Wilkes County Board of Health Meeting Minutes February 10th, 2025 The Wilkes County Board of Health held a regular business meeting Monday, February 10th, 2025, at 5:30 p.m. at the Wilkes County Health Departmenti tin the Ann Absher Conference Room. Board of Health members in attendance were: Dr. Keaton Mash Dr. Tyler Davis Ms. Adina Watkins Mr. Chris Anderson Dr. Laura Hubbard Ms. Susan Bachmeier Dr. Sarah Miller-Wyatt Ms. Lourdes Carillo Perez Commissioner Shirley Randleman Ms. Rachel Willard, Ms. Jenna Daye, Ms. Natalie Williams, Ms. Nancy Moretz, and Mr. Chad Shore were also in attendance. Prior to the February meeting, packets containing the materials to be discussed were mailed and sent via email to each Wilkes County Board member for review. 1. Welcome and Introductions: Dr. Keaton Mash welcomed everyone and called the meeting to order at 5:30 p.m. 2. New Board Member Inductions: Commissioner Shirley Randleman, Dr. Tyler Davis, and Ms. Lourdes Carillo Perez were sworn in by Ms. Jenna Daye to be members of the Board of Health. 3. Adoption of Agenda*: Ms. Susan Bachmeier made the motion to adopt the agenda for the Board of Health meeting for February 10th, 2025; the motion was seconded by Commissioner Shirley Randleman, and unanimously approved. 4. Approval of Minutes*: Commissioner Shirley Randleman made the motion to approve the minutes from the December 9th, 2024 meeting; the motion was seconded by Dr. Sarah Miller-Wyatt and unanimously approved. 5. Old Business: None 6. Administrative Report 2024 Child Fatality Report Ms. Natalie Williams Presented the 2024 Child Fatality Report to the board. 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Disease Aamsal Repoirt 20303 2021 2022 2023_2034 Soenaceccal Erasire GA Wikes Heakt aelies on hogials. benihce geonders. labs and odber beeltb-relared Syals serice proriders so sport cotmmcable divensas. NC General Satte 130A-135 reguires Teams boesed phyicss ta report cases ad sarpeced CIseE df ceuiz seportable diesses zad Tobersleis cesdtiniess a peneas who here coasaled CeER penfessionaly 3e de Depernseez e Healt sad Tybeia Fever Hmas Servicis. Vinol bfectien edrdand chelen Aifs 3030 3021 2023 393363 Thee were 437 iscidests efc commanicalle disesse dhat lve bees repocted for Wikes Covaty i Ceae 34 30 32 39 41 2024, 244 STDs and 193 oer mpertble duesses. Thee wee 8S cases ef Sootbemei iess CHbsyds s7 390 150 353 16P mpenedias 2024. There 11 cases cf vecier berae aess eperad. Thete wee 18 ase ef CRE acooes poretalle rgenalle diseases, iacodag Haenaphas Bafoense, Paemococal Cazopentess Mesingicis, Perasis, Tessns, adFlD Ders. Theres wasa spriacreese: int bes soet cemmaly sepeneds fedbemei Cen, Campylobecter, but deceses int de mmber ef Salmmadlas ads Shiga Cyciosperss Temg peoducag E. CeL Nop perisent bickpes: aoned. Dera E.cli Aips Eozin podag Ri rtble n * M Eltidiosis Easepbalie aterinl WAV Foedhere Disense. OrU Uhiaer Gemomben $2 84 $ Evsspkhn fuane iraived desse o Henolvtic Ueks Sraioee FeaisA - 40 Hepaifi B. Ane Hepadtinl B. Chrvuic Bepatis CA Ace Hepattic C. Chrsic (pee leen spened e3EI HV Faen Adal Det 3 Lepiesellesss Eeprosy HaaveDisase) Iseriosis Lse Malara Mersles Dengis PMmcace! Netr Perict Inflammatery Daaste Perssa Simenals Grpk 1 Shralleis SpaFeNr Rickenssesis 2 4IPage There were 18 cases thet AD usder vaccine preventable disesses. We didi Botl he say cases of WilkesH Heakh srespomsbihses: reprding COVD-19 inchudest reporunge ofo outbrecks ando cluslers Hepatiss Ac or Hepsctis B mportedin 2024. Ouo claic staff comtose pot be viplanti ini identifying 10 NCDHHS throuh NCEDSS. proriding COVID vacines, COVD venng to patient's wi those individanls wbos tres strk for being exposed Bo Hepatitis A, B, ad C, mdu westing is symptoms ad proriding a bome COID tess to the pablc. COVI-19 oabraaks ando chassers provided. Vaccioes aret tbes adminismrd to those indrviduals whol buves sots received, or finisbed are reported TO NCDHHS throuph NCEDSS. Wikes Healh offers Fudances o fchon data an thel Hepetitis vaccioe seriest for Hapsicis A and Hepaticis B. There were reporedo casesof experiencing these oubresks and folow ua! dhe obreaks are declared ovB. Testing is Haemophils Iofuenzae. A13 individuals were older, and hadi sotn rceived HIB Vaccines. We completad a Willes Health for individusls with symproms by making aa sppointmest under our alsel havet had 11 reperted fuc desds a 2024., ABl bur oBe oft tbese cases wene older individosis Nuses Screen of wth provder ift de person S aa establisbed parient. Denng 2024, tberes were wiso co-morbido cosditions. The last oDe was oaly 48 years old. No definicise resos other that pumerous changes 1o vaccmes availablet to various apes groups. Wihes Baalb offered vaccines to shes wasi inc critical cooditioe wbes shei wis broughr tol bospital aod deda very short tel laser. all elipblen rapiens. Wikes Healta coatacest tob bec diligest md dedicatedt a beiping mngate de Wea alsob hade ope case of paemococcal meniapitis. Linle backprodi informstion Wass svailable spread oft tbes virs. ast thisp patien waa iss conta adc conld soto commnicite. Patient was stiB mmbered at time ef Wilkes Health is alsor rsposubla for rportag oubruak and csers for) Fh, Nororins, or any seding repor o sut. Wes asol had OsE case ofPermssis. Patient wis 17-yuar-oldi male ta odber ourbrak datc coudb be sen as threst 1o poblic heaid. ln: 2034. Wiles Heslih rporads special: Deedi class. Het had peolonpad colgh ad lested positive for Pernussis. School Darse was COVID ourbreaks, 1 COVID chuster. 51 Fha Oubreaks snd 21 Norovires Oabreak. All outbresks potified, bett no odes povancis cases were fouod. We so ad o0e case ofTerous and ose case were followed by CD mse ad educaton was provided to ageacies involved for prevennos of ofTypboid Fever. The sesats case hads stapped 003 ansty aal. She westt tol ER adi receiveda a furtber spreadng. All apencies cooperatedy wids Wilkes Hoalth and followred recomsendatiots. MetaDuS vacibe, but! later dute evening she drvelopeds symproms.. At wwowek follour up, she was Theres were 4 aypial commumicable disaase cases repored t 2024. Tbese inchuded: solle eperiencing symptoms aadv was soll under dec care afi infections disesse. The Typhoid Feverc case wsa child whol had a ertended visirs 1o famdy in Iadia Ry was donght thtd drinking Tetasns wateri in family's bome wis dhe most likely canse for the dhess. Encephalinis Arboviral, West Nile Virus TypboidF Fever Control Mescures were implemesad forl Hepadis C, both chronic aod scue, for pew Cses, or Porumococcal Meninpids those wbo! badi Dot received coatrolt meantesy prrionly. An 41 wrere imvestipand by CD Nuse and reponed sa NCEDSS to NCDHHS. There war 3o Acute Hepstis c:2i issued (11 losEp tof follow w) significantpublici healh rsk potedins asy ofbe cases Alli individeah didr reconer, ber bhe Chroak Hepatitis: 30is issued (101 lost fallow wp) with Poeumococcal meningiés had last effects aads sow livesi in loag sem cae. Tbese cases penet were alsos shared wib dbe EPIN veam. Prluary Categerles ofCommunkcable) Diseases 2024 oBecD. nr Grapk? Reportable SIDs for Wikes County Heparos Bi patients srecaser managedt unlo chronic carrier stanus is desemined through addinonal testing For 2024, wel hadnos acutel Hepaticis B patients. Hepaticis Cp pacieots whos test aa posicvef for Hepatitis C RNA are phes Hepaticis C Coural Messures as well: as assistace and coordination fort trestmant for Hepaticis C. Costol) Measares were implenenned for Hepacitis C. botb chroasc anda acue, for DER cases, ort dboses whol bad: not received control meesures prionsly. Acu Heparitis C:2 ssued(1 lost to followr tp) Chroaic Hepatitis: 30 issued (10 lost to followr wp) - In: 2024, ose of our proriders begas olfering tresmest for Hepatins c. Indrviduals must mert - à - certain criteria for bepnaing treamnent at Wilkes Heakh. The CD atrse asaists de provider wit Dlya Caabe - s aa makg appoinments fori individaal and puing information s seeded. en 3021 2023 a3 Rables: ln: 2024, allrabies exposures werereportedtot tbe CD: nurse. Prwviously, oaly CasAs where thes victim may meed rabses VAECIDES were reported. There were 272: repons so bealh departmest is: 20340 thatoccuredin Whes Comry:s Wilkes Counry resideats were ic otber Graph 3 butreporad to1 Healh Department to follow up medically. eposedi coanties Tberes wass tonl of37 atimals snt o NCS SLPH for rabies Tbene was aai increse in de ouber of cases ofChlanydia in 2024. This appears to ber retumiag cas.1 10 dops. 9bars. 1 groad bog. 1 fox,3 raccoons, 3 shunks, testingi andi in: I 2024 gont). (E toy prepadeni mumbers. Ia 20241 deres were 169n mporado cases aadin 2023,1 153.1 There wasa also Dereh have ben animab thary wares sents toNC SLPH aod wereg m 2034, an incresse Cases with posee in bec of gonorbes in 2024 60 cases repored compared so 28 m 2023. (ground bog fox,3s skunki. cat) Tberes was no baan eposar for dbe fox, cat or Wilkes Heshe contimmes vop provide educstions 1o0E Ares providersr rpardings guidehnes for STD Bofthe skunks, burt thereu wras fort he groundboga and ooe shak. Thed three sesting and treatnest, as well as assisting wich trestment when individusls canset afford individualt who were exposed to the groand bog aador skunk weri instruced medications. Tbere were 12 motald Cses afs Syphiis reperted in 2024, 21 primary à secondary. 3 thatr rabies vaccines wee wammted. early, and7 minows darstion, or late." This numberi 15 consistenty wit: 2023' totlt mmber ofl 11. Ofihose 272 imvestigicions, 42 resuled 1a clients idestified as potestial expostres wih rabies la 2024, the STI nurse issued control meaure for HV andsc comtol measrest for Syphilis. We post-exposure prophylaxis recommended. due to animal unable to be captured for quaratine areo oaly rquiredsoi sse comtol mesaares for HIV, bett Wilkes Hesla issoes thec control messeres andort testing. Our Epi Team contimes o wok on public education Asd ontreach, encocraging for Syphilis dues 1ot thes mmber ofc casest not only a our costy, bur int thes state anda nation. Thisis mdividuals rabies. Animal to have animals vaccinand, anda aoidance ot animals wbo arel hiph-risk for hvng comsidered public besid risk and this S ooeway Wikes Balth tes to coptrol the spred of Control also coordinased with aret veerinarans' oflices and olfered rabies Syphilis. vsccines. ats reduced cost. to ty ad belp coetrol dbe spreed of mbus a WAlles County. Tbe following 1S a overvie aftbec clinics that were provided andt ther nuber ofvaccioes givea Wel bado one aypical case à oor STD proprm, Ocular Syphilis. Patiesr i 45-yorr-old famnale. Rables VaccieChak: All shots cosed $7 for each aamal Wbos presented to ER wit 3 days af Wt eye redaess md visios loss. Sbe was ealaated by ophrhalmology who diagaosad ber wit moss graioosious aserior sveitis. She was gives Tuesday April 300 2034 medications and discharped. Aber laby wark reseled, shen as foandso) luveposmes syphilisa esting. 61-Auimal Hospinle ofWities aMm Vin Schod! Sbew was admited ad diapnosad withd ocular sypbis. Sbe wis bested witb IV abbiotics. 9-Riverview 3-Wilkes Veri Animal Horpnia Hespital Sanrday, May 43 2024 18-Wilkes Veliospint Esfercemest Actiens: Winkes Counry had no active TB cases in: 2024. The TB ause foliowed 18-1 Riverview Aaimal Horpata) say individasls wity positiw TB skine ort blood sts adt tresmes for lannt TB wIs offereds as Wikes Watches: appropriate Tbee were3 Cses whor wee offerd treatmerr for laat TB. Twod declined ando ose sccepted. Tremmenti is engoing. Thare was onei individaal witht lanar TB thate due te medical I2034t there weea socal o235 Wiikes Waxhas seat 0o area providers ca vnous conditions and: medicacios, was not candidate for trestment ofl latent TB. topiss as recommended by, NC DHHS ander CpC. 5 Six Month Financial Report* Ms. Nancy Moretz presented the six-month financials. Ms. Moretz explained to the board that this is for our current fiscal year, beginning in July through December. Starting with actual YTD revenue through December, it was $3,331,843, and that is 59% of our revised budget. General expenses and program expenses are broken out. Total general expenses through December were $1,304,918, and that is 46% of our revised budget. Total program expenses through December were $2,374,368, and that is 41% of our revised budget. Total expenses YTD for general and programs combined was $3,679,286, which is 42%. Ms. Willard added that general is usually our county appropriations, whereas programs are all of our state, federal, and grant dollars that come in. Dr. Sarah Miller-Wyatt made the motion to approve the Six-month Financial Report; the motion was seconded by Ms. Susan Bachmeier and unanimously approved. Bad Debt Write Off* Mr. Chad Shore presented the six-month bad-debt write-off. Mr. Chad Shore explained to the board that the $11,510.67 amount represents the sum total for the accounts with no activity for the last six months. This is about $3,000 more than it usually is. We did some research into this amount, and we narrowed it down to about 20% of this amount being lab fees. We tend to get al lot of new adult health patients; they will go through the process and then be asked to bring in proof ofi income. We give them five days to bring that in, and if they don't, they will slide to 100%. They get their one visit in, and then they disappear. They may show back up in a few months or years down the road. On the second page, you can see where that debt is per program. Commissioner Shirley Randleman said, down at the bottom of the page, I see it says three patients have transferred their records. Have they transferred to a private physician. Mr. Shore said yes, normally when we discharge someone, we will make a referral to other offices. Ms. Willard added that when they get kicked out of those practices because that's generally what happens to non-compliant patients, they will try to come back here, and we have them pay 25% of their balance to be seen again. Dr. Keaton Mash added that generally when we have discussed this in the past, even though we have written this amount off, iti is written on their ledger, SO they are required to pay that 25% before being seen again. Mr. Chad Shore said we even have patients that will pay the 25% and then drop off again. It's not a nice cycle that some patients are in. Ms. Bachmeier asked if there was an opportunity with the lab fees. Ms. Willard said that is something we are working on; we have a meeting set up soon to talk about that. Ms. Susan Bachmeier made the motion to approve the Bad Debt Write Off; the motion was seconded by Dr. Tyler Davis and unanimously approved. Health Department Monitoring Visits Ms. Willard explained to the board that we did have our accreditation site visit at the end of last month. was really hoping we would have our site visit report by today, but we do not. I will tell you that they were supposed to be here until five o'clock, but they ended upl leaving here at two o'clock. We had everything in a row and only had four questions before they came on site. We went through the motions; we completed our interviews and took ai tour of our facility. It think our team did a phenomenal job; that's mostly thanks to Natalie. She kept us organized and made sure we were on target. Ms. Susan Bachmeier said it's always a good thing when your surveyors cut out early. Ms. Willard added that Susan got to talk to them during her interview; could you tell us a little about how 6/Page that went. Ms. Susan Bachmeier said they were very complimentary; the interview went great, and could tell by the attitude of the ladies that they were in a good mood. Ms. Willard said we will be able to continue to keep our state funding for the next four years. Departmental Update Ms. Willard gave the departmental update starting with vacancies. We do have two provider positions open; I - think in December when we spoke, we only had one, but now we have two. Our MESH provider did leave at the beginning of January, SO we have moved one of our providers from the clinic to MESH full-time, which I think is working well. I think we have this discussion at the beginning of every year; we always start out behind. We do have good prospects we are hoping to hire. One of them is doing clinical rotations with us currently. Our plan is to capture them in May. We have had a few internal shifts. We had two contract people come on board as county employees; we always try to bring our contract people over to the county. The biggest downside is our director ofr nutrition has left. That means that our Diabetes and Nutrition center is on pause for the meantime. Without an RD, we cannot see those patients; unfortunately, that is a very difficult position to fill. think the last time before we hired Stacy that position was open for eight months. Ms. Susan Bachmeier asked if there was anyone else we could use for that position besides an RD. Ms. Willard said no, not for that position. We still have our WIC nutritionists who are seeing patients and filling that need, but they are going to help us do some weight management. We do still have Silvia, who is working with our Hispanic population doing diabetes prevention. There is al huge need in the county for our diabetes and nutrition program; no one else in the county offers those services. Dr. Laura Hubbard asked, when that position is filled, if that person will have a really full schedule. Ms. Willard said that is a complicated question; it just depends on the day. Fori instance, some days Stacy would see all eight patients, and then the following day she would see one. Dr. Hubbard asked if someone from another county could fill in maybe one or two days a week to fill the vacancy. Ms. Willard said she does know Surry County has three RDs on staff, SO we will reach out to them tomorrow and see if they have any availability. Ms. Willard explained to the board that over the last two weeks we have seen new directives and executive orders come out through the federal administration. While they came out rather fast, there have been updates almost daily. We have tried to work feverishly; I know I sent you all an email about a week ago conceming this. We do know that the federal funding does have a temporary restraining order. We were able to pull down our federal grant dollars for the FQHC. It took us about a week and a half to get our payment in, but that was because everyone was trying to pull down their dollars as well before the five o'clock deadline. Internally, have asked each of our program coordinators to review the state agreement addendum; that is what outlines what we have to do for the money that we receive. The program coordinators will be looking for wording that would include gender-affirming care, diversity, equity, and inclusion language. Those AAs will be the ones that get their funding pulled. We did have a state representative come to our meeting on Friday; the state is interpreting it as having to have diversity, equity, and inclusion as one phrase, not intermittent. We also know there is no budget; it will run out on March 13th. Again, even if the funding is still flowing, WIC may temporarily be paused ifwe don'th have an agreement. If this happens, we will do what we have done in the past and start furloughing employees one day a week. Hopefully this will not happen, but we are preparing for iti if it does. We had a clinic huddle today to talk about the immigration executive order with our staff. am working with Brooke, our assistant county attorney, to figure out a policy to direct us and guide us. The vision is we are going to treat it like the First Amendment. Law enforcement/ICE can come into the public areas; anything outside of that will be off-limits. We have identified Chad and myself to be the points of contact if anyone shows up with a warrant. We will be called once they get here 7/Page to review it; we will call Brooke and then let them do what they need to do. We are also printing the "Know your rights" cards to give to our staff and clients SO that our community that comes to see us can feel safe. will say, WIC numbers have significantly dropped; they are not coming in to get their benefits. We talked a lot last week about using our telephone protocols to be able to issue their benefits for three months ift they do miss their appointment. Arizbeth and Silvia have been doing a really great job reaching out and making sure they feel safe. The clinic is aware, and we have given them some strategies, lots of moving parts, but we are working alongside legal to help us navigate and help us understand. Even with our hiring practices, we are trying to figure out what we need to have in our job postings and those types of things. We are just trying to communicate to staff and make them feel secure if they get asked questions. Dr. Laura Hubbard asked what other programs, other than WIC, did Ms. Willard think would be most affected. Ms. Willard said our health education program; this is people who go out in the community and do fall prevention, substance abuse education, and things like that. say health education because, specifically in their goals, we have diversity and inclusion language in there. We have to do a whole assessment of our county based off of that. As well as some of our measures are targeted toward our historically marginalized populations, which is in direct opposition to what that is looking for. We are trying to work through that and see if that money got pulled, what we could do versus what we can't do. Dr. Laura Hubbard said that is very significant in regards to the Hays population; there are many different sexual orientations, and that population may not be able to be reached. Ms. Willard said that was a great point. - didn't talk about the gender-affirming care because we don't see that population as much here. We are not able to use any federal funds that support transgender care or youth who are exploring those options at this time. 7. Committee Reports Workforce Subgroup Update Ms. Willard said the group did meet briefly; we will meet again to talk about our recruitment and retention strategies. We are going to send out a survey to all staff tomorrow and get some feedback on that. We are also going to be working to come up with a step ladder/lexibility type program for some staff; that we can bring back to you all to approve and then hopefully take to the county commissioners for approval. Hopefully by April we will have some tangible things to bring to the group. 8. Closed Session* Motion to go into closed session under Section 143-318.11 (a)(5) of the North Carolina General Statutes to consider the qualification, competence, performance, character, fitness, conditions of appointment, or conditions of initial employment of an individual public officer or employee or prospective public officer or employee, known as the personnel exception. Motion made by Dr. Sarah Miller-Wyatt to approve moving to closed session; motion was seconded by Mr. Chris Anderson, all were in favor, unanimously approved. 9. Adjournment*: Ms. Adina Watkins made a motion to adjourn; Dr. Tyler Davis seconded, unanimously approved. 8IPage Next Meeting date: The next Board of Health Meeting will be on April 7th, 2025 at 5:30 p.m. in the Ann Absher Conference Room at Wilkes County Health Department. Minutes respectively submitted by: Jenna Daye, Administrative Assistant à7w Dr. Keaton Mash 9Page