Board of Health

City of Columbia, Missouri Meeting Minutes Board of Health Thursday, February 11, 2016 Public Health and 5:30 PM Human Service 1005 West Worley Columbia, MO 65203 I. CALL TO ORDER With a quorum present, the meeting was called to order at 5:30 pm by Dr Szewcyk. II. APPROVAL OF AGENDA There were no changes made to the agenda. III. APPROVAL OF MINUTES There were no additions or corrections to the minutes. They were approved as presented. City of Columbia, Missouri Page 1 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 IV. DIRECTOR'S REPORT Ms. Browning gave an update regarding the Public Health Accreditation Board (PHAB) site visit, which went very well. The site visit included a session with stakeholders and partners. Dr. Szewczyk attended the session as Board of Health Chair. Dr. Szewczyk felt the group was very positive about the Department. The Department submitted documentation on 12 domains with the site reviewers meeting with staff to validate the information. Janet Thompson and Tony St. Romaine attended a session where the site visitors met with the City and County as the governing entities. Ms. Thompson felt that this session went well. The site visitors asked Tony and Janet what happens if there is a difference in opinion between City and County. They responded that, in general, health issues transcend jurisdictional borders and that they both were very pleased with the performance or the department. Ms. Browning reported that at the end of the site visit, the site visit team offered three strengths and three opportunities for potential improvement they see in the Department. The three opportunities for improvement were: 1) Solidify the Department’s identity by consistently calling if by a specific name; 2) Document how the Department informs governing entities of their roles and responsibilities; 3) Have the Board of Health provide a stronger role in advising the County. Our three strengths were the Department’s: 1) Community health assessment process; 2) Community improvement plan and the way we engage our citizens and work with partners to develop it; 3) Relationship with our governing entities. The Department hopes to have a decision from PHAB by the June Board of Health meeting. Dr. Szewczyk asked about Zika virus in Columbia. There are no cases at this time. City of Columbia, Missouri Page 2 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 V. OLD BUSINESS Ms. Browning provided an update on work completed regarding the three neighborhoods which are the City’s Strategic Plan focus areas. Ms. Browning reported that there was a kick off meeting this morning to welcome three recently hired, supporting team members. They are: 1) Carl Kenney who is an Adjunct Professor at the University of Missouri and writes a weekly column for The Missourian. He is the first African American to graduate from the UMC School of Journalism and is going to help with community engagement work; 2) Glenn Cobbins who is a longtime resident of Boone County; 3) Judy Hubbard- going door to door seeing what is needed in the community 4) Jim Whitt, current president of the Columbia School Board, who is going to be working with disadvantaged business enterprises and examining City policies that make it difficult for small businesses to do business with the City. Ms. Browning also reported that she attended a productive meeting last month with the Home School Communicators. This group was willing to share the struggles of families they visit. The group also wants to be a partner with the City in these efforts. The home school communicators felt that they could each get at least 10 families that would be willing to come and talk with the City. Ms. Browning also reported that each focus area now has two police officers assigned to it. Ms Browning reported that Laina Fullum gave her information on a pilot program about free or reduced lunches at the schools. It was also discussed that a recent newspaper article stated that the school district is going to be subsidizing the Nutrition Services Program, which will not be self-sustaining. Ms. Browning asked for more time to get more information from Laina about the program. She hopes to have information to report back to the Board in June. City of Columbia, Missouri Page 3 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 VI. NEW BUSINESS Review of Current Legislation Scott handed out a list of state legislation that could impact public health. Motorcycle Helmet bills - several bills, some without any action and other which were heard. Similar bills have passed in past sessions, but the Governor has vetoed them. Texting/using electronic devices while driving - those bills had hearings this week and no actions have been taken . There were lots of questions about these bills in the hearings (e.g. if an officer stops a vehicle, does the officer have the right to ask to see the device to see if it was just being used?) . HB1465 - Is one of four House bills and one Senate bill dealing with advanced practice nurses and the nurse practioner/physician partnership. Some of these bills make the partnership more regulated and some make is less regulated. This particular bill, HB1465, has been voted “Do Pass” and will go back to the House floor . Current law states that an advance practicing nurse must have a collaborating physician review a minimum of 10% of their charts every 14 days. This bill states that collaborating physician does not need to be present at the health care practitioner’s site. Also waives the one month requirement of practicing with the collaborating physician when the collaborating physician is new to a patient population that the advanced practicing nurse is already familiar with. HB1541 - Introduced by Representative Webber, this bill requires employers to allow veterans , who are receiving medical care at a veteran’s facility, to be given leave without pay from their employer. This bill has not yet been assigned to a committee. This bill states that if the veteran’s employer doesn’t offer paid sick leave, the veteran is given the right to take off for medical care, without pay. This bill doesn’t address how this may impact FMLA requirements. HB1542 and HB 1544 are both about texting and driving again. They have been referred to a committee for hearings. HB1553 - The Board discussed this bill at the last meeting and gives the responsibility of inspecting hotels and motels to the local health department. At a recent hearing, there was opposition to the bill by health department officials from Clay County who felt that if the committee moves forward with this bill, there should be language added that gives public health officials the authority to close a lodging facility for safety or sanitation reasons. This piqued the interest of committee members. City of Columbia, Missouri Page 4 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 HB1554 - Transfers the authority to inspect nursing homes from DHSS to local public health agencies. For Boone County alone, this could cost a half million dollars. As of earlier this week, the bill has been withdrawn. The sponsor then introduced another bill that calls for a pilot project looking at transferring this authority. Language for that bill hasn’t been published as of yet. HB1657 - Another bill about motorcycle helmets that had a hearing on February 8. HB1679 - Changes laws regarding contraceptives. It says pharmacists can prescribe and dispense either patches or pills. The bill had a hearing and has been referred to another committee at this point. HB1689 - Prohibits smoking in motor vehicle if a person under 18 is present in the motor vehicle. This hasn’t been assigned to a committee yet. HB1697 - Currently, a collaborating physician can enter into a collaborative practice agreement with three full time equivalent advanced practice registered nurses. This bill increases this number to five. The bill has had a hearing, but not voted out of committee yet. HB 1707 - Authorizes an Animal Abuse registry . This bill hasn’t been assigned to a committee. HB1823 - This bill doesn’t affect Boone County, but it takes authority for passing health regulations out of the hands of elected Boards of Health and puts it in County Commissioners’ hands. This is mainly about large corporate farming organizations in Northern Counties. Several years ago, health ordinances where passed due to community complaints about CAFO’s. Farmers and supporters then got themselves elected to health boards, fired public health administrators and rescinded the ordinances. Now we have a legislative agricultural committee that is made up of many farmers northern Missouri. The Cooper County Public Health Administrator, who has an elected Board of Health, did testify. The committee was hostile to the witness and some members did apologize to her. The Callaway County Presiding Commissioner testified against the bill also. This bill was passed out of committee. HB1830 - Specifies that any person who disseminates false information relating to a perishable food product implying that the product is not safe for consumption will be liable to the food product producer. The bill has been referred to the select committee, which means it had an initial City of Columbia, Missouri Page 5 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 committee hearing and was approved in the initial committee. HB 1815 - Establishes the Abortion Ban for Sex Selection and Genetic Abnormalities Act of 2016. The bill has been referred to committee, but hasn’t been scheduled for a hearing . HB1855 - This bill requires health care facilities to report carbapenem resistant enterobacteriaceae (CRE) to the State Health Department. Representative Allen has introduced this in the House and Senator Schaaf, who is a physician from St. Joseph , has introduced a similar bill in the Senate. HB1866 - Grants full prescriptive authority to APRN’s to prescribe, administer and dispense controlled substances. Removes current limitations on prescriptive authority of APRNs, removes requirement that collaborative practice arrangements be in writing, permits collaborative arrangements with registered nurses who are NOT advanced practice nurses and removes requirements pertaining to collaborative practice arrangements with an APRN. It redefines an APRN and list four roles, including a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner, and certified registered nurse anesthetist. Requires an APRN’s prescriptive authority to include the authority to prescribe, dispense and administer non-scheduled legend drugs and medications within their practice and specialty. HB1892 - The Narcotics Control Act establishes a prescription drug registry and was sponsored by a Representative who had a teenage daughter die from a drug overdose. Voted “Do Pass” out of committee 9-3. Missouri is the only state that doesn’t have a statewide prescription drug monitoring program. HCR 75 - A resolution urging the United States Army to explain chemical testing that occurred in St. Louis in the 1950s and 1960s and requests the federal government to conduct a study on the health effects of such tests. Resolutions do not carry the same authority as a law. HB 2540 - Establishes a pilot program to transfer the authority for nursing home inspections from DHSS to local public health agencies. This bill is not listed on the handout . SB644 - This bill deals with abortion and received a lot of attention at first of session. It was filed as result of hearings of the Sanctity of Life committee. It has passed out of committee and is on the Senate calendar to be voted on. City of Columbia, Missouri Page 6 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 SB677 - Epi pen bill allows non-medical facilities, such as restaurants to have epinephrine available. The bill lays out requirements for these facilities to use epi pens if they want to keep some in stock. Stepping Up Initiative Janet Thompson talked about the Stepping Up initiative started last year by the National Association of Counties. The initiative is co-sponsored by the American Psychiatric Association and Department of Justice. The goal of the Stepping Up initiative is to evaluate and find a solution to the problems associated with mental health issues among inmates in county jails. Boone County is no different than any other county in this respect. About one-third of the population in our jail is presenting with mental health issues. That in and of itself is problematic, but it also creates a whole host of issues because those folks recidivate at a much higher rate, stay in our jails longer, and have much worse outcomes. This not only affects these people, but it has a huge budgetary impact on counties and businesses. The Stepping Up initiative is designed to address that problem. Boone County is one of two counties in Missouri to join the program. The other is Pettis County. Boone County is using a group called the Judicial and Law Enforcement Task Force to work on this initiative. Rusty Antel, who is a member of the Criminal Defense Bar in Boone County, is chair of the group. The Task Force is meeting with stakeholder groups throughout Boone County to discuss resources and how to utilize them, barriers to using resources, and how to use them in a better way. The Task Force has discovered that while we have a social worker in the jail, the position is divided among four people, which doesn’t give much, if any continuity of care. Social workers are there for clinical health, but they don’t do any kind of case management. When individuals are leaving jails, there is nothing we, as a community, can offer them to get them to the next place for a soft hand off. Often, that means they come back to the jail. The group has identified the need for clinical social workers at the jail, connected with the UMC School of Social Work. We need to get a full-time licensed social worker in the jail to do case management, and will also have that person supervise graduate students from the UMC School of Social Work. The Task Force has created links between the jail and some re-entry programs which didn’t exist before, and between the entry programs and the behavioral health care community. The group has also linked up with the Missouri Department of Mental Health (DMH), which has a program called SOAR. They help people apply for federal benefits if they are eligible for them. There are about 60 folks that are in jail currently who are self-identifying with mental illness. Johnson County, Iowa is doing this kind of program and has reduced the City of Columbia, Missouri Page 7 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 population by 100 people per day since starting this program. The Task Force has been talking about how they can utilize community resources better and try to help people before they end up in the judicial system. They talked to Dr. Sally Beth Lyon and other folks from our education community about the people who come into contact with people at risk before they enter the judicial system. The schools are part of that, including our teachers and counselors. With the help of Stephanie Browning, Tony St. Romaine and John Glascock, the group thinks they have identified some of the other canaries in our community and are hoping to start a pilot program in one of the neighborhoods that have been identified so they can see what kind of difference they can make. The Task Force has talked to the folks at DMH and they are willing to provide the mental health first aid training to the canaries. The group believes Johnson County has the best model. They don’t have a housing model, but they do have an access center. After discussion, the Board agreed to add a Commissioner’s Report to the agenda of the monthly Board of Health meeting. The Board also agreed to have Scott provide a Legislative Report at each Board meeting while the legislature is in session. Scott can send copies of bills to Board members, should any of them want to contact their legislator. The Board members discussed their role in regards to advocating for legislation at the state level. After some discussion, the Board decided that as legislation starts to be filed in December, they will review the various pieces of legislation and determine if there are three or four particular issues they may be interested in. At that point, they will prepare a short report to both the City Council and the County Commission describing the bills, that the Board will be monitoring the bills and is requesting permission to advocate or oppose the bills. Membership in citizen groups and other City committees was discussed. Any Board of Health member can join these committees, but they do say as an individual, not representing the Board of Health. Lynelle mentioned that the UMC School of Nursing is very engaged in legislation impacting Nurse Practitioners. It was suggested that perhaps someone from the School of Nursing can brief the Board on the pros and cons of those bills. Missouri has one of the most restrictive nurse practice acts in the country. Some of the bills are to get us in line with the rest of the country and what nurse practitioners are doing. City of Columbia, Missouri Page 8 Printed on 5/12/2016 Board of Health Meeting Minutes February 11, 2016 XII. ADJOURNMENT There being no further business, a motion was made, seconded, and carried, to adjourn the meeting at 7:35 p.m. Members of the public may attend any open meeting. For requests for accommodations related to disability, please call 573-874-7214. In order to assist staff in making the appropriate arrangements for your accommodation, please make your request as far in advance of the posted meeting date as possible. City of Columbia, Missouri Page 9 Printed on 5/12/2016