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HomeMy WebLinkAboutApproved Minutes of September 20, 2023 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 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 September 20, 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, Shielda Rodgers, Alison Stuebe, and Tony Whitaker. Per Keith Bagby's request, Aparna Jonnal served as chair for the evening's meeting. BOARD OF HEALTH MEMBERS ABSENT: Lee Pickett and Rachel Royce. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Dr. Stephanie George, Dental Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing 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; Renee Kemske, Nutrition Program Manager; Chinyere Ekenna, Communicable Disease/Refugee Health Nurse; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Victor Arahirwa. I. Welcome New Employees Quintana Stewart, Health Director, announced that while there have been two new employees hired since the August meeting, neither were in attendance this evening. As such, no new employees were introduced. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Keith Bagby Mr. Bagby shared that earlier that day he had volunteered at the North Carolina Senior Olympics state finals in Durham and been impressed and touched by the determination and athleticism shown by several of the athletes, specifically highlighting both a nonagenarian and a centenarian. Dr. Alison Stuebe Dr. Stuebe provided an update on the Thriving Hearts Grant which she and Ms. Stewart recently applied for to support maternal health in Orange and nine other counties. She shared that the feedback she's received has indicated that she is still in the running for funding and that she's cautiously optimistic. Dr. Stuebe also mentioned that Thriving Hearts is a six-year grant for $21 M, but that intervention costs are not covered by it, so she is looking for an alternate funder to cover the $8M needed to complete the planned intervention. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 Tony Whitaker Mr. Whitaker shared that there was recently a new federal office established focusing on gun violence prevention, the White House Office of Gun Violence Prevention, which makes him hopeful for momentum to address gun violence. Dr. Aparna Jonnal Dr. Jonnal mentioned that she's noticed an anecdotal uptick in COVID-19 cases. However, she also expressed that she feels that COVID response has become normalized, so people seem more willing to be vaccinated and/or wear masks without controversy. IV. Approval of the September 20, 2023 Agenda Ms. Stewart submitted an additional item for the agenda, FY 2023-24 Personal Health Updates to Fee Schedule, the review and approval of a fee change related to COVID-19 vaccinations. The addition was adopted by Dr. Jonnal as item VI.B. Motion to approve the amended agenda of the September 20, 2023 BOH meeting was made by Dr. Alison Stuebe, seconded by Commissioner Jamezetta Bedford, and carried without dissent. V. Approval of August 23, 2023 Minutes Motion to approve the minutes of the August 23, 2023 BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Alison Stuebe, and carried without dissent. VI. Actions Items A. Board of Health Policy Review and Approval Ms. Stewart reviewed the updates to proposed policy changes introduced in August with the board members. There were three potential options presented and discussed in detail for the policy around Review of Reports and Documents (1. Change frequency of financial reports to Board from quarterly to semi-annual.; 2. Change frequency of financial reports to Board from quarterly to semi-annual with the condition that a variance of 20% or greater than the Budget, a financial report will be given at the next scheduled Board meeting.; 3. Keep frequency of financial reports to Board quarterly with two reports (August & January) given during scheduled Board meetings and two reports included in Board Packet but on the Consent Agenda. If a Board Member has questions, they may request that the financial reports be pulled from Consent Agenda and discussed during the scheduled Board meeting.). Dr. Baldwin asked whether the financial reports would be completed regardless of if they were presented to the board and if creating the reports presented no extra work for the department, to which Frederick Perschau, Finance and Administrative Services Director, replied yes. S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ September Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 Dr. Crandell requested clarification of the 20% variance in option 2, asking whether it applied quarterly and was based on projections, which Mr. Perschau explained would apply across the year based on annual and quarterly projections. Commissioner Bedford expressed that she prefers option 3, as she would be concerned that the board wouldn't be performing their fiduciary duty if they weren't regularly reviewing the financial statements. Mr. Whitaker also liked option 3, as he would prefer to have a budget report in front of him at least quarterly, ideally with a summary flagging any discrepancies or aberrations. Dr. Baldwin asked if the variance caveat from option 2 should be added to option 3. Ms. Stewart clarified that it was only included in option 2, and Commissioner Bedford suggested merging options 2 and 3 so the board receives quarterly reports, but any concerning or odd trends are still flagged and brought to the board. This idea was later echoed when Dr. Jonnal asked Mr. Perschau which option he preferred and if he felt there was anything missing from the options. Mr. Perschau said that he felt quarterly reports are the best practice, so he preferred option 3, but that he also liked the idea of having a system to flag aberrations. Dr. Jonnal then suggested merging all options, adding an option to report to the board 'at the discretion of the department' if something seemed off. Mr. Bagby expressed discomfort with the 20% variance from option 2, as he felt it seemed arbitrary and that such a variance might occur naturally, for example if the government was late to send a reimbursement to the health department between fiscal periods. He said he'd rather not spend time addressing the budget if there wasn't genuine cause for concern. Dr. Crandell asked how the health department might account for a large, unexpected expense, giving the examples of medical equipment breaking or the COVID-19 pandemic. Ms. Stewart replied that during the pandemic the impact to the budget was referenced frequently during board meetings, even outside of budget presentations. She also expressed that another similar catastrophic expense seemed unlikely—for example, the clinic's medical equipment is covered outside the budget—and the board would be notified almost immediately if something serious happened. Based on the discussion, Dr. Jonnal summarized that the board wished to have the budget presentation twice per year, with quarterly reports available and the option to discuss or have the information reported in the case of exceptional items. Ms. Stewart confirmed that the board agreed to move forward with option 3, adding a caveat that exceptional items in the budget could be brought before the board as needed at the discretion of the financial department. Motion to approve the Board of Health Policy Changes was made by Dr. Bruce Baldwin, seconded by Dr. Alison Stuebe, and carried without dissent. The adopted changes are as follows: 1.0 Mission Statement and Scope of Services • Replaced old mission Statement with new one adopted at the April 26,2023 meeting. • Added the new Vision Statement to the policy. I.A. - Requests for Environmental Services and Assessments • No Changes I.B. - Fee and Eligibility Policy S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 • No Changes; policy was reviewed and updated by the Board at the June 28, 2023 meeting in response to follow up corrective actions from the May NCDHHS Administrative & Clinical Monitoring Visit. I.C. - Community Assessment Policy • Changed Health Promotion & Education Services Division to Community Health Services Division throughout the policy • Added detail about the newly formed CHA Leadership Team throughout the policy I.D. — Review of Reports and Documents • Revision on page 1, Procedures 2f. Fiscal Oversight— In order to exercise fiscal oversight, the Board receives quarterly financial summaries on revenues and expenditures by Division for the Health Department with two reports (August & January) given during scheduled Board meetings and two reports included in Board Packet but on the Consent Agenda. If a Board Member has questions, they may request that the financial reports be pulled from Consent Agenda and discussed during the scheduled Board meeting. At the discretion of the Health Director and Finance & Administrative Services Division Director, notable financial information such as variances out of the normal course of business may be presented to the Board outside of the prescribed schedule. I.E. - Operating Procedures BOH Manual IV. New Board Member Tasks • ( Page 3) V. Training • Board members shall complete New Board Member Orientation training with the Health Director within their first year of service. The Orientation training will provide an overview of the health department and highlight the authorities and responsibilities of the local board of health. • In accordance with North Carolina Local Health Department Accreditation Standards, Board members shall also complete ongoing training related to the authorities and responsibilities of local boards of health. At a minimum training shall occur at least once in between Accreditation site visits. Added new section on training as recommended by Accreditation Standards; the BOH has always completed training for new members and ongoing training for the full board, this practice was not spelled out in the Operating Procedures. I.E. - Operating Procedures BOH Manual —Appendix H — Confidentiality and Conflict of Interest • No Changes B. FY 2023-24 Personal Health Updates to Fee Schedule Carla Julian, Public Health Nursing Director, presented the proposed fee changes to the board. Ms. Julian explained that the vaccines are now sold commercially and that the cost of the vaccines is based on the different formulations and was not known until the week of September 11, 2023. These adjustments will ensure the cost to the health department is recuperated. The proposed fee changes are as follows: • Moderna COVID-19 Vaccine, Adult (12 years and older) (single dose vial): $115.00 S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ September Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 • Moderna COVID-19 Vaccine, Adult (12 years and older) (prefilled syringe): $115.00 • Moderna COVID-19 Vaccine, Pediatric (6 months to 11 years) (single dose vial): $115.00 • Pfizer COVID-19 Vaccine, Adult (12 years and older) (single dose vial): $115.00 • Pfizer COVID-19 Vaccine, Adult (12 years and older) (prefilled syringe): $115.00 • Pfizer COVID-19 Vaccine, Pediatric (5-12 years) (single dose vial): $77.00 • Pfizer COVID-19 Vaccine, Pediatric (6 months-5 years) (3-dose vial): $58.00 • Novavax COVID-19 Vaccine, Adult (12 years and older) (5-dose vial): $113.00 Mr. Whitaker asked how the costs were tabulated. Ms. Julian explained that there is a separate administrative fee of$24.50 and the fee schedule is calculated based on the cost to the health department per dose. Ms. Stewart added that insurance covers 100% of the cost of immunizations under the Affordable Care Act, and individuals who are un/under-insured can be bridged so they still receive the vaccine at no cost under this fee schedule. Dr. Stuebe asked if Medicaid fully covers the cost of a vaccine, and Ms. Stewart replied yes. Motion to approve the fee changes was made by Dr. Shielda Rodgers, seconded by Dr. Alison Stuebe, and carried without dissent. VII. Educational Sessions A. Nutrition Update/Employee Health and Wellness Renee Kemske, Nutrition Program Manager, presented the annual update on OCHD nutrition and employee wellness services. Ms. Kemske provided an overview of the various programs offered by the OCHD nutrition department and their positive impacts. Below are some highlights of her presentation: • Ms. Kemske discussed the Nutrition Counseling/Medical Nutrition Therapy program, which is a medical referral program which helps individuals living with a chronic condition better manage their illness. She shared that over the past two years the demographic makeup has shifted so about two thirds of patients in the program are referred by the OCHD and one third are referred by other providers, but that generally the split is even (50%-50%). The services are available either in-person or through telehealth, depending on the patient's preference, but for a first appointment it is best practice to have an in- person visit. She also expressed that she expected to see an increase in telehealth visits over the winter. In response to Dr. Jonnal's question about 43% of patients being self- pay, Ms. Kemske said that it depends on the patient's insurance coverage, but they can slide the fees when necessary so those who self-pay are not paying full price. • Ms. Kemske shared that the Diabetes Self-Management Education program has resumed in-person classes as of April 2023. The classes are primarily attended by older individuals (45+ years of age) and offer a holistic approach to Diabetes management. The program offers nutrition education between two four-hour classes and one review of the program indicated that over the last fiscal year 82% of patients lowered their Al C levels. Ms. Kemske mentioned that individuals with Pre-Diabetes or Type II Diabetes are eligible for the program, but that Medicaid does not cover individuals with Pre-Diabetes and only covers one Diabetes management course per lifetime. • Discussing the Access to Care/NCCARE360 Grant, Ms. Kemske stated that this involves using a community-based referral platform to increase access to support for self- S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 management of disease. Two specific structures she mentioned were the piloting of a medication assistance program for primary care patients and to provide support in between medical appointments and use of the Modivcare program, a ridership program partnering with Uber and Lyft to address transportation barriers for patients. • Ms. Kemske also highlighted: 1. the Primary Care Bag Initiative, which gives patients a bag of supplies to help monitor blood pressure and Diabetes; and 2. the Diabetes Prevention Program, which supports participants in performing 150 minutes of physical activity per week and in achieving 5% body weight loss, both of which are evidence- based Type II Diabetes prevention strategies. • Ms. Kemske shared that while New Employee Orientation offers an opportunity to promote nutrition services to new county employees, staffing issues have served as a barrier to providing them. In response to Mr. Bagby's question about whether there are wellness classes available for employees, especially physical activity classes, Ms. Kemske said that the Orange County Wellness Committee recently relaunched and she expects to see fitness classes starting again soon. Ms. Kemske also affirmed that Orange County government employees receive a discount at the local Sportsplex in response to Commissioner Bedford's clarifying question. • Dr. Jonnal prompted Mr. Bagby to ask about the vending machines in Orange County Government buildings — Mr. Bagby feels that there is a lot of `junk food' in vending machines that encourage people to make poor food choices. Ms. Kemske replied that unfortunately the OCHD does not control what is in the vending machines, though there's previously been a partnership to address this, and that at the end of the day it's about money and negotiating cost with the vending machine companies. • Dr. Jonnal asked whether Ms. Kemske knows anything about insurance companies covering the cost of healthy food options, as this is something she has heard of and would like to have an option to offer her patients when they say they can't afford healthy food. Mr. Bagby shared a personal anecdote about receiving healthy premade meals covered by his insurance after a past surgery and Dr. Steube expressed she'd also heard of something similar. Ms. Kemske said this was not a service that she was aware of, but that she'd be happy to ask a colleague at UNC and share back. B. Refugee/Immigrant Update Chinyere Ekenna, Communicable Disease/Refugee Health Nurse, presented the annual Refugee/Immigrant Health Update. Ms. Ekenna explained the distinction between a refugee (one who flees their home country due to violence or persecution and is unable/afraid to return) and an immigrant (one who elects to leave their home country for other opportunities) and then provided an overview of the state of refugees and refugee health in Orange County. Below are some highlights of her presentation: • Ms. Ekenna shared that refugees living in Orange County are from all over the world. Recently, new benefits have been extended to refugees from certain countries, including Afghanistan, Ukraine, Cuba, and Haiti. OCHD has received and screened 52 refugees since December 2022. Of these, 13 were refugees from Ukraine. • Sharing demographic information about refugees arriving to North Carolina, Ms. Ekenna said that around 1,000-4,000 arrive per year and there is an even split between males and females, nearly half(44-47%) are under 20 years old, and most (80-90%) do not speak English as their primary language. • Ms. Ekenna explained that there are two different medical screenings available for refugees: 1. a mandatory immigration exam prior to departing their home country, which S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 checks for medical diseases that would exclude the individual from entering the US and may not provide routine vaccinations; and 2. An elective (but recommended) refugee health assessment completed upon entry to the US, which provides the opportunity to screen for communicable diseases (CDs), administer routine vaccinations, and offer continuity of care for refugees. • Per requirements from DHHS, OCHD currently performs a CD screening for refugees within 30 days of their arrival and provides laboratory testing for immunity to varicella, hepatitis B&C, TB blood test, Syphilis, HIV and blood lead level for infants and children under 16 years of age. The health department also provides abnormal lab results follow up, treatment if needed, and referrals for physical examinations. Ms. Ekenna shared that in the past fiscal year, OCHD has treated three refugee patients for lead and TB. • Ms. Ekenna recommended that OCHD consider establishing a full-scale refugee clinic to provide both communicable disease screening and physical examination to this population, as currently OCHD is only able to provide screening services and refugees are referred to Piedmont Health for primary care services (i.e., physical exams). • Ms. Ekenna added that implementation of a refugee clinic would benefit OCHD because providing the entire assessment including a physical examination would increase reimbursement through Medicaid or Refugee Medical Assistance (RMA). Ms. Stewart clarified that there is currently not staff capacity to provide primary care services for refugees and OCHD would need to hire additional clinicians to move forward with such a clinic. Dr. Jonnal asked how the health department can screen for communicable disease without performing a physical examination and Dr. Crandell suggested symptoms may be self-reported, which Ms. Ekenna confirmed. Dr. Rodgers pointed out that even among citizens, healthcare provision is often siloed and fragmented, as healthcare practitioners tend to focus more on immediate symptoms than whole health. VII. Reports and Discussion with Possible Action A. Media Items Marcy Williams, Health Promotion and Education Services Manager, briefly summarized the articles. Article topics included pending Medicaid expansion, legal disputes around the Swimply pool rental app, local mental health support training opportunities, Carrboro's Coronato Pizza closing due to secondhand smoke from a neighboring cigar bar, and a possible action in Wake County to ban tobacco and hemp stores within 1,000 feet of schools or parks. Dana Crews, Community Health Services Director, added that Rita Krosner, Tobacco Prevention and Control Coordinator, has done similar environmental checks at tobacco retailers. 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 Ashley Rawlinson, Compliance Manager, shared a brief update on the ongoing Orange County Community Health Assessment. She stated that the surveys are now closed, and that we received a total of 582 responses. Ms. Rawlinson added that there have been some technical difficulties with extracting the raw data from Redcap, creating obstacles in data aggregation and tabulation. Once this is resolved, the team will be able to move forward with the listening sessions in October and November; listening sessions may be available in a mix of in-person S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 and virtual or in a hybrid format to reach a greater proportion of the population. The team is selecting peer counties, focusing on comparing qualities such as geography, economics, and population. C. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • New COVID-19 vaccine boosters have been approved and the health department has received the state supply intended for un/under-insured patients, while the vaccines for individuals with private insurance have not yet been distributed. Ms. Stewart added that the department will perform specific outreach to unhoused, sheltered, and incarcerated individuals but there will not be large-scale vaccine clinics because OCHD doesn't have the resources for something of that scale at this time. • The Opioid Advisory Committee has heard five new proposals over the past two months, and the group is splitting into two subcommittees — one to review proposals for funding recommendations, and one to prepare for the community-wide annual meeting. The first report on the use of the Opioid Settlement Funds is due on September 27th. In response to Mr. Bagby's question about whether the Opioid Settlement Fund amounts were available to the public, Ms. Stewart replied that they were available on the BOCC's website, and she would share the link with him. • Though State budget approval (and thus Medicaid expansion) has been stalled, there is a high likelihood that it will be voted on and passed by the end of the month. • Based on wastewater surveillance and hospitalization rates, there has been an increase in COVID-19 cases in Orange County. However, data is beginning to trend down and there has not been a spike in deaths. Dr. Rodgers suggested that the return of UNC students may have been a factor in the increase in COVID cases. Ms. Stewart also shared that OCHD staff have been asked to wear masks to slow the spread until cases are low again. • The upcoming community event, Building Community & Health, will take place on Sunday at Schley-Grange Hall from 2-4:30pm and will provide flu shots, a CPR demonstration, distribution of Narcan, and education around firearm safety and opioid and substance use disorders. • Ms. Stewart reminded the board of the upcoming Fall Educational Conference in Concord, NC, which many OCHD staff members will attend. She mentioned that staff attending the conference will still be accessible, just not physically present at OCHD. • There is a volunteer appreciation reception hosted by the BOCC on October 3rd in Whitted's Donna Baker room to celebrate board members for their service. • The next all-staff meeting will be held on Friday October 131h at Fairview Park. Board members are welcome to attend but should alert Ms. Stewart if they wish to do so to ensure there is not a quorum. • Environmental Health received a shout out from Chapel Hill Town Manager Chris Blue for their support after the fire at Mediterranean Deli in July. VIII. Adjournment A motion was made by Dr. Alison Stuebe to adjourn the meeting at 8:28 p.m., was seconded by Dr. Bruce Baldwin, and carried without dissent. S:\Managers Working Files\BOH\Agenda &Abstracts\2023 Agenda &Abstracts/ September Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 20, 2023 The next Board of Health Meeting will be held October 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 S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ September Page 9