The Larimer County Board of Health (BOH) convened its regular meeting at 7:00 PM at the Larimer County Department of Health and Environment (LCDHE), 1525 Blue Spruce Drive, Fort Collins, CO.


           MEMBERS PRESENT:                                   N. Mark Richards, M.D., M.P.H.

                                                                                    Lee Thielen, M.P.A.

                                                                                    C.J. McKinney, M.A.

                                                                                    Steve Yurash

                                                                                    Debbie Healy, R.N., B.H.S.                                                                                                   


      Executive Secretary:                                       Adrienne LeBailly, M.D., M.P.H.

      Commissioner Liaison:                                     Steve Johnson

Staff:                                                                Avie Strand, Marie Macpherson,

                                                                        Bruce Peters, Jerry Blehm and Paula Lady



1.   Call to order The Board of Health meeting was called to order at 7:00 PM.

The Board acknowledged the unexpected death of Health Department employee Ann Chaisson.  Dr. LeBailly reported that employees held a recent session with a counselor from the County’s Employee Assistance Program.


2.   Approval of July 14, 2011 meeting minutes -  amendment to the minutes regarding information about the Nurturing Program ; Ms. Strand clarified for the BOH that the Nurturing Program does serve individuals beyond the age of 18.  This is a recent change in requirements of the Nurturing Program. Minutes were then approved with this amendment.  


3.   Northern Colorado AIDS Project – response to BOH questions –Jeff Basinger, NCAP

Dr. LeBailly shared copies of NCAP documents for those who had not printed the ones sent by email.  Mr. Basinger began his presentation by saying that the syringe exchange program is seen as important for protecting public health by reducing Hepatitis C and HIV disease in Larimer County.  NCAP wants to demonstrate that they have a good history of working with the injection drug-using population.  The work of securing funding for the syringe exchange program would be the responsibility of NCAP, not Larimer County.  Mr. Basinger believes that NCAP should be the host of this program as they have demonstrated that they have the experience to support and counsel this population.   The numbers of clients served by NCAP listed in the handout are not unduplicated but NCAP will be working to obtain the unduplicated number.  NCAP has currently set up their program as a social network. They offer food, personal hygiene items and socks, hats and gloves when needed through their pantry, as well as bleach kits that can also be used for wound care.  Sharps containers are provided and can be returned to NCAP filled with used syringes and needles; in exchange, clients are given a $10 gift card to Safeway. Currently NCAP is serving 190 drug users.  Mr. Basinger pointed to research that shows that offering a syringe

exchange program does not increase crime or drug use, and leads to a measurable increase in access to treatment and recovery drug abuse programs.   NCAP has developed a very solid referral network with mental health and substance abuse counselors and providers.  NCAP currently has staff that are trained to provide this syringe exchange program as they have been funded through the Colorado Department of Health and Environment to provide services to injection drug users for the past five years. NCAP is currently the only non-medical bio-waste hazard disposal site in Larimer County.  For one week each year, NCAP participates in the national “Drop to Stop” program; last year they collected 16,000 used syringes.  This is the second highest number in the state and gets a lot of needles off streets and out of homes and disposed of properly.   


Dr. Richards asked Mr. Basinger what specifically the BOH needs to do.  Mr. Basinger said he was asking the Board to support consider NCAP’s request to provide a local syringe exchange program, which requires BOH approval and annual review.  Dr. LeBailly provided information on the authorizing legislation to the BOH regarding syringe exchange programs and what the law requires.  Interested stakeholders must be consulted, including but not limited to law enforcement, substance abuse treatment providers, nonprofit organizations, etc. The legislation also defines what a program will include at minimum.  Mr. Basinger stated that the BOH could count on NCAP to do the bulk of the work on contacting stakeholders to arrange meetings and conversations to support a transparent and well-informed process.  It is thought that Board approval and authorization for a syringe exchange program would involve a memorandum of understanding rather than a contract, and would not involve any county funds.  The cost of an authorized legal syringe exchange program is approximately $40-50,000 per year, or $11,000-$21,000 above the cost of the program NCAP is currently providingto injection drug users. This is funding that NCAP will secure, not Larimer County, and a program could be piloted as early as December 2012.  Ms. Thielen asked how the Board would proceed to meet the intent of the law.  Dr. LeBailly replied that perhaps the board could offer public meetings or “open houses”  where we invite entities to come discuss how each group would be affected by this. Mr. Basinger replied that NCAP could develop two or three different strategies on how communications could happen so that stakeholders have ample opportunities to have concerns addressed.


Dr. LeBailly inquired whether the BOH still desires Boulder County Works to present to this Board.  There was agreement that the BOH would like to hear from them at a future BOH meeting at the Larimer County Health and Environment site, most likely in October, as there is no September meeting.


Mr. Basinger stated that another component of the syringe exchange program is HIV and Hepatitis C testing and getting drug users over the fear of knowing their infection status.  Behaviors can shift once one’s infection status is known, and approximately 65% of negative behaviors are eliminated.


Mr. Basinger thanked the BOH for their time and will remain in contact with Dr. LeBailly regarding next steps.


4.     Review of Board of Health Member Communications - President Richards presented and distributed guidelines regarding communication among BOH members.  Because there are several new members to the board President Richards reviewed what is appropriate in the BOH’s communications. He provided the BOH with a handout of these guidelines.   BOH meetings are considered public meetings.  Policy issues should be discussed within the meeting, as no individual can speak for the board as a whole, and any discussion among 3 or more Board of Health members constitutes a public meeting, which requires public notification.




5.   Update on Status of 2011-Revised and 2012-Proposed Budget – Ms. Macpherson discussed information regarding the proposed budget.  Ms. Macpherson reminded the BOH that we would be meeting again on August 24th to review and vote on the proposed budget for 2012.  There have also been some revisions of the 2011 budget The 2012 budget is due September 2nd.  


  Ms. Macpherson reminded the Board how the commissioner’s rankings of our department impact our budget.  Our relatively high ranking has resulted in approximately a two percent reduction in funding.   The commissioners were also able to give some general fund support  to departments to help cover employee  salary increases to help mitigate their cost.  Overall, with reductions and additions,  we will see a reduction of approximately $33,000 of county tax dollars allocated to our budget.  Ms. Macpherson wanted the BOH to be aware that what she is sharing at this meeting is a draft, and by Wednesday, August  24th she will have a more complete budget.  The final budget could still increase or decrease by $50,000 out of approximately a $9 million overall budget.  Ms. Macpherson also spoke to the BOH about the reserves and wanted to remind them that we are fiscally conservative and that we generally will not use as much of the reserve money as had previously been estimated.  Much of the savings has come from delays in filling vacant positions. Currently there are five vacancies, most of which are grant-funded or fee-funded.  These positions are currently included in the  2012 budget, and will have a lower cost than in 2011, if re-hired, because they replace five long-term employees with considerable longevity and higher salaries.  With this budget we have made several reductions in grant programs, including WIC, Family Planning, Emergency Preparedness, and ARRA funded projects.  As we find out about additional reductions in funding we will do amendments to the budget. 


There are two items that are not currently reflected in the preliminary budget  which will be brought forward in the budget that you will see on August 24th.  These are special projects which Ms. Macpherson hopes the County will allow a one-time request for “investment proposal” funding of the projects.  The County is moving toward a new payroll system, ADP, which will involve staff entering their own time records for payroll on the computer. We currently use two separate systems in the Health Department, one that collects time information for payroll and one that collects “effort” data—the actual activities done during their work time.  We collect a lot of detail that allows us to do good cost analysis for personnel and program management, for grant requirements, and for setting fees for services.  The County’s new payroll system will not collect the detailed effort data that we need and will not work with the Project Accounting modules that we currently use.  We will need to gain efficiencies by creating a single new web-based interface to collect both time and effort data from staff—to transmit time worked to the ADP system for payroll purposes, and to collect activity/effort data for managing department programs.  We will also have to give up our Project Accounting System and use only the county’s General Ledger system, which provides less detail and is difficult for grants and contracts which don’t run on the calendar fiscal year, but will allow us to use some new budgeting and accounting tools that could increase our efficiency.  The accounting system will have to be converted and be ready to go live by January 1, 2012, and the payroll system must be ready to test in February 2012, so we have very limited time to make these changes. We are estimating the project to cost between $75-150,000 to get us where we need to be.  The goal is to move toward efficiency with payroll reporting and activity reporting.  The estimated cost of these projects is not in the current draft budget.  


6.   Update on Internal Feedback Survey of Department Staff –  Dr. LeBailly reported on the feedback survey employees have been asked to complete.  This survey just closed on Wednesday, August 10th.  The completion of the survey has proven to be time-consuming.  We have seen that the Health Department is especially strong in building collaborative relationships and partnerships with other entities throughout our communities.  We will be doing more analysis of the survey results before we are able to share this information.   We hope to have some more information at the August 24th meeting.


7.   Director's Report –  There won’t be a September Board of Health meeting other than the Budget Hearing that Dr. Richards will attend, if possible.  The State Board of Health will be considering regulations regarding the core public health services expected of all local health departments at a meeting in October.  Dr. LeBailly handed out the draft regulation  on the core services.  The State BOH will also be working on the funding formula of how they will be dividing up money for general public health services among the previous 14 organized public health and county nursing services to 54 local health departments. 

8.   Next meeting, August 24,  2011, 7:00 pm.  A second BOH meeting in August will be needed for budget review and approval. 

9.    Adjourn - meeting was adjourned at 9:15 pm. 




_______________________________           _______________________________________________

Paula Lady, Recording Secretary                    Adrienne LeBailly, MD, Executive Secretary