MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS

Executive Committee Meeting

July 16, 1998

Wake County Commons

Raleigh, North Carolina

CALL TO ORDER - President Smith called the meeting to order at 9:00a.m. (See Attachments, pp. 1-2, Attendance Roster.)

APPROVAL OF MINUTES - The minutes of the June 18, 1998 Executive Committee Meeting were approved unanimously.

TREASURER'S REPORT - Tim Green

Mr. Green presented the Treasurer's Report. Account balances as of June18, 1998: checking $22,343.55; savings $32.25; money market $11,078.80; certificates of deposit $40,000. Mr.Green stated the projected revenue for the annual budget would likely be realized. (See Attachments, pp. 3-4.)

ANNOUNCEMENTS

The Association has been invited to contribute a written article on a regular basis to the N.C. Medical Society's Medical Journal.

It was reported that Jenny Kirksey will soon be leaving her position in Burke County.

Motion and second were duly made for Gayle Brown to fill the unexpired term for Dennis Harrington on the Executive Committee representing Region III. The motion carried.

ACTION ITEMS

ENVIRONMENTAL HEALTH COMMITTEE - Mimi Cooper

Motion from Committee:

Motion to appoint MiMi Cooper to serve on a committee with Sue Grayson and representative of the Department of Public Instruction to investigate a Memorandum of Agreement with local public health and cooperative extension to provide Serve Safe instruction to school cafeteria managers.

Motion to support the concept of effluent filters and risers on septic tanks but oppose the specific language and time constraints in HB 1462 and SB 1303 (committee substitutes) with adopting temporary commission rules and potential costs to local health departments and further recommend that all interested parties be brought together to discuss the issues and develop mutually acceptable substitute language.

The motion was amended in the meeting by Don Younsey to accept substitute language that would clarify that the riser height is checked at final inspection.

Motion was duly made and seconded to approve as presented. The motions carried unanimously. (See Attachments, pp. 5-8A.)

COMMUNITY HEALTH COMMITTEE - Wayne Sherman reporting for Elaine Russell.

A draft of a North Carolina Community Health Assessment 1998 Survey was discussed. The distribution of the survey was approved by consensus of the Executive Committee. (See Attachments, pp. 9-14.)

The Annual Healthy Carolinian Conference is scheduled for October. There will be four sponsorship levels. The Committee recommended a contribution of $1,000,00. After some discussion, the motion passed unanimously.

POLICY AND PLANNING COMMITTEE - Maggie Dollar

Ms. Dollar presented to the Association for consideration resolutions relating to:

After some discussion, the committee made recommendations for minor revisions and passed resolutions regarding the above. (See Attachments, pp. 15-26B.)

EDUCATION AWARDS - Wayne Raynor

NACCHO Scholarship funds are still available for someone to attend the annual meeting in September.

The Legal Conference is scheduled for October20 and 21, 1998 in Chapel Hill.

NCALHD Executive Committee meeting is scheduled for October21, 1998 beginning at 1:15p.m. at the Friday Center in Chapel Hill.

THE HEALTH DIRECTOR OF THE YEAR AWARD WAS PRESENTED TO MIMI COOPER at which time a resounding, spontaneous standing ovation was given.

STATE AND LOCAL RELATIONS COMMITTEE - Tom Bridges

1. Mr. Bridges stated Mel Crocker, Manager of Local Government Services, Office of State Personnel, had furnished a report to him in June on a salary survey of Public Health Educators. This survey was conducted in 1997 over the southeastern United States with responding states of Arkansas, Florida, Georgia, Louisiana, Missouri, Mississippi, Oklahoma, South Carolina, Tennessee, Virginia and West Virginia. Results indicated that North Carolina's salary range for Public Health Educator I of $21,386 - $25,874 was 3.6% above the average minimum salary and 3.1% above the average maximum salary.

He stated the State and Local Committee may need to inquire among schools of Public Health Education about job placement and inquire about information regarding turnovers. Not included in the survey are hospitals and other institutions that now actively recruit public health educators.

2. The Local Providers Work Group met with Dr.Bruton and selected DHHS staff on July 8, 1998. Representing Public Health Directors were Tim Green, Barry Blick, Jim Baluss and Tom Bridges. Discussion focused on mental health concerns which did give public health pause for reflection on the importance of establishing a good cost-reporting mechanism for accountability.

TECHNOLOGY COMMITTEE - George Bond

Mr. Bond announced the next meeting of the committee will be August6, 1998. Project Initiation Document Workshop is scheduled for August18, 19, and 20, 1998. Target date for completion is August31, 1998. He stated Guilford County indicated Acclaim is not functional. There is a question as to whether to award one or two contracts.

EPIDEMIOLOGY COMMITTEE - Sherman Kahn

Mr. Kahn shared with the group an e-mail message from Kim Fox relating to Hepatitis B immunization. The message indicated their section is working with the Immunization Section to encourage the use of Hepatitis B vaccine in STD clinics. Through the Vaccines for Children Program, free vaccine is available to children/adolescents who start the three-shot series before their 19th birthday. There is no longer any other criteria that patients must meet to receive free vaccine. Sheree Smith of the Immunization Section is working with Gayle Daniels in our section to develop a memo which will go out to local health departments detailing this program and suggesting ways to facilitate vaccine use in STD clinics. Steve Martin suggested to me that you might want to announce this at the next meeting of your committee or at the Association meeting so that health directors are aware of this. If you have questions, please call me (919-733-9589) or reply by e-mail. Mr. Kahn said a memo is forthcoming from the Immunization Section.

HOME HEALTH ALLIANCE (NCAPHHA) - Dr. Louis Latour

Dr. Latour reported the new name for the Alliance is "North Carolina Alliance of Health Agencies." Everyone was reminded that dues for this year (1998-1999) are now due. The dues are $2,000 for Clinical (alone), $2,500 for Home Health (alone) or $2,500 for both. A copy of the newest newsletter for the "Alliance" was distributed. Several staff members along with Alliance staff members are planning to visit several agencies across the State to better explain the operations of the Alliance on a one-to-one basis. He mentioned the "Alliance" is looking into the process of accrediting health departments. Nominations are being solicited by a Nomination Committee of the Alliance due to the retirement of Ms.Marion Duncan who has served in that capacity for the Board of the Alliance. Also, the Board will be expanded to accommodate input from home health directors and nursing directors. (See Attachments, pp. 27-30.)

WOMEN'S & CHILDREN'S HEALTH COMMITTEE - Dr. John Morrow

Items discussed by the Committee:

1. Vaccine Accountability

Barbara Sterritt discussed recent concern about vaccine wastage. North Carolina does an excellent job of protecting its vaccine but there have been situations in counties where at times vaccine has been wasted. She emphasized that it is critical that public health departments continue to do a good job accounting for vaccine and urged health departments to be sure that their accountability data entered on NCR is in by the fifth day of the month. Other discussion was about possible involvement of local health departments to help oversee private providersÕ accountability of vaccine.

2. Legislative Update

• There is a possibility of piloting six counties for single-stream funding which would include Prenatal Care, Family Planning, Child Health, Child Service Coordination, and Immunizations. Federally funded programs such as WIC or Title X Family Planning will not be included. Presently this legislation is in the house appropriation's committee.

• TANF funding presently is stable at 1.6 million dollars. Also proposed is an amount of 2 million dollars for the department of HHS to prevent adolescent pregnancy which will be RFP based. Included in this would be the follow-up for negative pregnancy tests. The department of HHS will also be studying CHIP or what will soon be called Health Choice Program to evaluate the amount of money saved through this program over the initial years.

• The Work First Program was also discussed. Last month there was some discussion as to whether public health departments may be placed in a position to assist families coming off the Work First Program to assure that they do not lose other benefits such as Medicaid. Since then, Department of Social Services (DSS) directors have approached the legislature and at this time it appears the responsibility will be charged to DSS.

1. CHIP Outreach

The Child Health Insurance Program has officially been renamed to North Carolina "Health Choice." The plan was approved on July14, 1998 by the federal government. Start-up date will be October 1, 1998. Health departments should receive a memo next week. A teleconference is planned for July22, 1998 to be broadcast statewide to discuss how local coalitions can be formed and outreach for both Health Choice and Health Check made possible. According to Tom Vitaglione, plans are to let Health Check coordinators spend more of their time in outreach over the next year. Apparently one-year eligibility has been approved by the general assembly. Also, monthly reports will be produced giving data by county on the success of CHIP and Medicaid enrollments. It is imperative that public health departments and DSS pay attention to these reports as they become available.

2. Metabolic and Sickle Cell Screening

Discussed at length was concern by several local health departments that results of sickle cell and metabolic screening tests are no longer available. Tom Vitaglione researched this with the state lab and found that changes were implemented approximately six months ago and that local health departments receive only positive results on those children who were not tested in the health department. Health Departments will continue to receive both positive and negative results for those children for whom they perform the test. This change was made to save time and money as there was a massive printing each month in order to send negative test results on all those children to local health departments. It was stressed that the state lab is very willing to provide results on demand by telephone that same day if local providers need the information. There was some concern about older children as universal testing has been available for approximately six years; therefore, children older than age six may need to be retested.

4. Fetal Infant Mortality Review

STATE HEALTH DIRECTOR'S OFFICE - Dr. Andrew McBride

Dr.McBride commented he had visited a number of health departments and was very complimentary in his remarks. He emphasized the strengths possessed by each local health department and the Association. Some issues mentioned were the formulation of a health position and concern for environmental health and hog industry problems. A primary concern is support for asthma. He also mentioned school nurse presence, school health in every school, and partnering at the local level with hospitals, local providers and communities.

OFFICE OF PUBLIC HEALTH NURSING AND LOCAL SERVICES - Joy Reed

Ms. Reed reported the Office of Public Health Nursing and Professional Development is now located at 1330 St. Mary's Street. The new mailing address is PO Box 29605, Raleigh, NC 27626-0605; Courier #56-20-11; Fax #(919) 715-3144. Telephone numbers did not change.

There will be a one-day "Orientation for New Health Directors" on Friday, August28, 1998, in G-1 at 1330 St. Mary's Street. Registration information and materials will be sent next week to health directors who are new within the last year. Anyone needing a packet who does not receive one, should call OPHNPD to request one. Registration fees for this course will be handled through NCAHD. OPHNPD will collect the checks and send them all at once to the treasurer along with the two invoices to be paid.

On September14, 1998, the organization will be offering a FREE teleconference on "The Enhanced Role Nurse: Appropriate Utilization and Training." This teleconference will clarify an increasing number of questions about what the "enhanced role" nurse can legally do as compared to the "non-enhanced role" RN and the Nurse Practitioner. Staff involved in developing policies and protocols and who supervise these "enhanced role" RNs are encouraged to attend. (See Attachment, p. 31.)

Carmine Rocco, Director of the North Carolina Association of Boards of Health, mentioned the next Board of Directors Meeting is scheduled for August22, 1998 at the North Carolina Hospital Association Building in Cary, NC.

Mr. Rocco also mentioned the organization is seeking a liaison to serve on the Board of Directors from the NCALHD. Jenny Kirksey, previous representative, has been employed by Baptist Hospital.

Mr. Rocco expressed appreciation to everyone for sending in their dues. Anyone who has not done so is asked to please do so right away.

The organization has compiled a training manual for Boards of Health entitled "Access, Address and Assure." This manual is available at $35.00 each with a quantity discount available.

The organization is also recruiting members of the local boards of health to serve on the Board of Directors.

NCPHA COMMITTEE - Debra Rowe

Effective July29, 1998, the North Carolina Public Health Association will be located at 4208 Six Forks Road, Suite 2-338B, Raleigh, NC 27609. The new telephone number will be 919-789-8004; new fax number will be 919-789-8005. The e-mail address will remain the same at ncpha@interpath.com.

Leadership and development opportunities are being offered by the National Public Health Institute as well as the Tri-State Leadership Institute. Respectfully submitted, Tim Green Secretary/Treasurer (health\minutes\ncalhd bd mins 7-16-98.doc)