HomeMy WebLinkAboutFinal Minutes of February 23, 2022 MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
February 23, 2022
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 23, 2022 virtually via Zoom.
BOARD OF HEALTH MEMBERS PRESENT: Bruce Baldwin — Chair, Keith Bagby—Vice-
Chair, Brian Crandell, Jessica Frega, Commissioner Jean Hamilton, Aparna Jonnal, Sam Lasris,
Lee Pickett, Shielda Rodgers, Alison Stuebe, and Tony Whitaker.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Services
Director; Micah Guindon, Financial and Administrative Services Director; Victoria Hudson,
Environmental Health Director; Carla Julian, Compliance Manager; Alvina Long, Public Health
Nursing Director; Dr. Monica Meng-Haggerty, Dental Director; Kristin Prelipp, Communications
Manager; Thomas Privott, Soil Scientist I; Kimberlee Quatrone, Business Officer; Caroline
Shumaker, Dental Clinic Coordinator; and La Toya Strange, Administrative Support I.
GUESTS PRESENT: None.
I. Welcome New Employees: Ms. Stewart introduced Stephanie Bowes (she was not
present). Ms. Stewart also took this time to speak about OCHD current vacancies and
recruiting efforts.
II. Public Comment for Items NOT on Printed Agenda: None.
Bruce Baldwin, Chair, read aloud the policy regarding public comment including that each
person receives a maximum of 3 minutes to comment. He also noted that the maximum time
for public comments would be a total of 15 minutes.
There were no public comments.
III. Approval of the February 23, 2022 Agenda
Motion was made by Alison Stuebe to approve the agenda, seconded by Aparna Jonnal
and carried without dissent.
III. Action Items (Consent)
A. Minutes of January 26, 2022 Meeting
Motion was made by Lee Pickett to approve the minutes of January 2022, seconded by
Alison Stuebe and carried without dissent.
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ORANGE COUNTY BOARD OF HEALTH
February 23, 2022
IV. Educational Sessions
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.
• COVID-19 Context
o Robert Wood Johnson Foundation County Rankings Health Factors — OC falls below
the national average in regards to excessive drinking and alcohol-impaired driving
deaths.
o Increase in alcohol sales since pandemic
o RTI Study
➢ 36% in drinks per month
➢ Almost 40% exceeding federal guidelines
➢ Largest increases amongst populations that are historically low such as Black
and Hispanic women, Black men and men of color, and women with children
under age 5
➢ Increase in frequency and drinking to cope amongst undergrads
• Burden of Excessive Alcohol Use in OC in 2017 (unfinished study)
o Cost analysis — used local-level data to put a price tag on excessive alcohol
consumption
o Data sources included healthcare facilities, crime, car crashes and deaths
o 38 deaths occurred in 2017 due to alcohol
0 3rd leading cause of death behind heart disease and cancers in OC
o Conservative dollar amount of$111.8 million in total costs of excessive drinking in 1
year with the government bearing the largest share of the costs
• 2020 Action Plan Strategy Implementation
o UNC Alcohol Policy Education — reached over 40K people and will be repeated
annually
o Responsible Server Trainer— paid persons (e.g. bartenders) to attend the training
where they learn best practices
o Business compliance checks to ensure they're not serving underage clientele
o Place of Last Drink —for those that are stopped for a DWI, they are asked where
they received their last drink. Police go back to that establishment and educates
them.
• Evaluation
o Evidence of success — CHCCS high school drinking rate is declining
o UNC binge drinking is down
o Fewer UNC students are experiencing fewer alcohol-related consequences/harm
reduction
• Color of Drinking Project
o Designed for predominately white institutions & how their use of alcohol affects
people of color and LGBTQ+ students
o Partnered with UNC Student Wellness & Gillings School of Health
The BOH had questions and comments that were addressed by Elinor Landess.
VI. Action Items (Non-Consent)
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ORANGE COUNTY BOARD OF HEALTH
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A. FY 2022-2023 Budget
Micah Guindon, Finance and Administrative Services Director, presented the Board with a
summary of the proposed FY 2022-2023 budget for the Health Department. The Health
Department will request a County General Fund budget in FY 22-23 of$7,641,686. This
represents an increase to the FY 22-23 base budget of$218,155. In a change from previous
years, the County is excluding time-limited staff from the base budget thus $117,236 of the
increase is due to this change. The major drivers of the remaining $100,919 is an increase in
temporary staff, client transportation, training, travel, medical and pharmacy supplies, and
nicotine replacement therapy (NRT) program costs.
The total increase in expenditures is $466,292 from the FY 22-23 Base Budget; the majority of
which is related to personnel requests including three staff for the Mobile Dental Clinic. Staff
project a $248,137 increase in revenues for FY 22-23, including an increase in Medicaid
Maximization funds of$53,900 and an increase in service revenues in Dental and
Environmental Health.
The proposed total expenditure budget is $11,394,210 and the proposed total revenue budget is
$3,752,524. The County General Fund request of$7,641,686 is a 3% change from FY 22-23
base.
New Staff Requests
The Health Department requests 5.9 FTEs in personnel. These positions are 100% covered by
reallocation of existing expenses or by new projected revenue.
The Dental Division requests staff to support the Mobile Dental Clinic (MDC): a 1.0 FTE Dentist,
1.0 FTE Dental Assistant, and 1.0 Mobile Dental Clinic Operator. The MDC Operator is
requested in collaboration with Orange County Public Transportation and cost shared at 50%
per department. The MDC Operator will drive the MDC vehicle throughout the County, removing
transportation as a barrier to care, as well as ensure it is properly maintained. These three
positions will increase service capacity of the MDC allowing expansion into the community and
schools.
Additionally, the Health Department requests 0.4 FTE making the Preparedness Coordinator
position full time. The position will liaise to State Preparedness ensuring staff are ready to
respond to the myriad of possible public health emergencies. The Health Department also
requests a 1.0 FTE IT Support Specialist as the Department's IT and informatics demands have
only continued to increase. The Department is in need of in-house technical support.
Finally, the Health Department requests conversion of two time-limited positions to permanent
status: 1.0 FTE Community Health Aide and 1.0 FTE Property Development Specialist. The
Community Health Aide position was originally grant funded in a partnership with UNC in the
Formerly Incarcerated Transitions (FIT) program, which ended in FY 20-21 fiscal year and has
been fully absorbed into the Health Department budget since then. We 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. The Property
Development Specialist has been crucial to ensuring timely and accurate data entry in the
Energov system so licensed Environmental Health staff are able to perform On Site Water
Protection (OSWP) inspections in a time sensitive way.
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ORANGE COUNTY BOARD OF HEALTH
February 23, 2022
State Funding
The NC Department of Health and Human Services (NCDHHS) has provided us with the FY 22-
23 Consolidated Agreement Addenda. We received an increase in the Refugee Health
Assessment program of$5,200 for a total allocation of$10,400 (related to an increase in
anticipated refugees resettled in Orange County) and an additional allocation of Advancing
Equity of$28,080 for a total allocation of$67,980 (to address COVI D-1 9-related health
disparities and advance health equity). Staff anticipate various COVID-19 allocations to be
awarded in the coming months.
Fee Changes
The FY 22-23 requested budget includes fee changes and additions for the Personal Health and
Environmental Health divisions. Staff recommends multiple fee changes for Personal Health,
reflecting adjustments from vendors, Medicaid, Medicare, and as well as new UNC Labs,
COVID-19 administration, and vaccine fees. Environmental Health fee changes include revision
of fee structure in OSWP and adjusting fees that have not been changed since 2016-2017. All
proposed fee increases are described in more detail in a separate Fee Change abstract.
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 fees in multiple programs including On-Site Well &
Septic and Food & Lodging. The division proposes to change the fee structure of residential
improvement and construction fees to be $1 per gallon per day rather than a flat rate for various
sized septic systems. This change will benefit residents with smaller homes making the fees
lower to the majority of residents. The workload required is directly proportional to the size of the
septic system, but the fees have not historically reflected that variance. Additionally, six
requested fee changes are to cover increased programmatic costs; these fees have not
changed since 2016-2017. There are three new fees requested per customer demand and to
cover additional staff time required for multiple site visits and permit revisions. Lastly, the Health
Department is requesting to waive two fees for solar system inspections to aid County
sustainability goals and reduce a mobile home space inspection fee to address health equity.
The total financial impact from Environmental Health fee changes is projected to be an increase
of$27,320.
Personal Health
Personal Health requests to add 55 new fees to the fee schedule. The majority of these are
UNC Labs fees that are needed infrequently by patients, but have not historically been on the
schedule. In addition, we would like to add administration fees for COVID-19 vaccines (to be
used when/if the distribution of COVID-19 vaccines begin in the clinics). Lastly, the Department
requests to continue scheduled adjustments to the fees for 340B drugs to equal the County's
cost to purchase them, as required by the state and federal government, and to reflect
Medicaid, vendor, and Medicare rate changes.
The total financial impact from Personal Health fee changes is projected to be a maximum
decrease of$792.
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ORANGE COUNTY BOARD OF HEALTH
February 23, 2022
Motion was made by Alison Stuebe to approve the total budget requested in the amount
of$7,641,686 for FY 2022-2023 and all fee changes for FY 2022-2023 as presented and
forward to the County Manager and Board of County Commissioners for action,
seconded by Sam Lasris and carried without dissent. Commissioner Hamilton
abstained.
The BOH had questions and comments that were addressed by Micah Guindon and
various OCHD Division Directors.
VII. Reports and Discussion with Possible Action
A. Health Director Report
Quintana Stewart, Health Director, began by thanking Micah Guindon and the rest of the
division directors for all of their work on the budget. Ms. Stewart chose to highlight the following
items from her report.
• The NCALHD created a work group that has been working to address the retention and
recruitment of nurses and to remove hiring barriers, as it is a problem amongst all health
departments.
o Public Health nursing experience has now been expanded to include, but not limited
to, faith-based, home health hospice, jail/prison, and refugee camp nurses.
o Proposed changes to the PHN I and PHN II minimum experience and educational
requirements include:
➢ PHN I - Graduation from an accredited school of nursing vs graduation from a 4-
year college/university with a BS in Nursing and 1 year of professional nursing
experience.
➢ PHN II - Graduation from an accredited school of nursing with 1 year of
professional nursing experience vs graduation from a 4-year college/university
with a BS in Nursing with 2 years of professional nursing experience
• Congratulations to Renee Kemske and the OCHD Nutrition Team for earning the CDC
Full Plus Recognition for the National Diabetes Prevention Program. This designation is
reserved for programs that have effectively delivered a quality, evidence-based program
that meets all of the standards for CDC recognition and additional retention thresholds.
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 of her presentation are below.
• As of today,
o In the last 7 days, there were 146 per 100K residents
o There were 110 COVID+ hospitalizations ending the week of February 51"
o The percent positivity is 7.3% in the last 14 days.
0 78% of residents are partially vaccinated.
0 76% of residents are fully vaccinated.
• The trends show that we're moving in the right direction, as there is now more access to
vaccines, treatment options, high-quality masks, and testing.
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• At-home test results are not being reported.
• Global recognition that COVID-19 will be endemic.
• COVID-19 Response 2.0
o Early indicators of COVID-19
➢ Wastewater surveillance
➢ Syndromic surveillance
➢ Genomic surveillance
o Community Resources
➢ Testing — more at home tests available; no-cost COVID-19 tests available
➢ Treatment— monoclonal antibodies and other therapeutics are available;
NCDHHS has removed the recommendation of use for high risk patients
➢ Masks —
■ Free masks are still available
■ 64,265 KN95/N95 masks were distributed; also gave masks to some of our
community partners; 1,340 At-home rapid antigen test distributed
o Universal case investigation and contact tracing are no longer optimal.
➢ NC DHHS advised LHDs to end it for the general public in January 2022
➢ NC DHHS advised K-12 schools and Childcare settings to end contact tracing
and quarantine of asymptomatic on February 21s'
➢ Public Health will continue to manage clusters and outbreaks in high-risk
settings.
o CDC recommends universal masking in areas with high or substantial community
transmission and the appropriate wearing of high-quality masks offers protection for
those at risk.
o The School Superintendents will prepare recommendations for their respective
Boards of Education regarding masking.
o We can continue to slow the spread if everyone follows guidance for isolation if they
test positive and/or have symptoms.
The BOH had questions and comments that were addressed by Ms. Stewart.
E. Media Items
Kristin Prelipp, Communications Manager, briefly mentioned that, in addition to an article stating
that Orange County leads the state with a 79% vaccination rate; most of the articles were
referencing mask distribution.
Media items were in the packet which focused on Orange County's events and our
involvement in various efforts.
VII. Board Comments
Tony Whitaker, Engineering Representative, gave a brief update on the Gaines Chapel
neighborhood sewer issues. He referenced the previous study that identified an "environmental
injustice", some having public sewer and some not; some of the more affluent areas have sewer
service and those not as affluent do not. Based on his reading of the report, he states that it's
incomplete and that there is a need to know more about the data. Mr. Whitaker stated that,
currently, he's in the data gathering mode. He will take this information to the Health Equity
subcommittee.
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February 23, 2022
Jessica Frega, At-large Representative, announced that she will withdraw from the Board.
She'll be on the committee to assist with finding her replacement. She reminded the Board of
their commitment to diversity and the value of her At-large seat. She asked the Board to
encourage people to complete an application. She was thanked for her 7 years of service with
the Board including her time serving as Chair. Well wishes were conveyed.
A temporary committee to deal with COVID mitigation issues, consisting of Board members,
Aparna Jonnal, Keith Bagby, Brian Crandell, Commissioner Jean Hamilton &Alison Stuebe, will
meet & review Quintana's COVID-19 presentation as well as seek other information sources.
The committee will draft a statement asserting their position on COVID mitigation strategies and
local COVID guidelines.
In regards to the BOH subcommittees, Keith Bagby proposed that each subcommittee have
goals so that there's direction. Ms. Stewart agreed stating that she will be re-engaging with the
subcommittees and assisting with the Strategic Plan, its progress and outcomes, which is also
an Accreditation requirement. Ms. Strange will be reaching out to the Board to ask preferences
in meeting time and frequency.
Vill. Adjournment
Shielda Rodgers moved to adjourn the meeting at 9:14pm and Alison Stuebe seconded.
The next Board of Health Meeting will be held March 23, 2022 at 7:00pm via Zoom.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
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