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HomeMy WebLinkAboutApproved Minutes of October 23, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 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 October 23, 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, Bruce Baldwin, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Tony Whitaker. Commissioner Amy Fowler and Keith Bagby arrived later. BOARD OF HEALTH MEMBERS ABSENT: Brian Crandell. STAFF PRESENT: Quintana Stewart, Health Director; Dr. Erica Pettigrew, Medical Director; Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Financial and Administrative Services Director; Thomas Privott, Environmental Health Supervisor; Libbie Hough, Communications Manager; Tommy Green, Formerly Incarcerated Transitions (FIT) Program Manager; Paula Johnson, Certified Medical Assistant; Shatocka Carlton, Community Health Worker; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTSNISITORS PRESENT: Spencer Sullivan, Aaron Dobbins, Sam Haddad, and Priya Vasan. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employee in attendance: Paula Johnson — Certified Medical Assistant. Shatocka Carlton — Community Health Worker for the Formerly Incarcerated Transitions (FIT) Program arrived later. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments: None. IV. Priority Committee Updates Ad Hoc Committee on Well Rules Mr. Whitaker provided the update for the Committee on Well Rules. He shared that the committee is in the process of gathering evidence, including reviewing groundwater protection policies from other areas and collecting scientific data, and is not ready to present anything yet. Dr. Jonnal commented that it must be difficult to find good scientific evidence for well rules, as science can change over time as new developments emerge and supporting evidence for long- term safety typically requires longitudinal data. The committee will next meet in early February. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 Access to Care Committee Dr. Pickett provided the update for the Access to Care Committee. The Access to Care Committee is planning a Photovoice project examining barriers to healthcare in Orange County. The goal is to learn more about barriers to care through qualitative data collection — allowing people to share their experiences instead of letting them pick from a preexisting list of potential experiences. Currently, the committee is in the process of planning the project timeline, the budget, and the IRB application. Dr. Pickett added that the project plans to intentionally target certain populations to ensure their inclusion, including migrant workers, formerly incarcerated individuals, individuals living with a substance use disorder, those eligible for expanded Medicaid, immigrant and low-English proficiency neighborhoods, low-income and public housing neighborhoods, rural neighborhoods and those far from public transit, especially in Northern Orange, college students, and individuals who are living unsheltered. Dr. Nickelson commented that she was glad that the project was asking people to share what they need instead of giving them a list of options to choose from; she shared a story about a friend of hers who works for an organization that helps link people to care and that a question this organization asks clients is "what would you do next if you didn't call us?" and many people draw a blank in response. She added that many people seem to go to the emergency room for non-emergencies because they don't know what else to do. Dr. Jonnal cautioned about limiting participation to certain groups, as everyone is having a hard time right now. She shared a story about struggling to get care for her own father-in-law despite her being an ER doctor and her father-in-law having insurance. Dr. Pickett assured her that the project will be open for participation to everyone in Orange County who is eighteen or older. Dr. Rodgers added that the committee has discussed how all the committee members, who are educated and have health insurance, still face difficulties in things like getting appointments. Dr. Jonnal agreed and mentioned that referrals expire after a year, and she has had appointments cancelled because the referral expired before they could get her in to see a doctor. Dr. Stuebe commented that the Thriving Hearts project recently completed an exercise called Extremes and Mainstreams, which uses design thinking to consider the needs of people on opposite extremes of an issue, which helps cover the needs of the majority of people who are somewhere in the middle. She suggested that the group could invite the design thinker working with Thriving Hearts, Kyle, to speak at a future meeting, but added that the goal of such a project is to expand knowledge rather than to learn everything, the project could always be iterative, and that the enemy of done is perfect. Dr. Pickett said that the culmination of the project is to host an exhibit, educate people, and open a community conversation about access to care. Dr. Royce added that this project can help build political will to make changes. Commissioner Fowler arrived during this discussion. The committee will next meet in late January. Connections to Community Support Committee Mr. Whitaker provided the update for the Connections to Community Support Committee. He shared that the committee recently heard from Julia Sendor, lead organizer for Justice United. Ms. Sendor shared some past organizational wins, including collaborating with Alliance S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 to improve availability of bilingual mental health services, and that they are currently working to address affordable housing. Some affordable housing strategies that Ms. Sendor discussed included keeping people in their existing affordable housing through repairs/renovations, providing property tax assistance and caps, changing zoning laws to build affordable housing communities on church properties, and creating landbanks which allow affordable housing developers to purchase property at competitive prices. Dr. Stuebe applauded the methodology of Justice United, sharing that they hold regular listening sessions with hundreds of people and then perform community organizing and movement building based on the feedback they receive. Commissioner Fowler mentioned that, from the receiving end, it is an effective strategy. Dr. Royce suggested that in the future the board may be able to support a resolution on behalf of Justice United. Dr. Jonnal agreed, saying that the board could get feedback from other community groups about need and how to help. Commissioner Fowler mentioned that the tax code is unfortunately a statute at the state level, and there is a limit to what the Board of County Commissioners (BOCC) can do about it. She added that Orange County does provide a longtime homeowners assistance program to help individuals afford their property taxes, but that the state needs to be paying their share rather than pushing the expenses onto the counties. She concluded by saying that the BOCC supports many of the initiatives being worked on by Justice United, though they could potentially increase funding. Mr. Whitaker noted that Ms. Sendor had seemed surprised when the committee expressed that affordable housing is a public health issue, and that he feels it's important to raise awareness of this among community members and community organizations. The committee will next meet in early January. Behavioral Health Committee The Behavioral Health Committee will next meet in early November. V. Approval of the October 23, 2024 Agenda Motion to approve the agenda of the October 23, 2024 BOH meeting was made by Dr. Rachel Royce, seconded by Dr. Shielda Rodgers, and carried without dissent. VI. Approval of September 25, 2024 Minutes Motion to approve the minutes of the September 25, 2024 BOH meeting was made by Commissioner Amy Fowler, seconded by Dr. Alison Stuebe, and carried without dissent. VII. Consent Agenda A. 1st Quarter Financial Reports & Billing Dashboard Commissioner Fowler observed that several areas in the revenue section were red and asked what that means. Frederick Perschau, Finance and Administrative Services Director, explained that it is a formatting style indicating that the revenue source has not yet met its projected target S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 for the year, but it is a positive (not negative) amount of revenue. He added that he could change the formatting if it was confusing. Dr. Stuebe suggested including a legend for the formatting, though Mr. Perschau said that there is a legend on another page. Mr. Perschau also shared that last year's data breach, which had impeded the Dental Health Division's ability to bill for services, has been resolved, so Dental will once again be able to process claims and payments. B. Modified Minutes for August 28, 2024 When Dr. Jonnal expressed that she had not received a copy of the modified minutes, Jean Phillips-Weiner, BOH Strategic Plan Manager, explained that the only modification was the correction of a small typo on page 9, which had originally read "permits for buildings begin at only 20 square feet in size" but should have read "permits for buildings begin at only 400 square feet in size." Dr. Baldwin, who was not present at the September meeting, pointed out this typo after the minutes had been approved, necessitating their reapproval. Motion to approve the consent agenda for October 23, 2024 was made by Dr. Alison Stuebe, seconded by Commissioner Amy Fowler, and carried without dissent. Vill. Educational Sessions A. Annual Satisfaction Surveys Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; and Carla Julian, Public Health Nursing Director, presented the results of the annual satisfaction surveys for their respective departments. Some highlights of their presentations are below: • During the discussion, Dr. Pickett commented that she did not like the use of the term "customer" related to the satisfaction surveys, as customers are not people with whom an organization typically builds a sustained relationship, and people served by the health department are generally either clients or patients. Ms. Stewart said that the use of "customer" is borrowed from the Accreditation requirements and is not used in any external-facing communications. She added that this language can be amended to better reflect the relationship the health department has with its clients. The language throughout these minutes has been updated accordingly. • The Dental division received 100 satisfaction survey responses over the past year, from around 5,000 total patient appointments. The Dental Clinic aims to receive around 10 survey responses per month. Respondents were generally satisfied with the services provided, though a few expressed that it was difficult to schedule urgent appointments. • In response to Commissioner Fowler's question about whether Dental Services accepts appointments on Fridays, Dr. George replied yes, from 8am until 11:15am. She added that these appointments book up quickly. • Environmental Health received 120 responses from more than 10,000 clients served. The responses were likely primarily from individuals who had not completed a survey in the past due to an uptick in survey fatigue. Environmental Health recently added some voluntary demographic questions and noted that, based on the responses received, their clients are predominantly white men. • On the whole, the majority of respondents are satisfied with the services and education provided by Environmental Health Services, though some expressed dissatisfaction S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 related to a permit being denied. As an example of an educational program in Environmental Health, Ms. Hudson shared that they piloted a loaner chlorination kit to help provide education and resources when an individual receives a poor water sample, and that this program has been well received by clients. • Several respondents expressed frustration or dissatisfaction with the functionality of the website. Ms. Hudson noted that there is also some confusion among clients owing to automated emails ("noreply@orangecountync.gov") and that there is a need for technological equity, which she hopes to focus on during fiscal year 2024-2025. Dr. Stuebe asked when the website was last updated, as it is not super easy to navigate, and Ms. Stewart explained that Libbie Hough, Communications Manager, is in the process of implementing website updates. Ms. Hudson added that the issue is more with the software being used than with the website itself. Dr. Rodgers applauded Ms. Hudson for acknowledging that not everyone is computer literate, and this is important for justice. • Personal Health Services received 91 satisfaction survey responses. Personal Health Services considered partnering with UNC MyChart to collect surveys, but ultimately determined that it would not meet the clinic's needs. The majority of responses were positive, with 99% of respondents saying they would recommend the clinic to friends and family. However, some clients expressed frustration with wait times or that they wished the clinic had an on-site pharmacy. Ms. Julian mentioned that lower staffing numbers and staff turnover have led to delays in getting appointments. • Ms. Julian also noted that quite a few respondents reported that they were not asked about family planning (e.g., if and when they would like to have a child/another child), and there is a need to review with clinicians the importance of having this conversation. In response to Dr. Jonnal's question, Ms. Julian explained that the family planning coordinator position was a pre-existing position which had been filled but is now vacant. However, she is not sure if the data reflects the position being open, as all providers are supposed to ask about family planning. Dr. Erica Pettigrew, Medical Director, mentioned that patients are asked many questions during appointments, and it is possible that some patients were asked but did not remember amid all the other questions that they are required to answer. Commissioner Fowler asked if family planning is different than contraceptive care, to which Ms. Julian explained that contraceptive care is encompassed within family planning. Dr. Royce suggested hosting a training rather than just reminding staff to ask the question. Dr. Stuebe noted that conversations about family planning are nuanced, and it can be difficult to ask the right questions in an obvious and memorable way without making assumptions; she mentioned that a good approach is to ask "do you plan to become pregnant within the next year?" and go from there, and referenced the One Key Question Framework and the PATH Framework as a useful tool to help guide the conversation. Dr. Pettigrew commented that the clinic often uses the One Key Question Framework but that it in fact requires four questions and doesn't necessarily account for"pregnancy ambivalence," i.e., when a person feels they would be okay either way. She agreed that the clinic has room for improvement and that conversations about reproductive choices are difficult to do perfectly. IX. Actions Items A. Present Chair/Vice-Chair Slate Dr. Jonnal reminded the board that at the end of each calendar year, the board votes on a chair and vice-chair for the next calendar year. Traditionally for the Orange County Board of Health S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 the current chair steps down and the vice-chair steps into the role, with a new vice-chair nominated based on seniority, though adhering to this system is not required for the operation of a board in Orange County. Dr. Jonnal asked Dr. Stuebe if she was interested in being nominated as chair for 2025, to which Dr. Stuebe assented. Dr. Jonnal and Ms. Stewart invited board members to email the executive committee with nominations for the vice-chair position. In response to Dr. Royce's question about tracking where board members are in the continuity of the chair and vice-chair rotation, Dr. Rodgers said that the Orange County website has a record of the length of each board member's tenure. The board then collectively reviewed the current lengths of each board member's service to determine the current lineup. Dr. Pickett and Dr. Rodgers have both previously expressed that they would prefer not to serve as chair, meaning that Dr. Crandell, Dr. Royce, and Mr. Whitaker are next in line to serve as vice-chair. Mr. Whitaker said that he would be open to serve as vice-chair in 2025, for which Dr. Royce expressed support. Dr. Pickett shared that she may be moving out of Orange County in 2025, which could lead to a gap in a veterinary representative for the Board of Health —though she has begun looking for a replacement, most of her colleagues already have many commitments and may not be able to commit to another board. Dr. Baldwin mentioned that there may be an option to temporarily fill the veterinary position with an at-large member if a suitable veterinary representative cannot be found. However, he also said that the state likely has a registry of all veterinarians who reside in Orange County which could be used to help find a new representative; Dr. Pickett recommended contacting the North Carolina Veterinary Medical Board for this information. Dr. Royce expressed that if an at-large position opens, she would like to strongly advocate for the consideration of a Latino/a/e member to better reflect the population of Orange County. Mr. Bagby arrived during this discussion. The board will vote on the Chair and Vice-Chair Slate at the November meeting. B. Annual Board of Health Policy Review The recommended changes to the Board of Health Policies and Procedures Manual were presented at the September meeting. The recommended policy changes are as follows: 1.0 Mission Statement and Scope of Services No Changes. I.A. — Requests for Environmental Services and Assessments No Changes. I.B. — Fee and Eligibility Policy • Some minor updates to wording and punctuation throughout. • Section 11111.113.1 Updated income verification window to be in line with current practice (10 days or less rather than 30 days or less). S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 • Section VI.1.2: Updated wording to reflect the minimum fee for Dental services, which does not slide to the 0% pay level and stops at 20%. • Section VII.J.1.a: Updated billing statement cycle to reflect current practice (sending out bills monthly rather than no more than three days after charges post). I.C. — Community Assessment Policy • The policy was updated throughout to reflect changes in the State of the County Health (SOTCH) reporting requirements. • Several broken links were removed or replaced. I.D. — Review of Reports and Documents • No Changes. I.E. — Operating Procedures BOH Manual • IX. Officers and Committees C. 3. & 5: Updated the Priority Committees to reflect new priorities identified in 2023 CHA. • X. Meetings G. Minutes: Updated broken link to access minutes. • XVI. Adjudication Procedures A: Defined days as "Calendar days" (update made at BOH Retreat in March 2024). • XVII. Annual Review of the Health Director: Added updated guidelines to detail Board members use of County HR PERFORM program in NeoGov. I.E. — Operating Procedures BOH Manual —Appendix H — Confidentiality and Conflict of Interest • No Changes. Motion to approve the proposed updates to the BOH Policy and Procedures Manual was made by Commissioner Amy Fowler, seconded by Dr. Alison Stuebe, and carried without dissent. X. Reports and Discussion with Possible Action A. Bi-Annual Advisory Board Report Jean Phillips-Weiner, Board of Health Strategic Plan Manager, presented the report to the board. The report comprises the past six months of activities engaged in by 30 committees, coalitions, or community partners ("boards") that are regularly attended by members of the OCHD Health Promotion and Education Services (HPES) team. It does not reflect all partnerships within the Health Department. As a focus, Behavioral Health is one of the main topic areas, though many boards are addressing multiple focus areas (e.g., working to address both Access to Care and Behavioral Health). Ms. Phillips-Weiner added that the Behavioral Health numbers are skewed slightly, as five of the twenty-one are related to Rita Krosner's work as Tobacco Prevention and Control Coordinator. Mr. Whitaker asked if any of the boards are focused on environmental health, to which Ms. Hudson replied that the health department is engaged in environmental health work, but they are not reflected in this report. Ms. Phillips-Weiner affirmed this but said that she could collaborate with the Environmental Health Department to include their boards in future reports. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 Ms. Phillips-Weiner reminded the board that this report is not a public-facing resource but is intended to assist board of health members in committee work and committee planning, both to identify opportunities for collaboration and to help steer initiatives based on what work is already being done. Dr. Stuebe asked how this report was generated, to which Ms. Phillips-Weiner explained that the HPES team log their board activities in a spreadsheet over the course of a six-month period, which she then uses to create a word document/PDF. In response to Dr. Jonnal's question about her opinion of the lay of the land for committees and boards working in Orange County, Ms. Phillips-Weiner said that there may be some redundancies within the existing boards, but she wouldn't say that this is the case for most boards or that this has been her personal experience. She added that, as Board of Health Strategic Plan Manager, she can be a bit more selective about which boards she joins and that someone like McKayla Creed, Healthy Carolinians Coordinator, might have a different experience. Dr. Jonnal commented that numbers are so important for advocacy, and she wonders if streamlining and combining some of the boards might result in better outcomes. Dr. Royce observed that the level of work completed by the boards varies a lot, with some working with individual patients and others working at a broader population level. Ms. Phillips- Weiner agreed and added that a lot of the boards are still in a planning phase post-pandemic. B. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. Topics included: the recent measles case in Mecklenburg County, updates on the Formerly Incarcerated Transitions (FIT) program, an update on the COVID bridge program, recent threats against the Orange County School (OCS) and Chapel Hill/Carrboro City School (CHCCS) systems, and recent rabies cases. Ms. Hough added that she is working to update the health department website, particularly to update the content and to make it more accessible, as it is federally mandated to be compliant with the Americans with Disabilities Act (ADA). She shared that there are limitations related to the software and the templates available. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. C. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • The annual All-Staff Meeting was held on Friday October 18th and was attended by Mr. Bagby. Ms. Stewart highlighted several service milestones celebrated at the picnic, including twenty years of service by Ms. Julian. • McKayla Creed, Healthy Carolinians Coordinator, and Marcy Williams, Health Promotion and Education Services Manager, attended the 2024 Fall Community Health Assessment (CHA) Institute and were honored for their excellent work on the 2023 CHA. Additionally, the statewide CHA Guidebook was recently updated, and Orange County is noted in it as an example of best practices for use of secondary data. • Seven OCHD staff members have been deployed as part of the emergency response to Hurricane Helene. Environmental Health staff assisted with onsite wastewater S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ October Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH October 23, 2024 management, while nursing staff assisted with emergency sheltering. Countywide, 88 staff members have been deployed from eleven agencies to assist with seventeen different missions. Dr. Royce asked if anything about the emergency response could be featured in the News of Orange, to which Ms. Stewart said she hasn't collaborated with News of Orange since the pandemic, but she could explore this. Ms. Hough said she would love to help feature this work and keep the recovery efforts in peoples' minds. • The first flu death of the season occurred in Mecklenburg County the second week of October. Ms. Stewart reminded everyone to get a flu shot, as well as the updated COVID vaccine — COVID cases and hospitalizations continue to trend down. • The Mobile Dental Unit hosted their first event, spending a day at Central Elementary School. She added that the response was so great that future events will need to be 2-3 days to account for the demand. Dr. George shared that earlier that day the Mobile Dental Unit was hosted at New Hope. • Ms. Stewart concluded by sharing that she recently met with Dr. Jones, the Orange County School Superintendent, and that she would share more details in future committee meetings. Commissioner Fowler commented that the Faith Connections on Mental Illness organization is hosting a suicide prevention workshop on November 2"d from 10am-3pm at Emmanuel AME Church at 2018 Riddle Road in Durham, and to speak with her for more details. XI. Closed Session to Discuss Health Director's Annual Review A motion to enter closed session at 8:50 p.m. to discuss the health director's annual review was made by Commissioner Amy Fowler, seconded by Mr. Keith Bagby, and carried without dissent. During the closed session, the Board of Health discussed Quintana Stewart's job description and annual performance review. Vicki Jones, HR Program Manager from Orange County Human Resources, guided the board members through their discussion. A motion to end the closed session at 9:13 p.m. was made by Dr. Davia Nickelson, seconded by Commissioner Amy Fowler, and carried without dissent. XII. Adjournment A motion was made by Dr. Davia Nickelson to adjourn the meeting at 9:13 p.m., was seconded by Commissioner Amy Fowler, and carried without dissent. The next Board of Health Meeting will be held November 20, 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/ October Page 9