Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

June 19, 2003

Wake County Human Services Building
Raleigh, NC

Call to Order

President Jim Baluss welcomed the members of the association and guests to the June 19th meeting at 9:00 am. Fifty-eight members were present at that time, which did constitute a quorum. Therefore the meeting proceeded as a full association meeting. (See attachment for attendance roster)

Fellowship

Glenn Martin provided the fellowship.

Approval of the Minutes

Due to a late website posting by the Secretary, the approval of the minutes for the May meeting will be deferred to the July meeting.

Treasurer's Report

Secretary Elaine Russell presented the Treasurer’s report with balances as of April 27, 2003. Account balances were as follows:

• Checking: $31,179.51
• Savings: $36.41
• Money Market: $363.70
• CD: $40,000.00

President's Report--Jim Baluss

President Jim Baluss introduced special guests Speaker Black, Senator Hartsell, Secretary Hooker Odom, Deputy Secretary Bernstein and Linda Attarian. The meeting would open with their discussion of the intent surrounding Senate Bill 672 : Strengthen Public Health Infrastructure.

Speaker Black: As an optometrist, he has a great deal of interest in public health. He wants to ensure the bill receives the attention it deserves in the House of Representatives.

Senator Hartsell: The bill is a result of project of a team from the Institute of Public Health. In addition to himself, John Shaw and Linda Attarian comprised the team.

Ms. Attarian: The intent was to have this endeavor as a grass roots bill, but unfortunately it emerged as a bill first and subsequently worked back through the local health directors.

Secretary Hooker Odom: It is necessary to move forward. The Executive Committee of NCALHD has spoken in the past with this office regarding needed changes, an accreditation process being among the changes. Public health has in the past not had a champion in the legislature and now that advocate exists in Senator Hartsell. Thanks to the work of Ms. Attarian and Senator Hartsell, we also have a bill that starts reform and has local public health as the driver. The indicated timeline is appropriate, but public health should be leading the effort. This process has 100% support from her office.

Dr. Devlin: Public health has a champion in Senator Hartsell. His work in Cabarrus County speaks to his history of advocacy. The fact that public health is being debated by the legislature, along with many other important issues, is extremely important and speaks to their interest in the profession.

Deputy Secretary Bernstein: To date he has spent 30 years facilitating change at the local level. He looks forward to working with this change.

Senator Hartsell: As of five or six years ago, he had no interest or knowledge in the area of public health. Then he began working with Fred Pilkington on public health restructuring in Cabarrus County. He also has a son that recently received a MPH from UNC-Chapel Hill. The bill is a team project, which has had fits and starts at the local level, however the “Turning Point Model Bill” emerged as the guiding template. The bill is not based on the mental health reform model, although there are similarities. Collaborative efforts are essential now in any health care delivery system. How do we use the resources we have in a better way. Simply create a set of standards, with a goal of availability and consistency. It is necessary for all parties to become involved in the change. There has been growth in budgets due to Medicaid, but the private sector is quickly consuming that growth. Public health cannot continue to do business the same way and be successful, and offer standard services. Although consolidation is out of the bill, it may still need to happen if we are to be successful. We need to think in new ways. For example, in the Cabarrus Public Health Authority, the local hospital administrator was placed on the Authority Board. It raised concerns at the time, but it has been successful. The intent is not to privatize public health, but to have the public drive the process through their expectations and knowledge. The bill is not prescriptive, but should drive change. Collaboration is essential. Many County Commissioners will cite an increased cost as a result of this bill. Currently, there are two Access III pilot programs. The results, due to collaboration and trust, have lowered Medicaid costs in Cabarrus in one year. The plan is set-up to accomplish that, sometimes with a carrot and sometimes with a stick. This bill is a study with legs.

The guests opened the floor to questions and comments from the association.

Wanda Sandele (Craven County): Please don’t expect the private sector to pick-up the populations served by public health. The implementation of Access III has been a hit/miss endeavor. Public health was not included in the beginning of the Access III process and the hoops/barriers to current and on-going participation appear to be unending.
Senator Hartsell: He hopes this process places us ahead of the game. The intent is to decrease emergency department usage by building better use of the public health system. The Medicaid costs and mental health reform have had a significant impact on this matter.

Jenny Lassiter (Pamlico County): Pamlico has accomplished the cited collaboration on numerous fronts, access to maternity care, pediatric care, childhood dentistry, and epidemiological collaborations to name but a few. Furthermore, she would encourage statewide representation on the State Steering Committee, coastal, middle and mountain should be represented.

Secretary Hooker Odom: She thanked Jenny for her input and encouraged her participation in the referenced committee.

Dorothy Cilenti (Chatham County): She spoke to the role of current planning endeavors and questioned how that would fit with the intent of the bill.

Ms. Attarian: It will not be necessary to abandon or reconduct current planning endeavors.

Mike Hanes (Lee County): Public health is 1% of the overall budget in the large scheme; therefore funds are an obvious struggle for all counties. It will be necessary to create an incentive for working with the poor more disenfranchised counties.

Senator Hartsell: He has not worked through that level of detail at this time.

Bill Smith (Robeson County): The local financial burden of the Medicaid match is a fast emerging issue. Medicaid match significantly reduces the funds left from the local tax base that are available for allocation among county agencies. This is a looming threat for all parties anticipating any use of those dollars. Economic development packages associated with something such as an increased cigarette tax are potential solution to this very complicated matter. It would benefit public health, local communities, and the state.

Speaker Black: The Legislature will be more inclined to find resources if health directors have a plan. We need to move forward if we are to save public health. Thankfully, this is not viewed as a partisan issue.

Secretary Hooker Odom: She thanked the group for their work, but indicated the need to return to the Legislature for pending business.

George Bond (Buncombe County): He reiterated several points for collaboration and Access III advocacy, and identifying supporting funds for the goals of the bill. He also emphasized the importance of reunification for health services and environmental services under a single secretary. The best public health is delivered from a unified system with common goals and objectives of serving and protecting the health of the public.

Jerry Parks (Albemarle District): He cited the current success of the epidemiology work being conducted by former Tier I counties. The work is being conducted with newly identified funding. This is an example of current work advocated by the bill.

Roddy Drake (Granville-Vance): Currently, 1% of the budget is allocated to public health. Different health departments have different needs; therefore a uniform approach may present certain challenges. It is readily apparent that communicable disease and population-based services are in desperate need of new allocations.

Senator Hartsell: Our current funding system is antiquated in relation to current public health needs.

Tim Green (Alamance County): To date, eight studies have been conducted to assess the future of public health, but nothing has been resolved or planned in relation to funds for the future of public health. Public health is the provider of last resort; however, don’t expect counties to accept the bill by default.

Senator Hartsell: Resource allocation and reallocation must be addressed with this bill. North Carolina has been a leader in the nation for the delivery of public health services. However, local health directors are not noted for their flexibility on the issue of structuring and delivery of services.

Tom Bridges (Henderson County): We cannot allow other disciplines and entities to define public health. That has happened too much already. We must participate with this process and form it to suit our needs and goals.

Steven Keener (Mecklenburg County): One ounce of prevention is worth one pound of cure; we should work with this process to make the most for local public health.

Senator Hartsell: He is supportive of a per capita allocation for local public health. Furthermore, collaboration must occur beyond the local health department and county commissioners. It must include the community and health care delivery system. Together we can work through the details of this process.

Jim Baluss (President/Edgecombe County): He thanked the remaining guests for their time, interest and commitment to public health and its future.

President's Report Continued

Jim noted that the following Health Directors would be representing the association on the “Health Disparities Taskforce”: Mike Hanes, Dorothy Cilenti, Wanda Sandele, and himself. Bill Smith has agreed to represent the association on an upcoming Medicaid committee.

Executive Director--Deb Rowe

Deb reported that H1094, which reaffirmed Board of Health authority, was not successful in getting out of committee. Representative Justus was a tremendous advocate in very difficult circumstances. A letter of thanks and a bouquet of flowers were delivered on behalf of the association. Deb encouraged everyone to acknowledge the courageous stand Rep. Justus took on this matter. Bill Smith noted that we are often lacking in our acknowledgement of our advocates and champions in the legislature and throughout the system. This is a trend we need to correct

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

Report waived due to time constraints.

Dennis Harrington

Dennis introduced the team from PCG. They provided a brief overview and answered questions related to the training for the Random Moment Time Study, which is the basis for the reimbursement claim. A MOU will be forthcoming from DMA to each of the local health directors. All MOUs must be signed and returned for the process to begin. The requirement to attend the Random Moment Time Study teleconference training is a reflection of a CMS standard. CMS will not allow a “train-the-trainer” dynamic at this juncture. That may be an option in years to come. The Random Moment Time Study will be on going; the size and scope will change with time. The start-up is the difficult part, however ways to streamline the process are always being considered.

Office of Public Health Nursing--Joy Reed (see attachment)

Bioterrorism Preparedness--Steve Cline

Steve reminded everyone that Year Three of federal bioterrorism funding is drawing to a close. The RFP for Year Four is due July 1st. The North Carolina RFP has been completed and is awaiting the Secretary’s signature for submission. Priorities for Year Four will include continued support for the PHRST concept/staffing and aid to local health departments. Additional priorities include 3 pharmacists to coordinate policy and planning related to the Strategic National Stockpile (SNS), support for smallpox planning and preparedness, and the funding for a public health position to each of the 7 RACs across the State. No decision has been made at this time to move toward Stage 2 of smallpox vaccination. In conclusion, he noted that Epidemiology and Technology would be meeting jointly on July 16th at 1:30pm at St. Mary’s.

Health Promotion/BCCCP--Diana Bradshaw

The CDC has been placed on a performance-based budget; therefore they have been forced to address with NC the failure of the BCCCP Program to meet its target numbers. The Division has reviewed the numbers served per agency in relation to the agency’s contracted number. The counties that had not served their contract numbers received a reduction in their BCCCP allocation. The program staff from Raleigh is available to work with any county experiencing difficulty in the administration and delivery of the program. The Division is hopeful of revisiting the funding cut with the CDC in the coming year to re-establish the cut funding. The majority of the funding cut was absorbed at the Division level. (See attachment).

Committee Reports (action items)

Policy and Planning -- Mimi Cooper

Mimi led a discussion of the changes that have occurred with S672. The input of the guests was extensively debated. Motion: The NCALHD supports S672 with its most recent changes and requests that new or existing funding be found to support implementation. An amendment to the motion was made and seconded. Amendment: In the motion from committee, the phrase “be found” will be replaced with “shall be appropriated.” The amendment failed with a vote of 28 (no) to 25 (yes). The motion from committee was passed with a vote of 51 (yes), 1 (no), and 1 (abstain). (See attachment)

Women and Children's Health -- Wanda Sandele

Motion: The NCALHD will support participation in a federal survey related to the Universal Vaccination Supply. The motion was passed unanimously.

Committee Reports (information items)

Epidemiology -- John Morrow

John reported the committee met via conference call. He referenced Steve Cline’s summary of the bioterrorism grant activities and noted the submission of the Year Four RFP. The first WNV positive bird has been identified in Macon County. The State lab will begin receiving birds for testing. The eighth lab confirmed SARS case (resided in NC) potentially exposed 300 in their worksite. The death certificate for a deceased contact to this case is still pending. John also addressed the concerns related to the release of potential monkey pox carriers into the wild. This is a situation all parties are trying to avoid. In conclusion, he reminded everyone that passwords must be renewed if interaction with the HAN system is greater than a 30-day timeframe. (See attachment)

Women and Children's Health -- Wanda Sandele

Wanda reported that the Family Planning waiver might have hope of finalization by January 2004.

Education and Awards -- Scott Harrellson

Scott reminded everyone of the pending deadline for nominating the Health Director of the Year. Please email your nominations to Deb.

The Alliance -- Barry Bass

Barry reported that the Alliance would hold it’s annual meeting at the conclusion of the NCALHD. Meeting.

Marsh and Associates -- Terrie Snowden

Terrie presented the final bids from C.N.A. and A.C.E. for medical malpractice renewal. She provided an overview of their comparability. Motion: The NCALHD will accept the “Renewal ACE Medical Risk – Non Admitted” on the terms presented in the written bid. The motion was seconded and passed unanimously.

Task Force on Standards and Efficiencies

Final information reports were provided by the committees with the reminder that a vote will be taken in July related to the process of accreditation. (See attachments).

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 1:30 pm.

Respectfully Submitted,

J. Elaine Russell, MPH
Secretary-Treasurer