President Wayne Raynor called the meeting to order at 9:07 am and welcomed members and guests. Mr. Raynor announced that there were snacks and hot cider in the back of the room. President Raynor then conducted a count of members present and found a quorum for a full association meeting did not exist (only 32 members were present). He announced that since a quorum was not present, that this would be an Executive Committee meeting. Please see attached Attendance Roster for actual attendance.
Mr. Raynor then recognized Mr. Jim Baluss who presented three handouts (please see attachments) regarding his upcoming year as President of the association. These were:
Jim noted that he looked forward to working with everyone next year as there were many challenges regarding funding, legislative priorities, etc. yet to be dealt with.
Mr. George Bond shared a couple humorous stories about “Vocational Rehab” and our “Unsung Hero -- Dr. Leah Devlin."
President Raynor reminded members that the minutes of the last meeting were posted on the web site and asked for a motion to approve the minutes as posted. There was a motion to approve the minutes as written and a second. The motion was unanimously approved.
Don Yousey presented the treasurer's report (see attachments for full report). The balances are as follows:
There was a motion and a second to approve the Treasurer's Report as presented which passed unanimously. Don Yousey reported that he was still receiving suggestions for next year’s proposed budget. He said he would try to have it completed with asterisks by the changes for distribution via email well before next month’s meeting so all members have time to review it and make suggestions at the January meeting.
Deborah Rowe reminded everyone that they will need to provide her with a “user name” and “password” if they want to use the new message board on the webpage. She noted that they could give these to her in person if they wanted to. For those not present or unable to provide the info today, she asked that they fax the info to 910-250-6109. Ms. Rowe also reported that the Sheraton had extended the date for reserving rooms until January 10th for the State Health Director’s Meeting at the special rate. She noted that our Awards Luncheon and Business Meeting will be on the 29th of January with the conference to follow on the 30th and 31st. Lastly, Ms. Rowe reported that the ERC is scheduled to meet January 16th and the 23rd. The agenda for these meetings has not been set yet.
Mr. Raynor said that he would like to take a moment to talk about this past year’s legislative work. He noted that we will have to do even more work this coming year. That being said, Wayne noted that we have accomplished some great achievements. We have had excellent attendance even with the money shortages. Doug Urland had attended a meeting in Washington, DC as part of our hope of doing more legislative work at the federal level. Wayne went on to praise how we defended public health funding and held off Medicaid rate cuts, collected 100% of our dues, improved liability coverage for EHS specialists, and established the seven PHRST teams. Additionally, we established a link between our webpage and the County Commissioners’ webpage, set up a private message board, maintained an excellent mentoring program (a great help to new health directors) and the NCPHA/Legal Conference offered some of the best training we have ever had. We maintained our liaison with the Minority Health Advisory Council to work on Hispanic issues and the Task Force on Standards and Efficiencies (and its three subcommittees) is now up and running, Wayne noted that he hoped to see some innovative things coming out of this work. Lastly, Mr. Raynor asked that we continue to work with our legislators so we can have inputs into the upcoming work on public health. He stressed that we need to prioritize our programs so that we can have meaningful inputs in this process. He closed by stating that he had a very positive meeting with Secretary Hooker-Odom and noted that she is a strong advocate for public health.
Dr. Devlin said that she hoped all the health directors got away for a few days’ rest during the holidays. She thanked the health directors for all the wonderful work being done in public health on improving health indices. Dr. Devlin then thanked Mr. Raynor for all the work he has done this past year for public health as well. Dr. Devlin then noted that a lot of work still needed to be done. She said that she had just been asked to provide 7 – 10% reductions by January 10th for the 2003 –2005 budget work. She vowed that she is committed to preserving mission essential services and we will probably lose a lot of purchase of care (i.e. Home Health, Intensive Home Visiting, etc.) as we fight to preserve what we feel cannot be cut. Dr. Devlin asked that we be aware that Access II and III efforts to get a handle on Medicaid cost growth through the funding of pilot projects continues and performance based funding is getting a close look.
Dr. Devlin then noted that as we move from theory and planning to implementation of our Small Pox effort that there are going to be some controversies. Since we do not have some of the “security information” used in developing the federal plan, it may be difficult to defend our plan at times (since it was based on the federal plan). Tom Bridges asked if there were not some “commonly asked questions” that might be shared with us to help with this. Dr. Cline said that this was available, but that they had not wanted to flood us with too much information as had occurred in the past. He said his folks would try to get something out along these lines in the near future. Mr. Yousey said this would be helpful as he was already scheduled to meet with his hospital’s doctors who were questioning the plan.
Mr. Harrington then reported that he wanted to discuss three issues. First, the Secretary has gone to bat for us. The MMIS rebid was ready to go out while we were working to get EDS’s “Goodness of FIT (GOF)” report done. The Secretary stopped the rebid process so public health could be built into this. Mental Health had 18 months to work on this and public health was only going to get a couple weeks. Dennis noted that a tremendous amount of work was going on and this at least gets our foot in the door to try to get a “multi-payer system.” Second, CSC/MCC billing for October was terrible due to the confusion over what we can and cannot bill for. Lastly, Dennis noted that the revised Agreements with the new HIPAA language are being sent out. He asked that we sign them and get them back in immediately.
Dr. Kirkpatrick then reported that he had the County Small Pox Plans in hard copy. He said they were in the front of the room for distribution. Those not present will have their plans mailed to them. Dr. Kirkpatrick reported that the CDC was now looking specifically at how things are going to look at the clinic level as the vaccinations are given. Additionally, questions are coming up from hospitals regarding the liability issue. Dr. Kirkpatrick then shared some details on who would be receiving vaccine first. Don Yousey stated that he would be leaving out the details of the plan from these minutes as the plan was a confidential document. Dr. Devlin has written two letters to try to explain the state’s logic for the State plan to gain better support for it. Copies of Dr. Devlin’s letters will be sent through the list serve so local health directors can see what is being sent to their local physicians. Dr. Kirkpatrick noted that compensation for vaccinees who have problems secondary to receiving the vaccine have not been worked out yet. He did note that asking those who volunteer to bear the risk of participating is not a good plan. He said there is no state answer at this time and that this issue will need to be worked out at the federal level.
Chris Hoke reported that the liability coverage is better for hospitals if they do their own vaccinations “in house.” He noted that compensation for those who get sick is poor. Right now, they have to use their own insurance, sick time, etc. Chris stressed that he did not feel this was the way to treat those “heroes” who step forward and volunteer. We do not treat others (military, children, etc.) this way. He noted that they are trying fix the compensation problem and make it similar to the Federal Compensation Vaccination Program. However, discussion has shown that vaccinators do need to be vaccinated before they can be allowed to give the vaccine. Dr. Kirkpatrick went on to say that the state has decided to purchase the ancillary gloves, gauze dressings, etc. instead of asking the counties to pick up the tab for these supplies. .
Ms. Wall distributed a handout entitled " Using and Disclosing Patients' Health Information for Treatment, Payment, and Health Care Operations: Recommendations for North Carolina Local Health Departments." (Please SEE attachments) The handout will be posted on the IOG HIPAA website under "Frequently Asked Questions" (http://www.medicalprivacy.unc.edu/faqs/). While there has been discussion about not needing a consent form under HIPAA, the IOG recommends that one be obtained from all clients for using and disclosing health information for treatment, payment and health care operations. Ms. Wall noted that while no specific law requires one, general law would indicate that one should be obtained. Aimee went on to explain (as an example) that the Communicable Disease Statute (GS 103A-143) significantly restricts release of this information for payment and health care operations without consent. Since this information is dispersed throughout patient records, obtaining a consent form from each client would be easier than trying to segregate all of the communicable disease related data from the rest of the records. Ms. Wall went on to report that there is no real guidance IN HIPAA or state law on what such a consent form should look like, but indicated that Frances Taylor is working on a template to be used for this purpose.
Health Promotion/Oral Health -- Dr. Rosemary Summers
Dr. Summers distributed a handout entitled “Health Promotion Funds and Preventive Health Services Block Grant Update – December 19, 2002. (Please see attachments) Dr.. Summers then went on to explain three options offered for distributing Health Promotions funding for this upcoming year. The Committee moved to adopt Option A. This option would raise the baseline funding to at least 1 FTE per health department. Funding would be provided to a limited number of health departments based upon local need, existing state and federal health promotion resources, past performance and a competitive 5-year plan of action. Danny Staley remarked that this approach would force some counties not to be funded and had concerns that it would worsen the gaps that already exist. Jerry Parks remarked that the proposal doesn’t tell us what we will get and thus we wouldn’t know what we were voting for. He said that he leaned towards Option C that would set the funding level to $38,000 per county stating that at least that way we would know what we are getting. He added that some small part of the funding might be set aside for competitive allocation if that was desired. Coming from Committee and needing no second, the motion to adopt Option A was voted on. The vote was unanimous against the motion. Danny Staley then stated that Option C at least gave everybody something and still allowed small counties to partner with other counties if they so chose. Louis Latour then moved to adopt Option C as discussed. Tim Green seconded the motion and it carried with six for and four against.
Policy and Planning Committee -- Jim Baluss
Mr. Baluss distributed a handout listing the proposed legislative goals for 2003. (Please see attachments) Jim noted that there will very serious funding issues again this year and this may over shadow our efforts on the list. He also noted that there are some carryovers from last year. Mr. Baluss reported that we would be producing a pamphlet similar to that used in the past and wanted to get the association’s approval. He then went on to explain the difference between the goals that indicated “seeking” versus “supporting.” He stressed that we would be actively seeking sponsors for the items listed as seeking and would just support the efforts of others for those indicated as supported. There were a few changes to the attachment as follows:
- Fourth bullet was changed from “restore” to “seek;”
- Fifth bullet was changed from “seek” to “support;”
- Last bullet was changed from “restore” to “seek;” and
- The next to last bullet was deleted.
Coming from Committee and needing no second, the motion to approve the legislative goals with the changes listed above carried unanimously.
Policy and Planning -- Jim Baluss
Mr. Baluss reported that the committee had met with Mr. Blackburn of the County Commissioners’ (CCs) Association and discussed their goals for the Legislature this year. He noted that the CCs are stressing the state picking up the county match for Medicaid. Jim said that if the CCs are successful, the state would be $450 million worse off than they were this year. Mr. Blackburn also reported that the CCs are concerned with the Public Duty Doctrine as well. This is due to concern over the erosion of community protection from liabilities. The CCs are also supporting allowing local fees for inspections that more closely match the cost of providing the inspections. Lastly, the CCs are seeking to make local health departments and departments of social services departments of local governments. It is thought this is another attempt at giving county managers and CCs more hiring and firing power over these departments. There is some hope that this will be defeated within the CCs Association itself. If not, we may need to contact our legislators about our position on this.
Alliance -- Barry Bass
Mr. Bass announced that the Alliance Meeting would take place right after this meeting in the same room. He thanked all the health directors for paying their bills in a timely fashion and noted how important this will be for the Alliance this year with the continued revenue shortages across the state. Barry closed by stating that the Alliance Office is now operating out of Jen’s home as a cost saving measure.
Environmental Health -- Terry Pierce
Mr. Pierce announced that Anna Dean had resigned. He stressed that if this position is frozen (as many others have been) that this could have a very negative impact on Centralized Training. Terry noted that work on the grade cards is progressing, but said that working in the current rule as proposed may interfere with “Golden A Awards” currently being used by local health departments to reinforce their best restaurant performers.
Health Promotions/Oral Health -- Dr. Rosemary Summers
Dr. Summers distributed a handout entitled “Licensure by Credentials Update.” She reported that the program is ready to start January 1st. (Please see handout). Rosemary also reported that the state is also getting ready to settle the State Dental Medicaid suit. The settlement proposal may make the reimbursement rate 80% of the allowed amount versus the current 60% payment schedule. Dr. Summers also reported that the nursing functions and the state hygienist description intermeshing duties are being worked on. Lastly, Rosemary reported that the dental assistant classification problem is causing some difficulty in recruiting for these positions. Health Directors are being asked to share specifics on such problems with Rick Mumford for use with State Personnel in alleviating this problem. Dennis Harrington remarked that discussions he has had with State Personnel seem to show willingness on their part to help alleviate this problem. Barry Blick reported that current guidance does not discuss independent practice of Dental Assistants and he felt this needed to be worked on as well. Dr. Summers also reported on efforts to garner $3,000,000 for obesity prevention and noted that Diabetes Today is moving to more of a CVH model where more money will be distributed to fund two regional projects.
At this point, several handouts were distributed by Bill Smith regarding a resolution to raise the State Cigarette tax to 75 cents per pack. The handouts included a copy of the actual resolution and several support documents showing the advantages of making this tax change. (Please see handouts) It was reported that the Alliance for Health will try to get legislators to sponsor this. South Carolina is proposing to use increased revenues from the tax increase to meet the Medicaid match. It was stressed that the best way to slow down tobacco use is to increase cost. The motion from Committee was to adopt the resolution to increase the cigarette tax to 74 cents. Coming from Committee and needing no second, the motion carried unanimously.
Epidemiology Committee -- Dr. John Morrow
Dr. Morrow reported that the Committee had discussed the Epi Agreement Addenda for FY 03-04. He noted that Dr. Cline had discussed the calendar for the addenda and that there were only a few minor changes needed. (Please see the attached minutes for specifics on the Epi Committee Report) Dr. Morrow reported that the committee discussed potential changes to the TB Program. The state is looking at possibly contracting with doctors to cover a larger region than a county and local health director inputs are being solicited on this. The committee also discussed the Flu Surveillance program and noted that an additional number of sentinel sites had been added. Lastly, Dr. Morrow discussed Colleen Bridger’s experience prosecuting a control measure violator and the importance of baseline serology tests in these cases. It was wondered if baseline STD serology could be drawn on all HIV clients when they first present for treatment as a baseline? This will be further researched with the Attorney General’s Office.
UNC-SPH -- Penny Whiteside
Mr. Whiteside reported that work has begun on assessing the bioterrorism training needs of the public health workforce in North Carolina. The assessment (being implemented by the NC Center for Public Health Preparedness at the UNC School of Public Health) is part of the state-wide bioterrorism effort of the NC Division of Public Health supported by CDC. (Please see attachment for details) Mr. Whiteside also announced that a new wall chart is now available from SPICE. The new chart on chemical agents can be accessed and downloaded at www.unc.edu/depts/spice/chemical.html. Full-size laminated charts can be ordered (details are available at the SPICE web site). Finally, information on the UNC School of Public Health certificate program on Community Preparedness and Disaster Management can be found at: www.sph.unc.edu/hpaa/academic/disaster.htm. Mr. Whiteside reported that the first cohort of participants would start in January 2003. A second cohort will start in June 2003. Contact Jim Porto at 919-966-7354 for details
ANCBH -- Penny Whiteside for Barbara Ann Hughes
Mr. Whiteside reported on Board of Health Training: 35 trainings were completed in 2002; and eight are scheduled for the first two months of 2003 (including Richmond, Scotland, Alamance, Union, Granville-Vance, and Person Counties). The NC Institute for Public Health, in collaboration with the Association of NC Boards of Health, provides the training. NCIPH is also currently discussing a possible regional training session for boards of health with Area L AHEC--if this session is finalized, information will be sent out to counties in that area. Local Health Directors who would like to schedule board training sessions should contact Teme Levbarg at the NCIPH (Tel: 919-966-4917; Email: teme_levbarg@unc.edu). Schedules permitting, multi-county training sessions can be arranged.
OPHN -- Joy Reed
Ms. Reed reported that a list of RNs in each county is available at no cost from the Nursing Board. This is for use with bioterrorism training only. If you are recruiting a full-time nurse as an employee, you must pay for this data. Additionally, Train the Trainer for Nursing Schools is underway. So, all the graduating nurses should be ready to provide small pox vaccinations upon graduation. Lastly, Joy reported that the Public Health Nurse Administrators met during the ice storm and this did negatively impact attendance. Future work will focus on recruitment and retention of public health nurses.
Region I and II
Bob Wood reported that the coordinated flu effort in these two regions was a great success
Region VI
Jim Roosen reported that he had a motion from his region: That the videotape produced by ANCBH be allowed to meet the agreement addenda requirement for training. Carmine Rocco said he felt this would interfere with the interaction aspect of the training that live training allowed. Mr. Whiteside added that the training had changed and was now completely different than what the video contained. He said that he was willing to discuss streamlining the training, but did not want to weaken the effort to educate board members. George Bond noted that he felt Region VI was talking about setting a minimum standard that would soon become the maximum of what people do. Mr. Whiteside then added that they try to tailor the training to each group and a “one video for all” approach would not allow that. Mr. Roosen then asked who determined if the training was adequate or not? Dennis Harrington replied that the State did. There was not second to the motion and Mr. Roosen withdrew it.
There being no further business, and subsequent to motion and second, the meeting adjourned at 12:05 pm. The next meeting of the Health Directors' Association will be an Award Luncheon on January 29, 2003 at noon followed by the business meeting at the Sheraton Capital Center, Raleigh.
Respectfully Submitted,
Don Yousey
Secretary