Harnett County Board of Health Minutes of Regular Meeting October 2, 2018  The Harnett County Board of Health met in regular session on Thursday, October 2, 2018 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Ms. Patricia Chalmers, Chairwoman, Ms. Amy Allen, RN, Ms. Linda Sturdivant, Ms. Emily Barefoot, Ms. Barbara McKoy, Dr. Laura Smith, Ms. Gayle Adams, Dr. Catherine Evans, Dr. Nicholas Pennings and Mr. John Rouse, Jr., Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Donna  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Health Director.  Surles, Gail Hobbs, and Natasha Johnson.  Chairwoman Chalmers called meeting to order at 7:00 p.m.  Announcements = Mr. Rouse would like to thank everyone for coming to the meeting tonight, due to having to reschedule the September 20, 2018 meeting because of Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot for the May 17, 2018 and July 19, 2018 minutes to be approved as presented and seconded by Consider additions and deletions to the published agenda - Chairwoman Chalmers called for additions and deletions to the published agenda. Mr. Rouse asked to remove line item 7 Good Hope Behavioral Health Advisory Board; this has been rescheduled for the November 15, 2018 meeting, and replace item 7 with Hurricane Florence Update. Mr. Rouse asked to add 6a Susan G. Komen Grant application. Motion by Dr. Laura Smith to approve the addition to the agenda as presented and for the Susan G. Komen grant request to be approved and seconded by Dr. Public Comment - Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation - Chairwoman Chalmers opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Seeing no one, Chairwoman Chalmers closed the informal comments. Nomination Committee - Chairwoman Chalmers 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 2018  Hurricane Florence.  Ms. Gayle Adams. Motion Carried.  Catherine Evans. Motion Carried.  and at the January meeting the officers will be nominated.    Page 2 Board of Health October 2, 2018  Harnett County Health Department Board Room  Susan G. Komen Grant - Debra Harris-Hawkins presented a request for the opportunity to submit a grant application to the North Carolina Triangle to the Coast Affiliate of Susan G. Komen for approximately $20,000 for year 2019-2020. Harnett is one of the counties located within the Komen service area. The community health grant seeks innovative projects in the areas of breast cancer education, outreach and screening. The funds requested will be used to support program expansion, which will allow for additional education programs within the community and increase the number of mobile mammography screening dates. The priority population will include medically underserved populations of uninsured and under-insured women. Grant funds are available for one year. There are no matching funds required. The mammography screening programs provides access to screenings annually for over 200 women, year to date over 1,900 women have been seen in this program. Hawkins shared information from the Komen letter dated March 2018, from the Health Department's previous proposal citing Komen' 's reply the application was approved for funding, but not enough funding was available to support the project. Hurricane Florence Update - Mr. Rouse reported on the devastation of Hurricane Florence in Harnett County. The county opened shelters on Thursday, September 13, 2018 and closed them on Wednesday, September 19, 2018 when American Red Cross arrived to manage the shelters. Triton High School and Overhills High School were the first two shelters to open, with Triton High School having to close due to water leaks and Overhills High School having water and sewage issues. Evacuees from Triton High School were moved to Coats Erwin Middle School and evacuees from Overhills High School were moved to Western Harnett High School. Staff with the Health Department worked an average. of 1,092 hours at the shelter and Emergency Operations Center (EOC). After the hurricane donation sites in the county opened. The county had two donation sites, one was located at Gospel Tabernacle Church in Dunn and Crossroads Since the hurricane, Environmental Health has been collecting mosquito counts in the county. The mosquito counts and population density are needed to determine the worst areas in the county with mosquitos. One hundred people per mile in an area determine population density. Mr. Rouse presented a population density map of Harnett County to the board members. The population density areas on the map are around 235,000 acres, the money that was provided from the state will allow around 125,000-156,000 acres to be sprayed. The process will be done by aerial spraying and will be done at night. The aerial spraying will cut down on the breeding cycle of the mosquitos. The  Church in Lillington, the Division on Aging assisted at the sites.  worst areas affected are the southern part of the county.    Page 3 Board of Health October 2, 2018  Harnett County Health Department Board Room  Dunn Housing Authority Smoke Free Update - Debra Harris-Hawkins provided a power point presentation, regarding the U.S. Department of Housing and Urban Development (HUD) requirement for all public housing to go smoke free by July 30, 2018. The Dunn Housing Authority's smoke free policy became effective on July 18, 2018. This policy effects all of their 143 units, which prohibits the use of cigarettes, cigars and pipes in all public housing units and common areas, as well as any outdoor areas up to 25 feet from public housing and administrative office buildings. The Health Department, which included the Health Education Division staff Belinda Rayner, Public Health Educator and the Region 6 Tobacco Control Manager worked with Dunn Housing Authority on the implementation of their smoke free policy. Health Department staff provided information on the health consequences of smoking and provided resources for smoking cessation. Two listening sessions were conducted prior to the policy becoming effective. Listening sessions provided an opportunity for residents to learn about the new policy, ask questions, and share any concerns. The ban on smoking products must be included in public housing tenants' leases. Tenants will not be evicted for a single instance of smoking, but could face eviction after several smoking violations. Residents are required to sign a lease addendum that reflects the smoke free policy. For each offense, residents will be provided information on smoking cessation resources including the Health Department providing smoking cessation classes' onsite. This report was an update from the State of the County (SOTCH) report that was presented in March 2018. Recommendation to Established Fees - Gail Hobbs presented the following fees for  new: fees or an increase to established fees:  CPT CODE 90621 90662 90670 90674  DESCRIPTION Trumenba (Meningitis B) Fluzone High Dose Age 65>  RECOMMENDED PRICE $180 (old rate $150) $78 (old rate $74) $210 (old rate $198) $49 (old rate $48)  This increase is a result of purchase price increase from $107.67 to $152.24/dose.  This increase is a result of Medicare reimbursement rate for vaccine.  Prevnar 13  This increase is a result of purchase price increase from $169.11 to $199.47/dose.  Flucelvax Quad 4>  This increase is a result of Medicare reimbursement rate for vaccine.    Page 4 Board of Health October 2, 2018  Harnett County Health Department Board Room  90681 90698 90710 90732  Rotarix Pentacel  $116 (old rate $110) $88 (old rate $85)  This increase is a result of purchase price increase from $105.51 to $109.75/dose. This increase is a result of purchase price increase from $72.03 to $83.17/dose. This increase is a result of purchase price increase from $187.17 to $198.22/dose. This increase is a result of purchase price increase from $75.77 to $90.77/dose.  ProquadMMR & Varicella) $225 (old rate $190)  Pneumovax 23  $105 (old rate $83)  NEW VACCINE 90750  Shingrix  $182  Motion to approve the increase of the established fees and add new fee from Dr. Nicholas Pennings and seconded by Ms. Barbara Mckoy. Motion Carried. Debt Setoff - Gail Hobbs reported the total amount of Debt Setoff money received Clinical Fee Policy Revision Gail Hobbs stated the changes to the Clinical Fee Policy. The changes were made due to the recommendations from State auditors. Motion by Dr. Catherine Evans to approve the changes to the clinical fee policy as presented and seconded by Ms. Amy Allen. Motion Carried.  fiscal year 2018 is $9,627.23.  Accreditation Activities Report - John Rouse  Review of Operating Procedures - Mr. Rouse reviewed and presented the Operating Procedures with the Board through aj power point presentation. Workforce Development Plan - Donna Surles reported this year the plan to promote Continuous Quality Improvement by providing staff training in customer service and ensuring competence in staff performance through Continuing Education and training opportunities. We want to provide excellent customer service and engage staff in training opportunities that will positively promote the services that the health department provides. This year we have been promoting excellent customer service through tips provided in the  There were no recommended changes.  quarterly newsletter as well as annual staff training.    Page 5 Board of Health October 2, 2018  Harnett County Health Department Board Room  We are looking at Health Department employees who have advanced degrees and at those where certifications could be obtained. We want to look at utilizing the talents, skills, and experience of our trained staff. Our Environmental Health division has four employees with advanced degrees, our Health Education division has four employees with advanced degrees, and we have three Social Workers and four with Women, Infant and Children (WIC) staff with advanced degrees. We have four out often Registered Nurses (RNs) who have a Bachelor of Science in Nursing (BSN) degree and two RN's that are Nurse Practitioners. We also have two Physician Assistants in our clinics that rotate among various programs. Annually during the performance evaluation, we are continuing to review Nursing Core Competencies for Tier 1 and Tier 2 nursing staff. We are planning to continue staff training in Emergency Preparedness with additional training in emergency shelter operations and assuring appropriate staff receive the National Incident Management System (NIMS) Training. We are looking at the training and staff development needs of our staff that we feel helps improve employee satisfaction and staff retention. To promote teamwork and a positive work environment we conduct team building exercises and activities around holidays, staff birthdays, and public health month. We seek employee input with ideas to improve areas of service. We are always seeking opportunities to improve our programs by providing additional services that will better meet the needs of our clients. While we seek to provide needed services and excellent customer service, we must continue to look at staffing and our ability to take on new programs, as well as outreach opportunities and services. We strive to meet the requirements set forth in the State Agreement Addendums and update programs based on recommended best practices. We continue to expand our clinic services, which allows us to expand our programs and better meet the needs of our clients. Through the succession planning process, Ic considered the Health Management Team who has approximately 1/3 ofits members eligible for retirement within the next five years. The current Health Department staff consists of 68 Full-Time Employees (FTE), and approximately 25% of those being eligible for retirement within the next five years. When considering succession planning for clinical staff we have trained Enhanced Enrolled Registered Nurses (ERRN) staff to provide coverage for STD and Child Health (CH) clinic operations. We have four billing staff in our clinics, two of those being fluent in Spanish and English. We have two FTE Spanish interpreters and a contract interpreter. The billing staff and interpreters work well together, and have been cross-trained to cover all clinics, There are two lab technicians, one who is the Lab Supervisor and the Health Department Safety  Coordinator.    Page 6 Board of Health October 2, 2018  Harnett County Health Department Board Room  They are cross-trained and capable of working independently in the lab. Licensed clinical staff are able to obtain required continuing education credits through webinars and face-to-face training opportunities. ERRN's complete re- rostering requirements through state offered trainings, regional meetings and Communicable Disease Report - Donna Surles provided the incidence data of confirmed disease cases using the North Carolina Electronic Disease Surveillance System (NCEDSS). In fiscal year 2017, we reported two Tuberculosis (TB) cases (1 in 2016, 7 in 2015, and 5 in 2014). We have two nurses who usually work the TB cases that can often be time consuming. Direct observational therapy (DOT) requires the nurse to physically observe the client taking the TB medications for latent tuberculosis (LBTI) therapy, requiring daily home visits by the nurse or observation through skype if the client has internet and skype capability. There was one case of Pertussis reported in 2017 (1i in 2016, 2 in 2015.)Iused data from NCEDSS to compare the incidence of cases of Salmonella, Chlamydia, and Gonorrhea for this report. The number of Salmonella cases decreased slightly in 2017 to 30, compared to 33 cases in 2016, and slightly higher than 2015 with 26 cases. Our Health Education staff continues to promote food safety by educating the public through news articles and postings on the website about food borne illnesses and safe food preparation. Chlamydia cases remain the highest of all reportable STDs and that number continues to increase each year. In 2017 there were 738 cases reported, up from 640 in 2016 and 513 cases in 2015. The incidence of Gonorrhea also increased in 2017 with 228 cases reported, up from 181 cases in 2016 and 132 in 2015. We continue to see a large number of STD clients in our clinic. We provide Expedited Partner Therapy in efforts to decrease the number of Chlamydia cases. The Health Education Division coordinates our HIV testing in nonclinical or community-based settings. Nonclinical settings are easy to access and useful for people who might not be willing or able to access medical services regularly and to increase the number of persons who know their status and are linked to prevention, care, and treatment services. Educational materials about HIV/STDS including risk reduction are provided annually to Department of Corrections. Health Education also implements a condom distribution program as part ofits prevention, education, and outreach  state public health conferences.  programs.    Page 7 Board of Health October 2, 2018  Harnett County Health Department Board Room  Health Director's Report and Program Reports - John Rouse  Medicaid Transformation Update - Mr. Rouse presented information about the Medicaid Transformation from the state. In August, North Carolina (NC) has put out a request for proposal (RFP's) for the insurance companies to start bidding on becoming a provider. The Health Department has signed a contract with Community Care. The state will then notify providers who will be vendors. All providers will receive their current Medicaid rates for two years. In 2019, NC will begin enrolling the Medicaid recipients into those plans. November 2019 will begin phase 1 and by February 2020 all Medicaid Transformation will be WIC Food Expenditures Report - Mr. Rouse presented a power point presentation which included the Women, Infants and Children (WIC) program and the economic impact in Harnett County. The WIC program infused approximately $2,793,395 million in funds into the Harnett County retail food economy fiscal year 2018. The benefits of this economic boost extend beyond WIC families to the local economy. The top three vendors in Harnett County included Walmart, Food Lion and IGA Carlie C's, these retail outlets are authorized to accept WIC benefit substantially. The NC WIC program from July 2017 - June 2018, through the monthly redemption reports approximately $169,265,208 million dollars across the state. In addition through the Department of Social Services (DSS) Food and Nutrition Services/Food Stamps, issued approximately $25,107,586 million to the local income July 2017 -June 2018. Approximately $28 million dollars through these two programs, WIC and the DSS Food and Nutrition Services/Food Stamps greatly impact the local Financial Report 2017/2018 Year Ending Mr. Rouse reviewed the closeout revenues summary report for FY17-18. Mr. Rouse reviewed the expenditure summary report. The staff has done a good job monitoring their expenditures. In the revenue summary, State and Federal contracts we received the amounts we were suppose to receive. In the WIC program, not all the money was spent, allowing the county to open a full time position for the Breastteeding Peer Coordinator. The position was previously a contract position. The Medicaid cost settlement will go away once the Medicaid transformation is in place. The total amount of carry forward money for FY 2018-2019 is  complete.  economy.  $542,879.70.    Page 8 Board of Health October 2, 2018  Harnett County Health Department Board Room  Clinical Report - Donna Surles  Child Health (CH) In August, CH clinic visits more than doubled and immunizations vastly increased as well due to back to school requirements. Home visiting numbers were down in September with the hurricane and road closures making home visits impossible. The Activities Summary Report shows the increase in immunizations from 171 in July to 265 in August, and the number of CH Well Clinic visits from 77 in July to 165 visits in August. This number usually continues to increase throughout September and October. On September 25, 2018, we held an after-hours immunization clinic for all children and targeting those who were at the 30 day suspension date. We administered vaccines to 45 children during that clinic. That same afternoon the state extended the deadline to November. The employee clinic remains popular with employees and their families during the fall season as seasonal allergies tend to We are offering flu shots to the public Monday - Friday on a walk-in basis. We have been providing the flu vaccine to county employees within several of the larger departments since the Employee Health Fair was cancelled due to Hurricane Florence and Federal Emergency Management Agency (FEMA) being Adult Health (AH) clinic has been conducting flu vaccination clinics throughout the county at senior nutrition centers, health fairs, assisted living facilities and other sites during the months of September and October. AH has begun to see more clients asking about the pneumonia vaccine. We will soon be offering the new Shingles Vaccine Shingrix for ages 50-64. We are unable to bill Medicare Part D therefore; we will only be offering the Shingrix vaccine for Our maternal health medical provider, Dr. Gray retired September 28, 2018. Dr. Okpala with Harnett Health Obstetrics Gynecology (OB/GYN) will be our Aging & Case Management - Mary Jane Sauls reported the Senior Fun and Fitness day will be held on Wednesday, October 3, 2018 from 10:00am-1:00pm at the Al Woodall Municipal Park in Erwin. The event is designed to encourage Medicare open enrollment is held October 15, 2018 thru December 7, 2018. The Division on Aging has scheduled several night and weekend clinics to serve clients. Retired Senior Volunteer Program (RSVP) and Campbell University Pharmacy students will be utilized during these events to assist clients.  reoccur.  in the Commons area.  clients with private insurance or those who are self-pay. new medical director for the maternal health program.  seniors to participate in senior games.    Page 9 Board of Health October 2, 2018  Harnett County Health Department Board Room  The RSVP volunteer's recognition banquet will be held on Friday, October 12, 2018 at the Dunn Community Center from :00pm-8:00pm. At this event, we thank our volunteers for their service. They will enjoy a meal and music, and we Environmental Health - Oliver Tolksdorf reported that onsite wastewater has not been busy with soil evaluations due to the wetness in soil since the hurricane. Septic system installation has decreased at this time due to the wetness after the hurricane. Environmental Health staff came in on Monday, September 17, 2018, to contact local restaurants about power outages and Marketing/Communty Outreach - The Health Department has several community health and educational events scheduled in the coming months. The Girl Talk-Glamp Out, which provides an educational session on physical and emotional changes associated with puberty. The program is for mothers and daughters and scheduled for Friday, October 12, 2018 from 6:00pm-8:00pm. We will be launching the Prevent Type 2 Diabetes session starting on October 16, 2018 with two sessions at 12:00pm-1:00pm and 5:30- 6:30pm. Health Education staff will be utilizing the Centers for Disease Control (CDC) approved curriculum and trained lifestyle coach to implement this program. October is recognized as National Breast Cancer Awareness Month, the tenth annual Pink Ribbon Breakfast will be held on Saturday, October 20, 2018 from 9:00am-11:00am at the Campbell University School of Nursing. This  will also be choosing our volunteer of the year.  proper food handling since the hurricane.  is a free community event.    Page 10 Board of Health October 2, 2018  Harnett County Health Department Board Room Closed Session = There was no need for closed session. none Vice-Chairwoman Chalmers closed New Business. Chairwoman Chalmers adjourned the meeting.  New Business = Chairwoman Chalmers opened the floor for New Business. Being  Respectfully submitted, qhwl John Rouse, Jr. Health Director  Ms. Patricia Chalmers,  Gak