MINUTES ORANGE COUNTY BOARD OF HEALTH
February 28, 2008
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 February 28, 2008 at the Hillsborough Town Barn, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Tim Carey; Ernie Dobson; Moses Carey, Jr.; DeWana Anderson; Sharon Van Horn; Sharon Freeland; Jessica Lee; Matt Vizithum BOARD OF HEALTH MEMBERS ABSENT: None STAFF PRESENT: Rosemary Summers, Health Director; 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, Quality Assessment/Risk Management Division Director; Anne Miles Cassell, Administrative Assistant; Barbara Pringle, RN, Adult Health Nurse; Pam Diggs, Senior Public Health Educator; Javier Amador, Language Coordinator; Susan Clifford, Refugee & Immigrant Health Program Manager; Stacey Snipes, Public Health Nurse; Galey Tatum, Medical Office Assistant; Shani Blank, Medical Office Assistant; Amanda Bartolomeo, Volunteer Coordinator GUESTS PRESENT: None I. Welcome and Introductions Anissa Vines, Vice-Chair, called the meeting to order at 7:00 P.M. Rosemary Summers called on Division Directors to introduce members of their staff present at the meeting. Those introduced were either a new employee or employees that had not previously attended a Board of Health meeting. Staff is required to attend one meeting of the Board of Health as part of their orientation. II. Educational Presentation: Accreditation Briefing Rosemary Summers explained the process of the site visit for accreditation and gave examples of questions that Board of Health members would be asked by the accreditation team. Dr. Summers explained that all activities must be met for each benchmark to pass. Governance Standards and Activities: Examples were given to Board members of questions that would be asked during the accreditation interviews with the Board and given the opportunity for input. One point brought out is that although Board members have been active in communicating with units of government in support of the local health department efforts to secure national, state and local resources the department has not been provided with copies of the communication for its files. Board members were asked to please copy the department, either electronic files or hard copy, so this activity will be documented. Dr. Summers explained that there would be four site accreditation visitors. They usually want to interview the Board members on the 2nd day of the visit. After coordination of calendars, 8:30 A.M. on the 30th was selected and Chris Harlan, Matt Vizithum, and Moses Carey, Jr. will represent the Board.
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MINUTES ORANGE COUNTY BOARD OF HEALTH
February 28, 2008
II.
Approval of February 28, 2008 Agenda The agenda was amended to include Item V.L. No Fault Well Repair Fund Water Treatment for Arsenic. The motion to approve the Agenda of February 28, 2008 as amended was made by Jessica Lee, seconded by Tim Carey, and carried without dissent.
III.
Public Comment for Items NOT on Printed Agenda None
IV.
Action Items on CONSENT Agenda A. B. Minutes approval of January 17, 2008 meeting. Accept Additional Funds 1) The Health Department received confirmation of additional allocation of Family Planning Title X funds. These funds are calculated on a minimum basis per county and additional funds based on performance. OCHD has been allocated $12,215 in Family Planning funds to be used by May 30, 2008. It is expected that the Department will use these funds for: a. Capital Equipment – replace centrifuge b. Capital IT Equipment – new tablet PC’s c. Departmental Supplies d. Office Supplies e. Printing – FP brochures and posters f. Advertising – DTH, CH Herald for FP, Evening Clinic hours and other related services 2) The Health Department has a number of staff that have been involved in a “Random Moment Time Study” (RTMS) with the state for reimbursement of Medicaid administrative funds. At this time, OCHD has been allotted $10,000 to be spent by May 30, 2008. This funding will to be used to pay an Administrative/Office Assistant to help with new and existing programs, including Refugee and Immigrant Health. A request for temporary staff has been submitted and approved by the county Personnel Office. C. Contract with Trans-Verse Inc. for Preparedness Services The Health Department is charged by the North Carolina Division of Public Health with a number of deliverables in the area of Public Health Emergency Preparedness. The Health Department staff member responsible for these activities was transferred to a new position in the summer of 2007. The Department has been unsuccessful to date in recruiting a replacement nurse, however the deliverables remain a requirement of both our agreement addenda with the State of North Carolina and an accreditation requirement. Some deliverables have been met, however, there are a number of outstanding items that require attention before the end of the fiscal year. These include
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a significant revision of the Orange County Strategic National Stockpile Plan, appropriate training for the new plan requirements, and training and respiratory fittesting of Health Department staff to ensure that proper protective equipment is utilized during a public health event requiring staff response. A consultant has been identified with local and state experience that can accomplish these agreement deliverables for the Health Department. The NC Division of Public Health provides funding to partially support the public health emergency preparedness function. These state funds will be utilized to fund this agreement in the amount of $13,050 and are available in the Health Department budget. Staff recommended approval and forwarding of Contract to the Board of County Commissioners for approval. D. Contract with CDP for Food and Lodging Software The Environmental Health Section of the Orange County Health Department is responsible for permitting, tracking, and inspections of restaurants, meat markets, lodging facilities, schools, daycares, public swimming pools, and a variety of other establishments that operate in Orange County. The EH staff are equipped with the computer hardware to conduct field inspections, however, they are employing an inspection software program supplied by the state that that is inadequate in its functionality. A new software product developed in-house by the state was proposed in 2007 and beta tested by Orange County staff, but it has been found to be problematic and the rollout date has been postponed indefinitely. Central Data Processing (CDP) is a software company that has developed software to meet the needs of the NC environmental health food and lodging program. This specific inspection software has been successfully implemented in over 40 North Carolina counties. This software is a web-based platform that is maintained by the vendor. No customization will be needed particular to Orange County as this is a statewide program and the company responds with upgrades and revisions in response to rule changes. Upgrades are provided at no additional cost. The conversion of existing data is included in the cost. Of the two vendors in North Carolina, CDP is the only vendor that has been able to successfully tie data in to the state reporting system. Information technology staff and environmental staff have made visits to other counties that have implemented this software solution and there are no concerns about its ability to serve needs of this program in the foreseeable future. With the implementation of this system, it is anticipated that staff will finally be able to accurately track activities and inspection results with maximum efficiency and single entry of data. This will increase our responsiveness to our clients and ensure that establishments are not overlooked. First year cost for this software is $21,440. This includes all set-up, data conversion, linkages to the state reporting system, and training for staff. The second year costs are $14,440. The cost structure is based on the number of users of the system, so if the number of staff members using the system increase, costs will also increase. As new staff members are added these costs will be considered as part of the new position
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request. Funds have been allocated in the Information Technology Services Department budget for fiscal year 2007-08 for this project. Motion to approve the minutes of January 17, 2008 and items on the Consent Agenda was made by Tim Carey, seconded by Jessica Lee, and carried without dissent. V. Reports and Discussion with Possible Action A. Community Assessment Policies The Community Assessment Policy and Procedures, if approved by the Board, will become part of the Board of Health Policy Manual. The accreditation process requires a specific policy on community involvement in the community health process. This has been a long-standing practice of the Board and the Health Department but the policy has never been documented. Motion to approve the Community Assessment Policy and Procedure was made by Tim Carey, seconded by Jessica Lee, and carried without dissent. B. Public and Community Input Policy The proposed policy on public and community input captures the current practices in the Health Department. This is an accreditation item that must be documented in a policy statement. It will be included in the Board of Health Policy Manual. Motion to approve the Public and Community Input Policy was made by Jessica Lee, seconded by Tim Carey, and carried without dissent. C. Complaint Policy This policy states the Health Department’s current practice in handling complaints. Our practices had not been captured in a written document with the exception of specifics regarding appeals for permit denials and the process of enforcement for the Smoking Control Rules. This is a policy required by the accreditation process. Motion to approve the Complaint Policy was made by Anissa Vines, seconded by Ernie Dodson, and carried without dissent. D. Health Director’s Job Description Discussion One of the governance requirements for the Board of Health in the accreditation process relates to hiring a qualified Health Director. If a Health Director has not been hired in the last 48 months, the Board is still required to regularly examine the Health Director’s job description for any needed adjustments. The Board Chair, Chris Harlan, reviewed the job description at the end of 2007 and verified that it was current, however, the activity requires a documented Board discussion of the job description. The Board reviewed the current description. Dr. Carey commented that the job description accurately reflected what the Health Director actually does. Dr. Vines and
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Dr. Van Horn commented that the Board considers this during annual review. There was no further discussion. E. Research Policy Review The Board had previously considered input to the staff in the formulation of a research policy that would govern and protect client privacy and would guard against participating in research that might disrupt patient/client services. The policy has been revised several times and was reviewed at the meeting for input to the staff on needed changes. This policy is part of the overall Administrative Policy Manual for the department. Dr. Carey commented on Institutional Review Board (IRB) approval and funding. NIH changed the process several years ago because the IRB was overburdened approving protocols that never received funding. It can take three or longer months to get IRB approval. The NIH requested that no approvals should be requested before funding is approved. He also requested the CCP committee inform BOH of research requests to enable any BOH input. He stated that where we will get solicited for support is if an investigator is looking for external funding which would help the health department as well as investigator. There should be a statement that no research actually commences until we have the funding but this should be flexible to allow letters of support for research proposals. Jessica Lee suggested the word “university” in Procedure 5.1.2 be struck from the policy, as other organizations have independent IRBs. F. Uncollected Debt Write Off The Board was provided with a summary listing of delinquent client accounts for Dental Health, Personal Health and Health Promotion Services. These accounts have had an outstanding balance in which at least 12 months have elapsed since the last payment on a client’s account. Upon Board approval this write-off of delinquent client accounts, the Health Department staff will work the IT staff to ensure that the accounts receivable system indicates the recording of the bill as uncollectible. The client will never be informed that a debt has been written off. If a client returns to the clinic after their accounts had been determined uncollectible, the delinquent writeoff amount will be reactivated and the billing process resumed. Tim Carey asked about tracking of fees, debts and unpaid balances. Tracking of ratios of insurance coverage, written off debts and unpaid balances, may increase the charity care total. Matt Vizithum requested clarification on the status of returning clients that have been written off. He asked if the patients pay any percentage of their outstanding balance
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before being provided services or if patients are billed. Angela Cooke replied that most dental patients expect to pay for their services. In the case of primary care there is a specified co-pay at the time of each appointment. Ernie Dodson asked what efforts are made to collect unpaid balances. Dr. Summers replied that patients are billed for 3 months in a row trying to collect. Staff works with patients to establish a payment plan. Title X states that we can charge but we cannot pursue collection, at least for family planning patients. Motion to approve the write-off of delinquent accounts was made by Moses Carey, Jr., seconded by Sharon Van Horn, and carried without dissent. G. Customer Service Survey Results Each of the Divisions that have a major direct service component has implemented a customer service survey that provides feedback on service provision. The Board was provided with copies of the surveys and results for review. The surveys are in English and Spanish. After surveys are gathered and analyzed, the results are discussed in a staff meeting with the appropriate unit so that corrective actions can be formulated if needed in order to improve the Department’s service provision. This is one way that the Department can be more responsive to public input on our services. The results were presented to the Board for further discussion by each responsible Division Director, Angela Cooke, Dental Health Services, Tom Konsler, Environmental Health Services, and Wayne Sherman, Personal Health Services. Personal Health has been utilizing customer surveys for feedback on service provision for several years. Environmental Health and Dental Health surveyed their customers for the first time this past year. Sharon Van Horn noted the comment on the Environmental Health survey that recommended inspections be standardized. Tom replied the process is standard but staff will be working on calibrating their inspection procedures. Angela Cooke commented that several issues brought out in the surveys are being addressed, such as waiting area being too small, and obtaining services of a full time dentist. Wayne Sherman stated that the Personal Health Services Division has been doing surveys every six months for several years to keep abreast of customer concerns. He commented that most patients expressed satisfaction for the services they received. One suggestion from the survey was to provide memo pads in the interview room for patients use to write down issues they want to ask the provider about. This has now been implemented. Jessica Lee asked if the department accepted credit cards as payment. Dr. Summers stated that the cost of that service has been a barrier to the county offering them in the past. Medical patients and Environmental Health customers have asked for that service in the past. The department will continue to pursue the possibility of providing that service for clients; however the county will require us to pass along the convenience
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fee. H. BOH Orientation Manual Each new Board member received an orientation manual and a data and rules manual as part of new Board member orientation. These manuals have been significantly revised in order to make them more useful to new Board members. In addition, we have developed the new Board of Health Policy Manual that captures Board adopted policies and Board operating procedures. The new policy and procedure manual that were adopted at the October 2007 meeting were distributed at the meeting. The operating procedures will replace the Board of Health By-Laws in the orientation manual. The Board reviewed these manuals for any other changes. The Board also received a CD with NCGS 130A updated in 2007. I. Public Health Month Proclamation The North Carolina Office of the Governor has traditionally proclaimed the month of April as Public Health Month for the State. The purpose of Public Health Month is to recognize contributions of local public health professionals in protecting residents’ health through health promotion, disease prevention and surveillance, and environmental sanitation. Orange County, North Carolina has outstanding public health resources and professionals. As a result, the County boasts low diabetes mortality rates, low heart disease and stroke mortality rates, and low smoking rates among residents. The Orange County Health Department concluded that April 2008 should be recognized as Orange County Public Health Month and will help increase awareness of the many personal and community benefits of public health. Staff prepared a proclamation designating April as Orange County Public Health Month for presentation to the Commissioners and suggested a Board of Health member be present at the March 18, 2008 Board of County Commissioners meeting to receive the proclamation. Motion to approve the Proclamation of April as Orange County Public Health Month and forward to the Board of County Commissions for approval was made by Tim Carey, seconded by Jessica Lee, and carried without dissent. J. Informational Items a. Space Update The Commissioners considered several additional options presented by Commissioner Gordon at a work session on the capital improvement plan. There was a staff work session to compare and contrast all four options that have been under consideration. The Commissioners had requested that the Social Services and Health Board consider the strengths and weaknesses of the proposals. In consultation with the Chair and ViceChair a follow-up letter was sent to Commissioners. Commissioners will consider all of the options presented to them at their regular meeting on March 6, 2008 and will likely
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choose an option to pursue. The Board discussed the need for one and perhaps more Board members to be present at the Commissioners meeting on March 6 in Hillsborough. Chris Harlan, Chair, volunteered to attend the meeting on the Board’s behalf. b. Flu Update Wayne Sherman gave a flu update. February has been a record high month of reported cases. The department still has approximately 170 doses of vaccine. Dr. Carey stated that there were 80 people in the emergency room at 8:00 am that morning. He felt this was an indicator of severity of flu in the area. c. Smoking Ordinance Update The Board was given a copy of the tobacco use ordinance that was passed by Commissioners on February 19. The nest step is to ask each of the municipalities within the county to pass a resolution allowing the ordinance to be enforced in their jurisdiction. The Health Director will be attempting to schedule all three municipalities in March and April to allow full implementation of the ordinance. d. Social Justice Goal Follow-Up The Human Rights and Relations Commission presented the social justice goal draft to the Board of Commissioners at a joint meeting of the two boards. The narrative portion of the goal was given to the Board for review. If Board members would like to review the entire document, staff will make it available via email. Moses Carey reported that the Commissioners were positive toward the goals and the direction the policy is heading but asked for some adjustments to the statement. K. Tracking Form Review The tracking chart helps the Board and staff track upcoming agenda items and projects that will require attention in the coming months. The Board was asked to review the table for additions, deletions and changes. L. No Fault Well Repair Fund Water Treatment for Arsenic As a component of the No Fault Well Repair Fund (NFWRF), bottled water has been provided to 9 homes (on 8 wells) due to detectable levels of arsenic in the drinking water (>1 part per billion ([PPB]). If the well were otherwise satisfactory, the homeowner would receive bottled water to be paid by the NFWRF at a rate of 15 gallons per person per month. The basis for provision of bottled water rather than treatment was that the treatment systems available in years past have had varying success with arsenic removal at these low levels. In November of 2007, the Board of Health approved the installation of a reverse osmosis water treatment unit on one of the homes where the homeowner preferred a treatment system to bottled water. The unit was installed in January. After one month
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of operation, the water was tested and it was found that the unit was successful in lowering the arsenic to a non-detectable level (<1 PPB). As proposed in the November action, Environmental Health will proceed with arranging for similar units to be installed at the remaining 7 wells with follow-up testing. Following verification of arsenic levels below 1 PPB, bottled water service will be discontinued. VI. Board Comments/Announcements A. VII. None
Adjournment Motion to adjourn the meeting was made by Ernie Dodson, seconded by Tim Carey, and carried without dissent.
The next Board of Health meeting will be held on March 27, 2008 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
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