05/12/1999
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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
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Service Awards
Five (5) Year Service
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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
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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.
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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
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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
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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).
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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.
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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.
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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.
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Mr. Steuer asked about time frames, and Dr. Speck stated that testing takes only minutes, but treatment
takes months.
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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.
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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.
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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
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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
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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.
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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.
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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
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