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HomeMy WebLinkAboutBOH Final Minutes of August 25, 2021 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 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 August 25, 2021 virtually via Zoom. BOARD OF HEALTH MEMBERS PRESENT: Sam Lasris — Chair, Bruce Baldwin —Vice-Chair, Keith Bagby, Brian Crandell, Commissioner Jean Hamilton, Aparna Jonnal, Lee Pickett, Shielda Rodgers and Alison Stuebe. BOARD OF HEALTH MEMBERS ABSENT: Jessica Frega. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Compliance Manager; Renee Kemske, Nutrition Program Manager; Zin Lyons, Public Health Nurse Supervisor I; Dr. Monica Meng-Haggerty, Dental Director; Kimberlee Quatrone, Business Officer; Kristin Prelipp, Communications Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: None. I. Welcome New Employees Sam Lasris, Chair, called the meeting to order. Ms. Stewart, Health Director, introduced the new employees: Chinyere Ekenna, Cuianna Sanford and Lesly Penick (not in attendance). Ms. Stewart also introduced the new Community Health Services Division Director, Dana Crews. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the August 25, 2021 Agenda Motion was made by Keith Bagby to approve the agenda, seconded by Aparna Jonnal and carried without dissent. IV. Action Items (Consent) A. Minutes of June 23, 2021 Meeting Motion was made by Shielda Rodgers to approve the minutes of June 2021, seconded by Bruce Baldwin and carried without dissent. V. Educational Sessions A. Food Insecurity Board Chair, Sam Lasris, introduced presenter, Mariamu Amadi. Ms. Amadi presented on food insecurity. She began by providing a brief bio of herself. Below are some highlights of her presentation. S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 1 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 • Food security is defined as having physical and economic access to sufficient food to meet dietary needs for a productive and healthy life. • According to the World Health Organization (WHO), three main aspects of food security are: o Availability— sufficient and consistent supply o Access - sufficient and appropriate resources o Utilization —appropriate use • In 2020, between 720 and 811 million people faced hunger. More than half(418 million) of those affected by hunger were in Asia and more than one-third (282 million) were in Africa. • Three levels of food insecurity o Food security—adequate access to food in quality and quantity o Moderate to severe food insecurity— uncertainties about the ability to obtain sufficient, safe and nutritious food o Severe food insecurity— inadequate access to food, with some people going days without food • Biggest drivers of food insecurity: o Gender inequality -women are more likely to suffer from hunger and malnourishment in nearly two-thirds of countries around the world o Food waste — 30% of most food is lost or wasted o Extreme weather— over 80% of the people suffering from hunger live in disaster- prone countries o Conflict—60% of those facing hunger live in countries affected by violence and conflict • In America, households with children are more likely to experience food insecurity. Many households that experience food insecurity do not qualify for federal nutrition programs. • According to the NC Justice Center, NC has the 101" highest rate of food insecurity in the nation. • According to the Hunger in America 2014 study, food insecurity and the impact on health results were: 0 24% of households had at least one member in poor health 0 33% had a household member with diabetes 0 66% of households had to choose between food and medical care 0 58% had a household member with high blood pressure • Ending hunger is a solvable problem. A key factor in addressing the world's food security challenges is improving the availability, access and utilization of food across global communities. The BOH members had questions and comments that were addressed by Ms. Amadi, Ms. Stewart and Ms. Crews. B. Nutrition Update/Employee Health &Wellness Renee Kemske, Nutrition Program Manager, gave an update on the OCHD's Nutrition Services section. Below are some highlights of her presentation. • Nutrition Services o Medical Nutrition Therapy (MNT) is a service provided by a registered dietitian nutritionist (RDN)who works with a referring medical provider to improve a variety of S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 2 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 conditions such as diabetes, heart disease, and obesity. Referrals are received from medical providers within and outside of the OCHD. The RDN conducts a review of the medical history, medications, diet, and lifestyle patterns and together with the referred client or a family member, if it's a young child. A personalized plan is developed to help them meet their nutrition goals. There were 856 encounters in FY 2020-21. There was a 10% increase in primary care clients. The payment type for the 856 encounters were: ➢ Insurance at 34% (290 ppl), Medicaid at 26% (224 ppl) and self-pay at 40% (342 ppl). • Diabetes Self-Management Education Services (DSME) o Clients receive 10 hours of education on the basics of diabetes prevention and management in this American Diabetes Association recognized program. There's an initial health assessment and sign up for 2 of the group education classes on the basics of diabetes care. Clients will then return in 3 months for a follow-up appointment where knowledge is measured as well as any change in blood sugar management. Nutrition Services have collaborated with local experts in the different areas of diabetes management including partnering with Walgreens to provide the medications and the utilization of a nurse, health educator and an exercise physiologist. o NCDiabetesSmart featured OCHD's DSME program in a video for a statewide marketing initiative. Some OCHD staff participated in the video. o All services were provided last year via telehealth. Telehealth appointments have been very successful. There was an 11% decrease in the no-show rate. Group education sessions are held using the Zoom meeting format as it possesses a simultaneous interpretation feature to offer Spanish classes. Telehealth materials such as appointment reminders and pre-appointment connectivity meetings ensure a smooth log in process. Scales, self-management/behavior change tools, and education materials were mailed to clients. • Community Health Grant (CHG) o In 2017, the CHG was awarded by the Office of Rural Health. The grant was renewed for FY 21-22. The purpose of this award is to increase access to primary care and self-management support services for residents with chronic disease. Groups specifically targeted include adults who are uninsured, on Medicaid or Medicare. The focus is on the chronic conditions of obesity, pre-diabetes and diabetes abnormal lipids, which is cholesterol and hypertension. • There is a voucher program that waives the fee to those clients in which the $20 fee is a barrier. Diabetes tests and supplies are offered at no cost to help clients manage their diabetes. • Some of the specific objectives and outcomes of the CHG include: o Working on increasing accessibility of interpretation services for the L.E.P. clients of the MNT and DSME programs o Offering behavior change incentives by providing water bottles, calories tracking books, and step trackers • There was a transportation assistance program for adults and pregnant women in which 45 rides were provided pre-COVID-19. Those funds have since been reallocated for telehealth services. They are also being used to create primary care bags that include items such as those that assist with at-home blood pressure self-checks and diabetes testing supplies. S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 3 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 • Community partnerships include establishing relationships to establish a formalized referral network, working with the OC Department of Aging with screenings and health promotion programming and enhancing the Community Health Worker role. • New Grant Initiatives o Scholarships for YMCA medical memberships o Pilot food access/cooking education program o Pilot lending library for tablets and hotspots • Diabetes Prevention Program (DPP) o DPP is a 16-week class for people with prediabetes or who are at risk for Type 2 diabetes helping them make realistic and achievable lifestyle changes that can cut their risk of developing Type 2 diabetes by 50%. The goal is to help them lose at least 5% of their body weight and/or to achieve 150 minutes or more physical activity per week. Grant funding is used to provide prizes to aid in behavior change. o The DPP classes are averaging a 6.4% weight loss and 205 physical activity minutes per week. o DPP is free for county employees and $25 a year for non-county employees. Financial assistance is available. • Employee Wellness Program o Available for county employee 0 61 appointments (42 individual and 19 group) have occurred The BOH members had questions and comments that were addressed by Ms. Kemske. C. 411 Quarter Financial Reports & Billing Dashboard Kimberlee Quatrone, Business Officer, gave a report on the 4t" quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Budget vs. Actuals: Average YTD monthly revenue in FY20-21 after the fourth quarter is $389k/month or $4.7M YTD, representing 81% of our overall budgeted revenue for the year compared to last year, which was 91.8%. This number looks low due to the amount of COVID funding we received, but didn't draw down because we didn't have eligible expenses. Without COVID funds, our revenue was 98% of our overall budgeted revenue. Expenses are below revenues, at 91.08% of the overall budget. • Dental Earned Revenue by Source: The FY 20-21 average monthly revenue ($37.1 k/month) for the fourth quarter is below our budget projection ($41 k/month) and our FY 19-20 average of$39.7k/month. This was due to the clinic having reduced hours during much of the fiscal year because of COVID. FY 20-21 dental earned revenue totaled $445k at the end of the fourth quarter compared to $476k at the end of the FY 19-20 fourth quarter. • Medical Earned Revenue by Source: Medical earned revenue is above the budgeted projection for FY 20-21 ($33k/month) at $40.8k/month. Telehealth visits have been very successful and allowed the clinic to continue to see patients and bill for services even as in-person visits were limited. We have increased the number of in-person visits and will continue to add clinic visits as PPE and staff are available. Medical clinic revenue totals $489k after the fourth quarter FY 20-21 compared to $482k after fourth quarter FY 20-21. S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 4 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 • Environmental Health Earned Revenue by Source: Environmental Health earned revenue is below the budgeted projection for FY 20-21 ($53k/month) at $50.2k/month. We saw our seasonal trend of increased revenue in the third quarter of the year due to spring pool inspections and better weather for outdoor inspections and site visits. EH staff have worked hard to continue OSWP inspections during the pandemic with little to no in-person required of residents. FY 20-21 YTD revenue totals $602k compared to FY 19-20 YTD revenue of$552k. • Grants Fund Revenue: FSA has drawn all $300k of the multi-year Kenan grant and have received authorization to continue to use this funding into next fiscal year in order to fully expend the grant. FSA will rely predominantly on county general funds next fiscal year as staff move away from the pandemic response and back to FSA duties on a full time basis. The BOH members had questions and comments that were addressed by Ms. Quatrone and Ms. Stewart. VI. Action Items (Non-Consent) A. New Board Member Recommendation As of June 30, 2021, the BOH Engineering Representative seat was vacated by Timothy Smith. An ad hoc committee consisting of Bruce Baldwin, Jessica Frega, Aparna Jonnal, and Timothy Smith, with guidance from Sam Lasris, was formed tasked with finding a replacement. A phone interview occurred on July 14'. Co-chair, Bruce Baldwin, gave a brief background of Tony Whitaker reiterating some of the information sent to the Board prior to tonight's meeting. Sam Lasris thanked everyone for their efforts. Motion to recommend Tony Whitaker to the BOCC as the BOH Engineering Representative was made by Bruce Baldwin, seconded by Alison Stuebe, and carried without dissent. B. One Orange Countywide Racial Equity Plan — Community Engagement Meeting Quintana Stewart, Health Director and member of the county's racial equity team, One Orange, requested the Board's assistance in facilitating a community engagement session with the community to get feedback on the countywide racial equity plan. There are five questions posed to get feedback. • What three results would you like to see as a result of this plan? • What sections of this plan will help us achieve those results? • Who should be involved in future community engagement? • Who is negatively affected by using this framework/plan? • What do you see as the most critical racially equitable outcomes? After some discussion, it was agreed that the community engagement session which would be a part of next month's Board meeting. Annette Moore, Director of Human Rights and Relations, will facilitate it. S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 5 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 Motion to host the Community Engagement Session was made by Alison Stuebe, seconded by Bruce Baldwin, and carried without dissent. VII. Reports and Discussion with Possible Action A. Health Director Report In addition to her report, some of items Ms. Stewart briefly highlighted are below. • The Environmental Health staff held its annual mobile home park inspections at Ridgewood. They answered numerous questions. Animal Services also attended. There were many positive responses received. • Victoria Hudson, Environmental Health Director, received the Trenton G. Davis Award at the 58t' Annual Conference of Eastern District NC Public Health Association (EDNCPHA) held on August 11, 2021. The award is the EDNCPHA's highest award for environmental health professionals, presented in recognition of distinguished and devoted service. • Legislative Updates: o The House has approved its budget and it includes the $36 million for Communicable Disease for public health. o Senate Bill 191 (No Patient Left Alone Act) an act providing patient visitation rights will not be impacted during declared disasters and emergencies and directing the DHHS to impose a civil penalty for any violation of those rights; going back to Senate for review after multiple revisions. o State law (Session Law 2021-110) changed on August 20, 2021, and health care providers are now required to obtain written consent from a parent or legal guardian of a minor prior to administrating any vaccine that that has been granted emergency use authorization and is not yet fully approved by the United States Food and Drug Administration to an individual under 18 years of age. As Pfizer has received final FDA approval, those 16 years of age and older don't need written permission, only those ages 12 -15 require it. B. COVID-19 Update Quintana Stewart, Health Director, gave an update on the COVID-19 status in Orange County (OC) as well as took questions from the Board. Some highlights are below. • The Governor has extended the State of Emergency for NC. The BOCC will reassess after Labor Day whether the advisory boards will still meet virtually. • As of today: o The Delta variant is still the most prevalent in NC due to its high rate of transmission. o According to the county alert system, OC is in the red tier, which indicates high community spread. o In the last 7 days in OC, there were 194 new cases and 1 additional death. o The percent positive case rate is 3.5%. o There were 2 outbreaks in nursing homes — Parkview and Signature Health. • The state has changed the way it displays their data. It's broken down by age and shows data for those eligible to be vaccinated vs the population as a whole including S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 6 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH August 25, 2021 those ineligible. Currently, of those ages 12 and up, 87% are fully vaccinated. The percentage of those ages 12 and up with at least the 1 st dose is 91%. • The OCHD is still pushing out messaging regarding getting vaccinated. • Immunocomprised people are able to receive an additional (31) dose of Moderna or Pfizer vaccine. Boosters may be available by late September, pending full review and recommendations by the FDA and CDC. Those most likely eligible will be so 8 months after receiving their 211 dose of Pfizer vaccine. C. Media Items Kristin Prelipp, Communications Manager, articles that were included in the Board's packet. Some of the articles highlighted include: - NPR audio diary that documented time spent with the Mobile (Vaccination) Team. - News & Observer article on using vaccines before they expire. - WRAL article on vaccination rate discrepancy. - Herald Sun article about Orange County's mask mandate. Media items were in the packet which focused on Orange County's events and our involvement in various efforts. Vill. Board Comments Commissioner Jean Hamilton mentioned that she'd received some emails complaining about the mask mandate and that some businesses are not enforcing it. Ms. Stewart also stated that she'd received some as well. The Environmental Health division goes out and educates people/businesses on how to be compliant with the mask mandate. XI. Adjournment Keith Bagby moved to adjourn the meeting at 9:14pm and Aparna Jonnal seconded. The next Board of Health Meeting will be held September 22, 2021 at 7:00pm via Zoom. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2021 Agenda &Abstracts/ August Page 7