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
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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