Loading...
HomeMy WebLinkAboutApproved Minutes of April 24, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH April 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 April 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; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Finance and Administrative Services Director; Libbie Hough, Communications Manager; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: None. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employee in attendance: Libbie Hough — Communications Manager. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Dr. Aparna Jonnal Dr. Jonnal commented that, though it turned out the adjudication hearing needed to be rescheduled, she appreciated that the details were well-communicated and orderly and that the board responded to everything in a timely manner. Keith Bagby Mr. Bagby shared a recap of the recent Orange Partnership event, Take Down Tobacco Day, which was held at A.L. Stanback Middle School on April 12, 2024. He said that the event was a big success and that there were three major activities: an educational presentation about tobacco given by the ADAPT high school students, Bingo and other games, and a kickball tournament. He added that some of the teachers participated in the kickball tournament, and that it was a good way to break up the school day and give students a chance to do something different. Mr. Bagby went on to say that several other schools have expressed interest in having Orange Partnership host a similar event but that this is likely not feasible at this time, as Orange Partnership has a very small staff, and the event required a lot of planning, funding, and collaboration with parents and community partners. Dr. Jonnal congratulated Mr. Bagby on the event and all the work that he does in the community. She said that if she ever retires, she hopes to give as much as he does. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 Commissioner Fowler added that both Marilyn Carter, BOCC candidate, and Commissioner Phyllis Portie-Ascott had mentioned attending Take Down Tobacco Day to her and spoke highly of the event. IV. Priority Committee Updates The new Access to Care Committee met on April 22, 2024. Dr. Rodgers provided an update on the committee meeting, explaining that the committee has elected to maintain a focus on reaching community members who are newly eligible for expanded Medicaid, as addressing this will likely help with other barriers to care. The committee will also be conducting a photovoice project with community members to learn more about pain points that prevent people from accessing care, as recruitment for this project and promoting Medicaid expansion can be easily combined. Regarding equity/justice, Dr. Rodgers explained that the group is planning to intentionally target much of their efforts on reaching out to and building trust with those who have been largely insufficiently served, such as communities in rural northern Orange. Dr. Royce added that the committee is looking at demographic data for everyone who has been enrolled in expanded Medicaid vs. the population. She underscored that the committee is also planning to compare enrollment data with the demographics of individuals who are eligible to ensure that outreach is equitable and inclusive of any populations who may be underrepresented. Dr. Rodgers observed that the fact that Hispanic is considered an ethnicity rather than a race presents a wrinkle in examining demographic uptake of Medicaid expansion. Dr. Royce concluded by saying that the next meeting will involve drafting a formal plan for outreach. Board members brainstormed several ways to reach out to community members who may be eligible for expanded Medicaid: • Dr. Jonnal mentioned that Person County is seeing extremely high success in Medicaid enrollment, which she largely attributed to their system of automatic referral of all patients and aggressive follow-up. She suggested that healthcare facilities in Orange County such as UNC, Piedmont Health, and OCHD, should also automate their process, to which Ms. Stewart replied that UNC has a similar auto-referral system, but she is unsure about the aggressiveness of their follow-up. Dr. Jonnal noted that it is possible eligible people are not interfacing with the medical system as they don't have insurance. • Dr. Rodgers suggested that UNC's Student Health Action Coalition (SHAC) could be a good place for outreach, as they serve a lot of un- or under-insured community members. Dr. Nickelson pointed out that the SHAC has separate clinics for medical and dental services, increasing the possibility for outreach. • Dr. Royce recommended sharing information through schools and at PORCH and TABLE to better reach individuals who are food insecure. Dr. Royce noted that Medicaid expansion alone does not solve the issue of access, as there are individuals in Orange County who are undocumented and thus are not eligible for Medicaid but may still be uninsured. Dr. Jonnal added that even with expansion, many people make too much to qualify for Medicaid but not enough to afford to pay for insurance. In addition, Dr. Stuebe wondered whether people know how to even get to/navigate the healthcare system regardless of insurance status. She mentioned that the Chapel Hill and Carrboro School System (CHCSS) has added a mandatory financial literacy class for high school students but suggested that there should be a required healthcare literacy class as well. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 Dr. Stuebe asked Commissioner Fowler to comment on the process of young adults transitioning out of pediatric care and whether they receive guidance on how to find an adult Primary Care Provider (PCP), to which Commissioner Fowler replied that once her patients turn eighteen, she begins regularly reminding them that they can continue to see her until they turn twenty-two but they can also make an appointment with an adult PCP if preferred. She added that once they turn twenty-one, she reminds them that it can take up to a year to get an appointment with a new provider and encourages them to schedule an appointment with an adult PCP as soon as possible. In response to Dr. Jonnal's suggestion of reaching out to folks who are in the justice system, Dr. Stuebe pointed out that incarcerated individuals lose their Medicaid while in prison and must have it reinstated upon release. Ms. Stewart said that Sherrif Blackwood wants to change this practice, which is mandated by the state. Dr. Jonnal observed that carceral healthcare is quite minimal compared to what is covered under Medicaid, and Dr. Baldwin said that in his past practice he saw many prisoners who needed specialty eye care but that it was a clunky process. Dr. Royce shared that there is an online dashboard where board members can track Medicaid enrollment from month to month, which can be found here: https://medicaid.ncdhhs.gov/reports/dashboards/enrollment-dashboard The other two committees — Behavioral Health and Connections to Community Support—will each convene for the first time during the month of May. V. Approval of the April 24, 2024 Agenda Motion to approve the agenda of the April 24, 2024 BOH meeting was made by Dr. Lee Pickett, seconded by Commissioner Amy Fowler, and carried without dissent. VI. Approval of March 27, 2024 Minutes Motion to approve the minutes of the March 27, 2024 BOH meeting was made by Dr. Alison Stuebe, seconded by Dr. Lee Pickett, and carried without dissent. VII. Consent Agenda Mr. Bagby applauded the detail of the financial report and said that the highlights and comments by Frederick Perschau, Finance and Administrative Services Director, preemptively answered all his questions. Motion to approve the consent agenda was made by Dr. Alison Stuebe, seconded by Commissioner Amy Fowler, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 Vill. Educational Sessions A. Opioid Advisory Committee Update Ms. Stewart provided an update on the Opioid Advisory Committee's activities since mid-2022. Some highlights of her presentation are below: • Ms. Stewart mentioned that the last major update to the board on the Opioid Advisory Committee's activities had been in Fall 2022, though she had provided minor updates since then in her monthly Health Director's Reports. • In July of 2021, North Carolina was awarded $2613illion in funding to help provide relief for those affected by the opioid epidemic. During planning for the Opioid Settlement, Orange County Commissioner Sally Greene served on the 5-5-5 Committee, comprised of five county commissioners, five county managers, and five county attorneys from across the state. This committee was instrumental in deciding how to allocate the settlement funds. Orange County will be receiving over$12Million total in funding. • Ms. Stewart provided an overview of the funding allocation agreement, including a memorandum of understanding (MOU) for how the funds were to be spent and the requirements for reporting impact and outcomes. Another requirement is hosting an annual meeting to get feedback from community members. Ms. Stewart reminded the board that this year's annual meeting would take place on Saturday April 27'n • UNC and the OCHD already had an existing opioid task force prior to the settlement. The BOCC has formalized this task force into the Opioid Advisory Committee and now appoints the committee members. Based on community needs, the BOCC has added two additional at-large members to the committee, as well as a representative from the Department on Aging, as elderly people who use opioids were initially overlooked as a population. • The BOCC is also responsible for making the final decisions about how to use the settlement funds, including choosing between two plans for strategies: Option A, which is a set of twelve clear-cut mitigation strategies meant to help people who are in active use and addiction, and Option B, which is more abstract and focused on preventative strategies. Ms. Stewart shared that most NC counties have adopted Option A, though the commissioners retain the ability to change plans if they so choose. Dr. Royce asked how the BOCC decided which option to pursue, to which Ms. Stewart explained that they looked at the data and decided to focus on individuals in current use. Commissioner Fowler added that the BOCC selected Option A in part because it would be faster to initiate and gave the BOCC more initial control over spending, while Option B would have required significantly more time and community input to set up. • Ms. Stewart shared that the Opioid Advisory Committee met for the first time in January and that she is serving as interim coordinator, but they are hiring someone to take over this role. She added that so far, a major responsibility of the committee has been managing settlement payments but that there is a plan to begin an assessment of community needs and gaps. • While reviewing the settlement deposit history, Ms. Stewart explained that there are multiple waves of the settlement, as the Attorney General went after multiple companies and won. Mr. Bagby asked why two payments for the same amount were received on the same day and Ms. Stewart replied that this was a coincidence due to the payment schedules, and that the payments came from two different sources. • In response to Dr. Stuebe's question about a lack of payments from Purdue Pharmaceuticals, Ms. Stewart said she wasn't sure where their payments were, but she anticipated that they would show up soon. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 • Mr. Bagby asked how the BOCC had decided to allocate the funding, to which Ms. Stewart replied that the BOCC received applications from community partners, which were reviewed by the Advisory Committee. The Advisory Committee made recommendations and the BOCC then selected proposals. She added that the first year of funding approvals required some trial and error, but the parameters are clearer now. • In response to Dr. Royce's question about evaluation and accountability for the funded opioid programs, Ms. Stewart explained that it is a requirement for all programs receiving opioid settlement funds to report annually about their processes and impact. • Dr. Royce asked if the funds were designated only for opioid use or if they could also be used for programs targeting other substances based on need, to which Ms. Stewart replied that programs must be opioid-targeted but are allowed to address other substances tangentially. • Mr. Whitaker asked about municipal areas in the county and whether they receive funding and representation for allocation decisions, as the MOU is primarily county centric. Ms. Stewart explained that some larger municipalities statewide are receiving funding, but most are not. However, municipal law enforcement agencies are represented on the Advisory Committees and are in contact with elected officials, so municipal representatives are not locked out of the loop. Municipal elected officials are also required to be invited to all annual community meetings. • In response to Dr. Crandell's question about funding for law enforcement to help address the influx of illegal Fentanyl, Ms. Stewart said that provision of Fentanyl test strips to community members is covered by opioid settlement funding. • Dr. Jonnal wondered why there are no alcohol company settlements given the related harms, to which Commissioner Fowler replied that ABC Stores are required to help fund treatment and prevention programs, adding that the El Futuro, El Centro, and the Campus Community Coalition (CCC) are partially funded by the ABC Board. • Dr. Stuebe mentioned the Horizons Program, which is a substance treatment program in Orange County focused on pregnant and parenting individuals which has both in- and out-of-county participants; Ms. Stewart said that once you are in Orange County, community supports are available to you regardless of your county of origin. • Ms. Stewart concluded her presentation by sharing that the OCHD has made an offer to fill the Harm Reduction Coordinator role, and that employee will begin on May 4t" B. 2024 Board Retreat Evaluation Jean Phillips-Weiner, Board of Health Strategic Plan Manager, provided an overview of the data and results of the evaluation survey for the 2024 Board Retreat. Some highlights of her presentation are below: • Five of the eleven board members (45.45%) responded to the survey. Those who responded seemed to be satisfied overall with their retreat experience. However, several respondents felt that at least one of the retreat activities (such as the adjudication training or the discussion of priority areas) should have been longer or shorter. All respondents strongly agreed that they had gotten to know another board member better during the retreat and that they had learned something that would be useful to them as a board member going forward. • Dr. Pickett expressed concern about the low response rate, wondering if perhaps two thirds of the board members had strongly disliked the retreat and simply didn't want to say so. Several other board members chimed in that they felt this was unlikely, as generally people with strong negative feelings are more likely to respond to anonymous or semi-anonymous surveys compared to those who were relatively satisfied. Board S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 members agreed that they would like the response rate for similar surveys to be higher in the future. • To improve the response rate, Dr. Stuebe recommended that time to complete the evaluation be built into the retreat itself, to which several board members agreed. Ms. Stewart explained that this had been the plan but due to a change in software providers earlier this year, the survey was not able to be made available until after the retreat. • Dr. Fowler suggested that, since one of the items had mixed responses (some respondents felt it was not enough time, some felt it was too much), perhaps more preparation materials could be made ready ahead of the retreat to allow everyone to come prepared, which might reduce the time actively spent on the activities during the retreat but still allow people to invest as much time as desired. Dr. Baldwin also suggested that the mixed response may have seemed less pronounced if there had been more respondents. IX. Actions Items A. Letter of Support for Vape Shop Land Development Ordinance The former Health Equity Committee has been drafting a letter of support recommending that the Orange County Planning Board, the Orange County Planning Department, and the Orange County BOCC adopt a Land Development Ordinance (LDO) restricting the opening of new tobacco, vape, and hemp shops to at least 1,000 feet from places where youth congregate, such as schools, libraries, and parks. Ms. Phillips-Weiner reviewed the draft letter of support with the board. Mr. Whitaker clarified that initial feedback on the letter had been only from the former Health Equity Committee and that this was the first time the full board had seen the letter, which Ms. Phillips-Weiner affirmed. Dr. Jonnal asked about potential opposition to the LDO; Commissioner Fowler explained they expect very little but if there was any it would likely be from people who run vape shops. Mr. Bagby added that other counties, Wake and Cumberland, have already adopted similar ordinances. Mr. Whitaker suggested that a local Chamber of Commerce might oppose this LDO as a representation of business interests and that it would be very powerful if the BOH could get their buy in on the LDO. Dr. Jonnal mused that opposing the LDO is tantamount to admitting that you want to sell tobacco to children, so she is not sure who would do so openly. Dr. Fowler added that she believes the BOCC will likely easily approve this, and the challenge will then be moving on to pass something similar in the municipalities (Carrboro, Chapel Hill, and Hillsborough). In response to Dr. Crandell's question about whether an LDO would stand up in court as opposed to being overridden by state law, Commissioner Fowler explained that several other NC counties and municipalities have used this strategy, and using zoning regulations is currently considered the best practice for managing tobacco sales in NC. Dr. Stuebe asked about the potential inclusion of libraries and places of worship and if there was a precedent for this. Mr. Whitaker said this is a mixed bag, and Ms. Phillips-Weiner chimed in to explain that the committee built their letter based on sample language from existing LDOs from other counties and municipalities, which may include schools, libraries, green spaces/parks, residential areas, and halfway houses/rehabilitation facilities. Because some S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 committee members expressed discomfort, places of worship were not included in the BOH's draft letter. Mr. Whitaker expressed that he liked the formatting of the letter to include an appendix with some of the more technical details, so any readers have the option to engage with the intricacies of a policy like this based on their personal preference. In response to Dr. Crandell's question about the impact of this LDO and whether any facilities would be in immediate violation, Mr. Bagby clarified that the LDO would only apply to new facilities. Mr. Whitaker added that existing facilities would be affected only if they applied for a change to their operations, for example a shift in their product sales. Dr. Jonnal asked how many new facilities might be being planned, to which Commissioner Fowler said it is likely not very many in the unincorporated county, but if Orange County passes an ordinance and the municipalities follow suit, then it would have a greater impact. Dr. Stuebe observed that residential land use would likely have the greatest impact since there are homes or apartments everywhere and added that she is a fan of all things zoning so she is excited to see what happens. Overall, the board liked the language of the letter draft, and few revisions were requested. Because the letter would be signed only by the chair, Dr. Aparna Jonnal, a few minor edits were made for the sake of clarity (e.g., "On behalf of the Orange County Board of Health, I am writing" vs. "We are writing"). Motion to approve the letter and forward it to the Orange County Planning Board, the Orange County Planning Department, and the Board of County Commissioners was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. Dr. Rachel Royce abstained from the vote. X. Reports and Discussion with Possible Action A. Vending Machines Update Ms. Stewart provided an update on the board's request to incorporate more healthy food options into county vending machines. Unfortunately, due to a reduction in foot traffic in county buildings related to the pandemic, the company that stocks the vending machines has decided it is not worthwhile to regularly refill the vending machines with any food, healthy or otherwise. Though the county has pursued an alternative contract, they were not able to find another vendor to replace the original one. Therefore, the county is planning to remove vending machines from all county buildings. Several board members suggested co-opting one or more of the vending machines and turning it into a harm-reduction station. Dr. Stuebe recommended stocking items like Narcan, condoms, and Plan B (Morning After) pills, while Dr. Royce encouraged stocking stress balls and jump ropes. Ms. Stewart clarified that Plan B is now available over the counter, which Commissioner Fowler and Dr. Stuebe affirmed. Ms. Phillips-Weiner noted that UNC has at least one vending machine that offers Plan B for less than what it costs at a pharmacy. Mr. Bagby mentioned that he has observed that schools generally have healthier food options in their vending machines compared to county government buildings (e.g., nuts, low-sugar, and S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 low-sodium options). He added that he had not really considered clients before, instead primarily thinking about employees/staff. He said that, since the health department would no longer have vending machines, he would like the board to help provide some healthier snacks for staff since the health department does so much for the Board of Health and the community. Dr. Jonnal seconded this idea and asked if there was a pantry somewhere that the board could keep stocked, and Dr. Rodgers echoed that UNC offers something like this for students; Ms. Stewart thanked Mr. Bagby and replied that she would be happy to identify a space to serve as the snack pantry for staff. B. Bi-Annual Advisory Board Summary Report Ms. Phillips-Weiner presented her report to the board. The report comprises twenty-one (21) committees, coalitions, or organizations ("boards") active in Orange County, the local region, or the state of North Carolina over the past six months. Each board in the report is regularly attended by at least one OCHD staff member. To maximize the utility of the report, work completed by these boards was organized based on BOH priorities. Ms. Phillips-Weiner encouraged board members to make suggestions for ways to make the report more user- friendly or for any boards/organizations with which they would like to see staff collaborate in the future. Dr. Jonnal asked if other Orange County boards are required to do a similar report, as she feels this could help reduce redundancy and increase collaboration; Ms. Stewart replied that she does not know of any other boards which produce a similar report. Several board members had ideas for ways to use this report more effectively, including Dr. Stuebe suggesting making a searchable version available on the health department website and Dr. Royce suggesting that the most recent copy of this report be shared with new board members during orientation. Ms. Stewart expressed that the primary idea behind this report is to help BOH priority committees remain aware of what work is being done in the county, create opportunities for partnership or collaboration, and avoid duplication of efforts. Mr. Bagby suggested that there should be more health department representation at El Futuro, as he felt that the Latino/a/e population were not reflected in the report. Ms. Stewart assured him that the health department does collaborate with El Futuro, such as through Family Success Alliance (FSA), but that currently no members of health department staff sit on any El Futuro boards. She added that the report is not exhaustive of every health department partnership. C. Media Items Ms. Phillips-Weiner briefly summarized the articles in the meeting packet. Article topics included a case of bird flu identified in a dairy herd in North Carolina, a new initiative at Rex Women's Center to improve health outcomes for postpartum individuals by giving them bracelets saying "I Gave Birth", Durham county applying for the Federal Government's universal meals program to provide free breakfast and lunch to all public-school students in the county, a new NCDHHS "Fight the Bite" campaign to raise awareness of tick and mosquito safety, that Medicaid expansion enrollment has surpassed 400,000 statewide, the EPA's passage of more stringent standards for PFAs ("Forever Chemicals") in drinking water, that advocates are pushing to allow expanded abortion access in NC, and that OCHD is preparing for measles cases to show up in NC given the recent rise in cases nationwide. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ April Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH April 24, 2024 Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. D. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • Bonnie Hammersley, the County Manager, has recently announced that she will be retiring in mid-July. • Earlier that morning, there was a plane crash at RDU involving a former board of health member, Dr. Paul Chelminski. Both he and the pilot are okay, but Ms. Stewart wanted to alert the board in case any of them wanted to reach out. • Ms. Stewart recently attended the Health Director's Legal Conference at UNC. During the conference, OCHD was used as a case example of best practices regarding the recent dispute between Coronato's Pizza and Oasis Cigar Bar. • The health department is entering a hiring freeze, during which only essential/direct care positions will be filled. Grant-funded positions are not affected. She added that currently there are only 8 vacancies of 121 positions and that no positions are being cut at this time. Mr. Whitaker asked about revenue-generating positions, to which Ms. Stewart replied that it is possible to appeal if you believe a position is essential but being revenue-generating does not make it an exception. In response to Dr. Stuebe's question about why the budget is short, Ms. Stewart explained that it is related to a deficit from the Medicaid Hold Harmless Agreement, from which the County had expected to receive a reimbursement but is instead being required to make a $2.2 million payment. • The adjudication hearing needs to be rescheduled, as the appellant's legal counsel was unable to make the previous date. Mr. Whitaker asked if the appellant had surrendered their right to appeal by not meeting the deadline imposed by the legal statute, to which Ms. Stewart replied that she had spoken at length with County Attorney Morgan Pierce, who recommended honoring the request to reschedule as a best practice to ensure equity to the appellant. Based on the availability of the board members, Monday May 13t" at 6:30pm was chosen for the rescheduled hearing. IX. Adjournment A motion was made by Commissioner Amy Fowler to adjourn the meeting at 9:07 p.m., was seconded by Dr. Lee Pickett, and carried without dissent. The next Board of Health Meeting will be held May 22, 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/ April Page 9