Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

November 20, 2003

Wake County Human Services Building
Raleigh, NC

Call to Order

President Jim Baluss welcomed the members of the association and guests to the November 20, 2003 meeting at 9:00 am. A count was taken of health directors present and a quorum was not met at the time of the headcount to hold a full association meeting; therefore, the meeting proceeded as an Executive Committee Meeting. (see attachment for attendance roster)

Fellowship

Dr. John Morrow delighted the audience with “real-life” humor found in the aftermath of Hurricane Isabell.

Approval of the Minutes

Ms. Deborah Rowe, Executive Director, reported that the minutes of the October meeting were not available for review/approval. Ms. Elaine Russell, Secretary-Treasurer, was unable to attend the meeting due to unexpected demands in her role as Cherokee County Health Director. She requested that review/approval of October minutes be postponed until the December, 2003 meeting.

Treasurer's Report

Ms. Rowe presented the Treasurer’s report with balances as of October 27, 2003:

• Checking: $14,918.34
• Savings: $36.66
• Money Market: $366.76
• CD: $40,000.00

A motion was made by Dr. John Morrow, seconded by Dr. Louis Latour, to approve the Financial Report. All votes affirmative.

Announcements--Mr. Jim Baluss, President

President Baluss announced that Ray Rabe, Iredell County Health Director, was on medical leave. He introduced Dr. Ed Baker as the Director of the North Carolina Institute for Public Health. Mr. Baluss also announced that the Public Health Task Force meeting held on November 19, 2003, was very successful. Several legislators attended the full day session. The issue of reunification of Division of Public Health and Division of Environmental Health was discussed with the assistance of several health directors and was well received. Mr. Baluss encouraged all health directors to attend Task Force meetings.

Executive Director--Deb Rowe

Ms. Rowe reminded the audience that December 1, 2003 is the deadline for the Legislator of the Year Award and Public Health Partner Award. She announced that the nominations for the Ham Stevens Award were closed.

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

Dr. Devlin reported a successful Great Faith Conference. The Department will be working on faith initiatives with minority churches to help eliminate health disparities and will be in discussion with Kate B. Reynolds for possible funding. Dr. Devlin reported that Syphilis rates have decreased by 60%. She reminded everyone of the upcoming State Health Director’s Conference to be held the end of January.

Dr. Devlin echoed Mr. Baluss’ review of the success of the Task Force and thanked those involved in the formation and continuation of the task force. Dr. Devlin announced that the PowerPoint presentation given by Mr. Lanier Cansler, Deputy Secretary, would soon be available on their website and would be forwarded to all health directors via email that week. This presentation provided an excellent overview of the funding stream of public health dollars. Mr. Dan Gerlach, Financial Advisor for the Governor, reported an improvement in the state of the economy at the Task Force Meeting. The announcement for the next Task Force meeting will go out on the “lhd” listserv so that everyone will be aware of the meeting. Dr. Devlin asked that each committee of the task force give a report to the association.

Accreditation--Dr. Joy Reed

Dr. Reed ensured that legislators were aware that accreditation plans were already in progress before the formation of the Public Health Task Force in her report to the Task Force on the work of the Accreditation Committee. The Committee has been divided into three work groups: Assessment, Assurance and Policy Development. Dr. Reed announced that six pilot counties have been selected to participate in the accreditation process. Three staff members from the Division of Public Health will be assigned to help these counties in the process. A report on Accreditation will be presented to the Task Force in April, 2004. Nominations for site visitors and Accreditation Board members are being sought. (see attachments)

Planning and Outcomes--Dr. Steve Cline

Dr. Cline stated that there are three subcommittees: Assessment, which evaluates existing tools/activities and identifies gaps and makes recommendations; Integrated Planning, which evaluates present planning process and design new process combining program areas and state/local integrated planning; and Outcomes/Priorities which identifies existing gaps/problems that have public health solutions for possible legislative initiatives. Dr. Cline stated that the accreditation system will drive local health department organization. There may be possible incentives for districting, etc.

Accountability--Dr. Ed Baker

Dr. Baker reported that this committee is looking at indicators for health status and Best Practices.

Workforce Development

This committee has been charged with reviewing the current training and development opportunities and make recommendations for improvements to strengthen the core competencies of the workforce.

Structure and Organization

Chris Hoke and Dianah Bradshaw co-chair this committee that is charged with identifying the optimal structure and relationship of both state and local public health agencies.

Finance

This committee is charged with identifying strategies to develop and sustain funding for the public health infrastructure. This committee is reviewing current funding streams and identifying which funds are restricted categorically and what other funding sources may be available.

Local Technical Assistance and Training Branch--Dr. Joy Reed

This Dr. Reed reported that the Random Moment Time Study hopefully will generate approximately $4 million per year. The first claim is planned to be submitted in January, 2004. There will be another training via PHTIN on December 10 for any staff who are new or missed both the June and August trainings. They are actively working on back billing issue. The claim does not need back up documentation for time. There has been no decision made as to the disposition of money.

An analysis was performed on dental rates. There will be an approximate 5% increase in dental rates for local health departments using the recent lawsuit rates. Three health departments would lose less than 1% of their current rates.

The question was raised as to the requirement of attendance of health directors at the monthly NCLAHD meetings. Dr. Reed stated that the data collection for Long Range Planning was independent to the Accreditation standards. This data collection was used as an education tool for legislators as to the current leadership activity of local health directors. The 50% participation in NCALHD meetings IS NOT part of the Accreditation Standards. (see attachments for full report)

Committee Reports (action items)

Women and Children's Health -- Wanda Sandele

Contract Addenda were reviewed for the coming year with no surprises. There is a stipulation that if your Family Planning Workload falls below target by 5% or better for two years in a row, funding may be cut by 5% for the following year. This is because the funding the state receives is based upon workload. There is a DMA requirement that will address vacancies in CSC positions. If a position is vacant for three months, the state will assist you in recruiting for the vacancy. If the position remains vacant for six months, other providers in the community would be offered the opportunity to provide the service. In Family Planning, you may write a prescription for folic acid vitamins for patients with Medicaid and use your funding to provide the vitamins to patients who are uninsured and low income.

Motion: Recommend acceptance of WCH addenda as presented. The motion was approved unanimously.

Committee Reports (information items)

Epidemiology -- John Morrow

Dr. Morrow provided an arboviral update. The Arboviral Core Team met in November to discuss dollars spent on testing. To ensure that enough resources are available for human testing, the team recommended that no dead bird testing be done next year. It was suggested to notify the public of this change. The State Veterinarian Department will not provide Epi with information on arboviral. Vets will still be notified; however, health directors will need to have close contact with their local veterinarian to get local information. It was suggested that this information could be shared through the Health Alert Network.

The BT Triple Play Phase 2 exercise went well. The Phase 3 (Isolation/Quarantine) will be a table-top exercise to be held December 11, 2003. Results will be available via PHTIN on December 19, 2003. Aid to County funding for BT funding was sent out. Ensure you have enough funds budgeted to carry you through July and August. 2005 funding is not expected to decrease. It was requested that a clearing-house for BT Coordinator job descriptions and RFP’s for contracts be developed.

A committee is being formed to review the future of State Laboratory of Public Health testing pap smears. Anyone interested in serving on that committee should contact Dr. Morrow. The State expects to have a “brisk” flu season as cases have already been reported. This is early compared to previous years. The antigenic drift of the Type A Fuji variant has been diagnosed in other states and is expected to account for the majority of cases that North Carolina sees. The state has no plans to purchase the FLUMIST nasal vaccine this year as the cost is prohibitive. A draft of the State’s SARS policy will be reviewed by the Epi Committee and a final version should be available January, 2004. The CDC’s SARS policy can be reviewed on their website.

Women and Children's Health -- Wanda Sandele

An RFP will come out in December for Targeted Infant Mortality grants. For a number of years these funds have gone to the same eight counties, and now this will be open to the competitive process. There will be training related to this RFP during the first week in January. A request is also coming out for nominations for an award for a Superintendent of Schools for efforts in school health. Please submit nominations. This bi-annual survey on education that is required by Title X will be coming out, since this is mandated by Title X, no action item is required.

Technology -- Jerry Parks

Frances Taylor is looking for pilot counties for HIPAA compliance.

Education and Awards -- Deborah Rowe

Education and Awards Committee will be having a conference call with Aimee Wall, Institute of Government, to discuss possible topics to be presented at the Spring Legal Conference. All suggestions welcomed.

State and Local -- Don Yousey

Don Yousey said that he wished to report on two issues. The first being one the association asked him to work on and one he had taken up on his own. He stated that he wanted to be sure that the group agreed with the work on the second issue since they had not asked him to take up this work.

State Personnel Act Rewrite: Don noted that he had spoken to Rep. Dewie Hill and Sen. R.C. Soles about this issue and had received support from both regarding maintaining local public health protections at least at the current level within the Act. He noted that they had also agreed that public health needed its own representation on the rewrite task force. Don also said he had spoke with Rep. Thomas Wright during the Public Health Task Force meeting the previous day and that Rep. Wright also voiced support for the association’s position on both points. Rep. Wright had said that he would contact Tom Wright of the State Personnel Office to voice his concerns and support for our position. Don noted that the letter the association had asked be written to Tom Wright had been drafted but had not gone out yet. There was general consensus from those present to continue to work towards getting our own representation on the task force and maintaining local due process protections for local public health employees under the State Personnel Act.

Companion Animal Task Force: Don noted that he had just recently become aware of this task force that had been convened to look at how animals were being handled across the state. Don said that he felt the task force was heavily weighted with animal rights folks and did not have enough representation from local animal control folks who are tasked with dealing with this problem on a daily basis. Don noted that his county spends upwards of $450,000 to deal with animal control issues even though state law really only requires rabies control and animal bite investigation. He reported that his county had tried to use needles only euthanasia for three years but after having to treat two employees for post exposure to rabies had gone back to using a euthanasia chamber to protect workers when the animals in question were feral, vicious or of questionable health and not deemed adoptable. He said his county had built a large chamber so that these animals did not have to be manhandled inhumanely as had been reported in the task force as happening in some counties. Don noted that if the state just mandated a chamber like theirs in every county that would cost $1,000,000 and to require this without providing the money needed to purchase such chambers would be an unfunded mandate (something the Legislature had recently said it would stop doing if at all possible). Further, such chambers were deemed an acceptable method of euthanasia by veterinary professional associations and should not be banned based on emotions without looking at all the issues. Don stated that his past experience dealing with OSHA issues led him to believe that his county’s policy where the type of euthanasia chosen was based on a case by case decision making process taking into consideration the adoptability of the animals, subsequent risk and the health of employees was in line with OSHA requirements. Don asked the group if they agreed with what he was doing regarding this task force. There was general agreement that Don should continue to work on this issue along the lines he had been describing.

Policy and Planning -- Mimi Cooper

Ms. Cooper had no report from Policy and Planning, but took this opportunity to distribute the 2004 Leadership list (see attachments). A conference call for the 2004 Leadership will be held on December 1, 2003 at 2:00 pm. A schedule of 2004 meetings dates will be forwarded via email (see attachments).

Alliance (NCAPHA) -- Barry Bass

Mr. Bass reported that the Alliance would meet at 12:30 that afternoon to discuss a contract for interpreter services at group rates.

Nominations and Bylaws -- Wayne Raynor

Committee will be meeting with a final Bylaw report to be provided at the December, 2003 meeting.

Environmental Health -- David Rust

Mr. Rust reported that the committee discussed the FDA Food Code that is more of a risk based inspection for food service establishments. Catawba County piloted this program and found it to be successful. The current grade card would not change. The FDA rules are updated more frequently than local rules. It was suggested that we may use this as a vehicle to get authority to charge local fees for inspections. The committee is not prepared to make a recommendation whether North Carolina should adopt the Food Code. The stakeholders met in October on the Soil/Wetness Rules. An Environmental Health Specialist must re-take Centralized Training in the program area where he/she has not been authorized in three years. If an individual has not been authorized in five years, the entire Centralized Training will have to be repeated.

Health Promotion -- No report

The Alliance -- No report

Regional Reports

Jenny Lassiter announced that she was in the process of securing a block of guest rooms at the Quality Suites Hotel, Raleigh, for those wishing to stay in Raleigh for the 2004 NCALHD monthly meetings. Anyone wishing to stay in that facility should contact her to ensure that an appropriate amount of guest rooms are blocked.

Maggie Dollar stated that a motion from Nominations and Bylaws was to be made at this meeting on the issue of quorum for full association/executive committee business meetings. Mr. Wayne Raynor, Chair of Nominations and Bylaws, announced that the issue shall be discussed at the December, 2003 meeting.

Liaison Reports

Management Support Supervisors

Mr. Yousey introduced Pam Yates as the new liaison for the Management Support Supervisors.

Institute of Public Health -- Dr. Ed Baker

Dr. Baker announced that Penny Whitesides is at the University of Alabama. Bill Browder will be the liaison for NCALHD. There are four priority areas that have been identified through a Strategic Planning Process for strengthening local practice of public health:

• Education and Training
• Consultation and Technical Assistance
• Evaluation
• Explanation of Emerging Issues in Public Health

Public Health Nurse Administrators -- Vivian Paynter

The Public Health Nurse Supervisors Meeting will be held December 4 and 5, 2003. Mr. Mary Jane Nichols will be the new President.

ANCBH -- Tim Green

Mr. Green announced that award nominations for ANCBH have been forwarded via email as well as available on the website: www.ANCBH.org. He urged all health directors to educate their Board of Health members on issues and encourage them to be advocates in the legislature and at the local level.

State Board of Sanitarian Examiners -- Tim Green

Mr. Green announced that the Board has formed a workgroup to review legislation or rule changes that may need to be made in the practice of Environmental Health.

NCPHA -- Deborah Rowe

Ms. Rowe announced that NCPHA’s annual meeting will be August 25-27, 2003 in New Bern. The NCALHD Educational Conference will be in conjunction with that meeting.

Administrative, Local Community Support Section--Dennis Harrington

Mr. Harrington stated that he had received several calls from legislators impressed by the presentation on the reunification of DEH/DPH. The presentations were well received and the legislators are anxious to resolve the issue.

Adjournment

With no further business, the motion to adjourn was made, seconded, and approved unanimously at 11:30 am.

Respectfully Submitted,

Deborah R. Rowe
Executive Director