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HomeMy WebLinkAboutApproved Minutes of February 28, 2024 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 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 February 28, 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, Brian Crandell, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Dr. Stephanie George, Dental Services 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; La Toya Strange, Administrative Support I; David Gahary, Informatics Manager; Caroline Shumaker, Dental Office Manager; Raphaele Saiah, Public Health Nurse II; Ashlyn Clark, Environmental Health Specialist; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Heather Paele, Juliana Eike, Hayman Linn Lae Zaw, and Collin Walters. I. Welcome New Employees Quintana Stewart, Health Director, welcomed everyone and explained the shelter-in-place procedures in case of inclement weather, i.e., a tornado warning. Ms. Stewart then introduced the new employees in attendance: Raphaele Saiah — Public Health Nurse II and Ashlyn Clark— Environmental Health Specialist. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Dr. Lee Pickett Dr. Pickett thanked Dr. Jonnal for her recent presentation to the Board of County Commissioners (BOCC) and said that she felt Dr. Jonnal did a great job and made the Board of Health look very impressive. Dr. Jonnal responded by thanking Ms. Stewart for preparing her for the presentation and thanking the Board of Health and the health department staff for their great work over the past year. She added that the BOCC asked some follow-up questions about the emerging concern of screen time in youth, which she is very worried about, and that she was happy to see further interest in the community around addressing this issue — she hopes that Orange County can be a pioneer on this topic. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 Keith Bagby Mr. Bagby thanked Dr. Jonnal for showing interest in learning more about Orange Partnership, for which he is the chair, and thanked Commissioner Fowler for bringing the idea of a land use ordinance related to regulating tobacco and vape shops to the BOCC. Mr. Bagby gifted both board members a tote bag from Orange Partnership. In response, Commissioner Fowler shared that she has made a proposal to the BOCC about advancing such an ordinance, which she learned their attorney was already working on, and that she has been in contact with several local mayors to seek further support. Dr. Rachel Royce Dr. Royce shared that earlier that day the CDC recommended that individuals who are 65+ years of age should get a second COVID-19 booster if they are 4+ months from their last booster or 3+ months from COVID infection. She wondered if this would happen, though, as there is generally low uptake of COVID vaccines and currently only 42% of adults who are 65+ years of age are fully vaccinated and boosted. Dr. Royce added that, compared to last year, the number of new COVID-19 hospitalizations nationwide is about the same and that most deaths related to COVID-19 occur among individuals who are 65+ years of age and/or among those with comorbidities. Related to infectious disease prevention, Dr. Royce expressed concerns about Measles, as it is 6-8x more infectious than the flu and she is unsure about the vaccination rates in Orange County. Dr. Royce concluded her comments by saying that she has looked at the NC Department of Health and Human Services (DHHS) Medicaid Enrollment Dashboard, which can be found at https://medicaid.ncdhhs.gov/reports/dashboards/enrollment-dashboard, and was concerned that the number of new enrollments into expanded Medicaid appears to be tapering off with around 3,000 total new people enrolled. She added that Medicaid expansion is a significant way to help people avoid financial difficulties related to medical debt and thus improve access to housing, and that she would like to consider ways to increase enrollment. IV. Priority Committee Updates Substance Use Disorders — Dr. Baldwin, Dr. Crandell, Dr. Jonnal, and Dr. Royce Dr. Crandell shared that the Substance Use Disorders committee had met a few weeks ago and had the opportunity to speak virtually with Landon Weaver, Community Paramedic Coordinator, who has access substantial amount of data related to health issues among those seeking emergency services in the county. He said that the committee is working to get a copy of this dataset for the health department, which David Gahary, Informatics Manager, would be able to analyze. Dr. Jonnal chimed in to mention that this dataset is comprehensive about all EMS calls in Orange County and can likely be used to help target and frame future interventions by the Board of Health and health department. Dr. Crandell added that Dr. Sharon Brown from NC DHHS also spoke with the committee at their recent meeting about Opioid and other substance use in the state, specifically highlighting fentanyl and that about 80% of fentanyl in circulation in North Carolina was obtained illicitly. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 Access to Care — Dr. Baldwin, Dr. Nickelson, Dr. Rodgers, and Dr. Stuebe Dr. Stuebe shared that the Access to Care committee has not met since the previous meeting and doesn't plan to meet again until after the Board Retreat. She confirmed that there were no updates on the photovoice project at this time. She added that the photovoice project should help showcase the barriers people in the community perceive related to getting healthcare. Dr. Stuebe suggested that the project may assist with Medicaid enrollment and help the board determine why some people aren't enrolling. Dr. Royce and Ms. Stewart briefly discussed numbers around Medicaid enrollment to get an impression of how many eligible people have not yet been enrolled in expanded Medicaid, highlighting that the goal for Orange County is to enroll 6,869 new people, while enrollment is currently around half that. Ms. Stewart agreed that there is a lot of work left to be done and shared that the Department of Social Services (DSS) is working on community engagement to help identify and reach those who are eligible but not enrolled. Dr. Royce said that she has signed up to help with community outreach but hasn't been called on to help yet and that she would like to promote this further. In response to Dr. Royce's question about whether there are devices (e.g., laptops, tablets) available to assist with enrollment, Ms. Stewart replied that DSS has these available. As Dr. Royce hoped to discuss Medicaid enrollment further, Dr. Jonnal suggested scheduling a time to revisit the topic in greater detail. Ms. Stewart added that the board could invite Lindsey Shewmaker, Human Services Manager from DSS, to come back and present an update on Medicaid expansion and enrollment. Health Equity— Mr. Bagby, Commissioner Fowler, Dr. Pickett, and Mr. Whitaker Mr. Whitaker said that he was delighted that Commissioner Fowler was able to attend the most recent Health Equity committee meeting, where the members discussed supporting a land development ordinance to prevent new tobacco and vape shops from opening within a certain distance of schools. He added that other counties, such as Wake, have moved forward with similar policies so there is already some discourse on the topic among elected officials. Mr. Whitaker suggested that advancing this new ordinance this would likely involve the Board of Health and/or health department staff collaborating with the Planning Board to guide and finalize policy language. V. Approval of the February 28, 2024 Agenda Motion to approve the agenda of the February 28, 2024 BOH meeting was made by Dr. Shielda Rodgers, seconded by Dr. Rachel Royce, and carried without dissent. VI. Approval of January 24, 2024 Minutes Motion to approve the minutes of the January 24, 2024 BOH meeting was made by Dr. Davia Nickelson, seconded by Dr. Lee Pickett, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 VII. Educational Sessions A. Diversity, Equity, and Inclusion Update Ashley Rawlinson, Compliance Manager, provided an update on Diversity, Equity, and Inclusion (DEI) efforts at the Orange County Health Department (OCHD), including a 2022 survey conducted among staff to assess the culture of the health department. Some highlights of her presentation are below: • Ms. Rawlinson introduced the Orange County Health Department Racial Equity Commission (REC) and explained that REC was chartered in 2017. She clarified that REC prescribes to the Racial Equity Initiative's Groundwater philosophy—that is, that racism is in the fundamental institutions and policies of the United States ("the groundwater") and that racial justice work needs to focus on addressing the root cause instead of only treating individual people or organizations ("fish" or"lakes"). REC aims to increase staff trainings and conversations around equity, create an equitable environment, and formalize support systems for those burdened by racism. • Due to the COVID-19 Pandemic, REC work was temporarily paused beginning in early 2020 to focus on responding to the state of emergency. After the Orange County government established the Office of Equity and Inclusion and began the One Orange countywide equity group, this hiatus was further extended to allow time for Orange County to establish a strategic plan with which the health department can align. So far, county goals include reorganizing their racial equity group (One Orange), creating a racial equity toolkit for use by organizations in the county, conducting a deep dive into the Orange County departments already working on equity and ensuring adequate training, creating intentional methodologies to address racial equity, and updating the county website to increase accessibility. • In the coming weeks, OCHD will be re-recruiting for REC with representation from all five divisions. REC members will further assess results from the 2022 survey and determine if they still apply or if a new survey is needed. The REC team will also determine next steps and determine how to move forward in alignment with the Orange County Office of Equity and Inclusion. Ms. Rawlinson also mentioned that the Environmental Health Services department recently received a grant to advance equity in retail food service. • Ms. Rawlinson shared data from a 2022 staff assessment asking health department staff about their perceptions of racial equity and diversity in the organization. She highlighted that, while 39% agreed that OCHD has internal policies to address hiring inequities, 12% disagreed. She also mentioned specifically that about 40% of respondents neither agreed nor disagreed about whether the Board of Health is diverse across demographics and perspectives and reflects the communities OCHD seeks to impact, which she suggested may be a result of many staff members lacking familiarity with the board members. Dr. Jonnal expressed that she would be happy to be more present to staff members so they could get to know her better. Mr. Bagby mentioned that the health department has profiles on board members that can be shared with staff and that board members can attend all-staff meetings. He also said that, like board members should know the BOCC, OCHD staff should be able to know their board of health. • Board members had several questions regarding survey methodology: o Dr. Jonnal asked how many respondents completed the survey, to which Ms. Rawlinson replied 66. Commissioner Fowler asked how many total staff work at the health department, to which Ms. Stewart replied 113 (meaning a 58% response rate). o In response to Dr. Jonnal's question about whether the survey had open response questions, Ms. Rawlinson explained that the survey was entirely S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 multiple-choice items but there are plans to have conversations with staff to learn more specific details. Ms. Stewart added that this survey was conducted during the active pandemic phase and staff were already fatigued by many surveys and extra work, so the goal was to keep the survey as simple as possible. o Dr. Rodgers wondered if neutral might be an equivalent to "I don't know," and Ms. Rawlinson agreed this was a possibility. Dr. Stuebe commented that some of the questions appeared to be double-barreled (that is, containing two or more questions), which may have made them more difficult for participants to answer. o Dr. Stuebe asked about validated instruments and Ms. Stewart replied that she believes the questions used for the survey came from a validated tool. • Dr. Royce asked if there were plans to conduct focus groups to learn more detailed information, to which Ms. Rawlinson replied this is something REC plans to do in the future, though it may take the form of team meetings or informal conversations. Regardless of method, the hope would be to encourage more openness among staff. • In response to Dr. Rodger's question about whether board members are permitted to participate in REC activities, Ms. Stewart replied yes, so long as there is not a quorum present. • Dr. Royce mentioned that comparing only "agree" and "neither agree nor disagree" somewhat undersold the overall level of agreement—she suggested that, when presenting this data in the future, "agree" and "strongly agree" should be combined. VIII. Actions Items A. 2024 — 2025 Proposed Budget Frederick Perschau, Finance and Administrative Services Director, presented on the 2024 — 2025 Proposed Health Department Budget. Some highlights of his presentation are below: • The Total Budget Request was $8,111,112 (-$34,142 under base, with a decrease of less than 1%). In response to several board members' questions about this figure, Mr. Perschau explained that it was calculated based on how much of the budget from the previous year was used and in which areas. • Several major changes highlighted included that the American Rescue Plan (ARPA) funds have expired, the Regional Infection Prevention & Support (RIPS) Teams are being removed, additional funding is available around public health infrastructure and addressing concerns around lead poisoning, there are ongoing increases in pharmaceutical costs, and that service fees in several divisions are increasing, including the fee schedule for the Dental Health Services division being updated for the first time since 2013. • Mr. Perschau explained that there are four major areas of the budget— revenue, expenses, personnel, and overall. These cover five divisions — Dental Health, Community Health, Environmental Health, Personal Health, and Finance and Administrative Services. • There is a net proposed personnel expense increase of$56,793 (which is separate from the Overall Budget Request), based on the creation of 2 new positions and amendments to 6 current temporary positions to convert them to FT/PT Permanent (a total addition of +5.09 Full-Time Equivalent (FTE) workloads across all 8 positions). Mr. Perschau clarified that this number is the sum of the time commitment across all eight positions S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 and that no one person is receiving pay for only 0.09 FTE workload. Several of these positions, such as a new dental hygienist, are considered revenue generating. • Dr. Royce asked if positions that generate revenue should be compensated at a higher rate, as they provide value to the county, to which Mr. Perschau responded that this is a loaded question. He went on to say that many of these roles are part-time and that in all cases the health department considers equity and tries to meet the market rate. Ms. Stewart clarified that the specific role being discussed, part-time foreign language interpreter, is a role that allows other services to be used but does not directly generate revenue, as the county provides interpretation services to patients at no charge. • In response to Dr. Crandell's question about what "reallocated expenses" means, Mr. Perschau explained that this means the money is already being spent on something comparable (e.g., paying salary for a temporary position rather than a permanent position) and that the expense will be sustained going forward. • Medicaid cost settlement offers a substantial revenue source but is only settled at the end of the fiscal year. Because of recent Medicaid expansion, it is expected for the Medicaid cost settlement to increase over the 2024-2025 fiscal year. • Mr. Perschau shared a photo of the new Communicable Diseases (CD) suite in the Whitted Medical Clinic for use by the nursing staff and mentioned a new conference room at Environmental Health. • In response to Dr. Crandell's question about the expense increase for Public Health Infrastructure, Ms. Stewart explained that this is due to new funding from the CDC covering a five-year period to help support workforce development as ARPA funds are ending —this new funding can be used to assist with staffing needs, workforce development, and training across all divisions. She added that some of this will be used to increase staff capacity to meet the increase in demand from Medicaid expansion. Dr. Crandell said that he'd like to know how much of the Public Health Infrastructure cost increases are related to new programs vs. expansions of existing programs, to which Ms. Stewart replied that most are expansions of existing programs and that these increases will be fully offset by corresponding revenue increases. • Dr. Stuebe asked about the decrease in NCCARE360 funds and Carla Julian, Public Health Nursing Director, said that this was a grant that had expired. • Dr. Royce asked if the decrease in funding for STD services was related to a decrease in STDs in the community. Ms. Stewart explained that this is a projection based on the previous year's use of STD services. Mr. Perschau said that there is still some flexibility and that this can be adjusted if there is more demand for STD services than expected. • In response to Dr. Jonnal's question about the goal for dental fees, Mr. Perschau explained that the department is implementing a stepwise increase that is intended to keep OCHD dental fees on par with health departments in surrounding counties without overwhelming patients. Ms. Stewart added that the fees are needed to cover the costs to the health department related to providing services, e.g., the cost of staff time and supplies. As the market rate of dental services is unaffordable without dental insurance, Dr. Jonnal asked if it was possible to charge different fees to those with and without dental insurance. Ms. Stewart replied unfortunately no, our fee is our fee regardless of insurance status, but we are a safety net and for those unable to afford the increased fee there are options available, such as sliding scales and fee waivers. Motion to approve the total budget requested in the amount of$8,111,112 for FY 2024- 2025 as presented, and approve an increase in the personnel budget by$56,793, and forward to the Board of County Commissioners for action was made by Dr. Shielda Rodgers, seconded by Commissioner Amy Fowler, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 B. 2024 — 2025 Proposed Fee Schedule Mr. Perschau covered the details of the 2024— 2025 proposed fee schedule during his presentation on the proposed budget in the above section. Motion to approve all fee changes for FY 2024-2025 as presented, and forward to the Board of County Commissioners for action was made by Dr. Alison Stuebe, seconded by Dr. Lee Pickett, and carried without dissent. Mr. Perschau also presented a proposed adjustment to the current 2023 — 2024 fee schedule focused on services provided by the Personal Health Services division. Motion to approve all new fees as presented, and forward to the Board of County Commissioners for action was made by Dr. Rachel Royce, seconded by Dr. Brian Crandell, and carried without dissent. C. Board Appointments Four current board members have terms ending on June 301", 2024. The Board of Health voted to recommend Dr. Alison Stuebe to her 2nd full term, Mr. Tony Whitaker to his 2nd full term, Dr. Bruce Baldwin to his 3rd full term, and Mr. Keith Bagby to his 3rd full term. In order to allow each appointee to vote, the Board decided on four different motions for the reappointment of the members with each of them abstaining from the vote in regard to their own reappointment. Motion to recommend the reappointment of Dr. Alison Stuebe and forward to the Board of County Commissioners was made by Dr. Lee Pickett, seconded by Mr. Tony Whitaker, and carried without dissent. Dr. Alison Stuebe abstained. Motion to recommend the reappointment of Mr. Tony Whitaker and forward to the Board of County Commissioners was made by Dr. Rachel Royce, seconded by Dr. Aparna Jonnal, and carried without dissent. Mr. Tony Whitaker abstained. Motion to recommend the reappointment of Dr. Bruce Baldwin and forward to the Board of County Commissioners was made by Dr. Alison Stuebe, seconded by Dr. Rachel Royce, and carried without dissent. Motion to recommend the reappointment of Mr. Keith Bagby and forward to the Board of County Commissioners was made by Dr. Rachel Royce, seconded by Mr. Tony Whitaker, and carried without dissent. Mr. Keith Bagby abstained. Ms. Stewart reminded the board that these are recommendations rather than formal reappointments, and that all board members ultimately serve at the pleasure of the BOCC. D. Outside Agency Applications Ms. Stewart explained that the annual outside agency review process has been revised this year, with food agencies now being scored separately by a food agency panel (made up of the directors of DSS and the Departments of Aging, Health, and Cooperative Extension) rather than by board members as in previous years. Because of this, there are a total of six applications to review— Club Nova, El Futuro, Orange County Partnership for Young Children, Orange County S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 Rape Crisis Center, Planned Parenthood (all previously reviewed), and Arc of the Triangle (new/previously unfunded). She requested six volunteers, one board member per agency, to review the applications and score them on dimensions such as impact, equity, and provision of services that address a unique need in the community, by no later than March 8t". She also clarified that Commissioner Fowler was not permitted to volunteer as this is considered a conflict of interest with the BOCC. Dr. Jonnal expressed regret that she did not have time to review an application this year, as in a previous year she had the opportunity to review Transplanting Tradition, a local farm operated by Burmese refugees, to which her family's bloated, angry goat was eventually rehomed. She said that the process is a fun opportunity to learn more about local organizations serving the community and that the application is not difficult to complete. Based on her story, several board members felt compelled to volunteer. Final volunteers included Dr. Nickelson, Dr. Rodgers, Mr. Whitaker, Dr. Stuebe, and Dr. Crandell. Because several board members remembered Dr. Baldwin enjoying this process in the past, Ms. Stewart said she would reach out to him to see if he would be interested in reviewing an application; Dr. Jonnal agreed to be a backup volunteer if Dr. Baldwin was not willing. Dr. Crandell expressed that in the future he would prefer to avoid a one-week turnaround, to which Ms. Stewart agreed and explained that it was unfortunately out of her control due to the county's revision to the review process. 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 full staffing of the 988 suicide prevention lifeline, a new policy pulling bars that serve food under regulation of the health department, the Surgeon General recommending an increase in regulations around baby foods, the Wake County School Board considering suing social media companies related to damages to youth around their mental health, and a recent recall on certain products, including cheeses, related to a Listeria outbreak. After the potential lawsuit towards social media companies was compared to the Juul lawsuit, Dr. Crandell asked if that lawsuit had been successful. Ms. Stewart affirmed that it had, and that the health department had received some settlement funds. Dr. Jonnal expressed excitement over the potential emergence of a method to push back against predatory companies. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 B. Health Directors Report Ms. Stewart presented her report to the Board, which she explained would cover both January and February, as she was unable to prepare a formal report for January due to a personal matter. Below are brief highlights of her report. • Ms. Stewart expressed that it has been a time of many meetings for her, including planning for the Thriving Hearts grant and settling into her new role as President of the State Health Director's Association. • The Community Health Assessment (CHA) is being finalized and will be submitted to the state next Monday, March 4t". Ms. Stewart reminded the board that they would learn more about the selected priority areas at the Board Retreat on Saturday, March 2nd where the board would also have the opportunity to discuss and select their own priority areas for the next four years. • Ms. Stewart acknowledged Dr. Jonnal's presentation to the BOCC and said she did a great job. • Environmental Health Services received a grant from the National Environmental Health Association (NEHA) and the FDA for$24,458 to help fund equity improvements through the retail food program and send two employees to complete a food standards course. • As discussed, Medicaid expansion remains a focus area for the health department. • The Formerly Incarcerated Transitions (FIT) Program recently received $5.5 million in funding from NC DHHS. Additionally, FIT recently celebrated their five-year anniversary and hosted a benefit event. • The Board Retreat will be held Saturday, March 2nd beginning at 8:30am at Southern Human Services Center, 2501 Homestead Rd, Chapel Hill, NC 27516. Ms. Stewart added that during the retreat there will be a speaker from the Association of NC Boards of Health, a tour of the mobile dental unit, a session focused on adjudication training, a presentation of the CHA priorities and selection of future priority areas and committees, which she confirmed are not required to align with the priority areas identified by the CHA. In response to Dr. Royce's question about CHA data, Ms. Stewart explained that this will be presented at the March board meeting. • The Orange County Opioid Settlement Community Meeting will be held at 10am on Saturday, April 271" in the Donna Baker Meeting Room of the Whitted Building, 300 West Tryon Street, Hillsborough, NC 27278. X. Adjournment A motion was made by Dr. Lee Pickett to adjourn the meeting at 8:54 p.m., was seconded by Dr. Rachel Royce, and carried without dissent. The next Board of Health Meeting will be held March 27, 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\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 9