1424  Columbus County Board of Health  Minutes  Regular Meeting  Special Meeting  June 26, 2024 6:00 P.M.  Columbus County Health Department, 304 Jefferson Street, Whiteville NC  Members Present  Pat Ray Shane Cartrette Drew Cox Scott Floyd Patty Hobbs Dr. Brent Lawson Dr. Nicole Martin Dr.A Amy Sessions  Members Absent Staff Members Present Guests  Dr. Randy Kirby, Frankye Boone- Newkirk, Dr. Christy Perdue, Kimberly L. Smith, Yvonne J. Ammstrong, Daniel Buck,  Charlene Bush, Jamika Lynch Nicole Hopkins, Mark Tomeucci  Quorum was present. I.C Call to Order  Pat Ray called the meeting to order at 6:05 p.m.  II. Welcomelnyocation  Pat Ray welcomed everyone to the meeting. Invocation was given by Pat Ray.  III. Approval of Agenda  A motion to accept the agenda, as presented, was made by Dr. Nicole Martin, seconded by Scott  Floyd, and carried by the board.  IV. Public Comment  There were no comments from the public.  V. Approval of Minutes  Motion to accept was made by Scott Floyd, seconded by PattyHobbs, and carried by the board.    1425  VI. Preparedness and Response Update  Mark Tomeucci, Coordinator with On Target Preparedness, gave the  following updates:  Currently we are closing out a grant cycle.  Waiting on new guidance from the state and CDC regarding preparedness activities for the next five years. It is probably going to remain the same. With a major emphasis on chemical, biological, nuclear, radiological and explosive Ina addition to the EOP (Emergency Operation Plan) with the Kim Smith mentioned the regional table top exercise coming up in  planning.  county, we are reviewing it. September. It'll be conducted online  Mark continued:  It_is regional. We will be partnering with Emergency Management to use the updated USC: for that. Other trainings we conduct on ay yearly basis, we will continue todo so; like our Respiratory Protection Training and Shelter This past year we participated in the NC Public Health Preparedness and Response put out some epidemiological training. We completed this training around six months ago, We also conduct quarterly notification drills to the staff members. Emergency Management did get a new notification system, called Hyper Reach. We are currently in the process May of 2026 the major focus for this year is to begin the initial planning and the state mandated trainings. We have to have three meetings; the first being the initial planning meeting, mid-term and then the final planning stage. We have to have two discussion exercises before we can conduct that full scale exercise. This is going to be our primary focus, because this is going to be an extensive process. Nicole Hopkins, Columbus County Resource Line coordinator gave  Training.  and it was extremely beneficial.  ofrolling over the staff contact list to that.  VII. Opioid Task Force Update  the following updates: (Benchmark 41, Activily 41.3)  I'm here to present our yearly report for the Opioid referral line, that Ia am responsible for 24/7.This ist the line that Ia am  over that the county has provided. We've had 81 calls this year. 44 were between the hours of 12pm to 6pm.  27 referrals were to admissions and 16 were referred to other  facilities. Nor re-admits to the facilities. None were IVC.  Heroin is tied with cocaine in our county, and third is alcohol.  11fentanyl, 10 crack, 10marijuana Alcohol 18, stimulants 36.    1426  18h hallucinogens throughout the county. get these individuals transported  Av very popular calling source is Whiteville, second is Chadbourn, we had six from Clarkton and then broken down Healing Heart transportation: has teamed up with us, tol help We had a caller, who stated for 30 years, they had been chewing fentanyl patches. We did need to get him to medical detox. They got the provider on the phone, and Healing Heart transportation was able to get them transported; otherwise, they would not have beenable to get there. The individual thanked me for not beingjudgmental and for caring for getting them the care they needed. Idon'tsay this to pat myself on the back, but for apoint ofreference, to remain non-judgmental and to be: an encourager. We give them that space and keep that door open SO they can reconnect. AtThe Healing Place, often times people have been known to walkout and leave. Within 481 hours, ifthey meet qualifications to return, they are welcomed back to try again. Scott Floyd asked was the 48 hours deal new. Before It thought once they left, they didn'thold al bed. Nicole Hopkins responded that they do not hold the bed, but ift they decide to return, within the 48 hours, they can do so, as long as they meet the qualifications.  Are there any questions?  Nicole Hopkins continued:  Iwent to the Healing Place and reconnected with them because they are constantly changing theiry way ofdoing business. What we startedo doing was email referrals. Now one oft their participants is over the admission process, and she is phenomenal. You really havet to stay in behind folks regarding these referrals and make sure you have good points of contact. Inever did hear back from the Ahoskie facility. II have tried to let The Healing Place know that I am not trying to come across hard, but I am trying to make sure these folks are attended too, and that we are getting the job done. Charlene Bush, Budget Director stated the following: A. Financial Statement April and May (Benchmark. 33, Activily33.6) Any questions?  VIII. Financial Update  For the Financial Statement, yous should have April and May. Motion to accept Financial Statement for April and May was made by Dr. Nicole Martin, seconded by Shane Cartrette, carried by the board. For Total Revenue Received we are at 82%a as far as self-pay, We are at 69% ofwhat wel had budgeted for Local County For our Total Budgeted Expenses, we are at 66%.  Charlene Bush continued:  state funding, Medicaid and grants.  Appropriations.    1427  B. Patient Count-April and May (Benchmark 33, Activily 33.6) Iny your packets are the Patient Counts for April and May. C.2 2024- 2025 Budget /I Fees Final Update (Benchmark 33, Activity You received a copy oft the budget at the last meeting. First,I had to take out any budgeted position that Id did not have anyone ini it. Then there were all of our part time positions were cut. We asked for ai new Environmental Health (EH) Specialist, which we told youa all about. This is probably going tot take care ofitself. Once they start building all ofthis down in the southern area of the county. They have got six EH Specialist, and they are already behind. Other than that, our We do not get to do the raises, this will be added later at 3%, and that does not start until November. Other than that, that was our approved budget after the cuts. The individual we have in the Lab, where they cut that part time position, she has already retired, and camel back to work Part-Time. Now this will only leave us two individuals int there, and both of them can retire at any time. Westill haveal Nutritionist position to Kim Smith stated that thel Nutritionist position has been vacant for three years. We had an individual who we hired, worked Friday and Monday morning she came in andi resigned. She stated Bladen County had called her and they pay more for the same positions. They pay more and they only work four days a week. Itis is hard to compete with surrounding counties when they offer  33.1; Benchmark. 33, Activily 33.2)  budget stayed the same.  fill.  Charlene Bush added:  more than we do. (Benchmark 33, Activily 33.6)  D. Dental, Preparedness: and Response Financial Updates  Igave you a sheet that shows) you what was budgeted. We have the Duke Endowment Grant, expenditures, and thisi is through the end of May. Ibudgeted for $550,000 and we are Emergency Preparedness, Mark told you what all wel have done. The state gives us $34,969, and the county has to match itat 10%. These are the deliverables, with the contract we  currently at $494,173.54.  have to sign.  IX. Nursing  Patti Nance, Director ofNursing, stated the following: A. Nursing Staff Update Hanhaw37,clwiy374  We are fully staffed.  Child Health Program, one ofour nurses has completed the Enhanced Role class is able to perform Well Child visits. We are in the process now forour second pediatric nurse to go through this program. Then we will have two who can perform Well Child visits, as well as immunizations that we  provide.    1428  B. Sexually Transmitted Disease Audit (Benchmark 28, Activily 28.1) Back in February, the nurse consultants did the STD and STI, communicable disease (CD) programs. The comments in her letter were that both the CD and STI programs are in basic compliance, areas ofneeded improvements are listed on the monitoring tool site. Her notes stated that we needed to add some info to some of our standing orders and policies. These items were completed before the consultants left the facility. Our policies were there but we needed to add some verbiage STD Enhanced Role Registered Nurses (ERRN) demonstrated competency and to continue practicing as such. C. Immunization Audit (Benchmark2 28, Activily 28.1) We are enrolled in the vaccine for children program. They came in November and completed this audit. In their program letter they stated that we were following all oft the guidelines, that we are required too, for the children. They stated no We also had an Immunization assessment when they look at our rates in. January. The rates for this assessment were extracted on October Ist of2023 from the Immunization Registry for all children, 24 months through 35 months of age, who are either active in our local Health Department, or reside in our county. The cohort assessed includes all clients born from October of 2020 to Octobero of2021. Compliance rates are based upon a percentage ofc clients, with documentation, ofr receiving the following vaccines by 24  tot them to be in compliance.  follow up required.  months of age: Four DTap Three Polio One MMR Three Hib Three Hep B's One Varicella Four Pneumonia  The summary with the Health Department and the county's assessment rate was at 90% for the benchmark goal. For us and the county, we both had 61%; sO we are lacking a great deal there. The State average was 77% for LHD (Local Health Department's): and we were 71% for the county; SO we were below our benchmark fort the county. Our benchmark for this year is 90%. We've had to learn! how to disassociate clients from our Health Department.Ifilhey. come here once for a vaccine and then go to Advanced Peds two or three times, then they are not considered ourc client anymore. This will help bring our numbers up. Also with our change ofstaff, we can learn how to manipulate these numbers in our favor.  Overall, everything looked good.    1429  X. Health Education  Jamika Lynch, Health Educator, stated the following: A. Community Health Assessment (Benchmark 1,Activity 11;  Benchmark 38, Activily 38.2)  Iam ready to submit it. We have an extension; I will be submitting here in the next few days. Our target priorities are:  Obesity Opioid's Lung Cancer  C changed the format as opposed to what it has been in the past. It looks a lot like our strategic plan we worked on in Management Team. Oncei it is submitted, then we will be waiting for our approval letter. Once we have that, Iy will let  you all know.  XI. Quality Assurance  Daniel Buck, QA Specialist, stated the following: A. Patient Satisfaction Survey Results (Benchmark 9, Activily 9.5) Italked to you all about the changes we were working on, moving from paper surveys to the tablets. What you: see with that other packet of data, is the actual first look oft true results. This makes sure we survey our community, or whoever comes We lacked some in Environmental Health. Other than that, Iwas impressed, I was only asking for five per group. Some groups are doubling or tripling that number. What it has shown is we can doi it a lot quicker. We want to see what their  in to use our services. everyone is meeting theirmark.  experience is like. We are almost in to month two. Kim Smith stated that the staff was very receptive.  Daniel Buck continued:  There is a code they can walk by, put in, and let the patient do their survey on the tablet. It is quicker and easier to get the That is coming up inl November. Ms. Kim and Martha have been working on the benchmarks. Management Team has been working hard on getting their items together. Ithink we are moving along pretty well.  results from. B.A Accreditation Update  Kim Smith stated the following:  My goal was to get 98%ofitin before we have a bad storm. You all have a few little goodies that the folks brought for us to share. You have a handy little first aid kit. This is Alzheimer's Awareness Month. The Health Department (HD) came up with thei idea ofhelping Candace Grey, she is our representative from Wilmington, who hasa support group for caregivers. They meet oncea month on Thursdays, at Whiteville United Methodist Church (UMC), in the parlor. Candace wanted to have something on Alzheimer's  XII. Chairperson's Forum  Pat Ray, Chairman, gave the following update:    1430  Awareness.  Jamika took it and ran with it. We had a walk. We had this flyer developed, and we did itincollaboration with the hospital and NCI Family Caregivers Support Program. Wea are part oft the Wilmington area ofDepartment of Aging (DOA). They did a great) jobofworking and providing information for us to distribute. We had 35 people to participate. Several were from the HD, some from the hospital, Lower Cape Fear Hospice and some. just came on their own. We were thrilled we had 35 people. It started at the Whiteville UMC. Iactually had for or five phone calls from nurses, outside of the HD who said it was ai fun walk. Daniel brought his family, Jamika and Mark. It was a fun day. We hope we spread the word. Wei made this poster and had the folks sign it to remembera friend or family member who had been touched by Alzheimer's. Candace Grey is our representative and she does an amazing. job with getting information. We are anxious to do it again next year. There are some brochures here. If you want information or possibly would like her to come speak regarding Alzheimer's, please feel free to reach Candace Grey. Kim Smith, Health Director gavethe following updates: A. New Program for FY 24-25Gun Lock Safety Program; Continue our Car Seat Safety Program, Vision Program In Child Health, we. havet to choose different programs we would like toj provide for citizens. For the upcoming Fiscal Year, we have decided totry our luck at a gunlock safety program. We have put in thel budget, using our Child Health Money we receive from the state, around $9,700 worth of gun locks. These locks also come with educational material. When they come in to pediatrics, we will assess ifthey have guns in the home, and then we: are gonna try to get them interested in ag gunlock. Especially when the child isi right there in the We are going to continue our Car Seat Safety Program. Hope tol have a Car Seat Safety Check, Drive-Thru Exercise on November gth. We have fiveindividuals in our Health Department who went through this training last year. This coming year we have tol havea an event. We are going to ask Smart Start and Whiteville PD who have some oft their employees who are certified, to come together and get one done sO they all can get credit for it. With the help of Mark Tomeucci, he is going tol help pull thisall together for us. We are also going to continue our Vision Program. This current year we are in, we were able to send three children to see Dr. Kirby, and then go next door for glasses. Now that we have new pediatric nurses, we either have to provide the  XIII. Director's Forum  (Benchmark 28, Activily 28.1)  home.    1431  service, or make the referral, or encourage the parents to take Amy Sessions asked how many gunlocks is that. Kim Smith stated there are two different kinds we. looked at. We don't have to spend that much,j just depends how our money. goes throughout the year. We Shane Cartrette asked ifthere is any other gun safety information you hand out. Like how to handle a gun, how not to handle a gun. Kim Smith responded not at the moment. Some people do not put it up high. Juvenile Crime Prevention Council, the state gave us some locks. Those ones went through the trigger area. With that came the educational material. I think that one did include other items. (Benchmark 19, Activily 19.1; Benchmark 39, Activily 39.2) This information is current up until May 30th, 2024. That is the last time we saw any patients in Dental, due to Dr. Benbow giving me a two week notice, and her last day was Some of the numbers from Dental are as follows: 433 Comprehensive Exams Went to 11 schools Columbus High Schools.  them to that appointment.  can redo that budget with the state.  B. Dental Update  May 30th.  Two schools they didnot go to East and West Medicaid was the number one payer source The Grant was the number two payer source. Through Child Health, we put money into Dental. The first year we put $20,000 in and we had to re-arrange those funds with the state, because we went over. Last year we did not go over that; wel had 85 patients who were grant recipients. What that means is that you have no health insurance or any means top pay; then we will pay for it out ofour Child Health funds.  Wes saw the following: 393 African Americans 327 White SEVERAL NO REPORT Most were Non-Hispanic 160 Hispanic 459 Females 388 Males  With our recruitment ofaDentist, next year, we will havea bunch ofindividuals from Whiteville graduating from Dental School. II have al list Ih have been working offt that includes every retired, semi-retired, thinking of retiring dentist in the three county area. Either they did not renew their license, they are working for someoner else or they have hand issues. We were able to talk withl Dr. Ryan Morgan, he works at Chadbourn Dental, and he has one hygienist. In order to get the kids in for cleanings, and the kids going into kindergarten    1432  needing a dental exam, Susan McPherson, orl hygienist, can do all ofthat ifs she has a standing order from a Dentist. Dr. Morgan has stated he willo dothat; he will write the standing order. I go before the county commissioners on Friday to We decided on $500 a day, it's at three month contract. That's one issue. The other issuel before the county commissioner'sI have is that II have talked with a recruiter; we have four interested individuals from the HRSA website. The four who have contacted me, we had Zoom meetings with two ofthem, one was coming from Arizona. He: stated he was good on 14 and up. The other wasn'tcomfortable on just children. Then the other two, once. Is sent them the information, did not respond back. There wasai fifth one but he graduates next Ihave resorted to a recruiter; this is a contract that is going to Then today, Dr. Ladner who was here before Dr. Benbow. Who was here during 2019 to 2021.Thel Dental staffis coming in tomorrow to talk withl Dr. Ladner, sO we will see Amy Sessions asked what the $500 a day was for again. Kim Smith explained that is for Dr. Ryan Morgan' 'si fee for being a supervising Dentist, offs site, for his to sign our standing orders stating such. C. Case Management (Social Worker) Program(s) Update  approve his contract.  year.  be $28,000 to recruit.  what that produces.  (Benchmark. 39, Activily 39.3)  Mindy Caines, the supervisor is still out under FMLA, so I figured I would talk about Case Management for At Risk Children (CMARC). This program is for children under five, who have special health needs; they have spent time in ICU when they were born, dealing with adverse child events ori if the physicians feel that the parents need extra help with the The Social Worker's will catch the families here at the Health Department, meet them atl McDonald's, or even make home visits. They work to make a link between the physician and the parents oft the child. Any other community resources they may need food or electricity. They mostly try to instill child development; what your child should be doing at these ages. Between the two Social Worker's, they have helped with services for about 450: families with children. Their caseloads run anywhere from 36 to 42 in amonth's time. The biggest Catholic Charities, when they come around, our Social Worker's go out and helpthem distribute items. Ift they have any leftover items, they donate it to us. Wel have a special closet where those items are stored until a family in need  children.  issue they see is diapers and wipes.  comes along.    1433  Case Management for High Risk Pregnancies, there are three Social Worker's in this program. The women these individuals see either have a chronic disease, diabetes, asthma orifthey have had a pre-lerm baby before. Ifthe Nurse Practitioner's or the OB docsacross the: street, see aj pregnant woman that is having complications with her pregnancy, and then she has missed appointments, or they cannot get int touch with them at all, they will contact our Social Worker's to try and find this individual to get them to come in for the care they need. They will go out and try to find the pregnant women. They meet them here for their pre-natal or for their WIC. They have a special area they can take them across the street, sO they can have theirprivacy. Yet again, they will Itis basically the same thing as the high risk children. We coordinate services between the physician and the patient. They do breastfeeding education, childbirth education, WIC, any medications they are taking, they try to make sure they are taking their medication properly and that they are able to get those medicines. Their caseload is around 35 to 40 each. They served around 400 women this past year. The pregnant women have two benchmarks the state is 0 Are they actively case managing these individuals? The goal for that is 85%, we ares at 100%. Any referral The penetration rate is used to measure how fast they can get out there and make contact with those individuals, and document itin the record. The goal is Foractive case managing, the goal is 85 we are at 100. Outreach and engagement, the goal rate is 85 we area at 85.7. Our penetrationrate, for at risk children is 1.85, Our Social Workers who do the at risk children, they are out. You barely find them in the Health Department. Come July 1s,the Tailored Plans for these programs will be instituted. That'sifyou) havea child oraj pregnant woman who has mental health, substance abuse ort traumatic brain injury issues, we will be sharing these patients with Trillium; we will have to coordinate things with Trillium. We will still handle the medical part ofit, and they will handle the mental Shane Cartrette asked ifwe have had many ofthose patients. Kim Smith stated yes. We have had many we walk from our department, down to Port Health. Karen Wright from Port Health has come to speak to the staffa and then she has spoken with the Women's Health  even meet them at McDonald's.  looking at  we get, we: see.  1.23 and we are at2.0. Forl high-risk children, they have three goals.  we are at 2.5.  health part ofit.    1434  prenatal group twice as well. Kim Smith continued:  The thing about these two programs is that the Medicaid prepaid health plans, we meet with them on a quarterly basis. There are five ofthem. Theyl have staffwho can do this, but they are located inj places like Charlotte, Raleigh, or Chapel Hill. IH have stressed to the staff that you need to make those home visits. The State ofNC wants to see home visits, not someone sitting behind a desk and making phone calls. Ithink they have picked up on the number of! home visits they are They could easily take these programs from us, but that would take six ofmy employees.. I really do not want that. Shane Cartrette, with the home visits, does that have to be an RN. Kim Smith stated in the state ofNC, fort those two programs, you either have tol have a bachelor's degree for Social Work or be an RN. Itc cost too much to have al RN. We have a good crew of Social Worker's. Shane Cartrette stated that I know in New Hanover county, paramedics are starting tol be ablet to go out, all ofit being hospital bases, Ididn't know if paramedics would be allowed to do, or information gathering, would that bes an option. Reason being is because we have al lot of paramedicsin this county. Kim Smith stated that this was a good question. II havenot seen anything stating that they can, it has always been a Social Worker or RN. StaffDevelopment and' Training (Benchmark 37, Activily 37.6) Youa all have seen these policies before. In order to meet he accreditation benchmarks, we had to tweak some. The biggest tweak we. have on this one ishow we assess our staff for training. It is on page twoin bold. Part oft this wel have added to our Performance Evaluation. Wec do evaluations in We as al Management Team sat down to come up with these policies. They involve the whole Management Team, every Motion to approve the Staff Development and Training Policy Update, as presented, was made by Scott Floyd, seconded by Dr. Workforce Development Plan (Benchmark. 26, Activily 26.2; Benchmark You can see on the front we updated the sexual orientation and gender identity. Thenonpage three we updated how you get to the county application. Those were all oft the updates Motion to approve the Workforcel Development Plan Update, as presented, was made by Scott Floyd,seconded by Dr. Nicole Martin, Policy Development & Revision (Policy on Policies) (Benchmark. 37,  doing.  D. Policy Updates  December and January. area oft the Health Department.  Amy Sessions, and carried by theboard.  37, Activily 37.6))  there.  carried by the board. Activity37.2)    1435  We were able to change on Page2 2, down at the bottom; MIS now backs up our servers, once or twice a week. We changed that whole process. Then the last page, the Management Team sat down, and worked on thel Dress Code Policy as a team; that process went well soldecided to use that process on all Administrative policies. Then wel have each) Management Team member, along withn myself, review their policies (area) Motion to approve the Policy Development & Revision (Policy on Policies) Update, as presented, was made by Scott Floyd, seconded  they are responsible for.  by Dr, Nicole Martin, carried by the board. Kim Smith stated the following:  We talked earlier about Environmental Health (EH) being behind, yes they are six weeks behind. Part oft the reason EH is behind is due to NC REBUILD. The state has special funds for folks who qualify, where they sustained displacement or damage from hurricane Matthew or Florence. Right now we have about 2,000 homes that qualify for special funds. Before they can do anything, they need to have their septic system and their well checked. The state is offering us funds tol help speed up this process. They have also found us an EH Specialist who will work one day a week, that is authorized. Right now we are waiting ont the state for an MOU. Itold them Ia am waiting on somethingi in writing. Terry Duncan, and myselfa are in the same pickle. Teresa Davis who is our State Consultant for EH, has alsoj joined in with us. Shei is the one who found the individual. The person lives in Fayetteville Anyone interested in the Board of Health Governance Network, there is a free event. July 22"d, PII be glad to email this out to anyone. It will be held from 7pm to 8pm. You can click oni it and go and register for the event.  and the state is going to pay for it.  Board Comments  Next Meeting Date August 28, 2024 at 6:00 pm Meeting Adjourned  Respectfully submitted: Aml rh 1u Seeretary  OB2B24 Date  Signature