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MINUTES
NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
Executive Committee Meeting
May 15, 1997
Albert Coates Building Raleigh, North Carolina


CALL TO ORDER - With the Association constituting a quorum, President Barry Bass called the meeting to order at 9:00 a.m. See Attachments, pp. 2-4 for attendance roster.

APPROVAL OF THE MINUTES - Motion was duly made and seconded that the minutes of the April 17, 1997 be approved as written. The motion passed unanimously.

TREASURER'S REPORT - Tom Bridges membership that all health departments that had not already sent in their dues need to do so. See Attachments, p. 5 for memo re: health departments that have not paid. The dues notice was sent out with the February meeting agenda. See Attachments, pp. 6-7 for Treasurer's Report. He reported that as of May 12, 1997 the Savings Account balance was $ 25,074.35 and the Checking Account balance was $ 45,937.57. The 1997 Budget Report was not available but Tom Bridges said that the budget is in good order. Motion was duly made and seconded to approve the budget as presented. Motion passed unanimously. Tom Bridges said the Budget would be reflected in the minutes.

ANNOUNCEMENTS - President Bass had the following announcements:

1. He recognized Chris Szwagiel, Dr.PH, Halifax County Health Director; J.T. Garrett, DEd, Carteret County Health Director; Roxanne Frederick, Wayne County Interim Health Director; and Lynda Smith, New Hanover County Interim Health Director.

2. He reminded membership of the July NCALHD meeting will convene in Davie County at the Bermuda Run County Club. The registration form (purple) was sent out with the May 15 meeting agenda. Please complete and send in by June 20, 1997 so that arrangements be appropriately made.

3. The August 14 NCALHD meeting is to meet in conjunction with the Annual Meeting of the NC Association of County Commissioners. This will take place at 1:00 p.m., in Auditorium #2 at the Koury Convention Center (4 Seasons), Greensboro, North Carolina.

4. He urged membership to vote for the four North Carolina health director candidates running for Members at Large on the Board of the NACCHO. They are George Bond, Dr. Louis Latour, Wayne Raynor, and Wayne Sherman.

5. He noted a letter from Dick Peruzzi, Director of the Division of Medical Assistance, was sent out to local health departments about Carolina ACCESS II. President Bass reminded the membership that Dr. Bruton has said that Carolina ACCESS will very much include and involve public health departments.

6. The NCALHD needs a volunteer to serve as liaison on the DEHNR Forms Restructuring Committee. Please let President Bass know if you are interested.

7. The Wood Endowment has reached the $ 100,000 funding goal.

8. Barry Goldstein will present a special report following today's committee reports and before liaison reports.

9. Tamera Hower shared a copy of Beaufort County's 1 year Moratorium on Intensive Livestock Operations. See Attachments, pp. 8-11.

10. Roberson County Health Department has received a NACCHO award for their ILO program.


COMMITTEE REPORTS


EPIDEMIOLOGY - No report.

HEALTH PROMOTION - Curtis Holloman reported the following issues:

1. He recognized Beth Joyner who presented an update on Senior Vaccination Sunday which will now be called Senior Vaccination Season. This year the event is scheduled to occur October 12 - 25. Erica Norton and Beth Joyner will each serve as co-chairs. Dr. Christopher Cooke will chair Marketing/Education. Dr. Bill and Ida Friday will be Honorary Chairs for the event. The local marketing campaign is to be conducted by the local health department media facilitators.

The 1996 SVS event won an award from HCFA, "Beneficial Services Award". Beth Joyner said that local participation is essential to the success of these events.

Motion from Committee that the NCALHD support and endorse the Senior Vaccination Season scheduled October 12 - 25, 1997. Motion passed unanimously.

2. Curtis Holloman said that Meg Malloy from the UNC- SPH, presented information on Managed Care and efforts being made in setting the table for North Carolina. Her proposal is to assure that Health Promotion and Prevention fit into managed care. A coalition is being assembled to support and foster a foundation, NC Prevention/Promotion in Managed Care. Dennis Harrington said that The Managed Care & Reimbursement Committee also recommends support for these efforts. President Bass will appoint representatives to the coalition.

3. Curtis Holloman said that HB 827 SB 728 need NCALHD members' support. The Bill is to provide for $ 3.7 million to Healthy Carolinians, however due to limited expansion funds, a compromise of $ 300,000 may be the best that can be expected. Please contact your representatives and urge passage on this compromise. The telephone number to the switchboard of the General Assembly is 919/733/4111. Mary Bobbitt-Cooke is in charge of Healthy Carolinians. A model resolution was passed out (See Attachments, p. 12) that Local Boards of Health could send their legislators to urge passage of this legislation.

The next Health Promotion Committee meeting is scheduled for June 18, 1997 at 2:00 p.m., room G1B, 1330 St. Mary's Street.

HOSPITAL & COUNTY COMMISSIONERS ASSOCIATION NETWORK - No report.

# INSTITUTE OF GOVERNMENT - No report

HOME HEALTH ALLIANCE (NCAPHHA) - Dennis Harrington reported:

1. The Alliance is working closely with DMA through work groups on how long term care/personal care can be improved. Model concepts have been proposed to save Medicaid funds.

2. Getting Tax Exempt status for the Alliance is progressing well.

3. The Alliance is marketing with managed care its Home Health services, and also clinical services offered through local health departments. Dennis Harrington said that he has only received 46 responses so far on local health department clinical services. He urges all local health departments to send in the survey to him immediately, whether or not there is a home health program in the health department. See Attachments, pp. 13-14 for copy of this survey.

MANAGED CARE & REIMBURSEMENT - Dennis Harrington reported:

1. He reiterated Meg Malloy's presentation on Prevention and how it would be a win-win for managed care and public health to better serve communities. Our active participation is necessary. See Attachments, pp. 15-24 for Meg Malloy's report.

2. Dennis Harrington praised the wonderful work being done by Dr. Dale Simmons and Nan Rideout. Several training opportunities are being developed for local agencies. They include: coding, patient flow analysis, telephone triage, and customer service excellence.

3. Dennis Harrington said that at another meeting he heard Dr. Bruton, Secretary to DHR, say that Medicaid is not going to grow by the year 2000, even with an 8% increase that is indicated.
4. He included for the minutes a report on Medicaid Managed Care Strategy. See Attachments, pp. 25-29.

Meeting next month is scheduled for June 11, 1997 at 1:30 p.m., room 297, Kirby Building, Dorothy Dix Campus, Raleigh.

MATERNAL & CHILD HEALTH/DENTAL - Dr. Harold Gabel reported the following:

1. "Seal the State in '98" project will be a state wide endeavor to promote dental sealants. During the week of this program it is hoped that 100,000 sealants will be applied. The project will involve state and local dentists. Dr. Steve Cline hopes to locate funds to pay for supplies. It is hoped that local dentists will each contribute at least two hours of their time to apply sealants. Motion from Committee is that the NCALHD supports the "Seal the State in '98" project. Motion passed unanimously.

2. A representative from "Covenant with North Carolina Children" is to attend the next NCALHD meeting to share information on this cause. The NCALHD is being urged to endorse and support these efforts.

3. The Streamlining Committee has been diligently working to reduce the paperwork burdeon on local health departments, however there is local sentiment that the committee has not gone far enough. Harold Gabel will send out a copies of a summary committee report to local health departments. He urges local health department review of the report and to e-mail any feedback to him.

4. Barry Goldstein is to present a special report on local accountability. Motion from Committee is that the NCALHD endorse and support this proposed accountability system. President Bass recommended that the motion would be acted on immediately following Mr. Goldstein's presentation.

POLICY & PLANNING - Bill Smith reported that P&P jointly met with the Association of North Carolina Boards of Health and the NCPHA on legislative issues.

1. HB 515 was passed over (ILO site). Still maintain one year moratorium, but site requirements not as stringent.

2. SB 143 passed to House Committee on Rules Ban Tobacco Sales to Minors.

3. Motor Cycle Helmet required deletion - did not cross over. Dead.

4. Control of County Boards did not cross. However, may be attached to another bill, so have to be vigilant.

5. Public records law did pass over. It is opposed by county commissioners, state government and other groups. Opens up personnel records of state, county, university, city, etc., employees.
6. Ad Hoc Task Force Report was made available at last month's meeting (See April 17, 1997 NCALHD meeting minutes Attachments, pp. 49-65) and a motion to endorse the report was tabled to allow time for review and feedback. Bill Smith said that Marc Kolman gave the only feedback he received. The Motion from P&P Committee was that the NCALHD accept the Ad Hoc Task Force Report as presented. Motion passed unanimously. President Bass will send the report on to the Vision Committee which he appointed to look at the concepts in more detail on June 19, 1997 at 10:00 a.m., Albert Coates Building. The Vision Committee includes the NCALHD Executive Committee, along with Jim Baluss, George Bond, Dr. Louis Latour and Dr. Fred Pilkington. At the next (June 19, 1997 at 1:00 p.m.) NCALHD
meeting, President Bass will open the floor to the full association for a discussion at length the options and recommendations made by the Vision Committee.

7. Concern was expressed over insurance companies that change from non-profit status to for-profit status and carrying with them large funds that were accumulated while they had tax exempt status as a non-profit institution. Many states have sought protection from losing these funds to private interests and have legislated provisions to ensure that these funds go to a trust to be expended on public trust matters. Motion from committee that the NCALHD support the view that as an organization converts from a non-profit to a for-profit, resources obtained while in the favorable tax position will be identified by the Attorney's General Office and these resources will be placed in a fund for the good of the public as determined by an overseeing body. This support will be demonstrated by the appointment of 1 or 2 health directors who will work in a lead role with NCPHA and for Health Care Access Coallition. The motion passed unanimously.

8. SB 271 Tommy Jarrell informed the NCALHD that this bill would authorize borrowing from the State Employees Trust to fund local business loans. Need to oppose this legislation. The bill is in the Senate Finance Committee. Senator Hoyle chairs. This, being a money bill, does not need to cross over to the House.

Please refer to Attachments, p. 30 for NCPHA Legislative Committee Current Status of Bills as of May 13, 1997.

STATE & LOCAL RELATIONS - Margaret Dollar reports her committee met on Tuesday afternoon with Secretaries Howes and Bruton. She said they are awaiting legislative approval to reorganize the departments. Dr. Bruton said that he intends to strengthen public health. He said information/automation is critical. He wants to encourage networking at state and local levels, and he wants open and honest communication. Recommendations made will be passed to Vision Committee. The next meeting of State & Local Relations are tentatively scheduled for June 18, 1997 at 4:00 p.m., 1st floor, room 158, Adams Building, Dorothy Dix Campus, Raleigh.

# STATE HEALTH DIRECTOR'S OFFICE - Dr. Leah Devlin reported

1. Medicaid maximization money: very positive signals in this regard that funds will come.

2. House met this week: Better idea on budget after 2:00 p.m. next Monday when they meet again. Senate version contains less money. At present, health staff are very positive about the budget, but their proposed appropriations have yet to be revealed. Know a lot more Monday evening. After House and Senate pass their versions, there will be differences which will have to be negotiated in the Conference Committee comprised of members of both houses. It is hoped that business will be completed by early June, however the Redistricting Plan (voting districts) may keep the Legislature in session.

3. He anticipates a relatively very smooth transition during the reorganization to the new Department of Health and Human Services. He is very positive on the outcomes.

TECHNOLOGY - George Bond had the following items to report:

1. Memorandum of Understanding between the NCALHD and the Office of the State Health Director with regards to the Enhanced Health Services Information System (EHSIS) was sent out to all local health departments for review and comment. George Bond said that two provisions were added at the request of the Work Plan Task Force ("Busy Bees"): 1. That the EHSIS be changed to Health Services Management System (HSMS) and 2. That both the Association and the Office of the State Health Director agree to review and approve any new modules or versions of HSMS prior to statewide implementation. George Bond said further that even though the agreement is a five year agreement, that the NCALHD could withdraw if the workplan (annual mutual agreement) is not met. The local financial supplement to the HSMS ($ 100,000) was passed during the March 20, 1997 meeting of the NCALHD. Motion from Committe is that the NCALHD accepts the provisions of the Memorandum of Understanding as presented. The Business Plan/Work Plan will be developed by the Technology Committee. Each January, a Technology Plan will be presented by Delton Atkinson/State Center to the NCALHD for approval. What is wanted is a process driven by the NCALHD and the State Health Director's Office. If the plan is not going where we want it to go, then locals have the option to stop it. A friendly amendment was made by Dr. Harold Gabel and accepted by George Bond that the maximum annual commitment by local health departments share be $ 100,000 for FY '97-98 and that maximum nay be increased annually during the term of this agreement by a percentage equal to the consumer price index so long as the health department share stays within the 25% local allocation described above. Barry Blick said he felt that the real control would be through the business plan and $ 100,000 is a small amount for what we stand to gain. Dr. Chris Szwagiel said that a statewide system is absolutely essential for assessment, planning and evaluation of health status in North Carolina and he recommended that the CDC's health assessment tool should be considered in the development of the data management system. The motion with friendly amendment passed unanimously. (See Attachment, pp. 31-32 for copy of MOU).

2. George Bond said that while the MOU was proceeding, the Technology Committee with nevertheless consider submitting Request for Information (RFI) to private software vendors to determine costs for similar systems.

3. The Environmental Health module will be looked at during subsequent meeting. Also, there will be inquiry by the Technology Committee as to why WIC cannot make provisions for Ann Presnell, QS and other software systems to print on-site. It was revealed that other QS in other states have been allowed to do on-site printing of WIC vouchers. Next Technology Committee meeting is scheduled for June 18, 1997 at 1:00 p.m., room 1A224, Parker-Lincoln Building.

NOMINATIONS & BYLAWS - No report.

EDUCATION & AWARDS - Leonard Wood reported the following:

Health Director of the Year nomination forms need to be sent to him by next meeting of the NCALHD.

ENVIRONMENTAL - The committee met yesterday. Terry Pierce shared the following:

1. Ed Norman presented a draft memo to be sent to all health directors regarding childhood lead poisoning prevention aid-to-counties funds available by grant application. Applications will be due by June 30, 1997; Maximum award is $ 10,000 per project per year (FY 97-98); informational meeting is scheduled for June 3, 1997, 1:30 p.m. - 2:45 p.m. on PH-TIN at usual sites; funding decisions made by August 1, 1997; total funding available is $ 75,000; any remaining funds may be re-allocated to funded projects, may exceed $ 10,000 maximum. Motion from Committee: To approve the draft letter and application form for proposed childhood lead poisoning prevention projects. (See Attachments, pp. 33-39) Motion passed unanimously.

2. Committee discussed two items on the agenda for next Commission for Health Services meeting scheduled for May 21, 1997:

a. Lead Abatement Contractor Certification Rules are temporary rules as the result of Executive Order (# 108). Funds are to be directed to Department of Commerce and will not effect local lead investigators. No action/position is recommended by NCALHD

b. Food Sanitation Rules for Mega-food Bars is from a petition from New Hanover County. The Association has previously opposed this proposal regarding adult supervision of children aged 10 and under at self-service food bars. Restaurant Rules Review Committee did not support a rule change to address this concern. Michael Rhodes will recommend no changes in the rules at this time and may suggest an educational effort to inform the public on "mega-bar" food safety.

Motion from Committee: That John Shaw present the Association's position opposing the proposed mega food bar rules to the Commission for Health Services. Motion passed unanimously.

3. The Public Water Supply has drafted the Intended Use Plan. EPA has commented that the draft is a "very good plan" and Linda Sewell believes it will "sail through" when presented. Matching funds are still in the Budget.

4. Kae Henderson, Supervisor, Wastewater Discharge elimination (WaDE) Program presented an overview of the program. It focuses on the 29 western most counties and has the following goals:

a. Administer the Amnesty Program for violators who self-report (toll-free #1-800-9-sewage);

b. Identify and eliminate direct discharges in watershed areas;

c. Inform and educate public through news releases, etc., regarding need to eliminate discharges.

5. Linda Sewall provided handouts of the Expansion Budget and provisions that have been attached to the Budget Bill. A copy will be included with the minutes. See Attachments, pp. 40-41. Items shown with "R" is for Reoccurring funds; "NR" = non-recurring funds; the non-monetary figure(s) indicated the number of new positions associated with funding.

One other item: "Reissue Certain Wastewater Permits" has passed Senate and need to try to halt it in the House. Terry Pierce said he discussed this at the last NCALHD meeting and it involves reissuing expired permits from as far back as 1982. (See Attachments, p. 42) Practical problems identified are:

a. many of the expired permits have been purged, LHD has no copy;

b. local EHS will need to know/learn all the different revisions of the rules as they apply to the expired permits;

c. no idea of how many expired permits there are, therefore don't really know the impact it will have at the local level.

Motion from Committee: That the NCALHD oppose Special Provision Code No. 97ENV-S020, "Reissue Certain Wastewater Permits" and that LHD be encouraged to contact their respective Representatives in the House to urge the removal of this provision. Motion passed unanimously.

6. Bill update:

a. Preliminary Evaluation Bill will not be passed, but was referred to Environmental Review Commission. commission could recommend the bill for the Short Session.

b. Modified penalty for late payment of restaurant fees alive and in Appropriations Committee.
c. HB 165: Not required to sanitize glassware in "condo" settings should pass.

d. HB 471: Re: packaged foods, permitte/non-permitted establishments treated the same, juice bars. Michael Rhodes is meeting with Department of Agriculture to clear up lines of responsibility.

e. House Joint Resolution 1201 - "Authorizing the Legislative Research Commission to Study the Requirements for Issuance of a Certificate as a Registered Sanitarian" allows the study of requirements for a sanitarian to practice in North Carolina; Commission make recommendations; interim report to General Assembly in 1997 and/or 1998, with a final report to the 1999 General Assembly. (See Attachments, p. 43)

f. Code No. 97ENV-S024A "Monitor Coastal Water Quality" to protect swimmers and other users. Prompted by concerns about fish kills, the fact that NC has no water quality monitoring of coastal waters and to track pfiesteria. (See Attachments, pp. 44-51)

7. Dennis Retzlaff volunteered to serve on a training committee of EHS. As part of his involvement with this committee he recognized the need for health directors to have a better understanding of EH services and processes. He asked the EH Committee to consider recommending some level of training for new health directors and to permit existing health directors to also participate in this process. After considerable discussion, the EH Committee made the following motion: Due to health director turnover, and the complexity and liability associated with EH matters that a comprehensive orientation to EH services be provided to new health directors, as part of the orientation process and to existing health directors and that the proposal be referred to the Education (/Awards) Committee to work with the State Health Director's Office to develop the details. Motion passed unanimously.

OTHER -

1. Dr. Anne Wolfe shared a statewide and county by county report on infant mortality that was being released to the press. This report had been requested by the Winston-Salem Journal. The report provides 1996 provisional data. See Attachments, pp. 52-57 for this report.

2. Carl Tuttle is retiring from the Appalachian Health District and a retirement reception is planned in his honor from 3:00 p.m. until 5:00 p.m., on June 27, 1997 at the Appalachian State University Cultural Center, Boone, North Carolina. The Cultural Center is located along Blowing Rock Road. NCALHD members are envited to attend. Call the Appalachian Health District Department, telephone 704/264-4995 if you need more information.

SPECIAL REPORT - Barry Goldstein reported:

1. Tom Vitaglionne has been meeting with the State Partnership for Smart Start on promoting the use of Smart Start funds for health services. A letter has been sent by Dr. Bruton to encourage this idea. For more information giving guidance to Smart Start funds for local health department services, see Attachments, pp. 58-60.

2. Barry Goldstein made a presentation on Proposed Accountability System which Barry Goldstein calls, "Accountability Lite". The proposal lays out some steps that here to fore were not in place. See Attachments, pp. 46-55 from the April 17, 1997 meeting for a copy of this report. Following Barry Goldstein's report, President Bass brought up the motion raised earlier from the MCH Committee that the NCALHD adopt the Proposed Accountability System as presented. Motion passed unanimously. Dr. Harold Gabel asked that the minutes reflect the Association's gratitude to Barry Goldstein, Chris Hoke, Dr. Kevin Ryan, and Tom Vitaglionne for their efforts on developing the accountability system.

LIAISONS & OTHERS

OPHN/OFFICE OF LOCAL HEALTH SERVICES - Joy Reed had the following to report:

1. New services being developed for local health departments include:

a. Patient flow analysis - CDC developed Two teams to be trained to provide service to local agencies on request.
b. Training in telephone triage. Tentative date is July 15, 1997, 1:00 p.m. - 4:00 p.m. via PH-TIN. Flyer sent out for local staff training.
c. Piloted team consultants to work with local staff on customer service excellence.
d. May 7, 1997, discussion focus groups. Two prioritized items to develop ASAP.

ANCBH - No report. HB 213 did not cross over. Need, however, to watch funding bills and other devices where this legislation could resurface.

NCPHA - Debra Rowe reminded membership to send in NCPHA awards nominations, due by June 1, 1997 and Glaxco-Wellcome Child Health Awards nominations, due by close of business on May 30, 1997. Public Health Authority 636 did pass Senate and is now on House side. While no problems are anticipated, you need to let your legislators you want their support.

PHTIN - Joy Reed said that some additional affiliate sites are available when no other programming is scheduled. These sites include Surry Community College, Montgomery Community College and Coastal Community College.

Other Liaisons: No reports.

ADJOURNMENT - With no further business the meeting was adjourned at 3:45 p.m. The next meeting is scheduled for 1:00 p.m., June 19, 1997 at the Auditorium, Albert Coates Building, Raleigh.

Respectfully submitted,


Thomas D. Bridges, MPH
Secretary