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11/02/2005 r NEW HANOVER COUNTY BOARD OF HEALTH New Hanover County Health Department Dr. Thomas Fanning Wood Memorial Conference Room 2029 S. 17th Street Wilmington, North Carolina 28401 Wednesday, November 2, 2005 AGENDA Date: November 2, 2005 Time: 8:00 A.M. Place: Dr. Thomas Fanning Wood Memorial Conference Room New Hanover County Health Department fis Presiding: Mr. Donald P. Blake, Chairman Invocation: Mr. John S. Tunstall • - Minutes: October 12, 2005 Recognitions: Mr. Donald P. Blake Personnel New Emplovee(s) Kelly Haggerty, Administrative Support Technician, Animal Control Services Brenda Rivenburgh, Animal Control Officer, Animal Control Services Five (5) Year Service Award Rebecca Balthazar, Public Health Nurse, Maternal Health, Personal Health Services Kelly Johnson, Public Health Nurse, School Health, Personal Health Services Fifteen (15) Year Service Award Thurman Grady, Vector Control Operator, Vector Control, Environmental Health Services Departmental Focal: Environmental Health Services - Response to Waste Water Spills -Ms. Dianne Harvell Environmental Health Services Manager r BOH Agenda November 2, 2005 Page 2 Monthly Financial Report: Seotember 2005 Ms. Cindy W. Hewett (Includes Grant Update) Business Manager Committee Reports: Executive Committee Mr. Donald P. Blake New Business: Mr. Donald P. Blake i 10 Grant Application - Healthy Carolinians - Health Programs Administration - $5,000 Sp Grant Application - Primary Care Project - $50,000 Performance Appraisal - Health Director 5 Nominating Committee Report - Dr. Sandra L. Miles Comments: Lam" Board of Health Members UU -Mr. Donald P. Blake • N~'f ate ~1 1. ~ Health Director ` l~fd Mr. David E. Rice Health Director 1. New Coast Guard Commander - Byron Black / f3G"~~~~t7 2. Performance Appraisals - Management Team " 3. School Physical Screenings Meeting - October 31, 2005 4. Satorre et al. v. New Hanover County et al.; 0 C S 17, New Hanover County Superior Court r Other Business: FLU cL/idi~i r. Donald P. Blake }tia~ Able - v w P Adiourn: P. Blake T-0 - 39 3___ z. Mr. Donald P. Blake, Chairman called the regular business meeting of the New Hanover County • Board of Health (NHCBH) to order at 8:00 a.m. on Wednesday, October 12, 2005 in the Thomas Fanning Wood Conference Room of the New Hanover County Health Department located at 2029S.17 Ih Street, Wilmington, North Carolina. Members Present Donald P. Blake, Chairman Edward Weaver, Jr., OD, Vice-Chairman James R. Hickmon, RPh Cheryl Lofgren, RN Sandra L. Miles, DDS Nancy Pritchett, County Commissioner Robert M. Shakar, MD John S. Tunstall, PE Stanley G. Wardrip, Jr. G. Robert Weedon, DVM; MPH Members Absent Marvin E. Freeman, Sr. Others Present: Betty Rauth, Administrative Support Supervisor, Program Support, Support Services - Retiree • Jay Edwards, Environmental Health Specialist, Environmental Health Services Leigh Ann D'Adamo, Public Health Nurse, Clinic Team, Personal Health Services Yvonne Hughes, Fiscal Support Supervisor, Fiscal Operations, Support Services Juanita Sneeden, PHN, Child Health Services Supervisor, Personal Health Services Joyce Hatem, Social Worker, Child Health Services, Personal Health Services Gail Bordeaux, PHN, School Health, Personal Health Services Laura West, PHN, School Health, Personal Health Services Courtney Parker, Shelter Attendant, Animal Control Services Renae Lopez, Health Educator, Health Programs Administration Cindy Hewett, Business Manager Elisabeth Constandy, Health Promotions Supervisor, Health Programs Administration Dr. Jean McNeil, Animal Control Services Manager Janet McCumbee, Personal Health Services Manager Dianne Harvell, Environmental Health Services Manager, Environmental Health Services Betty Jo McCorkle, PHN, Clinic Supervisor, Personal Health Services Scott Harrelson, Assistant Health Director David E. Rice, Health Director Marilyn Roberts, Recording Secretary Invocation: .,Dr. Sandra Miles gave the invocation. Minutes: • The minutes of the September 7, 2005 Board of Health Meeting were approved as submitted. 1 Recognitions: Personnel New Employee(s) Leigh Ann D'Adamo, Public Health Nurse, Clinic Team, Personal Health Services Jay Edwards, Environmental Health Specialist, Environmental Health Services Yvonne Hughes, Fiscal Support Supervisor, Fiscal Operations, Support Services Courtney Parker, Shelter Attendant, Animal Control Services Five (5) Year Service Award Gail Bordeaux, Public Health Nurse, School Health, Personal Health Services Laura West, Public Health Nurse, School Health, Personal Health Services Retired Betty Rauth, Program Support Supervisor, Program Support, Support Services - 9/30/2005. Mr. David E. Rice, Health Director and Mr. Blake congratulated staff. Other Recognitions The New Hanover County Health Department received the Glaxo Smith Kline - Child Health Recognition Award - Special Recognition for the New Hanover County Health Department SAFE KIDS Program. Ms. Renae Lopez, Health Educator and Coordinator for the SAFE KIDS Program accepted the award. Ms. Betty Jo McCorkle, PHN Clinic Supervisor, Personal Health Services was the recipient of the • North Carolina Public Health Association (NCPHA) Margaret B. Dolan Award for Nursing Excellence for the year 2005. Department Focal: Personal Health Services - Child Health Services (CSC) Update Ms. Juanita Sneeden, PHN, Child Health Services Supervisor and Ms. Joyce Hatei Social Worker, Team Leader for Child Health Services gave a presentation on Child Health Services with a brief glimpse into the Child Service Coordination Programs. Highlights of the presentation included: Child Health Services staff includes: • 6 RNs • 5 Social Workers • 1 Program Coordinator - Special Education Clients are often: • emotionally and socially needy • in the midst of a crises • never had a visit from/at the Health Department and do not understand that they may be eligible for preschool services • in denial and do not understand child development Ms. Sneeden and Ms. Hatem gave a demonstration of services while referencing a flower: • Flower - as the family unit • Stem - as the linkage to knowledge (supports the family) • Stick - as the scaffold (supportive services) (not dependency... offer advice/guidance and then STEP back to observe growth and maybe regroup) • Flower Pot - as the Health Department Services available through Child Services Coordination Programs 2 Contact Information: Where - • • Face to face contact with families (home, school, child care, work, park, etc.) • Telephone/letters • Meetings (doctor's office, school meeting, evaluation appointments, etc.) When - • 40 hours/week (flexible) from 7:30 a.m. until 7:00 p.m. Why - • all families (regardless of socio-economic status) have the right to access these programs Child Health Services staff serves as mentors (connecting with families and watching for readiness cues) Programs: • Child Service Coordination - for families with children birth to 5 years at risk for developmental delays and/or children with diagnosed condition/special needs who do not enroll in early intervention or who are over 3 years of age. Health information, developmental screenings, counseling, and assistance with resources provided. • Child Find - identifies children (birth through age 5) who may need services to prepare them for preschool and kindergarten. This involves a continuous process of public awareness activities, screening and evaluation designed to locate, identify and refer as early as possible all children with disabilities. • Family Care Coordination (combination Maternal Child Care (MCC) and CSC) - MCC provides education, information, support, resource referral, post-delivery follow-up, for pregnant women. CSC enrolls child after birth only if there is need for service coordination to continue based on CSC criteria. • Family Assessment Coordinator - goes daily to the hospital and provides a survey for new mothers to complete and based on these responses, new moms are linked to community resources. Surveys are also available in OB-GYN offices. • Navigator - home visits to first time mothers (to be) during pregnancy and may continue until the • child reaches three years of age. Education about pregnancy, childhood development and parenting is provided to help families achieve goals related to education, employment, and housing. • Target Case Management - provides service coordination to children from birth to age 3 years who have a diagnosed delay or medical diagnosis and are enrolled in early intervention. These children typically are also receiving therapeutic services, such as speech, occupational or physical therapy. Connective Goals (of all the Programs): • Collaborate and cooperate with families • Assure identification and access to preventive, specialized and supportive services • Assist families with identifying their concerns and develop or enhance self-reliance skills • Provide links to community resources Mr. Blake thanked Ms. Sneeden and Ms. Hatem for their presentation. Monthly Financial Report - duly/August 2005 (Including Grant Status Report) Ms. Cindy W. Hewett, Business Manager reported that we are making progress with the new financial system (MUNIS). Ms. Hewett presented the July Revenue and Expenditure Summary Report that reflects an earned revenue total of $439,708 with a remaining revenue budget of $6,367,793 and an expenditure total of $790,167 with a remaining budget of $12,173,933. A summary of the financial report is below: • 3 July Summary: Budgeted Actual % FY 05-06 FY 05-06 Expenditures: Salaries & Fringe $11,205,722 $702,855 Operating Expenses $1,577,178 $77,497 Capital Outlay $181,200 $9,815 Total Expenditures $12,964,100 $790,167 6.10% Revenue: $6,807,501 439,708 6.46% Net County $6,156,599 $350,459 5.69% . Ms. Hewett presented the August Revenue Summary Report that reflects an eamed revenue total of $721,711with a remaining revenue budget of $6,739,342 and an expenditure total of $819,454 with a remaining expenditure budget of 13,027,420. The August report brings us to the cumulative point and in comparison with last year we are above in revenue and spending a little under. We are moving forward into web base expenditure reporting. County appropriations are at 1.53%. A summary of the financial report is below: August Summary: Budgeted Actual % FY 05-06 FY 05.06 Expenditures: Salaries & Fringe $11,315,151 $680,502 Operating Expenses $1,852,498 $139,952 Capital Outlay $679,225 Total Expenditures $13,846,874 $819,454 5.92% Revenue: $7,461,053 721,711 9.67% Net County $6,385,821 $97,743 1.53% Ms. Hewett reported the Health Department Grant Status. Totals for grants requested $986,700 received $451,700 and denied $205,000. We have received: NC Dept. of Insurance - Office of State Fire Marshall - Risk Watch Continuation Grant for $25,000 in it's entirety. Two pending grants: Wolfe-NC Public Health Association Prenatal Grant for FY 05-06 and FY 06-07 for $5,000 and HUD (partnership with City of Wilmington) - Lead Outreach and Education Program (3 year funding) for $275,000. The NC Alliance (NOAH) for Secondhand Smoke - Local Control Initiative- ( PA funds to be used for educational purposes and media campaigns only) - $5,000 - denied. Committee Reports: Executive Committee Old Business: None 4 New Business: • Changes in the New Hanover County Health Department Fee Policy - Use of State Codes, Implementation of Lab Codes Implementation of an Administrative Penalty Fee for delinquent patient accounts Adjusting "Proof of Income" grace period to 10 business days and Billing (Third Party Payors) for administration of State provided Menactra Vaccine. The New Hanover County Health Department is proposing to change its current Fee Policy, in order to: (1) Submit statistical data to the State through the use of State approved codes (referred to as Local Use (LU) Codes). Retroactive effective date 07/01/05. (2) Implement use of Current Procedural Terminology (CPT) Codes 87081 (Culture-to be used for Family Planning visits) and 82948 (Glucose, blood reagent strip-this will replace CPT 82962) for respective laboratory services. Fees for each of these codes are set at $20.00. (3) Bill third party payors (private insurance companies and Medicaid) for the administration fee of State provided Menactra vaccine for children. Fee for this service is $20.00. (4) Implement ability to apply a $15.00 administrative penalty fee to delinquent patient accounts. Administrative penalty be "applied" to those delinquent accounts-that are sent to NHC Legal for processing. Patient statements will be updated to reflect this change. (5) Change Fee Policy Narrative, Section I, General Guidelines, Item F. to the following: The New Hanover County Health Department (NHCHD) will require "proof of income" to reduce charges when applying the sliding fee scale. If a patient is unable to produce this required information, they will be placed on a 100% sliding fee scale status, for a • period of ten (10) business days (inserting the word "business"). Fee Policy currently states "for a period of ten (10) days". If proof of income is provided within the ten business-day period (inserting the word "business"), the patient will be billed accordingly. There was discussion at the September Executive Committee Meeting regarding "CPT" codes and "LU" codes. Ms. Hewett stated that "LU" was the abbreviation for "Local Codes" following up of a previous request from the Executive Committee. Motion: Mr. Blake moved from the Executive Committee for the Board of Health to accept and approve the Changes in the New Hanover County Health Department Fee Policy - Use of State Codes, Implementation of Lab Codes, Implementation of an Administrative Penalty Fee for delinquent patient accounts, Adjusting "Proof of Income" grace period to 10 business days and Billing (Third Party Payors) for administration of State provided Menactra Vaccine as presented and submit to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNANIMOUSLY. Other Business Mr. Blake appointed the following Board of Health members to the Nominating Committee for the selection of the 2005 Chairman and Vice-Chairman of the New Hanover County Board of Health: Mr. Marvin E. Freeman, Sr., Chairman Ms. Cheryl Lofgren Dr. Sandra L. Miles • Mr. Freeman had previously accepted and Ms. Lofgren and Dr. Miles accepted to serve on the Nominating Committee in which the committee will submit a slate of officers at the November Board of Health Meeting and voting will take place at the December Board of Health Meeting. 5 Health Director's Job Performance Appraisal Mr. Blake gave each Board of Health member a performance evaluation form that is to be • completed and returned to Mr. Blake by October 20, 2005. Comments: Mr. Stanley Wardrip expressed concern regarding the Avian Flu. Mr. Wardrip also expressed concern as to how New Hanover County is partnering with other counties in respect to environmental matters. Ms. Cheryl Lofgren expressed concern in regards to mosquito "Light Traps". Ms. Nancy Pritchett reported that the "new" New Hanover County Manager would be announced today at 1:15 p.m. in the County Courthouse during a press conference. The latest elections were discussed among Board of Health members. Mr. Rice reported that Wilmington re-elected Mayor Spence Broadhurst was a previous Board of Health member in Wake County. Mr. Blake commended Dr. Jean McNeil, Animal Control Services Manager, and staff for their continued outstanding job dedication and also inquired as to updates on the SAFE KIDS van and Environmental Health Services. Mr. Blake reminded the Board of Health members that Dr. Robert M. Shakar, Jr. is the incoming . President of the New Hanover-Pender County Medical Society for 2006. Annual Report FY 2004-05 Ms. Elisabeth Constandy, Health Education Supervisor gave a brief power point presentation of the New Hanover County Annual Report for FY 2004-05 along with handouts. Health Director Flu Clinic Mr. Rice reported that New Hanover County Health Department began their flu clinic on October 10, 2005. Registration will be different this year - clinic will be on an appointment schedule and nurses will be entering data through the North Carolina Immunization Registry (NCIR). Pnuemonia and tetanus shots will also be available. Flu Shot Clinic has improved dramatically this year as compared to last year. Hurricane Ophelia Mr. Rice reported on Hurricane Ophelia aftermath by giving each member a copy of the After Action Report and there was discussion on additional follow-up regarding shelter staff challenges. Dr. Shakar expressed concern with Triage in the shelters. Mr. Rice reported that FEMA reviewed the New Hanover County emergency operations during Hurricane Ophelia. • 6I Performance Management - Work Plans • Mr. Rice stated that new work plans are being processed and staff supervisors will be working with their staff to meet the mid-November deadline for Job Performance Appraisals. North Carolina Public Health Association (NCPHA) Annual Meeting Mr. Rice reported on the North Carolina Public Health Association (NCPHA) Annual Meeting held in Ashville, October 4-6, 2005. Adjournment Mr. Blake adjourned the regular business meeting of the Board of Health at 9:15 a.m. Mr. Donald P. Blake, Chairman New Hanover County Board of Health David E. Rice, M.P.H., M.A., Health Director New Hanover County Health Department • Approved: • 7 New Hanover County Health Department Revenue and Expenditure Summaries for September 2005 Cumulative: 25.00% Month 3 of 12 • Revenues Current Year Prior Year Type of Budgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remalnin Federal & State $ 1,816,791 $ 574,191 $ 1,242,600 31.60% $1,851,509 $ 920,615 $ 930,894 49.72% C Fees $ 659,496 $ 180,222 $ 479,274 $ 659,496 $ 180,222 $ 479,274 27.33% Medicaid $ 1,500,300 $ 324,019 $ 1,176,281 21.60% $1,138,039 $ 158,931 $ 979,108 13.97% Medicaid Max $ - $ - - $ 151,600 $ - EH Fees $ 300,212 $ 55,996 $ 244,216 18.65% $ 300,212 $ 64,575 $ 235,637 21.51°h Health Fees $ 128,000 $ 51,985 $ 76,015 40.61% $ 113,545 $ 43,207 $ 70,338 38.05°h Olher $ 3,072,186 $ 512,392 $ 2,559,794 16.68% $2,421,354 $ 442,125 $ 1,979,229 18.26% otals $ 7,476,985 $ 1,698,804 $ 5,778,181 22.72% $6,556,420 1,784,825 $4,674,481 27.22°h /L°cet~to we Expenditures Current Year Prior Year • Type of Budgeted Expended Balance % Budgeted Expended Balance 0/0 Expenditure Amount Amount Remaining Amount Amount Remaining- Salary & Fdnge $ 11,315,151 $2,002,450 $ 9,312,701 17.70% $10,422,330 $1,949,727 $8,472,603 18.71% Operating $ 1,868,430 $ 376,951 $ 1,491,479 20.17% $ 1,578,519 $ 343,552 $1,234,967 21.76% ,Capital Outlay $ 679,225 $ 9,815 $ 669,410 1.45% $ 206,841 $ 15,858 $ 190,983 7.67% orals $ 13,862.806 $2,389,215 $ 11,473 591 117.23%1$ 12,207 690 $ 2,309,137 $9,898,553 18.92% Summary Budgeted Actual % FY 05-06 FY 05-06 Expenditures: Salaries & Fringe $11,315,151 $2,002,450 Operating Expenses $1,868,430 $376,951 Capital Outlay $679,225 $9,815 Total Expenditures $13,862,806 $2,389,215 17.23% Revenue: $7,476,985 $1,698,804 22.72% Net County $6,385,821 $690,411 11.00% • Revenue and Expenditure Summary For the Month of September 2005 8 NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-06 Date BOH Grant Requested Pending Received Denied 10/12/2005 No activity for October 2005. • 9/712005 No activity for September 2005. Wolfe-NC Public Health Association Prenatal Grant for FY 05-06 and FY 06-07- 8/3/2005 assistance for diabetic prenatal patients. $5,000 $5,000 • allocating North Carolina Alllance(NCAH) for $5,000 from Secondhand Smoke- Local Control existing PA Initiative-if approved and awarded PA funds ' allocating budget- • Grant was to be used for educational and a5,000 from approved by not approved purposes existlng PA NHC-CC by RWJ media campaigns only. budget 9/19/05 Foundation 7/6/2005 No activity for Jul 2005. NC Dept of Insurance- Office of State Fire 6/1/2005 Marshall- Risk Watch Continuation Grant $ 25,000 $ 25,000 HUD (partnership with City of Wilmington) Lead Outreach and Education Program (3 year funding) $ 275,000 $ 275,000 Ministering Circle- Good Shepherd Ministries Clinic supply & Equipment $ 15,000 $ 15,000 $ No activity for May 2005. Cape Fear Memorial Foundation- Living 4/6/2005 Well Program $ 20,000 $ 20,000 $ National Safe Kids Coalition- Mobile Van for 3/2/2005 Car Seat Checks $ 49,500 $ 49,500 $ Smart Start- Child Care Nursing Program $ 239,000 $ 170,000 $ 69,000 Smart Start- Health Check Coordination • Program $ 43,800 $ 43,800 Smart Start- Navigator Program $ 155,000 $ 44,000 $111,000 2/2/2005 No activity for February 2005. Champion McDowell Davis Charitable 1/5/2005 Foundation - Good Shepherd Clinic $ 56,400 $ 56,400 12/1/2004 No activity for December 2004. March of Dimes- Maternity Care Coordination Program educational supplies and incentives 11/7/2004 for pregnant women. $ 3,000 $ 3,000, $ 10/6/2004 No activity to report for October 2004. 9/1/2004 No activity to report for September 2004. Office of the State Fire Marshal- N Department of Insurance- Risk Watch 8/4/2004 continuation funding 3 ears $ 25,000 $ 25,000 NC Physical Activity and Nutrition Branch- Eat Smart Move More North Carolina $ 20,000 $ 20,000 C arc o Dimes Community Grant Program- Smoking Cessation- Program did 7/7/2004 not apply for rant. $ 50,000 $ - $ - $ IWolfe-NCPHA Prenatal Grant- Diabetic Supplies for Prenatal Patients $ 5,000 $ 5,000 • Totals $986,700 $280,000 $451700 $205,000 28.38% 45.78% 20.78% Pending Grants 2 13% Funded Total Request 8 53% Partially Funded 3 20% Denied Total Request 2 13% 9 Numbers of Grants Applied For 15 100% As of 10/2012005 • NOTE: Notification received since last report. • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 11/07/05 Agenda: Department: Health Presenter: Scott Harrelson Contact: Scott Harrelson, Assistant Health Director, 343-6592 Subject: Health Carolinians Funding Application Brief Summary: Our local Healthy Carolinians Task Force, Cape Fear Healthy Carolinians, has the opportunity to apply for $5,000 from the state office of Healthy Carolinians. This money can be used for various reasons outlined in the application, including staff. Our local Task Force is currently restructuring to include Brunswick County. We have gone through strategic planning and chosen four areas to concentrate on which are all high priority areas in each of the four recent community assessments done for our area. The four focus areas are: Access to Care, Obesity, Childhood Injury and Domestic Violence. The plans that we are establishing now will dictate the work of the entire task force for at least the next three years. Many local Task Forces have full time coordinators, ours does not. We do not feel that the current workload would justify a full time employee. We do feel that.a part-time. contract coordinator would be most beneficial. The deliverables for this coordinator would involve working with each subcommittee to develop goals that tie in with the national Healthy People 2010 objectives, to complete the action plans for each of the focus areas and to complete the task force certification and present it to the entire task force and submit to the state for certification b May 2006. Recommended Motion and Requested Actions: To accept and approve our request to contract with a local professional to gain certification for the Cape Fear Healthy Carolinians as presented and to approve any associated budget amendment if funding is awarded and to submit to the New Hanover Count Commissioners for consideration. Funding Source: If funding is approved a total of $5,000 would be added to an established agreement addenda for the department. Funds would be reimbursed by the State as the money is spent at the rate of $20/hour. Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ?No Change in Position(s) Explanation: This funding would include one coordinator paid via contract services for 250 hours from November 2005 throw May 2006. • Attachments: Application 10 RFA #100 APPLICATION/AGREEMENT ADDENDUM Certified Healthy Carolinians Partnerships Review the Instructions and Information document before completing application. Before sending the application to OHC/HE, be sure all the required signatures are on page three and the three required letters o support are attached. 1. County (ies):Brunswick/ New Hanover Agreement (OHC/HE will provide) Cape Fear Healthy Carolinians 2. Name of Healthy Carolinians Partnership 3. Amount of funding requested: $_5,000 No assurance is provided at this time about continued funding beyond FY06. • One-county HC partnerships are eligible to receive $5,000. • Two-county HC partnerships are eligible to receive $10,000. • Partnerships having more than two counties are eligible to receive $10,000 for the first two counties and $2500 for each additional county. 4. Use of Funds: Review the Instructions and Information document BEFORE you complete the application. Provide complete information for the following: (1) Background: Describe how these funds will be used to enhance local Healthy Carolinians activities/initiatives and contribute to the Partnership's overall mission and goals. • Cape Fear Healthy Carolinians is in the process of restructuring to become a two-county task force. We have also completed our strategic planning with various community. assessments done for our area to arrive at three focus areas for the task force. The focus areas are Chronic Disease-Obesity, Injury (Childhood and Domestic Violence) and Access To Care. Our partnership has completed strategic planning, adopted newly constructed bylaws and divided in to four sub-committees based on the interest of our membership. (2) Purpose: What problem will these funds address? What will improve as a result of these funds? Cape Fear Healthy Carolinians is at a point where we need to develop our sub-committee goals, effective action plans and timelines. We will also need to complete the certification document by May 2006 to become a certified two county taskforce. We do not currently have a coordinator for our local task force. We are now restructuring our entire task force and will be applying for certification during the next cycle. We have very talented people on our taskforce that could offer sound program content. The task force has agreed that at this early stage what we need most is a dedicated professional to aid our sub-committees in forming their goals, action plans and timelines as well as completing the certification application for our task force. We have chosen our focus areas and we have the infrastructure and support of our communities and local agencies. What we need assistance with is the roadmap and the planning in order for our taskforce to be a success. (3) Scone: Refer to the Instructions and Information document that lists eight options that these funds can be used for. i. Provide the who (population served), • ii. What (activities, services, deliverables), and iii. When (timeframes-what will happen between November 1 and May 31 with these funds) These funds will be used to hire a contract professional to assist Cape Fear Healthy Carolinians with drafting the goals and action plans for four subcommittees: Obesity, Access To Care, Childhood Injury Prevention and Domestic Violence. This individual would also be expected to deliver a 2005-06 Healthy Carolinians Funding - Page t of 3 11 completed Healthy Carolinians Certification application by the May 2006 deadline. This funding would not pay a portion of a current employee's salary. This funding would be utilized i to contract with a local professional. Members of our steering committee know of various • members of the community that would be quite capable of accomplishing these tasks. (4) Performance Requirements. Refer to # ii (above) describe the performance expectation. If you apply these funds to a salary, you still must state through SMART objectives how your activities will further your Healthy Carolinians priorities and demonstrate that these funds will accomplish the desired results. (SMART: S = specific, M = measurable, A = achievable, R = relevant, T = timeline). Objectives should be written for each goal in a manner that specifies how the goal will be accomplished. The applicant, through objectives, should state the measurable outcomes of the project. The objectives must be Specific. Thatlis, they tell how much (e.g., 40 of what is to be achieved and by when. Measurable. Information concerning the objective can be collected, detected, or obtained from records (at least potentially). Achievable. Not only are the objectives themselves possible, it is likely that the applicant organization will be able to achieve them within the time confines of the contract. Relevant. The organization has a clear understanding of how these objectives fit in with the overall purpose of the contract. Timed. The applicant organization has developed a timeline a portion of which is made clear in the objectives b which the objective will be achieved. Timeline: November- Initiate contract with local professional. November-January Contractor works with each subcommittee to set goals ant] measurable objectives utilizing the Healthy Carolinians action plan template. Contractor reports progress/challenges to the Steering Committee at regularly scheduled meetings as well as the whole task force at scheduled full task force meetings. I • March Completed sub committee action plans submitted to the Steering Committee for review May Completed action plans and completed certification application are presented to the Steering Committee and the full task force These deliverables will assist our membership in having measurable plans to improve the health of our citizens. Our task force is very cognizant of the importance of planning and measurable results. This will enable a newly reorganized task force to get off on the right foot. These plans will dictate the work of our Task Force for at least the next three years. (5) Monitorin Ouality Assurance: How will you monitor these funds? You are required to have a mid-term report due February 28 and a final report due June 30 that will report activities, services, and deliverables. The funds will be drawn down and paid directly to the contractor at a rate of $20/hour for hours worked in a two-week period. The time sheet for the contractor will be turned in to the Assistant Health Director for New Hanover County. The Assistant Health Director is also a Steering Committee member. The Assistant Health Director will validate the hours worked and sign off on the time sheet. The time sheet will then be forwarded to Kim Roane, New Hanover County Health Department Business Officer. The Business Officer will then use New Hanover County contract protocols to manage the contract, which we will establish. (6) Reimbursement: Describe how you will be reimbursed. i. If you are receiving your funds through the local health department (LED), these funds will be appended to the existing agreement the LHD already has with the State. You are eligible for monthly • reimbursement and will follow the policies provided by the LHD. ii. If you are establishing a separate contract with the state, refer to the instructions provided in the Instructions & Information document that accompanies this RFA. 2005-06 Healthy Carolinians Funding - Page 2 of 3 12 We will be receiving the funds through the New Hanover County Health Department. • • 2005.06 Healthy Carolinians Funding - Page 3 of 3 13 Budget Request: Your budget should reflect expenses from November 1, 2005 to May 31, 2006. , Complete the following budget, listing your expenditures where applicable. • Name of Healthy Carolinians Partnership: -Cape Fear Healthy Carolinians County (ies): -Brunswick and New Hanover Healthy Carolinians FY 2005-2006 Funds Amount Salary- Contract Employee 250 hours @ 20/ hour $ 5,000 Fringe Benefits $ • FICA $ • Health insurance $ • Retirement $ • Other: $ Travel expenses $ • Mileage: @ per mile (cost per mile cannot exceed state rate for reimbursement) • Lodging: • Registration fees: $ • Other: Operating Expenses $ • Supplies: • Postage: • Telephone: • • Educational materials: • Printing/copying: _ • Other (please list): $ Program Expenses (If not listed under Operating expenses) $ Honorariums: $ • Meeting costs: $ • Fees for services (e.g., Community Health Assessment data collection) $ • Other (please list): $ Total $ 5,000 can not be more than the amount re uested 2005-06 Healthy Carolinians Funding - Page 4 of 3 14 Application/Budget request approved by: Signature - Health Director Date Telephone number Signature - Partnership Chair or another member if Date Telephone number Health Director is Chair Signature - Coordinator Date Telephone number **Signature/Title- Fiscal Agent Date Telephone number **Agency with fiscal responsibility For example: • Health Director/LHD • Finance Officer of lead agency for HC Partnership • Treasurer of HC Partnership with 5016 status * *Note: The signature for the lead agency of HC Partnership signing this application, agrees that his/her agency or HC Partnership (501 c3) will serve as the fiscal agent for these funds and that these funds will be • used for Healthy Carolinians activities only. PLEASE ATTACH IRS LETTER VERIFYING YOUR NOT-FOR PROFIT STATUS. For HC Partnerships with two or more counties: If you want one LHD to receive the funding for your Partnership, please complete and sign below. -Brunswick and New Hanover Counties of -Cape Fear (Healthy Carolinians Partnership) would like the 2005-2006 Healthy Carolinians Funding to go to the local health department of -New Hanover-County, which will serve as the fiscal agent for these funds. Name of Health Director/County Date Name of Health Director/County Date Name of Health Director/County Date • 2005-06 Healthy Carolinians Funding - Page 5 of 3 15 h, • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 11/07/05 Agenda: -Department: Health Presenter: Scott Harrelson Contact: Scott Harrelson, Assistant Health Director, 343-6592 Subject: Primary Care Project Grant Application Brief Summary: Our department has been notified by the Division of Medical Assistance, Carolina Access of the Lower Cape Fear, New Hanover County DSS and representatives of local pediatric groups to alert us of the need for additional providers for low income and indigent children in New Hanover County. Currently in New Hanover County there are 14,167 children on Medicaid, 2,168 on NC Health Choice and approximately 4,234 with no insurance coverage. When you combine all three groups there are 20,569 children in this target population and the number is growing. Currently in New Hanover County there are no pediatricians accepting Medicaid clients without restrictions. This information is timely. We have received a request for proposal from the Office of Research, Demonstrations and Rural Health for which we can apply for funding to create • new or expand existing services provided to uninsured and medically indigent patients including medical services. This would also tie in to one of our priority areas from our -strategic plan, access to care. Recommended Motion and Requested Actions: To accept and approve our request to submit an application to the Office of Research, Demonstrations and Rural Health for $50,000 to establish a pediatric primary care clinic geared towards low income and indigent children as presented and to approve any associated budget amendment if funding is awarded and to submit to the New Hanover County Commissioners for consideration. Funding Source: Grant funding in the amount of $50,000 would enhance our capability to establish a much needed pediatric primary care clinic for the community. Financial projections based on the documented need, current reimbursement rates and similar programs in neighboring health departments would yield approximately $190,950 in Medicaid revenues, $36,900 in health fees and $23,600 from Health Choice revenues during the course of a year. The combined total for projected revenue is $301,450. Will above action result in: ®New Position (3) Number of Position(s) ?Position(s) Modification or change ?No Change in Position(s) • Explanation: This program would include three new positions, an LPN, a Community Health Assistant and an Administrative Support Assistant. The combined salar /frin e 16 for all three of these positions would be $127,170. Operating expenses are projected to be $109,280 for a combined total expenses of $236,450. . Attachments: Application • 17 • New Hanover County Health Department Pediatric Primary Care Program Business Plan Executive Summary Definition of Business The clinical services provided at the New Hanover County Health Department (NHCHD) currently include: Adult and childhood immunizations, TB screening, physician ordered injections, pregnancy testing, birth control methods, vasectomy counseling, physical exams for adults and children, the Breast and Cervical Cancer Control Program (BCCCP) and screening and treatment for sexually transmitted diseases. The additional services that are put forth in this business plan are primary care services for children. These services would include sick treatment visits such as those found at local general practice physician offices in the area. However, this would not include specialty care. These services would be provided on a daily basis from 8AM-5PM at the main health department facility. Recent changes made in our clinic model to accommodate open access scheduling make our clinics more conducive to providing primary care. The services would be provided by a team of qualified professionals including one full time nurse practitioner, one full time physician assistant, one part time contract physician, nurses and certified nursing assistants. • Market The target population for primary care services is children 0-18 who receive NC Health Choice, Medicaid and those that are uninsured. There are currently 14,167 children 0-18 on Medicaid in New Hanover County. There are 2,168 children 0-18 on NC Health Choice. According to the latest information from the county level estimates of uninsured from the Cecil G. Sheps Center there are approximately 4,234 uninsured children in New Hanover County. When you combine all three of these groups in our target population the total for New Hanover County is 20,569. Breakdown of NHC Target Population 21 % O Medicaid ¦ NC Health 11% Choice 68% OUninsured • 18 Medicaid . According to Liz Schulz, Family & Children's Medicaid/Child Care Chief with New Hanover County DSS as of September 6, 2005 New Hanover County has no pediatricians who will accept Medicaid patients without restrictions. Most are only seeing established patients, though Carolina Pediatrics will also see siblings of established patients. This problem has been recognized by Carolina Access of the Lower Cape Fear, New Hanover County DSS and the Division of Medical Assistance. For this reason our department has been asked to consider providing primary care services by the Division of Medical Assistance. NC Health Choice NC Health Choice was created to provide health care coverage to the children of the working poor with incomes to large to be eligible for Medicaid. Unfortunately this system is unable to keep up with the current demand and will be transferring all the 0-5 population on Health Choice to Medicaid as of January 2006. This means that new providers willing to accept Medicaid patients will need to be found for these children. The Uninsured Data from the North Carolina Healthcare Safety Net Report provided by the North Carolina Institute of Medicine shows that 85% of the uninsured in New Hanover County do not have a primary care home. There are currently three safety net providers for the uninsured listed for New Hanover County, NBC Community Health Center, AHEC • Outpatient Uninsured and Tileston Free Clinic. These providers saw approximately 17% of the uninsured population for New Hanover County in 2003. The Safety Net Report also included some interesting data entitled "Indicators of County- Specific Categories of Need." They scored each county on 5 different areas in regard to the uninsured: • Number of uninsured in the county • Percent of the county population that is uninsured • Number of uninsured with no identified source for Primary Care • Percent of uninsured with no identified source for Primary Care • The ratio of primary care providers to the county population When you compare New Hanover County with a very similar county such as Buncombe who provides a Community Access Program for the uninsured and has a health department that provides primary care there is a noticeable difference: New Hanover Buncombe Population 160,307 206,330 Median Age 36.3 38.9 Per Capita Income $23,123 $20,384 Child Poverty Rate 15.7% 15.3% • 19 Physicians Per Population 33.1 33.4 Percent Uninsured 17.4% 17.8% Uninsured with No Identified Source of Primary Care Bottom 25% Top 25% Even though New Hanover County scored high on the physician to population ratio, in the top 25% for the state, the uninsured with no identified source of Primary Care was one of the worst in the state, the bottom 25%. Financials Salary/Fringe LPN (f/t) 48,152.00 Community Health Asst (f/t) 41,939.00 Admin Support Asst (f/t) 37,079.00 Total Salary/Fringe 127,170.00 Operating Expenses Contract Services - Interpreter 17,000.00 Contract Services - FNP (60%) 68,670.00 M&R Equip 1,000.00 Printing 2,000.00 • Supplies 18,000.00 Dues & Subscriptions 500.00 Employee Reimbursements 350.00 Training & Travel 1,760.00 Total Operating Expenses 109,280.00 Total Expenditure Budget 236,450.00 Revenues Medicaid 190,950.00 Health Fees (private pay patients) 36,900.00 Health Choice 23,600.00 Office of Rural Health Grant $50,000.00 Total Revenues 301,450.00 Net Income (Revenues - Expenditures) 65,000.00 To add to this projected budget if we were able to hire a bi-lingual CHA we could save the $17,000 in contracted interpreter services. With the addition of the new staff we would also have the capability of providing more appointments for much needed Family • Planning services, which would also produce revenue. 20 Risk and Exit Strategy The risks for the organization are moderate for this project. The risks would include additional expense in the way of staffing to have more capacity to see customers. The health department is currently not able to fully staff all three of the clinic suites each day of the week. In order to provide primary care services for children we would need to. have each clinic suite operating at maximum capacity. Even though we have 4,234 children that are uninsured, several of those children would fall somewhere on the sliding fee scale and provide some revenue. Families with two or more workers comprise 18% of all uninsured, and families with one full-time worker comprise another 50% of all uninsured according to the NC Institute of Medicine. All new positions would be sustained through clinic revenues. In the event that revenues do not meet projections, we would have to implement a reduction in force. 21 ,yam a.SfAi[v - North Carolina Department of Health and Human Services Division of Medical Assistance Managed Care 421 Fayetteville St. - 2501 Mail Service Center - Raleigh, N.C. 27699-2501 One Hannover Bldg. Courier No. 2501 Michael F. Easley, Governor L. Allen Dobson, Jr, M.D., Assistant Secretary Carmen Hooker Odom, Secretary for Health Policy and Medical Assistance August 29, 2005 Scott Harrelson, MPA Health Programs Administrator New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 ear Mr. Harrelson: Earlier this summer you informed me of the Health Department's proposed plan to examine reopening the Child Health Clinic. The proposal was that the clinic be fully staffed and available to provide preventative child exams as well as sick care. In my opinion, there is a critical need for this health service in New Hanover County. I have reviewed the enrollment restrictions details of the clinics and practices that participate with Carolina ACCESS (CA). Of the CA participating providers of care for Medicaid individuals under the age of 18, the largest either do not accept new patients or only accept them if they see the newborn in the hospital; they are: • The Children's Clinic • Cape Fear Pediatrics • Knox Pediatrics • The Pediatric Center Carolina Pediatrics and Seaside Pediatrics will accept new patients, but are close to or exceeding the maximum number of patients they desire enrolled under CA. .here are only two other clinics that have open enrollment, but they are clinics that see all ages of patients. They are New Hanover Community Health Center and Atlantic Health Clinic. Both of these clinics see Medicaid recipients under the age of 18 and will accept new patients. 22 Page 2 Scott Harrelson New Hanover County Health Programs Administrator August 29, 2005 I have also received information from Tina Tagin, the New Hanover County Health Check Coordinator that CA enrollment in the county is difficult except for newborns. Staff at the Department of Social Services has also in the past commented on access to care for children due to closed enrollment at the largest pediatric practices. If the Health Department does reopen the child health clinic, I encourage you to enroll as a Carolina ACCESS provider with Community Care of North Carolina (CCNC) and to also participate with ACCESS III of the Lower Cape Fear (the CCNC care management network serving your cI ounty's Medicaid population). Let me know of your decision and I can assist you with this process. In addition to the need for this children's health service in New Hanover County, it is al to my opinion that this would be supported by the pediatric providers in your community. I have spoken with several, although I have not contacted all of them. If you have any questions or if I can assist you in any way, please do not hestitate to contact me. I have enclosed my business card. Sincerely, • Rosemary Long DMA Managed Care' onsultant Region 6 cc: Lydia Newman, Executive Director, ACCESS III of the Lower Cape Fear Page Dunn, Health Check Supervisor, Community Services, NH Health Department Darryl Frazier, DMA Managed Care, Program Operations Supervisor 23 • NC General Statute 143-215.1C. (pasted below) clearly establishes 1000 gallons as the threshold for notifying the public of wastewater spills. It also gives the owner/operator up to 48 hours in which to issue notice of a spill to the public. This broad timeframe does not, however, satisfy our compelling duty to address and protect the public's health. As we have experienced this scenario, the owner/operator typically notifies by phone the regional NCDENR DWQ staff (Ed Beck or staff), whereupon, they (DWQ staff) notify DEH Shellfish Sanitation Office staff and in some cases the local health department. DWQ staff makes the decision to notify local health department staff based on the projected impact of a wastewater spill. This includes factors such as location/estimated quantity of the spill, and proximity to drinking water supplies and surface waters. G.S. 143-215.1r § 143-215.1C. Report to wastewater system customers on system performance; publication of notice of discharge of untreated wastewater and waste. (a) Report to Wastewater System Customers. - The owner or operator of any wastewater collection or treatment works, the operation of which is primarily to collect or treat municipal or domestic wastewater and for which a permit is issued under this Part, shall provide to the users or customers of the collection system or treatment works and to the Department an annual report that summarizes the performance of the collection system or treatment works and the extent to which the collection system or treatment works has violated the permit or federal or State laws, regulations, or rules related to the protection of water quality. The report shall be prepared on either a calendar or fiscal year basis and shall be provided no later than 60 days after the end of the calendar or fiscal year. (b) Publication of Notice of Discharge of Untreated Wastewater. - The owner or operator of any wastewater collection or treatment works, the operation of which is primarily to collect or treat municipal or domestic wastewater and for which a permit is issued under this Part shall: (1) In the event of a discharge of 1,000 gallons or more of untreated wastewater to the surface waters of the State, issue a press release to all print and electronic news media that provide • general coverage in the county where the discharge occurred setting out the details of the discharge. The owner or operator shall issue the press release within 48 hours after the owner or operator has determined that the discharge has reached the surface waters of the State. The owner or operator shall retain a copy of the press release and a list of the news media to which it was distributed for at least one year after the discharge and shall provide a copy of the press release and the list of the news media to which it was distributed to any person upon request. (2) In the event of a discharge of 15,000 gallons or more of untreated wastewater to the surface waters of the State, publish a notice of the discharge in a newspaper having general circulation in the county in which the discharge occurs and in each county downstream from the point of discharge that is significantly affected by the discharge. The Secretary shall determine, at the Secretary's sole discretion, which counties are significantly affected by the discharge and shall approve the form and content of the notice and the newspapers in which the notice is to be published. The notice shall be captioned "NOTICE OF DISCHARGE OF UNTREATED SEWAGE". The owner or operator shall publish the notice within 10 days after the Secretary has determined the counties that are significantly affected by the discharge and approved the form and content of the notice and the newspapers in which the notice is to be published. The owner or operator shall file a copy of the notice and proof of publication with the Department within 30 days after the notice is published. Publication of a notice of discharge under this subdivision is in addition to the requirement to issue a press release under subdivision (1) of this subsection. (c) Publication of Notice of Discharge of Untreated Waste. - The owner or operator of any wastewater collection or treatment works, other than a wastewater collection or treatment works the operation of which is primarily to collect or treat municipal or domestic wastewater, for which a permit is issued under this Part shall: (1) In the event of a discharge of 1,000 gallons or more of untreated waste to the surface waters • of the State, issue a press release to all print and electronic news media that provide general coverage in the county where the discharge occurred setting out the details of the discharge. The owner or operator shall issue the press release within 48 hours after the owner or operator has determined that the discharge has reached the surface waters of the State. The, owner or operator shall retain a copy of the press release and a list of the news media to which it was 1 10 distributed for at least one year after the discharge and shall provide a copy of t he press release and the list of the news media to which it was distributed to any person upon request. (2) In the event of a discharge of 15,000 gallons or more of untreated waste to the surface waters of the State, publish a notice of the discharge in a newspaper having general circulation in the county in which the discharge occurs and in each county downstream from the) point of discharge that is significantly affected by the discharge. The Secretary shall determin e, at the Secretary's sole discretion, which counties are significantly affected by the discharge and shall approve the form and content of the notice and the newspapers in which the notice) is to be published. The notice shall be captioned "NOTICE OF DISCHARGE OF UNTREATED WASTE". The owner or operator shall publish the notice within 10 days after the Secretary has determined the counties that are significantly affected by the discharge and approved the form and content of the notice and the newspapers in which the notice is to be published. The owner or operator shall file a copy of the notice and proof of publication with the Department within 30 days after the notice is published. Publication of a notice of discharge under this subdivision is in addition to the requirement to issue a press release under subdivision (1) of this subsection. (1999-329, s. 8.1; 1999456, s. 68.) • e E _ ~ 01 C y O 1 ry= 'v a m~ rn V ~ n m O ` O _ o Z r. 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N E N d a d d m °I a O i r N m N o mp 3 y o N m o m i o p N U w w y m d E x o E o m 3° O° d an d o m c y t E m n? n V 3 E° d pp E ' E m Y ~L K E m a n Uc 2 L E N °1 y d o~ c M. - d C6 s d t a N r y v. 3 m O N L a 3L... N C O C m al M •O d i+ Cl. t m O) 3 a 'u - c o o n i, rn W y 3 E F- a Cl C U d U J m -p N N d 'mC• 3 N N ~ .d. C m d !/1 N L 3 O N r w O a v v E d D 0 Z` y N N m v N` m e N Ol m o "mo w m E N N CL N d C 3G J m ~ V O y Ya d L y 0 J L N d d n c o n V C c~ n« - d> C r p n• d m O o L y m a E N ~i~i N 3 K r r o d d L d w O "c an O. d G ~ C N ~ N -L.. ti d c o a w Q E N m > L d V! y o. ~ ~ aL.n O w 30 Improper disposal of household hazardous waste is harmful to our health & our natural resources HHW can pollute our streams, rivers, drinking water & groundwater. The folo ing items will be accepted from New Hanover (CIounty residents: -Pesticides & Herbicides in labeled containers -Computers, TVY & Cell Phones -rat t, Solvents, Paint Thinner, 6 Cleaners _ -Mercury & Fluorescent Tubes -Fuels, Motor oil, & Antifreeze -Household & Auto Batteries -Used Tires Coordinated Uyl New Hanover County Dept of Environmental Management, [ne City ofl Wilmington, New Hanover Cooperative Extension b UNC-W. For additional irrormation call 341-4373. 5302 Clear Run Drive • Wilmington, NC 28403 October 10, 2005 New Hanover County Health Department 2029 South 17' Street Wilmington, North Carolina 28401 Attention: Mr. David E. Rice, Health Director Dear Mr. Rice: I had my flu shot this morning and was impressed beyond words with the organization and coordination of the event. You and your organization are to be congratulated and we in the community thank you. Additionally, the appointment system was an added bonus for those of us who do not care to wait in line. • Thank you again Sincerely, J.A. McClure I Dr. Roscoe H. Turlington v 554 Waynick Blvd., Wrightsville Beach, NC 28480 A H. (910)256.5821 Cell (910) 617-2401 Helms Mulliss & Wicker, PLIA Attorneys at Law Charlotte Raleigh Wilmington www.hmw.com HELMS MULLISS WICKER HENRY L. KrrCHIN, JR. 127 Grace Street 910.254.3822 Post Office Box 599 (28402) t 1 910tch4.3822 .com Wilmington, North Carolina 28401 1910.254.3800 f 910.254.3900 October 17, 2005 Ms. Wanda Milligan Copley Mr. David Parker, CPCU AIC County Attorney Claims Administrator New Hanover County Sedgwick Claims Management Services, Inc. 320 Chestnut Street, Room 309 Post Office Box 186 Wilmington, North Carolina 28401 Cary, North Carolina 27512 • Ms. Anne S. Brown Risk Manager New Hanover County Post Office Box 607 Wilmington, North Carolina 28402 Re: Satorre et al. v. New Hanover County et al.; 02 CVS 1017, New Hanover County Superior Court Dear Wanda, Anne and David: As you know, the plaintiffs' Petition for Discretionary Review to the North Carolina Supreme Court in the above-referenced matter was denied by order of the court dated January 21, 2005, and subsequently the North Carolina Court of Appeals issued its order/mandate to the Clerk of Superior Court of New Hanover County informing the Clerk of the denial of the plaintiffs' Petition. I have also confirmed with the Clerk of the Court of Appeals that no further mandate will be issued, and have confirmed with the Trial Court Administrator for New Hanover County that because of the language of the Court of Appeals' decision, she and the Clerk's office consider this matter closed. We agree with the Trial Court Administrator's assessment that the decision of the Court of Appeals is sufficiently clear to constitute a final judgment in this matter. Accordingly, we intend to close our file on this matter. If you have any questions, please do not hesitate to contact me. Ms. Wanda Copley Ms. Anne S. Brown . Mr. David Parker October 17, 2005 Page 2 With the hard copy of the letter to David, we are enclosing two checks. One, in the amount of $93.55, represents our firm's return of an apparently overpayment made to our firm by Sedgwick. The second, in the amount of $862.25, represents the filing fee and record on appeal fee that we had paid to the Clerk on the County's behalf, and which was refunded to us by the Court of Appeals on account of our favorable appellate result. We enjoyed the opportunity to represent the County, Mr. ONeal, Mr. Rice and the opportunity to have worked with David and Sedgwick in this matter, and are happy to have obtained this good result. With kind regards, I remain Very truly yours, HEaenry'tchin, S & R, LLC Jr. HLK,Jr./ Enclosures cc: L. D. Simmons, Esq. (via interoffice courier) Mr. Allen O'Neal Mr. David Rice • The Year in Review from Your Health Department:. - EP000HivMEPU~~ a f i New Environmental Health Positions: elementary schools in both counties. The Looking Toward the Future processed during the fiscal' year} `for the O The B. Reynolds Charitable Trust and Cape - fiscal year 2004-2005 was $13,153,290. 1 {?The beginning of the 2004.2005 fiscal year Fear Memorial Foundation have pledged Akeycomponenftopublic health istheability Actual expenditures for FY 2004-2005 were saw the addition of three new environmental funding to purchase a state of the art mobile to recognize health trends in the community. $11,456,773. The Health Department's health specialist positions to the health dental unit with three chairs and a full dental In addition to . ongoing monitoring of budget was composed' of .34 individual department staff. These positions were filled staff. This exciting program will take the infectious diseases, public health agencies programs. The Health `Director andBusiness with intems during July and August of 2004, dental office to the schools, which remove in North Carolina conduct an in-depth , Manager, reviewed all budget requests. who then completed 7 weeks of training and the barriers of transportation and have little review of chronic health statistics every 4 Budget hearings were conducted and a a written examination. Their training was impact on time out of the classroom. This years, through completion of a document Budget Workbook including all programs officially complete after observation by program should have an instant impact on, entitled the Community Assessment. New . with line item narrative justifications was regional state staff from the Department of the, lives of the children in Brunswick and Hanover County completed this analysis prepared and submitted to the 135`_~Ird of Environment and Natural Resources. These New Hanover counties, and is anticipated to in December of 2004, and results were Health for approval. additional staff members will improve the be functioning in the spring of 2006. conveyed to management and staff, and to health department's capacity to, provide other partner agencies in the area. The Health Department's Business Manager. adequate surveillance of restaurants and Bioterrorism Preparedness Exercise was responsible for preparing expenditure other similar establishments. In April of 2005, members of the health reports that ensured billing and receipt of In October of 2004, the health department department staff and Board of Health the Health Department's state grant funds. , More Reasons to Smile! conducted a Mass Vaccination Exercise at participated in a Strategic Planning Retreat. The Health Department complied with Hoggard High School, in an effort to simulate This retreat was facilitated by Bill Herzog, New Hanover County Financial Policies " N o r t It a countywide terrorism event. This planned a retired professor from the School of and Procedures, which included an annual C a r o l i n a event allowed rq 4 Public Health at the University of North audit. 1 has one of the department " V Carolina at Chapel Hill. Mr. Herzog led A , Tottl Mutl E6p.ntl1tun. for FY 20042000 the lowest to test our staff through prioritization activities in an 11. t* dentist-to- capability to effort to establish key goals and ` objectives op"M wW. $).165.681 $WON population adequately for the next few years. Following is the list 15% 1% Ci) ratios in provide of ranked community priorities established 3u° s ` the nation. services to 300 through this process. Even if people per hour. the number of dentists. in our state were The goal of the exercise was to establish a ' 1. Access to Health Care ® ~6 $ s,6zt,zea Idoubled,. we would still be below the learning environment to familiarize the 2. Obesity eax - national average. That spells trouble for necessary agencies with the. protocols in 3. Emerging Health Risks Medicaid recipients and the uninsured. The place for opening a dispensing site. 1,058 4. Environmental Health Risks result is dental neglect and people eventually individuals, representing 14 different local 5. STD and Pregnancy Prevention crowding local emergency rooms for dental agencies and organizations participated. - 6. Animal Control and Rabies extractions, and that is expensive dental The event helped solidify the partnership 7. Health Disparities care. between public health, law enforcement, 8. Violence In an effort to improve access to preventive emergency - management and community ....E.. u.ium d dental service, the New Hanover and 'volunteer organizations,' and provided an Financial Management Brunswick County Health Departments opportunity for individual training and The - New Hanover County Health - have teamed up to develop a mobile dental agency cross-training to achieve a high level Department Amended Budget (Adopted unit program that will set up at local of collective. preparedness. Budget plus any amendments that were ca IGETY j1IDCftdill{zA~+mo . ' t t m 0 ' „ "yr } VuI.ISPA$I.lafurJ.'i E~lA4At11911:I Va+9J®tvaWL Participate bringing medical news "es to our community.