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DCHC Minutes 9-22-2005
MINUTES
DUKES COUNTY HEALTH COUNCIL
September 22, 2005 Meeting
West Tisbury Public Safety Building

CALL TO ORDER
Chairman Cindy Mitchell called the meeting to order at 7:35am.  A quorum was present.  Attendees included:  Chris Knowles, Jane Cleare, Tom Bennett, Olga Church, Terry Appenzellar, Antonio Teixeira, Judy Flanders, Linda Swanson, Patsy McCornack, Jo Ann Murphy, Murray Frank, Rhonda Cohen, Susan Wasserman, Dr. Ilene Klein, Paddy Moore, Nancy Gilfoy, and Tad Crawford.  Member Michele Lazerow arrived at 8:45.  Also present were E. Winn Davis, member ex officio, Sarah Kuh, member ex officio (at 8:05), guest Dedie Wieler, potential member Matt Poole, and Deborah H. Potter, executive assistant to the county manager to record minutes.

INTRODUCTION:  
Cindy Mitchell remarked that there have been an unprecedented number of turnovers to the council recently; consequently there were several new members attending the meeting.  Welcomes were extended to Linda Swanson, Project Coordinator for Hospice; Tom Bennett, MVCS; potential new member Matt Poole, Edgartown Health Agent; and Murray Frank, former member of the council and a guest at this meeting.  All members then introduced themselves as well.

NEXT MEETING:
With the consent of those present, the next meetings for October, November, and December were set.  The dates for these meetings will be October 27th, November 17th (due to Thanksgiving) and December 15th (due to the holiday season).

MINUTES:
The minutes of the May 26th minutes were discussed and revised.  A motion to adopt the minutes with the revisions was made by Chris Knowles and seconded by Paddy Moore.  The motion carried unanimously.

The minutes of the July 27 minutes were discussed and revised.  A motion to adopt the minutes with the revisions and adding additional information from Paddy Moore was made by Jane Clare and seconded by Olga Church.  The motion carried unanimously.

REVIEW OF OUTSTANDING BUSINESS:
Cindy Mitchell reviewed the status of ongoing business with the council:
  • The Coordinating Committee is still wanting to move forward on issues raised during the  recent Health Forum series.  The planning committee for the series expect to complete the work of distilling and summarizing these issues soon.  Nancy Gilfoy suggested that the results could be productive for the Rural Health Network Development Grant  consultant as well.
  • The Health Council’s integrated work plan has been drafted, but due to membership and committee changes, the plan will need some revision.  A final draft should be available for the October meeting.  She reminded all Committee chairs that they needed to finalize their workplans.
  • There have been numerous membership changes to the council recently and the nominating committee is working diligently to fill available positions.
TREASURER’S REPORT:
Terry Appenzellar deferred her report to the next meeting awaiting confirmation of the approval of the budget.  E. Winn Davis advised that the budget approval had just been received.   

HEALTH COUNCIL COMMITTEE/PROGRAM REPORTS AND UPDATES:
  • Nominating Committee Report.  Cindy Mitchell advised that Cathy Brennan was unable to attend the meeting but wanted to continue working with the DCHC is some capacity.  Chris Knowles delivered the following report:  The nominating committee has been re-activated to fill existing vacancies and plan for next year’s terms.  The committee consists of Patsy McCornack, Paddy Moore, Tad Crawford, Cathy Brennan, and Chris Knowles.  Some of the changes being presented include:
        Bob Tonti moving to a Community Health slot as theVineyard Nursing Association          representative.
        Chris Knowles will move into a Community Health Organization slot as a MV Hospital
        representative.
        Freddy Rundlet has resigned as the Wampanoag Tribe representative, and the Tribe
        should have selected a new representative last night.
        Matt Poole has been invited to fill the Elected Official slot that is available.
        Dr. Klein changes from a practitioner slot to a County appointed position as the Dukes
         County Associate Commissioner Health Care Access
        Cathy Brennan will move into an open Practitioner’s position
        Linda Swanson fills the open Hospice representative position
        and the Associate Commissioner for Elder Affairs position is still vacant.

This plan will be formalized soon making appointments as necessary.  Individuals requiring appointment by the County Commissioners will be sworn in as appropriate.  Chris also advised that after reviewing the By-Laws, the Nominating Committee discovered it has much greater flexibility to make these recommendations than previously believed.
E. Winn Davis remarked that Tad Crawford’s earlier suggestion (July 27, 2005) to allow members to finish their terms despite changes in their employment or category of membership was a good idea.  Chris stated that for now they have managed to rework individuals into new categories but are reviewing this suggestion for the long term after checking to see if it complies with the provisions of the By-Laws.  E. Winn Davis also asked if a letter from the DCHC has been sent to Freddy Rundlet thanking him for his service.  Cindy replied that since he had left so abruptly, she only had time to send one via e-mail.  Mr. Davis advised the council that the Dukes County Commissioners sent a letter from the county thanking Fred for his efforts.  Paddy added that she had recently spoken to Fred, gave the group a brief update on his current activities, and said that Fred intended to keep in touch with the group.  Cindy ended this report on the note that all of these changes were Phase 1 to address immediate vacancies and the Phase 2 will begin and address the nominations for next year.

  • Coordinating Committee Report:  Cindy Mitchell reiterated that the work plan would be available for review at the next meeting.  Additional areas of interest included:
        
The Mental Health Substance Abuse Committee has been meeting on a consistent basis.  They took on the responsibility for the coordination of this year’s UMASS Clerkship and  it has worked out well.  Tom Bennett will now chair this committee.

Dr. Ilene Klein and Winn gave a report to the committee earlier on County efforts to help address community Health needs.  The DCHC will have a place within these new functions and the Coordinating Committee will be making this area a priority in the upcoming year.

The DCHC will continue to work closely with VHCAP to address their sustainability issues.  As it currently stands, VHCAP receives 40% funding from the county and 60% from grants.  As the grants expire, so will related services unless other sources of revenue can be obtained.

  • UMASS Clerkship Planning Group Report:  Olga Church reported that this is the 3rd year that the interns have come to the island but this year is the first time with an interdisciplinary group.  Three 1st year medical students and two 1st year graduate nurse students will be
arriving in October.  They will focus on rural health care and how it is administered.  This year they will also expand into mental health care as well.  There are 26 sites within Massachusetts that provide this type of internship to students.  Olga and Murray Frank attended a meeting earlier with the other sites to discuss various ideas, operational methods, and practical advice to improve the effectiveness of this program.  

Our group is finalizing the orientation package that the interns will receive.  The projects for this year’s group include the completion of a student survey questionnaire for key community informants and a plan for each student to “shadow” some of these key community informants in their areas of work such as the Rural Health Clinic, ER, and Hospital Rounds for real life experience.

Members of the planning group will be available as needed for support.  On October 18, the students will make a Power Point presentation regarding the results of their internships.  Murray Frank remarked that this whole program is part of a larger relationship with UMASS.  UMASS is aware of the unique learning opportunities available here which is one reason why this program seems to work so well.  Dr. Klein, he added, was very helpful in her mentoring of earlier participants and now Dr. Ellen McMahon will be assuming this role.  The Hospital provides the housing for the students.  Everyone is invited to the students’ presentation on October 18th, 2005 at 2pm, in the South Side Conference Room of the Hospital.  He encouraged everyone to attend.  Their arrival date is October 4th with a full orientation to be conducted on October 5th.

Antonio Teixeria inquired if they also had a dental program and Murray Frank advised that we do not have one here but that UMASS did subsidize other programs elsewhere.  Cindy Mitchell then advised that the questionnaire is now not just related to drug and mental health issues but now includes primary care issues as well.  This may eventually lead to the development of a common screening tool.  Sarah Kuh asked if this would include the Brazilian community and Cindy replied that inclusion in this likely would fall to Sarah and the Access Program.  E. Winn Davis advised that the County is coordinating with out website provider (Virtual Town Hall) to have surveys available on the website which would be unlimited in number, in any language desired, and even screened to ensure that multiple responses from individual were not permitted so as not to skew the survey results.

  • Lighthouse Health Access Alliance (LHAA):  Cindy Mitchell advised that she and Tad were the representatives for the Cape, Nantucket and Martha’s Vineyard Alliance.  The funding for this group has expired; however, they would like to continue their work on assess behavioral health issues with a particular focus on youth.  A work plan has been developed but we need representation for Martha’s Vineyard in some of these areas and initiatives.  She would also like the Youth Task Force to look into this and maybe get involved as this is within their area of service.
  • Primary Care Working Group/Rural Network Development Planning Report:  Chris Knowles reported on that the Island’s proposal for a federal Rural Health Network Development Planning Grant was originally not funded but that changed and the funds are now available.  The grant is being coordinated by 8 institutions/organizations and the Primary Care Working Group will now meet quarterly in conjunction with the timeline of the grant.  This group will address issues not covered by the Rural Health grant group.  The Primary Health Working Group is trying to make a clear distinction between the two processes.  
Dr. Klein continued by reporting that the Rural Network Development Planning Group work was progressing.  They had their first informal meeting already and she said that Representative Delahunt and the state’s Office of Rural Health were supporting the grant process.  The group issued a RFP for consulting services and received three responses.  At their meeting tomorrow, they will rank the responses and schedule interviews in the beginning of October with the goal of beginning the project late October or early November.  The proposals and the ranking criteria can be reviewed on the internet.

  • Other Committee Reports:  None
  • General Announcements and Updates:  
Sarah Kuh advised members that the Massachusetts Health Tech Forum, which includes information on billing on other related information, was meeting soon.  Her staff attends these meetings and is willing to car pool with others who may want to attend.

Also a Medical Interpreter training program will be held on the first three Fri/Sats in November.  It is limited to 10 people so early enrollment is advised.  Nancy Gilfoy asked if the interpreters would be volunteers and Sarah advised no they will get paid for their services.

Cindy Mitchell advised that the agenda for next month would include the work plan, various reports and an update on the Island Health Plan.
SPECIAL REPORT: DISCUSSION ON PUBLIC HEALTH
Dr. Ilene Klein gave a very detailed report on Rural Health.  She started with a report on Quality through Collaboration, the Future of Rural Health by the Committee on the Future of Rural Health Care that basically detailed information on how our existing health care system is not functioning well and needs to be re-tooled to address current needs.  The report identified 6 areas that a re-tooled system should be: safe, effective, patient-centered, timely, efficient, and equitable.  The report notes the challenges of Rural Health Care systems and suggests looking at the following areas when trying to improve programs:
  • Assessing the quality of health care in rural areas
  • Developing a framework for a core set of services and the essential infrastructure necessary to deliver...these services to the rural communities.
  • Recommending priority objectives...changes in policies and programs...to achieve the objectives
  • Considering implications for federal programs and policies.
The report continues with a five-pronged approach for accomplishing these tasks.  Most of this information will be available on the county’s website, dukescounty.org.  She is also adding to the website information about a community planning guide for “Healthy People in Healthy Communities.”  This report covers 28 focus areas with 467 specific objectives.  There are also 10 specific public health priorities that address major public health care concerns.  They include:
  • Physical activity
  • Overweight & Obesity
  • Tobacco Use
  • Substance Abuse
  • Responsible Sexual Behavior
  • Mental health
  • Injury and Violence
  • Environmental Quality
  • Immunization
  • Access to Health Care
  • More information on the leading Health Indicators is available at www.health.gov/healthypeople/LHI.
Dr Klein advised that the County would be participating in many of these areas but over the next year will focus on:
  • Health Communication:  Designing a central informational database for public and health care providers.  Kendra Read, the Dukes County Health and Environment Director, has been authorized to work up to 20 hours a week on this project with Dr. Klein.  The primary goal being to get the information coordinated, available, and organized in a logical and useful manner.
  • Organizing a Committee to assess the state of our Public Health Care system:  We have many groups performing a variety of wonderful services but there is no coordinated plan to prevent a duplication of services or to determine if a gap in services exists.  A survey designed by various agencies could be used and then prepared in a variety of functional formats.
She concluded by stating that a lot of attention is now being paid to Rural Health communities.  We need to get organized to capitalize on a variety of new funding opportunities, to focus on meeting the initiatives established by healthy People 2010, and to assess our health care needs.  One area that she is particularly looking into with Matt Poole is the development of an island wide disaster plan that coincides with new mandates for Boards of Health to formalize any plans they have.  Terry Appenzellar commended Matt Poole on being a role model for the other Board of Health Agents for taking initiative into helping prepare this information and strongly encouraged trying to get the cooperation of the other town’s agents.  Antonio Teixeria asked how the Boards of Health were regulated and Matt Poole advised that he would be willing to come back and give a detailed report on that topic.  For now, the Board of Health departments are regulated by the State and the State is mandating the formulation of specific disaster preparedness plans soon.  Mr. Teixeria asked Mr. Poole if he would be willing to work on that for the DCHC and Mr. Poole said yes.  Cindy Mitchell advised that the Coordinating Committee would help with this area as well.



SPECIAL REPORT: MVCS and State Emergency Services Contract:
Susan Wasserman described the financial difficulties in providing the State mandated Emergency Services as currently described in the MVCS contract.  MVCS has a great amount of support but not necessarily the financial means to pay for many of these mandatory programs.  Our Emergency Services program operates at a deficit every year with limited funding despite our psychiatric rates being double than other more heavily populated and financially supported areas.  
She stated that MVCS needs a different model to provide better services.  MVCS will be asking the State for more money in support of these services.  MVCS wants to reorganize into a “firehouse” model adopted by many other communities in Massachusetts and across the country that would be based at the hospital.  

MVCS wants to give the 60-day termination of service to the State to force the funding issue.  Although this notice will generate some conflict, there does not appear another means of addressing the problem.  MVCS will be prepared for the possibility that the State may come back and say no to the additional funding request.  Dedie Wieler noted that once the termination notice is given, the pressure is directed toward the State as it is a State requirement that this service be provided.  If MVCS no longer provides the service, the State then becomes responsible for filling the void.  

Susan continued by stating that MVCS is going to give out as much information to the public as possible.  Once the Board decides to give the 60 days notice, MVCS will immediately send out letters to over 3000 donors with instructions to contact their government representatives.  Most of our local representatives are already supporting the MVCS position.

Linda Swanson asked if there had been any similar precedents with other agencies.  Susan explained that this part of the State was unique in that the rest of the State goes to a 3rd party for funding.  We are the only group funded directly by the Department of Health that has a limited budget that is why other groups have not had to take this course of action.

Tad Crawford added that the Union will be supporting this initiative and that although the DCHC normally does not offer public support for specific issues, this is such a substantial problem that this is any area where out public support could be helpful.  After some discussion about whether to postpone deciding on this issue until next meeting, Tad Crawford made the following motion, seconded by Michelle Lazerow:

That the Chair of the DCHC, with Susan Wasserman, craft a letter of support for MV Community Services efforts to properly fund services provided through State Contracts.  This letter would then be available for submission as needed.


Prior to voting the following additions to the motion were made to include the following items in the letter:

that the DCHC notes the severity of this problem and that the problem is county-wide,

that MVCS needs full State funding for the full time emergency staff as mandated by State law and,

that MVCS, to our detriment, is an exception to the funding model that exists in the rest of the State.

Cindy Mitchell asked if this included authorization for her to speak to the press as well.  The Motion was amended to include all items and so voted unanimously.

Adjournment
A motion to adjourn was made by Nancy Gilfoy, seconded by Terry Appenzellar.  The meeting adjourned unanimously at 9:40 a.m.

Respectfully submitted,
Deborah Holtzer Potter