MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
January 22, 1997 1:00 PM
Wake County Health Department - Board Room
Raleigh, North Carolina
CALL TO ORDER - President Barry Bass called the meeting to order at
1:07 PM. He thanked everyone for attending the meeting and reminded the health
directors in attendance that the meeting was a Full Association meeting, therefore
all items of business, everyone would be able to vote on. He extended his thanks
for those willing to chair committees and taking liaison appointments for the
1997 year. He asked everyone to look over the list handed out to verify appointments
for accuracy and to let him know if any discrepancies. He also requested that
anyone willing to fill any position vacancies should call him.
RECOGNITION OF PAST PRESIDENT, Dr. Louis E. Latour - President Bass presented
a plaque to Past President Dr. Louis Latour with the words inscribed, "Louis
E. Latour, 1996 President, North Carolina Association of Local Health Directors,
for your leadership, dedication and service to public health in North Carolina."
Past President Latour remarked that the organization becomes more complicated
every year and wanted to thank all who were willing to serve on committees.
The difficulty was compounded by the amount of turnover in local health directors.
He asked all new local health directors to give their new President all the
support he asks for. Past President Dennis Harrington requested that the minutes
reflect that the out-going President's (Louis Latour) brow looks a lot less
wrinkled and the crows feeding around his eyes are a lot better since the stress
is off of him.
President Bass thanked the Wake County Health Department for allowing the meeting
to take place there since the meeting could not be arranged at the Velvet Cloak
where the State Health Director's meeting will be held.
APPROVAL OF MINUTES FOR DECEMBER 19, 1996 MEETING - Dr. Louis Latour
moved that the minutes be accepted as written. Dennis Harrington seconded. Danny
Jacob questioned the report on Senior Vaccination Sunday and data missing on
Eastern North Carolina. Hugh Young said that the data was indeed not yet available
but would be included in a final report to be released subsequently and included
in future minutes. With no further questions the motion passed unanimously.
TREASURER'S REPORT - Tom Bridges provided the budget report prepared
by Margaret Dollar for the month of December 1996, the 1996 year close-out,
and the January 1997 year to date expenses. As of December deposits which came
from reimbursements for the November Greensboro luncheon, also the State Health
Director's meeting deposit $ 33,831.97 in checking and total assets of $ 27,537.58,
excluding the funds covering the State Health Director's meeting ($ 6,294.38).
Savings account has $ 24,812.21. The 1996 Budget Final Report shows revenues
for the year at $ 32,335.58 and expenses of $ 16,093.49. This leaves $ 14,910.00
to carry forward to the 1997 Budget year. The January 1997 Budget Report shows
that there were additional deposits resulting from the reimbursements for the
Greensboro luncheon and the State Health Director's meeting registration and
debits budgeted for in 1996 but paid in 1997 of $ 1,332.09. Total in checking
to date, minus the State Health Director's Meeting balance ($8,294.39) is $
26,264.77. The total in savings is $ 24,812.21. Bob Wood made the motion to
approve the Treasurer's Report as presented. Rick Steeves seconded and the motion
passed unanimously.
Margaret Dollar requested that an audit of the records be conducted and suggested
that the ad hoc audit committee consist of Bill Smith, Margaret Dollar, Tom
Bridges and Barry Bass. President Bass asked for and got Dennis Harrington to
agree to serve on this committee since all others on the committee have a vested
interest in the audit in the sense that all the others have handled the books
over the last three years.
APPROVAL OF 1997 BUDGET - Margaret Dollar passed out copies of the proposed
budget for 1997. She suggested that the NCALHD purchase a PA system ($ 600)
and a Dictaphone ($ 500) that could be passed along to the next Secretary each
year, rather than these new officers having to purchase new or rely upon their
own local equipment. She proposed revenue estimates with dues remaining the
same and interest projections more according to the past year's earnings. She
budgeted additional costs for new NCALHD logo letterhead and possible computer
software for NCALHD homepage applications. Printing and postage, while projected
with some increase may be reduced in the year if e-mail and the NCALHD homepage
were better utilized. She left the Meeting Expenses, President's Expenses, Miscellaneous,
Wood Endowment and Legislative/State Expenses line items as budgeted in 1996.
Although the $ 1,000 Legislative/State Expenses line item for 1996 showed $
0 spent, it was paid out of Meeting Expenses line item in 1996. Margaret Dollar
said she would make an adjustment in that line to reflect the payment. Although
$ 5,500 was proposed for the Contractual Services line, Margaret Dollar said
that there may be additional costs depending upon the services needs of the
NCALHD. She said that the NCALHD may opt to pay the equipment, computer software,
NACHO Scholarships and Board Member Expenses out of savings and transfer the
funds indicated to the Contractual Services line back up to the $ 12,000 to
13,000 amount previously budgeted in 1996. President Barry Bass said that he
and Past President Dr. Louis Latour were, in fact, going to talk with an individual
later in the day about providing Administrative Support services to the NCALHD
through a contractual agreement. He said that the NCALHD dues were restructured
a few years ago to allow for Administrative Assistance and monitoring legislative
activities and so he was going to pursue this. Also the NCPHA is going to allow
for some office space to be used by the NCALHD. Dennis Harrington requested
that the NCALHD continue at least another year in support of the NC Alliance
of Public Home Health Agencies. He believes that the Home Health Alliance is
going to be self-supportive in light of current progress with 38 members and
projects that are under consideration. Margaret Dollar showed that $ 2,000 is
now available in the proposed budget, since $1,000 was not requested in 1996
by the Home Health Alliance. Dennis Harrington made the motion that the PA system
be deleted this year, and that the NACHO Scholarships and NACHO board Member
Expenses be paid out of Savings, with those three line item amounts going to
Contractual Services. Dr. Louis Latour seconded. Bill Smith requested that in
light of the savings and last year's actual budget balance, to increase the
1997 Budget by $ 5,500 to cover the NACHO Scholarships and NACHO Board Member
Expenses. With the consent of Dennis Harrington and Dr. Louis Latour for this
friendly amendment to the motion the 1997 Budget was approved unanimously.
ANNOUNCEMENTS - President Bass made the following announcements:
1. To get a consensus from the NCALHD for the April and May meeting dates, to
meet in conjunction with the EDNCPHA in April and WDNCPHA in May, or to meet
again in April in Chapel Hill in conjunction with the Health Directors' Spring
Workshop and in May in Raleigh. President Bass determined the consensus was
that it will be imperative that the NCALHD be in the Raleigh area while the
long session of the State Legislature was meeting. Therefore the April NCALHD
meeting will be held on Thursday, April 17, 1997 AM in Chapel Hill at the Carolina
Inn, followed by the Spring Educational Conference April 17, 1997 PM - April
18, 1997. The May meeting will be held in Raleigh May 15, 1997 PM, site TBA.
2. Really good press from NACHO newsletter due to: a. The NCALHD provides financial
support for North Carolina NACHO Board members, b. NCALHD has offered to host
the 1998 meeting in North Carolina c. NCALHD provides scholarships to support
the travel expenses of members to attend the annual NACHO meetings. North Carolina
also has the largest membership in NACHO than any other state. Bob Parker urged
members to run for office in NACHO Board. Past NACHO Board members representing
North Carolina include Jesse Williams, Fred Pilkington, Sherman Kahn. Bob Parker's
term expires this year.
3. Barbara Matula, who is retiring from the NC Department of Human Resources,
is being given an appreciation reception to be held in the Cardinal Room, Raleigh,
North Carolina. The NCALHD has been asked to co-sponsor this event with a $
500.00 donation. This will enable the NCALHD to send one member and five associates
to attend. The Home Care Association, the North Carolina Health Care Facilities
Association, and other non-profits will be sponsoring the event. The $ 500.00
goes to the expense of membership participation in the event. Tom Johnson suggested
that rather than use NCALHD funds, that a collection be taken up among local
health directors to be a co-sponsor of the event. John Shaw felt that perhaps
the NCALHD needs to come up with its own way of recognizing the significant
contribution that Barbara Matula has made for public health. He felt that the
NCALHD should be more sensitive to the use of the NCALHD budget which largely
represents tax payers dollars. Bill Smith expressed his concerns that local
health directors seem to be more and more invisible and that it would be an
appropriate use of NCALHD funds. Bill Smith made the motion that the NCALHD
support Barbara Matula's retirement (reception) for $ 500.00. Don Yousey seconded.
The question was raised if the $ 500.00 could be used towards a charity of Barbara
Matula's choice. The vote on motion to co-sponsor the reception failed. President
Bass will pass the matter to the Education/Awards Committee for their consideration
and that their proposal would come back to the NCALHD at the February meeting.
4. Bob Parker announced that Bill Burgess resigned from the Brunswick County
Health Department and has accepted the Health Director position at the Martin-Tyrrell-Washington
Health District.
5. Reminder of the reception at 6:30 PM, sponsored by Sedgewick-James.
COMMITTEE REPORTS
TECHNOLOGY - George Bond, Chair reported that, although there was no
meeting in January, he has sent out an announcement of future meetings which
will be usually held the day before or just prior to the NCALHD meetings. 1.
The Technology Committee will be making appointments/liaisons to the HSAPP Council
and the HSIS Committees, 2. Development of a Memorandum of Understanding/Resolution,
3. Training a major initiative/focus, and 4. Other technologies to consider.
Tom Bridges provided copies to the membership on the Resolution from the Technology
Committee for consideration by the NCALHD. He read out the Resolution to the
membership. Concern was expressed about the moratorium. Delton Atkinson said
if the resolution is passed that any additional counties purchasing private
software could incur costs related to the expense of providing technical support.
The cost for technical support from the State Center may be paid by the local
health department or by the private software vendor. Dennis Harrington expressed
concern that the 34 counties with current private software not be cut off from
technical support and that what is being provided would not be changed. Tom
Bridges suggested that issue # 3 of the Resolution could be revised to read:
"That a moratorium go into effect on any additional counties receiving
"free" technical support from the North Carolina Center for Health
Statistics of private vendor software within local health departments."
Barry Bass asked if, in the case a local health department purchases private
software, the State Center would provide the necessary documentation and other
pertinent information for the private software vendor to configure their software
to work for the local agency. Delton Atkinson agreed that this would be provided
and could be spelled out in the proposed Memorandum of Understanding. The Technology
Committee also needs to look over how costs for the additional technical support
will be paid. Tom Bridges said that the purpose for the resolution is to help
all local health departments with their data management needs and to get better
coordination from state divisions. It suggests a funding mechanism and also
holds the State Center accountable for delivering a high quality product (software)
that can be available to local agencies at reasonable cost. Barry Bass noted
that another clarification to the resolution was to strike out the redundant
word "needs" in the AND WHEREAS sentence. Tom Blum suggested that:
(1) in issue # 5 that the Memorandum of Understanding be between the NCALHD
and the DEHNR rather than with the State Center to prevent inconsistency from
other Divisions in DEHNR. (2) That issue # 5 be stated first that it become
a shared view, and that the other issues (1-4) be designated as issues a, b,
c, and d, to the Memorandum of Understanding. George Bond questioned why the
MOU would need to be with DEHNR. Dr. Levine said that he saw no problem having
the MOU with DEHNR. Barry Bass pointed out that the MOU with the State Center
may place Delton Atkinson into an agreement where he has no authority and that
the agreement would be stronger with the higher authority. Tom Johnson wanted
to know how much money would come out of "old item #2". George Bond
said that the State Center needs about $ 300,000- 400,000 to develop and maintain
an effective data management system for local and state needs. If the State
Center could contract directly with DMA they would realize about $ 230,000 annually,
rather than the current $ 15,000. The State Laboratory is willing to contribute
$ 70,000 to the system. This leaves approximately $ 50,000 - 70,000 from local
agencies. With the MOU agreement with DEHNR we are an active participant with
the development. We are at a crossroads now in data management and we need to
take charge of the issue. Denise Stallings asked about time a time frame for
developing the system. Delton Atkinson said that enhanced HSIS is already underway,
but with a joint agreement between state and local groups, a time line and project
plan be developed. Barry Bass said that this matter would be taken back to the
Technology Committee and reported at the next meeting. Harold Gabel and Glen
Martin both wanted to say that they hope that local agencies who went ahead
prior to this meeting in purchasing software will not be penalized or have to
resort to an inferior system. It was pointed out that this was noted in the
Resolution. Vote on the motion was passed.
Tom Bridges said that 65 local health directors now have e-mail capability and
that 21 are still at various stages of getting on line. He said that he would
like to expand the NCALHD homepage and make more information available to the
NCALHD while saving $ 300 - 500 each month from current printing and mailing
costs. This could be done by downloading free software, called Adobe Acrobat
Reader. The CDC, Atlanta now makes the MMWR available over the Internet, but
the Adobe Acrobat Reader software must be installed. It is automatically interfaced
in Netscape. It is also possible to use Internet for general information and
the Intranet for information that needs to be kept confidential. The Technology
Committee will look into these issues and make recommendations and time frame
at a future meeting.
Special software has been installed on the EHNR mail server to eliminate the
UUDECODE problems that have occurred when EHNR staff sent messages to local
health departments. Harriet Mermes says that messages can be now sent out in
Word Perfect 5.1, or possibly modify if they know what the recipient is using
for word processing. Protocols have yet to be developed, but should be forthcoming
via the Technology Committee.
NOMINATIONS AND BYLAWS - Dr. Louis Latour reminded the committee members
consist of Mike Hanes, Bill Hill, Tamara Hower, Dr. Peter Morris, and Randall
Turpin. No other report.
EDUCATION & AWARDS - Leonard Wood had no report but requested suggestions
from the Association members for topics for the Spring Workshop.
STATE HEALTH DIRECTOR'S OFFICE - Dr. Ron Levine said
1. That he appreciated the fine work that went into the January 16, 1997 Legislative
Teleconference to spotlight public health telecommunications development and
use of the information highway.
2. The State Supreme Court has scheduled for February 14, 1997, a hearing on
the discontinuation of anonymous HIV testing.
3. Governor Jim Hunt has replaced three Secretaries, one of which is for the
Department of Human Resources. Dr. David Bruton, a pediatrician, will head this
department. He is politically active and has served over many years as Chairman
of the Democratic Party of Moore County, Member of the State Board of Education,
and Member of the American Medical Association. He is oriented in public health
prevention and progressive in his thinking. He is the Immediate Past-President
of the NC Medical Society and he is a very, very strong supporter of public
health prevention issues.
The General Assembly: There is tremendous politicking going on. House Leadership
has been actively working on electing a speaker. This is to be decided next
week.
This year's State Health Director's Meeting promises to be an excellent program.
The State Director from Georgia is to be the Keynote Speaker.
Dr. Levine wanted to render the last segment of his report to Dr. Georjean Stoodt
on a recent activity on the Robert Wood Johnson and Kellogg project. She reported
there was much interest at the December 18, 1996 meeting. As of Friday, 13 letters
of intent and input ideas of 25 counties participating in local component. February
12, 1997, a follow-up teleconference at the PH-TIN sites, plus 1 additional
site will be held from 10:00 a.m. - 1:00 p.m. to provide the best thinking on
the state-wide concept to develop a fairly lengthy letter of intent from North
Carolina. Partnership approach; dialogue. For more information, please call
Dee Vernon at 919/715-6728, or Georjean Stoodt at 919/715-0124. Bill Smith and
Dr. Sherman Kahn are also working on the project and can be contacted to give
your input.
ENVIRONMENTAL HEALTH - Terry Pierce reported that the Environmental Health
Committee met last week and have several issues to discuss in detail:
1. North Carolina Risk Analysis Framework and 80 copies were made available
for handout. The framework is for determining the methods and procedure for
clean up of contaminated soils and ground water, and the group in charge is
developing a document, the handout will describe. Lou Anne Williams, State Toxicologist
with the Division of Environmental Epidemiology, presented the handout. She
has requested to be included on the Health Directors' Spring Education Conference
in April 1997. Ms. Williams could not be present because she was at the time
meeting with the Issues Forum.
2. Terry Pierce was able to get Don Womble to serve on a committee involved
with writing the Permanent Sewage Rules (1900).
3. Restaurant Rules Committee Report. A meeting was held on January 15, 1997
with local health directors, Dr. Ron Levine, Linda Sewall, and Michael Rhodes
were there to discuss concerns. As a result of the meeting, the Environmental
Health Committee proposed the motion that the NCALHD go on record as opposing
the report of the Restaurant Rules Review Committee and send a representative
to the February 19 (1997) Commission for Health Services meeting to express
the concerns of the NCALHD regarding the public health implications of this
report. This was the motion, however, Terry Pierce wanted to supplement the
motion with some clarifying information. The Environmental Health Committee
takes exception and is concerned by the tone and implications of the report
due to the following: a. The report overstates the scope and frequency of the
problems. Some of the proposals offered in this report, such as the elimination
of the A, B , C grade card would weaken the inspections program rather than
improve it. A majority of health directors, environmental health supervisors
and environmental health specialists take issue with several statements in the
report that state or imply environmental health specialists in the field are
commonly abusing or misusing their authority. Further, these broad assertions
are not supported by facts within the text of the report. The report states
that anything less than a scope control system is not a solution to the problem
of division of authority even though the likelihood of achieving this recommendation
is remote. The Environmental Health Committee does find that several recommendations
in the report which strengthen the inspections program and welcomes the opportunity
to discuss these suggestions in a committee with restaurant owners, Division
staff and adequate local representation. These recommendations include number
of inspections based upon risk criteria, revised grade sheets with comments
directly beside the criteria for inspection, official guidelines for inspections
to eliminate differences in interpretations from county to county, improved
and additional training for environmental health specialists, and an increase
in the number of regional environmental health specialists. President Bass asked
if the motion presented was a unanimous decision by the Environmental Health
Committee. Terry Pierce said that the motion was developed as a consensus and
agreed to by the representatives to the Committee. It was learned that a majority
of the local health directors present at the NCALHD meeting had read the proposed
restaurant rules. The motion coming from the Environmental Health Committee
was passed by the NCALHD unanimously.
4. Request for changing the method of disbursement of lead funds. Motion from
the Environmental Health Committee is the NCALHD approve the unused portion
of the $ 50,000 of training funds available for childhood lead poisoning prevention
each year be made available for local health department staff who receive training
in day care sanitation, as well as for childhood lead poisoning prevention,
and that any unspent funds be made available to counties that spend over $ 500
per year, on a first-request basis. This motion would allow for local flexibility
for training in lead or day care. The motion from the Environmental Health Committee
was passed unanimously.
5. Another related motion from the Environmental Health Committee was that the
NCALHD approve the portion of the $ 375,000 of aid-to-counties funds used for
reimbursement of case management and environmental lead investigation activities
being set aside for innovative proposals submitted by local health departments
seeking to take a more active role in community wide education or other prevention
activities, and that a predetermined amount of $ 1,500 be reimbursed for each
case, under the existing distribution formula, with the remaining funds, approximately
$ 75,000 for the next fiscal year, be made available for innovative local projects;
and that the funding would be determined by a committee that would be established
to review and evaluate the proposals; and that a local health director serve
on this selection committee. The motion was approved unanimously. President
Bass suggested he and Terry Pierce collaborate on the appointment of the local
health director to serve on this selection committee.
6. Authorization Work Group continues to meet. The goal is to have some procedures
that will go to the November Commission for Health Services meeting and these
could be then sent to the Legislative Short Session for adoption the following
year (1998). Malcolm Blalock is working on a memo which will have some fact
sheets which will be sent out by mid-February.
7. The Environmental Health survey of local agencies, conducted by Terry Pierce,
is being tabulated and plan is to present the report at the February NCALHD
meeting.
8. Local livestock rules may be impacted by the recent NC Appeals Court ruling
on the Halifax County Board of Health's smoking rules that were overturned.
An additional comment was made that the Division of Water Quality is not monitoring
emergency dumping. The concern is that when there are heavy rains, many operations
are releasing waste from the lagoons. The Hog Caucus is still alive and well
and they plan to produce a resolution for the February NCALHD meeting.
9. Public Water Supply funds. There is an opportunity for the State to receive
$ 46 million in Federal funds for public drinking water. The State would be
required a 20% match, which would be $ 9.5 million. This would enable local
expansion of public supplies and extend water lines. Don Womble is representing
the Environmental Health Committee on this. This is for public supplies only.
A motion from the Environmental Health Committee that the NCALHD support the
State match of $ 9.5 million in order to get the $ 46 million in state revolving
funds, and to defer this to NCALHD Policy and Planning Committee to follow up.
The motion was passed unanimously.
10. A couple of legislative issues from the County Commissioners that warrant
attention of the NCALHD include that dealing with training/education requirements
of environmental health specialists. The NCALHD needs to oppose this because
it weakens the training requirements in that it allows for a 2 year degree.
MANAGED CARE AND REIMBURSEMENT - Dennis Harrington reported that the
Managed Care and Reimbursement Committee met yesterday and had good active participation
although not so many attending possibly due to a change in the time. Managed
Care Committee brought forth four policy issues at the December NCALHD meeting
and the Committee will be following up on these important issues with the various
Secretaries, one which is on Carolina ACCESS that an outcome study be done before
expansion and the other that the benefits advocacy be a role for public health.
Dennis Harrington requests that a task force jointly appointed by Dr. Ron Levine
and President Bass to look at the ideas associated with benefits advocacy. And
finally, public health stepping forward and making a real strong statement that
whatever happens in health care reform and in managed care, that we be the ones
leading the way that improved health outcomes be one of the key and one of the
most important issues of whatever system change occurs and that also whatever
changes a mechanism be in place protecting the basic core public health services.
We must champion this. Discussion followed regarding the MCH Wraparound services
bundling proposal. Motion from Committee regarding the MCH Wraparound proposal
was made as follows: 1. To add Health Check case management into the bundled
services, and 2. General client advocacy relative to Managed Care (specifically
HMO enrollment) be pursued through the Task Force referenced last month involving
NCALHD, DSS Director, and Dr. Levine's Office. The motion from Managed Care
and Reimbursement Committee was approved unanimously.
Bill Smith made the motion that the Managed Care and Reimbursement Committee
be authorized to negotiate with DMA for these wraparound services and anything
else in that is within that purview. John Shaw seconded and the motion passed
unanimously.
Dennis Harrington shared the MC&R Committee roster and extended the invitation
to others who wanted to attend the meetings scheduled the second Wednesday of
the month at 2:00 PM in the Kirby Building (room # 297), Dorothy Dix Campus.
He also shared a copy of the resolutions which he hopes will drive the Committee
for the rest of the year.
HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported that the
Alliance met yesterday. He presented for the minutes a copy of the operational
plan and evaluation on what was accomplished, particularly in the last couple
of months of 1996 and the 6 month plan beginning January 1997 indicates a lot
of activity. He also shared the Committee's meeting schedule which will be offered
in conjunction with the NCALHD meetings.
EPIDEMIOLOGY - Dr. Walter Linz had no report, however, he said that he
had a chat with
Dr. Mike Moser and Dr. Lou Turner about the issue of rabies funding for the
State Laboratory. This continues to be of concern as the number of cases of
rabies across the state mounts. The Institute of Medicine recently had a report
that STD/HIV we are in the midst of a scourge.
HEALTH PROMOTION - Curtis Holloman met that AM with a very ambitious
agenda for the year.
1. Hugh Young was called upon to present a report on the Senior Vaccination
Sunday Project. Hugh Young said that there was a tremendous response to the
survey. To date 42 had responded and valuable information was being obtained
from them. A report will be forthcoming which will look into the future use
of a Senior Vaccination Sunday. He hopes to obtain information on whether the
event provided more seniors flu and pneumonia vaccinations than would have otherwise
had. In May, a Medicare report for 1995 and 1996 will come out that will identify
if more vaccinations actually took place. Hugh Young anticipates in late spring
a final report with state data as well as the survey results. Hugh Young can
be reached for further comment at telephone 919/823-5985, fax 919/823-4630 and
e-mail at HughYoung@aol.com
2. The HP Committee reviewed legislation that addresses CVD funding and Community
Health Promotion for an Aging Population which the HP Committee refers to the
Policy and Planning Committee.
3. The HP Committee discussed the Heart Health Day to be held on February 13,
1997. Local health departments should have received information on this from
Libby Pucket and the HP Committee asks local staff support and participation
in this health fair, which is being conducted in the State Legislative Building.
4. Curtis Holloman said that Susan Velazquez from the Division of Health Promotion
discussed plans for the Health Promotion Symposium which will be held August
12 - 14, 1997 at the Holiday Inn Four Seasons in Greensboro. Look for "Save
the Day" mailers to go out next month. The Symposium will be held in conjunction
with the NCALHD August meeting and the County Commissioners Annual Meeting..
The goal of the Symposium is to provide opportunity for diverse array of health
professionals to share and learn strategies to "grow" partnerships
and promote healthier communities.
5. Update on status of the Nutrition Project Grant which funded 9 local health
departments. This report will be included in the minutes.
6. Curtis Holloman said that Peter Anderson and Steve Sherman discussed the
BCCCP - CVD project renewal application which is due in April 1997 for another
5 years funding of this project. They added another element of CVD Screenings
which they hope can be extended to all local health departments.
7. Steve Sherman updated the HP Committee on the Division of Health Promotion's
role in the Enhanced HSIS project. He stressed that the changes would make the
system user friendly and make it a true managment information system.
8. The staff also sent out a memo regarding a Request for Proposal for funding
to provide medical/dental services to HIV patients. This RFP is also being sent
to hospitals and other providers in addition to local health departments. They
look to fund 3 to 5 projects. The RFP is due February 21, 1997.
7. Betty Wiser gave a report to the HP Committee on Older Adult Health Promotion
Plan. It is a state-wide comprehensive plan developed over the past five years
to improve health and quality of life of older North Carolinaians. She outlined
several priority initiatives which will advance older adult health: Osteoporosis,
Physical Wellness, Medication Use, Immunization, and Capacity-Enhancement. As
a result of the planning efforts, the Osteoporosis Coalition of NC was formed.
The coalition promotes education and support of prevention, diagnosis, and treatment
of osteoporosis, so as to achieve a reduction in its prevalence, severity, and
costly consequences in NC. The Coalition has drafted legislation which will
provide an osteoporosis education, prevention and treatment program to achieve
a reduction in the prevalence of osteoporosis and its costly consequences. A
motion came from the HP Committee to the NCALHD that the NCALHD Policy and Planning
Committee support this legislation. The motion passed unanimously.
HOSPITAL AND COUNTY COMMISSIONERS ASSOCIATION NETWORKING COMMITTEE -
Jim Baluss reported that the Committee met yesterday. He emphasized the need
for networking with these two associations is very important in light of the
time. He said that he hopes the Committee can meet one more time in a closed
meeting (directors only) to clarify the Committee's hopes and expectations and
to try to develop some informal principles to take to them to enhance our relationship.
He encouraged everyone to look at the County Commissioners Legislative Agenda
items which may be added to. One item may prove to be contentious, however it
is noted that this year there is a lack of many contentious items, and that
the NCALHD should take this opportunity to look to areas to work closely and
show our cooperation and collaboration with these groups. We should also look
to areas that may not at first appear public health related. Areas such as education.
We also have a lot of overlap in our Committees that afford us tremendous opportunities
to work. Also Jim Baluss suggested that local health directors hold a joint
meeting with hospital administrators within the Hospital Association. The County
Commissioners Association will be inundated by folks at their 3 day Annual meeting
on community health matters. We need to develop a more visible presence and
working relationship, especially at this time.
INSTITUTE OF GOVERNMENT - No Report
MATERNAL AND CHILD HEALTH - Dr. Harold Gabel invited anyone to attend
their next meeting scheduled for February 19, 1997. At their most recent meeting
several issues were discussed:
1. Meeting arranged by Dr. Steve Cline regarding dental health in our state.
Counties are trying to put together a dental health program and one of the blockages
is the inability to recruit a dentist. Steve is trying to gather names of dentists
who are interested in working in a public health setting. In this effort he
is hoping to serve as a repository for this information. Any local health departments
needing this information should contact Dr. Cline.
2. Heard from Barbara Sterritt about new regional assignments for Immunization
Consultants. A map indicating these assignments will be included in the NCALHD
minutes. If a local health director has a problem with the assignments, please
call her. These new regional assignments are to be implemented on March 1, 1997.
3. Recitation of the MCH Contract Addenda items. The Committee decided that
they did not have an opportunity to review them, so they asked if copies of
the Contract Addenda modifications could be made available to the NCALHD membership
as well as to the MCH Committee members. Harold Gabel urges the NCALHD members
to look over them and provide him comments. Also, comments should be sent to
Dr. Anne Wolf so that she can share with her staff. Harold Gabel hopes to finalize
the recommendation on these Contract Addenda items at the February 19 meeting.
Several of these items will take into account issues that the Streamlining Committee
did deal with.
4. The main issue that the MCH Committee dealt with was the item that was referred
to them by Past-President Louis Latour regarding the Equity Formula. The MCH
state funds took a jolt resulting in some counties taking relatively a much
larger cut than others. Dr. Wolf did find some one time funds to cover the situation
at that time last year so that no county suffered greater than a 10% cut. The
cut was largely due to an anticipated decrease in the Social Services Block
Grant funds. We don't know if this will happen again, so the MCH Committee wanted
to look into a way that inordinate cuts may be dealt with in the future without
redoing the entire Equity Formula. The MCH Committee came up with the following
recommendation: No county would lose more than two times the state's percentage
decrease of funds. That would be done by other counties who otherwise would
have small losses making up the difference. That would potentially mean that
if the (state) loss was 10%, no county would lose more than 20% of the MCH funding.
Also, a county that would ordinarily lose, say 5% would lose a little more of
a percent to make that overall county loss no more than 20%. The way that would
be calculated would be through the Division of MCH. Therefore, the MCH Committee
made the motion that no county would lose more than two times the state's percentage
decrease of funds. Wanda Sandale raised the question that if after what was
done in coming up with the Equity Formula, then when it comes to cuts and we
don't like the way the formula comes out, we make an adjustment? Harold Gabel
said that the MCH Committee was instructed by the NCALHD Executive Committee
that the formula that we had been using would remain in tact -- we're not looking
for changes in the formula. We are only looking at ways to be sure that no one
would take an inordinately large decrease. That is what came up as the recommendation.
This adjustment would be made for future years if it were to occur. What has
already gone on has gone on. Wanda said that she would speak in opposition to
this change. Carl Tuttle remarked that the Equity Formula is a process. It did
not go into great details. The main thing said moneys would be allocated on
the basis of 60% of need, 20 % on performance and 20% base, and our cuts we
said that we would move toward equity and we laid out some processes but agreed
that the kinds of things and the factors go into it would be left to the Division
of MCH. We are disagreeing that the factors recently went too far in achieving
equity when our new money's allocation. Barry Goldstein did point out a couple
of years ago that we were moving toward equity, however. But we did not try
do so in one sweep. Harold Gabel said that some counties lost as much as 40%
and this new policy is trying to address the concern that this could be too
drastic of a cut. Bill Smith voiced opposition in that we never did cap those
who got a disproportionate amount of money. Nobody came back and said that too
much money was given to them. And now, when the bad times come, it's like no
one wants to give up their share because they have been overpaid ten years.
So he thought the Equity Formula should remain in tact as is. Dr. Anne Wolf
reminded the group that many counties would have suffered a greater than 10%
cut resulting from last year's SSBG funds had it not been for the Division of
MCH finding some one time funds of $ 400,000 to prevent so great a loss. These
funds may not be available again this year, so there will be counties that could
face additional cuts. This will mean, based on the Equity Formula, that 8 health
departments would be cut from 20-40%, another 15 would be cut over 15% and there
are the 33 that would be cut over 10%. This is not the recommendation of the
Division of MCH. The Division wants what the NCALHD wants. John Shaw said that
it will be important to be able to plan for a budget. He suggested that the
MCH Committee go back and look at what these potential cuts could mean in terms
of real dollars. President Bass said that we are looking at funding allocation
based upon two scenarios: 1. The allocation based upon the existing Equity Formula
and 2. The allocation based upon what the MCH Committee is recommending. Ann
Wolf reminded the NCALHD that what they could do is look at the $ 1.8 million
from the state legislature, minus the $ 400,000 and project on that basis what
the two scenarios would look like. Tom Johnson disagreed with this approach
because everyone would vote according to the amount of dollars to their individual
county. He thought that the NCALHD should vote on the matter of principle, whether
we are going to put a stop loss per county or whether we are not going to. He
thought that the vote could be made without waiting until next month. Janice
Patterson said that her county receives $ 55,000 total, and the cut she could
have faced would have likely closed her program down. Her operating base for
her county is not sufficient to provide MCH services. Denise Stallings called
the question. The motion as it came from the MCH Committee passed with 29 yes
and 19 no. Harold Gabel said that Dr. Wolf has asked Dr. Levine to request that
there be some restoration of the SSBG funds in light of the fact that there
was not so drastic a cut realized by DHR.
5. Harold Gabel reported that he is the liaison with the North Carolina Medical
Society and the NCALHD, and he has written to Dr. Ferree who is President of
that Association and indicated our willingness to deal with issues that the
NCMS is involved with. Harold Gabel said he would be glad to accept any items
brought forth to the NCMS, to let him know.
POLICY AND PLANNING - Bill Smith had no report, but requested that the
Technology Committee look into other areas of technology in addition to computers.
STATE AND LOCAL RELATIONS - Margaret Dollar reported that her Committee
was meeting with Secretary Jonathan Howes for a breakfast meeting tomorrow morning
in the Charter Room at the Velvet Cloak to look at various public health issues.
Barry Blick, Leah Devlin, Chris Hoke and Ron Levine are anticipated to attend
as well. Other Committee members include Bill Burgess, Danny Jacob, Howard Campbell,
Dr. Peter Morris, Linda Mayo, Dennis Retzlaff, Jesse Williams and Emma Waldroup.
SPECIAL PRESENTATIONS
1. Barry Blick gave a presentation on governance infrastructure that his county
(Catawba) is undertaking. His presentation is included in these minutes. He
requests that the NCALHD consider what they are proposing and consider whether
the Association would endorse the principles outlined in the paper. He said
that the paper has been submitted to the County Commissioners Association who
has distributed it to several subcommittees of the General Assembly that look
at local governance issues. His Catawba County Mental Health and Social Services
counterparts are submitting the paper to their professional associations. He
hopes that Bob Parker will take it to NACHO to see what response are willing
to provide, as well as any other professionals. Barry Bass submitted the paper
to the NCALHD to consider endorsement, improvement and other ideas to contribute
to it. Bill Smith made the comment that it seems that the governance issue always
brings up the three human services agencies rather than to be more inclusive
of other service agencies. President Bass recommended that the paper be sent
out in the minutes as information and asked that the State and Local Relations
Committee and the Policy and Planning Committee look at this particular document
and provide a response or recommendations. John Shaw wondered if the Committees
might look at a broader scope than just the four principles given in the document.
President Bass clarified his charge being the more narrow charge specifically
because the request came from Catawba County and that two other human service
associations will also be looking at the document for their consideration. Barry
Bass said that he was open to any additional input comments that may be added
to the current document. Dr. Peter Morris said that after having so many operating
principles developed recently by Wake County's reorganization efforts, he admired
the brevity of four guiding principles and that it is important to distill down
the issues to a sound bite that others can comprehend and remember.
2. Dr. Kevin Ryan gave a report on the Accountability Task Force. He said that
the work grew out of legislation passed by the General Assembly in 1994. Their
work has tried to simplify the process and set up a means of ranking local health
departments based upon three levels of accountability. Level I is a Community
Wellness Index as a measure of a community's health status and is county specific
based upon a compiled set of indicators from which data were available on a
county specific basis. County specific packets were made available to NCALHD
members to take home with them. These reports are not public information and
are not intended to penalize counties. They are intended to facilitate their
ability to improve health status in their communities by increasing awareness
and mobilizing support for the efforts of local health departments. Kevin Ryan
said that he hopes to receive input from local agencies to learn how they can
get maximum impact from these documents. Level II is a combination of some outcome
measures and some process measures and is intended to again use available data
to get a sense of how well the community is responding to the public health
needs within that community. Due to demographic variability of counties the
Task Force divided the state into four categories into like communities. For
example, more populous counties were grouped together and then the others were
divided up into geographic basis, eastern, western, etc. The groupings may vary
in the number of counties in them. There would be two categories to recognize
counties within these groupings: 1. Those who indicate outstanding achievement
2. Agencies at the low end may get additional assistance. Chris Hoke said that
it was important that public health take a lead role in the accountability issue,
which may make eventually contribute greatly to the health care reform issues.
The report is admittedly not perfect but is a start. The report at present is
only a snapshot and may not be able to identify the impact a program, such as
Carolina ACCESS, has on a community. This would have to be captured over time,
according to Kevin Ryan.
LIAISONS & OTHERS
SOPHE - Denise Brewster reported that the new liaison will be Susan Hockaday
from Davie County. Health Educator's week will be February 16-22, 1997. A packet
was mailed last month to local health departments to facilitate the event to
make special recognition of health educators. A packet was sent out last fall
from the Department of Human Resources, Personnel is looking at guidelines for
implementing five levels classifications for Public Health Educators. Those
are a work in progress being developed by staff from DHR Personnel, DEHNR, and
NCSOPHE. A job classification study has not been done on health education positions,
and SOPHE still advocates for a complete job classification study to be conducted.
This issue is not a resolution but rather for information.
ANCBH - Margaret Dollar reported for Dr. Pamela Horne, saying that the
Human Services Governance legislation has been removed from the legislative
agenda of the County Commissioners' Association. Other bills that may be coming
up have to do with flexibility of human services delivery. Billy King, President
of the Association of NC County Commissioners and Jim Blackburn, General Council,
Association of NC County Commissioners are among the individuals to discuss
the legislative goals that impact Boards of Health. This will be part of the
program of the Eleventh Annual Meeting of the ANCBH which takes place tomorrow
afternoon.
NCPHA - Deborah Rowe asked that Christopher Cooke give his report. He
said that Barbara Chavious has taken his place in the Office of Continuing Education,
School of Public Health. She will be working with the Awards/Education Committee
on its education programs. His new position is Manager of North Carolina Public
Health Awareness Program. He provided some handouts giving information on the
origin and development of the program. Finally, he reported that the School
of Public Health, Chapel Hill, is in the process of selecting a new Dean. Dean
Michel Ibrahim is in the last year of the third year of his term as Dean, and
Dr. John Stamm, UNC School of Dentistry is chairing the selection committee.
Christopher Cooke urged that local health directors may want to provide input
to the selection committee, stressing what the relationship between the School
of Public Health and local public health departments ought to be. Christopher
Cooke said he would e-mail follow-up information.
NCIH - No report.
OFFICE OF PUBLIC HEALTH NURSING - No report.
NC ASSOCIATION OF LOCAL NUTRITION DIRECTORS - Annette Piner, RD, LDN, from Wayne County is the liaison to the NCALHD.
NC LOCAL PUBLIC HEALTH MANAGEMENT SUPPORT SUPERVISORS ASSOCIATION - Barbara Smith, Guilford County Health Department is the liaison to the NCALHD.
ADJOURNMENT
There being no further business, the meeting was adjourned at 5:10 PM. The next Executive Committee meeting of the NCALHD is scheduled for Thursday, February 20, 1997 at 9:00 AM in the Auditorium, Albert Coates Building, Raleigh.
Respectfully Submitted,
Thomas D. Bridges, MPH
Secretary/Treasurer