Board of Health Meeting Minutes
September 3, 2009
The meeting of the Board of Health was called to order by Chair Bill Hance at 4:00 p.m. in room 212 of the Lentz Public Health Center.
Present
Bill Hance, JD, Chair
Ruth Stewart, MD, Vice Chair
Samuel Okpaku, MD, PhD, Secretary
Henry Foster, MD
Keri Fowler, JD, Metro Legal
Stan Romine
Rob Raney
Spencer Hissam
Dr. Foster and Mr. Hance thanked the committee (Rhonda Brooks, Cheryl Edwards, Becky Green, Becca Richey, Phil Trevathan and Jannie Williams) who arranged the reception honoring Janie Parmley’s 15 years of service on the Board of Health.
Consent Agreement A-09-007
Rob Raney, Pollution Control Division (PCD) Director, presented a brief timeline of events leading to Consent Agreement A-09-007 regarding violations of Regulation No. 4, “Regulations for Hazardous Air Pollutants to Countryside Lodge, 2500 Music Valley Drive, Nashville.
In order to resolve this violation, Mr. Raney recommended that the Board ratify Consent Agreement A-09-007. Countryside Lodge was represented by Ms. Francis Garrison.
Dr. Foster made a motion to approve Consent Agreement A-09-007 to Countryside Lodge. Dr. Stewart seconded the motion. The motion passed unanimously.
Title V Fee Schedule for Calendar Year 2009
Mr. Raney stated that Title V of the Clean Air Act requires an operating permit program for major air pollution sources.
Mr. Raney recommended that the Board grant a one year variance from the provisions of Section 10.56.080 of the Metropolitan Code of Laws by establishing an annual emission fee of $28.00 per ton of regulated pollutants, except for carbon monoxide, up to 2,000 per year of any regulated air pollutant for calendar year 2009.
Dr. Stewart made a motion to approve the Title V Fee Schedule for Calendar Year 2009. Dr. Foster seconded the motion. The motion passed unanimously.
Resolution No. 09-02
Mr. Hissam presented Resolution No. 09-02 requesting that the Davidson County Delegation to the Tennessee General Assembly introduce and enact the necessary legislation to require pools owned and operated by multi-family residential housing homeowners’ associations to come into compliance with applicable health regulations.
Dr. Foster made a motion to approve resolution No. 09-02. Dr. Stewart seconded the motion. The motion passed unanimously.
Approval of Grants/Contracts
Stan Romine referred to the Grants/Contracts Summary which was submitted to Board members for their review. The grants and contracts were as follows:
- Grant Award from the State of Tennessee, Department of Health. Compensation, $2,691,100.
- Grant Award from Health Resources and Services Administration. Compensation, $211,298.
- Contract with National Association of County and City Health Officials. Compensation, $27,280.
- Contract and Business Associate Agreement with Meharry Medical College Board of Graduate Studies. Compensation, none.
Dr. Foster made a motion to approve the Grants/Contracts. Dr. Stewart seconded the motion. The motion passed unanimously.
Report of Chair
The Chair did not have a report.
Report of Director
Copies of the Director’s update were provided to Board members. Dr. Paul gave a brief summary of this report (Attachment I).
Approval of August 6, 2009 Minutes
Dr. Foster made a motion to approve the August 6, 2009 minutes as written. Dr. Stewart seconded the motion. The motion passed unanimously.
CIVIL SERVICE BOARD
Personnel Changes and Exit Interviews
Personnel changes and exit interviews were unremarkable.
Next Meeting
The next meeting of the Board of Health will be held at 4:00 p.m. on Thursday, October 1, 2009 in room 212 of the Lentz Public Health Center.
The meeting adjourned at 4:26 p.m.
Respectfully submitted,
William N. Hance, JD
Chair
ATTACHMENT I
Director’s Update to the Board of Health
September 2009
Prevent, detect, and alleviate outbreaks and emergencies
H1N1 Influenza –
Surveillance, preparedness planning and communications are continuing in relation to H1N1 influenza. Several schools have reported cases of flu-like illness and we know the new H1N1 flu is circulating in Davidson County.
Our 44 school nurses are reinforcing the prevention message at their schools--wash your hands, cover your cough, and stay home if you are sick. The Health Department is working closely with Metro Schools to monitor concerns raised in regard to H1N1 flu. A well developed communication plan is being implemented to keep students, parents, and teachers informed about H1N1 flu.
Plans are being made to provide H1N1 flu immunizations to students once the vaccine is available in October. We will also go into the schools and provide seasonal flu immunizations at several key school sites for school staff in early October.
Departmental planning is underway to administer flu vaccines in a timely and efficient manner. Current plans are to begin administering the seasonal flu vaccine in September. This is about a month earlier than in prior years. H1N1 vaccine will be administered later (likely in October and November) when the vaccine is released.
Public Health Emergency Preparedness Team (PHEP) - The CDC has developed a Strategic National Stockpile (SNS) Technical Assistance Review (TAR) assessment tool for both state and local preparedness plans to be measured against. The intent of the TAR is to ensure that regional and county preparedness planners have incorporated guidance offered by Tennessee Department of Health and CDC. TAR's are conducted annually with each project area across the nation. The DSNS (Division of Strategic National Stockpile) Program Services Consultant (PSC) meets with project area staff and determines a score between 0 and 100 using the State and Local TAR Tools.
To satisfy our scope of services, the expectation is that an improvement will be demonstrated from year to year in the form of an improved TAR score. Each jurisdiction is expected to obtain a score of sixty-nine (69) or higher on the TAR submitted November 30, 2009. Each jurisdiction is expected to obtain a score of seventy-nine (79) or higher on the TAR submitted November 30, 2010.
MPHD's scores on the TAR have improved steadily over the past three years with a significant improvement and score of 93 on this year's review.
2007: 47
2008: 56
2009: 93
The following PHEP Team members have been selected to serve on the following NACCHO workgroups:
Jeselyn Rhodes, HIV/STI Prevention Workgroup
Rob Seesholtz, Exercise and Evaluation Workgroup
Stephanie Golden, Advanced Practice Centers Workgroup
Brook McKelvey, NACCHO workgroup
STD/HIV - The jail Early Intervention Services (EIS) and testing programs have expanded into the Hill Detention Center. Both programs are expanding into the male and female Correctional Development Centers as of September 1. Once those sites are up and running, HIV and syphilis testing, as well as HIV EIS will be available to all inmates in the Davidson County jail system.
TB - Staff successfully completed a trial test of the Ojo video phone. The next phase is to pilot test the phone for use in providing directly observed therapy to patients receiving TB treatment.
Due to recent state cuts, TB Elimination has lost its health educator position. Kim Brown was transferred to a comparable vacancy in the Occupational Health and Wellness Program.
Improve health and wellbeing of children
Start of School – Metro Schools opened the 2009-2010 school year on August 14th. There is a new school assignment and school choice plan in place this year which is a challenge for the transportation department but so far everything seems to be working well. The school health program is gearing up to deal with concerns about H1N1 flu. (see above)
Our biggest program challenge currently is that we are receiving more requests (than last year) to place a nurse at one school all day to help ensure the safety of children with particular medical problems such as seizures.
Reduce tobacco use and increase physical activity and healthy eating in Nashville
WIC - The much-anticipated new WIC Food Package will begin October 1 in Tennessee. The new food package requires stores to provide fresh fruits and vegetables. Many WIC stores located in low-income neighborhoods have not done so previously. In addition to giving WIC families a healthier choice of foods, the revised food package better supports successful long-term breastfeeding, and provides WIC agencies with greater flexibility in prescribing food packages to accommodate cultural food preferences.
Key Changes to the Food Package
- Adding whole grain products and cereals: whole wheat bread, corn tortillas, brown rice, cracked wheat and whole grain cereal.
- Issuing participants cash value vouchers to purchase fresh fruits and vegetables: $6 for children, $8 for women and $10 for exclusively breastfeeding women.
- Infant Juices: juices are eliminated and replaced with baby food fruits and vegetables.
- Dairy Products: less milk and cheese offered; reduced fat milk issued for all participants over 2 years old; soy milk available for women.
- Provides incentives for breastfeeding: less formula for partially breastfed infants; discourages use of formula in the first month for breastfed infants; and increases the market value of the food packages for fully breastfeeding mother and infant.
Key Nutrition Education Messages:
- Babies are meant to be breastfed.
- Eat more fruits and vegetables.
- Increase whole grains and fiber.
- Drink less juice and sweetened beverages.
- Lower saturated fat intake.
Health Promotion - The 11th annual Walk Nashville Week will take place October 3-9, 2009. As the signature event for the Community Health and Wellness Team, Walk Nashville Week is an annual event that embraces the Nashville community and promotes active living for all. The event includes Walk to School Day, Walk to Worship, Walk for Active Aging, Walk Your Neighborhood, and Nashville on the Move Day. Participation in the week's activities is free of charge. To learn more - visit www.nashvillechwt.org
Improve access for everyone to needed preventive, medical, and mental health services
Occupational Health and Wellness Center (OHWC) - The work load in the OHWC increased due to recent requests for pre-hire physicals for Metro Action Commission, Sheriff's Department, Police Department, and Emergency Medical Service (EMS) providers.
The federally funded adult immunization program has been successful with the majority of eligible fire, police, EMS, and health care providers receiving
the TDAP vaccine. Pertussis or whooping cough has increased dramatically and the OHWC is encouraging the TDAP for all eligible first responders.
Preventive Health Services - The Department expects to receive 2,900 of a total 5,000 doses of fluzone vaccine in early September. We have no delivery date for the balance but expect to receive it by mid to late September. We have also ordered 7,000 doses of vaccine for Metro employees. Plans now are to hold a one-week fast lane clinic in the Lentz Auditorium in September. The exact date will be set after receipt of the first shipment of vaccine. Promotion of the fast lane clinic will then follow.
Ryan White - HRSA sponsored training in Nashville August 18 – 19 for all five new Ryan White Transitional Grant Areas-TGAs (Charlotte, Memphis, Baton Rouge, Indianapolis, Nashville) and Phoenix and Minneapolis. The training focused on the role that peers (persons who are HIV+) can play in bringing HIV+ persons into HIV medical care. Nationally, large numbers of HIV+ persons never engage in HIV medical care or drop out of care. In Nashville, 30 - 40% of persons who are HIV+ are not in care (similar to the national percentage). HRSA is reviewing peer models used with other health conditions (diabetes, cancer) and the positive health outcomes that are achieved through peer intervention. HRSA is also investigating the application of the concept of "community health workers" to HIV treatment.
Behavioral Health – September marks the 20th anniversary of National Alcohol and Drug Addiction Recovery Month. Behavioral Health Services is celebrating with an art exhibit. Board members are invited to stop by the art exhibit outside room 211 immediately following the Board meeting today to help celebrate Recovery Month. Angie Thompson and staff will be present to discuss the art project and answer questions.
Ensure cleaner air and a safer environment
Systech has completed all specified items contained in the contract with Metro. Systech paid Metro liquidated damages in the amount of $63,500 due to Systech’s delay in completing promised contract deliverables. The payment was received June 29, 2009, and deposited in Metro’s General Fund.
Systech has five fully operational mobile testing vans in service plus a stationary site at Carmax on Thompson Lane.
On June 13, 2009, Systech worked with the County Clerk’s office and Councilman Charlie Tygard to perform vehicle testing using two mobile vans in Bellevue as part of the Bellevue Clean-Up Day.
During the months of June, July and August, Systech used one of their mobile vans to partner with the Vehicle Inspection Program to test 163 fleet vehicles. During September, we will work together to test fleets from NES and the Federal GSA for a total of approximately 400 additional vehicles.
During FY09, Systech performed 528,153 paid tests. Total revenue was approximately $4.75M. Of that total, Metro was allocated approximately $1.85M. The Clerk’s office was allocated approximately $0.8M. MPHD was allocated approximately $1.05M. FY09 paid tests were approximately 2% less than FY08 paid tests.
Vehicle related clean air messages were provided to Systech by the Vehicle Inspection Program. Systech is in the process of having signs with these messages prepared. These educational signs will be placed in the wait queue for customers to read as they enter the test station.
A Clean Air Radio message has been prepared that will be broadcast on a low power FM frequency at each testing station. The message provides useful information to the customer related to the testing process. A sign will be placed along with the others indicating the FM frequency that the customer can tune their radio to in order to hear the message.
Overall, Systech’s performance has improved in FY09 over FY08.
Management and accountability
Break in at Animal Control - We are continuing to work with Detective Lori Gross of Metro Police Department on this case and have provided all requested information. Enhancement of the video did not produce a clear image mostly due to the hat worn by the robber and low after hours light in the area. We have not received a report on the court ordered phone records to see if they can be useful. We have been told this robbery is not a high priority due to the small amount of money taken, no one else was threatened by this action and fingerprints were not useful and possible subject information is circumstantial. It is worth noting, however, that a number of important changes were immediately made following this incident and include changing the locks, limiting the issuance of new keys, changing access codes, training all affected staff on setting the security system when the building is vacated, receiving a weekly opening/closing security report, purchasing and installing a floor mounted safe up front, changing out the area lights in the lobby area to a more reliable source that are on 24/7, changing the camera monitoring this area to an improved resolution model and improving the deposit handling procedure.
New Health Department Building - The first step in the new building project will be the introduction of a Metro Council resolution authorizing the project to move ahead. We expect the resolution to be filed soon and will require approval on three readings by the Council. The construction company has projected a 13 - 14 month construction period. We are hopeful that the building can be started in early 2010.
Upcoming Audit – State of Tennessee Department of Health auditors will conduct audits of several state grants provided to MNPHD. Program audits of Dental, Breast Cancer Screening and TenderCare will take place September 8 – 17.
State Budget Cuts - In July we were relieved to receive notice from the Tennessee Department of Health that for FY-10 the funding of our State grants would not be reduced. However, as State revenues quickly began to decline below projected levels, the decision to reduce State funding in our grants was communicated to us in a conference call with the other health departments in metropolitan areas of the State. Our portion of the overall reduction is $372,000. We developed a plan to make the reductions in ways that would minimize the operational impact on our programs and our mission. Five (5) grant funded positions were eliminated and other "below the line" funding was reduced to achieve the required level of cuts. Two of the five eliminated positions were vacant; three staff were moved from grant to local positions.
Key Result Measure Report – The end of fiscal year key result measure report is included in your package. Twenty seven of the 33 programs (82%) met their target. The Homeless Program has been transferred to United Neighborhood Health Services. Four programs (Tobacco Control, Home Visiting, Emergency Preparedness and General Sanitation) did not reach their target and discussions are underway to improve program results. The State has not released results of the 24 month old survey which measures the Immunization Program.