1 of 3 www.wakegov.com Wake County Human Services Board June 27, 2013 AGENDA Human Services Center 220 Swinburne St, 2nd Fl., Rm. 2132 Standing Time: 7:30AM – 10:00AM Pablo Escobar, Chair Leila Goodwin, Vice Chair Purpose: Advocacy, Policy, Advisory, Accountability 7:30 am Meeting Called to Order Reflections Approval of Minutes: May 23, 2013 Next Board Meeting: July 25, 2013, 220 Swinburne St., 2nd Fl., Rm. 2132 Note: August 22 HS Board Meeting will be held at the Northern Regional Center, 350 E. Holding Avenue, Wake Forest Regular Agenda 7:35 am Review & Approve Updated Wake County Human Services Department and Environmental Services Department Rules of Appeal (Accreditation #35.1a) 7:45 am Remarks to the Board - Ms. Octavia Rainey 7:50 am HS Board Appeal Hearing Panel Recommendation and Oral Arguments to Appeal of Dangerous Dog Determination - Mr. Ken Murphy, Assistant County Attorney (HS Bd. Panel Members: Frank Eagles, Sharon Foster, Tameko Piggee) • Oral Arguments - Attorneys Mr. Allen Swaim, Mr. Andre McDavid, and Ms. Calley Gerber on behalf of the appellant, Mr.
Next Board Meeting: July 25, 2013, 220 Swinburne St., 2nd Fl., Rm. 2132 Note: August 22 HS Board Meeting will be held at the Northern Regional Center, 350 E. Holding Avenue, Wake Forest
Regular Agenda
7:35 am Review & Approve Updated Wake County Human Services Department and Environmental Services Department Rules of Appeal (Accreditation #35.1a)
7:45 am Remarks to the Board - Ms. Octavia Rainey
7:50 am HS Board Appeal Hearing Panel Recommendation and Oral Arguments to Appeal of Dangerous Dog Determination - Mr. Ken Murphy, Assistant County Attorney (HS Bd. Panel Members: Frank Eagles, Sharon Foster, Tameko Piggee) • Oral Arguments - Attorneys Mr. Allen Swaim, Mr. Andre
McDavid, and Ms. Calley Gerber on behalf of the appellant, Mr.
Cory Burns; and Dr. Jennifer Federico and Ms. Karen Rogers, on behalf of Wake County Environmental Services/Animal Center.
8:50 am Social Services Committee: Ms. Angie Welsh, Chair • Child Fatality Task Force Report - Dr. Warren Ludwig / Ms. Lisa
Cauley Purpose: Inform the HS Board about the causes of childhood mortality in Wake County
9:00 am Report on Enacted Laws Impacting Human Services and Board Advocacy - Mr. Ramon Rojano
9:10 am Budget Updates: • Update on Approved County FY'14 Budget - Mr. Paul Gross &
Mr. Joseph Threadcraft • Public Health Ten Essential Services Tied to the Budget
(Accreditation #39.2) - Ms. Sue Ledford
9:25 am Preparation on Board Advocacy Presentation to County Commissioners (Identify Board Advocacy Ad Hoc Group) - Chair Pablo Escobar
9:35 am Follow up on the Board's Input into the HS Director's Annual Evaluation (Accreditation #37.5) - Chair Pablo Escobar and Vice Chair Leila Goodwin
9:40 am Board Committee Chairs' Reports on Committee Work Plan & Priorities Process
• Dr. Sharon Foster, Chair, Public Health Committee • Ms. Angie Welsh, Chair, Social Services Committee
9:50 am Board Participation in Community Events (sharing session)
9:55 am Staff Changes - Chair Escobar, Mr. Rojano, Ms. Petteway
10:00 am Adjournment
Information Packet Items
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Next HS Board Appeal Hearing Panel Members: Leila Goodwin Rosaline Saunders Paul Scruggs James Smith (alternate)
Human Services Mission Statement Wake County Human Services in partnership with the community will anticipate and respond to the public health, behavioral health and the economic and social needs of Wake County residents. We will coordinate and sustain efforts that assure safety, equity, access and well-being for all. - December 2006 _____________________________________________________________________________
Environmental Services Mission Statement
To protect and improve the quality of Wake County’s environmental and ensure a healthy future for its citizens through cooperation, education, management and enforcement. Environmental Services combines:
• water quality • air quality • solid waste (recycling, landfills, etc.) • environmental health and safety (sanitation inspections, pest management,
swimming pool regulations, animal control) ________________________________________________________________
FY 2011 Board’s Top Six Priorities: #1 Prevent Child Abuse and Support Families #2 Housing for Vulnerable Populations #3 Obesity Prevention and Nutrition #4 Access to Mental and Physical Health Services #5 Protect Wake County’s Water Resources #6 Human Capital Development (added 10/28/10)
Assignments to Committees
As of March 2013
Social Services
Monthly 1st Friday, 9am – 10:30am
220 Swinburne Street
Rm. 5032
Public Health Monthly
3rd Friday, 8am – 10am
Duke Raleigh Hospital Cardinal
Conf. Rm. 1st Fl.
Angie Welsh
Pablo Escobar
John Myhre
Tameko Piggee
Rosine Sanders
Jacqueline Tavárez
McKinley Wooten, Jr.
Staff:
Ingrid Bou-Saada Martha Crowley
Janny Flynt
Vielka Gabriel
Giang Le
Warren Ludwig
Nikki Lyons
Liz Scott
Community:
Kim Best
Dudley Flood
Kathryn Johnson
Marjorie Menestres
Lorrinda Michieka
Paul Norman
Lynn Templeton
Anna Troutman
James Williams
Sharon Foster
Leila Goodwin
Fiorella Horna-guerra
Margaret Raynor
Paul Scruggs
James Smith
Seth Wexler
Staff:
Michelle Ricci
Sue Lynn Ledford
Brent Myers, EMS
Regina Petteway
Andre Pierce
Joseph Threadcraft
Yvonne Torres
Community:
Kevin Cain
Barbara A. Hughes
Anne McLaurin
Leena Mehta
Benny Ridout
Ann Rollins
Lynette Tolson
Sherée Vodicka
Penny Washington
Assignments to Administrative Committees:
1. Julian Smith, Human Rights/Consumer Affairs Committee (meets Quarterly)
2. Frank Eagles, Regional Networks Committee (meets as needed)
3. Stephanie Treadway, Housing Committee (meets as needed)
Stephanie Treadway, Liaison to Alliance Behavioral Healthcare
Wake County Human Services Wake County Environmental Services
Rules Of Appeal [Board Procedure 300 2.0]
Countywide or X
Department: Human Services & Environmental Services
Division: Public Health/Environmental Health
Supersedes: Wake County Human Services, Department of Environmental Services Rules of Appeals dated 03/28/2002 Effective Date: 8/25/2011
Authority: North Carolina General Statute (NCGS) 130A-24(b),(c),(d) and (e)
Originating Department: Human Services & Environmental Services
Page 1 of 5 Printed copies of this document may not be current
I. Purpose: To provide a single Wake County Human Services and Environmental Services Board
appeals process that applies to all functions under the purview of the Board. This procedure specifies how any aggrieved person may request an appeal hearing to contest a decision or ruling of the Director or his designee, or his Delegate regarding the interpretation and enforcement of State or Wake County health regulations, rules adopted by the Board, or the imposition of administrative penalties.
II. Procedure Statement:
1. Hearing Request: Any aggrieved person may request an appeal hearing under these rules to contest a decision or ruling of the Director or his Delegate regarding the interpretation and enforcement of State health regulations; rules adopted by the Board; or the imposition of administrative penalties if:
a. The request is submitted in writing to the Director within thirty (30) days following receipt of the decision or ruling; and
b. The notice contains the following information: i. The name and mailing address of the Appellant;
ii. A description of the challenged decision or ruling; and iii. A statement of why the decision or ruling is incorrect.
c. The Director shall, within seven (7) working days after receipt of the notice of appeal, transmit to the Hearing Panel the notice of appeal and all papers and materials upon which the challenged decision or ruling was based.
2. Notice of Hearing:
a. The Hearing Panel shall schedule and hold a hearing within fifteen (15) days following receipt of the notice of appeal from the Director. The Board shall issue notice to Appellant of the date, time, and place of the hearing not less than seven (7) days prior. If notice is sent by United States Mail, the Hearing Panel shall mail the notice not less than ten (10) days prior to the hearing.
b. The Appellant may waive notice by supplying the Board with a written statement signed by the Appellant to that effect.
Human Services/Environmental Services Rules of Appeal HS Procedure XXX ###
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3. Continuance, Waiver of Hearing: a. The Appellant may, for good cause, request a continuance of the hearing. The
Panel shall determine if a continuance should be granted, and shall inform the Appellant of its decision at least one day prior to the scheduled hearing.
b. An Appellant waives his right to a hearing if: i. He fails to file a notice of appeal with the Director within thirty (30) days of
the decision or ruling; ii. He fails to attend a scheduled hearing after sufficient notice; or
iii. He submits a written waiver to the Panel of his right to a hearing.
4. Filing of Written Answer: The Appellant who has been served with notice of a hearing may file a written response. Said response shall not be included in the record of the hearing unless served upon the Panel, through the Director, at least three (3) working days before the hearing.
5. Discovery: Pre-hearing discovery shall not be available to any party.
6. Pre-hearing Conference:
a. Prior to appearing before the Hearing Panel, the appellant shall appear at an informal pre-hearing conference. The conference shall be held and directed by the Environmental Services Director or his designee or by the Human Services Division Director for Public Health or her designee.
b. The persons attending the conference will: i. Simplify issues;
ii. Stipulate facts or findings; iii. Identify areas where evidence will be needed; iv. Discuss the needs for consolidation of cases or joint hearings; and v. Consider any other means to expedite disposition.
7. Disqualification of Panel Members: If any Panel member cannot attend the hearing or
feels they cannot conduct a fair and impartial hearing in a particular case, or any Appellant objects to a member of the Panel, and files a written objection at least two (2) working days before the hearing date, the Board shall appoint a substitute member to the Panel to conduct the hearing.
8. Oath: No person may testify or present any evidence, oral or written, to be admitted into
the record without first being put under oath or affirmation. The Panel, its Clerk, or its attorney shall have the power to administer oaths or affirmations.
9. Conduct of Hearing: The Panel shall have complete control in conducting the hearing,
including: a. The responsibility of preparing a complete record of all testimony and exhibits
presented at the hearing. b. The order of the calling of witnesses or the prosecution of evidence.
Human Services/Environmental Services Rules of Appeal HS Procedure XXX ###
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c. Excluding irrelevant, immaterial, repetitious or redundant testimony or evidence. c.d. The responsibility of determining the adequacy of the room in which the hearing
is held for the safety of the Panel and of those persons involved in the hearing or observing the hearing. The room shall be large enough to ensure a safe environment and a setting conducive for the rendering of an impartial decision by the Panel. Security shall be provided by Wake County as reasonably requested by the Chairperson of the Panel, by a majority of the Panel, or as deemed appropriate in the discretion of the Panel’s attorney.
10. Evidence at Hearing: The rules of evidence as applied in general courts of justice shall not
apply at the hearing. Any competent evidence, relevant to the decision or ruling in the case shall be admissible in the record. The Panel may restrict or exclude unduly repetitious or redundant testimony or exhibits.
11. Counsel: Appellant may have an attorney to present the case before the Panel. A
representative of the County Attorney’s Office may be present to assist procedurally, and to assist in the development of evidentiary aspects of the hearing.
12. Recommendation of the Panel: After all competent testimony has been heard and all
evidence presented to the Panel, the Panel shall deliberate in open session and: a. Assimilate and review all evidence presented, and, based on clear and convincing
evidence, render a decision by majority vote; b. Prepare proposed findings of fact and conclusions of law, based on the evidence
presented; c. Prepare recommendations to the full Board to either affirm, modify, or reverse the
decision or ruling of the Director or Delegate on appeal; d. Promptly transmit copies of the findings of fact, conclusions of law and
recommendations (the record) to the Board and to Appellant; and e. Transmit a copy of the record and all exhibits of the hearing to the Board if either
party pursues further appeal.
13. Objection. Oral Argument before the Board: a. The Appellant shall have ten (10) days from receipt of the Panel’s recommendation
to file objections with the Board. Objections must be made in writing and actually received by the Director within the ten (10) day limitation.
b. The Appellant may request the right to present oral argument to the full Board. Such request must be made along with the objections described in subsections (a) above.
c. Upon receipt of an objection and request for oral argument, the Board shall schedule a time and date. The Board shall notify Appellant of the date, time, and place of the argument at least ten (10) days prior to the scheduled date.
d. In presenting oral arguments to the Board, no new evidence shall be allowed. The record below shall be the only evidence considered, and new evidence or written argument shall not be received. Oral argument is limited to twenty (20) minutes
Human Services/Environmental Services Rules of Appeal HS Procedure XXX ###
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per side. The Board shall decide by simple majority vote based on a reasonableness standard, whether or not the recommendations of the Hearing Panel should be adopted, reversed, or modified.
14. Decision:
a. After review of the record and any oral argument presented to the Board, the Board shall issue a binding written decision adopting, modifying or reversing the proposal of the Panel. The Board shall notify all parties of its decision. The decision shall contain a concise statement of the reasons for the decision.
b. Appeal from the Board’s decision may be pursued under N.C.G.S. 130A-24(d), as amended.
15. Record: The official record of contested case hearings shall be maintained by the Hearing
Office. Any person who wishes to examine the record shall submit a written request to the Hearing Office in sufficient time to allow the record to be prepared for inspection and all material properly held confidential to be deleted. The Hearing Office shall maintain the record for a period of sixty (60) days following the decision of the Board. If an Appellant appeals the Board’s decision to the District Court pursuant to N.C.G.S. 130A-24(d), the Appellant is responsible for notifying the Hearing Office to maintain the record and all exhibits of the hearing for transmittal to the District Court.
16. Transcript: Any person who desires a transcript of a hearing or part of a hearing shall
contact the Hearing Office, which shall require fees to be paid in advance of providing the transcript. The Hearing Office shall delete from the transcript all materials properly held confidential.
III. Definitions: For the purposes of these rules, these terms have the following meanings:
1. Appellant: Any aggrieved person appealing under this Section a decision or ruling of the Wake County Human Services director or his Delegate regarding the interpretation and enforcement of State health regulations; rules adopted by the Board; or the imposition of administrative penalties.
2. Board: The Wake County Human Services Board. 3. Delegate: A staff member acting on behalf of the Human Services Director with the
authority to issue decisions regarding the interpretation and enforcement of State health regulations; rules adopted by the Board; or the imposition of administrative penalties.
3.4. Designee: A staff member exercising the actual authority of a Delegate as directed by the Delegate.
4.5. Director: The Wake County Human Services Director. 5.6. Hearing: An appeal hearing as provided for by NCGS 130A-24(b),(c),(d) and (e). 6.7. Hearing Office: The hearing may be scheduled at a Wake County Government location
convenient to the parties. However, if not otherwise specified, the location will be:
Wake County Human Services Center 220 Swinburne Street
Formatted: Underline
Formatted: No underline
Human Services/Environmental Services Rules of Appeal HS Procedure XXX ###
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Raleigh, NC 27620 Phone: 919-212-7000
7.8. Hearing Panel: A panel consisting of three members of the Wake County Human Services Board. The panel has the authority to conduct hearings under these rules.
IV. Applicability and Exceptions: This procedure applies to all parties subject to decisions, rulings,
or administrative actions of the Director relating to State or Wake County health regulations administered by the Human Services or Environmental Services Departments.
V. Procedure Responsibility and Management:
• The Environmental Services Director or the Human Services Division Director for Public Health, or their delegates, shall review this procedure at least every two years to ensure currency.
• Employees who make decisions that are subject to these appeal procedures will be trained on the appeals process during their new employee orientation.
• Approved protocol will be located on the departmental shared network drive.
VI. Related Publications: N/A VII. Appendices: N/A
VIII. History: Replaces Rules of Appeal approved on March 28, 2002.
Effective Date Version Section(s) Revised Author
8/25/2011 1 n/a Scott Warren, Matt Roylance,
Sue Lynn Ledford 5/23/2013 reviewed 6/27/2013 2
Section I, Section II.6.a & 12, Section V. Added: Section II.9d, Section III.4.
Scott Warren & Ken Murphy. Reviewed by Sue Ledford and Joseph Threadcraft
WAKE COUNTY HUMAN SERVICES BOARD
AGENDA ITEM SUMMARY SHEET
Agenda Date: June 27, 2013
Committee/Item: Full WCHS Board’s consideration of the WCHS Board Appeal Panel’s
recommendation to uphold Wake County Environmental Services/Animal Center’s designation
of “Marco” (ID # 85709) as a Dangerous Dog, pursuant to the Wake County Human Services
Rules of Appeal
Specific Action Requested: (1) For the full WCHS Board to consider the recommendation of
the WCHS Board Appeal Panel to uphold Wake County Environmental Services/Animal
Center’s designation of “Marco” (ID # 85709) as a Dangerous Dog; (2) For the full WCHS
Board to hear oral argument from “Marco’s” owner’s attorneys on their objections to the WCHS
Board Appeal Panel’s recommendation (if such objections are timely filed); and (3) For the full
WCHS Board to vote on whether to adopt, reverse, or modify the WCHS Board Appeal Panel’s
recommendation.
The Board’s Role:
The full WCHS Board’s role in this item is to determine whether the Appeal Panel followed the
proper procedure in making its recommendation that the full WCHS Board uphold Wake County
Environmental Services/Animal Center’s designation of “Marco” (ID # 85709) as a Dangerous
Dog. No new evidence will be allowed. The full WCHS Board will decide, by a simple
majority vote based on a reasonableness standard, whether the recommendation of the Hearing
Panel should be adopted, reversed, or modified.
\
Item Summary: Pursuant to the Wake County Human Services Board Rules of Appeal, the
WCHS Board Appeal Panel [comprised of Mr. Frank Eagles, Dr. Sharon Foster, and Ms.
Tameko Piggee] held an appeal hearing on May 22, 2013 on an appeal by Mr. Cory Burns of
Wake County Environmental Services/Animal Center’s designation of Mr. Burns’ dog, “Marco”,
as a Dangerous Dog. The Appeal Panel unanimously voted to recommend to the Full Board that
the Dangerous Dog designation be upheld. Pursuant to the Wake County Human Services Board
Rules of Appeal, the Appeal Panel’s recommendation is now before the full WCHS Board for
the full Board’s consideration. Pursuant to the Wake County Human Services Board Rules of
Appeal, Mr. Burns’ attorneys may file written objections to the to the WCHS Board Appeal
Panel’s recommendation, and if they do so, the attorneys may present oral argument (not to
exceed 20 minutes total) to the full WCHS Board as to why they believe the full WCHS Board
should reverse or modify the Appeal Panel’s recommendation. If such objections are filed, a
representative of Wake County Environmental Services/Animal Center may likewise present oral
argument (not to exceed 20 minutes) to the full WCHS Board as to why the full WCHS Board
should adopt the Appeal Panel’s recommendation.
Purpose for Action: Compliance with the Wake County Human Services Board Rules of
Appeal
Next Steps: The WCHS Board Chair will sign a written order containing the full WCHS
Board’s findings and conclusions in support of the full WCHS Board’s decision to adopt,
reverse, or modify the Appeal Panel’s recommendation.
Opportunities for Advocacy, Policy or Advisory:
Connections to Other Committees:
WAKE COUNTY HUMAN SERVICES BOARD
AGENDA ITEM
Agenda Date: June 7, 2013 – Social Services Committee
June 21, 2013 – Public Health Committee
June 27, 2013 – Human Service Board Meeting
July 1, 2013 – County Commissioners Agenda
Committee/Item: Social Services Committee
Specific Action Requested: Wake County’s Child Fatality Task Force/County Child Protection Team
(CFTF/CCPT) is required to provide annual reports of activities to the Wake County Board of
Commissioners.
Item Summary: Wake County’s CFPT/CCPT performs regular confidential reviews of representative
deaths of infants and children age 17 or less seeking systematic causes or conditions that might be
preventable and suggesting public policy and programmatic solutions.
This 2012 report reflects infant mortality rates and child mortality rates for 2010 and 2011. State and
County wide data are compiled and reported a full year (or more) after the calendar events and are
unavailable until released by the State Center for Health Statistics. The 2010 child death data were
released Nov. 8, 2011; the 2011 data were released Nov. 8, 2012.
The number of childhood deaths decreased markedly in 2010: 106 children ages birth to 18 years died in
Wake County, down from 132 in 2009. Birth defects and other birth-related conditions (prematurity
and/or low birth weight) decreased in number and rate though continued as the leading cause of infant
deaths, followed by deaths from illness and unintentional injuries. Deaths attributed to SIDS dropped
dramatically, from 10 to 1. Review of sudden infant death (SIDS) indicated that deaths that previously
may have been attributed to SIDS may now be classified as unknown, following extensive death scene
and autopsy review. ‘Roll-over’ and ‘unknown cause’ deaths prompted recommendations to enhance
“back to sleep” awareness, including the risks of infant co-sleeping.
The number of childhood deaths increased in 2011: 137 children age’s birth through 17 years died in Wake County. Ninety-one infants died in the first year of life. As in the previous year, most were born extremely fragile and premature and suffered from immature lungs, or were born with inherited diseases. Two infants died of Sudden Infant Death Syndrome (SIDS). Five children or teens died by motor vehicles, a 50% decrease from 2010. There were three suicide deaths and four homicide deaths (trends are difficult to analyze because of the rarity of these deaths). Twenty-seven deaths were due to illness and sixteen, to unintentional injuries.
Purpose for Action: Inform Wake County Human Services Board and the Wake County Board of
Commissioners of the causes of childhood mortality in Wake County.
Next Steps: Receive, discuss and forward report to Wake County Board of Commissioners
Attachments: 2012 CFPT/CCPT Report
Membership roster, Wake County CFPT/CCPT
Summary of Causes of Childhood Deaths, Wake Co and NC, 2010 and 2011
Representative Case Reviews, 2011-12, ongoing
Opportunities for Advocacy, Policy or Advisory: See recommendations
Connections to Other Committees: Social Services, Public Health
Wake County Child Fatality Prevention Team/County Child Protection Team
2012 (Presented in 2013)
Who are local Child Fatality Prevention Teams/County Child Protection Teams? Local Child Fatality Prevention Teams (CFPT) and County Child Protection Teams (CCPT) are required in each county by statute. Since 1998, Wake County combined the two team review processes. Attachment A lists current team members. This representative group of community based professionals and volunteers meet each month to share confidential and detailed information about children who have died or have been abused or neglected. The team reviews ambulance call sheets, emergency room visits, medical examiners reports, police and sheriff investigations, district attorney and court records, child welfare and public health case notes, mental health visits, academic progress, school attendance, and family dynamics. Together, the team assembles the story of a child’s life and death, looking for systemic issues and interventions that might have prevented the death. Since combining our CFPT/CCPT teams we have been flexible in scheduling timely child protection reviews while continuing detailed child fatality reviews. How does the local team work? Wake County’s CFPT/CCPT can review in detail only a sample of child fatalities. The chair, utilization review nurse, and medical examiner chose 5-6 representative deaths for review each quarter, including all suicides and homicides. The lag between the date of death and the availability of death certificate and other information is such that in a year the team reviews deaths from the previous calendar year. In 2011-12 the team continued reviewing any deaths of children previously or known or currently involved with the protective services system. Child fatality reviews were directed towards suicides, homicides, deaths by motor vehicle accidents, and medical-related deaths. The statute that created the CFPT/CCPT allows teams to request and review any and all materials relevant to the investigation of a child death. The CCPT/CCPT may not contact the family members of a deceased child. CFPT/CCPT deliberations are confidential and not discoverable; recommendations are reported to the State. However, summaries of Child welfare investigations and findings and recommendations of completed intensive reviews involving deaths of children currently or previously known to the Child Welfare system may be requested by and released to the press after consultation with the District Attorney.
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The CFPT/CCPT is not performing a forensic review, nor is it determining liability for a death or adverse occurrence. Rather, the team searches for systematic problems that can be remedied by information and training, changes in rules and regulations, and legislation. The CFPT/CCPT is required to review the death of any child reported or investigated by child protective services in the previous twelve months. Though the child may have died for reasons unrelated to child abuse or neglect, a county child protection death review may result in recommendations for improvements in the child welfare system. State statute also requires any such death to be reported to the State Division of Social Services. A more detailed, two day state led local review may be required. One intensive review for 2010 is still pending completion. The team both makes system recommendations and receives system recommendations to decrease the likelihood of untimely child deaths and to improve staff practice, agency performance and community outcomes by better protecting children known to the Child Welfare System or otherwise at risk for untimely death. Why do children die in Wake County? In 2010 Wake County achieved its lowest child death rate ever. One hundred six children ages birth through 17 years died in Wake County. Seventy infants died in the first year of life. Most were born extremely small, fragile, and premature, and suffered from immature lungs or respiratory distress syndrome, or were born with inherited diseases. One infant died of Sudden Infant Death Syndrome – a dramatic drop from ten SIDS deaths in 2009. Death scene investigations have become routine and the medical examiner’s office more often assigns cause of infant deaths as “unknown” or “roll over” if the pathology or scene investigation is inconclusive for SIDS. Ten children or teens died by motor vehicles. There was one suicide death and two homicide death (trends in homicide and suicide are difficult to predict as these are relatively rare events). Twenty-seven deaths were due to illness. In 2011 Wake County experienced an increase in child death rate. One hundred thirty seven children ages birth through 17 years died in Wake County. Ninety-one infants died in the first year of life. As in the previous year, most were born extremely fragile and premature and suffered from immature lungs, or were born with inherited diseases. Two infants died of Sudden Infant Death Syndrome (SIDS). Five children or teens died by motor vehicles, a 50% decrease from 2010. There were three suicide deaths and four homicide deaths (trends are difficult to analyze because of the rarity of these deaths). Twenty-seven deaths were due to illness and sixteen, to unintentional injuries. Attachment B provides 2010 and 2011 Child Death Summary information for Wake County and North Carolina (the most recent year of complete data). Attachment C shows state infant mortality deaths by race, highlighting the disparity between white and non-white deaths. In 2010, Wake County again recorded its lowest infant mortality rate ever -- 5.5 per thousand live births – and the non-white to white ratio narrowed but remains an unacceptably twice the white rate, at 2:2. In 2011, Wake County recorded a higher infant mortality rate than the previous year, 7.3 per thousand live births. This increase was primarily in the African-American Non-Hispanic and Other Non-Hispanic groups. The African-American to white ratio (disparity) rose to 3.1. Attachment D shows the representative case reviews for 2012.
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What has Wake County’s CFPT/CCPT accomplished? Wake County’s CFPT continues to perform detailed fatality reviews in hope of providing local and state recommendations that might decrease untimely childhood deaths. Wake County’s CCPT continues to have an open process of receiving, accepting, investigating and substantiating child abuse and neglect including cases referred by the community review and feedback. The CFPT/CCPT met eleven times in 2012. Emergent reviews of childhood deaths or adverse outcomes of child in the child welfare system are always discussed at the most proximate meeting. All team members are welcomed to all reviews. What actions are required of the County Commission? Wake County’s CFPT/CCPT periodically submits to the State case review information and recommendations. Any identifying information that might violate confidentiality is first removed. The CFPT/CCPT is required to provide annual reports of activities to the County Commission. This report covers reviews from January 2012 through December 2012. County Commissioners may appoint members to local teams. Wake County’s CFPT/CCPT will continue to inform the Wake County Board of Commissioners of team composition and will welcome any additional appointments. U:WakeCoCFPTCCPTAnnualReport-12
Produced by the N.C. Division of Public Health – W
omen’s and Children’s Health Section in conjunction with the State Center for Health Statistics.
U:W
CChildDeathsinNC&WakeCo.-11
(C)
INFANT MORTALITY REPORT
North Carolina 2011 Final Infant Death Rates (per 1,000 live births)
White Non-
Hispanic
Infant Deaths
Af. Am.
Non-
Hispanic
Infant
Deaths
Other
Non-
Hispanic
Infant
Deaths
Hispanic
Deaths
Minority
Infant
Deaths
Total Infant
Deaths
White
Non-
Hispanic
Births
Af. Am.
Non-
Hispanic
Births
Other
Non-
Hispanic
Births
Hispanic
Births
Minority
Births
Total
Births
White
Rate
Af.Am
Rate
Other
Rate
Hispanic
Rate
Minority
Rate
Total
Rate
North
Carolina
2011
369
367
32
98
866
67,5
42
28,5
09
6,1
35
18,2
17
120,4
03
5.5
12.9
5.2
5.4
7.2
Wake
County
2011
32
42
8
9
91
6,6
72
2,8
46
987
1,9
53
12,4
58
4.8
14.8
8.1
4.6
7.3
2010
30
27
3
10
70
6,7
86
2,8
38
1,0
18
2,0
63
12,7
05
4.4
9.5
2.9
4.8
5.5
2009
42
57
99
9,2
42
3,7
68
13,0
10
4.5
15.1
7.6
2008
4
3
37
80
9,6
30
3,9
12
13,5
42
4.5
9.5
5.9
2007
49
48
97
9,6
03
3,6
96
13,2
99
5.1
13.0
7.3
2006
49
41
90
9,2
64
3,5
85
12,8
49
5.3
11.4
7.0
2005
36
49
85
8,9
41
3,3
23
12,2
64
4.0
14.7
6.9
2004
46
36
82
8,5
72
3,1
79
11,7
51
5.4
11.3
7.0
2003
32
40
72
8,3
00
3,0
42
11,3
42
3.9
13.1
6.3
2002
34
26
60
7,9
59
2,9
65
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29
37
66
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2,8
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10,6
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Wake County Child Fatality Prevention Team/County Child Protection Team
Representative Case Reviews, 2012 The Wake County CFPT/CCPT meets monthly eleven times a year to review a representative sample of infant, child, and teen deaths. Death certificates, diagnoses and medical examiner reports are used to select cases for review. Time limits the team reviews to only 4-6 deaths each quarter. The CFPT/CCPT must review the deaths of infants, children, and teens reported to Child Welfare services in the 12 months prior to death, including children involved in Child Protective Services investigations, treatment, and foster care. The statutes governing CFPT/CCPT reviews require confidentiality for both death reviews and reviews of active Child Welfare cases. Team reports include demographic information, such as age, sex, race, and cause of death. The reviews concentrate on systems issues identified, recommendations, and actions taken. When system issues are identified the CFPT/CCPT may suggest specific recommendations, including letters of concern and commendation, legislative and community advocacy, and community or professional education. Recommendations can include team sponsored trainings, education, or awareness events. On occasion, the State Division of Social Services requires a two day intensive review of deaths of children currently or previously known to protective services. The team participated in one intensive review in 2011 and two in 2012. Categories of deaths reviewed and representative systems issues identified for 2011-2012 included: Unintentional Poisoning
• The team investigated one death related to overdose of prescription medications that had been prescribed for another individual but were available to the decedent. Our case reviews have informed State efforts to decrease prescription of, access to, and unauthorized use of controlled substances.
Motor Vehicle Deaths
� Review of complicated motor vehicle deaths of minors and teens, both passengers and drivers
� Continued advocacy for increased parental involvement in driver’s education and adoption of a standardized curriculum. The team noted several deaths where the driver was in violation of the State graduated driver’s license (GDL) statutes and also expressed concern that, while progress has been made in education and “stigmatization” of drinking and driving, our culture continues to tolerate excess speed.
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______________________________________________________________________ Sudden Infant Death Syndrome (SIDS) and Overlay Deaths
� Continued support of legislative appropriations for enhanced social marketing campaigns for Safe Sleep – an expansion of teaching regarding Back to Sleep
� Parental education on the risks of parent-child co-sleeping and the risks of placing infants to sleep on soft bedding, sofas, or improvised cribs
� Increased awareness not only of the role of alcohol and substance use in overlay
deaths but of the need for increased family support and behavioral health services for at risk families
Homicides
� Two homicides reviewed were of young children who died from non-accidental trauma perpetrated by a parent
Suicides
• Continued concern for suicide by gunshot related to availability of firearms and recommendation to expand safe storage statute to include storage in any house where a child may be unsupervised
Neonatal Deaths (Deaths in first 28 days of life) � A persistence of preterm and very preterm infant births with high morbidity and
mortality rates with a persistent racial disparity gap
� Unsuspected, undetermined, or undocumented use of alcohol, tobacco, and other drugs during pregnancy, labor and delivery
Perinatal Deaths (Deaths associated with labor and delivery) • Review of two deaths presumably related to planned home or birthing center
births where fetal distress and emergent transfer were still associated with infant death. Presented concerns to Joint Oversight Committee of Medical and Nursing Board regarding concern over fetal distress and neonatal resuscitation at out of hospital births.
Cultural and Societal Issues
� Parental awareness of teen mood disorders, e.g., depression and anxiety
� Parental responsibility in preventing under-age drinking and driving
� Parental responsibility and caution in use of ATVs on personal property Administrative Issues
� Continued concern for administrative coding of cause of death in summary
statistics
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_____________________________________________________________________ Child Welfare and Adoptions
� Updated information on Wake County’s internal quality improvement program and “mock” chart reviews in preparation of State and Federal Child and Family Services Review (CFSR). In 2013, the State will adopt a continuous quality improvement approach to improvement of child welfare practices.
U:WakeCoCFPTCCPTrecs11&12
HUMAN SERVICES AND ENVIRONMENTAL SERVICES
BOARD AGENDA ITEM
Agenda Date: Executive Committee: June 13, 2013 HS & ES Board: June 27, 2013
Committee/Item: Public Health 10 Essential Services Tied to the Budget
Specific Action Requested: Review and discuss fiscal reports that assure the provision of public health essential services in accordance with local, state and federal requirements.
Item Summary: This report is generated by the Public Health Division and shows funding sources for delivery of public health essential services as well as funding by each essential service provided (ex. 1. Monitor heath status, 2. Diagnose and investigate, etc.)
Purpose for Action (Proposed Solutions/Accomplishments): Meet NC Public Health Accreditation Benchmark 39, Activity 39.2 “ The local Board of Health shall review and discuss fiscal reports to assure essential services of public health are being provided in accordance with local, state and federal requirements.”
Next Steps: Document review and discussion in Board minutes
Attachments:
• Public Health Essential Funding by Service Division: FY ’13 Budget $38, 609, 671
• 2013 Public Health Essential Services Funding Sources FY 13 Budget $38309671
Opportunities for Advocacy, Policy or Advisory: Use information to inform educational and advocacy activities as appropriate
Connections to Other Committees:
2013 Public Health Essential Funding by Service DivisionFY ’13 Budget - $38,309,671
