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HomeMy WebLinkAboutApproved Minutes of January 22, 2025 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON January 22, 2025, online on Microsoft Teams owing to inclement weather. BOARD OF HEALTH MEMBERS PRESENT: Alison Stuebe — Chair, Tony Whitaker—Vice Chair, Keith Bagby, Bruce Baldwin, Commissioner Amy Fowler, Aparna Jonnal, Davia Nickelson, Lee Pickett, Shielda Rodgers, and Rachel Royce. BOARD OF HEALTH MEMBERS ABSENT: Brian Crandell. STAFF PRESENT: Quintana Stewart, Health Director; Erica Pettigrew, Medical Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Financial and Administrative Services Director; Libbie Hough, Communications Manager; Thomas Privott, Environmental Health Supervisor; Alex Rimmer, Environmental Health Supervisor; Amber Benner, Nutrition Program Manager; David Gahary, Health Informatics Manager; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Dayana Estephanie Bermudez, Elizabeth Kathleen Branch, Victor Brozovsky, Supriya Marina Caton, Farhan Chowdry, Michaela Jones, Annmarie Li- Yedica, Timothy Meade, Victoria Vivi Nguyen, Charlie Miller Roethling, Vivi Santana, Gustavo Panduro Vargas, Claudia Vial, Alan Haosheng Zhao, Annmarie, and Jackie. I. Welcome New Employees Quintana Stewart, Health Director, shared that there were no new employees in attendance this evening. II. Public Comment for Items NOT on Printed Agenda: Jean Phillips-Weiner, Board of Health Strategic Plan Manager, shared that the FDA is considering lowering the nicotine levels in combustible tobacco products, including cigarettes, cigars, and pipes, and the FDA will have a public comment period going until September 15t" 2025. She asked the board to consider submitting something during the public comment period in support of lowering nicotine levels, which would help reduce the addictiveness of combustible tobacco products. She also shared that Vision Zero Chapel Hill will be holding an event tomorrow evening at 6:00 PM at the Chapel Hill Public Library to discuss the new Bolin Creek Greenway and Estes Drive Extension Bike and Pedestrian Projects. III. Board Comments: Dr. Bruce Baldwin Dr. Baldwin commented that ABC News featured a story about school cell phone bans, specifically focusing on one school which had implemented using special locking pouches to store phones during the school day. He shared that they interviewed various people from the S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 school, including teachers, students, and parents, and that the response was very positive. He said that he hoped that Orange County School System and the Chapel Hill Carrboro City Schools Systems would adopt a similar system soon. Keith Bagby Mr. Bagby shared that he and his wife are planning to move to Virginia in May or June of this year, and that he will have to step down from the Board of Health. He asked if the board would prefer for him to step down now in order to try to bring on a new member in time to participate in the board retreat. Commissioner Fowler suggested checking with Tara May, Deputy Clerk to the Board of County Commissioners, about the process, though it is unlikely that a month and a half would be enough time to interview, select, and onboard a new board member; Ms. Stewart shared that there are several current applicants but agreed that the timeline was likely too tight to bring on a new member before the retreat in mid-March. Ms. Stewart told Mr. Bagby to submit a formal resignation statement by letter or email and include by what date he will have to leave the board. Several board members expressed their appreciation for Mr. Bagby's service and said that Virginia will be lucky to have him. Tony Whitaker Mr. Whitaker mentioned that he had read the recent newsletter from the National Association of Local Boards of Health (NALBOH), which included a recording of a webinar by Dr. Karl Johnson, a professor at UNC Gillings who previously came to speak to the Behavioral Health Committee about screen use and mental health. This webinar focuses on effective training of BOH members to provide better tools and information for local public health decision making. Mr. Whitaker encouraged other board members to watch the webinar. Dr. Aparna Jonnal Dr. Jonnal thanked Dr. Baldwin for bringing up the news story about cell phones and encouraged other people to consider having screen-free homes. Dr. Jonnal also shared that she has been reappointed chief of medical staff at Person Memorial Hospital and as a condition of her accepting the appointment she needs the hospital to speak more openly about the brokenness of the US Healthcare System. She added that since the shooting of the United Healthcare CEO, she has been thinking a lot about how there are now a handful of people with the money and influence to create systems that decide whether millions of other people, especially those from poor and less historically fortunate groups, live and die. She concluded by saying that she's been wondering what, if anything, separates this from a modern genocide. Commissioner Amy Fowler Commissioner Fowler shared that on Tuesday night the BOCC passed a resolution that they are sending to the Department of Environmental Quality opposing UNC's application for conversion of the coal power plant to instead burn pellets that are 50% wood and 50% plastics, which have an unknown risk of PFAs not really understood yet by the CDC or EPA. She invited other board members to send personal letters opposing this application but added that the S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 deadline for comment is in two days (January 2411) so there is not time for the BOH to submit a resolution without calling an emergency meeting. Dr. Rachel Royce Dr. Royce announced two events which would be taking place on Saturday morning: a Medicaid information and enrollment session in Cedar Grove at Lee Chapel Missionary Baptist Church at 9am, and a community forum to address low barrier housing needs at 10am at the Whitted Human Services Center in the BOCC meeting room. She also commented that she is concerned by upcoming changes to laws and practices wherein health facilities will no longer be protected from raids from ICE and urged the Health Department to prepare as best as possible, for example with staff trainings on immigrant rights and their requirements for legal compliance. She concluded by saying that, in light of Mr. Bagby's announcement that he would be stepping down later this year, she wanted to consider the makeup of the BOH and how it is not reflective of the proportion of the Orange County population that are Spanish speaking, and she wanted to advocate for representation or participation on the board from the Latino community. Dr. Lee Pickett Dr. Pickett also commented on two topics: rabies and H5N1 avian influenza (bird flu). Dr. Pickett shared that the number of reported rabies cases increased this year. In 2024, 13 cases of rabies were reported in Orange County, including 2 cats and 1 cow, while the others were wildlife species. In 2023, 8 cases were reported, all in wildlife. In 2022, 5 cases were reported: 2 were sheep, and 3 were wildlife. She stressed that people should be aware that rabies is around, and they should continue to take all possible precautions to prevent it. She also shared that while H5N1 avian influenza is mostly found in poultry and dairy cows, it has infected more than 70 species of mammals, including cats, dogs and humans. Of those three species, it is most lethal to cats, but it has also killed dogs and at least one human in the U.S. In Europe and elsewhere in the world, H51\11's mortality rate from 2003 to September 2024 has been just over 50% of around 900 cases. Cats and dogs are most often infected by eating uncooked meat or by drinking raw milk. She stressed that cats and dogs should not be eating raw diets for two reasons: there is no benefit to them, and risks include high prevalence of Salmonella and other pathogens which can easily transfer to humans. Raw food includes not just commercial raw and frozen diets but also freeze-dried pet treats and backyard birds. Dr. Alison Stuebe Related to Dr. Royce's comment, Dr. Stuebe shared a New York Times column about the risk of undocumented individuals being swept out of healthcare systems and asked what can be done to avoid this at the health department. Ms. Stewart said that during the last Trump administration the health department had a task force on immigrant safety and rights, which will be brought back for the new Trump administration. S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 IV. Priority Committee Updates Ad Hoc Board Retreat Planning Committee Dr. Nickelson provided the update for the Ad Hoc Board Retreat Planning Committee. The committee has met twice and has been working to finalize the agenda and the retreat location. The retreat will be held at the Cedar Grove Community Center and the agenda will include and overview of the Health Department strategic plan, a legislative session to discuss trends and priorities locally and statewide, time to discuss how to align the work that the BOH is doing with the BOCC with Commissioners Fowler and Bedford and wrap up with discussion and training around the Health Director Annual Review. Dr. Nickelson said that many board members have expressed that they didn't really know how to evaluate Ms. Stewart on certain things and what areas we need to focus on since they don't typically see her in the day-to-day, so this training should help with that. Dr. Royce added that there will also be time during the retreat for committees to work together to put forward resolutions related to their focus areas. Connections to Community Support Committee Mr. Whitaker provided the update for the Connections to Community Support Committee. The committee met with Don Elliott, a city planner with a group called Clarion Associates, which helps local governments across the country work on their zoning policies and helps them establish zoning ordinances that control land development in their jurisdictions. The committee learned more about how zoning affects the supply of housing, specifically affordable housing. Depending on the policies, zoning can facilitate or obstruct a community having an adequate supply of housing, and an adequate supply of housing lowers demand and allows for more affordable units. Zoning policy can be influenced by a lot of things, including people's perceptions of what they want for themselves, their families, and the properties they already own. Orange County is currently revising its comprehensive plan, which is a long-term vision for the county, and includes a land use plan. The committee is considering ways to advocate locally for zoning policies that might free up the ability for more housing to be constructed in our county. It's important from a public health perspective to push the idea that we need to find ways to get people housed more easily and more readily, as access to safe and humane housing is crucial for the wellbeing of people and families. However, while zoning is an important component, it's important to remember that the government cannot really drive the economic considerations associated with housing, and it's necessary to work with market forces and people who are acting within the market. From an equity point of view the committee discussed that the lack of housing disproportionately affects people who are already marginalized in other ways, meaning affordable housing is itself an equity issue. Dr. Stuebe recommended that board members who wanted to learn more look at the Equity in Zoning Policy Guide from the American Planning Association. Jean Phillips-Weiner, Board of Health Strategic Plan Manager, will be assessing or investigating whether there's already some kind of data out there about the housing units available in the county (i.e., a housing needs assessment) so the committee can assess quantitatively more about what the needs are. S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 Access to Care Committee The Access to Care Committee will next meet in late January. Ad Hoc Committee on Well Rules The Ad Hoc Committee on Well Rules will next meet in early February. Behavioral Health Committee The Behavioral Health Committee will next meet in late February. V. Approval of the January 22, 2025, Agenda Motion to approve the agenda of the January 22, 2025, BOH meeting was made by Dr. Aparna Jonnal, seconded by Commissioner Amy Fowler, and carried without dissent. VI. Approval of November 20, 2024, Minutes Motion to approve the minutes of the November 20, 2024, BOH meeting was made by Commissioner Amy Fowler, seconded by Dr. Shielda Rodgers, and carried without dissent. VII. Educational Sessions A. Nutrition Services and Employee Health and Wellness Update Amber Benner, Nutrition Program Manager, presented an update on the Nutrition Services and Employee Health and Wellness program over the past year. Some highlights of her presentation are below: • Ms. Benner provided an overview of the Medical Nutrition Therapy Program. She explained that not all counties have medical nutrition counseling, but Orange County offers it for patients to help manage conditions like heart disease, gestational diabetes, iron deficiency, high levels of lead, and appropriate feeding and growth in children. She said that Medical Nutrition Therapy offers additional support beyond what a healthcare provider can offer in the time constraints of a normal appointment. The dieticians cover not only nutrition but also medication management and physical activity with patients. • OCHD offers sliding scale payments to increase access, which is especially helpful for those with Medicaid or Medicare, which only cover Medical Nutrition Therapy for patients living with diabetes or with chronic kidney illness. Ms. Benner explained that they are able to see patients for as low as $20. • About 50% of patients receiving Medical Nutrition Therapy are Maternal or Child Health patients. Nearly three quarters (74%) of patients need language services, with the majority (78%) of language services being provided in Spanish. • Telehealth services are available to increase access, which is especially beneficial for maternal health patients, but there is more demand for in-person services. Ms. Benner S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 said that in-person services are beneficial for working with patients who may be less tech or healthcare literate, as it allows more opportunities for education. • Ms. Benner gave an overview of the Diabetes Self-Management Education Program. The program consists of ten hours of education, including how people are coping with their diabetes, and helps to prevent chronic complications and to lower patient Al-Cs. In a recent cohort, 100% of participants said that they learned something, and all participants felt that participating improved their motivation and self-efficacy in managing their diabetes. A Spanish-language version of the Diabetes Self-Management Education Program is offered at least annually and is provided with simultaneous interpretation. • The Diabetes Prevention Program is a year-long program which helps participants identify barriers they face in making healthy nutrition and physical activity choices and come up with ways to overcome those barriers. Recent cohorts saw an average weight loss of around 5% of starting weights and a 70+ minute increase in weekly physical activity. The program sees a generally high retention rate, and one former participant still follows up with the dieticians weekly. • Ms. Benner concluded her presentation by sharing that the Nutrition Department is fully staffed and will be bringing back Employee Wellness Program group sessions with peer support. The department also offers other programming to promote employee wellness, including National Nutrition Month in March and the annual Wear Red Day Heart Health Walk, which will be held on February 71" • Dr. Stuebe applauded the good work of the Nutrition Department and mentioned that she has referred several patients with gestational diabetes. Ms. Benner told the group that healthcare providers can refer patients either through the client portal Epic or by using a paper referral packet (available upon request). She also shared that the department is hoping to offer gestational diabetes management classes once childcare can be made available. Some options suggested for childcare included the YMCA and local churches. • In response to Dr. Nickelson's question about the ages of participants for the Diabetes programs, Ms. Benner explained that the courses are available for patients who are eighteen and older, and that they have seen an uptick in participants who are forty and under. For those under eighteen, there are generally programs like camps available but not through the Health Department. B. 2nd Quarter Financial Reports & Billing Dashboard Frederick Perschau, Finance and Administrative Services Director, gave an update on the Health Department budget at the conclusion of the second quarter. Some highlights of his presentation are below: • Mr. Perschau shared that halfway through the year the budget for FY2025 is balancing well, with a flat-line net revenue (50%) and overall revenue at 38%. Overall, revenues for FY2025 are down compared to the same point in time in FY2024. Mr. Perschau reminded the board that more revenue means there is less need for county funds to cover operating expenses. • Two divisions, Environmental Health Services and Dental Health Services, have had lower service revenue than expected (33% and 34%, respectively). Environmental Health has been seeing some delays related to resources being diverted for disaster relief after Hurricanes Debby and Helene, while Dental Health are still processing Medicaid requests from the data breach delay during FY2024 and have had several staff members unexpectedly needing to take leave. In response to Commissioner Fowler's question, Mr. Perschau explained that they are anticipating that Dental Health will S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 recuperate much of the funds affected by the Medicaid data breach, but he can't say exactly how much. Ms. Stewart added that there have also been issues with a provider being unable to work due to a credentialling issue caused by a name change. • In terms of expenses, there is a strong demand for Spanish-language services and lab services. Overall expenditure is around 46% and involves some equipment repairs and some encumbered funds (i.e., funds that have not yet been spent but have been set aside for a future anticipated expense). • Dr. Stuebe asked why revenue for Personal Health Services is up, to which Mr. Perschau replied that he didn't have a specific reason at this time, but there have been fee increases, staffing improvements, billing improvements, and better claims processing, all of which may contribute. He also agreed with Dr. Stuebe that it could be related to Medicaid expansion. • The budget request for FY2026 will be presented at the February meeting. Vill. Actions Items A. BOH Annual Workplan Jean Phillips-Weiner, BOH Strategic Plan Manager, presented the annual workplan report draft. Each spring, the chair of the BOH presents this report to the BOCC, which helps keep the commissioners up to date on the board's activities and the priorities that the board is working to address. Board members had a few additional revisions and suggestions for the report, including: • Dr. Royce requested the addition of a board that she sits on, the Board of Directors for the nonprofit After the Rain. • Dr. Stuebe suggested adding that the board receives regular reports from Environmental Health Services, who regulate food and lodging services and swimming pools, under the Diverse and Vibrant Economy goal. Dr. Jonnal seconded this idea, adding that they also permit development within the county. • Dr. Royce requested that the four committee names be specified within the report. Motion to approve the workplan draft with the proposed revisions was made by Commissioner Amy Fowler, seconded by Dr. Aparna Jonnal, and carried without dissent. B. 2025 BOH Meeting Schedule Ms. Stewart shared the proposed revisions to the schedule, clarifying that the annual North Carolina Public Health Leadership Conference will take place the third week of September this year, necessitating the meeting being moved to the fourth week of September, and that there was an oversight when the Board Retreat was scheduled for the 8` of March, so it needs to be moved to the 15tn Motion to approve the revisions to the 2025 BOH Meeting Schedule with the Board Retreat rescheduled for Saturday, March 15th was made by Dr. Rachel Royce, seconded by Commissioner Amy Fowler, and carried without dissent. IX. Reports and Discussion with Possible Action S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 A. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. Topics included: the current Opioid Settlement Funds grant funding cycle, service for Western NC in the wake of Hurricane Helene, and rabies cases in Orange County. She also shared that there is currently a freeze in public communications for Federal agencies as the new administration settles in, which will hopefully be temporary. 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. • Ms. Stewart opened her report by giving kudos to health department and other local government staff for their hard work over the past week to provide support for cold weather cots during the arctic blast. • Ms. Stewart thanked Dr. Nickelson and Mr. Whitaker for attending an emergency preparedness event in November and shared that Orange County Health Department received a certificate from ANCBH. • Recently, Ms. Stewart met with the new county commissioner, Marilyn Carter, and she expressed an interest in environmental health. Her background includes working on the planning board so there may be opportunities for collaboration. • There is a new system for Child Fatality Review and Reports coming; Ms. Stewart recently presented to the BOCC about the changes to annual Child Fatality Reporting. Beginning in July, the health department will switch to a new software system for Child Fatality Review. • Ms. Stewart recapped several recent changes in state leadership, including Secretary Dr. Devdutta Sangvai replacing former Secretary Kody Kinsley and the departure of State Health Director Dr. Betsey Tilson. Ms. Stewart commented that the Health Department has worked closely with Dr. Tilson in the past and that she will be missed. • Related to Dr. Pickett's comments, Louisiana has had the first human death caused by H5N1 avian influenza. Ms. Stewart reiterated that people and animals should avoid consuming raw foods and raw milk to reduce their risk. Dr. Rodgers asked if people should be cautious with things like backyard bird feeders, to which Dr. Pickett replied that experts are saying that if people are washing their hands after handling their bird feeders and regularly sanitizing the bird feeders (both of which are already best practices), then it should be okay. Dr. Royce asked about whether backyard bird feeders could pose an increased risk to domestic chickens, as she has egg-laying hens in her backyard. Dr. Pickett replied that she is not fully aware of the current guidance for this, but anything that increases the number of birds in a space could present an increased risk as there would be more opportunities for exposure. • There is an upcoming event hosted by the Association of North Carolina Boards of Health (ANCBH), A State of Affairs of Dental Public Health in NC, which will be held virtually on Monday February 10tn • Dr. Stuebe commented on the book The Sum of Us, which Ms. Stewart referenced in her report. She said that the book discusses how policies that damage equity and inclusion are bad for everyone, giving the example of how communities in the South chose to fill in rather than integrate public swimming pools, meaning ultimately no one had access to S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ January Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH January 22, 2025 swimming pools. She shared a NYT article by the author of the book. Dr. Rodgers mentioned that all Federal Diversity, Equity, and Inclusion (DEI) employees are currently on administrative leave. She added that, though many people have either lost their jobs or been moved to different roles, people are still able to do good work at a local level which does have an impact. She applauded the board for the work that they do to improve the health of the people of Orange County. X. Adjournment A motion was made by Commissioner Amy Fowler to adjourn the meeting at 8:44 p.m., was seconded by Dr. Aparna Jonnal, and carried without dissent. The next Board of Health Meeting will be held February 26, 2025, 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\2025 Agenda and Abstracts/ January Page 9