.90% Credit Card Exp 3,200 17,458 10,000 174.58% Capital Exp Under $500 2,130 3,710 4,069 91.17% Nicotine Replacement Therapy 690 3,085 5,000 61.69% Grant Project Expenditures Health Disparities 27,001 97,343 80,382 121.10% Meaningful Use Incentive 6,197 44,997 47,497 94.74% Susan G. Komen Grant 16,389 28,177 49,624 56.78% Capital Expenditures Equipment 4,100 4,775 4,775 100.00% IT Equipment 2,245 9,588 11,571 82.86% Furnishings 3,159 5,659 5,660 99.99% Grand Total 2,496,877 8,632,065 9,228,137 93.54% Total County Revenue (Appropriation)2,496,877 8,632,065 9,228,137 93.54% BO H  GO V E R N A N C E  DA S H B O A R D Q4  FY15‐16 * NO T E  : FY 1 5 ‐16  Bi l l i n g  Ac c u r a c y  no  lo n g e r  co m b i n e s  de n t a l  an d  me d i c a l  pa i d  cl a i m s  & un p a i d  cl a i m s .    Be c a u s e  tw o  di f f e r e n t  ac c o u n t i n g  sy s t e m s  ar e  be i n g  us e d  (M e d i c a l :  Ac c r u a l ;  De n t a l :  Ca s h )  the two clinics are shown separately. Bi l l i n g  Ac c u r a c y  Fo r m u l a s :  Me d i c a l  = Pa i d  cl a i m s / ( #  en c o u n t e r s  mi n u s  no  ch a r g e  cl a i m s ) .  Un ‐cl a i m e d  ap p o i n t m e n t s  ar e  no  lo n g e r  fa c t o r e d  in ;  De n t a l  = Pa i d  Cl a i m s / #  ke p t  ap p o i n t m e n t s .    Cl a i m s  ca n  ta k e  a qu a r t e r  to  re a l i z e  pa y m e n t  ‐   bi l l i n g  ac c u r a c y  fo r  al l  mo n t h s  in c r e a s e s  wi t h  ti m e  as  cl a i m s  ar e  fi n a l i z e d  an d  er r o r s  ar e  re w o r k e d . 36 40 43 40 35 42 37 36 54 43 40 40 0204060 JA S O N D J F M A M J Thousands DE N T A L  EA R N E D  RE V E N U E  BY  SO U R C E vs .  bu d g e t  pr o j e c t i o n  & pr i o r  ye a r ME D I C A I D IN S U R A N C E SE L F  PA Y To t a l  Ea r n e d  Re v e n u e  ($ 4 8 5 k  YT D ) Bu d g e t  Pr o j e c t i o n  ($ 4 5 k / m ,  $5 3 7 k / y ) YT D  Mo n t h  Av g  ($ 4 0 k / m ,  ~$ 4 8 5 k / y  es t ) FY 1 4 ‐15  D Re v e n u e  ($ 4 2 3 k / y ) FY 1 4 ‐15  D Re v e n u e  ‐   Av g  ($ 3 5 k / m ) 46 36 48 41 54 46 38 5057646352 020406080 JA S O N D J F M A M J Thousands ME D I C A L  (P H )  EA R N E D  RE V E N U E  BY SOURCE vs .  bu d g e t  pr o j e c t i o n  & pr i o r  ye a r ME D I C A I D INSURANCE SE L F  PA Y Total Earned Revenue ($596k YTD) Bu d g e t  Pr o j e c t i o n  ($ 5 0 k / m ,  $6 0 0 k / y ) YTD Month Avg ($50k/m, ~$596k/y est) FY 1 4 ‐15  M Re v e n u e  ($ 6 0 5 k / y ) FY14‐15 M Revenue ‐ Avg ($50k/m) 18 2 20 1 38 6 21 4 20 9 22 2 16 3 21 5 28 2 27 1 27 9 28 4  (5 0 )  ‐  50  10 0  15 0  20 0  25 0  30 0  35 0  40 0  45 0 JA S O N D J F M A M J Thousands TO T A L  HE A L T H  DE P A R T M E N T  RE V E N U E vs .  bu d g e t  pr o j e c t i o n s  & pr i o r  ye a r Pe r s o n a l  He a l t h De n t a l En v i r o n  He a l t h Gr a n t s St a t e Ot h e r To t a l  OC H D  Re v e n u e  ($ 2 . 8 M  YT D ) YT D  Mo n t h  Av g  ($ 2 4 2 k / m ,  ~$ 2 . 8 M / y ) FY 1 5 ‐16  Bu d g e t  Pr o j e c t i o n  ($ 2 6 0 k / m ,  $2 . 8 M / y ) Pr i o r :  FY 1 4 ‐15  To t a l  OC H D  Re v e n u e  ($ 2 . 5 M / y ) Pr i o r :  FY 1 4 ‐15  Re v e n u e  ‐   Av g  ($ 2 1 0 k / m ,  $2 . 5 M / y ) 95 % 94 % 92 % 95 % 91 % 89 % 8 9 % 91 % 92%82%89%87% JA S O N D J F M A M J Me d i c a l  Bi l l i n g  Ac c u r a c y * vs  pr e v i o u s  ye a r  & go a l M FY 1 6  To t a l  Ac c u r a c y  (Y T D  av g  91 % ) M FY 1 5  Av g  Ac c u r a c y  (92%)Accuracy Target (90%) 10 3 % 97 % 92 % 10 2 % 97 % 11 1 % 10 8 % 92 % 100%101%93%101% JA S O N D J F M A M J De n t a l  Bi l l i n g  Ac c u r a c y * vs  pr e v i o u s  ye a r  & go a l D FY 1 6  To t a l  Ac c u r a c y  (Y T D  av g  10 0 % ) D FY 1 5  Ac c u r a c y  ‐   Av g  (9 7 % ) Accuracy Target (90%) Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 24, 2016 Agenda Item Subject: Update on 2014-16 Strategic Plan Attachment(s): Strategic Plan Update - presentation Staff or Board Member Reporting: Coby Jansen Austin Purpose: ____ Action _ x_ Information only ____ Information with possible action Summary Information: In preparation for transitioning to the new Strategic Plan, Coby Jansen Austin will provide a final review of accomplishments from the 2014-2016 Board of Health Strategic Plan. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to _______________ _x_Accept as information ___Revise & schedule for future action ___Other (detail): Orange County Board of Health 2014-2016 Strategic Plan Accomplishments AUGUST 2016 Priority Areas Access to Care Childhood and Family Obesity Prevention Substance Abuse and Mental Health Engagement Priority #1: Access to Care Focus #1: Family Success Alliance Focus #2: Policies improving access to care Two cohorts of K- Readiness students Second cohort of families now enrolling with navigators Robust evaluation plan and partnership with UNC Collective Impact approach / United Way Health literacy policy, toolkit & trainings Priority: Access to Care Focus #3: Culture of Innovation Focus #4: Scale up Effective Interventions 2015 Projects Video Remote Interpretation Software/Hardware Whitted Bike Share Pilot Mobile Technologies (Apps) for Health Improvement Priority: Access to Care 2016 Projects Mindfulness training Uber pilot with FSA Septic Double Handle Lift Tool Mobile Devices for patient ed Priority #2: Childhood and Family Obesity Focus #1: Catalyst for partnerships Focus #2: Evidence-based PA/nutrition interventions Focus # 3: Policies to reduce obesity Go NAP-SACC pilot New partnerships Summer Feeding Programs OCS universal breakfast! BOH seat on OUTBoard OCHD lactation room Priority: Childhood and Family Obesity Priority #3: Substance Abuse & Mental Health Focus #1: Advocate for SA&MH Services Focus #2: Advocate for Childhood MH Services •Town and Gown Task Force to address underage drinking and binge drinking. New collaborative position recently hired. •Health Department now offers PrEP counseling and prescriptions for individuals at high-risk HIV infection. •Safe Syringe Initiative launched & in accordance with new state law •Raising of America - screening Substance Abuse and Mental Health 75% of law enforcement agencies in Orange County now equipped with naloxone – projected to be 100% soon! Focus #3: Health and Criminal Justice Focus #4: Support OC Smoke-Free Public Places •Commissioned report on Orange County criminal justice system that led to objectives in 2016-18 Strategic Plan •OC continues to be smoke-free! Substance Abuse and Mental Health Engagement On to the next! Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 24, 2016 Agenda Item Subject: NALBOH Update Attachment(s): Staff or Board Member Reporting: Susan Elmore/Timothy Smith Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: Susan Elmore and Timothy Smith will give an update on the NALBOH 2016 Annual Conference held on August 10-12, 2016. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ _X_Accept as information ___Revise & schedule for future action ___Other (detail): Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 24, 2016 Agenda Item Subject: Bad Debt Write-Off: Transfer of Uncollectible Debt from Active to Inactive Attachment(s): Delinquent and Uncollectible Accounts Policy Staff or Board Member Reporting: Colleen Bridger Purpose: _X_Action ___ Information only ___ Information with possible action Summary Information: Per the department’s Delinquent and Uncollectable Accounts policy (15.0), uncollectible accounts are to be administratively written off the books. The purpose of this accounting function is to precisely account for and pursue funds which are truly unrecoverable. The last administrative write-offs were performed by the Board of Health in August 2016 (Personal Health, Dental Health, and Environmental Health) for FY 2015. Personal Health, Dental Health, and Environmental Health continue to participate in the NC Debt Set-Off Program, which allows the county to collect debts on delinquent accounts with a balance between $50 and $4,000 through the customer’s tax refund. The Health Department anticipates collecting payments on delinquent accounts being pursued through the NC Debt Set-Off program; therefore, those accounts are not included in this write-off request. Based on the definitions of uncollectible accounts in the department’s policy, the following table represents all uncollectible debt from clients for FY 2015-2016. Division Number of Uncollectable Accounts Write-Off Amount Personal Health 80 $1,401.15 Dental Health 73 $2,222.56 Environmental Health 13 $2,049.19 Total 166 $5,672.90 We request to administratively move a total of $5,672.90 in uncollectible debt from ‘active’ to ‘inactive’ status for the reasons indicted in the table above. The customer shall never be informed that a debt has been written off. If a customer whose account had been determined uncollectible returns to clinic within three years, the delinquent write-off amount will be reactivated and the billing process resumed. Likewise, if a customer requests a non-required service from Environmental Health, the delinquent write-off amount will be reactivated and the billing process resumed. Recommended Action: _X_Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ____________________ ___Accept as information ___Revise & schedule for future action ___Other (detail): Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: August 24, 2016 Agenda Item Subject: BOH Policy Review Attachment(s): Proposed Revisions: Sections I.E. & I.H. Staff or Board Member Reporting: Coby Jansen Austin & Rebecca Crawford Purpose: __X_ Action ____ Information only ____ Information with possible action Summary Information: The Board of Health reviews its policy manual annually. After two consecutive years in which several updates were made to the policy, there are very few changes needed this year. Updates to two sections of the policy are recommended below: I.E. Fee and Eligibility Policy Staff recommends making the following revisions to the Fee and Eligibility Policy for the purpose of clarification and to be in compliance with federal Medicaid requirements: - Residency Requirements (Section IV.A.): The Residency Requirements section was revised to replace “is” with “may” regarding whether any Orange County resident or non-resident can/will be eligible for services. This change was made to clarify that non-residents are not automatically eligible for all services (certain Communicable Disease services, etc.) and to clarify that only Orange County residents qualify for the Family Home Visiting program. - Fees for Services (Section VI.O.): The Fees for Services section was revised to add language explaining that Medicaid patients will be charged only the cost for OCHD to purchase 340b drugs (a federal drug pricing program that reduces the cost of certain medications for eligible healthcare providers only). Since 340b drug pricing changes quarterly, the department will be reviewed and set annually based on an average purchase price throughout the year. This additional section is required in order to remain in compliance with DHHS and our ability to bill for Medicaid reimbursement for these drugs. OCHD typically purchases Family Planning related 340b drugs only. I.H. Complaint Policy Staff recommends streamlining the current BOH Complaint Policy by 1) removing the language about the procedure for handling a general complaint from the Board of Health policy manual, and 2) including that language in the complaint section of the Health Department’s Administrative Policy and Procedure manual, alongside other existing complaint forms and procedures. Background: The NC Local Health Department accreditation benchmarks include a standard to have written policies and procedures in place for handling of complaints related to enforcement of laws, rules and ordinances. Policy H of the Board of Health Policy Manual meets that requirement by stating its policy regarding complaints. However, it would be most efficient to locate the procedures and forms for implementing that policy in the Health Department’s Administrative Policy and Procedure manual. Type of complaints covered through existing procedures include: Complaints that are general in nature and those related to HIPAA privacy and security, Title VI of the Civil Rights Act of 1964, and Executive Order 13166 (meaningful access to services for persons with limited English proficiency). The Environmental Health Policy and Procedure Manual also includes a process for responding to, documenting, and resolving environmental complaints. Recommended Action: _X_Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to _______________ ___Accept as information ___Revise & schedule for future action ___Other (detail): ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 1 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 I. Purpose A. Public health services are increasingly costly to provide. The Health Department serves the public’s interest best by assuring that all legally required public health services are furnished to all citizens. The department provides recommended and requested public health services based upon the priorities established by the Board of Health. B. Fees are a means to help provide services to the residents of Orange County. Fees help finance and extend public health services when government funding is not sufficient to support the full cost of providing all required and requested services. C. Fees for Orange County Health Department services are authorized under North Carolina G.S. 130A-39, provided that: 1. They are in accordance with a plan recommended by the Health Director and approved by the Board of Health and the Orange County Board of Commissioners. 2. They are not otherwise prohibited by law. 3. They are deposited to the account of the local Health Department for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act. D. Fees for services must also be in compliance with N.C. Administrative Code, Title X Regulations, and Women’s and Children’s Health Program Rules. E. There will be no charge for Title X Services provided for individuals with income less than 100% of the Federal Poverty Level (FPL.) II. Policy Implementation The implementation of this policy is delegated to appropriate financial or support staff in each division of the health department. III. Income Eligibility A. Definitions 1. Definition: A family is defined as a group of individuals who are living together as one economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods are related. A pregnant woman is counted as a family of two in determining family size. 2. Income eligibility requirements apply to: Dental Health, Family Planning, Child Health, Maternal Health, Adult Health, Nutrition Services, Family Home Visiting, and Primary Care Services. 3. The Health Department utilizes a sliding fee scale based on Federal Poverty Guidelines in accordance with the Fee Schedule approved annually during the County Budget process. NC DPH updates and issues the scale yearly. Specifically, ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 2 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 the health department uses the 101% - 250% Federal Poverty Level sliding scale. Determination of Sliding Fee percentage is based on gross income and family size. 4. Verification of income is required at time of enrollment for services, at the annual financial interview, or if there is a change in the work status in the family unit for clients to be eligible for the sliding fee scale. a. An annual gross income statement is preferred for evaluation. i. Gross income is defined as the total of all cash income before deductions for income taxes, employee social security taxes, insurance premiums, bonds, etc. For self-employed applicants, net income after business expenses. Gross income does NOT include money earned by children for babysitting, lawn mowing and other tasks. ii. In general gross income includes: salary, wages, commissions, fees, tips, overtime pay, unemployment compensation, public assistance money, alimony and child support payments, Social Security benefits, VA benefits, Supplemental Security Income (SSI) benefits, retirement & pension payments, worker’s compensation, bonuses, prize winnings and other sources of cash income except those specifically excluded. B. Sources 1. Sources of income verification may include, but are not limited to: a. Current pay stub b. Self-employment accounting records c. Letter documenting current employment and wages from employer d. Recent income tax return e. Unemployment or workers compensation receipt f. Public assistance letter g. Prior income verification through enrollment in other Health Department programs 2. If an individual claims “no income” (except for minors consenting to specific services under G.S. 90-21.5), a signed “Verification of Income and/or Residency” form (Attachment A) indicating financial support from another party must be submitted. 3. Failure to provide verification within 10 business days of date of service will result in charges being assessed at 100% of sliding fee scale. The client will receive notification of required income verification at the time the initial appointment is made. 4. The client must read, sign and understand the “Determination of Eligibility Payment Plan for Clinical Services” and “Statement of Financial Responsibility Payment Plan” form (Attachment B) at their initial visit and annual financial reviews. C. Environmental Health Persons seeking Environmental Health services must obtain and properly complete an application for service and pay the corresponding fee for service (all applicants pay at the 100% pay status) before an appointment for a field visit will be scheduled. Sometimes ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 3 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 additional fees may be necessary if during service delivery it is determined that the correct fees were not initially paid, or services requested are more than applied for. Wastewater Treatment Management Program (WTMP) and Mobile Home Park fees are the only Environmental Health services invoiced after the inspection. These inspections are not application based but occur on a regulated, recurring schedule. IV. Residency Requirements A. Any individual, Orange County resident or non-resident, is may be eligible for services provided by the Health Department. Exceptions include non-STD Communicable Disease cases, designated Family Home Visiting programs (Orange County residents only), and when prohibited by law or regulation. B. Proof of Residency may be determined by using the US Postal and/or Orange County GIS website and one of the following: Driver’s License, Government-issued identification, Pay Stub (Within the last 30 days), Utility bill (Within the last 45 days); Current rental or lease agreement; Personal or property tax bill; Student identification, and Matrícula Consular (Mexican ID Card1). Clients without one of the above identifying information sources but reportedly living within the county will be required to produce a written statement or letter from the head of household, verifying that the person resides in their home. Special cases will be referred to the Clinic Manager or Supervisor. Failure to provide proof of residency may result in referral to another resource. C. Proof of Residency in Orange County is required for self-pay patients to be eligible for the sliding fee scale when requesting Maternal Health, Child Health, Primary Care, Nutrition Services, and Dental Health Services. Out-of-county residents will be assessed at 100% of charges not covered by a third party payer source. V. Service Limitation/Denial A. Services will not be denied based solely on the inability to pay, with the exception of those services that require a flat or minimum fee. Emergency dental services and urgent primary care services will be provided to clients regardless of any outstanding balance due. B. Otherwise, services may be denied if the department does not have the resources needed to provide a quality non-mandated service or the individual does not meet the residency or financial requirement. 1 The Matrícula Consular de Alta Seguridad (MCAS) (Consular Identification Card) is an identification card issued by the Government of Mexico through its consulate offices to Mexican nationals residing outside of Mexico. Retrieved from http://en.wikipedia.org/wiki/Matr%C3%ADcula_Consular on October 14, 2012. ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 4 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 C. Family Planning clients will never be refused service due to an outstanding balance or inability to provide proof of income. D. Maternal and Child Health clients who are at 60% to 100% pay status may have services limited or denied for failure to make payments based on designated Payment Plans (“good faith” effort). E. Falsification of eligibility by the client may result in denial or limitation of services. F. The Health Department shall not deny a service due to religion, race, national origin, creed, sex, marital status, familial status, sexual orientation, veteran status or age. G. The Health Department shall assure that no otherwise qualified handicapped individual, solely by reason of his/her handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity covered by this agreement. H. The Health Director can override any decision to deny or limit services to a client in accordance with the existing fee waiver process. VI. Fees for Services A. In order to facilitate early entry into prenatal care or family planning services, pregnancy tests will be provided free of charge unless they are required as part of another service. B. In order to facilitate early identification of and referral for hypertension, two blood pressure screenings will be provided in the clinic free of charge. Borderline readings will be checked free until determined to be normal or the client is referred for further evaluation. Follow-up of clients with a diagnosis of hypertension will be charged according to the fee policy. C. Fees are not charged for diagnosis and treatment of sexually transmitted diseases, or investigation and control of communicable diseases. There is also no charge to clients for any State-provided vaccine. D. Fees are charged for health and dental services provided to individuals unless prohibited by law or regulation. Fees are established based upon cost analysis, Medicaid and Medicare rates, comparable provider rates and/or state or contractual agreements. The Health Director shall inform the Board of Health and the Orange County Board of Commissioners of these adjustments in a timely manner. E. Fees may be charged to clients for “non-program” specific services without being adjusted on a sliding fee scale (flat fees). ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 5 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 F. Fees may be charged for education, community-based limited clinical services (such as influenza shots) and screening services provided to individuals or groups. The following applies to these services: 1. They include orientation, field training, dental screening and education, and/or other health promotion activities such as infant and toddler car seats, bike helmets, or equipment rental. 2. The Health Director will negotiate fees for services where fees have not been previously determined. 3. Income eligibility requirements do not apply to these services. G. Per NC General Statute Chapter 7B, Subchapter 4, Article 35, and confidentiality regulations, emancipated minors and other individuals requesting confidential services will be considered a family of one for determination of charges. Private insurance will also not be billed for minors receiving services for which they can consent unless permission is received from the minor. H. Persons requesting any program services may be encouraged to apply for Medicaid, as applicable. I. The Personal Health Services Division clinical and nutrition services will use the appropriate sliding fee schedule for services when adjustable fees are allowed; all other fees will be charged at 100%. 1. Clients, who require services provided on the sliding fee schedule, are expected to pay the appropriate fee in full based on sliding fee guidelines. 2. This schedule will require assessment of the client’s financial status on an annual basis or when a financial status change occurs, as specified in section III. J. Dental Health Services, Primary Care Services, and Nutrition Services will use a sliding fee schedule for all services, with a minimum charge to be established at the annual fee review during the budget preparation process. 1. The minimum charge for dental, primary care, and nutrition services will apply regardless of the determination of the client’s financial status. 2. If a client is determined to fall at the 0% pay level, the minimum charge will be the only charge levied and collected. 3. Minimum charge is due at time of service. K. Fee schedules will be reviewed annually during the budget process and adjusted as appropriate; a complete cost analysis for purposes of fee adjustments will be performed every five years. The process for this cost analysis includes a review of the following elements: a. Most recent vaccine and drug purchase costs b. Most recent lab pricing lists c. Most recent Medicaid Cost Settlement data for procedure costs d. Environmental Health equipment, labor, and staff costs e. Review of fee schedules of surrounding jurisdictions ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 6 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 f. Analysis of existing self-pay client base and how increased costs would affect their ability to get necessary care L. Based on G.S. 130A-41, the Health Director is authorized to enter into contracts, which may include negotiated reimbursement rates. M. The Health Director may not make exceptions to the Fee Policy except to accommodate specific situations through the fee waiver process (Attachment C). N. Any minimum administrative fee or flat fees shall be applied without discrimination to all patients. O. There will be no “schedule of donations”, bills for donations, or any other implied coercion for donations from clients as a condition for being seen at the Health Department. Donations to the health department can be made through the Orange County Community Giving Fund. Fees for services will not be waived because of client donations. O.P. Fees for 340b drugs dispensed to Medicaid patients will be reviewed and set annually based on the average, annual cost to the County to purchase the drugs. VII. Fee Collection A. Environmental Health service fees are paid before an appointment is scheduled. Field staff cannot accept fees in the field. B. Fees collected from Medicaid and Medicare and other third party insurance for a covered service, combined with payment of any applicable co-pays and co-insurance, constitutes full payment for that service. C. A co-payment, deductible, or balance of charge can be collected at the time of service from individuals covered by other third party insurance plans when OCHD is a member of their provider panel (exception family planning). For Family Planning clients, family income should be assessed before determining whether co-payments or additional fees are charged; if their family income is verified to be at or below 250% FPL, they should not pay more (in copayments or additional fees) than what they would otherwise pay when the schedule of discounts is applied. With regard to other insured clients, payments towards a deductible for clients whose family income is verified to be at or below 250% FPL should have the appropriate sliding fee schedule applied. D. If OCHD is not on the insurance provider panel, the client will be charged for the service(s) based on the Health Department’s fee schedule. The client will be provided with documentation of services for submission of a claim to their insurance company. ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 7 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 E. At the time services are received, the client will be given a statement showing the cost of services for that visit as well as their total account balance. F. Payment is due at the time services are rendered. G. When the client is unable to pay in full at the time services are rendered, a payment plan is established, and the client must sign a “Payment Agreement Form” (Attachment D) except for minimum-fee or flat-fee charges. Client must then make a payment in any amount in order to activate the payment plan. H. When a client requests “no mail”, discussion of payment of outstanding debt shall occur at the time the service is rendered. A remark regarding “no mail” is entered into the medical data system. No letters or other correspondence concerning insurance or past due accounts will be sent to any client that requests “no mail”. Reasonable efforts will be made to collect charges without jeopardizing client confidentiality. I. The Billing Cycle for the Health Department (by Division) is as follows: 1. Personal Health & Dental Health Divisions a. Bills will be sent monthly by the tenth of the month for two months after services have been rendered indicating a statement of balance due. Every quarter, all accounts with a balance $50 or more that are more than 60 days past due will be forwarded to the County Attorney Office and pursued through debt set-off in accordance with the county policy. Accounts with a balance of less than $50 will remain delinquent until paid or written-off. b. If a debt is not paid, when the client attempts to make another appointment, the client will be told they have a previous balance, and they must have an active payment plan or make a payment at time of next service except for Family Planning clients. 2. Environmental Health Division a. An initial invoice for additional or miscellaneous Wastewater Treatment Management Program (WTMP) charges is mailed with the inspection form. b. If no payment is received within 90 days, a second notice is mailed. c. If no payment is received after an additional 30 days and the debt is $50 or greater, the account is forwarded to the County Attorney’s Office, which will pursue it through the county’s debt set-off procedure. d. Debt owed by a corporation or non-individual is dissolved upon sale of property. e. The county attorney’s office has deemed debt that becomes part of an estate will become dissolved. f. If the client presents and voluntarily wishes to pay on the account, any amount the client offers will be accepted, documented in the client file, and a receipt will be provided. g. Mobile Home Parks are billed annually on the calendar year. The procedure is the same as noted above. ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 8 of 8 Original Effective Date: January 25, 2001 Revision Dates:, 2/4/13, 8/12/13, 10/22/14, 9/22/15 J. Insurance and Third Party Billing 1. Where a third party is responsible, bills are to be submitted to that party; 2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL are properly billed 3. Third party bills (including Medicaid) show total charges without any discounts unless there is a contracted reimbursement rate that must be billed per the third party agreement. 4. The health department will bill insurance and managed care organizations for which provider approval has been established. The patient will be responsible for all deductibles, coinsurance and non-covered charges. 5. Patient or parent/guardian signature is required to give authorization to file claims and provide necessary information to the insurance company (Attachment E). 6. Patients, or the accompanying parent/guardian of an un-emancipated minor with appropriate insurance benefits, who receive public health services will be given the opportunity to choose whether to have insurance filed in order to avoid breach of confidentiality or pay the associated fee according to where the patient falls on the sliding fee scale. VIII. Review and Approval A. This Policy shall be reviewed annually by members of the Financial Review Committee. The committee shall have representatives from each division, and must also include the Health Department’s Finance and Administrative Services Director B. Any policy revisions must be approved by the Health Director and the Board of Health. ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I. Board Adopted Policies Policy H: Policy and Procedure for Complaints Reviewed By: Board of Health Approved By: Board of Health, Health Director Review Annually (July) Page 1 of 2 Original Effective Date: February 28, 2008 Revision Dates: 11/2013, 11/2014, 8/2015, 8/2016 \\kingcharles\Depts_AH\HEALTH\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.H Complaint Policy BOH_(8-2016 Revised).docS:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.H Complaint Policy BOH_Oct2015.doc Policy I.H. The Board of Health and Health Department staff will ensure that a mechanism exists for complaints to be considered and resolved from clients, patients, or residents regarding services delivered by the Health Department. Purpose The purpose of this process is to ensure that the Orange County Board of Health and Orange County Health Department have reasonable means in place to ensure that timely appeals can be heard from clients, patients, or members of the public. Guidelines 1. The Department will follow all provisions and requirements outlined by North Carolina General Statutes governing Health Departments, including but not limited to GS 130A. 2. If any provision of the following procedures is in conflict with General Statutes, the current Statute will govern. Procedures: Complaint procedures can be found in the following locations: 1. Orange County Health Department Administrative Policy and Procedure Manual a. Section X, Policy 12.0 HIPAA Privacy Complaints b. Section X, Policy 13.0 Discriminatory Complaints c. Section X, Policy 14.0 General Complaints 2. Environmental Health Services Policy and Procedure Manual a. Policy 6.0 Environmental Health Complaint Response Procedures 1. Procedure for a General Complaint a. A complaint shall be made either verbally or in writing to any staff member in the Health Department. b. The staff member receiving the complaint shall attempt to resolve the complaint. c. If the complainant is not satisfied, the staff member shall provide contact information for the most closely aligned Division Director. d. The Division Director will contact complainants within one working day and attempt to resolve the complaint. e. If the complainant is not satisfied, the Division Director shall provide contact information to the complainant for the Health Director. f. The Health Director will attempt to contact complainants within one working day and attempt to resolve the complaint. ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedure Manual Section I. Board Adopted Policies Policy H: Policy and Procedure for Complaints Reviewed By: Board of Health Approved By: Board of Health, Health Director Review Annually (July) Page 2 of 2 Original Effective Date: February 28, 2008 Revision Dates: 11/2013, 11/2014, 8/2015, 8/2016 \\kingcharles\Depts_AH\HEALTH\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.H Complaint Policy BOH_(8-2016 Revised).docS:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\Current Policy Manual\I.H Complaint Policy BOH_Oct2015.doc g. If the complainant is not satisfied, the Health Director will provide the complainant with the time and date of the next regularly scheduled Board meeting and invite the complainant to speak to the Board. The Board Chair and Vice-Chair shall be informed prior to the meeting. A summary of actions taken to date along with a description of the complaint will be provided to the Board in the agenda packet. Health Director’s Report June-July, 2016 • In June, I was invited by UNC Chapel Hill’s Chancellor to join other Zika experts in a discussion about Zika. This event was well attended and turned out to be quite the press event. My talk focused specifically on how people can avoid Zika infection. As a result of this talk, I received an invitation to speak at a national Zika conference. Unfortunately, I had a conflict, so was not able to attend. • The General Assembly legalized syringe exchange during the short session. This law goes into effect October 1. One challenge with the legislation is that it prohibits the use of “public funds” to purchase syringes. As a result, we’ve been working with the NC Harm Reduction coalition to develop a syringe-donation program so local health departments can request syringes that have been donated. In Orange County we implemented the program prior to the passage of the legislation so the syringes we purchased will last us through this year. We’ll work with the General Assembly to get a “technical correction” to change the wording to “state funds” rather than public funds. • The salmonella outbreak associated with the Chapel Hill Creamery was a great opportunity for us to work with our state and federal partners in food safety. The investigation continues, but we know for a fact that over 50 people in NC had the identical strain of salmonella as the raw milk from the creamery. Again, I can’t state strongly enough how cooperative and proactive Chapel Hill Creamery has been in their response to this outbreak. • We have filled the newly created Integrated Behavioral Health position. We are excited to have somebody with such great experience who is also bi-lingual. We’ll have an update on the program in about 9 months. We are also close to filling the newly approved Healthy Homes/Community initiatives Health Educator position. • Congratulations to Coby Austin for being selected as the FSA/BOH program manager in June. We are close to filling her position as well. • We are struggling to recruit people into our higher-level nursing positions. We are working with the county to figure out what we can do to increase interest in our positions. A typical non- nursing job posting here at the Health Department received on average 30-50 qualified applicants. Our nursing positions may get 1 or 2 and after the interview/job offer we get a lot of no’s. We know salary is an issue, but there are other things we are exploring as well. • We were notified this month that the second year of a two year grant we had received from the Office of Minority Health was cancelled. The General Assembly decided to move those funds from the Office of Minority Health to the Division of Public Health to focus exclusively on diabetes prevention programs for minorities. Ironically, that was exactly what our program did, so we were a bit of collateral damage in this decision. This represents a loss of about $50,000. We are working on various funding scenarios to present to the county. • I participated in a call with DPH leadership and the Secretary of DHHS to brainstorm ways to decrease the number of children in the state who are excluded from school because of immunizations not being up to date (or the exemption waiver not submitted). We’ll work closely with our two school systems to do whatever we can to keep our kids in school and appropriately vaccinated. • I gave two presentations at the NC Association of County Commissioners Annual Meeting in Winston Salem this month. One on naloxone and why it is important for health departments to continue to offer it even in light of the statewide standing order passed in the General Assembly in June. The other was on cost reports and why Medicaid billing accuracy is so important to maximize cost settlement payments. You’ll get a report on our total billing accuracy at the meeting, but for Medicaid, we’re doing about as well as any Health Department can do at over 96%. • We’ve rolled out the new Zika commercial (which I sent you) and the “Spray Before You Play” kiosks in all the county parks. The kiosks have been a big hit with the public. We’re tracking how often the cans of bug spray disappear, but right now, I’d say this is a successful experiment. We’re also responding collaboratively to standing water complaints. • We had another Gateway meeting this week and continue to make good progress on addressing system issues in the complex. This truly is a great opportunity for the Health Department to bring together a community group to address a social determinant of health, something I hope to see us do more and more. Public Health is all about root causes, and we need to get all the way to the start of these roots if we are to make significant progress in improving the population’s health. • We are working with other county departments and the architect to design a recommended expansion of the Southern Human Services Center space in Chapel Hill. Our first priority is to increase space for our medical clinic which has seen double digit growth in patient’s served over the last 4 years. Our next priority is the build a dental clinic. As I’ve mentioned in the past, we are exploring a collaboration with Piedmont Health Services to determine if the county could build the clinic, and Piedmont could staff/operate it. I’ll keep you posted. County budget in progress Zoe Schaver | Published 15 hours ago Read more: http://www.dailytarheel.com/article/2016/05/county-budget-in-progress Quoted from The Daily Tar Heel The county manager’s recommended Orange County budget for fiscal year 2016-2017 prioritizes affordable housing, transit and a livable wage for county employees, according to a presentation before the Orange County Board of Commissioners on May 5.At a public hearing on the budget on May 12, residents expressed concern that the budget provided only $1 million in additional funding to Orange County Schools, compared to the $1.7 million increase that was requested.Two public hearings and four Board of Commissioners work sessions are scheduled to finalize the budget by June 21. The next public hearing will take place May 19. Commissioner Penny Rich said while the board of commissioners will take residents’ concerns into account, Orange County has consistently provided its schools with high funding relative to other counties. “Orange County is and has been number one or two in the state for local funding of schools for over 20 years,” Rich said in an email. According to the 2016 Local School Finance Study by the Public School Forum of North Carolina, in the 2013-2014 school year, Orange County spent $4,355 per student, the highest of any county in the state and nearly $3,000 more per student than the state average of $1,500. Efforts to promote wage fairness in the recommended budget include a total wage increase of three percent for county employees over the course of the fiscal year. The budget also allocates more than $300,000 to maintain Orange County’s status as a certified living wage employer. For the 2016-2017 fiscal year, Orange County Living Wage has calculated an increase of $0.39 per hour in the living wage rate for Orange County to a total of $13.15 per hour. The Board of County Commissioners also identified salary compression, or the mismatch of employee salaries to their qualifications, as a major issue. The budget allocates $500,000 to begin a multi-year process of reducing salary compression. The recommended budget recognizes lack of access to transit as a main barrier to county services and recommends the creation of a county transit department that would report to the county manager’s office. In addition, the budget allocates $68,000 to create new fare boxes on Orange County Public Transit buses. The boxes will accept bus passes and prepaid cards to improve upon the current system where riders pay with cash. Another policy priority established by the commissioners is affordable housing. The recommended budget increases funding for affordable housing programs by $236,600, including urgent home repair, rehabilitation and home ownership programs, bringing the total allocation of funding toward affordable housing to $1.2 million. In the realm of education, the recommended budget eliminates the fair funding program, which split funding equally among school districts, in favor of health and safety service contracts that will provide school resource officers to middle and high schools and a public health nurse to every school facility. This change requires an addition of $1.4 million in funding on top of the $1.9 million already allocated for the fair funding program. Other aspects of the new budget include enhancements to OC Alerts, the current public emergency notification system for Orange County. Read more: http://www.dailytarheel.com/article/2016/05/county-budget-in-progress Quoted from The Daily Tar Heel Getting to know your EHR! View this email in your browser May 2016 Attention all users There is no better time than NOW to has taken an Orange County Health Department start living healthy. active role in encouraging not only their community but also their " Walking the Walk"And not only that, they turned it into a staff! challenge with neighboring health departments. Setting good examples can have widespread contagion! Let's all do our part to set good examples for those around us! Patagonia Health has recently rolled out various enhancements to our software that should have a big impact on your agency's efficiency, safety and security. These have been sent out in our release notes, but we'd like to point out a few in this month's Vital In addition, we .Photo Capture and State Consent Forms News: who was a pivotal publicly thank Sarah Graham would like to contributor, along with Steve Garner (DMA), throughout the lengthy consent forms development process. In addition to the above system enhancements, this issue of the about your EHR system quick tips and How to's Vital News has the company ng and rainy photos from ouruse, as well as some smili As usual, feel free to share this with your last weekend. outing coworkers who are not already on our mailing list. If you wish to change your subscription preferences (subscribe or unsubscribe, or .eclick her change email address etc) please Cheers! From the Patagonia Health team! In This Issue User Focus Groups Electronic Consent Forms -Thank You Sarah Graham Cost Settlement Reports Quick Tip Reminder Take My Picture Orange County's Walking the Walk Challenge How to Reactivate Inactive Patient Records Fun & Laughs! Did you know... that our "Patient Name" PS: Sorry for the delay in sending the May issue (in June), but it is all still good information! search function now displays 30 possible name results rather than just 10? Quick Tip After any system updates, such as a new release, clearing your browser's cache will prevent old data from being displayed in the system. See details on how to clear your cache in our Knowledge Base Articles here: Clear the Cache in Firefox User Focus Groups Clinical & Billing User Groups - Next Up! Combined Groups Meeting June 9, 2016, 9a - 5p Dare County Health Department Dare County Administration Building, room 168 954 Marshall Collins Drive Manteo, NC 27954 Topics will include:  Lab Widget & Update (Abhi Muthiyan)  HIS Data & Data Interface (Abhi Muthiyan)  Demo of New Orders and Procedures Section (Sonali Luniya)  Maternal Health App Item (App District Health)  Billing Update (Debbie Widener) If you have questions contact Melissa Bracey, Director of Marketing & Regional Services, Appalachian District Health Department Electronic Consent Forms We're excited about the collaborative work between Patagonia Health and the Clinical User Group to develop new Electronic Consent Forms in the EHR. It includes all standard consent forms and will have touch screen electronic signature capability. These forms can be flagged "to be completed" in a patient's record, and can be signed during registration or in clinical areas while the patient is being seen. This functionality will be piloted with a few counties (in June/July) and be available for everyone once testing has been completed (hopefully Oct/Nov 2016). Thank you Sarah Graham - Beaufort County Health Department! When NC DHHS Division of Medical Assistance (DMA) announced new requirements for NC cost settlement reports, a critical collaboration of efforts kicked in. The development was a long process to insure report accuracy and compliance and we could not have done it so well without Sarah Graham, Finance and Administrative Services Division Director at Beaufort County Health Department. Sara was instrumental in getting us detailed information and feedback required throughout the development process. This project was led by Steve Garner, Medicaid Consultant for NCDHHS Division of Public Health who played in integral role as an interpreter and liaison between Patagonia Health and DMA. Together Steve and Sarah's efforts helped Patagonia Health produce a final Cost Settlement Report that can be easily compiled and submitted by every county health department in NC. Instructions to run the Cost Settlement report for FY 2015 1. Log in to EHR 2. Go to Reports -> Custom Reports 3. Select Cost Settlement Report 2015 4. Click on Export to Excel (you do not need to select date range) 5. This will generate report for July 1 2014 - June 30 2015 6. You will see an Excel spreadsheet downloaded. 7. Send the downloaded spreadsheet to Steven Garner Quick Tip Reminder For many of our clients, the end of the 2nd quarter means expiring fee schedules! To avoid a billing backup on July 1st, please have your Billing department review, verify and copy your fee schedules prior to June 30th. Full instructions are filed in our Knowledge Base Articles: Copy Fee Schedule Take My Picture! Another System Enhancement Coming Soon - Quick Photo Capture process! Currently under pilot testing with Franklin County Health Department, the new "photo capture" process will allow you to quickly take a patient's photo (from within the patient demographics screen) at the time of registration and easily click and save to his/her record. No manual uploads required! The biggest benefit of adding a patients' photo is the visual confirmation of pulling the correct record for each patient, especially for common names! Performing Meaningful Use Measures for 2016 Last week we conducted a webinar to walk through the how-tos of performing Meaningful Use measures in your Patagonia Health System. Thank you to all who attended. If you didn't get the chance to attend the webinar we now have a recording with the Power Point available on our support portal. View here Orange County Health Department Completes "Walking the Walk" Challenge This year's Walking the Walk Challenge, organized and monitored by Orange County Health Department, was won by Orange County, with their cumulative miles walked between March 7 and April 22nd totaling 4,786 miles! Photo shows Durham County handing over the trophy. Since 2014, Orange County has been organizing their annual event and challenging their staff to live healthier lifestyles. The challenge has grown in number since then and now includes Durham and Alamance Counties. "Our first challenge, OC to OC, drew national attention from APHA and Walk with a Doc out of Denver. This was my favorite of our all of our challenges because it linked us to other health departments and public health initiatives across the country" said Stacy Shelp, Communications Manager (and the challenge organizer), Orange County Health Department. "We have found tremendous success from the challenges and seen significant increases in the levels of physical activity of our staff as well as improved cross - departmental team work and morale." A local reporter picked up the story with an added editorial message about health departments walking the walk as an example to the community. Stacy adds "I would say that example, as well as motivating sedentary staff to become more active and increasing team cohesion were our main goals. All of which I would say we accomplished." If you have a program the sets a good example and challenges your staff, we'd love to hear about it!! If you don't yet, perhaps now is a good time to find the right motivational program for your area. Get your staff moving, with a "healthy lifestyle" program that fits your department's unique needs, personality and cultures! And use your neighboring departments to add friendly rivalry for extra motivation! Whether you climb the Stairway to Heaven, or commit to the 12-step program, do something now for a healthier life. How To Reactivate Inactive Patient Records If a patient's account is in inactive and you would like to reactivate the account, please follow the steps below: -On the dashboard, locate the "Patient Advanced Search" widget. -Click on "Advanced Search" (click on image for larger view) -Enter the patients first and last name or the MRN#, also check the box to "Include Inactive Patients" -Then Click "Search" (click on image for larger view) You will see the name appear at the bottom of the widget. -Click on the patients name, it will open up to the patient's inactive account. -Click on "Patient Details" (click on image for larger view) -On the Patient tab, in Patient Details (on the right side of the screen) click the "Active" radio button. This will move the patients account from an "Inactive" to "Active" status. (click on image for larger view) -Click the "Save Button" to accept the change. (click on image for larger view) Back to Top Fun & Laughs! Patagonia Health's staff and guests assembled at Cary, NC's Koka Booth Amphitheater to see comedian Russell Peters. Very fun and funny night... It poured for awhile, but we didn't care! Copyright © 2016 Patagonia Health, All rights reserved. Combined lists Our mailing address is: Patagonia Health 1915 Evans Road Cary, NC 27513 Add us to your address book Want to change how you receive these emails? You can update your preferences or unsubscribe from this list Chapel Hill Resident Being Monitored After Encounter with Rabid Raccoon By Blake Hodge Posted June 2, 2016 at 3:18 pm The second positive rabies test result of 2016 in Orange County has been confirmed by the North Carolina State Laboratory of Public Health. Orange County Animal Services officials say this incident originated from a Chapel Hill resident finding an injured raccoon on the roadside. The resident picked the raccoon up in a towel, according to a release, and transported the animal to a veterinary office. Animal Control was called and removed the raccoon to have it tested for rabies. No domesticated animals were involved in the case, according to officials. A communicable disease nurse from the Orange County Health Department is working to evaluate whether the resident is at risk of rabies. The release says the resident directly handled the towel the raccoon was in without gloves and possibly had open wounds on his hands at the time of handling. Orange County reported a total of 10 positive cases last year, which was a drastic drop from the 23 cases in 2014. Orange County Establishes Rules for Food Trucks By Chris Grunert Posted June 8, 2016 at 1:22 pm The Orange County Board of Commissioners passed an ordinance establishing rules for food trucks in the county Tuesday. The ordinance applies to unincorporated land in Orange County outside of town limits. Commissioner Penny Rich wanted to extend the time those businesses can operate until midnight, opposed to nine, which was originally proposed. “If you really want to let food trucks make some money with their business it should be later,” said Rich. After some discussion, the board decided on 10 o’clock as the latest time they can operate. That applies to trucks operating within 200 feet of a residence. Food trucks in Chapel Hill and Carrboro proper can operate much later, with many staying open past two o’clock in the morning. “I think the county is going to be a different animal anyway, I don’t see that it’s hanging out waiting for the bars to close so everyone can get their last bite before they go home,” said Rich. The ordinance prohibits food trucks from setting up on residential zoned or undeveloped land, unless it’s a private event. Those parked in commercial properties must also leave parking spaces for customers to that respective business. State law sets some basic health requirements for food trucks but doesn’t mention location or time restrictions. Commissioner Barry Jacobs said the time restriction would be difficult to enforce. “Unless we vigorously publicize the details of this ordinance, when 10 o’clock comes and somebody doesn’t shut down, nothing’s going to happen,” said Jacobs. The ordinance doesn’t require food trucks to get any additional permits, outside of what is required to comply with the health department. New Hope Elementary Students Get Books for Summer Break By Charlton Budd Posted June 11, 2016 at 11:49 am An estimated 650 elementary students at New Hope Elementary School in Hillsborough picked out six to ten books to read over their summer break to keep them engaged. Students gathered at the elementary school on June sixth and seventh to work with staff members and volunteers to help the students select books. Students were encouraged to select books they were interested in to keep them engaged over the summer. According to a New York Times article, researchers found that the lack of intellectual engagement over the summer accounts for about half of the overall difference of achievement between higher and lower income students. The achievement gap is one of the main reasons for the Books on Break program allowing kindergarten and first grade students to stay engaged during the summer months. New Community Health Report Released By Chris Grunert SHARE THIS: Posted June 15, 2016 at 8:27 am The Orange County Health Department has released its Community Health Assessment for 2015. Ashley Mercer with the Orange County Health Department said the assessment lets her office better understand what they need to focus on. She said their main priorities were improving access to healthcare, preventing substance abuse and promoting physical activity. “We assess the health of the overall county and it just gives us the health priorities that are deemed important by our residents,” said Mercer. According to the assessment, about 15.3 percent of Orange County residents are uninsured. And even with a high median income in the county, 17 percent of residents live in poverty. So for many that means not being able to go to the doctor or missing out on needed medical services. Mercer said many factors go into solving that issue. “The overall availability and affordability of services, physically being able to access services, understanding the health system and then socio-economic conditions that includes things like poverty,” said Mercer. Approximately 6,000 Orange County residents did, however, sign up for the healthcare marketplace in 2015, according the assessment. Orange County has made progress in the past year on dealing with substance abuse. Emergency services have also begun using the drug naxolone in opioid overdose situations. So far it reversed overdoses for at least four people in Orange County. The Health Department is making efforts to improve physical activity and nutrition in the county. Mercer is also in charge of Healthy Carolinians of Orange County, which partners with schools, churches and businesses to promote active lifestyles. Mercer said that local partnerships are crucial for the department’s work. “So even though we see these numbers and what it means, we know that it’s not doable unless we have everyone involved,” said Mercer. “It takes a village to decrease these numbers and make our county healthier. SHARE THIS: Orange County Gets More Aggressive in Zika Fight By Chris Williams Wednesday, June 15, 2016 at 03:14 PM EDT ORANGE COUNTY -- Health officials are ramping up their efforts to stop the spread of the Zika virus. "Part of that comes from just all of the national and global attention around Zika," says Stacy Shelp with the Orange County Health Department. According to the CDC, North Carolina has 11 cases of the Zika virus. No cases have been reported in Orange County, but health officials say they're not waiting around. Orange County health leaders have released an educational video on reducing the mosquito threat and how to use bug repellent. They also have mosquito “dunks,” which are tablets that are used to treat standing water. As early as July, the county will make bug spray available to the public at all of the county's parks. "We call it the spray before you play. We want people outside having fun but doing it safely," says Shelp. In Hillsborough, town leaders want to do more. They are looking to raise more awareness and also proactively checking ponds and wetlands. They're also considering an ordinance that will regulate standing water on private properties. "We're interested in educating people and taking care of problems," says Mayor Tom Stevens. In Chapel Hill, town leaders recently hired a mosquito control officer to help reduce the Zika threat. Health officials also caution people to remove or treat standing water to help reduce the spread of the Zika virus. New Hope Elementary students receive ‘Books on Break’  The Family Success Alliance  Updated Jun 11, 2016 HILLSBOROUGH — Approximately 650 elementary school students at New Hope Elementary School were able to select six to 10 books each to enjoy over their summer vacation thanks to the Books on Break program. Students gathered at the elementary school in Hillsborough on June 6 and 7 to work with staff members and volunteers from Orange County Schools, the Orange County Public Library, Friends of the Orange County Public Library, New Hope Elementary and the Family Success Alliance to help them select books. Students were encouraged to select books of interest, not just reading level, to provide many opportunities for reading over the summer, when a large number of kids experience “summer slide” due to lack of educational engagement. Inequity is one of the main reasons the Family Success Alliance is partnering with the Friends of the Orange County Public Library, the Orange County Public Library, Book Harvest and the Orange County Schools to ensure kindergarten and first -grade students receive books to help keep them engaged during the summer months. “This is just so powerful. The partnership and working together has been amazing and inspiring” said Lori-Anne Shapiro, Chair of the Orange County Friends of the Library, in a statement. “We are so pleased to not only have been able to contribute more than $5,000 to purchase books for the kids, but also getting to work side -by-side with the school throughout the process.” It was this partnership that inspired the Orange County Schools and New Hope Elementary to contribute additional funding to create the opportunity for second through fifth-grade students to also able to participate in the program. “Literacy and a love of reading are some of the greatest gifts that we can foster in our students,” Orange County School Superintendent Dr. Todd Wirt said in a statement. “Through the work of our school system and the support our partners, we're pleased to be able to provide this opportunity at New Hope.” Orange County Health Department is Fighting Mosquitoes By Erin Wygant SHARE THIS: Posted June 16, 2016 at 2:11 pm Mosquito Prevention Tips. Photo via Orange County Dept. of Health. Warm summer nights are perfect for sitting on the front porch and enjoying the company of family and friends. But this time of year, there are also some unwanted guests – mosquitoes. The pesky insects known for their itchy bites and dangerous diseases come out in full force this time of year, something that public information officer Stacy Shelp says the Orange County Health Department is ready to fight. “With all the talk this year of Zika, we wanted to take a proactive approach in providing our residents with some resources and education that would empower them to fight the bite.” One of the best ways to fight the bite, is to invest in mosquito dunks. “Mosquito dunks look like a very small donut. You place them in standing water. A mosquito dunk as a whole can treat up to 100 square feet of water, but you can also break them up into smaller bodies of water like a bird bath.” Mosquito dunks have naturally occurring bacteria that is only toxic to mosquito larvae. It prevents the insects from breeding in standing water and maturing into biting adults. Orange County residents can stop by one of the health department’s three locations to pick up mosquito dunks on a first come, first serve basis. They can also be purchased at most home improvement and hardware stores. But Shelp says there’s even an easier way to stop mosquitoes from breeding. “After a rain storm, walk around your property and look where you have standing water – flower pots, gutters, leaves, also tall grass is another good place for mosquitoes to breed. So just walking around your property, taking inventory and getting rid of any standing water is the best way to strop breeding.” In addition to eliminating standing water, Shelp advises residents to secure their homes and use protective sprays. “Make sure you’re covered up as much as possible, using air conditioning rather than opening your windows and letting the mosquitoes in, making sure your screens don’t have holes in them – there’s a whole variety of things you can do.” The health department is also working to place boxes with insect repellent in seven county parks. The “Spray before you Play” stations will include cans of bug spray and instructions on to how to use them. The boxes are scheduled to be installed in mid-July and remain through the end of September. Although Shelp says mosquitoes are more active in the evenings, it doesn’t mean those warm summer nights have to go to waste. She’s got a trick for that too. “Put a fan out there with you. Mosquitoes have a really hard time flying in that current, so it’ll keep you refreshed and the mosquitoes away.” More information and educational videos about mosquito prevention can be found on the Orange County Health Department’s website. Study: North Carolina Minors Have Easy Online Access to E- Cigs JUNE 22, 2016 by EDITOR in CHILDREN'S HEALTH, FEATURED, PUBLIC HEALTH, RESEARCH NEWS, SUBSTANCE USE with 1 COMMENT By Bradley Allf Gone are the days of the Marlboro Man, but the tobacco industry is finding new ways to lure young people. Though today’s youth smoke far fewer cigarettes than their counterparts did 20 years ago, an emerging market for electronic cigarettes is providing a new outlet for nicotine use among young people. Since funding for North Carolina’s teen smoking cessation program was cut, more teens are using nicotine, either by lighting up or using e-cigarettes. Photo courtesy Nerissa’s Ring, flickr creative commons Despite a state law prohibiting the sale of these products to people younger than 18, a study by UNC -Chapel Hill researchers found that North Carolina minors can easily obtain electronic cigarettes over the internet. “E-cigarettes,” as they are called, are a group of various battery-operated devices that allow users to inhale nicotine vapor. Originally promoted as smoking cessation devices, the products are now exploding in popularity among teens, ma ny of whom have never smoked conventional cigarettes. One recent study found that high school seniors are now twice as likely to use e - cigarettes as conventional cigarettes. Of the estimated 4.7 million middle and high-school students in the US that used tobacco products in 2015, 3 million were e-cigarette users. The e-cigarette business, almost nonexistent 10 years ago, has burgeoned into a multi-billion-dollar industry. Effective policies have struggled to keep pace, leading one FDA official to label the market the “wild, wild West.” North Carolina, for its part, outlawed the sale of e-cigarettes to minors in 2013. Researcher Rebecca Williams from UNC-Chapel Hill wanted to find out how effective this law was in preventing minors from purchasing e-cigarettes online. To test this, her team recruited 11 teenagers from 14 to 17 years old to try to purchase e-cigarettes over the internet. The research is described in an article in the Journal of the American Medical Association. The research The team identified 98 online e-cigarette vendors for the study. They then allowed the 11 teens, under supervision, to attempt to buy e-cigarette products from the different vendors. Of the 98 purchase attempts, only 5 failed due to age-verification requirements. NC State Fair Premium List, 1893. Image courtesy of Government & Heritage Library, North Carolina State Library, via Flickr Creative Commons In fact, more than 80 percent of vendors either did not attempt to verify age, or used clearly ineffective means of verifying age, such as offering a check box. The only consistently effective age-verification techniques that Williams and her team found were requirements to enter a date of birth in conjunction with a social security number. Williams is a researcher at the UNC Lineberger Comprehensive Cancer Center and Center for Health Promotion and Disease Prevention. She has done similar studies on youth access to conventional cigarettes and anticipated these results. “The rate of success with e-cigarettes is similar to what we found with cigarettes,” she said. “So it didn’t surprise me at all that it was easy to buy e-cigarettes online for teens.” So why aren’t online vendors following North Carolina law? Williams explains that part of the issue is jurisdictional. “When you’re making an online purchase, where is that purchase taking place? Is it taking place where the person who is ordering is located? Is it where the website is hosted? Is it where the business is located?” she asked. “Those all may be in different states and different countries.” It can be tough to know where exactly the boundaries of enforcement fall when dealing with online purchases. It is also exceedingly difficult to track down these vendors, many of whom operate internationally. Better than cigarettes? According to a report released by the American Heart Association last year, “[e]- cigarettes are mostly unregulated and their health effects are not fully known, especially when associated with long-term use.” Research on the effects of traditional cigarettes accumulated over decades. However, because e-cigarettes sprang quickly onto the US market in 2007, there hasn’t been enough time for researchers to determine how e -cigarettes affect the human body. Some of the e-cigarette liquids for sale in N.C. today. Flavors from left to right: watermelon, Irish Cream and appletini. Photo credit: Rose Hoban Despite this, there are already some known risks associated with e-cigarettes. One instance concerns the chemicals used to flavor the vapor. While these chemical products are approved by the Food and Drug Administration for ingestion, they have not been approved for inhaling. “Safe to ingest does not mean safe to vaporize and inhale,” Williams says. “When they vaporize a product at a high temperature, it creates more and more dangerous chemicals that can be damaging to lung tissue and other tissue.” Chemicals such as diacetyl (butter or popcorn flavor) and cinnamaldehyde (cinnamon flavor), both of which are found in many e- cigarette flavorings, pose known health risks. In addition, nicotine itself is highly addictive and can have long-term consequences for brain development, particularly for young people. Taken together, these health risks have many people concerned. “I think we know they’re not safe and we’re still finding out how unsafe they are,” says Peg O’Connell of the North Carolina Alliance for Health. “I think that’s the public health message.” Policy changes At the national scale, the FDA announced in May that it will begin regulating the sale of e -cigarettes in August. This policy was partially informed by the Internet Tobacco Vendors Study, which based its suggestions on the research findings of Williams an d her team. Williams believes this is a step in the right direction. She said a national policy would address some of the jurisdictional problems associated with having different regulations in different states. She hopes that the FDA will end up enacting strict age-verification requirements for online vendors at both the point of order and the point of delivery to keep minors from getting access to e - cigarettes. Locally, North Carolina health organizations are working on a number of fronts to enact policies designed to stem the rising number of young people who are using e-cigarettes. O’Connell is working with the North Carolina Alliance for Health to bring back the state’s formerly award -winning youth tobacco prevention program. According to O’Connell, education initiatives such as the state’s previous anti-tobacco effort may be effective in keeping e-cigarettes away from minors. The Orange County Health Department, in concert with the Orange County Board of Commissioners and counties across the state, has been advocating other e-cigarette control policies. Orange County health educator Coby Jansen Austin supports a public policy of giving jurisdictions the right to raise the minimum sale age for tobacco and e-cigarettes from 18 to 21. According to Austin, policy actions make a real difference in decreasing the number of young people who start using tobacco products. “What we know has worked in tobacco control and contributed to a lot of the drop in tobacco use that we’ve seen over the last five or six decades are some of the policies around tobacco,” she says. “And so I think the FDA regulations are a good exampl e of where we have the appropriate research and we take appropriate policy actions. It’s not just about education and sharing information, though those are also components.” Tagged American Heart Association, Centers for Disease Control and Prevention, e-cigarette, FDA, Food and Drug Administration, National Youth Tobacco Survey, NC Alliance for Health, Orange County, tobacco, tobacco cessation, UNC Chapel Hill, UNC Lineberger Comprehensive Cancer Center and Center for Health Promotion and Disease Prevention, youth tobacco use Horse Owners Urged to Vaccinate Equine to Prevent Fatal Virus By Logan Wheless Posted June 24, 2016 at 10:21 am Horse owners are urged to vaccinate their equine after two horses were diagnosed with Eastern Equine Encephalomyelitis in Horry County, South Carolina. The North Carolina Department of Agriculture and Consumer Services released the news Wednesday about the two horses that have contracted the virus which is most often fatal due to the swelling of the brain and spinal cord. Public Information Officer for the NCDA Jennifer Kendrick explained the mosquito-borne virus as something to be aware of year-round. “We’ve been encouraging horse owners to get their horses, donkeys, mules vaccinated against EEE for several years now and because our mosquito season can go pretty much all year long at times depending on the year, we do encourage horse owners to keep up that vaccination twice a year to protect their equine.” Kendrick shared some signs of the EEE virus and what types of behavioral changes you may want to look out for. “Fever and rapid heart rate, them not wanting to eat, depression, circling is one of the signs of it, muscle weakness, head pressing and wall leaning, those are some of the things you should look out for,” Kendrick said. “Those could also be several other viruses as well, so whenever you do notice any changes in your equine, you really do need to contact your veterinarian and have them checked out pretty quickly.” This virus can also be contracted by humans, although it is very unlikely to happen, Kendrick said it’s always smart to take extra precautions around your property to protect your equine and yourself. “Just do everything you can, you know, we get a lot of rain in North Carolina in the summer so being vigilant about keeping things emptied out, as small a bottle cap, mosquitoes can breed in very small spaces and very little bit of water, so being vigilant in keeping those kinds of things cleaned up on your property is a great way to prevent.” Orange County Health Department shared more helpful tips on how to maintain a mosquito-free property. Folt holds panel on Zika virus Noni Shemenski | Published 6/30/16 Chancellor Folt hosted an event on Zika virus awareness Thursday. The event included informational booths, guest speakers and a Q&A with the speakers. “We want to give people as much information as possible to help them protect themselves and the community,” Folt said. Among those in attendance were researchers, professors, UNC employees, members of the Chapel Hill community and students. Junior Barbie Adams decided to attend as a precautionary measure before her trip to Jamaica, a country affected by the virus. “I know I’m always getting bit here so I can only imagine what will happen when I go over there," Adam said. "Especially if the mosquitos are carrying the virus, I just want to prevent (getting infected). "Representatives from various university and state departments camped out in booths outside of the Union to spread information and pass out fliers and bug repellent to attendees. Chris Goodman, travel clinic coordinator for Campus Health, suggested to those traveling abroad, especially to areas with active Zika transmission, to stop by the clinic for more information about how to stay healthy during their travels. David Stamilio, a professor from the department of obstetrics and gynecology, warned of the threat Zika poses for pregnant women and how to prevent the sexual transmission of the virus. Frank Stillo, an environmental specialist with the Office of Environment, Health and Safety, urged students and university employees to report standing water to prevent mosquitos. Stillo also told attendees how to control mosquitos. Guest speakers then took the stage to share information about risk factors, how to prevent the virus and what research UNC is doing on the virus. Aravinda de Silva, a researcher from the UNC School of Medicine, said the school is currently involved in research focusing on the virus and other associated viruses, such as yellow fever and Japanese encephalitis. “As an educational moment, this is fascinating,” Folt said. Colleen Bridger, the Public Health Director for Orange County, reported the best ways to prevent Zika are to avoid areas where Zika is active, avoid unprotected sex with men who have traveled to areas known to have Zika, avoid mosquito bites, mosquito-proof your home and garden and to avoid mosquitos if you have had Zika. “It is important not to panic," de Silva said. "You need to put your risk in perspective.” UNC Hosts Zika Awareness Event By Erin Wygant Posted June 30, 2016 at 5:25 pm UNC Zika Awareness Event. Photo via UNC. Bug spray and ice cream are an unusual pairing. But both were free during UNC’s Zika awareness event on Thursday. People lined up for their bottle of “Off” and scoop of ice cream alongside Chancellor Carol Folt. “I have to admit, I said let’s do the ice cream because I wanted students to come and it’s summer and it’s always fun to share ice cream,” Folt said. The sweet treat lured people to the seven booths set up outside the Student Union where representatives from the North Carolina Department of Health, UNC Ground Services, Campus Health Services and more were sharing information about the Zika Virus. Mary Beth Koza, the director of environment, health and safety at UNC, said the event focused on eliminating people’s fears. “We are creating a Zika awareness event. It’s for our faculty and staff and students to learn what it is, how to prevent it and to eliminate any fears.” The event also included speeches from Folt and health professionals. More than 80 people crowded into an upstairs room of the Student Union, lined the walls and listened from the hallway to hear what they had to say. “I’m so pleased to see everyone here. We have a wonderful group of people to talk about Zika virus. It’s an important topic, I know it’s been in the news a lot and is going to continue to be in the news, so this seemed like a good time for this event,” Folt said. Joining Chancellor Folt on stage was Dr. Colleen Bridger, the Orange County Health Director and Dr. Aravinda de Silva, a professor of microbiology at UNC and a Zika researcher. De Silva, who recently received a $50,000 pilot grant for his work on Zika, spoke about the virus’ specific impact on Chapel Hill. “For the campus and the surrounding community, the biggest threat is for people who travel and get infected or from Zika endemic areas that come here.” He said that although the type of mosquito that carries Zika can be found in North Carolina, it’s unlikely that many in the Triangle are carrying the disease. “I think the risk is very low. The main vector is nearly absent in our community. Even if it does present in low numbers, the probability is really low.” Dr. Randall Williams, the director of North Carolina health and human services, shared what is being done at the state level. “We’re not waiting on any funding. We use resources within public health because that’s what we do. We’re always faced with emerging threats, so we’re working with entomologists who know the area well to identify the main carrier.” The speakers answered questions from the audience that addressed travel concerns, the threat of birth defects and how to best prevent the virus’ spread. In the audience was Chapel Hill Mayor Pam Hemminger who said she was relieved to get some answers. “One of the things that makes Chapel Hill so special is that we have a lot of talented people that work and live here, and that’s pretty special for a small town.” As Folt looks to the new school year, she said the University is still developing a plan to support and educate students about Zika. “We haven’t figured out exactly what we’re going to do – probably integrate some things into orientation. I also think we need to see how it progresses.” As scientists keep an eye on how Zika progresses, students and community members are advised to wear long sleeves, wear bug repellent, secure all screens and windows and avoid travel to Zika infected areas of pregnant. More information can be found on the CDC’s website. Napoli delivers taste of Italy in a truck By Matt Goad July 6, 2016 6:00 AM When Gael Chatelain decided to start a Neapolitan -style pizza truck in Carrboro, complete with a wood-burning oven, he figured there would be some bureaucratic hoops t o jump through. That part, at least, turned out to be easier than he expected. Chatelain contacted the Fire Department, which referred him to the Orange County Health Department. “It’s one of those things that so few people have tried that it’s not in the rule book that you can’t do it,” Chatelain said. He bought an old delivery truck in 2014 that would be sturdy enough to support the nearly 2- ton oven and the several hundred pounds of wood the Napoli Gourmet Wood -Fired Pizza truck also carries. He built the 56-inch oven using a kit and then covered it in insulations and four layers of mortar, and covered that with 10,000 pennies, an idea that wife Sonja got from seeing pennies used as tile on Pinterest. “I was looking for some way to cover the oven that wou ld be easy to clean that wouldn’t be too heavy,” Gael Chatelain said. “The pennies were the cheapest, lightest, most interesting way we could think of to cover it.” He had to have a bank special order the pennies for him. To decorate the outside of the truck, he went to a business that covered it in vinyl designed to look like bricks with a background map of Naples, Italy, the home of Neapolitan pizza. Chatelain found a spot to set up at a dentist office’s parking lot at 203 N. Greensboro St., just south of Fitch Lumber & Hardware, and first opened on July 2, 2015. For the first few weeks he manned the truck by himself, working 16-hour days. He made his first hire at the end of that July and now he has seven employees and is open seven days a week from 5 to 10 p.m. Napoli also now delivers, although Chatelain stresses that Neapolitan pizza is meant to be eaten right out of the oven. They only make one delivery at a time to ensure freshness. Until his family moved to Hillsborough when Chatelain was 12, he had grown up in West Africa. His family spent those summers in Switzerland, where he first had Neapolitan pizza, featuring a crust no more than 3 millimeters thick. In Italy, restaurants do not even slice the pizza, giving the customer just a knife and fork to use. There is an organization founded in Naples about 30 years ago that certifies true Neapolitan pizza, which Chatelain said he plans to get. First of all, the oven must be entirely wood-fired, which Napoli has covered. The oven temperature must be 900-950 degrees Fahrenheit, and the pizza must be cooked in 90 seconds or less. For the sauce, a certified business must use only San Marzano tomatoes, salt and olive oil. For the crust, 00 (referring to the most finely ground type) Caputo flour forms the base, with only salt, fresh yeast and water added. The best way to judge a Neapolitan pizza business, Chatelain said, is to order the Margherita. Because it calls for only tomato sauce, mozzarella, olive oil and a few leaves of fresh basil, there is no way to mask inferior ingredients. Fresh out of the oven, the crust is somehow both a bit spongy but still crispy, even with a slice folded in half. Chatelain imports his meats from Europe and uses organic greens. His olive oil comes from Italy. In warm weather Napoli serves about 400 pizzas a week. Business has been good enough that Chatelain is looking for a second used truck to expand. Jeff Herrick, who lives about a block away from the current location, said he orders about once a week. He calls ahead and by the time he makes the 10-minute walk over his pizza is usually ready. “I have to walk by it a lot, and it calls to me,” he said. Gaorav Gupta of Carrboro and his family have made a Thursday-night tradition of stopping at Napoli after picking up the kids from daycare. They recently moved from New York, where they learned to love Neapolitan pizza. “When we first saw this truck in Carrboro, as first we didn’t know if it would be good, but once we tried it, it was wonderful,” Gupta said. Read more here: http://www.newsobserver.com/news/local/community/chapel-hill- news/article87475952.html#storylink=cpy New Syringe Initiative in Orange County By Erin Wygant Posted July 15, 2016 at 3:32 pm Orange County Health Department According to the CDC, the spread of Hepatitis C in North Carolina jumped a staggering 200 percent between 2007 and 2011. The Orange County Health Department is working to combat those statistics with a new initiative. “We know that there’s an overwhelming amount of evidence that increasing access to clean syringes is a cost effective way to decrease the transmission of HIV and Hep C,” said Robin Gasparini, a nursing supervisor at the Orange County Health Department. Gasparini is working on the new Syringe Initiative – something that was illegal until this month. “We’re trying to reduce the spread of HIV, AIDS, viral Hepatitis and other blood borne diseases that impact our communities,” she said. “And we’re also trying to reduce needle stick injuries to law enforcement officers and other emergency personnel.” On July 11, Governor McCrory signed House Bill 972 which legalized syringe exchange programs in North Carolina. The latest legislation allows for government and private agencies to establish exchange programs where citizens can get sterile syringes as well as deposit their used ones for safe disposal. Within days of the bill passing, the Orange County Health Department’s syringe initiative is already up and running. “We know that we have a lot of individuals in the community who use needles for a lot of different reasons,” Gasparini said. “Chronic illness, diabetics, people who take allergy shots and things like that, in addition to IV drug use, so we have a lot of needles that need to be disposed of properly and this provides access for that as well.” The initiative also connects people who struggle with addiction to health care services, housing, career training, and drug testing and treatment programs. “This has been a controversial topic but we’re very excited to be able to offer such an important initiative that is going to address this hidden but stigmatized and very large public health issue,” Gasparini said. This legislation comes in the wake of the naloxone initiative – legislation that made the life- saving opioid reversal drug more accessible. Gasparini says the new syringe initiative will work in tandem with naloxone as they both seek to address overdose issues in the community. The Orange County Health Department has been working on its syringe program for several months, preparing for the new legislation. “We have been looking and investigating and really gearing up over the last three to four months to provide syringes to the community since the early part of the year when we had need brought to our attention.” Gasparini says the health department is ready to serve the community’s needs and is now working to establish a trusting relationship with those in need of the syringe initiative. “We have our drop boxes, we’re ready to go, we have our syringes ready to distribute as needed, so I think moving forward it’s about engaging the community and building that trust with individuals who may need our services,” Gasparini said. There are drop boxes in the lobbies of both clinics in Chapel Hill and Hillsborough. More information about the initiative can be found on the Health Department’s website ORANGE COUNTY HEALTH DEPARTMENT SWAPPING USED NEEDLES FOR CLEAN ONES 7-20-16 HILLSBOROUGH — The Orange County Health Department has been quietly exchanging needles for drug users and diabetic patients since April. The Safe Syringe Program only became official when Gov. Pat McCrory signed a new state law July 11 outlining the requirements under which local agencies could offer needle, or syringe, exchanges. It’s exciting to be able to offer a program that’s addressing “a large but hidden and stigmatized public health issue,” said Robin Gasparini, county nursing supervisor. “Having this law passed allows us to really go out there and actively partner with the community about our program and share information,” she said, “and I think it’s really critical for people to know that there’s a safe avenue.” They are still working with the state to amend a portion of the law that prohibits using public money to buy needles, hypodermic syringes and other injection supplies. The law also requires programs to address the spread of HIV, hepatitis and other blood borne diseases; reduce needle-stick injuries to public safety workers; and encourage drug users to seek treatment. The N.C. Harm Reduction Coalition reports that one out of every three officers will be stuck accidentally with a needle during their careers, potentially exposing them to HIV and Hepatitis B and C. Roughly 28 percent will be stuck more than once, the group reported. Gasparini noted North Carolina has had a significant problem with hepatitis, with the Centers for Disease Control and Prevention reporting the number of cases had increased more than 200 percent between 2007 and 2011. More than half of the hepatitis transmissions reported are traced to shared needles, she said. Low-income residents and those with chronic illnesses or who face stereotypes when buying needles through a pharmacy also may reuse needles, she said, which raises the risk of infections and bruising. The new law also is expected to help officers stay safe as they patrol the streets, Chapel Hill Police Chief Chris Blue said. “Law enforcement officers, I think, pretty universally support the notion that a needle exchange program can help people get directed to resources they need to perhaps address their addiction,” he said, “and can also reduce the likelihood that dirty needles are out there that can harm people out in the community or officers that may encounter users.” Five people have visited the Hillsborough and Chapel Hill clinics since April to drop off dirty needles and pick up a bag of 20 clean ones, Gasparini said. Now, dirty needles can be dropped into white metal boxes located in both buildings. They aren’t tracking personal details or the reasons someone might trade their needles, she said, but they do know at least one client is diabetic and has had trouble buying needles through a pharmacy. Two others who picked up needles also got tested for HIV, she said. Law enforcement officers “play a huge role in helping us build trust with our clients,” Gasparini said. “I would ask for their support to help us connect to the community and help the community members connect to our program based on need.” The state law requires programs to include educational materials about the prevention of overdoses; HIV, AIDS and viral hepatitis transmission; and drug abuse. The materials also must address treatment and referrals for mental illness and substance abuse. Business cards with information about Orange County’s Safe Syringe Program have been sitting on the front desk of the Orange County Sheriff’s Office for months. The Carrboro Police Department also has received the cards, police spokesman Capt. Chris Atack said. Tammy Grubb: 919-829-8926, @TammyGrubb Needle exchange The Orange County Health Department has set up white, metal dropboxes for depositing dirty needles at its clinics. The boxes can be found at 2501 Homestead Road in Chapel Hill and 300 W. Tryon St. in Hillsborough. A bag of clean needles and other items is available at each clinic’s front desk. More information is available by calling 919-245-2400. Orange Co. safe syringe program looks to decrease Hepatitis C cases By Carleigh Griffeth Published: July 20, 2016, 5:27 pm Updated: July 20, 2016, 5:48 pm HILLSBOROUGH, N.C. (WNCN) — A large increase in the cases of Hepatitis C has helped spur a safe syringe program. North Carolina’s Hepatitis C rates have gone up 200 percent between 2007 and 2011, Robin Gasparini of the Orange County Health Department reports. As a result, local police and health officials have teamed up to start the health department’s program. Under the program, anyone who wants them can get new, sterile syringes. So far a handful of people have taken up the offer. Gasparini, a nurse, says it’s a safe resource for those who need syringes for prescribed medication, and have trouble getting them from a pharmacy. “It’s at the pharmacists’ discretion who they sell syringes to,” Gasparini said. “So individuals that may have chronic diseases or individuals of low socioeconomic status may have difficulty obtaining syringes.” In addition to the 20 syringes provided, users also get a needle disposal can and several fliers. “Information on local resources including referrals on where to seek help or where to seek treatment if needed,” Gasparini said. There are two safe disposal sites for used syringes in Orange County but Sheriff Charles Blackwood said he’d like to see more. “That prevents a child from running into a needle at a playground, a bus stop, and those are calls we’ve responded to in the years,” Sheriff Blackwood said. He added that his deputies encounter used syringes on the job. “If you arrest someone and they may be an illegal user and they may have them in their pocket,” he said. The N.C. Harm Reduction Coalition reports that one in three officers will be stuck with a syringe during their careers, and that safe syringe programs can reduce exposure by 60 percent. Watch online at URL: http://wncn.com/2016/07/20/orange-co-safe-syringe-program-looks-to-decrease-hepatitis-c-cases/ Orange County Health Department Wins Award for Breastfeeding Support Services By Logan Wheless SHARE THIS: Posted July 20, 2016 at 4:05 pm Orange County Health Department The Orange County Health Department received the Mother-Baby Award for Outpatient Healthcare Clinics from the North Carolina Breastfeeding Coalition. This competitive award has recognized the health department as one of the best support programs for breastfeeding families in North Carolina. Orange County Health Department’s Public Information Officer Stacy Shelp said this has been an ongoing effort from the department. “It is a recognition we are amazingly proud of. We have been working a long time to be a breastfeeding friendly facility and encourage other county departments to be that as well,” Shelp said. The Orange County Health Department actively supports breastfeeding families and provides a variety of services to educate and encourage women to breastfeed. “We do have prenatal services, as well as, newborn services, and a nutritionist/dietician on staff that can work with that new mom or soon-to-be mom on their nutritional diets and prepping for the birth of that baby, and that team of lactation consultants and home visiting services are fantastic,” Shelp said. “So we have a full variety of services we can offer, as well as, an actual nursing and breastfeeding room in our facilities.” Shelp said she hopes the community continues to advocate the educatio n for breastfeeding mothers. “I think the more that we can make breastfeeding normal and support moms out in the community, the better it will be as these children are raised in a healthier way with stronger immune systems and a better bond with their parents,” Shelp said. “The more we can do that the better. I am just so thrilled that the Health Department and the Board of Health and our communities and hospitals are all seeing the benefit and the need for this. They have all done their own part to make Orange County and our communities supportive for moms.” Learn more about the services provided on the Health Department’s website. Give Now UNC-Chapel Hill Takes Aim At Campus Alcohol Abuse By ELIZABETH FRIEND • JUL 22, 2016 ShareTwitter Facebook Google+ Email The university's new policy attempts to balance enforcement with education. Credit Pixabay Officials at UNC-Chapel Hill hope a new initiative will change the way students think about alcohol. The school's revised alcohol policy takes a public health approach to problem drinking, emphasizing education, prevention, treatment and recovery. Dean of Students Johnathan Sauls said while alcohol abuse has been a long -standing problem on many college campuses, more students these days are engaging in dangerous consumption habits. "Students are drinking significantly larger quantities of alcohol in single settings, in ways that I don't think were probably as pervasive, or certainly not recognized, even a genera tion of students ago," said Sauls. The new approach attempts to balance enforcement of current regulations with education about the impact of drinking on individuals and the campus community. "We finally concluded that a comprehensive multi -disciplinary approach was going to be a much better approach than simply trying to discipline our way out of this," said Sauls. "That has not worked on this or any other campus, to my knowledge." The policy offers medical amnesty, meaning students who have been drinking won't be penalized if they seek help in an emergency. It's meant to encourage students to report alcohol poisoning, or sexual assaults and other crimes. The university will hire a substance ab use counselor to work with students, as well as a liaison to collaborate with the Town of Chapel Hill, the Orange County Health Department and businesses near campus that sell alcohol. The plan comes one year after a former UNC student was charged in a head-on collision that killed three people on I-85. Authorities say Chandler Kania had been using a fake ID to drink at bars in downtown Chapel Hill before the crash. The university's new alcohol policy goes into effect in August. Chapel Hill Creamery Issues Voluntary Recall After Salmonella Outbreak By Blake Hodge SHARE THIS: Posted July 28, 2016 at 4:41 pm Photo via chapelhillcreamery.com A multi-state Salmonella outbreak may have started at Chapel Hill Creamery. Orange County Health Department director Dr. Colleen Bridger said the investigation began because of local numbers that were out of sync with normal figures. “Orange County, Durham County, Wake County and Chatham County were all noticing that we had higher-than-usual reported cases of Salmonella,” Bridger said. Bridger said “it’s not unusual” to see spikes in Salmonella throughout the year but these spikes were out of the ordinary. That caused officials to ask those who had tested positive for Salmonella ab out their eating habits in an attempt to pinpoint the source. “In doing that questionnaire,” Bridger said, “we had one person identify that they had eaten cheese from Chapel Hill Creamery.” Bridger said that the state Department of Agriculture reached out to the Orange County Health Department around that same time to report that they had a sample from Chapel Hill Creamery test positive for Salmonella. Bridger said further testing determined the same strain found in the sample from Chapel Hill Creamery was found in those testing positive for Salmonella. Bridger said Chapel Hill Creamery responded immediately by issuing a voluntary recall of all Chapel Hill Creamery cheese products. “I can’t state enough how proactive Chapel Hill Creamery has been in this inv estigation, how cooperative they have been,” Bridger said. “They have done everything they were supposed to do in the preparation of their cheese. These things sometimes happen. “They did not do anything wrong.” Bridger added that “there is always a risk” when using raw milk to make cheese, which she characterized as a one percent risk. Bridger said Chapel Hill Creamery goes “above and beyond” federal guidelines in most cases when processing and aging cheeses. Bridger said it is important for anyone who has already purchased any cheese from Chapel Hill Creamery that they do not eat that cheese and throw it away. Bridger said Salmonella typically has symptoms including nausea, vomiting and diarrhea. Bridger said individuals with symptoms should just let it “run its course.” She said as long as the individual is staying hydrated then there is no need to see a medical provider. But Bridger did say that if you are becoming dehydrated, you should then seek medical attention. Chapel Hill Creamery co-founder Portia McKnight said in a release: “Although there is not yet a definitive link between the CHC cheese and the illnesses, there is enough evidence to implicate the cheese and we are asking customers to not consume these cheeses or use them in food service.” Officials say they have also asked wholesalers to remove CHC cheese from their shelves and dispose of it. The outbreak has been connected to cases in North Carolina, Georgia, South Carolina, Tennessee and Virginia. Orange County has provided a hot line (919) 245-2378 for any questions. Food Safety News Creamery recalls cheeses linked to at least 100 Salmonella cases By Cathy Siegner | July 28, 2016 The Chapel Hill Creamery in Chapel Hill, NC, is recalling all of its cheese products because they have been linked to a growing Salmonella outbreak in North Carolina and elsewhere. A local county health officer said Thursday that the outbreak has sickened at least 50 people in North Carolina and about the same number in other states, and that it’s the same strain found in samples of raw milk from the Chapel Hill Creamery. Nine of those sickened in North Carolina have been hospitalized so far, she said. These Jersey cows are the same kind as those at the Chapel Hill Creamery. “This is way more than usual, which is why we started doing the investigation. We hit clusters of Salmonella, especially in the summertime, but we started seeing dozens and that’s when we started doing questionnaires to identify a common source,” said Colleen Bridger, director of the Orange County Health Department in Chapel Hill. Bridger said not all of the 50-plus in-state cases have been interviewed, but the “vast majority” of those who have recalled eating cheese from the Chapel Hill Creamery. “We’ve been monitoring the Salmonella cases for about three weeks and started doing questionnaires about a week ago, and it was just yesterday that we felt we had enough information to say this is probably the Chapel Hill Creamery. We didn’t want to make the declaration until we were sure,” she added. The products being recalled include all codes, packages and sizes of 14 varieties of cheese manufactured by the Chapel Hill Creamery and distributed through retail locations, farmers markets and restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia. The cheese varieties are: Quark, Danziger, Swiss, Paneer, Calvander, Hot Farmers Cheese, Dairyland Farmers Cheese, Smoked Mozzarella, Fresh Mozzarella, Burrata, Hickory Grove, Carolina Moon, Smoked Farmers Cheese, New Moon, and Pheta. “Although there is not yet a definitive link between the CHC cheese and the illnesses, there is enough evidence to implicate the cheese and we are asking customers to not consume these cheeses or use them in food service,” said Portia McKnight, Creamery co-founder. Chapel Hill Creamery has asked its wholesale customers to remove any CHC cheese from their shelves and dispose of it. Consumers who have this product in their home should not consume it and should throw it away. Customers are also being reminded to thoroughly wash their hands and any utensils or equipment that may have contacted the cheese in warm, soapy water. Chapel Hill Creamery is working in cooperation with the North Carolina Department of Agriculture, North Carolina Department of Health and Human Services, and the Orange County Health Department to identify the source of the Salmonella and which of its cheeses are affected. The Creamery plans to provide updated information on its website as it becomes available. Bridger noted that some of the Creamery’s cheese products are made with raw milk and some are not. She also said it was the first such incident she knows of involving the local business. The U.S. Centers for Disease Control and Prevention (CDC) is aware of the outbreak and has been assisting the other states, Bridger said, while North Carolina state and local health officials are coordinating on their part of the investigation. “We’re working with public health and with agriculture to try and figure out what the next step is to make sure we’ve resolved the problem and that they can resume production and selling their cheese again,” she said. Orange County has provided a hotline at (919) 245-2378 for anyone in North Carolina who has questions about the outbreak. Most persons infected with Salmonella experience fever, diarrhea, nausea, vomiting and abdominal pain. People who are concerned they might have Salmonella infections should contact their doctor to discuss testing and treatment. The illness typically lasts four to seven days, and most people recover without treatment. However, in some people, the diarrhea may be so severe that the patient needs to be hospitalized. More information on Salmonella is available here and here. Chapel Hill Creamery recalls all cheeses over possible salmonella risk By CBS North Carolina Published: July 29, 2016, 9:55 am Updated: July 29, 2016, 5:42 pm CHAPEL HILL, N.C. (WNCN) – Chapel Hill Creamery has voluntarily recalled all of their cheese products because of a potential association with a salmonella outbreak, the company said in a press release. Chapel Hill Creamery’s Dairyland Farmers Cheese (Photo: Chapel Hill Creamery) Some who have consumed Chapel Hill Creamery’s products have been identified as having salmonella. A strain of salmonella was found in milk from the creamery that was used while preparing the cheese products, the release said. The products included in the recall include all codes, packages and sizes of the company’s cheese products. The products are distributed through retail locations, farmers markets and restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia. The products recalled are:  Quark  Danziger  Swiss  Paneer  Calvander  Hot Farmers Cheese  Dairyland Farmers Cheese  Smoked Mozzarella  Fresh Mozzarella  Burrata  Hickory Grove  Carolina Moon  Smoked Farmers Cheese  New Moon  Pheta “Although there is not yet a definitive link between the CHC cheese and the illnesses, there is enough evidence to implicate the cheese and we are asking customers to not consume these cheeses or use them in food service,” said Portia McKnight, co-founder of the Creamery. McKnight said that Chapel Hill Creamery has requested wholesale customers to remove any CHC cheese from their shelves and dispose of it. Consumers who have this product in their home should not consume it and should dispose of it. Customers are reminded to thoroughly wash their hands and any utensils or equipment that may have contacted the cheese in warm, soapy water. “Our customers are our top priority,” McKnight said. “If there is any potential of risk, we take that very seriously and are committed to addressing it fully.” The Creamery is working with the North Carolina Department of Agriculture, North Carolina Department of Health and Human Services and the Orange County Health Department to identify the source of the salmonella and which cheeses are affected. “It’s important to recognize that they were doing everything according to regulations. This was not anything that they did wrong. It just sometimes happens,” Health officials said. The Creamery will provide updated information on its website as it becomes available. Orange County has provided a hot line (919) 245-2378 (919) 245-2378 for any questions. FoodQualitynews.com Breaking News on Food Safety & Quality Control Chapel Hill Creamery link to Salmonella illnesses Meanwhile in a different incident, Chapel Hill Creamery in North Carolina has recalled all its cheese because of a link to an outbreak of Salmonella. Picture: Chapel Hill Creamery website. Pheta cheese. Salmonella infection has been identified in people who ate Chapel Hill Creamery products. A matching strain has been found in milk from the creamery used during preparation of the cheese products. Products were distributed through retail locations, Farmer’s Markets or restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia. Colleen Bridger, Orange County health director, told us it was investigating more than 100 cases of Salmonella that have the same strain as the raw milk that tested positive. However, as it was a fairly common strain the state lab is doing genetic testing to determine exact matches and it will be weeks before exact numbers are known. Asked why all products were withdrawn, she said for Chapel Hill Creamery it was the fastest, most conservative approach. "The owners wanted to err on the side of caution and therefore pulled all their cheeses until the investigation could more definitively identify the source," she said. Portia McKnight, co-founder of the creamery, said: "Although there is not yet a definitive link between the CHC cheese and the illnesses, there is enough evidence to implicate the cheese and we are asking customers to not consume these cheeses or use them in food service.” Chapel Hill Creamery, the North Carolina Department of Agriculture and Department of Health and Human Services and the Orange County Health Department are trying to identify the source of the Salmonella and which cheeses are affected. Copyright - Unless otherwise stated all contents of this web site are © 2016 - William Reed Business Media SAS - All Rights Reserved - Full details for the use of materials on this site can be found in the Terms & Conditions Related news: WRAL.com Chapel Hill Creamery cheese recall More on this Chapel Hill Creamery website FDA website Chapel Hill Creamery has recalled all of their cheese products because of a possible Salmonella issue. According to their website, the cheese is sold at various farmers markets in the Triangle including Durham, Carrboro, Raleigh and Eno River. You can also find them at Whole Foods Markets, Southern Season, Weaver St. Markets, Earth Fare, Orrman’s Cheese Shop, Guglhupf Bakery & Cafe in Durham and various CSA and home delivery options. Here are the details from the FDA website: Chapel Hill Creamery in Chapel Hill, NC, has announced a voluntary recall of all Chapel Hill Creamery cheese products because of a potential association with an outbreak of Salmonella infections. Health officials have identified recent cases of Salmonella infection in persons who consumed Chapel Hill Creamery products. A matching strain of Salmonella has been identified in the milk from the creamery that was used during preparation of the cheese products. The products involved in the voluntary recall include all codes, packages and sizes of the following varieties of cheese manufactured by Chapel Hill Creamery and distributed through retail locations, Farmer’s Markets or restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia. Quark Danziger Swiss Paneer Calvander Hot Farmers Cheese New Moon Smoked Mozzarella Fresh Mozzarella Burrata Hickory Grove Carolina Moon Smoked Farmers Cheese Dairyland Farmers Cheese Pheta Portia McKnight, co-founder of the Creamery, said “Although there is not yet a definitive link between the CHC cheese and the illnesses, there is enough evidence to implicate the cheese and we are asking customers to not consume these cheeses or use them in food service.” Chapel Hill Creamery has requested wholesale customers to remove any CHC cheese from their shelves and dispose of it. Consumers who have this product in their home should not consume it and should dispose of it. Customers are reminded to thoroughly wash their hands and any utensils or equipment that may have contacted the cheese in warm, soapy water. 1 “Our customers are our top priority,” McKnight said. “If there is any potential of risk, we take that very seriously and are committed to addressing it fully.” Chapel Hill Creamery is working in cooperation with the North Carolina Department of Agriculture, North Carolina Department of Health and Human Services and the Orange County Health Department to identify the source of the Salmonella and which cheeses are affected. “The Chapel Hill Creamery has been an integral part of our local community for many years. They have consistently adhered to and exceeded safety measures and it is this adherence that allowed us to identify the issue so quickly. Since identification they have gone above and beyond to protect the health and safety of their customers.” Dr. Colleen Bridger, Orange County Health Director. The Creamery will provide updated information on its web site (chapelhillcreamery.com) as it becomes available. Most persons infected with Salmonella experience fever, diarrhea, nausea, vomiting and abdominal pain. People who are concerned they might have Salmonella infections should contact their doctor to discuss testing and treatment. The illness typically lasts four to seven days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. Orange County has provided a hot line (919) 245-2378 image: skypec2c://r/204 (919) 245-2378 for any questions. Read more at http://www.wral.com/chapel-hill-creamery-cheese- recall/15889829/#DRDmatDO5uOvWST1.99 Chapel Hill Creamery recalls cheese products The products may be contaminated with Salmonella 08/02/2016 | ConsumerAffairs | Salmonella Warnings By James Limbach Photo (c) TatianaShepeleva - FotoliaChapel Hill Creamery in Chapel Hill, N.C., is recalling all Chapel Hill Creamery cheese products because of a potential association with an outbreak of Salmonella infections. Health officials have identified recent cases of Salmonella infection in people who consumed Chapel Hill Creamery products. A matching strain of Salmonella has been identified in the milk from the creamery that was used during preparation of the cheese products. The recall includes all codes, packages and sizes of the following varieties of cheese manufactured by Chapel Hill Creamery:  QuarkDanzigerSwiss  PaneerCalvanderHot Farmers Cheese  New MoonSmoked MozzarellaFresh Mozzarella  BurrataHickory GroveCarolina Moon  Smoked Farmers CheeseDairyland Farmers CheesePheta The products were distributed through retail locations, Farmer’s Markets or restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia. What to do Customers who purchased this product should not consume it, but should dispose of it. Consumers with questions may contact the Orange County, N.C., Health Department at (919) 245-2378 (919) 245-2378.