MINUTES

NORTH CAROLINA ASSOCIATION OF LOCAL HEALTH DIRECTORS
EXECUTIVE COMMITTEE MEETING

FEBRUARY 15, 2001

NC HOSPTIAL ASSOCIATION
CARY, NC


Call to Order:

President Tim Green welcomed the executive committee to the February meeting at 9:00am. Thirteen executive committee members were in attendance (see attachments for attendance roster) which constitutes a quorum.

Fellowship:

George Bond, Buncombe County provided fellowship with the reading of the results of a humorous study.

Approval of Minutes:

The minutes of the January meeting were posted on the web site and approved as posted.


Treasurer's Report:

MiMi Cooper presented the treasurer’s report through February 7, 2001. Account balances were as follows:

Checking: $35,792.97 Savings: $34.62 Money Market: $336.63 CD: $40,000

(See attachments for full treasurer’s report)

She also presented the changes approved at the January meeting to the 2001 budget. The budget now accurately reflects contributions approved and leaves a balance for additional contributions as needed (See attachments for final budget).

Audit Committee Report:

Bill Smith reported that the audit committee, consisting of himself, Gayle Brown, and Jennie Lassiter met on February 14th and found all documentation to reflect the activity of the association. The Audit Committee will submit a written report (See attachments for report).

Executive Director's Report:

Susan Smith-Wharton reported that most of her work for the Association lately has been to serve as a bridge between local and state government with the new administration. She has met and talked with several key members of the Governor’s staff including Alan Hursh and Lydia Faulkner, Policy Advisors and Cathy Tobin, Assistant to the Secretary of DHHS dealing particularly with Medicaid issues. Susan is working with Jim Blackburn of the NCACC to help give local input concerning the new governor’s budget before it goes to the legislature. Susan is transitioning to work full time for the NCAPHA beginning March 1,2001.


Announcements:

  1. Joy Reed asked local health directors to check the document that asks who was providing prenatal care in 1998 to make sure it is accurate for our counties.
  2. Tim Green reminded the attendees of the Public Health Leadership Conference with author, Laurie Garrett that will be broadcast over PHTIN. Rachel Stevens with the School of Public Health requested that people at the meeting sign up on her sheet if they are planning to attend according to the site where you will attend. She encouraged people to reserve space due to the limited amount. Leonard Wood, Rowan County, said that when he called to inquire about being at the live broadcast, he was told that local health directors were not part of the invitation list for the live audience. Rachel Stevens apologized for the misinformation and made it clear that all local health directors were invited to the Friday Center for the live broadcast. George Bond, Buncombe County asked if a tape would be made of the broadcast for later viewing and Rachel responded that if the speaker gave permission, they would tape.
  3. Tim Green announced that Greene County is still looking for a health director. He also announced that John Morrow, Pitt County will represent the association at the Medical Society, Gibby Harris, Wake County will represent the association at the North Carolina School Health Association, John Morrow on the immunization advisory committee, and Barry Blick, Catawba County on the Access Care II and III Board. Wayne Sherman is leaving Chatham County to serve as Personal Health Director in Orange County. Bill Lail will serve as interim director in Chatham. Sherman Khan has left Forsyth County. Peggy Lemons is serving as interim. Lee Ann Whisnant is the new director in Alexander County. David Stone is the new director in Surry County.
  4. Tim asked for volunteer health directors to serve on Senior Vaccination Season Committee, Citizens for Public Health and the Governor’s Task Force for Healthy Carolinians.
  5. Tim reported that he sent a letter on behalf of the association to Dr. Bruton urging him to sign the application for grant funds from the American Legacy Foundation. There was no response to the Association. Bill Smith, Robeson County, asked if we should resubmit the letter to the new DHHS secretary. Dr. McBride said we should assume the outgoing secretary forwarded the letter to Secretary Buell. He suggested we give her some time to read the letter and react.
  6. Tim circulated a yellow sheet that lists the liaison positions we have with other organizations and which health directors are serving. He asked that we please check it for accuracy and sign up in areas where there is no coverage. There was also a committee membership list circulated that should be updated by those present (See attachments for committee lists).

Special Report from Deborah Cerrito, NCSOPHE

Deborah Cerrito, liaison from NCSOPHE presented the attendees with information about the history of health education, the mission of NCSOPHE, and an invitation to the Mid-Year Conference to be held at the Wake Commons on March 8th (See attachments for history).

Special Report from Stephen Orton, Management Academy for Public Health:

Stephen Orton brought additional brochures describing this Executive Education program that joins faculty from the School of Public Health with faculty from the Kenan-Flagler Business school. Applications are due April 2, April 16 if applying online. The purpose is to train teams who are actively managing people, money and data. There is no cost to the teams with the exception of costs to travel to the teaching site (Go to www.maph.unc.edu for more information).

State Health Director's Report:

Dr. McBride reported on several issues of concern:

  1. New Secretary of Health and Human Services, Carmen Hooker Buell: Dr. McBride reported that she has enthusiasm, interest in reaching out to communities, and a strong background in health policy in both Mass. and NC. He feels we have a good opportunity to orient her to public health in NC. There may be an opportunity to get her in a local health department on April 27 for Public Health Day in Mecklenburg County. The Division of Public Health will work with the Association leadership to orient her.
  2. Budget: Dr. McBride reported that these are tight times in the current budget and there will be cuts in the FY 2001-02 budget. There have been a lot of legislative inquiries about different programs so it is unclear what will happen. The Division has looked in-house first at what could be cut. Second they will look at bringing in more revenue particularly bringing in more federal dollars. There will be some lab fees that will be increased and those increases will be passed on to local health departments but these are just inflationary costs. The third step will be to look at programs that are not in concert with the mission of the Division to consider for elimination. The fourth step will be to examine programs whose value has diminished over time.
  3. Senior Management visits to local health departments: Even though travel funds are a problem, Dr. McBride will ask senior management to begin to plan their visits to local health departments as they have been assigned by first visiting at one of the regional health directors meetings. The purpose of this effort is to make Raleigh staff more aware and appreciative of the needs of local health departments.
  4. West Nile Virus: Even though other mosquito-born illnesses might be of greater public health concern in North Carolina, the public and the media are most likely going to be focused on WNV. Dr. Bride has asked LuAnne Williams to do a briefing paper on WNV. He would like a strong education program. DHHS will be working with DENR to put together a communication campaign. Resources will be a problem. Laboratory capacity will be a problem as well as turnaround time for specimen reporting. The information we have about the New York City experience tells us that these spaying programs were very costly. Questions were asked about how state budget cuts would affect our ability to prevent WNV. McBride answered that local health departments have already made the legislature aware of the vital role vector control will play. In addition the State Health Director’s Office and the Division of Environmental Health have a responsibility to prepare now as well as we can so that there it won’t be chaos when cases occur. Rachel Stevens reminded the Association that Public Health Grand Rounds on May 23rd would be on the topic of West Nile Virus (See attachments for summary of WNV National Planning Meeting).

Wanda Sandele asked Dr. McBride to please not lose sight of the prenatal care crisis that is occurring in local health departments with uncompensated care. She feels that we could see some departments having to close Maternity clinics as early as July. Dr. McBride agreed that this is a problem. He stated that we have to make sure it does not get lost during the budget crisis. The Division will be convening a group of stakeholders to discuss this issue (health departments, hospitals, rural health centers, private practitioners).

Institute of Government Report:

Jill Moore reported on the new Federal Privacy Rule. This was part of HIPPA and was published at the end of the Clinton Administration. Jill felt the rule would last into the new administration and would not be affected by President Bush’s suspension of rules (because this rule was attached to legislation). It will becomes effective April 14, 2001 but agencies must be in compliance by 4-14-03. This will be a big deal with one of the first big challenges to find out what is State law in NC in terms of privacy. States may have more stringent rules but not less stringent than the federal law. Jill has agreed to co-chair a work group of NCHICA to determine what the State law is. They are striving for a check-list format. The IOG will serve as a resource as always because a great deal of education and training will need to take place. There was a big difference between the proposed rule and the final rule. This affects all health information we have in our possession.


Committee Reports: (action items)

Technology ­ Ray Rabe

MOTION: The technology committee recommends that the association approve the termination of the current web site management and also moves that we move the website to YAHOO with the assistance of John Rowe at the cost of $785.

DISCUSSION: We now pay $250 a month for web site management with slow response. It is also difficult to change the web site. The committee talked to John and was impressed with his credentials and his cost.

Motion passed unanimously.

MOTION: The technology committee recommends that the association support the request of a State appropriation in the amount of $124,800 to help finance the operation of the eight PHTIN sites statewide.

DISCUSSION: The PHTIN sites are in financial trouble. This appropriation would help finance the sites for a year. Down the road we should look at the capacity to download to sites that have satellites now.

Motion passed unanimously.

MOTION: The technology committee recommends that the association continue the process, Public Health Enterprise Visioning, by using our reserved technology funds to keep the process alive including paying the cost for three local staff to participate in the process but with no further appropriations until the action plan is initiated. Additional funding may be requested after the product of phase II is delivered.

DISCUSSION: Ray gave background information of our association’s effort to create/purchase a data system that would serve all local health departments and would enable us to communicate better with each other. We started with the decision that HSIS was no longer able to do the job we needed. Medicaid maximization funds were set aside in the amount of three million dollars to work on a data and information system in 1996. We first looked at upgrading HSIS and determined that would not work. Next we spent $200,000 on an RFP to see what software was out there that we could use. Even though we didn’t select software, the process gave us good information about what we needed. We decided in November to put an additional $25,000 and later $250,000 into a two phase project with DRIM. That MOA we signed in November is dead on arrival because the state has no funding to continue. We are at a crossroads. We are the only ones with money to fund the process. The steering committee has asked that we fund the process entirely. Jennie Lassiter, Pamlico County, asked what is the process of phase II. Chris Szwagiel, Halifax County, replied that the phase II group is to work 40 hours for two weeks to come up with the deliverable. Harold Gabel, Guilford County, stated that he felt we were going into quicksand. He suggested that we split the money left from the original 3 million and use it to cover our local budget shortfalls now and if in the future the state is ready to work on this project we will come back to it.

SUBSTITUTE MOTION: (Harold Gabel, Executive Committee Member) recommends that we split the remaining money from the original three million and distribute it back to counties according to the formula. The motion was seconded by John Morrow, executive committee member.

DISCUSSION: Bill Smith, George Bond, Leonard Wood, Don Yousey and Jennie Lassiter spoke in opposition to the substitute motion citing the small amount that would result from the split, the quality of the recent efforts, the loss of the total effort and all we’ve learned if we stop now and the need to stay with our partners in this crisis.

WITHDRAW THE SUBSTITUTE MOTION: Harold Gabel requested to withdraw his substitute motion. John Morrow agreed to withdraw his second.

In final discussion, Ray Rabe reminded the association that we are in the power seat because right now we are the only ones with any money.

The original motion was called for a vote and passed unanimously.

Health Promotion and Oral Health­ Rosemary Summers (See attachments for committee minutes)

MOTION: The committee recommends that the Association write a letter of support to the Secretary of DHHS to provide the matching funds in support of Medicaid coverage funds for treatment of breast and cervical cancer in BCCCP patients.

DISCUSSION: These are matching funds to draw down federal Medicaid dollars. This is new funding.

The motion passed unanimously.

MOTION: The committee recommends that the Association write a letter of support for the State application to the Nutrition Network for enhancements of the Winner’s Circle and 5A Day initiatives.

DISCUSSION: The overall focus of these initiatives will be on limiting fat intake and increasing fruit and vegetable consumption at and away from home.

The motion passed unanimously.

Policy and Planning ­ Wayne Raynor

MOTION: The committee recommends that the Association support the legislative agenda by promoting goals 1,2,3,4 and 6.

DISCUSSION: The other goals on our legislative agenda will still receive our support but we will not actively seek sponsors for legislation.

The motion passed unanimously.

Women and Children’s Health ­ Wanda Sandele (See attachments for Committee minutes)

MOTION: The committee recommends that the Association endorse the Position Statement from the NC Association of Public Health Nurse Administrators which: "urges each local Board of Education, in conjunction with its County Commissioners, to select as its first option for providing school health nursing services contracting with the local health department in that community.

DISCUSSION: The PHNA feels strongly that where it is possible, school health nurses should come from a public health agency.

The motion passed unanimously.

Executive Director Support Committee ­ Wayne Raynor

MOTION: That the NCALHD authorize the President to negotiate a contract with Deborah Rowe to provide or arrange for conference planning, legislative advocacy, legislative liaison and networking.

DISCUSSION: Susan Smith-Wharton will move full time to the Alliance starting March 1. Tim will work with Deborah to draw up a contract that will meet our priority needs.

The motion passed unanimously.


Committee Reports: (information items)

Health Promotion and Oral Health ­ Rosemary Summers

HIPPA ­ Leonard Wood

Leonard reported that he had met with the HIPPA office. They have a plan that he will send to be posted with the minutes. It seems that a lot of people are doing a lot of things concerning HIPPA. This committee is trying to facilitate a connection between the HIPPA office and our association. Local Health Directors need to identify someone in their offices to work with the HIPPA office. This will come to you as a request in a memo from Ann Nance.

Environmental Health ­ Terry Pierce (See attachments for committee minutes)

The committee discussed:

Alliance ­ Chris Szwagiel

Chris just wanted to remind everyone that in pursuing the contracts for services, the alliance, according to the by laws, can only represent alliance members.

Women and Children’s Health ­ Wanda Sandele

Epidemiology ­ John Morrow


Liason Reports

Rachel Stevens, UNC-SPH, NCIPH

Rachel reminded all health directors that they are invited to the Friday Center for the Public Health Leadership Conference on March 26th. Please see her to make sure a spot is reserved for you.

Joy Reed, Office of Public Health Nursing

Joy reminded the group of the OSHA Standard change that will become effective in April mandating needle safety devices. She also spoke to the success the nurse consultants are having in helping counties look at their coding practices. It would be even more effective if she could get the nursing consultant position filled in the west. This position was frozen due to the State budget crisis. Letters from Health Directors to Dr. McBride would help if you feel strongly about this. You will be receiving a letter that lets you know that CPT code adjustments were made in error (see attachments for copy). If you have questions, call Joy. The State is behind on mailing out Contract Addenda. There will be a February 26th teleconference on the impact of the budget crisis on contracting. The first two hours will be specifically for local health departments.

Carmine Rocco, ANCBH

Carmine announced the Advocacy Institute in June. The target audience is local boards of health, and local health directors. Carmine also asked for health departments to respond to Catherine Moon’s email asking for a list of your board of health members, addresses, etc. Also please return the survey on public health advocacy sent by Julie Sweedler (See attachments for copy).

Deborah Rowe, NCPHA

Deborah told the group about SB 114, Act to appropriate funds for prenatal care. She will look into this effort further (See attachments for copy).

Jackie Boggs, NCAPHNA

Tim introduced Jackie Boggs with NCAPHA and said she or Blanche Hardy from Robeson County would be attending our meetings as the liaison from the nurse administrators association.


Closing­ Tim Green

Bill Smith asked Tim if we had heard from Dr. McBride concerning the vacancy in the director of the Division of Public Health. Dr. McBride had left the meeting but Shirley Bullard from his office said that there was a meeting scheduled for the afternoon that should address that issue and we should hear soon.

Tim asked the group to be creative and keep lines of communication open during these tough times. He reminded us to look for the positives and the opportunity to raise awareness about public health. A calm sea does not a good sailor make.

The meeting was adjourned at 1:15pm. The next meeting is scheduled for March 15th at 9:00am in the NCHA building in Cary.

Respectfully submitted,

MiMi Cooper