Davidson County Board of Health Minutes Regular Meeting of the Board of Health Health Department Boardroom February 4, 2025 Board of Health Present Staff Present Visitors Present Dr. Terry Ellington, Chair Lillian Koontz Adam Jones, County Attorney Mr. Calvin Odom, Vice Chair Janna Walker Ms. Tammy Troublefield Corinne Bates Dr. Mark Hamrick Stacy Hull Mr. Jason Gibson Randy Swicegood Ms. Datra Delk-Patrick Michelle Allen Dr. Christian Brandyberry Belinda Wilson . Welcome, Introductions, announcements = Ms. Lillian Koontz Ms. Koontz called the meeting to order at 3:01 and welcomed everyone to the meeting. II. Election of Chair and Vice-Chair = Ms. Lillian Koontz Ms. Koontz opened the floor for nominations for the 2025 Chair of the Board of Health (BOH). Mr. Calvin Odom nominated Dr. Terry Ellington. The motion was seconded by Ms. Tammy Troublefield and was approved without dissent. Dr. Ellington requested a nomination for Vice Chair. Ms. Troublefield nominated Mr. Odom. The motion was seconded by Dr. Christian Brandyberry and was approved without dissent. III. Agenda = Discussion and Amendments - Dr. Ellington Dr. Ellington requested an amendment to the agenda removing item IV, Board of Health Member Introductions. Mr. Odom made a motion to approve the removal of item IV. Mr. Jason Gibson seconded the motion and was approved without dissent. Dr. Ellington requested a motion to approve the amended agenda. Ms. Delk-Patrick made a motion to approve the amended agenda, and Mr. Gibson seconded the motion. The motion was approved without dissent. IV. Board of Health Member Introductions - Dr. Ellington This was removed from the agenda. V. Public Comment None VI. Consent Agenda = Dr. Terry Ellington The consent agenda which was part of the meeting packet was presented and included the December 3, 2024, meeting minutes, the December 3, 2024, Evaluation Subcommittee meeting minutes, the December 3, 2024, closed session meeting minutes, the financial report as presented and the 100.78 Visit Verification Notes policy. Ms. Datra Delk-Patrick made a motion to accept the consent agenda as presented, and Dr. Brandyberry seconded the motion. The motion was approved without dissent. VII. Commissioner's Report - Commissioner Tripp Kester Per Ms. Koontz, Commissioner Kester did not have any agenda items to share with the BOH. VIII. Health Director's Report (Including Program Reports) - Ms. Lillian Koontz Vacancy Report: Actively recruiting for 3 positions. An offer was extended for the school nurse position last week, but it was declined due to salary. There are 5 open positions that are being held for now, including an Environmental Health Office Support position that is held by Kathy Musgrave who will be retiring at the end of February. Renovations: The downstairs breakroom is being remodeled, and we will also be getting a new roof sometime this year. External Funding Sources: We are closely monitoring all external funding sources. Flu Cases: Currently seeing an increase in the number of flu cases. Providing messaging regarding hand washing and sanitizing high touch surfaces. Program reports: We have a new hire in On-Site Water Protection, Josh Grubb. He starts CIT in February. Mr. Gibson asked if. Josh Grubb was taking Jason Koontz' place on the team. Ms. Koontz replied, yes. Nurses for the Davidson County schools are getting acclimated to their new schedules and assignments, since they have resumed responsibilities again for the middle and high schools. The EH Food and Lodging (F&L) team is doing great with inspection compliance. One staff member is on FMLA. Stacy Hull, EH F&L Director, is ensuring all work is completed. Budget season is here, and Corinne Bates, our Business Officer, is incredibly busy. Community Health Needs Assessment (CHNA): The CHNA will begin soon, and this year we will have a new format. We will be partnering with other counties in a more regional approach. We will still have an opportunity to ask questions specific to Davidson County. This assessment is our opportunity to engage with the community about what services they feel are needed, what is working well, and what we can do better to respond to the needs in our community. Once all the data is collected and a strategic plan is formulated, we will look at the services we are providing to make sure we meet the needs of our community. Ms. Troublefield asked who all would be involved in the CHNA. Janna Walker, Health Promotions Director, shared that there are 10 counties working together with 4 health systems, since Atrium and Novant are very regional now. We will still assemble our local groups to hear data, look at the survey, and identify priorities. Ms. Koontz asked if there was a go-live date for the survey. Janna responded that they are still working on making additions and getting them translated. We are hoping for the middle of February, but it could be toward the end of February. Ms. Troublefield asked ift there was something the BOH members could do to participate in the assessment. Ms. Koontz responded that first and foremost BOH members can complete the survey. You can also share the survey with others electronically on social media or by email. - believe there will also be stakeholder groups, SO we can get an invite for folks to participate in those. Janna also added that more information will be coming soon once she has some concrete dates. WIC: Staying busy and monitoring the federal funding. IX. Old Business a. None X. New Business a. Opioid Epidemic - Davidson County Update: Janna shared a timeline of milestones of the opioid epidemic in Davidson County including DCSPAN, the Substance Abuse Coordinator position, the impact of COVID on overdose deaths which reached an all-time high in 2021, the rebranding of DCSPAN to Partners in Prevention, and the opioid settlement funds. Janna also reported on trends in overdose deaths in Davidson County since 2015 and that the death rate is trending down. She also reviewed the number of emergency department (ED) visits for overdoses in Davidson County and the percentage of residents living in Davidson County that sought treatment for overdoses. The numbers for 2024 did decrease which is great. Janna also reviewed the treatment options available in Davidson County including in-patient and out-patient options and overdose recovery medication. The Sheriffs' department has also started a Medication-Assisted Treatment (MAT) program for those incarcerated, and the program seems to have had some real successes in the first 6 months. The role of the Health Department in the fight against substance use is prevention, which includes starting early education campaigns and working with school systems and after school programs. We also have Naloxone here at the Health Department, and we educate people on how to access it and when and how to use it. Communicable diseases associated with IV drug users are also monitored. We will continue to work with our community partners through DC Connect to connect folks that are struggling with substance use with the resources they need and will continue to raise awareness of this problem in the community. We will also post a report summarizing all of this on our website. Dr. Ellington asked if she found in her research that prescription drugs were the main cause of substance use or was it mainly street drugs and things like that. Janna stated that they are starting to break down the data now showing which overdoses are caused by prescribed medications and those that are caused by illicit drugs. There are also new drugs that have come into play that do not respond to naloxone and require different approaches in the treatment of a drug overdose. Janna stated that she believes that a lot oft the substance use now is not caused by prescription opioids but now stems from a variety of factors. Mr. Gibson asked if the Health Department was allotted any of the opioid settlement money that the county received. Janna replied that we did not receive any of the settlement money. Ms. Koontz expanded on the explanation sharing that there were different models that counties could use to distribute the opioid settlement funds. Davidson County chose a collaborative approach by establishing a committee with representatives from county management and various county departments, which includes the Health Department. Two Commissioners are also on the committee. To date, this committee has allocated funds for the Vivitrol program at the jail and for peer counseling, which is a part of the program. Mr. Gibson asked if there was anything that the Health Department could do to curb the epidemic. Ms. Koontz responded that the Health Department's role in this is prevention. By engaging with children that live in homes where opioid addiction is prevalent, we can empower them not to choose that path. However, it is very difficult to talk about funding programs for prevention, because you cannot measure prevention. It was requested on the next agenda for this committee that we develop a request for a proposal type process (RFP) to ask community partners to come to share their ideas with us on what they would like to do. I hope that Family Services and similar agencies will do that, and then we will be able to use some of those dollars for that. Mr. Jones responded that you could do an RFP process, or you could do a grant program for people to submit applications which would be ongoing and not just a one-time RFP. b. Appointment of Board Members to Committees: A slide ofthe current subcommittee appointments was shared with the BOH. Dr. Ellington asked if anyone wanted to change their subcommittee assignments. Dr. Ellington stated that he would like to come off the Budget, Environmental, and General Services Subcommittees but remain on the By Laws and Evaluation Subcommittees. He asked if anyone else would like to make any changes. Ms. Troublefield asked if she needed to come off the subcommittees since her term is expiring in May 2025. Ms. Koontz replied that no, she should remain on the subcommittees. Mr. Odom asked if he needs to be on each subcommittee since he is Vice Chair now. It was suggested that Mr. Odom and Ms. Troublefield switch places on the subcommittees. Ms. Troublefield would be on the By Laws and General Services Subcommittees, and Mr. Odom would be on each subcommittee as Vice Chair. Dr. Ellington suggested that Mr. Odom could just be on the three subcommittees that Dr. Ellington isn't on. Dr. Brandyberry made a motion to approve Dr. Ellington's assignment to the By Laws and Evaluation Subcommittees, Ms. Troublefield's assignment to the By Laws and General Services Subcommittees and Mr. Odom's assignment to the Budget, Environmental Health and General Services subcommittees. Mr. Gibson seconded the motion. The motion carried without dissent. C. Review of Appointment Terms and Expirations: Ms. Koontz shared that two BOH members have served their maximum terms and will be coming off the BOH. Ms. Troublefield concludes her term on May 3, 2025, leaving a public citizen spot available on the BOH. Several applications have already been received by the county manager's office. Also, Dr. Rob William's term expires on September 13, 2025, sO we will be seeking a physician this year for the BOH. d. Annual Report: Ms. Koontz shared a report giving an overview of the activities of the Health Department for the year 2024 including staff members that separated from the Health Department with comparisons between the Health Department and the county. She also shared information on the activities and services provided by the Health Department for the year 2024 which included the following: the Triple P Program, the Care Management team, the number of inspections completed by the Food & Institutions Team, the number of WIC participants and caseload, community outreach events held by the Health Promotions team, the number of rabies vaccines given in the 3 clinics held in 2024, and the number of rabies cases for 2024. Dr. Ellington asked about inspections for temporary food establishments. Stacy replied that we permit temporary food establishments and go back out for mid-checks, but inspections are not required. Dr. Ellington asked what an example would be of a temporary food establishment. Stacy replied that a food tent at a fair would be one example. Ms. Koontz also gave a report on the different activities of the OSWP team and numbers for each activity including IPCA Applications, final Ops issued and repairs. Mr. Jones asked about the type of repairs done and if the repairs were required by the Health Department. Randy replied that the repairs were applications received from residents that have issues with their septic system. Ms. Koontz also shared reports on the activities of Personal Health Services, the Billing Team, and Vital Records. e. Destruction of Records Report: Janna gave a report of all the records that were destroyed in accordance with the G.S. $121-5 for the year 2024. f. Budget Subcommittee Meeting Date: Dr. Ellington shared that Ms. Koontz had sent an email to all the Budget Subcommittee members with several dates for them to consider for the Budget Subcommittee meeting. There was discussion on which date would be best. Mr. Jason Gibson made a motion for the Budget Subcommittee to meet on Tuesday, February 25 at 4:00. Dr. Ellington seconded the motion. The motion was approved without dissent. Next BOH meeting is March 4, 2025. XI. Adjournment Dr. Brandyberry made a motion to adjourn. Mr. Gibson seconded the motion. The motion carried without dissent. This meeting was recorded and is available for viewing in its entirety on the Health Department website at htps/www.co.daidsondonnsu/asemdicemte/BoardolHeath, These minutes reflect actions and an overview of conversation during the meeting. The presentation slides from the meeting are also attached to these minutes. This is a true and accurate copy of the February 4, 2025, Board of Health Minutes. Respectfully submitted, Silla out Ms. Lillian Koontz, MPH, RÉHS Secretary to the Board y - ERE Dr. Terry Ellington Chair to the Board Consent Agenda Minutes Meeting December 3, 2024 Evaluation Subcommittee Meeting December 3, 2024 Closed Session December 3, 2024 Financial Report Policies . 100.78 Visit Verification Notes Health Director's Report: State of the Agency Open Positions, Recruiting NEWS WIC:N Medical Office Assistant Remodel of downstairs breakroom underway Communicable Disease: PHNI School Nurse: PHNI II Ar newr roofi is part of the County Capital Improvement Plan for this year Closelyv watching: all externalf funding sources Open Positions, Holding linic: Provider Currentlys seeingi increased activity with Flu linic: Nurse Offices Support Clinic: Office Support IV EH:Offices Support WIC: Office Support III Progress on remodel Program Reports Budget season is upon us, Business Office is . OSWP Trainee hired, will attend incredibly CIT in February busy Health Needs - DCS school nurses are Community acclimating to new schedules Assessment will begin soon EH food team is doing great with WIC staying busy, watching federal funding inspection compliance OPIOID EPIDEMIC DAVIDSON COUNTY UPDATE DAVIDSON COUNTY TIMELINE IMPACT 2022 2019 D/CFUNDSFOR' SUBSTANCE SACPOSITION ABUSE PNP: INCREASE COORDINATOR, PUBLIC AWARENESS 2021 2023 2013 OD DEATH MPACTI RATESALL OPIOID DCSPAN TIME HIGH SETTLEMENT FUNDS REBRAND PNP 38.6 38.9 56.2 60.7 73.4 HIGHEST Overdosel Death rate, NC2 2023 (projected) HIGH MIDDLE LOW LOWEST ZERO ver ose teil Davidsoni whodied 562 out of100,000 epresent inglarpastteds pme TaEA HCES ESTAN van 137.9 147.3 148.2 184.5 153.6 HIGHEST Overdose EDV Visit rate, NC: 2024 HIGH MIDDLE LOW LOWEST Davidson EDVISERATE sel DV COUNT ZERO s B 148.2 Compare (A):T This ratei is amongt thek HIGHr rates seeni in NC. Trend(>): This ratei isa -35960 changec over the prior Year. 015 ED: OVERDOSE: OPIOID OVERDOSE PERCENTAGE OF TOTAL EDV VISITS GROUPEDE BY MONTH -c Counts -Percentage Of1 Total 0.45 30 0.4 A 25 O 0.35 6 0.3 5 0.25 0.2 0.15 - 0.1 0.05 2022 2023 2024 TREATMENT OPTIONS IN DAVIDSON COUNTY UNDUPLI ICATEDF PATIENTSF FROMI DAYMARK RECOVERY SERVICESINE DAVIDSON COUNTY DAYMARK WITH SUBSTANCE USE DISORDER *Does NOTC count any patients with onlya ser ental health LEXINGTON TREATMENT ASSOCIATES diagnosis: 1400 andnos SAC diagnosis 1200 1000 PATH OF HOPE THOMASVILLE TREATMENT 800 600 400 DAVIDSON CORRECTIONAL - MAT 200 RHA HEALTH SERVICES 2022 2023 2024 NAZARETH CHILD & FAMILY CONNECTION MATCARE o OGRAM: STATITICS FOUR DIRECTIONS COUNSELING LEXINGTON THE GREEN CENTER OF GROWTH & DEVELOPMENT 0 DCHD ROLE Life SavingN NALOXONE muy AaT mCTuEncE Kates 1 V Demographic:. Age Group Year(s): All IncaseotOPIOID OVERDOSE 2022 2023 Usedtor from About (NARCANhe Naloxone who urisdiction Disease Der hic dence Cases idence unt es ounty idenc nop andheroin on 18-24 EV VNSS à wears OFI 30- on minutes," naloxone on 25-49 17.6 SHOU E 50-64 Shink lookst luh wnaEDoranoverdesel ray LOoKU Uike? 65+ 1 B SE 1E ER 6THINGS S berdbec E lipsi pokd dark Nob breatringors ng Acute 18-24 30 you NEED 49 BMANE. TNERS TO KNOW OPIOIDS WHAT TODOIFYOUA SUPPECTEDOF AREW ADVEPN ONE WHOIS 5064 50 ABOUT Checkf for Calls 911 MARCA 55+ ta DRUG USE STIGMA Responsiveness hem lone -12 39 Shake them usteine 18-24 "Vastanbe sternai ub inspctons. CALL 25-49 57 GOODS LAN. 50-64 - for 65+ 3 Total PARTNE 12 ly BHing 24 Breathingg em (Rescue Rescue Breathing 25-49 Dack, 50-64 two 65+ patiti 13-17 Chronic 18-24 99.4 532 29.8 25-49 3405 2115 1735 5064 159:5 1038 5 66.5 55+ 913 24 733 354 179 132 V C Board of Health Sub-Committees (2025) Budget Environmental Health Dr. Terry Ellington, Chair Dr. Terry Ellington, Chair Ms. Tammy Troublefield, Vice-Chair Ms. Tammy Troublefield, Vice-Chair Ms. Datra Delk-Patrick Mr.. Joseph Thomas Commissioner Tripp Kester Commissioner Tripp Kester Mr.. lason Gibson Ms. Datra Delk-Patrick Dr. Christian Brandyberry Dr. Mark Hamrick Byl Laws General Services Dr. Terry Ellington, Chair Dr. Terry Ellington, Chair Ms. Tammy Troublefield, Vice-Chair Ms. Tammy Troublefield, Vice Chair Dr. Christian Brandyberry Mr.. Jason Gibson Mr. Calvin Odom Dr. Rob Williams Dr. Mark Hamrick Mr. Calvin Odom Mr. Justin Nifong Evaluation Dr. Terry Ellington, Chair Ms. Tammy Troublefield, Vice-Chair *Each committee shall have at Commissioner Tripp Kester least three members oft the Board. Each Board member Mr. Justin Nifong shall be on at least one Mr. Joseph Thomas committee. Dr. Rob Williams Members Member Position Present Term Expires Maximum Term Date Dr. Terry Ellington, Chair Optometrist 7/7/2026 7/7/2029 Ms. Tammy Troublefield, Public Citizen 5/3/2025 5/3/2025 Vice-Chair Mr. Calvin Odom Pharmacist 9/5/2026 9/5/2032 Dr. Mark Hamrick Veterinarian 10/1/2027 10/1/2033 Ms. Datra Registered Nurse 11/3/2026 11/3/2029 Delk-F -Patrick Ms. Lillian Koontz Health Director N/A N/A Mr. Jason Gibson Public Citizen 6/4/2027 6/4/2033 Dr. Christian Brandyberry Dentist 3/5/2027 3/5/2033 Mr.. Joseph Thomas Professional Engineer 6/4/2027 6/4/2033 Mr. Tripp Kester Commissioner N/A N/A Dr. David R. Williams Jr. Physician 9/13/2025 9/13/2025 Mr. Justin Nifong Public Citizen 9/5/2026 9/5/2032 Davidson County Health Department 2024 366 Days LEAP Year 13 DC Government Recognized Holidays 104 Weekend days 249 working days 95 FTE positions DCHD Staffing Separated January 2024-December 2024 . 23 total 17% 22% . 24.2% of positions . 41 terminations, all occurred 61% during probationary period Retired() Resigned/14) Termina ated! (4) Davidson County Staffing Separations 15% 12% . 240 total . 24.74% of total positions . 31.5% of terminations were NOT during the probationary period 72% Deceased(2) Retired(30) Resigned(173) Terminated(35) Comparison DCHD Separations/Total DC DCHD Retirements 22% VS. DCG 12% DCHD Resignations 61% VS. DCG 72% DCHD Terminations 17% VS. DCG 15% Triple P TOTAL SERVED . 78 parents 131 children Parents of Children 0-12 yo . 11 classes (3 seminars each) Parents of Teens . 4 classes (3 seminars each) Discussion Group . 2s sessions Community Health -MarylouCollett Care Management CMARC 35 clients, average caseload CMHRP . 49 clients, average caseload July 2024-December: 2024 . 63 Care Management clinical visit connections Number of Inspections Number Establishment Type Establishments Required Inspected 1- Restaurant 248 788 640 2-FoodSlands 76 177 152 3- Mobile Food 24 51 40 4-PushCarts 4 8 6 5-F Private Schools Lunchroom 3 12 11 9-Elderly Nutrition 5 20 14 11 - Public School Lunch 42 149 133 14-LimitedFood 39 78 43 15- Commissary (Pushcarts/Mobile Foods) 2 6 7 16-Ir InstutionalFoodSenice 13 31 25 20. - Lodging 14 14 15 22-Summerc Camps 3 3 EH: Food & 26- Resident Camp 1 2 1 30-MeatMarket 18 55 60 40. Rest/Nursing Homes 13 26 22 Institutions 41-Hospitals Z 4 4 42- Child Care 59 118 163 43-Residential Care 37 37 41 Team 44- School Building 53 53 20 45-localConfnement 1 1 -StacyHull 48- Adult Day Care 4 4 8 50-Seasonaiswimming: Pool 40 40 75 51- Seasonal Wading Pool 10 10 20 52-Seasonal Spa 1 1 3 53- Year-Round Swimming Pool 10 20 21 5-Yea-RoundWading! Pool 2 4 3 55. Year- Round Spa 4 8 7 56-Seasonal Specialized Water Recreation 4 4 6 61 -1 Tattoo Artists 46 46 48 73-Temporary! Food Establishment 1 0 Report Totals: 779 1,771 1,590 Clinic Average Month/ Participants Caseload Estimate Closure Business Per Year /1000 (Days) Days day Jan-24 3513 3765 93.31% 2 21 167.3 Feb-24 3570 3765 94.82% 0 21 170.0 Mar-24 3684 3765 97.8% 1 20 184.2 WIC Apr-24 3805 3765 101.1% 0 22 173.0 Michelle Allen May-24 3932 3765 104.4% 1 22 178.7 Jun-24 3972 3627 109.5% o 20 198.6 Jul-24 4019 3627 110.8% 1 22 182.7 Aug-24 4093 3627 112.8% 0 22 186.0 Sep-24 4097 3627 113.0% 1 20 204.9 Oct-24 4153 3974 104.5% 0 23 180.6 Nov-24 4194 3974 105.5% 3 18 233.0 Dec-24 4209 3974 105.9% 3 19 221.5 Health Promotions Jannal Walker 53 Community Outreach Events 24,206 Facebook Views (clicks) 66/day avg 543 Rabies Vaccines given (3 clinics) 5 positive rabies cases VS. 10in 2023 Activity Total Individual Actions IPCA Application 399 IPCA A2-A5 Applications (Hybrid Private/Public) 348 AOWE (all private) 134 IPC Only 134 IPC Only A2 16 CAC only 94 BAMH/Existing System 110 OSWP Complaints Investigated 123 Randy Swicegood Repairs 402 Water Sample Requests 31 Well Applications 101 Final OPs Issued 793 MHP Inspections 239 DOL Migrant Housing 7 Animal Exposures/Rabies 433 Personal Health Services -Maryl Lou Collett unduplicated duplicated FP 1489 6920 Clinical visits STD 1446 7500 Jail immunizations Imm 843 3272 Nursing! home Tb 22 immunizations BCCCP 64 266 TBS Skin tests AH 1755 3753 totals 5604 21733 Billing Team -Corinne Bates Processed 5793 claims . Individual claims, does not include resubmitting denied claims 3361 Self-Paid claims 2432 Insurance Claims Private insurance and Medicaid Vital Records -Corinne Bates . 1619 Death Records Death Records Processed (burial, cremation, donation, entombment, relocation from the State) 2024 Destruction of Records Report According to G.S. $121-5a and G.S. $132-3, we may only destroy public records with the consent ofthe Department of Cultural Resources. Wel have adoptedt their retention: schedule, which gives us that consent. This is a summary of what was destroyed throughout the year in 2024. ALLI DIVISIONS PERSONAL 1.Outdatede educationall brochures HEALTH SCHOOL HEALTH 1.2018 Clinic cleaning 1.FY2 2012-2 2023 Studenti information forms 2.20211 logs labr requestions 2.Outdateds school healthi information ENVIRONMENTAL HEALTH 3.2022/20231 Lab orders 1.2014-2 2018 Dailies 4.20181 labt trackingl log WIC 5.COVID-1 -19 documents (26b boxes) 6.Patienty visiti information 1. 12/2019- 11/2020 NVRAI Forms (4b boxes)* *now digital* HEALTH PROMOTIONS 7.Clinic RN competency assessments 1.Jan2 2022- May2 20231 Interpreter calll logs 8.0 Outdated proficiency 2.2005- 2010E EPI Meetingr minutes (paper copies) testingpolicy Monday February 24: 4:00pm Potential Meeting Tuesday February 25: 4:00pm Dates T.Troublefield Thursday February 27: 4:00pm D. Delk-Patrick Commissioner Kester J. Gibson Dr. C. Brandyberry