ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT To enhance the

MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON August 27, 2009 at the Southern Human Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Michael Wood, Jessica Lee; Mike Carstens; Paul Chelminski; Christopher Cooke; Tony Whitaker; Steve Yuhasz BOARD OF HEALTH MEMBERS ABSENT: DeWana Anderson; STAFF PRESENT: Wayne Sherman, Personal Health Services Division Director; Tom Konsler, Environmental Health Services Division Director; Donna King, Health Promotion and Education Services Division Director; Angela Cooke, Dental Health Services Division Director; Carla Julian, Risk Management/Quality Assurance Director; Letitia Burns, Business Officer; Anne Miles Cassell, Administrative Assistant; GUESTS PRESENT: None I. Welcome and Introduction of New Board Members Chris Harlan, Chair, called the meeting to order at 7:00 P.M. Anne Miles Cassell administered the oath of office to the four new Board of Health members. Ms. Harlan welcomed all newly sworn in Board members and requested all Board members introduce themselves and give a brief background synopsis for everyone’s benefit. II. Approval of August 27, 2009 Agenda Steve Yuhasz requested that item IV.B. Approval of Write-off of Uncollectable Accounts be moved to Section V. for discussion. The motion to approve the Agenda of August 27, 2009 as amended was made by Steve Yuhasz, seconded by Jessica Lee, and carried without dissent. III. Public Comment for Items NOT on Printed Agenda None IV. Action Items on CONSENT Agenda A. Approve New Fees There were several unanticipated changes to the fee schedule adopted during the budget process. Because of the grant awards from the State of North Carolina and Kate B. Reynolds Foundation for Diabetes Self Management, the Health Department will be providing several new services related to the Diabetes program. Establishing these fees will enable the Department to recover costs for these services. There is a new lab fee for a test that is sent to UNC McLendon Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 1 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 Labs. Also, the temporary food establishment fee charged by Environmental Health is set by the state and was increased by the State during the state budget process. These additions and change must be approved before the department can begin charging these fees. Once the Board of Health approves the fees as required by NC General Statute 130A, they will be forwarded to the Board of Commissioners for approval. B. Approve Contract Renewal for Dental Preschool Project Coordinator The Health Department has traditionally received funds from the Orange County Partnership for Young Children (OCPYC) for a preschool dental screening, education and referral program for child care centers and family child care homes in Orange County. For FY 08-09 a new full-time position was approved for the Community Dental Care Coordinator/Dental Hygienist position. The duties for this position were to be split between this grant project and clinical services in an effort to increase our dental capacity in the hygiene area. The Department was unable to recruit a qualified candidate and requested to return to the previous model of contracting for services with a hygienist. As the state budget crisis grew throughout 08-09, it became apparent that there might not be the same level of support from Smart Start during the next funding cycle. The Department is recommending continuing with contract personnel for this project until the budget stabilizes and then the Department will reconsider the reactivation of the approved dental hygiene position. The Department has not yet been notified of a final approved amount for this grant project, but the interim funds committed are sufficient to cover the costs of this contract. In the event that funds are reduced, the contract has a clause that allows for a renegotiation of the contract. Ginger Mann, a private dental hygienist has served in this role for more than 8 years and as Project Coordinator is responsible for scheduling dental screenings with facilities, UNC School of Dentistry Hygiene Students, private dental providers, calibration for students and dentists, data entry, quarterly and final reports. A small amount of funds for temporary personnel would pay a Public Health Dental Hygienist to provide follow-up for children identified with dental needs, additional screenings in child care homes, and educational workshops for directors, teachers and parents. c. Approve Minutes of June 24, 2009 Meeting. The Board is required to review and approve minutes from all meetings held by the Board according to the Board’s adopted operating procedures. Motion to accept items on the Consent Agenda was made by Steve Yuhasz, seconded by Michael Wood, and carried without dissent. V. Reports and Discussion with Possible Action Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 2 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 A. Approve Write-Off of Uncollectable Accounts According to the Health Department’s Administrative Policy & Procedure Manual, Policy 15.0 – Delinquent & Uncollectable Accounts, OCHD shall remove delinquent and uncollectible accounts from the Accounts Receivable system on an annual basis. A list of delinquent and uncollectible outstanding client balances – accounts that have had no activity in the preceding 12 months was prepared by the Business Officer. The Board was reminded that at least three billing attempts had been made to collect the outstanding balance; however, some clients were “lost” due to address changes. The list was provided to the Board with the request for approval to move these accounts from “active” to “inactive” status. • Dental Health Services, $3,406.60 • Personal Health Services: o Child Health, $928.40 o Primary Care, $203.80 o Maternal, $551.00 o Family Planning, $10,889.56 o Adult Health, $335.51 o Epi (including IMM, STD, CD), $215.00 o Nutrition, $35.20 The total amount of client balances to move to “inactive” status is $16,565.07 Steve Yuhasz asked why the Family Planning fee amount was so much higher than any of the other write-offs. Rosemary Summers replied that as a recipient of the Title X funds for family planning (part of the state block grant), by virtue of the federal regulations attached to Title X, the department is prohibited from requiring people to pay for family planning services if they state they are unable to pay. Christopher Cooke asked for clarification on the regulations of Title X to prohibit the Department to require payment for services as they apply to family planning, but not the other areas of healthcare. He also asked if there was a way to know if the amounts due were disproportionate to the services provided. Rosemary Summers responded that the regulations consider requiring payment a barrier to receiving services only for family planning. Some of our other services are free (STD’s) and others have a minimum charge such as primary care and dental services. Commissioner Yuhasz asked if it was possible to establish a percentage these write-offs represent when compared to the total amount billed for corresponding services. Dr. Summers replied that a full educational session on billing practices and finances will be scheduled for October. Motion to approve the proposed write-off of delinquent and uncollectable accounts according to Policy 15.0 was made by Steve Yuhasz, seconded by Christopher Cooke, and carried without dissent. B. Pandemic H1N1 and Seasonal Flu Planning Report The 2009-10 influenza season is anticipated to be active. In addition to providing Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 3 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 over 2000 seasonal flu vaccine doses to the elderly and high risk, the Department will be coordinating the provision of 6500 seasonal flu vaccine doses to students in the 3rd – 8th grades in both school systems under a federal stimulus program by parental permission only. This will entail coordinating with school nurses, hiring supplemental temporary nurses to provide the vaccine, entering flu encounters in the NC Immunization Registry, and submitting billing as appropriate. In addition, the Department is charged with collecting information from Orange County medical providers regarding the number of clients in their practices who are in the priority groups for H1N1 vaccination. Health Departments are being asked to identify partners within the community such as medical offices, pharmacies, and clinics who seek to provide H1N1 vaccine to their patients or high-risk public and are willing to comply with federal guidelines and reporting requirements. Depending on the interest, the Health Department will then assess our need to expand vaccine provision beyond our staff and client population to include other recommended populations. Since the H1N1 flu impacts younger individuals more than older people, who may have some immunity, the CDC recommended groups are: • Pregnant women, • Household contacts/caretakers of infants <6 months, • Healthcare and emergency medical services personnel, • 6 mos. – 24 year olds, and • 25 – 64 year olds with chronic medical conditions placing them at increased risk for complications from flu. These groups may change depending on the volume of vaccine available. Meetings with community partners are being planned to keep them informed of the current status of H1N1 planning and CDC guidelines, and to engage them as partners. Regular communications are being planned to keep the community informed and aware. Anti-virals would only be recommended for those, with the flu also categorized as at-risk. Steve Yuhasz asked when a letter regarding the seasonal influenza immunization would be sent home with the students from the schools and also if the letters would be language appropriate for the non-English speaking parents. Judy Butler stated that the letters had been translated into several languages and would be sent home during the first week of school. Jim Stefanadis asked if only one Saturday morning H1N1 clinic would be offered. Ms. Butler replied that we currently are reserving 3 dates with one of our dispensing sites 21 – 28 days apart to accommodate the 2nd required dose. We will know more when we receive amounts and dates for vaccine arrival. Chris Harlan asked about what kind of general community education is planned. Judy Butler replied that UNC Campus Health, newsletters, communications with media and medical providers on a regular basis are currently being used. Currently prevention messages are being published. Rosemary Summers stated that a breakfast is planned in September for medical providers to talk with them about their messages to their high-risk patients to make sure that it is consistent with guidance from the CDC. Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 4 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 C. Board of Health Committee Assignments Each Board member with the exception of the Commissioner and the Chair are required by Board Operating Policy to serve on at least one Board of Health Committee. The Committees generally meet only when needed, although the two major committees do establish a monthly schedule for meeting to simplify calendar planning for members. The four new Board members were given the opportunity to serve on the committee of their choice. Tony Whitaker chose to serve on the Environmental Health, Preparedness, & Quality Assurance Committee. Paul Chelminski and Christopher Cooke chose to serve on the Personal Health, Dental Health & Health Promotion Programs Committee. D. Rogers Road Community Request for Environmental Services Tom Konsler reported that Environmental Health was recently contacted by Reverend Robert Campbell who represents a group of residents who live in the Rogers Road community. He expressed concerns over the safety of well water supplies and septic systems in this neighborhood. He also expressed concern about illnesses in the area. Board members were provided meeting notes for reference. Rev. Campbell would like for the Health Department to conduct an environmental assessment of the wells and septic systems in the neighborhood. Students from the UNC School of Public Health may be included in the effort as well as representatives of the community in a team effort. Because of the size of the area of concern and the anticipated cost of the study, there are not adequate resources to accommodate this request. An estimate of costs and time will be developed pending further information from the community representatives. In accordance with the policy that was developed in 2006, it is anticipated that a request will be made of the Board of Commissioners by Rev. Campbell to consider appropriation of money to fund this request. Mike Carstens asked for clarification of the letter of intent requirement for the community development block grant and the results already on file with Environmental Health. Tom Konsler reported that the records already on file showed no higher failure rate for this area than other areas of the county, but that there was no information in files for about 1/3 of the systems. Steve Yuhasz inquired about the results from the UNC study that was done. Tom Konsler replied that the study had just been received and he had not had a chance to read the report prior to the meeting. Steve Yuhasz said there were several task forces assigned to this issue, one by the Town of Chapel Hill and one by the County. Resentment among residents has been present for many years because they felt the County had promised Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 5 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 compensation for suffering incurred as a result of the landfill. There are on-going discussions between the Town of Chapel Hill and the County. The County’s Solid Waste Enterprise Fund did pay to install a trunk water line in the community, however, few have chosen to hook up to the line due to the individual expense of connection to the line, plus there is a problem of running pressurized water from the main line through the older plumbing in the homes. The County plans to apply for a grant to bring the community up to the level it should be. Anissa Vines stated that there are concerns in the community that environmental qualities have affected health in the community. Tony Whitaker stated that he has worked on projects in this area and has noted the level of distrust with local government is high in that community. E. Biosolids Forum Chris Harlan gave a brief synopsis of the issue for the newer Board members. Tom Konsler reported that in June, the Environmental Health staff in partnership with NCSU and Cooperative Extension began planning for a biosolids forum to be held in October. The focus was to familiarize participants with the current state of practice, completed and proposed research, and risk management of the land application of biosolids. The BOCC was asked to re-direct a portion of the funds originally appropriated for a biosolids research project in order to partially offset the cost of this workshop. The Commission of the Environment (CFE) took exception to the forum, asking the Board to continue reserving these funds for the planned research. They also renewed their request for a task force. Board members were provided with copies of the memoranda from the Commission for the Environment for the details. At the BOCC meeting on August 18, there were several community activists who spoke against the forum, stating that they felt it was pro-biosolids and that the speakers would be biased in favor of land application. They believed that the Health Department is unwilling to pursue the research study and that the money should be used for local testing of soil and water for contaminants to “prove that there are health effects.” A representative from the Commission for the Environment spoke against the forum, stating that the research could be done with other partners and that they felt the commission was left out of the planning for the forum. Chris Harlan, Board of Health Chair, and Commissioner Yuhasz were both articulate in their support of the Health Department’s role in this matter and spoke in favor of the forum and the redirection of funds for this purpose. The Commissioners voted 6-1 to delay the forum pending further discussion. One Board member felt that local authority for regulation of biosolids should be added to the county’s legislative agenda and be actively pursued. Board of Health members discussed the results of the Commissioners’ decision to provide direction to the staff on: • Participation in a forum sponsored by academic institutions only Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 6 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 • • • • Health department responsibilities in the biosolids arena Viability of the current Board of Health rule on biosolids monitoring Board’s position on a “multidisciplinary” task force on biosolids policy Burden of monitoring and enforcement of local regulation of biosolids Tom Konsler stated that the purpose of the forum was to get complete unbiased information out to the citizens. Jessica Lee stated that the Board of Health has been studying this issue from the time she began serving on the Board two terms ago. She stated that when these discussions began many years ago, the Commission for the Environment was completely unaware that Environmental Health already had staff assigned to this issue and that local rules included monitoring these sites. Dr. Lee stated that the Board of Health has a long history of acting on this issue and tried diligently to get a study going from the very beginning without much success. Tom Konsler stated that he had spoken with David Stancil, the department head of Environment and Resource Conservation Department and had received favorable feedback regarding a public forum at that time. Anissa Vines stated that the Board had indicated they would participate in a task force but that we remain concerned about the task force’s scope of work and the inherent bias of information in widespread circulation. Christopher Cooke felt that even if we had the study and the forum there are still those parties that are biased against the application of biosolids regardless of any facts or scientific data and that no progress would be made. Steve Yuhasz commented that the Commission for the Environment did not include nor invite Environment Health or Board of Health to their meeting to discuss this issue. He stated that the CFE’s approach is purely biosolids affect on the environment, whereas the Health Department’s approach is the effects of biosolids application on the environment that also affects health. Tom Konsler stated that NCSU may take the forum on and continue with the planning. Because of the Commissioners directive, the Department would have to decline participation. F. Informational Items a. Project Homeless Connect: The 3rd Project Homeless Connect Orange County will be held on Thursday, October 8, 2009 from 9:00 am – 3:30 pm at the Hargraves Community Center in Chapel Hill. Angela Cooke reported that PHC is a one-day, one-stop center to provide people experiencing or at risk of experiencing homelessness with a broad range of services including housing, employment, health and dental care, mental health care, veterans’ and social service benefits, legal services, and more. This year more than 200 – 250 guests are anticipated being served with participation of over 50 social service agencies. This program is part of the County’s 10-year plan to end homelessness. Wayne Sherman and Angela Cooke are chairs of the PHC health and dental Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 7 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 committees, respectively. OCHD, Piedmont Health Services and other community providers are working together to provide needed health services to visitors to the event. OCHD will be providing flu shots, adult and child vaccinations, cholesterol and glucose screenings, and Maternal Care Coordination and Health Check/Health Choice information. Piedmont Health Services will be providing Blood Pressure screening, medical assessment and consultation, Pharmacy consultation, Carolina HealthNet enrollment (to provide a medical home) and acute medical services off-site as needed. In addition, the UNC Kidney Van will be on-site to screen for kidney disease and rapid HIV Counseling and Testing services will be available. Podiatrists will assess feet and trim nails, and vision screening with an optometric visual exam will be offered. The OCHD Dental Health Service will be providing two days of dental treatment. Dr. Day and Angela Cooke will conduct a dental screening at the men’s shelter prior to the event and schedule clients based on treatment needs. On October 1, 2009 scheduled clients will receive dental treatment, fillings and cleanings, at the Carrboro Dental Clinic and on October 8, 2009 extractions will be provided by dentists from UNC School of Dentistry and OCHD dental staff on site in the Men’s Baptist Dental Bus. Ms. Cooke sent out 2 communications to all dentists in Orange County asking for volunteer participation or funding to support the event and received no responses. b. Case Management Reductions: Rosemary Summers reported that part of the state budget process that was approved was a severe cut in Medicare reimbursement for case management services. A task force was appointed to come back to the legislature by September 1st with a plan that would achieve this goal. This would affect nearly all of our home visiting programs and about 12 positions in the department. We do not know what the draft plan contains, but the way the Department of Medical Assistance is defining duplication is that if a client or part of the client’s family is receiving more than one service in a 12month period it is considered duplication, and the services being received would be case managed by a single case manager regardless of the specialty needed. There is also a possibility that all case management services would be assigned to Community Care of NC. Implementation of this plan would devastate the infrastructure of the department and make it difficult to respond to emergency situations. Chris Harlan stated that when the current Baby Love Program was originally developed in NC the system was looked up to as a model all around the country. Rosemary remarked that a 1980’s research study showed a $2 savings from every $1 spent in the program. c. Board of Health Policy Manual: The Board approved revisions this past spring to several procedures or policies contained in the Board of Health Policy Manual. New members received a new policy manual as part of their orientation. Staff had complete new copies of the manual for each member at the meeting. All Board members are required to acknowledge by signature that they received and reviewed the Policy Manual. d. Pending and Recurring Items: The chart details upcoming agenda items. Staff made several adjustments to better correspond with state reporting requirements or the budgetary flow for the year. The changes were marked for Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 8 August 27, MINUTES ORANGE COUNTY BOARD OF HEALTH August 27, 2009 convenience. f. Board of Health Roster: Board members were provided with Rosters including information for new Board members. V. Board Comments/Announcements A. VI. None Closed Session Motion to adjourn to Closed Session (ref. NCGS 143-318.11(a)(6) to consider the qualifications, competence, performance, fitness, conditions of appointment, of an individual public officer or employee was made by Jessica Lee, seconded by Paul Chelminski, and carried without dissent. Motion to return to Open Session was made by Chris Harlan, seconded by Jessica Lee and carried without dissent. Motion to adjourn the meeting was made by Steve Yuhasz, seconded by Michael Woods and carried without dissent. The next Board of Health meeting will be held on September 23, 2009 at the Southern Human Services Center, Chapel Hill, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board Board of Health Minutes Transcription completed by Anne Miles Cassell 2009 9 August 27,