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HomeMy WebLinkAboutBOH minutes 022818MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 1 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON February 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith – Chair, Johanna Birchmayer, Barbara Chavious, Jennifer Deyo, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin, Commissioner Mia Burroughs, Paul Chelminski and Jessica Frega. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Cintia Gevawer, Dental Office Assistant; Henry Green, Community Health Aide; Victoria Hudson, Interim Environmental Health Director; Carla Julian, Dental Clinic Practice Manager, HIPAA Privacy and Security Officer; Donna King, Health Promotion & Education Services Director; Pam McCall, Personal Health Services Director; Kristin Prelipp, Communications Manager; April Richard, Tobacco Prevention and Control; Beverly Scurry, Board of Health Strategic Plan Manager; Ana Salas, Dental Assistant; La Toya Strange, Administrative Assistant II; Iulia Vann, Public Health Services Manager and Phil Vilaro, Interim Environmental Health Director. GUESTS PRESENT: Kelly Kester and Sara Pequeno. I. Welcome New Employees Susan Elmore, Chair, called the meeting to order. Ms. Stewart welcomed new employees, Cintia Gevawer and Henry Green. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the February 28, 2018 Agenda Motion was made by Jennifer Deyo to approve the agenda, seconded by Liska Lackey and carried without dissent. IV. Action Items (Consent) A. Minutes of January 24, 2018 Meeting Motion was made by Jennifer Deyo to approve the minutes of January 2018, seconded by Liska Lackey and carried without dissent. V. Educational Sessions MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 2 A. Campus & Community Coalition Update Elinor Landess, Director of the Campus & Community Coalition to Reduce the Negative Impacts of High Risk Drinking (the CCC), presented an update on the status of the Coalition's activities. Below are some highlights: Three focus areas – Policy/Environment, Education/Awareness and Enforcement  Policy/Environment • In 2016-17, there were 114 alcohol-related EMS transports in Carrboro/Chapel Hill. Campus alcohol policy cases totaled 217. Chapel Hill Police Department (CHPD) responded to 340 loud party calls for service. • Updates include: o Party Registration Policy was soft launched in January. The program lets students register their off-campus parties. If police get a noise complaint about a registered party, they will call or text the host(s), giving them 20 minutes to lower the volume or end the party. If another noise call comes in about the same party, a police officer will investigate and could issue a citation. Loud parties that aren’t registered may be cited for the first call. Two consecutive warnings result in the loss of their registration privileges for 90 days. They can also lose privileges for one year for a citation. This gives students an opportunity to take responsibility prior to any intervention.  Education/Awareness • In 2016-17, the CHPD conducted 24 B.A.R.S. (Be A Responsible Server) trainings. There were 4,254 incoming students that completed Alcohol.edu training module. • Updates include: o Bee Safer was developed by media and journalism students. An Alcohol Resource guide was created which is intended for staff who are new to selling and serving alcohol in Chapel Hill. It includes information such as tips on spotting fake IDs, preventing sales to underage patrons as well as other helpful information.  Enforcement • In 2016-17, the CHPD wrote 101 alcohol-related citations. There were 47 alcohol-related incidents/charges recorded by the UNC Police Department. • Updates include: o The new Campus Alcohol Adjudication policy is applicable to all members of the campus community not just the students and all will go through the same adjudication process. Regarding what’s next for the CCC, Ms. Landess stated that it is important that consistency and equity in all the processes remains. The CCC is looking into engaging landlords as partners, possibly having them include provisions in their lease agreements pertaining to being a model tenant. The CCC also wants those people who are doing right to feel good and/or be acknowledge for doing so. The importance of educating the community and students was heavily stressed as the use of alcohol among the college population not only affects the individual but the community as well. The BOH had questions that were addressed by Ms. Landess. MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 3 B. Communicable Disease Protocol Iulia Vann, Public Health Services Manager, gave a presentation on the Health Department’s efforts in initiating, managing, and preventing outbreaks in Orange County. Below is a summary of her presentation. Outbreaks  Defined as an occurrence of 3 or more ‘epi-linked’ (exposure to same person, same school, showing some commonality) cases  Some reasons to Investigate an Outbreak • Identify and describe the source • Describe new diseases, learn more about known diseases • Identify populations at risk • Opportunity to educate public about disease prevention • Address public concern • Develop strategies to prevent future outbreaks • Terminate the outbreak  10 Steps of an Outbreak Investigation • Identify investigation team and resources • Establish existence of an outbreak • Verify the diagnosis – confirm signs, symptoms, test results • Construct case definition – unique to outbreak • Case finding – active and passive • Perform descriptive epidemiology– line list and epi curve • Evaluate hypotheses – agent, source, transmission, exposure • Implement control measures – prevent further exposure, good balance for credibility and reputation. • Communicate findings • Maintain surveillance  Vaccine Preventable Disease (VPD) • Mumps cases in Orange County by year o 2015 – 1; 2016 – 0; 2017 – 4 • Pertussis cases in Orange County by year o 2015 – 6; 2016 – 14; 2017 – 10  Vaccine effectiveness • Pertussis vaccines are effective, but not perfect. • Typically offer good levels of protection within the first 2 years after getting the vaccine, but then protection decreases over time. • Public health experts call this ‘waning immunity.’ • DTaP vaccines are 80% to 90% effective. • There is a modest decrease in DTaP effectiveness in each following year. Lastly, Ms. Vann informed the Board that the OCHD CD team collaborates with the school districts, providers, parents and state agencies. The BOH had questions that were addressed by Ms. Vann. C. Strategic Plan Update MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 4 Beverly Scurry, BOH Strategic Plan Manager, briefly, presented highlights of the achievements accomplished to date centered around the four priority areas of Social Determinants of Health, Physical Activity and Nutrition, Substance Abuse and Mental Health and Engagement. Highlights of Ms. Scurry’s presentation included successful, not so successful ventures and upcoming/ongoing activities: Social Determinants of Health  Success - Patient/Client text messenging • In July 2017, OCHD contracted with Solutionreach to provide a texting service through Eagle Soft (Dental EMR) for clients. o 2000 text confirmed appointments since implementation. o Patient no show rate down from 15% to 12% since implementation.  Not so successful - Medical-Legal Partnership • FSA created a working relationship with Legal Aid in 2016. o A referral form was created for residents of Gateway to seek counsel regarding tenant issues. o The program did not generate many referrals due to resident’s fear of possible negative retaliation from management. o There was staff turnover at Legal Aid that created a halt in the program; although, there are plans to follow-up with Madlyn Morreale of Legal Aid.  Upcoming Activities – Translation Boot Camp and SDH Clinical Tools to assist with ACE and other screenings Physical Activity and Nutrition  Success – School Staff Support • Both schools systems were offered opportunities to apply for and receive funding to support a physical activity and nutrition project in their school. o Orange County Schools applied for Community Project Support funding. o BOH provided funding for 3 Partnership Academy teachers to attend the Action Based Learning and Kidsfit Kinesthetic Classroom Training in July 2017.  Not so successful – Nutritional Review of Homestead Aquatic Center • A review of the Aquatic Center revealed they are not providing hot meals which would warrant a nutritional review. • Moving forward, vending machines in county owned facilities will be evaluated for their nutritional content.  Upcoming Activities - Collaboration with Orange County Food Council as a food database is being creating by a UNC student that will consist of policies that will address incentives for food retailers and other interventions that address food deserts. We’lll work together to determine ways to effectively disseminate that information to the community. Substance Abuse and Mental Health  Upcoming/Ongoing Activities – MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 5 • Continued exploration of Screening, Brief Intervention, and Referral to Treatment (SBIRT) options for medical clinic. • Ric Bruton will present on Cardinal Innovations annual report on the use of county dollars in March 2018. • BOH Strategic Plan Manager continues to participate on the Jail/Mental Workgroup and Justice Advisory Council. Engagement  We’ll continue to monitor other Boards and present an update twice a year. The next update will be given at the April BOH Meeting. Lastly, Ms. Scurry stated that she’s working with Susie Green, referred by Susan Elmore, to assist with cleaning up/updating the current Strategic Plan. D. Outside Agency Review Process La Toya Strange, Administrative Assistant II, summarized the Outside Agency Review process and the assignments required of Board of Health members for evaluating applications. The Health Department received ten applications to review. Board members are to review the applications assigned to them, record scores on the appropriate scoring cards and send the completed scoring cards back to Ms. Strange by March 22nd. VI. Action Items (Non Consent) A. 2018-19 Budget Quintana Stewart, Health Director, began by acknowledging staff and division directors for their hard and creative work. Rebecca Crawford, Financial and Administrative Services Director, presented the Board with a summary of the proposed FY 2018-2019 budget for the Health Department which shows an increase in expenditures of $150,750 from the FY 18-19 Base Budget; $97,364 of which are expenditure increases related to increases in permanent staffing (1.0 FTE Dental Hygienist, full supported by fees for service) and temporary staffing (Environmental Health Specialist, Graphic Designer, Dentist, and Foreign Language Interpreter).The remaining $53,386 of the expenditure increase is related to service levels increases for the Family Success Alliance and enhanced medical services. This also includes budget increases approved during the FY 17-18 budget process for the Formerly Incarcerated Transitions (FIT) and Youth Tobacco grants. Staff projects a $150,750 increase in revenues for FY 18-19, which will fully offset the expenditure increase. The Health Department will request level county funding for FY 18-19. The proposed total budget is $10,251,749. In relation to new staff requests, the Health Department requests a 1.0 FTE Dental Hygienist, which will decrease patient wait times for routine cleanings from nine months to the industry standard of care of six months. This position will be fully funded by self-pay, Medicaid, and Commercial Insurance reimbursements for our fees for services. The department also requests to make our time limited 1.0 FTE Property Development Tech a permanent employee, funded by Environmental Health fees for services. Finally, the department requests to have an ongoing line item for Environmental Health Specialist temporary employees. The EHS temps used in the current fiscal year to help with an increased number of WTMP inspections have also helped MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 6 decrease overall wait times for well and septic inspections while contributing additional revenue to the department. In relation to state funding, the NC Department of Health and Human Services has provided us with the FY 18-19 Consolidated Agreement Addenda. We received a minor decrease in six programs for a total of $12,441, which will be offset by an anticipated decrease in expenditures for the Refugee Health and Youth Tobacco programs. Refugee Health funding is determined based on the number of refugees assigned to Orange County. Since we have seen fewer refugees in FY 17-18, most likely due to decreased immigration in the existing political climate, the FY 18-19 funding allocation was decreased. The FY 17-18 Youth Tobacco program allocation included a one-time $8,000 increase for QuitlineNC services, which was not included in the FY 18-19 allocation. In relation to fee changes, the FY 18-19 requested budget includes fee changes for the Personal Health, Dental Health, and Environmental Health divisions. Staff recommends multiple fee changes for Personal Health to add a new UNC lab test for colorectal cancer screening and adjust the fees for 340B drugs according to state and federal policies around 340B drugs. In addition, Dental Health would like to add a fee for root extractions, which they are currently performing but without an associated fee. Also, Environmental Health would like to add several new swimming pool and Food Service Establishment permit fees. All proposed fee increases are described in more detail in a separate Fee Change abstract. Ms. Crawford facilitated a discussion about the proposed fee changes which touched briefly on making multiple fee changes in Personal Health, adding a fee in Dental Health, and adding several new fees in Environmental Health division. Personal Health requests annually scheduled adjustments to our fees for 340B drugs (Family Planning drugs not including birth control pills) to make them match the county’s cost to purchase them, as required by the state and federal government. This will have very little impact on both the department and patients as only 10% of self-pay patients pay more than $0 for Family Planning drugs or procedures and of that 10% we had no patients in prior years that have had to pay 100% of the cost. Personal Health would also like to add a UNC lab test that is a patient-friendly take-home screen for colorectal cancer. Dental Health requests to add a fee for the removal of the root or a root fragment of a tooth after the tooth itself has previously been removed but not completely. The Dental clinic is performing this procedure but has not had a fee in their schedule for which to charge. We anticipate performing 20 root tip extracts in FY 18-19. Environmental Health requests to add multiple new swimming pool and food service fees and corrections to two other fees. The new swimming pool fees are directly related to year round pools and the increased time required to make no fewer than two annual site visits and the additional visits required for those that do not meet standards. One new Food Service Establishment (FSE) fee also focuses on extra time required for additional site visits when a permit is denied. The final FSE fee addition is used in our surround counties but is new to Orange County. This fee is typically used when a FSE changes ownership; the transitional permit is able to be used until the county determines if a new permit is required. Motion to approve all fee changes for FY 2018-2019 as presented, the total budget requested in the amount of $10,251,749 for FY 2018-2019 as presented and forward to the MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 7 County Manager and Board of County Commissioners for action was made by Sam Lasris, seconded by Jennifer Deyo and carried without dissent. The BOH had questions that were addressed by Ms. Crawford. VII. Reports and Disccussion with Possible Action A. Fluoridation Discussion Quintana Stewart, Health Director, began by reiterating that this is a follow-up to the November 3rd OWASA letter to the BOH requesting help with a community review of fluoridation. It was determined, during the November 27, 2017 BOH meeting, that the Board will decide if they wish to create a subcommittee to plan for the Countywide review of fluoridation upon arrival of the new Health Director. Ms. Stewart informed the Board that she had previously spoken with Ed Kerwin, OWASA Executive Director. The subcommittee’s focus will be on health concerns. The subcommittee duties will consist of the planning and reaching out to the experts. After the Board reviews the information, they will present it to the public. After some discussion, the Board voted on whether to create a subcommittee. Motion to create a planning subcommittee was made by Liska Lackey and seconded by Sam Lasris. Johanna Birckmayer abstained. B. Health Director Report Ms. Stewart elaborated on the Health Department’s activities that occurred in February as well as the upcoming activities that were in her Health Director’s Report. There were no questions from the Board regarding the Health Director’s Report included in the packet. C. Media Items Kristin Prelipp, Communications Manager, distributed the Annual Report to the Board. Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments None. IX. Adjournment Barbara Chavious moved to adjourn the meeting at 8:55pm and Liska Lackey seconded. The next Board of Health Meeting will be held March 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, MINUTES ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 8 Quintana Stewart, MPA Orange County Health Director Secretary to the Board