Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

May 15, 2003

Wake County Human Services Building
Raleigh, NC

Call to Order

President Jim Baluss welcomed the members of the association and guests to the May 15th meeting at 9:00 am. Thirty-five 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

Barry Bass provided the fellowship.

Approval of the Minutes

The minutes of the April meeting were posted on the web site, ncalhd.org, and approved as posted.

Treasurer's Report

Secretary Elaine Russell presented the Treasurer’s report with balances as of April 28, 2003. Account balances were as follows:

• Checking: $33,303.25
• Savings: $36.36
• Money Market: $363.12
• CD: $40,000.00

President's Report--Jim Baluss

President Jim Baluss reported on the leadership meeting held with Senator Hartsell to discuss S672. He also reported on the leadership meeting with Secretary Ross of DENR. A future, and on-going guest, will be Patrick McCoy of State Personnel. He will provide updates to emerging issues with the State Personnel Act. Jim also addressed the planning for the January 2004 State Health Director’s Conference. The topics of accreditation and health disparities are under consideration. Please forward any comments or ideas for the conference to the Education and Awards Committee. In working to address health disparities, Jim has met with Barbara Pullen Smith to discuss mentoring and management issues. In closing his remarks, Jim introduced the guest speaker from ECU.

ECU MPH Program--Chris Mansfield

Jim Baluss and Wanda Sandele were recognized as serving on the advisory committee to the new Masters of Public Health program at Eastern Carolina University. The program is organized as a division within the Family Medicine Department and will contain tracks for Health Education, Environmental Health, and Public Health Research among others. A candidate search is underway for the Program Chair position. A health director noted the need for more dentists and dental hygienists. Mr. Mansfield acknowledged that a market survey showed a need in a variety of health-oriented disciplines. In closing he provided the program’s website: www.ecu.edu/mph.

Executive Director--Deb Rowe

Deb encouraged all health directors to advocate quickly with their legislators on budget issues. Current points for advocacy: maintain $1M in TANF funding, maintain $1.5M in APP funding, eliminate increased fees for pap smears, and maintain Medicaid eligibility at 185%. She also encouraged health directors to submit applications for the Glaxco Smith Kline Child Health Recognition Award. In closing Deb announced Colonels Jerry and Nancy Jaax would provide the Wood Lecture at NCPHA in September. Their story is the inspired the movie “Outbreak” and plays a leading role the bestseller The Hot Zone.

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

Leah opened her comments by introducing the revised White Paper for Access II/III “Community Care of North Carolina: Roles of Public Health Departments in the Access II/III Networks.” (see attachment). The change in leadership at DMA was the next point of discussion. Nina Yeager will leave June 1st, to be replaced in the interim by Gary Fuquay. Leah shared that she was serving on the search committee for the new director, with applications set to close on May 16th. She next provided an update on the School Health Matrix Team. The Matrix Team continues to evolve and will provide a training conference in June covering tobacco free schools, nutrition policies, and school health advisory committees. It was determined that locals did need a chance to negotiate related deliverables. Leah also reminded local health directors to return the CBO survey distributed earlier in the spring. With regard to upcoming grant opportunities, the “Steps to Healthier US” has a letter of intent due June 1st. The grant addresses chronic disease prevention. Janet Reaves is the contact person for the grant. The CDC Bioterrorism Grant is due July 1st. In closing she noted that 1,300 healthcare professionals have been vaccinated in NC. The State will not begin to explore Stage 2 vaccination until the CDC grant has been submitted.

Dennis Harrington

Dennis reminded everyone to submit expenditure reports in a timely manner. There will be no state carry forward this year. With regard to current bioterrorism dollars, Dennis will seek clarification on allocations awarded FY03-04 to some counties from the current funds. The clarification will determine by what point in FY03-04 the funds must be encumbered. In closing Dennis encouraged the public health family to recognize the major supports of public health in other agencies at the time of their retirement.

Office of Public Health Nursing--Joy Reed (liaison report)

Joy opened her remarks with news that parenting classes can no longer be reimbursed by Medicaid per directive of CMS. The Division is attempting to have the component incorporated to the childbirth series. A train-the-trainer will be provided at NCPHA for “Dispensing for Public Health Nurses.” In closing Joy responded to a request for an update on the Family Planning Waiver. Our proposal has been shifted from the regional to central federal contact. The turnover at DMA has slowed the process to some extent, but fortunately no deal breakers have been identified at this time. (see attachment).

Marsh and Associates--Terrie Snowden

Dennis Terrie provided an overview of the medical malpractice costs and options facing local health directors. Currently, 72 of the 86 local administrative entities participate with her company. Our profile was submitted to 15 markets. C.H.U.B. declined to bid. Medical Mutual also declined to bid. C.N.A., although a good partner in the past, changed their limit from a $25M umbrella to a $10M umbrella for the $1M and $3M coverage differential. A.C.E. offered a $10M umbrella, with a $15M aggregate on the primary. The price, in this case, will be acceptable. However, the terms of the contract will be far less. In the course of 12 years the loss ratio for Association participants has been 1.8% ($152,000), which is outstanding. Those claims have been associated primarily with jail health. Given the recent market changes, Terrie strongly recommended the group look at a self-insured approach. Reinsurance would be sought beyond the self-insurance coverage. Marsh or the insuring partner can serve as the escrow agent. Terrie also discussed moving from a July 1 to an October 1 start date for fiscal planning purposes. This would require a long/short term contract. Motion: Allow Terrie Snowden to negotiate for the best deductible and premium increase in accordance with the best possible future insurance product, given current trends, for presentation to the Association. The motion was seconded and approved unanimously.

In closing, there was a discussion of whether Marsh would serve a Business Associate under HIPAA, after extensive debate, the question was referred IOG and Francis Taylor for further clarification.

Committee Reports (action items)

Policy and Planning -- Mimi Cooper

Mimi provided an overview of the leadership meeting with Senator Hartsell. Motion: The NCALHD will issue a letter to Senator Hartsell outlining the points of opposition and consensus held with S672. The motion was approved unanimously.

Committee Reports (information items)

Standards and Efficiencies Task Force -- Tim Green

Tim reported that the group would meet again on June 3rd and June 18th. The “Best Practices” workgroup will meet in the coming week to review a draft of their report. He thanked the committee chairs for their work and involvement throughout the process. The final recommendations will come from the Task Force in June, with a final vote slated for July. Given the presence of accreditation in proposed legislation, it is imperative for Health Directors to remain involved in the process. Barry Bass provided an update on the work of the “Accreditation” workgroup. (see attachment)

Epidemiology -- JohnMorrow

John reported that eight suspect cases of SARS have been identified in NC at this time. Good staff education is critical to handling this emerging infectious diseases issue.

Technology -- Jerry Parks

Jerry reported that due to building complications, the committee met under the oak tree picnic tables at St. Mary’s. A presentation was made by in relation to the work of Dr. Spicer at Duke for his electronic database for syndromic surveillance. A joint meeting with Epidemiology is anticipated in the future.

Policy and Planning -- Mimi Cooper

Mimi reported that Senator Stevens bill S927 will be heard on the upcoming Tuesday. The Home Builders Association has been a strong ally on this bill. The bill seeks to grandfather in current on-site wastewater installers, but would require licensure for all new entrants to the field. Work conducted on homes owned by the installer would be exempt. The bill sponsored by Representative Justus would restore authority to local Boards of Health regarding animal operations. The bill should appear in the Health or Environmental Subcommittee. House bill 916 would offer, but not mandate, the provision of vaccinations to First Responders. The verbiage of the bill would allow for a fee to be established.

The Alliance -- Barry Bass

Barry reported that the Alliance would be meeting at 12:30 following the current meeting. Dues have been reduced from $500 to $250 annually.

Environmental Health -- David Rust

David reported a 3-_ hour meeting that dealt extensively with the adoption of the FDA food code by the State. The code is based on HACCP and deals with the risk associated with various foods and food preparation processes. The level of risk dictates the frequency of inspection, high-risk results in more frequent inspections. The code contains an index and appendix. There is a cited scientific reason for every rule of the code. The code is currently available in 21 languages. Currently 41 states have adopted the FDA food code. Catawba County served as a pilot for the code in NC. Training is scheduled for October. In closing, David cited the BRAT training that is available through the Radiation Protection Division. Mike Kelly will serve in Linda Sewall’s capacity until her replacement is hired. The anticipated follow-up meeting with Secretary Ross will occur in October.

School of Public Health

Ed Baker is the new Director for the NC Public Health Institute. He will be the Institute’s first full-time appointment to the position. Please continue to contact Teme Levbarg for Board of Health trainings.

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