ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT To enhance the

MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 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 April 23, 2009 at the Government Services Center, Hillsborough, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; DeWana Anderson; Tim Carey; Sharon Freeland; Steve Yuhasz; Michael Wood, Jessica Lee; BOARD OF HEALTH MEMBERS ABSENT: Matt Vizithum, Jim Stefanadis, illness; Ernie Dodson, out of town. 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: Annette Moore, Orange County Staff Attorney; Kaye Bernadas, UNC Nursing Student Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:00 P.M. and introduced the guests present. I. A. Public Health Month Photo Presentation Candice Watkins Robinson reported that the health department invited UNC Gillings School of Global Public Health (UNC) students to join us for the “This Is Public Health” month sticker campaign. Students were recruited on campus in March and campaign materials were made available in the Office of Student Affairs. Carla Julian also recruited UNC Nursing students during a class presentation. OCHD staff received emails and campaign packets during the first week of April. Kick off sessions were held on April 17th and teams from OCHD went out in the Northern and Southern part of the county to obtain photos. Staff and students used the stickers to identify and photograph public health in action in honor of Public Health Month. Photos were uploaded to the national campaign’s Flickr website and to the department’s Public Health Month web page. Candice reported that this effort looks like the first for North Carolina and a first for UNC. When the website is accessed, Orange County is the first listing for the state and the first to upload pictures to the site. Chris Harlan requested additional stickers in Spanish. Board of Health Minutes Transcription completed by Anne Miles Cassell 1 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 B. Volunteer Month Recognition Amanda Bartolomeo discussed the receipt of scholarship awards for two Orange County Public Health Reserve Corps (PHRC) volunteers to attend all-expenses paid, four day training in Maryland. This training, sponsored by National Association of City and County Health Officials, will focus on national deployment of Medical Reserve Corps Volunteers. There were only 25 of these all-expenses paid training scholarships available and over 300 applicants. Orange County was awarded two. Orange County currently has 285 registered volunteers, both medical and non-medical. Our goal for next year is to recruit 50 new volunteers focusing on the pharmaceutical field. Ms. Bartolomeo also discussed recent leadership training that she attended and upcoming April Community Emergency Response Team (CERT) and PHRC trainings and events. Ms. Bartolomeo is working closely with Orange County Emergency Services to develop a Geographic Information System (GIS) map documenting the location of current CERT teams in relation to Orange County fire departments and volunteer fire districts. She shared this map and discussed how this map will be used to target the CERT program’s next recruitment campaign to begin in early June 2009 and briefly described several of the focused trainings. Tim Carey complimented Ms. Bartolomeo for making the program fun and varied for participants and stated that people were more likely to volunteer for something that seemed like a fun activity rather than an activity that appeared to be like work. II. Approval of April 23, 2009 Agenda The motion to approve the Agenda of April 23, 2009 was made by Tim Carey, 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. B. Minutes approval of March 25, 2009 meeting. Third Quarter Financial Report The Board received the Third Quarter Financial Report, detailing the Department’s revenues and expenditures as of the end of the third quarter ending March 31, 2009. The report also included a report of additional state and federal funds received after July 1,, 2008. C. Acceptance of Additional Family Planning Funds 2 April 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 The Department has received notification of additional Federal funding. The Federal Title X (Family Planning) has approved a second allocation of bonus funding for all local health departments. These funds must be spent by May 31, 2009 or they will revert back to the state. The state allocation committee has approved the method of distribution, which includes a base amount for all counties and an additional amount determined by performance (client visits). The total amount allocated for this second round for Orange County is $3,157. These funds may be used for any approved Family Planning expenditures. Due to the increased need for interpreters in the clinics, we propose to use this money in Professional Contract Services for interpreter contract costs. Motion to accept items on the Consent Agenda was made by Sharon Freeland, seconded by Steve Yuhasz, and carried without dissent. V. Reports and Discussion with Possible Action A. Receipt of Medicaid Cost Settlement Funds Each year the Health Department receives a cost settlement based on the previous year’s Medicaid claims. The cost settlement is only on the federal portion of the Medicaid payment and is intended to provide the agency the difference between the actual costs of providing the service versus the reimbursement amount. North Carolina Division of Public Health performs the annual cost reimbursement analysis to determine the amount each county will receive. The Association of Local Health Directors has agreed that costs across the state will be averaged and then determined on a basis that is either above or below the cost for each service code. Orange County Health Department has received funds annually for all programs that earn Medicaid reimbursement since 1998. The amount of funds varies from year to year based on the costs across the state and the reimbursement levels for various services; our average has been around $200,000 annually. These funds are placed in a capital account and are utilized for renovation projects and emergency equipment needs. These funds must be used by programs that actually earned the revenue (child health, family planning, dental, maternal health, etc.). For 09-10, the State, with Health Director Association concurrence, is withholding $3 million from the 07-08 settlement funds to balance the state budget. This will preserve the recurring fund gains we have recently made in Aid to County Funds. The allocation for Orange County Health Department for the 07-08 settlement year (including our share of the proposed reduction) will be approximately $272,760.34. We had a substantial service count increase for the 07-08 year with a corresponding increase in our settlement amount. We will be requesting to budget approximately $250,000 for limited renovations to Whitted and SHSC after the Department of Social Services moves, to enable us to continue to provide services until a final decision is made regarding the Mayo Street property in 2012. The remaining funds will be placed in the capital Board of Health Minutes Transcription completed by Anne Miles Cassell 3 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 account and will be available for the larger projects scheduled for future years. By consensus the Board agreed to table the motion to approve receipt of these funds until the May meeting and a firm amount is known. B. Review of BOH Policy Manual Anissa Vines reported that the annual review of the BOH Policy Manual was conducted by the Committee as required in the policy. In March the Board approved changes to Section 1., Policy E. Fee and Eligibility Policy. There are minor proposed changes to Section III.B.b. Orientation and Education for New BOH Members; and B.d. Annual Performance Review Process for Health Director. Committee Members or Board members reviewed suggested changes. Rosemary Summers stated that at a recent legal conference she attended, the opinion given by the attorney at the Institute of Government was that some of the Board’s hearing processes should to be amended because appeals should be heard by the entire Board. Previously appeals were heard by hearing officers of the Board. The Recruiting Process went into more detail than the previous policy and incorporated the informal process of retiring member recommendations for their position into formal policy. Chris Harlan suggested clarification of wording to the policy. Motion to approve changes to the Board of Health Policy Manual as proposed by Committee was made by Anissa Vines, seconded by DeWana Anderson, and approved without dissent. C. Review of Terms of Office for Board Members Anissa Vines, Matt Vizithum, Ernie Dodson, and Sharon Freeland all have terms that expire on June 30, 2009. Matt Vizithum has served two terms and is not eligible for reappointment under Board of Commissioner policy. Ernie Dodson and Sharon Freeland have both indicated that they prefer not to serve a second term. Dr. Tim Carey, second term ending June 30, 2010, has submitted a letter of resignation from the Board as well. Generally members serve until a replacement is acted upon by the Board of Commissioners. Steve Yuhasz asked who the engineers are that have served on the Board. The two most recently serving were Alan Rimer (6 years) and Rick Marinshaw (9 years). Tom Konsler stated that he has a data base of the Professional Engineers if needed for recruitment. The vacant slots as of June 30, 2009 will be: Optometrist Engineer (must be a Professional Engineer) Physician Board of Health Minutes Transcription completed by Anne Miles Cassell 4 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 At-Large The Committee has reviewed the procedures contained in the Board Policy Manual and will report on a recruitment plan. A physician and optometrist have recently applied through the Commissioner’s office. Motion to forward recommendation of Anissa Vines for a second term to the Board of Commissioners and accept Dr. Carey’s resignation letter was made by Chris Harlan, seconded by Jessica Lee and carried without dissent. D. Red Flag Policy In November 2007, several federal agencies jointly issued a new set of regulations intended to help prevent, detect, and mitigate identity theft. The regulations are known as the identity theft “red flag” rules and require the entities they cover to develop policies and procedures to recognize and respond to circumstances that may indicate identity theft has occurred. This rule applies to local health departments that allow their clients to receive services and pay for them at a later date. Both the county and health department are subject to the red flag rules and need to take several specific actions, no later than May 1, 2009. The key actions that a health department must take are: 1. Determine which of its accounts are covered accounts, as defined by the rules. 2. Develop and implement a written identity theft prevention (ITP) program with policies and procedures in areas specified by the rules. 3. Obtain administrative (Board of Health) approval of the written ITP program. 4. Train appropriate staff members to implement the ITP program. 5. Provide for the continuing administration of the ITP program. At the present time Orange County has developed a “Red Flag Identity Theft Program” that has been submitted to the Board of Commissioners for their approval and adoption of the policy. The Orange County Health Department’s Red Flag Identity Theft committee drafted a policy separate from the county’s policy. The committee recommended the Board of Health adopt the county policy to be in compliance by May 1, 2009 until the state provides local health departments with guidance of what needs to be included in the health department policy. Annette Moore, staff attorney for the county, was present for the meeting and explained that there were a number of departments within the County affected by this program. The policy drafted was careful not to conflict with HIPPA. Rosemary Summers stated that the law was written unclearly referencing “Board of Directors” as the source of approval. Dr. Carey asked if the operational procedures of the staff would change as a result of this policy. He stated that the core mission was to provide healthcare and not deny access by focusing on payment or identity fraud. This policy does not require reporting to law Board of Health Minutes Transcription completed by Anne Miles Cassell 5 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 enforcement. Rosemary Summers explained that the Department does not charge for some services, therefore this policy would not apply to those services. Motion to adopt the Orange County Red Flag Policy was made by Sharon Freeland, seconded by Anissa Vines, and carried without dissent. E. Review Draft Re-Certification Application for Healthy Carolinians The Governor’s Task Force on Healthy Carolinians awards certification to communities who have broad-based community partnerships which represent the needs of the disadvantaged and whose mission is prevention based. To be recertified the following criteria must be met: • Must have planned and implemented activities that work toward achieving at least two different 2010 objectives from two different focus areas • Action plans/objectives/interventions must target populations with health disparities • Must have long term (10 year) objectives and short-term (5 year) objectives that are measurable and have a baseline. The strategies must have multiple levels of interventions and be effective in achieving the desired outcomes stated in the objectives. Strategies/objectives should have evaluation plans that include impact and/or outcomes. • HC Partnership must have diversity represented in leadership committee and full partnership. Membership must represent race/ethnicity of community, a wide variety of agencies, businesses, churches, schools, gender, sex, geographic, community members and community leaders. Community members must participate in the decision making process. • Must demonstrate collaborative leadership. The Partnership should not be the work of a sole agency. HC Partnership applying for recertification must demonstrate that leadership is shared and has evolved to include others beyond the original lead agencies and have influential community leaders supporting its work. • Must demonstrate that the HC Partnership has conducted or used a recent community assessment to determine priorities and identify priority populations. Community members should help decide priorities. • HC Partnership must report to the community and make presentations to various boards and commissions about its work. HC Partnership must have a communication plan that includes media and/or a marketing campaign. The Partnership must be working toward high visibility in the community. • Letters of support demonstrate commitment to HC Partnership and actions plans clearly demonstrate wide variety of agencies/organizations have roles and responsibilities for the strategies. • HC Partnership should have some ongoing financial support or a financial plan to seek funding. Support is both in-kind from member agencies and funds that underwrite the work of the HC Partnership. Board of Health Minutes Transcription completed by Anne Miles Cassell 6 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 Motion to draft a letter of support from the Board of Health was made by Steve Yuhasz, seconded by Tim Carey, and carried without dissent. F. Committee Reports The Clinical and Community Programs Committee met since the March Board meeting. The minutes of this meeting were available to the Board. Tim Carey reported that the main issues addressed were the identity theft policy and the pertussis outbreak and immunization exemption issues. Approximately 1% of students are exempted for religious exemptions in Orange County. For the fall, staff will be preparing letters detailing exclusion from school requirements for parents of children with these exemptions. The Environmental Health and Quality Assurance/Risk Management Committee did not meet since the last Board meeting. G. Informational Items a. Legislative Update Rosemary Summers pointed out several legislative items of interest to the Board. Senate Bill 202 requires centralization of funding to enable single stream funding. This would disrupt any reallocation in funding streams and add additional stress in an already fragile system that is funded by too few dollars. The same bill would also support regionalization of county health departments. In addition, this bill would suspend the accreditation process for one year. North Carolina has a nationally recognized accreditation program and has proven to be affective at achieving improvements to local health departments. Orange County Health Department already puts the money it receives from the state to mandated services. This bill would put more limitations on the money. Board members were asked to review this part of the budget bill and forward any questions to staff. They were also urged to contact their representatives regarding this section of the bill. Steve Yuhasz asked about the regionalization of health departments. Dr. Summers explained that several of the more sparsely populated and poorer counties are already in a shared regional department. He asked if there were any legal impediments to regionalization of health departments. The only requirement is that the Boards of Health and Boards of Commissioners in those counties all agree to regionalize and provide funds. b. 09-10 Budget Update 7 April 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 Rosemary Summers reported staff was sent a survey by the Manager listing possible areas to cut funding and asked to rank items by importance. There was little new to report as the Manager and Commissioners are still reviewing options available to balance the budget. Many staff members felt they were unable to express other options that might work instead of staff cuts and prepared memos with these suggestions to the Manager. c. Directory of Mental Health Services Donna King stated that the Orange County Healthy Carolinians recently published a directory of Mental Health Services for Orange County. All providers wishing to be listed were included under their specialty or field of practice. This is similar to the Teen Therapy listing published several years ago. The directory is available online and hard copies have been provided to all schools. The Manager’s office has received hard copies for Commissioners. d. Swimming Pool Requirements – Virginia Graeme Baker Act Tom Konsler reported that the Virginia Graeme Baker Act (VGB) prompted a federal law that requires public pools to comply with drain devices and designs to prevent suction hazards and entrapment. Compliance was required for all public pools effective December 19, 2008. It is in effect for all public swimming pools. Before staff issues permits for operation of public pools for the 2009 season, the pool owner must provide verification that the requirements of the VGB act have been met. This is being required despite a statement issued by the NC Division of Environmental Health that enforcement by the state of the standard for multi-drain pools would likely be delayed until the 2010 swimming season. Staff has reviewed the issue with the Environmental Health Committee and presented this approach in the interest of public health and safety and to assure compliance with the federal law currently in effect. The Board of Health has the authority to make rules to protect the public’s health and safety. Any appeals by pool owners would go to the state. Jessica Lee brought up the point of what ramifications there could be if we did not have a rule in place. Annette Moore clarified that should the local Environmental Health not approve a permit, the owner’s recourse would be to obtain the permit from the state. Tim Carey pointed out the seriousness of the liabilities the county could face should a pool be permitted without the required upgrades. Motion to make a local rule based on the Virginia Graeme Baker Act was made by Steve Yuhasz, seconded by Sharon Freeman, and carried without dissent. e. Media Clips Newspaper articles on various topics of interest to the Health Department were included for information. Board of Health Minutes Transcription completed by Anne Miles Cassell 8 April 23, 2009 MINUTES ORANGE COUNTY BOARD OF HEALTH April 23, 2009 Tom Konsler gave some updates on the bio-solid study. The study was initially contracted with Dr. Sobsey and Dr. Simmons in the UNC School of Environmental Health; however, Dr. Simmons has since taken a job with NC State and the study was never done before he left UNC. The staff has attempted many contacts with Dr. Sobsey and will continue to pursue clarification and a decision regarding this study. H. Pending and Recurring Items May agenda items were briefly discussed, along with upcoming summer items. VI. Board Comments/Announcements A. Steve Yuhasz commented that he had mentioned to District Attorney Jim Woodall that his office was not represented at the Child Fatality Task Force. Commissioner Yuhasz stated that Mr. Woodall was not aware that the DA’s office was supposed to be represented on the Task Force and that he would look into it. VII. Adjournment Motion to adjourn the meeting was made by Steve Yuhasz, seconded by Sharon Freeland, and carried without dissent. The next Board of Health meeting will be held on May 27, 2008 at the Government Services Center, Hillsborough, 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 9 April 23, 2009