Harnett County Board of Health Minutes of Regular Meeting November 16, 2023  The Harnett County Board of Health met in regular session on Thursday, September 21, 2023 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. Members present: Dr. Laura Smith, OD, Chairwoman, Dr. Amanda Langdon, DVM, Dr. Kim Fowler, PhD, Dr. Brandon Washington, DDS, Dr. Catherine Evans, DDS, Ms. Amy Allen, RN, Dr. Lori Langdon, M.D., Ms. Emily Barefoot, Ms. Stacie Hogan, RPH, Commissioner Barbara McKoy, and Mr. John Rouse, Jr., Health Director. Others present: Debra Harris-Hawkins, Mary Jane Sauls, Gail Hobbs, Ainsley  Johnson, Oliver Tolksdorf and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements - Chairwoman Smith reported that she and Vice Chairwoman Amy Allen met on November 8, 2023 and performed Mr. Rouse's annual performance evaluation and reviewed his job description. A copy of Mr. Rouse'sj job description was mailed to the Board members for review, and the Board are not recommending any Consent Agenda - Minutes - Motion made by Emily Barefoot, for the September 21, 2023, agenda and minutes to be approved and seconded by Dr. Brandon Consider additions and deletions to the published agenda = None made. 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. Nomination Committee Report - Chairwoman Smith asked Dr. Amanda Langdon, DVM, to give the Nomination Report. Dr. Amanda Langdon, DVM submitted on behalf oft the nominating committee Dr. Laura Smith will serve as Chairwoman and Ms. Amy Allen will serve as Vice-Chairwoman. The nominating committee submitted no other nominations to the board. Chairwoman Smith opened the floor for any other nominations. No other nominations were received. Dr. Catherine Evans, DDS, asked that nominations be closed and accept the slate of officers as presented, Meeting Schedule for 2024 - Mr. Rouse provided a copy of the Board of Health meeting schedule for 2024, and reminded the Board the March meeting is the first Thursday of the month and all other meetings are scheduled for the third Thursday.  changes at this time.  Washington, DDS, Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.  seconded by Dr. Lori Langdon, M.D., Motion carried.    Page 2 Board of Health November 16, 2023  Harnett County Health Department Board Room  Recommendation to Established Fees - Gail Hobbs presented the following fees for  new: fees or an increase to established fees:  CPT CODE 90380 90381 90678 91318 91319 91320 91321 91322 90480  DESCRIPTION 0.5ml Beyfortus RSV (CH) 1ml Beyfortus RSV (CH) RSV (AH) COVID Pfizer (6mth-4yrs) COVID Pfizer (5-11yrs) COVID Pfizer (12yrs +)  RECOMMENDED PRICE  $619.00 $619.00 $373.00 $72.00 $96.00 $143.00  COVID Moderna (6mth-1lyrs) $154.00  COVID Moderna (12yrs) COVID Admin Fee  $162.00 $65.00  The rates RSV vaccines were reviewed to include cost per dose as well as Blue Cross Blue Shield rates available. These vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) for pregnant women, infants and The rates for COVID vaccines are based upon the 23-24 pricing provided by CMS as Motion to approve the established fees from Amy Allen, RN, and seconded by Dr. Infant Mortality/Child Fatality Prevention Reports - Debra Harris-Hawkins presented the Infant Mortality and Child Fatality Prevention reports. Infant mortality is the death of a baby before his or her first birthday. Infant mortality rates are the number ofi infant deaths for every 1,000 live births within a given time frame, usually ayear. County data presented for 2021 the total number of live births 1,829 reported. The number ofi infant deaths reported was nine (9). Harnett County's infant mortality rate was 4.8 per 1,000 live births. In comparison with the NC's infant mortality rate of 6.7 for the year 2021. In comparison with the 2020 data, Harnett's infant mortality rate was 3.7 per 1,000 live births. The number of infant deaths reported was seven (7). The total live births reported was 1,867. Reviewing data from 2017-2021 rate NC 6.9  children during the RSV season. well as purchase prices for vaccines. Lori Langdon, M.D., Motion Carried.  per 1,000 live births and Harnett 6.4 per 1,000 live births.    Page 3 Board of Health November 16, 2023  Harnett County Health Department Board Room  Child Fatality Prevention Team: The Harnett County Child Fatality Prevention and Community Child Protection Team (CCPT) is a multidisciplnary group charged to review child fatalities in Harnett County occurring in children between the ages of birth through seventeen. The purpose of the Child Fatality Prevention is to review child deaths to better understand the causes of these deaths and to make recommendations based on the team's findings to reduce future child fatalities. Members discuss outcomes of services and circumstances surrounding the child's death. The number of child deaths in 2022 for Harnett County was a total of 17 deaths. Review of cases by Age Group: Nine of the deaths (53%) were under the age of 1, one death (6%) ages 1-4 years, five deaths (29%) ages 10-14 and two deaths (18%) ages 15-17. Review of cases by Race/Ethnicity: Based on Race/Ethnicity, 59% of the deaths were White, non-Hispanic; 18% were Black, non-Hispanic; and remaining 24% were Other. Review of cases by Cause of Death: Ilness-birth defects/Other birth- related conditions: Fifty-three (53%), nine of the 17 deaths were due to illness-birth defects, and other birth-related condition prematurity/perinatal causes). Accidents: Twenty-nine (29%) five deaths were due to accidents, this included 4 vehicles related (2 children struck outside of vehicles/pedestrians. Two children were passengers. Drowning resulted in the death of one child in a pool. Other: Two deaths (18%) were cited as other. Homicide by Other: One death (6%) was reported as a homicide. System Issues: Inadequate prenatal care, (late entry to prenatal care, no prenatal care teen mom), Lack of Supervision for minors, Impaired drivers, Insecure private swimming pool, Gangs, Minors involved in gang activity. Recommendations for Prevention: A few of the recommendations that the team made, in efforts to prevent future child fatalities and educate communities: Educate on the importance of early and continuous prenatal care. Promote ongoing supervision of children. Emphasis of supervision around water/pools. Comprehensive strategy to address gang activities. Accreditation - Mr. Rouse discussed the Health Department's site visit that was October 10, 2023 through October 12, 2023, and provided the Board with the North Carolina Local Health Department Accreditation Reaccreditation Site Visit Report. The Health Department met 100% of the standards and the recommendation for reaccredited with honors. The North Carolina Accreditation Board will meet tomorrow on November 17th and the Accreditation site team will submit their report on the Health Department to the Board. The Board will then vote to reaccredit or not to reaccredit the Health Department. Three members of the Health Department's management team will attend. Mr. Rouse thanked all the staff who were involved in the Accreditation process. Once the Health Department has been officially, reaccredited Mr. Rouse will present the award to the Board of Health at the next  Community wide approach is needed.  meeting.    Page 4 Board of Health November 16, 2023  Harnett County Health Department Board Room  Health Director's Report and Program Reports - John Rouse, Jr.  COVID-19 Updates - Ainsley Johnson reported we began administering the 23- 24 formula COVID-19 Vaccine on October 9, 2023. Currently we have administered 240 COVID-19 vaccines since starting the new formula. Due to budgetary limitation and the cost of the vaccine, we are currently unable to purchase any additional adult private vaccine. In total, we ordered 150 private Moderna and 100 private Pfizer. The total price of these vaccines was $32,080.78, and the expense was not budgeted for 23-24. We have previously scheduled all appointments for all our COVID-19 vaccines, with some no-shows and a very limited number available - approximately 5 doses of Moderna and 10 of] Pfizer. The public can call our COVID-19 vaccine line or our main line to schedule (910-814-6582 or 910-893-7550). We continue to encourage you to receive your COVID -19 vaccine and advising the public to reach out to local pharmacies or primary care providers. Currently we have adequate supply of state vaccine for children (VFC) and child health private Moderna and Pfizer COVID-19 vaccine in our child health clinic. We are participating in the state bridge program for COVID-19 Vaccine, and the program provides vaccine for adults aged 19 years and older that are uninsured or underinsured for the COVID-19 vaccine. We have limited number of doses and are requiring appointments for these vaccines. Outbreaks of COVID-19 in congregate settings are still reportable. Currently Harnett County has one active outbreak of COVID-19 in a long-term care facility. We are watching trends of COVID-19, our monthly reported cases have decreased over the last month and North Carolina Department of Health and Human Services (NCDHHS) reported a decrease of emergency department visits for COVID-19 like illness by 0.05% in the last week. Our COVID-19 home test program is still going well. We continue to distribute home tests in the lobby and to community partners/organzations. In the month of October, we distributed 2,018 at home test kits. Financial Report - Mr. Rouse reported the Employee Clinic saved the county $53,268.00 in the first quarter. Mr. Rouse provided a handout of the First Quarter finance report July 2023 through September 2023. Mr. Rouse explained the expenditure and revenue summary reviewing the revenue summaries is our State and Federal money that comes in by programs. Staff have continued to monitor their expenditures within the departments.  Clinical Report - Ainsley Johnson  Flu Update - NCDHHS releases a weekly flu surveillance report on the online    Page 5 Board of Health November 16, 2023  Harnett County Health Department Board Room  dashboard. In North Carolina, there have been three flu-associated deaths sO far this season. One death in the age range of 25-49 years old and two deaths in the 65+-age range. We encourage everyone 6 months and older to receive their flu vaccine. We have ample supply of regular dose flu vaccines and high dose flu vaccine. The Health Department held a flu drive thru event on October 2, 2023, 75 individuals were vaccinated. We also attended the county employee health fair on November 1, 2023, and provided flu vaccinations and COVID-19 home tests. Since September 2023, we have administered 1,772 flu shots (this Child Health Child Health sick clinic numbers have greatly increased with 261 sick visits in October 2023. Clinicians are reporting viral illnesses including flu A, covid, RSV and strep throat as the most common diagnoses. Well appointments have decreased since our back-to-school rush has completed. During the back-to-school months, Child Health was extremely busy and provided 547 well child exams and 1,272 children with immunizations in the months of August 2023, September 2023, and October 2023. In the month of October 2023, Child Health hosted a car seat safety event on October 2, 2023 by appointment. During this event our nurses that are car safety seat Adult Health - Adult Health, Prenatal, Family Planning, and Sexually Transmitted Disease services have all increased this past month. We have had some changes to the Prenatal clinic for referrals for delivery services, since the closing of labor and delivery at Harnett Health Betsy Johnson. Harnett Health has worked with our staff and supervising physician Dr. Ponder to establish continuity of care in c-section consultants, inductions, assurance of availability ofultrasound, nonstress test (NST), biophysical profile (BPP), and RhoGAM administration at Harnett Health. We collaborate with Harnett Health who collaborates with Cape Fear Valley OBGYN and Jones Center for Women to ensure delivery at Cape Fear Valley Medical Center. Some patients may choose neighboring hospitals and we are working with the clients and facilities to ensure medical records are provided. We currently have 99 active prenatal clients. On your activity summary, reportable disease cases decreased over the past month. NCDHHS released a Public Health Alert Memo to all clinicians on November 9, 2023, citing the rise in congenital cases. Our staff continues to work closely with disease intervention specialists (DIS) and prenatal providers to ensure adequate early treatment. In the month of November 2023, we will  includes in house and at outreach events).  technicians, inspected 29 seats.    Page 6 Board of Health November 16, 2023  Harnett County Health Department Board Room  restart our Welcome Baby program. Previously this program was a full-time program, we are tailoring this program to a high-risk program and will offer home visits to high-risk mothers and infants up to 8 weeks old who are referred by their care manager or primary care provider. This program will allow staff to continue to work in established programs and provide this service one day per week. High-risk classifications may include but not limited to postpartum depression/baby blues, high blood pressure, history of substance abuse, NICU admission, multiple gestation (twins), need for weight check and history of Narcan - We continue to distribute Narcan to community members and community partners. We have distributed 84 kits to community members since we started this program. We have tracked zip codes during distribution. 37% of kits given out have been to the Lillington and surrounding area zip code of 27546. The next highest area at 18% was the zip code of 28334, Dunn area. Training We have an upcoming staff training on preparedness and shelters that will be taking place in the Commons on November 20, 2023. The training will be provided by On Target Preparedness and the NCDHHS Preparedness Nurse Consultant; Harnett County school nurses will also attend. Environmental Health - Oliver Tolksdorf presented a plan review list of the upcoming Food & Lodging establishments throughout the county. A plan review is for new establishments and establishments making any changes. This includes restaurants, pools, grocery stores, convenient stores and any establishments serving food. Environmental Health conducts a plan review on every facility. Oliver explained the process to the Board. Aging & Case Management - Mary Jane Sauls announced in October 2023, the Division on Aging assisted 222 Medicare Beneficiaries, resulting in a substantial savings of $85,962.00. Three dedicated Harnett retired volunteers played a crucial role in managing appointments, welcoming beneficiaries, and making reminder calls. Furthermore, the NC Department of Insurance deployed two staff members weekly to assist with Medicare Counseling. On November 14, 2023, the Family Caregiver Program organized a special event in recognition of National Family Caregiver Awareness month. Melanie Bunn, a highly regarded Dementia Specialist, shared valuable insights on caring for loved ones with dementia, addressing caregiver stress, burnout, and offering effective coping strategies. The event drew 46 attendees, who enjoyed refreshments afterward. The program concluded with an Honor and Remembrance Candle service.  prematurity, low birth weight, or feeding complications.    Page 7 Board of Health November 16, 2023  Harnett County Health Department Board Room  As ofr now, the CAP/DA program is actively assisting 96 beneficiaries, and efforts are ongoing to fill the vacant Social Worker II position. The Elderly Nutrition Program is providing an average of 40 congregate meals and 200 home-delivered meals daily. Recruitment is ongoing for the Elderly Nutrition Coordinator position, following two resignations and four rounds of advertising. Marketing/Communty Outreach - Debra Harris-Hawkins presented the Health Education Division have a couple of community health and education events scheduled in the coming weeks. Overweight and obesity are major risk factors for a number of chronic diseases. People who have overweight and obesity, compared to those with healthy weight, are at increased risk for many serious diseases and health conditions. This outreach program aligns with our current Strategic plan, to reduce the number of persons who are at risk for Chronic Diseases. The Holiday Challenge is designed to help individuals maintain their weight during the holiday season; this program provides strategies and resources to maintain healthy eating and physical activity. "Living Well with Diabetes": From the most recent Community Health Assessment Chronic Disease, is listed as aj priority area. Diabetes remains among the top ten leading causes of death in the county. The Health Department in partnership with Campbell University along with Board of Health member Amy Allen, will provide "Living Well with Diabetes" which is a program designed for educational session provided information on type 2 diabetes and the role that healthy eating plays in preventing and controlling it.  Closed Session - There was no need for closed session.  New Business - Chairwoman Smith opened the floor for New Business. Being none  Chairwoman Smith closed New Business.    Page 8 Board of Health November 16, 2023  Harnett County Health Department Board Room Chairwoman Smith adjourned the meeting.  Respectfully submitted, John Rouse, Jr. Health Director  B  ntun