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HomeMy WebLinkAboutApproved Minutes of February 25, 2026 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON February 25, 2026, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Tony Whitaker— Chair, Brian Crandell —Vice Chair, Aparna Jonnal, Commissioner Earl McKee, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Natalicio Serrano. Alison Stuebe attended virtually. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Dr. Erica Pettigrew, Medical Director; Dana Crews, Community Health Services Director; Dr. Stephanie George, Dental Services Director; Frederick Perschau, Financial and Administrative Services Director; Ashley Rawlinson, Compliance Manager; Molly Chadbourne, Advanced Practice Provider I; Kim Quatrone, Business Officer II; Marcy Williams, Health Promotion and Education Services Manager; John Davis, Environmental Health Specialist; Olivia Obeng, Public Health Nurse ll; and Jean Phillips- Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Ann Brady, Erin Sley, Philip Sley, and Fnu Vrinda. I. Welcome New Board Members and New Employees Tony Whitaker, Chair, welcomed Commissioner Earl McKee and Dr. Natalicio Serrano, the two newly appointed Board of Health members. Board members introduced themselves and welcomed the new members. Quintana Stewart, Health Director, introduced the new employee in attendance: Olivia Obeng — Public Health Nurse II. II. Approval of the February 25, 2026, Agenda Motion to approve the agenda of the February 25, 2026 BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Davia Nickelson, and carried without dissent. III. Approval of Meeting Minutes Because there was not a quorum present at the January meeting, the Board of Health meeting minutes from both November 2025 and January 2026 were presented for consideration. Motion to approve the minutes of the November 19, 2025 meeting was made by Dr. Aparna Jonnal, seconded by Dr. Rachel Royce, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 Motion to approve the minutes of the January 21, 2026, meeting was made by Dr. Davia Nickelson, seconded by Dr. Aparna Jonnal, and carried without dissent. IV. Public Comment for Items NOT on Printed Agenda None. V. Board Comments Commissioner Earl McKee Commissioner McKee commented that the county budget has a shortfall of$18M, meaning that it was likely that there would be cuts to services and additional revenue sources will need to be found, as the county is not allowed to run a deficit budget. He encouraged Board members to contact himself and the other members of the Board of County Commissioners (BOCC) to advocate for their needs throughout budget season. Dr. Aparna Jonnal Dr. Jonnal shared an update on her ongoing issues with private equity firms in healthcare settings, noting that she has left her previous role as Chief Medical Director at a nearby Duke hospital after it was bought by a private equity firm and care conditions became untenable. She commented that there is a growing body of literature suggesting that outcomes are worse for patients when the hospital is owned by a private equity company. She added that she is planning to present a statement about the reason for her resignation to the hospital and said she hoped for support and encouragement, especially if she receives backlash. In answer to Dr. Royce, she said that she may request letters of character/support in the future, and that feeling kinship with the Board of Health members has been a balm throughout this experience. In response to Dr. Rodger's question, Dr. Jonnal affirmed that after the hospital was bought by the equity firm it became a Duke hospital in name only, with minimal ongoing affiliation. She added that it seems like private equity companies own most things these days and she looks forward to seeing additional literature about the harms coming out. Tony Whitaker Mr. Whitaker shared that Dr. Bruce Baldwin, Optometrist Representative, has put in his resignation from the Board of Health, as he has retired and allowed his optometry license to lapse, meaning he no longer meets the required qualifications to serve as the optometrist representative for the Board of Health. Commissioner McKee encouraged the Board to loop him in on any communications regarding recommendations for future Board members. VI. Priority Committee Updates Access to Care Committee Dr. Pickett provided the update for the Access to Care committee. The committee met earlier in February and discussed plans for how to publicize the Resolution on Immigration and S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 Access to Public Health Resources, including sharing it with other local health departments and local law enforcement offices. The Photovoice project is ongoing and is ramping up for another round of data collection over the summer to hear from individuals eligible for Medicaid and, time permitting, those living in rural communities. The committee is refining recruitment materials and working to recruit a new summer intern. The committee will next meet in mid-March. Behavioral Health Committee Dr. Nickelson provided the update for the Behavioral Health committee. The committee met in early February and heard from Dr. Evan Ashkin, Director of the Formerly Incarcerated Transitions (FIT) Program, and Shatocka Carlton, Community Health Worker, about the FIT Wellness Program, which helps individuals with serious mental illness transition out of incarceration. The process begins prior to release and allows individuals to set their own goals and work with a support team to help achieve them while receiving assistance with needs like housing, primary care, and cell phone access. The committee is also preparing for National Screen-Free Week, which is coming up in May. The committee will next meet in early April. Dr. Jonnal noted that she knows of a group of parents with whom the Board may be able to collaborate for Screen-Free Week. Connections to Community Support Committee Dr. Jonnal provided an overview of the Connections to Community Support committee, sharing that the committee has previously produced a resolution on affordable housing and is working with local governments to promote changes in land use and zoning plans. Mr. Whitaker added that he has had some follow up with local elected officials, such as an ongoing conversation with Commissioner Sally Greene and some positive feedback from the Chapel Hill Town Council. The committee will next meet in early March. Dr. Serrano shared that he is currently working with Orange County Habitat for Humanity around homeownership rates, and that in the past he has done work on the impact of zoning and neighborhood development on physical activity and nutrition. Ad Hoc Committee on Well Rules Mr. Whitaker provided the update for the Ad Hoc Committee on Well Rules, reminding everyone that the committee was formed in response to a recent court case litigating a point where the Orange County Groundwater Protection Rules differed from the State Groundwater Protection Rules regarding the required horizontal setback between a well and a building foundation. The committee is working on a policy statement to clarify how the rule will be interpreted going forward, which they hope to present for action at the March meeting. The committee will next meet in mid-March. VII. Educational Sessions A. Proposed Budget for Fiscal Year 2026-2027 Frederick Perschau, Financial and Administrative Services Director, presented the budget request and proposed fee changes for Fiscal Year 2026-2027 (FY26-27). Some highlights of his presentation are below: S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 • The Orange County Government is working to standardize fees countywide, and all fees are ultimately approved by the BOCC. Mr. Perschau reminded the Board that it is the final year of the Dental Divisions stepwise fee increases, after which the fees should be in line with national standards. • Mr. Perschau clarified that the budget request is based on the net of the total authorized expenditures minus the service revenue. For FY25-26, this worked out to be about $10.1 M, with $14.35M in authorized expenditures and $4.193M in revenue streams. • Mr. Perschau reviewed the timeline for the annual budget process and reminded the Board that the FY26-27 budget will be formally adopted by the BOCC in June. • Because of ongoing budget cuts and uncertainty, the goal for this year's Health Department budget is to remain "flat"—that is, to minimize any new expenditures without corresponding new revenue. Mr. Perschau clarified that personnel and capital expenditures are considered separate processes to the main budget process. • At Mr. Whitaker's request, Mr. Perschau shared several assumptions that are relevant to the budget request, including an ongoing lack of a state budget and projected service revenue amounts for FY26-27. • Mr. Perschau highlighted the Public Health Infrastructure Local Workforce Development funding and said that it is similar to American Rescue Plan act (ARPA) funding in that it can be used for workforce development such as training, consulting, and conferences without needing county funds. Ms. Stewart shared that Local Workforce Development funds were used to pay for consulting services from the Carden Group last year. • Mr. Perschau shared that the Health Department is working with a team of consulting graduate students to improve the clinic's front desk and billing operations, as well as that Travis Myren, County Manager, has tapped the Orange County Health Department for an audit to assess staffing needs and operational efficiency. This audit will consist of an outside vendor coming in to examine staffing needs, scheduling, and operations to ensure staffing is adequate based on service levels. Ms. Stewart explained that the county government is trying to audit one department per year, with last year being focused on the Sheriff's Office. In response to Dr. Jonnal's question, Erica Pettigrew, Medical Director, commented that she is feeling hopeful that the results of the audit will be positive. • There has been a net operating expense decrease of$47,465 due to operational optimization and increased efficiency, leading to an overall net operating decrease of $8K. In response to Dr. Crandell's question, Kim Quatrone, Business Officer II, said that the projected personnel cost of the Health Department for FY26-27 is $13.1 M, which is higher than the total budget request (which excludes personnel costs. • Mr. Perschau reviewed the Medicaid Cost Settlement process, in which previously provided Medicaid services are partially reimbursed by the state, and reminded the Board that any funds received in the Cost Settlement process must be used in the program in which they were originally generated. There is currently a fund with a balance of$11.31M across all divisions, and this fund has so far generated $529K in interest revenue. In response to Commissioner McKee's question, Ms. Stewart explained that the interest revenue account is new and is not yet earmarked for anything specifically but that it still must be used to support the program where the funds were originally generated. She added that the Health Department is prepared to use some of these funds to help cover shortfall expenses where possible or to support additional positions if it is determined in the upcoming audit that these are needed. Ms. Quatrone added that a certain amount of funding must be allotted to certain programs to meet requirements to receive state funding, and Commissioner McKee expressed concern that the state funds may not come through regardless. S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 • In response to Mr. Whitaker, Ms. Quatrone confirmed that the cost of things like facilities, building renovations, and utilities do not come out of the Health Department budget but through other county funding. However, the cost of things like equipment replacements do come from the Health Department budget. • Mr. Perschau reviewed the proposed fee changes by division. Mr. Whitaker asked about fees listed as "at acquisition cost", which Ms. Stewart confirmed means that the fee charged to the client cannot exceed the cost to the Health Department to purchase the item. Most common item for this criterion are the 340B drugs. • Commissioner McKee noted that he is planning to call for a 2% countywide budget cut and so the budget as presented may need to be cut further in the future. Ms. Stewart clarified that the task for this meeting is for the Board to pass a budget request asking for what the Health Department needs for FY26-27 and that modifications would be coordinated between the Health Department, the County Manager's Office, Budget Office and the BOCC. She added that she will be completing a worksheet to determine what Health Department functions are truly mandated and what may be able to be cut to help meet the shortfall. A motion to approve the total budget requested in the amount of$10,734,044 for FY 2026- 2027 as presented, and forward to the County Manager and Board of County Commissioners for action was made by Dr. Alison Stuebe, was seconded by Dr. Lee Pickett, and carried without dissent. A motion to approve all fee changes for FY 2026-2027 as presented, and forward to the Board of County Commissioners for action was made by Dr. Lee Pickett, was seconded by Dr. Aparna Jonnal, and carried without dissent. B. Resolution on Newborn Screening for Metachromatic Leukodystrophy and Duchenne's Muscular Dystrophy Jean Phillips-Weiner, Board of Health Strategic Plan Manager, presented a draft resolution advocating for the inclusion of Metachromatic Leukodystrophy (MLD) and Duchenne Muscular Dystrophy (DMD) on the North Carolina Newborn Screening Panel. Some highlights of her presentation are below: • At the January meeting, Vrinda from the nonprofit Youth for Rare Diseases presented about the importance of adding MLD and DMD to the North Carolina Newborn Screening Panel, and she has since helped draft this resolution for the Board's consideration. The hope is for local lawmakers to encourage state law and policymakers to amend the NC Newborn Screening Panel to include MLD and DMD. • MLD is a neurodegenerative disorder and DMD is a progressive muscular wasting disorder. Both are inherited, both have effective screening tests and gene therapy treatments, and in both cases, time lost on diagnosis means function lost for the individual with the condition and that, once lost, the function cannot be regained. • Though MLD and DMD were added to the Federal Recommended Uniform Screening Panel (RUSP) at the end of 2025, this is no guarantee that the conditions will be added to the North Carolina panel in a timely manner; in the past, the condition Pompe was added to the NC Newborn Screening Panel fifteen years after it was added to the RUSP. • North Carolina already has screening infrastructure in place to screen for DMD, as well as scientific expertise at Duke and UNC, posing them to be a leader in newborn screening for MLD and DMD. S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 • Dr. Royce commented that she appreciated how the resolution included information requested at the previous meeting but suggested a revision to focus more on the Department of Human Services rather than the specific secretary. She also noted that the ask was a little unclear and that the language should be strengthened to make it clear who the Board is asking and what they are asking them to do. Through discussion, the Board determined that the resolution should be addressed to the Department of Health and Human Services' Division of Child and Family Wellbeing. Commissioner McKee requested a copy of the resolution draft to share with the Orange County Commissioners so that they can approve a corresponding resolution to encourage expedited action. Board members agreed to review and revise the draft resolution in advance of the March Board of Health meeting, where it will be presented for further consideration. VIII. Actions Items A. Inactive Accounts Policy Frederick Perschau, Financial and Administrative Services Director, presented the revision to the policy, which would lengthen the amount of time before a debt is deemed uncollectible from twelve months to twenty-four months and would increase the frequency of sending outstanding debts to collections from once every twelve months to once every six months. In response to Commissioner McKee's question, Ms. Quatrone said that there are 1,390 unique debtors and approximately $262K in outstanding debt, with over $70K collected. Mr. Perschau noted that often people will pay their outstanding debts when they receive a letter noting the outstanding balance and said sometimes asking is all that's needed. A motion to approve the revisions to the Inactive Accounts policy as presented was made by Dr. Rachel Royce, was seconded by Dr. Aparna Jonnal, and carried without dissent. B. Board Member Reappointments Three current board members have terms ending on June 30th, 2026. The Board of Health voted to recommend Dr. Rachel Royce to her 2nd full term, and Dr. Shielda Rodgers to her 3rd full term. Dr. Lee Pickett declined to be considered for reappointment, as she plans to move out of the county in the near future. To allow each appointee to vote, the Board decided on two different motions for the reappointment of the members with each of them abstaining from the vote in regard to their own reappointment. A motion to recommend a second full term for Dr. Rachel Royce and forward to the Board of County Commissioners was made by Dr. Lee Pickett, was seconded by Dr. Brian Crandell, and carried without dissent. Dr. Rachel Royce abstained. A motion to recommend a third full term for Dr. Shielda Rodgers and forward to the Board of County Commissioners was made by Dr. Lee Pickett, was seconded by Dr. Aparna Jonnal, and carried without dissent. Dr. Shielda Rodgers abstained. C. Ad Hoc Nominating and Operating Procedures Committee S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 Mr. Whitaker invited volunteers to join the Ad Hoc Nominating and Operating Procedures committee to recommend a replacement optometrist representative, as Dr. Baldwin has resigned, and a veterinary representative, as Dr. Pickett will not seek another term. Volunteers appointed to the committee were Dr. Pickett, Dr. Stuebe, Dr. Serrano, and Mr. Whitaker. IX. Reports and Discussion with Possible Action A. Media Items Marcy Williams, Health Promotion and Education Services Manager, presented the media packet to the board. Topics included: PFAS levels in water across the state, recent STI testing events on UNC Campus, information about respiratory illnesses in wintertime, and a chickenpox case at UNC. There was also a lot of coverage of the recent measles exposure in Chapel Hill. Commissioner McKee commented on a recent Orange Water and Sewer Authority (OWASA) report that determined that their water was significantly below the Environmental Protection Agency (EPA) threshold for PFAS. He noted that, while this is a good thing, there is concern about PFAS exposure for individuals who use private wells and that he would expect this might show up within water testing at the Health Department. Ms. Stewart said that Environmental Health staff are stepping up their testing to meet the demand and providing treatment when possible. In response to Dr. Royce's question about monitoring the results of private well testing, Ms. Stewart said that to her knowledge there is not a formal repository of private well testing results but that the Health Department may be able to access some of that information. Mr. Whitaker added that he has been meeting with the Orange County Department of Environment, Agriculture, and Parks and Recreation's (DEAPR) Commission on the Environment and that they're concerned about groundwater quality and that they are particularly interested in PFAS. Dr. Royce suggested recruiting an intern to work on uniting the data, as it would be good to be able to track regional trends in groundwater quality. 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. • Measles cases continue to grow in North Carolina, with one new case confirmed in Western NC since Ms. Stewart initially shared her report. The Health Department is working closely with the schools to prepare; while there are solid immunization records for the students, it is highly recommended that the school districts review staff immunization records as a best practice. Ms. Stewart added that the schools are a little traumatized after the COVID-19 pandemic. In response to Mr. Whitaker's question, Ms. Stewart said that they are doing their best to work one-on-one with charter and other non-district schools. Dr. Jonnal asked about literature to provide to the schools, to which Dr. Pettigrew responded that they will be meeting with the schools tomorrow to discuss and offered to share a new slide deck which provides guidance about exclusion from school after a measles exposure or outbreak. Dr. Pettigrew clarified that guidance states that an unvaccinated child with a vaccine exemption should be excluded from school in the event of an exposure or outbreak. • Medicaid funding is still short $319M —the state budget still has not been passed, leaving many state and local organizations in limbo; Jay Ludlam, Director of the NC S:\Managers Working Files\BOH\Agendas &Abstracts\2026 Agenda and Abstracts\ February Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH February 25, 2026 Medicaid Program, recently resigned. Commissioner McKee noted that he recently spoke with Representative Ren6e Price and Senator Graig Meyer and the passage of the state budget is not yet on the horizon. • The Care Management for At-Risk Children (CMARC) and Care Management for High- Risk Pregnancies (CMHRP) programs are also still in limbo; it's expected that Orange County will be able to keep the programs, but reimbursement rates remain unclear. Ms. Stewart noted that she hopes to have clarity around reimbursement by the end of the month. The Health Director's Association has requested a six-month extension to better transition the care management programs, but it's unclear from where the money to extend this would come. X. Adjournment A motion was made by Dr. Shielda Rodgers to adjourn the meeting at 9:08 p.m., was seconded by Dr. Alison Stuebe, and carried without dissent. The next Board of Health Meeting will be held March 25, 2026, 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\2026 Agenda and Abstracts\ February Page 8