MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Executive Committee Meeting
March 20, 1997
Albert Coates Building - Auditorium
Raleigh, North Carolina
CALL TO ORDER - With the executive committee constituting a quorum, President Barry Bass called the meeting to order at 9:07 a.m.
APPROVAL OF THE MINUTES - Dr. Louis Latour made the motion to approve the February 20, 1997 meeting minutes with correction. Bob Wood seconded and the motion passed unanimously.
TREASURER'S REPORT - Tom Bridges reported that as of March 14, 1997 the NCALHD assets include $ 43,097.31 in checking and $ 24,968.12 in savings. The 1997 NCALHD Budget has receipts as of March 14, 1997 of $ 24,004.73 and total expenses to date of $ 2,693.97. Bob Wood made the motion to approve the report as presented. Dr. Louis Latour seconded and the motion passed unanimously.
ANNOUNCEMENTS - President Bass had the following announcements:
1. He thanked the NC Association of County Commissioners and the staff at the Albert Coates Building for again allowing the NCALHD to conduct its meeting in the facility.
2. Hospital Association Representative
3. Secretary (Dr.) David Bruton, NC Department of Human Resources, is to speak later in the meeting.
4. Tom Blum, Health Director, Wayne County Health Department, has resigned.
5. The recent NACCHO survey has been completed and returned by all but three local health departments: Moore, Beaufort and Toe River District Health Department. President Bass will follow up on requesting these remaining local health departments to complete their surveys so that a 100% response to NACCHO will be obtained.
6. In the interest of promoting efficiency in the NCALHD meeting proceedings and in getting more concise minutes, President Bass asks all committee chairs to use a new form to present their committee meeting reports. The form will be sent out for them to use before the April meeting of the NCALHD.
7. President Bass has sent a letter to Dr. Ron Levine and Dr. Georjean Stoodt thanking them for their efforts on Turning Point initiative, sponsored by Robert Woods Johnson.
8. President Bass has appointed a Vision Committee for the purpose of developing recommendations from the Task Force on Public Health Systems Report, and to explore staffing options for an administrative executive director position for the NCALHD. The recommendations may also include linkages with NCPHA and NCAPHHA. Local Health Directors who will serve on this Task Force include, President Bass, Jim Baluss, George Bond, Tom Bridges, Margaret Dollar, Anne Thomas, Bill Smith, and Dennis Harrington.
9. Thanks for efforts made by many local health directors on HB 488 and S32.
10. The American Public Health Association has sent out badges promoting National Public Health Week in April 7 - 13, 1997. Badges were distributed among the meeting attendees.
11. Dr. Louis Latour distributed sample copies of the Philanthropy Journal which local health departments may find of benefit.
COMMITTEE REPORTS
EDUCATION & AWARDS - Leonard Wood reported his committee met yesterday to discuss:
1. The Leadership Conference planned for April 17 - 18, 1997 at the Carolina Inn, Chapel Hill. Speaker is Ron Rosenberg, who comes highly recommended by the Divisions of Maternal and Child Health and Adult Health Promotion. Leonard Wood urges all local health directors in addition to themselves, to bring along a key member from their agency for this training.
2. NACCHO scholarships to attend the Annual Meeting to be held in Houston, Texas July 16-19, 1997. Four health directors applied and the committee decided to split the available funds among them. The recipients are Tim Green, Glen Martin, Maggie Dollar and Tom Bridges. Each will be provided up to $ 750.00 to cover their costs to attend the meeting.
3. The Health Director of the Year will be awarded at the June 1997 NCALHD meeting. Nomination forms will be mailed out to Board of Health Chairs, Board of County Commissioners Chairs and County Managers.
4. Education & Awards Committee plans to meet with Anne Dellinger on April 6, 1997 at the Institute of Government, Chapel Hill to discuss the fall 1997 Health Directors Legal Conference. Suggestions for topics and other input are welcomed.
ENVIRONMENTAL - The committee met yesterday. Terry Pierce shared the following:
1. Jessica Miles and John McFadyen, Public Water Supply, said that between $ 750,00 and $ 1,000,000 will be available to contract with local health departments for transient water supplies, if the state match is approved. Reimbursement to local health departments are as follows: $ 50.00 for address changes; $ 100.00 for identifying new systems; and $ 150.00 for sanitary surveys. The plan will be sent to EPA in April/May. Motion from committee: That local health departments be surveyed regarding interest in contracting with Public Water Supply and that health departments be provided with a brief description of the program and a listing of transient systems on the current inventory for each county. Motion passed unanimously.
for their interest in contracting with Public Water Supply, which will include a brief description of transit system in county. Motion passed unanimously.
2. Ed Norman suggested that $ 10,000 in unused lead training funds be provided for a lead prevention outreach program. This project was submitted by Buncome County and UNC-A. The environmental health committee decided to defer this request until next year when a competitive process for projects like this is in place.
3. Secretary Howes' stakeholders meeting regarding the reorganization of DEHNR was well attended. Bill Smith represented the NCPHA and the Environmental Health Supervisors' Association was also represented. Terry Pierce spoke on behalf of the Local Health Directors' Association and cited the public health reasons for maintaining on-site wastewater disposal as a public health program. Four speakers were against keeping on-site in public health. These speakers represented the Sierra Club, Home Builders Association, Wildlife Federation, and The League of Municipalities and other environmental groups. After this meeting, Terry Pierce and others spoke to the committee chairman in the House. The chairman of that committee indicated that HB 478 was "dead in committee" in its present form. Terry Pierce said the Senate version, SB 383, was scheduled for discussion yesterday in the assigned Senate committee. this bill was pulled at the last minute and ultimately the meeting was canceled due to an emergency. The County Commissioners' Association has taken no position yet, but Ed Reagan is asking county managers for feedback. Local health directors are urged to contact their county managers about this. Terry Pierce also urged all health directors to contact their legislators, especially their senators, to stress that all current public health programs need to be moved to the new department. Motion from committee: That the NCALHD send letters to the NC Association of County Commissioners and to the Association of North Carolina Boards of Health stating the Association's position and reasons for keeping the on-site wastewater program with the other health programs being transferred to the new Department of Health and Human Services. The motion passed unanimously.
4. Jim Hayes has requested endorsement by the local health directors to collect information from environmental health staffs regarding swimming pools that are currently under inspection. This would consist of a one-page (less than 10 questions) survey regarding fencing, lighting, double drains, type of pool, etc. He needs to have this information to help him better estimate the cost associated with legislative changes. Motion from committee: That the local health directors endorse a one page survey letter regarding swimming pools being sent to local health departments. Motion passed unanimously.
5. Bills pending:
a. HB 475 - Preliminary Site Evaluations.
This bill allows local boards of health to adopt rules to provide preliminary site evaluations, but does not guarantee the issuance of a permit. The bill also clarifies that all other preliminary site evaluations are prohibited. Motion from committee: To support HB 475. Motion passed unanimously.
b. HB 165 - Lodging Establishments/Sanitation.
This bill was recommended by the Administrative Procedure Oversight Committee as a result of reviewing existing rules. This bill would remove the requirement to sanitize eating and drinking multi-use utensils for guests preparing food while staying in a lodging unit. Motion from committee: To oppose HB 165, with the current wording, and support the Division recommendation which requires the sanitation of multi-use drinking utensils, (glasses) and multi-use ice buckets. Motion passed unanimously.
c. HB 471 - Food Establishments/Clarify Definitions.
This bill clarifies the definition of "pre-packaged" to be the same as the definition used by the Department of Agriculture. Currently permitted establishments have more stringent requirements for events that last two days or less than non-permitted facilities. this bill would make the requirements of a facility associated with these events to be the same. It also requires the permitting and inspection of juice bars. The committee does not support the current wording and has asked Michael Rhodes to check with the Department of Agriculture about regulating all juice bars. NCDA currently regulated some juice bars.
d. HB 469 - Permit Fees - Restaurant/Food Stands.
This bill would change the late charge for paying permit fees from $ 25.00 to $ 250.00 and also establish a $ 900.00 reinstatement fee for establishments which have had their permits suspended for non-payment. The proposed fee structure is the result of the State Auditor's Office recommendations. Motion from committee: To support HB 469. Motion passed unanimously.
The Division of Environmental Health is trying to improve training programs and has established three sub-committees consisting of local and state staff. Terry Pierce asked for volunteers to serve on the three committees. The following health directors volunteered to serve:
1. Training Committee - Dennis Retzlaff
2. Quality Assurance - Jenny Kirksey
3. Local/State Partnerships Enhancement - Diane Crouse
The first meeting of these committees is scheduled for April 16, 1997.
Dennis Retzlaff expressed concern that the ANCBH had not taken a position on the on-site sewage issue. The NCALHD needs to assure that they are informed about the issue and its importance, and urge their support and involvement.
John Shaw was concerned about coordination of legislative issues between the various NCALHD Committees and the Policy & Planning Committee. Bill Smith said that the P&P Committee does not set priorities, but supports them. It was the consensus of the group that the coordination of legislative policies is taking place fairly well and there needs not be additional processes that may impede quick action by all committees. Margaret Dollar concurred that her committee has also been able to coordinate satisfactorily with the other committees.
SPECIAL REPORT - Kim Grantham, staff member with the NCACC, presented issues on state and local government retirement systems and efforts being made to establish equity. Her report is included as an attachment to the minutes.
EPIDEMIOLOGY - Dr. Walter Linz expressed concern about the Expansion Budget not funding 18 rural counties' HIV projects. This $ 209,000 cut from the Expansion Budget would mean a $12,000 to $12,500 reduction in available funds to these 18 counties for HIV efforts.
SPECIAL PRESENTATION - Dr. David Bruton, Secretary to DHR, was introduced by Dr. Ron Levine. Dr. Bruton has furnished written comments to the NCALHD which are included in the Attachments to these minutes.
HEALTH PROMOTION - Curtis Holloman reported the following issues:
1. Wanda Sandele attended the Senior Vaccination Liaison Planning committee for the year's event. It was recommended that the President of NCALHD and one other health director serve on the Advisory Committee. Wanda Sandele will represent the Health Promotion Committee on the Advisory and Planning Committee. Recommendations for this year's event are to allow more flexibility for local health departments to coordinate their efforts with the state plan.
2. Healthy Carolinians Appropriations Initiative - Details of the proposal were distributed. Jim Boehm of the Health Promotion Committee is working with representatives from the Healthy Carolinian's Task Force and Legislators to draft a Bill for introduction in the House. Bill Smith made the motion that the NCALHD offer its support for this initiative and legislation to be drafted from it. Dennis Harrington seconded and the motion passed unanimously.
3. Mary Bobbit-Cooke made a presentation to the Committee regarding the role of health education in North Carolina. She shared the process for which members of the Health Promotion staff have been engaged in to assess the need and role of health educators. Findings and recommendations are included as an attachment to the minutes.
HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported
1. that DMA through Dennis Williams had presented a concept proposal to the staff of the NC Home Care Association concerning options for long term care case management. The proposal spoke about early intervention and assessment of the seniors (no later than age 60 years) using a strong case management piece in order to prevent debilitation and loss of productive life. This model proposed public health home health as the gatekeeper of such a system. Except for the public health representatives, the Home Care Board was generally opposed to gatekeeping and especially if public health was to serve that role. This model should be explored and discussed in further detail in the context of providing less expensive basic services in order to prevent more expensive long term care options,
2. that NCAPHHA workgroups are continuing to meet and explore service delivery options to enhance care to our Home Health clients - especially the senior populations - Marian Duncan and Anne Scott/Rick Steeves Groups are both moving quickly to products and discussion points with DMA,
3. a strategic Planning Session was held last week by an Ad Hoc Group from the Board of Directors to explore Mission and Purpose, staffing plan for Alliance, and develop a plan of action for Board review, and
4. that Jody Vogelzang, Executive Director of the Alliance reported and the President will be following up on a contact for Home Health Business that evolved into a marketing opportunity for health department's basic clinical services - The President will follow-up with a survey of services by county and a plan for consideration by the Executive Director of the NCALHD. The Executive Committee of the NCAPHHA (everyone welcome) is scheduled to meet today after the 3:00 p.m. Meeting of the NCALHD.
HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - Jim Baluss introduced Jim Spade, NC Rural Health Center, NC Hospital Foundation who will serve as a liaison with the NCALHD and will work along with Hugh Tilson, Jr. on planning collaborative workshops on community health, to be held in conjunction with the Health Promotion Symposium and the Annual meeting of the NC Association of County Commissioners.
# INSTITUTE OF GOVERNMENT LEGAL ADVISORY - no report.
MANAGED CARE & REIMBURSEMENT - Dennis Harrington reported that the Committee met on March 12, 1997 at the Kirby Building. Ann Christ, President/CEO, Generations Family Health Plan shared some of the plans going into a new HMO being developed by North Carolina Memorial Hospital and Wake Medical Center. Their plan includes working with a catchment area of 16 counties surrounding the two medical centers. Although it will be principally directed to serve Medicare/Medicaid, it is expected to have a 25% mix of commercial accounts. She was interested in what public health departments could offer in services for the HMO. The HMO is expected to be approved and underway in a week or so. Prior to her current position, Ann Christ worked for an HMO in Minnesota that initially failed because public health was left out of their plan.
Dale Simmons gave the Committee an update on his activities in providing technical assistance to local health departments. He and Nan Rideout have had to make visits to health departments separately due to the demand and travel time. To date 21 counties have had visits and assessments. Additionally, Dr. Simmons and Mrs. Rideout have developed an educational piece for staff conducted during the course of the assessment. Much positive activity have been noted during field visits; however, it is clear that many departments have a lot do to get ready for the more competitive managed care environment. Dr. Simmons reported that he had sent out by e-mail a document jointly developed by the team dealing with issues/concerns noted in assessments that everyone should individually assess and make every effort to address immediately. Watch your e-mail.
Mr. Harrington reported that the Proposal to Medicaid regarding the MCH Wrap-around services has been accepted and endorsed by a DMA Official. This individual working with MCH had submitted this proposal to the current acting DMA Director with their full endorsement. It is anticipated that consideration and action will be forthcoming after the new DMA Director is in place
Mr. Harrington reported that he and a small group of other public health representatives met on a follow up visit with Mr. Duncan Yaggy, Duke University Medical Center, to discuss the 12 large hospitals' proposed HMO. Mr. Yaggy indicated a strong interest in working with public health using the services that we can consistently provide a HMO, but indicated that at this time, the Consortium is working on financing and the general policies of the HMO proposal. It was clear that Rural health and Primary Care centers have succeeded in strong inclusion in the HMO with some strong consideration for cost based reimbursement for a limited start-up period (2-3 years). The next three months will be critical for a go or no-go on the HMO of this Consortium. If all efforts are positive, the Consortium will then be ready to talk seriously about network inclusion and service utilization of public health by the public HMO. Chairman Harrington will follow-up after 3 months.
Chairman Harrington reported on a meeting with the Dr. Russ Harris, Chair of the NC Medical Society's Committee on community Services last week in Chapel Hill. Mr. Rick Steeves, an active member of the MR&R Committee attended and actively participated. Basically, this was a great educational opportunity for public health with a very positive and receptive contact from the private medical community. Dr. Russ Harris was very interested in the role that public health plays currently in the care of the Medicaid population, as well as, the underinsured and the uninsured citizens in North Carolina. The benefits of serving Medicaid populations in public health was discussed at length. The fact that this had created a reliable and consistent funding stream for public health was emphasized, as well as, the critical need to continue/protect these funds for the future of public health. Dr. Harris certainly indicated a good understanding and commitment to support these issues with the Medical Society.
Dr. Leah Devlin from Dr. Levine's Office reported and the MC&R Committee that DHR had agreed to restore at least half of the lost SSBG funding in the new FY 1997-98 up to approximately $ 613,000. this represents a significant turn around by DHR. Dr. Levine, and Secretary Howes, and Dr. Devlin have all supported Dr. Wolfe in her efforts to accomplish this restoration of funds. Clearly, it is less than we hoped, but certainly a move in the right direction.
MATERNAL AND CHILD HEALTH/DENTAL - no report.
POLICY & PLANNING (Legislative) - Bill Smith reported that
1. They are working in conjunction with the NCPHA on the major legislative issue for public health authority. Discussion on board representation number and makeup offers some concern over its eventual persuasion. The local board of county commissioners would have to make the decision to establish the authority and the authority's board would have all the duties of a current local board of health. A bullet summary will come out as soon as it is drafted.
2. There is some legislation regarding expanding the number of hygienists to more than two that a dentist can support at one time, and would allow dentists not to have to be on site. Still a proposal is out to allow a Hygienist to set up an independent business offering exams and cleaning services. The Dental Society is opposed to this. Consideration of support for this legislation has been tabled for the time being by the NCPHA Legislative Committee. (MDs can only support 2 PAs at a time.)
3. HB 358 - Pertains to access to Ob-Gyns. Pregnant woman can access anyone they want. P&P Committee has not taken a stance at this time.
4. HB 85 - Intensive Livestock Operations. Out of Environmental Committee last month. Letters sent by Bill Smith and President Bass on this issue.
STATE & LOCAL RELATIONS - Margaret Dollar reports her committee has been working on discretionary funding issues. She is working to get Secretary Bruton's support for Health Promotion, HIV, Physical Fitness, SSBG cuts restoration. Anne Wolf has been diligent on SSBG issue. Trying to stress that public health has not gotten equity with mental health and social services. Medicaid Maximization funds are still unresolved. Request for decision has gone back to HCFA which will take at least 90 days to receive response. Dennis Harrington made the motion: To request that rather than accept only $ 613,000, all the SSGB funds be restored back to the $ 1.2 million level. Bob Wood seconded and the motion passed unanimously. This issue will be taken up by Policy and Planning Committee.
Margaret Dollar said that the next Committee meeting will be a breakfast meeting at 8:00 a.m., at the Carolina Inn, April 17, 1997.
# STATE HEALTH DIRECTOR'S OFFICE - Other than items mentioned earlier, Dr. Leah Devlin reported that the Public Health portion of DEHNR faces an $ 875,000 cut in salaries which will assuredly translate to RIFs in state positions.
TECHNOLOGY - George Bond had the following issues to report:
1. The NCALHD is now a member of the North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA), a non-profit membership corporation. Membership is open to any healthcare provider, persons providing services to healthcare providers, governmental entities, educational or scientific research organizations, and other non-governmental entities serving the healthcare industry. Currently NCHICA is working on promoting legislation dealing with the privacy and composition of electronic patient medical records. Allied with this organization is the NC Council on Health Policy Information of which George Bond and Tom Bridges have been appointed to serve on two committees dealing with patient records and community diagnosis issues.
2. The Technology Committee continues to work on the Memorandum of Understanding between the NCALHD and DEHNR/DH&HS. It is hoped that the MOU will be ready to present to the NCALHD Executive Board by May's meeting.
3. The TB module of the Enhanced HSIS software will be tested in three counties in April and three additional counties are being contacted to pilot the system.
4. Need exists to develop an annual work plan for EHSIS. George Bond is appointing an 18 person sub-task force comprised of local health department nurses, clerical, technical folks, etc., to work with state folks on development of the plan. Kim Pruitt, Buncombe County Health Department and Russell Jones, Person County Health Department will co-chair this work group. Laura Zimmerman, UNC School of Social Work, will be a facilitator. The group will begin work in a couple of weeks, tentatively April 7 - 8, 1997. George Bond said he hopes local health directors will allow any of their staff called to spend a couple of days to meet and get the work turned out.
5. The National Telecommunications Information Grant proposal is being developed by the State Center to target 12 rural counties to enhance their computer capabilities. If this federal grant is awarded, the funding cycle will begin October 1, 1997.
6. Marc Kolman, Anson County Health Department, will represent the NCALHD Technology Committee on the Human Services Automation Policy and Planning (HAPP) council. Representative to HSIS council will be made by a subsequent meeting.
Two motions from the Technology Committee:
1. The Resolution on EHSIS development and maintenance that was adopted by the NCALHD last January included a provision for funding the State Center's costs. Twenty-five percent of the funding would come from local health departments, which would be about $ 100,000. A cost allocation plan based upon volume of Medicaid billing seems most plausible and would cost most local health departments less than $ 900.00 per year. The motion from committee to adopt this cost allocation plan was approved unanimously.
2. The NCALHD homepage has been up and running for several months now. It costs between four to five hundred dollars each month to print and mail out the 120 copies of the minutes, whereas the homepage could be done more efficiently and even include the committee minutes. A method that would allow for scanning handout and other material to put on the homepage would include the NCALHD purchasing a scanner and software. Currently Tom Bridges can use his agency's equipment for this. Each local health department or other groups who want to access the additional information will need to install Adobe Acrobat Reader software, which is available on the Internet free of charge. This software, however, requires about 4 MB memory and may take some time to download. One solution would be to purchase 100 CD-ROM disks containing the software at a cost to the NCALHD $ 150.00 and make it available to all local health departments. This standard has also been approved by the NC IRMC and is also required for anyone wanting to receive the electronic MMWR from CDC. Motion from committee is to purchase the 100 CD-ROM disks for local health departments and switch minutes and other NCALHD information to the homepage on July 1, 1997. Anyone after this date will need to pay a fee of $ 120.00 per year/ $ 10.00 per month if they want to continue receiving the printed minutes and attachments by mail. Motion passed unanimously. George Bond is to send out this information in a separate mailing to all local health departments. Tom Bridges was asked to provide training during the Health Directors' Leadership Conference in April on how to load the Adobe Acrobat Reader and access the minutes.
NOMINATIONS & BYLAWS - Dr. Louis Latour said that there was no meeting, however he wanted to thank the group for the tremendous response to the NACCHO survey. He will fill the unexpired term of Bob Parker's post with NACCHO. He said that it was particularly gratifying to North Carolina had the highest response rate in the country. He also said that public health folks from other states are amazed with the degree of organization and level of activity of the NCALHD.
SPECIAL REQUEST: Dan Reimer said that the Orange County Board of Health adopted a much stricter smoking rules that do not fall under the same litany as have the local rules from other counties. Orange County's rules provided no exceptions or discriminations other than allowing smoking in a tobacco shop. They are interested in sustaining their rules and going forward with enforcement. They anticipate opposition and have two requests to make:
1. There will be a called meeting of interested parties.
2. They would appreciate some financial support if they have to defend their position in court.
Please call Dan Reimer if you are interested in details. Any comments are welcomed and he can also be reached by e-mail.
LIAISONS & OTHERS
NCPHA - Debra Rowe reported:
1. The NCPHA is looking for nominations for several awards that they offer each year. Listing included in minutes.
2. She appreciates use of e-mail for important legislative announcements/developments and hopes that everyone finds this valuable to them to have timely information.
3. Glaxco-Wellcome Awards nomination forms should be in mail soon to local agencies. They have extended the time period to the end of May for return of nominations. Please respond with your nominations.
OPHN - Dr. Leah Devlin made the following report from Joy Reed who could not be present:
1. On April 29, Barbara Pullen-Smith and Joy Reed will be convening four (4) focus groups across the state on how to maximize the role of consultants to provide better integration between state and local public health. Some received invitations today. Please read those carefully as several of you are asked to bring another person (a health educator, nutritionist/WIC staff, social worker, or management support staff) with you to the focus group. One of the sites is not yet finalized, so others will get invitations in the mail.
2. On April 18, Pharmacy Training for PHNs will be offered at Moore County Health Department from 9:00 a.m. - 12:00 noon. If other counties have PHNs who need this training, they are welcomed to attend. Please call OPHN so space can be arranged and adequate handouts will be on hand.
ANCBH - Dr. Pam Horne reported that HB 213 is scheduled for public comment at 11:00 a.m. on March 27, 1997 in room 643, Legislative Office Building, Raleigh. Representatives Howard and Aldridge are co-chairs. Please call their clerks if you want to comment on this bill. Pam will be sending out a letter on e-mail.
MANAGEMENT SUPPORT - Barbara Smith reported that the NC Local Public Health Management Support convenes its annual meeting November 5 - 7, 1997 at the Sheraton Crabtree Hotel, Raleigh. On a sad note, Betty Lange, Past-President and an active member of NCPHA passed away recently. She will indeed be missed by the public health family.
NCALND - Annette Piner announced that March is National Nutrition Month. She passed out a brochure with the theme, "All Foods Can Fit".
NCACC - Ed Regan said he had no report.
ADJOURNMENT - With no further business the meeting was adjourned at 12:30 p.m. The next meeting is scheduled for 9:00 a.m., April 17, 1997 at the Carolina Inn, Chapel Hill and will be a Full Association Meeting.
Respectfully submitted,
Thomas D. Bridges, MPH
Secretary