05/07/2008
Illibe New Hanover County Health Department
Revenue and Expenditure Summaries for March FY 2007-2008
Cumulative: 75.00% Month 9 of 12
Revenues
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgeted Revenue Balance %
Revenue Amount Earned Remaining Amount Earned Remaining
Federal & State 2,116,715 1,677,972 $ 438,743 79.27% 1,948,525 1,646,145 $ 302,380 84.48%
AC Fees 640,161 496,540 $ 143,621 77.56% 611,161 516,605 $ 94,556 84.53%
Medicaid 1,569,058 764,183 $ 804,875 48.70% 1,655,867 793,979 $ 861,888 47.95%
Medicaid Max 309,128 0 $ 309,128 0.00% 310,000 0 $ 310,000 0.00%
EH Fees 310,000 215,371 $ 94,629 69.47% 310,000 198,784 $ 111,216 64.12%
Health Fees 359,700, 346,018 $ 13,682 96.20% 334,200 314,677 $ 19,523 94.16%
Health Choice 35,125 19,100 $ 16,025 54.38% 35,125 11,351 $ 23,774 32.32%
Other 3,778,707 2,590,020 $ 1,188,687 68.54% 2,524,988 1,897,586 $ 627,402 75.15%
MOM I
Totals $ 9,118,594 $ 6,109,205 $ 3,009,389 67.00% $ 7,729,866 $ 5,379,127 $ 2,350,739 69.59%
Expenditures
Current Year Prior Year
~Illiw Type of Budgeted Expended Balance % Budgeted Expended Balance %
Expenditure Amount Amount Remaining Amount Amount Remaining
Salary &Fringe 13,220,325 8,713,471 $ 4,506,854 65.91% 12,101,765 7,791,949 $ 4,309,816 64.39%
Operating 2,597,392 1,388,334 $ 1,209,057 53.45°/b 2,257,023 1,119,847 $ 1,137,176 49.62%
Capital Outlay 67,029 37,212 $ 29,817 55.52°~ 94,894 68,223 $ 26,671 71.89%
Totals $ 15,884,746 $ 10,139,017 $ 5,745,729 63.83% $ 14,453,682 $ 8,980,019 $ 5,473,663 62.13%
Summary
Budgeted Actual %
FY 07-08 FY 06-07
Expenditures:
Salaries & Fringe $ 13,220,325 $ 8,713,471
Operating $ 2,597,392 $ 1,388,334
Capital Outlay $ 67,029 $ 37,212
Total Expenditures $ 15,884,746 $ 10,139,017 63.83%
Revenue: $ 9,118,594 $ 6,109,205 67.00%
Net County $ 6,766,152 $ 4,029,812 59.56%
Revenue and Expenditure Summary
For the Month of March 2008
8
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 07-08 and FY 06-07
Date (BOH) Grant Requested Pending Received Denied
41212008 Weight Wise year funding) - Center or
Health Promotion and Disease Prevention at
UNC-Chapel Hill; weight loss program for low
income women ages 40 and 64. $24,755 $24,755
3/5/2008 (Letter of Intent Only: Cape Fear Memorial
Foundation - Men's Preventive Health - 3
ears, $232,000
2/6/2008 Community Waste Reduction & Recycling
to secure low cost Community Animal
Neutering $25,000 $25,000
11212008 Smart Start - New Hanover County
Partnership for Children - Child Care
II Nursin Program • • • $196,500 $161,042 $35,458
Maternity Care Coordination - North
Carolina Department of Health and Human
Services funds to provide Maternity Care
Coordination services to non-Medicaid eligible
clients $17,580 $17,580
HIV/STD Prevention Outreach--_-North
1215/2007
Carolina HIV/STD Prevention and Care
Branch - total of multi-year funding thru May,
2010 $175,000 $175,000
Family Counseling Services - Cape Fear
Memorial Foundation continuation funding for
1 year (of a possible 3 years) $53,000 $50,000 $3,000
111712007
Living Well - Additional funds added to
original grant to complete winter edition of
newsletter - Cape Fear Memorial Foundation $650 $650
Asthma Program - North Carolina Dept. of
Health and Human Services Division of Public
Health Asthma Program $18,000 $15,000 $3,000
10/312007 Healthy Carolinians,- Request for funds from
the North Carolina Division of Public Health,
Office of Healthy Carolinians, for support of
the local task force. $12,048 $12,048
ACHIEVE Grant - Centers for Disease
ControlNMCA - Workplace Wellness
Services $40,000 $40,000
9/512007 No Activity for September 2007
811/2007 No Activity for August 2007
711112007 WIC Mini-grant - Request to ratify application
for mini-grant funds for minor renovations to
the WIC registration workstations to improve
customer service. $18,000 $18,000
61612007 Landfall Foundation - Request for funds to
purchase 16 wheelchairs for the NHCHD
School Health Nursing Pro ram. $2,700 $2,700
5/2/2007 Living Well: Received notification from Cape
Fear Memorial Foundation of continuation
funding for the publication of the Living Well
newspaper insert. $0 $12,000
9
i 1-_1
As of 4/16/2008
N HCHO BOARD OF HEALTH APPROVED GRANT APP LIGATION STATUS FY 07-08 and Fr 06-07
R¢ uested Pendln Received Denied
Date BOH Gra ni
414/2007 Min istering Circle (Colposco py fundina) -
Raquast for $92,000 star[-up funds from
Ministering Circle for purchase of Colposcopy
equipment. Also plan to request additional
funds from other grant sources such as Capa
Fear Memorial Foundation for expansion Of
program to include a second colposcopy unit
and additional training. supplies. and contract
services. $12,000 $1 2,000
Cape Fear Memorial Foundation -
Colposcopy Program - VV.-ens Preventative
Health. $25,000 for start up cost for physician
and intarpratar contracted services.
-qulpmant, supplies, and training. $25,000 $25,000
31712007 ios ng The ap - -quest or 225,000
($75,000 par year for 3 years) from North
Carolina Office of Minority Health and Health
iJisparitlas fora Health Educator to focus On
pr-vantion of HIV and other saxually
transmitted disease in tha Latino and Afro- $225,000 $225,000
American o ulations.
21712007 CA -M RSA= Funding from UNC-Chapel Hill
School of M.dicing to assist with rasaarcM1
ralatad to the pravalance of community
associatad mathicillin rasistant staphylococus $12,600 $12 600
aur-us
11312007 mart Tart - Naw anover ounty
Partnership for Children - Child Care $178,500 $170000 $8500
Nursin Pro ram
12/6/2006 17uke Endowment Funds, NHRMC - l)antal
Unit - Personal Health Services. $25,000 for
indigent dental care and $15,000 for sedation $40,000 $20000 $20.000
e uipment
11/1/2006 No Aciivi for -----006
10/4/2006
Mann" of Dimes - Matarnity Care
Coordination expenditures for Baby Love $3 000
Program Baby Boutique and Laarnin Center $3,000
9/6/2006 No Acttvi for Se tember 2006
8/2/2006 No Aci1v1 Tor Au rust 2006
7/5/2006 erv ca oo Ana on am y
Counseling Program (Cape Fear Memorial
Foundation) -Funding for Licansed Clinical $260 000 - $76,000 $185,000
Social VVorK-r for 3 ears
at Smar[ ove ore - ommun ty rant
(NC Oept -I. Health Physical Actlvlty 516,495 $12 416 $4,079
and Nutrltlon Branch
Totals 51 355,828 $42 336 $773 756 5551,737
3.12 % 57.07 % 40.69 %
2
Pend in Grants 9 q1%
Funded Total Re quest 7 32 % .,y
Pa rtiall Funded 7 98
Denied Total Re uest 22 100
Numbers of Grants A lied For
1 0
As oT 4/18/2008
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
`Y~.r Request for Board Action
Agenda: L-A Consent Meeting Date:
Agenda: ® BOH: 5/7/08
CC- 5/19/08
Department: Health Presenter: Kim Roane, Support Services
Mara er
Contact: Kim Roane 798-6522
Subject: Budget Amendment - Request to Decrease Revenues and Expenditures in the
Mobile Dental Unit Budget ($71,000), School Mental Health Budget ($68,000), School
Health Bud et $65,000 and Care Coordination Bud et $97,000 for IF-k'07-08.
Brief S~~mmary: The New Hanover County Health Department's Mobile Dental Unit
program was without a dentist for the first two and a half, months of the current fiscal
year, causing less than expected revenues and reduced expenditures- The School Mental
Health and School Health program contract amounts were each reduced for the current
fiscal year due to savings in salary and operating expenditures- The Care Coordination
program has experienced several vacancies for the current fiscal year, reducing salary
expense and resultant revenues- We are requesting approval to decrease our expenditure
and revenue budgets for each of these programs to provide a more accurate reporting of
current bud et amounts needed too crate.
`r
Recommended Motion and Requested Actions: To accept and approve the budget
amendment reducing expenditures and revenues in the Mobile Dental Unit (S71,000),
School Mental Health ($68,000), School Hcalth ($65,000) and Care Coordination
($97,000) budgets for FY 07-08 and to submit to the New Hanover County
Commissioners for their consideration-
Fundirn Source: Health Fees and Medicaid cumin s.
Will above action result in:
New Position Number o£ Position(s)
Position(s) Modification or change
No Chan a in Position s
Ex lanation•
Attachments-
ADMOOI NHCBOH Request for Board Action
I 1 /07
1 1
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Vj~, Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 5/7/08
CC- 5/19/08
Department: Health Presenter: Janet McCumbee, Personal
Health Services Mama er
Contact: Janet McCumbee 798-6559
Subject: Request to Accept Donation from Ministering Circle - Lab Equipment -
Personal Health Services - $1300
Brief Summary: 1'he Ministering Circle has verbally notified the Health Department of
their intention to donate $ 13 00 for the purchase of a Cholestech lab machine and some
supplies- The machine is portable and will be used to provide lab testing in the
community for preventive health fairs and wellness projects-
Recommended Motion and Requested Actions: To accept and approve the $1300
donation from Ministering Circle for the purchase of the Cholestech machine and
supplies for the Lab and to submit to the New Hanover County Commissioners for their
~.r consideration.
Fundin Source: ministering No matching Count funds are re uired_
Will above action result in:
F-lNcw Position Number of Position~s~
OPosition~s~ Modification or change
X No Chan a in Position s
Explanation: The Chol¢st¢ch machine is needed to provide lab testing in the community
Burin health fairs and wellness ro rams.
Attacltments-
NHCBOH Request For Board Action
ADMOO I
1 1 /07
J L.2
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 5/7/08
CC: 5/19/08
Department: Health Presenter: Dianne Harvell, Environmental
Health Services Manager
Contact: Dianne Harvell 798-6665
Subject: Grant Application - Request to Submit a Grant for Funding of Tick Control
Demonstration Project - Vector Control - Environmental Health Services - $15,000
Brief Summary: The Health Department's Environmental Health Services Division
proposes to apply for a $15,000 "Tick Control Demonstration Project" grant. North
Carolina Department of Environment and Natural Resources (NC DENR), Division Of
Environmental Health, will award grants to three NC counties. Vector Control Program
staff will develop and implement surveillance activities for ticks in parks and other public
places as well as treatment protocols. Staff will also use a variety of media to educate the
public about protection from tick-borne diseases. If grant approval is obtained, a budget
amendment will be submitted at that time.
r?
Recommended Motion and Requested Actions: Request to accept and approval to submit
an application to The North Carolina Department of Environment and Natural Resources
for $15,000 in grant funding for a Tick Control Demonstration Project and to submit to
the New Hanover County Commissioners for then consideration.
Funding Source: NC DENR grant. No matching County funds required.
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Explanation:
Attachments: Budget and Description of Grant Requirements
13
A
NCDENR DEH Tick-borne Disease Control Demonstration Project
New Hanover County
• Available to three counties
• Can be funded $15,000 per year
• Up to 3 years of funding
New Hanover County is an ideal candidate for this project:
• Has a significant population of ticks based on staff experiences working
throughout the county
• Has a large deer population in portions of the county which contributes to
the tick distribution and population (example 4 Fort Fisher)
• Warm climate supports a longer tick season
• Residents and a large number of tourists spend significant time outdoors
where tick exposure is inevitable
• Has adequate staff to distribute brochures providing public education,
implement surveillance through collection, identification, documentation,
and treatment for ticks
New Hanover County can utilize funds for tick-borne disease control in
the following ways:
• Print and distribute brochures providing public education on ticks and tick-
borne infections
• Potential media component of educational effort via NHCG -TV segment
on ticks and tick-borne infections
• Implement surveillance through collection, identification and
documentation of tick species
• Sample parks and other areas of public gatherings where the risk of tick
exposure may be high
• Apply treatment for ticks where justified through surveillance activities
• Determine efficacy through post treatment surveillance activities
• Report findings and lessons learned
ikw
14
New Hanover County Health Department
Tick demonstration Project ..ri+?
NC E)[=-NR Grant Budget
Educational Materials $4,000
Surveillance $6,000
Treatment $5,000
Total $15,000
1 5
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NEW HANOVER COUNTY HE
i i
Environmeninl Health Services
230 Market Place Drive, Suite 140
Wilmington, NC 28403 =mPr0Per GOO Iif19 1s filte
910-798-6667 major cause of foodbor-ne illf'less
• • • • • • • • • •
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"~'~NEW HANOVER COUNTY ~i.
~c;_ HEALTH DEPARTMENT _
z o Environmental Health Services
230 Government Center Dr_, Suite 140
Wilmington, NC 28403
TE LF_PHONE !91 Ol 798-6667 FAX !97 Ol 798-7269
Risk Based Inspections
Risk Category 1 = 1 inspection per 12 months (July 1 June 30)
Establishments that prepare only non-PHF
Establishments that use only multi-use eating or drinking utensils
Examples: Drink stands 8c Nachos with non-potentially hazardous cheese
Risk Category 2 = 1 inspection per every 6 months (Julyl-Dcc.31) (Jan_l-June 30)
Establishments that cook 8c cool no more than two PH foods
Establishments that receive raw PH ingredients ready-to-cook
Examples: C'riocery Delis, Pushcarts SL Mobile Food Units, Cook 8c Serve establishments
Limited Food Service Establishments (Ball Park Concessions Stands) and Sandwich shops
Risk Category 3 = 1 inspection per every 4 months
(Julyl-Oct_31) ~Nov_1-Feb. 28) (Marchl-June 30)
Establishments cook 8a cool no more than 3 PH foods
Establishments that prepare raw PH food
Examples: Grocery store seafood markets, Crrocery store delis. Middle 8c High School
Lunchrooms, Some sandwich shops, Some Mobile Food Units and Meat Markets
Risk Category 4 = 1 inspection per every 3 months
(Julyl-Sept 30) (Oct_1-Dec_31) (Jan_1-March31) (April I -Juno 30)
Establishments serving highly susceptible populations
Immunocompromised, preschool age children, or adults, 55 years of age or older
Establishments using specialized food processes: Reduced oxygen packaging
Establishments that cook SV cool unlimited number of PH foods
Examples: Full Service Restaurants, Buffet Restaurants, Nursing Homes, Catered Elderly
Nutrition Sites, Meat Markets that cure ham, School Lunchrooms Serving Pre-School or Special
Needs Centers
Cool Hot Potentially Hazardous Foods Rapidly to
70-F within 2 hours and then to 45-F within an additional 4 hours-
Document all cooling times and temperatures for each food item cooled_
Reheat food items rapidly to 165°F and hold hot food items at 135°F or above-
"Healthy People, Healthy Environment, Healthy Community"
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J-1- April 2008
Mr_ David E_ Rice
Health Oirector
New Hanover County Health [Department
2029 South 17th Street
Wilmington, NC 28401
Oear Mr. Rice,
On behalf of the NC Local Health Oepartment Accreditation Board, 1 would like to congratulate the New
Hanover County Health Department for becoming one of the first 3 health departments in NC to be re-
accredited!
The focus of North Carolina's Local Health Department Accreditation (NCLH[DA) is on the capacity of the
local health department to perform at a prescribed, basic level of quality the three core functions of
assessment, policy development, and assurance and the ten essential services pf public health- It is now
required by legislation that all health departments will be accredited- New Hanover County, 1 am
pleased to say was one of the first 3,4 health departments to be accredited in the state and is now one of
the first 3 to become re-accredited. Accreditation represents what the staff does for the community in
preparation for day-to-day activities, but also to be prepared for any type of public health emergency.
The instrument that is used to evaluate the health department includes 41 benchmarks and 148
activities, all of which were 'Met' by the New Hanover County Health [Department, with exception of 2
activities.
The Accreditation Board has a true appreciation for all of the hard work completed by the Agency
Accreditation Coordinator (AAC), Scott Harrelson, and the rest of the health department staff- Achieving
accreditation is truly an accomplishment that your health department and community should be very
proud of.
The Accreditation Board truly appreciates your dedication to improving the public's health in NC_
Sincerely,
Or_ Betty Alexander
2008 Board Chair
NC Local Health Oepartment Accreditation Board
CC: [David Stone, Accreditation Administrator, NC Local Health [Department Accreditation
Scott Harrelson, Agency Accreditation Coordinator, New Hanover County Health [Department
Sandra L. Miles, Chair, New Hanover County Board of Health
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
~r Request for Board Action
Agenda: Consent Meeting Date:
Agenda: ® BOH: 5/7/08
CC: 5/19/08
Department: Health Presenter: Dianne Harvell, Environmental
Health Services Manager
Contact: Dianne Harvell 798-6665
Subject: Repeal New Hanover County Board Of Health Rules Governing Water Supply
Wells
Brief Summary: The NC Environmental Management Commission and Commission for
Public Health have adopted regulations governing the permitting, inspection, sampling
and testing of water supply wells which become effective July 1, 2008. At present it
appears, these standards will adequately protect the public's health and our groundwater
resources. We, therefore, propose to repeal the New Hanover County Board of Health
Rules Governing Water Supply Wells.
Recommended Motion and Requested Actions: Repeal New Hanover County Board of
Health Rules Governing Water Supply Wells and submit to the New Hanover County
Commissioners for their consideration.
Funding Source:
Will above action result in:
?New Position Number of Position(s)
?Position(s) Modification or change
®No Change in Position(s)
Ex lanation:
Attachments: Frequently Asked Questions: Local Regulation of Private Drinking Water Wells
Frequently Asked Questions:
r Local Regulation of Private Drinking Water Wells
Aimee Wall
UNC School of Government
In 2006, the General Assembly enacted legislation directing the Environmental Managemhealth e t
commission (EMC) to adopt rules "governing the permitting and inspection by local
departments of private drinking water wells...."' In addition, the legislation directed the
Commission for Public Health to adopt rules governing the sampling and testing of water from
private wells. The EMC and the Commission for Public Health finalized the rules and they are
expected to go into effect July 1, 20
Before the legislation was enacted, approximately 35 counties had local board of health rules or
ordinances in place that governed private drinking water wells. After the legislation was
enacted, the remaining counties adopted local laws governing private drinking water wells
primarily because they were offered a financial incentive to begin getting local well programs in
place.5
Once the state regulations go into effect it July, they will be applicable statewide. Environmental
health specialists in local health departments will be responsible for enforcing the state, s
requirements in their respective jurisdictions. One critical decision that each county will need to
make is whether it wants to adopt a local well rule or ordinance that supplements of state
regulations. In a question and answer format, this bulletin will review the scope
regulations and the authority of local governments to adopt more stringent local laws.
Q1. To what types of wells do the new state regulations apply?
Chapter 87 of the North Carolina General Statutes imposes wells. d rwelln is defined c on, as "any
operation, maintenance and abandonment all types otherwise constructed:
excavation that is cored, bored, drilled, dug, or
1 S.L. 2006-202, sec. 2 (adding a new subsection (7) to G.S. 87-87).
2 S.L. 2006-202, sec. 4 (adding new G.S. 87-97(i))
22 N.C. Register 1691-94 (Apr. 1, 2008) (amending 15A NCAC 2C). Thirty-five counties have some sort of
4 Pat Stith, Clean Wells Left to Chance, News & Observer (Mar. 26, 2006) C'
construction oversight or well-testing program, but only 14 require even minimal tests. In the other 65 counties, well
drillers are on the honor system when it comes to construction standards.").
s The incentive money was included in the 2006 and 2007 appropriations acts. See S.L. 2006-66 (providing over
$800,000 to the Department of Environment and Natural Resources for distribution to counties "for technical
support and enforcement assistance " an as [counties] enforce statewide private water additional $300,000 for distribution to county well /programction
standards S.L. 2007-323 (providing
1 - 4/14/2008 [DRAFT]
• For the purpose of locating, testing or withdrawing groundwater or for evaluating,
testing, developing,- draining or recharging any groundwater reservoirs or aquifer, or
• That may control, divert, or otherwise cause the movement of water from or to any
aquifer. "6 -
This definition is broad enough to encompass many types of wells that are used in the state,
including drinking water supply wells, monitoring wells, and injection wells-
-Me 2006 legislation and the new regulations require Iocal health departments to manage the
inspection and permitting process for n subset of wells, "private drinhi.,g water wells," which are
defined as "any excavation that is cored, bored, drilled, jetted, dug, or otherwise constructed to
obtain groundwater for humctn consumption" and that serves or is proposed to serve
• 14 or fewer service corineetions or
• 24 or fewer individuals.
The term also includes any "well that supplies drinlcillg water to a transient noncommunity water
system as defined in 40 Code of Federal Regulations § 141.2 (July 1, 2003 Editions" which
encompasses wells at locations such as campgrounds and rest areas.
Q2- What state laws appli¢d to private drinking water wells before the new legislation?
The state laws in Article 7 of Chapter 87, which have been in place for many years, govern the
construction, operation, repair, and abandonment of wells. The EMC has also adopted detailed
regulations implementing the statutory requirements found in Chapter 87, often. referred to as the
"2C rules" because they are found in Title 1 sA, Chapter 2C of the North Carolina Administtetive
Codc.7 A smaller subset of wells-those serving certain establishments regulated under state law
such as restaurants, hotels, summer carps and local jailsa~ a subject to additional regulations _
adopted by the Commission for Public Health-'
While all of these laws ware in place regulating how wells should be constrrl=cd, operated.,
repaired and abandoned, state law required only a few categories of wells to be inspected and
permitted by state or local officials- Wells associated with regulated establishments, such as
restaurants, were inspected in conjunt-lion with the issuance of the establishment's operations
permit In addition, the EMC is authorized to issue permits for a small subset of wells= Cl) those
with a designed capacity of 'l 00,000 gallons per day or greater and (2) those in certain
geographical areas identified by the EMC.1O
° G_S_ 87-85_
'15A NCAC 02C_
Establishments regulated pu-t to l sA NCAC l &A-
' l5A NCAC 18C; ISA NCAC 18A _1700.
1O rho EMC is authorized to hold public hearings to identify geographical areas where requiring prior permission for
well west-cation is "-sonably necessary to protect the groundwater resources and the public welfare, safety and
health..." G.S. 87-88(a). To date, the EMC has not identified a y geographical areas requiring permits pursuant to
this provision.
2 - 4/14/2008 [DRAFT]
Q3. Did local governments previously have authority to adopt local laws governing private
drinking water wells?
Yes. Some local governments concluded that more oversight of well construction, operation,
repair, and abandonment was necessary therefore
local permitting systems and imposed and of
health rules. These local laws typically
additional substantive requirements or restrictions on the well construction process.
Cities and counties may adopt ordinances governing private drinking water wells because the
state has delegated local governments the general authority to adopt ordinances necessary to
protect the "health, safety, or welfare of its citizens and the peace and dignity" of the city or
county.
Local boards of health may cite to two sources of authority for the adoption of local public health
rules governing private drinking water wells. First, the public health chapter of the North
Carolina General Statutes (Chapter 130A) grants boards of health the general authority to adopt
rules necessary to protect the public's health. The law provides that a local board may even adopt
rules that are more stringent than those adopted by the Commission for Public Health or the
Environmental Management Commission when, in the board's opinion, a more stringent rule is
required to protect the public health. 12 Second, boards of health have specific authority in the
Article 7 of Chapter 87, which governs well construction, to "adopt by reference rules adopted
by the Environmental Management Commission pursuant to3this Article and may adopt more
stringent rules when necessary to protect the public health.
Qa. May a local government continue to enforce its local well ordinance or board of health
rule or adopt a new ordinance or rule after the state regulations governing private drinking
water wells go into effect?
The existence of a state law can sometimes preempt - or override - the authority la can
governments to adopt local laws in the same substantive field. For example, state expressly prohibit local laws, such as the prohibition on local board of health rules related to the
grading, operating, and permitting of food and lodging facilities. 14 State law can also impliedly
preempt local law if the state has created a regulatory scheme that is so "complete and
integrated" that there is no room left for additional regulation. 15
" G.S. 153A-121 (counties); 160A-174 (cities); see also A. Fleming Bell, The Police Power in COUNTY AND
MUNICIPAL GOVERNMENT IN NORTH CAROLINA, at 2, UNC School of Government (2007).
12 G.S. 130A-39 (a)-P.
13 G.S. 87-96(c).
" G.S. 130A39(b). "The enactment and operation of a
15 Craig Y. Chatham, 356 N.C. 40, 44-46, 565 S.E.2d 172, 175-76 (2002)
general, statewide law does not necessarily prevent a county from regulating in the same field. However, preemption
issues arise when it is shown that the legislature intended to implement statewide regulation in the area, to the
exclusion of local regulation.")
3 - 4/14/2008 [DRAFT]
But, in the case of well construction, the state has expressly recognlzed and allowed for local
laws to coexist with the state laws. Two provisions in Article 7 of Chapter 87, in particular,
indicate that the legislature anticipated and condoned local action in this area:
• ,The provisions of any law, rule, or local ordinance which establish standards affording
greater protection to groundwater resources or public health, safety, or welfare shall
prevail within the Jurisdiction to which they apply, over the provisions of this Article and
rules adopted pursuant to this Article.-16
• "A local board of health may adopt by reference rules adopted by the Envirorunental
Management Commission pursuant to this Article, and may adopt more stringent rules
when necessary to protect the public he d-a..s 17
Thus, it appears that local governments may regulate the same subiects governed by the private
drinking water well rules adopted by the Environmental Management Commission if tho local
laws are "more stringent" than the state rules or afford "greater protection to groundwater
resources or public health, safety, or welfare." But before assuming that a local well ordinance or
rule can continue to be enforced, the local government must carefully examine the new state
regulations and evaluate which local provisions are more stringent.
Under the law, the testing rules adopted by the Commission for Public Health are treated
somewhat differently. While the Environmental Management Commission's rules establish a
floor upon which more stringent protections may be built, the Commission for Public Health's
rules establish a ceiling- The law states that "rules relating to public health, wells, or groundwater
adopted by the Comrrrissioa for Public Health shall prevail over this Article, rules adopted
pursuant to this Article, and rules adopted by a local board of health.. -."ts 'Thus, a local board o£
health may not adopt more stringent testing rules.19
Q5_ When is a local provision "more stringent" than a provision in the EMC rules?
While the clauses "more stringent" and "provide greater protection" are not expressly defined in
the stata.law, a common sense interpretation would suggest that the local provision build upon or
increase the regulatory requirements already imposed by the state laws. In the context of
ordinances, state statutes also refer to local authority to adopt ordinances that require "a higher
standard of conduct or condition. "2O
16 G_S_ 87-96(aj-
'i G S_ 87-96(b~-
'9 ]r however, a local government had an ordinance or rule in place prior To July 1, t 989 that is effectively more
stringent than the Commission's new testing rules, the pre-1989 law would remain a Forcoalslc. I.I.
~O This language is taken from G.S. 160A-I 74(1b)("The fact that a State or federal law, standing alone, makes a given
act, omission, or condition unlawful shall not preclude city ordinances requiring a higher standard of conduct or
condition ^l- This law addresses the authority of cities to adopt ordinances- The courts have extended
4 - 4114/2008 [DRA]F`T']
%Aw" For example, the state regulations governing well construction require the water supply source
for most wells to be at least 20 feet below land surface_21 Under certain circumstances, the state
regulations would permit wells to draw on water supplies tbat are less than 20 feet below the
surface and in other, situations, the state epWations require wells to draw on water supplies that
are at least 35 feet below the st rface_22 A county may conclude that, based upon characteristics
specific to the county or region, all wells should be required to draw on water supplies that are at
least 35 feet below the surface- This type of local law would likely be considered "more
stringent' than the state regulations.
Another example could be a local law that proposes to modify the timeline for local health
department staff to conduct a grout inspection. Under the state regulations, before the well
contractor grouts a new well, he must contact the health clepartment and schedule a time for a
health depaxtT*+ent representative to inspect the grouting- If the local health department
representative is unable to conduct the inspection witliin one hour of the scheduled time, the
contractor is allowed to move forward with grouting the well without the inspection 23 if a health
department in s particularly large county wanted more time to arrive at the grouting site to
complete the inspection, it might consider extending the window of time from one to two hours.
It is not entirely clear whether such a provision would be considered "more stringent." The
argument in favor of such a conclusion is that allowing the health department more time to attend -
and inspect the grout before it is conducted increases the likelihood that the grouting will be done
in compliance with the law. The opposing argument would be that such a provision is not -
necessary to protect the-public health because it does not increase the standard or level of
protection to the groundwater or public health; it simply increases the amount of time the
contractor must wait at a well site.24
When considering a local ordinance or rule provision, local governments will need to evaluate
the provision carefully, compare it to the state law, and decide whether it considers the provision
to be "more stringent" or provide greater protection to groundwater or public health than the
state law. For each local provision adopted, it would be wise to prepare a clear explanation of
the local law that includes an explanation as to why the provision is more stringent or provides -
greater protection_ -
Q6_ What is the difference between adopting a ]"cal well ordinance and a board -of health -
rule?
Ordinances are adopted by local elected officials, such as boards of county commissioners and
city councils. Board of health rules are adopted by appointed bodies called local boards of health.
City and county ordinances and board of health rules are all laws and they can all be enforced
" l5A NCAC 024-- _0107_
u 15A NCAC 02C .01 16 Cless than 20 feet); 02C _01 17 (35 feet or more).
I s^ NCAC 02C _0305-
24 There may be some situations in which leaving a well open for a longer period oftime could be detrimental to
public health or the environment- ]For example, in some types of soils, it may be difficult to keep the space needed
£or the grouting open for a long period of titrae. Before proceeding with a local rule extending the period oftime For
a grouting inspection, local lawmakers should consider all relevant in£orrraation and make an independent
determination as to whether an extended inspection period is appropriate_
5 - 4/14/2008 [DRAFT] -
through the imposition of civil and criminal penalties- But when deciding what forth a local well
law should take, officials should be aware of a few key differences between these types of local -.J~
lawsJurtsdtctiots: , board of health rule applies throughout its juri sdiction,25 including within all
rnxmicipalities 26 "I7'te jurisdiction of city and county ordinances, on the other hand, is generally
more limited- With some exceptions, a county ordinance typically governs only the -
nnincorporated areas oFa county27 A municipality within that county may, however, adopt a
resolution empowering the county to enforce its ordinance within the municipality." A city
ordinance will govern within the city limits and may also extend to city property and rights-of-
way outside the city limits.29
Scope ofauthorityr Cities and counties have the relatively expansive authority to adopt
ordinances necessary to protect and promote the "health, safety, and welfare of its citizeris and
the peace and dignity ofthe [city/county], and may define and abate nuisances.-3O
Local boards of health, by comparison, are charged with "the responsibility to protect and
promote the public health [and] have the authority to adopt rules necessary For that purpose.s31 In -
addition, the state well laws specifically authorize local boards of health to "adopt by reference
rules adopted by the Environmental Management Commission pursuant to this Article, and may
adopt more string=ent rules when necessary to protect the public health 32
Thus, the authority of boards of health is more narrowly confined to protectit g the public health.
This limitation presents a challenge for local boards that atternpt to draft rules that address
concerns other than health. For example, a board of health rule should not include exceptions -.woo
that are based on economic factors rather than health factors_33
"Local health a¢¢d": In a 2002 case, the North Carolina Supreme Court stated -that, in a Feld of
law heavily regulated by the state, a local board of health Sacked the authority to "superimpose
additional regul~a~~tions without specific reasons clearly applicable to a local health need_"34 The
court went on further to explain that the board of health failed to "provide any rationale or basis
for making the restrictions in Chatham County more rigorous than those applicable to and
followed by the rest of the state"35 Based on the language in this decision, a board of health may
need to consider adopting private drinking water well rules only if the rules address "local health
needs."
zs A board ofhealth may govern a single county or multiple coumics_
za G_S. 130A-39(c)_
z' G_S_ 753A-722.
zw Jd.
z9 G.S. 160A-176.
3o G.S. 153A-121 <counzies); 160^-174 (cities).
G.S. 130^-39(a)_
12 G_S. 87-86(c).
3J S¢¢ 12oanoke Rapids v_ Peedin, 124 N.C_App_ 578,478 S_F2d 528 (1996); see also Aimee N. Wall, 77-
R-!-long A.fhority of North Caroline Local Boards -rZT-lth, 1-lealth L.aw Bulletin No_ 81 (Nov- 2003),
ovailable at www.ncphlaw_unc.edu_
3, Craig v_ County of Chatham, 356 N.C. 40, 51-52, 565 SAE- 2d 172, 179 (2002)
33 Jd
6 - 4/14/2008 [OKAPI']
Enforcement: There are three options available to enforce an ordinance: civil monetary fines,
criminal penalties, and equitable relief such as an injunCtion.36 Only two options are available to
enforce a board of health rule: criminal penalties and equitable relief.37 The board is not
authorized to impose civil fines for violations of board of health rules.
Q7. What process should a board of health follow if it wants to retain or adopt local well
rules?
Once the state rules go into effect in July, there is the potential for tremendous confusion in those
jurisdictions that have a local well rule or ordinance. Do the state rules apply? Are some or all of
the provisions of the local laws still in effect because they are more stringent? Which laws will
govern the construction of a new well? The public, the drillers and the EHS's charged with
enforcing the law will likely all have similar questions and concerns.
The burden is on the local government to minimize the confusion. In those jurisdictions that have
local well rules, the board of health will need to take some action in order to harmonize the state
and local laws. For example, a board of health has several options available:
• A local board of health may adopt a "sunset provision" that repeals local rules upon the
effective date of the state rules. By doing so, the board of health makes it clear that only
the state rules apply within the board's jurisdiction.
A local board of health may take action to repeal local rules effective July 1. By doing so,
the board of health makes it clear that only the state rules apply within the board's
jurisdiction.
• A local board of health may adopt a new rule or amend a rule with an effective date on or
after July 1. The new or amended rule should adopt the state rules by reference and
incorporate "more stringent" requirements deemed necessary to protect the public health.
Such a rule would provide clear guidance regarding the law applicable within the
jurisdiction.
For any of the above actions, the board of health will need to follow the general rulemaking
procedures outlined in G.S. 130A-39. Specifically, not less than 10 days before the adoption,
amendment or repeal of the local rule, a copy of the proposal must be made available at the
office of each county clerk within the board's jurisdiction and a notice must be published in a
newspaper having general circulation within the jurisdiction. The notice must provide a general
description of the subjects and issues involved, the proposed effective date, and a statement
explaining that copies of the proposal are available at the local health department.
When a board of health passes a local rule that adopts the state rules by reference, reading the
two laws together may be challenging. To assist the public and others trying to understand the
law, the board or staff members could develop "guidelines" that bring together both the state
36 G.S. 14-4 (criminal remedies); 153A-123 (other remedies available to counties); 150A-175 (other remedies
available to cities).
37 G.S. 130A-18 (injunctions); 130A-25 (misdemeanor).
7 - 4/14/2008 [DRAFT]
-1:
rules and the local rules in one document While the guidelines would not have the Force :,f law,
they could help improve understanding c f the law applicable within the
QS--If a local government adopts m local board of health rule and is sttbsequeatly sued by s
property owner or outer individual, will the state provide for legal representation and pay
settlements mad judgments?
In some fields of public health, local health department staff members that are enforcing state
rules are considered authorized agents of the state-38 For example, if an environmental health
specialist (IF-HS) employed by a county complies with specific training requirements and passes a
certain test,39 he or she may be "authorized" to enforce statewide sanitation regulations
governing restaurants- 'I7te authorized agent (i.e., local EHS) is allowed to enforce the state rules,
which includes inspecting restarrrarlts, issuing, suspending or revoking a resta~V s permit, and
issuing a sanitation grade to a restarrr-s t 40 -
If a restaurant owner challenges an action taken by the EHS either by filing an appeal with the
Office of Administrative Hearings or by suing the EHS, the county or others, the state will
typically be involved in providing representation and paying all or some of any settlement or
judgment. State law provides:
Any local health department sanitarian enforcing rules of the Commission For Public
Health or of the Environmental Management Commission under the supervision of the
Department of Environment and Natural Resources pursuant to 1 30A-4 shall be
defended by the Attorney General, subject to the provisions of G.S_ 143-300.4, and shall
be protected from liability in accordance witli the provisions of this Article in any civil or
criminal action or proceeding brought against the sanitarian in his official or individual
capacity, or both, on account of an act done or omission made in the scope and cotarse of
enforcing the rules of the Comrission for Public Health or of the Environmental
Management Commission-41
If, instead of enforcing a state law, an E14S is en.Forcing a Iocal law or policy or is acting outside
the scope of his or ber agency, it is highly unlikely that the- state will provide representation or
pay any part o£ a civil judginent.42
Controversy surrounding state and local responsibility for litigation-related costs typically arises
in the context of enforcing laws related to on-site wastewater (i_e_, septic systems) permitting and
inspection programs- State law sets out detailed requirements governing the permitting of on-site
as G.S. 130A-4(d) (17-he local health department sha11 utilize local staff authorized by the Department of
Environment and Natural Resources to enforces" the rules of the Commission For Public Health and 'l-1ic
Enviroantental Management Commission.)
O9 15A NCAC 010. 0100 et seq_ -
ISA NCAC 18A _2600 et seq_
143-300.8.
a2 See Cates Dept- of justice, 346 781 (1997) (holding that a specialist who conducted a preliminary
soil evaluation was not entitled to representation by the A"o-,ey General because the evaluation was not provided
for in the state rules)-
8 - 4/14/2008 (DRAFT]
%W wastewater systems. 3 State law also specifically authorizes local boards of health to adopt local
rules governing permitting and inspection of on-site wastewater systems. In such cases, the local
board of health must:
• Adopt the state rules by reference "with any more stringent modifications or additions
deemed necessary by the local board of health to protect the public health,, 44 and
• Ask the Department of Environment and Natural Resources (DENR) to review its
proposed rules as
DENR may approve of the local rules if it finds that the local rules are "at least as stringent" as
the state rules and "sufficient and necessary to safeguard the public health. A6 DENR retains the
authority to revoke its approval of local rules if it later concludes that they are "not as stringent
as [the state rule, are not sufficient and necessary to safeguard the public health, or are not
being enforced.'
When a local board of health decides to adopt local rules and follows through with the process
outlined above '41 the state's position has historically been that the entire body of rules -
including those state rules that are adopted by reference - are considered local rules. In such
cases, the state's position is that the EHS is not acting as an "authorized agent of the state" with
respect to any of the rules, even those that are "adopted by reference" from the state. Therefore,
when those local rules are challenged, the state does not provide legal representation and does
not pay any portion of the settlement or judgment.
At this time, it appears that the state will take the same approach with respect to local well rules.
Thus, if a jurisdiction wishes to enforce more stringent local well rules, it should adopt the state
rules by reference and add provisions it considers necessary to protect the public health. Once the
local rules are in place, the EHS will not be acting as an agent of the state, the Attorney
General's office will not provide representation in legal challenges based on the rules and the
state will not pay any judgment or settlement that arises from such litigation. Given the potential
liability exposure, a local board of health should consult with the county or health department
attorney prior to moving forward with local rules.
13 G.S. 130A, Article 15A NCAC 18A .1900 et seq.
44 G.S. 130A-335(c)(2).
" G.S. 130A-335(cX I
G.S. 130A-335(cX3).
" G.S.130A-335(d).
lkw `s only three counties, Guilford, Orange and Wake, currently enforce local on-site wastewater rules.
9 - 4/14/2008 [DRAFT]
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M a a.bv a va r
i
Rice, David E.
From: Rice, David E.
Sent: Friday, April 18, 2008 7:39 AM
To: Roane, Kim
Subject: RE: F.A.C.T. Recommendations from 4116/08 Meeting
Approved.
David E. Rice, MPH, MA
Health Director
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
910-798-6591
drice@nhcgov.com
http://www.nhchd.orq
From: Roane, Kim
Sent: Thursday, April 17, 2008 5:52 PM
To: Rice, David E.
Subject: F.A.C.T. Recommendations from 4/16/08 Meeting
Dave,
The F.A.C.T. meeting held on 4/16/08 resulted in the following recommendations for your approval, three of which
are expected to result in affecting revenues more than $5000/year:
• Add Nodnyl 1+35 to the list of approved birth control drugs, establishing a fee of $8.001cycle
• Change LU014 Printing of Immunization Record to read Printing of Immunization Record/TB Skin
Test Results. This will reduce the fee paid by patients requiring only a 1-page copy of their TB Skin Test
results from $5.00 to $2.00. Previously, patients requiring a copy of their TB Skin Test results have had to
pay for the cost of a Medical Record copy (LU018), which was $5.00. The team recommends the fee
reduction to bring the TB Skin Test copy cost in line with the cost of a patient's immunization record.
• In order to comply with requirements of the United Healthcare contract, we will begin allowing Spectrum
Labs to bill third party insurers for laboratory work performed for our patients referred to them. This will
also eliminate the expenditures we have made to Spectrum Labs for payment of laboratory work performed
for patients we have referred to them. We will continue to pay Spectrum for laboratory work performed for
our self-pay patients.
The following recommendation will require your approval to request Board of Health and County Commissioner
approval for implementation, as it is expected to result in an increase in revenues of at least $5,000:
• Currently, Medicaid pays an immunization administration fee of $27.42 per patient, regardless of whether
one dose or multiple doses are given. Medicaid has changed this, splitting it into two fees: 90471 EP is the
new code for Administration of one injectable vaccine, and 90472EP is the new code for Administration of
multiple injectable vaccines (per dose). If a patient is administered multiple vaccines in one visit, Medicaid
will now pay multiple administration fees, one per each dose administered. We request approval to make
the following changes to the fee policy to incorporate the new change in Medicaid payment of
administration fees:
Code Description 2007 2008 Current Suggested Action
Medicaid Medicaid F.A.C.T. F.A.C.T. Needed
Rate Rate Rate Rate
90471 EP Administration of injectable vaccine(s) - 27.42 $27.42 $27.42 $0.00 Delete
visit
4/18/2008
r90465F-=F 7EP Administble vaccine O $'1725 $0.00 $17.50 Add EP Additional injectaO $971 $000 $17.50 Add
do n Administration of injectable 27.42 $27.42 $27.42 $0.00 Osl-tvisit - with physician -8
ears
465EP Administration of one injectable vac-in- 0 $17.25 $0.00 $17.50 Add
with physician counseling - 8 Y-ars
90466EP Additional inject- bl- vaccines (per O $9-711 1 $0.00 $17.50 Add
dos-) with physician couns-ling - 8
ears
If you approve this change to the Fee and Cod-s. 1 will prepar- a Board Action for submission to the OOH and
County Comrrassion-rs for approval.
Thank you,
Kim
Kim Roane
Support S-rvices Manag-r
hl-w Hanov-r County Health Department
(910) 798-6522
fax (910) 341-4146
- --.0 °
4/18/2008
Rice, David E.
From: Jenkins, Paula
Sent: Friday, April 18, 2008 5:59 PM
To: Health -All Users
Subject: F.A.C.T. Recommendations/Approvals
The F.A.C.T. (Fees and Coding Team) met this past Wednesday and forwarded several recommendations to Mr.
Rice for approval. The following recommendations were approved:
1. Add Norinyl 1+35 to the list of approved birth control drugs with a fee of $8.00 per cycle. The $8.00 fee is
charged to patients for replacement pills (lost/stolen) and for employees and their dependents who present
with a prescription for the pills.
2. Change description of LU014 from "Printing of Immunization Record" to "Printing of Immunization
Record/T13 Skin Test Results." This will reduce the fee patients have been paying for copies of TB Skin
Test Results from $5.00 to $2.00. Patients were being charged the $5.00 rate for LU018 Medical Record
Copy, and the TB skin tests results are a one page copy more in line with immunization records.
3. In order to comply with billing requirements set forth in the United Healthcare contract for outsourced lab
testing, we will begin'to allow Spectrum Labs to bill patients' Medicaid and/or third party insurance for the
labs they are processing for our patients. Patients without Medicaid or insurance will continue to be billed
by the health department. There are a number of changes to be made to processes, forms, etc. prior to
implementation. More information will be forwarded to staff as soon as details are worked out.
Paula S. Jenkins
Fiscal Support Supervisor
Billing Unit
~4w New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
(910) 798-6501
~Ow
4/21/2008