LARIMER COUNTY BOARD OF HEALTH – August 20, 2009
The Larimer County Board of Health convened its regular meeting at 7:00 PM at the Larimer County Department of Health and Environment, 1525 Blue Spruce Drive, Fort Collins, CO.
MEMBERS PRESENT: Teri Olson, R.N., M.S.N.
Dr. Mark Richards, M.D., M.P.H.
Judy R. Robinson, B.S.N., M.P.H.
Executive Secretary Adrienne LeBailly, M.D., M.P.H.
OTHERS PRESENT: Marie Macpherson, Bruce Peters, Gerald Blehm, Averil Strand, and Amy Smith
1. Call to order
The Board of Health meeting was called to order at 7:08 P.M.
2. Approval of minutes of the July 9, 2009 Board of Health Meeting.
The minutes of the July 9, 2009 meeting were unanimously approved.
3. Discussion of Proposed Budget 2010 – Marie Macpherson and Dr. LeBailly
Ms. Macpherson, Director of Administrative Services, distributed a draft of the proposed budget to the members of the Board. She explained that this budget is mostly complete; however there are some details that still need to be finalized. These changes including any made tonight from the Board will all need to be completed by next Thursday, as the budget numbers have to be entered into the County’s budget system by Friday, August 28th.
As a result of the county’s resource allocation for 2010, the Department will receive approximately $77,000 less in tax dollars than in 2009. She discussed the overall impact of the budget on reserves in 2009, which will be slightly higher than originally anticipated. But she pointed out that the Department added $300,000 to the fund balance at the close of 2008, which will help cover the anticipated budget constraints in 2009 and into 2010. She explained some anticipated expense savings and increased revenues, including delayed implementation of the on-call compensation plan (not implemented in 2009 but re-budgeted in 2010), leaving positions or parts of positions vacant, taking on some new grants without expanding staffing, and getting new grants that help support the Department with indirect costs. She also explained the recent grant award of approximately $110,000 for H1N1 pandemic response planning, with more funds to follow. The Department most likely will be hiring temp staff and increasing hours worked for some existing staff for the mass immunization effort. Ms. Macpherson explained to the BOH members of the intent to use these grant monies to cover H1N1 expenses before needing to use County resources..
Ms. Macpherson discussed the use of reserves in the revised 2009 and the 2010 budgets. Even with a projected use of over $391,000 of fund balance in 2010, the Department will still have enough reserves to stay comfortably within the 10% of total expense budget fund balance guidelines. She stressed that this year and next are not years in which it would be wise to reduce the Department’s workforce because of the need to have public health workers available to respond to the emerging pandemic. However, should this rate of fund balance use continue into 2011, the Department would need to plan for changes to reduce the reliance on reserves.
She indicated that the Department has always been conservative with revenue estimates and has always worked to have expense savings. Most years when a fund balance use is projected, a much smaller amount is usually used and often additional funds are added to reserves. She expressed her concern about the potential loss of select State-funded grants compared to federally funded grants, which seem to be more stable or even receive increased funding when the economy is poor. Dr. LeBailly noted that State Per Capita for public health services was not cut out of the State’s budget this year, although it did receive a slight reduction from the original funding formula amount.
Ms. Macpherson stated that the department expects to see some increased revenues of about $100,000 with the food license fee increases for 2010. ISDS fees will also increase, but overall revenues in that program will not until the economy recovers. She reported on the WIC Program’s increase in grant funds, which will allow the Department to increase staff and remodel areas of the Loveland office to accommodate this expansion, as well as have a computer self check-in window, as the program funds do not support a receptionist. A remodel of the reception/vital records window area in the Fort Collins office is required due to the new vital record security standards and safety.
With regard to Personnel line items, Ms. Macpherson described the increases in the County’s Retirement Plan and the Commissioners’ decision to not give pay increases to employees in 2010 due to the budget constraints county-wide caused by current economic conditions. In general, the overall personnel costs increased by approx. $25,000 in 2009, mainly due to some increases in the WIC Nutrition Program. It is anticipated that the personnel costs will go down in 2010 with the loss of certain grant funds.
Board Member Steve Yurash acknowledged that the budget information distributed contained a lot of detail and requested a more global picture specifically related to labor costs that might differentiate between grant labor costs and non-grant labor costs. While this information is part of the budget development effort, it was not complete by this meeting time. Ms. Macpherson agreed to email this analysis to the board at a later date, including a roll-up of the FTEs/labor costs associated with grant versus non-grant activities. She did note that the detail of the Department’s accounting system helps the Department make good fiscal decisions.
***Motion was made that revised 2009 and 2010 budget proposals appear reasonable and to move forward as planned.
***Motion was unanimously passed.
4. Update on Pandemic Flu – Dr. LeBailly
Dr. LeBailly updated the members of the Board on the 2009 H1N1 Pandemic flu, and her concerns that the outbreak will escalate quickly now that schools have re-opened. The CDC has issued pandemic flu guidance for K-12 schools and businesses in past week, and for Higher Education today. The Health Department has communicated on workplace issues with the HR department. We had hoped the county might be more flexible with those employees who had little or no sick leave, so that they would not have an incentive to come to work sick. So far that does not seem to be happening. The CDC’s guidelines allow most workers to return to the workplace 24 hours after a fever has resolved (off fever-reducing medicines). However, it’s likely that employees will be shedding virus before they become ill and even after they return to work, and some will be asymptomatic, so you should assume anyone could be shedding flu virus. It’s important to continue to wash hands, cover coughs, keep hands away from nose and mouth, etc.
Dr. LeBailly discussed the unpredictable public demand for the vaccine, and the enormous logistical challenges of organizing a mass vaccination campaign involving tens of thousands of immunizations. She also discussed the reimbursement allowed for administration by vaccinators. [At the time of the meeting, it appeared local health agencies could charge, but since then that decision has be reversed.] The logistics of organizing the response effort, getting local providers enrolled to receive H1N1 vaccine, and getting antivirals out to high-risk persons within 48 hours have also been enormous. She also discussed some school closure issues.
5. Director’s Report – Dr. LeBailly
· Dr. LeBailly provided the BOH an update on West Nile Virus and the level of infected mosquitoes in the county. No spraying as occurred in the Fort Collins area this summer. While WNV case numbers have been fairly low, we’ve seen some severe disease in relatively young people.
· Dr. LeBailly discussed the State Public Health Improvement Plan Critical Input meeting held in Fort Collins on August 4, 2009. She also briefly mentioned the 2009 NACCHO Conference she attended July 29-31.
· The Department’s Budget hearing is to be held September 15, 2009 at 10:30am, at the courthouse. Dr. Richards will attend.
6. Next meeting –The next regular meeting will be October 8.
Meeting was adjourned at 8:47 P.M.
Amy Smith, Recording Secretary Adrienne LeBailly, MD, Executive Secretary