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HomeMy WebLinkAboutApproved Minutes of June 28, 2023 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON June 28, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Keith Bagby— Chair, Aparna Jonnal —Vice- Chair, Bruce Baldwin, Commissioner Jamezetta Bedford, Brian Crandell, Lee Pickett, Shielda Rodgers, Rachel Royce, Alison Stuebe, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Dr. Stephanie George, Dental Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Thomas Privott, Environmental Health Supervisor; Angela Sowers, Environmental Health Program Specialist; La Toya Strange, Administrative Support I; and Lena Wegner, Communications Manager. GUESTSIVISITORS PRESENT: None. I. Welcome New Employees Prior to the introduction of new employees, the BOH members introduced themselves and their seat positions. Quintana Stewart, Health Director, introduced the new employees in attendance: Amanda Griffin - Public Health Nurse I, Alexus McPherson — Family Navigator, Kanjana Pankhum — Environmental Health Specialist, Dominic Smolic— Dental Hygienist, and April Thompson —Office Assistant II- Nutrition. Christlan Crisp — Certified Medical Assistant, arrived later. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Dr. Bruce Baldwin Dr. Baldwin apologized for his abrupt early departure at the last meeting. His newborn granddaughter had a health scare. Rachel Royce Dr. Royce referenced an article from Your Local Epidemiologist's violence epidemiologist, Dr. Katelyn Jetelina. Amongst other air pollutants, the article discussed how air quality is affected by smoking. The statistical information is provided in an easily digestible form. Dr. Royce stated that she'd share a link to the article with the Board. In response to Dr. Royce's comments, Dr. Alison Stuebe asked if the OCHD has been inundated with questions about air quality due to the wildfires and our decreased air quality. Adding to Health Director, Quintana Stewart's reply of no, Environmental Health (EH) Director, S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ June Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 Victoria Hudson, responded by mentioning that EH has been proactively sending out information regarding modifying outside activities of children based on the Air Quality Index. Dr. Aparna Jonnal Dr. Jonnal mentioned that her place of employment has 14 beds in the emergency room with 1/3 of them being occupied with 5 people being treated for angioedema as a result of the air quality. Commissioner Jamezetta Bedford Commissioner Bedford revealed that the BOCC approved the county's budget with no changes to the OCHD's requests. Keith Bagby Mr. Bagby revealed that the BOCC will hear the Board's recommended Dental Seat Representative appointment at their work session in September. He also provided an update on the topic of illegal farm parties, which was originally mentioned during the April Board meeting. Mr. Bagby stated that there was a collaborative meeting including OCEMS, the Department of Aging, and law enforcement to discuss these parties occurring in OC. Some of these parties are starting to move to neighboring counties. The landowners are paid, sometimes erroneously told that the parties are for charity and that their ending time is much earlier than they are. There have been cases of aiding and abetting underage drinking. Education of property owners is key. Mr. Bagby also attended a meeting at Whitted regarding the county's Strategic Planning. Public feedback is being requested. Commissioner Bedford also added that the County is undergoing its Strategic Planning process and that there's a link on the website designed to get input and ideas that will assist in creating the OC Strategic Plan. IV. Approval of the June 28, 2023 Agenda Motion to approve the agenda of the June 28, 2023 BOH meeting was made by Dr. Lee Pickett, seconded by Dr. Bruce Baldwin and carried without dissent. V. Action Items (Consent) A. Minutes of May 24, 2023 Motion to approve the minutes of the May 24, 2023 BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Alison Stuebe and carried without dissent. VI. Action Items (Non-Consent) A. Fee & Eligibility Policy The OCHD successfully completed a NCDHHS Administrative and Clinical Monitoring visit on S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ June Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 May 24, 2023. The department also completed the Women, Infant, and Wellness Section (WICWS) policy and clinical record review for June 13 through June 15, 2023. Administrative and Nursing Consultants from both visits recommended changes to the Board of Health Fee and Eligibility Policy. Carla Julian, Public Health Nursing Director, presented the following recommended changes: • III.A.4.b. Add description of Family Planning Income Verification process including required statement that verbal report of income is acceptable for Family Planning patients. • III.B.2.a. Add statement that Family Planning patients can make verbal declaration of income without any supporting documentation. • III.B.3.a. Add statement that Family Planning patients cannot be charged at 100% of sliding fee scale for not providing proof or verification of income. • W.C. Add statement that all Maternal Health, Child Health, and Family Planning residents must be placed on a sliding fee scale. • V.E. Add sex characteristics, marital status, familial status, gender identity, and number of pregnancies to conditions for which OCHD will not deny services. • VI.O. Add statement that OCHD bills Medicaid acquisition cost of 340B drugs and devices and include summary of process for doing so. • VII.H. Add statement of how fee waivers are documented and where these records are maintained in the agency. Ms. Stewart followed up by stating that most of these changes are because of the state's guidance which assists in removing barriers to care. In response to Dr. Royce's question asking if the OCHD has enough funds to provide care, Ms. Stewart replied yes. In response to Dr. Royce's question regarding whether the clinic sees out-of-county patients, Ms. Julian replied yes. She added that, although the clinic provides services to some out of county residents, many of the patients start out as county residents and then move out of the county. Dr. Rodgers added that it may be other reasons that out-of-county residents come to the OCHD such as convenience and proximity. In response to Dr. Stuebe's question regarding whether out-of-county residents are tracked, Ms. Julian replied yes and that they're able to run reports based on zip codes. In response to Dr. Baldwin's question regarding receiving verbal reporting of income, Ms. Julian stated that verbal reporting of income is acceptable for family planning due to Title X to prevent any barriers. Motion to approve the suggested changes to the Fee & Eligibility Policy was made by Dr. Alison Stuebe, seconded by Dr. Lee Pickett, and carried without dissent. VII. Educational Sessions A. Annual Communicable Disease Report Michael DeFranco, Public Health Nurse III, gave an overview of the communicable disease (CD) data for the year 2022, which began with the purpose of the CD program within the health S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ June Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 department. Reportable diseases are flagged by the state and sent to local health departments where they are investigated. While the individual's care is the primary concern, there are also follow-ups with the individual, medical facilities, etc. He also noted that the presentation of this report meets Accreditation Benchmark 2.5. Below are some brief highlights. Vaccine Preventable Diseases — • Pertussis— o This number declined due to mask wearing. Vectorborne Illnesses— • June is prime time tick season, which is a prevalent time for tick-borne illnesses, Rocky Mountain spotted fever (RMSF) and Lyme disease, in OC. Mr. DeFranco spoke about the distinctions between probable and confirmed cases and that they're based on the level of diagnosis (culture, PCR assays, serological assays). There were more probable cases vs confirmed. Dr. Jonnal added that, most of the time, her facility doesn't draw a serology, they just treat the patient as if they were infected as the sensitivity level is so low. Waterborne Illnesses— • Cryptosporidium o These cases involved people that travelled internationally, came back and tested positive. Sexually Transmitted Illnesses (STI) — • Chlamydia and gonorrhea continue to be the highest cases of STIs in OC. Mr. DeFranco added that the chart only showed cases that were flagged by the state's system and sent to OCHD. In response to being asked if PrEP is offered, Mr. DeFranco stated yes. COVID-19— • In NC, there were over 3 million lab-reported cases with over 29,000 deaths. At-home tests are not included in those numbers. • In OC, there were almost 40,000 lab-reported cases with 159 deaths. • At-home tests were not included in the NC and the OC numbers. Demographics of confirmed cases, broken down by race, age, gender, etc., can be found on the NCDHHS Covid-19 Dashboard. • Mr. DeFranco revisited the COVID-19 vaccination response providing a summary of the activities. Currently, the OCHD offers the Moderna vaccine. • NC DPH recommends the following definition for reporting outbreaks of COVID in congregate living settings. o Criteria to report an outbreak in a congregate living facility. • Two or more laboratory-confirmed cases of COVID-19 in residents or staff within 14 days in the same facility. o Criteria to declare an outbreak over • 14 days since the date of specimen collection of the most recent outbreak- associated case in the facility • As of May 11, 2023, COVID-19 is no longer a reportable infection to the State or Local Health Departments (LHD) S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ June Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 o LHDs should continue to report outbreaks in congregate living settings, which include: • Long-term care facilities • Correctional facilities • Housing facilities for migrant workers • Shelters o Currently, OCHD Communicable Disease continues to investigate and report clusters in schools. ■ Clusters are defined as 5+ confirmed cases epidemiologically linked or 15+ confirmed cases affiliated with an institution. Monkeypox (mpox)— • As of May 2023, there were 3 cases that the OCHD CD Team investigated and worked up. • In NC, there have been 26,173 vaccines administered. OCHD has administered 751 mpox vaccines as June 2023. • Jynneos is the vaccine, administered both subcutaneously (SC) as well as Intradermally (ID). It is now being offered at the OCHD Medical Clinic if the NCDHHS vaccine eligibility criteria are met, which can be found at the link below. https://www.ncdhhs.gov/mpox • Testing has become more widely available and continues to require the presentation of a rash as a symptom of MPDX for testing to occur. • The antiviral drug tecovirimat (TPDXX) has been approved by the FDA to treat smallpox in adults and children. Drugs developed to treat smallpox may be used to treat mpox. VII. Reports and Discussion with Possible Action A. Media Items Lena Wegner, Communications Manager, briefly summarized the articles. Some of the articles' topics included Governor Cooper launching a safe gun storage campaign; a legislative bill approved by the state House, and headed to Governor Cooper's desk, that would prohibit anyone entering a state government workplace, such as a private contractor or a diversity trainer, from compelling employees to believe they should feel guilty or responsible for past actions committed by people of the same race or sex; the approval of a bill that allows Blue Cross and Blue Shield of NC and a dental insurance provider to transfer assets into a parent holding company with little oversight; and a federal lawsuit filed by abortion providers challenging several provisions of the state's law banning most abortions after 12 weeks of pregnancy. - In response to Dr. Stuebe, Ms. Stewart stated that the OCHD is awaiting final guidance from DHHS on this subject, our providers are aware, and that the OCHD provides optimal care in optimal timespan. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ June Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH June 28, 2023 • Governor Cooper has proclaimed the first week of June as NC SAFE (Secure All Firearms Effectively) Week of Action to raise awareness about the importance of safe gun storage. The OCHD will also be promoting this as well. • The OCHD's vacancy rate is at 8.7%, which is a record low. • The SHSC Medical Clinic will be reopening July loth as the HVAC phase of renovation has been completed. Both medical clinics haven't been operational in about 2 years. If additional staff are needed, we have the capability to ask. • Former Secretary of NC DHHS, Dr. Mandy Cohen, has been chosen as the new Director of the US Centers for Disease Control. • NC Medicaid is changing the timely filing for Standard and Tailored plans with timely filing deadline moving to 365 days effective July 1, 2023. Medical claims with a date of service prior to July 1, 2023, will maintain the filing requirement of 180 days. Vill. Adjournment A motion was made by Dr. Shielda Rodgers to adjourn the meeting at 8:06 p.m. was seconded by Dr. Aparna Jonnal and carried without dissent. The next Board of Health Meeting will be held August 23, 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 S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ June Page 6