Board of Health - May 12, 2023 Minutes
Regular Meeting: May 12, 2023
Opening: The regular Meeting of the Board of Health of the City of Fargo, North Dakota, was held in the City Commission Chambers at City Hall at 12:00 o’clock p.m., Friday, May 12, 2023. Chair Lyn Telford presiding.
Present: Jayme Steig, PharmD; Avish Nagpal, MD; Arlette Preston; Kayla Nelson, DNP, APRN, FNP-C; Lyn Telford, MSN, RN, CPHQ; Nyamal Dei, MPH; Bernie Dardis; Tony Grindberg
Absent: Grant Syverson, MD
Others: Tracie Newman, MD, MPH, FAAP, Desi Fleming, Melissa Perala, Jan Eliassen, Chandler Esslinger, Jordan Joshua, Justin Bohrer, Dr. Chris Tiongson
Announcements:
Approval of Agenda: Motion to approve by Ms. Telford, move to approve by Arlette Preston, seconded by Bernie Dardis. All members voted aye, and the motion was declared carried.
Meeting Minutes Approval: From February 10, 2022; motion to approve by Ms. Telford, move to approve by Arlette Preston, seconded by Bernie Dardis. All members voted aye, and the motion was declared carried.
Department Updates: Desi Fleming update: Update on building rehab., everyone is back in their original area we are still missing some things. Emergency Preparedness Response is still located in the PD substation. We need to find space for that division.
Be SMART Curriculum: Dr. Tiongson is a pediatrician in Fargo. Introducing Be SMART which is a talk for parents and adults to reduce gun injuries in children. There are different presentations that are tailored to healthcare professionals, adults, and children, he is going to present a brief one for adults and parents. Be SMART is not about laws and policies, it is about the leading cause of death for children, which is guns. Be SMART is a program to bring together all adults concerned about kids, guns, and safety. This is no different than seatbelts and bike helmets. It is about guns and safety and secure storage. An important part is to share suicide prevention resources, 1-800-273-8255 (National Suicide Prevention Line), 988 (Suicide & Crisis Lifeline), 1-866-488-7386 (Trevor Lifeline-LGBTQIA+ Youth Suicide Prevention line), and you can text “home” to 741-741 at any time for any type of crisis.
Secure - secure all guns in your home and vehicle.
Model - model responsible behavior
Ask - ask about unsecured guns in other homes.
Recognize -recognize the role of guns in suicide.
Tell – tell you peers to be SMART.
Secure: There are 13 million households with at least one child in them in the US have guns in them. In a lot of these homes, children know where the guns are stored. Guns should be inaccessible to children, hiding them is not securing them. Safe storage slide, many affordable options that keep the gun safe from children but allow the gun owner the ability to access the gun quickly for self-defense. Locking up these guns prevents children and others who are at an increased risk of hurting themselves or others. An unsecured gun, increases the risk of more violence-guns can be stolen, used in suicide, or result in unintentional injuries. More than half of all stolen guns are taken from cars. There are gun lockboxes for cars. There are trigger locks, cable locks. Some community organizations can provide you with a cable lock for free. Model: Model responsible behavior. Kids know where parents store their gun. Kids report 1/3 of them have handled the gun in your household, many times without the parent’s knowledge. It is the adult’s responsibility to secure guns. Talk to kids about gun safety as a precaution, but remember it is not a guarantee. Study showed that kids that have attended a weeklong gun safety program are just as likely as children who have not to approach and play with a handgun when they find one. Smart adults make sure that children don’t have access to them. Talk to your children and tell them not to handle or touch a gun and give them the tools to get out of a dangerous situation and to alert an adult. Ask: Ask about unsecured guns in other homes. Make it a part of your general safety conversation you have when you send your child to any home. Email or text the other parents. 4.6 million children lived in a home with at least one loaded unlocked gun. When your child goes to someone else’s house you ask about other things allergies, pools who is supervising children, this is no different. It can feel awkward, but it should be a natural part of protecting your child. They provide slides with text examples of how to approach through a text. Recognize: Recognize the role of guns in suicide. As children get older you may need to change how you they are stored, children become more resourceful. If you have a loved one in distress, remove the gun from your home for a while. Firearm suicide is uniquely successful with 90% of them being lethal. Half of all suicides in the US are gun suicides. 70% of people who attempt suicide will not try again. If you need to remove a gun from your home, gun ranges, police, and family member can assist in keeping the gun. Most people who attempt suicide and don’t use a gun live. Kids only spend 10 minutes or less before attempting suicide. Time and space between the person thinking about it and the means can make a big difference. 20% of high school students had seriously considered suicide within the last year. 41% of adolescents have easy access to a gun in their home. Some signs that you should be aware of prolonged sadness and depression, changes in sleeping patterns (sleeping too little or too much), withdrawing, isolating, aggression, alcohol use, and suicidal ideation. Tell: Tell everyone you know to Be SMART – share this information.
Arlette Preston inquired that during a yearly exam that guns in the home could be addressed. Dr. Tiongson said that pediatric national entities recommend it, but each practice is different whether they follow it or not. Lyn Telford remarked that Be SMART stays away from the legal side of this issue and talks about it being a community approach. It is simple and easily applied. Desi Fleming mentioned that we have been having discussion in the health department, this is a national issue. In our programming we talk about suicide, but we never have gone down the road of talking about storage and safety. Is there a way to incorporate this into our programming. Public Health is looking for feedback from the board, is this important? And should public health be putting it out, how would we do this? Kayla Nelson stated that since guns are the leading cause of death in children, we have a responsibility to do this. Avish Nagpal agrees and feels that highlighting the basic statistics should be a part of the strategy (intentional and non-intentional). Nyamal Dei, thanked Dr. Tiongsin and remarked that it is a crucial issue and with all of these facts and the percentage of suicides, hopes that the community finds a way to talk about gun violence. Regardless of politics, we need to be safe as a community and keep our children safe. Lyn Telford, we have a responsibility to reduce gun injuries and suicides. The community needs to adopt the platform and Public Health utilizing it is a good start. Arlette Preston likes the educational approach. Can we start with city staff and departments, do an internal and external campaign. Tony Grindberg mentioned working with sporting goods stores about providing free locks.
Faces of Suicide Video: Ms. Fleming introduced the video which resulted from a partnership with Fargo Cass Public Health, 463 foundation, and Fargo Police Department. They worked with families who have been touched by suicide and created this video. We had a premiere at Fargo Theatre. City Comms department were instrumental in making this a quality PSA. This went out to all the Fargo Public School. Second leading cause of death, 10–24-year-olds in North Dakota. 75% of all suicide attempts think about it for less than one hour beforehand. Suicide rates are increasing, since 2007 the nationwide rates for 10–24-year-olds has increased by 56%. Please use the 988 national suicide and crisis lifeline and dial 911 in an emergency. Lyn Telford talked about the misconception that talking to your kids about suicide gives them to idea to do it, but that is not true. It is important to discuss so children can process their feelings and understand that they are not alone. Dr. Newman mentioned that they start screening for anxiety and depression at about 12 to 13 years of age.
Credible Mind Update: Justin Bohrer- Credible Mind contract has been signed. FCPH has been meeting with them to customize the website and make it our own. Credible Mind is a website mobile platform to use for mental health assessments, podcasts, information, data, and resources for mental health. Can be used 24 hours a day and 7 days a week so help is always available. You can sign up for an account with is confidential and anonymous. It covers many topics: job burnout, suicide, depression, medical treatments, self-help treatments. There is a lot of information available everywhere on the web, but this information has been vetted and reviewed and found to be credible information. We are hoping to launch mid-summer. The two years of our contract do not start until the site is up. It will have local resources in there so they can reach out for more care if they want. This is for all of Cass County.
Harm Reduction Update: Jan Eliassen presented a quick summary of their activity At the Downtown Engagement Center (DEC) they averaged about 88 visitors a day and saw more than 430 individuals come through the door for various services. They have reduced the hours of the DEC, it was from 8 am to 8 pm but now it is 8 am to 5 pm because of staff shortages. It doesn’t affect the numbers they serve. They have a lot of community-based services in that building, Presentation Partners, Native Inc., Family Healthcare Homeless Healthcare, and numerous others. In addition, they have two new positions: Community Liaison, Chandler Esslinger and Jordan Joshua, Program Operations Manager. Jordan has been working in the Harm Reduction program for about 11 years and was in charge of the Withdrawal Management Unit and Chandler is new hire whose role is evolving fast and hopefully her work will lead to having dedicated resources to deal with shelter overflow. The burden has increased for area shelters. She is also working to bring more wellness activities, cultural activities, and skill building into the DEC. Chandler is also facilitating conversations about adopting a crisis tool that SAMHSA has put out. The entire FM community is dealing with a lack of crisis response, especially when it come to a mental health crisis. We have been trying to find people housing and getting them to the services that they need. The DEC has been operating in its current role since last March/early April because that is when we stopped providing quarantine and isolation services for COVID.
Budget: Melissa Perala reminded everyone that the budget process is now being worked on in April. We have submitted our numbers to them. 22 FTEs to 19 FTEs to move temporary seasonal staff to full time positions. Larger items in the day-to-day expenses are covered mostly by grants.
Our day-to-day operating expenses are increasing by $320,000, also we are asking for an additional $3.00 an hour for our harm reduction advocates. Capital increase includes an upgrade for our environmental health department software. Bottom line for expenses is that we are going for 13.7 million to requesting 16 million for 2024. Pharmacy expense cost is mostly from our substance abuse grant since we provide Naloxone. The Ryan White expense is made up medical, dental, eye exams etc. expenses that those participants incur (this is all covered by a state grant). Most of the grant money is going to cover their other medical costs not their HIV prescriptions. For our revenue, our state aid increased from $564,000 to $881,000. We received funds to have Harm Reduction staff triage those who are leaving the VA, we are being paid $49.32 a day to provide this service. Ms. Fleming interjected that Harm Reduction has grown and we have grant funds to support a lot of it but overall, we get a lot of extra responsibilities without getting the additional funding. To do the harm reduction programs safely we need to figure out the staffing need. We are asking for a bigger budget. We asked for a 2 million dollar increase but we are getting told to decrease it almost in half. So, the challenge is, do we have the program or not? We have to do these programs responsibly so staff is safe but without additional funds it seems we may need to reduce some of these programs. DEC and Withdrawal Management Unit (WMU) has had to cut down on time. We will be at a lower response level because of funding. That results in police, fire and hospitals getting more of the calls. Tony Grindberg wanted to know with grants and city/county funds if we would be good for the year. Ms. Fleming responded that yes, if we received it, we could back to having the DEC open from 8 to 8 and the WMU being open 24 hours. We aren’t guaranteed grant dollars so we ty to not use them in the budget models. We know there is money coming from an opioid settlement, but we don’t know how much, we can’t rely on these, so we can’t promise services and then the grant falls through. Ms. Preston pointed out that Harm Reduction is the biggest bite from our general fund and because of budgeting issues it would be under threat of going away. Health Department is treated differently than other city departments. Others get to monitor their budget as the year goes on and adjust it if the revenue does not come in as projected.
Health Officer Report: Dr. Newman started by discussing the expiring of the public health emergency, both internationally and federally. On 05/05/2023 the WHO declared these three reasons that the global health emergency for COVID-19 was over: COVID-19 is not unusual and unexpected, it does not require a coordinated international response, and cross-border transmission can’t/won’t be stopped. A Public Health Emergency on international concern means that we mobilize international coordination, streamline international funding, and accelerate development of vaccines, therapeutics, diagnostics under emergency use authorization (EUA). On the federal level the public health emergency expired on May 11, 2023, COVID-19 remains a public health priority. Over the past two years, 270 million Americans received at least 1 COVID-19 vaccine. Since Omicron Surge 1/2022 the daily COVID-19 cases are down 92%, deaths have declined 80%, and new hospitalizations are down 80%. What will not be affected, access to COVID-19 vaccines, treatments (Paxlovid), covid products, tests, Medicare, and Medicaid telehealth flexibilities will remain, access to buprenorphine in Opioid Treatment programs, access to expanded methadone take-home tests. They will continue to monitor wastewater and genomic surveillance and emergency room data. What will change: Medicare and Medicaid waivers for health care providers, coverage for COVID-19 testing, change in reporting of COVID-19 lab results and immunization data to CDC, certain FDA COVID-19 related guidance documents will end or be temporarily extended, FDA ability to detect early shortages of critical devices related to COVID-19, PREP Act liability protections, ability of health care providers to dispense controlled substances via telemedicine; anticipate allowance to extend flexibilities. Hospitalization data will remain through April 2024, the death data remains but data source changing, we will no longer see test positivity rates, cases will be dropped, vaccination coverage will be spotty.
You can still receive COVID-19 vaccines by appointment at FCPH by calling 701.241.1383. At home test kits are available at FCPH for pick up from 7:45 am to 4:30 pm (1240 25th St South, Fargo).
Public Comments: None
Adjourn: 1:11 pm
Next Meeting: August 11, 2023