Board of Health - May 10, 2024
Regular Meeting: May 10, 2024
The regular Meeting of the Board of Health of the City of Fargo, North Dakota, was held in person at City Hall Commission Chambers at 12:00 p.m., on Friday May 10, 2024.
The Board members present or absent during roll call were:
Present: Jayme Steig, PharmD; Arlette Preston; Lyn Telford, MSN, RN, CPHQ (Chair); Nyamal Dei, MPH; Bernie Dardis; Grant Syverson, MD; Jim Kapitan
Absent: Avish Nagpal, MD; Kayla Nelson, DNP, APRN, FNP-C
Others: Melissa Perala; Desi Fleming; Dr. Tracie Newman; Christina Cook, MPH (Sanford Hospital); Robyn Litke Sall; Holly Scott
Announcements No announcements.
Approval of Agenda Mr. Dardis moved the agenda for approval and Mr. Steig seconded this motion. This motion was declared carried.
Approval of Meeting minutes Ms. Dei moved the previous meetings’ minutes to be approved and they were seconded by Ms. Preston. This motion was declared carried.
Department Updates
Ms. Fleming provides the Board with updates of the ongoing work within the department. The Emergency Preparedness and Response division has been relocated into a new space at the main public health building, that was previously utilized by the Surveying Department, who has now moved offices back into engineering. This space allows for garage doors and extra storage that is easily accessible. Ms. Fleming also provides an update on the ongoing process of the interview process for the director’s position. Ms. Fleming notes that interviews took place previously in the week and the process is still ongoing. She hopes that an announcement will be made in the next few weeks about where the selection committee is at and moving forward.
Program Update – SUPTRS Grant
Robyn Litke Sall (Prevention Coordinator from the Harm Reduction Division of Fargo Cass Public Health) provided an overview and background of the Substance Use Prevention, Treatment and Recovery Services (SUPTRS) block grant. This grant was awarded with a focus on prevention and promotion on addressing underage drinking. This grant is first awarded to the State of North Dakota Health and Human Services Division from the Substance Abuse and Mental Health Services Administration (SAMHSA), which is a federal level entity. Fargo Cass Public Health is a subgrantee of the State. Funding includes activity-based reimbursement during a 3-year contract period up to $62,500 per year. Ms. Litke Sall continues her presentation by describing how the strategies used for this grant are going to create a healthier community. This grant allows for collaboration and program sharing with other grantees, training and technical assistance, and regional prevention events. Ms. Litke Sall displays the phases of the grant which include assessment, planning, implementation, and evaluation. She notes that we are currently in step 3, implementation of planned strategies. The focus area is underage drinking because of the high retail access and common use of Fake IDs in the area. Ms. Litke Sall notes the 7 strategies for community change include information dissemination, enhancing capacity or skills, providing support, enhancing access/reducing barriers, changing consequences, physical design and environmental changes, and modifying/changing/implementing policies.
Ms. Preston discusses the data of the fake ID trend that has been noticed in various other meetings and questions where the data Ms. Litke Sall is presenting comes from. Ms. Litke Sall notes that there are various data sources she compiled for today.
Ms. Litke Sall continues her presentation by providing an overview of one of the strategies currently being piloted. This strategy is using a forensic ID scanner at retail alcohol establishments to address the intervening variable of high retail access and local condition of large amount of fake ID’s. This scanner provides a 40–50-point security check and has up to 98% efficacy in hopes of deterrence. She notes that 34 scanners are on loan to FCPH from the State and currently are at no cost. Retail alcohol establishments can loan them from FCPH for no charge. She also notes that in North Dakota, establishments are allowed to confiscate fake ID’s.Ms. Litke Sall provides an overview of the IDentiFake ID Scanner (TokenWorks) and shared a video from the company that gives a guide to use of the equipment.
Discussion
Ms. Preston notes the ongoing discussions in other meetings regarding this issue and wonders where the scanners are currently being piloted at. Ms. Litke Sall notes that only 3 are currently implemented within the Fargo area and that areas outside Fargo can be considered but data really exists within the Fargo area. Ms. Preston asks if there is any intent to making this system a requirement. Ms. Litke Sall responds by noting that creating a policy would be best practice to ensure everyone plays by the same rules. Ms. Preston also asks about the costs, which Ms. Litke Sall notes that each scanner costs around $5,300 which could be an expense to a business.
Ms. Telford asks about the locations of these scanners and what type of businesses they are currently located in. Ms. Litke Sall notes the types of establishments which include bars and entertainment venues. Ms. Telford asks about the flexibility of the grant dollars and if the dollars could be used to buy additional scanners.
Ms. Telford asks if law enforcement would have access to the information, which Ms. Litke Sall was unsure about and what the parameters for that would look like since the scanners are owned by the State. Ms. Preston wonders if the city’s law enforcement would have full access to information from the scanners if they were purchased with State funds and what the public information process would be like.
Ms. Telford asks about the results and if there is any data to show the scanners’ efficacy from the current jurisdictions in the State.
Ms. Dei asks about where the assessment research took place and Ms. Litke Sall notes that the research is just for Cass County but other health units who use this grant did similar assessments and jurisdictions can share their research and data. Ms. Dei also asks about where the most underage drinking comes from in the Fargo area. Ms. Litke Sall notes that the college campus may contribute to this problem, but it is not the only source. Ms. Dei also asks if other retailers are aware of this machine and why businesses might not consider using this device. Ms. Litke Sall notes that working with the City Auditor, specific locations were considered because of previous violations and contacted because of that. Some businesses refused because of privacy concerns.
Mr. Syverson asks about the information for retailers and what the consent process would be like for customers who might use this device. Ms. Litke Sall responds by noting that the State would have an answer for this as they have investigated the laws for this.
Ms. Preston asks about the plan for evaluating the success of the pilot program. Ms. Litke Sall notes that retailers are responsible for signing a user agreement which includes at least a monthly survey that reports all the results from the scanner. The State will receive this information since they own the machines, and the reporting is ongoing and required.
Ms. Preston notes the difficulty in evaluating the results since this process is not a requirement of establishments, Ms. Litke Sall does note that feedback has been received and the establishments have noted confiscation of fake ID’s that have been scanned. Ms. Telford discusses that these machines may allow businesses to protect themselves should there be any problems.
Mr. Dardis asks about the marketing of these machines and what the outreach to the public has been. Ms. Litke Sall notes that it’s only been a handful of calls to businesses, and one reached out. Mr. Dardis asks about when the scanners were received and what the loaning process is like. Ms. Litke Sall notes that the scanners were received in March of this year and there is a possibility that the scanners, which depreciate after 5 years, will be loaned for that time from the State and then we will assume the property of the scanners since they will no longer be of value. Mr. Dardis asks about the number of liquor licenses in Cass County and Ms. Litke Sall notes that in Fargo alone there are over 200 licenses.
Mr. Kapitan asks about Fake ID confiscation and what that process looks like. Ms. Litke Sall notes that the law in North Dakota allows liquor licenses to confiscate fake ID’s, but they must notify law enforcement for them to pick up. She also notes that there is follow-up and occasionally consequences to those in possession of fake ID’s, but Ms. Preston notes that follow-up is rare unless it was alongside another more serious crime. Ms. Preston notes the discussion from another meeting with the Police Chief and how law enforcement deals with fake ID’s and the challenges to track and identify the suppliers.
Mr. Dardis asks if Clay County uses any similar process. Ms. Litke Sall notes that she is unaware of anything of the like.
Ms. Telford asks about if there is a strategy to utilize all the grant funds and if they can be used for other subject areas such as adult binge drinking. Ms. Litke Sall notes there is some flexibility to tie in other topic areas, but the current data focuses on underage drinking since it would be more addressable.
Mr. Dardis notes the utilization of these machines by some entities, others may become aware and avoid these establishments, hence the need for a blanket of these machines and processes.
Ms. Telford asks about incentivization if a business were to use these processes. Ms. Litke Sall notes several ideas that have been discussed during this process, which include changing ordinance to allow establishments who have received a fine for failing a compliance check to take on these machines instead of paying the fine.
Mr. Syverson asks about troubleshooting and technical assistance for the software and hardware of these machines. Ms. Litke Sall responds by noting that training has been given and there is assistance from the state who has also been trained, additionally the free support from the company online and by phone.
Mr. Dardis asks about working with law enforcement from various levels and the importance of their input. Ms. Litke Sall notes that the County Sheriff’s Office has used these for events, like the Red River Valley Fair.
Ms. Preston notes the concerns about fake ID’s adapting to these machines and the need for updated machines. Ms. Litke Sall notes the software can be updated while connected to an internet source and the company does provide various updates to their system.
Colorectal Cancer Prevention Strategies
Christina Cook, MPH (Quality Improvement Advisor from Sanford Hospital) presents a data and strategy review related to Colorectal Cancer and prevention of the disease.
Ms. Cook’s presentation begins with a public health perspective of a review of the data and risk factors for colorectal cancer. Ms. Cook showcases various national statistics as well as specific data and risk factors in North Dakota. Ms. Cook provides information about screening guidelines and recommendations for various population groups for screenings. Screening options and methods are also discussed during this time of the presentation, and each is described in detail by Ms. Cook.
Ms. Cook continues her presentation by describing some of the barriers to getting screenings that people have experienced and how it can vary depending on the person. Ms. Cook also notes the next steps that the partners around the state are partaking in, which include a coalition and other community partnerships to identify screening needs and raise awareness.
Discussion
Mr. Dardis asks about access and the length of time it takes to receive a colonoscopy. It is noted by Ms. Telford that based on the provider level, there may not be enough providers in the area who are able to perform colonoscopies. Plus, according to Ms. Telford, some providers do not recommend newer tests. Ms. Cook agrees that it is challenging in the area for wait time for screenings.
Mr. Steig notes the importance of various options for stool screening and opportunities to raise awareness about these options could be beneficial, plus the changes in recommended ages for screening can also be a way to raise awareness for screening.
Mr. Syverson notes that certain age ranges might not go to the doctor as often as other age groups, which may play a role in the lack of screening among certain age groups.
Budget 2025
Ms. Fleming introduces the budget discussion by reviewing where the health department currently is tracking in the overall budget process for the City, which is still ongoing. It is noted that the health department has made 2 human capital requests for additional Harm Reduction Division positions, a request to hire an Assistant Director position to begin mid-year and make some temporary Harm Reduction Division appointments permanent and funding to continue the neighborhood response team with local funding (versus federal), plus reclassing on various positions. Ms. Fleming notes that the total request is around $300,000.00 of this amount $175,000 is in human capital requests. Ms. Fleming continues the discussion by noting the Correctional Health Nursing division is shifting to be a part of the county, which includes 8 nursing positions. Ms. Fleming also notes that statewide local public health is generally asking for an increase in state aid to allow for flexible funding. Other important changes as noted by Ms. Perala include increasing in grant funding that is expected to be ongoing, reallocating funding as based on recommendations from the finance committee and moving donations to the harm reduction program to a special revenue fund rather than general fund.
Mr. Dardis asks how many full and part-time employees are currently in the department and Ms. Perala notes that there are about 120 full-time employees and about 40-50 part-time/temporary employees currently or 170 employees in total. Mr. Dardis also asks about the revenue within the budget and which number of employees are strictly supported by grants and if that makes those positions vulnerable. Ms. Perala notes that grants cover about 20% of the total budget and some of them cover staff time and some grants are activity based.
Ms. Preston asks about the decrease in revenue from Cass County Jail and Ms. Perala notes that this has not been shown on the budget side yet.
Ms. Perala continues her presentation by showcasing where items have changes across various items by each division. Ms. Perala also shows the revenue numbers spreadsheet.
Health Officer Update/Presentation and Spring Social Updates
Ms. Fleming briefly provides an overview of the department’s recent open house, which was held at the end of April. It is noted by Ms. Fleming that North Dakota Public Health Association (NDPHA) provided funding that allowed the department to host the event to advocate and raise awareness for public health and showcase the department’s services.
Dr. Newman continues by providing the Board with a presentation titled, “The Importance of Local Public Health”, which was presented during the open house. This presentation focuses on what public health is and how much of an important collaborative effort the field of local public health is. Dr. Newman notes how during the open house, each division highlighted their services which focus on the essence of public health. Dr. Newman continues her presentation by overviewing the basics of public health and how it differs from the clinical field, plus the upstream-downstream public health parable. Dr. Newman highlights the main focuses of public health, including protecting, promoting and prevention. Dr. Newman completes her presentation by showcasing ways to support local public health which include staying informed, advocating for policies and funding, supporting local health clinics, promoting preventative measures and much more.
Mr. Steig and Ms. Dei show their appreciation for hosting the spring social. Ms. Telford shows her appreciation for the work being done for the Board. Dr. Newman closes out her presentation by sharing a happy retirement message to the director, Ms. Fleming and the board also shares their appreciation.
Public Comments: None
Next Meeting: 9/20/2024
Adjourn : 1:26 pm