Wilkes County Board of Health Meeting Minutes  April 8, 2024  The Wilkes County Board ofH Health held a regular business meeting Monday, April 8th, 2024, at5 5:30p.m.a at the Wilkes County Health Department in the Ann Absher Conference Room. Board of Health members in  attendance were:  Dr. Sarah Miller-Wyatt Ms. Adina Watkins Dr. Keaton Mash Mr. Chris Anderson Ms. Martha Brame Dr. Laura Hubbard Mr. Casey Joe. Johnson Ms. Deborah Britton  Ms. Rachel Willard, Ms. Nancy Moretz, Mr. Jared Belk, and Ms. Jennal Daye were also in attendance. Prior to the April meeting, packets containing the materials tol be discussed were mailed and sent via email to 1. Welcome and Introductions: Ms. Rachel Willard welcomed everyone and called the meeting to 2. Elect al board member to run the meeting*: Ms. Deborah Britton volunteered to run the April 8th meeting. Mr. Casey Jo Johnson made the motion to approve Ms. Deborah Britton tos serve as chair for tonight's meeting; the motion was seconded by! Ms. Adina Watkins, and unanimously approved. 3. Adoption of Agenda*: Ms. Martha Brame made the motion to adopt the agenda for the Board of Health meeting for April 8th, 2024; the motion was seconded by Mr. Casey Joe. Johnson, and 4. Approval of Minutes*: Dr. Keaton Mash made the motion to approve the minutes from the February 19th, 2024 meeting; the motion was seconded by Mr. Casey Joe Johnson, and  each' Wilkes County Board member for review.  order at 5:30 p.m.  unanimously approved.  unanimously approved. 5. - Old Business  Wilkes State of The County Health (SOTCH) Report Mr. Jared Belk presented the SOTCH Report to the board.  Presentation below.  1    State oft the County Health Report: Wilkes County: 2023 Fromstingheal  ILKES Health*k  ethe:  57,3005  18,6005  2    Quality Improvement Annual Report Presentation below.  Ms. Rachel Willard presented the QII Report tot thel board.  QualityandR semerats RiskN Management Report: WIES  E  3    F  PEER AUDITS 2023  Payor  TOTAL TOTALF PAYMENTS 2023  E  4    Communicable Disease Report Presentation below.  Ms. Willard presented the Communicable Disease PowerPoint to thel board.  Reportable Communicable Diseases for Wilkes County  Wilkes Health Communicable Disease Annual Report Calendar Year 2023  Repartable  WIkesCoraty  ahe  - A  325 cases reported in: 2023 (193 STDs, 132 other). 98 cases foodbome illness, 9 cases of vaccine preventable diseases and 3 cases of Vectorborne illness reported  Primary Categories of Communicable  Reportable STDs for Wilkes County  Disease Pricarycamgartes rComoaskable  Reportables SID:for WilkesCosty  3030 3021 33 33  Ther number reported STDs was 193f for 2023 (2022-213). The cases of gonorrhea was 28( (2022-55).  Foodborne llIness 98 cases of foodborne illness (2022-59) EColi: 24 cases (2022-9) Campylobacter: 39 cases (2022-31) Salmonella: 23 (2022-11) Noted increases in the 31 most commonly reported linesses. No specific epidemiological linkage noted. May! be that more people are going to MD: and being tested post-COVID  Vaccine Preventable Disease 9cases ofVPD. 2r new cases of Acute Hepatitis B,3 cases of Haemophilus Influenzae (invasive disease), and4 4 flu deaths. We didr not have any cases of Hepatitis Ar reported in 2023. Clinic staff continue tol be vigilant ini identifying individuals who are at risk for beinge exposed to Hepatitis A, B, and C. Testingi is provided: for atr risk individuals with follow up as needed. Clinic staff also encourages vaccinations for VPD.  pandemic.  5    SARS-CoV-2 (COVID-19) On May 11, 2023 the CDC declared the COVID- 19 Public Health Emergency tol be over. Medical providers are no longer required to report positive cases of COVID-19 Wilkes Health's responsibilities regarding COVID-19 are to report outbreaks and clusters tol NCDHHS vial NCEDSS, provide COVID vaccines, COVID testing to patient's with symptoms, and provide at-home COVID tests to  SARS-CoV-2 (COVID-19) In2 2023 there were 18 outbreaks reported involved local long term care and assisted 1involved Wilkes Correctional Center No clusters from schools, churches or businesses were reported  17 living facilities  the public.  Pleural Tuberculosis- Atypical Patient is a 33 year old male whoi immigrated from Mexico 41 months prior to admission to hospital. He began experiencing cough, fever, decreased appetite, and nausea. CT scan showed moderate had increased level ofA Adenosine Deaminase which infection disease ruled as suspect for extrapulmonary TB. Patient was started on medications directly observed therapy. Hei is currently taking meds via video directly observed therapy and will complete  Rabies Update  Case  36i investigations ofp potential humans exposedt tos suspecto or 21€ exposures significante enought tov warrant post-exposure Bexposures unablet toreach. Certifiedl letters sentt tos address provided There were 30r reportsr receivedf from! NCSLPHf fors animalst tested from ouro county. Only 2v were positive for rabies. One was acata and therev were 3peoplee exposed whoc didt take Rabies vaccines. The other wase as skunk. There was nol human exposure. Dogy with potentiale exposure wasg given rabies booster ando quarantined. No signs ors symptoms ate endof4 450 day quarantine. Publice educationa ando outreach animals vaccinatede ande avoidance ofa animals high-riskf forr rabies  confirmed rabid animals prophylaxis. byA Animal Control  effusion. Culture  pleural for TB via  from pleural fluid was negative, but  treatment ine early  February.  Leprosy (Hansen's Disease) Patienti isa6 68y year oldr malet thatv was diagnosedy with! Leprosy. Upon furtheri investigation, discovered.t that! hev was actuallyo diagnosedy with Leprosy in2 2021. Hel had completed 2y years oft treatmenti inF February: 2023. Patients statedt thats symptoms originally began 6) years agot butt they finally didthe! biopsyi inl late 2020. Patient states! hisr rasho drasticallyi improved with treatmente andi inF February was consideredt too only! haves scart tissue. Then on6 6/12/2023, hes startedt to! have ani increasei int rash againa ands statedt that thep painh hed! been much worse witht thisr relapse. Patient wast hospitalized fort treatmento oft bothr rasha and pain. Patienti is unsure oft how! hec contracted disease andd didr notr meett theu usualr riskf factors. Itisv very raret tos see cases inNC, ona average! lesst thand onec case per year reported. Afew Southem states likel Louisiana andT Texas havel lowe endemic leprosy rates, but most cases comef from outside thel United States. Patiento denied any travelt to endemica areas such as India andE Brazil. Leprosy does nots spreade easily from persont top person. Prolonged, closed contact withs someonev with untreated Leprosy over many monthsi isr needed! tob becomei infected.  Hemolytic Uremic Syndrome Patient is a2 2y year old male who developed Hemolytic Uremic Syndrome after being diagnosed with a shiga toxin producing thrombocytopenia. and kidneyf failure requiring dialysis. Most cases ofH Hemolytic Uremic Syndrome involve children and can be deadly if left untreated. 14% ofp pediatric cases have poor recovered and per mother does not appear tol have any oft the protection of water supplies are importanti inp prevention.  Atypical_Case  AtypicalCase E.Colii infection. Patient had outcomes (chronic renal failure, andlor strokes). Death Scrupulous personal  anemia, hemolytic seizure disorders, in 3-5% of cases. This patient hygiene, thorough cooking of meat and  occurs blindness, above issues.  6    Gonococcal Arthritis - Atypical Patient is 52-year-old male. Patient had a sexual encounter in Amsterdam. Approximately- 4 weeks after return had sudden onset of pain and swelling in left wrist. Was treated for tenosynovitis initially and then with intra-articular steroids for possible gout with no improvement. positive for Nisseria gonorrhea. Patient completed treatment and symptoms improved.  Dengue - Atypical Case Patienti isa40y yeard old male. Hev worksf for Samaritan's Purse: andh hadj justs spent severalv weeks assistingy withh hurricaner reliefi inA Acapulco! Mexico. Hen retumedf from Mexico andv wentt tov visit hisf family inP Pennsylvania. Hed developed somen mild symptoms andh hiss supervisor: asked thath hebet testedf forD Dengue. Results cameb back Denguei isay viralb tropical mosquito-bome diseaset thatd does occur in! NC, though, so far, onlyi inp personsy whoh havea arivedorn retumed! heref froma ana areaa affected byti the diseasea atthet time. Thef flu-like commont form ofc dengue, denguef fever, ist then most commona arbovirald diseasei int thew world. Because ofthes severer myalgias and arthralgias thatc cana accompanyt thisd disease, ithas been aptlyr nicknamed" "breakbone fever". There aret twop potentiallyf fatalf formsc of Dengue (Hemorhagic fevera ands shock denguev viruss serotype. Effectivep prevention ofd denguei in! NCi isb two-fold. Foreign travelerss should bem made aware ofp precautionst to preventn mosquito! bites andh herein NCV wes shoulda avoid exposure andp preventr mosquito breedingi ine  Case  positive. Patienth hasn recovered.  Join aspiration was  culture and was  syndrome)t thata arek lessc  performed  commona andr require previousi infectionv witha ac different  under  ouro control.  . Administrative Report Strategic Plan Review Presentation below.  Mr. Jared Belk presented the Strategic Plan tot the board.  Stralegie Yeara0z2.  WILKES COUNTY FianFical HLAITH DEPARTMENT 2035  7        9    Health Department Monitoring Visits  Ms. Willard explained tot thel board thatt this is an accreditation year. We willl be having state consultants come visit throughout the year to do some monitoring. When we have the state consultant come in, we will get reports; we will bring those tot the board or present them att the end of 2024. April is a very heavy month forr monitoring. Environmental Health is going to get hard in July and August, with all the monitoring. We have to have all of our letters from the state to send back to the state in September. Our staff works really hard tol be prepared fori those visits, and we  always do agood job. Departmental Update  Ms. Willard started by announcing that we did hire ar new Director ofl Nursing (DON), Angela Wood. She was over at Community Health Services before she took on this position. With her moving into the DON role, wel had to restructure our department. Looking att the handout of the organization chart, Angela is still covering WIC/MESH and the Diabetes center, but she also gained all oft the Clinical Nurses and Care Management. Angela really has about 60% oft the department. Another shift was moving Health Education out from under Angela and back under myself. One tol help Angela, and another is just SO Jared and Ican work on a closer level since we work hand-in-hand anyway. Wel have four vacant positions: al Nutritionist, Processing Assistant and two Providers. We do have an offer out for one provider; we are just waiting on her to pass her exam. We did have an offer out for the second position, but upon pre-employment, we had to change directions. Mr. Casey, Joe Johnson asked how many employees we had all together. Ms. Willard said about 80, including contract employees. Mark is retiring; his last working day is April 18th and his official last dayi is April 30th, We are sad to see him go; he's a huge asset, and it's going to be really weird when he does leave and we can'trely on! him anymore. As part of our retention and succession plan, we split Mark's role. We promoted Matt to do our QI piece of wells and septic and put him in charge ofs swimming pools. We also promoted Mike due to all of our difficult onsite septic and well problems. With Mark leaving, we also have to hire fori that Environmental Health Specialist position; we have put an offer out; he graduates May 10th and will start with us on the 20th. The other exciting thing about Environmental Health is that we are working with the GIS folks to add al layer for the public to see where your septic system is located and your tail lines. Eventually, we want to add how deep your well goes. The teami is really excited abouti this; the kickoff is next week. As you know, Merlefesti is right around the corner, along with the Allstar Race. Food andl lodging will be very busy, while we also try to maintain 100% compliance with the: state for our restaurant and Moving on to Community Health, MESH is going to be going out to provide vaccines for kids. We did this int thei fall for those who don'thave transportation access or who tend to be delinquent on getting the required vaccines. We are focusing on our 7th graders and our seniors; we are going to be working with the school nurses to see who is not up to date already and catching them SO when September comes, they won't be excluded from school. We found it very successful last year, and the schools wanted to doi it again this year, SO we agreed. WIC is really knocking it out of the park with their participation; we are at about 110%. Health Education hasi really been pushing social media, especially this past week with national public health week. With the warmer months ahead, we are going to be doing some activities at the greenway to get people out and active. Mr. Jared Belk said last week that the North Wilkesboro Housing Authority and the Town of North Wilkesboro  lodging inspections.  hosted al block party, andl Health Education handed out bicycle helmets.  10    Ms. Willard said that our Hep-C treatment is slow to start, but we are finding some clients are not willing to do the treatment due tot the side effects of the treatment. Wel have a meeting with Wilkes Recovery on Wednesday. They are currently sending possible patients to Boone for treatment, but we are hoping we can work with them and have the mild patients come here. The big thing with Clinici is that we are starting a data visualization platform called i2i, this will be integrated with our EHR: SO we can pull reports. We had no choice but to do this. CureMD will not be ready for UDS  reporting in February 2025. COPE Update  Ms. Willard said she just wanted tor remind everyone that the COPE steering committee is meeting tomorrow. The County Commissioners have al MOU with thel Health Foundation tol bring recommendations forward tot them to accept or change based on what they feel is right for the community. Tomorrow, what we are doing for the Steering Committee is reviewing all the grants that were written and submitted and then making our recommendation to the County Commissioners. We have at few big asks this year, but with al lot oft funding that comes with that, whichi is well over double what we asked the Commissioners for last year. Mr. Casey Joe. Johnson asked ift there were several applications this year. Ms. Willard said yes, there were 11;lonly gott to read 8. AK lot of $300,000 and $400,000 asks from organizations. Mr. Casey Joe Johnson asked if any oft the ones from last year were reoccurring costs. Ms. Willard said yes; when we started out, we were only doing grants one year at a time. Ideally, in the future, we will ask for multiyear grants. Mrs. Willard really expressed great concern over one-year grants VS. multi year grants. The board agreed. General consensus oft the board was tol have Mr. Casey Joe. Johnson take this recommendation back to thel Board of Commissioners and County Manager for consideration. Ms. Willard explained tot the board that she hates that Susan is not here tonight since this is something that Susan and Ihave talked abouti for two to three years. Mobile Medicine is basically street medicine; we, the hospital and! health department, want tol be able to reach homeless communities and different areas of need and take the unit to provide basic care to those who need it. That kind of care would include wound care, antibiotics, and those types of things. We have a little momentum around it; we actually wrote a grant tot the Hospital Foundation, and we were awarded funding. Our next stepi is tol hold focus groups to see ift this is something our community actually needs. Our target population is truly the homeless community; from talking to agencies, that seems to be al huge area of need. We are really excited about this, and we are finally putting boots on the ground to gett this in motion. As soon as Susan and Iget our focus group dates, we will send them out. We really needi input from community members and providers; this will impact how we move forward. Whatl lwant tol happen, ideally, is that the Health Department will housei it, but the hospital will recruit and! hire since they have the ability and flexibility to pay more than county govemment. Ms. Martha Brame asked if there would be a need for volunteers. Ms. Willard  Mobile Medicine Idea  said absolutely, all the admin, provider, nurse support we can get.  Grant Updates  Ms. Willard said she has not heard back on our Office of Rural Health Grant yet; we are supposed tot find out this week. Thati is $150,000 that we desperately need for our budget. Thel Duke Endowment Grant opens up in May, and we will be applying for that one. Angela and Jared both have Health Foundation grants out rightr now that willl be discussed, and a decision will be madei in  11    May. Wel have about $300,000 worth of grants that we don't know about yet, SO we are very hopeful that we will have those revenue streams comei in as we move forward into our next budget  year. 7. Committee Reports None 8. New Business  FY 2024-2025 Health Department Budget*  Ms. Nancy Moretz presented the 2024-2025 proposed budget to thel board, starting with the fact that we are waiting on several grants. When we talk about the Program and State grant revenue, those amounts are not int there. Ifa and when we receive these grants, we will revise the budget. Starting with Revenue, our proposed budgeted revenue for General Funds is $152,876. Our proposed budgeted revenue for our Programs and State Grants is $3,671,578. Our Federal Grants did not change from last year; they stayed the same at $633,900. We do not anticipate receiving any covid funding this year, soi that revenue is zero. Ourp projected revenue for our Permits and Feesi is $508,780. This gives us a Total Projected Revenue of $4,967,134. Ms. Deborah Britton asked ift the grants that Rachel had mentioned were in this proposal or not. Ms. Moretz said no, they are not. If we receive those grants they would be revised under the Programs and State Grants. Ms. Moretz moved on to General Expenses for the year. Our proposed Salaries and Benefits is $2,213,274, and our General Operating Expenses are proposed at $545,660. We did not budget any Capital Vehicles. We did budget $15,000 in our Capital Outlay and Improvements; thati is for al HVAC unit. It hasn'tdied yet but we are anticipating it will sooner than later. Ms. Willard stated that wel have replaced three this year; this one would be number four. Moving on to Program Expenses, our proposed Salaries and Benefits for 2025 are $2,598,533. Our proposed Operating expenses are $2,308,563. Federal Grants Operating Expenses are $56,250, the same as last year. Total Proposed Program Expenses are $4,963,346. Our Total Proposed Expenses for 2025 come to $7,737,280. Ify you look back at last year, you can see thati iti isn'tal big jump from $7,746,628. If you look at County Appropriations, we are asking for $2,770,146; thati is really not a huge increase. Dr. Sarah Miller-Wyatt asked if that was an acceptable number. Ms. Moretz said she felt very good about this number; we worked hard to reduce that number. Ms. Martha Brame asked what she meant by we worked hard to reduce that number." Doy you mean you sacrificed things. Ms. Moretz said yes. Ms. Willard explained that pharmaceuticals' take the hardest hit; in general, we did cut, trim, and reduce things that we needed tol have. However, we did not see how we could justify asking the county for more money. So, some services will experience more cuts this year than Ms. Deborah Britton made the motion to approve the 2024-2025 Proposed Budget; the motion was  others.  seconded by Ms. Adina Watkins and unanimously approved.  Health Department Fees*  Ms. Willard explained toi thel board that she is not asking the board to increase fees. As you all know, wei fought for years to get Environmental Health Fees increased, and last year they were passed. We did look at our current Medical Fee schedule, and we didi increasei it by 5%1 last year. When we look at other counties and compare, we didn't see a need toi increase. The board had a  12    lively discussion, and decided it was best at this time tor not increase fees. However, did want to make sure ifi increases were needed during the year, they were brought forward. Ms. Deborah Britton made the motion to approve to noti increase Health Department Fees; the motion was seconded by Mr. Chris Anderson and unanimously approved. Ms. Rachel Willard presented the Annual Child Fatality Report to the board.  Annual Child Fatality Report Report below.  PYBUCNEETNK  Delegation of Authority*  Ms. Willard explained to the board that she has updated the Delegation of Authority since Angelal has taken the DON position. Basically, what the document outlines is who is next in line for succession when I am out oft the office. Chad will still stay as my first backup, and then it would fall to Angela and Ms. Martha Brame made the motion to approve the Delegation of Authority; the motion was seconded 9. Public Comments or Concerns regarding SOTCH Report or Strategic Plan: None  then Nancy; this ist the order of progression that we would follow.  by Dr. Laura Hubbard, and unanimously approved.  10. Public Comments: None unanimously approved.  11. Adjournment": Ms. Adina' Watkins made ar motion to adjourn; Dr. Keaton Mash seconded,  Next Meeting date: The next Board of Health Meeting will be on April 8th, 2024 at5 5:30 p.m. in the Ann  Absher Conference Room at Wilkes County Health Department.  13    Minutes respectively submitted by: Jenna Daye, Administrative Assistant Bmmifiehns  Ms. Susan Bachmeier  14