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HomeMy WebLinkAboutBOH Minutes of 022620 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality Hof 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 26, 2020 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega, Chair, Jennifer Deyo, Vice-Chair, Keith Bagby, Bruce Baldwin, Liska Lackey, Sam Lasris, Commissioner Earl McKee, Aparna Jonnal, Lee Pickett, Timothy Smith and Alison Stuebe. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson, Environmental Health Director; Donna King, Health Promotion & Education Services Director; Pamela McCall, Public Health Nursing Director; Courtney McLaughlin; Family Navigator; Jessica Miles, Certified Medical Assistant; Erica Pettigrew, Medical Director; Kristin Prelipp, Communications Manager; Thomas Privott, Soil Scientist; Kimberlee Quatrone, Business Officer; BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: Elinor Landess, Cynthia Lopez, and Kristin Tully. I. Welcome New Employees Jessica Frega, Chair, called the meeting to order at 7:00pm. Quintana Stewart introduced the new employees in attendance: Jessica Miles and Courtney McLaughlin (arrived and introduced later in the meeting). II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the February 26, 2020 Agenda Motion was made by Alison Stuebe to approve the agenda, seconded by Jennifer Deyo and carried without dissent. IV. Action Items (Consent) A. Minutes of January 29, 2020 Meeting Motion was made by Alison Stuebe to approve the minutes of January 2020, seconded by Aparna Jonnal and carried without dissent. V. Educational Sessions A. Social Determinants of Health Screening & Management in Maternity Care S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 1 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 Dr. Kristin Tully, Center for Maternal and Infant Health at the UNC School of Medicine, along with assistance from Board of Health member, Dr. Alison Stuebe, provided an overview of their findings from a human-centered design project involving social determinants of health (SDoH) in maternity care. A tip sheet for health care providers was also included in the Board's agenda packet. Below are some highlights. • The project included workshops where mothers and health care professionals met and whose purpose was to build relationships, develop clinical workflows and make improvements. There were also two activities, journey maps and cards that aided in addressing feelings and the emotional needs around SDoH. Journey maps were used to show where they resonated with situations presented. It was found to be more effective that just asking them to talk about their lived experiences. The cards were used in a similar fashion; although, explanations were written on them to further express their thoughts and experiences. • The mothers were given gift cards for their time and participation. Mothers were also encouraged to bring their infants. Transportation and food were offered. • Some additional points presented: ➢ Patients need to feel listened to. They need to be set up to thrive. Assist in establishing humanity in health care. ➢ We live in either privilege or oppression. More people of color are living in poverty. ➢ Screening and mitigating for SDoH hasn't been fully implemented. It can be a difficult topic to approach, especially when time is limited during a medical visit. Four out of five health care professionals don't feel comfortable asking SDoH questions. Engagement needs to be authentic as patients will feel more open. The mothers in the project preferred that SDoH questions are embedded into other questions as some of them felt ashamed when asked separately. ➢ When engaging with the mother, health care providers can't make it about surveillance as people don't like being tracked. The mothers had also stated that they need to leave with resources vs finding out about resources after they're needed. Health care providers need to be informed of resources and that they patient is eligible to receive them. ➢ Clinician turnover can make staying up to date impossible which in turn could possibly affect being attentive to some patient barriers which cause them to miss multiple appointments and not refill medications. Patient barriers to care include finances, transportation, communication breakdowns and time. Paying for parking and transportation need to be considered. If Medicaid has paid for their transportation, a patient could possibly miss their ride if the appointment runs over. ➢ There should be trainings around communication and biases for patients and clinicians. The BOH members had questions that were addressed by Ms. Tully and Alison Stuebe. B. 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: • The CCC was formed in 2014 as a collaborative effort with the Town of Chapel Hill, UNC Chapel Hill, the Orange County Health Department and the Orange County ABC Board S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 2 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 that focuses on high risk drinking in Chapel Hill. The CCC is thankful for the commitment of funding from these partnering organizations. • There are 21 recommended strategies that fall into three focus areas: Policy/Environment, Education/Awareness and Enforcement. • The CCC adopted the Results Based Accountability (RBA) way of thinking. Over the last year, they used RBA for their 2019-2020 Action Planning Framework. Five questions were asked: ➢ How are we doing? o Average of 250 nuisance noise calls per year (2013-2019) o Almost half(49.1%) of UNC students have experienced memory loss (blackout) as a result of drinking last year with most of them being 20 year old students o Average of 144 alcohol-related EMS transports per year (2011-2019) ➢ What's the story behind the curve? o Parental and alumni attitudes o Collegiate normative environment o Additional alcohol in the environment (e.g. Alcohol in collegiate athletic stadiums) ➢ Who are the partners who have a role to play? o Students/parents o Law enforcement/first responders o University, town and county staff ➢ What works to turn the curve? o The CCC is taking a look at The Maryland's Collaborative's "Reducing Alcohol Use and Related Problems Among College Students:A Guide to Best Practices" and bringing it to NC. ➢ What is our action plan to turn the curve? o Enhanced enforcement of minimum legal drinking age and of adults supplying alcohol to underage persons o Compliance checks o Making alcohol less available by restricting alcohol marketing o Educating parents, alumni and students • Next steps ➢ March 20t" Coalition meeting in which 18-month, 3-year and 5-year strategies will be revealed. ➢ Continue looking at the research and starting with the low hanging fruit to make the change. The BOH members had questions that were addressed by Ms. Landess. C. Environmental Health Rules NCGS 130A grants Boards of Health the general authority to adopt rules necessary to protect public health. The Orange County Board of Health (BOH) adopted local rules in 1980 for the protection of the groundwater and the Orange County community that drinks groundwater. In July 2019, new permitting, construction, and inspection requirements have become effective with the State. Since the local Rules must be at least as stringent as the State per NCGS 87, Article 7, the State changes must be adopted except in places where Orange County is already more stringent. Additionally, it has been five years since a full revision. There are important proposed revisions to the rules that represent increasing technology in well construction and the need for clarification. These proposed revisions have been developed with stakeholders including well contractors representing the NC Well Contractors Commission and the NC Groundwater Association; Environmental Health staff; and NCDHHS Regional Environmental Health. Victoria Hudson, Environmental Health Director, presented and reviewed the proposed S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 3 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 changes, which were included in the Board's agenda packet. After the Orange County Attorney's office has completed its legal sufficiency review, the BOH will be asked to approve the proposed changes at the March 25th meeting. The BOH members had questions that were addressed by Ms. Hudson. D. Outside Agency Review Process La Toya Strange, Administrative Support I, summarized the Outside Agency Review process and the assignments required of Board of Health members for evaluating applications. The Health Department received seven 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 20tn VI. Action Items (Non Consent) A. FY 2021-21 Budget Request & Fee Schedule Quintana Stewart, Health Director, and Rebecca Crawford, Financial and Administrative Services Director, presented the Board with a summary of the proposed FY 2020-2021 budget for the Health Department presents an increase in expenditures of$143,975 from the FY 20-21 Base Budget; all of which are related to an increase in permanent staffing (5.0 new FTEs and 1.0 FTE converted from Time Limited to Permanent, supported by re-allocated county general funds, fees for service, Medicaid Cost Settlement, and new County General funds). Staff projects a $99,354 increase in revenues for FY 20-21, which will partially offset the expenditure increase. The Health Department will request a County General Fund request in FY 20-21 of $44,621. The proposed total budget is $11,074,200. In relation to new staff requests, the Health Department requests to convert previously allocated contract services funds for an IT Support Analyst to a permanent IT Support Analyst as we have been unable to recruit for this position as a contractor. This position will be fully funded by existing, reallocated County General Funds. The department has requested to add a Mobile Dental Clinic (MDC) Coordinator and Administrative Support I (to provide administrative assistance in the medical clinics) during the current year. These positions are included in our budget request and will be fully funded by Medicaid Cost Settlement funds. The department requests to add two new positions that will each be partially funded by new User Fees and New County General Funds. The Dental Clinic would like to add a Dental Hygienist as an existing Dental Hygienist will serve on the Mobile Dental Clinic and we anticipate that adding a new Hygienist will enable the Dental Clinic to maintain the current patient load and not extend wait times for new/return appointments. The Environmental Health Division would like to add an additional Environmental Health Specialist (EHS) to dedicate 100% to Onsite Water Protection Services (OSWP) inspections. Currently an OSWP EHS has been reassigned to work 50% of her time in the Food and Lodging Inspections (FLI) program to inspect an additional 11 locations on the UNC campus as newly required by a NCDHHS plus many new restaurants, food trucks, and new food offerings at UNC Athletic events. This has meant other existing OSWP EHS have taken on additional inspections and lengthened inspection wait times. The new EHS would allow all inspections (OSWP and FLI) to be conducted within acceptable wait times and improve client satisfaction. Finally, the department requests to convert a time limited Reentry Case Manager position to a permanent position. This position was originally grant funded in a partnership with UNC in the Formerly Incarcerated Transitions (FIT) program, which ended this fiscal year. We S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 4 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 have seen many benefits to the residents of Orange County through this program and have reallocated County General Funds to support keeping the position on a permanent basis. In relation to state funding, the NC Department of Health and Human Services has provided us with the FY 20-21 Consolidated Agreement Addenda. We received increases in the Family Planning and Breast and Cervical Cancer Control Program (BCCCP) programs totaling $30,521. That increase was offset by an anticipated decrease of$20,000 in the CLAS program (funding not available in FY 20-21), in the Refugee Health program (related to the decrease in Refugees coming to Orange County for resettlement), and the Healthy Communities program, which was an anticipated decrease from a one-time funding increase we received last fiscal year. The BOH had questions that were addressed by Ms. Crawford and Ms. Stewart. Motion to approve the total budget requested in the amount of$11,074,200 for FY 2020- 2021 as presented and forward to the County Manager and Board of County Commissioners for action was made by Liska Lackey, seconded by Aparna Jonna and carried without dissent. Ms. Stewart praised Kimberlee Quatrone, Business Officer, Rebecca Crawford, and the other division directors for doing a great job with their involvement on the budget. Proposed Fee Changes In reviewing Health Department fee schedules, which are done on an annual basis, the Department would like to make multiple fee changes in Environmental Health and Personal Health. The proposed changes are summarized below with a detailed list of the fees in the attached fee schedule: Environmental Health Environmental Health requests to adjust multiple sample testing fees, Tattoo Artist, and Pool/Spa permitting fees and add two well permit fees and a Mobile Food Unit fee. The sampling fees will be adjusted in order to remain competitive with both private sector sampling services and surrounding jurisdictions and the fee for a Radon Air Sample kit will be deleted as these are no longer provided. These adjustments should have little to no impact on the total fee revenue. A fee increase for the Tattoo Artist Annual Permit will offset the cost for annual training offered to tattoo. The proposed new fees for Well Repair Permits with Water Sample (with and without Liner) will ensure that well water is tested for contamination after well repairs (currently there is no requirement for homeowners to test the water after a repair, which can impact basic potability). The proposed new fee for Mobile Food Units (MFU) removes MFUs from an umbrella fee category (Shared Kitchen, MFU, PC, LFSE Plan Review and Permit) due to the time and complexity required to inspect and permit a MFU, which is similar to the time and complexity required for a brick and mortar establishment. The total financial impact from Environmental Health fee changes is projected to be: $14,675. Personal Health Personal Health requests to adjust multiple fees for vaccines (to reflect the cost to purchase the vaccines), to add fees to charge for maternal health ultrasounds (will help patients avoid hospital visits and will be adjusted on a sliding fee scale for self-pay patients), to delete procedure codes that are no longer used (originally added with specific modifiers as required by Medicaid Cost Settlement but no longer required), and to add a new MMR and Varicella S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 5 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 vaccine. Finally, the division requests to continue scheduled adjustments to the 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. The total financial impact from Personal Health fee changes is projected to be a maximum of $13,493.38. The BOH had questions that were addressed by Ms. Crawford and Ms. Stewart. Motion to approve all fee changes for FY 2020-2021 as presented and forward to the Board of County Commissioners for action was made by Sam Lasris, seconded by Lee Pickett and carried without dissent. VII. Reports and Discussion with Possible Action A. Fluoride Recommendation Approval Jessica Frega, BOH Chair, stated that the BOH Ad Hoc Committee is in the homestretch of the process. They had a meeting to proofread the draft and are waiting to hear back from one expert. Honorariums were offered but are being held until the Board approves the recommendation. B. Health Director Report In addition to mentioning upcoming events, Ms. Stewart also highlighted the items below from her report. • COVID-19—The CD is monitoring those being quarantined. Everyone has been compliant and asymptomatic. The OCHD is working with the State. • Census 2020 — Kristin Prelipp developed videos, in multiple languages, to explain the importance of the Cenus and benefits for the County. Links to the videos were included in the Health Director's report. Census postcards will be mailed out mid-March. A request was made of the Board members, that will be attending meetings, to remind people to complete the Census. • On tomorrow, a Town Hall on gun safety will be held in the BOCC Room 230. • The Minority Health Conference takes place on February 281". OCHD employee, Krishnaveni Balakrishnan, will be hosting one of the breakout sessions. • Trauma Informed Care Seminar will be taking place on March 131" at the DSS in Hillsborough. It will be presented by Colleen Bridger. C. Media Items Kristin Prelipp, Communications Manager, briefly mentioned articles regarding UNC banning nonessential university-affiliated travel to China due to the coronavirus, the OCHD'S plan to upgrade the septic system at the historic White House in Mebane, an FSA community event, and filtration systems to remove toxic perfluroalkyl substances (PFAS). Media items were in the packet which focused on Orange County's events and our involvement in various efforts. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 6 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH February 26, 2020 Vill. Board Comments. Keith Bagby asked if there was any thought about having our dental mobile van connecting with other mobile vans, sort of a one stop shop of services. Quintana Stewart replied by stating that it is anticipated that the new clinic coordinator position would be organizing these types of tasks. Alison Stuebe mentioned that she wanted to say thanks for the opportunity to attend the REI training. Aparna Jonnal expressed the desire to attend and was told to reach out to Beverly Scurry for assistance with getting registered for a training. Ms. Scurry added the latest newsletter has the most up to date list of training dates and times. IV. Adjournment Liska Lackey moved to adjourn the meeting at 9:10pm and Bruce Baldwin seconded. The next Board of Health Meeting will be held March 25, 2020 at the Whitted Human Services Center, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ February Page 7