HomeMy WebLinkAboutBOH agenda 082615
ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: August 26, 2015
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 26, 2015 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of June 24, 2015
7:15 – 7:45 V. Educational Sessions
A. ICD-10 Preparedness April Walker
B. 4th Quarter Financial Reports Colleen Bridger
C. 4th Quarter Billing Dashboard Reports Colleen Bridger
D. Annual Bad Debt Write Off Colleen Bridger
E. NALBOH Meeting Susan Elmore
7:45 – 8:15 VI. Reports and Discussion with Possible Action
A. BOH Policy & Procedure/By-laws Review Meredith/Colleen
B. Fee Schedule and Requested Changes Colleen Bridger
C. BOH Recommendations – Engineer & General Nick Galvez/Dan Dewitya
Public Positions
D. Health Director Report
E. Media Items
8:15 – 8:20 VII. Board Comments
A. Plaque Presentation
8:20 VIII. 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.
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ORANGE COUNTY BOARD OF HEALTH
June 24, 2015
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON June 24, 2015, at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Vice Chair; Commissioner Mia
Burroughs, Mike Carstens, Paul Chelminski, Corey Davis, Dan Dewitya, Nick Galvez, Sam
Lasris and Tony Whitaker
BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore.
STAFF PRESENT: Dr. Colleen Bridger, Health Director, Judy Butler, Community Health
Services Supervisor, Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance
and Administrative Services Division Director; Samantha Croffut, Dietetic Intern; Madelyn Davis,
Southern Human Services Center Clinic Manager; Emily Earnest, Senior Public Health Educator
– Medical Reserve Corp Coordinator; Carla Julian, Dental Clinic Manager, Donna King, Health
Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Terri
Pope, Dental Office Assistant; Jessica Salerno, Public Health Nurse II; LaTosha Scott, Social
Worker II; Stacy Shelp, Communications Manager; Meredith Stewart, Public Health Program
Manager; La Toya Strange, Administrative Assistant II; Melissa Walter, Dietetic Intern; David
Ward, Soil Scientist; and Patrice Whitted, Public Health Nurse I.
GUESTS PRESENT: None
I. Welcome
Dr. Bridger introduced new staff members: Samantha Croffut, Dietetic Intern; Madelyn Davis,
Southern Human Services Center Clinic Manager; Emily Earnest, Senior Public Health Educator
– Medical Reserve Corp Coordinator; Terri Pope, Dental Office Assistant; LaTosha Scott, Social
Worker II; Melissa Walter, Dietetic Intern; David Ward, Soil Scientist; and Patrice Whitted, Public
Health Nurse I.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the June 24, 2015 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Dan Dewitya
and carried without dissent.
IV. Action Items (Consent)
A. Minutes Approval of May 27, 2015 Meeting
Motion to approve Consent Agenda without corrections to the May 27, 2015 minutes was
made by Sam Lasris, seconded by Dan Dewitya and carried without dissent.
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V. Educational Sessions
A. Syringe Exchange Programs
Tessie Castillo, Advocacy and Communication Coordinator, North Carolina Harm Reduction
Coalition, spoke on the statewide perspective on the need for syringe exchange programs which
allow injection drug users to exchange their used syringes for new ones. She began by
providing some statistics on drug use. In NC, heroin use has increased 400% in the last five
years which has caused injection drug use to increase as well. Ms. Castillo reported that
Medicaid spent $70 million for Hepatitis C and $50 million for HIV on prescription drug costs
alone. This is due in part that there’s more infection and more expensive new drugs in the
market. A conservative count states that there are 160,000 injection drug users in NC and the
number is increasing. When asked, users stated that they used their syringe an average of 50
times.
As it is illegal to have a syringe exchange program in NC, some programs operate underground.
In NC, there are 6 currently operating underground by citizens in Asheville, Fayetteville,
Hendersonville, the Triangle (2), and the Triad. The only southern state with a legal syringe
program is in Kentucky which is run by the public health department. W hile it is not illegal for
pharmacists to sell them, possession of a clean syringe could be considered a crime –
possession of drug paraphernalia. In NC, if someone knowingly dispenses a syringe for the
purpose of using drugs, they’ve violated the Controlled Substances Act. Ms. Castillo mentioned
that there are two bills regarding syringe exchange. HB850 (Needle-stick Prevention law
passed in 2013) partially decriminalizes the act of having a syringe as long as that person alerts
an officer to the fact that he/she has a syringe prior to being searched. HB 712 (Pilot
Project/Used Needle Disposal) will authorize the State Bureau of Investigations, in collaboration
with the North Carolina Harm Reduction Coalition, to establish pilot programs to collect and
properly dispose of used syringes. HB 712 also amends the existing HB850 to state that a
person who declares a syringe to a law enforcement officer prior to being searched will not be
charged for possession of the syringe or for trace residue inside the syringe.
Ms. Castillo reiterated that there have been over a 100 studies that have concluded that syringe
exchange programs do not increase or encourage drug use but have actually assisted in its
decrease. She stated that the most effective way to combat the spread of bloodborne disease
among injection drug users is through syringe exchange programs. Syringe exchange
programs have been proven to reduce HIV and Hepatitis C rates among injection drug users
and can connect them with drug treatment programs and other social services programs as this
population tends to avoid those places. Drug overdoses have decreased and studies have
shown that 20% or more injection drug users go into treatment programs. Another benefit is
that there is a dramatic reduction in discarded syringes found in public areas.
The BOH members had several questions that were addressed by Ms. Castillo and Corey
Davis.
B. New Immunizations Requirements
Judy Butler presented the new immunization requirements effective July 1, 2015. They will
apply to all individuals except those that provide documentation of a valid medical or religious
exemption. Orange County is number 2 in the state with exceptions to vaccinations, Buncombe
County is number 1. Some highlights of the new requirements include:
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• Incoming kindergarteners must have the Chickenpox (Varicella) vaccination.
• Rising 7th graders are required to have Meningococcal vaccination.
Ms. Butler expressed that getting the word out regarding these new requirements is priority in
hopes that children will get the correct immunizations when they get their physicals (e.g. sports
and school). Stacy Shelp, Communications manager, stated that $9,000 of State money has
been spent for this purpose. There have been print ads and media (e.g. banners, posters,
brochures, public service announcements) produced. Ms. Shelp showed the commercial
developed for online usage by schools and the OCHD as well as communication via social
media. Prior to showing the showing the commercial, Ms. Shelp thanked the Chapel Hill-
Carrboro schools that assisted as well as the OCHD staff and their children that participated in
the commercial.
The BOH members had several questions that were addressed by Ms. Butler and Ms.
Shelp.
C. Communicable Disease Annual Report
Judy Butler gave an overview of the communicable disease data for the year 2014. She also
referred to the NC Communicable Disease Branch website for those who wanted more in depth
information such as county rates on various diseases. Ms. Butler noted other communicable
disease-related activities performed by her staff including documenting health law violators,
quarantine orders, control measure orders, pregnant Hepatitis B positive women and treating
their newborns and bloodborne pathogens exposure. Some of the highlights from the
information she gave during her presentation include:
• Pertussis aka whooping cough/100 day cough is a disease that affects the respiratory
system. DT aP is now used for children as it’s safer with fewer side effects but doesn’t
last as long. Tdap is recommended for the adolescent and adult population.
• There hasn’t been a human rabies case in NC since 1940-50s. However, there were
523 referrals involving human contact to potentially rabid animals in 2014 in Orange
County. Standard recommendation from the CDC is that anyone sleeping in the room
with a bat should be treated with post-exposure prophylaxis which costs range from
$1,500-$2,500. Treatment should be given within 48 hours of exposure to a bat or wild
animal and within 72 hours of exposure to a domestic animal.
• Outbreaks involving diarrheal disease were discussed. Norovirus in long-term care
facilities was the most prevalent outbreak as it spreads quickly.
• Sexually transmitted diseases such as syphilis and HIV have different stages; therefore,
when reporting, more research has to be completed to determine if it is a new case.
Syphilis cases are on the rise. In 2015, the OCHD already has 11 syphilis cases;
although, they’re still preliminary.
• Ebola was also briefly mentioned. Any person travelling into Orange County from an
infected country has to be monitored for 21 days after their last contact. Nurses perform
home visits and phone calls. There were 6 people monitored in 2014 and 20 people
monitored in 2015.
The BOH members had questions and comments that were addressed by Ms. Butler.
VII. Reports and Discussion with Possible Action
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A. Orange County Advisory Board Summary
Meredith Stewart provided an update on the 3rd quarter of our advisory board summary and
discussed what other county boards are doing in related to the BOH 2014-2016 Strategic Plan.
Some updates include:
• The proposal to have Alcopops reclassified so that they’re not sold as a lower alcohol
beverage has been presented to the Board of County Commissioners to be included in
their agenda packet.
• Commissioner Bernadette Pelissier, who also serves on the Substance Abuse/Mental
Health Subcommittee, requested that Cardinal Innovations provide a detailed report on
their usage of the $1.3 million they were awarded by the county in order to provide
mental health services.
• Family Success Alliance Advisory Council requested and received $90,000 out of the
Social Justice funds from the County Commissioners which allowed the Kindergarten
Readiness Program to be funded. The program will allow up to 30 children in 3 schools
(2 in zone 5 and 1 in zone 4) to participate in a 3-4 week readiness program for children
that have not had a formal pre-school experience or have been deemed at high risk for
being behind at the start of the kindergarten. This program will help ease the transition
into kindergarten. Currently, there are 70 children enrolled.
• The Family Success Alliance will also be working with Orange Literacy which will work
with the parents of the children in the Kindergarten Readiness Program which will offer
two-generational support.
• The Tobacco Preemption Resolution was adopted by the Board of County
Commissioners.
The BOH members had several questions were answered by Meredith Stewart.
B. Consideration of Expanding BOH Terms from 2 to 3
Colleen Bridger began by conveying that every August the Board reviews the BOH bylaws. In
preparation for that review, she posed the idea of considering expanding the BOH terms from 2
to 3 as it is allowed under the NC General Statute. Under the NC General Statute, the BOH
terms are defined as up to 3 terms. While 99% of the counties in NC have them set at 3 terms,
Orange County has them set at 2. Each term is 3 years. In Orange County, BOH members can
serve 2 full terms totaling 6 years; meanwhile, other counties allow their members to serve 3 full
terms totaling 9 years. Given the turnover, the struggle to fill some positions and the fact that
members reach their peak during their 2nd term as they’re just getting accustomed to what
transpired during their 1st term, the consideration of a revision in the bylaws was suggested.
The BOH members collectively agreed in doing so and will discuss it further in August.
The BOH members had several questions that were addressed by Colleen Bridger.
C. Health Director’s Report
There were no questions from the Board regarding the Health Director’s Report included
in the packet. Dr. Bridger stressed the need for volunteers for the Community Health
Assessment. She stated that the County Manager will assist by encouraging all Orange
County employees to volunteer. Dr. Bridger also expressed that it would be a great
opportunity for BOH members. It was also mentioned that there’s a small group working
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on filling the vacant BOH positions. They will present their recommendations at the BOH
meeting in August.
D. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Board Comments
Liska Lackey, co-chair, presented plaques of appreciation to BOH members Michael Carstens
and Corey Davis for their service.
VIIII. Adjournment
A motion was made by Michael Carstens to adjourn the meeting at 8:35 p.m., was
seconded by Sam Lasris and carried without dissent.
The next Board of Health Meeting will be held August 26, 2015 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 26, 2015
Agenda Item Subject: ICD-10 Implementation Update
Attachment(s): ICD-10-CM 2015: Will We Be Ready?
Staff or Board Member Reporting: April Walker
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
The ICD-10 Implementation Project Coordinator for the Health Department has been
making preparation for the transition to ICD-10 coding effective October 1, 2015. The
ICD-10 Coordinator as well the ICD-10 Implementation Project Team has assessed
areas within the Health Department for potential impacts. Areas assessed were to the
budget, system (EMR-Patagonia), and business processes. After the completion of the
assessments, we do not foresee a major impact to the Health Department’s budget,
systems, or business processes. The Health Department will be compliant on October
1, 2015 and be able to submit claims for reimbursement with minimal denials.
What is ICD-10? ICD-10-CM, International Classification of Diseases, Tenth Edition, is a clinical cataloging system that will be replacing its predecessor; ICD-9-CM. U.S. healthcare regulators will require ICD-10 compliance on Oct. 1, 2015. All entities covered under HIPAA must transition to ICD-10-CM coding.
Source:
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):
WILL WE BE READY?
ICD-10-CM 2015
About ICD-10-CM
The ICD-9 code sets used to report medical diagnosis
and inpatient procedures will be replaced by ICD -10
code sets on October 1, 2015. ICD-10 consists of two
parts:
o ICD-10-CM diagnosis coding for all U.S. health care
settings.
o ICD-10-CM inpatient procedure coding for all U.S.
hospital settings.
About ICD-10-CM (continued)
ICD-10 will affect diagnosis and inpatient procedure
coding for everyone covered by the Health Insurance
Portability Accountability Act (HIPAA), not just those
who submit Medicare or Medicaid claims.
Why transition? What’s changing?
Improve clinical communication and
documentation
Capture data (signs, symptoms, risk
factors and comorbidities) to better
describe the clinical issues overall
ICD-9 cannot accommodate addition of
codes to reflect new diagnosis and
procedures
Exchange information across country
borders
ICD-9 codes are currently 3 to 5 digits
alphanumeric whereas ICD-10 codes
will be 3 to 7 digits alphanumeric and
more specific.
Only ICD-9 codes are changing to ICD-
10. CPT (Current Procedural
Terminology) and HCPCS (Healthcare
Common Procedure Coding System)
codes are not affected by this
transition.
About ICD-10-CM (continued)
Where are we?
Formation of the ICD-10-CM Implementation Team
ICD-10-CM Implementation Coordinator
April Walker, Medical Office Supervisor
Two Nurse Practitioners
Andrea Mulholland, SHSC Clinic
Jean McDonald, WHSC Clinic
Two Registered Nurses
Katy Johnson-WHSC Clinic
Teresa Martin-SHSC Clinic
Two Office Assistants I (Financial OA’s/Keyers)
Anjail Woods, SHSC Clinic
Johnna Reed, WHSC Clinic
Where are we?
Formation of the ICD-10-CM Implementation Team (continued)
Billing Supervisor
Susan Wagoner
Two Accounting Technicians
Darlene Wirag-Medicaid Billing
Susan Ward- Third Party/Private Pay Billing
OCDH IT Analyst
Steven Campbell-reports/data collection
Where are we?
Impact Assessments
Budgetary Impacts $
System Impacts
Business Impacts
Budgetary Impact Assessment
Potential Budgetary Impacts
Staff Training Cost
New Code Books and/or coding assistance software
Modification of processes and forms
Necessary software changes
Denial of claims following the 10/1/15 effective date due to:
Inaccurate coding and data entry
Diagnosis code needs to be more specific
Total anticipated cost of ICD-10 Transition:
Under $1,000.00
System Impact Assessment
Patagonia- EMR
Patagonia and Office Ally (clearing house) tested claims on
behalf of the health departments. All test claims submitted
passed and some still pending.
New ICD-10 codes are in Patagonia but will not upload until
October 1st.
Entry of ICD-10-CM codes tested:
ESB side
Claims side
Clinical Documentation tested
Assessment and Plan
Business Impact Assessment
Modification of processes and work flows
Modification of internal and external forms
Administrative Services
Clinical areas
EHR/Medical Records
Questions….
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 26, 2015
Agenda Item Subject: 4th Quarter Financial Report FY 14-15
Attachment(s): 4th Quarter Financial Report
4th Quarter Billing Dashboard
Staff or Board Member Reporting: Colleen Bridger
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Total Health Department Revenue: Average YTD monthly revenue in FY15 after the
4th Quarter is $205k/month or $2.5M YTD, representing 100.15% of our overall
budgeted revenue for the year. This is an increase from an average of $174k/month in
FY14. Year-end revenue is in line with initial budget projections ($207k/m, $2.5M/y).
Due to slightly exceeding our anticipated revenues, budgeted Medicaid Maximization
funds were not transferred into the budget at the end of the fiscal year, which is in
accordance with Health Department practices. Expenses were lower than budgeted at
93%.
Total Billing Accuracy: After surpassing our billing accuracy goal of 80% in FY 13 -14,
we set a new goal of reaching 90% in FY 14-15. The average billing accuracy rate for
medical at the end of FY 14-15 is 91% as compared to 86% in FY 13-14 and the
average rate for dental for FY 14-15 is 96% as compared to 73% in FY 13-14 (Dental
only had 7 months of billing accuracy data for FY 13-14 due to the addition of
processing payments through the Eaglesoft system.)
Progress continues in refining our definition of billable claims, though the billing
accuracy percent presented here always reflects a conservative estimate of accuracy.
Though reducing the proportion of unpaid Self -Pay claims is a work in progress, it’s not
likely we will ever recover 100% of those claims.
Dental Earned Revenue by Source: Dental earned revenue has consistently
increased from year to year, and FY 14-15 average monthly revenue ($35k/month)
exceeded our budget projection ($32k/month). FY 14-15 dental revenue totaled $423k
as compared to $317k in FY 13-14.
Medical Earned Revenue by Source: Medical earned revenue has exceeded the
budgeted projection for FY 14-15. The monthly average after the fourth quarter
($50k/month) is greater than FY14 ($44k/y) and FY13 ($25k/y), but slightly higher than
our budget projection ($48k/month). Improved billing efforts (coding, payment
collections, and debt set-off) contributed to the higher revenue collections for FY 14-15.
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
2014-2015
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Revenues
Donations
Dental Health 0 (338)0 0.00%
Personal Health 0 (814)(3,815)21.33%
Donations Total 0 (1,151)(3,815)30.18%
Internal Allocations
Dental Health 0 0 (18,000)0.00%
Finance and Admin Services 0 0 (23,500)0.00%
Internal Allocations Total 0 0 (41,500)0.00%
Service Revenue
Dental Health (111,391)(423,395)(387,000)109.40%
Health Promotion & Edu 0 0 (667)0.00%
Environmental Health (134,399)(429,378)(409,700)104.80%
Personal Health (170,690)(614,728)(594,066)103.48%
Service Revenue Total (416,480)(1,467,501)(1,391,433)105.47%
State Allocations
Finance and Admin Services (24,812)(42,885)(42,885)100.00%
Health Promotion & Edu (10,415)(52,832)(52,832)100.00%
Environmental Health (27,486)(31,486)(26,500)118.82%
Personal Health (178,552)(495,485)(454,103)109.11%
State Allocations Total (241,265)(622,688)(576,320)108.05%
Grants Project Revenues
Dental Health 0 (4,000)(4,000)100.00%
Personal Health (3,518)(3,518)(4,518)77.87%
NACCHO Grant 0 (3,618)(5,925)61.07%
Piedmont Hlth Srv - Nutr (982)(26,879)(29,920)89.84%
Meaningful Use Incentive 0 (42,500)(42,500)100.00%
Smart Start (8,294)(39,100)(65,574)59.63%
Susan G. Komen Grant 0 (24,827)(49,624)50.03%
CC4C Accesscare (35,822)(157,706)(152,769)103.23%
PCM Accesscare (35,927)(140,930)(133,234)105.78%
Health Disparities (18,462)(63,000)(92,504)68.11%
Grants Project Revenues Total (103,005)(506,078)(580,568)87.17%
Total Non-County Revenue (760,749)(2,597,419)(2,593,636)100.15%
Orange County Health Department
Profit Loss Budget Performance
2014-2015
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Expenditures
Expenditures
Salaries 1,295,613 4,900,595 5,196,834 94.30%
Benefits 480,056 1,693,436 1,784,268 94.91%
Travel 1,286 3,372 6,775 49.78%
Training 7,834 26,872 30,156 89.11%
Certifications & Licensing 3,635 16,113 17,043 94.54%
Mileage 7,083 26,471 28,943 91.46%
Telephone 20,700 81,349 77,391 105.11%
Postage 5,042 14,699 16,450 89.36%
Motor Pool 7,808 42,535 48,806 87.15%
Equip Repairs 1,308 6,964 9,506 73.26%
Equip Rent 228 941 1,200 78.44%
Duplicating 4,255 9,492 10,600 89.55%
Printing 3,773 8,057 12,304 65.48%
Advertising 1,348 10,521 12,548 83.84%
Dues 457 3,496 5,008 69.81%
Subscriptions 234 1,838 1,944 94.54%
Dept Supplies 12,354 30,159 33,059 91.23%
Edu Supplies 3,186 4,578 8,979 50.99%
Office Supplies 8,576 33,982 39,445 86.15%
Medical Supplies 37,612 131,102 134,203 97.69%
Bloodborn Path Supplies 242 1,168 1,011 115.55%
Pharmacy Supplies 49,282 209,854 224,838 93.34%
Comp Supp/Software 667 970 1,335 72.69%
Other Supplies 4,947 5,797 6,073 95.45%
Public Hlth Co 4,613 4,788 5,500 87.05%
Contracted Srv 114,238 365,859 410,874 89.04%
X-Ray 6,364 13,314 14,700 90.57%
Lab Srv 23,471 56,711 68,433 82.87%
Bonds & Insurance 11,950 11,950 11,950 100.00%
Uniforms 1,237 7,727 9,227 83.74%
Community Proj 16,475 21,243 28,416 74.76%
Employee Wellness 0 484 500 96.77%
Innovations Project 1,201 6,196 20,000 30.98%
Accreditation Project 0 2,750 3,700 74.32%
Wise Woman Program 0 0 0 0.00%
Preparedness BT 0 50 50 100.00%
Tobacco Project 0 13 0 0.00%
Family Success Alliance 52,857 52,857 100,000 52.86%
Credit Card Exp 2,582 10,005 9,500 105.32%
Capital Exp Under $500 2,640 3,360 3,947 85.12%
Civil Filing Fees 70 70 71 98.94%
Litigation 43,296 43,296 43,296 100.00%
NACCHO Grant 0 685 4,225 0.00%
Orange County Health Department
Profit Loss Budget Performance
2014-2015
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Grant Project Expenditures
Health Disparities 25,598 85,305 99,777 85.50%
Meaningful Use Incentive 10,749 35,253 42,500 82.95%
Smart Start 105 39,273 64,438 60.95%
Susan G. Komen Grant 0 0 49,624 0.00%
Capital Expenditures
Equipment 8,164 17,880 17,879 100.01%
IT Equipment 4,480 10,182 10,139 100.42%
Furnishings 0 688 1,018 67.53%
Expenditures Total 2,287,616 8,054,301 8,728,482 92.28%
Total County Revenue (Appropriation)1,526,867 5,456,882 6,134,846 88.95%
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Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 26, 2015
Agenda Item Subject: Annual 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 September 2014
(Personal Health, Dental Health, and Environmental Health) for FY 2012 and FY 2013
in the amount of $9,073.75.
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 2014-2015.
Division
Number of
Uncollectable
Accounts
Write-Off
Amount
Personal Health 77 $1,289.62
Dental Health 71 $2,226.55
Environmental
Health
9 $1,772.19
Total 157 $5,288.36
We request to administratively move a total of $5,288.36 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 26, 2015
Agenda Item Subject: Board of Health Annual Policy Review
Attachment(s): 1) 2015 Review Summary
2) BOH Policies & Procedures (Track Changes)
3) By-Laws
Staff or Board Member Reporting: Meredith Stewart
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Policies and Procedures
The Board of Health is required to review their Policies & Procedures each year to meet
accreditation standards.
Major recommended edits are summarized in the “2015 Review Summary” and also
shown in track changes in the attached policies.
By-Laws
Staff also recommends repeal of the Board of Health By-Laws, as initially discussed at
last year’s Board of Health meeting. The accreditation guidance on this issue states:
“This activity requires that the BOH have Operating Procedures. Although the BOH may
have Bylaws, a set of Bylaws alone will not meet the requirements of this activity. There
have been past concerns that local health departments may include items in bylaws that
do not comply with state statutes. The Institute of Government recommends that the
BOH have operating procedures instead of bylaws. An Operating Procedures template
is located on the NCLHDA website. It has been reviewed by the Institute of Government
and is free of any potential legal problems. Please note that in many instances a BOH
will usually repeal their Bylaws and replace them with the Operating Procedures.”
(Accreditation Benchmark 34, Activity 1)
The Operating Procedures template matches the format and content of the Board of
Health’s existing Policy III.A. Necessary information from the By-Laws, including Terms
of Office, have been moved to Policy III.A. The remainder of the content of the existing
By-Laws will be moved to a procedural document to be referenced as needed by the
Board.
The recommended changes will be reviewed at this meeting, with final approval of the
revised policies to occur at the October 2015 meeting.
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):
Section I: Board Adopted Policies
A. Compliance with Public Health
Laws/Regulations
Minor Change: Formatting
B. Program and Policy Adoption
Minor Change: Formatting
C. Confidentiality and Conflict of
Interest Policy for Board
Members
Minor Change: Formatting
Clarified where signed copies of agreements are kept.
D. Requests for Environmental Services
and Assessments
Minor Change: Formatting
E. Fee and Eligibility Policy
N/A
Policy will be reviewed separately at October 2015 BOH meeting.
F. Community Assessment Policy and
Procedures
Minor Change: Update reference documents
G. Community and Public Input Policy
No change
H. Complaint Policy
No change
Section II: Board Adoption or Review of
Reports and Documents
Recommend:
1) Standardizing policy format by including a “Policy” statement at the
beginning of the Policy.
2) Clarifying actions for each report, namely that to “receive and review” a
document is redundant. To “review” an item is not a regular action of the
Board as listed on meeting abstracts. Therefore, all mentions of “receive
and review” are simplified to “receive”
3) Removal of annual budget report due to redundancy with quarterly fiscal
reports and budget process.
4) Keep Communicable Disease Report as required by accreditation.
Section III: Board Processes
A. Operating Procedures
Recommend significant revisions to this document to reflect recommendations of
the Accreditation Board and to prevent duplication or noncompliance with state
statutes.
1) Removal of section VII. Rules Development Procedure from the Operating
Procedures and creation of a separate policy/procedure document in
Section III focused on Rule Development and Adjudication
2) Removal of section VIII Adjudication Procedures from the Operating
Procedures and creation of a separate policy/procedure document in
Section III focused on Adjudication of Rule Development and Adjudication
3) Recommend addition of sections on Board Composition, Terms of Office,
and Contract Negotiations. These sections currently reside in the “By-
Laws” and if the Board proceeds with repeal of the By-Laws this year.
B. Supplemental Processes
a. Oath of Office Minor Change: Formatting
b. Orientation and Education
for New BOH Members
No Change
c. Recruitment and
Reappointment Procedures
for Members
Clarify eligibility to serve three, three-year terms instead of two, three year terms.
Minor Change: Formatting
d. Annual Performance Review
Process for Health Director
Page 1 of 13
Amended June 27, 2012
Amended November 16, 2000
Amended December 18, 1980
Amended April 16, 1981
Amended April 26, 1984
Adopted February 8, 1979
Rules of Procedure Governing the
Organization and Operation of the
ORANGE COUNTY BOARD OF HEALTH
Charge to the Board
The Board is “the primary policy-making, rule making and adjudicatory body”1 for the
health department and is charged to protect and promote the public health of Orange
County.2 This function may include allocating resources, planning programs, and
advising the Health Director on health needs.
Organization and Duties of the Board
1. Composition3
The Board of Health shall consist of eleven members appointed by the Board of
Commissioners of the County of Orange. One member must be a North Carolina
licensed physician, one licensed dentist, one licensed optometrist, one licensed
veterinarian, one professional engineer, one registered nurse, one licensed pharmacist,
one county commissioner and three representatives of the general public. All members
shall be residents of Orange County and the composition of the Board shall reasonably
reflect the population makeup of Orange County. If there is not a licensed physician, a
licensed dentist, a licensed optometrist, a licensed veterinarian, a professional engineer, a
registered nurse or a licensed pharmacist available for appointment, the Commissioners
shall appoint an additional representative of the general public to serve until such a
professional becomes available for appointment.
2. Terms of Office4
Members are appointed to serve three-year terms. No member may serve more than two
consecutive three-year terms. Vacancies may only be filled for the unexpired portion of
the term of the member replaced. Members appointed to fill unexpired terms are eligible
to subsequently be appointed to two additional terms. The County Commissioner serves
a term concurrent with his term of office as a commissioner. On the date and at the time
of the first regular meeting after the member’s appointment by the Board of County
Commissioners, the newly appointed members shall take and subscribe to the oath of
office as the first order of business. After the oath of office they are full voting members
of the board. New members must also sign a confidentiality statement and a conflict of
interest statement.
3. Removal from Office
Page 2 of 13
By majority vote of a quorum present at a regular or duly called meeting, the Board of
Health may recommend to the Board of Commissioners that a member be removed for
cause.5 Before recommending removal, the Board shall, by written notice, inform the
member of the reasons for recommending removal with copies of this correspondence
sent to all members. If the member desires a hearing on the recommendation for
removal, then the member must submit a request for such a hearing in writing within ten
days after receipt of the notice of recommendation for removal. The hearing shall be set
within 30 days following receipt of the request for hearing.
Causes for removal from the Board shall include but not be limited to:
Commission of a felony or other crime involving moral turpitude.
Violation of a State law governing conflict of interest.
Violation of a written policy adopted by the county board of commissioners.
Conduct that tends to bring the office into disrepute
Failure to maintain qualifications for appointment required under GS 130A-35(b).
Unexcused non-attendance at three consecutive board meetings. The Board deems it
essential to its ability to effectively and efficiently discharge its responsibilities that
meetings are attended regularly. Quorum problems harm the ability to conduct public
business and irregular and/or infrequent attendance results in inefficiency and
uninformed voting.
4. Compensation6
Members shall receive a per diem reimbursement for subsistence and travel as established
by the County Commissioners for each properly called and scheduled meeting of the
Board and for attendance at official meetings and conferences.
5. Officers
The Health Director shall serve as Secretary to the Board. The Chairperson and Vice
Chairperson shall be elected annually by the Board and shall serve for one calendar year.7
The Chairperson and Vice Chairperson shall be elected annually at the last regular
meeting of the calendar year. A proposed slate of officers for Chair and Vice Chair will
be developed and presented at the regular meeting prior to the election. An ad-hoc or
regular committee of the Board as designated by the Chair will develop the proposed
slate. Nominations from the floor are also allowed. Each member shall vote by roll call
voice vote for Chairperson and for Vice Chairperson on separate motions. In the event of
a tie vote, the Board shall continue balloting until the tie is broken. The newly elected
officers shall be installed in January and serve for one calendar year.
6. Committees
The Board shall review the existing committee structure at least annually and make
decisions regarding the number and types of standing committees. Only Board members
may serve as committee members of standing Board committees and the number of
Board members on any single committee must be at least two members and may not
exceed five members. The Board may appoint time-limited ad hoc committees or task
forces to examine particular matters of importance to the Board. These ad hoc
Page 3 of 13
committees or task forces must limit their work to the specific charge outlined by Board
motion and may include members that are not serving on the Board of Health.
7. Open Records8
All written, printed or recorded materials received or made by the Board (with the
exception of closed sessions, matters considered in closed session, and confidential
patient files) may be examined by the public. Members of the public may receive
certified copies upon request. The Board may set reasonable times for and supervise the
examination and inspection of records. The Board may establish reasonable fees for both
certified and uncertified copies of records so as to recover clerical and copying costs.
The Health Director shall handle requests for information from personnel records and
work with the Director of Personnel to determine whether information can be released
according to statutes in effect as the time of request.
8. Contract Negotiations9
The Health Director is authorized to enter into a contract with any governmental or
private agency or with any person, for the provision or receipt of public health services.
The Board of Commissioners or its designee must approve contracts requiring payment
for services rendered to the Health Department. The Health Director will discuss with the
Board contracts that represent significant deviation from current Board of Health policy
prior to authorizing that contract.
9. Establishment of Fees10
The Board of Health “...may impose a fee for services to be rendered by a local health
department, except where the imposition of a fee is prohibited by statute or where an
employee of the local health department is performing the services as an agent of the
State. Notwithstanding any other provision of law, (the) Board may impose a fee for
services performed pursuant to …wastewater systems, public swimming pools, and
tattooing. Fees shall be based upon a plan recommended by the local health director and
approved by the local Board of Health and the appropriate county Board of
Commissioners.”
10. Appointment of Health Director11
“The …Board of Health, after consulting with the …County Board of Commissioners,
shall appoint a local Health Director. A local Health Director shall possess the
qualifications established for the position in G.S. 130A – 40(a) and qualifications
established for the position by the State Personnel Commission in accordance with
Chapter 126 of the General Statutes.” If the Board of Health fails to appoint a local
Health Director within 60 days of the creations of the vacancy, “the State Health Director
may appoint a local Health Director to serve until the local Board of Health appoints a
local Health Director in accordance with this section.”
Page 4 of 13
The Board will conduct a periodic evaluation of the Health Director at least annually.
The Director’s services may be terminated by the Board subject to the provisions of
Chapter 126 of the General Statutes and rules established by the State Personnel
Commission.
11. Rule-making12
The Board of Health may adopt a more stringent rule in an area regulated by the
Commission for Health Services or the Environmental Management Commission where,
in the opinion of the local board of health, a more stringent rule is required to protect the
public health. The Board of Health may not adopt a rule concerning the grading
operating, and permitting of food and lodging facilities as defined in G.S. 130A-247(1).
The Board of Health may adopt rules concerning wastewater collection, treatment and
disposal systems which are not designed to discharge effluent to the land surface or
surface waters only in accordance with G.S. 130A-335 (c).
The rules of a local board of health shall apply to all municipalities within the local
board’s jurisdiction.
Procedures for adoption of local rules shall be accordance with G.S.130A-39 Sections
(d)-(f).
12. Administrative Hearings13
The Board of Health is required by Statute to hold hearings when the interpretation and
enforcement of rules adopted by the Board of Health and the imposition of administrative
penalties is challenged. See Rules of Procedure, Rule 18.
Rules of Procedure*
Rule 1. Meetings
The Board shall hold regular meetings, at least quarterly, at which business may be
conducted.14 Such meetings shall be pre-scheduled at a time and place agreeable to the
majority of members. A calendar of regular meetings will be established at the last
regular meeting of the calendar year for the next calendar year.
The Board may hold work session meetings to study issues. Motions to conclude matters
shall not be permitted at work sessions.
The requirements of the open meetings law shall apply to all regular board, regular or ad
hoc committee or task force meetings. Notification of the public will be in compliance
with open meeting law notification.15
Rule 2. Special, emergency and recessed meetings
a. Special meetings
Page 5 of 13
The Chairperson or any three members may call special meetings.16 At least 48 hours
before a special meeting called in this manner, written notice of the meeting stating its
time and place and the subjects to be considered shall be given to each board member,
posted on the door of the board’s usual meeting room, and mailed or delivered to each
media outlet or person who has filed a written request for notice with the board’s
secretary. The Secretary to the Board is to be informed of the special meeting and shall
give proper notice of the meeting.
A special meeting may also be called or scheduled by vote of the board in open session
during another duly called meeting. The motion or resolution calling or scheduling the
special meeting shall specify its time, place, and purpose. Notification procedures remain
the same as those in the first paragraph.
Only those items of business specified in the notice may be discussed or transacted at a
special meeting, unless (1) all members are present and (2) the board determines in good
faith at the meeting that it is essential to discuss or act on the item immediately.
b. Emergency meetings17
The chair or vice-chair may at any time call an emergency meeting of the board by
signing a written notice stating the time and place of the meeting and the subjects to be
considered. Written or oral notice of the meeting shall be given to each board member
and to each local newspaper, local wire service, local radio station, or other media that
has filed a written emergency meeting notice request with the board’s secretary and
whose request includes the party’s telephone number.
An emergency meeting may be called only because of generally unexpected
circumstances that require immediate consideration by the board. Only business
connected with the emergency may be considered at an emergency meeting.
Except under emergency situations a minimum of three days prior notice shall be
required to hold a special meeting.
c. Recessed (adjourned) meetings.18
A properly called regular, special or emergency meeting may be recessed or adjourned to
a specific time and place by a procedural motion made and adopted as provided in Rule
12, Motion 2, in open session during the regular, special, or emergency meeting. The
motion shall state the time and place when the meeting will reconvene. No further notice
need be given of such a recessed session of a properly called meeting.
Rule 3. Agenda
a. Proposed agenda.
The Secretary and at least one other Board officer shall prepare an agenda and meeting
notices for proper distribution. A request to have an item of business placed on the
agenda must be received by the Secretary at least three working days before the meeting.
Members are encouraged to contact the Secretary if they wish to receive formal notice of
an agenda planning session. An agenda package shall be prepared that includes for each
Page 6 of 13
item of business placed on the proposed agenda, as much background information on the
subject as is available and feasible to reproduce. Each board member shall receive a copy
of the proposed agenda and the agenda package and they shall be available for public
inspection and/or distribution when they are distributed to the board members.
b. Adoption of the agenda.
As its first order of business at each meeting, the board shall discuss and revise the
proposed agenda and adopt an agenda for the meeting. The board may by majority vote
add items to or subtract items from the proposed agenda. If items are proposed to be
added to the agenda, the board may, by majority vote, require that written copies of
particular documents connected with the items be made available at the meeting to all
board members. The board may designate certain agenda items “for discussion and
possible action.” This designation means that the board intends to discuss the general
subject area of that agenda item before making any motion concerning that item.
Rule 4. Public Address to the Board
Any individual or group who wishes to address the board shall make a request to be on
the agenda to the board’s secretary. The board shall determine at the meeting whether it
will hear the individual or group.
Rule 5. Order of Business
Items shall be placed on the agenda according to the order of business. Generally the
order of business shall be:
Adoption of an agenda
Approval of the minutes
Administrative hearings on matters of appeal
General public comments
Committee reports
Unfinished business
New business
Informal discussion
Rule 6. Presiding Officer
The chair of the board shall preside at board meetings if he or she is present. The chair
shall have the right to vote in all cases. In order to address the board, a member must be
recognized by the chair. If the chair is absent, the vice-chair shall preside. If both the
chair and vice-chair are absent, another member designated by vote of the board shall
preside. If the chair wishes to engage in debate on an issue, the vice-chair may be asked
to temporarily fill the presiding officer’s role.
The presiding officer shall have the following powers:
To rule motions in or out of order, including any motion patently offered for
obstructive or dilatory purposes;
To determine whether a speaker has gone beyond reasonable standards of courtesy in
his remarks and to entertain and rule on objections from other members on this
ground;
Page 7 of 13
To entertain and answer questions of parliamentary law or procedure;
To call a brief recess at any time;
To adjourn in an emergency.
A decision by the presiding officer under any of the first three powers listed may be
appealed to the board upon motion of any member, immediately after such decision is
announced and at no other time. The member making the motion need not be recognized
by the chair and may not be ruled out of order.
Rule 7. Action by the Board
The board shall proceed by motion, except in the case of elections of officers that shall
proceed according to the rules established in that section of the by-laws. Any member
including the chair may make a motion.
Rule 8. Seconds to Motions
A motion from committee does not require a second. A motion from the floor does
require a second.
Rule 9. One Motion at a Time
A member may make only one motion at a time.
Rule 10. Substantive Motions
A substantive motion is out of order while another substantive motion is pending. A
substantive motion is one that refers to main or principal motions as opposed to those
procedural in nature. This allows the board to consider one piece of business at a time.
Rule 11. Adoption by Majority Vote
A motion shall be adopted by a majority of the votes cast, a quorum being present. A
majority is more than half of those present.
Rule 12. Debate
The chair shall state the motion and then open the floor to debate. The chair shall preside
over the debate according to the following general principles:
The maker of the motion is entitled to speak first;
A member who has not spoken on the issue shall be recognized before someone who
has already spoken;
Generally, the debate shall alternate between supporters and opponents of a motion.
If an agenda item has been placed for discussion and possible motion, then discussion
may occur prior to a motion being placed on the floor.
Rule 12. Procedural Motions
In addition to substantive proposals only the following procedural motions are in order.
Unless otherwise noted, each motion is debatable, may be amended, and requires a
majority of the votes cast, a quorum being present, for adoption. Procedural motions are
in order while a substantive motion is pending and at other times, except as otherwise
noted.
Page 8 of 13
In order of priority:
Motion 1 To appeal a procedural ruling of the presiding officer. A decision of the
presiding officer ruling a motion in or out of order, determining whether a speaker has
gone beyond reasonable standards of courtesy in his remarks, or entertaining and
answering a question of parliamentary law or procedure may be appealed to the board.
This appeal is in order immediately after such a decision is announced and at no other
time. The member making the motion need not be recognized by the presiding officer
and the motion, if timely made, may not be ruled out of order.
Motion 2 To adjourn. This motion may be made only at the conclusion of action on a
pending substantive matter; it may not interrupt deliberation of a pending matter. A
motion to adjourn to a time and place certain shall also comply with rules for calling a
meeting.
Motion 3 To take a brief recess. This motion allows the board to pause briefly in its
proceedings.
Motion 4 Call to follow the agenda. The motion must be made at the first reasonable
opportunity or it is waived.
Motion 5 To suspend the rules. The board may not suspend provisions of the rules that
state requirements imposed by law on the board.
Motion 6 To go into closed session. The board may go into closed session only for one
or more of the purposes listed in G.S. 143-318.11. The motion to go into closed session
shall cite one or more of these purposes and shall be adopted at an open meeting.19
Motion 7 To leave a closed session. This motion provides a mechanism for returning
from closed session to an open meeting.
Motion 8 To divide a complex motion and consider it by paragraph. The motion is in
order whenever a member wishes to consider and vote on subparts of a complex motion
separately.
Motion 9 To defer consideration. The board may defer a substantive motion for later
consideration at an unspecified time. A substantive motion that has been deferred expires
90 days thereafter unless a motion to revive consideration is adopted. If consideration
has been deferred, a new motion with the same effect cannot be introduced while the
deferred motion remains pending. A motion to suspend the rules is possible in raising a
new motion.
Motion 10 Motion for the previous question. The motion is not in order until every
member has had an opportunity to speak once. An affirmative vote on motion 10 does
not approve the substantive issue, which requires a separate vote.
Page 9 of 13
Motion 11 To postpone to a certain time or day. This motion allows the board to
postpone action on a substantive matter until the time or day specified in the motion. A
person who wishes to revisit the matter must either wait until the specified time or move
to suspend the rules.
Motion 12 To refer a motion to committee. The board may vote to refer a substantive
motion to a standing or ad hoc committee for its study and recommendations. Sixty days
or more after a substantive motion has been referred to a committee, the introducer of the
substantive motion may compel consideration of the measure by the entire board,
whether or not the committee has reported the matter to the board.
Motion 13 To amend. An amendment to a motion must be pertinent to the subject matter
of the motion. An amendment is improper if adoption of the motion with that
amendment added would have the same effect as rejection of the original motion. A
proposal to substitute completely different wording for a motion or an amendment shall
be treated as a motion to amend.
A motion may be amended, and that amendment may be amended, but no further
amendments may be made until the last-offered amendment is disposed of by a vote.
Each amendment will be clearly stated prior to the vote.
Motion 14 To revive consideration. The board may vote to revive consideration of any
substantive motion earlier deferred by adoption Motion 9. The motion is in order at any
time within 90 days after the vote to defer consideration. After 90 days the substantive
motion that has been deferred expires.
Motion 15 To reconsider. The board may vote to reconsider its action on a matter. The
motion to do so must be made by a member who voted with the prevailing side and only
at the meeting during which the original vote was taken. The motion cannot interrupt
deliberation on a pending matter but is in order at any time before final adjournment of
the meeting.
Rule 13. Withdrawal of Motion
The introducer may withdraw a motion at any time before it is amended or before the
chair puts the motion to a vote.
Rule 14. Duty to Vote
Every member must vote unless excused by the remaining members of the board. A
member who wishes to be excused from voting shall so inform the chair, who shall take a
vote of the remaining members. No members shall be excused from voting except in
cases involving conflicts of interest as defined by the board or by law. In all other cases a
failure to vote by a member who is physically present in the board meeting room or who
has withdrawn without being excused by a majority vote of the remaining members
present, shall be recorded as a vote with the prevailing side.
Rule 15. Quorum
Page 10 of 13
A majority of the currently appointed members (excluding vacant seats) shall constitute a
quorum. A majority is more than half. The chair shall be considered a member of the
board in determining the number on which a majority is based and in counting the
number of members actually present. A member who has withdrawn from a meeting
without being excused by majority vote of the remaining members present shall be
counted as present for purposes of determining whether or not a quorum is present.
Rule 16. Closed sessions20
The board may hold closed sessions as provided by law. The board shall commence a
closed session only after a motion to go into closed session has been made and adopted
during an open meeting. The motion shall state the purpose of the closed session. The
motion to go into closed session must be approved by the vote of a majority of those
present and voting. The board shall terminate the closed session by a majority vote,
using Motion 7 in Rule 12. Only those actions authorized by statute may be taken in
closed sessions. A motion to adjourn (recess) shall not be in order during a closed
session.
Rule 17. Minutes
The Secretary shall record meetings and prepare written minutes; however, the same need
not be verbatim. The minutes shall be open to inspection of the public. The exact
wording of each motion and the results of each vote shall be recorded in the minutes, and
on the request of any member of the board, the entire board shall be polled by name on
any vote.
Minutes and general accounts of closed sessions may be sealed by action of the board.
Such sealed minutes and general accounts may be withheld from public inspection so
long as public inspection would frustrate the purpose of the closed session.
Rule 18. Administrative Hearings21
The Board of Health is required by Statute to hold hearings when the interpretation and
enforcement of rules adopted by the Board of Health and the imposition of administrative
penalties is challenged.
”(b) Appeals concerning the interpretation and enforcement of rules adopted by the
local Board of Health and concerning the imposition of administrative penalties by a
local Health Director shall be conducted in accordance with subsections (b), (c) and (d)
of [Section 130A-24]. The aggrieved person shall give written notice of appeal to the
local Health Director within 30 days of the challenged action. The notice shall contain
the name and address of the aggrieved person, a description of the challenged action and
a statement of reasons why the challenged action is incorrect. The local Health Director
shall, within five working days, transmit to the local Board of Health the notice of appeal
and the papers and materials upon which the challenged action was taken.
(c) The local Board of Health shall hold a hearing within 15 days of the receipt of the
notice of appeal. The Board shall give the person not less than 10 days notice of the date,
time and place of the hearing. On appeal, the Board shall have authority to affirm,
Page 11 of 13
modify or reverse the challenged action. The local Board of Health shall issue a written
decision based on the evidence presented at the hearing. The decision shall contain a
concise statement of the reasons for the decision.
(d) A person who wishes to contest a decision of the local Board of Health under
subsection (b) of this section shall have a right of appeal to the district court having
jurisdiction within 30 days after the date of the decision by the Board. The district court
may affirm, modify or reverse the decision of the Board with the scope of review as
stated in G.S. 150B-51.”
Administrative hearings are designed to resolve factual controversies quickly without
becoming bogged down in the procedural and evidentiary technicalities that surround
judicial proceedings. To insure basic fairness, the courts require that that aggrieved party
be given an opportunity to be heard, that the Board’s findings be supported by competent
and substantial evidence, and that a record of the proceedings be made to enable review
by a court.
The right to be represented by counsel, to confront witnesses on the other side, and to
cross-examine the other parties and their witnesses must also be granted the aggrieved
party. These procedures are necessary to insure that the opportunity to be heard is
effective.
The Board is expected to seek the most reliable evidence available under the
circumstances. For example, hearsay evidence is normally not admissible because it is
thought to be less reliable than directed testimony. All decisions by the Board acting as a
quasi-judicial body are subject to review by the courts. The order in which evidence is
presented during Board of Health hearings is not structured. Any convenient sequence is
acceptable.
The Chairperson or Vice Chairperson or their designee and at least one other board
member will act as a Hearing Officer to gather all evidence and receive testimony. After
evidence and testimony have been presented, the Secretary shall transmit the proceedings
of the hearing to the full Board membership. At its next regular scheduled meeting
following the hearing, the Board shall deliberate and reach a decision. The decision will
be in writing so that it can be included in the record for appeal. The Board must set out
its findings of fact and conclusions derived from the findings in a clear and logical
sequence. The decision should also include a notice to the losing party of his right to
appeal the decision to the courts.
Rule 19. Revision of By-laws
These by-laws may be revised by simple majority vote of members present at any regular
meeting of the Board at which a quorum is present. Distribution of a copy of the
proposed by-laws change(s) to the members and a discussion of the proposed change at
the preceding month regular meeting shall precede such vote. The by-laws shall be
reviewed every five years for possible changes. No provision of the by-laws may be in
Page 12 of 13
conflict with state statute. Changes in law will automatically be incorporated into the by-
laws by notification of the Secretary of the Board.
Page 13 of 13
Footnotes
1 NC General Statute 130A-35 (a)
2 NC General Statute 130A-39
3 NC General Statute 130A-35 (b)-(d)
4 NC General Statute 130A-35 (c) The custom adopted by the Orange County Board of Commissioners in
1999 was to only appoint board members for two consecutive terms of office.
5 NC General Statute 130A-35 (g)
6 NC General Statute 130A-35 (h)
7 NC General Statute 130A-35 (e)
8 NC General Statute 132-6
9 NC General Statute 130A-41(b)(13)
10 NC General Statute 130A-39(g)
11 NC General Statute 130A-40
12 NC General Statute 130A-39
13 NC General Statute 143-318.11
14 NC General Statute 130A-35 (i)
15 NC General Statute 143-318.12
16 NC General Statute 130A-35 (i)
17 NC General Statute 143-318.12(b)(3)
18 NC General Statute 153A-40(a)
19 NC General Statute 143-318.11
20 NC General Statute 143-318.11
21 NC General Statute 130A-24
*T he procedures in these by-laws were drawn from the following publication:
Bell, II, A. Fleming. Suggested Rules of Procedure for Small Local Government Boards, Second Edition,
Institute of Government, The University of North Carolina at Chapel Hill, 1998.
\\WHITTED1\SYS\DOHADMIN\B O H\BOH New By-laws.doc
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy A: Compliance with Public Health Laws/Regulations
Reviewed By: Board of Health
Approved By: Board of Health, Health Director
Review Annually (July) Page 1 of 2
Original Effective Date: October 24, 2004
Last Revision Date: 1/2006, 11/2013, 11/2014, 8/2015
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Review\Track Changes\I.A. Compliance with Laws and Regulations BOH_DRAFT Aug 2015.doc
Policy I.A.:
It shall be the policy of the Orange County Board of Health and Health Department to ensure
that its workforce consults and follows federal, state, and local laws and regulations and the
current recommendations of regulating/advisory agencies in the delivery of public health
services.
Purpose:
The purpose of this policy is to ensure that the Orange County Board of Health and Orange
County Health Department workforce consults and follows federal, state, and local laws and
regulations and the current recommendations of regulating and advisory agencies in the
delivery of essential and mandated public health services.
Definitions:
1. Centers for Disease Control and Prevention (CDC) – an agency of the United States
government that serves as the national focus for developing and applying disease
prevention and control, environmental health, and health promotion and education
activities designed to improve the health of the people of the United States.
2. North Carolina Department of Health and Human Services (NCDHHS) – a
department of State government that is charged with “protecting health, fostering self-
reliance and protecting the vulnerable.”
3. Essential public health services – defined in NC General Statute 130A.
4. North Carolina General Statutes (NCGS) – The laws passed by the North Carolina
General Assembly. Public health statutes are generally located in Chapter 130A.
5. North Carolina Administrative Code (NCAC) – a compilation of the administrative
rules of approximately 26 state agencies and more than 50 occupational licensing
boards.
6. United States Code of Federal Regulations (USCFR) – the codification of the general
and permanent rules published in the Federal Register by the executive departments
and agencies of the Federal Government.
7. Ordinance – local rules adopted by the Board of Commissioners.
8. Regulating and advisory agencies – agencies that are created by a governing body to
recommend best practices for public health or are charged with interpreting and
enforcing public health laws. (Examples include the CDC, the National Immunization
Advisory Committee, US Department of Health and Human Services, the NCDHHS)
9. Mandated public health services – the public health services that a local health
department is required by state statute or administrative code to implement.
10. Workforce – Orange County Health Department employees, contract personnel,
volunteers, trainees, and students.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy A: Compliance with Public Health Laws/Regulations
Reviewed By: Board of Health
Approved By: Board of Health, Health Director
Review Annually (July) Page 2 of 2
Original Effective Date: October 24, 2004
Last Revision Date: 1/2006, 11/2013, 11/2014, 8/2015
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Review\Track Changes\I.A. Compliance with Laws and Regulations BOH_DRAFT Aug 2015.doc
GuidelinesProcedures:
1. The Board of Health and Health Department workforce must follow laws, established
guidelines, and consistent procedure in order to assure that the public receives fair,
efficient, and effective services.
2. The Board of Health must consult legal counsel such as the Orange County attorney,
the NC Attorney General or the UNC School of Government whenever legal
assistance is indicated to interpret laws and rules.
3. The Board of Health delegates to the Health Department Division Directors and
Supervisors of the appropriate division through the Health Director, the development
and implementation of all policies, procedures and/or task outlines to assure effective
and efficient service delivery of programs within the scope of the most current public
health laws and regulations.
4. All pertinent laws, regulations, and policy and procedure manuals shall be maintained
in the appropriate division. The NCGS 130A and related statutes on public health
law and administrative codes shall be maintained in the Health Director’s Office and
in a Board of Health Manual.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy B: Program and Policy Adoption
Reviewed By: Health Director, Board of Health
Approved By: Board of Health
Review Annually (July) Page 1 of 1
Original Effective Date: October 24, 2007
Revision Dates: 11/2013, 11/2014, 8/2015
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Policy I.B:.
The Orange County Board of Health authorizes and delegates the implementation of all
programs and services as defined by North Carolina General Statute 130A, the related NC
Administrative Code, and other programs approved by the Board to the staff of the Orange
County Health Department under the direction of the Health Director.
Purpose:
The purpose of this policy is to ensure that the Orange County Board of Health provides
guidance for programs and policies that affect the entire Health Department.
GuidelinesProcedures:
1. The Orange County Board of Health, upon recommendation of the Health Director,
shall review and approve policies or programs that commit the Health Department to
utilize significant additional or new resources outside of the scope of the approved
annual budget.
2. The Board of Health authorizes continuation of program activities through the annual
approval of a Health Department budget.
3. The Board of Health delegates the approval of all administrative policies and
procedures for the general functioning of the Health Department to the Health
Director.
4. The Board of Health reviews and approves policies as requested or in response to a
Board of County Commissioner initiative and forwards recommendations to the
Board of Commissioners on relevant changes. The Board of Health delegates the
implementation of these policies to the appropriate division staff through the Health
Director.
5. The Orange County Board of Health shall review at least annually all policies
adopted by the Board of Health.
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Review\Track Changes\I.C. Appendix A_Confidentiality and Conflict of Interest Statement.doc
Document History: Original 1998; Revised 10/24/2007, 10/8/2014
Confidentiality & Conflict of Interest Statement
For New Board of Health Member
Board Adopted Policy I.C. Appendix A
Confidentiality
In connection with my responsibilities as a member of the Orange County Board of
Health, I agree to treat all information concerning health department clients, personnel,
and financial matters in a confidential manner as required by state and federal statute
and will not divulge this information to unauthorized personnel or the public. I
understand that if I wrongfully and/or willfully disclose such information, I may be
subject to removal from the Orange County Board of Health.
Conflict of Interest
1. Each board member, upon accepting a seat on the board, agrees in writing by
signing below, to carefully guard against any conflict of interest that might
develop between his or her personal interest and that of the Orange County
Health Department.
2. If an issue arises in which a member of the board has a conflict of interest, the
member shall promptly disclose the conflict to the Chair of the Board prior to
consideration of the issue by the board.
3. In matters involving a conflict of interest, a board member must state the reason
for which they reasonably think a conflict exists and the board member shall not
vote on such policies or transactions unless requested by the board.
4. The abstention and the reason for it shall be recorded in the minutes.
5. A board member may not directly or indirectly benefit except as provided for as
members of the board of directors, from the county’s disbursement of funds.
6. Violation of this policy shall be grounds for recommending dismissal of a board
member. The Board of Health will forward recommendation for dismissal to the
Board of County Commissioners for action.
I have read and understand the confidentiality and conflict of interest statements. I
agree to abide by these policies.
___________________________ _______________
Board Member Signature Date
____________________________
Board Member Name (Printed)
_________ _______
Staff initials Date
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy C: Confidentiality Agreement and Conflict of Interest Statement
Reviewed By: Board of Health, Health Director
Approved By: Board of Health
Review Annually (July) Page 1 of 3
Original Effective Date: October 24, 2004
Revision Dates: 1/2006, 11/13, 11/2014, 8/2015
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Review\Track Changes\I.C.Confidentiality and Conflict for BOH_DRAFT Aug 2015.doc
Policy I.C.: Each Board member will sign a confidentiality agreement and conflict of
interest statement upon accepting a seat on the Board of Health.
Purpose:
To prevent individuals from deriving any profit or gain directly or indirectly by reason of
their association with the Orange County Health Department. All members of the Orange
County Board of Health will promptly disclose any conflict of interest between his or her
personal interests and the interests of the organization. To protect the disclosure of
information that is judged to be of a confidential nature by state or federal statute or policy.
GuidelinesProcedures:
1. Each new Board of Health member must sign a Confidentiality Agreement and Conflict
of Interest Statement (I.C. Appendix A) prior to attending their first meeting of the Board
of Health that states the following:
1.
Confidentiality
In connection with my responsibilities as a member of the Orange County Board of Health, I
agree to treat all information concerning health department clients, personnel, and financial
matters in a confidential manner as required by state and federal statute and will not divulge this
information to unauthorized personnel or the public. I understand that if I wrongfully and/or
willfully disclose such information, I may be subject to removal from the Orange County Board of
Health.
Conflict of Interest
1. Each board member, upon accepting a seat on the board, agrees in writing by signing below,
to carefully guard against any conflict of interest that might develop between his or her
personal interest and that of the Orange County Health Department.
2. If an issue arises in which a member of the board has a conflict of interest, the member shall
promptly disclose the conflict to the Chair of the Board prior to consideration of the issue by
the board.
3. In matters involving a conflict of interest, a board member must state the reason for which
they reasonably think a conflict exists and the board member shall not vote on such policies
or transactions unless requested by the board.
4. The abstention and the reason for it shall be recorded in the minutes.
5. A board member may not directly or indirectly benefit except as provided for as members of
the board of directors, from the county’s disbursement of funds.
6. Violation of this policy shall be grounds for recommending dismissal of a board member.
The Board of Health will forward recommendation for dismissal to the Board of County
Commissioners for action.
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy C: Confidentiality Agreement and Conflict of Interest Statement
Reviewed By: Board of Health, Health Director
Approved By: Board of Health
Review Annually (July) Page 2 of 3
Original Effective Date: October 24, 2004
Revision Dates: 1/2006, 11/13, 11/2014, 8/2015
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6. 2. The original, signed copy of the Confidentiality Agreement and Conflict of Interest
Statement will be filed in the Board of Health member’s file and kept at the Health
Department by the Administrative Assistant to the Health Director.
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy C: Confidentiality Agreement and Conflict of Interest Statement
Reviewed By: Board of Health, Health Director
Approved By: Board of Health
Review Annually (July) Page 3 of 3
Original Effective Date: October 24, 2004
Revision Dates: 1/2006, 11/13, 11/2014, 8/2015
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I have read and understand the confidentiality and conflict of interest statements. I
agree to abide by these policies.
___________________________ _______________
Board Member Signature Date
____________________________
Board Member Name (Printed)
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy D: Requests for Environmental Services and Assessments
Reviewed By: Board of Health & Health Director
Approved By: Board of Health
Review Annually (July) Page 1 of 4
Original Effective Date: August 24, 2006
Revision Dates: 11/2013, 11/2014
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Policy I.D.:
This policy covers processing and budgetary considerations regarding requests from citizens
and communities for environmental services and assessments to determine whether
environmental contaminants are present, environmental degradation has occurred or for the
applicant's information for future reference.
Purpose:
The purpose of this policy is to determine when environmental services, surveys or
assessments will be conducted and also to set forth the funding mechanisms for those actions.
Also covered within the policy scope are the decision tree for when community assessments
will be considered and the ensuing financial responsibilities for those expanded efforts. This
policy is not intended to cover nor does it cover applications, inspections, approvals or other
processes for regulatory programs generally administered in the Environmental Health
Services Division.
Section I Policy Overview
1.0 Environmental Health routinely receives concerns and queries from Orange
County residents regarding environmental investigations to determine whether
an environmental exposure exists and also whether unusual disease prevalence
is occurring. These requests may arise from an individual or from
communities. This policy addresses general and specific practices for these
requests and assigns responsibilities for their dispensation.
Section II Individual Requests
1.0 Individual residents may request services and environmental assessments for
their property, whether owned outright, leased, rented, or otherwise legally
occupied. These services include septic inspections, water samples, indoor air
quality (IAQ) assessments, vector control inspections, single disease case
investigations, or other services germane to current or future environmental
health programs.
Section III Community or Collective Requests
1.0 The following types of community or collective studies and assessments will
be considered and acted upon by staff with the appropriate approval(s) when
environmental conditions are suspected as a causative factor:
1.1 Acute and Chronic Disease
a. Airborne, vector-borne and waterborne diseases are environmentally
related in their transmissions and may affect a community as a whole.
Chronic diseases such as asthma and cancer can have causative factors
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy D: Requests for Environmental Services and Assessments
Reviewed By: Board of Health & Health Director
Approved By: Board of Health
Review Annually (July) Page 2 of 4
Original Effective Date: August 24, 2006
Revision Dates: 11/2013, 11/2014
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related to environmental conditions and exposures. The investigation of
acute and chronic diseases would be indicated with confirmed cases of
those diseases in rates extraordinary to baseline rates for Orange County
or statistically expected rates for that community. Investigations will be
carried out in accordance with best epidemiological practices established
by the EPI Team* in each community or collective request.
b. OCHD will conduct community studies for acute and chronic diseases
suspected of originating from environmental exposures and for wells and
septic systems failures when data or reports indicate that study beyond
the individual level is needed to confirm or deny multiple sources of
contamination leading to acute and/or chronic disease under
investigation.
1.2 Wastewater and Well Water Studies
a. Community studies will be considered and acted on or deferred by
OCHD based on several risk factors and other defined considerations.
Those include the following:
1. The study area consists of more than 5 households.
2. Known disease-causing environmental contamination (chemical
releases, improper biosolids applications, underground storage
tanks, junkyards, etc.) that could adversely affect a natural
resource (groundwater, stream, etc.) or negatively impact more
than a single property in that community.
3. Known geophysical conditions (e.g., underlying rock structure
that might lead to high levels of natural radon release, severe
disturbances of the underlying structure) with a scientifically
documented negative environmental impact potential that could
affect the intended use and sustainability of property in the
community.
4. More than 30% of the individual wells in a given geographical
community were drilled prior to 1981 or more than 30% of the
septic systems in the community are more than 20 years old.
5. Protection of water supply resources (protected water supply
watersheds, water quality critical areas, wellhead protection
areas, etc.).
b. Statistical Studies may be considered in order to gain important
information about septic system failure rates or groundwater quality or
quantity characteristics. Examples in this category might include:
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy D: Requests for Environmental Services and Assessments
Reviewed By: Board of Health & Health Director
Approved By: Board of Health
Review Annually (July) Page 3 of 4
Original Effective Date: August 24, 2006
Revision Dates: 11/2013, 11/2014
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1. comparing septic system failure rates in mobile home parks with
those of neighborhoods with stick built construction;
2. examining the existing data for septic system repairs to identify
common characteristics of failed systems;
3. studying the effect of water softener systems on septic system
failures;
4. exploring the relationship between well water quality and the age
of the well, length of casing, landscape position, etc.
5. gathering baseline water quality data and tracking water quality
over time in a defined geographical study area near a suspected
environmental hazard (such as a biosolid application site)
Section IV Funding
1.0 Individual Requests: The cost recovery for individual testing and assessments
will come from fees for service administered according to the Environmental
Health Division's Fee and Application Policy and from the fee schedule
approved by the Board of Health and the Board of County Commissioners. In
the case of an individual disease investigation that is a direct follow-up to an
outbreak, the individual charge is waived.
2.0 Community Surveys: The direct operational costs for materials needed for
community related surveys, assessments and other studies will be paid for by
Orange County as specified in Section V of this policy if:
a. surveillance data or other confirmed and documented medical or
scientific reports indicate a potentially environmentally caused or
transmitted disease prevalence at abnormal levels in that community, or
b. at least three of the five items in Section III. 1.2a are met.
3.0 Studies requested by other governmental agencies will be evaluated by the
Health Director and County Manager as appropriate.
Section V Community Study Funding Approvals
1.0 When estimated operational costs are less than or equal to $250, the Orange
County Health Director will approve or deny the study and the study will be
funded through the Environmental Health Services budget.
2.0 When estimated operational costs are greater than $250 but less than or equal
to $2,500, the Orange County Health Director will approve or deny the study
based on current availability of budgetary and staff resources and present it to
the Orange County Board of Health for final decision. The Health Director
will determine the specific funding source for an approved study.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy D: Requests for Environmental Services and Assessments
Reviewed By: Board of Health & Health Director
Approved By: Board of Health
Review Annually (July) Page 4 of 4
Original Effective Date: August 24, 2006
Revision Dates: 11/2013, 11/2014
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3.0 When estimated operational costs are greater than $2,500, or if the budgetary
and staff resource needs are greater than available in the Health Department
budget, the Orange County Health Director will recommend to approve or
deny the study and present the recommendation to the Orange County Board
of Health for consideration. The Board of Health’s recommendation will be
presented to the Orange County Board of County Commissioners for final
decision and funding source identification if approved.
*The EPI Team is the interdisciplinary health department staff team that is responsible for all
outbreak investigations.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy F: Community Assessment Policy
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 1 of 3
Original Effective Date: February 28, 2008
Revision Dates: 10/15/12, 11/2013, 11/2014, 8/2015
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Policy I.F.
This policy establishes that the Orange County Health Department will complete a
Community Health Assessment (CHA) every four years that ensures community input and a
State of the County Health (SOTCH) report in the interim years between assessments,
according to guidelines published by the North Carolina Division of Public Health.
Purpose
The purpose of this policy is to provide guidelines for the development of the CHA and
SOTCH report and to ensure that these are collaborative efforts that include input from
community members, county agencies and organizations, the Board of Health and other
county stakeholders.
Delegation
The development and implementation of procedures for the CHA and SOTCH reports are
delegated to the Division of Health Promotion and Education Services through the Health
Director.
Procedures
1. Community Health Assessment process procedures:
a. This process will be coordinated through the Health Promotion and Education
Division every four years.
b. Health education staff will recruit a diverse group of partners to form a CHA
team. Partners that will be approached about serving on this team include
representatives from but not limited to the following:
i. Various ethnic and cultural backgrounds (Hispanic, Native American, etc.)
ii. Economic development and industry
iii. Educational systems
iv. Human service agencies
v. Organizations that serve children through senior adults
vi. Law enforcement
vii. And others as identified.
c. As funding is available, the Department will contract with an educational
institution or consultant to facilitate the team in the collection, analysis, and
reporting of the primary and secondary data.
d. The Community Health Assessment Guide Book available on the North Carolina
Division of Public Health website will be used as a resource document or toolkit
throughout the community health assessment process. This book will guide the
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy F: Community Assessment Policy
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 2 of 3
Original Effective Date: February 28, 2008
Revision Dates: 10/15/12, 11/2013, 11/2014, 8/2015
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team on the various components (i.e. demographics, economic factors, health
needs, etc.) that need to be included in this process and the final document.
e. Primary data will be collected from community members, clients receiving direct
services from the health department, the Board of Health and other county
stakeholders through their participation in written surveys, focus groups, or
interviews.
f. Secondary data will be obtained from the North Carolina State Center for Health
Statistics (NC SCHS) and other resources identified and available to CHA team
members.
g. CHA team members will assist with the collection of primary and secondary data.
h. The CHA team will collaborate with county stakeholders to prioritize health
concerns according to the primary and secondary data collected. The CHA team
will reference the CHA Guidebook for guidance on reporting data findings and
involving community members, the Board of Health and other county
stakeholders in the process to establish health priorities for the county.
i. Designated members of the CHA team will summarize the data and priority health
topics to produce a document to report the community health assessment process
and its findings.
j. The CHA document will be submitted to the North Carolina Division of Public
Health by the first Monday in March every four years and will be disseminated to
community and county stakeholders as specified in the North Carolina Local
Health Department Accreditation Standards. This may include electronically via
the department’s website as well as presentations of findings and copies of reports
to partner agencies and community organizations for public access.
k. The CHA document will be used by the Orange County Health Department in the
development of the department-wide strategic plan, grant writing, program
planning and advocacy for funding. This document will be available as a resource
for other individuals, agencies, and organizations.
1. Using the CHA, Health Promotion and Education staff and the CHA team will
create Community Health Action Plans to describe plans for health activities to be
carried out in the county. The Community Health Action Plan form is due the
first Monday of September the year the county was assigned to complete their
CHA. The form is available through the NC Division of Public Health website.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy F: Community Assessment Policy
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 3 of 3
Original Effective Date: February 28, 2008
Revision Dates: 10/15/12, 11/2013, 11/2014, 8/2015
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2. State of the County Health (SOTCH) report process procedures:
a. The SOTCH report will primarily be produced by the Department’s Health
Promotion and Education staff in the interim years between community health
assessments.
b. This report will include:
i. A review of major morbidity and mortality data for the county
ii. A review of health concerns selected as priorities
iii. Progress made in the last year on these priorities
iv. A review of any changes in the data that guided the selection of these
priorities
v. Other changes in the county that affect health concerns (such as economic or
political changes, new funds or grants available to address health problems,
etc.)
vi. New and emerging issues that affect health status
vii. Methods of direct community involvement with ongoing efforts
c. The primary source of data for this report will be the NC SCHS website.
d. The SOTCH report will be submitted to the state by the first Monday in March of
each year it is due and will be disseminated to the community and county
stakeholders according to North Carolina Local Health Department Accreditation
Standards. .
References:
Community Health Assessment Guidebook online at:
http://publichealth.nc.gov/lhd/cha/docs/guidebook/CHA-GuideBook-
June2014.pdfhttp://publichealth.nc.gov/lhd/cha/docs/guidebook/CHA-
GuideBookUpdatedDecember15-2011.pdf
Community Health Action Plan Form online at:
http://publichealth.nc.gov/lhd/cha/docs/guidebook/GuidelinesForCommunityHealthActionPl
anForms.pdf
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section I: Board Adopted Policies
Policy G: Community and Public Input Policy
Reviewed By: Board of Health
Approved By: Board of Health, Health Director
Review Annually (July) Page 1 of 1
Original Effective Date: February 28, 2008
Revision Dates: 11/2013, 11/2014, 8/2015
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Policy I.G.
It shall be the policy of the Orange County Board of Health and Health Department to ensure
that reasonable mechanisms for community/public input are available.
Purpose
The purpose of this policy is to ensure that policies and services of the Orange County Board
of Health and Orange County Health Department have considered the health and
environmental safety needs of the general population and any at-risk populations of Orange
County.
Guidelines
1. The Board of Health will reserve a public comment period on each regularly
scheduled Board meeting. Each individual will be given a maximum of three minutes
for comments, and the public comment period will be limited to 15 minutes each
meetingeach meeting.
2. Annually the Board of Health will receive from the staff of the Health Department the
results of patient and client input on services received, including any corrective
actions deemed necessary to improve services.
3. The Health Director or his/her designee will maintain current contact information on
the Department and the Board of Health on the Health Department website.
4. The Health Director shall report significant community-wide input received by the
staff to the Board at least quarterly.
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 1
Original Effective Date: February 28, 2008
Revision Dates: 11/2013, 11/2014, 8/2015
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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:
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.
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.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section II: Board Adoption or Review of Reports and Documents
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 1 of 2
Original Effective Date: October 24, 2007
Revision Dates: 11/2013, 11/2014, 8/2015
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Policy II.
It shall be the policy of the Orange County Board of Health to provide input and
guidance on the work of the Health Department as it affects the health and well-being
of county residents by review of key documents.
Purpose: The purpose of this policy is Tto ensure that the Board of Health provides
guidance and input for community and departmental planning that affects the health and well
being of county residents and to meet the requirements for program review as specified by
law or regulation.
Procedures:
1. The Board of Health will review the documents listed below and take
appropriate action as described for each document. Scope of Review and
Approval:
2. A particular document or program may have differing review and adoption
requirements. Annually, the Health Director and Division Directors will review
program requirements and recommend changes to the reports or documents and
actions required that are listed in this Section.
1.a. Community Health Assessment: (2007, 2011, 2015) A comprehensive
county-wide community health assessment every four years is the current
requirement of the contract agreement the health department has with the
NCDHHS. The assessment has several components, all of which are
individually adopted by the Board of Health in the year that the assessment is
due to the NCDHHS. The components include:
a.i. Approval Review of community input process.
b.ii. Approval of priority selection.
c.iii. Approval of final document.
d.iv. Approval of action plans based on priority selection.
2.b.State of the County Health Report (SOTCH): An annual update on progress
toward the community action plans of the community health assessment and a
review of secondary data related to the priorities. The Board reviews and
endorses this report. (Due December of each year a Community Health
Assessment is not due).
3.c. Health Department Budget: The Board annually reviews and approves for
forwarding to the Board of Commissioners, the proposed budget for the
Health Department in accordance with the county adopted schedule for budget
completion. The review and approval includes but is not limited to new
position requests, capital requests, technology requests, fee schedules, and
new program requests.
4.d.Board of Health Strategic Plan: The Board of Health develops and adopts a
strategic plan every two years to define the Board’s policy and programmatic
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section II: Board Adoption or Review of Reports and Documents
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 2 of 2
Original Effective Date: October 24, 2007
Revision Dates: 11/2013, 11/2014, 8/2015
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goals. These goals are shaped by the Community Health Assessment,
available primary and secondary data, and available department resources.
The Board adopts the plan and provides updates to the Board of
Commissioners at joint meetings of the Board of Commissioners and Board of
Health.
5.e. Child Fatality Prevention Task Force Report: The Board of Health receives
and forwards annually to the Board of Commissioners a report and
recommendations for improvement from the Orange County combined Child
Fatality Prevention Task Force and the Child Protection Task Force as
required by state law.
6.f. Fiscal Oversight: In order to exercise fiscal oversight, the Board receives and
reviews quarterly financial summaries on revenues and expenditures by
Division for the Health Department. The Board forwards recommendation
of approval for the receipt of all grant funds and funds not originally part of
the approved annual budget to the County Commissioners. Contracts that
require the Board of Commissioner approval for execution are reviewed by
the Board of Health, either prior to submission to Commissioners or
immediately following the submission to Commissioners.
7.g.Research Project Requests and Reports: The Board receives information on
all research project requests that are made to the Health Department and on
final reports as a result of research approved by the Health Director. Projects
that are conducted by health department staff members require a written or
oral report to be submitted to the Board of Health.
8.h.Annual Activity Communicable Disease Reports: The Board receives and
reviews an annual activity and budget report for the Department after the
close of the fiscal year, before the next budget is prepared. An annual
summary ofreport on communicable disease activity. may be included as part
of the Annual Activity Report.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 1 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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Purpose
To outline operating procedures for the Board of Health in accordance with pertinent state,
local and federal requirements for the operation of the Board.
I. Name and Office
The name of this organization is the Orange County Board of Health (hereinafter
“Board”). The principal office of the Board is located at 300 West Tryon Street,
Hillsborough, NC 27278.
II. Charge to the Board
The Board is the primary policy-making and adjudicatory body (NCGS 135A-25(a))
for the health department and is charged to protect and promote the public health of
Orange County (NCGS 130A-39).
III. Composition
A. The composition of the Board of Health is governed by NCGS 130A-35(b)-
(d)
IV. Terms of Office
A. By NCGS 130A-35 (c), members shall serve three year terms and no member
may serve more than three consecutive three-year terms unless the member is
the only person residing in the county who representes one of the professions
designated in subsection (b) of NCGS 130A-35.
B. It is the policy of the Orange County Board of Health that members may serve
three, three-year consecutive terms. Members appointed to fill unexpired
terms are eligible to subsequently be appointed to three additional terms.
III.V. Officers and Committees
A. Chair and Vice-Chair
The Board members shall select a Chair and Vice-Chair by majority vote each
year at the last meeting of the calendar year.
B. Secretary
The Orange County Health Director shall serve as Secretary to the Board, but
the Director is not a member of the Board. The Health Director may delegate
the duties of the secretary that are set forth in these operating procedures to an
appropriate local health department employee.
C. Committees
The Board shall review the existing committee structure annually and make
decisions regarding the number and types of standing committees. Board
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 2 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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members are appointed to committees in January of each year. Only Board
members may serve as committee members of standing Board committees and
the number of Board members on any single committee must be at least two
members and may not exceed five members.
The Board shall have the following standing committees:
1. Executive Committee
To provide the structure for the work of the Board of Health and act as an
advisor to the health director and senior management staff as needed.
Chair and Vice-Chair are committee members.
2. Nominating and Bylaws Committee
To develop and present an annual slate of officers for Board consideration,
to oversee the board recruitment process, and to recommend operating
procedure changes as needed. Members are appointed by the Chair on an
ad hoc basis.
3. Access to Care
To oversee the action steps and deliverables outlined in the Access to Care
section of the Board of Health Strategic Plan
4. Mental Health and Substance Abuse
To oversee the action steps and deliverables outlined in the Mental Health
and Substance Abuse section of the Board of Health Strategic Plan
5. Childhood and Family Obesity Prevention
To oversee the action steps and deliverables outlined in the Childhood and
Family Obesity Prevention section of the Board of Health Strategic Plan
All standing committees are subject to the North Carolina open meetings
laws and shall comply with the provisions of those laws.
6. Temporary Committees
The Board may establish and appoint members for temporary committees
as needed to carry out the Board’s work. Temporary committees must
limit their work to the specific charge outlined by Board motion and may
include members that are not serving on the Board of Health.
All temporary committees are subject to the North Carolina open meetings
laws and shall comply with the provisions of those laws.
IV.VI. Meetings
A. Regular Meetings
The Board shall hold regular meetings no less than quarterly. As a general
rule, the Board will meet monthly. A calendar of regular meetings and
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 3 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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Review\Track Changes\III A Operating Procedures_DRAFT Aug 2015.doc
location of each meeting will be established at the last regular meeting of the
calendar year for the next calendar year. The dates may be adjusted annually
based on Commissioner meeting dates for the year to enable the
Commissioner member of the Board to attend. The requirements of the open
meetings law shall apply to all regular board, regular or ad hoc committee or
task for meetings. Notification of the public will be in compliance with open
meeting law notification.
B. Agenda
The Secretary to the Board shall prepare an agenda for each meeting. Any
board member who wishes to place an item of business on the agenda shall
submit a request to the Secretary at least five working days before the
meeting. For regular meetings, the Board may add items to the agenda or
subtract items from the agenda by a majority vote. The agenda for a special or
emergency meeting may be altered only if permitted by and in accordance
with the North Carolina open meetings laws.
C. Presiding Officer
The Chair of the Board shall preside at Board meetings if he or she is present.
If the Chair is absent, the Vice-Chair shall preside. If the Chair and Vice-
Chair are both absent, another member designated by a majority vote of
members present at the meeting shall preside.
D. Quorum
A majority of the actual membership of the Board, excluding vacant seats,
shall constitute a quorum. A member who has withdrawn from a meeting
without being excused by a majority vote of the remaining members shall be
counted as present for purposes of determining whether or not a quorum is
present.
E. Voting
Each Board member shall be permitted to abstain from voting, by so
indicating when the vote is taken. A member must abstain from voting in
cases involving conflicts of interest as defined by North Carolina law. If a
member has withdrawn from a meeting without being excused by a majority
vote of the remaining members, the member’s vote shall be recorded as an
abstention.
F. Minutes
The Secretary shall prepare minutes of each Board meeting. Copies of the
minutes shall be made available to each Board member before the next regular
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 4 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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Review\Track Changes\III A Operating Procedures_DRAFT Aug 2015.doc
Board meeting. At each regular meeting, the Board shall review the minutes
of the previous regular meeting as well as any special or emergency meetings
that have occurred since the previous regular meeting, make any necessary
revisions, and approve the minutes as originally drafted or as revised. The
public may obtain copies of Board meeting minutes at the Board of Health
website
(http://orangecountync.gov/health/BOHAgendasandMinutes.asphttp://www.or
angecountync.gov/departments/health/agendas_and_minutes.php).
VII. Contract Negotiations
A. The Health Director is authorized to enter into a contract with any
governmental or private agency or with any person, for the provision or
receipt of public health services. The Board of Commissioners or its designee
must approve contracts requiring payment for services rendered to the Health
Department. The Health Director will discuss with the Board contracts that
represent significant deviation from current Board of Health policy prior to
authorizing that contract.
V.VIII. Amendments to Operating Procedures
These operating procedures may be amended at any regular meeting or at any
properly called special meeting that includes amendment of the operating procedures
as one of the stated purposes of the meeting. A quorum must be present at the
meeting at which amendments are discussed and approved, and any amendments
must be approved by a majority of the members present at the meeting.
VI.IX. Other Procedural Matters
The Board shall refer to Bell, II, A. Fleming. Suggested Rules of Procedure for Small
Local Government Boards, Second Edition, Institute of Government, The University
of North Carolina at Chapel Hill, 1998 to answer procedural questions not addressed
in this document, so long as the procedures prescribed in Suggested Rules of
Procedure for Small Local Government Boards do not conflict with North Carolina
law.
VII.X. Rules Development Procedure
The board shall evaluate the need for adoption of rules to protect and promote the
public health. In addition, existing rules should be evaluated periodically for the need
for revisions to respond to new risks, advances in technology, or changes in statutes
or state regulations.
A. The Board will follow the procedures outlined in NCGS 130A-39.
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 5 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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1. Not less than 10 days before the adoption, amendment or repeal of any
local board of health rule, the proposed rule shall be made available at
the office of the county clerk, and a notice shall be published in a
newspaper having general circulation within Orange County. The notice
shall contain:
a. A statement of the substance of the proposed rule or a
description of the subjects and issues involved.
b. The proposed effective date of the rule, and
c. A statement that copies of the proposed rule are available at
the local health department.
A local board of health rule shall become effective upon adoption
unless a later effective date is specified in the rule.
2. Copies of all rules shall be filed with the secretary of the local board of
health and will be made available to all Board of Health members.
3. A local board of health may, in its rules, adopt by reference any code,
standard, rule or regulation, which has been adopted by any agency of
this State, another state, any agency of the United States or by a
generally recognized association. Copies of any material adopted by
reference shall be filed with the rules.
VIII.XI. Adjudication Procedures
A. The Board will follow all procedures as specified in NCGS 130A-24. In the
case where a member of the public is appealing a staff decision on the
application of an Orange County Board of Health adopted rule or policyor
concerning the imposition of administrative penalties by a local health
director, the process will include the following steps:
1. The aggrieved party shall provide written notice of appeal to the Health
Director within 30 days of the challenged action. The notice shall
contain the name and address of the aggrieved person, a description of
the challenged action and a statement of the reasons why the challenged
action is incorrect.
2. The Health Director shall notify the Board within five working days of
receipt of the appeal and transmit all documents upon which the
challenged action was taken.
3. The Board of Health shall hold a hearing within 15 days of the receipt of
the notice of appeal from the health director to the Board. The Board
will give the person not less than 10 days notice of the date, time and
place of the hearing. The local board of health shall issue a written
decision based on the evidence presented at the hearing. The decision
Comment [L1]: Details contained in NCGS
130A-39. Recommend creation of separate
policy/procedure to reduce confusion and ability to
find.
Comment [L2]: NCGS 130A-24 does not provide
for the application of this process to BOH policy.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process A: Operating Procedures
Reviewed by: Health Director
Approved by: Health Director, Board of Health
Review Annually (July) Page 6 of 6
Original Effective Date: February 8, 1979
Revision Dates: 12/18/1980, 4/16/1981; 4/26/1984; 11/16/2000; 2/23/2007; 10/24/2007; 4/23/2009, 7/24/12,
11/5/13, 11/14, 8/15
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Review\Track Changes\III A Operating Procedures_DRAFT Aug 2015.doc
shall contain a concise statement of the reasons for the decision.A
quorum of the entire Board of Health shall hear the appeal.
4.3.The hearing must meet the requirements of procedural due process.
a. No contact outside the hearing with parties involved or
between board members.
b. Board members with any bias must not participate.
c. Board must allow the appellant’s attorney to attend and
advise his/her client.
d. Board must take sworn and relevant testimony.
e. Board must provide for cross-examination of witnesses.
f. Board must keep detailed or verbatim minutes.
5.4.The proceedings shall be recorded and a transcript of the hearing shall
be prepared and be available to the appellant and/or the Board upon
request.
6.5.At the next regularly scheduled Board meeting following the hearing,
the Board must issue a written decision based on the evidence presented
at the hearing. The decision shall contain a concise statement of the
reasons for the decision and the Secretary will transmit the final written
decision of the Board to the person appealing via certified US mail.
7.6.A person who wishes to contest a decision of the Board of Health shall
have a right of appeal to the district court having jurisdiction within 30
days after the date of the decision.
IX.XII. Annual Review of the Health Director
The Board will annually review the performance of the Orange County Health
Director using the process detailed in the Board of Health Policy and Procedure
Manual, Section III, Process B.d. Annual Performance Review Process for Health
Director.
X.XIII. Compliance with North Carolina Law
In conducting its business, the Board shall comply with all applicable North Carolina
laws, including but not limited to open meetings laws, public records laws, and the
laws setting forth the responsibilities and duties of local boards of health. To assist
the Board in compliance, the local health director shall maintain a current copy of
relevant North Carolina General Statutes and make them available to Board members
on request.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section III: Board Processes
Process B: Supplemental Processes a. Oath of Office for New Board Members
Reviewed by: Health Director
Approved by: Board of Health, Health Director
Review Annually (July) Page 1 of 1
Original Effective Date: February 23, 2007
Revision Dates: 11/2013, 11/2014, 8/2015
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Policy III.B. Oath of Office for New Board Members
Purpose: To establish a process for new Board of Health members to complete requirements
for assuming their seat as an Orange County Board of Health member.
Procedures:
1. Each new Board of Health member must complete certain tasks prior to assuming
their seat as an Orange County Board of Health member. These include completing
the “Oath of Office”, a Confidentiality Agreement, and a Conflict of Interest
statement
1. .
a.2. The Oath of Office is administered to a new Board member by a public notary public
either at or before the first regular meeting of the Board of Health after the member’s
appointment by the Orange County Board of Commissioners. The oath may be
administered with or without a Bible by a notary public. The original of the signed
and notarized oath is placed in the official health department file and a copy is
provided to the Board member. The oath is as follows:
“ I, [name], do solemnly swear (or affirm) that I will support and maintain the Constitution
and laws of the United States, and the Constitution and laws of North Carolina not
inconsistent therewith, and that I will faithfully discharge the duties of my office as a member
of the Orange County Board of Health, (so help me God). {NCGS 11-7.1}
“I [name], do swear (or affirm) that I will well and truly execute the duties of the office of
member of the Orange County Board of Health according to the best of my skill and ability,
according to law, (so help me God). {NCGS 11.11}
b.3. Each new Board of Health member must also sign a Confidentiality Agreement
and Conflict of Interest Statement prior to attending their first meeting of the Board of
Health as specified in Board Policy I.C. Confidentiality and Conflict of Interest
Policy for Board Members.
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedure Manual
Section III: Board Processes
Process B: Supplemental Processes b: Orientation and Education for New BOH Members
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 1 of 1
Original Effective Date: October 24, 2007
Revision Dates: 4/3/09; 11/2013, 11/2014, 8/2015
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Policy III.B. Process for Orientation and Education for New BOH Members
Purpose
To orient new Board members so they can become effective Board members and to ensure
that Board members remain current health issues and best practices that affect the
community.
Guidelines:
1. Board members will complete a designated orientation program no later than 9 months
after their first appointment date.
a. Each Board member will meet with the Health Director and other staff as appropriate
to review the Orientation Manual for Board of Health Members and the Local Data
and Rules Manual.
b. The Health Director is responsible for reviewing and updating the Orientation Manual
and the Local Data and Rules Manual on an annual basis prior to new Board members
first date of appointment.
c. Each Board member will review the training (available on the Orange County Board
of Health website) “Protecting Your Public, Environmental Health Orientation Part 1
and 2” either independently or in a group.
2. Board members will participate in ongoing continuing education.
a. Board members will participate in at least 3 educational sessions each calendar year
b. The Health Director, in consultation with the Board, will establish a schedule of
educational sessions each fiscal year that take place either prior to or as part of a
regular Board meeting.
c. Board members will receive ongoing training on the responsibilities and authority of
the local board of health at least once every 4-year accreditation cycle.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process B: Supplemental Processes c. Recruitment and Reappointment Procedures for Members
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually: (July) Page 1 of 3
Original Effective Date: January 2000
Revision Dates: 4/23/09, 11/2013, 11/2014, 8/2015
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Section III.B. Process for Recruitment and Reappointment for BOH Members
Purpose
To provide advice to the Orange County Board of Commissioners on the appointment of
Board of Health members to ensure that they meet requirements of NCGS 130A and Orange
County Commissioner Policies.
Guidelines:
1. Recruitment procedures for new Board of Health members.
a. The Nominating and Operating Procedures Committee of the Board of Health is
delegated to carry out recruitment for vacant slots on the Board of Health. In order to
meet a timely transition the process should begin four months prior to expiration of
term. The procedure is as follows:
For representatives of professional slots:
1. Recommendations for replacements may be solicited from the “retiring” Board
member. Applicants must apply through the County Commissioner’s Clerk’s
Office.
2. If there are no suitable applicants in the current database, mailing list/labels from
appropriate licensing board or association may be obtained.
3. If a list is used to solicit suitable applicants, a recruitment letter is prepared by the
Health Director for Committee approval. Recruitment letter is signed by current
board chair and current board member occupying the slot or nominating
committee chair.
4. Applicants send applications to Clerk's Office. Application period open until
filled. Committee reviews applications no sooner than 15 working days after
mailing of letter.
5. Nominating Committee may add current professional representative, related
division director, and health director to review applications, apply criteria, and
may choose to interview top two or three applicants. At a minimum, committee
interviews top candidate to solicit interest, commitment, and understanding of
expectations of service on the Board. Committee makes recommendation to
Board of Health.
6. Board of Health receives roster of all applicants and applications from top
selections. Board makes recommendation to Board of Commissioners.
For at-large representative slots:
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process B: Supplemental Processes c. Recruitment and Reappointment Procedures for Members
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually: (July) Page 2 of 3
Original Effective Date: January 2000
Revision Dates: 4/23/09, 11/2013, 11/2014, 8/2015
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1. Recommendations for replacements may be solicited from the “retiring” Board
member. Applicants must apply through the County Commissioner’s Clerk’s
Office.
2. If there are no suitable candidates in the current database, the Committee meets
with all three at-large representatives and the Health Director to determine
community groups from which to recruit and mailing labels/list are obtained from
those community groups.
3. If a list is used to solicit suitable applicants, a recruitment letter is prepared by the
Health Director for Committee approval. The letter is signed by the current board
chair and current at-large representative occupying the slot or by nominating
committee chair.
4. Applicants send applications to Clerk's Office or apply on-line through the county
website. Application period open until filled. Committee will look at applicants
no sooner than 15 working days after letters were mailed.
5. Nominating Committee reviews applications, applies criteria, and may choose to
interview top two or three applicants. At a minimum, committee interviews top
candidate to solicit interest, commitment, and understanding of expectations of
service on the Board. Committee makes recommendation to Board of Health.
6. Board of Health receives roster of all applicants and applications from top
selections. Board makes recommendation to Board of Commissioners.
b. Criteria for Board of Health applicant review. The following criteria are meant to be
guidelines for assessing applicants and are not meant to be exclusive.
1. Full-time resident of Orange County, with commitment to stay in the county for at
least six nine years (32 terms)
2. Must hold required degree for service if in a professional slot: RN, MD/DO,
DVM, OD, BS Pharm, PE, DDS
3. Public health training or experience preferred for professional slots
4. For professional slots, actively employed in their profession (e.g., as a pharmacist
or in a pharmacy administrative role). Priority given to practicing professionals
(non-researchers).
5. Prior experience with community work (e.g., Red Cross, mission work, school
health)
6. Willingness to engage as an active member of the Board, serve in a leadership
position, and/or serve as an active member on a committee
7. Currently serving on not more than one other Board or committee that requires
significant amounts of time
8. Geographic representation of the county (balance on the current board)
9. Gender and culturally diverse representation on the current board
10. No former employees of the health department
11. No employees of other county departments
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process B: Supplemental Processes c. Recruitment and Reappointment Procedures for
Members
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually: (July) Page 3 of 3
Original Effective Date: January 2000
Revision Dates: 4/23/09, 11/2013, 11/2014, 8/2015
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2. Reappointment of Existing Board of Health Members
A Board of Health member is appointed to a three-year term beginning the month of their
appointment, unless serving in an unexpired term slot. Generally, members are eligible
for reappointment for a second and third terms. In March of each yearAs members
become eligible for reappointment, the Nominating Committee reviews the attendance
records of members who are eligible for reappointment, contacts each member to assess
willingness to continue and makes a recommendation to the Board of Health. The Board
Secretary (Health Director) sends a letter to the Clerk of the Commissioners indicating
the Board of Health’s review and endorsement for reappointment.
3. Resignation of Board Member from Current Term of Office
In the event that a Board member resigns prior to the official end of his/her term of
office, the Board member shall send a letter to the Secretary (Health Director) or the
Board Chair with the date of his/her resignation. The Secretary will transmit the letter to
the County Commissioners Clerk’s Office and ask that recruitment for the slot be
activated. The Board shall be informed at the next regularly scheduled meeting of the
Board.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process B: Supplemental Processes d. Annual Performance Review Process for Health Director
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 1 of 2
Original Effective Date: January 2000
Revision Dates: 4/23/09, 1/2014, 11/2014, 8/2015
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Section III.B. Annual Performance Review Process for Health Director
Purpose
To provide the Board with a process for accomplishing the required annual review of the health
director’s performance in accordance with the statutory requirement GS 130A-41.
Guidelines:
1) Orange County Personnel Policies are followed in conducting this review.
Steps in the standard process are:
•1. Preparation of an annual work plan by the employee and supervisor.
•2. Preparation of performance notes at the end of the plan year that relate to the objectives
contained in the work plan.
•3. A conference between the employee and the supervisor regarding the employee’s
performance for the year.
•4. Supervisor prepares a Work Planning and Performance Summary after the conference which
outlines the findings of the discussion and makes the final recommendation as to
performance.
•5. Supervisor forwards all paperwork to Human Resource Director.
2) In the case of the Health Director, the “supervisor” of the Director is the entire Board. The Chair
assumes the responsibility of managing the information flow and input into the performance
evaluation. This may include the formation of an ad-hoc committee to assist in the completion of
the performance evaluation.
1. The Health Director prepares performance notes relevant to the year and emails them to all
Board members.
2. The Chair schedules a meeting with the County Manager to obtain input on the Health
Director’s performance.
3. The Chair may or may not solicit additional feedback, including from senior management
staff and direct reports at the Health Department through electronic or in-person methods
each year. A 360⁰ evaluation should be conducted at least every 5 years.
4. The Chair presents these findings to the full Board at a closed session of the Board and a
general discussion of performance is then held. The Board reaches agreement on a
recommendation and then the health director is called into the room and the Chair guides the
discussion by Board members.
5. The Board is required to keep minutes during the closed session, including any motions made
and actions resulting from such motions and transmit them to the Secretary (Health Director)
for the permanent record.
6. Board members indicate changes they would like to see included in the following year’s work
plan and those areas are discussed with the Health Director in the meeting.
Following the meeting, the Chair writes the performance summary, finalizes the paperwork, obtains
the Health Director’s signature and sends it to the Human Resources Director for the County. The
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ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section III: Board Processes
Process B: Supplemental Processes d. Annual Performance Review Process for Health Director
Reviewed by: Board of Health
Approved by: Board of Health, Health Director
Review Annually (July) Page 2 of 2
Original Effective Date: January 2000
Revision Dates: 4/23/09, 1/2014, 11/2014, 8/2015
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Review\Track Changes\III.B.d.Evaluation of Health Director_DRAFT Aug 2015.doc
Human Resources Director processes the remaining paperwork. The goal should be to have the
performance review complete within 30 days of the hiring date anniversary.
Agenda Item Number
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 26, 2015
Agenda Item Subject: FY 2015-16 Fee Schedule & Requested Changes
Attachment(s): Fee Schedule & Requested Changes
Staff/Board Member Reporting: Colleen Bridger, Health Director
Purpose/Recommended Action: ___ Action/Approve
_x_ Action/Approve & forward to Board of Commissioners
___ Information with possible action
___ Accept as information
___ Revise & schedule for future action
Summary Information:
The Health Department reviews fee schedules on an annual basis through the budget approval
process; however, the state and private vaccine distributors have since increased rates and
clinic providers wish to make use of new or more descriptive procedure codes. In addition, the
Department would like to eliminate Environmental Health well water testing fees for medical
referrals. The proposed changes are detailed below:
Personal Health
Personal Health requests the addition of new fees for multiple procedures codes. These
procedures may have been in use at other times under different procedure codes or are more
descriptive than current procedure codes that are in use. The division also requests to charge
fees for new vaccine types and brands on the market. Finally, Personal Health requests to
increase the fees for multiple vaccines that have increased in cost since the last fee change; in
many cases this was in 2009 and 2012.
Name of Fee 2015-16
Current Fee 2015-16 Proposed Fee
Intranasal administration of live
quadrivalent influenza vaccine
$0 $26
Influenza vac 4 valent prsrv free 3 yrs
plus IM
$0 $18
Diphtheria tetanus toxoid adsorbed >7
yr IM
$0 $40
Alcohol and/or drug assessment $0 $20
Mental health assessment, by non-
physician
$0 $22
Injection, medroxyprogesterone
acetate, 1 mg
$0 $.67
Injection, hydroxyprogesterone
caproate, 1 mg
$0 $3
Fluvirin Vacc, 3 yrs & >, IM $0 $31
Fluzone Vacc, 3 yrs & >, IM $0 $40
PMH Risk Screening $0 $50
Meningococcal Group B (Bexsero) $0 $177
Meningococcal Group B (Trumenba) $0 $248
Twinrix $0 $102
Gardasil $136 $162
HPV 9 (Gardasil 9) $0 $180
Preservative free influenza vaccine 6-
35 mo
$16 $17
Pentacel (DTaP/IPV/Hlb) $0 $95
Prevnar (PCV13) – Pneumococcal
Vaccine
$130 $167
Rabies (IM) $237 $269
Rotarix $0 $124
Adult MMR $56 $66
Td (pres. free) $0 $35
Varicella vaccine $89 $111
Pediarix (DTaP/Hep B/IPV) $0 $91
Immunization: Pneumococcal – State $65 $80
Menactra Meningococcal Vaccine $106.87 $127
Zostavax Vaccine $179 $207
Tobacco Use Cessation Counseling -
Intermediate
$10.66
$13
Tobacco Use Cessation Counseling -
Intensive
$22.1
$32
Skyla IUD $0 $726
MNT $30 $34
DSME – Initial $22 $52
DSME – Group $12 $17
Environmental Health
Environmental Health and Personal Health request to eliminate fees for all well water testing
that is requested by a medical professional. This will allow clients in the Newborn/Postpartum
Homevisiting Program that are on well water to have the water tested at no charge. The
majority of clients whose medical professional refers them to have their well water tested
qualify for Medicaid or have a low enough income to pay $0 on the medical clinic sliding fee
scales. Income at these levels makes paying for the necessary tests cost prohibitive. The
average well water test for bacteria, inorganics, heavy metals and nitrate/nitrite totals $110.
Additional testing for VOC’s, pesticides and petroleum are $110 per sample (if requested by
the medical professional). Environmental Health receives an average of 24 medical referrals
per year. These are typically for the full well panel. The cost of these referred tests will be
absorbed within the Environmental Health budget.
Name of Fee 2015-16
Current Fee
2015-16 Proposed
Fee
Total Coliform P/A $60 $0
Nitrate/Nitrite $65 $0
Full Inorganic Panel $110 $0
Existing Well Full Well
Panel
$110 $0
Pesticides $110 $0
Herbicides $110 $0
Petroleum Products $110 $0
Volatile Organic Chemicals $110 $0
Fluoride - Physician,
Dentist request
$25 $0
Recommended Motion:
To approve the proposed fee changes for 2015-2016 as presented and forward to the Board of
County Commissioners for action.
Page 1 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
Personal Health 10060 Drainage of Skin Abscess $117.00 2009
10061 Drainage of Skin Abscess $200.00 2009
10080 Drainage of Pilonidal Cyst $195.00 2009
10120 Remove Foreign Body $133.00 2009
10140 Drainage of Hematoma/Fluid $147.00 2009
10160 Puncture Drainage of Lesion $94.00 2008
11000 Debride Infected Skin $56.00 2009
11055 Paring of corn/callus (1 lesion)$46.00 2009
11200 Remove Skin Tags $89.00 2007
11719 Trim Nail(s)$22.00 2008
11720 Debride Nail 1-5 $33.00 2008
11730 Avulsion of Nail Plate $97.00 2011
11740 Drain Blood from Under Nail $56.00 2009
11976 Norplant (Remove)$223.00 2008
11981 Insertion, non-biodegradable drug $250.00 2012
11982 Removal, non-biodegradable drug $154.00 2009
11983 Removal, with reinsertion, non-biodegradable drug $234.00 2009
12001 Repair Superficial Wound(s) 2.5cm or less $171.00 2008
12002 Repair Superficial Wound(s) 2.6-7.5cm $184.00 2009
16000 Initial Burn(s) Treatment $84.00 2009
16020 Dsg and/or debridement, small $97.00 2009
17000 Destroy Benign/Premal Lesion $72.00 2009
17003 Destroy Lesions, 2-14 $18.00 2009
17110 Destruct Lesion(s), 1-14 $109.00 2009
17250 Chem. Caut of granulation tissue $79.00 2009
20550 Inject Single Tendon-Ligament-Cyst $72.00 2009
20551 Inject Single Tendon Orgin ? Insertion $67.00 2009
20552 Inject Single-Multi Trigger Pts, 1-2 Muscles $67.00 2008
20553 Inject Single-Multi Trigger Pts, 3+ Muscles $78.00 2009
20600 Drain/Inject, Small Joint or Bursa $67.00 2008
20605 Drain/Inject, Intermediate Joint or Bursa $72.00 2007
20610 Drain/Inject, Major Joint or Bursa $84.00 2009
26010 Drain Finger Abscess, Simple $329.00 2009
29130 Apply Finger Splint, Static $44.00 2009
30300 Remove foreign body intranasal $244.00 2009
30901 Control Nosebleed $123.00 2009
36415 Lab: Venipuncture $18.00 2009
36416 Capillary Puncture $15.00 2012
46083 Incise External Hemmorrhoids $184.00 2009
46600 Diagnostic Anoscopy $100.00 2009
51701 Insertion of non-dwelling bladder cath $94.00 2009
54050 Destroy Lesion (Male)$315.00 2012
56405 Incision/Drainage of Vulva or Perineum $140.00 2009
56420 Incision/Drainage of Gland Abscess $173.00 2009
56501 Destroy Lesions (Female)$260.00 2012
57170 Diaphragm Fit $95.00 2009
57452 Colposcopy of the cervix (without biopsy)$160.00 2012
57454 Colposcopy of the cervix, with biopsy and endocervical cure $208.00 2012
57455 Colposcopy of the cervix, with biopsy $193.00 2012
57456 Colposcopy of the cervix, with endocervical curettage $183.00 2012
58300 Insert Intrauterine Device (IUD)$160.00 2012
58301 IUD Removal $200.00 2012
59025 Fetal Non Stress $90.00 2012
59425 Antepartum package 4-6 visits $1,900.44 2014
59426 Antepartum package 7+ visits $3,408.75 2014
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
Page 2 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
59430 Postpartum care only $175.00 2012
64435 Paracervical Block $176.00 2008
65205 Remove Foreign Body from External Eye $67.00 2007
69200 Remove Foreign Body from Outer Ear Canal $140.00 2006
69210 Remove Ear Wax $67.00 2006
80061 Lipid Panel (Fasting) - UNC Lab $18.00 2006
80101 Urine Toxicology Screen (UNC Lab)$160.88 2010
80178 Lithium Level (UNC Lab)$9.46 2011
81000 U/A (W/Micro)$28.00 2006
81002 U/A (Dipstick Only)$18.00 2006
81025 Pregnancy Test $15.00 2012
82040 Albumin Serum (UNC Lab Test)$6.00 2006
82044 Urine Micro-Albumin (UNC Lab) $4.18 2010
82150 Amylase (UNC Rate)$9.00 2006
82239 Bile Acid Test $93.00 2006
82247 Total Bilirubin (UNC Lab Test)$7.00 2006
82248 Direct Bilirubin (UNC Lab Test)$7.00 2006
82251 Neonatal Bilirubin (UNC Lab Test)$9.00 2006
82270 Hemoccult $11.00 2008
82306 Vitamin D 25 (UNC Lab)$71.00 2011
82310 Ca (UNC Lab Test)$7.00 2008
82374 CO2 (UNC Lab Test)$6.22 2014
82435 CL (UNC Lab Test)$6.00 2007
82465 Total Cholesterol (UNC Lab Test)$6.00 2006
82565 CREAT (UNC Lab Test)$7.00 2007
82607 B12 (UNC Lab Test)$21.00 2006
82728 Ferritin (UNC Lab Test)$19.00 2006
82746 Folate (UNC Lab Test)$20.00 2006
82772 Fecal occult blood, single spec.$10.00 2006
82784 Iga (UNC Lab) $13.58 2010
82947 GLU (UNC Lab Test)$5.00 2006
82952 GGT 3 HR $25.00 2012
82977 GGT (UNC Lab Test)$11.00 2006
83001 FSH (UNC Lab Test)$25.00 2006
83002 Luteinizing Hormone *UNC rate $25.00 2006
83516 Ttg (UNC Lab $16.85 2010
83540 Iron Profile (FE): IBC (UNC Lab Test)$9.00 2006
83615 LDH (UNC Lab Test)$8.00 2006
83690 Lipase (UNC Rate)$9.00 2006
83718 Lipid Panel (Non-Fasting) HDL (UNC Lab Test)$11.00 2006
83721 LDL (UNC Lab Test)$13.00 2006
84075 ALK PHOS (UNC Lab Test)$7.00 2006
84132 K (UNC Lab Test)$6.00 2006
84146 Prolactin (UNC Lab)$27.00 2006
84153 PSA Screen (UNC Lab)$25.00 2006
84153 PSA Diagnostic (UNC Lab)$25.00 2006
84155 TP-Serum (UNC Lab Test)$5.00 2007
84156 TP-Urine (UNC Lab Test)$5.00 2006
84295 NA (UNC Lab Test)$6.12 2014
84436 Thyroxine (T4) - (UNC Lab Test)$8.00 2006
84439 Free T4 (UNC Lab Test)$12.00 2006
84443 TSH (UNC Lab Test)$22.00 2006
84450 SGOT, AST (UNC Lab Test)$7.00 2006
84460 SGPT, ALT (UNC Lab Test)$7.00 2008
84466 Iron Profile/Tranferrin: % Saturation (UNC Lab Test)$17.00 2006
Page 3 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
84478 TRIG (UNC Lab Test)$8.00 2006
84479 T3U (UNC Lab Test)$8.00 2006
84481 Free T3 (UNC Lab) $42.00 2010
84520 BUN (UNC Lab Test)$5.01 2014
84550 Uric Acid (UNC Lab Test)$6.00 2006
84702 QUANT HCG/Serum (UNC Lab Test)$12.00 2006
85025 CBC with Diff (UNC Lab Test)$10.00 2006
85027 CBC w/o Diff (UNC Lab Test)$9.00 2006
85611 Prothrombin Time (UNC Lab)$5.00 2006
85651 SED Rate (UNC Lab Test)$4.51 2014
86038 ANA (anti-nuclear antibody) titer (UNC Rate)$16.00 2006
86039 Confirmation, if ANA+ (UNC Rate)$15.00 2008
86308 MONO Spot (UNC Lab Test)$7.00 2006
86430 RA Factors - Qual (UNC Lab Test)$7.00 2006
86431 RA Factors - Quan (UNC Lab Test)$7.00 2006
86580 PPD $17.00 2012
86677 H. Pyloric (UNC Lab Test)$20.00 2011
86706 Hepatitis B Surface Antibody (UNC Lab)$15.38 2011
86757 RMSF (Convalescent) (UNC Rate)$27.00 2009
86762 Rubella (UNC Lab Test)$20.00 2009
86787 Varicella Immune Status Test *UNC rate $17.00 2008
86803 Hep C Antibody (UNC Lab)$20.00 2007
86804 Hepatitis C RIBA (UNC Lab Test)$16.00 2009
86870 Antibody Identification (UNC Lab Test)$21.00 2010
86900 ABO Group (UNC Lab Test)$4.00 2009
86901 RH Type (UNC Lab Test)$7.00 2009
87070 Other Bacterial Culture (UNC Lab Test)$12.00 2008
87081 Throat Culture (UNC Lab Test)$8.00 2008
87086 Urine Culture (UNC Lab Test)$11.00 2006
87101 Culture, Fungal Dermatology Screen (UNC Lab)$10.00 2008
87184 ID & Sensitivity (UNC Lab Test)$9.00 2008
87205 STAT Male Smear $22.00 2008
87206 Fungal Direct Test (FDIR) (UNC Lab Test)$7.00 2008
87210 Wet Mount $18.00 2009
87269 Parasitology Test #9807-Giardia (UNC Lab Test)$16.00 2009
87272 Parasitology Test #9807-Cryptosporidium (UNC Lab)$16.00 2009
87340 HBsAG (UNC Lab Test)$13.00 2009
87420 RSV (Respiratory Syncytial Virus) Antigen Screen (UNC
Lab)$16.00 2008
87880 Streptococcus Group A Assay W/Optic (UNC Lab)$20.00 2009
88175 Cytopath C/V Auto Fluid Redo $35.00 2012
90460 Admin Fee (1 vaccine) to children by RN or higher $15.70 2012
90461 Admin Fee (2 vaccines) to children by RN or higher $8.84 2012
90470 Administration of H1N1 Vaccine $18.00 2010
90471 Admin Fee (1 vaccine)$18.00 2012
90472 Admin Fee (2+ vaccines)$18.00 2012
Page 4 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
90473 Immunization Adm. - Intranasal/Oral $13.71 2014
90474 Immunization Adm. - Intranasal/Oral Additional $13.71 2014
90620 Meningococcal Group B (Bexsero)New $177.00
90621 Meningococcal Group B (Trumenba)New $248.00
90632 Hep A - Adult $45.00 2012
90633 Hep A (Ped/Adol)$25.00 2010
90636 Twinrix New $102.00
90647 PedVaxHIS Self Pay $40.00 2012
90648 HIB Vaccine $26.00 2012
90649 Gardasil $136.00 $162.00 2012
90651 HPV 9 (Gardasil 9)New $180.00
90654 Intradermal flu vaccine $20.00 2012
90655 Preservative free influenza vaccine 6-35 mo $16 $17.00 2011
90656 Preservative free influenza vaccine $18.00 2012
90657 Influenza Split 6-35 mo.$14.00 2009
90658 Influenza Split 3yr and Above $15.00 2012
90660 Influenza Virus Vaccine Live for Intranasal $23.00 2012
90662 Influenza - high dose (65+)$40.00 2012
90669 Prevnar (PCV7) -Pneumococcal Vaccine $116.00 2009
90670 Prevnar (PCV13) -Pneumococcal Vaccine $130.00 $167.00 2012
90672 Intranasal administration of live quadrivalent
influenza vaccine New $26.00
90675 Rabies (IM)$237.00 $269.00 2009
90676 Rabies vaccine, for intradermal use New $212.00
90680 Rotateq (Rotavirus Vaccine)$99.00 2009
90681 Rotarix New $124.00
90685 Influenza vac quadrivalent prsrv free 6-35 mo IM New $16.00
90686 Influenza vac 4 valent prsrv free 3 yrs plus IM New $18.00
90696 Kinrix (DTaP/IPV)$52.00 2012
90698 Pentacel (DTaP/IPV/Hlb)New $95.00
90700 Dtap Vaccine (Pediatric) Self Pay $32.00 2012
90702 Diptheria tetanus toxoid absorbed>7yr IM New $40.00
90707 Adult MMR $56.00 $66.00 2009
90713 Inactived Polio Vaccine (IPV)$31.00 2009
90714 Td (pres. free)New $35.00
90715 Tdap Vaccine $39.49 2014
90716 Varicella vaccine $89.00 $111.00 2008
90723 Pediarix (DTaP/Hep B/IPV)New $91.00
90732 Immunization: Pneumococcal - State $65.00 $80.00 2012
90733 Meningococcal Vaccine, Subcutaneous/Jet $100.00 2008
90734 Menactra Meningococcal Vaccine $106.87 $127.00 2014
90736 Zostavax vaccine $179.00 $207.00 2007
90744 Pediatric Hep B Vaccine Self Pay $30.00 2012
90746 Immunization: Hep B (20+ yrs)$58.00 2007
90760 IV Infusion Up to One Hour $140.00 2007
90772 Therapeutic prophylactic/diagonostic injection $23.00 2008
90801 Psychiatric Diagnostic Interview Exam $151.00 2008
90802 Psychiatric Diag Interview Exam, Interactive $161.00 2009
90804 Psychother, Indiv, Insight, 20-30 min.$65.00 2009
90806 Psychother, Indiv, Insight, 45-50 min.$97.00 2007
90808 Psychother, Indiv, Insight, 75-80 min.$146.00 2008
90810 Psychother, Indiv, Interac, 20-30 min.$70.00 2007
90812 Psychother, Indiv, Interac, 45-50 min.$103.00 2009
90814 Psychother, Indiv, Interac, 75-80 min.$152.00 2009
90846 Psychotherapy, Family, w/o Patient $95.00 2009
90847 Psychotherapy, Family, (Conjoint) W/Pt Present $115.00 2009
Page 5 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
90853 Psychotherapy, Group $32.00 2009
91781 IV infusion Each Additional Hour up to Eight $39.00 2009
92551 Audiometry $18.00 2008
92587 OAE (Limited)$100.00 2012
93000 Electrocardiogram, Complete $33.00 2009
93005 Electrocardiogram, Tracing Only $22.00 2009
94640 Airway Inhalation Treatment $22.00 2009
94664 Aerosol/Vapor Inhalation Treatment $22.00 2009
94760 Pulse Oxygen $8.00 2009
96110 Developmental Test $23.00 2012
96152 Health & Behavior Intervention $55.00 2012
96372 Ther/Proph/Diag inj/SC/IM $60.00 2012
97802 Medical Nutrition Therapy/Initial 15 min. Unit $30.00 $34.00 2009
97803 Medical Nutrition Therapy/Re-Assess 15 min. Unit $30.00 2009
97804 Medical Nutrition Therapy-Group (2 or more)$15.00 2011
99000 Lab: Handling Fee $11.00 2009
99070 Special Supplies $18.00 2009
99173 Vision $7.00 2009
99175 Induction of Vomiting $67.00 2009
99201 New Office/Outpt Tx Brief E&M $110.00 2009
99202 New Office/Outpt Tx Expanded Prob Focused E&M $165.00 2009
99203 New Office/Outpt Tx Detailed E&M $200.00 2009
99204 New Office/Outpt Tx Moderate Complex E&M $335.00 2009
99205 New Office/Outpt Tx High Complex E&M $405.00 2009
99211 Estab Offic/Outpt Tx Brief E&M $60.00 2012
99212 Estab Office/Outpt Tx Prob Focused E&M $100.00 2012
99213 Estab Office/Outpt Tx Expanded Focused E&M $150.00 2012
99214 Estab Office/Outpt Tx Detailed E&M $225.00 2012
99215 Estab Office/Outpt Tx Comprehensive E&M $305.00 2012
99381 Preventive/New Pt < 1 yr.$255.00 2012
99382 Preventive/New Pt 1-4 yrs.$270.00 2012
99383 Preventive/New Pt 5-11 yrs.$275.00 2012
99384 Preventive/New Pt 12-17 yrs.$235.00 2012
99385 Preventive/New Pt 18-39 yrs.$235.00 2012
99386 Preventive/New Pt 40-64 yrs.$267.00 2009
99387 Preventive/New Pt 65+ yrs.$242.00 2008
99391 Preventive/Estab Pt < 1 yr.$225.00 2012
99392 Preventive/Estab Pt 1-4 yrs.$225.00 2012
99393 Preventive/Estab Pt 5-11 yrs.$200.00 2012
99394 Preventive/Estab Pt 12-17 yrs.$205.00 2012
99395 Preventive/Estab Pt 18-39 yrs.$225.00 2012
99396 Preventive/Estab Pt 40-64 yrs.$220.00 2012
99397 Preventive/Estab Pt 65+ yrs.$212.00 2004
99406 Tobacco Use Cessation Counseling - Intermediate $10.66 $13.00 2012
99407 Tobacco Use Cessation Counseling - Intensive $22.10 $32.00 2012
99420 Health Check Autism Assessment $9.20 2015
Recoding Education Classes $30.00/hr 2010
Recoding Consultant Services (Health Educators)$20.00/hr 2010
Recoding Patient Education (non Physician)$35.00/unit 2012
Recoding Health Risk Appraisal $12.00 2004
82465QW Cholesterol $11.00 2011
82947QW Glucose (Random)$18.00 2006
82950QW O'Sullivan $28.00 2007
82951QW OGTT (3 HR)$50.00 2006
83036QW Hemoglobin A1C $21.00 2006
Page 6 of 6
CPT Code Description Current Fee
Requested Fee
Change for FY
2015-16
Last
Revision
ORANGE COUNTY HEALTH DEPARTMENT FEE SCHEDULE
PERSONAL HEALTH SERVICES + NUTRITION
85018QW Hemoglobin $11.00 2009
88175-90 Pap, Thin Prep (State Lab)$18.38 2012
D0145 Oral Evaluation <3 yrs with counseling $55.00 2012
D1206 Topical Fluoride Appl $47.00 2012
Recode Employee Varicella Titer (UNC Lab)$78.00 2009
Recode Employee Measles (Rubeola) Titer $48.00 2009
Recode Employee Mumps Titer $50.00 2009
Recode Employee Rubella Titer $75.00 2009
G0008 Adm of Influenza Vaccine $18.00 2009
G0008 Admin. Influenza Vaccine - Medicare $18.00 2009
G0009 Adm of Pneumococcal Vaccine $18.00 2009
G0009 Admin. Pneumococcal Vaccine - Medicare $18.00 2009
New DSME Minimum Fee $20.00 2015
G0108 DSME/DSMT Individual Assessment $22.00 $51.82 2010
G0109 DSME/DSMT Group Class $12.00 $17.00 2010
G0270 Additional MD requested MNT indiv - Medicare $25.00 2010
G0271 Additional MD requested MNT group - Medicare $13.00 2010
H0001 Alcohol and/or drug assessment New $20.00
H0031 Mental health assessment, by non-physician New $22.00
J1055 Depo Provera Injection $40.00 2012
J1050 Injection, medroxyprogesterone acetate, 1 mg New $0.67
J1200 Diphenhydramine HCL/Benadryl up to 50mg $6.00 2009
J1725 Injection hydroxyprogesterone caproate, 1 mg New $3.00
J2550 Promethazine _ mg $8.00 2009
J2790 Rhogam Injection $88.00 2012
J3420 B-12 Injection $6.00 2009
J3490 17 Alpha-hydroxprogesterone $21.00 2012
J7300 Paragard IUD $390.00 2012
J7301 Skyla IUD $0.00 $726.00
J7302 Mirena IUD $745.23 2014
J7303 Nuvaring $57.00 2008
J7307 Implanon $698.99 2014
JO696 Ceftriaxone Sodium/Rocephin per 250mg $22.00 2008
Recoded Sports Physical $44.00 2008
Recoded Camp Physical $44.00 2009
Recoded College Physical $44.00 2009
Recoded I-693 Form $0.00 2015
Recoded Primary Care Minimum Fee $20.00 2012
Recoded MNT Minimum Fee $20.00 2012
Recoded Adult Medicaid Co-pay $3.00 2010
Q2037 Fluvirin Vacc, 3 yrs & >, IM New $31.00
Q2038 Fluzone Vacc, 3 yrs & >, IM New $40.00
S0280 PMH Risk Screening New $50.00
S4993 Oral Contraceptive Pills $5.00 2012
S9465 Diabetic management program, dietitian visit $35.00 2011
S9470 Nutritional counseling, dietitian visit $35.00 2011
T1002 RN Services up to 15 min.$21.00 2005
S9442 Birthing classes 8.69/ 1 hr block 2013
90714 TD Vaccine $35.00 2013
** UNC and State Lab Fees in BOLD are established by reference lab and not by OCHD
** "No Code and Recode" represent local use codes that can be billed, however are not recognized by ICD-10.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 26, 2015
Agenda Item Subject: General Public Seat Recommendation
Attachment(s): Volunteer Application
Staff or Board Member Reporting: Nick Galvez/Dan Dewitya
Purpose: ____ Action
____Information only
_X__Information with possible action
Summary Information: The Board of Health will vote to recommend a new Engineering and a General Public
Seat representative for appointment by the Board of County Commissioners.
Background: The new representatives will fill the seats vacated by Corey Davis and Tony Whitaker.
Recommended Action: ___Approve
_X_Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Health Director’s Report
August, 2015
• Board of Health Priorities
o We had great meetings with our Orange County State Delegation to discuss raising the minimum age of
tobacco sales to 21. Thanks to the BOH members who participated in these meetings, the TRU club
youth and school staff who initiated this conversation and Coby for setting it all up.
o I attended the Chapel Hill and Carrboro Breastfeeding Friendly celebration to recognize both
municipalities for their work in being breastfeeding friendly.
o Related to the Family Success Alliance, there has been some angst about the United Way funding
process this year and the Family Success Alliance has been a key partner for the United Way in their new
process. As such we have worked closely with the United Way and the non-profit agencies that were
funded to provide services through our collaborative to make sure they had enough funding to keep
operating. That meant we had to divert some of the funds intended for the building of the pipeline to
maintaining services and programs that currently exist. The BOCC has heard some concerns as well and
we will be sharing with them what non-profit funding looks like when they return in the fall.
• Various
o I was asked again to serve as a member of the County’s Personnel Hearing Board. After three years of
zero activity, things have picked up and this was my 5th one. I’ve encouraged the county to explore
another method of reviewing personnel decisions.
o We’ve received a lot of attention for our challenge of Durham County Health Department to see who
could walk the Appalachian Trail and back the quickest. Unfortunately after a quick start out of the gate
into the lead week one, week two had us falling behind. It will be a tight race I’m sure!
o You may remember our discussion with the BOCC at our joint meeting regarding our request that they
incorporate Health in All Policies approach to their decision-making. Unfortunately, we haven’t made
much progress. If we can’t get the issues resolved internally, we may need to return to the Board of
Health with a revised plan. Look for an update in October.
o At our September Board of Health meeting we’ll devote the entire evening to the accreditation
requirement of Board of Health training. This training will be done by Bill Browder from the Institute for
Public Health and given the number of new Board of Health members since our last training; it should be
a great time for this refresher.
o The NC Association of Local Health Directors (where I am President-elect) is very busy right now dealing
with a situation with the Division of Medical Assistance. While it is rather complicated, I’ll say that it
involves the Medicaid cost settlement and is resulting is a significant delay and potential significant
reduction in the 2014 cost settlement payment. Orange County does not budget cost settlement funds
in our operating budget, we use it for special projects and construction. However, many smaller health
departments rely on those funds to provide services and this delay could result in serious budget and
staff cuts in areas that are already struggling to do what they need for public health. I say all this
because as an Officer of the HD Association I’m spending a lot of time working on this issue including
weekly trips to Raleigh for meetings with DMA and others working on resolving it.
o Speaking of Raleigh, we are also monitoring the budget as it makes it way, albeit slowly, through the
compromise process. With the total budget figure agreed on, it doesn’t look like local public health or
education will be getting any relief from the recession-era spending mentality we’ve been living with for
5 years now. We are monitoring the details and will let you know if there are any specific cuts or issues
to be aware of.
o We are also working with our lobbyist and partners throughout the state to advocate for the best
Medicaid reform package we think we can get. We lost a major battle, however, when the House and
Senate agreed to a hybrid entity with the commercial MCOs and the homegrown PLE (provider led
entities). In my opinion the MCOs will quickly eliminate any homegrown competition and we’ll be stuck
with the MCO-only model. In spite of this, there are a lot of details that we are watching and trying to
keep in the reform plan to the benefit of local public health.
o We’ve also had a busy couple of days with Communicable Diseases here in Orange County. I’ll update
you at the meeting tomorrow.
News and Observer
Chapel Hill: Opinion
July 7, 2015
What’s so important about the early years?
By Ennis Baker and Linda Foxworth- Guest column
Our future as a community is inextricably linked to how we, as adult citizens, work to foster the health
and well-being of the next generation. In our jobs, we have the privilege each and every day to meet
Orange County’s future in our offices, classrooms and neighborhoods across the county. Regardless of
their age, when we see these children play, learn, and grow, we see the future prosperity of our
community. The good news is – we know exactly what we need to do in order for all children to thrive.
A child’s brain is built from before birth. By the time a child is three, about 85 percent of their brain is
developed. By age 5 that number is 99 percent. New insights from research over the past four decades
have shown that children’s early experiences literally shape the way the brain is built.
We think of the development of a child’s brain like the construction of a house. We know if we expect a
house to stand the test of time, it needs a strong foundation to support the walls and roof. The same
goes for the foundation of a child’s developing brain – they need positive early experiences to build a
strong brain foundation for all future learning, behavior, and health.
Early experiences need to include positive, stable relationships with adults, a safe and nurturing
environment, good nutrition and healthcare, and quality early learning experiences. When Orange
County fully addresses each of these areas for children, we can expect to see our children grow up to be
responsible citizens and productive workers. This means that what we invest in children almost always
comes back to us many times over. It also means that earlier investments help get brain architecture
right the first time, which is easier and less expensive than trying to fix issues later.
We have many opportunities in Orange County to make sure that every child has the environment,
relationships, and experiences that are critical for healthy development. The first step has already been
taken. A group of organizations in Orange County have come together to start the conversation. Over
the next few weeks, you’ll see perspectives from diverse people and organizations in Orange County in
the newspaper, on social media, and in your communities. We hope these perspectives will increase our
community’s understanding of the importance of the earliest years for the lives of Orange County
children, their families, and our entire county.
We also hope you’ll join in the conversation in at least one of the many ways we’re providing! You can
take part in the conversation on social media by following us on Facebook through the Orange County
Health Department and on Twitter @OrangehealthNC. There will be lots of information there, as well as
fun opportunities to show your support for our community’s youngest children. If you have a business,
organization, or group that you would like to have learn more about the importance of early childhood –
let us know by e-mailing mstewart@orangecountync.gov!
Ennis Baker, MSW, LCSW, is the early childhood manager/mental health specialist at Orange County
Head Start/Early Head Start. Linda Foxworth is the director of KidSCope.
Read more here: http://www.newsobserver.com/news/local/community/chapel-hill-news/chn-
opinion/article26615356.html#storylink=cpy
In Orange County and Across the Nation, Heroin Use is on the Rise
By Elizabeth Friend
SHARE THIS:
Posted July 10, 2015 at 12:58 pm
Photo by Mels Evans/AP
A new report from the Centers for Disease Control shows heroin use is on the rise across the nation.
That’s true in Orange County too.
A recent undercover drug operation by the Orange County Sheriff’s Office netted nearly 700 doses of
heroin. Narcotics Investigator Brandon Wilkerson says he wasn’t surprised.
“It’s really not new; it’s becoming an epidemic along with the abuse of prescription medications,” says
Wilkerson.
A study released Tuesday by the CDC shows heroin use increased 63 percent from 2002 through 2013.
At the same time, the rate of heroin-related overdose deaths has quadrupled.
Researchers say the increase in usage affects men and women across a wide range of ages and income
levels.
According to the report, heroin is cheaper, stronger and more readily available than in decades past, but
what’s driving the demand is the popularity of prescription opiates.
CDC officials say states can address the problem by reducing the availability of opiate pain relievers and
increasing access to medical insurance that covers treatment options.
States can also authorize law enforcement and medical personnel to carry naloxone, a drug that
temporarily reverses opiate overdose.
Orange County was the first in North Carolina to issue naloxone kits to emergency responders following
the passage of the state’s Good Samaritan law in 2013. The drug has already been used to save lives in
Carrboro.
Wilkerson says Orange County deputies are training to use the kits as well.
“Starting in February this year, we actually have 15 deputies that have gone through the training,” says
Wilkerson. “We’re still working on the naloxone kits and policies to implement that to be able to go out
there and use it. We’re looking to get the whole department trained before the end of the year.”
In addition, the Orange County Health Department offers naloxone kits to friends and family members of
those at risk of opiate overdose.
County seeks feedback on
community health
Elizabeth Harvell | Published 8 hours ago
The Orange County Health Department wants to know the health priorities of its county residents.
Stacy Shelp, spokeswoman for the health department, said a community health assessment survey
is currently being conducted to learn about the health and quality of life in the Orange County
community.
“We will use this survey to set priorities for the next four years of services across the county,” Shelp
said.
Shelp explained the survey will cover several topics related to health and quality of life.
Questions will range from issues across Orange County to personal health issues. It only takes 10 to
15 minutes to complete, is confidential and has no right or wrong answers, Shelp said.
The survey first opened in early June and will close late July, she said.
Shelp said the results of the survey will be analyzed and used in a public report. The report will be
available to agencies across the county to develop programs and identify gaps in service.
Some examples of questions on the survey include asking about where residents get health-related
information, what the most urgent health issues for teens in Orange County are and what cancer
screenings residents have undergone.
The survey also asks questions related to participants’ mental health, exercise habits and nutrition.
“The report will also be used at the annual Healthy Carolinians of Orange County meeting in
September,” Shelp said.
Some UNC students have mixed reviews of the survey.
Garrett Powell, a junior biology major, said he is less than optimistic about the number of residents
who will actually complete the survey.
“I think the survey is a great idea,” Powell said. “But I don’t think that many people will fill it out since
it’s voluntary.”
Maggie Brownrigg, a junior chemistry major, said she thinks the survey would be more effective with
a different title.
“The implications of the assessment go further than the name of the survey implies” she said. “It’s an
awesome idea — as long as people will do it.”
The survey asks about issues that are more indirectly related to health, such as poverty.
For example, one question asks the participant if there was a time in the last month where they had
to skip meals because of a lack of money for food.
Even though over 1,700 Orange County residents have already completed the survey, Shelp said
she urges residents who have not completed the survey to do so.
The survey can be found at surveymonkey.com/r/OCCHA2015.
Shelp said there will also be a door-to-door collection of the survey Friday, Saturday and Sunday for
those who do not use the online assessment.
Fayetteville ObserverHome
Live Wire: Sanitaton ratings for
Fayetteville restaurants available
online
Posted: Thursday, July 16, 2015 5:55 pm
Live Wire: Sanitaton ratings for Fayetteville restaurants available online
Q: How can you find a list of all the restaurant sanitation ratings? - M.B., Fayetteville
A: M.B., you can find information about restaurant sanitation ratings from the health department's Division of
Environmental Health on the county's website at co.cumberland.nc.us/health/ environmental/sanitation _ratings.aspx.
The site provides a link to a database of inspections of food and lodging businesses.
Soon, however, finding this information will be much easier. The county's restaurant ratings and inspections will be
integrated into Yelp, a website that provides information and user reviews of restaurants and other businesses.
"It's still in progress, and it should be within two weeks," said Daniel Ortiz, the environmental health director for the
Cumberland County Department of Public Health.
Yelp entries accessed with a computer browser will show violations for given inspections and number ratings in
addition to letter grades, he said.
Orange County has already made that move, and the health score of restaurants show up alongside their operating
hours, price range and menu details. Ortiz said the Yelp mobile app will give the letter grade for a given
establishment but they're still working "to get out the kinks" to show the full data on the mobile app.
- Paige Rentz
Live Wire seeks to answer questions of general interest and consumer topics within two weeks. Initials are used to
identify questioners when names are given. Contact Live Wire at facebook.com/foLiveWire, at
livewire@fayobserver.com or at 486-3516.
Health officials to walk ‘Appalachian Trail’
Jul. 25, 2015 @ 04:40 PM
Keith Upchurch
DURHAM —
Orange County Health Department officials have thrown down the gauntlet to their counterparts in
Durham, challenging them to walk the Appalachian Trail.
The 2,168-mile walk won’t really be on the trail, but will be measured by Fitbits and other devices that
count every step a staff member takes.
The first team to collectively log the equivalent mileage of the length of the trail wins bragging rights and a
trophy. The challenge begins Aug. 3.
It’s the second challenge this year for the Orange County staff, who collectively walked 2,505 miles in
March and April, reaching their goal ahead of the eight weeks they expected it to take.
This time, their competitive spirit is turned outward.
As of Friday, 35 people at the Orange County Health Department had signed up, compared to 50 in
Durham’s department, which has a larger staff.
“We hope to continue to motivate people to walk and practice healthy behaviors,” Stac y Shelp,
communications manager at the Orange County Health Department, said. “I think the extra challenge of
competing against Durham has really inspired more people to get involved.”
The real goal, she said, is to get the public to follow step.
“Walking is such a great form of physical activity,” Shelp said. “Walking during the day helps keep you
energized and your brain engaged. It improves your physical and mental health.”
Shelp said last spring’s challenge produced the added benefit of bringing staff members closer together.
“We’ve seen an increase in morale and staff cohesion,” she said.
Research shows daytime walking boosts a person’s mental capacity and stimulation in th e afternoon, she
said.
“A cup of coffee can wake you up but give you the jitters,” Shelp said. “I have yet to see a walk give
someone the jitters.”
Shelp expects the challenge to last seven or eight weeks. It will culminate in a joint celebration at Little
River Regional Park, a park shared by Durham and Orange counties.
OC Health Officials Challenge Durham
Officials to Walk-Off
By Jess Clark
SHARE THIS:
Posted July 27, 2015 at 4:52 pm
The Fitbit is a popular device for keeping track of steps. Photo Credit:
Wikimedia Commons.
If you’re wearing a fancy pedometer like a Fitbit or a Jawbone, you may be swept up in a little competition
for steps with your friends and co-workers. Last week, the Orange County Health Department took step
competitions to a whole new level.
“We have challenged our brothers and sisters at the Durham County Health Department to a walking
challenge,” Orange County Health Department Director Colleen Bridger said.
The two departments will compete to walk the equivalent of the Appalachian Trail starting August 3. The
first team to complete the trail’s 2,168 miles will win. And it’s not just bragging rights on the line.
“The health director and I have a friendly wager,” Bridger said. “So whichever health department wins, the
other health department will owe a basket of that county’s themed items for a value of about $50.”
This is the Orange County Health Department’s second walking competition. The department held an
internal competition among its staff this spring to walk to Orange County, California. Bridger says these
competitions are meant show that exercising doesn’t have to be a chore.
“It’s really important to have people understand that moving can be fun—should be fun,” Bridger
said. “And any time that we get the opportunity as public health professionals to kind of walk tha t walk—
complete pun intended—then we are really excited about it.”
Bridger says she hopes the competition will also raise awareness about the benefits of walking, which
she says, are many.
“It’s good for your weight, it’s good for your blood pressure, it’s good for your muscles and balance,”
Bridger explained. “But there have also been a lot of studies that show that walking is extremely good for
your mental health. And the way that we’re doing it facilitates the fact that it’s a really good way to build
camaraderie with people, which is also good for your mental health.”
The departments expect the challenge to last 6 to 8 weeks. We’ll have to wait until the fall to find out
which county will come out on top.
ON THE MOVE: FSA hits ground
running, preps kindergartners
Jul. 29, 2015 @ 05:38 PM
Katie Jansen
Sue Anne Decker reads during a Family Success Alliance summer program at New Hope Elementary School on Tuesday,
July 28, 2015.The Herald-Sun | John Joyner
Luis Rios, right, works with Gisel Nunez on an English exercise during a Family Success Alliance summer program at New
Hope Elementary School on Tuesday, July 28, 2015.The Herald -Sun | John Joyner
CHAPEL HILL —
A handful of small children sat in a classroom at New Hope Elementary Tuesday, playing with blocks and
answering questions about the blocks’ colors and shapes.
They had been in school for a week and a day as part of a new four-week kindergarten readiness
program launched by the Family Success Alliance.
The program provides extra academic and social support for students about to enter kindergarten and
helps bridge the gap between staying at home and sitting in a classroom fulltime.
The kindergarten readiness program is one of two programs recently launche d by the Family Success
Alliance, a new initiative launched in two pilot zones in Orange County geared toward providing support
for underserved children and families.
The Family Success Alliance used $90,000 from the county’s social justice fund to roll ou t kindergarten
readiness in three schools: New Hope Elementary in Zone 4 (Hillsborough east of Interstate 40) and
Carrboro Elementary and Frank Porter Graham Elementary in Zone 6 (Chapel Hill and Carrboro).
About 70 students are being served through the first rollout of the program, said Stacy Shelp,
communications manager for the Orange County Health Department and the Family Success Alliance.
Although kindergarten readiness is where the organization is starting, the Family Success Alliance plans
to focus on many different areas that affect children’s success, such as transportation and literacy.
Every school has had the freedom to develop its kindergarten readiness program to meet the needs of its
students, Shelp said.
Ambra Wilson, New Hope’s assistant principal, said this freedom has been helpful because it will be
easier to measure students’ growth and success throughout the year.
At New Hope Elementary’s kindergarten readiness program, the vast majority of the students speak
Spanish. This is representative of the school’s greater population — nearly half of New Hope’s students
are Latino.
At least one bilingual teacher is on hand at all times, giving instruction in both Spanish and English to help
students build their academic vocabulary. Dawn Bagwell, ESL differentiation coach for Orange County
Schools, also completed initial assessments so that ESL support would be in place for students from the
first day of the school year.
Shelby Nelson, a kindergarten teacher at New Hope that is also helping with the kindergarten readiness
program, said that she saw tremendous growth in the students just within the first week.
The students were getting used to a structured day and were also learning a new number each day, she
said.
“These kids will really be able to serve as role models once they get to school,” Nelson said. “It also helps
them socially.”
In addition to the kindergarten readiness program, part of the Family Success Alliance’s funding went
toward hiring three zone navigators who will help guide families through the network of services offered in
their communities.
Angela Clapp and Ali Rojas will serve as the zone navigators for Zone 4. Beatrice Parker will work in
Zone 6, and the Family Success Alliance is in the process of hiring another navigator for Z one 6.
Rojas is currently out of the country, but both Clapp and Parker have already started their work as zone
navigators. For both women, the work isn’t much different from what they were already doing within their
communities.
Both Parker and Clapp are active within their children’s respective schools. Both heard about the Family
Success Alliance and the zone navigator position through their schools’ social workers.
Parker said she sees the zone navigator position as peer guidance. She hopes to be a resource for
parents who are overworked and don’t have time or energy to seek out resources on their own.
“Those simple acts can sometimes lead to lifetime changes,” Parker said.
Wilson agreed, saying that the kindergarten readiness program is in place to “really set (students) up to
love learning.”
“That’s ultimately our goal,” she said. “To just develop lifelong learners who feel successful and can be
successful.”
The News of Orange County
Durham health departments duel in walk off
The Benefits of Walking
1 Reduce the risk of coronary heart disease
2 Improve blood pressure and blood sugar levels
3 Improve blood lipid profile
4 Maintain body weight and lower the risk of obesity
5 Enhance mental well being
6 Reduce the risk of osteoporosis
7 Reduce the risk of breast and colon cancer
8 Reduce the risk of non-insulin dependent—type 2—diabetes
Source: American Heart Association
Posted: Friday, August 7, 2015 5:00 am
By Amanda VanDerBroek, News of Orange staff writer, a.vanderbroek@newsoforange.com
Local health departments are not only talking the talk but walking the walk.
On Monday, Aug. 3, employees from the Orange County Health Department and the Durham
County Department of Public Health strapped up their shoes to compete against each other in a
walking challenge.
The competition tasks those participating to collectively walk 2,168.1 miles—the distance of the
Appalachian Trail.
Stacy Shelp, public information officer with the Orange County Health Department, said the idea
came from Health Director Colleen Bridger, who wanted to get her staff more active to promote
both physical and mental health.
Shelp said it wasn’t until Bridger challenged her staff this past spring to walk the distance
collectively between Orange County, N.C., and Orange County, Calif., that employees took
note.
“We had tremendous results,” Shelp said. “The staff was excited and competitive.”
Coming off the success of the California challenge, the health department decided to up the
ante by extending an invite to Durham. And Durham County Department of Public Health was
willing to take their counterparts head on.
“We’re going to give them a run for their money,” Eric Nickens Jr., Durham County Department
of Public Health communications and public relations manager, said.
Over the next six weeks, the two departments will track their steps in order to meet the more
than 2,000-mile goal. Shelp said the steps are logged using technology like Fitbits and
pedometers, making it easy for staff to keep up on the activity they do.
Orange County has 44 percent of the employees participating, while Durham has about 28
percent of staff lacing up their shoes for the challenge.
In addition to amping up the competitive spirit in the workplaces, Shelp and Nickens said the
walk off will help employees keep physically and mentally fit.
Shelp said the challenge shows residents that those in public health care are invested in their
own health.
“We need to practice what we preach,” she said. “We need to be doing it, too.”
Nickens agreed, saying the walk off not only raises employee moral but also promotes health as
a whole.
“Not only does it rally our employees in a team fashion, but it also looks after the overall
person,” he said.
Nickens said encouraging daily activity is already part of the culture in Durham County.
Employees are allowed 30 minutes each work day for exercise, and Nickens said staff is keen
on meeting the goal.
Shelp said at the end of the challenge, the departments will get together for a celebration.
The winner of the challenge not only gets bragging rights, but there is also a trophy and a
friendly wager between the health directors of a gift basket of local goodies.
News of Orange
Local teens seek change in
tobacco buying age
Infographic courtesy of the CDC
Smoking age
According to a study by the Centers for Disease Control and Prevention, 73 percent of
American adults support making the legal smoking age 21 years old, including 70 percent of
cigarette smokers. Orange High students conducted a similar survey.
Posted: Monday, July 27, 2015 7:30 am
From staff reports
On July 7, the Centers for Disease Control and Prevention issued a press release stating that
75 percent of American adults, including 70 percent of cigarette smokers, favor making 21 the
minimum age of sale for tobacco products. The research was published in the American Journal
of Preventive Medicine.
The same press release also stated that “Age-of-sale restrictions have been shown to contribute
to reductions in tobacco use and dependency among youth. In March, 2015, an Institute of
Medicine (IOM) report found that increasing the legal age of sale for tobacco will likely delay
tobacco use initiation by adolescents and young adults. The IOM found that if all states were to
raise the minimum age of sale for all tobacco products to 21, there would be a 12 percent
decrease in cigarette smoking over the next generation. This would translate into nearly
250,000 fewer premature deaths from cigarette smoking among people born between 2000 and
2019.”
In January 2015, local high school students who are members of the Tobacco Reality Unfiltered
clubs at Orange and Carrboro High School petitioned peers and educators at their schools.
They collected 318 signatures in support of increasing the minimum legal sale age to 21. Of the
signatures on the petition, 290 were high school students—44 of whom are 18 years or older—
and 28 adults.
“Many teens can easily access tobacco through people who are 18 or 19,” Shanaera Davis, an
Orange High School TRU Club member, said. “Because of this, we feel that tobacco shouldn’t
be sold to people younger than 21. We have collected over 300 signatures from people, mostly
high school students, who agree with this. Tobacco use is steadily increasing, and people
should take that into consideration and help stop it.”
According to the Campaign for Tobacco Free Kids, more than 68 cities and counties in eight
states have done the same. Hawaii became the first state to raise the tobacco sale age to 21.
In North Carolina, state law preempts local governments from regulating the sale, distribution,
display or promotion of tobacco products—including e-cigarettes—which prevents counties and
towns from increasing the minimum legal sale age. Local control and ability to pass such a
policy would be restored if the General Assembly rescinded preemption, or a law to increase the
sale age could to be adopted at the state level. Recently the Orange County Board of Health
and county commissioners expressed support for raising the legal sale age to 21.
News of Orange
FSA makes movement in the
county
Posted on Aug 13, 2015
by Amanda VanDerBroek
After just a year in existence, the Family Success Alliance is putting down roots in Orange County.
Last August, FSA started to link existing resources together to combat poverty and create a pipeline of
success for children and families.
“We’ve done a lot,” Meredith Stewart, program manager, said. “We started a year ago in August with
forming our advisory council, which is made up of a number of nonprofits, local government officials,
we’ve now included parent representatives as of this coming month.”
In December 2014, two zones in the county were selected to pilot FSA—Zone 4, an area located between
Interstates 40 and 85 in central Orange County that includes A.L. Stanback Middle School and New Hope
Elementary, and Zone 6, a densely populated area that encompasses downtown Chapel Hill and
Carrboro southwest of N.C. 54.
“We based that look of what it should be on national models like the Harlem Children’s Zone and the
other Promise neighborhoods around the country,” Stewart said. “That led to some community priorities
around children being ready for kindergarten, around affordable, accessible childcare, around
transportation, housing.
“And so from that we did two things with some funding we had available from the Social Justice fund at
the end of the year. The first was to hire our zone navigators from each zone so we have two part -time
navigators in each zone, and the other was to pilot a kindergarten readiness program in three schools—
two schools in Zone 6 and one school in Zone 4.”
Beginning in July and August, kindergarten readiness works to help 70 children—including some at New
Hope Elementary—to prepare for the big leap into school. Stewart said the program helps the kids
academically and socially.
“The kindergarten readiness program is aimed both at kind of the academic side that we think about —like
at New Hope—learning numbers, learning letters and colors, those kind of things but also at the transition
and the routine that happens from going to a home that you’ve been used to to a kindergarten setting
where you’re meeting new children, you’re learning new routines, you’re going to lunch —all of those
things that might be new to you,” Stewart said. “It includes academic curriculum that you would expect to
learn from school, and it’s also about learning about new routines and how kindergarten is going to work.”
In a two-fold approach, FSA has also implemented a literacy program for parents, as well.
“Supporting parent literacy program works directly with the parents of children in the program, helping
them with being able to navigate the school system,” Stacy Shelp, public information officer with the
Orange County Health Department and FSA, said. “So it’s very practical information that we’re giving
them. So it’s really a multi-generational approach.”
Two zone navigators help connect families to the resources they need. For years, Angela Clapp, Zone 4
navigator, had mentored children and adults at Gateway Village Apartments, a low-income, public
housing complex. Through her group Breaking the Cycle, Clapp hosted community events and took
children on trips outside of the neighborhood. It was a staff member at A.L. Stanback Middle School that
cued her in on what FSA was trying to do in Orange County.
“She sent me the information, and I read through it, and I thought, ‘This is pretty much what I do at
Gateway anyway,’ ” she said.
Clapp came on board happy to help link the community to FSA. Shelp said the navigators are key to
FSA’s success in the zones.
“The nice thing about the navigators is they were basically identified by the communities as people who
are already kind of doing this work within the communities,” Shelp said. “They come with the community
knowing them and them knowing the community, so they become a real bridge and liaison for the work
and a great source of knowledge and information with that.”
Clapp is currently working with the kindergarten readiness program at New Hope, helping teachers and
staff as well as getting input from the parents of students.
“It varies from day to day, but it’s basically helping to get the kids ready for kindergarten,” she said. “After
that program is over, I’ll be touching base with the families, the children, connecting them to resources,
connecting them to other outreach programs.”
With the navigators in place and two programs up and running, Stewart and Shelp said FSA is in the
community for the long haul. Stewart said the next step is looking at what other areas they need to cover,
including after school programs, child literacy, nutrition and child care.
“We’re in a period of where we’ve heard from the community, we’ve worked on this kindergarten
readiness and literacy programming and are going into a period where we want to look at the long-term
sequence of what’s going to happen and when,” she said. “That is going to include a wide variety of
items.”
Durham physician explains vaccination
requirements for back to school
A loca
Embed
By Caitlin Knute
Thursday, August 13, 2015 05:16PM
DURHAM (WTVD) --
With a new school year about to start, health officials are reminding you to make sure your
children are up-to-date on their vaccinations.
"For Pre-K and kindergartners, we want to definitely make sure they're up to date on their MMR
(measles mumps rubella) and the vaccine for chicken pox (varicella,)" explains Nicole Swiner,
MD, with Durham Family Physicians.
In addition to those vaccinations, 4 to 6 year olds need to have their DTaP (Diphtheria, Tetanus,
Pertussis) for whooping cough and tetanus, along with IPV, for polio.
For more on requirements for 4-6 year olds, click here.
Students entering 7th grade, or who are about to turn 12, must now have a Tdap booster for
tetanus, diphtheria and whooping cough. They are also required to have the meningococcal
conjugate vaccine, which is a protection against meningitis.
These requirements are new this year, giving students 30 days from the start of the school year to
comply before being suspended.
For more on requirements for 7th grade, click here.
"I think they're really important, not only for the protection of that particular patient, but also for
what's called herd immunity," Swiner said. "You're protecting the people around you."
She also cautions that cases of whooping cough are emerging in some areas in central North
Carolina.
"We got a report from the Orange County Health Department, and I think we had a number of
cases in Durham, but it's definitely spreading," she shares.
As for the safety of vaccines, Swiner stands by the medical community at large in supporting
them. She encourages patients to do their research and separate fact from fiction.
"There's a lot of information out there on the internet and the media that is not correct, like with
the MMR vaccine. It was actually proven that the reports were falsified that it was a dangerous
vaccine."
Swiner has advice for parents that are still skeptical.
"Be honest about it, bring it up to your doctor. If you have stories or articles that people have
shared with you, bring it to the doctor's visit so you can talk about it," she says.
For more common questions about vaccines including their safety, click here.
North Carolina only allows exemptions for medical and religious reasons.