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12/01/1978 00730 SPECIAL MEETING OF BOARD OF HEALTH - December 1, 1978 Present: Dr. James Furr, Chairman, Dr. Murray Seidel, Dr. William Eakins, Mr. Richard Reeder, Mrs. Roma Lee Hall, Mr. Deother Melvin, and County Manager, Dan Eller. This special meeting was called to consider the WIC (Women, Infant and Children) Nutrition budget for October 1, 1978 through September 30, 1979. Mr. Eller made a statement that the County is tired of carrying the burden of budgets such as this budget, CETA and other budgets for indefinite periods of time without a contract in hand. The money in last year's budget for salaries is exhausted - therefore this special meeting had to be called to approve the 1978-79 budget before the County Commissioners meeting on December 4th. The new budget was not received in this office until November 17, 1978. Dr. Seidel made a motion that the new WIC Budget and Contract for 1978-79 be approved, but questions were raised about the amount in salary and since this amount had to do with a promotion and a new position the Board went into executive session to discuss these positions. Executive Session: It was explained .to the Board that the State had recom- mended Ms. Kathy Huson, Nutritionist I be promoted to Nutritionist II and that a Nutritionist I be hired for the program. It was explained that if Ms. Huson was promoted to a Nutritionist II, at a grade of 71, this would put her at a higher grade than all except two employees in the department and that this would most certainly cause a morale problem since many others in the department carry more responsibility than she does. Dr. Finger sug- gested that she be given a two step increase at this time and leave her at a Nutritionist I. Mr. Eller explained that the County's Policy is to review personnel for step increases only after one year of employment and Ms. Huson has only been employed six months. After considerable discussion and questions directed to Miss Martha Noel, State Consultant for the WIC Program, Dr. Eakins made a motion that we consider giving Ms. Huson a step increase at the regularly scheduled time of one year and that we employ a second nutritionist. Motion was seconded and carried. Dr. Furr voted No. After the executive session, Dr. Seidel rephrased his motion to - approve the WIC Budget and Contract for 1978-1979 subject to changes made in executive session. Motion was seconded and carried. Approved: January 3, 1979 Respectfully submitted, ;Jo~ a-Le -'2 _ /{J p /l--c-<:-e.- ." ""-.... 00732 MINUTES OF BOARD OF HEALTH MEETING - December 6, 1978 Present. All Members Absent: None Minutes of the November meeting were approved as presented. Health Cards Mrs Hall asked why Health Cards are still being issued since the Board had voted to discontinue isSuing them. She had noticed in the monthly report that some had been issued. It was explained that some employers still require their employees to have them. It was suggested that if this is the case that perhaps a charge should be made to the employer. Dr. Finger was asked to get as estimated cost per person and bring this back to the Board It was also pointed out that this is still a good method of Communicable Disease Screening. Report by Dr. Seidel - Primary Care Program: Dr. Seidel had spent a day with Dr. Finger reviewing programs and visiting clinics and made a very extensive report on his findings. He gave a copy of the report to each Board Member after the meeting. He reported on work being done, number of personnel involved in each clinic, percent of neighborhood people participating in the clinics - percentage of blacks and whites attending, approximate cost of the clinics and source of funding. He reported on consultants and back- up for FNP's, source of drugs used in the clinics, and income guidelines used. A copy of this report is being placed in a notebook, along with other reports that have been given on various programs, and kept at the Health Department for use by new Board Members. Appearance before Board by Dr. Hubert Eaton, Sr. and Dr. Hal Franklin: Dr. Eaton presented a Statement to the Board registering "a formal complaint regarding the medical clinics sponsored by New Hanover County through the New Hanover County Health Department under the supervision of Dr. James Finger and run by Nurse Practitioners" - the statement is as follows. "Dr. James Furr and Members of the Board - my name is Hubert A. Eaton, Sr. I have been engaged in the delivery of health care in New Hanover County for over 35 years. I work in the area of family practice and general surgery. My son, Hubert A. Eaton, Jr. is an Internist and came to Wilmington approxi- mately five years ago. (He was the first Black Doctor to enter medical practice in Wilmington in 30 years.) On July lst of this year, Hal A. Franklin, who is also an Internist, joined the group. Our offices are located in the 400 block of South 7th Street here in Wilmington. I am Board qualified in the field of Family Practice. Dr. Eaton, Jr. and Dr. Franklin are Board qualified in the field of Internal medicine. -~ I am here this morning to register with you a formal complaint regarding the medical clinics sponsored by New Hanover County through the New Hanover Couyty Health Department under the "supervision" of Dr. James Finger and run by Nurse Practitioners. One of these clinics is located in the 400 block of North llth Street and one is located on South 8th Street between Ann and Nun Streets. Although the location of these clinics is of minor concern to us, our major concern is with the concept and philosophy which permit them to . 00734 exist any place. who happen to be for the next few The facts Black, sad minutes so concerning this and disturbing. that I may tell situation are to us, as physicians I request your close attention you why. When a person becomes ill in New Hanover County, if he has money, or if he has adequate insurance, or both, he goes to a Doctor of his choice for medical care; on the other hand, if this sick person has no money or adequate insurance, he is in trouble - for he finds himself at the mercy of a society which has fabricated a health delivery system for him which is different.... a system which is designed to save money rather than to provide for him medical care which is equal and adequate. What are the possible sources of medical care for the disadvantaged person who becomes ill in our community? 1. MEDICAID - If rigid, well-defined guidelines can be met, sick stamps can be obtained through the Department of Social Services. The problem here is that only one out of every 10 or 12 Doctors accept these stamps as payment for medical care. 2. EMERGENCY ROOMS - Each of the two (2) hospitals in New Hanover County has an Emergency Room. The problem here is that too many sick persons - without acute illnesses - present themselves at the Emergency Rooms. These facilities are staffed with well-trained Doctors, but after bonafied emergencies and acute illnesses are taken care of, little time is left, except for giving temporary relief to a sick person with an undiagnosed illness or with a reoccuring illness. It should be obvious that this source of health care is inadequate. 3. CLINICS AT NEW HANOVER MEMORIAL HOSPITAL - After meeting a certain guideline, a disadvantaged sick person may attend the hospital clinics. Except for certain special clinics, they are seen by a Nurse Practitioner who mayor may not call a Doctor. Most often than not this patient never sees a Physician. If so, it is a different Doctor each time. If he has an "interesting" problem, he may be admitted to the Teaching Program of the hospital. The "clinic system" of health delivery for our poor with its many inequities and humili- ating atmosphere plus other disadvantages is a disgrace to our way of life. 4. HEALTH DEPARTMENT CLINICS - Each of these clinics is staffed by a Nurse Practitioner. Here again the problem is that no Doctor is present. There is a so-called "back-up" Doctor, but he is way back, all the way back on 17th street in the person of Dr. Jim Finger. There is no way that Dr. Finger can properly operate and supervise these two (2) clinics and run the Health Department in an efficient manner. In spite of the fact that "supervision" of these clinics is provided on paper to satisfy Section 5 of Rule 1 of the Rules and Regulations for Registered Nurses Performing Medical Acts, the truth is that no Doctor is routinely present as these Nurse Practitioners examine and treat the disadvantaged sick. To make bad matters worse, a cloud of deception hangs over these clinics. To my knowledge a number of persons who have attended these clinics thought that they had been seen by a Doctor. The State of North Carolina through the - - 00736 North Carolina Board of Nurses and the "Iorth Carolina Board of Medical Examiners has once again 2sabotaged the health needs of disadvantaged citi zens. Each of these four (4) sources of medical care is without question "cut-rate". l\'hen a person is hungry, half a loaf of bread is better than none, but when a person is sick, inadequate medical care may well be the difference between life or death. The Constitution of our government guarantees to each citizen the right to LIFE, liberty and the pursuit of happiness This right to life becomes a mockery without the right to that which sustains and protects life - adequate medical care. Life and medical care cannot be separated, they cannot be viewed as separate entities for these are inextricably tied together. Accordingly, I charge New Hanover County and the New Hanover County Health Department with DISCRIMINATION against the disadvantaged citizens of this County, many of whom are Black. I respectfully request that the following steps be taken by New Hanover County and the New Hanover County Board of Health immediately. 1. Close the two (2) unsupervised clinics operated by Nurse Practi- tioners and located in the Black Community in Wilmington. 2. Make plans in the near future to make available to the disadvan- taged sick of our community medical care at the same level as is available to others with input from the medical community, both Black and White. (It is my understanding that the County Medical Society voted against the establishment of these clinics. This Board of Health should come forward with an explanation and reasons why the advice of The Medical Society was ignored. ) lAccording to information furnished to me by Mrs. Rosemary Ritzman, R. N., Nursing Consultant with the North Carolina Board of Nurses, a Nurse Practi- tioner must first have an R. N. Degree. Following completion of a Nurse Practitioner's course, application may then be made to the joint sub-committee, jointly with the Doctor whose responsibility it is to supervise her work. The joint sub-committee is composed of representatives from the North Carolina Board of Nurses and the Board of Medical Examiners for the State of North Carolina. "The term 'Registered Nurse' as used herein refers to a registered nurse who is functioning and performing medical tasks or combination of tasks at the direction of or under the supervision of a physician licensed to practice medicine in North Carolina, and which nurse is approved by the Board as being qualified by training and experience to perform the functions and tasks outlined in the application at the direction of, or under the supervision of a physician." It is important to note that approval is granted to the Doctor and to the Nurses working as a team. There are several Nurse practitioner courses offered in North Carolina. The length of time required seems to vary one (1) and two (2) years according to the program. \ 00738 2The North Carolina ~ledicaid program was similarly established to assist and aide the medically and financially disadvantaged citizens of this State. However, until recently, this system too fostered and discouraged physician participation because of enormous amounts of unnecessary paper work, red tape and unnecessary delays in reimbursement for services." The report was discussed at length by members of the Board with Dr. Eaton. A committee was appointed to investigate and study Dr. Eaton's charges. Dr. William Eakins, Chairman, and Dr. Murray Seidel and Mr Deother Melvin make up the committee. (Dr. Eaton asked that he receive a copy of these minutes.) Approved: January 3, 1979 Respectfully submitted, nL?ZbJ <3 tP~ ....-