President Tim Green welcomed the executive committee members, association members and guests to the June meeting at 9:00am. Ten executive committee members were in attendance (see attachments for attendance roster) which constitutes a quorum.
Harold Gabel of Guilford County provided fellowship with a reading of a humorous list of "Everything I ever needed to know I learned in Hebrew school".
The minutes of the May meeting were posted on the new web site, ncalhd.org, and approved as posted.
MiMi Cooper presented the treasurer’s report with balances as of June 7, 2001. Account balances were as follows:
(See attachments for full treasurer’s report). Dues are still outstanding for 7 health departments. MiMi also presented the 6-month budget report showing what the Association had earned in revenue and what had been spent (see budget report attached). We have earned 86% of our revenue and spent 21% of our expenditures.
Rachel announced that funding to the Boards of Health Association has been eliminated from the budget in both the house and the senate versions. The Association is looking for other funding sources. She thanked those Boards that have paid dues. She also told the group that the evaluation from the Academy have been completed. Also Assess, Address, Assure Manuals are available.
Terrie began her report by complimenting North Carolina’s health directors as being the best in the country. She said we were a great group to work with because of our cohesive attitude. Malpractice rates are the same this year as last even though there was expectation that they would increase. The rate for physicians went up 5%. This is 70% less than the private sector. The rate for dentist went from $125.00 to $250.00. This program is now ten years old. There have been 24 claims reported with a <3% loss ratio. Terrie listed the claims in the handout she provided (see attachments). Only three claims had payouts. One was a failure to notify a patient concerning an abnormal Pap smear. Terrie recommends doing notifications for abnormals by certified mail. One claim still pending concerns failure to diagnosis a heart attack in a jail health setting. The third claim concerns a patient who fell from the exam table from fainting after receiving an immunization. The nurse had left the room. Terrie invited attendees of the NACCHO conference to join her at Charlie Goodnights for an evening of comedy.
Leah reported that the search committee for a new state health director is actively seeking candidates for the position. The first candidate is due in tonight and another is coming next week. Tim Green serves on this committee for the Association.
Leah mentioned the work of the Health Wellness Trust set up by the Tobacco Settlement. There is a big move from the Governor’s Office to use these funds to pay for a prescription drug program. Lt. Gov. Purdue heads this committee. Let her know what you think about this.
Leah said that several positions in the Division of Public Health are still in jeopardy. This includes Chris Hoke, two environmental epidemiologists, Leslie Brown, and the Assistant to Steve Cline. Dorothy Cilenti and Rick Mumford’s positions were put back in the House version of the budget. Dennis Harrington’s contract position has been extended by 30 days.
Leah also reported that two regional health disparities meetings had been held in Greenville and Greensboro. There will be an additional one in Buncombe in the future. Leah left the details of the round table discussion with the secretaries of DHHS to be discussed by Jim Baluss in his report but said she felt the secretaries were very pleased with the program. The state has received a small grant for the NC Genome Plan.
Leah also invited everyone to Rachel Steven’s retirement party on August 24th. Dr. McCormack is also retiring on June 30th after 30 plus years of outstanding work in communicable disease. These comments brought a standing ovation from the audience. Dr. Kelly McKee will replace Dr. McCormack.
Tom Milne welcomed the North Carolina Health Director’s to NACCHO’s Annual Meeting. He said this was the largest attendance ever for a NACCHO meeting. He recognized Bill Smith and George Bond as local directors serving in an elected office. He invited other North Carolina directors to get involved in NACCHO. Tom then introduced Elaine O'Keefe, President of NACCHO. Elaine welcomed the group also and reminded us that even though health departments are diverse, they have many common issues.
All eighty-six health departments got their local expenditure reports in on time. This is a first. Eighty-two have local consolidated agreements signed. Medicaid billing in June amounted to 9 million with payout of 6.9 million not including the third billing. Dennis has a report showing the different billing and what was paid out to local health departments. On August 6th there will be a PHTIN training on the revamped expenditure report with opportunity for local questions. June expenditures will be paid out of next year’s budget from now on and forever. The Division used to encumber 1/12th of the budget to pay June expenses. There are continuing problems with immunization billing that Dennis’s office is continuing to work on.
Deborah announced that NCPHA will be held in September 12-14 at the Adams Mark in Winston Salem. The health director’s legal conference will be held in conjunction with this conference. Budget issues are still capturing most of Deborah’s attention in the legislature. She reminded us that any eliminated position could be discussed in the conference committee. Deborah also warned us that HIPAA compliance funds had been reduced from ten million to three million in the House version of the budget. Deborah will email us the comparison of the two budgets.
Barry distributed a survey to all regional representatives to determine how the regional process was working and to make recommendations for improvement (see attachments). The surveys reported good regional meeting attendance where there was a planned agenda and regional members were contacted about attending. Many regional meetings reported having outside speakers and many folks attended regional meetings outside their region due to common interest in issues. Barry reported that it was important to have a social part to the meeting such as eating together. Barry’s recommendations based on information from the survey were:
Leonard Wood reminded the group that regions came to be when he was president of the association because we were missing participation from big areas of the State. Tim Green referred the report to nominations and bylaws to follow up on recommendations.
Paula thanked the Health Director's Association for asking her to speak to the group. Paula said that nothing like the Covenant exists anywhere else in the country. One hundred and twenty-five organizations belong including NCALHD. There are seven work group areas including health and mental health. The NC Child Advocacy Institute is the Covenants biggest sponsor and hosts their web site. Paula encouraged members to visit the Covenant web site and become a cyber lobbyist. Paula spoke to several pieces of legislation that she is following for the Covenant.
Paula told us about the "Save Services/Raise Revenue" rally. Paula encouraged us to continue to stay involved in the process. Paula, Beth Melcher and Adam Searing are all working together for children’s issues.
Technology -- Leonard Wood
MOTION: To support the distribution of an information flow analysis assessment tool to local health departments.
There was no further discussion.The motion passed unanimously.
There will be a training session on how to fill out this tool. Announcement of dates will be coming soon.
Health Promotion and Oral Health -- John Rouse
MOTION: that the Association send a letter of support to the Health and Wellness Trust with a copy to the Secretary of DHHS for the findings/recommendations outlined in the President’s Commission on Tobacco Report.
There was no further discussion.The motion was approved unanimously.
MOTION: to send a letter of appreciation to the Secretary of DHHS for her support and the support of the Division of Public Health in providing the "Guidance on Partnering with Tobacco".
There was no further discussion.The motion was approved unanimously.
Epidemiology -- John Morrow
- The National Electronic Disease Surveillance System (NEDSS) is a system within the CDC. North Carolina has applied for funds for this system.
- Changes have been made to the prenatal HIV testing rule (we will receive a letter concerning this) and listeria has been added as a reportable communicable disease.
- WNV planning committee has sent out a draft and are close to finalizing the system that will be used across North Carolina. We can send in 100 birds from our state without additional cost. We have already sent in 60. The State will pay for testing and the county pays for shipping. If Nolan Newton does not think testing is warranted and the county still wants to test, the county will be responsible for cost of testing and shipping. The Pest Management Section is still working on getting funds to pay for shipping from CDC.
- Recreational Fishing Guidelines – There have been high levels of mercury reported in some fish. Recommendations are for children to avoid eating swordfish, mackerel and to limit fish to one time a week. ATSDR is developing educational materials on these EPA guidelines.
- Evelyn Foust reported that the saliva test for HIV (Ora Sure) when positive, is still to be reported as if it were a serum test.
Women and Children's Health -- Wanda Sandele
- The cost of pap smears has increased dramatically for local health departments. We should be receiving guidance about doing pap smears less often with documentation of three normal previous paps but it is doubtful that with our high-risk population that this will be of much help.
- ROCI funds look gone at this point. We do not know how local MD’s will react to this loss. The State will make it clear that these monies were not redirected to other programs.
- Kevin will work with the committee on revisions to the consolidated agreement to make sure that we are not being held to a higher standard than is reasonable. We need to make recommendations for these items rather than just react to the States objectives.
On a personal note, Wanda encouraged us all to call our legislators and campaign hard for the bike helmet law. She shared with us the true picture of recovering from head trauma from her own family’s perspective.
Education and Awards -- Barry Blick
- Encourage your county attorney to come to the legal conference this year.
- Barry and Jill Moore will work on a conference /training on legal aspects of HIPPA for public health.
- Nominations have been received for Health Director of the Year. Thanks for the nominations.
State and Local -- Jim Baluss
Jim reported on the roundtable meeting with Sec. Hooker-Buell and Assistant Secretary Bernstein. The Local Health Directors had forty-five minutes on the agenda. Tim Green, Jim, Deborah Rowe (filling in for Wayne Raynor) MiMi Cooper, and Tom Bridges reported on topics of interest to our association and answered the secretary’s questions.
Policy and Planning -- Wayne Raynor
Wayne stated that we had already received the legislative update from the Executive Director. The Office of Minority Health is working on a training session for evaluating interpreters. Wayne encouraged us to keep the letters going to our legislators.
Alliance of Public Health Agencies -- Barry Bass
Barry encouraged local health departments to join the alliance. The meetings will now be held after the Health Directors Association meetings starting in July. They are working on staffing issues, single source vendors, audits and more. Elections have just been held and Chris Szwagiel is the new president, Barry Bass the vice president, Bill Smith the secretary, and Debra Harris is the treasurer.
Nominations and Bylaws -- Barry Bass
Barry said that a slate of officers would be coming out soon.
Environmental Health -- Terry Pierce
- Recent court rulings have put EHS at greater risk of personal liability. Efforts are being made to attach a bill to the body-piercing bill that would make EHS public officials.
- Linda Sewall discussed the division cuts including one plan engineer and one support person.
- There will be three sessions of intern training scheduled for the coming year.
- No septic tank manufacturers have been inspected by the State office since January due to budget cuts.
- Maggie Dollar reported on information about the Smart Growth Commission. If it gets reauthorized we might like to work on getting someone from public health appointed to the commission.
- Ed Norman announced that the lead mini grants were awarded (see attachment).
- Linda also announced that the Straight Pipe Program had received a $500,000 grant.
- The second survey for the pilot grade card project has been prepared and is ready for distribution to consumers, EHS, restaurant owners, etc.
- Nolan Newton spoke to the committee and described many of the activities of the pest management section including the testing of live healthy birds. He reminded us that the funds for sentinel flocks are in both house and senate versions of the budget.
- Maggie Dollar spoke about an arsenic problem in Lincoln County in private wells. We learned that there are no rules that govern the quality of private drinking water.
Health Promotion -- John Rouse
- The oral health section and Dr. Mumford’s position has been restored in the House version of the budget but the oral epidemiologist is still out. The State has trained 25 local dental public health hygienists to date to operate independently in community settings. Fluoride varnish is offered in physician’s offices to increase access to care. Increased reimbursements to dentists under Medicaid is in jeopardy in the House version of the budget. Dr. Mumford has a list of local health departments with dental programs that he will distribute by email. The licensure by credentials bills looks good right now for both the dentists and the hygienists. The hygienist training provisions have been worked out. Watch for a tack-on to this bill that will expand independent practice for hygienist to State-owned facilities and to community centers.
- The State is still trying to identify the dollars for the Legacy grant match for year 1 even though it has been authorized by the Secretary. The funds have not been released due to the current freeze. The second year match is due by July 9th at $750,000. There is hope that the health and wellness trust funds can be used for the match (a dollar for dollar draw down from the Legacy Foundation). The House version of the budget has a $1 million cut in recurring health promotion funds that will be direct 25% cut to local health departments and also will cut the $250,000 match for the CDC diabetes grant. The house version has a $1 million non-recurring addition to healthy Carolinians.
- Senior Vaccination Season will be plagued by the same vaccine shortage as last year because there are fewer manufacturers. There has been some confusion about the "guarantee" date from Wyeth through the multistate contract. Phillip confirmed that the guarantee date was through June 29th although Wyeth said it was June 14th. The season will extend from late October through February this year due to the focus again on high-risk populations. There was considerable discussion about the difficulty this places on local health departments who have limited staff for an extended season and are often stuck with the vaccine after the high-risk folks get early shots elsewhere. There was also considerable discussion about basing the vaccination rates on the Medicare claims data since there are some places that provide the vaccine free or don’t ask for Medicare B cards.
Technology/HIPAA Committee -- Leonard Wood
DIRM came to the technology meeting and brought a chart that no one understood. Every department should have a HIPAA coordinator.
Having no further business, the meeting was adjourned at 12:03 pm.
Respectfully Submitted,
MiMi Cooper
Secretary