Minutes - April 18, 2019 - Board of Health Meeting

Members Present:

Ms. Trish Fulton (Chair)
Ms. Maureen Cassidy (Vice-Chair)
Ms. Aina DeViet
Mr. Ian Peer
Ms. Elizabeth Peloza
Mr. Matt Reid
Mr. John Brennan
Ms. Tino Kasi
Ms. Kelly Elliott
Mr. Michael Clarke

Media:

Sean Irvine, CTV News

Others Present:

Dr. Christopher Mackie, Secretary-Treasurer
Ms. Elizabeth Milne, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Associate Medical Officer of Health
Ms. Marilyn Atkin, Harm Reduction and Outreach Team Lead
Mr. Jordan Banninga, Manager, Program Planning and Evaluation
Mr. Joe Belancic, Manager, Procurement and Operations
Ms. Shaya Dhinsa, Manager, Sexual Health
Mr. Dan Flaherty, Manager, Communications
Mr. Brian Glasspoole, Manager, Finance
Ms. Donna Kosmack, Manager, Southwest Tobacco Control Area Network
Ms. Heather Lokko, Director, Healthy Start
Ms. Sarah Maaten, Epidemiologist
Mr. David Pavletic, Manager, Food Safety and Healthy Environments
Ms. Kendra Ramer, Manager, Strategic Projects
Ms. Maureen Rowlands, Director, Healthy Living
Mr. Alex Tyml, Online Communications Coordinator
Mr. Stephen Turner, Director, Environmental Health and Infectious Diseases
Mr. Endri Poletti, Architect
Mr. Tom Bes, BES Project Management

Disclosures of Conflict(s) of Interest

Chair Fulton inquired if there were any disclosures of conflicts of interest. None were declared.

Chair Fulton inquired if there were any disclosures of conflicts of interest. None were declared.

Chair Fulton made note of an addition to the agenda: walk-on Report No. 035-19 re: “Update on Opioid Overdose Deaths in Middlesex-London,” which will be moved to the top of the agenda for the first presentation of the evening.

Approval of Agenda

It was moved by Mr. Peer, seconded by Ms. Elliott, that the AGENDA for the April 18, 2019 Board of Health meeting be approved as amended. Carried

Minutes

It was moved by Mr. Reid, seconded by Ms. Cassidy, that the MINUTES of the March 21, 2019 Board of Health meeting be approved. Carried

Delegations and Reports

Update on Opioid Overdose Deaths in Middlesex-London (Report No. 035-19)

Mr. Turner introduced Ms. Sarah Maaten, Ms. Shaya Dhinsa, and Ms. Marilyn Atkin, who contributed to this report. Mr. Turner provided context for the report. Ms. Maaten reported to the Board regarding the recent increase in deaths related to opioid poisoning in Middlesex-London. Her report included a timeline of events for data collection, analysis of the surveillance data, and the strategies MLHU has implemented to reduce harms associated with opioid overdoses.

Discussion ensued on the following items:
• Additional strategies in place at street level to reach the appropriate populations.
• How information about programs and services is shared among community partners and those who use injection drugs.
• Trends in overdose data in the past five years, progress made since the opioid crisis was declared, and changes in the illicit drug supply since then.
• Fentanyl: the timeline of its arrival in the illicit drug supply in the community, its impact on overdose trends in London, and how it is becoming more difficult to test for it due to analog forms of the drug being produced and distributed.
• The distribution of illicit drugs across the country and the consideration of a national investigation into the trafficking of drugs in order to better prepare communities for pending infiltration of new drugs into the illicit drug supply.
• Coordination of data and information across the country to better understand the issues and impact that illicit drugs are having on communities.

Public Health Inspector Enforcement Actions – Q1 2019 (Report No. 027-19)

Mr. Turner and Mr. Pavletic introduced the report and answered questions.

It was moved by Ms. Elliott, seconded by Ms. DeViet, that the Board of Health receive Report No. 027-19 re: “Public Health Inspector Enforcement Actions” for information. Carried

Chair Fulton introduced five program updates for the evening.

Program Update: Food Safety and Healthy Environments

Mr. Pavletic introduced the Food Safety Team and the Healthy Environment Team within the Environmental Health and Infectious Diseases Division. Mr. Pavletic provided a summary of key initiatives and outlined the teams’ work focuses for 2019, which include a vulnerability assessment to deliver interventions aimed at addressing the impacts of climate change, updating the disclosure website to include other program area inspections, and developing culturally relevant program materials.

Discussion ensued on the following items:
• The number of regular food safety inspections compared to the number of enforcement actions required.
• The frequency of risk-based inspections on an annual basis.
• The process in place for enforcement actions and the difference in enforcement actions for food premises versus for recreational water premises.
• The number of Public Health Inspectors that inspect premises.
• Coordination with City of London staff regarding work and inspections related to vulnerable occupancies.
• Awareness, education, and training for newcomers and how staff employ education and cultural sensitivity during an intervention at an inspection.

Program Update: Southwest Tobacco Control Area Network (SW TCAN)

Ms. Kosmack provided an overview of the SW TCAN program within the Healthy Living Division, which coordinates high-priority areas of tobacco control across eight health units within the Southwest Region. Ms. Kosmack provided an overview of the budget structure for the SW TCAN, how the funding is distributed through MLHU, and a summary of the impact the program has had on smoking rates in Ontario.

Discussion ensued on historical trends for smoking rates in the province, the increase in vaping rates among youth, and the current status of the plain packaging legislation at the federal level.

It was moved by Ms. Cassidy, seconded by Ms. Elliott, that the Board of Health receive Report No. 035-19 re: “Update on Opioid Overdose Deaths in Middlesex-London” for information. Carried

Program Update: Finance

Mr. Glasspoole provided an overview of the work of the Finance Team within the Healthy Organization Division and reviewed some of the team’s main functions, including program budgeting and marginal analysis, financial planning, supporting two major audits per year, coordination of statutory reports to the Ministry, treasury services, and payroll and benefit administration. Mr. Glasspoole also outlined key initiatives planned for 2019, including (among others) updating financial systems, enterprise resource planning, and outsourcing of payroll administration.

Program Update: Communications

Mr. Flaherty provided an overview of the Communications program within the Office of the Medical Officer of Health and reviewed its key activities, including the Healthcare Provider Outreach program, media relations, advertising and promotions, online and social media activities, producing the Health Unit’s annual report, graphic design, in-house graphic services, and graphic services procurement.

2018 Annual Report (Report No. 028-19)

It was moved by Mr. Peer, seconded by Ms. Cassidy, that the Board of Health receive Report No. 028-19 re: “2018 Annual Report” for information. Carried

Program Update: Procurement and Operations

Mr. Belancic provided an overview of the Procurement and Operations program within the Healthy Organization Division. He reviewed how the team functions within the organization and some of the key initiatives planned for 2019, which include contract management solutions, project planning, and the release of a tender to cover the budget to retrofit Citi Plaza.

Discussion ensued about procedures for RFPs versus sole-source contracts, and the cutoffs and criteria for each.

Location Project – Project Plan and General Contractor Pre-Qualification April 2019 (Report No. 030-19)

Mr. Belancic introduced and provided context for this report. He also noted some of the next steps in the process from a project management perspective, which include approving the selection of the pre-qualified contractors for fit-up, and the plan to have the general contractor select the sub-trades required for fit-up of the new space.

Mr. Clarke noted that he is not the same Michael Clark mentioned in the report.

Discussion ensued on the following items:
• The cost of the elevator extension and how much of the approved expenditure MLHU has spent on the work thus far.
• Additional details around the elevator, including updates and requirements associated with the fit-up and extension to the basement.
• MLHU’s liability if the contractor selects the sub-trades.
• That any sub-trades selected will still need to meet MLHU’s criteria, but that legal liability would flow through the main contractor.

It was moved by Ms. Kasi, seconded by Mr. Brennan, that the Board of Health:
1) Receive Report No. 030-19BOH re: “Location Project – Project Plan Update and General Contractor Pre-Qualification April 2019” for information; and
2) Approve the selection of the Pre-Qualified General Contractors for Fit-Up at Citi Plaza.

Carried

Impact of 2019 Provincial Budget (Report No. 031-19)

Dr. Mackie introduced and provided context for this report regarding the public health restructuring that emerged as part of the provincial budget announcement on April 11.

Dr. Mackie reviewed the information and projections regarding this announcement that he has received to date, noting that there are some steps MLHU can take to mitigate a potential deficit.

Ms. DeViet provided an update in regard to the alPHa teleconference she attended on behalf of the Board earlier this afternoon. The teleconference pertained to the provincial budget and changes to the structure of public health. Ms. DeViet provided a summary of the call and some key points from the discussion.

Ms. Fulton clarified that there had been two conference calls in regard to public health restructuring and the provincial budget: one for Boards of Health and one for Medical Officers of Health.

Discussion ensued on the following items:
• The two major components of the restructuring, which would be budget impacts and the reduction to ten health units from thirty-five across the province.
• The government’s commitment to implementing the restructuring to ten health units by this time next year.
• That the Board is established by legislation and how new legislation with regard to the new structure might look.
• The economies of scale within the boundaries proposed for the ten new public health entities, and the potential of communicating this to the Ministry to help visualize the potentially increased costs associated with amalgamation.
• What a governance and service delivery model for ten health units might look like and how populations might be affected.
• How populations and municipalities within the new catchment areas might be involved in the consultations, and discussions regarding next steps in the restructuring.
• Advocacy by board members in their respective areas with respect to the restructuring.

Ms. Fulton reviewed the three mitigation strategies outlined in the report and invited further discussion.

It was moved by Ms. Cassidy, seconded by Mr. Reid, that the Board of Health:
1) Receive Report No. 031-19 re: “Impact of 2019 Provincial Budget” for information; and
2) Approve the recommended steps under the section on “Mitigation.”
Carried

Medical Officer of Health/CEO Activity Report for April (Report No. 029-19)

It was moved by Mr. Brennan, seconded by Ms. Kasi, that the Board of Health receive Report No. 029-19 re: “Medical Officer of Health Activity Report for April” for information. Carried

Correspondence

It was moved by Ms. Cassidy, seconded by Mr. Peer, that the Board of Health receive correspondence items a) through i) and k). Carried

Dr. Mackie introduced and provided context for correspondence item j).

It was moved by Mr. Clarke, seconded by Ms. Kasi, that the Board of Health endorse correspondence item j): Private Members’ Bill re: Inspection of Clinics. Carried

Other Business

Chair Fulton reviewed the next meeting dates and the alPHa fitness challenge scheduled for Board members before the May 16 meeting.

• Next Finance & Facilities Committee meeting: Thursday, May 2, 2019 @ 9:00 a.m.
• Next Board of Health meeting: Thursday, May 16, 2019 @ 7:00 p.m.
• Next Governance Committee meeting: Thursday, June 20, 2019 @ 6:00 p.m.

Confidential

At 9:04 p.m., it was moved by Ms. Peloza, seconded by Ms. Elliott, that the Board of Health move in-camera to consider matters regarding identifiable individuals, information (e.g., a trade secret or scientific, technical, commercial, or financial) that belongs to the Middlesex-London Health Unit and has monetary value, and confidential minutes from the March 21, 2019 Board of Health meeting. Carried

At 9:05 p.m., everyone left the meeting except the Board of Health, Dr. Mackie, Ms. Milne, Dr. Summers, Ms. Rowlands, Ms. Lokko, Mr. Belancic, Mr. Bes, Mr. Poletti, Mr. Banninga, Mr. Glasspoole, and Mr. Turner.

At 9:41 p.m., it was moved by Ms. Peloza, seconded by Ms. Elliott, that the Board of Health rise and return to public session. Carried

At 9:42 p.m., the Board of Health returned to public session.

It was moved by Ms. Elliott, seconded by Mr. Reid, that Dr. Chris Mackie and the Board Chair consider meeting with Warden Kurtis Smith and Mayor Ed Holder to support advocacy efforts regarding the restructuring of public health and to discuss the importance of ensuring the delivery of public health at the local level. Carried

Adjournment

At 9:43 p.m., it was moved by Mr. Reid, seconded by Ms. Elliott, that the meeting be adjourned. Carried

TRISH FULTON
Chair

CHRISTOPHER MACKIE
Secretary-Tresurer