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HomeMy WebLinkAboutApproved Minutes of May 22, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 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 May 22, 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; Erica Pettigrew, Medical Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Thomas Privott, Environmental Health Supervisor; Libbie Hough, Communications Manager; McKayla Creed, Healthy Carolinians Coordinator; Kimberly Jones, Social Worker I; La Toya Strange, Administrative Support I; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTSIVISITORS PRESENT: Heather Pack, Celsi Simon, and Gayane Chambless. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employee in attendance: Kimberly Jones — Social Worker I for Family Home Visiting. II. Public Comment for Items NOT on Printed Agenda: Jean Phillips-Weiner, Board of Health Strategic Plan Manager, invited board members to the upcoming Our State, Our Wellbeing Statewide Suicide Prevention Forum at UNC on Thursday June 13, 2024. She explained that 15 coalitions across 24 North Carolina counties (including Orange) have been gathering for the past year to plan initiatives to prevent suicide in their communities and that the forum is an opportunity to share their work with the public. Registration is $90 per person. Dr. Erica Pettigrew, Medical Director, re-introduced herself to the board since it has been a while since she has attended a Board of Health meeting. III. Board Comments Dr. Davia Nickelson Dr. Nickelson shared that there will be a free dental clinic and health fair at Pine Grove Missionary Baptist Church on June 151". The event will include free cleanings, fillings, extractions, blood glucose checks, cholesterol checks, and more. In response to Dr. Royce's question, Dr. Nickelson confirmed that there will be Spanish-speaking providers at the event. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 Dr. Lee Pickett Dr. Pickett asked if there will be time during the meeting to discuss the recent NC bill prohibiting masking in public spaces, as she has concerns; Ms. Stewart confirmed that she included an update on this bill in her Health Director's report and the board can discuss it then. Dr. Rachel Royce Dr. Royce gave an update on the status of Medicaid Expansion enrollment, sharing that 60% of Orange County enrollees enrolled in the first month and likely most of these enrollees were automatically rolled over from partial coverage Medicaid plans into full coverage. She added that enrollment growth has been slowing down each month, and Dr. Jonnal observed that the state's enrollment numbers also appear to be slowing down. Dr. Royce provided board members with a datasheet summarizing current month-to-month Medicaid Expansion enrollment trends. Dr. Brian Crandell Dr. Crandell commented on the adjudication hearing, which was held on May 13'", saying that it was an interesting experience with lots of thoughtful discussion. He observed that it seemed to take the board a little while to work out what they could specifically do within the scope of the hearing. Dr. Crandell also shared that he was the dissenting vote in the 5-1 ruling and that he voted in favor of the appellant not because he felt that Environmental Health did anything wrong or that there was a question of how much distance should be permitted from a termite-treated structure to a well, but because he believes more than one thing can be true and that the wording as written in the regulations had enough room for interpretation that he felt there was validity in their appeal. Dr. Aparna Jonnal Dr. Jonnal also commented on the recent hearing, adding that she felt the experience was extremely educational and that she had been surprised by the difficulty of deciding the case. She added that she was very impressed with the board members involved in the hearing and took a moment to specifically thank Mr. Whitaker for his grace and guidance. Keith Bagby Mr. Bagby shared a short video presentation from the recent Orange Partnership event, Take Down Tobacco Day, which was held at A.L. Stanback Middle School on April 12, 2024. IV. Priority Committee Updates The new Behavioral Health Committee met on May 6, 2024. Dr. Nickelson provided an update, explaining that the committee touched on many topics and isn't sure yet what to hone in on. Some of the topics that the committee discussed include suicide and Mental Health First Aid, screentime and its impact on mental health, loneliness and social connectedness, lack of mental health clinicians, and the lack of diversity in mental health clinicians. In terms of equity/justice, the committee is looking into the demographics of those affected by suicide in Orange County, discussed ways to ensure that Mental Health First Aid trainings are provided to people from diverse walks of life (e.g., Meals on Wheels volunteers, barbers, faith leaders) to increase the S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 reach of mental health support, and plans to consider factors that may influence the diversity of mental health providers. The new Connections to Community Support Committee met on May 15, 2024. Mr. Bagby provided an update on the meeting, sharing that they discussed affordable housing and homelessness, zoning and housing density, access to healthy food, what resources already exist, and committee approaches and scope. The committee focused primarily on access to affordable housing and healthy food, touching on access to farmer's markets and the availability of SNAP/EBT benefits at said markets. Mr. Bagby shared a flyer about local farmer's markets and shared that many offer"double bucks" for customers paying with SNAP/EBT, meaning a $20 voucher will buy $40 worth of food. The committee plans to invite Dr. Stuebe's husband, who is a zoning subject matter expert, to speak with them about zoning and affordable housing at a future meeting. Mr. Bagby added that the committee would like to learn from community members about what they need, the resources they are aware of, and how much support is available in specific situations, for example whether incarcerated individuals are made aware of housing resources prior to their release. Mr. Bagby also mentioned a recent community health fair at DSS, Be Well, which he felt lacked a final takeaway and recommended creating a one- page summary of the resources available. Dr. Stuebe added that a piece of paper can help but she's not sure it replaces assistance from an actual person. Regarding equity/justice, the committee has concerns about housing discrimination and affordability, particularly that Black people in Orange County are disproportionately cost-burdened (more than 30% of their income goes to housing) and are more likely to be denied a mortgage compared to people of other races. Mr. Bagby added that he is interested in tiny homes as an option, to which Commissioner Fowler mentioned the organization Pee Wee Homes, with which Orange County has worked in the past. Dr. Rodgers added that tiny homes have been priced out of many people's price ranges, especially those experiencing homelessness. Dr. Royce asked about eviction diversion, as Durham County's city manager recently added more money to their eviction diversion program. Commissioner Fowler replied that this is also available in Orange County, and Dr. Royce suggested advocating for more funding as a prevention measure. Dr. Jonnal chimed in that housing is a clear priority to virtually everyone in the county, and the first step is for the committee to learn from experts about ways that they can be helpful. Commissioner Fowler mentioned that the Housing Department is working on several areas to address housing, including eviction diversion, rental assistance, and homeownership; she added that it would likely be beneficial to hear from the housing department about initiatives. She added that the need outweighs the budget, and Dr. Stuebe said that the committee hopes to help stem need down the line by learning about and addressing zoning. The Access to Care Committee will next meet in early June. V. Approval of the May 22, 2024 Agenda Motion to approve the agenda of the May 22, 2024 BOH meeting was made by Dr. Lee Pickett, seconded by Dr. Rachel Royce, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 VI. Approval of April 24, 2024 Minutes Motion to approve the minutes of the April 24, 2024 BOH meeting was made by Dr. Brian Crandell, seconded by Dr. Alison Stuebe, and carried without dissent. VII. Educational Sessions A. Child Fatality Prevention Team Annual Report Dana Crews, Community Health Services Director, provided the annual update on the Child Fatality Prevention Team Report. Some highlights of her presentation are below: • As the board had previously talked in-depth about concerns about housing insecurity and homelessness, Ms. Crews shared that a parent experiencing homelessness also impacts their children, particularly when the children are in the foster system. She explained that a parent experiencing homelessness can prevent reunification and sometimes parents struggle to work with landlords due to a history of substance use disorders, felony convictions, or eviction. Dr. Jonnal shared that she sometimes sees foster children with behavioral issues being brought into the ER by Department of Social Services (DSS) workers when they have nowhere else to go, and that these children just stay indefinitely in empty rooms in the ER. • Ms. Crews explained the purpose and goals of the Child Fatality Prevention Team (CFPT). She clarified that the team reviews cases of fatalities for children (0-17yrs). Cases related to suspected abuse or neglect, are reviewed by the Community Child Protection Team (CCPT) at DSS. • While covering CFPT funding, Ms. Crews explained that much of the funding wasn't spent during the COVID-19 pandemic, as it was previously used for refreshments at in- person meetings. As the funding does not roll over, they used the unspent funds from the past year to purchase car seats for families in need. • No systems issues were identified that could be addressed with policy changes, but many of the fatalities in the report involved a parent leaving the hospital without their child, so priorities include ensuring that there is follow-up with families after leaving the hospital and providing bereavement and mental health resources, especially those culturally appropriate for Latino/a/e communities. • In response to Dr. Royce's question about detailed information and numbers, Ms. Crews explained that she did not have them tonight but could get them. • Dr. Stuebe was interested in child fatalities related to birth defects or perinatal conditions, and asked several questions, including what qualifies as a birth defect, when did the birthing parent receive prenatal care, and are the birthing parent's medical records available. Ms. Crews explained that some of this data is available but often parts of it are incomplete or missing, particularly the birthing parent's records. Dr. Royce added that the data from the medical portions of the birth and death certificates should give a clear idea of the condition, so long as the CFPT receives the medical part of the birth certificate. Ms. Crews confirmed that the CFPT receives both the medical part of the birth certificate and the death certificate, but this is often missing details of conditions affecting the birthing parent. • In response to Dr. Crandell's question, Ms. Crews confirmed that the age range covered by the report is from birth to 17, and that CFPT does investigate accidental deaths. She S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 shared that the previous year included a death by drowning, a death caused by a child being left in a hot car, and a death by suicide. • Dr. Royce asked what the leading cause of death was, to which Commissioner Fowler replied it appears to be perinatal/birth defects. Ms. Crews added that traffic accidents are an area of concern and that many parents need car seats. • Dr. Stuebe asked if the CFPT tracks preventable vs. unavoidable deaths, to which Ms. Stewart replied that this data is aggregated at the state level. She added that a lot of the recent child fatalities were related to Sudden Infant Death Syndrome (SIDS) and co- sleeping (i.e., a parent and a child sleeping in the same space), so educational campaigns have been targeted towards curbing deaths from these causes. Ms. Stewart commented that because there have been so many deaths related to perinatal causes in the past few years, a colleague at UNC Gillings is investigating whether COVID-19 infection or receiving a COVID-19 vaccine could be causing an increase in perinatal disease. Commissioner Fowler and Dr. Stuebe both suggested the increase in alcohol consumption during the pandemic seemed like a more likely factor. • The board clarified the total number of fatalities that the CFPT investigated in 2023: a total of 19, comprised of 13 deaths in 2022 and 6 from previous years. • In response to Dr. Rodger's question about organizations to which individuals can donate new car seats, Ms. Stewart said we would be hearing from one next (Safe Kids Orange). • Ms. Crews outlined some upcoming changes to the CFPT, including that the team will be getting a designated office, and that they will no longer be required to review every death (including deaths from perinatal causes). Ms. Stewart explained that the goal of the CFPT is to identify and advocate for policy changes that will reduce child fatalities, so generally the team focuses on deaths that are likely preventable. However, Dr. Royce expressed concern about this approach, as she felt it could lead to environmental exposure trends being overlooked. Dr. Stuebe shared that there is a statewide committee that completes surveillance related to birth defects, so surveillance will continue but it seems that the county resources are being prioritized based on need. She added that unless the birthing parent's medical records are available then it becomes a moot point anyway. Ms. Crews added that the CFPT will still have the option to request to review any case beyond what they are sent, including perinatal cases. • In response to Mr. Whitaker's question about gun deaths, Ms. Crews explained that there was a recent case of a 17-year-old boy who died in a gun related homicide, and the CFPT concluded that all the necessary supports had been in place, it was an unfortunate instance of poor choices. • Commissioner Fowler asked about deaths caused by family pets, to which Ms. Crews replied that she hasn't seen a case recently but has in the past. Dr. Jonnal added that pets frequently cause non-fatal harm to children. Dr. Pickett advised that parents should supervise their children and pets whenever they are interacting. B. Safe Kids Orange County Anna Stormzand, Pediatric and Adult Injury Prevention Coordinator for UNC's Trauma Program, presented on the Safe Kids Orange County program. Her colleagues, Celsi Simon, Assistant Fire Marshall, and Gayane Chambless, Program Director for Orange Partnership, also joined her for the presentation. Some highlights of her presentation are below: • Ms. Stormzand provided an overview of the Safe Kids program. She shared that Daniel Roberson from the sheriff's office is the current chair, Celsi Simon is the current vice- S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 chair, that Safe Kids Orange is funded entirely by grants and local funding, and that much of the labor is performed by volunteers. Ms. Stormzand explained that a major priority of the organization is to go out to the folks with the least access/resources, rather than only serving those people who contact them. • Per the CDC, the leading causes of unintentional child injury nationwide include falls, traffic accidents, suffocation, and gunshot wounds. Ms. Stormzand clarified that the word accident' may imply that the injury was not preventable, so they prefer the term unintentional injury.' • Safe Kids Orange is most well-known for their car seat programs; Safe Kids both distributes and helps install car seats. Since August 2021, they have distributed more than 487 car seats to over 337 families, with 153 car seats distributed in 2023 alone. Ms. Stormzand shared that about half of all car seats are installed incorrectly, and that they check or install car seats and provide education to parents who receive a citation for an incorrectly installed car seat. • Ms. Chambless spoke about the home safety program, sharing that the program covers things like safe medication storage and disposal, and distribution of safety tools like baby gates, doorknob locks, and gun locks. She mentioned that there are several organizations working to distribute gun locks in the community, including Safe Kids Orange, local law enforcement, and DSS. She also highlighted OCHD's previous initiative within the dental department to educate patients about safe medication storage and disposal, including provision of medication lockboxes. However, there is not currently funding to support this, though they are seeking more. Ms. Chambless provided board members with an educational handout about safe medication storage. • Regarding gun safety, Ms. Stormzand shared that the Orange County Firearm Safety Taskforce came out of Safe Kids, and that they also assist with distributing cable gun locks. They are collaborating with the Orange Resilience Initiative (ORI) to prevent gun deaths and suicide, especially among veterans. In response to Dr. Royce's question, Ms. Stormzand explained that a cable gun lock is like a small bike lock that goes through a gun to prevent it from firing. She added that this is not the most effective prevention tool, but one that is highly accessible. • Ms. Stormzand briefly touched on initiatives to promote water safety, fire and kitchen safety, and bike safety, and shared that there is a Safe Kids YouTube channel to help reach students in the schools, which can be found here: https://www.Voutube.com/(cb_SafeKidsOrangeCounty. She concluded her presentation by saying that the organization focuses on mental health, suicide prevention, and substance misuse as root causes for many of the injuries and fatalities they see. • Commissioner Fowler shared that during Med School she completed an internship that involved checking whether passing cars had correctly installed car seats, and the rates then were comparable to those of the present (approximately 67% incorrect and 33% correct). Dr. Rodgers applauded the Chapel Hill Fire Department for assisting her with installing a car seat for her grandson about ten years ago. Ms. Crews mentioned that several Family Success Alliance and Family Home Visiting staff members are now trained to install car seats, and that completing the training takes four days. • In response to Dr. Stuebe's question about a collaboration with Vision Zero, Ms. Stormzand explained that she works on the Vision Zero task force to help change the environment to be safer for cyclists and pedestrians, adding that signs and education are not effective interventions. • Dr. Crandell asked about Swim with Charlie, a program that offers two free weeks of swim lessons to second graders on an opt-out basis. Ms. Stormzand explained that Safe Kids promotes this program and that they are active in Orange County, but not S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 necessarily the surrounding counties, as indoor pools are needed to accommodate the number of students in the program over the course of the year. Chatham County had eight fatal drownings in Jordan Lake last year of people in their teens and older. • Dr. Jonnal said that the unpaid labor done for the program bothers her, as it is important work, and it should be compensated. She added that people should not have to rely on the goodness of volunteers to ensure the safety of their children and free installation should come with the purchase of a car seat. Ms. Stormzand said that many companies do offer installation for an upcharge. She also recommended that people buy the cheapest car seats available, as they all do the same basic thing and the more expensive car seats just have extra bells and whistles. VIII. Actions Items A. Adjudication Hearing Decision Jean Phillips-Weiner, Board of Health Strategic Plan Manager, presented the writeup of the decision from the adjudication hearing held on May 13 to the board. Dr. Jonnal reminded the board that the decision had been made and that the hearing is closed, so this was not a time for additional opinions or testimony. Rather, board members should review the language of the decision for grammatical errors and/or ambiguous content. Dr. Rodgers confirmed that the write-up had been completed with consultation from the legal team and clarified that the goal of this review was to make minor edits and approve the final decision. Mr. Whitaker expressed that he felt the write-up was comprehensive and clear. He suggested that the wording in page 2, section II, bullet point 4, be revised from "the proposed carport is unable to meet the required setback" to "the proposed carport does not meet the required setback" as he felt the original wording was a little unclear and this added clarity. The wording on page 1 under"Matter" was also changed to match. Victoria Hudson, Environmental Health Director, mentioned that she felt many of the verbs in page 2, section II, were passive and should be changed to active voice. Mr. Whitaker asked if she felt there was a degradation to the integrity of the report by using passive verbs, to which Ms. Hudson clarified that she feels it should read "the appellant proposed a carport that does not meet the required setback" as the carport did not propose itself. Commissioner Fowler commented that she felt the passive voice was more neutral, which Dr. Crandell seconded. Changes from passive to active voice were not made. Dr. Jonnal suggested removing the word "have" on page 1, under"Matter," so the text reads "the applicants appealed a decision" rather than "the applicants have appealed a decision." Dr. Crandell asked if the phrase "regardless of foundation construction type" was appropriate to use in both page 1, "Background," and page 2, section II, as he felt this was an interpretation of the group and would be subject to scrutiny. Ms. Phillips-Weiner clarified that the language was copied directly from a table in the Orange County Groundwater Protection Rules and edited only to make it flow in prose, which Mr. Whitaker corroborated against his copy of the text. The original phrasing was retained. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 Motion to approve the hearing decision with the aforementioned edits and forward it to the appellant was made by Dr. Shielda Rodgers, seconded by Mr. Tony Whitaker, and carried without dissent. IX. Reports and Discussion with Possible Action A. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. She shared that it was fifteen items, including local, state, and national news, and that her initial goal is to get a sense of what the board members were interested in and what their preferences are for the media packet. Mr. Bagby requested fewer items in the future, as he found the contents a bit overwhelming. He recommended including some quick hits of hot news or things that the board may have missed. Dr. Jonnal said that she loved having a comprehensive overview of the upcoming events and enjoyed being able to look at the flyers. Ms. Stewart chimed in that upcoming community events are also highlighted on the back of the monthly Board of Health agenda. Dr. Stuebe said that she felt the packet was very comprehensive but she felt it may have been preferrable to include some of the articles as hyperlinks so she could pull up the webpages instead of having to review the full PDF. Ms. Hough suggested that in the future she could include some hyperlinks with summaries. Dr. Jonnal suggested that in the future Ms. Hough should prioritize including news from Orange County, and that state and national news can be supplemented with hyperlinks so they're still accessible without needing to scroll through the full articles. Dr. Rodgers seconded this idea. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • The first Opioid Settlement Community Meeting took place on Saturday April 27t". It was a full day with 65 participants, including several board members, who heard from mental health providers, community members with lived experience, and community organizations working to address the opioid crisis. • Last Wednesday, the health department reinstated the healthcare providers' breakfast. This is an annual event to engage with local providers and discuss emerging issues relating to health. Two topics discussed at this year's breakfast include a presentation on immunizations for pertussis and measles by Dr. Erica Pettigrew, Medical Director, and a presentation by Carla Julian, Public Health Nursing Director, on the Student Health Action Coalition (SHAC) event with which OCHD assisted in March to ensure K-12 students in Orange County met vaccine and physical exam requirements for school attendance. • Several OCHD staff members have recently received awards for their service: S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 o Two staff members — Bronson Brim, Public Health Nurse, and Amber Benner, Nutrition Program Manager—were recognized with the Orange County "I Have It!" Award. o Two staff members —Alex Rimmer, Environmental Health Supervisor, and Marcy Williams, Health Promotion and Education Services Manager—were recognized with the William Bill Smith Outstanding Public Health Award at the Eastern District North Carolina Public Health Association Conference. They were recognized for their work educating Orange County bars that serve food about the new licensing and inspection requirements. • Ms. Stewart shared a legislative update on House Bill 237, the Unmasking Mobs and Criminals Act. She explained that this is not a new bill, but a reinstatement of one from 1953 that aimed to curb membership to the Ku Klux Klan, which had been amended in 2020 to allow public medical mask use during the COVID-19 pandemic. Ms. Stewart added that support for the current bill is falling largely along party lines, and there is some strong opposition to prohibiting public use of medical masks. Dr. Pickett commented that some people are questioning if this law may serve as a violation to the Americans with Disabilities Act (ADA) and asked if Orange County had the option to allow masks for medical reasons, as counties are allowed to implement more strict regulations than the state for the sake of health. Dr. Stuebe replied that she was unsure if this would qualify as stricter since the purported basis of the law is to prevent felonies. Commissioner Fowler agreed, saying that the text of the law implies that a ban on medical masks would only be enforced if someone is committing a felony. Dr. Stuebe expressed concern about disproportionate enforcement targeted towards Black and brown people, which Dr. Rodgers echoed, saying that people who look like her may be harassed for"masking while Black." Dr. Pickett said that people who are sick won't wear masks if they're afraid of getting into trouble and Dr. Rodgers added that if masking isn't available then people who are immunocompromised may be forced back into total isolation, sharing an anecdote of a friend who is undergoing chemotherapy, and both wears a mask and avoids entering crowded public spaces. Dr. Royce mentioned that if the intent of resurrecting the bill is to target political protestors, then this seems like a danger to anyone engaging in any form of protest and may lead to their being physically harmed or arrested. Dr. Jonnal mentioned that the bill has been around for a long time without being abused, but that it seems more menacing now. Board members generally agreed that they didn't expect enforcement of the bill to be perfect. Ms. Stewart said that law enforcement in Orange County has historically been uninterested in enforcing anything to do with masks but that the bill could become problematic. She mentioned that there is the possibility that challenges to the bill will be related to ADA discrimination, and that the situation will need to be monitored. Dr. Rodgers added that it may come down to who specifically is doing the enforcing. Dr. Royce asked if Orange County could write their own version of the law, which Ms. Stewart expressed caution about, saying it would be important to work with law enforcement as it hurts the credibility of public health when there's a law that isn't enforced. In response to Dr. Crandell's question, Ms. Stewart clarified that Orange County cannot have Taxer regulation than the state laws or create exceptions to state laws unless permitted as a specific test case. Several board members who work in healthcare expressed that their patients mask for medical reasons, including in cancer hospitals and nursing homes. Commissioner S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ May Page 9 MINUTES ORANGE COUNTY BOARD OF HEALTH May 22, 2024 Fowler said that this would increase the risk of respiratory disease in the population, including elderly and immunocompromised individuals. Dr. Stuebe added that the bill specifically covers locations including public ways, premises, enclosures, or houses of any other person or municipality, adding that the intent seems to be to avoid allowing someone going up to another person's home to rob or intimidate them. She said that despite the apparent good intent, she does still worry that because more people are regularly wearing medical masks than were pre-COVID, enforcement will not look the same as it used to. X. Adjournment Mr. Bagby shared a form related to a medical card with the board and requested their input, saying that Ms. Phillips-Weiner would share details of the form with them by email tomorrow. A motion was made by Dr. Alison Stuebe to adjourn the meeting at 9:04 p.m., was seconded by Commissioner Amy Fowler, and carried without dissent. The next Board of Health Meeting will be held June 26, 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/ May Page 10