The Macon County Board of Health met Tuesday, August 23, 2016 in the conference room of the Macon County Department of Health at 1830 Lakeside Drive.
Full video of the meeting and supporting documents are embedded below. Some of these documents were transcribed and clarifying links added to help the reader, and any errors are unintentional.
VIDEO
DOCUMENTATION
Meeting Agenda
Macon County Board of Health
August 23, 2016
Public Comment
Call to Order
Approve Agenda
Welcome
1. Presentation
A. Customer Satisfation Survey Results - Kathy McGaha
2. Approve Minutes of Meeting
3. Old Business
A. Needle Exchange - Lynn Baker
B. Rabie Compendium - Jimmy Villard/JIm Bruckner
4. New Business
A. Flu Plan - Jennifer Garrett
B. Billing Guide and Fee Plan - Diane Keener/Dorota Anthony
5. Board Traming and Announcements
A. Macon County Fair Handout
B. Annual Update of List of Committees
C. BUdget Update
Next Meeting
• Requested Agenda/Discussion Items (General Updates, Emerging Issues, etc)
• 9/27/2016
Adjourn
MEDIA ROLLCALL
(media outlets with reporters/photographers present)
Macon Media
The Franklin Press
Macon County News and Shopping Guide
WFSC-AM/WNCC-FM
Documents shared during the meeting are posted/embedded below.
HOUSE BILL 972 Needle Exchange Program Authorization
(Ratified during the 2015 session in the "Law Enforcement Recordings/No Public Record" Law)
Full Bill Text
SECTION 4. Article 5C of Chapter 90 of the General Statutes is amended by adding a new section to read:
"§ 90‑113.27. Needle and hypodermic syringe exchange programs authorized; limited immunity.
(a) Any governmental or nongovernmental organization, including a local or district health department or an organization that promotes scientifically proven ways of mitigating health risks associated with drug use and other high‑risk behaviors, may establish and operate a needle and hypodermic syringe exchange program. The objectives of the program shall be to do all of the following:
(1) Reduce the spread of HIV, AIDS, viral hepatitis, and other bloodborne diseases in this State.
(2) Reduce needle stick injuries to law enforcement officers and other emergency personnel.
(3) Encourage individuals who inject drugs to enroll in evidence‑based treatment.
(b) Programs established pursuant to this section shall offer all of the following:
(1) Disposal of used needles and hypodermic syringes.
(2) Needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to ensure that needles, hypodermic syringes, and other injection supplies are not shared or reused. No public funds may be used to purchase needles, hypodermic syringes, or other injection supplies.
(3) Reasonable and adequate security of program sites, equipment, and personnel. Written plans for security shall be provided to the police and sheriff's offices with jurisdiction in the program location and shall be updated annually.
(4) Educational materials on all of the following:
a. Overdose prevention.
b. The prevention of HIV, AIDS, and viral hepatitis transmission.
c. Drug abuse prevention.
d. Treatment for mental illness, including treatment referrals.
e. Treatment for substance abuse, including referrals for medication assisted treatment.
(5) Access to naloxone kits that contain naloxone hydrochloride that is approved by the federal Food and Drug Administration for the treatment of a drug overdose, or referrals to programs that provide access to naloxone hydrochloride that is approved by the federal Food and Drug Administration for the treatment of a drug overdose.
(6) For each individual requesting services, personal consultations from a program employee or volunteer concerning mental health or addiction treatment as appropriate.
(c) Notwithstanding any provision of the Controlled Substances Act in Article 5 of Chapter 90 of the General Statutes or any other law, no employee, volunteer, or participant of a program established pursuant to this section shall be charged with or prosecuted for possession of any of the following:
(1) Needles, hypodermic syringes, or other injection supplies obtained from or returned to a program established pursuant to this section.
(2) Residual amounts of a controlled substance contained in a used needle, used hypodermic syringe, or used injection supplies obtained from or returned to a program established pursuant to this section.
The limited immunity provided in this subsection shall apply only if the person claiming immunity provides written verification that a needle, syringe, or other injection supplies were obtained from a needle and hypodermic syringe exchange program established pursuant to this section. In addition to any other applicable immunity or limitation on civil liability, a law enforcement officer who, acting on good faith, arrests or charges a person who is thereafter determined to be entitled to immunity from prosecution under this section shall not be subject to civil liability for the arrest or filing of charges.
(d) Prior to commencing operations of a program established pursuant to this section, the governmental or nongovernmental organization shall report to the North Carolina Department of Health and Human Services, Division of Public Health, all of the following information:
(1) The legal name of the organization or agency operating the program.
(2) The areas and populations to be served by the program.
(3) The methods by which the program will meet the requirements of subsection (b) of this section.
(e) Not later than one year after commencing operations of a program established pursuant to this section, and every 12 months thereafter, each organization operating such a program shall report the following information to the North Carolina Department of Health and Human Services, Division of Public Health:
(1) The number of individuals served by the program.
(2) The number of needles, hypodermic syringes, and needle injection supplies dispensed by the program and returned to the program.
(3) The number of naloxone kits distributed by the program.
(4) The number and type of treatment referrals provided to individuals served by the program, including a separate report of the number of individuals referred to programs that provide access to naloxone hydrochloride that is approved by the federal Food and Drug Administration for the treatment of a drug overdose."
EMERGING PUBLIC HEALTH ISSUES
Unnecessary Exposures to Hepatitis-C THrough Sharing of Needles, Illegal Tattooing and Unregulated Body Art (piercings and Implants)
Hepatitis-C (Hep-C) is classified two ways; Chronic Hep-C and Acute Hep-C. Chronic Hep-C is a slow-progressing disease, with symptoms that may not appear for years, if at all. If left untreated, Chronic Hep-C can lead to liver damage, and potentially even liver cancer. Acute Hep-C is a short term viral infection that occurs within the first 6 months after someone is exposed to the Hepatitis-C virus. For most people an Acute Hep-C infection will turn into CHronic Hep-C. Hep-C is usually spread when blood from a person infected with the Hep-C virus enters the body of someone who is not infected. Hep-C is the most common bloodborne infection in the US, and there is no vaccine; however, it is a treatable condition. Today, most people become infected with the Hep-C virus by sharing of needles or other equipment used for injection purposes. Other ways Hep-C can be spread is through contact with dried blood on equipment or surfaces, and/or blood splashes in the eyes, nose or mouth.
The number of acute Hep-C cases is on the rise in North Carolina (NC). Between 2010 and 2015 the number of reported cases of acute Hep-C has tripled (close to a 300% increase). Acute Hep-C is a reportable disease under state law; however, it continues to go under-reported and underestimated. It is estimated that there are approximately 110,000 North Carolinians with Chronic Hep-C. Some facts about Hep-C:
• Hep-C virus in 10x more infectious than HIV;
• 50% of cases are more than likely unaware they've been infected;
• 41% od cases are between the ages of 21 and 30;
• 75% of adults with Hep-C are Baby Boomers (born between 1945 & 1965);
• 37% of those infected reported injection drug use; and
• 75% to 85% of people with Hep-C will develop chronic illness. (ii)
Hep-C in Western North Carolina (WNC):
In Macon County and many surrounding counties, Hep-C has become a significant health concern. A recent Center for Disease Control and Prevention (CDC) study identified five counties in NC, three of which are in WNC: Graham, Clay and Cherokee as being in the top 220 counties in the United States as having a high prevalence of Acute Hep-C infections (iii) Macon County shares a border with these counties.
Tattoos, piercings and other forms of body modifications (all referred to as "body art") are prevalent in today's society including here in WNC. While it used to be uncommon to encounter someone with a tattoo or piercing outside of certain groups, one can hardly go about their day without encountering someone who has been tattooed or pierced.
Research studies show that in the informal, unregulated tattooing and piercing settings, where poor infection-control practices are used that the transmission of Hep-C is possible. iv These same studies show that when tattooing and piercing are properly regulated Hep-C is not spread.
In recent months, we have seen a rise in the number of illegal tattoo artists operating in Macon County. There have been three that we know of. This department has invested a significant number of work hours to ensure that these individuals cease and desist from tattooing. Additionally, we have had to invest significant time in investigating this illegal operation in an effort to identify the people this individual tattooed so as to make sure they were appropriately tested for Hep-C, Hep-B and HIV as these viruses can make them sick and possibly their families sick. This is not just a Macon County problem. As the department has been working to address this issue, we have determined that other county health departments are experiencing a similar problem. Given how common body art is today, and due to the high prevalence of Hep-C in WNC, an examination of the impacts on health and possible further regulation of these industries should be considered.
Tattooing in NC:
The tattoo industry in NC is currently regulated and enforced at the local level by the county health department. These laws are in place to protect the health and safety of both the artist and the client due to the potential ease of transmission of bloodborne pathogens during the tattooing process. Improper (and illegal) tattooing techniques lead to the transmission of diseases (including Hep-C) that are serious and have a lifelong impact on the individual and could create significant increases in cost of health care for everyone. Proper tattooing techniques ensure that those who do receive tattoos do so in a safe manner. In addition to the techniques used, the use of proper equipment (such as autoclave and disposable needles), and the proper treatment of inks are important to prevent bloodborne pathogens/disease from bring spread.
There are consequences to those found to b e tattooing without a permit in NC law. However, these consequences are not proving to be severe enough to discourage those who tattoo illegally (class I misdemeanor), and enforcing these consequences has proven to be difficult (not viewed by the legal system as a significant crime).
Piercings and Body Modifications in NC:
Piercing and other body modifications (such as dermal implants) are currently unregulated in NC; however, there is mention in General Statute 14-400 that body piercing of a minor is prohibited.
ProfessionaL Organizations (such as Association of Professional Piercers) that support safe piercing techniques and practices exist; however, membership is voluntary and uncommon.
Piercing and body modification have their own set of issues in the spread of bloodborne pathogens. The use of equipment similar to what is found in a permitted tattoo establishment along with procedures to minimize the risk of spreading infection such as Hep-C to those who wish to be pierced are lacking or non-existent in most of these establishments.
Piercing and body modification also presents other health risks. For example individuals with diabetes, hemophilia, autoimmune disorders, cardiac issues, skin conditions or who are or may be pregnant may experience serious complications from the procedure (i.e., bleeding, skin rashes or lesions, scars or bacterial infections, etc.)
The following are Areas of Concern Regarding Tattooing, Piercing and Body Modification in Relation to Hep-C:
• Penalties for tattooing without a permit do not discourage individuals from practicing without a permit.
• The act of piercing or body modifications is not regulated or inspected even though many times these procedures require the insertion of a needle and/or in some cases a surgical incision with a scalpel to place rings, plugs, eyelets, gauges, and other articles of jewelry.
• Piercing and tattooing, done improperly, pose a risk for infection; training in prevention of bloodborne pathogens exposure for those practitioners would minimize risk for them and their clients.
• Occupational Safety and Health Administration Bloodborne Pathogens Standards that address accidental needle sticks do apply to this industry and this industry is required to maintain an OSHA Exposure Control Plan for accidental needle sticks, but these standards are generally not followed or enforced.
• Food and Drug Administration recently became aware of tattoo inks that had confirmed bacterial contamination in unopened bottles available for purchase online: neither the inks nor tattoo equipment are regulated by the FDA.
• Non-sterile water used to dilute concentrated inks can contaminate the ink with harmful germs which can lead to infections when deposited under the skin and spread to the bloodstream.
• Though Hep-C is treatable disease, the cost of treatment is extremely expensive and in many cases out of reach for the average person.
Sharing of Needles:
The sharing of needles by intravenous 9IV) drug users is a primary contributor to the spread of HIV and Hep-C in NC. The NC General Assembly passed legislation in 2016 which was signed into law and with an effective date of July 11, 2016. The new law allows any governmental or nongovernmental organization, including health departments, to establish and operate a needle and hypodermic syringe exchange program. The only issue with the new law is that no public funding can be used to support he program. The objectives of the new law are to:
• Reduce the spread of HIV, AIDS, viral hepatitis, and other bloodborne diseases in this State
• Reduce needle stick injuries to law enforcement officers and other emergency personnel
• Encourage individuals who inject drugs to enroll in evidence based treatment
This document was prepared by Kyle Jennings, REHS, Jonathan Fouts, REHS, and Jennifer Garrett, BSN, RN, CPN, CSN - Macon County Public Health
i -- Center for Disease Control and Precention: http://www.cdc.gov/hepatitis/hcv/cfaq.htm 8/5/2016
ii -- NC DHHS, DHP, Communicable Disease Branch, Hepatitis-C in NC 2016 Fact Sheet 05/13/2016
iii -- Center for Disease Control and Prevention, National Center for HIV/AIDS, Wiral Hepatitis, STD, and TB Prevention, County-level Vulnerability to Rapid Dissemination of HIV/HCV Infection Among Persons who Inject Drugs: 3/8/2016
iv -- Bloodborne pathogen risk reduction activities in the body piercing and tattooing industry. Lehman, EJ; Huy, J; Levy, E; Viet, SM; Mobley, A; McCleery, TZ, American Journal of Infection Control 2010 Mar, 38(2):130-138. http://dx.doi.org/10.1016/j.ajic.2009.07.008
§ 130A-39. Powers and duties of a local board of health.
(a) A local board of health shall have the responsibility to protect and promote the public health. The board shall have the authority to adopt rules necessary for that purpose.
(b) A local board of health may adopt a more stringent rule in an area regulated by the Commission for Public Health or the Environmental Management Commission where, in the opinion of the local board of health, a more stringent rule is required to protect the public health; otherwise, the rules of the Commission for Public Health or the rules of the Environmental Management Commission shall prevail over local board of health rules.
However, a local board of health may not adopt a rule concerning the grading, operating, and permitting of food and lodging facilities as listed in Part 6 of Article 8 of this Chapter and as defined in G.S. 130A-247(1), and a local board of health may adopt rules concerning wastewater collection, treatment and disposal systems which are not designed to discharge effluent to the land surface or surface waters only in accordance with G.S. 130A-335(c).
(c) The rules of a local board of health shall apply to all municipalities within the local board's jurisdiction.
(d) Not less than 10 days before the adoption, amendment or repeal of any local board of health rule, the proposed rule shall be made available at the office of each county clerk within the board's jurisdiction, and a notice shall be published in a newspaper having general circulation within the area of the board's jurisdiction. The notice shall contain a statement of the substance of the proposed rule or a description of the subjects and issues involved, the proposed effective date of the rule and a statement that copies of the proposed rule are available at the local health department. A local board of health rule shall become effective upon adoption unless a later effective date is specified in the rule.
(e) Copies of all rules shall be filed with the secretary of the local board of health.
(f) A local board of health may, in its rules, adopt by reference any code, standard, rule or regulation which has been adopted by any agency of this State, another state, any agency of
the United States or by a generally recognized association. Copies of any material adopted by reference shall be filed with the rules.
(g) A local board of health may impose a fee for services to be rendered by a local health department, except where the imposition of a fee is prohibited by statute or where an employee of the local health department is performing the services as an agent of the State. Notwithstanding any other provisions of law, a local board of health may impose cost-related fees for services performed pursuant to Article 11 of this Chapter, "Wastewater Systems," for services performed pursuant to Part 10, Article 8 of this Chapter, "Public Swimming Pools", for services performed pursuant to Part 11, Article 8 of this Chapter, "Tattooing", and for services performed pursuant to G.S. 87-97. Fees shall be based upon a plan recommended by the local health director and approved by the local board of health and the appropriate county board or boards of commissioners. The fees collected under the authority of this subsection are to be deposited to the account of the local health department so that they may be expended for public health purposes in accordance with the provisions of the Local Government Budget and Fiscal Control Act. (1901, c. 245, s. 3; Rev., s. 4444; 1911, c. 62, s. 9; C.S., s. 7065; 1957, c. 1357, s.
1; 1959, c. 1024, s. 1; 1963, c. 1087; 1973, c. 476, s. 128; c. 508; 1977, c. 857, s. 2; 1981, c. 130, s. 2; c. 281; c. 949, s. 4; 1983, c. 891, s. 2; 1985, c. 175, s. 1; 1989, c. 577, s. 2; 1991 (Reg. Sess., 1992), c. 944, s. 10; 1993 (Reg. Sess., 1994), c. 670, s. 2; 1995, c. 507, s. 26.8(c); 2006-202, s. 6; 2007-182, s. 2.)
2016 NASPHV Rabies Compendium: Proposed Model Board of Health Rule
Compendium of Animal Rabies Prevention and Control, 2016
LBOH Rabies Rule Memorandum by Bobby Coggins on Scribd
MACON COUNTY PUBLIC HEALTH FAIR BOOTH
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