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. 

                                                                        Teri Olson, R.N., M.S.N.

                                                                        N. Mark Richards, M.D., M.P.H.     

                                                                        Blair Trautwein, J.D.


                                                                        Adrienne LeBailly, M.D., M.PH. – Exec. Secretary


OTHERS PRESENT                        Staff: Marie Macpherson, Bruce Peters, Avie Strand, Gerald Blehm, Ed Schemm, Amy Smith


Public: Laura Ware and Burt Johanson .




1.    Call to order


The meeting was officially called to order at 7:00 pm.


2.    Variance hearing of ISDS regulations for Laura Ware - Blair Trautwein, presiding as hearing officer, and Ed Schemm


Lee Thielen introduced Blair Trautwein as the Board of Health member who would act as presiding hearing officer for the septic variance hearing. Ed Schemm, the assistant Environmental Health Director provided a summary of the variance request to the members of the Board.  Mr. Schemm explained that Ms. Ware’s request to install a vault on her property would require four variances relating to the distance from the drinking water well, the distance from the river, the distance from the property line, and the installation of the vault in a floodplain.  Mr. Schemm explained the State has approved the well permit with conditions of a cased well and the Health Department supports the granting of these variances.  The installation of a sealed vault would be an improvement over existing conditions.  Dr. Richards expressed his concerns about what would occur in the even of a flood.  Mr. Johanson explained that the current privy on the property is not sealed and the new vault would be sealed.  The members of the Board approved the four variances with the conditions the existing privy be removed. 


The variance hearing adjourned at 7:14 pm



The regular meeting was convened at 7:22 pm


3.    Approval of minutes of July 10, 2008 meeting


The minutes of July 10, 2008 were unanimously approved.


4.    Review and discussion of revised 2008 and proposed 2009 budget


Marie Macpherson, Director of Administrative Services, distributed a draft copy of the budget to the members of the Board.  Ms. Macpherson updated the Board on the budget guidelines and the progress of our budget preparations.  She stated that the Revised 2008 budget will use approximately $280,000 less in expenses than originally projected.  The Department estimates the use of approximately $46,000 in reserves in 2008 (much lower than originally projected).  In 2009, the Department will be receiving $24,396 additional county support compared to 2008.


Ms. Macpherson updated the Board on the steps the Department has taken to reduce expenses, increase revenues, and ultimately decrease our reliance on fund balance use.  Reductions in FTE/positions made over the past year were reviewed.  Mr. Trautwein asked if these reductions would have a significant impact on our services.  Ms. Macpherson informed the Board of other efforts that are in progress to obtain grants and to fill gaps to help maintain our services.  In some areas, workload and/or caseloads have decreased somewhat, and some of the vacancies can be handled currently.  This cannot be maintained if workloads increase in 2009.


She also informed the Board of the recent decision by the Department of Health Care Policy and Finance (HCPF) to deny Medicaid reimbursement for post-partum home visits completed by public health nurses, indicating they can only pay for physician or nurse practitioners under existing billing codes.  This will result in a loss of $112,000 and compromise the Department’s ability to provide this service.  Avie Strand, Director of Community Health Services, stated that she will be working with HCPF to find or create different billing codes to use that can be reimbursed for public health nurse-provided services, however this will likely take several months to work out.  


The budget document presented was a draft and work is still in progress.  The budget is due into the County system on Friday, September 8th.  The documents still need to be reviewed and some revenue and expense line items fine-tuned.  This will be done between the BOH meeting and the budget submittal due date. 


Motion was made to approve the budget draft with the understanding that minor fine-tuning of the draft would be allowed.


Motion was unanimously approved.


Dr. LeBailly, Director of the Department, informed the members of the Board of the departments budget hearing scheduled for September 23 at 9:35 AM at the Courthouse.  Several of the Board members expressed an interest in attending.

Ms. Macpherson offered to e-mail the BOH members the final proposal of the budget before submitting it to the County.




5.    Review of Board of Health Evaluation results and comments


With Board of Health consent,  Dr. LeBailly distributed the survey results of their self-evaluation.  The purpose of the survey is to help them do their best as a board and to provide guidance to the Department regarding their needs.


The Board of Health members also discussed options for evaluating the department director, beyond the policy governance report.  The BOH agreed to add discussion of the evaluation to the agenda of the next board meeting. 



6.    Director’s report


Dr. LeBailly reminded the Board about the resolution the Commissioners have to approve, re-designating the department as the public health agency for Larimer County, and re-appointing the Board of Health, in order to comply with Senate Bill 194, approved in the 2008 legislative session.  The Commissioners’ resolution will be passed prior to the next Board meeting, but will not go into effect until the Board of Health implements the resolution.  At the next meeting, the Board will need to readopt the by-laws, re-elect the officers, and re-appoint the Director.  Everyone agreed to hold the meeting on October 16, 2008 to allow the Board president to be present.


Dr. LeBailly updated the BOH about new physical security requirements for our Vital Statistics office.  These will be costly and will require construction of a secure vault.  There is a chance that there may be some federal funding to help with the cost.


Dr. LeBailly reported that the county will be looking at ways they might be able to save money, such as a four-day work week, energy conservation, reduced use of vehicles, and options to facilitate early retirements.


Dr. LeBailly reported that our regional disease control specialist, who is employed by the state health department, will be retiring and will not be replaced.  This will place a significant additional burden on our already-stretched communicable disease control staff.


Dr LeBailly informed the board that there has been a nationwide shortage of rabies vaccine, and it could be used only in post-exposure cases, not for preventive vaccination.


Dr. LeBailly updated the board on an apparent “outbreak” of respiratory illness at an assisted living facility where we had recently provided residents with immune globulin due to a potential hepatitis A exposure.  No connection with the immune globulin was
 established, and the outbreak appeared to be the result of a respiratory virus spreading in a very physically compromised population.


The goal to celebrate the 40th anniversary of the department with outside partners will not take place due to the lack of staff time to plan it.  The employee recognition breakfast will focus on the  department’s anniversary, however.




7.    Date of the next Board of Health meeting – October 16, 2008 at 7:00 PM



8.          The meeting was adjourned at 9:00 PM









­­­       ________________________________           ___________________________________

       Amy Smith, Recording Secretary                       Adrienne LeBailly, MD, Executive Secretary