Macon Health to offer primary care to limited number of residents

fr maconhealthA new program will enable a limited number of Macon County residents to seek primary medical care at the health department beginning this fall.

Jackson considers renovations for service centers

fr jaxcenterThe large, cavernous room at the heart of Jackson County’s Community Services Center doesn’t see much action these days. It’s no longer open to the public. A trash can sits solemnly collecting water dripping from a leak in the ceiling. 

But the room’s parquet floor still hints and harkens to better days gone by.

Haywood considers integration of county departments

Haywood County is moving slowly towards consolidating its Department of Social Services and Health Department to save money and become more efficient. 

Last year, the N.C. General Assembly approved legislation that allows counties to combine the two departments into one Department of Human Services. Previously, only Mecklenburg and Wake counties were allowed to have consolidated health and social services departments.

County workers ready for move-in day at remodeled Walmart in Haywood

Finishing on time and on budget, the Haywood County Department of Social Services and several other government offices will move from their deteriorating, cramped homes to the renovated former Walmart by mid-January.

The Walmart shell was purchased and renovated at a cost of about $12 million to house a host of county offices: the Department of Social Services, the health department, planning department, building inspections, environmental health services and Meals on Wheels kitchen.

Construction will be finished by Nov. 24, according to Dale Burris, the county facilities and maintenance director. But it will take another eight weeks to get some 200 employees moved in and their offices up and running, he said.

“We are very pleased with the progress,” said Mark Swanger, chair of the Haywood County Commissioners. The Walmart renovation is the “smoothest project I’ve been involved in,” he said.

The county commissioners Monday approved a request for additional funding — about $32,400 — to move furniture into the building once renovations are complete. The money will come out of the county’s general fund.

Between 55 and 65 subcontracted construction workers are on the job each day, Burris said. And, although there were a few hitches, as is usual with such projects, the contractor was able to identify and remedy any problems, he said.

The project stayed within the original estimated cost of between $12 million and $12.5 million.

The county purchased the building for $6.6 million. Construction costs totaled $5.48 million, Burris said.

The project included gutting the building, remodeling the entrance and replacing the old roof with new over-build, copper roof.

The roof “looks really good,” said Commissioner Kevin Ensley. “It looks expensive” because of the copper coloring.

The commissioners voted in January 2010 to purchase and renovate the old Walmart building. The current DSS building had been deteriorating for years, and by that time had peeling paint, water leaks, hanging wires and an aging elevator — as well as cramped work conditions.

Purchasing land and building a new DSS and health department building would have cost between $25 million and $30 million.

‘Free condoms’ replaced by patch

In Swain County, free condoms aren’t particularly controversial. But the words “free condoms” on a billboard certainly are.

At least that’s the position of Swain County commissioners, who ordered the announcement to be whitewashed last week after apparently fielding calls from concerned constituents.

The billboard on U.S. 19 a few miles from Bryson City that once heralded physical exams, low-or-no-cost family planning and free condoms at the Swain County Health Department now advertises only the first two services and a white rectangle where the contraceptive message once was.

Swain County Manager Kevin King said he took the decision to patch the offending phrase after being approached by several commissioners who wanted the words to come down. He then polled the other commissioners by phone on the issue, and when he got the go-ahead from all five, gave the order to Allison Outdoor that the words “free condoms” had to go.

There was no meeting called, no minutes were held and no vote was had on the issue, but King said the decision was made under the auspices of administrative tasks. There are some tasks, he said, that county staff can do without commissioners’ blessing, or without a formal vote.

“I mean, do they call a special meeting for us to go check the mail or call for an ad?” asked King. “Anything that’s an administrative type of thing, it’s just handled by the staff.”

And billboards, he said, count as administrative.

Frayda Bluestein doesn’t necessarily agree. She’s the associate dean at the University of North Carolina’s School of Government, and local government is her specialty.

“I don’t understand how that’s an administrative decision, frankly,” said Bluestein. “I can see how it would be an administrative decision of the health board.”

The health board, however, wasn’t consulted on the issue.

Health Department Director Linda White said she tried that route. When given the choice to either cover the message or replace it with another, she asked King to write a letter to the health board about the issue.

“I asked them to submit a letter to the board of health, and their concern was it was going to be too long a period of time before the health board was going to meet,” said White. “Because the billboard said ‘Swain County’ on it, they felt that they had the authority to remove it.”

King confirmed this, adding that since the decision was made administratively by White to put the sign up anyway, surely the health board didn’t need to be involved now.

“She said she had full power over the billboard and what went on the billboard, but now when the commissioners do get involved, she’s wanting us to write to the health board,” said King.

When asked why commissioners felt authorized to act on the sign, rather than waiting for the July meeting of the board of health, King said that the health department was a county department just like any other. That means the commissioners are in charge. And anyway, they get the bills and they sign the checks for things like advertising.

Bluestein said that this is a fair point. It’s really purse-string power that the commissioners hold.

“The health board has a lot of direct authority under the statutes, but they rely on the county for funding,” said Bluestein. “But again, if that’s the way they get the authority to intervene in that, it must be done in open meetings.”

In other words, a phone poll doesn’t really cut it.

Commissioner Robert White said he thought the decision should’ve been official, too, though he thinks the entire situation has been blown a bit out of proportion.

“If it wasn’t on the agenda, if it wasn’t in a regular meeting, then essentially it didn’t happen, legally,” said Commissioner White. “I’m opposed to it, but if the commissioners vote for it, then I have to support the commissioners’ position.”

Linda White said she was surprised by the maelstrom of controversy swirling around the sign. The health department has been giving out free condoms and offering low-cost contraception for decades, but never has there been such upheaval about it. On her end, said White, she’s only fielded a few calls about the sign.

“I’ve had two negative comments submitted directly to me by phone and I’ve had five positive phone calls,” she said. “Not too many people have contacted me directly.”

Of the two anti-sign calls, only one opposed the idea on moral grounds. The other was a Henderson County woman complaining that federal funds helped pay for it. If Swain County had a problem with unplanned pregnancies, she said, then Swain County should pay for trying to fix it.

And, according to Linda White, Swain County has a problem with unplanned pregnancies.

“There are a lot of unplanned pregnancies, as well as a lot of sexually transmitted diseases, and I think it’s important to realize that this billboard is in no way directed towards teenagers,” she said.

And that’s an idea that has been at the center of the firestorm: teenagers having sex.

According to a poll done by the health department itself, more than half of students in the county between the ages 15 and 19 have copped to being sexually active in some capacity. And some are concerned that the offer of free condoms would encourage more to jump on the bandwagon.

County Commissioner David Monteith, who led the charge to change the billboard, said he was concerned about the message the sign was sending.

“It’s like Swain County is promoting this [condom use] for anybody and everybody,” said Monteith, who is firmly against premarital sex. “It’s just my opinion that it should not be up there. I think we’re promoting the wrong thing to young kids.”

Linda White, though, remains baffled by any supposed links between offers of free condoms and encouraging premarital sex.

“I have pondered that for many days and cannot connect the wording of the billboard with premarital sex,” she said.

The health department, she said, has a sizeable chunk of people using their family planning services, but not too many of them are teenagers. In fact, the percentage of teens getting in on birth control and other contraceptives is smaller than other age groups.

“We have quite a few individuals and most of them are in their 20s and 30s,” said Linda White.

Commissioner Robert White doesn’t really have a problem with the billboard. He did OK the patch when King asked him, but only because King said that was the wish of the rest of the board.

“I have no problem with it. I can’t speak for the rest of [the commissioners], but there was no vote taken or whatever about that sign, but if there was I’d have voted against it,” said White, especially given that the advertising contract on the sign was only for two months.

Bryson City resident Denise Tyson said she was actually pleased when she saw the sign, taking it as a signal of progressiveness in county leaders.

As the mother of a teenager, she said she’s not worried it’s going to spur him towards sexual activity.

“My 15-year-old son looked at that sign and his perception was there are free condoms available in this community. That doesn’t necessarily give him permission to practice sexual behavior,” said Tyson. “I’m the first to say that practicing abstinence is a very effective practice among teenagers. We promote that in my household, along with an education about what it means to practice safe sex.”

Still, detractors argue, shouldn’t parents have to option to tell their kids — or not tell them — about condoms, rather than be subjected to the words on every drive to town?

After last week, Swain Countians no longer have to worry about it, and the health department will be turning back to the newspaper, health fairs and word of mouth to get the word out about those two pesky words.

Old Wal-Mart retrofit for county offices to begin soon

Remodeling work to the old Wal-Mart building in Haywood County could begin within weeks after commissioners approved a contract to transform the space into county offices.

The board heard from Scott Donald of Padgett & Freeman Architects, who are spearheading the revamp of the building. The now-empty storefront is due to be repurposed into headquarters for the department of social services and its 143 employees, as well as the health department, the planning department and building inspections, among others.

Architects were instructed to redesign the project after the county couldn’t get contractors to offer bids that were close enough to their budget. After cutting some features, they called for new estimates from contractors again late last year.

Donald reported that, after pulling down all the “low-hanging fruit” they could find, they’ve negotiated a price of $5.398 million for the remodel, which, he said, comes in around $9,000 under budget. The total project cost, including architect fees and purchase of the building is $12.5 million.

The board unanimously approved a motion to award the contract to Murray Construction of Monroe, which means that Donald and county staff can hold pre-construction meetings as soon as USDA officials, who are providing financing, come to have a look at the property later this month.

According to Donald, construction on the project could be underway as early as the first week of February. He also noted that the contractor was confident in their ability to finish the job in eight months, a month sooner than the plan called for. This would recoup some of the time that was lost when the project was rebid.

DSS is currently housed in the old county hospital, but the aging building was falling apart. Commissioners decided it would be cheaper to move into a new space than bring the old hospital up to par.

Haywood chooses contractor for Wal-Mart project

Clyde’s old Wal-Mart is now on track to get a new life after Haywood County commissioners voted Monday to sign a contract with Murray Construction of Monroe for the renovations. The project had stalled earlier this fall after the first round of bids came in millions of dollars over the $4.7 million budget.

After scaling back the project and putting it back out to bid, the county got back nine estimates that are almost all within $1 million of the budgeted cost. The final winning bid was just over $5.2 million and was only $14,000 below the next closest competitor.

Scott Donald of Padgett and Freeman Architects, who are leading the project, said that he thought the bids were all competitive and fair.

“We were able to bring down the project almost $2.1 million,” Donald told commissioners, who then voted unanimously to begin negotiating immediately.

The space will be home to the county’s Department of Social Services and health department, who will soon vacate their home at the county’s old hospital.

Haywood rolls back price of Wal-Mart renovation

Haywood County commissioners are reining in their grand plans for Waynesville’s old Wal-Mart, working with designers and almost everyone else involved in the project to try and get it close to the projected budget.

At a work session last week, commissioners heard from Padgett and Freeman, the Asheville architects in charge of the project, who suggested cuts in everything from plumbing to decorative masonry.

“We basically went in with the county manager’s office and the staff and the users that are moving into the facility and started with them on how to redefine the scope of work,” said Scott Donald, principal architect with the firm.

Donald said that, after getting bids for the project that were astronomically higher than the budget, a decision was taken to adjust the project’s scope, slashing everything that could go without affecting the building’s functionality or getting rid of programs or jobs.

“It’s stripped as far as we can strip it without redesigning it again, and that would mean taking out programs or leaving the departments behind, leaving them where they are,” said Donald. “But I don’t think that’s an option either. We’ve cut as much as we know how without actually scaling back the floor plan.”

For their part, commissioners were happy to hear about any measures that would shave off the $2 million needed to bring the project within budget.

“This is one of those cooperative efforts,” said Assistant County Manager Marty Stamey. “You’ve got to do what you’ve got to do to get it within budget, to make it to where it’s more efficient, more cost-effective. All the staff understand that and, as Mr. Kirkpatrick (chairman of the board of commissioners) said, as long as its functional, that’s what matters.”

Part of the problem, however, is the size of the building itself. Big boxes aren’t easy to partially renovate, and while Donald and his team have suggested leaving portions of the 115,000 square-foot space un-renovated, it would be difficult, if not impossible, to make large, wholesale cuts to the amount of revamped space without getting rid of jobs or programs that are slated to be housed at the facility.

“It’s a big project for very little money,” said Donald. “It’s a lot of square footage that we’re trying to renovate and the budget just isn’t there for that size of space.

The other large hurdle, however, is the financing. Most similar projects would be phased in, allowing gradual financing and more room — and time — for slight budgetary tweaks. But as a condition of the USDA loans the county secured to fund the renovations, phases are out. It must be done all at once, which also presents a challenge to architects and commissioners, who are forced to work with what they have at the outset.

Among the suggested cuts are technical savings, like plumbing and electrical work that could be done differently for a reduced cost. But aesthetic choices, like $25,000 of extra stonework on the building’s exterior, were pulled as well. Donald and his team have found savings in every possible corner of the project, he said: $25,000 for synthetic stucco instead of the real deal, $60,000 for axing a tongue-and-groove ceiling that would require a costly extra sprinkler system, $300,000 for using vinyl flooring instead of linoleum, and the list goes on.

In total, architects project that instead of the low bid being around $7.2 million, it should be closer to $5.1 million, only about $400,000 over the $4.7 million budget.  

They accepted information from everyone who had a hand in the job: county commissioners, the county manager’s office, engineers, subcontractors and even the original bidders. In the end, they came out with around 23 pages of recommendations, none of which the commissioners took issue with. In fact, they asked Donald if he and his team could look into pumping more savings out of the project.

Although Donald said he would look into it, he’s skeptical about what further cost reductions can be found.

“They were wanting us to look at even further items and we’ve done that,” Donald said. “We’re getting to the point now where it’s just that not much money is involved with small changes. It has to be something big to get the big money out of it, and that’s the hard part.”

As for the timing of the project, the need for a re-bid will only put completion between seven and eight weeks off schedule. That timeline was somewhat aided by the fact that it was operating around a month ahead of schedule and assumes that the bidding and contracting process won’t have to leap any more hurdles along the way.

When completed, the building will house the county’s Department of Social Services and Health Department, which have long been awaiting relocation from their current, aging homes elsewhere in the county.

Commissioners have not yet voted on the measures, but have a mandatory pre-bid conference with potential contractors scheduled for Nov. 17, with bids due Dec. 9. The projected completion date for the project is September 2011.

Design under way for old Wal-Mart renovations

The deserted Wal-Mart near Clyde will be hardly recognizable once Haywood County is through with its makeover of the megastore.

Sunlight will stream in through 30 skylights scattered across the low-slung ceiling of the former big-box store. A new metal roof will cover the front 25 feet of the building, with a mountain vernacular style entrance supplanting the once mundane building facade.

The made-over building will be a far cry from the cramped and crumbling offices that currently house the Department of Social Services and Health Department, which will relocate to the new site.

A $6.1 million renovation will transform the once gaping interior space into “little communities,” according to project architect Scott Donald with Asheville-based Padgett and Freeman Architects, PA.

The renovated space will include a shared entrance lobby, health clinic, Meals on Wheels kitchen, dental clinic, W.I.C. area, along with offices for more than 200 social workers.

Also included in the preliminary design is space for a central permitting office, including planning, erosion, building inspections and environmental health.

County commissioners voted to purchase the vacant big-box for $6.6 million in January. Architects estimate the renovations will cost another $6.1 million to retrofit the nearly 100,000 square feet of space.

Plans are still in the early stages. Commissioners will sign off on a design by fall and send the project out to bid. Construction could be completed by summer 2011.

Commissioners say the old Wal-Mart is a bargain to solve a problem that could no longer be ignored. DSS was fed up with leaky roofs, frozen pipes and cramped office space, as well as the lack of space and confidentiality at their offices, which date as far back as the 1920s. Facility inspections landed Haywood’s DSS building in the bottom 1 percent of 70 DSS facilities throughout the state.

Haywood health board gets more than it bargains for

A proposed health board rule in Haywood County has reignited a debate about how far officials can go when it comes to private property.

Public outcry crushed a nuisance ordinance considered by the county last spring. Now, it’s made a dent in the health board’s plans to amend a little known rule from 1970.

The rule spells out how to safely store garbage that can attract disease-carrying pests, like rodents and mosquitoes. With the new amendment, the health director is allowed to step onto private property if a property owner is uncooperative. Violators can be charged with a misdemeanor.

State law has long allowed health directors in North Carolina to abate public health risks by entering private property. They can even clean up the property if the owner refuses and recoup the cost through a lien.

The health board was ready to vote on the amendment with little ado in January. But a crowd of 75 rallied at the last minute and turned up to oppose it. The stunned board members decided to hold off on the vote.

A few changes to the rule change were announced last week after the board gathered for a work session. The rule now requires the health director to first obtain an administrative search warrant before entering private property — unless there’s an imminent hazard.

“Imminent hazard” means a situation that is likely to cause an immediate threat to human life, an immediate threat of serious physical injury, an immediate threat of serious adverse health effects, or a serious risk of irreparable damage to the environment if no immediate action is taken.

Haywood County Health Director Carmine Rocco said even in such an emergency case, he’d try to seek consent first.

Constitutional or not?

Many at the January meeting had cried that the health board rule was simply a back-door approach to passing a public nuisance ordinance they already defeated.

Jonnie Cure, who helped round up the opposition, argued that if neighbors were putting her health at risk, she could just take them to civil court.

“If somebody is putting my life in danger, I have remedy,” said Cure. “I don’t need to sic the health department on them.”

Lenise Paschke, pharmacist and chair of the Haywood health board, said the board didn’t have the time or the energy to police people’s yards.

“It is not our intention to go running through the county, entering people’s property. These statutes have been on the books quite a while. We haven’t done that yet,” said Paschke.

The health board maintains that the rule is a way to protect public health — not address aesthetic issues.

“It has nothing to do with how many bikes somebody has in their front yard or issues related to personal taste,” said Rocco.

The rule is more narrowly tailored than the nuisance ordinance considered by county commissioners last spring. The nuisance ordinance would have cracked down on junk on peoples’ property, prohibiting everything from outdoor storage of scrap metal to junked cars to non-maintained swimming pools.

County Attorney Chip Killian said the health board has gone out of its way to satisfy concerned citizens with recent changes. Killian considers the state law to be wholly constitutional.

“That’s really going the extra step, we feel,” said Killian.

But opponents argue the state law violates the Fourth Amendment of the Constitution, which protects citizens from unreasonable searches.

“The victim here is the property owner, not the person who’s supposedly put at risk,” said Cure.

Waynesville Attorney Russell McLean said a search warrant should be required every single time, despite state law saying otherwise.

Killian disagrees.

“It’s not up to us to decide whether the state statute is unconstitutional or not,” Killian said. “I don’t believe it is, but if it is, that’s another matter. We’re supposed to proceed under guidelines of state law.”

Rarely used rule

Rocco has worked in public health in North Carolina for more than 20 years and has never stepped on private property without the owner’s cooperation.

Usually, the health director works with property owners and educates them on the public health risks lurking in their backyard.

Knowing the health director could enter their property or put a lien on their land might provide an incentive to cooperate.

“This just gives us one more tool for us to address public health concerns,” said Rocco. “I will do what I think is necessary to protect the public’s health.”

Storing garbage improperly can attract flies, rats, snakes or other disease-carrying animals. Property owners who allow standing water to collect provide a breeding ground for mosquitoes, which can also spread disease.

Lacrosse encephalitis is of particular concern in Western North Carolina, which sees a few cases every year. Last year, through November 2009, four cases of lacrosse encephalitis were reported to the health department in Haywood. A boy in Cherokee died last year from the mosquito-borne disease.

Other complaints included 33 sewage complaints, nine vector complaints and six trash complaints — all would fall under the rule in question. Vectors are disease-carrying animals.

The rule regulating solid waste has been on the books for 40 years but was sitting dormant for the past two decades until it was rediscovered last year.

A solid waste task force was created last summer to look at where modifications to the rule needed to be made. The task force worked for several months to amend the rule and held public meetings to discuss the issue before the vote in January.

“Unfortunately, nobody came,” said Rocco.

The health board will decide the next steps at its meeting on Wednesday, March 10.

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