President Wayne Raynor welcomed the members of the association and guests to the March Meeting at 9:00 a.m. A quorum of members were present (see attachments for attendance roster).
Danny Staley Gave the Fellowship sharing some Bower Tales.
The minutes of the February meeting were posted on the web site, ncalhd.org, and approved as written. Don Yousey asked for feedback on how he was handling the minutes as he had heard some unhappiness from members. He noted that he tried to get the rough draft to Mr. Raynor within two business days of the meetings and onto the webpage within a week. Additionally, he had taken to including discussion on how we came to decisions versus just putting what the decisions were in the minutes. He said all this was driven by the travel restrictions we were under and the lower attendance these restrictions allowed. Thus, the changes would allow absent members to get the information in a more complete and timely fashion than had been necessary in the past. There was general consensus for Don to continue with the minutes as he was doing them.
Don Yousey presented the treasurer’s report with the balances as of February 20, 2002. Account balances were as follows:
Don said that the report included the usual monthly expenditures (i.e. rent, Executive Director Services reimbursement to NCPHA, etc.). He also pointed out that the checking account was still higher than usual, but that this still reflected the dues collected for NACCHO that had not been deducted as yet. Mr. Yousey reported that all but 16 counties had paid their dues and asked those in attendance to look at the attendance roster. He said those in bold had not paid yet. After motion and second, the treasurer’s report was approved without change. (See attachments for full treasurer’s report).
Wayne Raynor announced that Public Health had lost a dear friend in the passing of Dr. Anne Wolfe. He noted that memorial services for Dr. Wolfe had been distributed and reminded everyone how Anne had always looked out for local public health. Wayne then announced that Maggie Dollar’s mom had passed away the previous day and asked everyone to keep Maggie in their prayers and thoughts. A moment of silence was held in recognition of these losses.
Wayne then noted that Ms. Becky Garner of the Association of North Carolina Public Health Nurses and Ms. Samara Adrian of the Bioterrorism Shop were in attendance as guests.
Barry Bass then introduced Ms. Jennifer Johnson, the new Executive Director of the Alliance. He noted that she had been the Director of Special Projects for the Hospital Association before coming to the Alliance.
Wayne then reported that Carmine Rocco had been hired as the new Health Director of Warren County and that Colleen Bridger had been hired as the Health Director of Gaston County.
Wayne then introduced Doug Urland and asked him to share a few words about his recent trip to Washington, D.C. where he participated in a Legislative Conference. Doug talked of attending sessions that dealt with bioterrorism, homeland security, safety of drinking water and other issues. Upon completion of Doug’s presentation, Wayne noted that Doug’s trip seemed to meet the intent of our 10th goal for the year of having more inputs into the legislative process at the federal level. After some discussion, a motion was made to reimburse Caldwell County Health Department for the cost of the trip as it supported the goal as indicated. Dr. Gabel noted that he felt such requests should be approved in advance of trips in the future. Upon calling of the question, the motion to reimburse Caldwell for the amount of the trip ($1,121.80) was approved.
Lastly, Mr. Raynor introduced Ms. Dorothy Cilenti, to discuss the Blue Ribbon Panel that she had volunteered to chair for him. Wayne shared a list of those health directors who had already volunteered to serve on the panel and invited any others with such an interest to contact Ms. Cilenti. Ms. Cilenti then distributed a handout (see attachment) detailing the challenge, purpose and some guiding principles for the task force and invited anyone with an interest to participate. The handout also listed proposed meeting dates and desired outcomes for the task force. There was some discussion of other groups that we might want to include in this process (i.e. Regional Representatives, state staff, etc.). George Bond wondered if there was a carrot or a stick that might drive this issue to completion this time and there did not seem to be either. Mike Hanes said he felt that since public health was such a small part of the Medicaid budget that he did not see where any significant savings could be found for DMA though this visioning process. Still others felt that we could participate in this process and help define changes that would be coming or just sit back and let them happen to us. There was general agreement that we should be proactive on this. Wayne noted that the previous visioning documents had been sent out to help give the task force a starting place rather than having to rehash what had already been done on this.
Deborah discussed Dr. Wolfe’s death and noted this was an opportunity to start a memorial in Dr. Wolfe’s honor and promote public health at the same time. She said that those wishing to participate in this could send the checks to her at NCPHA. Deborah then spoke of NACCHO initiating their Public Health Dispatch and showed a copy to everyone present. She noted that it contained important information and urged health directors to take a look at it. (Since it was mailed to all health departments, a copy will not be included as an attachment.) Deborah closed by stating how much the survey on lost money due to the State budget crunch had been and said she would email the survey out "one more time" so that everyone who wanted to have inputs into this could.
Dr. Devlin Distributed a copy of a summary (see Attachment) of the Bioterrorism Grant that Steve Cline has been working on. She noted that her staff felt the plan was too large to allow timely review and had written this summary to help health directors be able to review it easier. Steve added that his office was looking at "system fixes" that are mandated. He added that while this plan did not address enhanced capacity at the local level, they will be looking at ways to do this through training money, technology support, etc. Dr. Gabel wondered if there was going to be money to have a full-time dedicated local staff member to deal with this issue at each health department. Dr. Devlin thought there was not enough money in this round, but since the money was thought to be continuation dollars that this might be looked at next year. Dennis Harrington agreed and also thought we should be looking at Epi needs upgrades as well in the future. Dennis stressed that if this is to be continuation dollars that we needed to spend it effectively and within the time constraints mandated.
Dr. Devlin then thanked the health directors for their participation in the survey on budget strains being caused by the State financial crisis. She further noted that this info had been useful in her defense of not passing on the cuts to locals. Louis Latour asked if Dr. Devlin thought there might be further cuts this year and she indicated that she had not seen any indication that further cuts for this year would be mandated.
Dennis Harrington reported that Management Academy enrollment information would be coming our shortly and that he felt this was greatly beneficial to health directors. He further noted that a new position classification was being reviewed by the State for a Deputy Human Services Director. Dennis thought this might be useful in training our replacements as we near retirement. Dennis then said he wanted the health directors to know that Dr. Devlin was being asked to look at proposed cuts and Medicaid rates. He noted that he was putting together a debate for why this wouldn’t be prudent, as our rates had not risen sharply like other providers. Lastly, Mr. Harrington reported that the Maximization Report would be going out soon with the hopes of the money being transferred to local health departments by the end of the fiscal year.
Ms. Wall said that she wanted to report back on a question that Francis Taylor had asked last month. That is, if an extension were asked for by the State on the EDI component of HIPAA, would this cover locals and thus give them an automatic extension. Amy said that her research did not support this as being doable. The reasons were (1) the State was not taking responsibility locals complying with HIPAA and (2) the State plan will only cover HSIS and may health departments do other electronic billing than HSIS. Amy reminded those present that an electronic form (not yet available) will be out by the end of the month that will assist us in getting our plans into the required template format. There was also some discussion on whether counties will be filing a HIPAA Plan or whether each health department had to file its own plan. Amy thought that since some health departments use their county’s billing number that those plans would probably have to come from the county and not the individual health departments, but others with their own numbers would need to provide their own plans.
Policy and Planning -- Deborah reported for Jim Baluss
Deborah reported that the committee looked at enhancing revenues in this time of tight budgets. She noted that the committee was looking at asking that food and lodging feeds be increased to help make up for lost money (i.e. printing costs recently passed on to locals). Terry Pierce said that the Environmental Health Committee was also considering this issue and shared proposed legislation on this issue. The proposed bill would:
- Increase fees for most establishments that are currently paying fees,
- Include other establishments that are not currently paying fees, such as Child Care Centers, Meat Markets and Summer Camps,
- Allow DENR to charge for plan reviews conducted by state staff for prototype franchised/chain facilities; and
- Allow local boards of health to establish fees for local plan reviews.
Based on projections from current fees collected, the revenue should be about doubled. A legislator has been approached about introducing this bill. Terry noted that some discussion at the committee included using the additional revenue for the state to pay for printing and training costs for local health departments. With that in mind, Deborah offered the following motion: The Policy and Planning Committee recommends the association support an increase in Food and Lodging Fees for FY 2002-03 with fees being determined by the Environmental Health Liaison Committee through consultation with the Division of Environmental Health based on current costs studies. After some discussion about the pros and cons of this action and needing no second, the motion carried.
Technology Committee -- Ray Rabe
Mr. Rabe reported that the committee had received a request from the Nurse Administrators Association to allow them to put a component on our web site dedicated to nursing activities. Both Joy Reed and Becky Garner spoke to the issue noting that they would like to put their minutes and attachments on the site similar to what the health directors do now. They noted that they were willing to pay to defray the cost for doing this. Bill Smith said he thought this should be opened up to all liaisons if we were going to do it for the nurses. Mr. Raynor said he felt like there were two questions that needed answering: (1) Would the Nurses be willing to pay the cost of this service and (2) was John Rowe willing to take on the extra work. The motion from committee was that the NC Association of Public Health Nursing Administrators be authorized to develop a component of the NCALHD’s web site dedicated to nursing activities. Furthermore, the Executive Director is authorized to expend association funds necessary to make this happen. After some discussion, it became apparent that the nurses’ association was willing to pay for the cost of this effort and was not asking our association to bear this financial burden. After further discussion, there was a request to amend the motion to include all liaisons in this request and to research the two questions raised by Mr. Raynor on whether Mr. Rowe had the time and was willing to take on this additional workload and to remove that portion regarding expending our funds to support this. Mr. Rabe agreed to the amendment. It was seconded and passed unanimously. (Open, All)
Women and Children's Health -- Deborah filled in for Wanda Sandele
Deborah reported that the State Consultants would be conducting a review of educational materials used in immunizations to try to gauge their effectiveness. With this in mind, the association is being asked to endorse health departments participating in this effort. The following motion was offered from committee: The committee recommends that the Association endorse the use of one-on-one (or one-on-small-group) surveys of 14 Health Departments regarding immunization educational materials and future needs for educational materials to be conducted by regional consultants. Coming from committee and needing no second, the motion carried.
Epidemiology Committee -- Dr. John Morrow
Dr. Morrow reported that the committee had discussed the problem with Flu Vaccine availability (or lack there of) the past two years. Since this is now handled under the free market system, there is not much we can do. However, the committee had a resolution that they wanted the Association to adopt that would be send to the North Carolina Medical Society asking their support for placing the distribution of Flu Vaccine under a system similar to that used for childhood vaccines (see attachment). Everyone present agreed that such a system was the best way to ensure that the vaccine got to those with the greatest need instead of to those with the most money. The motion from committee asked that the Health Directors’ Association support the resolution asking the Medical Society to support prioritizing distribution of Flu Vaccine similar to the way childhood vaccines are handled. Coming from committee and needing no second, the motion carried.
Regional Meetings -- Dr. John Morrow
Dr. Morrow reported that Region 9 had discussed threatening letters coming from the State and the negative effects they could have on budget negotiations locally. It was felt that letters that could be interpreted as threatening to remove state dollars if local dollars are cut back secondary to the State financial crunch would be counter productive. There was a motion from Region 9 asking the Association to take a position that these letters should not be sent. Coming from the floor, the motion required a second. After some discussion and no second from the floor, it was not voted on.
Epidemiology Committee -- Dr. John Morrow
Dr. Morrow gave a short overview of items discussed in committee (see attached minutes for details). These items included a request to provide feedback to Steve Cline on the Bioterrorism Plan, the new Hepatitis C Coordinator position in the Communicable Disease Branch, proposed rule changes by the Commission for Health Services, and the recent Blastomycosis outbreak in Duplin County.
Women and Childrens Health -- Deborah Presenting for Wanda Sandele
minutes for details): WIC using PHTIN to save travel money and still complete required training, Early Intervention Reorganization to eliminate barriers to accessing service, Family Planning proposed verbal survey regarding appointment lead times, and a request for health directors to talk to their staff about the appropriateness of changing CSC billing to something similar to that used for MCC.
Public Health Visioning/HIPAA -- Francis Taylor
Ms. Taylor distributed her activity report again this month (please see attached report for details). Her report covered accomplishments/milestones, Meetings attended, Deliverables distributed, Responses to HIPAA Questions, Speaker Requests and Outstanding Activities and Issues.
Technology Committee -- Ray Rabe
Mr. Rabe reported that, in addition to the previously discussed items (the action item, HIPAA and Bioterrorism), the committee received an update regarding progress on HSIS remediation (HIPAA compliance) activities. He noted that the work has not stopped, but has slowed up with the cut back in state funding. In response to last month's action, a letter has been submitted by the Association President to the Governor requesting that all or some of the budget relating to this activity be unfrozen. Ray also reported that a "Goodness of Fit" study is underway. This state funded activity is evaluating a system called MMIS as a possible alternative to HSIS. He noted that the committee understands that the consultants have indicated they will not necessarily be limiting their recommendation to the MMIS option. If they are aware of another software package that will better meet our needs, we will be told about that alternative as well. The Committee also received reports on the work on the Health Alert Network (HAN) , the National Electronic Surveillance System (NEDSS) and an effort by DENR to identify hand held, field technology that can be used to record findings during food and lodging inspections statewide.
Education and Awards Committee -- Deborah Rowe filling in for Janet Lindbloom
Deborah reported for Janet Lindbloom who could not be present. Deborah said she wanted to thank Danny Staley for his help in resurrecting the NACCHO Scholarship application. Deborah noted that there had been three requests for this scholarship and there was only $1,000 in the budget. Deborah said the committee would be looking at this matter and making a recommendation to the association.
Policy and Planning -- Deborah Rowe filling in for Jim Baluss
Deborah provided an overview of the items discussed in Policy and Planning (Please see attached minutes for details). These included the earlier motion already discussed, an ERC update, a review of the NCALHD Blue Ribbon Task Force (previously discussed), Flu vaccine mal-distribution, the budget crisis, and concern with what was happening in regards to the dental hygiene positions at the state level. Mark Swedenburg shared some fears the hygienists had shared with him secondary to annual dental evaluations being cut back. Dr. Devlin admitted that there was a move going on to cut back on these evaluations, but that the hygienists were still key players in the state’s plans for dental work in the future. She explained that many people thought that doing annual evaluations were not cost-effective (some thought maybe not even ethical) if we couldn’t offer some intervention to correct the problems noted. There seemed to be consensus that these positions were crucial to what needed to be done in the future and we all need to educate the hygienists of this fact to allay their fears (which by the way are realistic with the talk of a possible RIF by the state).
Alliance (NCAPHA) -- Barry Bass
Mr. Bass noted that the Alliance would be meeting at 12:30 PM immediately after this meeting in this same room. He reported that Jody Boroughs with NC Healthcare Enterprises would be making a presentation at the meeting. Lastly, Barry said that the board would be discussing transition in the office of the alliance to its new leadership and better ways to work with its members and their needs.
Environmental Health Committee -- Terry Pierce
Mr. Pierce reported that the committee had discussed the Pilot Project Survey and some questions that health directors had asked before any conclusion was offered. These questions were (1) whether the abnormal grouping of scores at 90.5 seen with the letter grading system went away with the numerical grading system as had been assumed would happen and (2) whether the two points given for training had a significant affect on the grades of establishments. The committee determined that there was no significant change in either arena. Terry said that the committee would be bringing a motion before the full-association meeting in April stating that since there was no significant improvement from the pilot project that there was no reason to change the way restaurants are inspected. In addition to the previously described proposed bill and the Pilot Project info above, the committee also had a report from DEH (Linda Sewall and Malcolm Blalock) and discussed Pfiesteria and other related water quality issues (Please see attachments for details).
School of Public Health -- Penny Whiteside
Mr. Whiteside reported that applications were now being taken for the Management Academy. He also noted that the Southeastern Leadership Program was changing and that information on this was available at their webpage. Lastly, he reminded everyone that ANCBH and the Institute of Public Health were working together to ensure that training continues for Board of Health members. He said that the scheduled training would go on with Carmine helping with some of the training. Penny noted that contact information for ANCBH remains unchanged for the time being.
Office of Public Health Nursing -- Joy Reed, RN
Ms. Reed reported that Cross Walk II was starting. She said that the codes had been chosen, but that limitations on billing frequencies, etc. were still being worked out to keep this revenue neutral. She also said that an agreement was being completed that will clearly identify how billing needs to be handled when Family Planning and STD Programs interface. Lastly, Joy reminded everyone that June 3oth marks the end of the two-year period for nurse credentialling. She noted that there may be some problems getting the required continuing education and suggested we look at using training in journals and nursing magazines to complete this if necessary.
ANCBH -- Carmine Rocco and Barbara Hughes, ANCBH President
Ms. Hughes noted that even with Mr. Rocco leaving ANCBH to become a health director, the training of Board of Health Members must go on (especially since it has been added to the agreement addenda). She said 60 – 70 percent of board of health members still do not have this training. She asked all health directors to support this effort to get all Board of Health Members trained on their responsibilities as board members. Ms. Hughes said that the AAA Manuals that had been ordered are being compiled and will be delivered soon. Lastly, she reminded all present of the need to maintain the Board of Health database and asked for our assistance in doing this.
See Action Items above
There being no further business, the meeting was adjourned at 12:35 p.m.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer