Minutes

North Carolina Association of Local Health Directors
Full Association Meeting

March 18 , 2004

Wake County Human Services Building
Raleigh, NC

Call to Order

President Mimi Cooper called the meeting to order at 9:05. A quorum was present for a full Association Meeting.

Approval of the Minutes

Minutes of the February meeting were approved.

Treasurer's Report

The Treasurer’s report was accepted and approved.

Audit Report

Bob Wood presented the report of the Annual Audit. There was a recommendation that no disbursements be made without an invoice. This was the result of one item that had been approved at an Association meeting, but had not been reflected in the minutes. In the future, there should either be an invoice or clean documentation of the authorization of the disbursement in the minutes. He also observed that this past year expenditures were $6,000 above revenues.

The Audit Committee recommended that the accounting duties of the Secretary-Treasurer be transferred to the Executive Director in order to avoid transferring the checkbook every year. The books should still be audited every year.

After much agreement by past Secretary-Treasurers that the responsibilities of the Secretary were sufficiently oppressive without the checkbook, motion passed.

The current Secretary-Treasurer performed a not-too-subtle, but still seated, celebratory jig!
It was noted that this action will require a change in the By-Laws of the Association.

Deborah Rowe thanked everyone for the confidence we showed in her ability to offer stability to control of the checking account and also took the opportunity to REMIND EVERYONE TO PAY THEIR DUES ASAP NOW THAT SHE IS IN CHARGE!$!$!$!$!

President's Report -- Mimi Cooper

Mimi asked for a volunteer for the public health nursing education committee. If no one volunteers, she will make an appointment

Someone took the opportunity to tell a story that was pure Public Health humor. It was about how to position a contraceptive device on a musical instrument in your home in order protect your health. It was really a good story, but it defied the use of any graphics. If you want more details, see Wayne Raynor.

Executive Director's Report -- Deborah Rowe

Deb thanked everyone for the level of support at the Town Meetings. Sixty Health Directors attended.

State Health Director's Report -- Dennis Harrington for Dr. Leah Devlin

School Health money has been a bit delayed but those that applied for these grants have been notified. There is a process to go through in the General Assembly to have the funds released. The transition of the Development Evaluation Centers to Child Development Service Agencies continues, along with the discussion of case management responsibilities. They are working to assure that Health Departments are not at a disadvantage in the process.

Environmental Health -- Terry Pierce

Terry informed the group that as part of his resolve to improve communications between Environmental Health and Public Health, he will be meeting with Leah monthly to be sure there is good conversation on all issues of common interest.

Guest Speaker -- Anne Butzen

Ms. Butzen shared the results of the survey of Health Departments on smoke free environments. 89% of health departments participated in answering questions on policy and practices relative to environmental tobacco smoke. The Executive Summary has been sent out (Copy Attached)
The survey found that Health Directors are well versed in, and knowledgeable of, the data regarding both long and short term exposure to ETS.

Questions have been considered relative to the shaping of more restrictive ETS policies in view of the preemptive legislation. Health Departments were found to be smoke free with some having restrictions around the entrances to their departments. There was interest in restricting smoking in parking lots in a desire to send the strongest message possible to the public that smoking is not good behavior. Most Health Directors felt that their employees would be receptive to more restrictive requirements. Health Departments had good policies for restricting smoking within their buildings, but not necessarily at exits or in walkways and parking lots. The benefits of the policies were seen as decreased maintenance costs and better health (fewer absences) of employees. An effective argument for the benefit to the county on smoke free campuses is the finding that a smoker taking breaks for cigarettes uses one month of work time each year. The most common barrier to more restrictive policies identified by Health Directors was POLITICS. The individual rights issue was often sited. There was also discussion of health departments being co-located in a building with other county departments where smoking might be permitted as a result of the preemptive law.

There was agreement that there needs to be more community education of the effects of short term exposure to ETS. Smoking permitted in county buildings makes it difficult for public health staff to advocate for smoke free environments elsewhere in the community. The preemptive law is confusing - it requires smoking in state controlled building, but makes exceptions of health departments, and now, college campuses. It requires that 20% of the space be set aside for smokers “unless physically impractical”. Some counties have used this to make all their buildings smoke free because the cost of separate ventilation systems makes it “impractical” to accommodate smokers and still protect non-smokers from ETS.. Some have also used the “No Child Left Behind” law that says every program that uses federal funds must be in a smoke free environment. So far no county has been sued for eliminating smoking from county buildings.

If you establish any smoking policy or rule at your facility, be sure to build in enforcement. A 100% tobacco free campus is the easiest to enforce because it is clear that there is no smoking anywhere. You may consider a restriction of smoking within 50 feet of an entrance for a start and work towards the campus restriction idea.

Anne Butzen is with the UNC Department of Family Medicine. She does ETS Training, Education and Research. They have model policies and other resources to assist with ETS control. She can be reached at (919) 843-8615 or by email at ayb@med.unc.edu.

Committee Reports (action items)

Reimbursement and Finance -- Tim Greene

Recommendation: That Association dues will be calculated annually using the current $200 base plus $.15 per 100 population for each county with the current year projected population determined by the State’s demographics web site.

There Updating the dues calculation in this manner will increase revenue by about $2,000. The source of the demographics is the web site http//demog.state.nc.us/demog.

Motion from committee needed no second, Motion passed.

Policy and Planning -- Don Yousey

In laying the groundwork for the Committee’s recommendation, Don gave a summary of the work done the previous day regarding the Public Health Task Force 2004 Recommendations. He noted that the group had agreed on several assumptions that helped direct their discussion and these were as follows:

• Estimates on amounts of funding needed would not be dealt with as there was no
  assurance that our estimates were any more accurate than those in the report.
• Attempts will be made to keep inflammatory or emotion provoking wording out of our
  assessment
• The number of suggestions or recommended changes would be kept to a minimum so as
  not to diminish our statement of support or make use appear unenthusiastic
• The motion of support was to specify that it was for the “preliminary” recommendations
  so we could alter our position if the recommendations were changed after this date.

With that in mind, and with full awareness of what he was turning loose Don offered the following lengthy motion from Committee:

Recommendation: That the NCALHD strongly support the preliminary recommendations of the Public Health (PH) Task Force 2004 with the following changes (considerations):

1. That state aid-to-counties for accreditation be recurring and not one-time
   Funding;
2. That any decision regarding consolidation of health departments be based on
   local decisions;
3. That the statement regarding re-unification of Environmental Health with PH be without specific direction of movement of agencies; and
4. That we endorse that the recommendation from the County Commissioner’ Association (as follows) be included in the deliberation of the PH Task Force Recommendations with the expectation of making final report to the 2005 session of the General Assembly.

NCACC Recommendation: The North Carolina Association of County Commissioners requests the NC Department of Health and Human Services and the NC General Assembly to more carefully and thoroughly analyze the recommendations of the 2004 Task Force on Public Health for fiscal and programmatic impact on the public health system at the county level before moving forward with implementation.

After Dr. Devlin shared some concerns about the possible loss of forward momentum in this very positive effort on behalf of Public Health, a motion was made by Ray Rabe, seconded by John Morrow, to change the wording in number 4, above, to say to the extent possible, but no later than the ’05 session. There was more discussion regarding the need to have this come to the short session.

Motion did not pass.

There followed a second motion for amendment of Number 4, made by Tommy Jarrell that the dates be removed altogether. This motion was also seconded by John Morrow. (He really is an agreeable fellow)

Motion passed.

Now, finally, enough being said, the motion from the Policy and Planning Committee, as amended (see strikethrough above) carried by a wide majority.

Women and Children's Health -- Jenny Lassiter

Recommendation: The WCH Committee recommends that division staff not put effort into exploring the possibility of doing a bulk purchase of flu vaccine that they would then pass on to local health departments.

Motion from Committee needed no second. Motion passed.

NOTE: This is not related to the state contract under which health departments purchase vaccine at a reduced price. The Division made the offer to explore a bulk purchase in order to improve availability of vaccine. It was finally concluded that a) it would greatly disrupt existing systems and b) it was too many eggs (literally) in one basket.

Committee Reports (information items)

Reimbursement and Finance -- Tim Green

The committee met March 17th and reviewed the Child Service Coordination (CSC) Medicaid revenue receipts comparing all counties for 2001-02 to 2002-03. There has been an overall $2.3 million DECREASE in Medicaid revenue considering all counties during the past fiscal year. This is 19% of the total Medicaid revenue generated by all counties via CSC services. Tim Green will ask Deborah Rowe to email all local health directors this report detailing county by county comparison of revenue for the two year time period indicating the amount of Medicaid receipt decreases. A few counties’ revenues actually increased. The committee will plan to look also at receipts for the past quarter. Tim thanked Carol Chandler and Dennis Harrington for generating the very informative revenue reports. In the past 18 months there seems to have been some inconsistent interpretation and billing of Medicaid for CSC services. The committee will ask Joy Reed to discuss this issue with state Public Health CSC program staff in order to clarify. The CSC case management services are provided at the local level under contract with the Child Development Service Agency (CDSA) formerly a part of mental health. During this time of transition there seems to be some question as to the provision of certain services by health departments. The committee will ask Leah Devlin to assist in this matter.

Environmental Health -- David Rust

The Committee discussed the proposal to allow counties to charge for foodservice establishment inspections. They felt that it might be best to pursue increasing the current state fee, with the stipulation that the new money generated be distributed to local health department. This proposal might stand a chance of getting through the legislature, whereas allowing counties to charge their own fees stands no chance of passage. We will continue to follow this issue and may have a recommendation soon.

The state continues to have expenses in on-site sewage system program due to having to pay for “mistakes” by local EH specialists. Please emphasize to EH specialists in your counties that they need to take extra care to exactly enforce the sewage rules, and always do complete, thorough site evaluations with proper documentation.

There was a situation recently where a local county permitted a facility with an individual water supply that should have been sent to the state Public Waster Supply Branch as a public water supply. Please inform EH specialists in your county to be careful when dealing with individual water supplies, and to make sure that when a water supply system fits the definition of a public water supply, it gets referred to the state.

Epidemiology -- John Morrow

Flu season coming to a close. The state lab had 350 positive flu cultures. Nine pediatric deths were attributed to flu, with the children ranging in ages from 3 to 6 years. Most of these had underlying health problems that made them vulnerable. The avian flu outbreak in Asia continues. There is still concern about this combining with a human virus and starting a new pandemic. The poultry industry is also concerned with outbreaks of flu in poultry in Delaware and Maryland. The state is working on a pandemic flu plan similar to the SARS plan. Flu vaccine next season will contain the Fujian strain of virus as well as New Caledonia and B-Shanghai.

Draft roles of the PHRST teams have been reviewed and input will be incorporated before the document is approved by the bioterrorism steering committee. Best practices from the “triple Play” exercises will be published and distributed. There will be a spreadsheet distributed to help keep track of spending and the categories they apply to. The CDC is planning to adjust the funding to coincide with state fiscal years which will make bookkeeping much easier. It is important that all health departments spent funds labeled EN as soon as possible.

Women and Children's Health -- Jenny Lassiter

Update on Medicaid Waiver for family planning. Process is still in the budget office and is not expected to be implemented on July 1. State staff is still looking for ways to use local contributions already made in family planning to cover the required match. Care needs to be taken to not double count with other matches required.

Update on Immunization Registry that has not already reported by technology is that a demo version will be available on line in the third quarter of this year that anyone can take a look at. The pilots will start in January with Cabarrus, Pitt, Chatham and Henderson Counties.

Health Promotion/Oral Health -- Curtis Dickson

The Committee reviewed the status of proposals to bring about a transition of health promotion funding to a performance based system. The first option considered would shift funding to provide all health departments with a minimum of $35,000 base funding to provide for one full time position, with the balance of state funding to transition to performance based allocations, but with existing higher funded agencies being given two to three years to absorb the funding cuts. The second option would have been competitive bidding for performance based allocations. The committee decided this small amount of state funding was not worth the problems to be caused to those agencies that would have to suffer major funding cuts. Dr. Marcus Plescia of the state agency suggested we take the issue off the table for one or two years and the committee concurred.

The committee reviewed the proposed Health Carolinians’ nine standards. They recommended that the Health Director’s review, approval, and signature be required on Healthy Carolinians Task Force Applications for certification or re-recertification. Health Director’s should also get feedback directly from the Governor’s Task Force on reasons for disapproval of certification or any suggested changes. The appeals process was also reviewed.

The committee is working on the idea of a workshop for health departments wishing to start dental programs.

Education and Awards -- Colleen Bridger

There were six applications for the NACCHO scholarship. Beth Lovette, Wilkes County Health Director, was chosen as the recipient of the 2004 NCALHD Scholarship to the annual NACCHO conference. Ms. Lovette will receive free registration to the conference and up to $1000 in reimbursed cost for her travel expenses to the conference. Wayne Raynor, Cumberland County Health Director, was chosen to receive a free registration to the conference.

Regional Reports

None

Liaison Reports

Alliance (NCAPHA) -- Barry Bass

At the February 19th Board meeting it was decided that

1. Staff that drive must have a valid drives license from the state in which they reside.
2. Criminal background checks will be conducted on all staff entering patient’s homes.
3. Contracting agencies must provide appropriate name tags effective 7-1-04. This will become part of the contract.

Barry Blick, Beth Lovette and Danny Staley were thanked for their willingness to participate on an ad hoc Finance Committee to assist the Executive Director with financial and accounting activities, as well as developing the business plan.

The NCAPHA will be working with a new accounting firm and ADP will begin performing payroll functions effective 04-01-04. The Alliance is initiating direct deposit for payroll, therefore staff will need to provide a deposit slip or voided check to Jen Johnson by March 29.

The next NCAPHA Board meeting is scheduled for Wednesday, March 31, at 11:00 am, in the Adams Building on the Dix Campus in Raleigh.

Adjournment

With no further business, the motion to adjourn was made, seconded and unanimously approved at 11:40 am.

The next meeting of the Association will be held in conjunction with the Legal Conference and will begin at 1:00 PM on Thursday, April, 22 at the Institute of Government.