President Wayne Raynor called the meeting to order at 9:00am welcoming all members and guests. President Raynor asked for a head count of member and there was not a quorum for a full association meeting (only 36 members were present at roll call). He noted that the motion calling for full association meetings the rest of the year stated that the meeting would revert back to an Executive Committee Meeting if a quorum were not present. The meeting then proceeded as an Executive Committee Meeting. It should be noted that several other health directors came into the meeting later, but the meeting had already been declared as described above.
David Rice 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. Dave Rice made the motion and Harold Gabel 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 Harold Gable seconded it. It passed unanimously. Don Yousey added that only one check as still outstanding. He further stated that he wanted to thank Mimi Cooper for filling in for him last meeting so he could celebrate with his wife and staff.
Deborah Rowe briefed the committee on the drawn out process the budget work is taking, but reminded everyone that this will give us an opportunity to educate our legislators on what the proposed cuts will mean to their districts. Deborah reported that she had emailed out a spreadsheet spelling out what the rate cuts will mean to each health department. She also sent some information from Senator Hartsell that is just useful in defending funding for public health programs. Lastly, she asked the committee to remind association members of the need to speak out for the $180,000 health promotion money as the first step in getting it back next year. Deborah then reminded everyone that New Health Director Orientation was scheduled for the week following the meeting. She noted that some had already signed up and asked others interested to go ahead and sign up so dinner reservations can be made. Lastly, Ms. Rowe reminded everyone that the Legal Conference is scheduled for September. All the rooms at the Sheraton have been booked, but the Comfort Inn still has some available. She also asked committee chairs to contact her regarding meeting space and asked folks to consider staying over Thursday night so they can participate in the NCPHA Awards Banquet.
Terry Pierce was invited forward to recognize Malcolm Blalock for his many years working with the association on EHS issues. Malcolm talked about how much he appreciated the many friendships he built working with the health directors and said he hoped these would continue during his retirement. Malcolm received a well-deserved round of applause from all present.
Ms. Melba Okum reported that she has been working on getting the cigarette tax raised as North Carolina had the third lowest tobacco tax in the country. She noted that the effort meshed well with public health goals of reducing smoking to improve health. She also noted that several bills had been put forth that proposed raising the tax anywhere from $.25 to one dollar. Ms. Okum further reported that a poll showed that there was steady support for raising the tax with 60% of previous voters polled stating they favored the increase in the money was targeted for preventing smoking by the young. To date 15 county boards of health have passed a resolution in support of this effort. Ms. Okum asked that any other counties that pass the resolution consider doing a press release and informing elected officials in their counties of the action. Mr. Raynor stated that passing the resolution was the right thing to do and asked others to consider asking the boards of health to pass the resolution.
Mr. Raynor announced that Alamance County had been recognized with a NACCHO award for the dental program they started four years ago. Time Greene shared that their program had treated 4,000 kids with over 10,000 visits and are operating in the black. He received a well-deserved round of applause from all present. Bill Smith shared that several other county health departments in North Carolina had received NACCHO Awards in the past as well.
Dr. Devlin reported that bioterrorism continues to be a high priority for her office. She stated that they are still working on the bioterrorism bill and that the Governor was being added to the notification list of the bill. She noted she and her staff are also working on proposed case coordination cuts, Pap Smear costs and the proposed Medicaid rate cuts to try to minimize the damage to local health departments. Dr. Devlin noted that a chart showing the differences between the Senate and House budgets had been distributed earlier. She also said that there was another approximately $6,000,000 of cuts that are being considered by the Governor. Dr. Devlin then noted that the State is working on a pre-event plan for mass immunization in advance of a known or suspected attack. Dr. Devlin then apologized for the potassium Iodide program moving forward so fast without more input from locals. She noted that if locals refused to participate the State would find a way to carry out the program without them. Dr. Devlin then reported that there was no a shortage of flu vaccine expected this year, reviewed the growing list of counties who have identified birds with West Nile Virus and noted that a case of EEE had been identified in Pamlico County.
Mr. Raynor reported that the task force had met again and had the following motion to offer to the association.
That the NCALHD, based upon areas of consensus from local health directors, support the formation of three committees to address local public health accreditation, best practices and demonstrations.
The accreditation committee would focus on local public health infrastructure and capacity issues. The best practices committee would focus on accountability, partnerships with community based organizations, administrative flexibility, and effectiveness in addressing health disparities. The demonstrations committee would identify successful collaboratives generated from the functional partnerships concept, and recommend strategies for replication.
The Task Force on Local Public Health Standards and Efficiencies would remain intact to facilitate the process and keep committee activities on track.
Committees would be co-led by a local health director and a state representative, and would set timeframes based on what is deemed reasonable. Committee chairs would also serve on the Task Force as liaisons to the committees.
The motion was seconded by Wanda Sandele. Ray Rabe offered that he felt the whole process had been divisive and not inclusive enough. Wanda Sandele spoke for the motion and noted that she had a written and signed proxy from Dr. Morrow empowering her to vote for the motion. Wanda stressed that it was either time for us to do something or expect something to be done to us. Unanimous in favor of the motion except for one vote (Mr. Rabe). Passed.
Ms. Wall reported that the final HIPAA privacy rules was out. She noted that the IOG was planning a teleconference for October 21st from 1:30 - 5 PM on this. The cost is $38 per person. This will be available at numerous sites across the state. Further details will be forthcoming.
Environmental Health -- Terry Pierce
Mr. Pierce reported that the institutional rules (HB1777) passed on the third reading. Rules and the sheets to go with them have been delayed until it can be determined if the rules will lead to increased cost or lowered scores. There is a plan to run both sheets side-by-side as a field trial. With that in mind, the following motion was proposed:
Field testing of new Institution Rules and inspection sheets be used statewide for routine inspections during the designated test period, if HB 1777 is ratified. Coming from committee, the motion needed no second.
There was some discussion about who decided locals needed to do the field testing, how much work it would be, etc. Don Yousey noted that if the Legislature was asking us to do the field testing that we should do this since we were going to them asking for help with the budget crunch (i.e. This is not a good time to alienate ourselves from them). Time Green agreed with Don’s logic. After this discussion, the vote was taken with all but one (Mr. Rabe) voting for the motion. Passed.
Health Promotion/Oral Health -- Rosemary Summers
Ms. Summers reported that the committee discussed in detail the options presented for distributing the cut in health promotion funds this year. Wanda Sandele wondered if the committee had looked at doing away with services versus an across the board cuts. Rosemary noted that the committee was going to look at performance based cuts next year if the data was available to do this. This would allow us to know what cuts are coming in advance instead of having to wait for the hammer to fall later in the fiscal year. Since a decision was needed now, the committee had gone with the cuts similar to last year. With that in mind, the following motion was proposed:
That for fiscal year 2002 – 2003 the State fund each county at baseline funding of $21,000 and that the cuts be distributed across all counties at an across the board percentage cut of any amount above $21,000 to achieve the total of $257,404. Coming from committee, the motion needed no second. The vote was eight for and three against. Passes.
Technology Committee -- Ray Rabe
Mr. Rabe reported that there were three motions from committee. He took them in the following order:
Motion that the President of NCALHD send a letter to Mr. Chuck Monteith of the Employment Security Commission of NC (ESC) to request that local health departments be allowed to access the ESC’s data base as a way to verify income form clients and that the President request that the State Health Director co-sign the letter. (Tim Monroe/Tom Bridges) Discussion centered around whether this would allow us to readily access this info and Mr. Harrington said that it would. Coming from committee and needing the no second, the motion passed unanimously.
Motion that the State Health Director require that, from its inception, there be a link between the new Immunization Registry and whatever information system is in place for local health department billing and reports related to immunization services be such that no double entry is required. (Leonard Wood/Curtis Dickson). Mr. Rabe reported that the committee had discovered that the new system will involve double entries even though we had been led to believe this was not the case a couple meetings ago. The committee wants to ensure there are “no” redundant entries. They further want to want to ensure that a new system that is supposed to cut workload does not increase it through built in redundant entry requirements. There was general consensus that we could ask for this, but could not mandate it. Coming from committee and needing no second, the motion passed unanimously.
Motion that the Association allow the use of up to $750 of the funding appropriated to send a non-health director representative to the NCHICA Annual Conference. (Tom Bridges/Tim Monroe) Since only one health director was interested in going, the committee felt that a non-health director (worker bee type) should be allowed to go. The committee felt that since Frances Taylor was working for all of us that she should be allowed to attend for us (if she can and desires to do so). If Ms. Taylor cannot attend, Mr. Bridges felt he had a person on his staff who could go and do a good job for us. Mr. Greene wondered, if a county person went, ho would the material get back to us. Mr. Rabe noted that we could ask the person to report back to us afterwards. Coming from committee and needing no second, the motion passed unanimously.
Mr. Rabe noted that the HIPAA Activity report had been mailed out. (See Attachment)
Policy and Planning -- Mr. Baluss
The committee met via conference call the day previous to this meeting and offered the following motion:
That NCALHD recognizes and commends the structured processes to seek streamlining and increased flexibility in program practices and standards as exemplified recently in work by the MCH Committee and state staff. In view of the overwhelming challenges at the local level in the administration of public health programs and mandates, the association calls on DPH leadership and program staff in all program areas, undertake a similar process in collaboration with their NCALHD liaison committees. There was general consensus for such work from those in attendance. Coming from committee and needing no second, the motion passed unanimously.
Women and Children's Health -- Wanda Sandele
Wanda reported that there is good news from the streamlining work. She noted that a joint effort of local and state staff are finding practices that are not required by Title X and/or are old habits that would not die. The consultants are enthusiastically working on this project to eliminate redundancies that make us appear inefficient, without compromising the quality of what we do. Ms. Sandele reported that they are also working on self-administered histories and have discovered that many more patients can do these (80%) than previously thought. Wanda also reported that a meeting was held regarding case management reimbursement. She noted that CSC and MCC billing can be done for up to 90 minutes per month (in 15 minute increments). Exceptions can be applied for for more time in MCC only. Carol Tant at "ncmail.net" is asking us to let her know how this will impact us. Wanda then reported that the CDC will be issuing an unknown number of small pox vaccine doses for a yet unspecified target of health care workers. Workers vaccinated will not be able to do direct patient care for 10 days.
Technology -- Ray Rabe
Ray reported that the committee was feeling pretty good that something positive will be coming out of the goodness of fit study. Projected time for completion of this work is still the end of September. Ray said that there may be some gaps, but that the program is expected to do what HSIS does and more but also be HIPAA compliant. Mr. Rabe also reported that EMS folks had briefed the committee on a UHF back-up communications system for emergency services that will allow public health to keep in touch when primary communications are out. The committee also was briefed on a health alert network update that will allow public health to tie into this system better than we can presently. Training on the use of the new system will be coming this fall. Bob Martin spoke to the committee regarding HSIS, but the phone line was poor and it was difficult to follow the discussion. However, modification to the system that will enable us to temporarily use it under HIPAA continues and is expected to be completed in time for our needs. Dennis Harrington said the bottom line is that the people working on this are losing five more people from the budget crunch. Lastly, Ray noted that the committee was using conference calls more and more and asked that the association look into buying each committee chair a conference call capable telephone.
Policy and Planning -- Jim Baluss
Jim reported that there appeared to be some motion towards drafting legislation to try to deal with the Chatham County rule preemption problem and all board of health rule making. There is some thought that there might be great resistance to this. However, the committee felt that we have lost most of our rule making ability secondary to legal decisions and thus the work needs to be undertaken anyway. Mr. Baluss also reported that Leslie Brown had briefed the committee on an intern program grant that has been submitted to the Golden Leaf Foundation to support community fellows in health departments. The idea is to recruit undergraduate interns to work on health disparity issues within local health departments.
Alliance -- Barry Bass
Mr. Bass reported that 25 counties had paid their dues and hoped the low number was just due to the budget crunch. He asked that we all give full consideration to joining if at all possible.
Nomination and Bylaws -- Tim Greene
Tim reported that the committee had met and will have a slate of officers to vote on. He noted that there were also some bylaws issues that will be dealt with. Lastly, Mr. Greene reminded everyone that it is time for the odd numbered regions to elect regional representatives.
Environmental Health -- Terry Pierce
Terry reported that the RF Board is in the process of developing a webpage. It will include approved training and other info. He also reported that the Grade Card Committee had met. A compromise had been reached on the grade card issue, but the details had not been finalized as yet. Mr. Raynor is participating and will keep us up to date on progress. Terry reported that the legislation to increase food and lodging fees is still alive. It would double fees in its current form, but would not add any new establishments. Mark Swedenburg remarked that we should frame our description of the fee increase as “a small increase” rather than saying the fees are doubling as this sounds like a lot (when in fact it is not). During discussion on on-site violation, Steve Steinbeck had recommended we take violators to criminal court. However, the committee felt each county should do whatever they fell will work best in their given circumstances. Lastly, draft regulations on water conservation have been written.
Office of Public Health Nursing -- Joy Reed reporting
Joy could not attend, but sent along a handout. (See Attachments)
School of Public Health -- Dr. Hollie Pavlica, MSW, DrPH
Dr. Pavlica reported that the online MPH Program is getting into full swing and stressed what a good financial deal it is. She noted that students would take two courses per semester at a cost of only $119 per month. She asked that we carry back information on the program to our staff. Bill Browder reported that the school is still collaborating with ANCBH and are still scheduling training for boards of health. Lastly, the next meeting of ANCBH is scheduled for October.
Region 5: Dr. Harold Gabel
Dr. Gable reported that Region 5 had met and two motions were offered to the association from that meeting.
First Motion, that at least one association meeting per quarter be a teleconference. Jim Roosen seconded the motion. Danny Staley questioned which sites would host such meetings. Bill Smith asked that such a decision be held off until the full association meeting next month. Dr. Gabel agreed to withdraw the motion until next month.
Second Motion, that committee meetings be scheduled at least two weeks before association meetings so members can digest the information and not have to make decisions so close to being briefed on the issues. There was some good-natured kidding regarding the merit of the motion and then it died secondary to not receiving a second as required.
Respectfully Submitted,
Don Yousey
Secretary/Treasurer