MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS

FULL ASSOCIATION MEETING

JANUARY 10, 2001

NC HOSPITAL ASSOCIATION

CARY, NC

CALL TO ORDER: President Tim Green welcomed the full association to the first meeting of the New Year at 1:30pm. Tim reminded us of an appropriate quote by Forrest Gump, "DonÕt you just love New Years! ItÕs just like starting over. Everybody gets a second chance." Fifty-five members were in attendance, which constitutes a quorum (See Attachment for Attendance Roster). President Green also welcomed the new liaison from NCSOPHE, Deborah Cerrito.

FELLOWSHIP: Elaine Russell, Cherokee County provided fellowship with the reading of a poem.

APPROVAL OF MINUTES: The minutes for the December meeting were distributed and approved with the following corrections: Bob Wood, Haywood County and Ken Ring, Macon County were in attendance.

TREASURERÕS REPORT: Jim Baluss presented the treasurerÕs report through January 4, 2001. Account balances were as follows:

Checking: $12,693.19 Savings: $34.50 Money Market: $334.13 CD: $40,000

(See attachment for full treasurerÕs report)

Leonard Wood, Rowan County asked what our balances were last year. Jim responded that he was unsure of the exact figure but that we had moved $10,000 into our checking to pay expenses this past year. Leonard asked if indeed this was a gradual decline in our overall assets and Jim responded, yes. The treasurerÕs report was approved by the membership.

MiMi Cooper presented the 2001 budget. The motion was made that we add $100 to line 118 for a donation to the NCALBOH. The motion was seconded. Discussion included the fact that the rent line item 108 is budgeted higher than the expenses, which would leave us with the ability to make this donation. An amendment was made to the motion to increase the donation to $500. A second for the amendment and further discussion with the parliamentarian brought the amendment to the floor for a vote, which was 53 in favor and 2 against. The original motion to make a donation to the NCALBOH was then voted on and passed unanimously. Further discussion continued about donations/dues the association had made in the past but were not included in this budget. A motion was made to support the NCPHAÕs legislative conference at the $1,000 level. The motion was seconded and passed unanimously. There was also a motion to include in line item 118, dues of $50 for membership in Prevention Partners for our association. There was a second and the motion passed unanimously. After further discussion there was a motion to accept the budget with the changes made at this meeting. After a proper second, the motion passed unanimously. President Green asked MiMi Cooper to incorporate these changes in the budget and bring the final copy to the association meeting in February.

1. Tom Bridges will serve as parliamentarian this year. In TomÕs absence, Wayne Raynor will serve and then Jim Baluss.
2. Tim presented Tom Bridges with an engraved gavel in honor of his years served as an officer in the association and president for 2000.
3. Tim urged everyone to sign the roster and choose a committee to serve on. He also asked each individual to check the directory information and make corrections on the sheet that was circulating.
4. Tim appointed Bill Smith, Robeson County to chair an audit committee with Jenny Lassiter, Pamlico County and Gayle Brown, Yadkin County to serve as committee members. Tim asked for a report at the February meeting.
5. Tim encouraged attendance at the State Health DirectorÕs Meeting to be held at the Raddison, GovernorÕs Inn at RTP on the 11^th and 12^th as well as the North Carolina Boards of Health meeting on the 12^th.
6. Tim reminded us of the PresidentÕs reception at the Embassy Suites at 5:30 sponsored by Seabury and Smith.
7. David Stone is the new health director in Surry County and Shelly Caraway has

resigned from Alexander County.

No report.

Debra Bryant told the association about several efforts to address smoking and tobacco use through programs funded through two sources. The Robert Wood Johnson Foundation grant, Smokeless States has a total of 40 million to award to states. North Carolina has applied for 1.5 million over three years. The National office of the Lung Association will match these monies. The recipients are GASP, SAVE, RAFE, American Cancer Society, North Carolina Prevention Partners, the Medical Society and others.

Another opportunity exists under the national tobacco settlement from the American Legacy Foundation. North Carolina has submitted a proposal for $750,00 a year for three years. This proposal requires that the State Health Department sign a statement that says it does not accept money from any tobacco business. Dr. Bruton has not signed this statement and the NC Prevention Partners are urging him to do so or let them know by 1-16-01 the reasons for not signing. A MOTION was made to support the NC Prevention Partners in their request to Dr. Bruton. Discussion on this issue included an explanation from Dr. McBride about the legal and technical problems Dr. Bruton had encountered and his work with the Legacy Foundation to understand the exact language of the statement. After discussion, the association unanimously passed the motion.

Tim Green presented the goals for the association for this year (see attachment). These goals have been reviewed by the officers and the committee chairs and are considered achievable. A MOTION was made to accept the goals. The motion received a second and after discussion the association voted unanimously in favor.

Dr. McBride reported on issues of concern and interest.

1. The public health study commission met on 1-4-01 and heard reports on health disparity, retooling of public health, placement of the DEH, information technology, and uncompensated care. The commission has pledged to be more active this year. Sen. Purcell expressed a commitment to the folic acid problem even in a year with limited funds. Dr. McBride is organizing a meeting with hospitals, rural health centers, and local health departments so the commission can hear more about uncompensated care.
2. On Jan. 9^th, the results of the asthma study were revealed. This consisted of a survey of all fourth and fifth graders in 99 out of 100 counties. Each health department will get the results for their county soon. The results showed asthma at 10% across the state, not particular to any one area. We should expect the results before they are released to the press.
3. Dr. McBride is still very interested in the school nurse issue. One issue of concern is who school nurses report to. The school health nurses association would like to see health departments get the first chance to operate these programs. Dr. McBride would like the issue to stay focused on getting the funds to hire school nurses, not the specifics of who will supervise. He wants to be at the table when school nurses are discussed to take ownership for public health and be an active player in the debate. Bruce Parsons, Gaston County, suggested we stop focusing on ratios and focus on what the nurses do and what effect it has. He suggested that their work should be focused on the child not the staff or other health issues in the school. Dr. McBride agreed and said that first we have to sound the alarm. There are now inadequate numbers of school nurses. Our rally cry should be one nurse for every school with public health leaders shaping the agenda for what is done in the school. Discussion continued about what the job of school nurses should look like.
4. Visioning group work is continuing with a strategic planning document.
5. Dr. McBride called the groupÕs attention to the memo from Kevin Ryan concerning the budgeting of the block grant and the state overpayment of the grant in the amount of 1.2 million. The section has cured about $600,000 of the problem but that still leaves $700,000 short. There will be a teleconference to discuss this.

Dennis Harrington said that he had received several calls about HSIS billing and how much is getting through. We will soon be receiving a report from Jim Womack. The rejection rate is very low. Dennis discussed financial stability indicators and said we are living up to our commitments but the section just has to verify that funds are being used correctly. These are the indicators that the State used several years ago when dealing with the mental health problem to measure what must be in place to assure solvency. Further discussion continued on this topic including the remark that it seems before we get audited that we ought to get our money on time and consistently. The good news from Dennis is that we are going to be able to settle on the three quarters of this fiscal year and add that crazy quarter to the end of next year when data should be cleaned up. In response to a question, Dennis answered that ADA codes are now being used and adjusted to UCR.

Jill Moore was not present.

Women and ChildrenÕs Health Ð Wanda Sandele

MOTION: The WCH committee recommends acceptance of the modified Contract Addendum for FY 2001-02 with the exception that nurses serving in management roles not be required to complete additional course work if they have already done so through another source. Motion from committee requires no second.

DISCUSSION: Training for enhanced role nurses has been broken down into modules more specific to the needs of that program. New hires will also be able to complete the public health nurse training with workbooks and on the internet which can begin at the time of hire rather than months away with no travel costs.

Motion passes unanimously.

MOTION: The method to be used to reduce the contract addenda by $700,000 should be the established equity formula. Motion from committee needs no second.

DISCUSSION: In the past, the department was balancing to the bottom line not line item by line item. Several years ago there was a 1.2 million dollar cut in the block grant that was not passed on to local health departments in the contract. If during the FY, money ran tight, the section used funds from other places to fill in. The section has found $600,000 to fill part of this cut permanently but not the other $700,000. This amount is going to have to be deducted from the amount in contract with local health departments. There may be lapsed funds during the year and if so they will be made available but the contract amount must reflect what is available in the beginning. The association has always used to equity formula to award additional funds and the committee feels like we should use the same standard to cut funds.

Motion passes unanimously.

COMMITTEE REPORTS (Information items):

Women and ChildrenÕs Health Ð Wanda Sandele

• WCH has a work group looking at how we fund maternity care and uncompensated care issues.
• They are also looking at the Medicaid wavier for family planning. HCFA came back with a list of 16 questions to be answered by the end of January. The State has responded but July of 2001 may be overly optimistic for implementation.
• Initially, the committee reported that there were no more funds to pay for sterilizations but before the meeting concluded, Harold Gabel, Guilford County, received a call from Joe Holliday saying that the program would be funded through the end of the year.

Technology Ð Ray Rabe

• Committee work is moving slowly but the work of the committee will not resolve any problems we have with HIPPA
• The timeline for this phase of the committeeÕs work is one month and includes drafting a mission statement.
• When asked by the membership what guidelines the committee might have for budgeting for meeting the HIPPA requirements, the committee was unable to say.

Education and Awards Ð Barry Blick

• Education committee plans to maximize attendance, cast a broader net for interested parties and form partnerships with others in this year.

Policy and Planning Ð Wayne Raynor

• The committee presented the associations legislative goals to the NCACC. The Commissioners association will hold their legislative conference in Pinehurst and Wayne will attend for our association.
• Debra Rowe presented the NCPHA goals to the committee. Carmine Rocco also presented the legislative goals of the NCALBOH.

Environmental Health Ð Terry Pierce

• The committee discussed reorganization of DEH in reference to a report from the secretary of DENR to the transition team.
• The restaurant grade card study report is due the spring of 2002.
• The proposal to increase food and lodging fees from $25 to $200 is not making any progress.
• The committee discussed the conflict between rules of the DEH and DWQ.
• DEH was asked by the DENR secretary to eliminate $431,000 in the budget. Those recommendations included $150,000 in aid to counties money. The list is attached.
• Due to these cuts, regional consultants have no travel money left.
• Centralized Training for Environmental Health Interns has moved from two classes a year to three sessions with a module format.

Chronic Disease Ð Rosemary Summers

• BCCCP counties with the lowest performance rate will have their contract addenda cut by 10% in the next fiscal year. These funds will probably move to the RFP process so others who have been able to reach the target population can do more.

Joy Reed, Office of Public Health Nursing

Joy provided a written report that is attached. She also reminded us that if you need to reach all nursing supervisors by email that she has them all grouped and will be glad to provide that service.

Having no further business, the meeting adjourned at 4:30pm. The next meeting is February 15, 2001 at 9:00am at the NCHA offices in Cary.

Respectfully Submitted,

MiMi Cooper, Secretary