September 2021 Board of Health Meeting

Meeting held via video.

PREPARED BY:

Lorie Gregg, Director of Corporate Services

DATE:

September, 2021

• Mandatory and related programs funded to a maximum of 70% (“Cost-Shared”) by the Ministry of Health (“MOH”) and 30% by  the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee (hereinafter referred to as the “Obligated Municipalities”).
• Related programs funded 100% by the MOH.  More specifically, this includes the Ontario Seniors Dental Care program and the AMOH/MOH Compensation Initiative.
• Related programs funded 100% by the Ministry of Children, Community and Social Services (“MCCSS”). 
• One-time business cases funded 100% by the MOH.

The second quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed above, except related programs funded 100% by the Ministry of Children Community and Social Services (MCCSS).  Forecasted financial results will be provided with the Q3 and Q4 financial report.

Related programs funded 100% by the MCCSS will be reported on in November of 2021.

COST-SHARED PROGRAM FINANCIAL RESULTS

At June 30, 2021, the variance from budget to actual total expenses amounts to $810,141. Specific variances are as follows:

• Salaries and Benefits:  Expenditures in these financial captions relate to salaries and benefits paid to the WECHU staff in service of the Mandatory Cost-Shared Program. Cumulatively, these financial captions are $519,587.  Substantial human resources were deployed to support COVID-19 Response and COVID-19 Vaccination Programs.  Salaries and benefits allocated to the Mandatory Program are not entirely an accurate depiction of the human resources working on Mandatory Programs at June 30, 2021.  A secondary analysis is being compiled for the purposes of Q2 reporting to the MOH delineating resources in a more granular fashion.  This report will be brought to the Board in October of 2021.
• Mileage, Professional development, and Travel and meetings:  Expenditures in these financial captions support WECHU staff in the completion of their public health responsibilities.  Cumulatively, these financial captions are $97,640 underspent at June 30, 2021. Mandatory program activities continue to be impacted by COVID-19 Pandemic.  A substantial portion of the WECHU staff continue to work-from-home and employ virtual means to interact with clients, partners, etc.  Professional development is completed on an “as needed basis” taking into consideration staff capacity.
• Association and Membership Fees:  Expenditures in this financial caption relate to memberships in an association or other group by virtue of professional requirements or to support initiatives associated with Public Health.  The majority of Association and Membership Fees are paid in the early in the fiscal year.  While overspent at June 30, 2021, the WECHU anticipates that this financial statement caption will remain within its overall budget for fiscal 2021.
• Program supplies:   Expenditures in this financial caption support the functions of departments, those that directly support public health programs as well as those that support corporate service departments such as Information Technology and Communications.  Cumulatively the Program supplies financial caption is underspent $93,385.  Program related expenditures continue to be underspent due to the on-going focus on the COVID-19 Pandemic (underspent $186,196).  Corporately, the budget is overspent $93,111, which is primarily to the prepayment of Information Technology software licensing for calendar years 2021 and 2022. 
• Professional fees:  Expenditures in this financial caption include legal, audit, consulting fees and dentistry services.  At June 30, 2021, this caption is underspent $83,004.  This variance is primarily associated with the variance in dentistry fees paid on account of the Healthy Smiles Ontario Program (HSO).  In February of 2021, the WECHU successfully recruited a second dentist FTE, whose time would be allocated evenly between the ODSCP and the HSO Program, reducing the requirement subcontracted dentistry services.
• Building Maintenance:  Expenditures in this financial caption include costs to maintain Windsor, Essex and Leamington locations.  More specifically, these costs relate to building and equipment maintenance, grounds keeping and housekeeping supplies.  The variance here relates primarily to:  i) Costs incurred to install electrical for 12 desks in the Leamington office in the amount of $5,662;  ii)  Prepayment of certain maintenance costs for calendar years 2021 and 2022. 
• Insurance:  Expenditures in this financial caption include costs associated with general liability insurance, property insurance, director and office insurance coverage as well as cyber coverage.   Insurance premiums are paid at the beginning of the year.  The WECHU anticipates that the budget for this financial statement caption will remain underspent for 2021. 
• Utilities:  Expenditures in this financial caption include utility costs for the Windsor and Leamington offices.  Utilities are underspent $29,462 due to lower than anticipated utilization (i.e. staff working from home; environmental factors).
• Vehicle:  Expenditures in this financial caption include vehicle maintenance, repair and fuel.  The WECHU incurred augmented fuel costs on account of: 1. Vaccine delivery to retirement homes, long-term care homes, pharmacies and physicians; 2. Supplies delivery to mass vaccination sites. It is anticipated that this financial caption will remain within budget for 2021.
• Offset revenue:  Revenues included in the financial caption relate to interest, proceeds on sale of tangible capital assets, parking revenue, vaccine recoveries, sales of contraceptives as well as course fees relating to the food handler course and examination.  At June 30, 2021, offset revenue is under budget by $21,165.  More specifically:  i) nil interest was earned (under budget $2,500).  ii) Nil was earned on account of food handler courses (under budget $5,000).  iii) Nil was earned on account of vaccine recoveries (under budget $18,844).  iv)  $618 was earned on account of the sale of contraceptives (under budget $6,382). v)  $14,186 was earned on account of parking revenues (over budget $686).  vi)  $34,708 was earned on account of seasonal housing inspections (over budget $7,622).  vii)  Sale of tangible capital assets of $4,759 (over budget $4,259). viii)  $1,280 in user fees (under budget $970).

COVID-19 RESPONSE PROGRAM

The COVID-19 Response Program was established to respond to the on-going impact of the COVID-19 Pandemic in Windsor and Essex County.  The budget for this program included 30 FTEs, more specifically: one (1) director FTE, five (5) Manager FTEs, nine (9) Registered Practical Nurse FTEs, seven (7) Public Health Nurse FTEs, four (4) Public Health Inspector FTEs, one (1) Epidemiologist FTE and three (3) Support Staff FTEs.

Variances from budget at June 30, 2021 are as follows:

• Salaries and benefits are underspent $382,882:  The staffing complement of this program has evolved from January to June of 2021, in response to the changes in local case counts.  Additionally, the Province of Ontario provided human resource support for case and contact management at no cost.  This provided the WECHU the opportunity to deploy nursing resources to support COVID-19 Vaccinations in March of 2021.

Programs supplies

• Communication and awareness is underspent $23,100: At June 30, 2021, $ nil was spent on communication and awareness campaigns associated with the COVID-19 Pandemic (excluding vaccine).  The WECHU has determined that there is a greater need for human resource capacity to support the Communications Department and, by extension, the messaging and media associated with public health measures as well as COVID-19 vaccination efforts.  As such, these financial resources will be expended on staffing to support this area.  Recruitment will occur in Q3 of 2021.

Purchased services

• Case and contact management support is overspent $132,884:  At June 30, 2021, 6,645 hours were acquired from Global Excel Management to support case and contact management.   The budget for case and contact management support of $549,504 was intended for a 6-month period. While on a pro-rata basis, the budget for case in contact management is overspent, the amount expended at June 30, 2021, is within the budgeted amount for the initial term of the contract.
• Translation and interpretation is underspent $34,600:  Translation and interpretation costs were lower than anticipated in the area of case and contact management.  Higher than anticipated translation and interpretation costs were experienced as for the COVID-19 Vaccination Program.

COVID-19 VACCINE PROGRAM

As per the approved budget (March of 2021), the COVID-19 Vaccine Program supports 63 FTEs comprised of two (2) manager FTEs, one (1) health promotion specialist FTE, ten (10) public health nurse FTEs, forty (40) registered practical nurses FTEs and ten (10) support staff FTEs.  Similar to the COVID-19 Response Program, the composition of the COVID-19 Vaccination Program evolved with vaccination requirements, as well as the availability of vaccine within Windsor and Essex County. 

Variance from budget at June 30, 2021 are as follows:

• Salaries and benefits are overspent $471,784: Additional human resource capacity was added at all levels to support three mass immunization clinics, mobile vaccination events as well as vaccine distribution to physicians and pharmacies in Windsor and Essex County. 
• Mileage is overspent $24,297:  The budget for this financial caption did not contemplate the additional human resource capacity (in excess of 63 FTEs) as well as the length of time mass vaccination sites would remain in operation.

Program supplies

• Communications and awareness is underspent $33,937:  At June 30, 2021, a nominal amount was expended on account of communication and awareness campaigns associated with COVID-19 Vaccinations.  The WECHU leveraged its YouTube broadcasts, media releases, website and social media (relatively in expensive), for communicating messaging.  Similar to the discussion noted under the COVID-19 Response Program, the WECHU has determined that there is a greater need for human resource capacity to support the Communications Department and, by extension, the messaging and media associated with public health measures as well as COVID-19 vaccination efforts. As such, these financial resources will be expended on staffing to support this area.  Recruitment will occur in Q3 of 2021.
• Information technology is overspent $75,773: Additional hardware was acquired to support COVID-19 Vaccination staff.  Computer hardware such as laptops, monitors, keyboards, mice, printers and cables were acquired ($97,721).  Tablets were acquired to support the check-in and queuing process at each of the mass clinics ($10,137).  Upgraded temperature control and monitoring equipment was acquired for the WECHU vaccine fridges and freezers ($4,975).
• Medical equipment is overspent $32,076:  This financial caption includes the cost of acquiring medical equipment and supplies to support COVID-19 vaccinations in various settings (i.e. long-term care and retirement homes; mobile events; mass clinics; physician offices).    Supplies included: Epi pens, needles, syringes, drape sheets, bandages, alcohol swabs, etc.  In the latter part of Q1, the Province of Ontario included vaccine administration supplies with its shipment of vaccine.  The WECHU continued to acquire and use its own needles and syringes for the administration of Moderna up to June 30, 2021, as our vaccination supplies more consistently drew additional doses per vial of Moderna.  This was critical at this time due to the limited supply of vaccine in Windsor and Essex County.
• Personal protective equipment is underspent $ 31,875:  This financial caption includes costs associated with rental and or purchase of isolation gowns, the purchase of N95 masks, and the purchase of nitrile gloves, hand sanitizer and similar supplies to support COVID-19 Vaccinations in various settings.  In the latter part of March 2021, certain personal protective equipment were distributed with vaccine shipments, eliminating the need for the WECHU to continue to acquire these supplies.
• Other is overspent $69,892:  This financial caption included:  Tents, generator and security for pop-up events ($6,080); Office supplies ($19,570); Licensing for scheduling application ($35,839); Copier/printer charges for printing resources ($9,388); Calibration and electrical for vaccines freezers ($5,418); other general supplies ($6,317).

Purchased services

• Other is overspent $224,250:  This financial caption includes amounts paid to independent contractors and paid volunteers (immunizers) augmenting the WECHU capacity to administer COVID-19 Vaccinations in various settings.  More specifically:
  • Total hours incurred on account of direct client service at a mass vaccination clinic were 7,109 hours or $199,937. 
  • Total hours incurred on account of call centre activities, support booking vaccination appointments were 1,637 hours or $100,681. 
  • Total hours incurred on account of other activities associated with planning were 216 hours or $6,520.
    In addition, costs were incurred on account of legal, namely the writing and review of legal agreements with the COVID-19 Vaccination Program totaling $33,075.
• Transportation is underspent $115,187:  The budget for this financial caption was developed based on the WECHU’s COVID-19 Vaccination plan submitted to the Ministry of Health in January of 2021.  The WECHU plan focused on the distribution and administration of vaccines through physicians and pharmacies thus resulting in the WECHU incurring additional costs associated with transportation (couriers).  The provincial vaccination plan varied from the WECHU plan, with a focus on vaccine administration at mass vaccination clinics.  Physicians and pharmacists were on-boarded later on in the process.
• Translation and interpretation was overspent $38,699:  This financial caption includes translation and interpretation costs to support mass vaccination clinics and mobile clinics.  The budget did not appropriately contemplate the volume of vaccinations to be delivered in a mass vaccination setting.

ONTARIO SENIORS DENTAL CARE PROGRAM

The Ontario Seniors Dental Care Program (OSDCP) supports eleven and one-half (11.5) FTEs comprised of one and one-half (1.5) manager FTEs, one and one-half (1.5) dentist FTEs, three (3.0) dental hygienist FTEs, three (3.0) dental assistant FTEs, one (1) health promotion specialist FTE and two (2) support staff FTEs.

Variances from budget at June 30, 2021 are as follows:

• Salaries and benefits are underspent $69,813 - This variance predominantly relates to: i) Deployment of one (1) manager FTE for the period January 1, 2021 to April 30, 2021, to support COVID-19 Response, representing a decrease in salaries and benefits of $43,571; ii) Delay in the recruitment of a second dentist supporting the OSDCP, and Healthy Smiles Ontario Program, representing a decrease in salaries and benefits of $8,600.
• Mileage, Travel and meetings, Professional Development are underspent $6,317 - These financial captions continue to be underutilized due to the on-going impact of the COVID-19 Pandemic.   Virtual or telephone conferencing continues to be leveraged to engage with clients and/or partners.  Professional development is completed on an “as needed basis”.
• Clinical supplies and other are underspent $57,747 - This financial caption is directly impacted by client volumes/visits.  For the period January to June 2020, the WECHU dental clinic had 272 visits from 148 OSDCP clients.  For the period January to June 2021, the WECHU dental clinic had 1,590 visits from 582 OSDCP clients.  Year-over-year increase in expenses is reasonable.  In terms of the variance from budget, the WECHU is relatively early in its experience administering the OSDCP.  The WECHU will continue to collect data on the experience/utilization of supplies to support a more accurate estimate of expenditures in future budget processes.
• Professional services are overspent by $7,746 - This financial caption includes translation and interpretation costs, fees paid on account of a denturist and dentist, lab fees and fees paid on account of oral surgery referrals.  In terms of the variance from budget, and similar to clinical supplies and other, the WECHU is still relatively early in its experience administering the OSDCP.  The WECHU will continue to collect data and experience to support more accurate estimates of professional services expenditures in subsequent budgeting processes.  Details of Professional services as at June 30, 2021 are as follows:

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MOHLTC

Note:  All funding approvals are for the period April 1, 2021 to March 31, 2022.

Public Health Inspector Practicum Program:  This one-time funding supports the hiring of two Public Health Inspector Practicum positions.  Eligible costs include student salaries, wages and benefits, transportation expenses associated with practicum positions.  At June 30, 2021, a recruitment for public health inspector practicum students had not yet been completed.

School-Focused Nurses Initiative:  This funding supports the hiring of 19 nurses to creating additional capacity to provide rapid-response support to school boards and schools, facilitating public health and preventative measures related to the COVID-19 Pandemic.  At June 30, 2021, $339,892 were incurred on account of salaries and benefits. The WECHU anticipates being on-budget for this program initiative at March 31, 2022.

Approved by: Nicole Dupuis

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Judy Lund, Robert Maich, Ed Sleiman, Larry Snively

Border Member Regrets:

Gary Kaschak

Administration Present:

Nicole Dupuis, Dr. Shanker Nesathurai, Lorie Gregg, Felicia Lawal, Kristy McBeth, Eric Nadalin, Dan Sibley, Lee Anne Damphouse

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

The WECHU, in partnership with representatives on the advisory committee and the Windsor-Essex Community Opioid & Substance Strategy, launched a site-specific community consultation on June 17th of 2021 to gather community feedback about two candidate locations for a local Consumption and Treatment Services (CTS) facility. The purpose of the site-specific community consultation was to understand community perceptions about the feasibility and acceptability of a potential CTS facility at either of the candidate locations. The comprehensive community consultation plan encompassed several components for engaging the community: 

• A widely promoted public survey with a total of 448 survey responses
• 13 key informant interviews with businesses and agency stakeholders within a defined radius from the sites
• 7 focus groups with area stakeholder groups
• 3 Virtual Town Hall meetings that allowed community members to ask questions and voice concerns to a panel of eight expert speakers. Fifty-three (53) community members registered to participate.

BACKGROUND

After an extensive search and consultation with local property owners, the WECHU with support of the CTS advisory committee, identified two candidate locations for a potential CTS facility in Windsor’s downtown core - 101 Wyandotte Street East and 628 Goyeau Street. Both of the candidate locations satisfied each of the mandatory and complementary requirements for an eligible site, and both are situated in the preferred neighbourhood (N9A) identified through the initial Safe Injection Services Community Consultations Report. Prior to facilitating the community consultation process, crime prevention through environmental design audits (CPTED) were completed by Windsor Police Services in order to determine the safety of the candidate locations, and to guide any mitigating interventions for improving the surrounding safety of the sites and discouraging criminal activity. Through the CPTED audits, it was determined that the placement and orientation of both site locations would lend themselves sufficiently to establishing a manageable “Safe Consumption Zone” whereby public safety can be maintained with any risks identified to be mitigated. The WECHU proposed the two candidate locations to the Board of Health on June 17th of 2021, and a resolution was passed in support of the completion of the site-specific community consultation as focused to the assessment of these two potential sites.

The results from the community consultation yielded local support for a potential CTS facility at both of the candidate locations. A majority of survey respondents indicated that they would provide at least some degree of support for a CTS facility at 101 Wyandotte Street East (67%) and/or 628 Goyeau Street (68%). Relatedly, respondents most frequently indicated that they would provide equal support for a CTS facility at both of the candidate locations (39%), while 19% preferred 628 Goyeau Street and 13% preferred 101 Wyandotte Street East. Nineteen percent (19%) of all survey respondents did not support or prefer either location. Survey respondents who identified as living, working, owning a business, or going to school in the N9A postal code area (N=126) responded with similar perceptions to the full sample, with 33% providing equal support for both locations, 22% preferring 628 Goyeau Street, and 13% preferring 101 Wyandotte Street East. Nineteen percent (19%) of respondents in the N9A postal code area did not support or prefer either location.

Majority of the key informant interview and focus group participants demonstrated openness or support to a CTS facility at one or both of the proposed locations, with few expressing strong opposition to either location. Although many of the participants noted minimal differences between the two locations, the primary differentiators in terms of perceived benefits and concerns were tied to the traffic flow surrounding the locations and the visibility of the sites. Many of the participants cited that 628 Goyeau Street is a less visible and lower traffic area compared to 101 Wyandotte Street East, with the perceived advantages of being a safer site option with less risks of pedestrian and vehicular-related injuries or traffic disruptions. Many participants also referenced that 628 Goyeau Street would provide improved privacy for potential service users, many of whom are socially stigmatized and may be deterred by a highly visible and higher traffic location, such as 101 Wyandotte Street East. In contrast, some of the participants highlighted that the visibility of 101 Wyandotte Street East would be particularly advantageous for enhancing observation capabilities and ensuring the safety and security of the surrounding areas.  Overall, five of the seven focus groups reached a consensus of 628 Goyeau Street being the preferred or superior location, while 31% of key informants equally supported both locations, 31% preferred 628 Goyeau Street, and 23% preferred 101 Wyandotte Street East. Fifteen percent (15%) of key informants did not prefer either location.

The results collected through the consultation will be interpreted extensively by the WECHU and the CTS Stakeholder Advisory Committee to inform mitigating strategies to address the cited concerns.

PROPOSED MOTION

Whereas, Opioid overdose and opioid related mortality has been declared a public health crisis, and

Whereas, Opioid overdose and opioid related mortality is at an all time high in Windsor-Essex, and

Whereas, Consumption and Treatment Services have the potential to address opioid overdose and opioid related mortality, and

Whereas, the WECHU is required to submit an application for a CTS that includes a site location and an accompanying community consultation, and

Whereas, the CTS advisory committee has identified a preferred site based on the results of a comprehensive community engagement process led by the WECHU,

Whereas, a formal request to City Council is required in order to present the results of the evaluation and is necessary for an extended presentation time,

Now therefore be it resolved that the Windsor-Essex County Board of Health support the recommendation from the CTS Advisory Committee that the WECHU move forward with their application for the site located at 628 Goyeau Street, and

FURTHER THAT, the Board of Health support administration to continue with the next steps of the application process which includes seeking City of Windsor council approval for the proposed site, and

FURTHER THAT, administration enter into an agreement with the proposed landlord to secure the site for submission of an application.

ISSUE

The Windsor-Essex County Health Unit (WECHU), in response to the resignation of the Medical Officer of Health (MOH), is required to recruit an Acting MOH.  This individual shall perform the duties of, and have the authority to exercise the powers of the MOH in accordance with the requirements of Section 69(2) of the Health Protection and Promotion Act, R.S.O. 1990

BACKGROUND

Part II, Section 4 of the Board of Health for the Windsor-Essex County Health Unit Consolidated By-laws (By-laws) speaks to the appointment of an Acting MOH by the Board.  The By-law requires that any appointments of greater than six (6) months be subject to approval in writing from the Ministry of Health and the Chief Medical Officer of Health. 

In addition, the Policy Framework on Medical Officer of Health Appointments, Reporting and Compensation established by the Ministry of Health indicates, “A board of health shall appoint forthwith a physician as acting medical officer of health”.  The Minister’s approval is not required for these appointments, as they are meant to be short-term in nature to permit boards of health to recruit the MOH position with a qualified physician on a full-time basis.

PROPOSED MOTION                                               

Whereas, the Medical Officer of Health has resigned effective September 12, 2021, and

Whereas, the WECHU has commenced a recruitment process in accordance with the By-laws, and

Whereas, an Acting Medical Officer of Health will be required to fulfill the duties of the Medical Officer of Health during the recruitment process

Now therefore be it resolved that the Windsor-Essex County Board of Health authorize and approve the Director of Human Resources and the Chief Executive Officer to communicate with the Ministry about a potential secondment and/or recruit a local physician for the role of Acting Medical Officer of Health.