Board of Health - August 16, 2019 Minutes
Regular Meeting: Friday, August 16, 2019
Present: Chelsey Matter, Christopher E. Anderson, MD, Mike Thorstad, Lyn Telford, John Strand
Absent: Chad Peterson, Robin Nelson
Others Present: Desi Fleming, Melissa Perala, Lori Sall
Chelsey Matter, Chair, called the meeting to order.
Approve minutes from May 31, 2019: Chelsey Matter made a motion to approve, John Strand and Mike Thorstad seconded, and the motion was carried.
Desi Fleming announced:
* A mural was painted on the building between the Fargo Cass Public Health building and the Police Department. The Police Department on the west side of the building will now become a Police Community Outreach Center for Youth and this was the kick off for that program. They had art students and children come help paint it.
* School Walk in Clinics: FCPH had student walk in clinics in June, July and August. We did the insurance and THOR checking when they came in. August went really well, and we have added more appointment slots. Children will have to be compliant with shot requirements by October 1st, 2019.
Budget:
Melissa Perala reviewed the revenue sheets. Women’s Way grant is at 20% but the state revenue is 53% so a total of 73% was received, actually. Under Shelter Detox, their revenue went up because of Giving Hearts Day. Environmental Health’s revenue went up 138% because they have had a lot of mowing complaints, etc. Everything is on track right now for revenue. On expense sheets, Vets Transportation will now be called Vets Services, not just transportation. Marketing expenses is all tobacco related, it was billed as marketing or media company. Building repairs are because of shelter. It is an old building. Medical supplies expenses are on track for Narcan and syringes. This year is at 52% and last year it was 55% so we are on track there as well.
Statistics:
Desi Fleming mentioned the switching of some categories that has caused some anomalies. Increase in harm reduction individuals seen was in part because of the bad winter. Also, the syringe services program had just started last year around May so there is going to be a big increase. We are on a plan of declining overdoses. Opioid usage is going down. One of the issues we are now facing is that people who were using opioids are now using meth because they have seen all the media regarding opioids so they think meth is safer. Meth is still a big problem and it is tricky because there is no way to treat or save a person who has an overdose. We need to educate the people on the risks of meth usage. Harm Reduction/Syringe Services will help decrease the hepatitis and HIV explosion that other areas have faced. We ideally want to see Narcan usage drop. Chelsey Matter mentioned she would like to see a better way to track usage and treatment.
Update on PHAB process:
Desi Fleming presented in Justin Bohrer’s absence. PHAB accreditation is being worked on until the end of November. Justin Bohrer is doing the Community Health Needs Assessment (CHA). It is a snapshot on the health of our community, needs areas and trends. They have met with Clay County, Sanford, and Essentia. CHA and CHIP work together to make some priorities for FCPH and our community. We have been working on our workforce development plan, which shows what our training needs are, and what are the succession plans for people retiring. We send these performance management plans and strategic plans to the Board of Health to get some feedback and input. Desi Fleming will be attending a meeting Monday in Detroit Lakes at Essentia to discuss population-based software that may help identify population based health issues. It may be a regional tool not just for Minnesota.
Update on Server Training, Alcohol Compliance, E-Cig legislations:
Larry Anenson presented. Fargo Cass Public Health has taught server training for 20 years and has served 1000's of individuals. Last year, over 2,200 servers were trained and that number will be surpassed this year, most likely. The class takes approximately two hours. They also need to take refresher classes which can be completed online or in person. Majority of servers like going to live classes. Some of the topics covered during the class include how to serve alcohol responsibly, fake IDs, legal liabilities, and much more. There are usually four to five classes a month. It is busier in May and June, which is liquor license renewal time. Some businesses have taken advantage of the fact that FCPH will go and do training on site. Class participants complete an evaluation so we can get feedback for continuous improvement. We take feedback seriously and what the participants are saying. If we receive negative evaluations, we address those areas and make changes if needed. 96% of participants say that the content of the class was about right; some of the scores for other areas covered were 96% positive for minor alcohol, 94.8% for ID checking, and 97% for how to intervene with intoxicated persons. Some of the comments: "course was helpful, strongly recommend, instructor was engaging, eye opening, and information". Initial class has to be taught by Fargo Police Officer, which helps them to build relationships too. We are getting better at getting servers trained. Talking to the Auditor’s Office about how we get number up with incentives and/or penalties so more servers can be trained. It is not just bars that serve alcohol, its restaurants, hair and nail salons, hotels, etc. The bars actually do fairly well getting their staff trained.
For compliance checks, we work with Fargo PD and minors that FCPH provides who are 18 to 20 years of age. We want businesses to pass. We do not try to trick the server. Not a “gotcha” philosophy, we want businesses to pass. We can check up to 4 times a year; however, we have 199 alcohol licenses currently to cover so it is difficult to check them all once not to mention 4 times. As of now, we have checked 62 businesses and have an 89% pass rate. There will be a liquor control board meeting on Wednesday where they will continue to discuss server training. Mike Thorstad feels that enforcement is key and that the noncompliance issue is down to the owners not the servers. They are trying to put teeth into the rules if they are not up to date, such as suspending licenses. The focus should be on the owners and managers because this is not optional; server training is a requirement. Evelyn Telford mentioned that it would be a good motivator if they would be suspended. John Strand said he heard comments that there is a backlog of servers to be trained and there was a discussion of liquor establishments providing their own training. He feels that the Board of Health must show its support to Fargo Cass Public Health and the Fargo Police Department. For a liquor group to teach their class they need to show their curriculum and have it approved by the Fargo PD and FCPH. Larry does not recall any business ever doing it. Larry Anenson stated that we did update our online and live server training class and will start adding afternoon classes, but we do have an issue with the no show rates. It is not uncommon to have a 20-40% no show rate. It may help if they had to pay in advance and if you do not attend, you lose the money so there is some penalty for taking up a spot and not attending the class. Usually, liquor establishments do not want to teach the class. Liquor establishments should not do their own training because of their own conflict of interest. There is definite value in having the staff at Fargo Cass Public Health oversee this process with the Fargo Police Department. Part of the difficulty is also that the servers are very fluid and tend to go from business to business.
Checking rosters from businesses is done once a year. We have been meeting with the City Auditor’s office to see if we could increase that number to quarterly and make managers and owners held more responsible. Managers and owners need to keep their staff up to date. If we can increase the accountability and having consequences for failure to do so may make a difference. The City Attorney is working with FCPH to put more teeth into the ordinance. When a business fails a compliance check, it is a $500 fine for the first penalty (unless the server is compliant with server training). If they fail again it goes up to $750, then $1,000. It must be a random test so businesses do not feel they are being singled out. However, if they have failed we do need to recheck them to see if they are in compliance.
Chris Anderson asked if we could release more of the information to the public about compliance. Lyn Telford asked if the compliance checks improved and Larry said that media was reporting a 49% compliance rate, which Larry does not know where that figure came from, but states we are currently at 88%. An issue that some people may have with the process is having minors participate that are under 21 years of age. If we send in a minor, they are not alone in the bar, officers are with them and if they are served, the police officer immediately takes over. John Strand introduced a resolution formalizing the Board of Health’s support of Fargo Cass Public Health and the Fargo PD’s work with server training.
Motion presented “The Board of Health reaffirms its support of server training classes being offered by Fargo Cass Public Health and the Fargo Police Department.”
Mike seconded and the vote was unanimous in support.
Larry also discussed the new laws for E-cigarettes, better known as vaping or Juuling. Some of the numbers that have come in show that 12.6% of youth are smoking cigarettes and 21% are using e-cigs. More youth are getting citations for tobacco use, which has actually doubled in recent years. Even some youth are admitting that they are addicted to the e-juice. Many people think the e-juice is harmless with no nicotine and is just water vapor. This is not the case, most include nicotine, which is extremely harmful to the adolescent brain, and they have other harmful substances that are being inhaled directly into the lungs. There is a link to e-cigs to switching to tobacco or other drugs. There are cases of poisoning from juice when on skin or eyes. It is illegal for minors to purchase the chemical juice or pods. Fargo Cass Public Health would like to be proactive and in addition, we feel it is important that the owners of these shops are held accountable when they sell to minors. HB 1477 went into effect August 1, 2019, which provides a $500 fine to anyone that sells e-liquid to minors. When this happens, some business fire the employee. We do not want the employees to be fired; we want the employees to be trained. Education and training should occur. As of July 15, 2019 Fargo City Commission is letting Fargo Cass Public Health review the ordinance on e-cigs and update it. We do compliance checks on the vape shops and so far, none have failed. Our Tobacco Coordinators visit with vape shop and retail owners to ask them questions and let them know that we can be a resource for them. Currently, after the first fail, the business would have a probation period of one year, the second time is a three-day suspension, then a 10-day suspension and 30-day suspension. The current fine to the employee can be very difficult, a fine then a potential firing. We would like to see a fine go to business as well, of $500. We cannot do anything about the employee fine because that is state law. We do not want youth using any type of e-juice, whether it has nicotine in it or not, we do not know the long-term effects of this vapor going into the lungs. FCPH’s focus at this time is keeping vaping and tobacco out of the hands of youth. Chris Anderson made the point that the fines for tobacco, tobacco chew and vaping should all be consistent as they are all tobacco products that youth should not be using. Lyn Telford made a motion to support the opinion that businesses will be held liable for a fine if they sell e-juice to a minor. Chris Anderson seconded and it was unanimously approved. Larry Anenson thanked them for their support.
Public Comments:
None
Meeting Adjourned
Next Meeting: October 18, 2019