LARIMER COUNTY BOARD OF HEALTH – November 13, 2008
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: Lee Thielen, M.P.A. via telephone
Teri Olson, R.N., M.S.N.
Judy Robinson, B.S.N., M.P.H.
Executive Secretary: Adrienne LeBailly, M.D., M.P.H.
OTHERS PRESENT: Marie Macpherson, Avie Strand, Janna
West-Kowalski, Darlene Huang, and Amy
Bruce Cooper, Bob Herrfeldt, and Commissioner Randy Eubanks
1. Call to order
The meeting was officially called to order at 7:09 pm. Vice-President of the Board Teri Olson presided over the meeting as Board President Lee Thielen was participating by telephone.
2. Approval of minutes of October 16, 2008
The minutes of the October 16, 2008 meeting were unanimously approved.
3. Follow-up on discussion of Tobacco Resolution – Janna West-Kowalski, Darlene Huang, Bob Herrfeldt, and BOH members
Janna West-Kowalski, the Tobacco Health Education Supervisor, and Darlene Huang, Health Educator, in a follow-up of the discussion at the October Board of Health meeting, provided information about the health toll that tobacco takes in our nation, state, and county and presented a revised county resolution to prevent the distribution of “give-away” tobacco products. She reminded them that this issue was raised in 2007, when a request was made, relating to a county-sponsored event, that the county allow cigars to be handed out for free at the event. Although there was not a written policy at the time, the County manager, basing his decision on past practice and public health interests, denied the request and planned to present a formal policy for Board of Commissioner approval. The current informal policy at The Ranch does not allow tobacco give-aways in events they sponsor, however that would not preclude third parties that rent the facilities from doing so. The revised resolution proposes that no free give-aways of tobacco or tobacco promoting products be allowed on Larimer County grounds.
Bob Herrfeldt, Director of the Ranch and Budweiser Event Center, explained the revenue sources of these facilities and informed to the Board that both the Budweiser Event Center and other Ranch facilities are rented by private entities for events. He also confirmed that the Ranch does not allow tobacco give-aways on the grounds for county-sponsored events, but if a private event has been sponsored by a tobacco company, then that could happen. There are some “Sponsorship Restraints,” such as restrictions on how they can advertise in most contract agreements. The county also owns the land where several stores and businesses are located and where the new Embassy Suites hotel is being built, and they may consider it inappropriate to restrict their operations. Commissioner Eubanks agreed it would not be appropriate to restrict such business operations. However, in situations like the store at the Carter Lake Marina, the county may want to put some restrictions in future lease agreements regarding sales or promotion of tobacco products. Mr. Herrfeldt stated that restricting some aspects of tobacco advertising or sponsorship may take some time and cannot be implemented immediately due to prior agreements and commitments. He also felt that language exempting the hotel and other private businesses located on county-owned land from county policy restrictions was necessary. He informed the Board that the Ranch does not currently receive a large amount of revenue from tobacco-sponsored events. Dr. LeBailly, clarified that the word “resolution,” in the sense being used by the Board of Health proposal, is intended to express the Board of Health’s recommendation, and is not a legal resolution such as those passed by the County Commissioners, nor does it encourage the passage of a law, but rather the creation of a county policy. Commissioner Eubanks also stated that the budget implications of any county policy would be examined by the Board of Commissioners, that this was not the Board of Health’s responsibility. Lee Thielen shared with the other members that California had legally banned the giveaway of tobacco products in 1991 and that this resolution was a fairly modest proposal.
*Motion was made by Lee Thielen to approve on the revised resolution (Option II) and to convey it to the Commissioners.
*Motion unanimously approved.
4. Discussion of Community Health Indicators for BOH to track
Dr. LeBailly distributed handouts with potential measurements that can be used as public health indicators. She explained to the Board various possible uses of public health indicators, and that it’s helpful to define the intended use of the indicators before selecting the ones to be tracked. She distributed a table from one of the handouts showing that there are numerous ways to look at the top 10 public health burdens and the lists will be different depending on how they are measured.
LeBailly discussed the availability of various indicator data, such as: birth
and death data, illness data (communicable disease, cancer registry, hospital
discharge data), self-reported survey data, use of preventive services, immunization
registry data, environmental health data, and other contributors to health
status such as social, economic, and education status.
She discussed the option of using surrogate data, such as tobacco sales information rather than a smoking survey. She also mentioned “process data” is often not as valued as outcome data, but sometimes is the only measure that we have (e.g. restaurant inspection findings). She also said that while some data are available annually (such as department program data, vital statistics data, and communicable disease reports), surveys of health status, health behaviors, and use of preventive services may not be available more frequently than every two or three years.
She also mentioned the Larimer County “Compass” project (www.larimer.org/compass) which tracks various indicators, health, economic, environmental, etc. that may be of interest.
It would help if the board would decide they want to do with the indicators they choose and department staff will help find measures that would be appropriate to meet their purpose. The department’s programs (about 34 of them) could each be asked to come up with one process indicator and one outcome indicator (if available) for the board to track from year to year if that would be helpful.
Ms. Robinson expressed her concerns of the number of indicators, if each program offered two, could be too many. She was suggesting more of a dashboard of indicators, maybe 12, that the board could follow, perhaps focusing on “hot topics” or gaps in services. Ms. Olson agreed, and thought that the department’s programs may need to track their own indicators as part the state’s requirements and that the Board did not want to unduly burden the staff.
Ms. Thielen shared some of her thoughts about the use of the indicators, as well as the likely templates that will come out of the state’s public health improvement plan. She also felt that the Larimer County Health Snapshot was very useful.
Ms. Olson suggested they discuss the issue at a later date when all members of the Board are present. Dr. LeBailly agreed that tonight’s presentation was only an introduction to the issue, and that we put this on the agenda in the New Year as the December agenda was already fairly substantial.
5.Report on Federal Audit of our Family Planning Program
Marie Macpherson, Director of Administrative Services, reported on a federal Title X Family Planning site visit on October 22 and 23, 2008, where federal and state auditors reviewed our family planning program. Nettie Underwood, the Assistant Community Services Director, and Paula Lady, the Office Manager of Community Health Services, as well as our administrative staff, dedicated many hours to prepare for the audit and to demonstrate that all the procedures and policies that are followed and all federal requirements are being met The state auditors did report back to us how much the federal auditors were impressed by the staff, the record-keeping, the tracking systems in place, etc. The auditors also stated they could see the good relationships the Department had with the State. They also stated that they had to look really hard to find any compliance problems. They did suggest that the Department should offer more materials to clients to show the services the Health Department and the family planning program have to offer.
Dr. LeBailly mentioned a Regional Pandemic Flu exercise that will take place on November 14, 2008. This exercise is more focused on Greeley and Weld County, but we will participate to test communications and medical surge capacity plans.
She advised the Board that the Public Health Summit in December was filled and closed to further registrations.
She mentioned that there would be a Public Health Day at the state Capitol building on February 4, 2008 at the Capitol from 9 am – 2pm.
Dr. LeBailly reported that the department’s staff contributed 150 hours to help out with the 2008 general election, with staff time valued at over $7,000.
Dr. LeBailly told the Board about the Cost Allocation study that county-hired consultants had done to determine the value of internal services provided to departments that serve the public. According to the draft document presented to Department heads, the amount allocated to the health department was about $1.6 million. However some issues with the allocations were identified, and they will likely be corrected before the final report is issued. It’s not known if anything specific will be done with this information, other than as an brief statement, with allocated dollar amounts, added to the bottom of each department’s budget reports. The County may start charging some special districts for some of the county services.
Dr. LeBailly passed around the Larimer County Workforce report, but so far it’s not available electronically, nor did she have additional copies to give to the board to keep.
Dr. LeBailly reported that visit fees have been added to international travel clinic and sexually transmitted disease clinic, in addition to the charges for shots or lab services.
Dr LeBailly reported that new implemented fees such as visit fees along with shot fees for the immunization program, and visit fees along with care fees for the STD program.
She and Marie Macpherson also shared an immunization program “success story” that we had provided to the state health department.
7.Date of next BOH meeting – December 11, 2008 at 6:30 PM. Because there will be septic variance hearing (assuming it’s not cancelled again), the meeting will be started ½ hour earlier to accommodate the variance hearing. Mr. Trautwein will preside over the hearing if he’s available.
8. The meeting was adjourned at 8:53 P.M.
Amy Smith, Recording Secretary Adrienne LeBailly, MD, Executive Secretary