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DCHC Minutes 1-26-2006
DUKES COUNTY HEALTH COUNCIL MINUTES
Thursday, January 26, 2006 Meeting
West Tisbury Public Safety Building

CALL TO ORDER
Chairman Cindy Mitchell called the meeting to order at 7:40am.  Chair determined that a quorum was present.  Attendees included: Cathy Brennan, Jacque Cage, Terry Appenzellar, Antonio Teixeira, Patsy McCornack, Jane Cleare, Janio Reder, Joann Murphy, Dr. S. Patrick Donegan, Susan Wasserman, Dr. Charles Silberstein, Tom Bennett, Linda Swanson, Bob Tonti, Jim Weiss, Dr. Ilene Klein, Tad Crawford, Nelson Smith, Judy Flanders, and Chris Knowles.  Also present were, E. Winn Davis, Dukes County Manager and member ex officio, Sarah Kuh, VHCAP and member ex officio, Miriyam Gerson, VHCAP Translator Program, Judy Crawford, and Deborah H. Potter, executive assistant to the county manager to record minutes.  

NEXT MEETING AND ANNOUNCEMENT:
Cindy Mitchell advised the next meeting is February 23, 2006.

Susan Wasserman announced that MVCS has hired Julia Burgess as the new Executive Director.  Ms. Burgess has strong island connections, including a house in Vineyard Haven, as well as extensive administrative experience in health and human services.  Susan Wasserman added that Ms. Burgess will start on February 27.

MINUTES:
The motion to accept the minutes of December 15, 2005 was made by Chris Knowles and seconded by Patsy McCornack, with the following changes:

Add Susan Wasserman to the attendees list and
Change “recommending a change” to “reiterating the by-law requirement of” in the Nominating Committee report on page 2  

and the motion was SO VOTED in the affirmative by all members with Dr. Weiss abstaining.  



TREASURER’S REPORT:
Terry Appenzellar provided a copy of the January Treasurer’s report.  She reported no issues or outstanding expenses.   Chris Knowles made the motion, seconded by Tom Bennett, to accept the Treasurer’s report and the motion was SO VOTED unanimously.

Terry Appenzellar reminded the chairs that during the last three months of the fiscal year they are only allowed to spend 1/12th of their budget per month and if they had any planned expenses that exceeded that amount, they needed to advise her so that she could coordinate appropriately with the county treasurer.

SPECIAL REPORTS:  Cindy Mitchell moved to Item 7 on the agenda and advised the DCHC that they were going to receive brief reports on the six various Health Care Forums that were conducted last February through August.  Each forum was televised and they are being well received.  The DCHC made the
commitment going into the forums to act on the good ideas and recommendations of the committees.  Tad Crawford noted that the breakthrough idea was the conversation in the round where experts from both on and off island were able to exchange ideas with other people.  He noted that the forum committee discussed that the next step in the progression is to record more events for broadcast on television to reach even more people within the community; therefore, as you hear the reports, think of how they could be presented and captured on TV for viewing by the public.  He added that the idea now is to broadcast meetings of the DCHC and to figure out how to stage the meetings for the best presentation.  Cindy advised that they were considering this for the next meeting.  She added that each member of the planning committee reviewed the DVD of each forum and identified the key points for the members of the DCHC to review keeping in mind the idea of the next discussion being recorded for television viewing.  

  • Mental Health Forum, Dr. Charles Silberstein:  He reported that the Mental Health forum took a different turn than expected.  He expected the forum to discuss the institutions available on the island and instead began by examining statistics presented by Dr. Tsai identifying the number of hospital visits comparing the two different periods.  He stated that Dr. Tsai’s statistics included:
Hospital Visits         4/1/01 to                       4/1/04 to
                                        3/31/02                 3/31/05

        Substance Abuse            199                             756
        Depression                           40                              92
        Suicidal Ideation                    16                              25
        Suicide Attempts                       3                                     29

He noted that it appears that we have a higher amount of substance abuse that surrounding communities like Nantucket but less than areas like the Berkshires.  He added that the participants were personally experienced in the area and discussed ideas on why this occurs.  He stated that what was interesting was that people were not looking to institutions to solve the problem but to themselves as they identified the loss of connection to the community as a major problem.  

He noted that some suggestions that came from the forum to help correct the problem included:
  • Make every massage therapist, physical therapist, bar tender, and consumer an outreach worker
  • Have a seventh health forum on Creating Connection
  • Teach Parenting
  • Teach connection skills
  • More Eastern Medicine which teaches people how to relate to others and how to connect to their worlds
  • Vineyard House (addiction is a disease of connection)
  • Inadequate funding for mental health.  Form an administrative collaborative so that the mental health professionals in private practice can bargain as a group with insurance companies.
  • Primary Care Forum, Tad Crawford:  He reported that there are six bullets from the forum he reviewed that are significant:
  • Health Care be patient centered  
  • Effort made to increase communication
  • Concern about access to care for uninsured and underinsured
  • Group practice and the benefits of it  
  • Treatment protocols and outcomes & clusters of chronic medical conditions
  • Accountability of specialists to primary care providers.
He added these ideas related to the notion of health care being patient centered includes:  helping people to learn about health conditions and how they can care for themselves; empowering patients and their families to navigate the system and advocate/coordinate their own health care; and more use of age and stage appropriate preventive care.  For enhanced communication, he noted, the two points of increased use of “grand rounds” to facilitate professional development and the increased use of electronic communication.  He continued by stating that one of the underlying ideas behind the electronic communication is the idea to develop an integrated network between various providers and agencies where information could be shared.   

Chris Knowles mentioned his concerned that emergency department of the Martha's Vineyard Hospital functions as the single largest provider of primary care for the island and for some reason that subject was never re-addressed.  He noted that to continue discussing primary care without identifying this fact is counter-productive and not fully addressing the problem.  Dr. Klein asked for permission to forward these items to the RHNPDG for their use as well, which was approved.

  • Public Health on Martha's Vineyard, Susan Wasserman:  She noted that when you return to the forums, there were several sessions that produced ideas that need to be followed up on.  The major interest in this forum was what is public health and how can we get the information as well as the need for public education.  She noted that some ideas included having a nurse available at certain hours at various town halls during specific hours to answer quick questions or have a simple test performed, the idea for Men’s health education in particular for men 25-50 because they are not paying attention to their health needs, and the whole notion of how the BOH operate and fit into what is needed in the areas of public health.  Dr. Silberstein asked if there was a big focus on the need for one public health department.  Susan Wasserman noted that topic of creating a Czar of Public Health who could pull all the fragments together was discussed.
  • Our Hospital Forum, Tad Crawford:  A lot of the discussion of the meeting covered areas that they would like to see in the new hospital although the new hospital itself was not specifically addressed.  He stated there was a lot of discussion on topics such as: having a full service hospital, the availability of alternative and complementary medicine, use of electronic medical records, and to some extent the use primary care physicians for care instead of the emergency room.  He noted there was some additional discussion on how the hospital partners with the community that primarily originated not from the public but from the providers that were present. Susan Wasserman noted that this was the first forum so the process was still being perfected to generate more public comment and involvement.  Tad thought that the forum put the hospital in a very good light and was productive.
  • Health Insurance Forum and National Health Policy, Cindy Mitchell: She noted that the random aspects of the comments characterized both forums and that the solutions to these problems are elusive.  She stated that most people did not discuss solutions but focused on discussing the problem, which is why there is not a flow in the key points.  She stated in the health insurance forum it was noted that employer based insurance may become a formula for disaster because as health premiums rise fewer employers will pay the premiums and more people become uninsured.  She added that Murray Frank noted that approximately 2000 out of 15,000 islanders are on Medicaid and that indicates that there is a high level of poverty on the island.  She reported that Jim Hooley noted the 30/70 rule in Medicaid that 30% of Medicaid recipients are responsible for 70% of costs, which holds true for other programs as well.   She stated how an audience member questioned changing the insurance model to pay for screenings and preventive care vice premiums might be smarter while another noted that Martha's Vineyard employers are in a pricey market due to small policies and aging population that result in higher premiums.  Ms. Mitchell added how Dr Fine, a visiting panelist, noted that 15-30% of physician’s charges go unpaid.  She noted that the question does the lack of insurance affect the quality of care and the responses stated that while it may not affect the population on the primary level this could result in problems with specialists.  The panel also discussed the merits of “boutique medicine.” She reported how panelist Dr. Fine described the Situate Health Plan model that offers primary care services to the entire population of the town.  
Ms. Mitchell then reported on the summary of health and noted that the United States is not doing a good job in health care.  She noted that the United States spends more than any other country but we rank 29th in life expectancy and 13th in infant mortality.  She noted our system focuses on illness and not on health.  She added that most people would be willing to pay for a system in which all people were covered but 85% of Americans rate the health care they receive as good.  She stated that Massachusetts is exploring some exciting proposals to reform health care and more of us should pay attention, become informed, and get the legislation passed.  She noted at this point there was a lack of strong agreement about what to do but clusters of agreement around: a public health approach to health care, a need to monitor and measure progress, providers need to educate themselves and the public about best practices and remain accountable, and Americans need to accept more responsibility for their own health.  She noted that many people support a health care system that covers all and we have a social responsibility to provide it but the disagreement lies in how to operate and pay for it; however, there was clear agreement among the panelists that everyone is currently paying for the unwieldy and incomplete system that we do have.  

Cindy Mitchell then asked how the group should proceed and asked for thoughts on how to stage the program and what the group would want out of the discussion.  She noted that the committee did not want to draw to any conclusions on its own but to bring the ideas to the group for discussion.  

Dr. Silberstein said if the group decided to something for TV, it needed to be hard-hitting and quick.  He suggested that one of the most important things is to expose people to the health council and the council could bring forth a few ideas from each forum and then discuss specific ideas and solutions to make it interesting to the public.  Tad Crawford noted not to forget the original purpose of the forums which was to how to address the different issues and that many of the ideas already relate to existing committees.  He said that at least the chairs of those groups should review the forums to identify means of assimilating the ideas.  Dr Klein noted, having received a lot of feedback, one of the most common comments was that people were pleased that someone was taking action on some of these topics.  She noted that having people report on the progress of the individual recommendations would be helpful to the public to show forward momentum.  Nelson Smith suggested working with the TV people for ideas on how to maximize the presentation of the each topic.  Susan Wasserman noted that correlating how the ideas relate to the group and how the group functions would also be helpful and productive.  Chris Knowles noted how 3 years ago the semi-circular stage format used for the Health Study Report meeting was very productive and might be a good model to use for reference.  

At this point, Judy Crawford recommended four parts to work on the TV element:
Message:  Although DCHC has been at work now for ten years, this is the first time the group will seen publicly.  She noted that many of the viewers will not understand what is going on, especially with many of the terms used, so the points will have to be concise and understandable by the general public.  She added that the council needs to be seen as taking action on the recommendations of the forum and not just talking about it like so many other groups.  She stated that the council also should identify actions or responses that have already started happening.  The constant message that needs to be communicated is that we have heard what you said and are moving on it.

Staging:  She stated that MVTV will send one camera over so additional cameras will have to be paid for by the DCHC.  She noted that with one camera a “u” shape set up will probable work well to give each member maximum visibility.  She also stated that the groups needs to avoid having 30 talking heads and that eye contact with each other will be essential to show the sense of enthusiasm and energy between the group members.  

People giving reports:  She stated that the DCHC members remember to think about the audience receiving the message to help understand the needs of the people watching.  She recommended keeping things short, concise and easy to understand.  She noted that a brief summary at the end of your comments might be helpful as well and ensure that each point is complete.  The DCHC then can acknowledge each point.

Image of Committee:  She reminded everyone that the primary objective is to make the group seem interesting and exciting so that people may want to become involved.

Jackie Cage asked if perhaps all six forums might be too much to cover in one meeting.  Cindy commented that we don’t necessarily need to cover the reports themselves but could pick several of the more specific points and discuss these items at the meeting.  Tad Crawford noted that there are a handful of salient points and that people can see the full report if interested in doing so.  He suggested that perhaps the council could have each report in bullet form on power point with the audience being able to see the report or possibly have the points on the television screen.  He noted that a re-cap at the end could also be included as a trailer.  Nelson Smith suggested taking a few minutes from each forum, that have already been videotaped, and using that as a lead in to each topic.  It was also mentioned that the reports could be added to the website for review.  Bob Tonti stated that he feels the message is more important and that taping the meeting of the DCHC isn’t the message that needs to be seen.  He noted that taking cuts and then having a specific discussion on those items might be the most productive.  

Tad believes that it is in a way about the DCHC and how they are going to proceed with the information.  Cindy Mitchell stated that it required more thinking.  She remarked that the question today should be is it a meeting of the DCHC or a smaller group?  Dr. Weiss suggested to refer back to the question of what message does the group want to send.  

Cindy Mitchell asked the group that if this is a discussion about what has been done and what will be done so do we want the whole group or a small group.  After some discussion the DCHC decided to start with a smaller group to discuss the forums and planning committee will move forward on this project.  

FINAL NOMINATING COMMITTEE REPORT:
Cathy Brennan noted that this year they had the most applicants than in the past three years and reiterated that attendance and participation was extremely important.  She briefed the DCHC on members who needed reappointment this year and who will expire at this year.  Ryan Malonson is the acting representative for the Tribe and this role will probably be taken over by the Tribe’s new Health Care Director.  She noted that in the consumer area the two new appointees were Janet Holladay and Ardell Otten.  Ms. Holladay, according to Cathy Brennan, a local resident who recently graduated from the Harvard Divinity School.  Ms. Holladay is taking the spot of Mary Jane O’Connor Ropp who is stepping down and although there is no requirement for a clergy member to be on the council, the council has decided that representation from the clergy is something beneficial and relates back to the shared values document.  Ms. Ardell Otten, as noted by Tad Crawford, has been on the island a while and is ready to get more involved in community affairs.  He noted that she has extensive experience in the health care field.  Ms Otten, he said, had substantial experience as a hospital administrator and worked as a Special Assistant to the Director of the Los Angeles Health Department.  He continued by reporting that she chaired the volunteers at Brigham and Women’s Hospital and that she was a Charter member of the Black Health leadership council in Philadelphia.  

Cathy Brennan noted that there was a question mark at the student appointee as the general sense of the committee is that these meetings are not attractive to students and that the student may be more interested in participating in the Youth Task Force.  She noted if the students position was waived that would open another consumer slot; therefore, the committee’s recommendation is to eliminate the student slot and the DCHC, having always wanted a representative from the Brazilian community, could fill the slot with someone from that group.  Chris Knowles stated that having a connection to a 15-16 year old, especially one who may be interested in a career in the medical industry, could be invaluable.  He also offered to volunteer to help the student with the project.  He noted that the national honor society has a community involvement requirement and this could be good for venue for them.  Judie Flanders noted she mentors at the hospital and that students can receive credit for their work.  She stated that perhaps a shorter appointment would work better.  Dr. Weiss noted that it would be a shame to lose the slot and that with some effort the right student could be found.  Tad Crawford suggested that perhaps creating a special slot for students and aim for representation from both students and the Brazilian community.  

Cathy Brennan added that there were three other individuals who actually applied and are excellent applicants.  Dr. Klein made request to charge the coordinating committee with looking into a variety of methods to fill the available student slot.  Cindy Mitchell asked for a motion to accept the recommendations for appointments and reappointments as presented, other than the consumer slot for the student, Terry Appenzellar moved the motion and it was seconded being SO VOTED unanimously.

Updates:
Dr. Klein:  Dr. Klein noted that she and Nelson Smith met with coordinating committee last week to discuss how the two groups were going to work as a team.  The Public Health Committee has been formally charged by the County with a mission to promote and protect the health and well being of our community.  She noted that the committee has four areas they are working on:

  • Integrated Emergency plan: How different elements interact and gaps within that coordination that exist island wide.
  • Public Health Disease Prevention programs: Implementing prevention and educational programs.
  • LPHS survey
  • Health Statistic database: Establishing a health statistics data base for use in a variety of situations and available to anyone who wants to use it.  The pilot testing of the database will be with tick borne disease information.
She also reported that she had started a monthly health awareness tip on the county’s website.  This month covered the topic of glaucoma and she added they are also working on survey for the website that would correlate to the monthly health tip issue.  She stated that the information collected from these surveys would be provided back to the DCHC and the monthly health care tip issues will be cataloged for reference.  

She reported that there will be a Tick Borne Disease Conference this April 28 & 29th sponsored by Liz and Mike Zane.  The County is working in partnership with the Hospital on this conference but they want to keep the DCHC included and informed as well. She stated that one day of the conference will be for practioners and the second day will be open to the public. She added that the LPHS governance survey is a primary focus of the Public Health Committee.  She noted there is a very excellent system put together to do strategic planning in the area of public health.  She noted over 600 counties throughout the country use this system and it has demonstrated its effectiveness in a variety of ways.  She referred to the MAPS process, Mobilizing Action through Partnerships, which provides a means of pulling the following four elements into one usable format: identifying health care needs and community profiles (which has been done with the pending Health Report), identifying health care systems (LPHS), identifying issues of changes such as changing demographics or other elements that can rapid change the service systems, and identifying existing strengths and assets.

She also added that for the LPHS survey, based on ten essential health services, she is looking for ten facilitators to pull together groups of 10 individuals to perform the work on the survey.  She asked that members review the ten essential services and contact her if they are interested in helping or knows someone who might be interested in participating.

Miriyam Gerson:  She is the new Coordinator for Interpreter Services.  She noted they are planning on offering 24-hour/7 day a week services for Portuguese translation and right now is in the process of contract negotiations and interviewing interpreters.  She stated the tentative start date for the service is March 1st.

Susan Wasserman: She noted that MVCS is still in negotiation with State regarding emergency services and they are still waiting for Senate and House committee information.  Congressman Delahunt’s office has become interested in our need for crisis stabilization and MVCS has set up a meeting to discuss options.  

Chris Knowles:  Mr. Knowles circulated the latest scoring sheet to evaluate applicants for the various RFP’s as required by the State and incorporated recommendations from other committees.  Mr. Knowles will email the scoring sheet to Cindy Mitchell for dissemination to the members of the DCHC and he is requesting any input be back by Wednesday of next week, as the scoring sheet then will go to the Associate Commissioner for Health Care Access and then to DPH for final review.  He noted that this scoring sheet is for the specific area of Behavioral Health and Substance Abuse only and he hopes to get the RFP’s out by February.  Sarah Kuh asked if the DCHC has any input into the RFP.  Chris Knowles responded the committee has input in development of the scoring tool.  She asked if any consideration into cultural community attributes had been included.  Chris Knowles identified areas on the scoring tool that covered these areas.  Cindy Mitchell noted that the RFP specification could cover and specify what areas of community attributes or concerns needing to be addressed and Chris Knowles reminded the group that the RFP has to be approved by the DPH.  
After a brief discussion, Cindy Mitchell requested members offer suggestions in areas applicable to both ideas for RFP program areas and for input regarding the editing of the applications rating sheet.  Terry Appenzellar recommended including this area as action item for under the health care forum for the hospital.

Adjournment:  Chris Knowles motioned to adjourn and Cindy Mitchell adjourned the meeting at 9:36 a.m.



Respectfully submitted,
Deborah Potter