Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

March 20, 2003

Wake County Human Services Building
Raleigh, NC

Call to Order

President Jim Baluss welcomed the members of the association to the March meeting at 9:00 am. Thirty-seven members were present at that time, which did not constitute a quorum; therefore the meeting proceeded as an Executive Committee meeting. Attendance would be monitored to determine if a quorum was reached during the meeting. (See attachment for attendance roster).

Fellowship

Danny Staley, Region III Representative, provided the fellowship.

Approval of the Minutes

The minutes of the February 2003 meeting were posted on the web site, ncalhd.org. Motion: The February minutes are approved as posted. The motion was seconded and approved unanimously.

Treasurer's Report

Secretary Elaine Russell presented the Treasurer’s report with balances as of February 25, 2003. Account balances were as follows:

• Checking: $42,929.43
• Savings: $36.27
• Money Market: $361.77
• CD: $40,000.00

Elaine reported that the CD was renewed for another 6-month term at a rate of 2.25%.

Bioterrorism Preparedness--Jim Kirkpatrick

Dr. Kirkpatrick provided a to-date summary of the smallpox phase one for NC. Thus far, 765 vaccinations have been administered: 320 public health employees, 445 hospital connected employees and physicians, and 6 government investigative agents. Only 1 adverse event has been reported for the pool. A public health employee experienced a rash-like outbreak, but recovered completely without medical intervention. Two days of missed work have been reported. Twenty-two hospitals will be participating in phase-one. Dr. Kirkpatrick reported that the continuing deterrent for participation is the issue of compensation for an adverse reaction. Ownership for the compensation issue has finally begun to emerge at the federal level. Legislator Waxman introduced a bill, which has the federal government assuming full responsibility, from the onset of illness. The bill also includes provisions for the purchase of safer needles and the protection of volunteers. The initiation of Phase Two has been approved at the federal level. However the issues of compensation and logistics remain unresolved. Therefore the states have not rushed to initiate Phase Two. In North Carolina, 90% of the firefighting force is voluntary. For voluntary manpower, the issue of compensation for adverse reaction must be resolved prior to a participation decision. Dr. Kirkpatrick also provided an update on the Health Alert Network (HAN). As of the meeting, 55 local health departments had signed-on. The importance of maintaining a local health department representative on-call 24/7/365 was discussed. In today’s society, public health is expected to be accessible at all times. The status of the SARS epidemic was the next point of discussion. Worldwide to-date, 264 cases have been identified with 11 deaths noted. The North Carolina counties of Wake and Orange each have a suspect case as a result of international flight contact. The current theory is one of a paramyxavirus virus origin. This particular virus is known for the ability to “jump species.” Should a suspect case present to the local health system, the standard CDC interview form should be utilized. The PHRSTs are available as back up. In conclusion, Dr. Kirkpatrick discussed the funding streams currently associated with bioterrorism. The CDC grant will end in August of this calendar year. A new grant request of $9.4M will be presented at the end of June, chemical and radiological preparation are partial elements of the grant. The importance of the PHRSTs, HAN, and local preparedness plans are central to all endeavors of the Division.

President's Report--Jim Baluss

Jim opened his remarks by recognizing the newly appointed Health Director for Madison County, Mr. Buck Wilson. He extended his thanks to all committee chairs and their participants for their work to-date. Jim provided an overview of Joy Reed’s “Access White Paper” which will be of great benefit to local agencies for the initiation of the Access II/III model this year. A strong reminder was also shared regarding the extensive access held to the LHD list-serve. Not everyone that receives the list-serve shares the local perspective. Therefore it is prudent to reflect on who will receive material and comments posted. It is not an appropriate venue to brainstorm and vent, please use the message board for these endeavors. An additional public health leader list serve is being developed. In closing, Jim read a letter of thanks from Senator Purcell for his recognition as our Legislator of the Year.

State Health Director's Report--Dr. Leah Devlin

Leah opened her remarks with a discussion of the on going funding necessary for bioterrorism. Information regarding the cost settlement was provided, with the reminder that all information shared is still pending. The Division submitted reductions totaling $12M, the response to the submission reflected a $13M reduction. She also detailed the work of the PCG consultants that will be reviewing Medicaid expenditures to determine what, if any, administrative costs can be billed. Leah also discussed the importance of local agencies becoming involved with the Access II/III rollout. The white paper provided by Joy Reed will be of benefit to local agencies in this endeavor. Provisions for indigent care must be considered in this evolving model. During her recent trip to Washington, DC, Leah detailed to Secretary Tommy Thompson the necessity of providing bioterrorism funding to the local level, the critical nature of resolving the smallpox compensation issue, the impact of increasing chronic disease funding by $135M and the growing need to examine HIV/AIDS allocations based on the emerging trends in infection in the South. She was also pleased to announce the June 1st appointment of Linda Sewell as the Green County Health Director. However, this transition highlights the growing trend of loosing public health “bridges” within DENR. The necessity of strengthening communications with Bill Ross and Dempsey Benton were a major point of discussion. She also provided a follow-up to the “Goodness of Fit” letter that remains at the Secretary’s office. The Division will continue to work with the Secretary’s office to facilitate the release of the letter to local health directors. With regard to the growing emphasis on school health, Leah discussed the April 22nd “Leadership Summit” which was designed for local health directors and school system superintendents. The Summit is meant to showcase exemplary work in the advancement of school health issues as supported by administration. She also noted the $2.5M recommendations in support of school nursing and chronic disease education as being further support for this work. The emerging role of public health accreditation was discussed. Leah noted the role of legislative support for the initiative, but recognized the necessity of good timing in relation to our preparedness for the issue. Total consensus on the matter is probably not a realistic goal. The Spring Conference will be a good opportunity to review and update the issue. With regard to environmental health, numerous parties are emerging to contest the proposed legislation for the privatization of on-site wastewater. However, we must remain vigilant on the matter. In closing Leah provided several remarks on fiscal matters. The Controllers Office has dropped the 1/12 payment standard and will adopt a payed-as-billed standard for State funds. Medicaid has rescinded their decision to reimburse for parenting.

Committee Reports (action items)

Women and Children’s Health -- Wanda Sandele

Wanda discussed the work of PCG consultants Thomas Aldridge and Kevin Coil. PCG will work to recover the administrative cost for the delivery of Medicaid services. Allowable administrative costs consist of seven pages of information therefore the potential is significant. Recovery is based on the federal match portion of Medicaid. A random moment time study will be piloted as the recovery tool. Motion: To actively support and participate in the Medicaid Administrative Match Project by a) assisting in developing the survey tool required and b) completing the random moment time study. Use of income should be reviewed and consented on by the Health Directors Association. The motion was approved unanimously.

Epidemiology -- John Morrow

John discussed the emerging importance and use of the HAN system throughout the public health system. NEDDS, when available, will also be a part of this system. Dr. Engle has provided the business rules necessary for HAN to be fully operational. To achieve this standard, it becomes necessary for all health departments to be accessible 24/7/365. The action alerts generated by HAN require a response to the system. Test alerts will be used to monitor the system. Motion: All LHDs participating in HAN must have 24/7/365 coverage. The motion was approved unanimously.

Committee Reports (information items)

Epidemiology -- John Morrow

John provided an overview of several topics. Flu surveillance data show the State as past the peak of infection. The calendar years of 02 and 03 mirror in infection and timing trends. With the emerging crisis of SARS, the CDC serves as the center of operations. The PHRSTs continue to work with the “Pre-Event Vaccination System” for data collection for the CDC. The time necessary for total data input has been a concern. The National Pharmaceutical Stockpile (NPS) has been renamed as the National Strategic Stockpile. Updates on the resource will be forthcoming. The early pilot of NEDDS in NC did not yield promising results. The State is now looking at comparable software being utilized in Georgia and Florida. As of March 3rd with open enrollment, 200+ were on the ADAP waiting list. The cost of medications is a serious concern, with some therapies costing $20,000 per client.

Women and Children's Health -- Wanda Sandele

Wanda briefed the group that Duncan Munn provided an update to the committee on the DEC/CDSA transition. It is important for LHDs to become involved with the local DEC/CDSA now in preparation for the transition that is slated for certain counties July 1, 2003, and the remaining counties on July 1, 2004. Opportunities for providing Early Intervention Case Management, Community Based Services and Nursing Services exist. However, LHDs need to be aware of credential/training requirements to emerge as viable service providers.

Technology -- Jerry Parks

Jerry shared that two presentations were made on Environmental Health software. The IBEAM product is actually a framework of DENR databases being assembled via Betsy Clayton. Daycare inspections are the first component of IBEAM. The system is not “live” at this time. The proprietary product by Garrison is being pursued by Mecklenburg. The Garrison presentation will be detailed under Environmental Health.

Standards and Efficiencies -- Tim Green

Tim reminded everyone that the work of the committee will be the focus of the Spring Conference. A notebook of best practices will be provided. Credentialing will also be a point of discussion.

Policy and Planning -- Mimi Cooper

Mimi discussed how Senator Purcell has emerged as an advocate for the issue of Medicaid coverage for pregnant teenagers. The inclusion of parental income has become a barrier to care for teenagers. Senator Purcell has also advocated for the protection of children in daycare through a mandated “back-to-sleep” position and restrictive policies on the administration of medications in daycare facilities. A misconception in the legislature is that LHDs may not be aggressive in prosecuting HIV+ violators under the law. Health directors should take any opportunity to correction this misperception.

The Alliance -- Barry Bass

Barry reported the staffing agency is in need of a registered nurse for the area east of Hwy. 220, please forward all interested parties to the Alliance. A 3-year Board term is available. Please contact Barry with any interest in serving.

Environmental Health -- David Rust

David provided reported that the Garrison product contains numerous impressive features and is very user friendly. The product has not downloaded to DENR at this time. The issue of on-site privatization continues to be pushed aggressively by the private sector to the legislature. Another piece of legislation has emerged that would delegate authority to local supervisor for local authorization. This legislation creates several issues of significant liability. The draft of Summer Camp Rules will be issued this spring. Will Service has drafted protocols for shipping materials and the associated liability and coverage. David closed with a request to all LHDs to become more involved with Environmental; many critical issues are on the table with the legislature. This is also a time of loosing our established bridges with DENR due to numerous retirements.

State and Local Relations -- Don Yousey

Don discussed the importance of connecting with DENR administration. Scheduling a meeting with Bill Ross or Dempsey Benton to discuss reunification and the replacement of Linda Sewall is imperative. Communication must be pushed from our side.

Liaison Reports

Executive Director -- Deb Rowe

Deb provided an overview of emerging legislative issues. The Joint Appropriations Committee needs to be educated regarding the impact of Medicaid reductions. The House Budget will emerge from Appropriations on April 17th. Further work on the cigarette tax will have to be grassroots for any hope of success. Deb reminded everyone of the necessity to look at e-mail communication with a critical eye on commentary. Due to public access laws, e-mail is a matter of public record and numerous individuals outside the public health arena receive our list-serve. Venting and speculation can be misconstrued and damaging.

NC Medical Society -- John Morrow

John discussed how the issue of medical liability has become a significant barrier to recruitment and retention of physicians in the state. Tort reform is being pushed with the legislature as means of combating these emerging issues.

Nutrition Society -- Louis Latour

DLouise reported all counties over their caseload will receive additional funds this year. Reimbursement will go from $7.80 to $7.90.

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 12 noon.

Respectfully Submitted,

J. Elaine Russell, MPH
Secretary-Treasurer