President Wayne Raynor called the meeting to order at 9:00am welcoming all members and guest. President Raynor reminded those present that this was a full association meeting and that all paid members are eligible to vote. Proxy votes must have been registered with the secretary.
Louis Latour provided fellowship.
President Raynor reminded members that the minutes were posted on the web site and asked for a motion to approve the minutes as posted. George Bond made the motion and Tim Green provided the second. With no discussion the motion was unanimously approved.
Don Yousey presented the treasurer’s report (see attachments for full report). The balances are as follows:
Tim Green made a motion to accept the treasurer’s report and Tom Bridges provided a second. After no discussion, the motion was approved unanimously
Janet Daly announced that the Education and Awards committee was delighted to present this year's Health Director of the Year award to Don Yousey of Brunswick County. Janet said that the letter of nomination cited Don’s strong leadership skills, the planning and implementation of Total Quality Management in the health department, increased staff morale and dedication, and the decrease in infant mortality rate in Brunswick County. After receiving a standing ovation, Don gave special thanks to Bill Smith of Robeson County for serving as his mentor, thanks to his wife of 32 years and thanks to the management team of the Brunswick County Health Department.
Dr. Visingardi told the group of his background in the mental health services field. He then brought the association up to date on mental health reform.
Area Mental Health Centers are the core of reform. It is important to remember that community mental health centers were designed to take care of people living in the community with mental health problems not those people with severe and persistent mental illness. Then with de-institutionalization many folks were placed in the community with much more in-depth problems. There are three issues that mental health centers are struggling with across the state.
The shift to the authority-based model or area program requires a size consideration to get economies of scale. The reform legislation says that size is around 200,000. As area programs plan to divest themselves of services, they should have provider networks identified so they are not in the business of both managing and providing services.
Currently the system is not serving those in highest need. So for the next year, systems must determine who they are serving and what percentage of these are the target population. As well as determine if the services are evidence-based best practices. All this change and budget issues too! All have to be ready by July 1, 2003. Right now local mental health centers are working on a business plan to be sent to Raleigh by January 1, 2003. They will be involving other community agencies to prepare these plans so please get involved when you are called.
Tim Green: What are the penalties for not meeting these change deadlines?
Rich: Eventually we think everyone will comply. It is the law but we have not discussed penalties. The big issues are consolidation and divesting themselves of services. If penalties are necessary, the next six months should determine what they are.
Dorothy C.: Talk about the revenue impact for local agencies.
Rich: The plan is not to reduce resources but to use the existing resources better. Of course budget issues have impacted this. The plan is to pay for management services off the top.
J.T. Garrett: There is a problem with insufficient providers in the far east/west. We are concerned about the shifting back of those with persistent mental health problems to the areas with the least resources; even to public health and most particularly patients with no money to pay for services.
Rich: Clearly there is an imbalance of providers. Area programs who cannot find appropriate service providers will still need to provide services. Patient shifting should stop if you have a good coordination and communication system. These things have to be talked out.
Harold Gabel: Thirty-nine programs are becoming twenty programs. Do you see boards merging/consolidating as program numbers become smaller?
Rich: If you go through the process carefully and determine what is valued, the new boards should be reflective of those values and these should be healthy consolidations.
Leah asked Steve Cline to make three announcements before he had to leave the meeting:
Danny Staley asked how soon we could expect these teams to be available and Steve responded that it has varied from region to region depending on how quickly they were able to hire staff.
Leah also reported:
Leah also reported on the Functional Partnership Meetings that were held across the State the first week of July (see attachment). This is a discussion document that has not been asked for approval. This discussion began in the Division of Public Health with these questions:
How can the DPH do business differently
(considering current constraints) and how can we do business better (not that
anything is particularly wrong now)?
Several health directors spoke in support of the partnership idea (Danny Staley,
Jennie Lassiter, J.T. Garrett). Ann Thomas asked about the additional work of
the task force that Wayne had appointed. Wayne replied that the work of the
task force is still the same; the speed with which they are working has just
slowed some. That is one of the reasons Wayne asked that this meeting be a full
association meeting. Wanda Sandele asked that we no let this become another
idea that sits on the shelf. In other words, let’s not slow it down too
much. Leonard Wood stated that he had some concerns with the plan but also supports
some ideas particularly accreditation. Discussion on this issue will continue
into the next several months.
Environmental Health -- MiMi Cooper reporting for Terry Pierce
(see attachment)
Motion: to ask the policy and planning committee to watch the bill introduced today that stops the implementation of the Institution Rule changes and advise the association about any proposed changes to the rule (delays in implementation are okay).
Discussion: The changes in the Institution Rules have been in progress for four years. The regulated industry have been involved in working on the changes but at the last minute, the lobbyist for the Institutions association worked with Representative Gibson to introduce the bill to stop the changes. Linda Sewall met with the representatives from the industry and the problem seems to be that the facility operators don’t understand what the changes mean. They feel that facility services will shut them down if their food service grade falls below an A. A delay in implementation while additional education goes on is acceptable but changes to the rule need to be looked at closely.
After no further discussion, the motion passed unanimously.
Environmental Health -- MiMi Cooper reporting for Terry Pierce
(see attachments)
- Nolan Newton reported that the July 12 issue of MMWR shows a considerable increase in tick-borne diseases in North Carolina and also Maryland, South Carolina and Georgia. The DEH will be sending us additional educational pieces to remind the public about prevention of tick bites.
- The EHS excess liability insurance coverage went into effect on 7-1-02. Anyone authorized as an EHS will be covered. The State is paying for this additional coverage.
- A draft bill was introduced to increase restaurant fees to $50.00 and allow State and local departments to charge plan and review fees.
Nominations and Bylaws -- Tim Green reporting
It is time to elect regional representatives in regions 1, 3, 5, 7, 9. The nominations are due in August.
Alliance -- Barry Bass reporting
The Department of Corrections contract can still be entered into. Contact Jen by Monday. Barry asked everyone to consider joining the Alliance this year to take advantage of new opportunities for increasing revenue.
Policy and Planning -- Deborah Rowe reporting for Jim Baluss
- The legislature doesn’t actually have to address the budget issue because it is a short session and there is already a budget from the long session. That would force the governor to adjust the budget…which he has but it depends on the lottery which hasn’t passed.
- The _ cent sales tax failed in yesterday’s finance committee.
- Clarification on the Health Director’s legal conference – the Legal Conference is for Health Directors and County Attorneys only. It does not show up on the NCPHA agenda so as not to confuse the others who will attend. Registering for the Legal Conference includes access to all NCPHA activities (unless they specifically call for additional cost such as the banquet). Don’t register for both NCPHA and the Legal Conference; just the legal conference.
Epidemiology: -- John Morrow reporting
- Small pox vaccination recommendation plan from the Immunization Practices Committee will be decided eventually by HHS. All you are hearing now is just recommendations or opinions.
- Arsenic levels in drinking water accepted levels are changing to .02 even though we can’t measure that low! There is currently a requirement to do a public notice for public water supplies if the level is above 10 ppm. This has to do with cancer risk and the EPA standard. This does not differentiate between naturally occurring arsenic and arsenic that was introduced through some means such as mining.
- Rabies rates are up significantly this year. CDC specification for diagnosing rabies has changed. You should have received specifics on this from the lab. The cost for running a rabies test is $125 so be precise about what you send. There is additional talk about oral vaccination for wildlife.
- There have been three cases of LaCrosse Encephalitis in the west this year along with the increased cases of RMSF and one positive bird for WNV.
Women and Children's Health -- Wanda Sandele reporting
- The Division is still working on the family planning wavier.
- The committee is working with Kevin Ryan to remove duplication issues in trying to comply with title X rules.
- The committee heard from a consultant from Health Metrics who has looked at all kinds of family planning programs across the country. The recommendations from the consultant include best practices, improved efficiencies etc. The committee will get access to this report.
Technology -- Ray Rabe reporting
- Technology had a good meeting with the Goodness of Fit group. Consultants introduced MMIS Plus, mental health software and asked the question, could this be made to fit public health and also address HIPAA. They will also look at the immunization software for fit.
- Ray is feeling good about the direction we are taking and the speed in which we are progressing.
- Mary Beth Lister from Immunization came to the meeting with the Wisconsin Immunization Software and advised the members on the pilot plan.
- Betsy Clayton from DEH came to the meeting to talk about new inspections software that is web based. They will start using this software first with Child Care to see how it works.
- The request from the Nursing Supervisor’s Association to use our web site unfortunately will not be possible. According to our web master, our site is overloaded as it is. Additionally it would cost the nurses group as much to add to our web site if that was possible as it would to set up their own. We will link to their site when they get it established.
HIPAA -- Francis Taylor reporting
- Francis passed out her monthly activity report (see attachments).
- There are still plans to update HSIS to comply with HIPAA. Systems administrators will have to decide who gets to see what documents.
- The privacy reviews have been completed with pilot counties.
- The is a link to NCHICA about purchasing some software (see email from FT)
- Policy templates for complying with HIPAA will be provided to us through the office of local health services by 12-02. We will each have to write our own procedures.
- Staff training on privacy procedures is required by April 03.
- County Attorneys are attending a workshop today and tomorrow on HIPAA.
- There is a meeting with DEH about HIPAA and EH issues planned with Aimee Waugh, the AGO and Mark Lodge
Office of Public Health Nursing -- Joy Reed reporting
- The one million dollar cut in aid to county funds memo went out to each department yesterday. It allows you to select which area you would prefer the cuts be made.
- The Cross Walk Conference is full. Do not send staff unless they are registered.
School of Public Health -- Penny Whiteside reporting
- Genomics and Public Health Conference (see attachment)
- Epi Surveillance Course is going on this week for regional BT Teams.
- Let the School know the names and contact information on the members of your epi team.
ANCLBH -- Barbara Ann Hughes reporting
- Lee K. Allen was elected regional trustee of the National Boards of Health Association.
- National Performance Standards were unveiled at the conference.
- On September 30th, there will be a consortium on Natural Medicines and Public Health. Attendance is by invitation only. If you are interested in attending, contact Barbara Ann.
Region 3: Danny Staley
Motion: As the future of Public Health in North Carolina is currently under systematic review and change, we move that the NCALHD meeting be made full association meetings from August 2002 through December 2003. During that time evaluating the need to continue full association. During the full association meetings if attendance of the meeting fails to reach a quorum, the business will be an executive committee.
Second: Bob Wood
Discussion:
- Leonard Wood- the by laws only allow the Executive Committee and President to make the decision to change to a full association meeting.
- John Morrow- he thinks the by laws only intend for this decision to be made one meeting at a time rather than a wholesale change.
- Bill Smith- Seems like you are making it more efficient to support this motion than for nine people to have to write in every month to make a change
- John- still thinks regional representatives method works well to discuss the issues and keep meetings less overwhelming in time and responsibility
- Deborah Rowe- with budget constraints, participation in full association meetings is more difficult
- Dorothy C.- With the by laws as they are, the only way this can happen is for the executive committee to take it up
- Leonard- the motion as stated is in conflict with the by laws unless it is changed to recommend that the executive committee take this up
- George- thinks we need to change the motion to allow the executive committee to consider this at another time rather than here today.
- Beth- I can’t imagine having full association meetings decreasing my participation on a regional level. I could not survive without the information I get at these meetings.
- Louis- Let’s refer it to the by laws committee for an opinion.
- General confusion abounds about whether the motion is in conflict with the bylaws
Amended Motion: (Rody Drake) that this motion be considered by the executive committee.
Second: John Morrow
No further discussion. Twenty-one in favor of the motion, thirteen in opposition. The motion passes.
Motion: (George Bond) that the Executive committee members present take this under consideration now.
Second: Ray Rabe
Discussion:
- John Morrow- Concern is conflict with the by laws. I propose we try it through December 02 rather than 18 months.
- Jim Baluss-Is the thinking that time is the issue or by laws are the issue?
- Barry Blick- I think the issues have changed and it is critical that individuals attend to help with input
- Jerry Parks- Call the question
Six voted in favor of the motion. Motion passed.
Having no further business, the meeting adjourned at 1:15 pm.
Respectfully Submitted,
MiMi Cooper
Acting Secretary in the absence of Don Yousey