HomeMy WebLinkAboutFinal Minutes of November 16, 2022 MINUTES
ORANGE COUNTY BOARD OF HEALTH
November 16, 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 November 16, 2022, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, INC.
BOARD OF HEALTH MEMBERS PRESENT: Bruce Baldwin, Chair; Keith Bagby, Vice Chair;
Brian Crandell; Commissioner Jean Hamilton; Aparna Jonnal; Allessandra Lowery; Rachel
Royce, Alison Stuebe (via phone) and Tony Whitaker.
BOARD OF HEALTH MEMBERS ABSENT: Lee Pickett and Shielda Rodgers.
STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health
Services Director; Micah Guindon, Financial and Administrative Services Director; Victoria
Hudson, Environmental Health Director; Carla Julian, Compliance Manager; Rita Krosner,
Tobacco Prevention and Control Coordinator; La Toya Strange, Administrative Support I; and
Marcy Williams, Public Health Education Manager.
GUESTS/VISITORS PRESENT: None.
I. Welcome New Board Members/New Employees
Dr. Bruce Baldwin, Chair, introduced newly appointed BOH At-Large Representative, Dr. Rachel
Royce. The Board members welcomed Dr. Royce, introduced themselves and stated their seat
representations. Quintana Stewart, Health Director, introduced the new employee in
attendance, Roni Sturk.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the November 16, 2022 Agenda
Motion was made by Dr. Aparna Jonnal to approve the agenda, seconded by Keith Bagby
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of October 26, 2022
Motion to approve the minutes of the October 26, 2022 BOH meeting was made by Dr.
Bruce Baldwin, seconded by Tony Whitaker and carried without dissent.
B. 2023 BOH Meeting Schedule
Motion was made by Dr. Aparna Jonnal to approve the 2023 Board of Health schedule,
seconded by Commissioner Jean Hamilton and carried without dissent.
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V. Action Items (Non Consent)
A. Elections (Chair& Vice-Chair)
The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last
meeting of the calendar year.
Motion to elect Keith Bagby to Chair and Dr. Aparna Jonnal to Vice-Chair for the 2023
calendar year was made by Dr. Bruce Baldwin, seconded by Dr. Rachel Royce and
carried without dissent.
VI. Educational Sessions
A. T21 Resolution
Dr. Bruce Baldwin, Chair, introduced Sally Herndon. Ms. Herndon is the head of the Tobacco
Prevention and Control Branch in the Department of Public Health (DPH) within the NC
Department of Health and Human Services (DHHS). She discussed the Tobacco 21 (T21)
Resolution, the need to establish a retailer permitting system, and raising the minimum age to
purchase tobacco from 18 to 21 in the state of North Carolina. Below are highlights.
• Tobacco usage facts
➢ E-cigarette usage has increased and is the number one tobacco product used by
youth. Ninety-five percent of tobacco users start before the age of 21.
➢ The most common social source of e-cigarettes among youth ages 13-17 is from
a friend who is under the age of 21.
• Tobacco 21 (T21) Resolution
➢ T21 suggests that NC raise its minimum age to purchase all tobacco products to
21 to match the new federal age requirement passed by Congress in 2019. NC's
minimum sales age remains at 18. It is confusing to retailers and consumers to
have separate ages for state and federal law. Many youth transition from
experimental use to daily use between the ages of 18 to 21.
➢ The Synar Amendment is a federal law that requires states to annually inspect a
random sample of tobacco retailers to determine what percentage are selling to
youth under age 21.
o If the percentage of underage sales goes above 20%, the state may be
forced to forfeit millions of federal substance abuse prevention and
treatment block grant monies that fund prevention, treatment, and
recovery initiatives.
• Licensing/Retailer Permitting System (LRPS)
➢ There are 40 states that require licensing/permitting of tobacco retailers as a tool
to enforce their tobacco laws and as an effective means to reduce sales to youth.
Ms. Herndon suggested that NC adopt this requirement as well as it is a proven
evidence-based measure to reduce tobacco sales to youth.
➢ T21 Interagency Workgroup, consisting of various state agencies including
DHHS, Department of Public Safety, Department of Revenue and the Alcohol
Beverage Control Commission, is a legislatively appointed task force formed to
provide input on this issue.
➢ LRPS is beneficial because:
o Allows the state to know where tobacco products are being sold;
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o Allows the state to inspect for responsible retail practices;
o Provides a more effective mechanism for enforcing the law when
violations are detected; and
o Provides a funding mechanism for inspections, retailer education and
enforcement.
The BOH members had questions and comments that were addressed by Ms. Herndon.
The Board opted not to make a decision on adopting the T21 Resolution at this time and
to have further discussion on its contents later.
B. Opioid Advisory Committee Update
Health Director, Quintana Stewart, provided an update on the BOCC's final decision on which
opioid remediation activities Orange County (OC) will address. She also shared the BOCC's
membership composition for the Opioid Advisory Committee. Below are highlights.
• Of the $26 billion National Opioid Settlement, OC is expected to receive $6,799,780 over
an 18-year period with the payments declining after the first year. OC has received the
initial payment.
• Local governments must comply with the NC Memorandum of Agreement (MOA)which
entails:
➢ Establishing a fund —
o Chief Financial Officer, Gary Donaldson has been tasked with ensuring that a
separate and secure account has been set up for the purpose of these funds
not combining with other funds.
➢ Authorizing spending
o Before the spending of opioid settlement funds can commence, authorization
of the expenditure of such funds must be obtained.
➢ Understanding and following the options
o Opioid settlement funds must be spent on the opioid remediation activities
authorized under Option A or B as stated in the MOA.
➢ Report spending and impact
o An annual financial report must be filed within 90 days of the end of the fiscal.
➢ Hold an annual meeting
o At least one annual meeting open to the public, with the purpose of receiving
feedback, must be held.
• Prior to the national opioid settlement, OCHD and UNC Health started an Opioid Task
Force. Three priorities were identified: 1) education, 2) reduce oversupply of
prescription opioids, and 3) expand treatment and recovery oriented systems of care.
These priorities were in alignment with the State Opioid Action Plan. Due to the arrival
of COVID in March 2020, the Task Force did not meet again until January 2022.
• An OC Opioid Advisory Committee (OAC) has been established by the BOCC. Ms.
Stewart thanked Commissioner Hamilton for her assistance in fine-tuning the charge for
the OAC. The charge adopted during the BOCC September 6, 2022 was:
➢ Discuss opioid-related health concerns and issues impacting the residents of OC;
➢ Advise the BOCC on options to expend funds to prevent opioid and remedy
opioid impacts;
➢ Plan and host an annual meeting open to the public to receive input on proposed
uses of the settlement funds and to encourage collaboration between local
governments.
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• Of the two options, Option A, High-Impact Opioid Abatement Strategies, was chosen by
the BOCC for the use of the settlement funds as the BOCC wanted to get the resources
out to the community sooner rather than later. They also wanted to compliment and
expand some of the existing work already taking place in the community.
• The BOCC appointed members to the OAC during its November 1, 2022 meeting.
There is representation from many of the stakeholders listed in the MOA, a
representative from the Aging Department and "flex" positions for two OC residents with
lived experiences.
The BOH members had questions and comments that were addressed by Ms. Stewart.
C. Strategic Planning Update
Health Director, Quintana Stewart, provided the Board with an update on the Strategic Planning
and its progress. Below are highlights.
• Background
➢ In December 2019, the OCHD Leadership Team met to begin the Strategic
Planning process. The following were completed.
o Developed a draft mission statement;
o Reviewed and updated departmental values; and
o Performed a SWOT (Strengths, Weaknesses, Opportunities, Threats)
Analysis
➢ COVID-19 interrupted the next steps, which were to obtain feedback from staff.
The Strategic Planning process restarted in August 2022. Division staff
meetings, multiple surveys and focus groups were conducted to gain additional
information from staff.
• Ms. Stewart reviewed the proposed changes to the OCHD Mission Statement and
Values.
• The Leadership SWOT 2019 and Department SWOT 2022 analyses were discussed.
• Strategic Plan
➢ In order to be in alignment with the Community Health Assessment (CHA), the
Strategic Plan timeframe will be 2020-2024.
➢ Results Based Accountability (RBA) framework is being used in the Strategic
Planning process. Three questions will be asked to measure performance.
o How much did we do?
o How well did we do?
o Is anyone better off?
➢ BOH Strategic Plan Priorities 2020-2022
o After discussing the 2019 CHA results at the May 27, 2020 BOH meeting,
the Board voted on the following priority areas: 1) Access to Healthcare,
2) Social Justice/Health Equity, and 3) Substance Abuse.
o Subcommittees were created to support the new priorities; however,
increased COVID response activities and staff turnover limited the
meeting frequency.
o Accomplishments of the BOH Strategic Plan Priorities 2020-2022 were
reviewed and included:
o In 2021, the Family Success Alliance (FSA) officially opened up
program participation to the entire county, increasing the program
reach from the original two zones.
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o The BOH and Environmental Health reviewed the Gaines Chapel
Study to assess the need/desire for connections to public sewer.
o "Preventing Underage & High-Risk Drinking", a community
conversation, was hosted in December 2021.
• Next Steps include working with:
➢ Staff to finalize performance measures for each division;
➢ BOH during 2023 retreat to finalize goals/strategies and desired outcomes for
identified priority areas; and
➢ Healthy Carolinians Coordinator on 2023 CHA and Community Health
Improvement Plans.
There were no questions or comments asked by the BOH members.
D. Accreditation
Health Director, Quintana Stewart, provided an overview of the NC Local Health Department
(LHD)Accreditation. Handouts of the presentation were given to Board members. In the
interest of time, Ms. Stewart briefly presented on the Accreditation process. Below are some
highlights.
• OCHD received initial Accreditation in 2008.
• Due to COVID-19, the Accreditation cycle will cover six, not four, years.
• Re-Accreditation Timeline
➢ Official notification (90-day notice) occurred August 1, 2022.
➢ HDSAI (self-assessment) and other materials were due November 1, 2022.
➢ OCHD Re-Accreditation Site Visit will occur on January 12, 2023.
o Options of a fully in-person or partially remote Site Visit were offered. OCHD
chose the partially remote option, which will include a Site Visit Coordinator and
Lead Site Visitor onsite with the remaining Site Visitors, participating via Zoom.
• Ms. Stewart briefly covered what occurs at the entrance conference and during the
facility tours.
• Ms. Stewart also reminded the Board that two of them would be interviewed. Current
Chair and Vice-Chair, Dr. Bruce Baldwin and Keith Bagby, respectively, will be
participating.
• Lastly, Ms. Stewart discussed the activity that occurs at the exit conference. She also
explained that an independent board makes the final decision.
Ms. Stewart and Ms. Hudson answered the questions and comments asked by the BOH
members.
E. 1st Quarter Financial Reports & Billing Dashboard
Micah Guindon, Finance and Administrative Services Director, gave a report on the 1 st quarter
revenue and billing accuracy. Her report is as follows:
• Total Health Department Budget vs. Actuals:
Average YTD monthly revenue in FY22-23 after the first quarter is $251 k/month or
$752,435 YTD, representing 17% of our overall budgeted revenue for the year.
Revenues are lower than this point last fiscal year (FY 21-22 1st Quarter YTD: $765k)
due to the medical and dental clinics seeing fewer patients than this time last year as
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well as a general slowdown of construction compared to last year. Nonetheless,
Expenses are in line with revenues at 18% of the overall budget.
• Dental Earned Revenue by Source:
The FY 22-23 average monthly revenue ($31 k/month) for the first quarter is below our
budget projection ($49k/month) and our FY 21-22 average of$43k/month. This decrease
in revenue is primarily related to staff vacancies. We currently have three dental
hygienist positions that have been vacant for almost a year. Additionally, there is one
less dentist this year compared to last year. The MDC is still operating two days each
week and is hoping to add a third day when a third dentist is hired. FY 22-23 dental
earned revenue totaled $93k at the end of the first quarter compared $148k at the end of
the FY 21-22 first quarter.
• Medical Earned Revenue by Source:
Medical earned revenue is currently below the budgeted projection for FY 22-23
($41 k/month) at $33k/month due to a reduced clinic schedule. During Q1, the clinic team
had several new staff onboarding and changing duties due to various vacancies. Medical
clinic revenue totals $98k for first quarter FY 22-23 compared to $119k in first quarter FY
21-22.
• Environmental Health Earned Revenue by Source:
Environmental Health earned revenue is below the budgeted projection for FY 22-23
($60k/month) at $48k/month. Notably, construction has slowed down in the building
world and some builders are seeking private options for inspections due to
Environmental Health staffing shortages across the Triangle. The fee schedule changes
made this fiscal year (which reduced the prices of permits for all new wells and smaller
homes) has not had a negative impact on revenue; in fact, the changes created a 4%
increase while engaging actively in equity. Lastly, Environmental Health Environmental
Health revenue totals $143k for first quarter FY 22-23 compared to $171 k in first quarter
FY 21-22.
• Multi-Year Grants Fund Revenue:
NC Integrated Care for Kids (NCInCK) is currently Health's only multi-year grant. We
have been awarded approximately $55k for NCInCK. The grant funds will be used
towards staff personnel costs to implement the InCK model in Orange County. Quarter 1
expenditures total $10k and, as of reporting time, no revenue has been reimbursed.
There were no questions or comments asked by the BOH members.
VII. Reports and Discussion with Possible Action
A. Media Items
Marcy Williams, Public Health Education Manager, briefly mentioned two articles. There was an
article regarding lead in UNC's facilities. The other article mentioned the Town of Chapel Hill's
safety measures in preparation for Halloween.
Media items were in the packet, which focused on Orange County's events and our
involvement in various efforts.
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A. Health Directors Report
In the interest of time, Ms. Stewart asked the Board if there were any questions regarding her
report that was included with the agenda packet. There was none. Ms. Stewart told the Board
to look out for emails from La Toya Strange, as she will be sending the updated policies for the
BOH manual and a Doodle Poll regarding dates for the Board retreat.
Vill. Board Comments
Dr. Baldwin, Chair, reiterated Ms. Stewart's comment regarding looking out for the email
regarding Board retreat dates. Commissioner Jean Hamilton thanked the Board for her two
years as the BOCC representative. She stated that she would be present at the January BOH
meeting. BOCC will appoint a new Commissioner in February and make committee/board
assignments at that time. Commissioner Hamilton also mentioned that Renee Price would
serve as BOCC Chair until December 31, 2022.
The Board continued their discussion on the T21 Resolution. It was determined that the
Substance Use Disorder Subcommittee will work on the draft and bring it to the Board at the
January meeting.
XI. Adjournment
A motion was made by Dr. Bruce Baldwin to adjourn the meeting at 9:01 p.m. was
seconded by Commissioner Jean Hamilton and carried without dissent*.
The next Board of Health Meeting will be held January 25, 2023 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
*Keith Bagby left at 8:39pm;therefore,he did not participate in the adjournment motion.
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