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:                    C.J. McKinney, Ph.D.

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

Steve Yurash

Jennifer Lee, Ph.D.

                                                Jana West Kowalski, M.S.


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

Staff:                                         Marie Macpherson, Averil Strand, Jerry Blehm,

Bruce Peters, Paula Lady


1.   Call to order – CJ McKinney, Board president - The Board of Health meeting was called to order at 7:00 PM.

2.   Approval of minutes of July 18, 2013 meeting – Minutes of the July 18, 2013 meeting were unanimously approved.

3.   Budget Review – Ms. Macpherson handed out a draft budget document with the revised 2013 and 2014 budget information, including the overall total of expenses, revenues, and fund balance use.

She briefly reviewed how grants are tracked in the county’s accounting system and the difficulties of summarizing this information for reporting and budgeting purposes. There are many line items in our budget, and now the number of line items has doubled for most grants. All of the grants and services shown in our budget are reported on a calendar year basis.

The revised expense budget for 2013 is about 1.7% more than the current 2013 budget primarily due to grant revenues and expenses not known when the original budget was prepared. Ms. Macpherson reviewed changes in several grant programs (both increases and decreases), noted some anticipated FTE changes and some fee revenue increases, and provided information on fund balance usage. Some of these changes include:


·  The Family Planning program received a one-time grant supplement of over $100,000 to remodel the family planning clinic to better accommodate our use of electronic health records, as well as to purchase some long-acting contraceptives.

·  The Immunization Program received a $10,000 grant to purchase vaccine refrigerators, wiring and temperature monitors. New grant dollars were allocated to help support the enhancement of our ETHOS system with an immunization module.

·  The TB Program was supplemented with $10,020 to pay for additional staff time to meet the increased needs.

·  We received a $6,500 West Nile Virus grant that we were not expecting.


There are also some grant reductions that unfortunately negatively impacted our staffing levels in WIC, Family Planning, Immunization, and Nurse Home Visitor Programs. The department has also left some non-grant funded positions vacant (a position in the clerical area and part of an immunization position) due to budget constraints.

In the revised 2013 budget, the projected use of reserves decreased to approximately $210,000. This is less than the original projection of approximately $588,000. We are seeing an increase in fee revenues, particularly in the area of childhood immunizations. The maximum administration fee allowed for federally-purchased vaccine was raised this year. In February the department increased the fees we charge for the administration of vaccines from $14.50 to $20.00. This change, coupled with a decrease in personnel costs from not filling certain vacancies and having existing staff take on additional grant work without increasing FTE, have contributed to our decreased use of fund balance.


Ms. Macpherson indicated that are two grants that are in process and not in the budget. We will be applying to the Kaiser Foundation to help to fund the transition from planning to implementa­tion of the Public Health Improvement Plan, as well as create a local health data website. We also are expecting a small amount of funding ($6,500) for the collaboration with the Health District on work related to the Connect For Health Colorado project they have been funded to implement.


The 2014 budget has been prepared with an increase in County support of 2% per the budget guidelines. This is an additional county contribution of $51,902. Our proposed draft expense budget for 2014 is very nearly the same level as our current budget. The 2014 budget includes a 1% market adjustment for staff positions and 2% merit increase. Ms. Macpherson reported on some of the expenses and savings that will be seen in the 2014 budget. It is projected that we use approximately $481,000 of reserve funds in 2014. We are required to maintain 10% of our budget in working capital, which we are still able to do with this 2014 budget, as well as maintain the funds set aside for public health emergencies.


Ms. Macpherson indicated that while the numbers presented at the meeting are very close to what would be entered in the county’s budget system, there are a few numbers that she is still waiting to obtain, and there may be some last minute changes or corrections. Ms. Macpherson asked the BOH for approval to move forward in concept with the draft budget and to continue working to finalize and submit the budget when done to the County.


Mr. Yurash made a motion to approve the proposed budget in concept. Any changes greater than $20,000 will be sent to the BOH approval. Ms. Lee seconded the motion. The motion was unanimously approved.


4.   Renewal of Syringe Exchange Operating Agreement with Northern Colorado AIDS Project

Dr. LeBailly rewrote the agreement with the two changes discussed with the board: the 20-syringe limit on the number given at one visit, and the ID card given to the participant in the SEP. Dr. LeBailly also spoke with the District Attorney, law enforcement (FC police, Loveland police), and Sheriff’s Patrol Commander, as well as the business community (Downtown Business Association); no one reported any complaints or problems with the SEP.


Mr. Yurash made a motion to approve the Memorandum of Understanding as written. Dr. Richards seconded the motion. The motion was unanimously approved .


5.   Review of 2012 LCDHE customer complaints – Ms. Macpherson distributed the summary of customer complaints received during the first 6 months of 2013 with the Board. This report was requested by the Board as one means to assess the department’s customer service performance. The Board expressed their appreciation for the report. 

6.   Director’s reportWest Nile update - Dr. LeBailly has made three recommendations to the city of Fort Collins to spray to control mosquitoes. The city manager made the decision to spray after the third recommendation, confirming that the city’s adopted criteria for spraying had been met. As of today, 38 patients in Larimer County have tested positive for WNV. Of these 38 cases, 8 are neuroinvasive (meningitis, encephalitis, or paralysis).

Other – City of Fort Collins is considering expanding their smoking ordinance. The staff from our Tobacco Free staff will be providing information on this.


7.   Next meeting: October 10, 2013 – We generally do not have a BOH meeting in September because of the Budget Hearing with the County Manager and County Budget Director. The BOH President generally attends this meeting. The date/time for the Budget Hearing is September 30, 2013 from 1:00 pm to 2:30 pm.

8.   Adjourn – The meeting was adjourned at 9:15 pm.




_____________________________     ____________________________________

Paula Lady, Recording Secretary         Adrienne LeBailly, MD, MPH, Exec.Secretary