Harnett County Board of Health Minutes of Regular Meeting September 19, 2019  The Harnett County Board of Health met in regular session on Thursday, September 19, 2019 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. Members present: Ms. Patricia Chalmers, Chairwoman, Ms. Judy Herrin, RPH, Vice- Chairwoman, Ms. Amy Allen, RN, Ms. Linda Sturdivant, Ms. Emily Barefoot, Dr. Laura Smith, Dr. Nicholas Pennings and Mr. John Rouse, Jr., Health Director. Other present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Donna Surles, Gail Hobbs, Allison Beam, Ainsley Johnson, Patricia Davis, Melissa McLamb  and Natasha Johnson.  Chairwoman Chalmers called meeting to order at 7:00 p.m.  Announcements = Mr. Rouse announced we have Health Department staffj joining the meeting tonight. Some were recognized by the Daily Record Best of Harnett awards and also staff who were recognized in the 100 Distinguished North Carolina Public Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot for the July 25, 2019 minutes to be approved as presented and seconded by Dr. Nicholas 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 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 2019 Best of Harnett County = Mr. Rouse announced the Daily Record Best of Harnett awards. Allison Beam, PA-Creceived 1st place for Best Doctor/Physician's. Assistant and Ist place for Best Pediatric Provider. Ashley Pope, LPN received 1st place and Ainsley Johnson, RN received 3rd place for Best Nurse. The Harnett County Health Department received 2nd place for Best Pediatric Clinic and 2nd place for Best Medical Facility.  Health Nurses.  Pennings. Motion Carried.  and at the January meeting the officers will be nominated.    Page 2 Board of Health September 19, 2019  Harnett County Health Department Board Room  100 Distinguished North Carolina Public Health Nurses - Mr. Rouse announced the staff that were nominated for the 100 Distinguished North Carolina Public Health Nurses. Those nominated were Melissa McLamb, FNP, Donna Surles, RN, Patricia Davis, RN and Ainsley Johnson, RN. They will be recognized at the North Carolina Public Recommendation to Establish Fees: Gail Hobbs presented the following fees for new  Health Association (NCPHA) conference that will be held next week.  fees or an increase to established fees:  CPT CODE 90674 90653 90756  DESCRIPTION Flucelvax Quad  RECOMMENDED PRICE $55.00 (was $49) $84.00 $55.00  Fluad Pre-Filed Syringe (PFS) Flucelvax Multi Dose  Motion to approve the new and increased fees from Ms. Emily Barefoot and Debt Setoff - Gail Hobbs reported we have received an additional $119.20 since the last Board of Health meeting in July. The total amount of Debt Setoff money received Bad Debt Write - Offs - Gail Hobbs requested to write-off: $2,862.18 through June  seconded by Dr. Nicholas Pennings. Motion Carried.  year to date is $8,527.15.  30, 2017 for program services as follows: Maternal Health/Prenatal Adult Health Family Planning Child Health Tuberculosis Total:  $906.41 $496.60 $490.62 $744.12 $224.43 $2,862.18  Motion by Dr. Laura Smith to write off $2,862.18 as presented, seconded by Ms.  Amy Allen. Motion Carried.    Page 3 Board of Health September 19, 2019  Harnett County Health Department Board Room Accreditation Activities Report - John Rouse  Review of Operating Procedures Mr. Rouse reviewed and presented the Operating Procedures with the Board through a power point presentation. There were no recommended changes. Mr. Rouse related that we will have the Chair sign the Operating Procedures yearly on a signature log format rather Communicable Disease Report Donna Surles provided incidence data of confirmed disease cases using the North Carolina Electronic Disease Surveillance System (NCEDSS). Data from NCEDSS to compare the incidence of cases of Salmonella, Chlamydia, and Gonorrhea for this report. The number of Salmonella cases increased slightly in 2018 to 34, compared to 30 cases in 2017, and in 2016 with 33. The Health Department continues to promote safe food preparation and storage in the local newspaper, website, and social media. Chlamydia cases remain the highest of all reportable sexually transmitted diseases (STDs) and that number continues to increase each year. In 2018 there were 798 cases reported, up from 738 in 2017 and 640 cases in 2016. The incidence of Gonorrhea also increased in 2018 with 262 cases reported, up from 228 cases in 2017 and 181 in 2016. In 2018 we also had 22 Syphilis cases, 6 Hepatitis B cases, 97 Chronic Hepatitis C, and 5 Hepatitis A cases reported in 2018. Of the 5 reported Hepatitis A cases, 4 of those were linked to the statewide outbreak. We continue to see a large number of STD clients in clinic. We provide Expedited Partner Therapy in efforts to decrease the number In fiscal year 2018, the Health Department reported four Tuberculosis (TB) cases in 2018, two in 2017, one in 2016 and 7 in 2015. Two of the TB cases were also human mmunodehiciency virus (HIV) positive. We have two Registered Nurses who work the TB cases. Direct Observational Therapy (DOT) requires the nurse to physically observe the client taking the TB mediçations for Latent Tuberculosis Infection (LBTI) Therapy, requiring daily home visits by the nurse or observation through Skype if the client has internet and skype  than having to actually sign the Operating Procedure.  of Chlamydia cases.  capability.  Workforce Development Plan = Donna Surles reported the Health Department continues to promote continuous quality improvement with our programs. Each year at the performance appraisal we complete a competency evaluation on each employee to determine strengths, improvement toward goals, and to    Page 4 Board of Health September 19, 2019  Harnett County Health Department Board Room  determine training needs. Annually during the pertormance evaluation, we continue to review Nursing Core Competencies for Tier 1 and Tier 2 nursing staff. All clinical staff are certified in Basic Life Support with some of our clinical staff being certified in Advanced Cardiovascular Life Support. We are looking at the training and staff development needs of our employees which 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 conduct annual staff training for all employees twice a year. The next staff training is Monday, October 7, 2019, when we will have Emergency Preparedness/Sheler Training as well as Customer Service Training. We provide customer service tips and Health Insurance Portability and Accountability Act (HIPAA) updates quarterly in the Health Department newsletter, which is sent via email to all Health Department staff. We encourage our staff to seek continuing education as required by their licensing board. We are looking at Health Department employees who have advanced degrees and those where certifications could possibly be obtained. We want to look at utilizing the talents, skills, and experience of our trained staff. Our Environmental Health has four staff with advanced degrees, our three Health Education staff have advanced degrees, two Social Workers and two Women Infant and Children (WIC) staff with advanced degrees. We have four out oft ten Registered Nurses who have a bachelor of science in nursing (BSN) degree and two Registered Nurses that are Nurse Practitioners. We have 3 nurses currently enrolled in programs to further their education, and 2 Physician Assistants in The Health Department always seeks opportunities to improve our programs by providing additional services that will better meet the needs of our clients. 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 better meet the needs of our Based on the results of the Community Health Assessment, we are continuing to work together to decrease child fatality rates and promote healthier babies and children. We have five nurses that have trained and received car seat certifications and 2 nurses that are trained sudden infant death syndrome (SIDS) counselors. Staff have been actively working in the community to educate our citizens on the importance of immunizations, healthy nutrition, child safety, and dental care. The DPH Oral Health Division Dental Hygienist  clinics that rotate among various programs.  clients.    Page 5 Board of Health September 19, 2019  Harnett County Health Department Board Room  was here last week to do two oral health trainings with our nurses and providers. We continue to educate our pregnant clients on eating healthy, smoking cessation and the importance of early and continuous prenatal care. Although our prenatal visits are consistent with previous months, the number of prenatal patients has decreased. Our Prenatal provider states she feels that our Hispanic clients are worried about all of the issues in the news about deportation and ICE. We are invited to attend a health fair Friday at the Migrant Head Start in Angier we are planning to promote our services. Through the succession planning process, the Health Management Team (HMT) who has approximately 1/3 ofi its members eligible for retirement within the next 3-5 years. The current Health Department staff consists of 69 full-time employees, and approximately 25% of those are eligible for retirement within the next five years, with two employees retiring this year. When considering succession planning for clinical staff we have trained Enhanced Role Register Nurse (ERRN) staff to provide coverage for STD and Child Health clinic operations. We have an experienced ERRN in the Adult Health Clinic that will be eligible for retirement therefore we have another STD ERRN in the Adult Health Clinic. The department has four Mid-Level Providers who rotate throughout the clinics and are able to provide coverage during absenteeism. We have one Midlevel Prenatal Provider and we are working with Harnett Health to train two of our other providers as back-up for Prenatal. The clinical staff consists of ten Registered Nurses, one LPN, and four Mid-Level Providers. One Registered Nurse works as the Preparedness Coordinator and as the NB/PP home visiting nurse. We have four billing staff located in the clinics, two whom are fluent in Spanish and English. We have two fulltime Spanish interpreters and a contract interpreter. 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. 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 state public  health conferences.  Health Director's Report and Program Reports - John Rouse    Page 6 Board of Health September 19, 2019  Harnett County Health Department Board Room  Community Leadership Forum - Mr. Rouse reported about the Community Leadership Forum that was held today at First Choice Community Health Center from 11:30 am-2:00 pm. Several departments with Harnett County and surrounding agencies in the county presented information on the services that are offered in Harnett County. Mr. Rouse presented information at the forum on the Community Health Assessment. The Health Department will have Medicaid Transformation - Mr. Rouse announced that the North Carolina Department of Health and Human Services announced in September that Medicaid Managed Care in North Carolina will now begin in February 2020 for all counties. Phase 1 which was to start for some counties November 2019 has been delayed. Open enrollment for beneficiaries will begin this fall. 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 $2,541,321 million in funds into the Harnett County retail food economy fiscal year 2018-June 2019. The benefits of this economic boost extend beyond WIC families to the local economy. In addition, through the Department of Social Services (DSS) Food and Nutrition Services/Food Stamps, issued approximately $28,773,216 million to the local income July 2018 - June 2019. Approximately $31 million dollars through these two programs, WIC and the DSS Food and Nutrition Services/Food Stamps greatly impact the local Financial Report 2018/2019 Year Ending - Mr. Rouse reviewed the closeout revenues summary report for FY18-19. Mr. Rouse reviewed the expenditure summary report. The staff has done a good job monitoring their expenditures. Additional State funds received for mosquito control was not spent due the weather not suitable for aerial spraying. The total amount of carry forward money for FY 2019-2020 is $292,191 for Health and $3,698 for Aging.  their Community Assessment due in March 2020.  economy.  Clinical Report - Donna Surles  Clinical Report is based on the Activities Summary for July and August. Since July 15, 2019 the Health Department began extended hours until 6:00pm Monday through Thursday, we have scheduled 105 appointments with an 80%    Page 7 Board of Health September 19, 2019  Harnett County Health Department Board Room  show rate. Approximately 84 patients were seen, nine did not show, twelve patients either rescheduled or cancelled with most of those due to Hurricane Dorian. The extended hours have been beneficial for our patients.  Child Health (CH) visits have doubled and they continue to work through the busy schedule of back to school physicals and immunizations that are common for this time of year. Immunizations in August were 342 compared to 265 in August 2018. CH will hold a late clinic tonight and again next week to help meet the demand at the 30-day school suspension deadline. The Teen clinic continues to grow and we have received positive feedback on the clinic. The Teen clinic is open to ages 13-19 and is available for Child Health Well and Primary Care visits as well as Family Planning, STD, and Pregnancy Tests. We compared the teen numbers from 2018 to 2019, since the clinic opened in May 2019 there were 130 teen visits from May 2019 - August 2019 compared to 89 visits during that same timeframe in 2018. Last month alone We continue to work on improving our home visiting program for newborn (NB) and postpartum (PPTM) mothers. The number of visits varies from month to month. About 50% of the referrals we receive either refuse the visit or never return a call to schedule. We are looking at other scheduling options with this program and we continue to promote our home visiting program during Employee Clinic has benefited by our extended hours clinic by county employees. As the Fall season begins we start to see the usual seasonal allergy symptoms. The employee clinic is offering the influenza vaccine to our Health Department employees. We are still waiting to receive the rest of our influenza vaccine before we advertise to the public. The Health Department will be offering influenza vaccines at our Employee Health Fair on October 10, 2019. Adult Health (AH) clinic offers the STD Express clinic that has been successful and continues to grow. Since the STD Express clinic opened on April 29, 2019, there have been 142 patient visits. The Department of Health and Human Services (DHHS) State TB Consultant conducted a TB Program Monitoring visit last week. We are still awaiting our official report although the consultant said we were in compliance and did not report any deficiencies. There continues to be a statewide shortage of TB serum. The Health Department has received guidelines from the state to determine who should receive the skin test during the shortage period. We are unsure when the shortage will be lifted.  there were 57 teen visits compared to 38 in August 2018.  outreach events.    Page 8 Board of Health September 19, 2019  Harnett County Health Department Board Room  Several influenza clinics have been scheduled for September and October, including the senior centers, assisted living facilities, school staff, and county offices. The Health Department Laboratory, Health Education and AH continue with community outreach programs for HIV/Syphilis testing as well as providing hepatitis A vaccine at the Harnett County Detention Center and the Aging & Case Management - Mary Jane reported The Division on Aging is now scheduling appointments to review prescription drug plans. Medicare Open Enrollment begins on October 15, 2019 and continues through December 7, 2019. During the annual enrollment period (AEP) beneficiaries may make changes to various aspects of their coverage. We are offering some evening and weekend appointments, and also providing off-site clinics at various places The annual Retired Senior Volunteer Program (RSVP) recognition event will be held on Friday, October 4, 2019 from 5:00 pm - 8:00 pm at the Dunn Community Building on 205 Jackson Road. The theme for this year's event is, "Rolling the Dice to Win with RSVP." The event will honor the volunteer of the year and will include dancing, a plated meal and awards. The 2019 Fun and Fitness Day for Seniors will be held on October 2, 2019 from 10:00 am-1:00 pm at the Erwin Park. Anyone interested in participating in Senior Games will get the opportunity to learn more about the games. Senior day at the Fair is Tuesday October 22, 2019. Buses will depart from the Governmental Complex in Lillington at 8:00 am. Transportation is free and drop Environmental Health = Oliver Tolksdori reported that On-site Wastewater is working with Geographical Information System (GIS) to create a GIS layer that will show the location of the septic tank and drain field on a property. This data is being collected as Environmental Health puts new septic systems into operation. A copy of the operation permit will also be attached. The layer will be available to the public in approximately one year when there is substantial data Marketing/Community Outreach = Debra Harris-Hawkins presented the Health Department has several community health and educational events scheduled in the coming month. We will be launching the Prevent Type 2 Diabetes session starting on October 17, 2019 with a session at 5:30 pm 6:30 pm. Health Education staff will be utilizing the Centers for Disease Control (CDC) approved curriculum and trained lifestyle coach to implement this  Morse clinic.  throughout the county.  offi is at the door.  available.  program.    Page 9 Board of Health September 19, 2019  Harnett County Health Department Board Room  October is recognized as National Breast Cancer Awareness Month, the eleventh annual Pink Ribbon Breakfast will be held on Saturday, October 19, 2019 from 9:00am-11:00am at the Governmental Complex  Commons area. This is a free community event.  Closed Session - There was no need for closed session.  New Business - Chairwoman Chalmers opened the floor for New Business. Being  none Vice-Chairwoman Chalmers closed New Business. Chairwoman Chalmers adjourned the meeting.  Respectfully submitted, CBLlanvl  John Rouse, Jr. Health Director  halnal Ms. Patricia Chalmers, Chairwoman