STATE OF NORTH CAROLINA                                                           )                        OFFICE OF THE COMMISSIONERS

                                                                                                                )                        STOKES COUNTY GOVERNMENT

COUNTY OF STOKES                                                                          )                        DANBURY, NORTH CAROLINA

                                                                                                                )                        MARCH 15, 2004



The Board of Commissioners of the County of Stokes, State of North Carolina, met  in special session in the Council Chambers of the Administrative Building, located in Danbury, North Carolina, on Monday, March 15, 2004, at 7:00 pm for a Joint Meeting with the Stokes

County Board of Health.  The following were in attendance:


                                                Stokes County Board of Commissioners

                                                Chairman Sandy McHugh

                                                Commissioner Howard Mabe

                                                Commissioner Leon Inman

                                                Commissioner Joe Turpin

                                                Vice-Chairman John Turpin (absent)


                                                County Manager Richard Morris

                                                County Attorney Jonathan Jordan

                                                Darlene Bullins, Clerk to the Board


                                                Stokes County Board of Health

                                                Chairman Dr. Nick Chalfa

                                                Vice Chairman Dr. Sam Simmons 

Dr. Debbie Cowan

                                                Greg Collins

                                                Keith Lawson                      

                                                Barbara Watkins

                                                Brenda Hall                         


                                                Health Director Steve Smith

                                                Wanda Hicks, Office Support IV


Chairman McHugh called the meeting to order and welcomed the Board of Health members in attendance.


Greg Collins, Health Board member, delivered the invocation.




Chairman McHugh opened the meeting by inviting the citizens in attendance to join the Board with the Pledge of Allegiance.


Purpose of Meeting


The meeting targeted toward a consensus on the scope of public health programs in Stokes County and discussions involving the direction of health care for Stokes County.


Director Steve Smith prepared booklets with backup information for each member in attendance with the following inserts for future reference:


County Health Report


Program Worksheets and Charts

Salary Allocation

Environmental Health F/Y 04/05

State Contracts



County Health Report Card


Health Director Steve Smith briefed those in attendance on the 2002-03 Public Health Report Card.  Director Smith noted that this report highlights areas of concern and areas of strength for Stokes County in terms of public health indicators.  Director Smith briefed the members in attendance in the following priority health concerns for Stokes County:


·          heart disease/stroke

·          suicide

·          pneumonia/flu

·          overweight/obesity

·          smoking during pregnancy

·          health care access. 


Director Smith included graphs detailing the following: 

·          overview of health data

·          progress and accomplishments 2002-03

·          emerging issues

·          other changes affecting health in Stokes County


Commissioner Joe Turpin noted the major issue of transportation for access to health services in the County.


Director Smith led the discussion in the following areas:


State Contracts

  Agreements signed by Director Smith on behalf of the Health Department.


Program Reviews

  Environmental Health – Being separated as a separate department in the upcoming fiscal year 2004/05 budget. 

   Mostly local funding.

   Discussion of services provided by Environmental Health Staff.

  Home Health – Established in 1978.  Successful track record generating $80 to $90 thousand range of revenue.  Great source for rural


   Good response from clients receiving services from Home Health.  No local funding, self supporting.

   Discussion of home health services in Stokes County.

   Adult Health Care – Began in 98/99 fiscal year.  Upcoming fiscal year will cease services in the King Clinic.  Sliding scale for payment. 

   Discussion of set fees for services to be considered by the Board of Health, better process of income screening.

   Discussion of poverty level.   Services to help clients with no insurance with prescription services.

   Breast, Cervical, Cancer, Control Program – Contracted with Novant Health to provide screenings such as mammogram, etc.


Discussion of immunizations given at the Health Department


Discussion of obtaining physicians for Stokes County

    Dr. Nick Chalfa noted the problems with family practice physicians starting a practice with high mal-practice insurance cost, cost of setting up a

    practice, etc.  Hospitals are buying out family practices in order to get referrals.


Discussion of preventive care provided by the Health Department.


Chairman McHugh requested an outline of services mandated, non-mandated but ensured services are available within the County.


Mandated Services:

 Communicable Disease

 Environmental Health-Food and Lodging



Not mandated, but high priority

Home Health


Can be provided by Health Department or ensure the provision of service to the citizens.

Adult Care


Child Health

Child Service Coordinator

Family Planning


Health Promotion

Maternal Health

Prenatal Care



Director Smith noted that several of the above services would have difficulties in obtaining private sector providers.


Discussion of Family Planning specifications, guidelines, and services being provided by outside providers.


Discussion of General Statutes as relates to the Health Department.


Discussion of services provided by the Health Department versus what can be provided by the private sector.


Discussion of WIC Program.

Provides income for local grocery stores. 

Commissioner Joe Turpin questioned the advertisement of  “Free” WIC Services in local papers. 

Janelle Kent, Nutritionist-Health Department, stated that the advertisement to offer services is mandated by the Federal Government.

Commissioner Joe Turpin suggested the possibility including a disclaimer stating advertisement is mandated by the Federal Government.


Discussion of Community Health Center for the future.


Discussion of Health Department Salary allocation as related to the Stokes County Budget.


Discussion of revenue charts provided by Director Smith.


Discussion of better software to enhance the State System in order to retrieve refined data for specific programs, gender, age, etc.


Discussion of State mandated programs included in the State Administrative Code.


Discussion of drafting a flat rate fee for services.

The Board of Health has already approved the concept, currently drafting procedures to implement the fee.


Discussion of responsibilities concerning Health services for the citizens of Stokes County.


Chairman McHugh entertained open discussion from members in attendance concerning the following:


                Educating the public concerning criteria of public health programs

                Educating the public via web page

                Possible Retreat for Board of Health members-road map for the future

                Customer service-Environmental Health

                Communicable Disease – need for more emphasis

                Addressing the need for Dentistry for citizens

                Preventive Health Care to help reduce cost

                Impact of local funding

                Joint meeting – a start for the future needs of Health Care for the future               

                Moral and ethical obligation to provide health care to those in needs

                Need for qualified physicians in the rural areas


Dr. Chalfa thanked those in attendance.


Chairman McHugh thanked those in attendance for taking the time to start the dialogue of getting items on the table and starting the challenge to make those items work.



There being no further discussion, Commissioner Inman moved to adjourn the joint  meeting. 


Commissioner Joe Turpin seconded and the motion carried unanimously.



_________________________                                  _____________________________

Darlene Bullins                                                                Sandy McHugh

Clerk to the Board                                                          Chairman