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Biennial Report The North Carolina State Board of Health UNIVERSIFi' OF NORTH CAROL! mi I 2 1996 Forty-Fourth Biennial Report [ HEALTH SCIENCES LIBRARY OF THE — NORTH CAROLINA STATE BOARD OF HEALTH July 1, 1970- June 30, 1972 (jOA L /l/\^ STATE OF NORTH CAROLINA Robert W. Scott governor Lenox O. Baker. M.D. DEPARTMENT OF HUMAN RESOURCES 6TATE BOARD OF HEALTH P O Box 2091 Raleigh 27602 January 15, 1973 Jacob Koomen. M D , M P H STATE HEALTH DIRECTOR AND SECRETARY TREASURER The Honorable James E. Holshouser, Jr. Governor of the State of North Carolina Administration Building Raleigh, North Carolina Dear Governor Holshouser: In accordance with the General Statutes of North Carolina, Chapter 130, Article 2, Section 120-11(12), we have the honor to submit to you, and through you to the Honorable Senate and House of Representatives, the biennial report of the North Carolina State Board of Health for the fiscal years July 1, 1970, to June 30, 1972. Very truly yours , Secretary '^./Jacob Koomen, M.D., M.P.H. State Health Director BOARD MEMBERS James S Rarer M D president asheville • Paul F Ma Charles T Barker DDS new Bern • Ralph W Coonhad MD. Durham • Jc Donald W Lackey. D V M lenoir • Jesse H Meredith. M D . Winston salem • Ernest A Randleman Jr B S Ph mount airy MESS M D VICE president BURLINGTON SEPH S Hiatt. Jr . MO. southern pinci Robert B Nichols. Jr . hillsborougx CONTENTS Letter of Transmittal v State Board of Health Members and Executive Staff ix Organization Chart x Local Health Directors xi Report of Secretary-Treasurer and State Health Director Abridged Minutes of State Board Actions Oct. 22, 1970—page 1; March 11, 1971—page 6; May 19, 1971—page 15; Oct. 28, 1971—page 19; March 23, 1972—page 26; May 24, 1972—page 33. Conjoint Reports May 19, 1971 39 May 24, 1972 47 Division Reports Administrative Services Division 55 Division of Epidemiology 61 Laboratory Division 64 Community Health Division 67 Dental Health Division 68 Sanitary Engineering Division 69 Personal Health Division 71 North Carolina Medical Examiner System 75 NORTH CAROLINA STATE BOARD OF HEALTH (Nine member policy-making body, five members appointed by the Governor and four members elected by the Medical Society of the State of North Carolina, each serving a four-year term.) Members Appointed by the Governor Charles T. Barker, D.D.S. Appointed 1969 Term expires 1973 Ralph W. Coonrad, M.D. Appointed 1972 Term expires 1973 Donald W. Lackey, D.V.M. Appointed 1972 Term expires 1975 Robert B. Nichols, Jr. Appointed 1972 Term expires 1973 Ernest A. Randleman, Jr., B.S.Ph. Appointed 1972 Term expires 1975 Members Elected by the Medical Society of the State of North Carolina James S. Raper, M.D., President Elected 1963 Term expires 1975 Paul M. Maness, M.D., Vice President Elected 1965 Term expires 1975 Joseph S. Hiatt, Jr., M.D. Elected 1965 Term expires 1973 Jesse H. Meredith, M.D. Elected 1969 Term expires 1973 EXECUTIVE STAFF AS OF JUNE 30, 1972 Jacob Koomen, M.D., M.P.II. Secretary and State Health Director (Term expires June 30, 1975) W. Bums Jones, Jr., M.D., M.P.H. Assistant State Health Director (Term concurrent with the State Health Director) Ben Eaton, LL.B., Director, Administrative Services Division Martin P. Hines, D.V.M., M.P.H., Director, Epidemiology Division Marshall Staton, B.C.E,, M.S.S.E., Director, Sanitary Engineering Division Ronald H. Levine, M.D., M.P.H., Director, Community Health Division Lynn G. Maddry, Ph.D., M.S.P.H., Director, Laboratory Di\ision E. A. Pearson, Jr., D.D.S., M.P.H., Director, Dental Health Division Theodore D. Scurletis, M.D., M.P.H., Director, Personal Health Division R, Page Hudson, Jr., M.D., Director, Medical Examiner Division S :S - ^ g NORTH CAROLINA STATE BOARD OF HEALTH Local Health Directors Alamance—Dr. W. L. Norxille, Graham-Hopedale Road, Burlington, N.C. 27215 —(919) 227-7451 or 228-1734 AUeghany-Ashe-Watauga"—Mr. Carl D. Tuttle, P.O. Bo.v 233, Boone, N.C. 28607 —(704) 297-2126 or 297-2127 Anson—P.O. Box 473, Wadesboro, N.C. 28170—(704) 694-2516 Avery—P.O. Box 325, Newland, N.C. 28657—(704) 733-4971 Beaufort—Dr. Karl L. Van Horn, P.O. Box 432, Harvey St., Washington, N.C. 27889—(919) 946-1902 or 946-1903 Bertie—Windsor, N.C. 27983—(919) 794-2057 Bladen—Dr. Caroline Callison, P.O. Box 188, Elizabethtown, N.C. 28337— (919) 862-2536 or 862-2537 Brunswick—Mr. W. Richard Walker, P.O. Box 398, Southport, N.C. 28461— (919) 457-6655 Buncombe—Dr. H. W. Stevens, Mr. Lawrence Burwell, Assistant Director, 35 Woodfin St., P.O. Box 7607, Asheville, N.C. 28807—(704) 255-5671 Burke—Dr. Lewis Bock, P.O. Box 945, Morganton, N.C. 28655 (704) 437-5152 Cabarrus—Mr. Albert J. Klimas, P.O. Box 1149, Concord, N.C. 28025—(704) 782-4121 Caldwell—Dr. Marjorie Strawn, 1121 East Harper Ave., P.O. Box 777, Lenoir, N.C. 28645—(704) 758-8451 Carteret—Dr. Luther Fulcher, P.T., Drawer B, Beaufort, N.C. 28516—(919) 728-4557 or 728-3046 "Catawba-Lincoln-Alexander—Dr. Melvin F. Eyerman, P.O. Box 1448, Hickory, N.C. 28601—(704) 328-2561 •Cherokee-Clay-Graham—Box 309, Murphy, N.C. 28906—(704) 837-2311 Cleveland—Mr. Richard G. Steeves, 315 Grover St., Shelby, N.C. 28150— (704) 487-8511 Columbus—Dr. John R. Black, Chadboume Road, P.O. Box 786, Whiteville, N.C. 28472—(919) 642-4145 or 642-4146 Craven—Dr. Verna Y. Barefoot, 403 George St., P.O. Box 1390, New Bern, N.C. 28560—(919) 637-3121 Cumberland—Dr. Carl Hammer, Box 470, 515 Person St., Fayetteville, N.C. 28302—(919) 483-9046 Currituck—Dr. John Sledge, Jr., Currituck, N.C. 27929—(919) 453-2506 Dare—Dr. John Sledge, Jr., P.O. Box 248, Manteo, N.C. 27954—(919) 473-3431 Davidson—Dr. Dermot Lohr, P.O. Box 439, Lexington, N.C. 27292—(704) 246-5953 "Davie-Wilkes-Yadkin—Mr. Alton Brown, Hospital Street, P.O. Box 457, Mocks-ville, N.C. 27028—(704) 634-5985 or 634-5986 Duplin—Dr. John F. Powers, P.T., Kenansville, N.C. 28349—(919) 296-4241 Durham—Dr. O. L. Ader, 300 E. Main St., Durham, N.C. 27701—(919) 682-8176 Edgecombe—Mr. Hugh Young, 2909 Main St., Tarboro, N.C. 27886—(919) 823-2174 or 823-2175 Forsyth—Dr. James A. Finger, P.O. Box 2975, 720 Ridge Avenue, Winston-Salom, N.C. 27102—(919) 727-2434 Franklin—Dr. J. B. Wheless, P.T., P.O. Box 300, Louisburg, N.C. 27549—(919) 496-3553 Gaston—Dr. B. M. Drake, P.O. Box 819, 615 N. Highland St., Ga.stonia, N.C. 28052—(704) 864-4331 Granville—Dr. J. U. Weaver, P.O. Box 367, O.xford, N.C. 27565—(919) 693-2141 Greene—Dr. J. L. Campbell, Box 67, Snow Hill, N.C. 28580—(919) 747-3578 Guilford—Dr. Sarah T. Morrow, 300 E. Northwood St., Greensboro, N.C. 27401 —(919) 275-0911 Halifax—Dr. Leslie G. Hoag, P.O. Box 178, Halifax, N.C. 27839—(919) 583-2191 Harnett—P.O. Box 36, Lillington, N.C. 27546—(919) 893-3425 Haywood—Dr. R. S. Roberson, P.T., 2216 Asheville Rd., Waynesville, N.C. 28786—(704) 456-3542 Henderson—Dr. Richard C. Irving, P.O. Box 925, Hendersonville, N.C. 28739— (704) 692-4223 'Hertford-Gates-Box 246, Winton, N.C. 27986—(919) 358-3191 Hoke—P.O. Box 638, Raeford, N.C. 28376—(919) 875-3717 Hyde—Dr. John Sledge, Jr., P.O. Box 254, Swan Quarter, N.C. 27885—(919) 926-3566 Iredell—Dr. J. H. Nicholson, Acting, 735 Hartness Road, P.O. Box 1268, States-ville, N.C. 28677—(704) 873-7271 'Jackson-Macon-Swain—8 Ridgeway St., Sylva, N.C. 28779—(704) 586-2913 Johnston—618 N. Eighth St., Smithfield, N.C. 27577—(919) 934-4168 Jones—Dr. John A. Parrott, P.O. Box 216, Trenton, N.C. 28585—(919) 448-2701 Lenoir—Dr. John A. Parrott, P.O. Box 1315, 200 Rhodes Avenue, Kinston, N.C. 28501—(919) 527-7116 McDowell—Mr. Clifford Fields, State St., Marion, N.C. 28752—(704) 652-6811 Madison—Mr. Lawrence Burwell, P.T., Route #5, Box 231, Marshall, N.C. 28753 —(704) 649-3531 or 649-2910 Martin—Mr. Homer Glover, P.O. Box 546, Williamston, N.C. 27892—(919) 792-4133 Mecklenburg—Dr. Maurice Kamp, 1200 Blythe Blvd., Charlotte, N.C. 28203— (704) 374-2164 Mitchell—Box 132, Bakersville, N.C. 28705—(704) 688-2371 or 688-3421 Montgomery—Dr. G. H. Armstrong, P.T., South Main Street, Troy, N.C. 27371— (919) 572-1393 Moore—Dr. Alfred G. Siege, Carthage, N.C. 28327—(919) 947-2711 Nash—Dr. J. S. Chamblee, P.O. Box 497, Nashville, N.C. 27856—(919) 459-3112 New Hanover—Dr. Joseph C. Knox, 21 N. 4th St., Wilmington, N.C. 28401— (919) 762-1863 Northampton—P.O. Box 635, Jackson, N.C. 27845—(919) 534-3071 or 534-5841 Onslow—Dr. Eleanor Williams, Georgetown Road, P.O. Box 460, Jacksonville, N.C. 28540—(919) 347-2154 or 347-6021 "Orange-Person-Chatham-Lee-Caswell—Dr. O. David Garvin, Dr. C. S. Fuller, Assistant Director, P.O. Box 191, Old Frat. Row, U.N.C. Campus, Chapel Hill, N.C. 27514—(919) 942-4168 Pamlico—Dr. Vema Y. Barefoot, Bayboro, N.C. 28515—(919) 745-2506 "Pasquotank-Perquimans-Camden-Chowan—Mr. Howard Campbell, Box 189, Elizabeth City, N.C. 27909—(919) 335-5429 Pender—Dr. N. C. Wolfe, P.T., P.O. Box 455, Burgaw, N.C. 28425—(919) 259-4026 Pitt—Dr. Robert D. May, P.O. Box 1903, Greenville, N.C. 27834—(919) 752-4141 or 752-4142 Randolph—Dr. Hugh Fitzpatrick, P.T., 139 N. Cox St., P.O. Box 1007, Asheboro, N.C. 27203—(919) 629-2131 E.xt. 280 Richmond—Dr. Z. F. Long, P.T., P.O. Box 419, Rockingham, N.C. 28379— (919) 895-6304 Robeson—Dr. M. B. Pate, Box 1088, Lumberton, N.C. 28358—(919) 739-3344 Rockingham—Mr. William Thompson, 205 Boone Road, Eden, N.C. 27288 (919) 623-9778 or 623-9779 Rowan—Mr. Herbert Hawley, 1216 W. Innes St., Salisbury, N.C. 28144—(704) 633-0411 'Rutherford-Polk—Mr. Clifford Fields, 225 W. 3rd St., Rutherfordton, N.C. 28139—(704) 287-4931 Sampson—Dr. Caroline Callison, 400 Cooper Drive, Clinton, N.C, 28328 — (919) 592-6177 Scotland—South Main St., Laurinburg, N.C. 28352—(919) 276-1411 Stanly—Dr. George M. Leiby, 921 N. Third St., Albein?rle, N.C. 28001— (704) 982-9171 Stokes—Dr. J. S. Taylor, P.T., Danbury, N.C. 27016—(919) 593-8788 Surry—Dr. Robert Caldwell, 113 S. Gilmer, P.O. Box 1267, Mt. Airv, N.C. 27030 —(919) 786-4163 or 786-4164 Transylvania—Dr. John R. Folger, P.T., Box 666, Bre\ard, N.C. 28712—(704) 883-4255 Tyrrell-^Washington-Mr. Homer Glover, P.O. Box 396, Plvmouth, N.C. 27962 —(919) 793-4416 Union—Dr. C. A. Bolt, 300 S. Hayne St., Monroe, N.C. 28110—(704) 289-4535 Vance—Dr. J. U. Weaver, P.O. Box 824, County Home Road, Henderson, N.C. 27536—(919) 492-1176 Wake—Dr. M. B. Bethel, Dr. Jane H. Wooten, Assistant Director, P.O. Box 949, Raleigh, N.C. 27602—(919) 833-1655 Warren—Dr. J. U. Weaver, 540 W. Ridgeway Road, Warrenton, N.C. 27589— (919) 257-3373 Wayne—Dr. O. Aiken Mays, P.O. Box 1537, Goldsboro, N.C. 27530—(919) 735-4331 Ext. 280 Wilson—Dr. Joseph Campbell, Route 5, Box 91, Wilson, N.C. 27893—(919) 237-3141 Yancey—P.O. Box 7, Burnsville, N.C. 28714—(7 )4) 682-2127 (CITY DEPARTMENT) Rockv Mount—Dr. J. S. Chamblee, 1616 W. Thomas St., Rocky Mount, N.C. 27801—(919) 442-5181 Ext. 270 or Ext. 271 "District Headquarters P.T.—Part-Time Branch Offices Alleghany—Mr. Carl Tuttle, Rt. #2 Box 13, Sparta, N.C. 28675—(919) 372-4346 Alexander—Dr. Melvin F. Eyerman, 324 1st Ave., S.W., Taylorsville, N.C. 28681 —(704) 632-3101 Ashe—Mr. Carl Tuttle, P.O. Box 208, Jefferson, N.C. 28640—(919) 246-9449 Brunswick—Mr. W. Richard Walker, Box 116, Shallotte, N.C. 28459—(919) 754-6611 Camden—Mr. Howard Campbell, Camden, N.C. 27921—(919) 335-4486 Caswell—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., Box 327, Yance>'\'illc, N.C. 27379—(919) 694-4222 Catawba—Dr. Melvin F. Eyerman, Newton, N.C. 28658—(704) 464-2027 Chatham—Dr. O. David Garvin, Dr. C. S. Fuller, As,st., City Hall, Siler Cit>', N.C. 27344—(919) 742-3441 Chatham—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., Route #1 Box lA, Pittsboro, N.C. 27312—(919) 542-2924 Chowan—Mr. Howard Campbell, P.O. Box 178, Edenton, N.C. 27932—(919) 482-2511 Clay—P.O. Box 55, Hayesville, N.C. 28904—(704) 389-8214 Davidson—Dr. Dermot Lohr, 10 W. Guilford St., Thomasvillc, N.C. 27360— (919) 475-2356 Gaston—Dr. B. M. Drake, 132 W. Virginia Ave., Bessemer City, N.C. 28016— (704) 629-2031 Gaston—Dr. B. M. Drake, Cherryville, N.C. 28021—(704) 435-6411 Gaston—Dr. B. M. Drake, 37 E. Woodrow Ave., Belmont, N.C. 28012—(704) 825-2178 Gaston—Dr. B. M. Drake, S. Main St., Mount Holly, N.C. 28120—(704) 827-5151 Gates—P.O. Box 71, Gatesville, N.C. 27938—(919) 357-6141 Graham—Robbinsville, N.C. 28771—(704) 479-3525 Guilford—Dr. Sarah T. Morrow, 936 Montlieu Ave., High Point, N.C. 27262— (919) 883-9166 Harnett—P.O. Box 491, Dunn, N.C. 28334—(919) 892-2424 Iredell—115 Institute St., Mooresville, N.C. 2811.5—(704) 664-5281 Lee—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., 402 W. Makepeace, Sanford, N.C. 27330—(919) 776-3512 Lincoln—Dr. Melvin F. Eyerman, P.O. Box 636, Lincolnton, N.C. 28092— (704) 735-3001 or 735-3002 Macon—55 River\dew St., Franklin, N.C. 28734—(704) 524-2718 Orange—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., 144 E. Margaret Lane, Hillsborough, N.C. 27278—(919) 732-8139 Perquimans—Mr. Howard Campbell, Hertford, N.C. 27944—(919) 426-5488 Person—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., P.O. Box 29, Roxboro, N.C. 27573—(919) 599-3414 Polk—Mr. Clifford Fields, Columbus, N.C. 28722—(704) 894-8271 Rockingham—Mr. William Thompson, 506 Sprinkle St., Reidsville, N.C. 27320— (919) 342-2989 Rockingham—Mr. William Thompson, West Main St., Madison-Mayodan Office, Mayodan, N.C. 27027—(919) 548-6335 Swain—P.O. Box 546, Bryson City, N.C. 28713—(704) 488-2586 Tyrrell—Mr. Homer Glover, Road St., Columbia, N.C. 27925—(919) 796-2681 Wilkes—Mr. Alton Brown, West College St., P.O. Box 30, \^'ilkesboro, N.C. 28697—(919) 838-5591 or 838-5512 Yadkin—Mr. Alton Brown, P.O. Box 457, Yadkinville, N.C. 27055—(919) 679-2252 or 679-8876 REGIONAL OFFICES Asheboro Regional Office Ingram-Brinson Building 146 S. Fayetteville St. Asheboro, N.C. 27203 (919) 629-3181 Raleigh Regional Office Cotton Building P.O. Box 2091 Raleigh, N.C. 27602 (919) 829-7413 Greenville Regional Office 3205 S. Memorial Drive Greenville, N.C. 27834 (919) 756-1343 Southeastern Regional Office 203 Grace Pittman Building Fayetteville, N.C. 28301 (919) 483-3635 or 483-3636 Hickory Regional Office 1008 Highway 321 West (Bypass) Hickorv, N.C. 28601 (704) 328-5341 Western Regional Office N.C. State Board of Health Biltmore Plaza Office Building Asheville, N.C. 28803 (704) 253-8424 NORTH CAROLINA BOARD OF HEALTH 1 REPORT OF THE SECRETARY-TREASURER AND STATE HEATH DIRECTOR ABRIDGED REPORT OF THE ACTIVITIES OF THE STATE BOARD OF HEALTH AS RECORDED IN THE MINUTES Thursday, October 22, 1970 The North Carohna State Board of Health met in the Board Room of the Cooper Memorial Health Building, Raleigh, North Carolina, on Thursday, October 22, 1970, at 1:00 p.m. Dr. James S. Raper, Presi-dent, presided. The following members were present: James S. Raper, M.D., President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Jesse H. Meredith, M.D. The invocation was given by Dr. Paul F. Maness. Dr. Raper said he was sorry that Mr. J. M. Lackey and Dr. Lenox Baker were unable to attend. Dr. Koomen introduced members of the staff and news media who were present. A motion was made by Dr. Dawsey, seconded by Dr. Maness, that the minutes of the last meeting be approved as circulated. The motion was carried. The first matter of business was a discussion of future meeting places. Dr. Raper said: "Ever since I have been on the Board we have met in Raleigh with one exception when we met in Western North Carolina for a fine one-day meeting. This adds, I think, to the esprit de corps of the State Board of Health. With this in mind, it was sug-gested that we hold a meeting in the eastern part of the State if the Board so desires. The members were polled as to their feeling about this and there was a little difi^erence of opinion. I think this should be discussed today. There is only one stated meeting with the place desginated, and this is the spring meeting in Pinehurst with the State Medical Society. There is nothing in the statutes or rules that says we have to meet in Raleigh; if the Board feels it would be good to meet outside of Raleigh, perhaps once a year, I think this would be entirely correct." The floor was opened for discussion. Dr. Barker said he would welcome the Board to the eastern part of the State for a meeting. 2 FORTY-FOURTH BIENNIAL REPORT Dr. Maness said he would be glad to go wherever the Board de-cided to meet, but he did not want to make it appear that it was for the purpose of recreation rather than the official business of the Board. Dr. Koomen read a letter from Dr. Baker regarding this matter, and Dr. Raper asked that this letter be made a part of the official minutes. A copy is attached. Dr. Raper said he was completely in sympathy with Dr. Baker's remarks about expense to the taxpayers; therefore, a tabulation was prepared reflecting the expenses of our Raleigh meetings, and those of the Western meeting last year. Tlie result was that when the Board met in Western North Carolina, the cost was actually a few dollars cheaper than when meeting in Raleigh. A motion was made by Dr. Dawsey that the Board meet in other areas of the State from time to time, at the discretion of the President. The motion was seconded by Dr. Maness and carried. Dr. Isa Grant, Chief, Chronic Disease Section, gave a report on current planning for kidney dialysis and transplantation. In May, 1970, Dr. T. D. Scurletis, Director, Personal Health Division, reported to you on the general plan developed by a large planning committee representing all localities and interested groups in the state. You will recall it gave a picture of the problem in North Carolina and gave a means of saving North Carolinians suffering from this disease, but it did not give specific steps or localities as to how this may be done. In June, the planning committee met and suggested that the planning be continued to include specific locations and means of getting the patient into the medical care system. Dr. Jacob Koomen accepted the challenge of continuation of planning and assigned the responsibility to the Chronic Disease Section. He requested from the Advisory Bud-get Commission a transfer of $20,000 unexpended funds to pay the salary and expenses of an administrator and his secretary. The trans-fer was granted and such an administrator has been hired. He is Mr. Charles Lee, formerly of Charlotte. Because a position was not avail-able in the Chronic Disease Section, Mr. Lee is working in the office of the North Carolina Regional Medical Program. As planning pro-ceeds it will be determined whether or not a new section should be established. Two committees have been appointed by Dr. Koomen. One is an Advisory Committee, chaiied by Dr. Louis G. Welt, and including representatives of the medical schools, localities where dialysis and transplantation may be done. Vocational Rehabilitation, the insurance companies. Comprehensive Health Planning, and the public and volunteer kidney associations. Also a special ad hoc com-mittee has prepared a grant proposal to be submitted to the North NORTH CAROLINA BOARD OF HEALTH 3 Carolina Regional Medical Program for funding. Dr. Roscoe Robinson is chairman of this Committee. It includes representatives from all groups that may utilize these funds. If the proposal is funded, it will enable the State Board of Health to begin the initial phase of a state-wide kidney program beginning July 1, 1971. Dr. T. D. Scurletis, Director, Personal Health Division, gave a report on the proposed regulations for implementation of quality con-trol for Medicaid. He reported as follows: The Title XIX Advisory Committee to the Department of Social Services recommended that quality control mechanisms be established with this program as a means of justifying and controlling expenditures in the Title XIX program. The mechanism recommended includes the following: 1. That the State Board of Health as part of its contractual ar-rangements with the Department of Social Services shall im-plement utilization review mechanisms of Title XVIII on sup-pliers of services for Title XIX (hospitals, nursing homes, home health services). 2. That the intermediary (Blue Cross-Blue Shield) shall develop patient profiles and physician profiles to evaluate services rendered by private practitioners of medicine, dentistry, etc. 3. That the Department of Social Services shall develop mech-anisms of monitoring drug prescriptions and optical services. In order to put this in perspective, one must recognize that the De-partment of Social Services is the primary agency and that we can only implement these programs through contractual agreements with them. Dr. Scurletis also was asked to report on recent developments with regard to rostering of physicians in the Crippled Children's pro-gram. He told the Board that the Advisory Committee established by the Medical Society of the State of North Carolina met in September. The first part of the meeting was in the form of an open hearing at which various members of the Medical Society expressed their feelings concerning the rostering program. There was liberal discussion about past history of the program, the ]:)resent program, and finally the mech-anisms being advocated for rostering. That same evening, the Com-mittee met behind closed doors and Dr. Rutli Burroughs, Chief, Crippled Children's Section, and Dr. T. D. Scurletis were invited. They discussed the many facets of the problem and decided that they should reconsider this problem after the membership has had an opportunity to reflect on the total aspects of the discussions. The Committee hopes to be able to report a recommendation by the next Board meeting, and 4 FORTY-FOURTH BIENNIAL REPORT in the meantime the staff is available to them for consultation and preparation. They made several generalizations which they felt were indicated, and these related to the fact that all disciplines should be treated alike and that national standards for certification of specialties should be generally adhered to. However, these are merely con-clusions at this point and are not to be inferred as actual recommen-dations. The Board at a previous meeting had asked that they be informed at each meeting of those physicians applying for rostering, and whether they were rostered or not. Dr. Scurletis distributed such a list to the members, reflecting those physicians rostered in North Carolina since May 20, 1970. A copy is attached to the official minutes. Dr. Raper asked Dr. Barker if he still wished to have an Orthodontist included in the membership of the Committee. Dr. Barker said two Orthodontists had spoken to him about this, and before the next Board meeting he would get in touch with them and see just what their interest was. Dr. R. Page Hudson, Chief Medical Examiner, was recognized and reported on the present status of the Medical Examiner System. There are at present 55 counties participating in the System, repre-senting 66 percent of the population. The problem with getting Medi-cal Examiners in most of the counties is that physicians are reticent to become Medical Examiners because of misconceptions as to what is involved. It is anticipated that by spring, possibly 90 counties will have Medical Examiners. In the 1971 General Assembly, we hope to have a bill introduced which would provide that in those counties having a Medical Examiner System, the office of "coroner" would be abolished upon the expiration of the term of the current coroner. Also, counties have expressed the hope many times that the General Assembly would take action to require the State to pay autopsy fees, rather than having counties pay the fees. Dr. Hudson said the Medical Examiner System is working more and more with other State agencies, such as the Highway Department and the State Bureau of Investigation, and re-ceived excellent cooperation from them as well as from various sec-tions here at the State Board of Health. Dr. Jacob Koomen, State Health Director, shared the following items of information with the Board: 1. The Sanitary Engineering Division, and the Iredell County Health Department, is to be commended for making the Love Valley Rock Festival as safe as it could be made. Helpful information was received from other areas having had similar festivals, and other State agencies with whom we worked on this proved to be unusually com-petent and did a fine job. NORTH CAROLINA BOARD OF HEALTH 5 2. Dr. Page Hudson and his staff have been hard at work with the Institute of Government on the matters which they hope to propose to the Legislature. 3. The "B" Budget has been presented to the Advisory Budget Commission. We were warmly received personally, and were asked some very good questions. It will be some time, however, before we know the outcome. 4. Dr. Koomen expressed the hope that all members of the Board would feel comfortable in talking with our staff, and in asking ques-tions of them. "I know you are asked many questions; sometimes tliese require study and sometimes they require an immediate answer. We are always here and glad to help you in any way we can." There being no further business, the meeting adjourned. 6 FORTY-FOURTH BIENNIAL REPORT MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, March 11, 1971 The North Carohna State Board of Health met in the Board Room of the Cooper Memorial Health Building, Raleigh, North Carolina, on Thursday, March 11, 1971, at 10:30 a.m. Dr. James S. Raper, President, presided. The following members were present: James S. Raper, M.D., President Lenox D. Baker, M.D., Vice-President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman, Jr., B.S.Ph. Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Jesse H. Meredith, M.D. Paul F. Maness, M.D. The invocation was given by Dr. Paul F. Maness. Dr. Jacob Koomen, State Health Director, read citations honoring the following former members of the State Board of Health staflF: Dr. J. W. R. Norton — State Health Director, Emeritus Dr. Watson S. Rankin — State Health Director, Emeritus Dr. C. C. Applewhite — Director of Local Health, Emeritus Dr. A. H. Elliot — Director of Personal Health, Emeritus Mr. Maurice M. J arrett — Director of Sanitary Engineering, Emeritus. Dr. Norton, Dr. Elliot, and Mr. Jarrett were present to accept their awards. Letters were read from Dr. Applewhite, and from Mrs. Watson S. Rankin, expressing appreciation for this honor. Dr. Charles T. Barker, son-in-law of Dr. Rankin, accepted on behalf of Mrs. Rankin. Motion was made by Dr. Dawsey, seconded by Dr. Maness, that the minutes of the last meeting be approved as circulated. The motion was carried. Mr. Marshall Staton, Director, Sanitary Engineering Division, pre-sented a proposed resolution to extend the boundary lines of the Sedgefield Sanitary District located in Guilford County, North Car-olina. He said all transactions regarding this matter had been re-viewed with the Attorney General's office, and were found to be in order. He recommended that this proposal be approved to provide water and sewage to the people in this area. Dr. Raper inquired if NORTH CAROLINA BOARD OF HEALTH 7 any member of the public desired a hearing on this matter and in-structed the secretary to let the minutes show that no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Dawsey, that the proposed resolution of the North Carolina State Board of Health extending the boundary lines of the Sedgefield Sanitary District located in Guilford County, North Carolina, be approved. The motion was carried. (Copy is attached to the oflRcial minutes.) Mr. Staton presented a proposed resolution recommending ex-tension of the boundary lines of the Roanoke Rapids Sanitary District located in Halifax County, North Carolina. He advised that all legal aspects had been discussed with the Attorney General's office and were found to be in order, and recommended that annexation be approved to give these people the benefit of receiving water and sewage. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no member of the public appeared. Motion was made by Dr. Mere-dith, seconded by Dr. Maness, that the proposed resolution of the North Carolina State Board of Health extending the boundary lines of the Roanoke Rapids Sanitary District located in Halifax County, North Carolina, be approved. The motion was carried. (Copy is attached to the official minutes.) A proposed resolution was presented by Mr. Staton recommend-ing creation of the Cooleemee Sanitary District located in Davie County, North Carolina. The petition for creation of this district has been signed by 51 percent of the resident freeholders living within the district. A hearing was held in January, 1971, and no opposition was expressed; however, a representative of Burlington Industries requested that all industrial properties owned by the industry be excluded from the sanitary district and these properties have been excluded. The Attorney General's office has found this matter to be in order, and Mr. Staton recommended that the resolution be ap-proved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one requested a hearing. Motion was made by Dr. Dawsey, seconded by Dr. Hiatt, that the resolution of the North Carolina State Board of Health creating the Cooleemee Sanitary District located in Davie County, North Carolina, be approved. The motion was carried. (Copy is attached to the official minutes.) The next item of business was the proposed name change of the administrative agency from State Board of Health to State Department of Health. Some background information was distributed, explaining that with the approval of the State Board of Health, a study has been 8 FORTY-FOURTH BIENNIAL REPORT undertaken of the proposed name change under the guidance and supervision of the State Health Director. Dr. Koomen appointed a committee composed of: Dr. W. Burns Jones, Jr., Assistant State Health Director; Dr. Ronald H. Levine, Director, Community Health Division; Mr. Marshall S. Staton, Director, Sanitary Engineering Division; and, Mr. Ben Eaton, Director, Administrative Services Division. The Institute of Government, under the direction of Mr. David G. Warren, was asked to serve as a resource to supply the necessary technical assistance to the project and to draft the required legislation to implement the objectives. This task has been completed and the legislation has been drafted for submission to the General Assembly, pending approval of the proposed change by the State Board of Health. In the material distributed, the "Purposes and Objectives" were defined, the advantages of the change were re-viewed, and a brief description was given of review procedures and the scope of statutory changes. The committee recommended to the Board that proposed legislation be approved by the State Board of Health to incorporate the concept of identifying the policymaking body as "State Board of Health" and the administrative agency as "State Department of Health". Also given to the Board were copies of a Bill to be entitled "An Act to Change the Name of the Adminis-trative Agency from the State Board of Health to the State Depart-ment of Health". Dr. Raper asked if any member of the public wished to be heard on this matter, and no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Maness that this matter be deferred to the Executive Committee of the State Board of Health and that this committee report back to the Board in closed session. Dr. Maness pointed out that since he had been a Board member a fair amount of discussion had centered about this matter. He realized time was important in order to get this before the General Assembly this Session, but he also felt it would be good to have the Executive Committee discuss the matter and bring a report to the Board at its May meeting in Pinehurst. Dr. Barker mentioned that, according to information presented, 47 other States in the Union use the name "State Department of Health", and apparently the term "State Board of Health" has outlived its usefulness. He pointed out that if we wait until the May meeting of the Board, it may be too late to have the General Assembly take action on it. "Two years of work has gone into it, and I feel we should not drag our feet any longer, that we need action now." Several others expressed opinions, and Mr. Eaton sum-marized: Great care has been exercised to preserve the intent of the Legislature throughout, and also to preserve existing practices and existing circumstances. This change will not cost a cent more, but it NORTH CAROLINA BOARD OF HEALTH 9 does clear up tremendous confusion that exists in the minds of the public, the General Assembly, and even the agency, as to how we should function. There is no change in the existing philosophy what-ever, but it will bring about, we believe, consistency in our operations, consistency in respect to how other state agencies are set up and we believe you will find it a very satisfactory and wholesome plan. Dr. Barker moved that the motion be amended to include the following: the Executive Committee would have the power to act on this matter. This would permit them to change the name now if they feel it neces-sary, or to study it further. The amendment was seconded bv Dr. Dawsey, and the motion was carried unanimously. Dr. Raper called for a vote on the original motion as amended, and it was carried unanimously. Mr. Marshall Staton presented a recommendation to amend Sec-tion C.401(c) of The North Carolina Regulations for Protection Against Radiation. He explained: Before changes can be made in these regu-lations, the Governor must approve the change. Written approval has been received from Governor Robert W. Scott approving the amendment. (Copy of letter attached to official minutes.) The purpose in changing the wording of this Section of the Regulations is that it might comply with that of the Atomic Energy Commission, except we use the word definite where they use the word permanent. Dr. Raper asked if any member of the public wished to be heard, and the secretary was instructed to let the minutes show that no one was heard. A motion was made by Dr. Meredith, seconded by Dr. Barker, that the request to amend Section C.401(c) of The North Carolina Regulations for Protection Against Radiation be approved. The motion was carried unanimously. Mr. Staton presented proposed revision of rules and regulations governing sanitation of summer camps. He explained that there are at present 171 camps in North Carolina which come under these regulations, and the proposed rules and regulations are intended to replace those now in effect which were adopted by the State Board of Health in 1947. The proposed revision has been reviewed by a committee of local camp directors and sanitarians who ha\e camps in their counties, the revision also includes certain requirements of the American Camp Association. The principal changes consist of bringing the regulations up to date primarily in the area of food service and by adding such procedures as investigation of camp sites. After some discussion, two changes were suggested. Dr. Raper asked if any member of the public wished to be heard, and instructed tlie secretary to let the minutes show that no one was heard. Motion was made by 10 FORTY-FOURTH BIENNIAL REPORT Dr. Maness, seconded by Dr. Barker, that the Revised Rules and Regulations Covering the Sanitation of Summer Camps in North Carolina be approved as amended, the effective date to be January 1, 1972. Tlie motion was carried unanimously. (Copy is attached to the official minutes.) Mr. Staton discussed the establishment of rules and regulations providing for solid waste disposal. A bill was presented during the last Session of the General Assembly designating the State Board of Health as the official State agency responsible for solid waste disposal. We have conducted 60 individual county studies in North Carolina and prepared plans for solid waste disposal programs in these counties. Thirteen additional counties have requested studies and recommenda-tions. We are well underway with this program, but we have been short of manpower. The A and B Budgets contain provisions for additional staff and the Advisory Budget Commission recommended that this program be staffed. The proposed rules and regulations have been reviewed by the North Carolina League of Municipalities and the Association of County Commissioners. The League of Municipali-ties made two minor suggestions for changes; these are clarifying words and do not affect the whole intent of the regulations in any way. Dr. Raper inquired if any member of the public desired a hear-ing on this matter. Mr. Lonnie C. Poole, of Waste Industries, spoke briefly representing private enterprise. He said: We are getting involved in the landfill business and can offer some alternatives in cost to the solid waste program. I think overall the proposed regula-tions show a great deal of professionalism on the part of the public and private enterprise involved. They have done a nice piece of work. Motion was made by Dr. Dawsey, seconded by Dr. Meredith, that the Rules and Regulations Providing Standards for Solid Waste Disposal be adopted, incorporating the changes suggested by the League of Municipalities, the effective date to be March 11, 1971. The motion was carried unanimously. (Copy is attached to the official minutes.) Dr. Martin P. Hines, Director, Division of Epidemiology, gave the following information reports: Byssinosis: Field work for the cooperative study of the prevalence of byssinosis among cotton textile workers is virtually complete. Teams of physicians and technicians from the State Board of Health and Duke Medical Center have interviewed, x-rayed and performed pulmonary function tests on 4,000 workers in this industry in the past nine months. Concurrently, engineers have collected 2,000 air samples in the work places for dust analysis. A dust sampling device NORTH CAROLINA BOARD OF HEALTH 11 developed specifically for this study shows promise in other areas of air sampling for toxic aerosols. Although the data collected has not yet been analyzed, there appears to be a definite relationship between the incidence of byssinosis and the exposure of the individuals to respirable-size dust, not cotton fibers, in the workrooms. Synthetic fiber and wool workers known to be essentially free of byssinosis were used as control groups in this study. The efforts of the study group are now being directed toward determining an effective and economically feasible method for control of this occupational disease. Studies re-lating to the long-term effects of exposure to cotton dust are also planned. Pesticides Program: The overall objective of this program, estab-lished in January, 1969, is to study the health effects of man's usage of pesticides, and where problems emerge, initiate sound corrective measures. Accomplishments have been made in each of the areas included in the work scope. This year we are working with pesticide formulating plants and other facilities with high occupational ex-posure risk to pesticides. We will hopefully set up a cholinesterase monitoring service to these groups to measure organophosphate ex-posure. We also will be working in cooperation with a large tobacco processing company in evaluating occupational hazards in their opera-tions due to pesticides. We will be cooperating with the Department of Agriculture and N. C. State University in residue studies of parathion on the extension experiment stations this summer. Addi-tionally, we will attempt to evaluate t^q^ical usage patterns of this chemical on selected farms. Driver Medical Evaluation of Visually Handicapped: As a result of an amendment to G.S. 111-28 by the 1969 General Assembly, the number of drivers being medically evaluated for visual problems has greatly increased over the past several months. This change in the law authorized the Commission for the BHnd to release to the De-partment of Motor Vehicles the name and medical record of any person listed on the register of the blind or added to the register in the future. The initial screening of this register turned up over 300 individuals with valid driving licenses. These cases were referred to the State Board of Health for evaluation to determine to what extent their visual difficulties would interfere with their ability to safely operate motor vehicles. The medical evaluation has been completed on approximately two-thirds of these cases, resulting in approximately 60 percent being denied driving privileges. Of the approximately 40 percent authorized to continue driving, many are being severely re-stricted, such as restriction to corrective lenses, daylight driving onh-, 12 FORTY-FOURTH BIENNIAL REPORT and 45 MPH speed limit. Since North Carolina has no legal visual standards for driving, these cases have been medically reviewed on the basis of guidelines established by the American Medical Associa-tion and the U. S. Department of Health, Education and Welfare. A need exists, however, for more definitive visual standards to be estab-lished for guidance of driver license examiners, medical consultant panels, and the Medical Review Board. With this in mind, representa-tives of the State Board of Health and the Department of Motor Vehicles have met with a group of ophthalmologists and an optometrist to recommend visual standards for adoption by the Commissioner of Motor Vehicles. These standards, hopefully, will be developed during the next few months. Dr. T. D. Scurletis, Director, Personal Health Division, reported on the following: Family Planning: The State Board of Health is participating in a Task Force for the development of a total comprehensive, coordinated plan for family planning. This Task Force was established by the Department of Administration and includes the Departments of Social Services, Mental Health, Education, Health, Local Affairs, the Population Center of the University of North Carolina, Medical Society of the State of North Carolina, Old North State Medical Society. The State Board of Health has been designated as the lead agency in developing and recommending the total plan. This effort is aimed at coordinating all state and federal funding sources and programs into an integrated comprehensive plan to meet the needs of North Carolina citizens. The initial plan is due to be submitted on April 1, 1971, but this will be just the beginning of the long-range coordinated effort so that the plan will be expanded and periodically updated to meet changing situations. Kidney Planning: This is an interim report on the progress of the planning for a total kidney program for the State of North Carolina as a result of the efforts of the initial kidney plan venture which was begun approximately three years ago. A program has been advocated and a project written for the development of the training components and is presently being considered by the Regional Medical Program. Legislation has been introduced by Senator Currie (copies of the bill were distributed) which will mandate the State Board of Health to maintain the planning and coordination of the development of a total kidney chronic disease program. The legislation calls for the develop-ment of an Advisory Group which is essentially the same as the Planning and Advisory Committee. This group is to advise the State Board of Health in the development and coordination of a system of NORTH CAROLINA BOARD OF HEALTH 13 service for dialysis and transplantation, continued study of the needs, the development of total educational program and finally the initiation of a program to assist medically indigent patients in securing ser-vice. This has been an excellent demonstration of what can be ac-complished by combination and coordination of eflPorts of health agencies, medical training institutions, providers of service and third party interest. Dr. Scurletis distributed a list of those physicians who have ap-plied for rostering in the Crippled Children's Program, and indicating those who have been rostered, since the last Board meeting. (Copy at-tached to the official minutes.) Dr. Jacob Koomen commented on Budget Requests: We have been very warmly treated by the Advisory Budget Commission. For the Health Aid to Counties item, nearly $1 million has been projected in the A Budget to help the counties carry their enormous burden. In the B Budget, we requested support for six items: Medical Examiner System, Environmental Health Services, Pesticides Program, Com-municable Disease Program (in particular, the purchase of vaccines), Crippled Children's Program, and the Cancer Control Program. The Advisory Budget Commission has recommended to the General As-sembly approximately $22 million in support of the State Board of Health, up some 25 percent over the present budget. We have also presented before the Appropriations Committee and requested: (1) Additional money for Health Aid to Counties, particularly to strength-en their environmental health work (this would involve sufficient funds to purchase services of 54 sanitarians and six supervisors in this field); (2) Money to continue the cancer registry; (3) Additional money for Occupational Health; (4) Additional money to expand child screening clinics; (5) Expansion of the family planning program; (6) Modest ex-pansion of the services for mentally retarded, which would involve increasing the number of child development clinics from 11 to 15; (7) Expansion of the Multiphasic Screening Program. In summary, we requested a total of .$19y2 million in the A Budget (approximately $2 million over the prior two years), and $2,458,000 in the B Budget (an increase of around $4y2 million). Mr. Ben Eaton, Director, Administrative Services Division, report-ed on the status of the new health building. Ten days ago the bids were let and the total cost of the project comes to approximately $4,200,000. The construction cost alone is $3,960,000; the cost per square foot will be approximately $31.57. A Greensboro firm, W. H. Weaver Company, has contracted for the construction. The building will face W^ilmington Street on the corner of Lane and North Streets, and \\ill hdvc an 14 FORTY-FOURTH BIENNIAL REPORT exterior of precast stone. The two top floors of the five-story building will be for the Laboratory and will almost double their present space. We are working out which of the other Divisions will move to the new building — those who work more closely together, and with the Laboratory, will probably be relocated there. The gross square footage is about 124,000 but the usable ofiice space will be about 68,000 square feet, compared with 87,000 at present. Upon completion of the build-ing, all State Board of Health oflBces will be relocated in the Cooper Building and the new building, as opposed to our present arrange-ment of nine different locations. Dr. Koomen commented that there are about six Day Care bills now before the General Assembly. We have a strong role in the in-spection of these facilities. No resolution has come about in the bills so far proposed. Dr. Koomen also mentioned the proposed revision of the Abortion Law which has been processed by the House Health Committee and Representative Nancy B. Chase. This bill has been passed by the House and is now before the Senate Health Committee. (Copies were distributed). Dr. Raper concluded: "Everybody performed beautifully! Thank you for coming today." There was no further business, and the meeting adjourned. NORTH CAROLINA BOARD OF HEALTH 15 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Wednesday, May 19, 1971 The North CaroHna State Board of Health met in the Dutch Room of The Carohna, Pinehurst, North Carohna, at 8:00 a.m., on May 19, 1971. Dr. James S. Raper, President, presided. Other members in at-tendance were: Lenox D. Baker, M.D., Vice-President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman, Jr., B.S.Ph. Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Paul F. Maness, M.D. The invocation was given by Dr. Joseph S. Hiatt. The minutes of the last meeting were discussed. It was pointed out that the effective date of the Revised Rules and Regulations Governing the Sanitation of Summer Camps in North Carolina should have been January 1, 1972 rather than January 1, 1971. This change will be made in the minutes. There were no further corrections, and upon motion of Dr. Dawsey, seconded by Dr. Barker, the minutes were approved as circulated. Dr. Raper reported that the House of Delegates of the State Medical Societ}' had taken action with regard to the rostering of phy-sicians in the Crippled Children's Program. Dr. Koomen read the resolution which was adopted on May 18, 1971, as follows: "The physician's eligibility for participation should be dependent upon (1) having unrestricted license to practice medicine in North Carolina (2) provision of curriculum vitae and a brief summary of his training and clinical experience in the category in which he is applying and (3) furnishing evidence of membership on the staff of hospitals having adequate facilities to provide satisfactory care in the category in which he is applying." Comments were heard from several members; however, no action was required on this matter. The first item of new business was the consideration of proposed Rules and Regulations Governing the Statewide Medical Examiner System, and these were presented by Dr. R. Page Hudson, Chief Medical Examiner. Dr. Hudson answered several questions and after discussion Dr. Raper inquired if any member of the public wished to be heard. He instructed the secretary to let the minutes show that 16 FORTY-FOURTH BIENNIAL REPORT no one was heard. Motion was made by Dr. Hiatt, seconded by Dr. Dawsey that the Rules and Regulations Governing The Statewide Medical Examiner System be approved. The motion was carried. (Copy is attached to the oflBcial minutes.) Dr. Martin P. Hines, Director, Division of Epidemiology, pre-sented a proposed revision of Regulations Governing Chemical Tests for Breath Alcohol. He explained that these regulations were originally adopted by the Board on May 10, 1964 and amended February 15, 1969. The amendments to be considered today represent changes which are deemed necessary after seven year's experience with the program. "They have been carefully reviewed and concurred in by Dr. Arthur McBay and by an ad hoc committee on chemical tests for alcohol. We request diat these regulations become effective August 1, 1971." Dr. Hines pointed out the major facts in the regu-lations, and invited questions. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one appeared. Motion was made by Dr. Baker, seconded by Dr. Maness that the revision of Regulations Governing Chemical Tests for Breath Alcohol be accepted as presented. The motion was carried unanimously. (Copy attached to official minutes.) Dr. Hines then presented for the Board's consideration approval of vaccine preparation and dosages. He said: The 1971 General Assembly has passed a rewrite of the state immunization laws, combining old Articles 9 and 9A of Chapter 130 of the general statutes into a single Article 9. In addition to the requirements of the old statutes relating to immunization against diphtheria, whooping cough, tetanus, polio, and smallpox, the new law requires administration of measles (rubeola) vaccine before two years of age; immunization against polio is now required by one year of age. Section 130-87 of the new law (copy attached to official minutes) provides that the State Board of Health will determine how many doses of each of the vaccines shall be re-quired and which vaccine preparations shall be approved for use. It was suggested that the following list of doses be approved as the minimum acceptable by the ages specified in the law for the specified vaccines: DPT — Three (3) doses by age one (1) year. Oral polio vaccine — Trivalent t>^pe — Two (2) doses by age one (1) year; or Monovalent type — One (1) dose of each type by age one (1) year. Measles vaccine — One (1) dose by age two (2) years. Smallpox vaccine — One (1) successful vaccination by age six (6) years. NORTH CAROLINA BOARD OF HEALTH 17 It is further suggested that all vaccine preparations licensed for interstate use by the Division of Biologic Standards of the U. S. Public Health Service (list attached) be approved for use in fulfilling the requirements of this law. Motion was made by Dr. Maness, seconded by Dr. Dawsey, that the suggested list of doses be approved as the minimum acceptable by the ages specified in the law for the specified vaccines. Dr. Raper inquired if any member of the public desired a hearing on this matter, and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. At this point, the Board adjourned to the Conjoint Session of the State Board of Health and the Medical Society of the State of North Carolina, at which time Dr. Jacob Koomen, State Health Director, presented his report, entitled "Transportation Versus Trauma: A Public Health Perspective of the Automobile". (Copy attached to the official minutes.) The Board reconvened following the Conjoint Session, and Dr. Charles T. Barker discussed Senate Bill 311 and Senate Bill 312 which are now pending in the General Assembly. The Dental Health Division is trying very hard to get these bills passed, representing a pioneer effort in support of the Preventive Dental Program. Dr. Barker ex-plained: It has only been within the last t\vo years that dentists have really found out what is probably the cause of oral disease. Dental disease affects 95-96 percent of human beings. We want to teach the Bass Technique to the dentists and children of North Carolina. Senate Bill 311, short-titled "Preventive Dental Program", calls for employment of 20 dental hygienists who will "implement major in-novations in the preventive dental program", providing salary, ti-avel, dental equipment, supplies and materials; also funds to provide special training in plaque control for private-practicing dentists. The total requested amounts to $545,050.00. Senate Bill 312, short-titled "School Dental Health", asks $77,706 to purchase equipment and sup-plies to fluoridate some 40 rural school water systems and for salaries and travel for two engineering technicians to maintain and monitor all the rural school water fluoridators. Dr. Barker said he would like to invite the Committee on Plaque Control to attend the ne.xt meeting of the Board to demonstrate the Bass Technique to the Board. He asked that each Board member talk with his legislator about this pro-gram and these t\vo bills. Dr. Raper excused Dr. Koomen and Dr. Jones and brought to the Board's attention that their appointments as State Health Director and Assistant State Health Director expire Jime 30, 1971. It is up to 18 FORTY-FOURTH BIENNIAL REPORT ihis Board to take action to recommend to the Governor that their services be retained, or that they be replaced. Dr. Maness moved that both Dr. Koomen and Dr. Jones be retained: They are outstanding physicians rendering excellent service and I do not think we could do better. The motion was seconded by Dr. Dawsey, and carried unanimously. This action will be reported to the Governor by the President. Dr. Jacob Koomen stated that Mr. J. M. Lackey of Hiddenite had been elected County Commissioner of Alexander County. Holding this position as well as membership on the State Board of Health would make him a "double oflBceholder"; therefore, Mr. Lackey submitted his resignation to the Governor. Dr. Koomen wished to know the feelings of the Board about writing a resolution citing Mr. Lackey's good services. Motion was made by Dr. Maness, seconded by Dr. Barker, that a resolution be written and presented to Mr, J. M. Lackey citing his outstanding services to the State Board of Health. The motion was carried unanimously. The hour of the annual meeting of the Board with the State Medical Society (in Pinehurst each year) was discussed. It was pointed out that the Public Health Section meets on Tuesday morning, and if the Conjoint Report could be given at the Tuesday noon session, and the State Board of Health could meet on Tuesday afternoon, it would be possible for Health Directors and others to come to the Board meeting and to participate in the Conjoint Report. Dr. Koomen stated that by law the Board must meet annually with the State Medical Society, but a change of meeting time could be discussed with the Society. Dr. Raper said he would be happy to write to Dr. Charles W. Styron, with a copy to Mr. William N. Hilliard, Executive Director of the State Medical Societ\', to ask that this change be made. It was the consensus of the group that this should be done. The place of the next meeting was discussed; it was felt that since the Board had met in the western part of the State, it would be good to hold a meeting in the East. Dr. Charles Barker and Dr. Koomen will make the necessary arrangements for the next meeting in the East. Dr. Raper reported that the Executive Committee of the Board had met regarding the name change, as directed at the last meeting of the Board. They decided to get a legal opinion on this matter; this was done, but not in time to act on it at today's meeting. Dr. Raper said, "It is my opinion that we would do well not to force this". There was no further business and the meeting adjourned. NORTH CAROLINA BOARD OF HEALTH 19 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, October 28, 1971 The North CaroHna State Board of Health met in the Nighthawk Room of the Blockade Runner, Wilmington, North Carolina, at 9:30 a.m., on October 28, 1971. Dr. James S. Raper, President, presided. Other members in at-tendance were: Paul F. Maness, M.D. Ernest A. Randleman, Jr., B.S.Ph. Ben W. Dawsey, D.V.M. Charles T. Barker, D.D.S. Jesse H. Meredith, M.D. The invocation was given by Dr. Paul F. Maness. The minutes of the last meeting were brought to the attention of the Board. There were no corrections and upon motion of Dr. Dawsey, seconded by Dr. Meredith, the minutes were approved as circulated. Nominations were received for President and Vice-President of the North Carolina State Board of Health. Dr. Barker nominated Dr. Raper to continue as President of the Board and the motion was seconded by Dr. Maness. Dr. Meredith moved that the nominations be closed, and the motion was seconded by Dr. Dawsey. A vote was taken and Dr. Raper was elected unanimously. Dr. Dawsey nominated for the Vice-President of the Board Dr. Paul F. Maness, with Dr. Barker seconding his motion. Some discussion was held in relation to this nomination and Mr. Ben Eaton was called upon to clarify the matter. Dr. Maness was then elected Vice-President of the State Board of Health. Dr. Barker and Dr. Meredith were nominated and unanimously elected to serve on the Executive Committee. Dr. Jacob Koomen was recognized and introduced staff members and others in attendance. Tlie following items of new business were introduced by Mr. Marshall Staton, Director, Sanitary Engineering Division: 1. Standards for Design and Construction of Public Water Supply Systems to Serve Residential Communities: Mr. Staton stated tliese regulations had been needed for some time. The 1969 General As-sembly directed the Legislative Research Commission to study cer- 20 FORTY-FOURTH BIENNIAL REPORT tain water and air resource laws and to report its findings and recom-mendations to the 1971 General Assembly. Public hearings were held and testimony received from quite a number of people in the State concerning the status of small water supplies — particularly, those serving mobile home courts and housing subdivisions. Many deficien-cies were found in these places, and the Attorney General's Office expressed the opinion that our laws were not broad enough to cover some of the deficiencies in existence. The 1971 General Assembly enacted new public water supply legislation based on the Legislative Research Commission's recommendations. This legislation authorized the State Board of Health to adopt more stringent regulations. We were pleased to have an opportunity to prepare these regulations, a copy of which, along with a copy of the bill passed by the General Assembly, was sent to the Board. The regulations are quite lengthy and technical but in general cover the source of water, the distribu-tion system, storage facilities, etc. They are prepared in two sections — one for housing communities, and one for mobile home courts. Fol-lowing discussion, a motion was made by Dr. Dawsey, seconded by Dr. Meredith, that the Standards for Design and Construction of Public Water Supply Systems be approved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion was car-ried. (Copy of Standards attached.) 2. Rules and Regulations to Protect the Health, Welfare, and Safety of Those Attending Mass Gatherings and of Other Persons Who May Be Affected By Mass Gatherings: Mr. Staton explained that these regulations originated as a result of a law passed by the 1971 General Assembly. The regulations are lengthy and cover, in general, water supply, sewage disposal, plans for emergencies, solid wastes, food dispensing and other provisions applicable to mass gatherings, includ-ing Rock Festivals. There was no discussion and Dr. Raper inquired if any member of the public wished to be heard; no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Barker, that the proposed Rules and Regulations Governing Mass Gatherings be Approved and Become Effective October 28, 1971. The motion was carried unanimously. (Copy of Rules and Regulations is attached.) 3. Rules and Regulations Governing the Disposal of Sewage From Any Residence, Place of Business or Place of Public Assembly in North Carolina: Mr. Staton said that these amendments would mean that: (a) the person owning or controlling the property will be re-sponsible for the maintenance of the septic tank, and (b) persons in the business of cleaning septic tanks must not only go to the health NORTH CAROLINA BOARD OF HEALTH 21 department and get a permit but also must discharge the wastes at a location and in a manner approved by the Local Health Director. A motion was made by Dr. Meredith and seconded by Dr. Dawsey that the proposed Amendments to the Rules and Regulations Govern-ing the Disposal of Sewage From Any Residence, Place of Business or Place of Public Assembly in North Carolina be approved and made effective January 1, 1972. The President inquired if any member of the public wished to be heard regarding this matter, and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. (Copy of Amendments is attached.) 4. Resolution of the North Carolina State Board of Health Ex-tending the Boundary Lines of the Walkertown Sanitary District Located in Forsyth County, North Carolina: Mr. Staton explained that the Board of Commissioners of the ^^'alkertown Sanitary District wish to extend the boundary lines to include properties described in a petition submitted to them on June 10, 1969. More than 51 percent of the owners of the real property within the territory proposed to be annexed have signed the petition. Plans for boundary extensions have been submitted to the Engineering Section of the Sanitary Engineering Division, and have been found acceptable. The Sanitary Engineering Division, therefore, recommends approval of the annexation. The Attorney General's OfRce has been consulted and advises that every-thing is in order. Dr. Maness moved, and Mr. Randleman seconded, that the Petition to Extend Boundaries of Walkertown Sanitary Dis-trict, Forsyth County, North Carolina, be approved. Dr. Raper in-quired if any member of the public wished to be heard and no one appeared. The motion was carried unanimously. (Copy of resolution is attached.) The next item of business was hearing on Legislative Room Rate Limitation for Nursing Homes established by the 1971 General As-sembly. Mr. James T. Johnson, President, North Carolina Association of Nursing Homes, was heard and made the suggestion that "we have a liaison committee for the Nursing Homes Association and the State Board of Health". He stated that according to figures supplied by the Department of Social Services "one-half of the nursing home beds in the State of North Carolina which were paid for in the month of September exceeded $14.00 in cost". Dr. Raper responded to the remarks of Mr. Jt)hnson. The Board has discussed with county com-missioners for years in an effort to get them to pay even close to the cost for hospital care of the indigent patients. Nursing Homes in general are profit organizations and hospitals are primarily non-profit. The obvious answer is that they charge the private patients 22 FORTY-FOURTH BIENNIAL REPORT more to make up for the slack. It isn't correct, but it's the only alterna-tive that you have. This report was received as information. No action was taken on this matter. Dr. Arthur McBay, Chief Toxicologist for the North Carolina Medical Examiner System, presented a summary of the North Carolina Controlled Substances Act enacted, which will become effective January 1, 1972. The Attorney General's office had advised that the State Board of Health should formally review, approve and estab-lish regulations for emergency prescriptions as required in G.S. 90-106 of the new law. A motion was made by Dr. Meredith, seconded bv Dr. Dawsey, that Regulations Governing Emergency Prescriptions of Controlled Substances be approved. Dr. Raper inquired if any mem-ber of the public wished to be heard and instructed the secretary to let the minutes show that no one appeared or requested a hearing. The motion was carried unanimously. (Copy of the Regulations is attached.) Dr. Ronald Levine, Director, Communit}- Health Division, re-viewed the 1971 General Assembly Resolution to Create a Study Commission on Organization and Delivery of Health Services. Dr. Maness moved that Dr. Levine's report be accepted as information. Dr. Baker seconded the motion and it was carried unanimously. Dr. Isa Grant, Chief, Chronic Disease Section, gave an informa-tion report concerning the Kidney Disease Program. She used flip charts to show the locations of the Dialysis Centers which have been approved by the Advisory Committee — namely, Bowman-Gray School of Medicine, ^^'inston-Salem; Uni\'ersit>' of North Carolina, Chapel Hill; Duke University School of Medicine, Durham. In addition, there are smaller centers in Asheville, Charlotte and Greenville. Dr. Scurletis presented the rules and regulations concerning procedures for issuing a Certificate of Need which were developed by the staff with the cooperation of the Institute of Government and the North Carolina Medical Care Commission. The legal basis for issuing these regulations is Chapter 1164 of the 1971 North Carolina General Assembly Session Laws. Motion was made by Dr. Dawsey and second-ed by Dr. Maness that the proposed Regulations Governing the Certificate of Need be approved. Dr. Raper inquired if any member of the public wished to be heard and the secretary was instructed to let the minutes show that no one was heard, and tliat the regulations were approved unanimously. (Copy of regulations is attached.) Dr. T. D. Scurletis, Director, Personal Health Division, presented proposed Regulations Governing Licensing of Home Health Agencies. NORTH CAROLINA BOARD OF HEALTH 23 Recently the Legislature passed a bill requiring the licensing of Home Health Agencies, the purpose of which was to allow organiza-tions other than non-profit organizations to provide home health ser-vices and is related to the Federal Medicare Law. The bill established the State Board of Health as the licensing agency and empowered it to develop rules and regulations. The regulations insure that any home health agency in this State must comply with Medicare- Medicaid Standards. They apply only to non-public agencies. We belie\'e that these are relatively all-inclusi\'e and that they fully cover the purpose of the law as passed by our legislature and are not in conflict with any Federal guidelines. The motion was made by Dr. Dawsey and seconded by Dr. Meredith that the proposed Regulations Governing Licensing of Home Health Agencies be approved. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. (Copy of Regulations is attached.) The next item of business related to the Revision of Nursing Home Regulations. Dr. Scurletis, in presenting this to the Board, said that these revisions introduce the Certificate of Need into our licens-ing requirement. He directed the Board's attention to the proposed revisions and answered questions from the Board. A motion was made by Dr. Maness, seconded by Dr. Dawsey, that the proposed Revisions of Nursing Home Regulations be accepted, effective January 1, 1972. The motion was carried unanimously. (Copy of Revision is attached.^ Consideration was then given to rostering of physicians for the Crippled Children's Program, and quite a lengthy discussion was held around this. Dr. Scurletis stated that this matter dated back to Ma\- of 1970 when the Board directed that the President of the Board consult with the Medical Society and establish an Advisory Committee to make recommendations for rostering of physicians for this program. This committee has met and agreed upon a set of requirements, which are presented to you today for your approval. Motion was made by Dr. Dawsey and seconded by Dr. Meredith that the proposed Rules and Regulations Governing the Procedures for Rostering of Physicians For The Crippled Children's Program be approved. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. (Copy of Rules and Regulations is attached.) The ne.xt presentation, in reference to the Repeal of Requirements for Health Cards for Food Handlers, was presented by Dr. Martin P. Hines, Director, Division of Epidemiology. E.xamples of health cards were distributed and Dr. Hines said this repeal was being proposi^d 24 FORTY-FOURTH BIENNIAL REPORT with the complete approval and cooperation of the Sanitary Engineer-ing Division. Motion was made by Dr. Dawsey, seconded by Dr. Meredith that the Requirements for Health Cards for Food Handlers Be Repealed and that the effective date be January 1, 1972. Dr. Raper inquired if any member of the public wished to be heard and instruct-ed the secretary to let the minutes show that no one was heard. The motion was passed unanimously. Dr. Hines also presented a proposal for the creation of a new section in the Division of Epidemiology. A motion was made by Dr. Meredith, seconded by Dr. Barker, that the Highway Safety Unit be made a Section in the Division of Epidemiology. The motion was carried. Dr. Hines presented the matter of Recognition of Live Tissue Culture Rabies Vaccine for Dogs and asked the Board to pass the proposed resolution that the modified tissue vaccine will be recom-mended for a period of three years as well as the chicken embryo. Motion was made by Dr. Dawsey, seconded by Dr. Maness, that Recognition of Live Tissue Culture Rabies Vaccine for Dogs be Approved. Dr. Raper inquired if any member of the public wished to be heard and so instructed the secretary to let the minutes show that no one was heard. The efi^ective date of this resolution will be October 28, 1971. The motion was carried. (Copy attached.) The next item for consideration was the addition of equipment items on emergency vehicles. Dr. Hines stated: The Advisory Com-mittee to the State Board of Health on Ambulance Services met on October 1 and recommended unanimously that a poison kit and obstetrical kit be added to the list of equipment on all emergency vehicles in the State (the cost involved for both items would be very small). The effective date is to be January 1, 1972, if approved by the Board. Dr. Dawson moved, and Dr. Maness seconded, a motion that a poison control kit and obstetrical kit be added as an equipment item on emergency vehicles, the effective date to be January 1, 1972. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Mr. David Warren, Associate Professor of Public Law and Government of the Institute of Government, Chapel Hill, addressed the Board briefly on the law as it pertains to the medical field in relation to eighteen-year-olds. A statute was enacted by the 1971 General Assembly which states that any person who is eighteen years of age or older or who is emancipated may consent to any medical NORTH CAROLINA BOARD OF HEALTH 25 assistance to himself or his child. This helps solve the diflBculty that the physicians and hospital administrators have been confronted with over the years. Final comments were heard from Dr. Jacob Koomen, State Health Director, and thereafter Dr. Raper declared the meeting adjourned. 26 FORTY-FOURTH BIENNIAL REPORT MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, March 23, 1972 The North CaroUna State Board of Health met in the Board Room of the Cooper Memorial Health Building at 10:00 a.m., on Thursday, March 23, 1972. Dr. James S. Raper, President, presided. Other members in attendance were: Paul F. Maness, M.D., Vice-President Joseph S. Hiatt, M.D. Charles D. Barker, D.D.S. Jesse H. Meredith, M.D. Donald W. Lackey, D.V.M. Ernest A. Randleman, Jr., B.S.Ph. Ralph W. Coonrad, M.D. Robert B. Nichols, Jr. The invocation was given by Dr. Paul F. Maness. Dr. Lenox D. Baker, Secretary, Department of Human Resources, spoke briefly to the Board regarding reorganization. He displayed an organization chart of the new Department and referred to it as a "road map" showing how the Department will get where it wants to go. He expressed the hope that the five major offices could be com-bined into "a committee to run the Department. This is what you call teamwork and without this we cannot survive. We must have your (the Board's) help, your drive, your knowledge, to help us find the way to work most efficiently for the taxpayer." Dr. Raper welcomed the three new members of the Board — Dr. Ralph W. Coonrad, Mr. Robert B. Nichols, Jr. and Dr. Donald W. Lackey. He congratulated Mr. Ernest A. Randleman on his reap-pointment. Members of the staff and other present introduced them-selves to the Board. Dr. Jacob Koomen, State Health Director, read an "Expression of Appreciation" to Dr. Lenox D. Baker, former member of the Board. Motion was made by Dr. Maness, seconded by Dr. Meredith, that this be approved. Motion was carried. Dr. Koomen also presented a similar expression written to Dr. Ben W. Dawsey, who has just completed 12 years as the Veteri-nary member of the Board. A motion was made by Mr. Nichols, seconded by Dr. Maness, that this expression be approved. The motion was carried. NORTH CAROLINA BOARD OF HEALTH 27 The minutes of the last meeting were presented for approval. One correction was brought out and duly noted the minutes. Dr. Meredith moved that the minutes be approved with correction; Dr. Barker seconded the motion and it was passed unanimously. Dr. Martin P. Hines, Director, Division of Epidemiology, dis-cussed proposed regulations governing the sale of turtles. He said there had been some concern over this matter for a number of years, as these turtles carry a variety of species of salmonella. Several epi-demiological investigations have been made, and culture surveys have been done; Dr. Hines recommended that the Board approve the pro-posed regulations. A motion was made by Dr. Barker, seconded by Mr. Randleman, that the Rules and Regulations Governing the Sale of Turtles be approved. Dr. Raper inquired if any member of the pub-lic wished to be heard on this matter, and instructed the secretary to let the minutes show that no one was heard. The motion passed with-out opposition. Dr. Hines gave an information report on changes taking place in immunization laws and commented on smallpox vaccine. He said: An Advisory Committee to the Surgeon General in Washington released recently information to the effect that there is no need to immunize against smallpox. We feel now that this policy should be abandoned. Dr. Raper asked that each member of the Board think about this thoroughly and look into it, in order to be ready to vote when the time comes. No action is required at the present time; action of the General Assembly may be necessary. Dr. Hines distributed, for informational purposes, sample copies of new forms being used by the State Board of Health, Division of Epidemiology, for reporting purposes — namely: Therapeutic Abortion Report, Removal of Graves Certificate, and Medical Examiner's Certifi-cate of Death. He also reported on: (1) the status of removal of health card requirement for foodhandlers; (2) the immunization program — nearly 340,000 children will be immunized this year; (3) the gonorrhea program which is just unfolding — plans are underway for a mass state-wide control program, and funds have been allocated by Con-gress for this purpose. It is hoped that this program will result in about 31,000 females being brought to treatment. Dr. Arthur McBay, Chief Toxicologist for the Medical Examiner System, presented proposed Rules and Regulations Governing North Carolina Controlled Substances Act, Chapter 90, Article V. Mr. Hem-y Poole of the Attorney General's Office was present and responded to questions by the Board. Motion was made by Dr. Meredith, seconded by Mr. Randleman, that the proposed Rules and Regulations Govern- 28 FORTY-FOURTH BIENNIAL REPORT ing North Carolina Controlled Substances Act, Chapter 90, Article V, be approved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Dr. McBay also discussed proposed rescheduling from Schedule III, G.S. 90-91 (Article V) to Schedule II, G.S. 90-90, the following drugs: (a) Amphetamine, its salts and isomers; (b) Phenmetrazine and its salts; (c) Any substance except injectionable liquid which contains methamphetamine and its salts and isomers; (d) Metholphenidate. Motion was made by Mr. Randleman, seconded by Dr. Coonrad, that the proposed Resched-uling be approved. Dr. Raper inquired if any member of the public would like to be heard; the secretary was instructed to let the minutes show that no one appeared. The motion was carried without opposi-tion. Dr. McBay then presented for action the proposed exclusion of the drug, naloxone hydrochloride, from Schedule II, G.S. 90-9, and the entire Article V. Dr. Barker moved, and Dr. Maness seconded, a motion that the drug Naloxone Hydrochloride be excluded from Schedule II, G.S. 90-9, and the entire Article V. Dr. Raper inquired if any member of the public \\'ished to be heard, and instructed the sec-retary to let the minutes show that no one was heard. The motion was carried. Mr. Randleman introduced discussion of the drug, paregoric. He said it ^^•as his interpretation that, even though this is not a scheduled drug, it could not be sold without a prescription. He further stated that he would like Dr. McBay and the Board to investigate this and see if anything can be done. Dr. McBay said he had been assured by the Attorney General's office that the Board can take action should it see fit. Mr. Marshall Staton, Director, Sanitary Engineering Division, pre-sented the following for the Board's consideration: 1. Proposed Amendment to Summer Camp Regulations — This amendment would eliminate the requirement that all employees and campers should give evidence of a successful vaccination against smallpox within 10 years of arrival at camp. Motion was made by Dr. Maness, seconded by Dr. Coonrad, that the proposed Amendment to Summer Camp Regulations be approved. Dr. Raper inquired if any member of the public wished to be heard; he instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. 2. Resolution Extending the Boundary Lines of the Roanoke Rapids Sanitary District — Mr. Staton explained that this proposal had been reviewed by the Attorney General's office and found to be in NORTH CAROLINA BOARD OF HEALTH 29 order. Motion was made by Dr. Maness, seconded by Dr. Coonrad, that the Resolution of the North Carohna State Board of HeaUh Ex-tending the Boundary Lines of the Roanoke Rapids Sanitary District Located in Halifax County, North Carolina, be approved. Dr. Raper asked if any member of the public ^^ ished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Mr. Staton said that since the first proposed resolution had been mailed to the Board, an urgent request had been received from the Roanoke Rapids Sanitary District to annex two additional areas — the Lincoln Heights area and the West Rosemary area. These areas are presentlv served by individual wells, many of which are contaminated due to the close proximity of septic tanks and privies. The Sanitary District has recently received confirmation of a Federal grant which will assist in proxiding the needed water and sewerage facilities to serve these two areas; however, to receive this financial assistance con-struction must begin in 90 days. For this to be accomplished, it is necessary that annexation of these areas be considered at this time. Favorable action by the Board will allow water and sewer facilities to be installed, which will eliminate unsanitary conditions which now exist in these areas. Motion was made by Dr. Barker, seconded by Dr. Coonrad, that the Resolution of the North Carolina State Board of Health Extending the Boundary Lines of the Roanoke Rapids Sanitary District to Include the Areas of Lincoln Heights and West Rosemary be approved. Dr. Raper asked if any member of the public \\ ishcd to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion passed without opposition. 3. Resolution Extending the Boundary Lines of the Sedgefield Sanitary District — Mr. Staton said this resolution had been discussed with the Attorney General's office and was found to be in order, and he recommended adoption. A motion was made by Dr. Maness, seconded by Dr. Hiatt, that the Resolution of the North Ciirolina State Board of Health Extending the Boundary Lines of the Sedgefield Sanitary Dis-trict Located in Guilford County, North Carolina be approved. Dr. Raper asked if any member of the public wished to speak, and in-structed the secretary to let the minutes show that no one w as heard. The motion was carried unanimously. Dr. T. D. Scurletis, Director, Personal Health Division, distributed copies of the North Carolina Cancer Registry, 1970 Annual Report, for information. This report, the third produced by the North Carolina Cancer Registry, marks a year of growth for the program. The number of participating hospitals increased from 10 to 19 and the 3,099 cases 30 FORTY-FOURTH BIENNIAL REPORT assessed during the year bring the total number of cases in the Regis-try's master file to more than 8,000. In reporting on the Kidney Program, Dr. Scurletis said this pro-gram has been operational in the sense of sponsoring some patients since mid-November. The scope of services the Program can provide are: financial assistance for in-hospital dialysis, financial assistance for home training dialysis, provision of expendable supplies used in home dialysis, financial assistance for other special needs of kidney patients if the petition is approved by the Renal Disease Advisory Committee. An example of a special need would be the payment of a kidney donor's expenses. Another service available to kidney patients was initiated by program personnel, but is administered by the Laboratory Division; this refers to the Riochemistry Section's performing SMA-6 and SMA-12 and hematocrit tests on serum submitted by kidney patients and their dialysis partners. Currently there are six hospitals in which program sponsored patients may be dialyzed. They are located in Asheville, Charlotte, Chapel Hill, Durham, Greenville and Winston- Salem. The Renal Disease Advisory Committee meets March 9, and is expected to raise the number of affiliations to seven with the approval of the Danville, Virginia Dialysis Center. The Committee is also ex-pected to approve a new program service — the provision of non-prescription drugs, such as Vitamin A and R, to sponsored patients at the request of their physicians. The program has been sponsoring home patients since early January. Probably one of the more satisfying accomplishments to date has been the coordination between the pro-gram, the Department of Social Services, and Vocational Rehabilita-tion. These other agencies are involved in providing services to kidney patients, and program personnel have evolved what appears to be an excellent continuum of services for patients from the first dialysis to the transplantation. Dr. Scurletis called attention to the matter of the Certificate of Need. Regulations were approved by the Roard at its last meeting, but it now appears that a revision is needed in order to specify the steps involved in processing public hearings concerning the issuance of a certificate of need by the State Roard of Health. The requirement for public hearings is mandatory under the law in order to provide an administrative review of decisions contrary to the request of the af-fected applicant or the Areawide Health Planning Council. Dr. Scur-letis proposed the acceptance of these two changes in the Rules and Regulations. Dr. Maness made, and Mr. Randleman seconded, a motion that the proposed Revision to the Rules and Regulations Governing the Certificate of Need be approved. Dr. Raper inquired if any mem- NORTH CAROLINA BOARD OF HEALTH 31 ber of the public wished to be heard, and instructed the secretary to let the minutes show tliat no one was heard. The motion was carried without opposition. Dr. Scurletis then distributed a list of physicians rostered in the Crippled Children's Program since the last report to tlie Board, a list of physicians pending rostering, as well as a copy of the Rules and Regulations Go\'erning the Procedure for Rostering Physicians. Dr. Maness made, and Dr. Coonrad seconded, a motion that these three items be accepted by the Board as information. The motion was carried. Dr. W. Burns Jones, Jr., Assistant State Health Director, spoke briefly to the Board on the biennial budget cycle; the budgetary process has taken a fairly substantial chan z,e this year. The new system under which we will be operating is kncvvn as the Base Budget and the Change Budget. The Base Budget will be restricted to those funds which were previously allocated for the past biennium — the only increases allo^^'ed will be for salary increases. All requests for additional funds will be shown in the Change Budget. This will ul-timately be a good thing because we are working more and more toward a program budget — an actual program distribution of the amount of money being spent, how it is being spent, what results it is having, etc. The other aspect is that we will be \\^orking toward a zero base budget. This means that we would ha\e to justify the first dollar spent and every dollar thereafter. This will necessitate additional planning and will put responsibility on the staff — a very forward step in State Government. The Base Budget is due April 1 and the Change Budget is due June 1; the Board will have opportunity to review the Change Budget. Dr. Jacob Koomen commented as follows: 1. A time will be selected in the near future for a formal portrait of the Board and advance notice will be given. 2. The next meeting will be held on May 24 at Pinehurst — b\' law the Board is required to meet with the Medical Society; the Conjoint Report to the Board and to the Medical Societ\' is given at that time. 3. We welcome the new members of the Board — we are here to serve you and invite you to call us at any time we can help you. 4. The last legislature established a Legislative Study Commis-sion — the Governor has appointed these members, including Dr. 32 FORTY-FOURTH BIENNIAL REPORT Ronald H. Levine, Director, Community Health Division. The first meeting will be held soon. Dr. R. Page Hudson, Chief Medical Examiner, invited the Board members to visit the oflBces of the Medical Examiner System any time they have opportunity to be in Chapel Hill. There was no further business, and the Chairman adjourned the meeting. NORTH CAROLINA BOARD OF HEALTH 33 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH May 24, 1972 The North CaroHna State Board of Health met in the Azalea Room of The Carolina, Pinehurst, North Carolina, at 8:00 a.m., on May 24, 1972. Dr. Paul F. Maness, Vice-President, presided. Other Board mem-bers present were: Dr. Charles T. Barker Dr. Ralph W. Coonrad Mr. Robert B. Nichols, Jr. Dr. Joseph S. Hiatt, Jr. Dr. Donald W. La:key The invocation was given by Dr. Hiatt. The first item of business was an information report by Dr. W. Burns Jones, Assistant State Health Director, on the State Board of Health's "Change Budget" requests for the 1973-1975 biennium, a summary of which had been mailed to the Board prior to the meeting. Dr. Jones stated that of the 56 requests made (totaling some $10-$15 million), 22 (totaling about $5 million) had been selected as being of a higher priority than others. Dr. Maness invited Dr. Jacob Koomen to comment and he stated that Division Directors have had to look carefully at what they do and what their hopes for the future are. He said that, realizing it highly unlikely that the Legislature could possibly grant all requests, these had been reduced to a minimum in priority order. In the past, budget requests have been presented to the Advisory Budget Com-mission only; now there are many hands involved, including the Secretary of the Department of Human Resources, the Governor, a "legislative watchdog committee", and finally the Advisory Budget Commission. Dr. Koomen emphasized that "in these times of austerity, we don't know how much of our request will be honored, but we felt impelled to ask for the funds." A motion was made by Dr. Barker, seconded by Dr. Hiatt, that the Board endorse the budget request as submitted. The motion car-ried. (Copy attached to the official minutes.) Mr. Marshall Staton, Director, Sanitary Engineering Division, was recognized for presentation of several items, the first of which was a request received on April 17 from the directors of Camp Illahee in Brevard, North Carolina, for a public hearing concerning 34 FORTY-FOURTH BIENNIAL REPORT the Summer Camp Regulations recently adopted by the Board. The portion of the Regulations which concerns them is Section 5-B re-quiring hot water at certain locations; Camp Illahee has lavatories but no hot water at these locations. Mr. Staton said the constraints of today's meeting had been explained to the camp directors, in-cluding the limited time for discussion, and the suggestion had been made that the hearing be delayed until facts were gathered and there was ample time for consideration of the matter. This was satisfactory with the directors; however, they asked that the Board authorize them to operate the camp without complying with this particular re-quirement until they could have a hearing with the Board. In re-sponse to a question, Mr. Staton explained that no other such re-quests or complaints have been received from the 60-65 camps in North Carolina. Two sanitarians have visited the camp to explain the necessity of such regulations, but Mr. Staton said he felt the group should have the privilege of expressing their feelings to the Board. A motion was made by Dr. Coonrad, seconded by Dr. Barker, that the request of Camp Illahee for a public hearing before the State Board of Health be granted and that the camp be authorized to operate without complying with the requirement in question until a hearing can be held. The motion passed without opposition. Mr. Staton then referred to the North Carolina Clean Water Bond Act, which was passed by the voters on May 6, 1972, and which will involve $150 million in bonds for water and sewer improvements. $70 million will be used for water improvements and the State Board of Health will be the project reviewing agency for use of these funds. Regulations are being prepared to implement this construction grant program and it may be necessary to call a meeting of the State Board of Health prior to its next regular meeting to consider these regulations. A resolution requesting extension of the boundary hues of the Rural Hall Sanitary District was presented by Mr. Staton. He said that 100 percent of the people living in this area had requested an-nexation into this district so they might be provided with water and sewerage. The Attorney General's office finds this resolution in order. A motion was made by Mr. Nichols, seconded by Dr. Coonrad, that the Resolution to the North Carolina State Board of Health Extending the Boundary Lines of the Rural Hall Sanitary District in Forsyth County, North Carolina, be approved. Dr. Maness inquired if any member of the public wished to be heard, and instructed the secre-tary to let the minutes show that no one was heard. The motion was carried. (Copy of the Resolution is attached to the official minutes.) NORTH CAROLINA BOARD OF HEALTH 35 Mr. Staton then presented a proposed resolution to create the Ocracoke Sanitary District in Hyde County, North Carohna, stating that the tourist trade has increased greatly and is imposing a water problem in this area. Over 51 percent of the property owners of this area have signed a petition requesting that Ocracoke Island in its entirety, except for that area now designated as National Seashore, be created as a sanitary district so that adequate water supply might be provided. Mr. Staton said the Attorney General's office finds this resolution in order. Dr. Coonrad moved, and Dr. Hiatt seconded, a motion that the Resolution of the North Carolina State Board of Health Creating the Ocracoke Sanitary District Located in Hyde County, North Carolina, be approved. Dr. Maness asked if any mem-ber of the public wished to comment, and instructed the secretary to let the minutes show that no one was heard. The motion was passed unanimously. (Copy of the Resolution is attached to the official minutes.) Mr. Ben Eaton, Director, Administrative Services Division, spoke to the Board regarding Rules and Regulations Governing the Con-trolled Substances Act which were adopted by the Board at its last meeting. He said that since the approval of these Regulations, the Federal Government has adopted a few "definitions" which were not in the original act. Since the preparation of today's agenda, this item has been discussed with the Attorney General's office, reaching the conclusion that even though this is just a matter of definition, 30 day's legal notice is necessary. Mr. Eaton requested that this item be deferred until the next meeting, and the Board concurred. Dr. Martin P. Hines, Director, Epidemiology Division, was recognized and discussed the Rules and Regulations Governing the Sale of Turtles, adopted by the Board at its last meeting. Since the approval of these Regulations, the Federal Government has published proposed regulations, which will probably become effective on or about July 1, 1972, and which differ from North Carolina's regulations in several respects. In order to avoid duplication and conflict of regulations, it is requested that the effective date for the Regulations adopted by the North Carolina State Board of Health be changed from July 1, 1972 to January 1, 1973. This delay will permit assessment of the effectiveness of the Federal regulations and the possible revision of the North Carolina regulations at the fall meeting of the Board to complement the Federal regulations. Dr. Lackey moved, and Dr. Hiatt seconded, a motion that the eflFective date for the Regulations approved by the North Carolina State Board of Health Governing the Sale of Turtles be changed from July 1, 1972 to 36 FORTY-FOURTH BIENNIAL REPORT January 1, 1973. Dr. Maness inquired if any member of the public wished to be heard, and the secretary was instructed to let the minutes show that no one was heard. The motion passed without opposition. Dr. Ronald H. Levine, Director, Community Health Division, gave a progress report on the Legislative Study Commission for Organization and Delivery of Health Services in North Carolina. At the fall meeting last year, the Board was presented with a bill passed by the 1971 General Assembly establishing this Commission; its charge is to examine the relationships of state and local government in projection, delivery and financing of public health services to the people. Dr. Levine is on the 11-member Commission appointed by the Governor. Dr. Jacob Koomen was asked to call the first meeting and to preside; this organization meeting took place on May 18 and the Commission unanimously elected Representative Nancy Chase of Wayne County as its Chairman. Representative Carl M. Smith of Orange County was elected Vice-Chairman. Mr. David G. Warren, Assistant Director of the Institute of Government at Chapel Hill, addressed the group on the current status of public health and his views of major issues which might be considered by the Commission. The next meeting will be held on June 7, at which time Dr. Levine will make a presentation covering in some detail the scope of public health services provided by local health departments and define relationships of the departments providing these services, in order that the Commission might be able to draw some parallels as to what can be done to strengthen public health services. Dr. T. D. Scurletis, Director, Personal Health Division, gave a report on the status of prevention of Ophthalmia Neonatorum. He stated that an investigation had taken place regarding this; in essence the only issue which was raised was that the American Academy of Ophthalmology recommended the use of Bacitracin Ophthalmia oint-ment as replacement for silver nitrate on occasion. The National As-sociation for Prevention of Blindness and the American Academy of Pediatrics, and the American College of Obstetricians and Gynecolo-gists felt that silver nitrate was the only drug of choice for three reasons: (1) it has been an effective drug over the years; (2) the organism that we are dealing with is one that has already demon-strated ability to develop antibotic resistance; and, (3) there is no evidence whatsoever available to indicate that there is an increase in the incidence of conjunctivitis in newborns with silver nitrate. Dr. Scurletis recommended that this regulation should be main-tained as it is today — namely, that silver nitrate be the only drug NORTH CAROLINA BOARD OF HEALTH 37 approved in the State of North Carohna. The Health Department does provide silver nitrate in wax sealed ampuls to all hospitals in North Carolina. Dr. Scurletis suggested that the Board reaffirm this regulation. Dr. Hiatt made a motion, seconded by Dr. Coonrad, that the Board Reaffirm that One Percent Silver Nitrate Solution Stored in Individual Wax Capsules Remain the Only Acceptable Prophylactic Agent in North Carolina. Dr. Maness inquired if any member of the public wished to be heard, and instructed the secretar\' to let the minutes show that one was heard. The motion was carried. A list was distributed of those physicians rostered for the Crip-pled Children's Program since the last Board meeting, as well as a list of those whose application is pending. (Copies of both lists attach-ed to the official minutes.) Dr. Maness thanked the group for attending at such an early hour and expressed the hope that sometime in the near future this meeting can be changed to a more convenient time when there can be more representation. Dr. R. Page Hudson, Chief Medical Examiner, informed the Board that Dr. David Wiecking, Associate Medical Examiner, has resigned his position here to accept appointment as Chief Medical Examiner for the Commonwealth of Virginia. Dr. Barker commented on the urgency of getting the plaque control program before the school children of the State, and expressed hope that this item will be among those approved in the Change Budget. Dr. Jacob Koomen, State Health Director, commented: 1. In follow-up of Dr. Barker's remarks, Dr. Koomen stated he was sympathetic towards a strong dental program in the State. 2. Dr. Lenox D. Baker, Secretary, Department of Human Re-sources, has appointed as his Deputy, Mr. William F. Henderson, who was long-time Executive Director of the Medical Care Commis-sion. Mr. Henderson is an enormously competent individual. Dr. Baker has appointed as Associate Secretary for Administration Mr. Ben W. Aiken, former Business Manager for the Mental Health System. These men will be great assets. 3. The minutes of the Board meetings are highly technical and are a legal document; therefore, they require careful preparation and review. The interval between the last meeting and today's meeting being a short one, it was not possible to have the minutes in final form for approval today; therefore, they will be acted upon at the next meeting. 38 FORTY-FOURTH BIENNIAL REPORT 4. At the request of Dr. Raper, Dr. Koomen asked the Board's feehng about holding the next meeting away from Raleigh, possibly in the western part of the State. Several members stated they would be willing to attend in any location agreed upon by the group; there were no objections to this idea. 5. Dr. W. Bums Jones, Jr. will not be in Europe this summer, as previously planned. Details could not be worked out for the trip, but Dr. Jones appreciates the Board granting its approval. There being no further business to come before the Board, the meeting was adjourned to the Conjoint Session of the State Board of Health and the Medical Society of the State of North Carolina, at which time Dr. Jacob Koomen, State Health Director, presented his report, entitled "A Public Health Perspective on the Limitation of Births". (Copy attached to the oflBcial minutes.) NORTH CAROLINA BOARD OF HEALTH 39 1970* CONJOINT REPORT by Jacob Koomen, M.D., M.P.H. State Health Director North Carolina State Board of Health Customarily, the report to the Conjoint Session by the State Health Director has been that of an overview of North Carolina's health needs and a synopsis of the State Board of Health's attempts to meet these needs. This report will depart from custom, in that a single issue will be addressed, in order to give greater coverage to a specific problem. The topic chosen is automobile safety. The product of a tech-nological triumph and cause of a revolution in mobility, the motor vehicle has at the same time proved to be a health hazard of critical proportions. This paper will offer a public health perspective on the problem of transportation versus trauma. The magnitude of the problem will be indicated, followed by a description of some control measures. Two common and convenient categories will be used, that of prevention and treatment. In discuss-ing prevention, the classic epidemiological model, the host-vector-environment triad, will be used. A paper such as this, with limited scope, cannot be an exhaustive study; rather, it is a resume of salient factors relevant to an important health condition. New York City claims the dubious distinction of reporting both the first motor vehicle accident and the first trafiic fatality. On May 30, 1896, Evylyn Thomas, while riding her bicycle, was struck by a Duryea Motor Wagon; she sustained a fractured leg and went down in history as the first casualty of a new automotive miracle, the horse-less carriage. On September 13, 1899, Henry H. Bliss, a real estate broker, 68 years old, was knocked down and run over while alighting from a street car near Central Park. His death became the first in an ever-increasing parade of statistics reflecting the negative side of automobile transportation. By 1916, our own state was reporting 54 deaths from motor vehicle accidents (including pedestrians), at a rate of 2.1 per 100,000 persons. (Table 1) Except for a marked reduction during World War II, there has been a steady increase in traffic deaths. By 1969, there '(Delivered before the Conjoint Session, North CaroHna State Board of Heahh and the Medical Society of the State of North Carolina, Pinehurst, N.C., May 19, 1971.) 40 FORTY-FOURTH BIENNIAL REPORT were 1,791 fatalities, at a rate of 35.7, making this the fourth leading cause of death. TABLE 1 FATAL MOTOR VEHICLE ACCIDENTS, NORTH CAROLINA, 1916-1969 NORTH CAROLINA BOARD OF HEALTH 41 There are, however, principles of disease control applicable to highway safety. Let us look at some of these measures, beginning with those designed to prevent traffic accidents or reduce their effect on the victim. Referring to the epidemiological model (Figure 1), we will identify the driver as "host". Control begins here by limiting the number of drivers to those who demonstrate minimal skills through a testing procedure. This is the rationale for the driver's license, based on the principle that operation of a motor vehicle is a privilege granted by the State through a licensing process. FIGURE 1 Host Vector < > Environment The "Epidemiological Triad' The physician has an important contribution to make through North Carolina's medical evaluation system. Cases for medical review are initiated by examiners of the Driver License Division, courts, or law enforcement officers, by an applicant's own admission of impair-ment, or as the cause of an accident. The first step in the review process is examination by a physician of a patient's choosing, followed by evaluation by a three-member panel of physicians (of which there are 36 in the State). From there, a hearing may be requested before the Driver License Medical Review Board, consisting of four phy-sicians appointed by the President of the State Board of Health, plus a representative from the Department of Motor Vehicles. This Board has authority to restore, restrict, or uphold denial of driving privileges and their decisions are binding on the Commissioner of Motor Vehicles (although subject to Superior Court review). During 1970, 4,764 medical reports were reviewed by the panels. Sixty-eight percent were new cases; the remainder were follow-up cases, previously identified. Of the total, 789 (17 percent) were denied 42 FORTY-FOURTH BIENNIAL REPORT driving privileges; 1,014 (21 percent) were allowed to continue to drive with restriction; the remaining 2,961 (62 percent) will continue to drive without restriction, but most will continue to submit follow-up medical reports. (Table 3) TABLE 3 DRIVER LICENSE MEDICAL REVIEW, NORTH CAROLINA, 1970 NORTH CAROLINA BOARD OF HEALTH 43 Of particular significance is the relationship between alcohol and highway accidents. A study by the North Carolina State Medical Examiner's Office of blood alcohol analysis of 486 operators and pedestrians killed in 1970 revealed that 65 percent of those dying in single car accidents were "under the influence", i.e. had a blood alcohol level of 0.1 percent by weight. One-third of those killed in multiple car collisions showed the same degree of intoxication, while 62 percent of slain pedestrians were under the influence (Table 4). TABLE 4 ALCOHOL AND AUTO FATALITIES, NORTH CAROLINA, 1970 Type of Accident 44 FORTY-FOURTH BIENNIAL REPORT In most instances of disease control, an attempt is made to either eliminate the vector or reduce it to a minimum (e.g., mosquito or fly eradication). This is hardly possible for the automobile, nor even desirable; nonetheless, it is not frivolous to consider modifications of the technique. For instance, alternatives to automobile travel are being explored, such as mass transit systems. Also, spatial separation of pedestrian and bicycle traflBc and automobile trafiic is in effect in many places. These measures have their principle but not sole appli-cation in urban areas. Where such efforts bring about not only im-proved safet\% but also curtailing internal-combustion engine emis-sions, ameliorating parking and other problems, and slowing down the decay of our cities, they have much to commend them. Incidentally, it is here that one finds another area of controversy. Many consumer advocates accuse the automotive industry of indif-ference to the safety of the driver or passenger, and government of laxity in its concern for protection of the public by not being vigorous in adopting and policing more adequate standards. The third element in our model is the environment. While this involves important geographic and meteorological factors, it also in-cludes, for our purposes, streets and roads and other structures in-volving automobile transportation. Here, too, effective measures may be taken to prevent or minimize the condition to which we address ourselves. Improved highway engineering and construction is an important undertaking. Arterial superhighways with medians, ramps, and parallel service roads, are designed to accommodate high-speed vehicular movement. Correction of existing problems also merits attention. For instance, early highways employed the crown drainage system, per-mitting the water to run off the roadway from a high point in the middle, sloping to either side. When cars traveled at 35 to 40 miles per hour, this presented little diflBculty. It is decidedly awkward nowa-days, however, for one to go careening full tilt around a curve on a winding country road and suddenly find himself banked in the wrong direction. This has been cited as one of the factors that causes North Carolina to have such an extraordinarily high rate of single-car ac-cidents on rural roads. Other safety features, such as improved guard-rails and "break-away" road signs are being increasingly utilized. A modern highway system and adequate urban and surburban street systems, are therefore an important consideration in reducing NORTH CAROLINA BOARD OF HEALTH 45 hazards. It is an interesting aside to note that North Carohna has the largest state road network in the nation. Since differences of opinions have been mentioned, another im-portant one should be considered. This is the debate between those who emphasize attempts to change the behavior of the driver, as opposed to those who concentrate on changing his surroundings (i.e., the car and the highway). Many feel strongly that effective accident control can only be accomplished by mechanical and engi-neering methods which prevent or control the release of trauma-producing energy. This is a position (in the words of Dr. William Haddon, Jr.) — "Fundamentally at variance with those who . . . regard harmful inter-actions between man and his environment as problems requiring reforming imperfect man rather than suitably modifying his environment." The latter of the two major categories is treatment. Emphasis will be given here to prompt and effective attention to victims of highway accidents. Emergency medical services are the chief factor in this phase. Here again, the State Board of Health and practicing physicians play a vital part. The 1967 General Assembly passed an "Act to Assure Adequate and Continuing Ambulance Services to the Citizens of North Caro-lina". This Act gave responsibility to the State Board of Health to develop and apply minimum standards of safety, sanitation, equip-ment, and training in regulating ambulance services. An Advisory Committee on ambulances was also established, among whom is a member of the Medical Societ)- of the State of North Carolina. The major basic training course for ambulance attendants has been provided b\' Community Colleges and technical institutes. The course outlined was developed by North Carolina physicians in 1966 and has been periodically revised in consultation with them. From the effective date of the rules and regulations governing ambulance ser-vice, January 10, 1968 through April 1, 1971, 122 courses have been conducted. Over 500 physicians have served as instructors. As of April 1, 1971, there were 3,051 ambulance attendants cur-rently certified; 306 ambulance services currently operate 560 am-bulances. These include 115 funeral homes, 116 rescue squads, 36 governmental units, and 39 commercial services. Approximately 80 percent of North Carolina's counties support these services b\- sub-sidization or direct operation. Additional studies are being conducted to improve emergency medical services, mostly in the area of communications systems, 46 FORTY-FOURTH BIENNIAL REPORT vehicles, and other equipment. A few states have successfully used helicopters in programs of this nature. These are costly, but can be effective in either remote areas or intense urban congestion. The implications for helicopters in North Carolina have yet to be explored. Care of accident victims in emergency rooms is important in the chain of life-saving events. Thorough analysis of this area needs to be made, but studies that have been done indicate improvements are necessary. It is expected that this will be the next step in our efforts to respond to the medical crises precipitated by motor vehicle ac-cidents. Once an accident victim has been through the emergency medi-cal services stage, he enters the regular medical care system. It is that first reaction to an accident that is critical: speedy response to a call, effective and accurate first-aid at the scene, prompt yet safe transportation, and adequate emergency room services, are all char-acteristics of a system designed to rescue the unfortunate victim from the effects of trauma once an accident has occurred. An attempt has been made to summarize the complicated pic-ture of highway safety, viewed principally from a health perspective. Attention has been given to the importance of automobile accidents as a major cause of death and disability. The roles of the private practitioners of medicine, and the State Board of Health have been emphasized. A continuing partnership between these two allies, in league with others concerned with this problem of major proportions, is necessary if the continuing toll of life and health is to be abated on our highways. NORTH CAROLINA BOARD OF HEALTH 47 197P CONJOINT REPORT by Jacob Koomen, M.D., M.P.H. State Health Director North CaroHna State Board of Health In keeping with the precedent set in 1971, the report to the Con-joint Session of the North Carohna State Board of Health and the Medical Society of the State of North Carolina will focus on a topic of timely and significant interest. The subject chosen is planned parenthood. Because of the growing concern over population control, it is appropriate to seriously consider this matter, and to share a pul)lic health perspective on the limitation of births with the medical profession. Any discussion of this topic immediately confronts the essayist with a number of terms, about which there is not either general agreement or general acceptance. Planned parenthood, birth control, family planning, contraception, and other expressions, are all widely used, but to many have limits to their usefulness. Some time ago, the word "prevenception" was used, but apparently has not gained popularity. It is hoped that in a broad survey article, one may be forgiven for using terms more or less indiscriminately. However, in a field where there is not consensus about definitive terms, interchange-able expressions may be excusable. These various terms all relate to birth limitation. This limitation may occur prior to conception or after. In this paper, emphasis will be given on the prevention of conception. This is perhaps in keeping with public health's historical attention to prevention. Interruption of pregnancy must nevertheless be part of the perspective. Indeed, today in many countries such as Japan, abortion is part and parcel of popula-tion control. Birth control may be regarded from several points of view. Most personal, and perhaps of greatest concern to the medical practitioner, is that of the individual. This is a concern shared by public health workers as well. This was reflected in the words of Dr. C.-E. A. Winslow thirty-five years ago: "The mother able to bear children should have adequate prenatal care; the mother able to bear children should have competent . . . obstetiical care; and the woman w ho is unable to bear children should be protected against the hazards of '(Delivered before the Conjoint Session, North CaroHna State Hoard ot Health and the Medieal Soeiety of the State of North CaroHna, Pinehurst, X.C, May 24, 1972.) 48 FORTY-FOURTH BIENNIAL REPORT childbirth." Today, in both the private and pubHc sector, this care for conception control for health reasons has been liberalized and extended to recognize "one of the most basic of human rights — that to freely determine the number and timing of one's children." A somewhat broader point of view would include the family and the community. The consequences of a large number of children in a household of limited means are well known to public health workers, social service workers, and almost any family doctor. To quote Dr. Winslow again, "The new child itself is one of the chief sufferers in a family that grows too fast for its economic resources. We owe it to future generations that children should not be born into families unable to provide for them homes which ensure a reasonable minimum of physical and mental health." Even more tragic is the "unwanted child" who suffers abuse or neglect. The entire community becomes involved, with its responsibility for supporting the impoverished family through social services and financial aid. On the widest scale, there is some alarm about an over-crowded planet. "People pollution", and the possible breakdown of our life-sustaining ecosystems, are matters which cause grave anxiety to many who consider the future. There is considerable worry over at least the deterioration of the quality of our life style, if not even more serious repercussions. The classic author on this subject. The Reverend Thomas Malthus, raised this spector at the turn of the 18th century: "If we multiply too fast, we die miserably of poverty and contagious diseases ... we have followed these impulses too far, so as to trench upon some other law which equally demands attention." Discounted for many years, the realization of the exponentially-growing problems of an expanding world population (reaching six billion by 1995) has reawakened concern. Doomsday predictions, the most recent one by The Massachusetts Institute of Technology, raise doubts about the world's ability to sustain itself without catastrophe for another 100 years. It is not within the scope of this paper to critically examine this latter aspect of birth control, much less resolve the controversy. Suf-fice it to say that population limitation involves a wide range of con-cern, from the most intensely personal to the global. Taking a middle-range view, it is relevant to look at some population particulars in the United States and in North Carolina. Looking at the undifferentiated mass of people, one sees first that our numbers are growing. Using different variables, projections of the population for the United States by the year 2000 lie between 322,- 277,000 and 271,082,000. North Carolina may be expected to contain NORTH CAROLINA BOARD OF HEALTH 49 as many as 7,000,000 persons by the same year. However, a more careful examination reveals significant changes in the characteristics of the population. The reader is referred elsewhere for references to the age distribution of our people, since limitations on space prohibit a detailed statistical analysis. It will be instructive to look at selected data pertinent to reproduction. North Carolina has historically shown a substantially higher birth rate than the national average. The graph (Figure 1) shows that these rates are converging. One will also note the v^ariation in birth rates occurring in both the state and the nation: the remarkable decline during the depression years, the post-war "baby boom", followed by the contemporary decline that has again occurred. FIGURE 1. ANNUAL BIRTH RATE: UNITED STATES AND NORTH CAROLINA, 1920-1971 * \ 50 FORTY-FOURTH BIENNIAL REPORT Table 1 shows comparative decennial figures from 1920 to 1970 for live births, as well as for fertility ratios. TABLE 1 FERTILITY RATIOS, NORTH CAROLINA, 1920-1970 Year NORTH CAROLINA BOARD OF HEALTH 51 mate birth results in an unwanted child, and is an unmitigated evil, is no longer tenable. Additional illustrations serve to show the changes in family size. Table 3 indicates the steady decline in the number of live births occurring after the fourth child, and substantiates the decrease in popularity of the large family. TABLE 3 NUMBER AND PERCENT OF LIVE BIRTHS ABOVE BIRTH ORDER 4 NORTH CAROLINA 1920- 1970 Year 52 FORTY-FOURTH BIENNIAL REPORT Contraception, by Norman E. Himes, makes interesting browsing. The briefest of excerpts may be permitted: "Man's attempts to control the increase in his numbers reach so far into the dim past, that it is im-possible to discern their real origin. Some forms of limitation on the rate of increase are undoubtedly as old as the life history of man." Dr. Himes points out that, sadly, the major means for population control up until modern times were infanticide and abortion. Although the use of a sheath, or condom, was known for some time (being dis-coursed upon by the doubtable Casanova), it was largely for the pre-vention of venereal disease. Intra-vaginal devices and medications were at best unacceptable and unreliable until relatively recently. Dr. Alan Guttmacher notes the late arrival of effective, safe conception control procedures developed by medical technology and made avail-able to the public. He states, "The three most important developments in contraception since 1935 are: (1) the more extensive and accurate use of the rhythm method; (2) the development of a modified intra-uterine ring; (3) the first truly physiologic method of contraception — the inhibition of ovulation by oral medication." Coupled with the lack of readily available technology were the constraints limiting the prescriptions and procedures relative to con-traception. The judicial overthrow of the restrictive "Constock laws", occurring in 1936, was a milestone decision that unshackled the hands of the medical profession. Further decisions, in 1965 and as recently as March, 1972, have had the same ejffect on similar state laws. In North Carolina physicians and public health workers, to say nothing of the public, have been fortunate in being free of restrictive legisla-tion, and in enjoying a relatively liberal climate of opinion regarding contraception. We would do well to recall that North Carolina took the leader-ship in developing a statewide, public, planned parenthood program. As early as 1932, the North Carolina Conference for Social Services had endorsed such a movement, followed by the North Carolina Fed-eration of Women's Clubs. The practicing physicians of the state have always been in the forefront. The first contraceptive clinic in this state was established privately in 1922. The Wake, Forsyth, and Nash- Edgecombe Medical Societies were the first to endorse public planned parenthood programs. In March of 1937, a philanthropic grant was made to the state by Dr. Clarence J. Gamble, heir of the Proctor and Gamble Soap fortune and at that time a member of the medical faculty of the Uni-versity of Pennsylvania. This grant enabled the employment of a full-time public health nurse, Miss Roberta Pratt, who worked throughout NORTH CAROLINA BOARD OF HEALTH 53 the state helping local health departments establish birth control clinics. Dr. George Marion Cooper, then Assistant State Health Officer, provided the foresight and inspired leadership that made the program possible. The director of the program, who also had the distinction of presenting the first paper on birth control ever read before the Ameri-can Public Health Association, was a young man making a name for himself in the public health field: our own Dr. J. W. Roy Norton. Count}^ medical societies were quick to endorse and support the new program, thereby ensuring its success. Since that auspicious beginning, public contraceptive services in North Carolina have grown. Today each of our 100 counties offers some type of family planning service. In 1970, 31,764 patients were served by county health departments. An additional 5,497 were served by OEO-sponsored projects, while three special projects funded by the National Center for Family Planning Services saw 4,328. Thus, public programs ministered to 41,589 persons. With a major increase in Federal financial support, the state's contraceptive services will continue to expand. The Medical Society of the State of North Carolina has reiterat
Object Description
Description
Title | Biennial report of the North Carolina State Board of Health |
Other Title | Report of the North Carolina State Board of Health. |
Creator | North Carolina. State Board of Health. |
Date | 1970; 1971; 1972 |
Subjects |
North Carolina. State Board of Health--Statistics--Periodicals Public health--North Carolina--Statistics--Periodicals Public Health--North Carolina |
Place | North Carolina, United States |
Time Period | (1945-1989) Post War/Cold War period |
Description | Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Publisher | Raleigh :The Board,1911- |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | v. ;24 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Reports |
Digital Characteristics-A | 4,713 KB; 112 p. |
Series | Biennial report of the North Carolina State Board of Health |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection N.C. Public Health Collection |
Digital Format | application/pdf |
Related Items | Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Title Replaces | North Carolina. Board of Health../1 |
Audience | All |
Pres File Name-M | pubs_edp_biennialreportboardofhealth19701972.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | Biennial Report The North Carolina State Board of Health UNIVERSIFi' OF NORTH CAROL! mi I 2 1996 Forty-Fourth Biennial Report [ HEALTH SCIENCES LIBRARY OF THE — NORTH CAROLINA STATE BOARD OF HEALTH July 1, 1970- June 30, 1972 (jOA L /l/\^ STATE OF NORTH CAROLINA Robert W. Scott governor Lenox O. Baker. M.D. DEPARTMENT OF HUMAN RESOURCES 6TATE BOARD OF HEALTH P O Box 2091 Raleigh 27602 January 15, 1973 Jacob Koomen. M D , M P H STATE HEALTH DIRECTOR AND SECRETARY TREASURER The Honorable James E. Holshouser, Jr. Governor of the State of North Carolina Administration Building Raleigh, North Carolina Dear Governor Holshouser: In accordance with the General Statutes of North Carolina, Chapter 130, Article 2, Section 120-11(12), we have the honor to submit to you, and through you to the Honorable Senate and House of Representatives, the biennial report of the North Carolina State Board of Health for the fiscal years July 1, 1970, to June 30, 1972. Very truly yours , Secretary '^./Jacob Koomen, M.D., M.P.H. State Health Director BOARD MEMBERS James S Rarer M D president asheville • Paul F Ma Charles T Barker DDS new Bern • Ralph W Coonhad MD. Durham • Jc Donald W Lackey. D V M lenoir • Jesse H Meredith. M D . Winston salem • Ernest A Randleman Jr B S Ph mount airy MESS M D VICE president BURLINGTON SEPH S Hiatt. Jr . MO. southern pinci Robert B Nichols. Jr . hillsborougx CONTENTS Letter of Transmittal v State Board of Health Members and Executive Staff ix Organization Chart x Local Health Directors xi Report of Secretary-Treasurer and State Health Director Abridged Minutes of State Board Actions Oct. 22, 1970—page 1; March 11, 1971—page 6; May 19, 1971—page 15; Oct. 28, 1971—page 19; March 23, 1972—page 26; May 24, 1972—page 33. Conjoint Reports May 19, 1971 39 May 24, 1972 47 Division Reports Administrative Services Division 55 Division of Epidemiology 61 Laboratory Division 64 Community Health Division 67 Dental Health Division 68 Sanitary Engineering Division 69 Personal Health Division 71 North Carolina Medical Examiner System 75 NORTH CAROLINA STATE BOARD OF HEALTH (Nine member policy-making body, five members appointed by the Governor and four members elected by the Medical Society of the State of North Carolina, each serving a four-year term.) Members Appointed by the Governor Charles T. Barker, D.D.S. Appointed 1969 Term expires 1973 Ralph W. Coonrad, M.D. Appointed 1972 Term expires 1973 Donald W. Lackey, D.V.M. Appointed 1972 Term expires 1975 Robert B. Nichols, Jr. Appointed 1972 Term expires 1973 Ernest A. Randleman, Jr., B.S.Ph. Appointed 1972 Term expires 1975 Members Elected by the Medical Society of the State of North Carolina James S. Raper, M.D., President Elected 1963 Term expires 1975 Paul M. Maness, M.D., Vice President Elected 1965 Term expires 1975 Joseph S. Hiatt, Jr., M.D. Elected 1965 Term expires 1973 Jesse H. Meredith, M.D. Elected 1969 Term expires 1973 EXECUTIVE STAFF AS OF JUNE 30, 1972 Jacob Koomen, M.D., M.P.II. Secretary and State Health Director (Term expires June 30, 1975) W. Bums Jones, Jr., M.D., M.P.H. Assistant State Health Director (Term concurrent with the State Health Director) Ben Eaton, LL.B., Director, Administrative Services Division Martin P. Hines, D.V.M., M.P.H., Director, Epidemiology Division Marshall Staton, B.C.E,, M.S.S.E., Director, Sanitary Engineering Division Ronald H. Levine, M.D., M.P.H., Director, Community Health Division Lynn G. Maddry, Ph.D., M.S.P.H., Director, Laboratory Di\ision E. A. Pearson, Jr., D.D.S., M.P.H., Director, Dental Health Division Theodore D. Scurletis, M.D., M.P.H., Director, Personal Health Division R, Page Hudson, Jr., M.D., Director, Medical Examiner Division S :S - ^ g NORTH CAROLINA STATE BOARD OF HEALTH Local Health Directors Alamance—Dr. W. L. Norxille, Graham-Hopedale Road, Burlington, N.C. 27215 —(919) 227-7451 or 228-1734 AUeghany-Ashe-Watauga"—Mr. Carl D. Tuttle, P.O. Bo.v 233, Boone, N.C. 28607 —(704) 297-2126 or 297-2127 Anson—P.O. Box 473, Wadesboro, N.C. 28170—(704) 694-2516 Avery—P.O. Box 325, Newland, N.C. 28657—(704) 733-4971 Beaufort—Dr. Karl L. Van Horn, P.O. Box 432, Harvey St., Washington, N.C. 27889—(919) 946-1902 or 946-1903 Bertie—Windsor, N.C. 27983—(919) 794-2057 Bladen—Dr. Caroline Callison, P.O. Box 188, Elizabethtown, N.C. 28337— (919) 862-2536 or 862-2537 Brunswick—Mr. W. Richard Walker, P.O. Box 398, Southport, N.C. 28461— (919) 457-6655 Buncombe—Dr. H. W. Stevens, Mr. Lawrence Burwell, Assistant Director, 35 Woodfin St., P.O. Box 7607, Asheville, N.C. 28807—(704) 255-5671 Burke—Dr. Lewis Bock, P.O. Box 945, Morganton, N.C. 28655 (704) 437-5152 Cabarrus—Mr. Albert J. Klimas, P.O. Box 1149, Concord, N.C. 28025—(704) 782-4121 Caldwell—Dr. Marjorie Strawn, 1121 East Harper Ave., P.O. Box 777, Lenoir, N.C. 28645—(704) 758-8451 Carteret—Dr. Luther Fulcher, P.T., Drawer B, Beaufort, N.C. 28516—(919) 728-4557 or 728-3046 "Catawba-Lincoln-Alexander—Dr. Melvin F. Eyerman, P.O. Box 1448, Hickory, N.C. 28601—(704) 328-2561 •Cherokee-Clay-Graham—Box 309, Murphy, N.C. 28906—(704) 837-2311 Cleveland—Mr. Richard G. Steeves, 315 Grover St., Shelby, N.C. 28150— (704) 487-8511 Columbus—Dr. John R. Black, Chadboume Road, P.O. Box 786, Whiteville, N.C. 28472—(919) 642-4145 or 642-4146 Craven—Dr. Verna Y. Barefoot, 403 George St., P.O. Box 1390, New Bern, N.C. 28560—(919) 637-3121 Cumberland—Dr. Carl Hammer, Box 470, 515 Person St., Fayetteville, N.C. 28302—(919) 483-9046 Currituck—Dr. John Sledge, Jr., Currituck, N.C. 27929—(919) 453-2506 Dare—Dr. John Sledge, Jr., P.O. Box 248, Manteo, N.C. 27954—(919) 473-3431 Davidson—Dr. Dermot Lohr, P.O. Box 439, Lexington, N.C. 27292—(704) 246-5953 "Davie-Wilkes-Yadkin—Mr. Alton Brown, Hospital Street, P.O. Box 457, Mocks-ville, N.C. 27028—(704) 634-5985 or 634-5986 Duplin—Dr. John F. Powers, P.T., Kenansville, N.C. 28349—(919) 296-4241 Durham—Dr. O. L. Ader, 300 E. Main St., Durham, N.C. 27701—(919) 682-8176 Edgecombe—Mr. Hugh Young, 2909 Main St., Tarboro, N.C. 27886—(919) 823-2174 or 823-2175 Forsyth—Dr. James A. Finger, P.O. Box 2975, 720 Ridge Avenue, Winston-Salom, N.C. 27102—(919) 727-2434 Franklin—Dr. J. B. Wheless, P.T., P.O. Box 300, Louisburg, N.C. 27549—(919) 496-3553 Gaston—Dr. B. M. Drake, P.O. Box 819, 615 N. Highland St., Ga.stonia, N.C. 28052—(704) 864-4331 Granville—Dr. J. U. Weaver, P.O. Box 367, O.xford, N.C. 27565—(919) 693-2141 Greene—Dr. J. L. Campbell, Box 67, Snow Hill, N.C. 28580—(919) 747-3578 Guilford—Dr. Sarah T. Morrow, 300 E. Northwood St., Greensboro, N.C. 27401 —(919) 275-0911 Halifax—Dr. Leslie G. Hoag, P.O. Box 178, Halifax, N.C. 27839—(919) 583-2191 Harnett—P.O. Box 36, Lillington, N.C. 27546—(919) 893-3425 Haywood—Dr. R. S. Roberson, P.T., 2216 Asheville Rd., Waynesville, N.C. 28786—(704) 456-3542 Henderson—Dr. Richard C. Irving, P.O. Box 925, Hendersonville, N.C. 28739— (704) 692-4223 'Hertford-Gates-Box 246, Winton, N.C. 27986—(919) 358-3191 Hoke—P.O. Box 638, Raeford, N.C. 28376—(919) 875-3717 Hyde—Dr. John Sledge, Jr., P.O. Box 254, Swan Quarter, N.C. 27885—(919) 926-3566 Iredell—Dr. J. H. Nicholson, Acting, 735 Hartness Road, P.O. Box 1268, States-ville, N.C. 28677—(704) 873-7271 'Jackson-Macon-Swain—8 Ridgeway St., Sylva, N.C. 28779—(704) 586-2913 Johnston—618 N. Eighth St., Smithfield, N.C. 27577—(919) 934-4168 Jones—Dr. John A. Parrott, P.O. Box 216, Trenton, N.C. 28585—(919) 448-2701 Lenoir—Dr. John A. Parrott, P.O. Box 1315, 200 Rhodes Avenue, Kinston, N.C. 28501—(919) 527-7116 McDowell—Mr. Clifford Fields, State St., Marion, N.C. 28752—(704) 652-6811 Madison—Mr. Lawrence Burwell, P.T., Route #5, Box 231, Marshall, N.C. 28753 —(704) 649-3531 or 649-2910 Martin—Mr. Homer Glover, P.O. Box 546, Williamston, N.C. 27892—(919) 792-4133 Mecklenburg—Dr. Maurice Kamp, 1200 Blythe Blvd., Charlotte, N.C. 28203— (704) 374-2164 Mitchell—Box 132, Bakersville, N.C. 28705—(704) 688-2371 or 688-3421 Montgomery—Dr. G. H. Armstrong, P.T., South Main Street, Troy, N.C. 27371— (919) 572-1393 Moore—Dr. Alfred G. Siege, Carthage, N.C. 28327—(919) 947-2711 Nash—Dr. J. S. Chamblee, P.O. Box 497, Nashville, N.C. 27856—(919) 459-3112 New Hanover—Dr. Joseph C. Knox, 21 N. 4th St., Wilmington, N.C. 28401— (919) 762-1863 Northampton—P.O. Box 635, Jackson, N.C. 27845—(919) 534-3071 or 534-5841 Onslow—Dr. Eleanor Williams, Georgetown Road, P.O. Box 460, Jacksonville, N.C. 28540—(919) 347-2154 or 347-6021 "Orange-Person-Chatham-Lee-Caswell—Dr. O. David Garvin, Dr. C. S. Fuller, Assistant Director, P.O. Box 191, Old Frat. Row, U.N.C. Campus, Chapel Hill, N.C. 27514—(919) 942-4168 Pamlico—Dr. Vema Y. Barefoot, Bayboro, N.C. 28515—(919) 745-2506 "Pasquotank-Perquimans-Camden-Chowan—Mr. Howard Campbell, Box 189, Elizabeth City, N.C. 27909—(919) 335-5429 Pender—Dr. N. C. Wolfe, P.T., P.O. Box 455, Burgaw, N.C. 28425—(919) 259-4026 Pitt—Dr. Robert D. May, P.O. Box 1903, Greenville, N.C. 27834—(919) 752-4141 or 752-4142 Randolph—Dr. Hugh Fitzpatrick, P.T., 139 N. Cox St., P.O. Box 1007, Asheboro, N.C. 27203—(919) 629-2131 E.xt. 280 Richmond—Dr. Z. F. Long, P.T., P.O. Box 419, Rockingham, N.C. 28379— (919) 895-6304 Robeson—Dr. M. B. Pate, Box 1088, Lumberton, N.C. 28358—(919) 739-3344 Rockingham—Mr. William Thompson, 205 Boone Road, Eden, N.C. 27288 (919) 623-9778 or 623-9779 Rowan—Mr. Herbert Hawley, 1216 W. Innes St., Salisbury, N.C. 28144—(704) 633-0411 'Rutherford-Polk—Mr. Clifford Fields, 225 W. 3rd St., Rutherfordton, N.C. 28139—(704) 287-4931 Sampson—Dr. Caroline Callison, 400 Cooper Drive, Clinton, N.C, 28328 — (919) 592-6177 Scotland—South Main St., Laurinburg, N.C. 28352—(919) 276-1411 Stanly—Dr. George M. Leiby, 921 N. Third St., Albein?rle, N.C. 28001— (704) 982-9171 Stokes—Dr. J. S. Taylor, P.T., Danbury, N.C. 27016—(919) 593-8788 Surry—Dr. Robert Caldwell, 113 S. Gilmer, P.O. Box 1267, Mt. Airv, N.C. 27030 —(919) 786-4163 or 786-4164 Transylvania—Dr. John R. Folger, P.T., Box 666, Bre\ard, N.C. 28712—(704) 883-4255 Tyrrell-^Washington-Mr. Homer Glover, P.O. Box 396, Plvmouth, N.C. 27962 —(919) 793-4416 Union—Dr. C. A. Bolt, 300 S. Hayne St., Monroe, N.C. 28110—(704) 289-4535 Vance—Dr. J. U. Weaver, P.O. Box 824, County Home Road, Henderson, N.C. 27536—(919) 492-1176 Wake—Dr. M. B. Bethel, Dr. Jane H. Wooten, Assistant Director, P.O. Box 949, Raleigh, N.C. 27602—(919) 833-1655 Warren—Dr. J. U. Weaver, 540 W. Ridgeway Road, Warrenton, N.C. 27589— (919) 257-3373 Wayne—Dr. O. Aiken Mays, P.O. Box 1537, Goldsboro, N.C. 27530—(919) 735-4331 Ext. 280 Wilson—Dr. Joseph Campbell, Route 5, Box 91, Wilson, N.C. 27893—(919) 237-3141 Yancey—P.O. Box 7, Burnsville, N.C. 28714—(7 )4) 682-2127 (CITY DEPARTMENT) Rockv Mount—Dr. J. S. Chamblee, 1616 W. Thomas St., Rocky Mount, N.C. 27801—(919) 442-5181 Ext. 270 or Ext. 271 "District Headquarters P.T.—Part-Time Branch Offices Alleghany—Mr. Carl Tuttle, Rt. #2 Box 13, Sparta, N.C. 28675—(919) 372-4346 Alexander—Dr. Melvin F. Eyerman, 324 1st Ave., S.W., Taylorsville, N.C. 28681 —(704) 632-3101 Ashe—Mr. Carl Tuttle, P.O. Box 208, Jefferson, N.C. 28640—(919) 246-9449 Brunswick—Mr. W. Richard Walker, Box 116, Shallotte, N.C. 28459—(919) 754-6611 Camden—Mr. Howard Campbell, Camden, N.C. 27921—(919) 335-4486 Caswell—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., Box 327, Yance>'\'illc, N.C. 27379—(919) 694-4222 Catawba—Dr. Melvin F. Eyerman, Newton, N.C. 28658—(704) 464-2027 Chatham—Dr. O. David Garvin, Dr. C. S. Fuller, As,st., City Hall, Siler Cit>', N.C. 27344—(919) 742-3441 Chatham—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., Route #1 Box lA, Pittsboro, N.C. 27312—(919) 542-2924 Chowan—Mr. Howard Campbell, P.O. Box 178, Edenton, N.C. 27932—(919) 482-2511 Clay—P.O. Box 55, Hayesville, N.C. 28904—(704) 389-8214 Davidson—Dr. Dermot Lohr, 10 W. Guilford St., Thomasvillc, N.C. 27360— (919) 475-2356 Gaston—Dr. B. M. Drake, 132 W. Virginia Ave., Bessemer City, N.C. 28016— (704) 629-2031 Gaston—Dr. B. M. Drake, Cherryville, N.C. 28021—(704) 435-6411 Gaston—Dr. B. M. Drake, 37 E. Woodrow Ave., Belmont, N.C. 28012—(704) 825-2178 Gaston—Dr. B. M. Drake, S. Main St., Mount Holly, N.C. 28120—(704) 827-5151 Gates—P.O. Box 71, Gatesville, N.C. 27938—(919) 357-6141 Graham—Robbinsville, N.C. 28771—(704) 479-3525 Guilford—Dr. Sarah T. Morrow, 936 Montlieu Ave., High Point, N.C. 27262— (919) 883-9166 Harnett—P.O. Box 491, Dunn, N.C. 28334—(919) 892-2424 Iredell—115 Institute St., Mooresville, N.C. 2811.5—(704) 664-5281 Lee—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., 402 W. Makepeace, Sanford, N.C. 27330—(919) 776-3512 Lincoln—Dr. Melvin F. Eyerman, P.O. Box 636, Lincolnton, N.C. 28092— (704) 735-3001 or 735-3002 Macon—55 River\dew St., Franklin, N.C. 28734—(704) 524-2718 Orange—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., 144 E. Margaret Lane, Hillsborough, N.C. 27278—(919) 732-8139 Perquimans—Mr. Howard Campbell, Hertford, N.C. 27944—(919) 426-5488 Person—Dr. O. David Garvin, Dr. C. S. Fuller, Asst., P.O. Box 29, Roxboro, N.C. 27573—(919) 599-3414 Polk—Mr. Clifford Fields, Columbus, N.C. 28722—(704) 894-8271 Rockingham—Mr. William Thompson, 506 Sprinkle St., Reidsville, N.C. 27320— (919) 342-2989 Rockingham—Mr. William Thompson, West Main St., Madison-Mayodan Office, Mayodan, N.C. 27027—(919) 548-6335 Swain—P.O. Box 546, Bryson City, N.C. 28713—(704) 488-2586 Tyrrell—Mr. Homer Glover, Road St., Columbia, N.C. 27925—(919) 796-2681 Wilkes—Mr. Alton Brown, West College St., P.O. Box 30, \^'ilkesboro, N.C. 28697—(919) 838-5591 or 838-5512 Yadkin—Mr. Alton Brown, P.O. Box 457, Yadkinville, N.C. 27055—(919) 679-2252 or 679-8876 REGIONAL OFFICES Asheboro Regional Office Ingram-Brinson Building 146 S. Fayetteville St. Asheboro, N.C. 27203 (919) 629-3181 Raleigh Regional Office Cotton Building P.O. Box 2091 Raleigh, N.C. 27602 (919) 829-7413 Greenville Regional Office 3205 S. Memorial Drive Greenville, N.C. 27834 (919) 756-1343 Southeastern Regional Office 203 Grace Pittman Building Fayetteville, N.C. 28301 (919) 483-3635 or 483-3636 Hickory Regional Office 1008 Highway 321 West (Bypass) Hickorv, N.C. 28601 (704) 328-5341 Western Regional Office N.C. State Board of Health Biltmore Plaza Office Building Asheville, N.C. 28803 (704) 253-8424 NORTH CAROLINA BOARD OF HEALTH 1 REPORT OF THE SECRETARY-TREASURER AND STATE HEATH DIRECTOR ABRIDGED REPORT OF THE ACTIVITIES OF THE STATE BOARD OF HEALTH AS RECORDED IN THE MINUTES Thursday, October 22, 1970 The North Carohna State Board of Health met in the Board Room of the Cooper Memorial Health Building, Raleigh, North Carolina, on Thursday, October 22, 1970, at 1:00 p.m. Dr. James S. Raper, Presi-dent, presided. The following members were present: James S. Raper, M.D., President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Jesse H. Meredith, M.D. The invocation was given by Dr. Paul F. Maness. Dr. Raper said he was sorry that Mr. J. M. Lackey and Dr. Lenox Baker were unable to attend. Dr. Koomen introduced members of the staff and news media who were present. A motion was made by Dr. Dawsey, seconded by Dr. Maness, that the minutes of the last meeting be approved as circulated. The motion was carried. The first matter of business was a discussion of future meeting places. Dr. Raper said: "Ever since I have been on the Board we have met in Raleigh with one exception when we met in Western North Carolina for a fine one-day meeting. This adds, I think, to the esprit de corps of the State Board of Health. With this in mind, it was sug-gested that we hold a meeting in the eastern part of the State if the Board so desires. The members were polled as to their feeling about this and there was a little difi^erence of opinion. I think this should be discussed today. There is only one stated meeting with the place desginated, and this is the spring meeting in Pinehurst with the State Medical Society. There is nothing in the statutes or rules that says we have to meet in Raleigh; if the Board feels it would be good to meet outside of Raleigh, perhaps once a year, I think this would be entirely correct." The floor was opened for discussion. Dr. Barker said he would welcome the Board to the eastern part of the State for a meeting. 2 FORTY-FOURTH BIENNIAL REPORT Dr. Maness said he would be glad to go wherever the Board de-cided to meet, but he did not want to make it appear that it was for the purpose of recreation rather than the official business of the Board. Dr. Koomen read a letter from Dr. Baker regarding this matter, and Dr. Raper asked that this letter be made a part of the official minutes. A copy is attached. Dr. Raper said he was completely in sympathy with Dr. Baker's remarks about expense to the taxpayers; therefore, a tabulation was prepared reflecting the expenses of our Raleigh meetings, and those of the Western meeting last year. Tlie result was that when the Board met in Western North Carolina, the cost was actually a few dollars cheaper than when meeting in Raleigh. A motion was made by Dr. Dawsey that the Board meet in other areas of the State from time to time, at the discretion of the President. The motion was seconded by Dr. Maness and carried. Dr. Isa Grant, Chief, Chronic Disease Section, gave a report on current planning for kidney dialysis and transplantation. In May, 1970, Dr. T. D. Scurletis, Director, Personal Health Division, reported to you on the general plan developed by a large planning committee representing all localities and interested groups in the state. You will recall it gave a picture of the problem in North Carolina and gave a means of saving North Carolinians suffering from this disease, but it did not give specific steps or localities as to how this may be done. In June, the planning committee met and suggested that the planning be continued to include specific locations and means of getting the patient into the medical care system. Dr. Jacob Koomen accepted the challenge of continuation of planning and assigned the responsibility to the Chronic Disease Section. He requested from the Advisory Bud-get Commission a transfer of $20,000 unexpended funds to pay the salary and expenses of an administrator and his secretary. The trans-fer was granted and such an administrator has been hired. He is Mr. Charles Lee, formerly of Charlotte. Because a position was not avail-able in the Chronic Disease Section, Mr. Lee is working in the office of the North Carolina Regional Medical Program. As planning pro-ceeds it will be determined whether or not a new section should be established. Two committees have been appointed by Dr. Koomen. One is an Advisory Committee, chaiied by Dr. Louis G. Welt, and including representatives of the medical schools, localities where dialysis and transplantation may be done. Vocational Rehabilitation, the insurance companies. Comprehensive Health Planning, and the public and volunteer kidney associations. Also a special ad hoc com-mittee has prepared a grant proposal to be submitted to the North NORTH CAROLINA BOARD OF HEALTH 3 Carolina Regional Medical Program for funding. Dr. Roscoe Robinson is chairman of this Committee. It includes representatives from all groups that may utilize these funds. If the proposal is funded, it will enable the State Board of Health to begin the initial phase of a state-wide kidney program beginning July 1, 1971. Dr. T. D. Scurletis, Director, Personal Health Division, gave a report on the proposed regulations for implementation of quality con-trol for Medicaid. He reported as follows: The Title XIX Advisory Committee to the Department of Social Services recommended that quality control mechanisms be established with this program as a means of justifying and controlling expenditures in the Title XIX program. The mechanism recommended includes the following: 1. That the State Board of Health as part of its contractual ar-rangements with the Department of Social Services shall im-plement utilization review mechanisms of Title XVIII on sup-pliers of services for Title XIX (hospitals, nursing homes, home health services). 2. That the intermediary (Blue Cross-Blue Shield) shall develop patient profiles and physician profiles to evaluate services rendered by private practitioners of medicine, dentistry, etc. 3. That the Department of Social Services shall develop mech-anisms of monitoring drug prescriptions and optical services. In order to put this in perspective, one must recognize that the De-partment of Social Services is the primary agency and that we can only implement these programs through contractual agreements with them. Dr. Scurletis also was asked to report on recent developments with regard to rostering of physicians in the Crippled Children's pro-gram. He told the Board that the Advisory Committee established by the Medical Society of the State of North Carolina met in September. The first part of the meeting was in the form of an open hearing at which various members of the Medical Society expressed their feelings concerning the rostering program. There was liberal discussion about past history of the program, the ]:)resent program, and finally the mech-anisms being advocated for rostering. That same evening, the Com-mittee met behind closed doors and Dr. Rutli Burroughs, Chief, Crippled Children's Section, and Dr. T. D. Scurletis were invited. They discussed the many facets of the problem and decided that they should reconsider this problem after the membership has had an opportunity to reflect on the total aspects of the discussions. The Committee hopes to be able to report a recommendation by the next Board meeting, and 4 FORTY-FOURTH BIENNIAL REPORT in the meantime the staff is available to them for consultation and preparation. They made several generalizations which they felt were indicated, and these related to the fact that all disciplines should be treated alike and that national standards for certification of specialties should be generally adhered to. However, these are merely con-clusions at this point and are not to be inferred as actual recommen-dations. The Board at a previous meeting had asked that they be informed at each meeting of those physicians applying for rostering, and whether they were rostered or not. Dr. Scurletis distributed such a list to the members, reflecting those physicians rostered in North Carolina since May 20, 1970. A copy is attached to the official minutes. Dr. Raper asked Dr. Barker if he still wished to have an Orthodontist included in the membership of the Committee. Dr. Barker said two Orthodontists had spoken to him about this, and before the next Board meeting he would get in touch with them and see just what their interest was. Dr. R. Page Hudson, Chief Medical Examiner, was recognized and reported on the present status of the Medical Examiner System. There are at present 55 counties participating in the System, repre-senting 66 percent of the population. The problem with getting Medi-cal Examiners in most of the counties is that physicians are reticent to become Medical Examiners because of misconceptions as to what is involved. It is anticipated that by spring, possibly 90 counties will have Medical Examiners. In the 1971 General Assembly, we hope to have a bill introduced which would provide that in those counties having a Medical Examiner System, the office of "coroner" would be abolished upon the expiration of the term of the current coroner. Also, counties have expressed the hope many times that the General Assembly would take action to require the State to pay autopsy fees, rather than having counties pay the fees. Dr. Hudson said the Medical Examiner System is working more and more with other State agencies, such as the Highway Department and the State Bureau of Investigation, and re-ceived excellent cooperation from them as well as from various sec-tions here at the State Board of Health. Dr. Jacob Koomen, State Health Director, shared the following items of information with the Board: 1. The Sanitary Engineering Division, and the Iredell County Health Department, is to be commended for making the Love Valley Rock Festival as safe as it could be made. Helpful information was received from other areas having had similar festivals, and other State agencies with whom we worked on this proved to be unusually com-petent and did a fine job. NORTH CAROLINA BOARD OF HEALTH 5 2. Dr. Page Hudson and his staff have been hard at work with the Institute of Government on the matters which they hope to propose to the Legislature. 3. The "B" Budget has been presented to the Advisory Budget Commission. We were warmly received personally, and were asked some very good questions. It will be some time, however, before we know the outcome. 4. Dr. Koomen expressed the hope that all members of the Board would feel comfortable in talking with our staff, and in asking ques-tions of them. "I know you are asked many questions; sometimes tliese require study and sometimes they require an immediate answer. We are always here and glad to help you in any way we can." There being no further business, the meeting adjourned. 6 FORTY-FOURTH BIENNIAL REPORT MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, March 11, 1971 The North Carohna State Board of Health met in the Board Room of the Cooper Memorial Health Building, Raleigh, North Carolina, on Thursday, March 11, 1971, at 10:30 a.m. Dr. James S. Raper, President, presided. The following members were present: James S. Raper, M.D., President Lenox D. Baker, M.D., Vice-President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman, Jr., B.S.Ph. Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Jesse H. Meredith, M.D. Paul F. Maness, M.D. The invocation was given by Dr. Paul F. Maness. Dr. Jacob Koomen, State Health Director, read citations honoring the following former members of the State Board of Health staflF: Dr. J. W. R. Norton — State Health Director, Emeritus Dr. Watson S. Rankin — State Health Director, Emeritus Dr. C. C. Applewhite — Director of Local Health, Emeritus Dr. A. H. Elliot — Director of Personal Health, Emeritus Mr. Maurice M. J arrett — Director of Sanitary Engineering, Emeritus. Dr. Norton, Dr. Elliot, and Mr. Jarrett were present to accept their awards. Letters were read from Dr. Applewhite, and from Mrs. Watson S. Rankin, expressing appreciation for this honor. Dr. Charles T. Barker, son-in-law of Dr. Rankin, accepted on behalf of Mrs. Rankin. Motion was made by Dr. Dawsey, seconded by Dr. Maness, that the minutes of the last meeting be approved as circulated. The motion was carried. Mr. Marshall Staton, Director, Sanitary Engineering Division, pre-sented a proposed resolution to extend the boundary lines of the Sedgefield Sanitary District located in Guilford County, North Car-olina. He said all transactions regarding this matter had been re-viewed with the Attorney General's office, and were found to be in order. He recommended that this proposal be approved to provide water and sewage to the people in this area. Dr. Raper inquired if NORTH CAROLINA BOARD OF HEALTH 7 any member of the public desired a hearing on this matter and in-structed the secretary to let the minutes show that no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Dawsey, that the proposed resolution of the North Carolina State Board of Health extending the boundary lines of the Sedgefield Sanitary District located in Guilford County, North Carolina, be approved. The motion was carried. (Copy is attached to the oflRcial minutes.) Mr. Staton presented a proposed resolution recommending ex-tension of the boundary lines of the Roanoke Rapids Sanitary District located in Halifax County, North Carolina. He advised that all legal aspects had been discussed with the Attorney General's office and were found to be in order, and recommended that annexation be approved to give these people the benefit of receiving water and sewage. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no member of the public appeared. Motion was made by Dr. Mere-dith, seconded by Dr. Maness, that the proposed resolution of the North Carolina State Board of Health extending the boundary lines of the Roanoke Rapids Sanitary District located in Halifax County, North Carolina, be approved. The motion was carried. (Copy is attached to the official minutes.) A proposed resolution was presented by Mr. Staton recommend-ing creation of the Cooleemee Sanitary District located in Davie County, North Carolina. The petition for creation of this district has been signed by 51 percent of the resident freeholders living within the district. A hearing was held in January, 1971, and no opposition was expressed; however, a representative of Burlington Industries requested that all industrial properties owned by the industry be excluded from the sanitary district and these properties have been excluded. The Attorney General's office has found this matter to be in order, and Mr. Staton recommended that the resolution be ap-proved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one requested a hearing. Motion was made by Dr. Dawsey, seconded by Dr. Hiatt, that the resolution of the North Carolina State Board of Health creating the Cooleemee Sanitary District located in Davie County, North Carolina, be approved. The motion was carried. (Copy is attached to the official minutes.) The next item of business was the proposed name change of the administrative agency from State Board of Health to State Department of Health. Some background information was distributed, explaining that with the approval of the State Board of Health, a study has been 8 FORTY-FOURTH BIENNIAL REPORT undertaken of the proposed name change under the guidance and supervision of the State Health Director. Dr. Koomen appointed a committee composed of: Dr. W. Burns Jones, Jr., Assistant State Health Director; Dr. Ronald H. Levine, Director, Community Health Division; Mr. Marshall S. Staton, Director, Sanitary Engineering Division; and, Mr. Ben Eaton, Director, Administrative Services Division. The Institute of Government, under the direction of Mr. David G. Warren, was asked to serve as a resource to supply the necessary technical assistance to the project and to draft the required legislation to implement the objectives. This task has been completed and the legislation has been drafted for submission to the General Assembly, pending approval of the proposed change by the State Board of Health. In the material distributed, the "Purposes and Objectives" were defined, the advantages of the change were re-viewed, and a brief description was given of review procedures and the scope of statutory changes. The committee recommended to the Board that proposed legislation be approved by the State Board of Health to incorporate the concept of identifying the policymaking body as "State Board of Health" and the administrative agency as "State Department of Health". Also given to the Board were copies of a Bill to be entitled "An Act to Change the Name of the Adminis-trative Agency from the State Board of Health to the State Depart-ment of Health". Dr. Raper asked if any member of the public wished to be heard on this matter, and no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Maness that this matter be deferred to the Executive Committee of the State Board of Health and that this committee report back to the Board in closed session. Dr. Maness pointed out that since he had been a Board member a fair amount of discussion had centered about this matter. He realized time was important in order to get this before the General Assembly this Session, but he also felt it would be good to have the Executive Committee discuss the matter and bring a report to the Board at its May meeting in Pinehurst. Dr. Barker mentioned that, according to information presented, 47 other States in the Union use the name "State Department of Health", and apparently the term "State Board of Health" has outlived its usefulness. He pointed out that if we wait until the May meeting of the Board, it may be too late to have the General Assembly take action on it. "Two years of work has gone into it, and I feel we should not drag our feet any longer, that we need action now." Several others expressed opinions, and Mr. Eaton sum-marized: Great care has been exercised to preserve the intent of the Legislature throughout, and also to preserve existing practices and existing circumstances. This change will not cost a cent more, but it NORTH CAROLINA BOARD OF HEALTH 9 does clear up tremendous confusion that exists in the minds of the public, the General Assembly, and even the agency, as to how we should function. There is no change in the existing philosophy what-ever, but it will bring about, we believe, consistency in our operations, consistency in respect to how other state agencies are set up and we believe you will find it a very satisfactory and wholesome plan. Dr. Barker moved that the motion be amended to include the following: the Executive Committee would have the power to act on this matter. This would permit them to change the name now if they feel it neces-sary, or to study it further. The amendment was seconded bv Dr. Dawsey, and the motion was carried unanimously. Dr. Raper called for a vote on the original motion as amended, and it was carried unanimously. Mr. Marshall Staton presented a recommendation to amend Sec-tion C.401(c) of The North Carolina Regulations for Protection Against Radiation. He explained: Before changes can be made in these regu-lations, the Governor must approve the change. Written approval has been received from Governor Robert W. Scott approving the amendment. (Copy of letter attached to official minutes.) The purpose in changing the wording of this Section of the Regulations is that it might comply with that of the Atomic Energy Commission, except we use the word definite where they use the word permanent. Dr. Raper asked if any member of the public wished to be heard, and the secretary was instructed to let the minutes show that no one was heard. A motion was made by Dr. Meredith, seconded by Dr. Barker, that the request to amend Section C.401(c) of The North Carolina Regulations for Protection Against Radiation be approved. The motion was carried unanimously. Mr. Staton presented proposed revision of rules and regulations governing sanitation of summer camps. He explained that there are at present 171 camps in North Carolina which come under these regulations, and the proposed rules and regulations are intended to replace those now in effect which were adopted by the State Board of Health in 1947. The proposed revision has been reviewed by a committee of local camp directors and sanitarians who ha\e camps in their counties, the revision also includes certain requirements of the American Camp Association. The principal changes consist of bringing the regulations up to date primarily in the area of food service and by adding such procedures as investigation of camp sites. After some discussion, two changes were suggested. Dr. Raper asked if any member of the public wished to be heard, and instructed tlie secretary to let the minutes show that no one was heard. Motion was made by 10 FORTY-FOURTH BIENNIAL REPORT Dr. Maness, seconded by Dr. Barker, that the Revised Rules and Regulations Covering the Sanitation of Summer Camps in North Carolina be approved as amended, the effective date to be January 1, 1972. Tlie motion was carried unanimously. (Copy is attached to the official minutes.) Mr. Staton discussed the establishment of rules and regulations providing for solid waste disposal. A bill was presented during the last Session of the General Assembly designating the State Board of Health as the official State agency responsible for solid waste disposal. We have conducted 60 individual county studies in North Carolina and prepared plans for solid waste disposal programs in these counties. Thirteen additional counties have requested studies and recommenda-tions. We are well underway with this program, but we have been short of manpower. The A and B Budgets contain provisions for additional staff and the Advisory Budget Commission recommended that this program be staffed. The proposed rules and regulations have been reviewed by the North Carolina League of Municipalities and the Association of County Commissioners. The League of Municipali-ties made two minor suggestions for changes; these are clarifying words and do not affect the whole intent of the regulations in any way. Dr. Raper inquired if any member of the public desired a hear-ing on this matter. Mr. Lonnie C. Poole, of Waste Industries, spoke briefly representing private enterprise. He said: We are getting involved in the landfill business and can offer some alternatives in cost to the solid waste program. I think overall the proposed regula-tions show a great deal of professionalism on the part of the public and private enterprise involved. They have done a nice piece of work. Motion was made by Dr. Dawsey, seconded by Dr. Meredith, that the Rules and Regulations Providing Standards for Solid Waste Disposal be adopted, incorporating the changes suggested by the League of Municipalities, the effective date to be March 11, 1971. The motion was carried unanimously. (Copy is attached to the official minutes.) Dr. Martin P. Hines, Director, Division of Epidemiology, gave the following information reports: Byssinosis: Field work for the cooperative study of the prevalence of byssinosis among cotton textile workers is virtually complete. Teams of physicians and technicians from the State Board of Health and Duke Medical Center have interviewed, x-rayed and performed pulmonary function tests on 4,000 workers in this industry in the past nine months. Concurrently, engineers have collected 2,000 air samples in the work places for dust analysis. A dust sampling device NORTH CAROLINA BOARD OF HEALTH 11 developed specifically for this study shows promise in other areas of air sampling for toxic aerosols. Although the data collected has not yet been analyzed, there appears to be a definite relationship between the incidence of byssinosis and the exposure of the individuals to respirable-size dust, not cotton fibers, in the workrooms. Synthetic fiber and wool workers known to be essentially free of byssinosis were used as control groups in this study. The efforts of the study group are now being directed toward determining an effective and economically feasible method for control of this occupational disease. Studies re-lating to the long-term effects of exposure to cotton dust are also planned. Pesticides Program: The overall objective of this program, estab-lished in January, 1969, is to study the health effects of man's usage of pesticides, and where problems emerge, initiate sound corrective measures. Accomplishments have been made in each of the areas included in the work scope. This year we are working with pesticide formulating plants and other facilities with high occupational ex-posure risk to pesticides. We will hopefully set up a cholinesterase monitoring service to these groups to measure organophosphate ex-posure. We also will be working in cooperation with a large tobacco processing company in evaluating occupational hazards in their opera-tions due to pesticides. We will be cooperating with the Department of Agriculture and N. C. State University in residue studies of parathion on the extension experiment stations this summer. Addi-tionally, we will attempt to evaluate t^q^ical usage patterns of this chemical on selected farms. Driver Medical Evaluation of Visually Handicapped: As a result of an amendment to G.S. 111-28 by the 1969 General Assembly, the number of drivers being medically evaluated for visual problems has greatly increased over the past several months. This change in the law authorized the Commission for the BHnd to release to the De-partment of Motor Vehicles the name and medical record of any person listed on the register of the blind or added to the register in the future. The initial screening of this register turned up over 300 individuals with valid driving licenses. These cases were referred to the State Board of Health for evaluation to determine to what extent their visual difficulties would interfere with their ability to safely operate motor vehicles. The medical evaluation has been completed on approximately two-thirds of these cases, resulting in approximately 60 percent being denied driving privileges. Of the approximately 40 percent authorized to continue driving, many are being severely re-stricted, such as restriction to corrective lenses, daylight driving onh-, 12 FORTY-FOURTH BIENNIAL REPORT and 45 MPH speed limit. Since North Carolina has no legal visual standards for driving, these cases have been medically reviewed on the basis of guidelines established by the American Medical Associa-tion and the U. S. Department of Health, Education and Welfare. A need exists, however, for more definitive visual standards to be estab-lished for guidance of driver license examiners, medical consultant panels, and the Medical Review Board. With this in mind, representa-tives of the State Board of Health and the Department of Motor Vehicles have met with a group of ophthalmologists and an optometrist to recommend visual standards for adoption by the Commissioner of Motor Vehicles. These standards, hopefully, will be developed during the next few months. Dr. T. D. Scurletis, Director, Personal Health Division, reported on the following: Family Planning: The State Board of Health is participating in a Task Force for the development of a total comprehensive, coordinated plan for family planning. This Task Force was established by the Department of Administration and includes the Departments of Social Services, Mental Health, Education, Health, Local Affairs, the Population Center of the University of North Carolina, Medical Society of the State of North Carolina, Old North State Medical Society. The State Board of Health has been designated as the lead agency in developing and recommending the total plan. This effort is aimed at coordinating all state and federal funding sources and programs into an integrated comprehensive plan to meet the needs of North Carolina citizens. The initial plan is due to be submitted on April 1, 1971, but this will be just the beginning of the long-range coordinated effort so that the plan will be expanded and periodically updated to meet changing situations. Kidney Planning: This is an interim report on the progress of the planning for a total kidney program for the State of North Carolina as a result of the efforts of the initial kidney plan venture which was begun approximately three years ago. A program has been advocated and a project written for the development of the training components and is presently being considered by the Regional Medical Program. Legislation has been introduced by Senator Currie (copies of the bill were distributed) which will mandate the State Board of Health to maintain the planning and coordination of the development of a total kidney chronic disease program. The legislation calls for the develop-ment of an Advisory Group which is essentially the same as the Planning and Advisory Committee. This group is to advise the State Board of Health in the development and coordination of a system of NORTH CAROLINA BOARD OF HEALTH 13 service for dialysis and transplantation, continued study of the needs, the development of total educational program and finally the initiation of a program to assist medically indigent patients in securing ser-vice. This has been an excellent demonstration of what can be ac-complished by combination and coordination of eflPorts of health agencies, medical training institutions, providers of service and third party interest. Dr. Scurletis distributed a list of those physicians who have ap-plied for rostering in the Crippled Children's Program, and indicating those who have been rostered, since the last Board meeting. (Copy at-tached to the official minutes.) Dr. Jacob Koomen commented on Budget Requests: We have been very warmly treated by the Advisory Budget Commission. For the Health Aid to Counties item, nearly $1 million has been projected in the A Budget to help the counties carry their enormous burden. In the B Budget, we requested support for six items: Medical Examiner System, Environmental Health Services, Pesticides Program, Com-municable Disease Program (in particular, the purchase of vaccines), Crippled Children's Program, and the Cancer Control Program. The Advisory Budget Commission has recommended to the General As-sembly approximately $22 million in support of the State Board of Health, up some 25 percent over the present budget. We have also presented before the Appropriations Committee and requested: (1) Additional money for Health Aid to Counties, particularly to strength-en their environmental health work (this would involve sufficient funds to purchase services of 54 sanitarians and six supervisors in this field); (2) Money to continue the cancer registry; (3) Additional money for Occupational Health; (4) Additional money to expand child screening clinics; (5) Expansion of the family planning program; (6) Modest ex-pansion of the services for mentally retarded, which would involve increasing the number of child development clinics from 11 to 15; (7) Expansion of the Multiphasic Screening Program. In summary, we requested a total of .$19y2 million in the A Budget (approximately $2 million over the prior two years), and $2,458,000 in the B Budget (an increase of around $4y2 million). Mr. Ben Eaton, Director, Administrative Services Division, report-ed on the status of the new health building. Ten days ago the bids were let and the total cost of the project comes to approximately $4,200,000. The construction cost alone is $3,960,000; the cost per square foot will be approximately $31.57. A Greensboro firm, W. H. Weaver Company, has contracted for the construction. The building will face W^ilmington Street on the corner of Lane and North Streets, and \\ill hdvc an 14 FORTY-FOURTH BIENNIAL REPORT exterior of precast stone. The two top floors of the five-story building will be for the Laboratory and will almost double their present space. We are working out which of the other Divisions will move to the new building — those who work more closely together, and with the Laboratory, will probably be relocated there. The gross square footage is about 124,000 but the usable ofiice space will be about 68,000 square feet, compared with 87,000 at present. Upon completion of the build-ing, all State Board of Health oflBces will be relocated in the Cooper Building and the new building, as opposed to our present arrange-ment of nine different locations. Dr. Koomen commented that there are about six Day Care bills now before the General Assembly. We have a strong role in the in-spection of these facilities. No resolution has come about in the bills so far proposed. Dr. Koomen also mentioned the proposed revision of the Abortion Law which has been processed by the House Health Committee and Representative Nancy B. Chase. This bill has been passed by the House and is now before the Senate Health Committee. (Copies were distributed). Dr. Raper concluded: "Everybody performed beautifully! Thank you for coming today." There was no further business, and the meeting adjourned. NORTH CAROLINA BOARD OF HEALTH 15 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Wednesday, May 19, 1971 The North CaroHna State Board of Health met in the Dutch Room of The Carohna, Pinehurst, North Carohna, at 8:00 a.m., on May 19, 1971. Dr. James S. Raper, President, presided. Other members in at-tendance were: Lenox D. Baker, M.D., Vice-President Joseph S. Hiatt, Jr., M.D. Ernest A. Randleman, Jr., B.S.Ph. Charles T. Barker, D.D.S. Ben W. Dawsey, D.V.M. Paul F. Maness, M.D. The invocation was given by Dr. Joseph S. Hiatt. The minutes of the last meeting were discussed. It was pointed out that the effective date of the Revised Rules and Regulations Governing the Sanitation of Summer Camps in North Carolina should have been January 1, 1972 rather than January 1, 1971. This change will be made in the minutes. There were no further corrections, and upon motion of Dr. Dawsey, seconded by Dr. Barker, the minutes were approved as circulated. Dr. Raper reported that the House of Delegates of the State Medical Societ}' had taken action with regard to the rostering of phy-sicians in the Crippled Children's Program. Dr. Koomen read the resolution which was adopted on May 18, 1971, as follows: "The physician's eligibility for participation should be dependent upon (1) having unrestricted license to practice medicine in North Carolina (2) provision of curriculum vitae and a brief summary of his training and clinical experience in the category in which he is applying and (3) furnishing evidence of membership on the staff of hospitals having adequate facilities to provide satisfactory care in the category in which he is applying." Comments were heard from several members; however, no action was required on this matter. The first item of new business was the consideration of proposed Rules and Regulations Governing the Statewide Medical Examiner System, and these were presented by Dr. R. Page Hudson, Chief Medical Examiner. Dr. Hudson answered several questions and after discussion Dr. Raper inquired if any member of the public wished to be heard. He instructed the secretary to let the minutes show that 16 FORTY-FOURTH BIENNIAL REPORT no one was heard. Motion was made by Dr. Hiatt, seconded by Dr. Dawsey that the Rules and Regulations Governing The Statewide Medical Examiner System be approved. The motion was carried. (Copy is attached to the oflBcial minutes.) Dr. Martin P. Hines, Director, Division of Epidemiology, pre-sented a proposed revision of Regulations Governing Chemical Tests for Breath Alcohol. He explained that these regulations were originally adopted by the Board on May 10, 1964 and amended February 15, 1969. The amendments to be considered today represent changes which are deemed necessary after seven year's experience with the program. "They have been carefully reviewed and concurred in by Dr. Arthur McBay and by an ad hoc committee on chemical tests for alcohol. We request diat these regulations become effective August 1, 1971." Dr. Hines pointed out the major facts in the regu-lations, and invited questions. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one appeared. Motion was made by Dr. Baker, seconded by Dr. Maness that the revision of Regulations Governing Chemical Tests for Breath Alcohol be accepted as presented. The motion was carried unanimously. (Copy attached to official minutes.) Dr. Hines then presented for the Board's consideration approval of vaccine preparation and dosages. He said: The 1971 General Assembly has passed a rewrite of the state immunization laws, combining old Articles 9 and 9A of Chapter 130 of the general statutes into a single Article 9. In addition to the requirements of the old statutes relating to immunization against diphtheria, whooping cough, tetanus, polio, and smallpox, the new law requires administration of measles (rubeola) vaccine before two years of age; immunization against polio is now required by one year of age. Section 130-87 of the new law (copy attached to official minutes) provides that the State Board of Health will determine how many doses of each of the vaccines shall be re-quired and which vaccine preparations shall be approved for use. It was suggested that the following list of doses be approved as the minimum acceptable by the ages specified in the law for the specified vaccines: DPT — Three (3) doses by age one (1) year. Oral polio vaccine — Trivalent t>^pe — Two (2) doses by age one (1) year; or Monovalent type — One (1) dose of each type by age one (1) year. Measles vaccine — One (1) dose by age two (2) years. Smallpox vaccine — One (1) successful vaccination by age six (6) years. NORTH CAROLINA BOARD OF HEALTH 17 It is further suggested that all vaccine preparations licensed for interstate use by the Division of Biologic Standards of the U. S. Public Health Service (list attached) be approved for use in fulfilling the requirements of this law. Motion was made by Dr. Maness, seconded by Dr. Dawsey, that the suggested list of doses be approved as the minimum acceptable by the ages specified in the law for the specified vaccines. Dr. Raper inquired if any member of the public desired a hearing on this matter, and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. At this point, the Board adjourned to the Conjoint Session of the State Board of Health and the Medical Society of the State of North Carolina, at which time Dr. Jacob Koomen, State Health Director, presented his report, entitled "Transportation Versus Trauma: A Public Health Perspective of the Automobile". (Copy attached to the official minutes.) The Board reconvened following the Conjoint Session, and Dr. Charles T. Barker discussed Senate Bill 311 and Senate Bill 312 which are now pending in the General Assembly. The Dental Health Division is trying very hard to get these bills passed, representing a pioneer effort in support of the Preventive Dental Program. Dr. Barker ex-plained: It has only been within the last t\vo years that dentists have really found out what is probably the cause of oral disease. Dental disease affects 95-96 percent of human beings. We want to teach the Bass Technique to the dentists and children of North Carolina. Senate Bill 311, short-titled "Preventive Dental Program", calls for employment of 20 dental hygienists who will "implement major in-novations in the preventive dental program", providing salary, ti-avel, dental equipment, supplies and materials; also funds to provide special training in plaque control for private-practicing dentists. The total requested amounts to $545,050.00. Senate Bill 312, short-titled "School Dental Health", asks $77,706 to purchase equipment and sup-plies to fluoridate some 40 rural school water systems and for salaries and travel for two engineering technicians to maintain and monitor all the rural school water fluoridators. Dr. Barker said he would like to invite the Committee on Plaque Control to attend the ne.xt meeting of the Board to demonstrate the Bass Technique to the Board. He asked that each Board member talk with his legislator about this pro-gram and these t\vo bills. Dr. Raper excused Dr. Koomen and Dr. Jones and brought to the Board's attention that their appointments as State Health Director and Assistant State Health Director expire Jime 30, 1971. It is up to 18 FORTY-FOURTH BIENNIAL REPORT ihis Board to take action to recommend to the Governor that their services be retained, or that they be replaced. Dr. Maness moved that both Dr. Koomen and Dr. Jones be retained: They are outstanding physicians rendering excellent service and I do not think we could do better. The motion was seconded by Dr. Dawsey, and carried unanimously. This action will be reported to the Governor by the President. Dr. Jacob Koomen stated that Mr. J. M. Lackey of Hiddenite had been elected County Commissioner of Alexander County. Holding this position as well as membership on the State Board of Health would make him a "double oflBceholder"; therefore, Mr. Lackey submitted his resignation to the Governor. Dr. Koomen wished to know the feelings of the Board about writing a resolution citing Mr. Lackey's good services. Motion was made by Dr. Maness, seconded by Dr. Barker, that a resolution be written and presented to Mr, J. M. Lackey citing his outstanding services to the State Board of Health. The motion was carried unanimously. The hour of the annual meeting of the Board with the State Medical Society (in Pinehurst each year) was discussed. It was pointed out that the Public Health Section meets on Tuesday morning, and if the Conjoint Report could be given at the Tuesday noon session, and the State Board of Health could meet on Tuesday afternoon, it would be possible for Health Directors and others to come to the Board meeting and to participate in the Conjoint Report. Dr. Koomen stated that by law the Board must meet annually with the State Medical Society, but a change of meeting time could be discussed with the Society. Dr. Raper said he would be happy to write to Dr. Charles W. Styron, with a copy to Mr. William N. Hilliard, Executive Director of the State Medical Societ\', to ask that this change be made. It was the consensus of the group that this should be done. The place of the next meeting was discussed; it was felt that since the Board had met in the western part of the State, it would be good to hold a meeting in the East. Dr. Charles Barker and Dr. Koomen will make the necessary arrangements for the next meeting in the East. Dr. Raper reported that the Executive Committee of the Board had met regarding the name change, as directed at the last meeting of the Board. They decided to get a legal opinion on this matter; this was done, but not in time to act on it at today's meeting. Dr. Raper said, "It is my opinion that we would do well not to force this". There was no further business and the meeting adjourned. NORTH CAROLINA BOARD OF HEALTH 19 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, October 28, 1971 The North CaroHna State Board of Health met in the Nighthawk Room of the Blockade Runner, Wilmington, North Carolina, at 9:30 a.m., on October 28, 1971. Dr. James S. Raper, President, presided. Other members in at-tendance were: Paul F. Maness, M.D. Ernest A. Randleman, Jr., B.S.Ph. Ben W. Dawsey, D.V.M. Charles T. Barker, D.D.S. Jesse H. Meredith, M.D. The invocation was given by Dr. Paul F. Maness. The minutes of the last meeting were brought to the attention of the Board. There were no corrections and upon motion of Dr. Dawsey, seconded by Dr. Meredith, the minutes were approved as circulated. Nominations were received for President and Vice-President of the North Carolina State Board of Health. Dr. Barker nominated Dr. Raper to continue as President of the Board and the motion was seconded by Dr. Maness. Dr. Meredith moved that the nominations be closed, and the motion was seconded by Dr. Dawsey. A vote was taken and Dr. Raper was elected unanimously. Dr. Dawsey nominated for the Vice-President of the Board Dr. Paul F. Maness, with Dr. Barker seconding his motion. Some discussion was held in relation to this nomination and Mr. Ben Eaton was called upon to clarify the matter. Dr. Maness was then elected Vice-President of the State Board of Health. Dr. Barker and Dr. Meredith were nominated and unanimously elected to serve on the Executive Committee. Dr. Jacob Koomen was recognized and introduced staff members and others in attendance. Tlie following items of new business were introduced by Mr. Marshall Staton, Director, Sanitary Engineering Division: 1. Standards for Design and Construction of Public Water Supply Systems to Serve Residential Communities: Mr. Staton stated tliese regulations had been needed for some time. The 1969 General As-sembly directed the Legislative Research Commission to study cer- 20 FORTY-FOURTH BIENNIAL REPORT tain water and air resource laws and to report its findings and recom-mendations to the 1971 General Assembly. Public hearings were held and testimony received from quite a number of people in the State concerning the status of small water supplies — particularly, those serving mobile home courts and housing subdivisions. Many deficien-cies were found in these places, and the Attorney General's Office expressed the opinion that our laws were not broad enough to cover some of the deficiencies in existence. The 1971 General Assembly enacted new public water supply legislation based on the Legislative Research Commission's recommendations. This legislation authorized the State Board of Health to adopt more stringent regulations. We were pleased to have an opportunity to prepare these regulations, a copy of which, along with a copy of the bill passed by the General Assembly, was sent to the Board. The regulations are quite lengthy and technical but in general cover the source of water, the distribu-tion system, storage facilities, etc. They are prepared in two sections — one for housing communities, and one for mobile home courts. Fol-lowing discussion, a motion was made by Dr. Dawsey, seconded by Dr. Meredith, that the Standards for Design and Construction of Public Water Supply Systems be approved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion was car-ried. (Copy of Standards attached.) 2. Rules and Regulations to Protect the Health, Welfare, and Safety of Those Attending Mass Gatherings and of Other Persons Who May Be Affected By Mass Gatherings: Mr. Staton explained that these regulations originated as a result of a law passed by the 1971 General Assembly. The regulations are lengthy and cover, in general, water supply, sewage disposal, plans for emergencies, solid wastes, food dispensing and other provisions applicable to mass gatherings, includ-ing Rock Festivals. There was no discussion and Dr. Raper inquired if any member of the public wished to be heard; no one was heard. Motion was made by Mr. Randleman, seconded by Dr. Barker, that the proposed Rules and Regulations Governing Mass Gatherings be Approved and Become Effective October 28, 1971. The motion was carried unanimously. (Copy of Rules and Regulations is attached.) 3. Rules and Regulations Governing the Disposal of Sewage From Any Residence, Place of Business or Place of Public Assembly in North Carolina: Mr. Staton said that these amendments would mean that: (a) the person owning or controlling the property will be re-sponsible for the maintenance of the septic tank, and (b) persons in the business of cleaning septic tanks must not only go to the health NORTH CAROLINA BOARD OF HEALTH 21 department and get a permit but also must discharge the wastes at a location and in a manner approved by the Local Health Director. A motion was made by Dr. Meredith and seconded by Dr. Dawsey that the proposed Amendments to the Rules and Regulations Govern-ing the Disposal of Sewage From Any Residence, Place of Business or Place of Public Assembly in North Carolina be approved and made effective January 1, 1972. The President inquired if any member of the public wished to be heard regarding this matter, and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. (Copy of Amendments is attached.) 4. Resolution of the North Carolina State Board of Health Ex-tending the Boundary Lines of the Walkertown Sanitary District Located in Forsyth County, North Carolina: Mr. Staton explained that the Board of Commissioners of the ^^'alkertown Sanitary District wish to extend the boundary lines to include properties described in a petition submitted to them on June 10, 1969. More than 51 percent of the owners of the real property within the territory proposed to be annexed have signed the petition. Plans for boundary extensions have been submitted to the Engineering Section of the Sanitary Engineering Division, and have been found acceptable. The Sanitary Engineering Division, therefore, recommends approval of the annexation. The Attorney General's OfRce has been consulted and advises that every-thing is in order. Dr. Maness moved, and Mr. Randleman seconded, that the Petition to Extend Boundaries of Walkertown Sanitary Dis-trict, Forsyth County, North Carolina, be approved. Dr. Raper in-quired if any member of the public wished to be heard and no one appeared. The motion was carried unanimously. (Copy of resolution is attached.) The next item of business was hearing on Legislative Room Rate Limitation for Nursing Homes established by the 1971 General As-sembly. Mr. James T. Johnson, President, North Carolina Association of Nursing Homes, was heard and made the suggestion that "we have a liaison committee for the Nursing Homes Association and the State Board of Health". He stated that according to figures supplied by the Department of Social Services "one-half of the nursing home beds in the State of North Carolina which were paid for in the month of September exceeded $14.00 in cost". Dr. Raper responded to the remarks of Mr. Jt)hnson. The Board has discussed with county com-missioners for years in an effort to get them to pay even close to the cost for hospital care of the indigent patients. Nursing Homes in general are profit organizations and hospitals are primarily non-profit. The obvious answer is that they charge the private patients 22 FORTY-FOURTH BIENNIAL REPORT more to make up for the slack. It isn't correct, but it's the only alterna-tive that you have. This report was received as information. No action was taken on this matter. Dr. Arthur McBay, Chief Toxicologist for the North Carolina Medical Examiner System, presented a summary of the North Carolina Controlled Substances Act enacted, which will become effective January 1, 1972. The Attorney General's office had advised that the State Board of Health should formally review, approve and estab-lish regulations for emergency prescriptions as required in G.S. 90-106 of the new law. A motion was made by Dr. Meredith, seconded bv Dr. Dawsey, that Regulations Governing Emergency Prescriptions of Controlled Substances be approved. Dr. Raper inquired if any mem-ber of the public wished to be heard and instructed the secretary to let the minutes show that no one appeared or requested a hearing. The motion was carried unanimously. (Copy of the Regulations is attached.) Dr. Ronald Levine, Director, Communit}- Health Division, re-viewed the 1971 General Assembly Resolution to Create a Study Commission on Organization and Delivery of Health Services. Dr. Maness moved that Dr. Levine's report be accepted as information. Dr. Baker seconded the motion and it was carried unanimously. Dr. Isa Grant, Chief, Chronic Disease Section, gave an informa-tion report concerning the Kidney Disease Program. She used flip charts to show the locations of the Dialysis Centers which have been approved by the Advisory Committee — namely, Bowman-Gray School of Medicine, ^^'inston-Salem; Uni\'ersit>' of North Carolina, Chapel Hill; Duke University School of Medicine, Durham. In addition, there are smaller centers in Asheville, Charlotte and Greenville. Dr. Scurletis presented the rules and regulations concerning procedures for issuing a Certificate of Need which were developed by the staff with the cooperation of the Institute of Government and the North Carolina Medical Care Commission. The legal basis for issuing these regulations is Chapter 1164 of the 1971 North Carolina General Assembly Session Laws. Motion was made by Dr. Dawsey and second-ed by Dr. Maness that the proposed Regulations Governing the Certificate of Need be approved. Dr. Raper inquired if any member of the public wished to be heard and the secretary was instructed to let the minutes show that no one was heard, and tliat the regulations were approved unanimously. (Copy of regulations is attached.) Dr. T. D. Scurletis, Director, Personal Health Division, presented proposed Regulations Governing Licensing of Home Health Agencies. NORTH CAROLINA BOARD OF HEALTH 23 Recently the Legislature passed a bill requiring the licensing of Home Health Agencies, the purpose of which was to allow organiza-tions other than non-profit organizations to provide home health ser-vices and is related to the Federal Medicare Law. The bill established the State Board of Health as the licensing agency and empowered it to develop rules and regulations. The regulations insure that any home health agency in this State must comply with Medicare- Medicaid Standards. They apply only to non-public agencies. We belie\'e that these are relatively all-inclusi\'e and that they fully cover the purpose of the law as passed by our legislature and are not in conflict with any Federal guidelines. The motion was made by Dr. Dawsey and seconded by Dr. Meredith that the proposed Regulations Governing Licensing of Home Health Agencies be approved. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. (Copy of Regulations is attached.) The next item of business related to the Revision of Nursing Home Regulations. Dr. Scurletis, in presenting this to the Board, said that these revisions introduce the Certificate of Need into our licens-ing requirement. He directed the Board's attention to the proposed revisions and answered questions from the Board. A motion was made by Dr. Maness, seconded by Dr. Dawsey, that the proposed Revisions of Nursing Home Regulations be accepted, effective January 1, 1972. The motion was carried unanimously. (Copy of Revision is attached.^ Consideration was then given to rostering of physicians for the Crippled Children's Program, and quite a lengthy discussion was held around this. Dr. Scurletis stated that this matter dated back to Ma\- of 1970 when the Board directed that the President of the Board consult with the Medical Society and establish an Advisory Committee to make recommendations for rostering of physicians for this program. This committee has met and agreed upon a set of requirements, which are presented to you today for your approval. Motion was made by Dr. Dawsey and seconded by Dr. Meredith that the proposed Rules and Regulations Governing the Procedures for Rostering of Physicians For The Crippled Children's Program be approved. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. (Copy of Rules and Regulations is attached.) The ne.xt presentation, in reference to the Repeal of Requirements for Health Cards for Food Handlers, was presented by Dr. Martin P. Hines, Director, Division of Epidemiology. E.xamples of health cards were distributed and Dr. Hines said this repeal was being proposi^d 24 FORTY-FOURTH BIENNIAL REPORT with the complete approval and cooperation of the Sanitary Engineer-ing Division. Motion was made by Dr. Dawsey, seconded by Dr. Meredith that the Requirements for Health Cards for Food Handlers Be Repealed and that the effective date be January 1, 1972. Dr. Raper inquired if any member of the public wished to be heard and instruct-ed the secretary to let the minutes show that no one was heard. The motion was passed unanimously. Dr. Hines also presented a proposal for the creation of a new section in the Division of Epidemiology. A motion was made by Dr. Meredith, seconded by Dr. Barker, that the Highway Safety Unit be made a Section in the Division of Epidemiology. The motion was carried. Dr. Hines presented the matter of Recognition of Live Tissue Culture Rabies Vaccine for Dogs and asked the Board to pass the proposed resolution that the modified tissue vaccine will be recom-mended for a period of three years as well as the chicken embryo. Motion was made by Dr. Dawsey, seconded by Dr. Maness, that Recognition of Live Tissue Culture Rabies Vaccine for Dogs be Approved. Dr. Raper inquired if any member of the public wished to be heard and so instructed the secretary to let the minutes show that no one was heard. The efi^ective date of this resolution will be October 28, 1971. The motion was carried. (Copy attached.) The next item for consideration was the addition of equipment items on emergency vehicles. Dr. Hines stated: The Advisory Com-mittee to the State Board of Health on Ambulance Services met on October 1 and recommended unanimously that a poison kit and obstetrical kit be added to the list of equipment on all emergency vehicles in the State (the cost involved for both items would be very small). The effective date is to be January 1, 1972, if approved by the Board. Dr. Dawson moved, and Dr. Maness seconded, a motion that a poison control kit and obstetrical kit be added as an equipment item on emergency vehicles, the effective date to be January 1, 1972. Dr. Raper inquired if any member of the public wished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Mr. David Warren, Associate Professor of Public Law and Government of the Institute of Government, Chapel Hill, addressed the Board briefly on the law as it pertains to the medical field in relation to eighteen-year-olds. A statute was enacted by the 1971 General Assembly which states that any person who is eighteen years of age or older or who is emancipated may consent to any medical NORTH CAROLINA BOARD OF HEALTH 25 assistance to himself or his child. This helps solve the diflBculty that the physicians and hospital administrators have been confronted with over the years. Final comments were heard from Dr. Jacob Koomen, State Health Director, and thereafter Dr. Raper declared the meeting adjourned. 26 FORTY-FOURTH BIENNIAL REPORT MINUTES NORTH CAROLINA STATE BOARD OF HEALTH Thursday, March 23, 1972 The North CaroUna State Board of Health met in the Board Room of the Cooper Memorial Health Building at 10:00 a.m., on Thursday, March 23, 1972. Dr. James S. Raper, President, presided. Other members in attendance were: Paul F. Maness, M.D., Vice-President Joseph S. Hiatt, M.D. Charles D. Barker, D.D.S. Jesse H. Meredith, M.D. Donald W. Lackey, D.V.M. Ernest A. Randleman, Jr., B.S.Ph. Ralph W. Coonrad, M.D. Robert B. Nichols, Jr. The invocation was given by Dr. Paul F. Maness. Dr. Lenox D. Baker, Secretary, Department of Human Resources, spoke briefly to the Board regarding reorganization. He displayed an organization chart of the new Department and referred to it as a "road map" showing how the Department will get where it wants to go. He expressed the hope that the five major offices could be com-bined into "a committee to run the Department. This is what you call teamwork and without this we cannot survive. We must have your (the Board's) help, your drive, your knowledge, to help us find the way to work most efficiently for the taxpayer." Dr. Raper welcomed the three new members of the Board — Dr. Ralph W. Coonrad, Mr. Robert B. Nichols, Jr. and Dr. Donald W. Lackey. He congratulated Mr. Ernest A. Randleman on his reap-pointment. Members of the staff and other present introduced them-selves to the Board. Dr. Jacob Koomen, State Health Director, read an "Expression of Appreciation" to Dr. Lenox D. Baker, former member of the Board. Motion was made by Dr. Maness, seconded by Dr. Meredith, that this be approved. Motion was carried. Dr. Koomen also presented a similar expression written to Dr. Ben W. Dawsey, who has just completed 12 years as the Veteri-nary member of the Board. A motion was made by Mr. Nichols, seconded by Dr. Maness, that this expression be approved. The motion was carried. NORTH CAROLINA BOARD OF HEALTH 27 The minutes of the last meeting were presented for approval. One correction was brought out and duly noted the minutes. Dr. Meredith moved that the minutes be approved with correction; Dr. Barker seconded the motion and it was passed unanimously. Dr. Martin P. Hines, Director, Division of Epidemiology, dis-cussed proposed regulations governing the sale of turtles. He said there had been some concern over this matter for a number of years, as these turtles carry a variety of species of salmonella. Several epi-demiological investigations have been made, and culture surveys have been done; Dr. Hines recommended that the Board approve the pro-posed regulations. A motion was made by Dr. Barker, seconded by Mr. Randleman, that the Rules and Regulations Governing the Sale of Turtles be approved. Dr. Raper inquired if any member of the pub-lic wished to be heard on this matter, and instructed the secretary to let the minutes show that no one was heard. The motion passed with-out opposition. Dr. Hines gave an information report on changes taking place in immunization laws and commented on smallpox vaccine. He said: An Advisory Committee to the Surgeon General in Washington released recently information to the effect that there is no need to immunize against smallpox. We feel now that this policy should be abandoned. Dr. Raper asked that each member of the Board think about this thoroughly and look into it, in order to be ready to vote when the time comes. No action is required at the present time; action of the General Assembly may be necessary. Dr. Hines distributed, for informational purposes, sample copies of new forms being used by the State Board of Health, Division of Epidemiology, for reporting purposes — namely: Therapeutic Abortion Report, Removal of Graves Certificate, and Medical Examiner's Certifi-cate of Death. He also reported on: (1) the status of removal of health card requirement for foodhandlers; (2) the immunization program — nearly 340,000 children will be immunized this year; (3) the gonorrhea program which is just unfolding — plans are underway for a mass state-wide control program, and funds have been allocated by Con-gress for this purpose. It is hoped that this program will result in about 31,000 females being brought to treatment. Dr. Arthur McBay, Chief Toxicologist for the Medical Examiner System, presented proposed Rules and Regulations Governing North Carolina Controlled Substances Act, Chapter 90, Article V. Mr. Hem-y Poole of the Attorney General's Office was present and responded to questions by the Board. Motion was made by Dr. Meredith, seconded by Mr. Randleman, that the proposed Rules and Regulations Govern- 28 FORTY-FOURTH BIENNIAL REPORT ing North Carolina Controlled Substances Act, Chapter 90, Article V, be approved. Dr. Raper inquired if any member of the public wished to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Dr. McBay also discussed proposed rescheduling from Schedule III, G.S. 90-91 (Article V) to Schedule II, G.S. 90-90, the following drugs: (a) Amphetamine, its salts and isomers; (b) Phenmetrazine and its salts; (c) Any substance except injectionable liquid which contains methamphetamine and its salts and isomers; (d) Metholphenidate. Motion was made by Mr. Randleman, seconded by Dr. Coonrad, that the proposed Resched-uling be approved. Dr. Raper inquired if any member of the public would like to be heard; the secretary was instructed to let the minutes show that no one appeared. The motion was carried without opposi-tion. Dr. McBay then presented for action the proposed exclusion of the drug, naloxone hydrochloride, from Schedule II, G.S. 90-9, and the entire Article V. Dr. Barker moved, and Dr. Maness seconded, a motion that the drug Naloxone Hydrochloride be excluded from Schedule II, G.S. 90-9, and the entire Article V. Dr. Raper inquired if any member of the public \\'ished to be heard, and instructed the sec-retary to let the minutes show that no one was heard. The motion was carried. Mr. Randleman introduced discussion of the drug, paregoric. He said it ^^•as his interpretation that, even though this is not a scheduled drug, it could not be sold without a prescription. He further stated that he would like Dr. McBay and the Board to investigate this and see if anything can be done. Dr. McBay said he had been assured by the Attorney General's office that the Board can take action should it see fit. Mr. Marshall Staton, Director, Sanitary Engineering Division, pre-sented the following for the Board's consideration: 1. Proposed Amendment to Summer Camp Regulations — This amendment would eliminate the requirement that all employees and campers should give evidence of a successful vaccination against smallpox within 10 years of arrival at camp. Motion was made by Dr. Maness, seconded by Dr. Coonrad, that the proposed Amendment to Summer Camp Regulations be approved. Dr. Raper inquired if any member of the public wished to be heard; he instructed the secretary to let the minutes show that no one was heard. The motion was carried unanimously. 2. Resolution Extending the Boundary Lines of the Roanoke Rapids Sanitary District — Mr. Staton explained that this proposal had been reviewed by the Attorney General's office and found to be in NORTH CAROLINA BOARD OF HEALTH 29 order. Motion was made by Dr. Maness, seconded by Dr. Coonrad, that the Resolution of the North Carohna State Board of HeaUh Ex-tending the Boundary Lines of the Roanoke Rapids Sanitary District Located in Halifax County, North Carolina, be approved. Dr. Raper asked if any member of the public ^^ ished to be heard and instructed the secretary to let the minutes show that no one was heard. The motion was carried. Mr. Staton said that since the first proposed resolution had been mailed to the Board, an urgent request had been received from the Roanoke Rapids Sanitary District to annex two additional areas — the Lincoln Heights area and the West Rosemary area. These areas are presentlv served by individual wells, many of which are contaminated due to the close proximity of septic tanks and privies. The Sanitary District has recently received confirmation of a Federal grant which will assist in proxiding the needed water and sewerage facilities to serve these two areas; however, to receive this financial assistance con-struction must begin in 90 days. For this to be accomplished, it is necessary that annexation of these areas be considered at this time. Favorable action by the Board will allow water and sewer facilities to be installed, which will eliminate unsanitary conditions which now exist in these areas. Motion was made by Dr. Barker, seconded by Dr. Coonrad, that the Resolution of the North Carolina State Board of Health Extending the Boundary Lines of the Roanoke Rapids Sanitary District to Include the Areas of Lincoln Heights and West Rosemary be approved. Dr. Raper asked if any member of the public \\ ishcd to be heard, and instructed the secretary to let the minutes show that no one was heard. The motion passed without opposition. 3. Resolution Extending the Boundary Lines of the Sedgefield Sanitary District — Mr. Staton said this resolution had been discussed with the Attorney General's office and was found to be in order, and he recommended adoption. A motion was made by Dr. Maness, seconded by Dr. Hiatt, that the Resolution of the North Ciirolina State Board of Health Extending the Boundary Lines of the Sedgefield Sanitary Dis-trict Located in Guilford County, North Carolina be approved. Dr. Raper asked if any member of the public wished to speak, and in-structed the secretary to let the minutes show that no one w as heard. The motion was carried unanimously. Dr. T. D. Scurletis, Director, Personal Health Division, distributed copies of the North Carolina Cancer Registry, 1970 Annual Report, for information. This report, the third produced by the North Carolina Cancer Registry, marks a year of growth for the program. The number of participating hospitals increased from 10 to 19 and the 3,099 cases 30 FORTY-FOURTH BIENNIAL REPORT assessed during the year bring the total number of cases in the Regis-try's master file to more than 8,000. In reporting on the Kidney Program, Dr. Scurletis said this pro-gram has been operational in the sense of sponsoring some patients since mid-November. The scope of services the Program can provide are: financial assistance for in-hospital dialysis, financial assistance for home training dialysis, provision of expendable supplies used in home dialysis, financial assistance for other special needs of kidney patients if the petition is approved by the Renal Disease Advisory Committee. An example of a special need would be the payment of a kidney donor's expenses. Another service available to kidney patients was initiated by program personnel, but is administered by the Laboratory Division; this refers to the Riochemistry Section's performing SMA-6 and SMA-12 and hematocrit tests on serum submitted by kidney patients and their dialysis partners. Currently there are six hospitals in which program sponsored patients may be dialyzed. They are located in Asheville, Charlotte, Chapel Hill, Durham, Greenville and Winston- Salem. The Renal Disease Advisory Committee meets March 9, and is expected to raise the number of affiliations to seven with the approval of the Danville, Virginia Dialysis Center. The Committee is also ex-pected to approve a new program service — the provision of non-prescription drugs, such as Vitamin A and R, to sponsored patients at the request of their physicians. The program has been sponsoring home patients since early January. Probably one of the more satisfying accomplishments to date has been the coordination between the pro-gram, the Department of Social Services, and Vocational Rehabilita-tion. These other agencies are involved in providing services to kidney patients, and program personnel have evolved what appears to be an excellent continuum of services for patients from the first dialysis to the transplantation. Dr. Scurletis called attention to the matter of the Certificate of Need. Regulations were approved by the Roard at its last meeting, but it now appears that a revision is needed in order to specify the steps involved in processing public hearings concerning the issuance of a certificate of need by the State Roard of Health. The requirement for public hearings is mandatory under the law in order to provide an administrative review of decisions contrary to the request of the af-fected applicant or the Areawide Health Planning Council. Dr. Scur-letis proposed the acceptance of these two changes in the Rules and Regulations. Dr. Maness made, and Mr. Randleman seconded, a motion that the proposed Revision to the Rules and Regulations Governing the Certificate of Need be approved. Dr. Raper inquired if any mem- NORTH CAROLINA BOARD OF HEALTH 31 ber of the public wished to be heard, and instructed the secretary to let the minutes show tliat no one was heard. The motion was carried without opposition. Dr. Scurletis then distributed a list of physicians rostered in the Crippled Children's Program since the last report to tlie Board, a list of physicians pending rostering, as well as a copy of the Rules and Regulations Go\'erning the Procedure for Rostering Physicians. Dr. Maness made, and Dr. Coonrad seconded, a motion that these three items be accepted by the Board as information. The motion was carried. Dr. W. Burns Jones, Jr., Assistant State Health Director, spoke briefly to the Board on the biennial budget cycle; the budgetary process has taken a fairly substantial chan z,e this year. The new system under which we will be operating is kncvvn as the Base Budget and the Change Budget. The Base Budget will be restricted to those funds which were previously allocated for the past biennium — the only increases allo^^'ed will be for salary increases. All requests for additional funds will be shown in the Change Budget. This will ul-timately be a good thing because we are working more and more toward a program budget — an actual program distribution of the amount of money being spent, how it is being spent, what results it is having, etc. The other aspect is that we will be \\^orking toward a zero base budget. This means that we would ha\e to justify the first dollar spent and every dollar thereafter. This will necessitate additional planning and will put responsibility on the staff — a very forward step in State Government. The Base Budget is due April 1 and the Change Budget is due June 1; the Board will have opportunity to review the Change Budget. Dr. Jacob Koomen commented as follows: 1. A time will be selected in the near future for a formal portrait of the Board and advance notice will be given. 2. The next meeting will be held on May 24 at Pinehurst — b\' law the Board is required to meet with the Medical Society; the Conjoint Report to the Board and to the Medical Societ\' is given at that time. 3. We welcome the new members of the Board — we are here to serve you and invite you to call us at any time we can help you. 4. The last legislature established a Legislative Study Commis-sion — the Governor has appointed these members, including Dr. 32 FORTY-FOURTH BIENNIAL REPORT Ronald H. Levine, Director, Community Health Division. The first meeting will be held soon. Dr. R. Page Hudson, Chief Medical Examiner, invited the Board members to visit the oflBces of the Medical Examiner System any time they have opportunity to be in Chapel Hill. There was no further business, and the Chairman adjourned the meeting. NORTH CAROLINA BOARD OF HEALTH 33 MINUTES NORTH CAROLINA STATE BOARD OF HEALTH May 24, 1972 The North CaroHna State Board of Health met in the Azalea Room of The Carolina, Pinehurst, North Carolina, at 8:00 a.m., on May 24, 1972. Dr. Paul F. Maness, Vice-President, presided. Other Board mem-bers present were: Dr. Charles T. Barker Dr. Ralph W. Coonrad Mr. Robert B. Nichols, Jr. Dr. Joseph S. Hiatt, Jr. Dr. Donald W. La:key The invocation was given by Dr. Hiatt. The first item of business was an information report by Dr. W. Burns Jones, Assistant State Health Director, on the State Board of Health's "Change Budget" requests for the 1973-1975 biennium, a summary of which had been mailed to the Board prior to the meeting. Dr. Jones stated that of the 56 requests made (totaling some $10-$15 million), 22 (totaling about $5 million) had been selected as being of a higher priority than others. Dr. Maness invited Dr. Jacob Koomen to comment and he stated that Division Directors have had to look carefully at what they do and what their hopes for the future are. He said that, realizing it highly unlikely that the Legislature could possibly grant all requests, these had been reduced to a minimum in priority order. In the past, budget requests have been presented to the Advisory Budget Com-mission only; now there are many hands involved, including the Secretary of the Department of Human Resources, the Governor, a "legislative watchdog committee", and finally the Advisory Budget Commission. Dr. Koomen emphasized that "in these times of austerity, we don't know how much of our request will be honored, but we felt impelled to ask for the funds." A motion was made by Dr. Barker, seconded by Dr. Hiatt, that the Board endorse the budget request as submitted. The motion car-ried. (Copy attached to the official minutes.) Mr. Marshall Staton, Director, Sanitary Engineering Division, was recognized for presentation of several items, the first of which was a request received on April 17 from the directors of Camp Illahee in Brevard, North Carolina, for a public hearing concerning 34 FORTY-FOURTH BIENNIAL REPORT the Summer Camp Regulations recently adopted by the Board. The portion of the Regulations which concerns them is Section 5-B re-quiring hot water at certain locations; Camp Illahee has lavatories but no hot water at these locations. Mr. Staton said the constraints of today's meeting had been explained to the camp directors, in-cluding the limited time for discussion, and the suggestion had been made that the hearing be delayed until facts were gathered and there was ample time for consideration of the matter. This was satisfactory with the directors; however, they asked that the Board authorize them to operate the camp without complying with this particular re-quirement until they could have a hearing with the Board. In re-sponse to a question, Mr. Staton explained that no other such re-quests or complaints have been received from the 60-65 camps in North Carolina. Two sanitarians have visited the camp to explain the necessity of such regulations, but Mr. Staton said he felt the group should have the privilege of expressing their feelings to the Board. A motion was made by Dr. Coonrad, seconded by Dr. Barker, that the request of Camp Illahee for a public hearing before the State Board of Health be granted and that the camp be authorized to operate without complying with the requirement in question until a hearing can be held. The motion passed without opposition. Mr. Staton then referred to the North Carolina Clean Water Bond Act, which was passed by the voters on May 6, 1972, and which will involve $150 million in bonds for water and sewer improvements. $70 million will be used for water improvements and the State Board of Health will be the project reviewing agency for use of these funds. Regulations are being prepared to implement this construction grant program and it may be necessary to call a meeting of the State Board of Health prior to its next regular meeting to consider these regulations. A resolution requesting extension of the boundary hues of the Rural Hall Sanitary District was presented by Mr. Staton. He said that 100 percent of the people living in this area had requested an-nexation into this district so they might be provided with water and sewerage. The Attorney General's office finds this resolution in order. A motion was made by Mr. Nichols, seconded by Dr. Coonrad, that the Resolution to the North Carolina State Board of Health Extending the Boundary Lines of the Rural Hall Sanitary District in Forsyth County, North Carolina, be approved. Dr. Maness inquired if any member of the public wished to be heard, and instructed the secre-tary to let the minutes show that no one was heard. The motion was carried. (Copy of the Resolution is attached to the official minutes.) NORTH CAROLINA BOARD OF HEALTH 35 Mr. Staton then presented a proposed resolution to create the Ocracoke Sanitary District in Hyde County, North Carohna, stating that the tourist trade has increased greatly and is imposing a water problem in this area. Over 51 percent of the property owners of this area have signed a petition requesting that Ocracoke Island in its entirety, except for that area now designated as National Seashore, be created as a sanitary district so that adequate water supply might be provided. Mr. Staton said the Attorney General's office finds this resolution in order. Dr. Coonrad moved, and Dr. Hiatt seconded, a motion that the Resolution of the North Carolina State Board of Health Creating the Ocracoke Sanitary District Located in Hyde County, North Carolina, be approved. Dr. Maness asked if any mem-ber of the public wished to comment, and instructed the secretary to let the minutes show that no one was heard. The motion was passed unanimously. (Copy of the Resolution is attached to the official minutes.) Mr. Ben Eaton, Director, Administrative Services Division, spoke to the Board regarding Rules and Regulations Governing the Con-trolled Substances Act which were adopted by the Board at its last meeting. He said that since the approval of these Regulations, the Federal Government has adopted a few "definitions" which were not in the original act. Since the preparation of today's agenda, this item has been discussed with the Attorney General's office, reaching the conclusion that even though this is just a matter of definition, 30 day's legal notice is necessary. Mr. Eaton requested that this item be deferred until the next meeting, and the Board concurred. Dr. Martin P. Hines, Director, Epidemiology Division, was recognized and discussed the Rules and Regulations Governing the Sale of Turtles, adopted by the Board at its last meeting. Since the approval of these Regulations, the Federal Government has published proposed regulations, which will probably become effective on or about July 1, 1972, and which differ from North Carolina's regulations in several respects. In order to avoid duplication and conflict of regulations, it is requested that the effective date for the Regulations adopted by the North Carolina State Board of Health be changed from July 1, 1972 to January 1, 1973. This delay will permit assessment of the effectiveness of the Federal regulations and the possible revision of the North Carolina regulations at the fall meeting of the Board to complement the Federal regulations. Dr. Lackey moved, and Dr. Hiatt seconded, a motion that the eflFective date for the Regulations approved by the North Carolina State Board of Health Governing the Sale of Turtles be changed from July 1, 1972 to 36 FORTY-FOURTH BIENNIAL REPORT January 1, 1973. Dr. Maness inquired if any member of the public wished to be heard, and the secretary was instructed to let the minutes show that no one was heard. The motion passed without opposition. Dr. Ronald H. Levine, Director, Community Health Division, gave a progress report on the Legislative Study Commission for Organization and Delivery of Health Services in North Carolina. At the fall meeting last year, the Board was presented with a bill passed by the 1971 General Assembly establishing this Commission; its charge is to examine the relationships of state and local government in projection, delivery and financing of public health services to the people. Dr. Levine is on the 11-member Commission appointed by the Governor. Dr. Jacob Koomen was asked to call the first meeting and to preside; this organization meeting took place on May 18 and the Commission unanimously elected Representative Nancy Chase of Wayne County as its Chairman. Representative Carl M. Smith of Orange County was elected Vice-Chairman. Mr. David G. Warren, Assistant Director of the Institute of Government at Chapel Hill, addressed the group on the current status of public health and his views of major issues which might be considered by the Commission. The next meeting will be held on June 7, at which time Dr. Levine will make a presentation covering in some detail the scope of public health services provided by local health departments and define relationships of the departments providing these services, in order that the Commission might be able to draw some parallels as to what can be done to strengthen public health services. Dr. T. D. Scurletis, Director, Personal Health Division, gave a report on the status of prevention of Ophthalmia Neonatorum. He stated that an investigation had taken place regarding this; in essence the only issue which was raised was that the American Academy of Ophthalmology recommended the use of Bacitracin Ophthalmia oint-ment as replacement for silver nitrate on occasion. The National As-sociation for Prevention of Blindness and the American Academy of Pediatrics, and the American College of Obstetricians and Gynecolo-gists felt that silver nitrate was the only drug of choice for three reasons: (1) it has been an effective drug over the years; (2) the organism that we are dealing with is one that has already demon-strated ability to develop antibotic resistance; and, (3) there is no evidence whatsoever available to indicate that there is an increase in the incidence of conjunctivitis in newborns with silver nitrate. Dr. Scurletis recommended that this regulation should be main-tained as it is today — namely, that silver nitrate be the only drug NORTH CAROLINA BOARD OF HEALTH 37 approved in the State of North Carohna. The Health Department does provide silver nitrate in wax sealed ampuls to all hospitals in North Carolina. Dr. Scurletis suggested that the Board reaffirm this regulation. Dr. Hiatt made a motion, seconded by Dr. Coonrad, that the Board Reaffirm that One Percent Silver Nitrate Solution Stored in Individual Wax Capsules Remain the Only Acceptable Prophylactic Agent in North Carolina. Dr. Maness inquired if any member of the public wished to be heard, and instructed the secretar\' to let the minutes show that one was heard. The motion was carried. A list was distributed of those physicians rostered for the Crip-pled Children's Program since the last Board meeting, as well as a list of those whose application is pending. (Copies of both lists attach-ed to the official minutes.) Dr. Maness thanked the group for attending at such an early hour and expressed the hope that sometime in the near future this meeting can be changed to a more convenient time when there can be more representation. Dr. R. Page Hudson, Chief Medical Examiner, informed the Board that Dr. David Wiecking, Associate Medical Examiner, has resigned his position here to accept appointment as Chief Medical Examiner for the Commonwealth of Virginia. Dr. Barker commented on the urgency of getting the plaque control program before the school children of the State, and expressed hope that this item will be among those approved in the Change Budget. Dr. Jacob Koomen, State Health Director, commented: 1. In follow-up of Dr. Barker's remarks, Dr. Koomen stated he was sympathetic towards a strong dental program in the State. 2. Dr. Lenox D. Baker, Secretary, Department of Human Re-sources, has appointed as his Deputy, Mr. William F. Henderson, who was long-time Executive Director of the Medical Care Commis-sion. Mr. Henderson is an enormously competent individual. Dr. Baker has appointed as Associate Secretary for Administration Mr. Ben W. Aiken, former Business Manager for the Mental Health System. These men will be great assets. 3. The minutes of the Board meetings are highly technical and are a legal document; therefore, they require careful preparation and review. The interval between the last meeting and today's meeting being a short one, it was not possible to have the minutes in final form for approval today; therefore, they will be acted upon at the next meeting. 38 FORTY-FOURTH BIENNIAL REPORT 4. At the request of Dr. Raper, Dr. Koomen asked the Board's feehng about holding the next meeting away from Raleigh, possibly in the western part of the State. Several members stated they would be willing to attend in any location agreed upon by the group; there were no objections to this idea. 5. Dr. W. Bums Jones, Jr. will not be in Europe this summer, as previously planned. Details could not be worked out for the trip, but Dr. Jones appreciates the Board granting its approval. There being no further business to come before the Board, the meeting was adjourned to the Conjoint Session of the State Board of Health and the Medical Society of the State of North Carolina, at which time Dr. Jacob Koomen, State Health Director, presented his report, entitled "A Public Health Perspective on the Limitation of Births". (Copy attached to the oflBcial minutes.) NORTH CAROLINA BOARD OF HEALTH 39 1970* CONJOINT REPORT by Jacob Koomen, M.D., M.P.H. State Health Director North Carolina State Board of Health Customarily, the report to the Conjoint Session by the State Health Director has been that of an overview of North Carolina's health needs and a synopsis of the State Board of Health's attempts to meet these needs. This report will depart from custom, in that a single issue will be addressed, in order to give greater coverage to a specific problem. The topic chosen is automobile safety. The product of a tech-nological triumph and cause of a revolution in mobility, the motor vehicle has at the same time proved to be a health hazard of critical proportions. This paper will offer a public health perspective on the problem of transportation versus trauma. The magnitude of the problem will be indicated, followed by a description of some control measures. Two common and convenient categories will be used, that of prevention and treatment. In discuss-ing prevention, the classic epidemiological model, the host-vector-environment triad, will be used. A paper such as this, with limited scope, cannot be an exhaustive study; rather, it is a resume of salient factors relevant to an important health condition. New York City claims the dubious distinction of reporting both the first motor vehicle accident and the first trafiic fatality. On May 30, 1896, Evylyn Thomas, while riding her bicycle, was struck by a Duryea Motor Wagon; she sustained a fractured leg and went down in history as the first casualty of a new automotive miracle, the horse-less carriage. On September 13, 1899, Henry H. Bliss, a real estate broker, 68 years old, was knocked down and run over while alighting from a street car near Central Park. His death became the first in an ever-increasing parade of statistics reflecting the negative side of automobile transportation. By 1916, our own state was reporting 54 deaths from motor vehicle accidents (including pedestrians), at a rate of 2.1 per 100,000 persons. (Table 1) Except for a marked reduction during World War II, there has been a steady increase in traffic deaths. By 1969, there '(Delivered before the Conjoint Session, North CaroHna State Board of Heahh and the Medical Society of the State of North Carolina, Pinehurst, N.C., May 19, 1971.) 40 FORTY-FOURTH BIENNIAL REPORT were 1,791 fatalities, at a rate of 35.7, making this the fourth leading cause of death. TABLE 1 FATAL MOTOR VEHICLE ACCIDENTS, NORTH CAROLINA, 1916-1969 NORTH CAROLINA BOARD OF HEALTH 41 There are, however, principles of disease control applicable to highway safety. Let us look at some of these measures, beginning with those designed to prevent traffic accidents or reduce their effect on the victim. Referring to the epidemiological model (Figure 1), we will identify the driver as "host". Control begins here by limiting the number of drivers to those who demonstrate minimal skills through a testing procedure. This is the rationale for the driver's license, based on the principle that operation of a motor vehicle is a privilege granted by the State through a licensing process. FIGURE 1 Host Vector < > Environment The "Epidemiological Triad' The physician has an important contribution to make through North Carolina's medical evaluation system. Cases for medical review are initiated by examiners of the Driver License Division, courts, or law enforcement officers, by an applicant's own admission of impair-ment, or as the cause of an accident. The first step in the review process is examination by a physician of a patient's choosing, followed by evaluation by a three-member panel of physicians (of which there are 36 in the State). From there, a hearing may be requested before the Driver License Medical Review Board, consisting of four phy-sicians appointed by the President of the State Board of Health, plus a representative from the Department of Motor Vehicles. This Board has authority to restore, restrict, or uphold denial of driving privileges and their decisions are binding on the Commissioner of Motor Vehicles (although subject to Superior Court review). During 1970, 4,764 medical reports were reviewed by the panels. Sixty-eight percent were new cases; the remainder were follow-up cases, previously identified. Of the total, 789 (17 percent) were denied 42 FORTY-FOURTH BIENNIAL REPORT driving privileges; 1,014 (21 percent) were allowed to continue to drive with restriction; the remaining 2,961 (62 percent) will continue to drive without restriction, but most will continue to submit follow-up medical reports. (Table 3) TABLE 3 DRIVER LICENSE MEDICAL REVIEW, NORTH CAROLINA, 1970 NORTH CAROLINA BOARD OF HEALTH 43 Of particular significance is the relationship between alcohol and highway accidents. A study by the North Carolina State Medical Examiner's Office of blood alcohol analysis of 486 operators and pedestrians killed in 1970 revealed that 65 percent of those dying in single car accidents were "under the influence", i.e. had a blood alcohol level of 0.1 percent by weight. One-third of those killed in multiple car collisions showed the same degree of intoxication, while 62 percent of slain pedestrians were under the influence (Table 4). TABLE 4 ALCOHOL AND AUTO FATALITIES, NORTH CAROLINA, 1970 Type of Accident 44 FORTY-FOURTH BIENNIAL REPORT In most instances of disease control, an attempt is made to either eliminate the vector or reduce it to a minimum (e.g., mosquito or fly eradication). This is hardly possible for the automobile, nor even desirable; nonetheless, it is not frivolous to consider modifications of the technique. For instance, alternatives to automobile travel are being explored, such as mass transit systems. Also, spatial separation of pedestrian and bicycle traflBc and automobile trafiic is in effect in many places. These measures have their principle but not sole appli-cation in urban areas. Where such efforts bring about not only im-proved safet\% but also curtailing internal-combustion engine emis-sions, ameliorating parking and other problems, and slowing down the decay of our cities, they have much to commend them. Incidentally, it is here that one finds another area of controversy. Many consumer advocates accuse the automotive industry of indif-ference to the safety of the driver or passenger, and government of laxity in its concern for protection of the public by not being vigorous in adopting and policing more adequate standards. The third element in our model is the environment. While this involves important geographic and meteorological factors, it also in-cludes, for our purposes, streets and roads and other structures in-volving automobile transportation. Here, too, effective measures may be taken to prevent or minimize the condition to which we address ourselves. Improved highway engineering and construction is an important undertaking. Arterial superhighways with medians, ramps, and parallel service roads, are designed to accommodate high-speed vehicular movement. Correction of existing problems also merits attention. For instance, early highways employed the crown drainage system, per-mitting the water to run off the roadway from a high point in the middle, sloping to either side. When cars traveled at 35 to 40 miles per hour, this presented little diflBculty. It is decidedly awkward nowa-days, however, for one to go careening full tilt around a curve on a winding country road and suddenly find himself banked in the wrong direction. This has been cited as one of the factors that causes North Carolina to have such an extraordinarily high rate of single-car ac-cidents on rural roads. Other safety features, such as improved guard-rails and "break-away" road signs are being increasingly utilized. A modern highway system and adequate urban and surburban street systems, are therefore an important consideration in reducing NORTH CAROLINA BOARD OF HEALTH 45 hazards. It is an interesting aside to note that North Carohna has the largest state road network in the nation. Since differences of opinions have been mentioned, another im-portant one should be considered. This is the debate between those who emphasize attempts to change the behavior of the driver, as opposed to those who concentrate on changing his surroundings (i.e., the car and the highway). Many feel strongly that effective accident control can only be accomplished by mechanical and engi-neering methods which prevent or control the release of trauma-producing energy. This is a position (in the words of Dr. William Haddon, Jr.) — "Fundamentally at variance with those who . . . regard harmful inter-actions between man and his environment as problems requiring reforming imperfect man rather than suitably modifying his environment." The latter of the two major categories is treatment. Emphasis will be given here to prompt and effective attention to victims of highway accidents. Emergency medical services are the chief factor in this phase. Here again, the State Board of Health and practicing physicians play a vital part. The 1967 General Assembly passed an "Act to Assure Adequate and Continuing Ambulance Services to the Citizens of North Caro-lina". This Act gave responsibility to the State Board of Health to develop and apply minimum standards of safety, sanitation, equip-ment, and training in regulating ambulance services. An Advisory Committee on ambulances was also established, among whom is a member of the Medical Societ)- of the State of North Carolina. The major basic training course for ambulance attendants has been provided b\' Community Colleges and technical institutes. The course outlined was developed by North Carolina physicians in 1966 and has been periodically revised in consultation with them. From the effective date of the rules and regulations governing ambulance ser-vice, January 10, 1968 through April 1, 1971, 122 courses have been conducted. Over 500 physicians have served as instructors. As of April 1, 1971, there were 3,051 ambulance attendants cur-rently certified; 306 ambulance services currently operate 560 am-bulances. These include 115 funeral homes, 116 rescue squads, 36 governmental units, and 39 commercial services. Approximately 80 percent of North Carolina's counties support these services b\- sub-sidization or direct operation. Additional studies are being conducted to improve emergency medical services, mostly in the area of communications systems, 46 FORTY-FOURTH BIENNIAL REPORT vehicles, and other equipment. A few states have successfully used helicopters in programs of this nature. These are costly, but can be effective in either remote areas or intense urban congestion. The implications for helicopters in North Carolina have yet to be explored. Care of accident victims in emergency rooms is important in the chain of life-saving events. Thorough analysis of this area needs to be made, but studies that have been done indicate improvements are necessary. It is expected that this will be the next step in our efforts to respond to the medical crises precipitated by motor vehicle ac-cidents. Once an accident victim has been through the emergency medi-cal services stage, he enters the regular medical care system. It is that first reaction to an accident that is critical: speedy response to a call, effective and accurate first-aid at the scene, prompt yet safe transportation, and adequate emergency room services, are all char-acteristics of a system designed to rescue the unfortunate victim from the effects of trauma once an accident has occurred. An attempt has been made to summarize the complicated pic-ture of highway safety, viewed principally from a health perspective. Attention has been given to the importance of automobile accidents as a major cause of death and disability. The roles of the private practitioners of medicine, and the State Board of Health have been emphasized. A continuing partnership between these two allies, in league with others concerned with this problem of major proportions, is necessary if the continuing toll of life and health is to be abated on our highways. NORTH CAROLINA BOARD OF HEALTH 47 197P CONJOINT REPORT by Jacob Koomen, M.D., M.P.H. State Health Director North CaroHna State Board of Health In keeping with the precedent set in 1971, the report to the Con-joint Session of the North Carohna State Board of Health and the Medical Society of the State of North Carolina will focus on a topic of timely and significant interest. The subject chosen is planned parenthood. Because of the growing concern over population control, it is appropriate to seriously consider this matter, and to share a pul)lic health perspective on the limitation of births with the medical profession. Any discussion of this topic immediately confronts the essayist with a number of terms, about which there is not either general agreement or general acceptance. Planned parenthood, birth control, family planning, contraception, and other expressions, are all widely used, but to many have limits to their usefulness. Some time ago, the word "prevenception" was used, but apparently has not gained popularity. It is hoped that in a broad survey article, one may be forgiven for using terms more or less indiscriminately. However, in a field where there is not consensus about definitive terms, interchange-able expressions may be excusable. These various terms all relate to birth limitation. This limitation may occur prior to conception or after. In this paper, emphasis will be given on the prevention of conception. This is perhaps in keeping with public health's historical attention to prevention. Interruption of pregnancy must nevertheless be part of the perspective. Indeed, today in many countries such as Japan, abortion is part and parcel of popula-tion control. Birth control may be regarded from several points of view. Most personal, and perhaps of greatest concern to the medical practitioner, is that of the individual. This is a concern shared by public health workers as well. This was reflected in the words of Dr. C.-E. A. Winslow thirty-five years ago: "The mother able to bear children should have adequate prenatal care; the mother able to bear children should have competent . . . obstetiical care; and the woman w ho is unable to bear children should be protected against the hazards of '(Delivered before the Conjoint Session, North CaroHna State Hoard ot Health and the Medieal Soeiety of the State of North CaroHna, Pinehurst, X.C, May 24, 1972.) 48 FORTY-FOURTH BIENNIAL REPORT childbirth." Today, in both the private and pubHc sector, this care for conception control for health reasons has been liberalized and extended to recognize "one of the most basic of human rights — that to freely determine the number and timing of one's children." A somewhat broader point of view would include the family and the community. The consequences of a large number of children in a household of limited means are well known to public health workers, social service workers, and almost any family doctor. To quote Dr. Winslow again, "The new child itself is one of the chief sufferers in a family that grows too fast for its economic resources. We owe it to future generations that children should not be born into families unable to provide for them homes which ensure a reasonable minimum of physical and mental health." Even more tragic is the "unwanted child" who suffers abuse or neglect. The entire community becomes involved, with its responsibility for supporting the impoverished family through social services and financial aid. On the widest scale, there is some alarm about an over-crowded planet. "People pollution", and the possible breakdown of our life-sustaining ecosystems, are matters which cause grave anxiety to many who consider the future. There is considerable worry over at least the deterioration of the quality of our life style, if not even more serious repercussions. The classic author on this subject. The Reverend Thomas Malthus, raised this spector at the turn of the 18th century: "If we multiply too fast, we die miserably of poverty and contagious diseases ... we have followed these impulses too far, so as to trench upon some other law which equally demands attention." Discounted for many years, the realization of the exponentially-growing problems of an expanding world population (reaching six billion by 1995) has reawakened concern. Doomsday predictions, the most recent one by The Massachusetts Institute of Technology, raise doubts about the world's ability to sustain itself without catastrophe for another 100 years. It is not within the scope of this paper to critically examine this latter aspect of birth control, much less resolve the controversy. Suf-fice it to say that population limitation involves a wide range of con-cern, from the most intensely personal to the global. Taking a middle-range view, it is relevant to look at some population particulars in the United States and in North Carolina. Looking at the undifferentiated mass of people, one sees first that our numbers are growing. Using different variables, projections of the population for the United States by the year 2000 lie between 322,- 277,000 and 271,082,000. North Carolina may be expected to contain NORTH CAROLINA BOARD OF HEALTH 49 as many as 7,000,000 persons by the same year. However, a more careful examination reveals significant changes in the characteristics of the population. The reader is referred elsewhere for references to the age distribution of our people, since limitations on space prohibit a detailed statistical analysis. It will be instructive to look at selected data pertinent to reproduction. North Carolina has historically shown a substantially higher birth rate than the national average. The graph (Figure 1) shows that these rates are converging. One will also note the v^ariation in birth rates occurring in both the state and the nation: the remarkable decline during the depression years, the post-war "baby boom", followed by the contemporary decline that has again occurred. FIGURE 1. ANNUAL BIRTH RATE: UNITED STATES AND NORTH CAROLINA, 1920-1971 * \ 50 FORTY-FOURTH BIENNIAL REPORT Table 1 shows comparative decennial figures from 1920 to 1970 for live births, as well as for fertility ratios. TABLE 1 FERTILITY RATIOS, NORTH CAROLINA, 1920-1970 Year NORTH CAROLINA BOARD OF HEALTH 51 mate birth results in an unwanted child, and is an unmitigated evil, is no longer tenable. Additional illustrations serve to show the changes in family size. Table 3 indicates the steady decline in the number of live births occurring after the fourth child, and substantiates the decrease in popularity of the large family. TABLE 3 NUMBER AND PERCENT OF LIVE BIRTHS ABOVE BIRTH ORDER 4 NORTH CAROLINA 1920- 1970 Year 52 FORTY-FOURTH BIENNIAL REPORT Contraception, by Norman E. Himes, makes interesting browsing. The briefest of excerpts may be permitted: "Man's attempts to control the increase in his numbers reach so far into the dim past, that it is im-possible to discern their real origin. Some forms of limitation on the rate of increase are undoubtedly as old as the life history of man." Dr. Himes points out that, sadly, the major means for population control up until modern times were infanticide and abortion. Although the use of a sheath, or condom, was known for some time (being dis-coursed upon by the doubtable Casanova), it was largely for the pre-vention of venereal disease. Intra-vaginal devices and medications were at best unacceptable and unreliable until relatively recently. Dr. Alan Guttmacher notes the late arrival of effective, safe conception control procedures developed by medical technology and made avail-able to the public. He states, "The three most important developments in contraception since 1935 are: (1) the more extensive and accurate use of the rhythm method; (2) the development of a modified intra-uterine ring; (3) the first truly physiologic method of contraception — the inhibition of ovulation by oral medication." Coupled with the lack of readily available technology were the constraints limiting the prescriptions and procedures relative to con-traception. The judicial overthrow of the restrictive "Constock laws", occurring in 1936, was a milestone decision that unshackled the hands of the medical profession. Further decisions, in 1965 and as recently as March, 1972, have had the same ejffect on similar state laws. In North Carolina physicians and public health workers, to say nothing of the public, have been fortunate in being free of restrictive legisla-tion, and in enjoying a relatively liberal climate of opinion regarding contraception. We would do well to recall that North Carolina took the leader-ship in developing a statewide, public, planned parenthood program. As early as 1932, the North Carolina Conference for Social Services had endorsed such a movement, followed by the North Carolina Fed-eration of Women's Clubs. The practicing physicians of the state have always been in the forefront. The first contraceptive clinic in this state was established privately in 1922. The Wake, Forsyth, and Nash- Edgecombe Medical Societies were the first to endorse public planned parenthood programs. In March of 1937, a philanthropic grant was made to the state by Dr. Clarence J. Gamble, heir of the Proctor and Gamble Soap fortune and at that time a member of the medical faculty of the Uni-versity of Pennsylvania. This grant enabled the employment of a full-time public health nurse, Miss Roberta Pratt, who worked throughout NORTH CAROLINA BOARD OF HEALTH 53 the state helping local health departments establish birth control clinics. Dr. George Marion Cooper, then Assistant State Health Officer, provided the foresight and inspired leadership that made the program possible. The director of the program, who also had the distinction of presenting the first paper on birth control ever read before the Ameri-can Public Health Association, was a young man making a name for himself in the public health field: our own Dr. J. W. Roy Norton. Count}^ medical societies were quick to endorse and support the new program, thereby ensuring its success. Since that auspicious beginning, public contraceptive services in North Carolina have grown. Today each of our 100 counties offers some type of family planning service. In 1970, 31,764 patients were served by county health departments. An additional 5,497 were served by OEO-sponsored projects, while three special projects funded by the National Center for Family Planning Services saw 4,328. Thus, public programs ministered to 41,589 persons. With a major increase in Federal financial support, the state's contraceptive services will continue to expand. The Medical Society of the State of North Carolina has reiterat |