MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS

EXECUTIVE COMMITTEE MEETING

OCTOBER 19, 2000

FRIDAY CENTER

CHAPEL HILL, NC

 

CALL TO ORDER Ð President Tom Bridges called the meeting to order at 1:00 p.m.

(See Attachments)

APPROVAL OF MINUTES Ð The minutes from the September 19, 2000 meeting of the Executive Committee were approved as submitted.

TREASURERÕS REPORT Ð Jim Baluss presented the TreasurerÕs report through October 16, 2000. Account balances were as follows:

Checking-$24,402.16 Savings-$34.34 Money Market-$331.07 CD-$40,000.00

(See Attachments)

ANNOUNCEMENTS

1. Tom announced this to be a Full Association Meeting.

2. Sherman KahnÕs resignation from Forsyth County effective February 2001 was announced.

3. The estate of former Health Director of Stokes County, Bill Johnson, has been left in a trust to make grants to citizens of Stokes County to encourage leadership in education, arts, and protecting the environment. (See Attachments).

4. The December meeting of NCALHD will be on December 20, 2000 from 9:00 a.m. to 1:00 p.m. over the PHTN at the following sites (as of this date): UNC-CH/SPH; Elizabeth City/PPCC; Fayetteville/Cumberland Co. HD; Hickory/Catawba Co. HD; Raleigh/Cooper Building; Sylva/Jackson Co. HD; Wilson/Wilson Co. HD.

5. Tom read a letter from Dr. Ann Wolfe expressing appreciation for the retirement reception last month in Wilmington. (See Attachments).

6. Tom will represent NCALHD at a State Level Bio-terrorism discussion and table-top exercise on November 16th at NCSU. President Elect Tim Green will preside at the NCALHD meeting scheduled that day.

7. Tom reported that a meeting was held October 4th with Dr. McBride and NCALHD officers and three past presidents. The purpose of this meeting was to express concerns over the vacant DHS Division Director, and other matters. Don Yousey and Brian Laturno have been appointed by Tom to assist Dr. McBride in recruiting for the position. Other issues of concern raised at the meeting dealt with the pace of the covering of the public health study commission; lack of input afforded Health Directors in prioritizing expansion budget items; and coordination/communication between state and local health director offices. Tom stated that Dr. McBride invited Health Directors to attend his weekly (Monday morning) Management Team meetings in Raleigh.

8. Tom then recognized Janet Place who presented information on the UNC-SPH Institute of Public Health. "Certificate Course Offering" on Core Public Health Courses such as bio-statistics, epidemiology, environmental health, health policy, and health behavior. More information may be found at the UNC-SPH website. Deadline for registration for the next course is November 20, 2000.

9. Tom then recognized Dean Roper, UNC-SPH, who welcomed Local Health Directors to Chapel Hill and provided an informative report on the significant accomplishments to date in further developing the Public Health Institute.

Dr. Roper reported:
    1. He has put forth an initiative to seek more faculty involvement and experience with local Public Health. Dr. Pennington Whiteside, a former NC Health Director, has been hired from Alabama to head up this project of "outreach" to local Health Departments.
    2. HRSA funding award for the "S.E. Public Health Training Institute" at UNC-SPH.
    3. CDC funding for Bio-terrorism training.
    4. The coveted "National Public Health Leadership Institute" will be located at UNC, as selected and funded by CDC recently.
    5. A more "executive friendly" Doctoral Program is being considered at UNC-SPH.
    6. The Public Health Institute is partnering with the Center for Creative Leadership in executive training for Public Health leaders

STATE HEALTH DIRECTORÕS REPORT

Dr. McBride expressed his appreciation to the membership for the opportunity to address important concerns raised by NCALHD officers and past presidents at the October 4, 2000 meeting. He stated the following:

1. He is in agreement on the importance of filling the DPH Division Director position ASAP. In the interim, he is functioning as the Division Director. This is a beneficial learning experience and he is working hard in this interim period as acting Division Director. Several organizational changes will be arising out of his experiences thus far, and recent concerns expressed by the Health Directors.

2. Dr. McBride characterized recent discussions with NCALHD officers as having centered around very "weighty concerns" in regards to the State Health DirectorÕs office. He stated he deeply regrets the perception that he is not supportive of local Public Health efforts, and stressed he has always tried to be "on the side" of local Public Health. He pointed to the fact that his office and local Health Directors do, in fact, have different agendas and roles, although they are very consistently aimed at the same overall goals of enhancing Public Health in the state. Upon reflection, he stated he felt he needed to issue an apology for a particular event at the last State Health DirectorÕs Conference in which an invited speaker had made disparaging remarks about a local Health Director.

3. Dr. McBride spoke to the issue of NCALHDÕs perceived lack of input on the DHS expansion budget prioritization. He stressed that this is an on-going process and that while acknowledging "inclusion" should have occurred, it will occur as the budget process moves forward.

4. Dr. McBride stated he is totally committed to working through Glen Wells and Chris Hoke and others to see to the Public Health Study Commission concerns this session. He hopes to see the Commission meet once in the West and once in the East, and to work closely with local Public Health to strategize ways to "showcase" Public Health accomplishments and concerns.

5. Dr. McBride strongly solicited input, ideas, suggestions, constructive criticism, etc. to deal with communication problems. He disagreed that senior DPH staff have a "morale problem". Communication is obviously critical here, and he indicated his desire to faster communication on an on-going basis.

6. Dr. McBride stated that it must be acknowledged that state and local administration of our Public Health mission have inherently different roles. We should be able to see diversity of roles and "agendas" as a strength Ð not a weakness.

7. Dr. McBride acknowledged that his statements at a NCALHD meeting highlighting the lack of racial diversity among local Health Directors were provocative. He expressed his deep and sincere feelings about the matter of racial disparities in health among minorities and the positive effects that a more racially diverse Public Health workforce might bring to this important initiative. He did, however, apologize if his statements were wrongly interpreted as criticism of Health Directors in North Carolina. Rather, he said, his remarks were intended to challenge our "best thinking" about how to meet the challenges of increasing racial diversity among leaders in Public Health.

8. Dr. McBride announced several organizational changes in an effort to enhance communication with local Health Departments. (See Attachments).

9. Dr. McBride encouraged all Health Directors to review the findings in the recent audit of the Martin-Tyrrel-Washington District Health Department. He emphasized his view that Public Health is not "broken" in North Carolina, and that past financial/administrative problems at MTW are not indicative of the system as a whole. However, the audit findings have "precipitated a scrutiny" of all of Public Health by policy makers and elected officials. This presents a challenge to us all. Not the least of which is a heightened administrative review Ð particularly of districts for accountability.

10. Regarding the recently established "Office of Alternative Medicine", Dr. McBride emphasized the expansive scope of supplements and herbs being used as "vital medicine". This has implications for maternal and child health, chronic diseases, etc. on a potentially massive scale. Accordingly, an "advisory group" has been established to chart a course for Public HealthÕs involvement in this phenomenon. Dr. McBride does not foresee scarce resources being diverted from core Public Health to "alternative medicine" initiatives.

Discussion/Q & A
  1. Bob Wood asked Dr. McBride about the status and commitment of the state in the important "Information Technology Project", both in terms of nominations for committee representatives and the $250,000 state funds per the MOA. Dr. McBride stated the document has been signed and the Division is committed to finding funding as a high priority in the Division and the Department of Health and Human Services.
  2. Tim Green expressed concern about the very "tight" time frame (i.e. essentially 6 months) in which local Departments must implement projects utilizing the one time/non-recurring childhood asthma funds. He stated this may cause "accountability" problems or revisions of funding. Dr. McBride agreed, but pointed to the hard won battle to get this funding for asthma, and his optimism that more will follow in the future. Bill Smith, NCALHD liaison to the Asthma Coalition, explained some of the reasons for the delay in getting this funding "on the ground".
  3. Dr. Latour observed that recently State DHS Management/Senior Leadership has been absent from NCALHD meetings. Dr. McBride stated that the focus of NCALHD Executive Committee meetings is, appropriately, an "action item" format. In-put at those meetings does not seem to fit in with this format. Dr. McBride suggested adding a place on the agenda for more formalized presentations/information items by senior staff at NCALHD meetings as a solution.
  4. Don Yousey commented that it was always very helpful to have Chris Hoke come to NCALHD meetings and he has been missed in the last year or so.
  5. Don Yousey and Danny Staley expressed their concern that District Health Departments should not undergo excessive or onerous scrutiny due to the M-T-W findings. The M-T-W findings were not at all representative of the practices and management of other District and single County Departments statewide. Dr. McBride agreed, but stated visible, affirmative, and proactive monitoring measures must be taken in light of these findings.
  6. Wanda Sandele expressed the need for Dr. McBride to take more consideration for local public health leaders (i.e. Boards and Health Directors) views and positions on local "hot topics". Dr. McBride stated that he would respond as best he could to local issues and take local Boards/Health Directors views into consideration.
  7. The issue of funding "core public health functions" was discussed. Dr. McBride said he favors "some kind of aggregation" of local public health services and activities Ð perhaps along the line of Healthy Carolinians, which is the closest we have come to new funding for core public health functions in several years.
  8. Barry Bass asked Dr. McBride for more specifics and a time line for filling the DPH Director position. Dr. McBride stated he would work closely with the two Health Directors on this project (Don Yousey and Brian Laturno), and would hope this position could be filled in a matter of weeks.
  9. George Bond expressed concern about the lack of consultation with local Health Departments in the recent decision to deploy senior managers and "liaisons" to local Health Departments. This may be redundant to the program consultants already assigned to counties and will be time consuming for all concerned. He stressed his hope that the senior staff would be coming as advocates for the local Public Health delivery system. He suggested that a close look needs to be taken at a recent initiative by DSS Directors to re-examine the relationship between the state and local services delivery system, and to design the system around strong state level support for their major "customers" Ð those being the local/county district level providers of service. Dr. McBride promised that the "liaison" system will go to great lengths to respect limited time constraints at the local level Ð and provide feedback if the system is not working.
  10. Jenny Lassiter also spoke to express the concern that the "alternative medicine" initiative may drain scarce resources away from other important new issues, for example, the "Tier I" Project (to pilot regional core public health functions). Dr. McBride replied that he does not regard those as competing, "either/or" initiatives.

Tom thanked Dr. McBride for his presentation and dialogue on matters of concern with the NCALHD membership.

COMMITTEE ACTION ITEMS

Women & ChildrenÕs Health Ð Chair Wanda Sandele brought forth an action item from committee. MOTION: Appoint Bill Smith as NCALHD liaison to a steering committee to work on HCFA funded immunization registry. Discussion: George Bond asked if this process was not a duplication of effort with the Technology Committee project, of which an immunization registry is a planned element. Tom and Wanda explained that the HCFA funded immunization registry project will occur independently of the Technology Project and we need a liaison to coordinate these projects. MOTION PASSED.

Epidemiology Ð No action items.

Managed Care & Reimbursement Ð No action items.

Chronic Disease/Dental Ð No action items.

Environmental Health Ð No action items.

Nominations & By-Laws Ð ELECTION: Chair Maggie Dollar presented the slate of officers for NCALHD 2001. No further nominations were received since the previous meeting when the committee slate was presented. Maggie also presented the nominees and alternatives for the regional representatives. (See Attachments).

Dr. Gabel made a MOTION for unanimous consent that the slate for officers and regional representatives be adopted as presented. MOTION PASSED.

Alliance (NCAPHA) Ð No action items.

Policy & Planning Ð No action items.

State & Local Ð No action items.

Education & Awards Ð No action items.

Technology Ð No action items.

COMMITTEE REPORTS AND INFORMATION ITEMS

Women & ChildrenÕs Health Ð Chair Wanda Sandele reported the following matters for information:

  1. Efforts are being made to obtain funding for folic acid for prenatal patients.
  2. A meeting is planned with Smart Start officials to express concern about relative priority (or lack thereof) being given to funding of Health interventions.
  3. Childhood asthma initiative funding RFAÕs have gone out, with start-up dates projected in January 2001.

Epidemiology Ð Chair George Bond reported the following information items:

  1. A Hepatitis C workshop is being planned for Spring 2001.
  2. Consideration is being given to eliminating the sentinel chicken flocks for arboviral surveillance in North Carolina.
  3. State Lab enhancements are underway in neurosyphlis and other procedures.

Managed Care & Reimbursement Ð No information items.

Chronic Disease/Dental Ð No information items.

Environmental Health Ð No information items. (Mimi: Hope you are OK after the horse riding mishap).

Nominations & By-Laws Ð No information items.

Alliance (NCAPHA) Ð No report.

Policy & Planning Ð Chair Tim Green reported on a very productive meeting in which he and Wayne Raynor reported to the County CommissionerÕs Association on October 24th to present the NCALHD 2001 Legislative Goals. The next meeting of the Policy and Planning Committee is November 15, 2000.

State & Local Ð Chair Wayne Raynor announced that after several months of no meetings, the next "local providers group" meeting with Secretary Bruton is set for November.

Education & Awards Ð Chair Jenny Lassiter announced the deadline for receipt of nominations for the Ham Stevens Award is November 30, 2000. Applications are available on the NCALHD web site.

Technology Ð Ray Rabe again encouraged all Health Directors who are able, to aware themselves of training and workshops on HIPPA compliance.

LIAISONS AND OTHER REPORTS

Office of Public Health Nurse Report: Dr. Joy Reed reported the following:

  1. CPT coding issues, especially modifiers, continue to present great challenges. DMA has sent out a special bulletin on modifiers. A training event is planned for another CPT Open Forum at the PHTN on November 14, 2000, from 1:30 p.m. to 4:30 p.m.
  2. Joy is setting up an "Audit Committee" to help get out resource packets to aid local Health Departments develop tools for self-auditing/quality improvement in CPT coding.
  3. Joy issued a reminded to check and make sure rostered child health screeners have a letter on file noting they are rostered (or re-rostered) to avoid DMA audit problems.

(See Attachments).

Local Health Services Section Report: Dennis Harrington, Chief

  1. Dennis strongly suggested local Health Departments not spend a great deal of time automatically re-billing error-coded reports without checking first to see if the state has/will do it for you. A lot of this work can be done at the state level.
  2. Notices of Medicaid cost settlements for 98-99 have gone out to counties.
  3. Medicaid "advances" to counties have gone out.

NC Association of Local Boards of Health

Carmine Rocco greeted Health Directors and reminded them of the October 30 deadline for nominations for awards for Boards of Health to be presented in January.

There being no further business coming before the full Association meeting, it was adjourned at 4:00 p.m.

Respectfully submitted,

Jim Baluss, Secretary