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05/12/1999 I I I 33 Mr. William T. Steuer, Chairman, called the meeting of the New Hanover County Board of Health (NHCBH) to order at 8:00 a.m., Wednesday, May 12, 1999, in the Dr. Thomas Fanning Wood Memorial Conference Room of the New Hanover County Health Department, 2029 South 17th Street, Wilmington, North Carolina. Members Present: William T. Steuer, Chairman Wilson O'Kelly Jewell, DDS, Vice-Chairman Henry V. Estep, RHU Michael E. Goins, 00 Robert G. Greer, Vice-Chair, County Commissioners W. Edwin Link, Jr., RPH Anne Braswell Rowe Philip P. Smith, Sr., MD Melody C. Speck, DVM Members Absent: Gela N. Hunter, RN, Nurse Practitioner Estelle G. Whitted, RN Others Present: David E. Rice, Health Director Lynda F. Smith, Assistant Health Director Kimberly Roane, Recording Secretary Invocation: Dr. Michael E. Goins gave the invocation. Minutes: Mr. Steuer asked for corrections to the minutes of the April 7, 1999 New Hanover County Board of Health meeting. The minutes of the April 7, 1999 Board of Health meeting were corrected and approved. Recognitions: Personnel Mr. Rice introduced the following new health department employees: New EmDlovees JoAnn G. Bauman, Physician Extender, Community Health/Jail Sharon E. Campbell, Environmental Health Specialist, Environmental Health Teresa L. Cooper, Public Health Nurse, Community Health/Jail Jenny L. Garner, Public Health Nurse, Community Health Gloria S. Umstetter, Public Health Nurse, Community Health 1 34 Service Awards Five (5) Year Service I Mr. Rice recognized and congratulated the following New Hanover County Service Award recipient: April J. MacAlpine, Nutritionist, NutritionlWlC Department Focal: Celebratina 25 Years of WIC: Buildina A Healthier New Hanover County Ms. Nancy Nail, Nutrition Director, presented the departmental focal on the history and current status of the WIC (Women, Infants & Children) program, celebrating its 25th anniversary at the federal level. A pilot program was started in 1972, linking health care and food assistance to pregnant women, nursing mothers, infants and children considered at-risk due to malnutrition and low income. In 1974, the WIC program officially began, named the Special Supplemental Nutrition Program for Women, Infants and Children. In 1975, 344,000 clients were served. Today, that number is 7.4 million, and it is thought that another million would qualify. WIC is recognized as the nation's premier public health nutrition program. It has strong bipartisan support because it is effective. It is a short-term intervention program designed to change lifetime I nutrition and health behaviors in a targeted, high-risk population. Studies have shown that pregnant women enrolled in WIC have fewer premature births, fewer infant deaths and healthier diets. Every dollar spent on a pregnant woman in WIC has been shown to save $3.13 in Medicaid costs during the first 60 days of an infant's life. While it costs less than $600 per pregnant WIC client, it costs $22,000/lb. to raise a low birth weight baby to a normal weight. WIC participation reduces Medicaid costs on average between $12,000-$15, OOO/infant for every prevented low birth weight child. Low-income children enrolled in WIC have less anemia, better vocabulary scores at age 4-5, and better digit memory test scores than other low-income children. WIC promotes breastfeeding. Foods provided include milk, cheese, iron-fortified cereal, vitamin-fortified jUice, eggs, peanut butter and dried beans. Breastfeeding women also receive carrots and tuna, and non-breastfed infants receive iron-fortified formula. To qualify, a family must be at 185% or less of the federal poverty level for family size. Those receiving Medicaid, food stamps or Work First aid are also income-eligible. However, WIC is not an entitlement program, as the participant must also be a medical or nutritional risk. Of the infants born in this country, 50% are on WIC, and 25% of pregnant women are enrolled in WIC. Mr. Rice asked Ms. Nail to share information about upcoming program changes. Ms. Nail explained that, in June, the integrity of the program is being strengthened. Prior to June 1, 1999, a client was able to self-declare income. After June 1, 1999, proof of income will be necessary, and the child must be I present for vouchers to be issued. Additionally, identification and proof of county residency will be required. Dr. Speck asked if the clients are aware of the pending changes, and Ms. Nail responded that they are being informed as they come in for re-certification. Mr. Rice stated that, for income reporting purposes, there is also a shift from the family to the economic unit of the household. Those living with 2 35 others must declare the income for the entire household. Mr. Link stated he feels these new changes are positive and may reduce fraud, and are therefore warranted. I Mr. Rice announced that Ms. Nail is President-Elect of the North Carolina Local Nutrition Directors' Association. Dr. Speck stated that, as a taxpayer, she wished to extend her appreciation to the staff for the extra work involved in the changes made to the processing, and further stated that she does feel the changes will be good. Mr. Steuer thanked Ms. Nail for making the department focal presentation on the WIC program. Committee Reports: Executive Committee Mr. Steuer, Chairman, reported the Executive Committee met at 6:00 p.m. Tuesday, April 30, 1999. Items discussed are listed under New Business on the Board of Health Agenda. New Business: Safe Communities Grant ProDosal: Safe Kids Coalition ProDosal I Mr. Steuer recommended from the Executive Committee for the Board of Health to approve the combined proposals for the Safe Communities Grant ($10,000) and the Safe Kids Coalition. MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve the Safe Communities Grant Proposal ($10,000) and the Safe Kids Coalition Proposal and to submit the grant request to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIMOUSL Y. Office of Juvenile Justice - Intensive Home Visitina Grant ProDosal Mr. Steuer recommended from the Executive Committee for the Board of Health to accept and approve the Office of Juvenile Justice - Intensive Home Visiting Grant Proposal ($100,000). This grant is through the Office of Juvenile Justice 1999 Discretional Grant Program. MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve the Intensive Home Visiting grant application ($100,000) from the Office of Juvenile Jllc::ti~p. Grant Program and to submit the grant request to the New Hanover County Commissioners for consideration. Upon vote, the MOTION CARRIED UNANIMOUSLY. North Carolina Center for Nursina Grant ProDosal I Ms. Janet McCumbee, Child Health Director, presented a North Carolina Center for Nursing proposal ($5,000) through the North Carolina Center for Nursing Recognition, Reward and Re Grant Program: 1999-2000. Ms. McCumbee explained that the grant money would be used to PUI exercise equipment for use by employees of the Health Department. The objectives of the pre project are to provide a designated exercise area for the purpose of physical exercise during no hours (break times, lunch times and before or after work). 3 36 Dr. Speck asked for an explanation of the in-kind matching funds. Ms. McCumbee explained that the in- kind represents only staff time spent developing the program, not actual dollars contributed. Dr. Speck was surprised about the number of staff hours required, and Ms. McCumbee detailed tasks requiring staff time, such as purchase of equipment and program development and evaluation. Ms. Rowe asked where the grant money comes from. Ms. McCumbee replied that it comes from the North Carolina Center for Nursing, which is a state agency. Dr. Speck stated that, if the money is being made available, she sees no reason why our staff should not apply for the money. I MOTION: Mr. Link moved for the Board of Health to accept and approve the North Carolina Center for Nursing grant proposal ($5,000) and to submit the grant request to the New Hanover County Commissioners for their consideration. Dr. Goins seconded the motion. Upon vote, the MOTION CARRIED UNANIMOUSLY. Manaaement Academv for Public Health Mr. Dave Rice requested approval by the Board of Health for management staff in the Health Department to attend the Management Academy for Public Health. The Management Academy is sponsored by the UNC School of Public Health and the Kenan-Flagler Business School, the Centers for Disease Control and Prevention, Health Resources and Services Administration of the Department of Health and Human Services, the Robert Wood Johnson Foundation and the W.K.Kellogg Foundation. The only cost to local health departments is the staff time required to attend the program. The UNC Management Academy for Public Health is a training program for public health managers from North Carolina, South Carolina, Georgia and Virginia. The total program covers a nine-month period, I beginning with Phase I, a one-week intensive management training program in Chapel Hill, NC. This is followed by Phase II, the distance learning portion of the program, during which courses will be offered via the Internet and two additional regional seminars over a nine-month period. During Phase III, Academy managers will return to Chapel Hill where they will be expected to demonstrate their acquired knowledge and skills. Mr. Rice explained that the reason he is bringing this before the Board of Health at this time is that applications for the first session of the Academy are due by the end of May. The staff he would like to send the first year includes himself, Lynda Smith and Cindy Hewett. MOTION: Dr. Goins moved for the Board of Health to accept and approve Mr. Rice's request to send staff to the UNC Management Academy for Public Health. Dr. Speck seconded the motion. Mr. Greer asked what the costs are to the Health Department, and Mr. Rice responded that, other than staff time, the program is free to participants. Mr. Rice stated that Phase I would be from August 9-13, 1999. Upon vote, the MOTION CARRIED UNANIMOUSLY. Peñormance Evaluation - Health Director Mr. Steuer recommended from the Executive Committee that the Board of Health approve a 7% merit increase for Mr. Rice. He explained that he is in the process of compiling all of the Board of Health members' comments into one job performance appraisal, which he intended to present to Mr. Rice by I the end of the week. Ms. Speck asked Mr. Steuer for confirmation that the increase would be 7%, and he acknowledged that to be the correct amount. 4 I I I 37 MOTION: Mr. Steuer moved for the Board of Health to approve a 7% merit increase for Mr. Dave Rice, Health Director. Upon vote, THE MOTION CARRIED UNANIMOUSLY. Dr. Speck thanked Mr. Rice for all of his hard work and for making the jobs of the members of the Board of Health so much easier. Comments: Board of Health Members Animal Control Services Survev - SDav/Neuter Service Questionnaires Dr. Speck reported that she met with Jean McNeil, acting Animal Control Director, to develop a questionnaire to send to veterinarians in the community. The intent is to thank the veterinarians for their past support of the New Hanover County Animal Control Division, and to request their assistance in developing a spay/neuter policy. Of specific interest will be the veterinarian's responses to questions about fees they would require for providing the spay/neuter service for pets being adopted from the Animal Control Services shelter. Dr. Speck mentioned that it is imperative that the veterinarians in the community not feel alienated, but that they are approached in a way that will strengthen the support they are willing to give to Animal Control Services. Dr. Speck added that the Animal Control Services Advisory Committee is scheduled to meet May 18, 1999. Ms. Rowe commented that it seemed that the goal should be to eventually have a veterinarian on staff at the Animal Control Services shelter to actually perform the spay/neuter services on-site. Mr. Steuer asked whose property the pets would be at the time the spay/neuter service is rendered. Dr. Speck explained that, at the time of the service, the pet would be the property of the adoptive owner. Dr. Speck stated that it will all boil down to cost, as veterinarians will not be interested in losing money to perform the service. Ms. Rowe asked for clarification of the current charges. The adoptive owner pays $45, which covers the cost of shots and a $35 certificate which is intended to cover part or all of the cost of the spay/neuter service. Dr. Speck stressed that the acceptance of certificates is handled differently by various veterinarians. Her clinic applies that certificate toward the fee for the service, and the owner pays the balance due, if any. She stated that $35 would not cover the total fee for most dogs. Mr. Link stated that Animal Control Services staff does not currently follow-up with the client to ensure the spay/neuter service is completed. Mr. Steuer asked questions regarding the current procedure, and Dr. Speck explained the procedure followed in her own clinic. Mr. Steuer asked if the goal is to have the spay/neuter procedure performed on-site at the Animal Control Services shelter. Dr. Speck stated that some would prefer that, and that it will depend on what is going to be the most economical and what the veterinarians would be willing to support. She stressed that these points are all being discussed, and that nothing has yet been decided. Dr. Speck again stated that it is very important that the veterinarians not feel alienated by any policy developed. Mr. Steuer inquired about other health issues of adoptive pets, such as heartworm treatment. Dr. Speck explained that, should a pet have heartworm, the owner should be given the option to have it treated. 5 38 Mr. Steuer asked about time frames, and Dr. Speck stated that testing takes only minutes, but treatment takes months. I Discussion continued regarding the differences between the services provided by the Humane Society and those provided by Animal Control Services. Dr. Goins stated that he would like to end this line of discussion, as the Humane Society typically deals with younger, healthier and more adoptable pets, and Animal Control Services frequently deals with animals having more complex health problems. Dr. Speck concluded by stating again that nothing has yet been decided. Ms. Jessica Nakell. Student from ChaDel Hill. North Carolina Mr. Link recognized Ms. Jessica Nagy, a student from UNC Chapel Hill, who has been spending some time in an internship with him. NewsDaDer Article in Wilminaton Star News Mr. Link commented that he had read the article in the Wilmington Star News referring to a patient being treated by the New Hanover County Health Department for a communicable disease who was served with a warrant and subsequently incarcerated for non-compliance. Letter Re: United States CitizenshiD -lIIeaal Aliens Mr. Estep requested that Board of Health members receive a copy of the letter sent to the congressional delegation regarding illegal alien citizenship. I Health Director State Health Director Visit to New Hanover County Mr. Rice mentioned that there was a recent article in the newspaper on a topic related to the State Health Director's visit to New Hanover County - the removal of signs at Hanby Beach. Mr. Rice showed the signs, and explained that Dr. McBride visited New Hanover County, rode on the Health Department's float in the Azalea Festival parade, and accompanied Mr. Rice to Hanby Beach to remove the signs and replace them with new signs - the subject of an article in the Wilmington Star News. Mr. Greer commented that the original sign was very offensive, and he felt that it was wrong to display signs without first having tested the water, which was not done. Mr. Greer stated that he thinks the new signs are an improvement. Mr. Steuer asked who put up the first sign, and Mr. Rice replied that the decision to put the first sign up was made between DEHNR (Department of Environmental Health and Natural Resources) and DHHS (Department of Health and Human Services). Dr. Goins asked how close we are to a solution to the actual problem at Hanby Beach. He stated that the original problem had to do with sewer line discharge from Kure Beach and Carolina Beach. Mr. Steuer stated that nothing was being done with the outflow pipe, which is in the area the signs were posted. Mr. Greer stated that the problem resolution has been developed and is currently in the works, I but there may be some delay due to the desire of some to include water lines in the project. 6 39 I Mr. Steuer asked if the water is being monitored, and Mr. Rice responded that the water is being monitored during events. Mr. Rice further stated that the Health Department is working with the Shellfish Sanitation Section to have samples analyzed. Bioterrorism Mr. Rice advised the Board of Health that several informative meetings have recently dealt with the issue of bioterrorism. The North Carolina Association of Local Health Directors' Spring Education Conference focused on this issue. Lynda Smith, Assistant Health Director and Beth Jones, Communicable Disease Director, both attended that session. A second workshop was held locally in New Hanover County on April 23, 1999, and was attended by Lynda Smith, Beth Jones and Dianne Harvell, Environmental Health Director. Additionally, there will be a satellite broadcast session at Coastal AHEC, which staff will attend. Thank You - EmDlovee ADDreciation Luncheon Mr. Rice delivered to the Board of Health thank-you notes written by Health Department employees, photographs of the event and a poem written by a staff member in appreciation of the employee luncheon given by the Board of Health members. Mr. Rice expressed his appreciation for the event, and stated that it was a wonderful opportunity for staff. North Carolina Association of Local Health Directors Leaislative Conference ReDort I Mr. Rice reported on his attendance at the NCALHD Legislative Conference, during which State Health Director Dr. McBride spoke about the state's focus on public health. Also discussed was the tobacco settlement and the fact that it's being looked at in terms of setting up a board of directors to develop guidelines for the spending of tobacco settlement funds, of which 25% is designated for Public Health funding. Mr. Rice reported on his attendance at the Eastern District conference in Kill Devil Hills, N.C. Eaale Island Field TriD A field trip has been planned to visit Eagle Island on Thursday, June 3, 1999 (time and details to be announced). The trip will include members of the New Hanover County Board of Health, the New Hanover County Commissioners and Brunswick County Commissioners. Eagle Island is a model for de- watering efforts for every spoil island from Louisiana to Maryland. Animal Control Director Interviews Appointments have been scheduled for interviews for the Animal Control Director position for the end of May through the first week of June. Mr. Rice stated that he hopes to have a director in place by the end of July. Budaet Schedule UDdate I Lynda Smith advised that the County Budget Office has issued a revised budget calendar that is attached to the meeting minutes (Attachment I). Ms. Smith stated that we have received the recommended budget, which will be presented at the next meeting of the Board of Health Executive Committee. The public hearing for the budget is now scheduled for June 7, 1999, during which the Board of Health will have the opportunity to present items to the County Commission. 7 New Coffee Muas for Board of Health Members Mr. Rice displayed new coffee mugs imprinted with the new Health Department logo for use by Board of Health members at meetings. Unfinished Business: Generators/HookuDS at Emeraencv Shelters Mr. Greer reported the status of a FEMA grant application to provide generators/hookups for emergency shelters in New Hanover County. Dan Summers, Emergency Management Director, is still waiting for the funds. Adjourn: There being no further business, Mr. Steuer adjourned the regular meeting of the New Hanover County Board of Health at 9:30 a.m. m~J~ William T. Steuer, PE/RLS, Chairman New Hanover County Board of Health David E. Rice, M.P.H., M.A., Health Director New Hanover County Health Department Approved: June 2, 1999 40 I I I 8