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HomeMy WebLinkAboutApproved Minutes of October 25, 2023 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 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 October 25, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Keith Bagby— Chair, Brian Crandell, Lee Pickett, Rachel Royce, Alison Stuebe, and Tony Whitaker. Davia Nickelson, the new dental representative, was introduced at this meeting. Aparna Jonnal —Vice Chair arrived later. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin, Commissioner Jamezetta Bedford, and Shielda Rodgers. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Dr. Stephanie George, Dental Director; Victoria Hudson, Environmental Health Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Finance and Administrative Services Director; Thomas Privott, Environmental Health Supervisor; Marcy Williams, Health Promotion and Education Services Manager; Lauren Spey, Public Health Nurse Supervisor; Christina Allen, Billing Technician; Nikki Thorpe, Certified Medical Assistant; Paola Sanchez-Ortiz, Dental Office Assistant I; Kesia Johnson, Dental Assistant; Bronson Brim, Public Health Nurse I; Hannah Baldwin, Dental Hygienist; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: None. I. Welcome New Board Member— Dr. Davia Nickelson Mr. Bagby introduced Dr. Davia Nickelson, the new dentist representative. Dr. Nickelson remarked briefly on her professional background and shared that she was excited to join the board. Welcome New Employees Quintana Stewart, Health Director, introduced the new employees in attendance: Christina Allen — Billing Technician; Paola Sanchez-Ortiz— Dental Office Assistant I; Kesia Johnson — Dental Assistant; and Bronson Brim — Public Health Nurse I. She also reintroduced returning employees Nikki Thorpe— Certified Medical Assistant and Hannah Baldwin — Dental Hygienist. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Keith Bagby Mr. Bagby reminded the board that Quintana's evaluation would take place at the upcoming November meeting. He explained that a representative from Orange County Human Resources would be present at the meeting to help guide the evaluation and asked that the board members come to the next meeting prepared to provide feedback. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 Mr. Bagby also shared that he recently attended the October 13th All Staff meeting and cookout for the health department. He said that he got to meet a lot of staff members, had the opportunity to witness team building and staff actively engaged at the event, and enjoyed himself greatly. Ms. Stewart added that after Mr. Bagby left, there was a trivia competition that included a question to which he had been the answer. Dr. Pickett then asked about the upcoming evaluation. She chairs the Animal Services Board and their November meeting conflicts with the BOH meeting in November. As a result, Dr. Pickett will not be able to attend the November meeting. She wanted to know if there was anything she needed to do to contribute to the health director's annual evaluation. Ms. Stewart explained that there would be a survey sent out in advance for all Board members to complete, which will guide the discussion held in closed session. Tony Whitaker Mr. Whitaker shared that there is an upcoming mobile medical drop for unwanted or expired medications this weekend on October 28th. Dr. Pickett added that if someone was unable to make it to the event, there are additional bins at local law enforcement offices year- round. Mr. Bagby confirmed this and listed several other locations in Hillsborough with medication drop boxes, while Dr. Stuebe mentioned one in Chapel Hill. A complete list of the locations of medication drop boxes in Orange County can be found at https://www.orangecountVnc.gov/361/Prescription-Drug-Drop-Boxes. Dr. Jonnal arrived during this conversation. IV. Approval of the October 25, 2023 Agenda Motion to approve the agenda of the October 25, 2023 BOH meeting was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. V. Approval of September 20, 2023 Minutes Dr. Royce asked if there would be copies of the minutes provided for review at meetings, as she felt in the past this had been inconsistent, with some meetings having them and some not. Ms. Stewart said that material from the meeting packet could be provided to board members upon request. Motion to approve the minutes of the September 20, 2023 BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Alison Stuebe, and carried without dissent. VI. Educational Sessions A. Customer Satisfaction Surveys — Dental, Environmental Health, and Personal Health Services Dr. Stephanie George, Victoria Hudson, and Lauren Spey presented the outcomes of the 2023 customer satisfaction surveys for Dental Health Services, Environmental Health Services, and Personal Health Services respectively. Some highlights of each presentation are below: S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 Dental Health Services Dr. George, Dental Director, reviewed the results of the 70 surveys received by Dental Health Services. Overall, 98% of English-speaking patients expressed satisfaction with the department and 100% of Spanish-speaking patients expressed satisfaction with the department. • In response to Dr. Jonnal's question clarifying the survey sample size, Dr. George affirmed that they received responses from a total of 70 patients, which is about how many patients they see in a week. She mentioned that the admin department had been short-staffed, which likely contributed to a decrease in responses compared to the previous year (-130 for 2022). • Dr. George attributed the highly positive responses from Spanish-speaking patients to the interpreter working with the department, Victoria Alonso. • Dr. George mentioned that the results indicated that the ease to schedule an urgent appointment had improved, rising from 50% agree in 2022 to 70% agree in 2023. In response to Dr. Jonnal's question about the wait time for urgent appointments, Dr. George explained that the department has enacted a new policy that if an appointment hasn't been confirmed within 24 hours, it will be removed, so on most days they now have at least one open appointment. She further explained that in general the wait is 5-6 weeks for a filling or extraction and 2-3 months for a cleaning. • Regarding negative comments, Dr. George said most were about the lack of hygienists and long wait times, both of which the department has been actively working to improve. • Mr. Bagby asked if the survey was available electronically, to which Dr. George replied yes, surveys are sent by text and email after the appointment and there is also a month of collecting paper surveys. Environmental Health Services Ms. Hudson, Environmental Health Director, reviewed the results of the 161 surveys received by Environmental Health Services. Approximately 90% of respondents were overall satisfied with the services they received. • Ms. Hudson explained that anyone who received an email from EHS during the fiscal year was eligible to fill out the survey, and that they also collected an anonymous convenience sample from individuals whom they regulate (e.g., restaurants, private pools, private well and septic systems). • This was the first `post-COVID' customer satisfaction survey and covered a period when EHS was facing significant staffing shortages. While new employees have since been hired, Ms. Hudson explained that onboarding can be a long process, as it involves both on-the-job training and professional credentialling. • In response to Dr. Royce's question about the total number of clients served by EHS in the 2022-2023 fiscal year, Ms. Hudson said that it was impossible to estimate with certainty but there were at least 2,100 inspections, 1,200 individual permits, and 600 water samples. • Ms. Hudson said that 1:1 education is a top priority within the department, and that staff treat every encounter as an opportunity for education. This was reflected in the survey results- nearly 90% of respondents agreed or strongly agreed that the staff was knowledgeable, and 90% agreed or strongly agreed that they were kept informed and had a chance to ask questions during the inspection. • Ms. Hudson speculated that some of the more negative responses received may have been from people who were upset that their permits were denied, as Environmental S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 Health is in the unique position of both regulating and serving their client base. Ms. Hudson also said that Environmental Health is inherently based on laws and regulations, which means some amount of delays are inherent to the process and can sometimes lead to frustration among the people they serve. • To provide a `sneak peek' at next fiscal year's survey results, Ms. Hudson randomly sampled clients served over the past year. Preliminary results suggest that respondents like the new online pay portal, appreciate the changes to the email system to improve email accessibility, and feel the department is more responsive, as having a full staff makes a difference. • In response to Dr. Crandell's question about the two-week turnaround for applications, Ms. Hudson explained that once the department receives an application, staff has 14 days to make it to the property and perform an inspection. If any deficiencies are found, staff notifies the applicant, and the applicant then has 60 days to correct the deficiencies and reapply. Dr. Crandell then asked if the 14-day window presents difficulties to staff or if they can meet this consistently, and Ms. Hudson said that the staff make it work. • Mr. Whitaker had several questions about the drone photos included in the presentation, particularly regarding who was taking the photos and with what drone. Ms. Hudson explained that a staff member, Mel Caesar, has been taking the photos using his personal drone, but that the department is planning to purchase their own as the photos provide valuable documentation. Dr. Royce asked for an explanation of the drone photo of a septic system installation, which Ms. Hudson then provided. Personal Health Services Ms. Spey, Public Health Nurse Supervisor, explained that Personal Health Surveys consisted of three different surveys based around services provided — Maternal Health, Family Planning, and Child Health. She reviewed the results of the 80 responses received across all three surveys. Overall, 100% of respondents felt good or great about the level of courtesy and respect from clinic staff and that staff listened and explained care clearly. However, there were concerns about wait times, particularly time between scheduling an appointment and being seen and length of time spent in the waiting room. • Ms. Spey said that more providers have been hired to reduce wait times and increase access. As some respondents expressed concerns about clinic cleanliness, Ms. Spey also shared that there is a plan to audit this, as they are unsure if it is an issue with the custodial staff or the clinicians. • In response to Dr. Pickett's question about the Likert scale values, Ms. Spey explained that the ranking was Great->Good->Fair->Ok based on the default values that came with SurveyMonkey, and that on past paper surveys they used stars. Dr. Stuebe suggested using different values in the future, as 'Ok' and `Fair' seem very similar. Ms. Stewart shared that the health department will be moving to a new survey platform through Microsoft Teams soon so it will look different next year. • Mr. Bagby asked whether the surveys distinguished between and compared the Chapel Hill and Hillsborough clinic locations, to which Ms. Spey replied generally yes, but the Chapel Hill clinic had been closed for the 2022-2023 fiscal year, so this survey did not. • In response to Mr. Bagby's question about whether there is any kind of standard benchmark or peer counties to which we compare our customer satisfaction survey results, Ms. Spey responded that these surveys are based on a standard survey model, but she is not sure if there is a comparison and she could find out. Ms. Stewart added that the health department generally does not compare itself too closely to other counties to better focus on the needs of its own community. Mr. Whitaker asked if these S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 surveys are an accreditation benchmark, to which Ms. Stewart replied yes. Currently, there is not a specific standard to meet with regard to customer satisfaction, simply a requirement that we get customer feedback and have a process to follow up on any complaints. VII. Actions Items A. Chair/Vice Chair Slate Mr. Bagby explained the process of setting the chair and vice chair slate and clarified that generally the people nominated and voted in are members who have been on the board for a little while, as they need the knowledge to do the job well and an awareness of the work and time commitment required. Dr. Jonnal added that on the Orange County Board of Health, traditionally the vice chair becomes the chair after one year and a new vice chair is nominated based on their tenure on the board, and that this is a very equitable process that ensures everyone will eventually get a turn. Mr. Bagby also shared that there is an executive committee responsible for agenda planning, which consists of the previous chair, the current chair, and the vice chair, allowing the prior chair to share knowledge and support with the newly selected chair and vice chair. Dr. Royce asked about the practice of replacing the chair each year and whether this was something the board wished to continue. Mr. Bagby explained that this has historically been the case but that the board could reevaluate the practice if desired. Mr. Whitaker added that in his previous tenure on the board this was also how things were done, although the step from vice chair to chair was less automatic. Ms. Stewart shared that there are boards of health in other counties where the chair will sit for multiple years, but that Orange County has generally favored the practice of rotating annually. Ms. Stewart stated that Dr. Jonnal, as the 2023 vice chair, has been put forward for the 2024 chair and that Dr. Stuebe, as the second most senior member of the board, had been put forward for the 2024 vice chair, but that other nominations were welcome. Dr. Jonnal added that nominations can be put forth now or over email, and that the vote will take place at the November meeting. In response to Dr. Crandell's question of how much extra time is required per month to complete chair/vice chair duties, Mr. Bagby noted that one thing he has experienced as chair is that he is typically contacted at least once per month with questions related to the health department or health in Orange County, and that these questions are often outside the scope of his role and he must spend extra time addressing or finding the correct person to address these questions. Dr. Jonnal added that the monthly meeting to set the board's agenda typically lasts around 40 minutes and is conducted virtually (though it used to be in person prior to the pandemic). Dr. Pickett stated that she believes this is a strong slate. Dr. Jonnal expressed that her only concern is that she and Dr. Stuebe are both physicians, which could potentially lead to bias or present a conflict with board responsibilities, i.e., if both were called in to work at the same time as a meeting. However, Dr. Jonnal said that this is unlikely, as she mostly performs shiftwork these days. Dr. Stuebe added that she is only on-call for five weeks out of the year and would likely be able to ensure that those weeks did not overlap with any board of health meetings. Mr. Bagby mentioned that, as the prior chair, he could step in to preside over a meeting should something happen that precluded both Dr. Jonnal and Dr. Stuebe from attending. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 Dr. Royce asked if there are specific guidelines for attendance for the chair and vice chair, to which Dr. Jonnal responded no. Mr. Bagby added that sometimes one may run late, citing last month's meeting when Dr. Jonnal served as chair in his place because he had expected to have a conflict, but if both are running late this could present a problem. Dr. Stuebe joked that both she and Dr. Jonnal are public health people trapped in physician's bodies, so she is not worried that they will get too medical, plus Ms. Stewart will be able to help them remain in a broad view. When Mr. Bagby called for any other nominations, none were put forth. Motion to approve the Chair and Vice Chair Slate with the nominations of Dr. Jonnal for 2024 Chair and Dr. Stuebe for 2024 Vice Chair was made by Mr. Tony Whitaker, seconded by Dr. Lee Pickett, and carried without dissent. B. Fee Schedule Amendment Request Ms. Stewart presented the proposed fee changes to the board. Ms. Stewart explained that the cost for these vaccines were included in the fee schedule approved in February, but that the prices they were initially given by the manufacturer were incorrect by as much as $385.35 (underquoted as $99.75 instead of$485.10 per dose). The proposed fee changes are as follows: • CPT Code 90380 - RSV, monoclonal antibody, seasonal dose, 0.5 mL dosage for intramuscular— Beyfortus - $485.10 • CPT Code 90381 - RSV, monoclonal antibody, seasonal dose, 1.0 mL dosage for intramuscular— Beyfortus -$485.10 • NEW- CPT Code 90678 - ABRYSVO (Respiratory Syncytial Virus vaccine, preF, subunit, bivalent, for intramuscular use) 0.5 mL solution for intramuscular injection -$292.05 Ms. Stewart added that the existing COVID-19/Communicable Disease (CD) relief funds have been used to purchase these vaccines, which means these vaccines are provided to patients at no charge. However, when Dr. Crandell asked how long these funds would last, she explained that these funds are limited and will likely not be enough to cover another large order. In response to Dr. Crandell's question as to whether the doses that were purchased using COVID/CD relief funds could be set aside for un/under insured patients, Ms. Stewart explained that the State currently has an allocation of vaccines for this population via the Bridge and VFC programs. The health department will continue to ensure that individuals who want these vaccines regardless of their insurance status, will be able to get them. Dr. Crandell expressed concern that the department might use up all the free doses on people with insurance. Dr. Stuebe asked if these vaccines are particularly expensive to manufacture and/or develop — Dr. Crandell responded that he couldn't say definitively, as he was not involved in the development of these vaccines, but that most new drugs are expensive and drug pricing is a controversial topic right now. Dr. Jonnal pointed out that in many cases, the exact same medicine is made available in countries outside the USA at a fraction of the cost. In response to Dr. Royce's question about how the prices are negotiated, Ms. Stewart explained that they are set by the manufacturer and the health department is not able to negotiate pricing. Dr. Jonnal compared this to a monopoly situation. For comparison, Dr. Royce asked how much S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 the annual flu vaccines and updated COVID boosters cost per dose, which was confirmed to be around $30 and $120 respectively. Mr. Bagby asked if the BOCC would also discuss this fee update, or if it would be `rubber- stamped' based on the BOH's recommendation. Ms. Stewart explained that the fee schedule amendments typically go onto the BOCC's consent agenda, meaning that they likely would not discuss it at a meeting unless a Board member has questions about the proposal. Ms. Stewart has already answered some questions from the Board of County Commissioners about this vaccine. Motion to approve the fee changes was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. C. Delinquent Accounts and Debt Set-Off Reports Frederick Perschau, Finance and Administrative Services Director, presented information about delinquent accounts within the health department. He explained that the finance department identifies accounts which have been delinquent for 12+ months with a balance of$50 or greater. These accounts are put into set-off, which means they are sent to a county attorney and then the state for debt collection. The outstanding balance can then be garnished from state tax refunds and lottery winnings. Mr. Perschau clarified that this is different from a write-off, which is done on delinquent accounts with a balance of$49.99 or less, wherein the relevant accounts are made inactive, and the debt is not collected. In response to Dr. Crandell's question as to whether there is a cost for the attorney, Ms. Stewart clarified that as it goes through the County Attorney's Office, there is no charge to the health department. However, there is likely a charge paid by the Attorney's Office for this service. Mr. Perschau said that for the 2022-2023 fiscal year, there is a total outstanding set-off balance of$3,589.17 across 32 accounts, which will move into collections. For the same period, there is an outstanding write-off balance of$4,162 across 59 accounts. Ms. Stewart clarified that this figure does not include any delinquent accounts in the Personal Health Services department (including the medical clinic) due to an ongoing software problem making calculations of these accounts infeasible at this time. These will be submitted in 2024. Dr. Crandell asked whether a person whose account had been made inactive would have to pay off their debt before the account would be reactivated and they would be able to again receive services at the health department. Ms. Stewart explained that this is not required, but we would certainly ask them to pay what they are able. Mr. Whitaker asked if this information is tracked by obtaining the taxpayer ID of patients. Ms. Hudson explained that the debt set-off program requires verification of the identity of the individual, generally using verification questions based on public records, such as previous addresses, middle initial, etc. A service through the County Attorney's Office then obtains the Social Security Number after sending the demand letter warning of the impending submission to debt set-off. She added that for Environmental Health Services, most accounts are written off when the account owner no longer owns the property, has passed away, or is a corporation. Dr. Jonnal expressed that she felt a little uncomfortable with the idea of a public health department sending people to collections for unpaid medical bills, and asked if there is another way to resolve the outstanding debt. Ms. Stewart explained that the department works with S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 individuals in hardship and does not send people who are genuinely working to pay their bills to collections. However, there are some folks who are genuinely trying to take advantage of the system, and so there needs to be a mechanism for accountability. She added that set off does not involve wage garnishing, and instead collects from state tax refunds and lottery winnings. Mr. Perschau further clarified that the department makes significant attempts to resolve the outstanding debt in other ways before resorting to set-off. Dr. Jonnal said that she felt better about the debt set-off process given there were multiple pathways for people in need to receive care. In response to Dr. Royce's question about whether there might be issues with cost satisfaction related to the services, Ms. Spey shared that there is an item in the customer satisfaction surveys about cost. Motion to approve the transfer from active to inactive status of$4,162 in bad debt, thus writing it off without collection, was made by Dr. Alison Stuebe, seconded by Dr. Rachel Royce, and carried without dissent. D. Presentation of New Septic and Well Rules Ms. Hudson presented information about the proposed updates to the septic and well rules for Orange County, which will be put to a vote at the November BOH meeting. She clarified that the proposed rules are specifically regarding on-site wastewater regulations. Ms. Hudson shared a brief history of wastewater regulations at the state level in North Carolina, which were originally created in the 1970s and have been periodically amended over the years. During this time, Orange County has abided by their own local codes, which comply with but are more stringent than the state's. Ms. Hudson explained that on January 1st, 2024, substantial revisions to the state regulations will pass, and that these revisions have been in the works since roughly 2005. She added that these new revisions are very similar in content to Orange County's codes but are numbered differently and a bit less stringent. As such, regardless of the board's decision regarding the proposed Orange County wastewater rules, the existing 2015 Orange County rules will have to be rescinded, as they will no longer be in compliance with the state's rules. Ms. Hudson said that if the proposed rules she is presenting are not adopted, Orange County will default to following the state guidelines. She also added that the rules she is presenting are essentially the same as the ones already in place in Orange County, simply updated to follow the state's new numbering conventions. Dr. Stuebe asked Ms. Hudson to define the term "Redoximorphic features," which Ms. Hudson had used in her explanation of the history and revisions to the codes. Ms. Hudson briefly explained that this essentially means the minerals (and thus color) have been stripped from the soil due to water percolation, turning it gray. In response to Mr. Whitaker's question, Ms. Hudson confirmed that all the highlighted portions of the proposed wastewater rules that the board members had been given were instances where Orange County's codes were stricter than the forthcoming state guidelines. Ms. Hudson shared that all Orange County septic tank contractors had the opportunity to review the proposed Orange County rules and had no criticism or recommended changes. She listed some examples of the policies Orange County wishes to retain (such as four inches of gravel below a septic tank or keeping septic tanks on risers) and speculated that most lawmakers are S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 not practitioners and therefore are less informed about best practices, meaning state regulations will most likely always be less stringent than county policies. In response to Dr. Crandell's question about septic tank volume requirements, Ms. Hudson explained that NC has slightly lower volume requirements compared to Orange County. Dr. Stuebe said she would like to discuss flow rates with Ms. Hudson after the meeting. Dr. Crandell asked about the policy of putting a septic tank on risers in Orange County's proposed rules compared to NC's rules, as he has a septic tank in the middle of his lawn, and he worries that risers may serve as a trip hazard when children play around it. Ms. Hudson explained that the forthcoming NC regulations only require marking, while Orange County's proposed rules require risers on both sides to allow for marking, monitoring, and diagnostics. Dr. Pickett added that when Environmental Health Services came to her home, she learned a lot about how her own septic system works and that in her experience an above-ground system on risers is much better than a below-ground system. Ms. Hudson added that if Dr. Crandell is concerned about risers presenting a trip hazard, it's possible to relocate the septic system or landscape around it. Ms. Hudson then clarified that the new rules would be applicable to systems installed while the rules are in effect, and existing systems would not have to be brought into compliance unless they are updated or relocated after these rules are adopted. Ms. Hudson reminded the board that if the proposed Orange County rules are not approved then the county policies will default to the state standards, as the 2015 rules must be rescinded either way as they will no longer be in compliance with the state standards. Mr. Whitaker applauded the Orange County standards and said that he feels Orange County tends to stand out as an exemplary county in terms of regulating health and safety. The Septic and Well Rules are subject to a thirty-day period of public comment and will be put to a vote at the November BOH meeting. VII. Reports and Discussion with Possible Action A. Media Items Marcy Williams, Health Promotion and Education Services Manager, briefly summarized the articles in the meeting packet. Article topics included the upcoming Medicaid expansion/transformation in December, a decline in the prevalence of comprehensive sexuality education in NC due to the passage of SB 49 ("The Parents' Bill of Rights"), the blocking of two provisions in SB 20 ("Care for Women, Children and Families Act") by a federal judge, historic lows in air pollution in NC, and the recent closure of Coronato Pizza in Carrboro. Ms. Williams added that the air pollution data was related to emissions and does not include smoke from wildfires, which saw a significant increase over the summer. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Community Health Assessment Update S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 9 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 Ms. Williams shared that the Community Health Assessment Listening sessions are slated to begin Monday of next week and will run through November. She said this will offer community members an opportunity to vote on priority areas for the upcoming strategic plan and for the board to engage with and receive feedback from community members. Dr. Royce asked about the status of data analysis, to which Ms. Williams replied that Mark Smith, the contract epidemiologist working to support the CHA, is using a CDC-based program to analyze the data. She added that Mr. Smith has unfortunately not been able to `drill down' on certain items such as outcomes for specific demographic categories due to the way the survey was conducted. In response to Dr. Royce's question about secondary data (i.e., data not collected within the CHA survey), Ms. Williams explained that while some would be presented during the listening sessions, the focus would be on sharing primary data (i.e., data that was collected within the CHA survey) and allowing time for discussion. However, she clarified that the final report would go into greater detail about both primary and secondary data. Ms. Stewart added that the listening sessions will be about an hour and a half long and that community members will be given a broad summary of findings to consider for priority setting. Dr. Stuebe clarified that the listening sessions are intended to learn from community member's lived experiences, which Ms. Stewart confirmed. Dr. Royce expressed that she now understood that we are listening to community members rather than them listening to us. Mr. Bagby asked when board members would receive information about their role in the listening sessions, as they would begin in only a few days. Ms. Stewart said that the staff working on CHA would confirm the plans for the listening sessions in their meeting on Friday morning and would share the information out shortly after. Dr. Jonnal asked for the information about listening session sign-ups to be shared out again and Mr. Bagby echoed this to ensure that Dr. Nickelson has access to it. Jean Phillips-Weiner, Board of Health Strategic Plan Manager, said she would resend this information. Mr. Whitaker asked if Ms. Phillips-Weiner could also share which sessions board members have already signed up for, which she agreed to do. C. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • The Health Department received two new awards and was granted $11,000 at the NCPHA Conference in September—the GlaxoSmithKline Child Health Local Health Department Award and the Dr. Sarah Morrow Health Department of the Year Award — for our collaborative and innovative work with the Gateway Village Community. In response to Dr. Royce's question about sharing this news in a press release or similar format, Ms. Stewart replied that Dana Crews, Community Health Services Director, is working on a press release as the Communications Manager role is currently vacant. • COVID numbers are slowly improving, with hospital admission rates dropping but ICU admissions increasing. Ms. Stewart also shared that the health department is encouraging folks to get their updated boosters and that the department is continuing to mask in an effort to slow spread among staff. • The new COVID vaccines and RSV vaccines are arriving in waves; we now have both Pfizer and Moderna boosters for COVID and the RSV doses for pregnant women and older adults. In response to Dr. Royce's question about whether the health department S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ October Page 10 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH October 25, 2023 tracks flu or COVID vaccine uptake, Ms. Stewart explained that this data is no longer available on a meaningful level as the state has stopped tracking it. • At the upcoming November meeting we will discuss the BOH meeting schedule for 2024 as well as the Spring Retreat— Ms. Stewart asked if anyone knew of dates that did not work, and Dr. Crandell suggested avoiding Spring Break/the Easter holiday weekend, while Ms. Phillips-Weiner suggested avoiding the day of the Duke/Carolina basketball game (if applicable). Dr. Stuebe suggested hosting the retreat at the UNC Farm, though it was pointed out this was outside of Orange County, while Dr. Royce suggested the Russell School, a historically African American school from before integration. However, Dr. Royce shared that the building does not have good heating or cooling, so it may be better for an April meeting. • Ms. Stewart concluded by sharing that the health department is working closely with DSS to prepare for Medicaid expansion rollout on December 1 st. She said she has reached out to them and invited a representative to attend the November BOH meeting to share an update with the board about Medicaid transformation. Vill. Adjournment A motion was made by Dr. Aparna Jonnal to adjourn the meeting at 9:12 p.m., was seconded by Dr. Lee Pickett, and carried without dissent. The next Board of Health Meeting will be held November 15, 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/ October Page 11