Page/1  Wilkes County Board of Health Meeting Minutes  February 19,2 2024  The Wilkes County Board of Health held a regular business meeting Monday, February 19th, 2024, at 5:30 p.m. 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 Dr. Gary Nash Ms. Martha Brame Dr. Laura Hubbard  Ms. Rachel Willard, Ms. Nancy Moretz, Mr. Chad Shore, Ms. Natalie Williams and Ms. Jenna Daye were also in attendance. Prior tot the February meeting, packets containing the materials tol be discussed were 1. Welcome and Introductions: Ms. Rachel Willard welcomed everyone and called the meeting to  mailed and sent via email to each Wilkes County Board member for review.  order at 5:30p.m. 2. New Board memberi induction:  Martha Brame: Ms. Martha Brame was sworn in by Ms. Jenna Daye tol be member oft the  Board of Health.  3. Adoption of Agenda*: Ms. Rachel Willard stated she would like to table the SOTCH Report, QI Annual Report and the Communicable Disease Report. Dr. Laura Hubbard made the motion to adopt the amended agenda for the Board of Health meeting for February 19th, 2024; the motion 4. Approval of Minutes*: Dr. Keaton Mash made the motion to approve the minutes from the December 11th, 2023 meeting; the motion was seconded by Ms. Adinal Watkins, and unanimously  was seconded by Dr. Keaton Mash, and unanimously approved.  approved.  5. Board of Health Training - Roles and Responsibilities of the Board  Special Guest Ann Absher presented the Board of Health Training to the board.  Presentation below.  GENERAL STATUTES u NOEICMHOLIXA  Roles and Responsibilities of North Carolina Local Public Health Governing Boards  EUNC    Page/2  Learning Objectives Objective1 playsi incarrying anda OUER publich coref functions health inNorth ande essential services  Agenda:  A Objective2 Carolina  Objective3 structuresin  Objective4 expectationsf for effective board member  identifyt then role Discusst thelegal Describe public Describe the health responsibilities heaithg governing guicelines and oflocalp public North Carolina beingan  Sectionl Public Health Milestones, the CoreF Functions  Section2 Authority  Section3 Public Health BoardMemberR Roles and Effective Governance  Currento Challenges, and Legal Responsibilides and Governing Structures,  Legal Authority for Public Health This: lawu UlU lcvelof: calthy possible forthep pcope ofNorth Carolina,a ancreguirescachk locclhealthd departmenttocnsure thathe 10essential puhlic N.C. Generals Statute (GS.)S1 130A1.1 NeCarolinalawr deparmentor consoid idated! humans servicesa agency,oro PAPATEMamsNy: district heanh depertment Alternatively, acourtyn may! forma single- orn mult-ccuny publici health euthority. MC. Generals Staruta! (65.) S 130A-34;1 130A-45 Alitypeso makrg.ruie-mang: anda adudicatcrys podyfortred ceparment. msomec countest theb boardofcounty sioners servesast theb boardofheath. NC Generals Statute 165) 5 130A-214) 130A-85; 1304-37; 130A-43(b): 130A-45.1,158A77 departmentn musthavea medicine.p public! health, orp publica dutiess states andrules. N.C. Génerais Statute (65.)5 130A-40:1 130A-41: see also1 153A-77e) Local Roles and Responsibilities  ofthepuli beahhsyplemist lopromute ende Wthrehigest countye top provides aublic health servcesbyo operatinga acounty health departments areg omdyhabaredhan which servea asthepoligy.  areavailablea  Legal Responsibilities and Authority  whoh  ande experiencein andv whoe exersiegaponesans  Sources of Public Health Lawi in NC North Carolina Publich Health Statutes (www.ndeg.gov) North Carolina Administrative Code PATEORSRACUVRACNPA  Governing Board  Health Department  Federal law Others sources: USa andN North Carolinad constitutions Localt rulesa andordinances Courtdecisions Contracts  Health Director  Sources of Authority Governing LHDS Statek laws: Essentialservices Mandatedservices Accreditation Publich healthp powers, duties, andp programmatic requirements Consolidatedagrement Federall law:  Local Health Departments    Page/3  Statel Laws: "Essential". Services 655130A13busthetens essential servicese ensuredbyt thel locall health department NOTE:lawist tiedtooriginal essentalsenicesmodel  Statel Law: Mandated Services Stater regulationsrequiret thate every loralheathdepatmente eitherp provide orensuret thep provisionoft twelve mandatedservices 10AN.CAC.46.4 .0201  TAT  10Essentiols Services Model(1994)  Mandated Services Regulations  State Law: Accreditation Requiredunder G.S.5 5130A-34.1:A Alll localh health departmentsmust obtaina andmaintain accreditation Focus onp performingthree coref functionsand delivering1 10 essentialservices Achievedby: Meetingas seto ofcapacity- basedstandards Prowidingevidences of completionof preseribedactivties  Provide Individualon-sitev waters supply Sanitarysewaged collection, treatment, ando disposal Food, lodgingandi institutional sanitation Communicabled disease control Vitalrecords registration  Provide orE Ensure Childhealth Maternalhealth Family planning Dentalpublichealth Home health Adulthealth Public! healthl labs support  G.5.51 130A-34.4(a) andi Obtaining maintaining condition for receiving state andf federal funds  Providee evidence of completion ofthe prescribeda activities Mustb bea accredited by theN North Carolinal Local Heaith Department Accreditation! Board Accreditation bya another accrediting bodys does nors satisly thes statel law requirement  NORTH CAROLINA LecalHsthp Department Accredikation Meetingthe Accreditation Standards  accreditation  isa  Federal Law Examplesofo obligationsunderf federall lawi include: Affordable Care Act(ACA)anti discriminationrule HIPAAF Privacya ands SecurityRules CiviRightsA Act7 Titlev Vir requirementfor provision of! languagea assistances servicesatr no cost PersonalR Responsibility& Work Opportunity Reconciliation/ Actl Titlel IVr requirementsr regarding whichs servicesmust! bep providedtoc cients regardlessofi immigrationstatus "Strings"a attachedto particularp programs (e.g. TitleXf familyp planninggrants)  Consolidated Agreement Alllocalh healtho departments enteri intoc contractswiththe stateino ordert toreceives state andfederalf funds. Imposes somep programmatic anda administrative requirements Includes somes service mandates  ET    Page/4  Local Health Directors  Appointment of Local Health Director Countyor Publict Heaith Consolidated Humans Services District Appcintedby Appointedby manager (CM) BOH Mirimum educaticnand education and experence G.S. 13GA.41and G.S.1 130A-45.5 healthd but may other  Authority PitAboard Minmum experience  Agency CHS Girector appointed! by county Ifdoes notr meeth healtho director qualifications. thec CHS directoriCM must appoints someone who does Acquires powers andd dutes ofak local laws    a  angee  delegate  ando laws GS. 153A.77p pius :30A-41 ando other  agdedos  Health Director Thel health director wears many hats... Administrator Enforcer Educator Community liaison  Administrator- Examples  toabrogatethe authorityofthe commissioners Publichealth Board contra  G.S.5 130A-41  Enforcer-E Examples  Educator/Liaison- Examples  It :  6S I  Local Governing Board  Big Picture "A local board of health shall havet the responsibility to protect and promote the public health."  G.S.5130A-39  Couny!    Page/5  Typeso ofL Local Public Health Agencies & Boards  Local Boards of Health Some key provisions: Mustber residentsofthe county Appointedremovedly commissioners Compostiondictasedly statute Healthdirectors servesas secretary  lunez 2021  Roles of Boards ofHealth Rulemaking Adjudication Administration  Rulemaking "A[BOH) shall havet the responsibility top protecta and promotet thep public health. The board: shalll havet thea authority toa adopt rules necessaryf for that purpose." G.5.5130A:39  Rulemaking - Examples Somej jurisdictions havel local rules governing Pivatedrinkngwaterw wells On-s sitev wastewater Mosquitocontrol  Whatisa BOH rule? Prohibito citizensf from doing something Requirec citizensto dos something Enforceablei inc court.A Aperson couldb be: Chargedwithacriminal misdemeanor Subjecttoa ani injunction orderedbyajudge Finedbytheh healthd director  Wearingn masksi inp publicp placesd duringa communicabledsessee emergency  U  Interactionwith Other State Rules BOHrule may be more: stringent than the Environmental Management Commission or Commission for Public Health rule where' "ar more stringent rule is required to protect the  Rulemaking- General Limitations Mustber relatedt tohealth Mustber reasonable Mustn not discriminate  GENERALSTATUTES OF NORTH CAROLINA  public health"  G.S.1 130A-39(a)-b)    Page/6  Additional limitations for local BOH rules that  address certain topics Food&lodging Private drinking sanitation Localrules allowed  Roles of Boards ofHealth Rulemaking Adjudication Administration  On-site wastewater Localrules supplement staterules Stater must approve local commissioners rules  water wells Localrules supplement staterules  Smoking Localrulesr may smokingin specfiedplaces Board ofo county musta approve localrules  generallyr not musta adoptand musta adopta and regulate  Adjudication When does al local board of health act like ac court? When ap person is aggrieved by the interpretation, ore enforcement, ofa local board ofh healthrule or imposition ofi fines or appeals  Adjudication (cont.) Thel Board may be asked to hold al hearing about thee enforcement of local board of healthr rule or imposition of fines.  (G.S. 130A-24)  Adjudication Role Acts asarquasi-judiciar body or court Evaluatesi iflegala authority existsf for thec decsion Evaluatesi ifthedecisioni iss supported bythee evidence When holdingahearing thet board must: Consultv withi its localo counsel regardingdue process and procedures Follows strict timelines Keepa verbatimt transcript Issuea written decision Followt thep procedures ins state statute Boards decision may bez appealedt to districto court  Roles of Boards ofl Health Rulemaking Adjudication Administration  Administration  Administration- - Fees  Alocalb board ofh healthmayi imposea afeef fors servicestob ber renderedbya alocalh health department, excepty wheret thei impositionofa afeei is prohibitedbys statuteory wherea an employeed of helsalhathdeparimemis; performingthes servicesasan agentofthe  State.  uate ton  G.S.130A-39(g  Regueryfvaiuste theDirector    Page/7  Administration- - Budget BOHI revlews anda approvest thel wahauthcgammemahude Consollaedhumansevest boardo does nott transmitorp presentt theb budgetrothe  Administration- - Financial  Board of County Commissioners County! Health Departments District Health Departments Consolidated Human Services PUbHC Health Authorities Musta approvet thec departmental Notr requiredt toa approvet the  BOCC  & Agencies budget  &  departmentalbudget Musta approver requestf for appropriationfrom: the county budget  Summary  Legal responsibilities and authority of publich healthi in North Carolina and thes sources of publicl health! laws Roles andi responsibilities ofl local health departments, health directors and! boards of health  Board Member Guidelines, Roles and  Responsibilities  Guidelines for Board Members Educateyoursefabout Youro communityandin litsp publichealthstatus AttendMeetings: Attendboardn meetings Reviewa allmeetingmaterials Carryoura assignedwork! betweenn meetings Participateinopen,t constructiedialogue  Guidelines for Board Members Representpublich health Representp publich healthtother community Speakf for theboardy whend delegated Workt tol linkt the communitytoi theh healthdepartment Actasa ana advocatef for publichealthbyr maintainingactive! involvement  History, goals, achievementsande currents situationofE BOHa andhealtho department  Q0D  Chair Roles and Responsibilities Leaderc oftl theboard Runsboardr meetings Speaksf fora ande representst thet board Promotest teamwork Mbwsapefomameisus: Recommendsremoaitocounycommisioners  Chair Roles and Responsibilities (con't) Initiatesstrategic planning Initiatesannuale levaluationoft theh healtho director Worksv witht theh healtho directort tos sett ther meeting agenda Counselsa ando cmsltbwthte-heatndice    Page/8  Commissiono ofaf felonyor other crimei involving: moralt turpitude nAprcANaA interest Violationo ofa awrittenpolicya adoptedby! the countyboard ofc commissioners Habitualfailureto: attendmeetings Conducthattendstob bringtheoffice into disrepute;or Failuret tomaintainther reguiredquailicationsfor appointment  All matters discussed thes minutes Minutes shouldbe  Youmust havea quorumto mutbe dobusiness recordedin Approvals mustbe recorded in preserved the minutes  Board Member Removal  Guidelines for Board Meetings and Activities  Overall Role of Board Rule-making adjudicationand policy-making Leaved dayto-dayoperationof asihogparmentoehai director Developa ands supportpolicies designedtop promote andprotect thepublicshealth  NCC OpenMeetings! law: noticed ofa allmeetings must! bes givent tot thep public Maintainr manualando loperatingprocedures Diidecommitteest ors subcommitteeswhen ppgpnutendaingmembent fromo outsidethe board  Guidelines for Board Meetings and Activities (cont.)  Summary Boardr members: should: Educatethemselves Bei involvedinb boardr meetings Seekt toli linko communityto! healthdepartment Representp publichealth, speakf fort boardv whend delegated Meetings must follows specifics guidelines The Chair has as specificr role publichealthg goals  Thel Board's Number One Goal: Sumpenthehaindepamtment inachievingitsgoals.  Board's overall roles are rule-making, adjudication andp policy-making Board's #1g goali ist to supportl local health departmenti ina achievingits  Six Expectations for Effective Board-Health Director Relations 1. Theb boarda asa abodys setso direction. community. body.  Summary health. responsibility. goal.  Itis anl honor tos serve on ag governing board for public Serving as a governing board for public healthi is a weighty Strivei for partnership! between thel board andt the director. Providing good service toy your community ist the ultimate  - Theb board respectst ther role oftheh healthdirector: asc chiefa administratorf fort the healthdepartmenta anda allows themt too demonstrated competencyint their role. Theb boarda andt theh healthdirector) jointlystrivefors goods servicetotheir Theb boardisn responsiblef forb board members'b behaviors. Theb boardf freely givesa ands seekst feedback. Theboardv worksw witht theh healhdirectortobea ahehperfomminggoemint    Page/9  6. Old Business: None 7. Administrative Report:  Wilkes State oft the County Health (SOTCH) Report-1 Tabled Quality Improvement. Annual Report-Tabled Communicable Disease Report - Tabled Six Month Financial Review*  Ms. Nancy Moretz presented the Six-Month Financial Review to the board, starting with revenue. Our budgeted Total Revenue was $5,464,641 and we revised itt to $6,526,994. The YTD actual Revenue is $3,323,689, the revenue consists of our State Funds, Federal Funds, Private donations, Private grants, Permits and Fees, there is also SO Covid Revenue int there. All oft those combined makes up what we budget for our revenue and what our actual revenue is to date. The current revenue to date is at 51% and wel like to revenue tol be atl least 50% this time of year, solam happy with that. Moving on to Expenses, starting with General Expenses we budgeted $2,702,655 and we revised those expenses to $2,754,482. Our actual YTD Expenses for General are $1,100,7621 that around 40% whichi is good. Program Expenses wel budgeted $5,378,061 we revied those budgeted Expenses to $6,388,587. The YTD actual Expenses for Programs is $3,613,342 or 41%. Overall, our Total Expenses for General and Programs wel budgeted $8,080,716 we revied thatt to $9,143,069 and our actual YTD expenses are $3,714,104. We are about 42% which is great, also if you are doing the math, lalsoi include the note at the bottom which says "available Dr. Gary Nashi made the motion to approve the Six-Month Financial Review; the motion was seconded by  budget includes 5144380-3inenoumbered expenses". Dr. Laura Hubbard, and unanimously approved.  Bad Debt Write Off*  Ms. Willard explained tot the board that we have been working with CureMD since December trying to get this report accurate. It took us until Friday to get this report sol apologize for you not having it ahead of time. Chad is going to talk abouti it, but you will notice that the numbers are up. We had several patients who came and utilized the services, got al bill and went to another practice. What wel havei found is they will got to another practice run up a bill there, get discharged and come back here. When they come back here, they dol havet to pay 25% of their bill before they are seen again. We talk al lot about Nancy's team and how hard they work to get those payments in and get people to pay, SO even with thei increase they are working really hard and still collecting al lot ofr money from our patients. Iti is about a $2,000 increase from where we have always been historically, Idid want to give that update before It turned it over to Chad. Mr. Chad Shore reiterated what Ms. Willard stated ands said we are at about $9,000 of bad debt write off. Like Ms. Willard said with the patients running up al bill, leaving then coming back that does seem to be the new trend. Most oft the write off is associated with the Adult Health program, Ithink we only had two other programs mentioned. We did make some collections; we do a really good job setting up payment plans and collecting money. We do have some new Registration folks working late clinic and theyl have done a really good job of collecting money. Idon'tknow what they are saying to them but they are getting some payments. Ithink we are on the right track, once again this is a constant worki in progress. Ms. Willard stated that on the back page! you will see AH, FP and CH, those stand for Adult Health, Family Planning and Child Health. That page is just to show you where those payments are coming from before we go write it off. We do this every six month SO we will do this again in August. Mr. Shore added that if thep patient does get discharged for not paying, they do have the opportunity to come back but they have to pay 25% of their balance before we will    Page 10  schedule an appointment. We don'tt totally kick them tot the curb, we make every opportunity tos set up payment plans. Ms. Adina Watkins asked for the five patients that have moved their records, is the still a Ms. Adina Watkins made the motion to approve the Bad Debt Write Off; the motion was seconded by Dr.  record here when they come back. Ms. Willard said yes.  Gary Nash, and unanimously approved.  Health Department Monitoring Visits  Ms. Willard explained tot thel board that we willl be getting our 90-day notification in August for Accreditation. Therefore, thats sends an alert to the division that we are due for all of our monitoring visits to ensure that we get ourl letters to say thaty we are in good standing. We are hitting the ground running; we have had our Diabetes monitoring; we have our Immunization monitoring on Thursday and Environmental Health is coming upi in April and June. Every single program will be monitored between now and. August to make sure we are in compliance with all the Federal and State guidelines. If theyi identify anyi issue, we will have to do a corrective action plan and submit that. The other big thing we have coming up is the HRSA site visit thati is scheduled for. July. Natalie and Chad are working hard getting everything ready for that to makei it as seamless as possible. Last time we! got to do it virtually which was really nice, they were done within 24 hrs. Unfortunately, they will bel here 3f full days this time, SO we will walk away with something wrong.  Departmental Update  Ms. Willard gave the Departmental Update starting with the new Medical Directors. If you remember Dr. Stopyra left andi now we have contracted with the hospital. Dr. Stopyra left because he is now the National Security Administrator for Atrium and he just had to much on his plate. We now have Dr. Wallace and Dr. Firestone who are here on Thursday aftemoons, we: seti it up soi ifone oft them is out on leave the other can cover and support our providers. Ifo one oft them were to leave iti is ont the Hospital tot find us someone tof fill that rolei instead of us att thel local level. They! have been really helpful soi far; the providers feel very supported by this move. I think they are getting al little more feedback than they were receiving, I'm very excited for whatl lies ahead. We have had to stop administering the Yellow Fever Vaccine because of the Medical Director switch. We haven't had time to get them to do the training and have new stamps ordered. Our goal is to have thatl back up and running by May, we had 6 vaccines left SO we nicely sent them to App District. We do have an open provider position; we made an offer last week and shel has already accepted another position with more money. We are going tol be making an offer for al Director ofl Nursing hopefully soon. We are still short with Environmental Health, the position we have posted is for Mark's position. His last day willl be April 30th, unfortunately we haven'tbeen able tor recruit for his position. We've had 0 candidates in about 4 months. The good news is the Environmental Health Associatel Language that got passedi in legislation SO that opens it up al little more to our candidate pool. Angie is going tos start working with the Community College to try to recruit people that way. The other thing with Environmental Health is we are making additions to the Pit Policy. What we have found is that on lots that are smaller than an acre, it's more time efficient to use al hand auger instead of waiting on the contractor to come and dig the pit on such as small area. We arel hopeful that this will help, we knew there would be some struggles. Therel have been no complaints but our turnaround time could be loweri if we didn'th have to get a contractor out to dig the pits. With Merlefest coming up we have been working really hard, lot ofr meetings with Wes over at the College to make sure everything will go smooth. Wel have even met with Faith Fest to start preparing for August. That relationship is still new and fragile we want to start early to make sure things wei identified last year as issues are being worked ont this year since they are att their new permanent spot. We did have Community Health Open House on Friday, we gott toi invite the community in and look at the new space. I    Page 111  wanti to encourage everyone to go see the new space its beautiful, Angela would be happy tos give youa tour. It's been great so far, moms are able to take WTA and got to WIC, thel Pediatrician and thel Dental Clinic all at one spot. One last thing, Idid want to mention Covid forj just ar minute, the goodi news is that we are at the peak of respiratory season. We: are starting to see RSV, Covid and Flu decline SO thati is a win. Our pediatric deaths in the state are up, not at an alarming ratel but definitely up compared tot the last few years. The rumor for Covid is the CDC is going to change the guidance to 24 hours fever free. The state has not received anything official that the CDCi is going to adopt that or when. Our current guidance is 5 days at home from onset ofs symptoms or from yourt test date ify you have no symptoms. If that changes the  state will change their guidance to align with that, att this timei its still 5 days.  8. Committee Reports: None 9. New Business: None unanimously approved.  10. Adjournment" Ms. Martha Brame made a motion to adjourn; Ms. Adina Watkins seconded,  Next Meeting date: The next Board of Health Meeting will be on April 8th, 2024 at 5:30p.m. in the Ann  Absher Conference Room at Wilkes County Health Department.  Minutes respectively submitted by: Jenna Daye, Administrative Assistant Sue Bekwaer Ms. Susan Bachmeier