President Wayne Raynor welcomed the members of the association and guests to the February Meeting at 9:00 a.m. A quorum of members were present (see attachments for attendance roster).
Wayne remarked that due to travel restrictions the regional representative that would normally have done the Fellowship Welcome could not be in attendance. He supplied some uplifting fellowship instead. Mr. Raynor also welcomed Mr. William Atkinson, PhD, President and CEO of New Hanover Health Network as a special guest to our meeting.
The minutes of the January meeting were posted on the web site, ncalhd.org, and approved as written.
Don Yousey presented the treasurer's report with the balances as of February 4, 2002. Account balances were as follows:
Don said that the report included the usual monthly expenditures (i.e. rent, awards plaque payments, and Executive Director Services reimbursement to NCPHA). He also pointed out that the checking account was higher than usual, but that this still reflected the dues collected for NACCHO that will not be deducted until next month. After motion and second, the treasurer's report was approved without change. (See attachments for full treasurer's report).
Wayne Raynor discussed problems some counties were experiencing with travel restrictions due to the State budget crisis. He noted that attendance might not be as good as it had been in the past, but encouraged all members to stay as active as their budgets would allow. He asked members to share rides as much as possible if this would allow better participation. Lastly, Wayne reminded those present that other meetings were going on and asked that we keep conversations in the lobby to a minimum. Mr. Raynor closed by giving a quick overview of the association goals for the year and progress being made in these areas.
Ms. Rowe announced that she would be emailing all the health directors asking for feedback on how the budget crunch was effecting each health department this fiscal year. She noted that we should probably include feedback on this and our upcoming fiscal year, but cautioned to differentiate between the two. She gave examples of not being allowed to fill vacancies versus having to let people go. Dr. Keener asked if we should include direct or indirect impacts. Mr. Raynor replied that he felt both should be included and encouraged all members to participate in this important data collection effort. Ms. Rowe also announced that due to the recent travel restrictions that the association had decided not to hold the April Spring Training Conference.
Mr. Raynor closed by announcing that Ms. Mimi Cooper would be serving as the association's liaison to the Commission for Health Services.
Frances Taylor spoke on progress that was being made on getting into compliance with HIPAA. She distributed a handout showing mileposts achieved since January 7th when she came onboard (See attachment). She noted that the hotline was up and running as promised and that the HIPAA Coordinators' List was growing daily. The handout also listed meetings Ms. Taylor had attended. Ms. Taylor also reviewed work that is being done regarding private information and "levels of security" called for under HIPAA. She noted that office is working on a matrix that will help delineate what specifically each person handling this info should be doing with it. She said she would be asking three counties (one small, one medium and one large) to help work on the matrix.
Ms. Taylor then reviewed a list of "deliverables" that had been sent to all the health directors regarding HIPAA. She noted that she had received a lot of questions regarding what is expected under HIPAA and that some health department staff were not even familiar with what HIPAA was (possibly due to staff turnover). Ms. Taylor then discussed recent budget cuts and their negative impact on HIPAA progress. The governor has frozen most of the $15,000,000 that was targeted for the HIPAA effort. Mr. Bob Martin and Ray Rabe stressed that this cut assured that the needed changes to HSIS will not be completed in time to meet HIPAA compliance. Ray stressed that if we do not keep this on schedule that he felt every health department would need to submit a plan asking for permission to delay compliance. Mr. Martin said that his staff would continue to work on remediating the problems with HSIS, but agreed the work will not get done on time (October 2002). DMA has agreed to continue to accept non-compliant billing for up to one year. The speakers informed those present that the template for extension requests had not been completed yet, and since requests must be in that format, no one can apply for extensions until the template is competed and distributed. Francis said she was not sure if individual plans would be required or not but has asked the IOG to look into this matter. Mr. Martin then added that his office would be asking for an extension even if the money is released.
With that in mind, a motion from the Technology Committee was made as follows: As part of the discussion at the Technology Committee on February 20th, motion was made by Leonard Wood, seconded by David Stone, that the NCALHD request that the governor release the HIPAA funds that have been frozen. Coming from committee, the motion needed no second and passed unanimously.
Ms. Sharon Rhyne provided a PowerPoint presentation on how the State Bioterrorism Medical Response Plan was being developed. She noted that the plan will be posted at her office's website in its entirety at some future date. She distributed a map showing the seven Regional Advisory Committees (RACs) being formed to develop each region's plan. She noted that the plan would call for different levels of response (State versus local). She reported that the RACs had been formed based on patient patterns of referral, as this would allow the RACs to take advantage of the communications links and relationships already in existence.
Ms. Rhyne further reported that this tiered response plan included the six Hazmat Teams (soon to be expanded to seven). She also noted that seven mobile packages were also being put together to supply equipment, etc. She said that these would be preplaced in each region, but could be moved to other regions as need arises. The packages will contain decontamination equipment, personal protective equipment, etc. to deal with bioterrorism responses. Ms. Rhyne asked that all health directors look at participating with one of the RACs. She also explained that while the RACs were designed to cover specific regions that it was expected that one RAC might help another if they become overwhelmed by some event.
(Dennis was out sick and the members sent their prayers for a speedy recovery.)
Dr. Devlin reported that she saw the near future as hard times for public health. She noted that she was proud of the way we were responding to the budget crisis and encouraged health directors to call on her if need be. Dr. Devlin reported that the most recent cuts called for an additional cut of $14,000,000 but that she was trying to absorb this at the state level. She cautioned that she might be forced to pass along some of the cuts to locals because of what was going on in other arenas. Dr. Devlin noted that the proposed cuts for this year were one-time-cuts but that next year's would be more permanent and might include RIF of employees. This might force some reorganization at the state level as her department tries to do more with less people. She noted that there was some discussion in the press of increasing the tax on tobacco this year as it would raise some of the money needed while cutting down on tobacco use. She also reported that she has asked to interface with the Secretary to discuss the issue of County Commissioners being given more say about hiring, firing and disciplining of health directors.
Dr. Devlin then discussed the bioterrorism money coming down from the Federal Government, the work being done on regional bioterrorism labs and the need to update public health law to empower local public health to respond to these events.
Leonard Wood asked about the Blue Cross/Blue Shield conversion to "for profit" and the recent letter sent asking for volunteers to serve on the foundation being formed to oversee the assets expected to come out of the conversion. This is estimated to be up to a billion dollars. There was discussion on whether the association should throw its weight behind one candidate to serve on the foundation or whether numerous candidates should be offered. Jim Baluss wondered if there was even a procedure for a unified approach to such a nomination. Names such a Dr. Ron Levine, Bill Smith and Bob Parker were bandied around, but none of these people had been approached about their willingness to serve as yet. After several options were discussed, the group agreed to have the association officers work with Dr. Devlin's office to come up with some recommendation. Members were encouraged to email Mr. Raynor with any suggestions they have on whom might serve in this capacity. Ms. Rowe said she wanted to take a second to thank Dr. Devlin for all she has done for public health recently (especially during the budget crisis). This was met with a resounding round of applause from all present. Mr. Bill Pully, President of the Hospital Association, also discussed the Foundation for Health Trust and how he felt someone from public health should be included on the Board of Directors. He noted that Anderson and Associates had been contracted with to help identify possible board members and the recruitment process was wide open but probably would be very competitive. He said that he hoped the Foundation Board would have a good geographic, racial, and sex mixture in its makeup. He noted that, while health expertise would be needed, there would also have to be expertise in finances to oversee the investment of the Foundation's assets. He offered no direction for making nominations as to whether they should be individual or from the association as a whole.
Steve Cline reviewed the numerous emails he had sent out recently regarding the projects ongoing in bioterrorism. These will not be included as attachments as all the health departments already have the emails. Steve reported that the grant guidance had already gone out. He noted that 20 percent of the grants are expected to be given with very little documentation being called for. He did stress that much more documentation would be required before the other 80 percent would be released. It was noted that the hospital grants are going through public health and that this should ensure that the money is not siphoned off to buy equipment or other things but instead be kept for use in bioterrorism response. Steve said the state hoped to have the first plan in place by March 15th. There was some discussion about whether some of this money is intended for information technology (IT) expansion at the local level and there was agreement that there was. Steve Cline noted that IT capacity building at the local level continues to be part of the state plan. He said that he was also somewhat encouraged as the President had included bioterrorism funds in his continuation budget. Steve cautioned folks not to get too optimistic though as this still had to go through the federal budget process and may well get cut. Dr. Keener asked if these grants were the same as the homeland defense grants and Steve Cline said they were different funding streams. Steve did however ask that those applying for the homeland defense grants build their requests around the central state plan being put in place.
Environmental Health -- Terry Pierce and Michael Rhodes of EH Division
Terry Pierce reported that Ed Norman had come to the EH Committee to discuss allocation of Lead Investigation funds for the upcoming year. Mr. Norman had presented last year's screening data and offered two options for allocation of the Childhood Lead Poisoning Prevention funds ($416,298). The committee had modified the preferred formula and offered the following motion: That the $416,298 in Childhood Lead Poisoning Aid-to-County funds for FY 2002-2003 be distributed by using the following formula:
- $2,500 per case triggering a mandatory lead investigation $245,000 (40 co.'s)
- $250 per case triggering a voluntary lead investigation $110,000 (80 co.'s)
- Remainder of funds reserved for local health department training and educational materials $ 61,298
After some minor explanation of what the specifics of the motion meant and coming from committee and needing no second, the motion passed unanimously.
Mr. Pierce then went on to the following motion discussion. Due to budget cuts being forced on the EH Division, they proposed each health department pay for forms and certificates used within their counties last month. Mr. Pierce reminded those present that the association had voted against this proposal last month, but that he had been asked to bring the request back and explain what other alternatives were available if the request was not supported. Terry noted that since the rejection of the request last month that the division had frozen all purchases. This included no POs being issued, no printing, no copy paper being purchased, etc. He further informed those present that some of this crisis had been caused by DHHS withholding $40,000 that it had previously contributed to the printing done by the division. Mr. Pierce cautioned the association that rejection of the request again would force the Division to look at finding the money by cutting centralized training, stopping travel of regional staff both of which would have crucial impact on local EH being able to complete its responsibilities. Mr. Yousey offered that he had asked Mr. Pierce to bring the issue up again at the EH Committee so that the association knew what the alternatives were should they reject the approach offered by the Division to this dilemma.
With that in mind, Mr. Pierce offered the following motion from the EH Committee. That printing costs for Environmental Health forms and other printed supplies be deducted from the food/lodging fee allocations before disbursement from the state; however the base allocation shall not be withheld from the counties.
There was much spirited discussion with some offering how unfair it was to charge the counties for printed materials needed to carry out duties mandated by the State. Others agreed but replied that the money needed to be found and that this approach would be less damaging than the other alternatives offered. There was also some discussion of whether some action needed to be done to handle the long-range implications of this recurrent problem with EH funding. There was agreement that some action was indeed needed, but this needed to be handled via some legislative initiative possibly through the Policy and Planning Committee. Coming from committee, the motion needed no second and passed by a seven to five vote.
EPI Committee -- Dr. John Morrow
Dr. Morrow reviewed seven proposed changes to the TB Agreement Addenda (see handout) being offered by Dr. Carol Dukes-Hamilton. Dr. Morrow reviewed the seven changes item by item with some discussion of what the changes meant. Subsequent to the above discussion, the committee offered the following motion: That NCALHD approve the proposed changes to the TB Agreement Addenda for FY 2002 – 2003. Coming from committee and needing no second, the motion carried unanimously.
Women and Children's Health -- Wanda Sandele
Ms. Sandele offered the following informational items as follows:
- WIC – Those who received increased funding last year due to increased caseload will continue to get the increase money as long as their caseloads still met the funding criteria. Additionally, WIC is looking for two health departments to help study the problem with what to do with money that is received late in the year as the previous practice of rolling it over into the next fiscal year will no longer be allowed.
- Vaccine Shortage: The new recommendation for varicella vaccine administration may not be able to be put in place due to a shortage of vaccine.
- Safety Device Syringes: There have been some reports that these devices do not reduce the risk of needlesticks as they are intended to do. The CDC and OSHA are studying this issue and are interested in feedback from those having problems with the syringes. There was some discussion by those present of whether these devices are mandated, as the law does not appear to do so. Joy Reed agreed that the law could be interpreted this way, but noted that OSHA has interpreted the law to require them. Since it is required on their field inspection forms, we will be cited for a violation if they are not available.
- Maternity Unfunded Care: This continues to be an issue. The committee is looking at alternative approaches to providing this care and funding it more equitably.
- Denvers: There was some discussion about when the Denver Exams will be finally done away with. Other less time consuming exams are supposed to be forthcoming. Joy noted that the State is not offering training in Denvers any longer, but there seemed to be some questions about when the replacement exams will be available.
Technology Committee -- Ray Rabe
Ray Rabe noted that Ellen Zimmerman still wants to complete work on the Health Alert Network and is committed to it. It was noted that she plans to have "fractional P1" lines to us by June 30th. Ray noted that the committee (and hopefully the association) supports getting additional funds so this work can be continued.
Education and Awards Committee -- Janet Lindbloom
Janet Lindbloom reported that although the Spring Conference has been cancelled there is still a lot of interest at looking at infrastructure and enhanced services some health departments are offering. She noted there is a tremendous variance in how we deliver services. Ms. Lindbloom felt that we needed to look at what we can all bring to the table through interlocal agreements and the like. Janet noted that some work has been done on this issue already and that we didn't need to rehash old ground. Copies of the previous reports done on this were made available at the front of the room for those present to review. Deborah Rowe agreed to email copies of the reports to all the health directors so everyone can review them. Mr. Raynor noted that the Executive Committee had taken up the vision of what public health might look like in the future yesterday. He said that the State felt that the rising cost of Medicaid would force a change in the way we do business in the future if we did not take the issue on ourselves. Some argued that the rising cost of Medicaid was due to long term care, prescriptions, etc. and not public health costs. They felt like looking for making the savings here versus looking at the large ticket items was like rearranging the chairs on the Titanic! Mr. Baluss wondered if a survey on the homepage asking for our inputs on this issue might be a low-cost way of gathering inputs as a start since travel was being curtailed. Ms. Cilenti noted that we "did" need to look at these issues because we were not achieving the measured outcomes that have been mandated when it comes to improving health indices. There seemed to be general consensus that the cancellation of the Spring Conference had nothing to due with the magnitude and importance of this issue.
Policy and Planning -- Jim Baluss
Jim Baluss reported that the Legislature was still looking at giving the CCs more input to hiring, firing and disciplining of health directors. The approach seems to be to offer the Mecklenburg or Wake County models without a population level being required. Jim noted that this issue could come up in either the ERC (where it is being pushed) or the Health Study Commission. Jim reported that Chris Hoke had said that he felt there were procedural issues that would preclude this from happening in the near future.
Mr. Baluss also noted that EHS had presented a report on the Pilot Project on Restaurant Grading to our EHS committee yesterday and that this would be tracked by that committee from here on out.
Mr. Baluss also reported that Mary Bobbitt-Cooke has been asked to put together a survey similar to the one that has been used for community assessments in the past to gather info from us for the State's Legislative Priorities (see attachment). Jim noted that this needed some tweaking to allow more varied inputs. He asked everyone to provide their inputs since Dr. Devlin has been gracious enough to include us in the effort.
Lastly, Mr. Baluss reported that two resolutions had been offered to the association for support. One had to do with handgun control and the other was to ask that none of the money in the Tobacco Trust be used to help with the State's financial crisis (see attachments). Mr. Baluss noted that there was no support on the committee for the handgun resolution, but said he would include it as an attachment. He offered to bring this before the full association if there were health directors who felt strongly about it after reviewing it. Jim said the committee did not support the resolution on not touching the Tobacco Trust money, as the money had to come from someplace. Thus, if we ruled this option out and the Legislature has to find the money, they would be forced to look at our funding.
Environmental Health -- Terry Pierce
Terry Pierce reported that EHS did receive a report on the Pilot Project and the Division was soliciting health director inputs into their report to the Health Services Commission. There are still some questions that need answering (i.e., has sanitation improved, has the old abnormal grouping of grades at 90.5 gone away, etc.). EHS plans on making their report to the Commission in May. While the Division has not decided what their recommendation will be, Linda Sewall is leaning towards opening the Pilot Project to other counties. Mr. Rhodes will be sharing the survey on the Pilot Project to all counties via email and the EHS Committee will discuss it again next month. Health Directors and their staff are encouraged to attend.
Other issues discussed included the following. EHS liability (SB1019) is being worked on. A list of authorized agents and authorized tasks has been compiled. Bids are being solicited. Bill Jeter has been asked to send a synopsis of what the bottom line is on the proposed on-site rule changes. Lastly, temporary rules for monitoring wells are being drafted and may be ready for the March meeting of the Commission for Health Services.
Institute of Government
Aimee Wall reported that work on May's classes on HIPAA discussed last month continues and appears to be on schedule.
Alliance (NCAPHA) -- Barry Bass
Barry Bass reported that search for a new Executive Director continues and it looks like Jennifer S. Johnson (Jen) may be coming. Additionally, the Alliance is looking at hiring professionals for work as temporary staffing for health departments.
School of Public Health -- Penny Whiteside
Mr. Whiteside announced that the School is looking at hiring someone on staff to lead the bioterrorism effort. He said they hoped to have someone in place by September. He also reported that the Institute for Public Health was collaborating with ANCBH to continue providing education to board of health members and that the Annual Minority Health Conference is planed for March. Lastly, Mr. Whiteside reported that the Institute is moving off campus. However, the mailing address and phone numbers will stay the same except that the address will no longer include the building name.
ANCBH -- Carmine Rocco
Mr. Rocco provided a handout that listed ANCBH Board Members and a schedule of upcoming Board of Health trainings. He also announced the annual awards winners for Board of Health Member of the Year (Eleanor McGinnis of Cumberland County), and Board of the Year (Brunswick County). Lastly, Mr. Rocco announced, that with the current schedule full, the earliest that new classes could be added to the schedule would be early June 2002.
Office of Public Health Nursing -- Joy Reed
Joy Reed reported that Dennis Harrington was out sick, but wanted to remind everyone once again that May's activity reports will be the last billing processed this year. No money will be carried forward to next year. Thus, late reports will come out of next year's funding allocation.
NCPHA-- Deborah Rowe, NCALHD/NCPHA Executive Director
Deborah Row reported again that the Spring Conference had been cancelled due to travel restrictions in many counties. She noted that the reports on public health visioning, etc. that were discussed earlier in the meeting would be sent out by her via email to all health departments. Also, NCPHA would be looking at reducing registration fees for their conferences to help health departments having financial trouble still be able to have their staffs attend training. Lastly, Ms. Rowe reported that she would be out of the office for the next two weeks on annual leave.
None
There being no further business, the meeting was adjourned at 12:30 p.m.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer