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HomeMy WebLinkAboutApproved Minutes of January 24, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 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 January 24, 2024, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Aparna Jonnal — Chair, Alison Stuebe—Vice Chair, Keith Bagby, Bruce Baldwin, Brian Crandell, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services 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; McKayla Creed, Healthy Carolinians Coordinator; La Toya Strange, Administrative Support I; Luz "Carolina" Lopez- Flores, Medical Office Assistant; Karina Kohls, Lab Technician; LaToya Jones, Family Success Alliance Navigator; Dr. Rivkah Stack, Dentist; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTSIVISITORS PRESENT: Stephen Gray, Sarah Litzinger, Courtney Thomas, and Aidan Walker. I. Welcome New Board Member—Commissioner Amy Fowler Dr. Jonnal introduced Commissioner Amy Fowler, the new BOCC Representative for the Board of Health. While board members introduced themselves to Commissioner Fowler, Dr. Jonnal invited board comments at this time. Board Comments Dr. Aparna Jonnal Dr. Jonnal welcomed Commissioner Fowler, stated that she is the physician representative for the board, and shared that her time as a member has been lovely, and she finds the board of health to be friendly, warm, and intellectually stimulating. Dr. Jonnal also commented that she is experiencing a low point existentially in her career related to a recent Harvard study published in JAMA, "Changes in Hospital Adverse Events and Patient Outcomes Associated with Private Equity Acquisition." In essence, this large study determined that hospitals owned by private equity corporations experience significantly higher risk of adverse outcomes, infections, and falls. She said this is related to modern medicine practicing under artificial scarcity due to inappropriate distribution of resources and as such could be addressed. As a physician practicing in two locations, one at UNC Hospitals and a smaller Duke location under a corporate umbrella, she was disturbed by these findings and tried to bring them up at work but felt rebuffed. She said that she feels this is an important topic for a board of health to be aware of and that she is frustrated that one of the wealthiest countries with the most expensive healthcare system in the world is failing to take adequate care of its S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 population. She invited other board members to connect with her to brainstorm ways to address this issue. Dr. Alison Stuebe Dr. Stuebe introduced herself and shared that she is a physician leading the Thriving Hearts study in collaboration with Quintana Stewart, Health Director, to address maternal health disparities in ten counties in North Carolina, including Orange County. She also recommended the book Why We Revolt by Victor Montori, which addresses many of the issues Dr. Jonnal brought up. She said that she believes one of the main challenges is thinking about the public health drivers, often Social Determinants of Health, and considering the upstream policy drivers. She mentioned a recent article by Seth Berkowitz, "Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health," which makes a case for a fairer system to address health disparities. Keith Bagby Mr. Bagby reintroduced himself to Commissioner Fowler, as he had previously presented to the BOCC. He invited the other board members to an upcoming free mobile pharmacy event at the Passmore Senior Center (103 Meadowlands Dr, Hillsborough, NC 27278) on Friday February 9, 2024, from 8am-2:30pm. He explained that this event is for individuals who struggle to afford their over-the -counter medication and that other board members should let him know if they're interested in volunteering to staff a two-hour shift. He also shared that Orange Partnership will be hosting a kickball game on April 1,2024, for National Tobacco Kick Butt Day, most likely at Fairview Park, to raise awareness about tobacco use and harms. Dr. Lee Pickett Dr. Pickett introduced herself as the veterinarian representative from the Animal Services Advisory Board. Dr. Shielda Rodgers Dr. Rodgers shared that she is the nurse representative and is the Associate Dean of Inclusive Excellence at the UNC School of Nursing. Dr. Davia Nickelson Dr. Nickelson introduced herself and shared that she is the dental representative, a practicing general dentist, and an adjunct faculty member at the UNC School of Dentistry. She expressed interest in further discussing Dr. Jonnal's concerns about Private Equity Corporations and the impact on healthcare, as these patterns are also appearing in dentistry on a different scale. S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 Tony Whitaker Mr. Whitaker introduced himself as the engineering representative and stated that he has done multiple tenures on the Board of Health, as he feels it is a great board doing important work. He also mentioned an article he recently listened to from WUNC, "Wastewater surveillance could be a new way to track trends for illnesses like COVID," which discusses how COVID-19 wastewater monitoring has predictive power related to hospitalization trends and peaks. He expressed that he would like to see Orange County Health Department establish partnerships with organizations that monitor wastewater. Dr. Bruce Baldwin Dr. Baldwin welcomed Commissioner Fowler to the board and shared that he is the optometrist representative and that he has only three years left before his tenure on the board expires. Dr. Rachel Royce Dr. Royce introduced herself as an at-large representative in her first full term and is an epidemiologist by training. Dr. Royce added that public health has degraded over time and that while OWASA in Chapel Hill is still measuring COVID-19 in the wastewater, there is not a surveillance location in Northern Orange, making it harder to initiate protective measures to reduce the spread of infection. She also expressed dismay that North Carolina has reduced the amount of COVID- related data available, with only deaths, hospitalizations, and wastewater still widely available. Dr. Brian Crandell Dr. Crandell shared that he is the pharmacist representative working at the UNC Hillsborough Cancer Hospital. He expressed that the cost of medication bothers him, and that this is a complicated and difficult issue. He said that it is difficult for him to witness patients who cannot afford their monthly Chemo pills despite having a fairly normal income. Commissioner Amy Fowler Commissioner Fowler introduced herself and expressed that she is both a County Commissioner and a pediatrician with a history in biomedical engineering and a Masters in Public Health and Maternal and Child Health. She also said her husband has an epidemiology background and that she is very excited to have the opportunity to serve on the board of health. She added that she is inspired by the vape ban ordinances that have recently been passed in some surrounding counties and plans to petition Orange County to prohibit vape shops from opening within 1,000 feet of schools and to work with local municipalities to enact similar measures, as the county only controls non-municipalities. She also said that as a pediatrician, addressing social determinants of health is meaningful to her. S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 Welcome New Employees Ms. Stewart introduced the new employees in attendance: Luz "Carolina" Lopez-Flores— Medical Office Assistant; Karina Kohls — Lab Technician; LaToya Jones — Family Success Alliance Navigator; and Dr. Rivkah Stack— Dentist. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Board comments were incorporated into the welcoming of the new board member, Commissioner Fowler. IV. Priority Committee Updates Access to Care— Dr. Baldwin, Dr. Nickelson, Dr. Rodgers, and Dr. Stuebe Dr. Stuebe shared that the Access to Care committee has been considering access as multidimensional (e.g., that some people might struggle to realize when they need care, some may struggle to find transportation to care, some may struggle to pay for care) and therefore the committee wishes to learn more from residents about their personal challenges. To this end, the committee is planning a Photovoice project, in which members of the community will be invited to take photographs of things that they believe prevent them from receiving healthcare and then to explain their photographs. The committee recently had a good planning session and hope to host the completed project in a gallery showing at Eno Arts Mill. Dr. Stuebe added that it is common for people to assume that there are no problems here because Orange County is a relatively wealthy and liberal county, and she believes it is important for projects like this to elevate that there is still work to be done. Dr. Baldwin expressed regret for not designating a speaker in advance to allow adequate time to prepare. He added that the committee is also interested in Medicaid expansion efforts. He shared that about 6,000 new people in Orange County are eligible to enroll in expanded Medicaid, but so far only about 2,000 have enrolled. Dr. Baldwin concluded by saying that the committee hopes to help locate and reach the people who are missing. Substance Use Disorders — Dr. Baldwin, Dr. Crandell, Dr. Jonnal, and Dr. Royce Dr. Jonnal shared that the Substance Use Disorders committee recently hosted Landon Weaver, Community Paramedic Coordinator, who gave a comprehensive overview of addressing substance use disorders, particularly the Opioid Epidemic, in the field and touched on issues around prevention and treatment. She added that he had spoken about a Post- Overdose Response Team (PORT) program for Opioids that was seeking funding, and Ms. Stewart chimed in to say that this program has since been reviewed and granted one year of funding. Dr. Jonnal mentioned that she had reached out to Mr. Weaver on behalf of Person County, as she also works there, and learned he had already shared data and resources there. S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 Dr. Royce highlighted some interesting data from Mr. Weaver's presentation, including that 4% of all EMS calls in Orange County are related to substance use, and a substantial portion of those calls are related to alcohol. She also noted that about 30% of calls refuse transportation, meaning that they are not linked to the medical system, and that more than 38% of calls about people who have experienced Opioid overdose have received Naloxone (i.e., "been reversed") by first responders prior to EMS's arrival. Dr. Royce mentioned that Mr. Weaver had offered to share his dataset, which she is very excited about digging into. Dr. Baldwin added that the dataset has geolocation capabilities that can be used to put together a picture of where substance use issues in Orange County may be clustering to help focus mitigation efforts. Health Equity— Mr. Bagby, Dr. Pickett, and Mr. Whitaker Mr. Whitaker shared that the Health Equity committee has been gathering information and data about health disparities in Orange County and considering how some of these things may be driven by cultural norms and expectations, which makes unpacking them complicated. He added that the subcommittee is discussing potential effectiveness and trying to decide whether it is more practical to define goals and create new projects or to partner with existing organizations. Several board members expressed appreciation for the work that Jean Phillips-Weiner, Board of Health Strategic Plan Manager, has done to coordinate these committees. V. Approval of the January 24, 2024 Agenda Motion to approve the agenda of the January 24, 2024 BOH meeting was made by Mr. Keith Bagby, seconded by Dr. Bruce Baldwin, and carried without dissent. VI. Approval of November 15, 2023 Minutes Motion to approve the minutes of the November 15, 2023 BOH meeting was made by Dr. Shielda Rodgers, seconded by Mr. Tony Whitaker, and carried without dissent. VII. Educational Sessions A. Nutrition in the Orange County School District Sara Pitts, School Nutrition Services Director, provided an overview of nutrition services in the Orange County School System (OCS). Dr. Jessica Dreher, Director of Student Engagement and Support Services, provided additional context around supplemental feeding programs which help provide nutrition to students and their families outside of school hours and assisted with questions. Some highlights of the presentation are below: • Between breakfast, lunch, and snacks, OCS served approximately 746,300 meals in the 2022-2023 school year. Breakfast is available to all Elementary students at no cost. • Last summer, the Summer Feeding Program served approximately 16,500 meals to students across 12 host sites. School staff, community collaborations, and volunteers provide summer food service. Any student under 18 may receive up to two meals per day on-site at approved locations. Dr. Dreher expressed that the Summer Feeding S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 Program is seeking additional support, particularly new host locations. In response to Dr. Nickelson's question, Ms. Pitts said there are specific requirements for host sites, and locations that are within walking distance of schools were preferred to increase access. • Prior to the pandemic, about 40% of OCS students were receiving free or reduced lunch. This figure dropped during the pandemic, as all students were made eligible to be fed at no cost without a waiver. Now that the school system has returned to normal operations, 49.6% of students are receiving free or reduced lunch. • In response to Dr. Rodger's question about students who are "in-between" financially (i.e., whose families make too much to qualify for free/reduced lunch but not enough to afford to pay for daily lunch), Ms. Pitts said that the Board of Education (BOE) takes nutrition seriously and that no child in OCS will be denied a meal. She explained that there are "Angel Accounts" that parents can donate to in order to offset the cost of meals for students in need and that any existing lunch debt at the end of the year is paid off with the school system's "fun" budget. Dr. Dreher added that if a student was consistently needing assistance to afford lunch, they would refer them to the school social workers to evaluate if that student might need additional support. Dr. Nickelson clarified whether students receiving meal assistance have the same menu as other students, to which Ms. Pitts replied yes and that all students receive 2-4 meal options. • Other supplemental food services available include a drive-through service at Weaver Street Market to collect fruits, vegetables, and nonperishable goods; PORCH food boxes, which can be delivered by social workers or picked up by families; and a "Backpack Buddy" program offered by local churches where children receive a backpack full of healthy food. There is also a food pantry at Hillsborough Middle School where emergency boxes can be filled. Orange Congregations In Mission (OCIM) also provides support for families in crisis. Dr. Pickett shared that the Hillsborough Community Garden supports PORCH and is looking for volunteers. • The BOE requires that healthy food standards be upheld until 30 minutes after the final bell. This means that all food available in the cafeteria, in vending machines on school grounds, and served for class and school events is required to meet nutritional standards. In response to Dr. Rodgers' question, Ms. Pitts affirmed that all food served on school premises is required to be commercially prepared to protect students from potential food poisoning outbreaks and reduce the chances of allergen contamination. • Mr. Bagby expressed that he is concerned about the specifics of the school menus, as there has been news emerging in surrounding counties that school nutrition policies were allowing for meals that were unhealthy. Dr. Jonnal echoed this concern, saying that she previously did a deep dive into nutrition and found that many of the USDA guidelines are influenced by corporations and cash crops. Mr. Bagby stated that he wishes to monitor school food in Orange County and ensure that it is balanced in regard to recommended daily intake. Ms. Pitts explained that that all the meal plans follow the National School Breakfast and National School Lunch Regulations, and that OCS is overseen by the NC Department of Public Instruction with prescribed ratios for carbs, fat, sodium, etc. and that all vending machines follow Smart Snack Compliance—though they cannot control how many of the items each student eats. She added that Mr. Bagby was welcome to follow up with her for specifics. • In response to Dr. Jonnal's question about to what degree the students have access to whole and healthy foods, Ms. Pitts explained that OCS is currently working with an Learning for a Sustainable Future (LSF) grant, allowing them to purchase more locally sourced and farm-fresh foods — however, cost is still a limitation, especially when purchasing healthier foods. She added that there is a balancing act between what is healthy for students and what they will actually eat. Dr. Royce expressed concern that S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 what is served in the schools can shift the norms of what children will eat, giving the example of her own son, who learned about chocolate and strawberry milk from the school cafeteria and then wanted these at home. • Dr. Stuebe applauded the work that the school system is doing to reduce hunger and asked if they interface with programs like Family Success Alliance (FSA). Dr. Dreher confirmed that the social workers reach out in both directions to partner as needed. Dr. Stuebe asked what the board can do or advocate for to assist the feeding programs, and Dr. Dreher said that she would confer with the social workers and get back to her. B. 2nd Quarter Financial Reports & Billing Dashboard Frederick Perschau, Finance and Administrative Services Director, gave an update on the Health Department budget at the conclusion of the second quarter. He also provided some brief education about the Financial and Administrative Services (FAS) department and their activities and accomplishments over the past six months. Some highlights of his presentation are below: • Mr. Perschau explained that the health department budget is getting back to normal after the pandemic and that the revenue is currently around 45% of the budget (at the halfway point of the year) so it is about what would be expected. • Several specific areas of the financials highlighted by Mr. Perschau included that, while there are always open positions, the majority of divisions are fully staffed; the remaining ARPA/COVID funding is going away; the service revenue is on track in part due to assistance from Medicaid funding and Medicaid expansion; and that three new dental hygienists were hired at half time rather than full, which frees up some funds while allowing the division to be fully staffed. Mr. Perschau also mentioned that the pharmacy supply costs are high this year owing to the unexpectedly high prices for COVID and RSV vaccines, though he reassured the board that pharmacy costs would even out by the end of the year. • Mr. Perschau also touched on several funds being tracked, specifically Fund 27 (Opioid funding) and Fund 30 (multi-year funding from NC Integrated Care for Kids (NCINCK)). • In response to Mr. Bagby's question about vehicle expenditures, Mr. Perschau explained that Environmental Health Services needed a new truck to enable them to haul emergency trailers necessary for their work. Carla Julian, Public Health Nursing Director, clarified that this purchase was made using state funds from the COVID-19 pandemic, rather than county funds. Mr. Perschau said that he would add a clarifying footnote to the report. • Mr. Perschau briefly explained the function of FAS as an administrative and liaison service, including health informatics, medical system services, accounts and billing, human resources, and vital records. He highlighted several accomplishments over the past six months by the FAS department, including new hires to improve and round out staffing, upgrading the health department phone system to improve patient experience, beginning engagement with UNC & Durham County Health Department on EPIC Community Connect, implementing an autodraft payment system, and processing over 3,000 vital records documents (i.e., birth certificates, death certificates, and affidavits of parentage). VIII. Actions Items A. Amendment to 2024 BOH Meeting Schedule S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 Ms. Stewart shared that, in the time since the board confirmed the 2024 meeting schedule at the November meeting, the annual NCPHA Fall Educational Conference has been rescheduled from the third to the fourth week of September 2024. In order to accommodate the Health Department staff who will be traveling to the conference, the September meeting date needs to be moved to the fourth week of the month. Motion to reschedule the September meeting date from September 181, 2024, to September 251h, 2024, was made by Dr. Rachel Royce, seconded by Dr. Davia Nickelson, and carried without dissent. IX. 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 recent roll-out of Medicaid Expansion, the funding of the Thriving Hearts grant, and the `Tripledemic' threat of Influenza, COVID-19, and RSV. 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 McKayla Creed, Healthy Carolinians Coordinator, shared that the total CHA sample consists of 582 total surveys (111 from door-to-door surveying and 471 from convenience sampling). There were 10 total listening sessions with 80 participants. Spanish-language interpreters were available at all sessions, and two of these listening sessions were held entirely in a foreign language (one in Spanish and one in Mandarin). A total of 223 priority voted were received, with priority voting available in English, Spanish, Mandarin, and Burmese. Based on priority voting, the emerging top priority areas consist of Access to Care, Social Determinants of Health, Community Resources, Mental Health, and Substance Use Disorders, though final selections have not been made. C. Health Directors Report Ms. Stewart thanked the board members for their support and condolences after she suffered a personal loss. Though she had not prepared a formal report, she highlighted the upcoming presentation of the 2024 Workplan to the Board of County Commissioners on Thursday, February 15th at 7pm, hosted at Southern Human Services Center. She shared that the workplan has been submitted but can still be revised if anyone has further feedback. Dr. Crandell asked if the upcoming Board Retreat on March 2, 2024, was open to the public, and Ms. Stewart affirmed that any event with a quorum is a public event. Dr. Crandell then confirmed if the retreat date worked for Commissioner Fowler, to which Ms. Stewart replied yes. X. Closed Session to Discuss Health Director's Annual Review S:\Managers Working Files\BOH\Agenda&Abstracts\2024 Agenda&Abstracts/ January Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH January 24, 2024 A motion to enter closed session at 8:24 p.m. to discuss the health director's annual review was made by Dr. Shielda Rodgers, seconded by Dr. Bruce Baldwin, and carried without dissent. During the closed session, the Board of Health discussed Quintana Stewart's job description and annual performance review. A motion to end the closed session at 9:19 p.m. was made by Dr. Bruce Baldwin, seconded by Dr. Lee Pickett, and carried without dissent. XI. Adjournment A motion was made by Dr. Rachel Royce to adjourn the meeting at 9:20 p.m., was seconded by Dr. Lee Pickett, and carried without dissent. The next Board of Health Meeting will be held February 28, 2024, 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\2024 Agenda &Abstracts/ January Page 9