Harnett County. Board of Health Minutes of Regular Meeting September 15, 2022  The Harnett County Board of Health met in regular session on Thursday, September 15, 2022 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. Members present: Dr. Laura Smith, Chairwoman, Ms. Amy Allen, RN, Ms. Linda Sturdivant, Ms. Emily Barefoot, Ms. Barbara McKoy, Dr. Amanda Langdon, DVM, Ms. Gayle Adams, Ms. Stacie Hogan, RPH, Dr. Kim Fowler and Mr. John Rouse, Jr., Health Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Melissa  Director.  McLamb, Gail Hobbs, and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements - Mr. Rouse announced that Board of Health member, Dr. Catherine Evans, DDS, is unavailable to attend tonight's meeting due to a prior meeting. Health Department staff unavailable to attend is Ainsley Johnson due to she is attending the North Carolina Public Health Association (NCPHA) conference. Mr. Rouse discussed three Health Department staff received awards at the NCPHA Conference this week; Melissa McLamb received the NCPHA All Star Award, Patricia Davis received the NCPHA Nursing Section Distinguished Service Award and Ainsley Johnson received Mr. Rouse reported Dr. Brandon Washington, DDS, is the newest member on the Board of Health and was appointed at the Board of Commissioners meeting on September 6, 2022. Dr. Washington, DDS, will temporarily fill the Physician vacancy Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot, for the July 21, 2022 minutes to be approved as presented and seconded by Dr. Amanda Consider additions and deletions to the published agenda - Chairwoman Smith called for additions and deletions to the published agenda. Mr. Rouse announced to add a line item under item 10 on the agenda for Mobile Health Unit, Action Item. Motion by Dr. Kim Fowler, PhD, to approve the addition to the agenda as presented and seconded by Ms. Linda Sturdivant. Motion Carried. Public Comment - Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation -Chairwoman Smith opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes.  the NCPHA Nursing Section Margaret B. Dolan Award.  on the Board and will attend the November 17, 2022 meeting.  Langdon, DVM. Motion Carried.  Hearing no one, Chairwoman Smith closed the informal comments.    Page 2 Board of Health September 15, 2022  Harnett County Health Department Board Room  Nomination Committee = Chairwoman Smith appointed Ms. Emily Barefoot as Committee Chair, and Ms. Amy. Allen as Committee Member to serve on the Nominating Committee. The committee will report at the next regular meeting in November 2022 Recommendation to Established Fees - Gail Hobbs presented the following fees for  and at the January 2023 meeting, the officers will be nominated.  new fees or an increase to established fees:  CPT CODE 90686 90694 90756 G0008 G0009 90632  DESCRIPTION Fluzone Fluad QIV age 65 and over Flucelvax Administration Fee Administration Fee Havrix/Hepatitis A  RECOMMENDED PRICE  $22.00 $72.00 $31.00 $28.61 $28.61 $80.00  The rates for flu vaccines and administration fees are based upon the 2022-2023 seasonal flu vaccine pricing provided by the Centers for Medicare & Medicaid Services Motion to approve the established fees from Dr. Kim Fowler, PhD and seconded Debt Setoff- Gail Hobbs reported that since the last meeting, the Debt Setoff program has collected an additional $276.58 and the collection year to date total is $4,753.76.  (CMS).  by Ms. Stacie Hogan, RPH. Motion Carried.  Accreditation Activities Report - John Rouse, Jr.  Review of Operating Procedures - Mr. Rouse presented and reviewed the Operating Procedures with the Board. Copies of the slides were provided in the member's packets. After the review, there were no recommended changes. Mr. Rouse reviewed the Rule Making/Procedures and Authority section, the Board of Health has not had a need for any ordinances or local ruling since the last Operating Procedure review on September 16, 2021. Mr. Rouse stated that we would have the Chair sign the Operating Procedures annual review log.    Page 3 Board of Health September 15, 2022  Harnett County Health Department Board Room  Communicable Disease Report - Melissa McLamb provided incidence data of confirmed disease cases using the NC Electronic Disease Surveillance System (NCEDSS). Handouts of chart slides were provided in member's packets with data ranges from July 1, 2021 through December 31, 2021 and from January 1, 2022 through June 30, 2022. Currently the Health Department has nine nurses who divide and work Communicable Disease cases. There were 36 cases of Salmonella reported this year, which is a slight increase from last year's reported 30 cases, and 19 reported cases of Campylobacter, which is 3 more than were reported last year. E Coli and Shigellosis reported case numbers of4 and 2, which is slightly higher than last year's reported cases. Health Education and Environmental Health staff continue to promote food safety by educating the public and preforming necessary inspections. Vector-Borne cases, the Health Department reported 4 Ehrichia, 5 Rocky Mountain Spotted Fever, and 2 Lyme Disease cases. These rates are similar to last year's number of reported cases. A review of Water-Borne and Streptococcal infections were provided. Vibrio and Cryptosporidiosis infections have not increased 2 and 3 cases, respectively, for last year. There were no cases of Legionellosis in 21-22, and 2 cases last year. Streptococcal Group A infections increased to 7 cases, compared to 1 case last year. Further investigation in this resulted that the increase incidence was due to reported skin breakdown in the majority of the cases. One case of Pneumococcal Meningitis was reported this year compared to zero cases last year. Hepatitis cases are continuously monitored by our Communicable Disease staff. In the fiscal year 21-22, we reported 2 Hepatitis A cases, 1Acute Hepatitis B case, 13 chronic Hepatitis B cases, and 137 Chronic Hepatitis cases. Hepatitis B and C chronic cases have decreased in the coming months, we will be conducting outreach to promote awareness, increase access and administer Hepatitis A vaccinations to individuals at a greater risk of contracting the disease. Hepatitis B and Hepatitis C testing is available through the NC State Lab for persons that meet criteria. Pregnant women who meet the high-risk criteria are offered testing twice during their pregnancy. Vaccine preventable diseases have also decreased this year. There were two reported Haemophilus Influenza cases and no Pertussis or Influenza deaths. The NC Influenza-Like Illness Surveillance Summary and the Emergency Department graph there were fewer ED visits in 21-22 compared to the 19-20 flu season. The Health Department offers flu vaccines Monday-Friday as a walk in or drive up service, and we also conduct community outreach and visit off site locations, assisted living facility, senior nutrition sites, school sites, and area businesses Sexually transmitted infections (STI) rates Chlamydia and Gonorrhea cases decreased slightly from last year. Syphilis increased to 74 cases, compared to 30 last year. In November of 2021, the NC Communicable Disease Branch issued a Syphilis increase alert to all North Carolina medical providers indicating that Syphilis infections had increased by 32 % statewide.  throughout the county to administer flu vaccines.    Page 4 Board of Health September 15, 2022  Harnett County Health Department Board Room  Human mmunodehiciency Virus (HIV) total new cases reported in Harnett County were 22, in 2020 there were 8 new cases, 2021 there were 12 new cases and the first quarter January-June 2022, there were 2 new cases reported to the NC HIV/STD Quarterly Surveillance Report. Staff continues to provide testing and risk reduction. Currently, in 2022, we have not reported any active tuberculosis cases, in 2021, two cases were reported. Infected individuals received direct observational therapy (DOT). The COVID-19 case count trends are the weekly case counts with the last peak week on January 28, 2022. We continue to investigate cases and educated the public on ways to decrease transmission and the necessity ofi isolation. Monkeypox has been declared a public health emergency, there has been one case reported in Harnett County, the case was investigated, contacts were notified and offered the Jynneos smallpox vaccine. Staff remain vigilant screening in clinics, and testing is performed when needed. The NC Communicable Disease branch reports the case count at 322 for state. The majority of these cases are in males. Our Epidemiological (EPI) team was activated and participated in COVID-19 investigations, outbreak management and Monkeypox investigations. Workforce Development - Melissa McLamb reported workforce development in Public Health aims to improve health outcomes by enhancing the training, skills, and performance of Public Health workers. A strong Public Health workforce is vital to protecting the public's health. Effective Public Health action requires an adequately staffed, highly skilled, diverse, and interdisciplinary workforce. The Harnett County Health Department is committed to providing employees with training opportunities, sO they are better equipped to deliver the 10 Essential Services of Public Health. The goal of the plan is to ensure a competent workforce that receives the training and guidance they need to be successful in the implementation of the Public Health programs we provide and serve our patients and clients to the best of their abilities, while also rising to meet any future workforce needs. The Health Department has 70 full time employees, 23 contract employees and five (5) Community Care of NC (CCNC) contract COVID-19 employees. This includes 30% Clinical staff, 21% Aging/Care Management staff, 19% Women, Infant and Children, 16% Environmental Health staff, 10% Administration staff and 4% Health Education staff. In 2022, eight (8) new full time employees were hired. The Health Department encourages advanced degrees and certifications that enhance the training, skills and performance of our. Public Health staff. Currently 15 employees that hold advanced degrees. Three Nurses are Rostered Enhanced Role Child Health Nurses and two are Enhanced Role STD Nurses. Nine nurses    Page 5 Board of Health September 15, 2022  Harnett County Health Department Board Room  have completed NC Communicable Disease Branch training and are Communicable Disease Nurses, three more will be completed in 2022. This training is required for every Public Health nurse with responsibility for communicable disease surveillance and investigation. Four full time staff members and two contract employee are fluent in Spanish. Employees are required to complete several mandatory trainings and obtain program specific continuing education throughout the year. Annual trainings include Health Insurance Portability and Accountability Act (HIPAA), Customer Service, OSHA/Satety, Respiratory Fit Testing/Hazard Exposures, Violence in the Workplace, Annual Policy Reviews, Diversity/Cultural Competency, and Emergency preparedness. Title X training is required for any staff that are involved in services covered under Title Xlaw. Several employees must complete Mandatory Reporting of Child Abuse and Neglect annually, and Title X Orientation. Clinical staff are also required to attend CPR bi-annually training, and two clinical staff members are. Advanced Cardiac Life Support (ACLS) certified. Staff are required to obtain program specific continuing education trainings and maintain licensures. Education opportunities are available to staff through webinars and online trainings. Some division specific trainings and requirements include: Child Health has four certified car passenger safety seat technicians. Two of those nurses have attended courses for special needs children. These technicians are required to obtain continuing education and install a certain number of seats per cycle. Our laboratory technicians have completed Stateside Program for Infection Control and Epidemiology (SPICE) trainings this year. All staff are also trained on Emergency Shelter operations, and complete National Incident Management System (NIMS) Training. Division supervisors are required to complete Intermittent Incident Command System (ICS) 300 and ICS 400 (Advanced ICS Command System) trainings. The Health Department's Director of Nursing and Environmental Health Supervisor recently completed these courses. Each year at an employee's performance evaluation, supervisors complete a competency evaluation to determine strengths, improvement toward goals, and to determine training needs. Annually during the performance evaluation, clinical staff are evaluated on core public health competencies. Regional and statewide conferences are encouraged when available to allow staff to obtain continuing education credit, collaborate with community partners, and to encourage professional growth. We have staff that are members and serve on executive committees of NCPHA, NC Association of Public Health Nurse Administrators (NCAPHNA) and the NC Public Health HIPAA Alliance. The Health Department works to recruit a diverse workforce    Page 6 Board of Health September 15, 2022  Harnett County Health Department Board Room  that reflects the County's population and population served by the Health Department. In addition to recruiting, the Health Department strives to ensure staff retention. The management team continues to strategize and implement plans to increase employee satisfaction and staff retention. To promote teamwork and a positive work environment we conduct team building exercises and activities during Public Health month. We seek employee input with ideas toi improve areas of service. We strive to meet the requirements in state agreement addendums and update our programs based on recommended best practices. Succession planning, it is estimated that approximately ten (10) full time employee will be eligible for retirement in the next five years. Current plans are in place to ensure that clinical staff are trained to be able to perform the duties of retiring staff and/or train new employees in that area. Efforts will also continue to ensure our workforce members have advancements in skillsets,  training, and knowledge.  Quality Improvement (QI) Plan Report - Debra Harris-Hawkins presented the QI plan as part of the upcoming Accreditation 2023, a requirement is for the Health Department to include current agency Continuous Quality Improvement (CQI) plan. QI is a method for continuously finding ways to provide better patient care and our services. QI activities are designed to improve how things work. In short, how can we do better. Quality Improvement helps the Health Department make a continuous effort to improve important processes and services. By creating stronger programs and services, the Health Department can better promote and preserve health in the communities we serve. The ultimate goal of QI in Public Health is to improve the population's 's health status. Copies of QI improvement handouts were provided, which included information  of examples of QI projects previouslyimplmented.  Health Director's Report and Program Reports - John Rouse, Jr.  Medicaid Transformation (Tailored Plans Update) - Mr. Rouse discussed the issues since Medicaid Transformation. Revenues are coming in however, there are issues with denied claims with the Prepaid Health Plans (PHPs). The North Carolina Association ofLocal Health Directors (NCALHD) has formed a committee to address billing concerns and timely matters with payments and denials. Medicaid Cost Settlement is currently working on a year behind and we are currently in the process of working on 2021-2022. Tailored Plans are mainly pediatrics and adults who have behavioral health and special medical needs.    Page 7 Board of Health September 15, 2022  Harnett County Health Department Board Room  The Health Department is working with Community Care on the contracts with the PHPS. Tailored Plans goes in effect on December 1, 2022. WIC Food Expenditures Report - Mr. Rouse provided a PowerPoint presentation, which included an overview for the participation and expenditures for the Women, Infants and Children (WIC) program and the economic impact in Harnett County. The WIC program aims to safeguard the health of1 low- income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care. Approximately 42,765 Harnett county families participated in the Health Department's WIC program. The WIC program in Harnett County provided $2,770,377 million in revenue for twenty (20) Harnett County WIC retail vendors. The time-line was July 2021 until June 2022, data was provided by the North Carolina County WIC Expenditure report. State Fiscal Year 2022 Monthly WIC Redemption. Additionally, Rouse provided a report from data provided by the Department of Social Services (DSS) Food and Nutrition Services/Food Stamps. For year 2021-2022, approximately $62,087,359 million was infused in funds into the Harnett County retail food economy fiscal year 2021-2022. Approximately, 65 million dollars through these two programs, WIC and the DSS Food and Nutrition Services/Food Financial Report 2021/2022 Year Ending - Mr. Rouse reviewed the closeout revenues and expenditures summary reports for FY ending June 30, 2022. The revenue report shows funds by programs; Aging and Health programs are able to carryforward an estimated $2,000,000 million in COVID-19 funding for the new: fiscal year. The Health Department received $2,645,354 million in COVID- 19 funds for FY 2021-2022. The Health/Aging Departments did not utilize $2,461,954 million of their budgeted county funds for FY 2022-2023. All COVID-19 carryforward funds allocated through North Carolina Department of Health and Human Services (NCDHHS) will expire at the end of May 2023. The funds are being used to complete the installation ofl handicap accessible doors at the front entrance of the Health Department and the Commons front and back doors. They are also being used to install plexiglass windows for the WIC stations and to install a permanent wall between WIC and Child Health clinics to allow for separation of well and sick clients. The WIC staff will resume face to Mobile Health Unit - Mr. Rouse discussed the Health Department is interested in purchasing a mobile health unit with the COVID 546 Communicable Disease Pandemic Recovery funds, the mobile health unit will provide the Health Department a way to have access throughout the community for vaccines, children's physicals and other community events. The mobile health unit will  Stamps greatly affect the local economy.  face appointments with patients on September 19, 2022.    Page 8 Board of Health September 15, 2022  Harnett County Health Department Board Room  need to be ordered and completely purchased by May 2023. Mr. Rouse provided the Board with a presentation on the different types of mobile health units that are available and how they are customized to: meet the needs of the Health Department. Mr. Rouse reviewed the purchasing information from Mission Mobile in Greensboro, North Carolina and asked the Board of Health for their Motion made by Dr. Amanda Langdon, DVM, that the Board of Health supports the purchase of a mobile health unit for the Harnett County Health Department to utilize the COVID 546 Communicable Disease Pandemic Recovery Funds to be approved as presented and seconded by  support in purchasing the mobile health unit.  Ms. Gayle Adams. Motion Carried.  Clinical/COVID-9 Report - Melissa McLamb  COVID-19 Case & Testing - COVID-19 cases are currently at a low community transmission level per the Centers for Disease Control and Prevention (CDC). Harnett County current total reported case count as of September 9, 2022is 39,394 with 356 reported associated deaths. This week's cases will be reported on our website September 16, 2022. For August 2022, there were 1,547 new cases reported. Currently Harnett County has seven active outbreaks, and the outbreaks are in long term care facilities, group homes, and correctional facilities. COVID-19 testing demand has decreased throughout the county. An estimated 800 tests have been performed each week for the last two weeks. The distribution of the COVID-19 home testing kits are continuing to do well, and we have received additional shipments. Kits are available to the public every COVID-19 Vaccination - COVID- 19 vaccinations are available every weekday in the clinics, and we offer all four brands of COVID -19 vaccine available, including Novavax. Novavax is now recommended for those 12 years and older. The Health Department began administering Bivalent Boosters of Moderna and Pfizer vaccine on September 9, 2022. These updated boosters include components of the original virus strain and Omicron BA.4/5 variant. The public may call 910-893-7550 to schedule their vaccine appointment or walk in between the hours of Bam-llam and 1pm-4pm, Monday through Friday. Child Health - Child Health is beginning to prepare for back to school physicals and immunizations. Back to school immunization walk in clinic days will be  weekday from Bam-llam and 1pm-4pm.    Page 9 Board of Health September 15, 2022  Harnett County Health Department Board Room  held on September 26-28, 2022. Visit numbers continue to increase from last Employee Clinic Employee clinic continues to operate well, with 142 visits Adult Health - Services for. August 2022 in Family Planning, Prenatal and Sexually Transmitted Disease (STD) clinics have increased based on the activity Communicable Disease = Reportable disease cases for August 2022 totaled 16 cases, with an increase in STD cases. Harnett County's first Monkeypox case was confirmed on August 2, 2022. The Health Department staff completed a case investigation and contact tracing for this case, and vaccination was administered for identified contacts. We currently have a limited supply of Jynneos on hand to offer to those who meet the criteria for administration. The criteria for vaccination has been updated as of September 8, 2022 and the new criteria is as follows: Anyone who had close contact in the past two weeks with someone who has been diagnosed with Monkeypox; or gay, bisexual, or other men who have sex with men, or transgender individuals, who are sexually active; or people who have had sexual contact with gay, bisexual, or other men who have sex with men, or transgender individuals in the past 90 days; or people living with HIV, or taking medication to prevent HIV (PrEP), or who were Laboratory - The lab is equipped to process any specimens related to Monkeypox and send to the state lab. The lab staff are attending an upcoming community outreach event to provide HIV and syphilis testing. The lab services Flu Update = The flu drive up clinic started on September 6, 2022. The Health Department offers regular and high dose flu vaccine for all ages. We have started off site clinics and scheduled flu vaccination clinics at senior sites, county offices, local businesses, churches, fire departments, police stations and other community events in Harnett County. The Health Department will hold a flu drive thru event in the parking lot of the Health and Aging on Monday, Preparedness Update - On August 26, 2022, the Health Department's preparedness coordinator and staff distributed Potassium Iodide tablets at Duncan Junction convenience store in the northwest part of Harnett County.  month with 119 sick visits and 149 well visits.  reported for August 2022.  summary, which is available in the packet.  diagnosed with syphilis in the past 90 days.  increased cases to 776 clients for August 2022.  October 3, 2022 from 3pm-7pm.    Page 10 Board of Health September 15, 2022  Harnett County Health Department Board Room  Potassium Iodide tablets are free of charge for people living, working, attending school within a 10 mile radius of a nuclear facility. At the event 723 tablets of Potassium Iodide were distributed. The Health Department also has tablets Aging & Case Management - Mary Jane Sauls announced the Medicare/Seniors Health Insurance Information Program (SHIIP) is beginning outreach to the pharmacies, nursing facilities and hospitals in Harnett County regarding the Medicare Open Enrollment Period for 2022. Two radio spots have been scheduled and information has been sent to the newspaper about the Medicare Open Enrollment Period. The Division on Aging will start scheduling appointments after October 1, 2022, to review prescription drug plans. Medicare Open Enrollment begins on October 15, 2022, and continues through December 7, 2022. During the annual enrollment period (AEP) beneficiaries may make changes to various aspects of their coverage. The Division on Aging are offering some evening and weekend appointments, and providing off-site Senior Day at the Fair is Tuesday October 18, 2022, and buses will depart from the Governmental Complex in Lillington at 8:00 am. Transportation is free and The Elderly Nutrition Program is coordinating with the Health Department to provide flu shots at the senior sites September 12, 2022 through September 16, The Community Alternatives Program is serving 103 beneficiaries. Harnett County with the assistance of the Division of Health Benefits has worked diligently to evaluate the waiting list and there are currently zero individuals Last month the Division on Aging held a back to school drive thru for the Grandparents Raising Grand Children program. Donations from community members and Harnett County Employees provided school supplies for the children to lessen the out-of-pocket expense for the Grandparents in the Currently there are 200: registered senior volunteers, ages 55 and older serving in Harnett County. These volunteers are vital in their communities and provide countless hours of unpaid service. The Division on Aging currently needs volunteers to deliver meals on wheels, to help with the Literacy Program, and to volunteer with the Harnett County Guardian ad Litem Program where they take training to become advocates for children in the court system. They also need volunteers who are veterans to serve as mentors to other veterans going through the Harnett County District 11A Veterans Treatment Court Program.  available to distribute Monday through Friday.  clinics at various places throughout the county.  drop offis at the door.  2022.  waiting.  program.    Page 11 Board of Health September 15, 2022  Harnett County Health Department Board Room  Environmental Health = Oliver Tolksdorf: reported the venue at Gross Farms held the 2022 Waves of Grain Music Festival on August 26, 2022 and August 27, 2022. The event featured a praise and worship event on Friday, August 26th and a concert with several bands on August 27th, The Environmental Health staff was not needed at the event due to the small attendance and licensed food Oliver Tolksdorf announced Environmental Health will be preparing for a fee Marketing/Communty Outreach = Debra Hawkins shared upcoming community outreach programs: As part of the Health Department's Strategic Plan, one of the goals identified was to reduce the number persons who are at risk for overweight/obesity. A goal was to identify and or introduce programs to increase physical activity. "Fall into Fitness" Move More Challenge begins September 26, 2022 through October 23, 2022 promoting physical activity, this is a free program. Additional information about the program is located on the Health Department's web site, information has also been featured on the Department's Facebook page article was featured within the Daily Record Drive-thru Flu Shots: The best way to reduce your risk from seasonal flu and its potentially serious complications is to get vaccinated every year. Everyone 6 months and older should get a flu vaccine. The Health Department is providing "Drive thru" flu shots on Monday, October 3, 2022 from 3:00pm-7:00pm. No appointment needed. Additional information is available on the Health Department's web site and social media pages. Community Outreach: As part of the Health Department Marketing plan, we are working continuously to broaden community awareness of Public Health purpose and services. Health Department staff will be onsite at the Potters House Outreach Ministries located at 4900 Bunnlevel Erwin Rd. Erwin, "Health and Community Day" Event on  trucks were available.  review for the FY 2022-2023 budget.  newspaper.  Saturday, September 17, 2022 from 10:00am-1:00pm.  Closed Session - There was no need for closed session.    Page 12 Board of Health September 15, 2022  Harnett County Health Department Board Room  New Business Chairwoman Smith opened the floor for New Business. Being none  Chairwoman Smith closed New Business.  Chairwoman Smith adjourned the meeting.  Respectfuyly submitted, (67 John Rouse, Jr. Health Director  886