Harnett County Board of Health Minutes of Regular Meeting September 21, 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, Ms. Linda Sturdivant, Dr. Lori Langdon, M.D. and Mr. John Rouse,  Jr., Health Director.  Public Guest present: Jennifer Newman.  Others present: Mark Morris, 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 - Mr. Rouse welcomed Mark Morris, Executive Director of Good Hope Hospital presenting an update on the Good Hope Hospital Advisory Board, and Fayetteville State nursing student Jennifer Newman who is attending the meeting tonight. Mr. Rouse announced Commissioner Barbara McKoy and Ms. Emily Allen would not be able to attend the meeting tonight. Mr. Rouse also announced Dr. Lori Langdon, M.D., completed her Board of Health Orientation training today, September Consent Agenda - Minutes Motion made by Ms. Linda Sturdivant, for the July 20, 2023, agenda and minutes to be approved and seconded by Dr. Amanda 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 = Chairwoman Smith appointed Ms. Emily Barefoot and Dr. Amanda Langdon, DVM, to serve on the Nominating Committee. The committee will report at the next regular meeting in November 2023 and at the January 2024 meeting, Good Hope Behavioral Hospital Update -] Ms. Sherrie Byrd is the liaison for the Board of Health and serves on the Good Hope Advisory Board which provides in- patient adult behavioral health services. Mr. Mark Morris, Executive Director provided the Board of Health an update and overview of the Good Hope Behavioral Health  21,2023.  Langdon, DVM Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.  the officers will be nominated.    Page 2 Board of] Health September 21, 2023  Harnett County Health Department Board Room  Services, and upcoming projects. The goal of Good Hope is to stabilize the patient's crisis through therapy and med-management, then to outpatient services. The facility accommodates sixteen adult beds for patients age 18 or older who have met the guidelines. Approximately 150-200 referrals are received each month and the facility is able to serve 40-45 patients a month. The facility is in the process of expanding to 22- 32 beds total, and hiring more staff to accommodate the facility. The Sandhills and Eastpoint Local Management Entity (LME) will possibly merge if approved by the state. Recommendation to Established Fees - Gail Hobbs presented the following fees for  This is due to the state reducing the LME's from six to four.  new fees or an increase to established fees:  CPT CODE 90686 90694 90674 G0008 G0009 90671  DESCRIPTION Fluzone Fluad QIV age 65 and over Flucelvax Administration Fee Administration Fee Vaxneuvance (Pneumonia)  RECOMMENDED PRICE  $23.00 $78.00 $35.00 $29.77 $29.77 $250.00  The rates for flu vaccines and administration fees are based upon the 2023-2024 seasonal flu vaccine pricing provided by the Centers for Medicare & Medicaid Services Motion to approve the established fees from Dr. Catherine Evans, DDS and  (CMS).  seconded by Dr. Lori Langdon, M.D. Motion Carried.  Debt Setoff- Gail Hobbs reported that since the last meeting, the Debt Setoff program has collected an additional $97.11 and the collection year to date total is $4,754.42. Bad Debt Write-Offs - Gail Hobbs requested to write-off $3,341.41 through June 30,  2023 for program services as follows:  Maternal Health Adult Health  $949.22 $395.77    Page 3 Board of Health September 21, 2023  Harnett County Health Department Board Room  Family Planning Child Health Other Services STD Tuberculosis Total:  $528.57 $1,172.62 $41.83 $3.00 $250.40 $3,341.41  Motion by Ms. Amy Allen to write off $3,341.41 as presented, seconded by Dr.  Kim Fowler, PhD., Motion Carried.  Health Director's Report and Program Reports - John Rouse, Jr.  Accreditation - Mr. Rouse announced the Health Department's site visit is Mr. Rouse stated the Health Department's guidelines for public comment for the Board of Health meetings will follow the county's guidelines for Board of Commissioners meetings. Public Comment Period: Harnett County Board of Health will hold a public comment period during their regularly scheduled meetings. The public comment period allows for up to 30 minutes for informal comments allowing 3 minutes for each presentation. For more information to view a copy of the Rules of Procedure, Rule 29, the link can be found on the Review of Operating Procedures - Mr. Rouse presented a power point and reviewed the Operating Procedures with the Board. 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 15, 2022. Mr. Rouse stated that we would have the Chair sign the Communicable Disease Report - Ainsley Johnson provided a power point presentation including incidence data of confirmed disease cases using the NC Electronic Disease Surveillance System (NCEDSS). The case counts are grouped by fiscal year; July 1, 2021 - June 30, 2022 and July 1, 2022 - June 30, 2023.  scheduled for October 10, 2023 through October 12, 2023.  Health Department's website.  Operating Procedures annual review log.    Page 4 Board of Health September 21, 2023  Harnett County Health Department Board Room  For gastrointestinal diseases, the Salmonellosis cases are at 39 for the year and we were at 38 last year. Campylobacter - 21, Shigellosis- 6, E. Coli- 1, Listeriosis- 1, and Botulism-nfant-l. In 2023, the Centers for Disease Control and Prevention (CDC) Health Alert Network related an alert on the increase in extensively drug -resistant shigellosis in the United States. This was emailed to all medical providers on our surveillance list in our county and shows the increase in cases. The vector borne cases, this year we have been fortunate to not have many confirmed or probable cases. We had 1 Elrilichia, 1 Rocky Mountain Spotted Fever, and 1 Lyme Disease. The water-borne and streptococcal reported 1 vibrio infection, 1 cryptosporidiosis, 10 Streptococcal Group A Infections, 1 Toxic shock syndrome streptococcal, 1 toxic shock syndrome non-streptococcal, and 1 pneumococcal meningitis. This year we have seen an increase in Invasive Group A Streptococcal Infections and that has been seen nationwide as well. The CDC released a Health Alert related to the increase in pediatric cases. Our median age for cases in Harnett was 55 years old. We reported 1 pediatric case and 2 associated deaths for Streptococcal Group A Invasive Infection. Hepatitis C Chronic decreased to 89, Hepatitis C Acute is at 1, Hepatitis B Chronic decreased to 4, Hepatitis B. Acute is at 3, and Hepatitis A is 0. Vaccine preventable cases for the last year are Haemophilius Influenzae - 3 Pertussis, O flu deaths for pediatrics and 2 flu deaths for adults. This past flu season we had an earlier than usual peak that occurred in November of 2022 and the adult deaths occurred then. In 2022, we investigated one outbreak ofi influenza in a long-term care facility and monitored seven school clusters. Sexually Transmitted Diseases Chlamydia went slightly down to 680. Gonorrhea cases stayed close to the same as the previous year at 255. Syphilis is broken down into different categories- primary and secondary, early and late, and unknown duration. Our unknown duration case have greatly increased. In addition, non-gonococcal urethritis (NGU) and pelvic inflammatory disease (PID) are noted on the graph and have went down in cases. AI NCDHHS public health alert regarding the increase in syphilis in women of reproductive age and in congenital syphilis. Between 2012 and 2021 there has been a 538% increase in cases among women. Trend data was provided since 2019 for Syphilis, Gonorrhea and Chlamydia. There have been newly diagnosed cases of HIV and advanced HIV, for the first quarter of 2023 there were 51 HIV and 1 AIDS case reported. Reference received from NCDHHS CD quarterly reports. Tuberculosis has decreased; we had zero cases for the last fiscal year. We did however treat 14 clients for LTBI Latent Tuberculosis Infection (LTBI) and investigate eight cases that did not meet criteria. We are  currently providing direct observation therapy.    Page 5 Board of Health September 21, 2023  Harnett County Health Department Board Room  The COVID-19 summary: for last year; in February 2023, we stopped weekly reported and transitioned to monthly, May 11, 2023 was the last day that North Carolina providers and laboratories were requested to report positive testing results. In 2022, we had 8,020 case reported, this does not include home tests. Harnett had 19 outbreaks, 1 cluster, and 31 deaths reported. Harnett had one confirmed case of Mpox (monkeypox) in 2022. NCDHHS data regarding the reported cases per week are sent in the bar graph. The shaded state map shows Workforce Development - Ainsley Johnson provided a handout. The report provides a brief description of the Health Department's Workforce based on 2022 data. Workforce Development in Public Health aims to improve health outcomes by enhancing the training, skills, and performance of public health workers. Effective public health action requires an adequately staffed, highly skilled, diverse, and interdisciplinary workforce. This report provides a brief description of the Health Department's Workforce based on 2022 data. Assuring ac competent workforce is one of the ten essential public health services. Itis our responsibility as a public health organization to assure and maintain public health workforce standards and use a universally accepted set of core competencies. A competent, capable public health workforce is essential for protecting and improving the health and wellness of the public and responding to major health threats. The public health workforce is multidisciplnary, at the HCHD our workforce is comprised of environmental health professionals, public health laboratory personnel, health administrators, billing specialists, social workers, nutritionists, health educators, nurses, physician extenders, care managers, and others from a wide range of disciplines. The Health Department has 68 full time employees and 14 contract employees. This includes 34% Clinical staff, 17% Aging/Care Management staff, 15% Women, Infant and Children, 16% Environmental Health staff, 15% Administration staff and 3% Health Education staff. Currently, all employees must complete several mandatory trainings, including Harnett County new employee training, National Incident Management System (NIMS), Health Insurance Portability and Accountability Act (HIPAA) except the Environmental Health staff, OSHA/Safety, Diversity/Cultural Competency and Emergency Preparedness. Title X training is required for any staff that are involved in services covered under Title X law. Clinical staff are also required to attend CPR bi-annually. Two clinical staff members are Advanced Cardiac Life Support (ACLS) certified. All staff are required to obtain program specific continuing education and maintain licensures. Educational opportunities are available to staff. Each year  the case counts throughout the state.    Page 6 Board of Health September 21, 2023  Harnett County Health Department Board Room  at an employee's performance appraisal, supervisors complete a competency evaluation to strengths, improvement toward goals, and to determine training needs. During the performance appraisal, staff are evaluated on core public health competencies. Public Health Leadership ensures all disciplines are: Provided and attend education and training opportunities as requested by the state, the county, and by their professional discipline, ensure program budgets provide support to assist staff in meeting the requirements held in each department, and provide on-site training and in-service when appropriate. The Department has 15 employees that hold advanced degrees. We strive to recruit ad diverse workforce that reflects the county's population and population served by the Department. We work closely with Harnett County Human Resources to advertise available positions. In the last 12 months, we have hired eight new staff: members. In addition to assist with recruitment efforts, in 2022 Harnett County adjusted the salary grade classifications scale to increase salary ranges. 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 surrounding public health month. The Health Department's employee newsletter remains a relevant and effective tool for internal communication. The newsletters provide an opportunity to highlight employees, feature new employees, share successes, and announce upcoming events. Employees received a salary increase; a market adjustment of 5% and a cost of living increase of 3 % effective July 16, 2023. We have 29 staff that have been employed greater than 11 years and 50 staff greater than six years. Itis estimated that approximately 19 full time staff will be eligible for retirement in the next five years. Budget planning for the next fiscal year will also reflect WICI Food Expenditures Report - Mr. Rouse presented aj power point presentation for the 2022 Economic Impact Food Expenditures Report. Women, Infants, and Children (WIC) program. WIC serves low to medium- income families (up to 185% of federal poverty level) that include aj pregnant or postpartum woman, an infant, or a child under the age of five years. WIC is an important resource for many families. The report highlighted data, for the caseload and included information on food expenditure and the economic impact for the WIC program in the county. WIC served approximately 43,018 participants in 2022. Overall, participation has increased since the onset of the pandemic. WIC food package benefit redemptions infused $3,087,540 million in revenue into the local economy. There were approximately twenty (20) WIC  training needs.    Page 7 Board of Health September 21, 2023  Harnett County Health Department Board Room  retail vendors from July 2022 until June 2023. Additionally, data was provided regarding the Harnett County Social Services Food and Nutrition Services (FNS - also known as Food Stamps), food assistance program for low-income families. Food and Nutrition Services help households buy eligible food in authorized retail food stores. Approximately $58,760,902 million was infused into the Harnett County retail food economy. Combined revenue from WIC and Food and Nutrition Services contributed $61,848, 442 million into the local Financial Report 2022/2023 Year Ending - Mr. Rouse reviewed the closeout revenues and expenditures summary reports for FY ending June 30, 2023. Aging and Health utilized COVID-19 funds we received. Our budget included 3.9 million from the county and 2.4 million was not utilized in FY 22-23 at the year-end in part because of the additional COVID-19 funds. Aging and Health programs are able to carryforward an estimated $800,000. Mr. Rouse explained the budget changes for FY 23-24, staff will have to make sure to check balances remaining in the line you are purchasing from to ensure they have funds available. A requisition will not be processed if the program line does not have the available funds. Mr. Rouse announced the Health Department has been awarded the NC Public Health Association's annual Dr. Ann F. Wolfe Mini Grant for Child Health and Infant Mortality. This grant is in the amount of $8,000. The Health Department submitted a grant proposal to reduce access to harmful household items. With these funds gun locks and medication lock boxes will be purchased and distributed to the community. The board acknowledged support for obtaining this funding and it will move. forward to the  economy.  Board of Commissioners.  Clinical Report - Ainsley Johnson  COVID-19 - Mr. Rouse announced the latest information for the COVID-19 booster. COVID-19 booster and RSV inventory/shipping dates are changing daily. Counties now. have to purchase COVID-19 vaccines; the state has a program with certain criteria's to provide vaccine for the uninsured and underinsured patients. We have just received standing orders from the state and received the Medicaid and Medicare reimbursement rates. We are currently waiting to receive more information on when we will receive the COVID-19  booster and RSV vaccine.    Page 8 Board of Health September 21, 2023  Harnett County Health Department Board Room  Upcoming Events - The annual flu vaccination drive thru event will be held on Monday, October 2, 2023, from 3pm to 7pm. This event will be held in our back parking lot and is open to the public. We recommend everyone 6 months and older receive their annual flu vaccine. We are collaborating with emergency management and on target preparedness staff to plan and implement this event. As part of our flu outreach, we have visited many community sites to offer flu vaccines. Staff1 have administered flu vaccinations at senior centers, assisted living facilities, county offices, and private business. Flu vaccines are offered every day of the week in our clinics by appointment or walk in. In addition, on Monday, October 2, 2023 from 9am to 12pm, our Child Health nurses that are car seat safety technicians will be holding a car seat safety check event. Appointments are encouraged for this event but walk-ins will also Child Health and Employee Health Clinics - Child Health has seen a great increase in well visits and immunizations during this back to school season. Child Health has three walk-in immunization clinics scheduled on September 25 -2 27, 2023 This time of the year is usually our highest demand for school vaccinations due to the end of the 30-day grace period for children to receive Adult Health Adult Health services have increased in the month of August. We continue to offer our. Family Planning extended hours clinics on the first Thursday of each month until 7 pm. This clinic has had a good show rate and received positive feedback. We plan to continue this service until the end of the year and then re-evaluate. On September 5, 2023, we began our Narcan distribution to the community. To date we have distributed 44 kits to the public. We are also working with community partners and have dispensed kits to Hogan's, Angier, and Thomas pharmacies for distribution. Aging & Case Management - Mary Jane Sauls announced Community Alternatives Program for Disabled Adults (CAP/DA) currently has a caseload of 104, which includes Alzheimer's and Dementia slots. We have advertised for the Social Worker II position in the CAP/DA program and the top two candidates that were recommended turned down the position. The position has been re- posted for two weeks. The Elderly Nutrition Program coordinated with the clinical staff to make flu shots available to participants at the senior nutrition sites September 8th-14th, The final sets of Farmer's Market coupons were distributed to seniors with several sites took trips to the Farmer's Market this month with HARTS providing transportation to use their coupons. Site  be accepted.  their required school immunizations.    Page 9 Board of Health September 21, 2023  Harnett County Health Department Board Room  managers participated in Food Safety training provided by Trio Community Meals. A candidate has accepted the position of Elderly Nutrition Coordinator and he will start on October 9, 2023. We are gearing up for open enrollment and the annual Medicare open enrollment period runs from October 15th to December 7th, Radio spots and speaking engagements have been scheduled to get the word out to residents and consumers about open enrollment. We have been advised by the Department of Insurance that we can start making appointments on October 2, 2023. The next New to Medicare class will be held  on September 29, 2023.  Environmental Health = Oliver Tolksdorf reported on the Legislative Session Law 2023-90 changes that affect Onsite Wastewater. He reviewed the following changes; Fees and review times for private permits have been modified, building permits on lots with existing structures that do: not increase total flow will no longer need approval from Environmental Health if the homeowner completes the required form which still needs to be created by the Building Commission and Environmental Associate position has been created which requires fewer science hours but is also limited in the duties they can perform. Marketing/Communty Outreach - Debra Hawkins reviewed upcoming community health events sponsored by the Health Department information was located on pages 27-29 in the packet which included the following flyers: The annual "Fall into Fitness" Move More Challenge begins September 25, 2023 -October 22, 2023, to align with Community Health Assessment priorities chronic disease, this program promotes promoting physical activity. As part of the Health Department's Strategic Plan, one of the goals is to improve the health status and prevent premature death for residents. Our Health Education Division coordinates this. Flu Shot "Drive-thru" clinics. In our efforts to make getting the flu shot easy, accessible and during non-traditional hours the Health Department is providing "Drive thru" flu shots on Monday, October 2, 2023 from 3:00pm-7:00pm. No appointment needed. Additional information is available on the Health Department's web site and social media pages. October is recognized as National Breast Cancer Awareness Month, which is an annual campaign to increase awareness and to promote regular screening and early detection of breast cancer. The Health Department will host the "Think Pink!" Breast Cancer awareness health and resource fair on Saturday, October 21, 2023 from 10am until    Page 10 Board of Health September 21, 2023  Harnett County Health Department Board Room  12:00noon at the Harnett County Resource Center and Library, located  Lillington. This is a free community health event.  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. Chairwoman Smith adjourned the meeting.  John Rouse, Jr. Health Director  Ka  B2